Dieter-Karsten Böker

Paragangliomas of the spinal canal

Paragangliomas are tumors arising in the paraganglia and rarely occur in the spinal canal. In the literature, 11 such cases have been reported. We present 7 additional cases, 3 of which were epidural in location in contrast to previously described intradural cases. The problems of histological diagnosis of these tumors are discussed. The value of determination of biogenic amines in the tumor tissue or the urine has been pointed out.

Radiologic long-term results after cervical vertebral interbody fusion with Polymethyl Methacrylat (PMMA)

Long-term results of cervical interbody fusion with PMMA were evaluated in a retrospective study. X-ray films of 83 patients were obtainable. Post-operative follow-up in this series was between 15 and 20 years. The results show that PMMA is engrafted after about 2 years. Stable vertebral interbody fusion is obtained in about 90% of cases. Development of malignoma was not observed. Resorptive bone alterations, which can be seen in about 2% of cases one to two years after operation are shown not to be progressive. This process heals and stable fusion develops.

The proliferation rate of intracranial tumors as defined by the monoclonal antibody KI 67. Application of the method to paraffin embedded specimens

Abstract60 intracranial tumors have been studied immunohistochemically to determine the proliferation rate by staining for the monoclonal antibody KI-67, which recognizes a nuclear antigen expressed by cells in proliferation. In gliomas a clear correlation of stained nuclei to the histologically determined degree of malignancy was found: slow growing astrocytomas and oligodendrogliomas had an average proliferation rate of 1%, more malignant forms of 7–10%. Glioblastomas were found to have a growth fraction of 15%. Metastases had an even higher rate of 20% proliferating cells. In meningiomas the proliferation rate was mainly about 1%, but in three cases it was between 5% and 7%. Whether this is indicative for a higher risk of tumor recurrence, remains to be correlated to the clinical course. Hemangiopericytomas had a proliferation rate of 9% and 16%, respectively, the latter recurring within four months. It may be concluded from the results of this study, that investigation of intracranial tumors with KI 67 may be of prognostic value and can possibly contribute to an individualized tumor therapy.

2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery

It is claimed that wound closure with 2-octyl-cyanoacrylate has the advantages that band-aids are not needed in the postoperative period, that the wound can get in contact with water and that removal of stitches is not required. This would substantially enhance patient comfort, especially in times of reduced in-hospital stays. Postoperative wound infection is a well-known complication in spinal surgery. The reported infection rates range between 0% and 12.7%. The question arises if the advantages of wound closure with 2-octyl-cyanoacrylate in spinal surgery are not surpassed by an increase in infection rate. This study has been conducted to identify the infection rate of spinal surgery if wound closure was done with 2-octyl-cyanoacrylate. A total of 235 patients with one- or two-level surgery at the cervical or lumbar spine were included in this prospective study. Their pre- and postoperative course was evaluated. Analysis included age, sex, body mass index, duration and level of operation, blood examinations, 6-week follow-up and analysis of preoperative risk factors. The data were compared to infection rates of similar surgeries found in a literature research and to a historical group of 503 patients who underwent wound closure with standard skin sutures after spine surgery. With the use of 2-octyl-cyanoacrylate, only one patient suffered from postoperative wound infection which accounts for a total infection rate of 0.43%. In the literature addressing infection rate after spine surgery, an average rate of 3.2% is reported. Infection rate was 2.2% in the historical control group. No risk factor could be identified which limited the usage of 2-octyl-cyanoacrylate. 2-Octyl-cyanoacrylate provides sufficient wound closure in spinal surgery and is associated with a low risk of postoperative wound infection.

Multiple spinal hemangioblastomas in a case of Lindau's disease

A 32-year-old man with Lindaus syndrome is presented. After an initial operation for cerebellar hemangioblastoma and laser coagulation of retinal tumors, other retinal tumors, a second cerebellar tumor, and four spinal hemangioblastomas occurred 10 years later; cystic lesions of both kidneys and of the pancreas could also be shown. There is no family history. Consequences for further diagnostic procedures in patients with hemangioblastomas are discussed.

Cerebrospinal Fluid and Serum Levels of Albumin, IgG, IgA and IgM in Patients with Intracranial Tumors and Lumbar Disc Herniation

CSF and serum albumin, immunoglobulin (Ig) G, IgA and IgM were measured in 100 patients with intracranial tumors, 79 with lumbar disc herniation and 68 free of neurologic diseases. Increases in one or more of the CSF Igs were observed in 46% of the patients with lumbar disc herniation and in 77% of those with intracranial tumors. The CSF-serum protein distribution suggested that impairment of the blood-brain barrier and CNS synthesis of IgG occurred in 15 and 8% of the patients with lumbar disc herniation, respectively; the proportions of tumor patients were 12 and 22%.

Indication for surgery of spinal metastases within the cervical region

A 40-year-old female patient developed a nearly complete tetraparesis within two weeks. Neurological examination showed nearly complete tetraparesis, complete sensory impairment from the level of C4 and hyperreflexia of tendon jerks. Radiological examination showed a space occupying lesion with an extraspinal extension. Operative decompression was carried out and the patient recovered completely within 3 months.