F. Ahlhelm

The Prodisc-c Prothesis: Clinical and Radiological Experience 1 Year After Surgery

Study Design. This is a prospective randomized and controlled study, approved by the local ethical committee of Saarland (Germany). Objective. The aim of the current study was to analyze segmental motion following artificial disc replacement using disc prosthesis over 1 year. A second aim was to compare both segmental motion as well as clinical result to the current gold standard (anterior cervical discectomy and fusion [ACDF]). Summary of Background Data. ACDF may be considered to be the gold standard for treatment of symptomatic degenerative disc disease within the cervical spine. However, fusion may result in progressive degeneration of the adjacent segments. Therefore, disc arthroplasty has been introduced. Among these, artifical disc replacement seems to be promising. However, segmental motion should be preserved. This, again, is very difficult to judge and has not yet been proven. Methods. A total of 49 patients with cervical disc herniation were enrolled and assigned to either study group (receiving a disc prosthesis) or control group (receiving ACDF, using a cage with bone graft and an anterior plate). Roentgen stereometric analysis (RSA) was used to quantify intervertebral motion immediately as well as 3, 6, 12, 24, and 52 weeks after surgery. Also, clinical results were judged using visual analog scale and neuro-examination at even RSA follow-up. Results. Cervical spine segmental motion decreased over time in the presence of disc prosthesis or fusion device. However, the loss segmental motion is significantly higher in the fusion group, when looked at 3, 6, 12, 24, and 52 weeks after surgery. We observed significant pain reduction in neck and arm after surgery, without significant difference between both groups. Conclusion. Cervical spine disc prosthesis remains cervical spine segmental motion within the first 1 year after surgery. The clinical results are the same when compared with the early results following ACDF.

Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases

BACKGROUND The widespread use of magnetic resonance imaging (MRI), now the first line investigation for back and leg pain, reveals cystic sacral lesions more often than myelography did in the past. There is agreement that symptomatic perineurial sacral cysts should be treated surgically. However, it is still debated whether the preference should be given to the curative option, consisting of excision of the cyst with duraplasty, or to drainage of the cyst to relieve symptoms. In this retrospective study the efficacy of microsurgical cyst resection with duraplasty is evaluated. METHODS In 15 patients presenting with pain and neurologic deficits, myelography and/or MRI detected sacral cysts. The clinical features suggested that the space-occupying lesions caused the disturbances. Microsurgical excision of the cyst along with duraplasty or plication of the cyst wall was performed in all the cases. Postoperative care included bed rest and CSF drainage for several days. RESULTS In 13 out of 15 patients the preoperative radicular pain disappeared after surgery. The 2 patients with motor deficits and the 6 patients with bladder dysfunction recovered completely. In all except 1 of the 10 patients complaining of sensory disturbances a significant improvement was achieved. No complications were observed. CONCLUSION Microsurgical excision of the cyst combined with duraplasty or plication of the cyst wall is an effective and safe treatment of symptomatic sacral cysts and, in the view of the authors, the method of choice.

Skull base tumors

Modern imaging techniques have great importance in the diagnosis and therapy of skull-base pathologies. Many of these lesions, especially in relation to their specific location, can be evaluated using CT and MR imaging. Tumors commonly found in the anterior skull base include carcinoma, rhabdomyosarcoma, esthesioneuroblastoma and meningioma. In the central cranial fossa, nasopharyngeal carcinoma, metastases, meningioma, pituitary adenoma and neurinoma have to be considered. The most common neoplasms of the posterior skull base, including the CP angle, are neurinoma, meningioma, nasopharyngeal carcinoma, chordoma and paraganglioma. One major task of imaging is the evaluation of the exact tumor extent as well as its relationship to the neighboring neurovascular structures. The purpose of this review is to recapitulate the most important anatomical landmarks of the skull base. The typical imaging findings of the most common tumors involving the skull base are also presented.

Spinale Tumoren@@@Spinal tumours

ZusammenfassungSpinale Tumoren können intramedullär, innerhalb der Meningen (intradural), zwischen Meningen und Knochen (extradural) auftreten oder von anderen Lokalisationen sekundär zu einer Beteiligung der Wirbelsäule führen. Das Wirbelkörperhämangiom ist der häufigste gutartige Tumor der Wirbelsäule. Zu den häufigsten malignen spinalen Tumoren gehören Metastasen, das Lymphom und das multiple Myelom. Primäre Knochentumoren der Wirbelsäule sind im Vergleich dazu eher selten und zeigen auch oft charakteristische Bildbefunde. Für die Differenzialdiagnostik spielen das Patientenalter, die Lokalisation des Tumors und die magnetresonanz- und computertomographischen Befunde eine wichtige Rolle.AbstractSpinal tumors can be intramedullary, intradural (within the meninges), or extradural (between the meninges and the bones), or they may extend secondary to the spine from other locations. Vertebral hemangioma represents the most common benign tumor of the spine. Metastases, lymphoma, and multiple myeloma are the most frequent malignant spinal tumors. Primary osseous tumors of the spine, in contrast, are rare conditions but may demonstrate typical imaging findings. For the differential diagnosis, the patient’s age, the topographic localization of the mass, and morphologic features of the lesion as depicted by computed tomography and magnetic resonance imaging play important roles.

Karotisstent beim akuten Schlaganfall

For patients with acute ischemic stroke due to total occlusion of the internal carotid artery (ICA), an effective intervention to improve neurologic symptoms and clinical outcome has not yet been established. Some authors have reported successful revascularization for patients with acute stroke symptoms secondary to ICA occlusion only in isolated series and case reports. Emergency recanalization and carotid artery stent placement can improve neurologic outcome in selected patients with acute ischemic stroke and total occlusion of the ICA.

Shaken-baby-Syndrom

ZusammenfassungDas Shaken-baby-Syndrom (SBS) oder Schütteltrauma des Säuglings beschreibt die Koinzidenz subduraler Hämatome, retinaler Blutungen und prognostisch ungünstiger, diffuser Hirnschäden durch heftiges Schütteln eines Säuglings. Die klinischen Symptome umfassen Irritabilität, Trinkschwierigkeiten, Somnolenz, Apathie, zerebrale Krampfanfälle, Apnoe, Temperaturregulationsstörungen und Erbrechen durch Hirndruck. Leichtere Symptome des SBS werden häufig nicht diagnostiziert, die Dunkelziffer ist wahrscheinlich viel höher. Die Diagnose des SBS wird durch die typische Symptomkonstellation gestellt, wobei das Fehlen einer retinalen Blutung die Diagnose nicht ausschließt. In der Regel werden die Säuglinge und Kleinkinder dabei am Thorax oder an den Oberarmen gehalten und in sagittaler Richtung geschüttelt. Dabei fällt der Kopf nach vorne und hinten und wird jeweils in der Extremposition abrupt gebremst. Als schädigender Mechanismus werden rotatorische Kräfte, die einerseits Gewebeschichten innerhalb des Gehirns gegeneinander verschieben und andererseits zum Abriss von Brückenvenen zwischen Schädelkalotte und Gehirn führen, angesehen. Die Prognose ist schlecht, etwa 1/4 der Kinder stirbt innerhalb von Tagen bis Wochen nach dem SBS. Bei den Überlebenden kommt es in 75% der Fälle zu Langzeitschäden mit körperlicher Behinderung, Beeinträchtigung des Hörens, Sehstörungen bis zur Blindheit, Epilepsie und geistiger Behinderung bzw. einer Kombination dieser Zustände. Wichtig ist deshalb die Prävention!AbstractShaken baby syndrome (SBS) describes the coincidence of subdural hematoma, retinal bleeding and, disadvantageous for the prognosis, diffuse brain damage caused by powerful shaking of the infant. The clinical symptoms include irritability, difficulty with drinking, somnolence, apathy, cerebral cramp attacks, apnoea, temperature regulation disorders and vomiting due to cranial pressure. Milder symptoms of SBS are often not diagnosed and the number of unregistered cases is probably much greater. The diagnosis of SBS is made through the typical symptom constellation, but the lack of retinal bleeding does not exclude the diagnosis. Normally the infants are held by the thorax or upper arms and shaken in a sagittal direction during which the head falls backwards and forwards and is stopped abruptly at each extreme position. The injurious mechanism is considered to be caused by rotational forces which force tissue layers in the brain against each other and also lead to rupture of bridging veins between the skull and the brain. The prognosis is poor and approximately 25% of infants die of SBS within days or weeks. Approximately 75% of survivors suffer from long term damage with physical handicaps, limitations in hearing, visual disturbances up to blindness and mental disorders or combinations of these conditions. Prevention is therefore the most important aspect.

Kavernöse Malformationen@@@Cavernous malformations

ZusammenfassungKavernome können intrazerebral oder intraspinal intramedullär auftreten und gehören zu den zerebrovaskulären Malformationen, die keinen AV-Shunt zeigen und daher angiographisch in der Regel nicht zur Darstellung kommen. Im Gegensatz zur Computertomographie (CT), mit der häufig nur verkalkte oder frisch eingeblutete Kavernome nachgewiesen werden können, ist es mit der Magnetresonanztomographie (MRT) möglich, auch kleine Kavernome zuverlässig zu detektieren. Eine häufig assoziierte Venenanomalie ist hier für die exakte Diagnose hilfreich.AbstractCavernomas of the CNS may involve brain parenchyma as well as the spinal cord and belong to those cerebrovascular malformations that have no arteriovenous shunt and thus are generally angiographically occult. Contrary to computed tomography (CT), which is generally suited to reveal calcifications or acute bleeding, magnetic resonance imaging (MRI) enables detection of even small cavernomas. A frequently associated venous anomaly is helpful for correct diagnosis.

Spinal cord infarction

Infarction of the spinal cord can cause a variety of symptoms and neurological deficits because of the complex vascular supply of the myelon. The most common leading symptom is distal paresis ranging from paraparesis to tetraplegia caused by arterial ischemia or infarction of the myelon. Venous infarction, however, cannot always be distinguished from arterial infarction based on the symptoms alone.Modern imaging techniques, such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) assist in preoperative planning of aortic operations to reliably identify not only the most important vascular structure supplying the spinal cord, the artery of Adamkiewicz, but also other pathologies such as tumors or infectious disorders. In contrast to CT, MRI can reliably depict infarction of the spinal cord.

Carotid artery stenting for acute stroke

For patients with acute ischemic stroke due to total occlusion of the internal carotid artery (ICA), an effective intervention to improve neurologic symptoms and clinical outcome has not yet been established. Some authors have reported successful revascularization for patients with acute stroke symptoms secondary to ICA occlusion only in isolated series and case reports. Emergency recanalization and carotid artery stent placement can improve neurologic outcome in selected patients with acute ischemic stroke and total occlusion of the ICA.

Behandlung der arteriosklerotischen Erkrankung der A. carotis

In order to find the most suitable therapy concept for patients with severe stenosis of the carotid bifurcation (>70%), knowledge on the currently available treatment methods is necessary. In addition to carotid endarterectomy, medication therapy and stent angioplasty are also available. The outcome after stent angioplasty must be considered under the aspects of rapid technical development and increasing experience. Results of studies are still only of limited value with respect to the development of protection systems, flexible guiding catheters, low profile and more visible stents and balloons as well as using thrombocyte aggregation.