Discovery of an epidermoid of the skull concomitant with a homolateral subacute traumatic subdural hematoma

The case of a man of 32 years with an epidermoid of the left side of the skull is reported. The tumor itself was asymptomatic and was discovered accidentally because of a subdural hematoma on the same side. After a closed head injury, this patient had symptoms of an intracranial space occupying lesion (hematoma) on the left after a symptom-free interval. The left carotid angiogram demonstrated the characteristic picture of a subdural hematoma in the left parieto-temporo-occipital region. At the same time, characteristic changes in the skull on the same side, which were more apparent after removal of the hematoma, suggested an epidermal tumour of the skull. This was verified at operation.

The Effect of Dexamethasone on Water and Electrolyte Content and on rCBF in Perifocal Brain Edema in Man

The results of clinical studies are reported dealing with the relationship between cerebral edema and regional cerebral blood flow in patients with brain tumor as well as with the effect of dexamethasone on this relationship. rCBF is found to be significantly reduced in brain tissue surrounding brain tumors. Autoregulation as well as cerebrovascular reactivity to PaCO2 is focally or generally impaired. Water content of perifocal white matter is markedly increased. The combination of tissue lactacidosis, low regional blood flow and vasoparalysis seems to be a characteristic finding in this type of local brain edema. The increased local tissue pressure, due to the increased tissue water conte…

Energy Metabolism, Lactate/Pyruvate Ratio and Extracellular Space in Cortex and White Matter Adjacent to and Distant from a Local Freezing Lesion

The present investigation was undertaken to study the distribution of pathological fluid accumulation and the local energy metabolism in the cortex and white matter following a localized traumatic lesion of the cortex. A systematic examination of the changes in the tissue following a trauma is the basis for further studies on the relationship between cortical blood supply, local tissue metabolism and local function.

Double-Blind Study on the Effects of Steroids on Severe Closed Head Injury

The results of a double-blind study on the effects of a low dose and a high dose of dexamethasone on severe closed head injury are presented. The steroid, particularly in high dose, reduced mortality, improved the neurologic course and the final outcome. Timing of steroid administration is of great importance.

Possible Adverse Effects of Hyperventilation on rCBF during the Acute Phase of Total Proximal Occlusion of a Main Cerebral Artery

Recent studies seem to favor a beneficial effect of hyperventilation (HV) in cases of cerebrovascular occlusion [1, 4] and brain trauma [2, 5]. On the other hand, it seems that, at least under certain circumstances, HV may exert an adverse effect upon cerebral blood flow and metabolism [3]. Since this question is not settled yet, it seems worthwhile to report briefly the present case of reversible total occlusion of the middle cerebral artery closely followed by successive rCBF studies (133Xe-gamma-clearance method), in which, during the acute phase, HV caused a latent ischemia to become manifest.

Reduced risk of ICA ligation after balloon occlusion test

Temporal retrogasserian resection of trigeminal root versus controlled elective percutaneous electrocoagulation of the ganglion of gasser in the treatment of trigeminal neuralgia. Report on a series of 531 cases.

In his experience with 531 surgical procedures for the relief of trigeminal neuralgia between 1955 to 1970, the author developed a strong preference for the percutaneous electro-coagulation of the gasserian ganglion. Although the method was repeatedly modified in the early years, a standardized technique of controlled, selective and fractional coagulation in the semiawake state of neurolept-anaesthesia was used since 1963 in 183 of his 311 patients, treated in this manner. The advantages of the method, particularly in comparison to open intracranial root sections, are: Minimal operative risk, control of operative effect during the operation, small sensibility deficit, low rate of complicati…

The course of intracranial pressure and volume-pressure relationships following extirpation of meningiomas and astrocytomas

Thirty-five patients with meningiomas were compared with 37 patients with astrocytomas with respect to the postoperative course of their ICP and elastance. In the case of the meningioma patients, the ICP increased on average over a longer period and achieved higher values than in the astrocytoma patients. In the first group, the elastance attained values that were three times as high as in the second group. There was no fixed relationship between pressure and elastance in the two groups of patients.

Experimental Hypertensive Intracerebral Mass Hemorrhage in Cats

About two–thirds of all patients with spontaneous intracerebral hemorrhage suffer from systemic hypertension. Additionally systemic hypertension is the main factor indicating a poor prognosis of intracerebral hemorrhage. This has been shown in our statistical evaluation of 117 cases of conservatively treated spontaneous intracerebral hemorrhage. More than 48% of the hypertensive patients died, but only 30% of the normotensive patients (Fig. 1). In an experimental study we investigated the influence of systemic hypertension and normotension on epidural pressure and on the formation of brain edema during the first 12 h after artificial intracerebral hemorrhage.

Rare sacral space-occupying lesions, their surgical management and reconstructive measures involved

Nine cases of space-occupying lesions of the sacral bone are presented. The problems of the clinical diagnosis, which in many cases comes too late, are discussed together with the indications for surgical treatment in this special group of tumours. The main clues are provided by the changes in the X-rays as well as the more modern imaging techniques (CT and MRI). The surgical technique aims at a most radical tumour removal with preservation of the sacral nerve roots, after which stabilisation of the sometimes weakened pelvic girdle may be necessary. The good prospects of complete removal of these tumours of the sacrum with satisfactory results seem to be very little known and justifies furt…

Untersuchungen über den Einfluß des Kationenmilieus und verschiedener Pharmaka auf die Kontraktilität und Autorhythmik eines spontan aktiven glatten Gefäßmuskels in vitro

The influence of the decompressive operation on the intracranial pressure and the pressure-volume relation in patients with severe head injuries.

Measurements of intracranial pressure by ventricular catheter were performed in 47 patients with severe head injuries. Thirty-three patients with decompressive operations such as osteoclastic craniotomy and dilatation by means of duraplastic have been compared with 14 patients with closed heads with regard to volume pressure response (intracranial elasticity). This was determined either by intraventricular injection of 2 ml saline or by drainage of cerebrospinal fluid. The examination clearly shows that patients with closed heads have a much higher intracranial elasticity than patients who have decompressive operations, so that in the first group minor differences of the intracranial volume…

Regional Cerebral Blood Flow in Cases of Brain Tumor

The present series consists of 21 patients with brain tumors: 12 malignant gliomas, 4 oligo- dendro gliomas, 3 meningeomas and 2 metastases, studied by the133Xe-gamma-clearance rCBF method. In 16 patients at least 3 determinations of rCBF were performed: a) in the resting state, R; b) during hyperventilation, HV, and c) during hypertension, HT. Of the remaining 5 patients, 1 was studied only during R, while the other 4 were submitted either to HV or to HT additionally to the R study. The average age of this series of patients was 47 years, the youngest being 19 and the oldest 64. rCBF studies had to be performed under general anesthesia (N2O + O2, Engstrom respirator) in 5 instances in whic…

Dermoide und Epidermoide des Schädelknochens, ihre Differentialdiagnose und Behandlung

An Hand acht beobachteter Dermoide bzw. Epidermoide des Schadeldaches mit extraduraler ossarer Lokalisation werden Haufigkeit, Ursprung sowie diagnostisch verwertbare Eigenschaften der seltenen epithelialen Misbildungstumoren diskutiert. Als charakteristisches radiologisches Kennzeichen gelten meist glattrandige, wie ausgestanzt erscheinende Lochdefekte im Bereich der Schadelkalotte und des Gesichtsskeletes. Dabei wird auf differentialdiagnostisch wichtige osteolytische Prozesse besonders hingewiesen. Die Behandlung erfolgt durch osteoplastische Trepanation mit Resektion der Knochenherde und vollstandige Entfernung aller auch epidural sich ausbreitender Kapselreste, wobei die Kommunikation …

Epidural spinal abscesses.

Fifteen cases of peridural empyemas are reported. 12 patients reported with motor dysfunction of the lower extremities and pain radiating from the spine. In one case, localized pain of the spine was discovered and in two cases there were no signs of spinal or radiating pain. Treatment in all cases was laminectomy and systemic antibiotic administration. Microbiological analysis showed staphylococcus aureus in 11 cases. 9 patients recovered with no neurological defects, two had major improvement of the paresis, and one died. Three patients with paraplegia recovered from the primary infection.

Intracranial pressure and pressure volume relation in patients with subarachnoid haemorrhage (SAH)

The development of the intracranial pressure after a subarachnoid haemorrhage was evaluated in 21 patients. A statistically significant relation between the intracranial pressure and the neurological findings was found, whereas vasospasms did not influence the intracranial pressure. In patients in a clinically critical condition, rhythmic pressure waves of a frequency of 1/minute were repeatedly observed.

Correlation between rCBF, Angiography, EEG and Scanning in Brain Tumors

The findings with techniques of different sensitivity, and which investigate different aspects of brain structure and/or function are difficult to correlate. However, such a comparison should help in elucidating the physiopathological mechanisms of brain lesions and the postoperative clinical evolution and prognosis in cases of brain tumors.

The Influence of Systemic Hypertension on Intracranial Pressure and Edema Formation in Experimental Intracerebral Hemorrhage

Systemic hypertension is not only the most frequent cause of intracerebral hemorrhage but also the most important complication of this disease. In our clinical investigation of 117 cases almost 70% of the patients suffered from systemic hypertension. Despite advances in diagnosis (Schiirmann, Dei Anang, 1980) mortality of hypertensive patients was 48%. Normotensive hemorrhages showed a better prognosis: only 31% of the patients died and 33% (17% in hypertensive patients) obtained good neurological recovery (Wallenfang et al., 1985).

Dexamethasone in severe head injuries

The results of a double-blind-study on the effects of placebo, a low dose and a high dose of dexamethasone on severe closed head injury are presented. 95 patients were selected and carefully analyzed according to mortality, neurological course and symptoms, midbrain lesions and final outcome. The results demonstrate that dexamethasone, particularly given in high doses, reduces mortality and improves the neurological course. The steroid treatment seems to improve chances as well as quality of survival. Apart from the dose, timing of administration is of great importance.

nrCBF for Timing of Angiography and Operation in Subarachnoid Hemorrhage

Early operation on cerebral aneurysms is demanded not least because of the threat of spasm of the cerebral vessels. As is generally recognized, this is to be expected in a very high percentage within a few days after the first aneurysm hemorrhage and frequently cannot be diagnosed clinically (4, 5). Many neurosurgeons have rated the risk of operating in the presence of vasospasm so high that, like C.G. DRAKE in 1975 (2), they demanded control angiography with its own risk, especially in existing vasospasm in early angiography and the aneurysm operation itself could not take place rapidly.

Effects of Various Therapeutic Management on Raised Intracranial Pressure and on Dynamics Brain Edema in Brain Abscess Model in Cats

In spite of the improved antibiotic treatment of brain abscess, the mortality remains high, between 30% and 40% (2,3). With the help of effective antibiotic treatment it is possible to bring the inflammatory Part of the lesion under control, but not the space-occupying element which is determined by the inflammatory brain edema. Any improvement in the results will therefore have to wait until an effective antiedematous treatment has also been developed. The aim of our previously described investigations on experimental brain abscess in cats (3) was to demonstrate that only the additional treatment with steroids as well as the antibiotics results in an improvement in the final outcome.

Immunohistochemical Investigation in Experimental Intracerebral Hemorrhage (ICH) and Its Correlation with Findings in Clinical Studies

Since McKissock et al. 1961 investigated the effects of surgical and conservative treatment of ICH on final outcome it is well known that systemic hypertension worsens the prognosis of this serious cerebrovascular disease. Our own studies on this problem have revealed differences in final outcome, as well as in level of consciousness after ICH, between normotensive and hypertensive patients. Whilst 30.6% of the normotensive patients died, 48.1% of the hypertensive patients had a lethal outcome.

Cerebral blood flow and cerebral death

At present the diagnosis of cerebral death is based on the absence of manifestations of cerebral function (deep coma, wide pupils, absence of reflexes and spontaneous respiration, isoelectric EEG, etc.) during a variable period of time. However, the absence of vital signs of an organ, even for prolonged periods, is no proof of its death. The death of an organ can only be considered as proved by the demonstration that this organ has remained completely deprived of its blood flow during a period of time that surpasses its ability to survive circulatory arrest. In the case of the brain, the permanent absence of clearance of a radioactive tracer deposed within the brain is considered to demonst…

Cessation of Cerebral Blood Flow in Total Irreversible Loss of Brain Function

After the demonstration, by our group [3, 4], that in cases of so-called “cerebral death” there is an absence of clearance from the brain of 133Xe selectively injected into the internal carotid artery, further attention was dedicated to establish possible sources of error in this technique.