Gernot Schulte-Altedorneburg

Three-dimensional constructive interference in steady-state magnetic resonance imaging in obstructive hydrocephalus: relevance for endoscopic third ventriculostomy and clinical results

OBJECT Endoscopic third ventriculostomy is the treatment of choice in patients with obstructive hydrocephalus caused by aqueductal stenosis. The authors examined the clinical course and results of surgical treatment for obstructive hydrocephalus with pre- and postoperative refined constructive interference in steady-state (CISS) MR imaging. METHODS Forty patients with obstructive hydrocephalus underwent pre- and postoperative 3D-CISS imaging and clinical evaluation. Radiological findings were correlated with intraoperative observations of the thickness and transparency of the floor of the third ventricle and the patients postoperative clinical course. RESULTS Three-dimensional CISS MR imaging provides precise visualization of the basilar/posterior cerebral artery, its distance to the clivus, the diameter of the foramen of Monro, and the extension of and thickness of the floor of the third ventricle. In 71% of patients a flow void was detectable postoperatively on the ventriculostomy. In this group 81.5% had strong and 14.8% moderate clinical benefit, and 3.7% required secondary shunt placement. In the remaining 29% of the patients without a visible flow void, strong improvement was seen in 54.5%, moderate improvement in 18.2%, and stoma failure occurred in 27.3% (p = 0.094). Radiological measurements of the thickness of the third ventricle floor correlated with intraoperative findings (r = 0.35, p = 0.029). Comparison of outcomes showed a statistically significant tendency for a better outcome in patients with thin and easily perforated third ventricle floors (p = 0.04). CONCLUSIONS Endoscopic ventriculostomy in patients with obstructive hydrocephalus is safe and mostly successful, and 3D-CISS MR imaging seems to be a valuable diagnostic method for precisely identifying the anatomy of relevant structures. Furthermore, 3D-CISS MR imaging allows judgment of the thickness of the third ventricle floor and display of the ventriculostomy/flow void, which are predictive for intraoperative course and clinical outcome.

Diagnostik und Therapie der Basilaristhrombose

ZusammenfassungAufgrund der schlechten Spontanprognose nimmt die Basilaristhrombose eine Sonderstellung bei den akuten zerebrovaskulären Erkrankungen ein. Durch die frühzeitige Rekanalisierung mittels intraarterieller Thrombolyse lässt sich aber bei einem Teil der Patienten eine gute klinische Erholung erreichen. Neben der medikamentösen Thrombolyse und teilweise in Kombination mit ihr werden an spezialisierten Zentren zunehmend auch mechanische Rekanalisierungsverfahren und der Einsatz von Glykoprotein-IIb/IIIa-Inhibitoren erprobt. Die vorliegende Arbeit gibt einen Überblick über aktuelle Entwicklungen in der Diagnostik und Therapie der Basilaristhrombose.SummaryIn view of the poor prognosis for untreated patients with basilar artery occlusion, rapid delivery of effective treatment has the highest priority. Early recanalization by intra-arterial thrombolysis can improve the outcome in some patients. Apart from this method, specialized centers are increasingly using mechanical devices and glycoprotein IIb/IIIa inhibitors to achieve recanalization. This review focuses on current developments in the diagnosis and treatment of acute basilar artery occlusion.In view of the poor prognosis for untreated patients with basilar artery occlusion, rapid delivery of effective treatment has the highest priority. Early recanalization by intra-arterial thrombolysis can improve the outcome in some patients. Apart from this method, specialized centers are increasingly using mechanical devices and glycoprotein IIb/IIIa inhibitors to achieve recanalization. This review focuses on current developments in the diagnosis and treatment of acute basilar artery occlusion.

Measuring carotid artery stenosis: Comparison of postmortem arteriograms with the planimetric gold standard

AbstractObjectiveFive different calliper methods for assessing the degree of carotid artery stenosis and visual estimation (“eyeballing”) of postmortem carotid arteriograms were compared with the planimetric gold standard of the area reduction at the site of the stenosis.MethodsDuring autopsy 53 carotid specimens were removed in toto from 31 neurological patients. Carotid arteries were ligated and redistended to a physiological degree for standardised three–plane arteriography. Afterwards, the entire specimen was filled with an embedding medium under the same conditions and sectioned. Slices at the site of stenoses were histologically processed. Computerised planimetric analysis of the lumen area reduction was performed and compared with the arteriographic findings. Arteriograms were evaluated by two independent observers by means of linear Common Carotid Artery (CC), the European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and squared measurements (NASCET2, ECST2) after applying the πr2 function. Further, three independent observers performed eyeballing of the degree of stenosis from the postmortem arteriographies.ResultsPlanimetry was carried out in 29 internal carotid artery (ICA) and 17 common carotid artery (CCA) stenoses ranging from 8.5 to 100%. The smallest mean differences of the degree of stenosis in % between planimetry and arteriography were –0.5 and 0.6%. The narrowest 95 %–limits of agreement covered a range of ±24.1 and 26.3% of stenoses, and the highest correlation coefficients were both 0.9 for the CC and ECST2 techniques, respectively. By eyeballing, the degree of stenosis was underestimated by 13.5 to 15.8% on average. The narrowest limits of agreement between two observers for eyeballing covered a range of 35%.ConclusionThree–plane arteriography has only a moderate accuracy and reproducibility in detecting and measuring carotid artery stenosis independent of the technique of measurement used.

Diagnosis and therapy of basilar artery occlusion

ZusammenfassungAufgrund der schlechten Spontanprognose nimmt die Basilaristhrombose eine Sonderstellung bei den akuten zerebrovaskulären Erkrankungen ein. Durch die frühzeitige Rekanalisierung mittels intraarterieller Thrombolyse lässt sich aber bei einem Teil der Patienten eine gute klinische Erholung erreichen. Neben der medikamentösen Thrombolyse und teilweise in Kombination mit ihr werden an spezialisierten Zentren zunehmend auch mechanische Rekanalisierungsverfahren und der Einsatz von Glykoprotein-IIb/IIIa-Inhibitoren erprobt. Die vorliegende Arbeit gibt einen Überblick über aktuelle Entwicklungen in der Diagnostik und Therapie der Basilaristhrombose.SummaryIn view of the poor prognosis for untreated patients with basilar artery occlusion, rapid delivery of effective treatment has the highest priority. Early recanalization by intra-arterial thrombolysis can improve the outcome in some patients. Apart from this method, specialized centers are increasingly using mechanical devices and glycoprotein IIb/IIIa inhibitors to achieve recanalization. This review focuses on current developments in the diagnosis and treatment of acute basilar artery occlusion.In view of the poor prognosis for untreated patients with basilar artery occlusion, rapid delivery of effective treatment has the highest priority. Early recanalization by intra-arterial thrombolysis can improve the outcome in some patients. Apart from this method, specialized centers are increasingly using mechanical devices and glycoprotein IIb/IIIa inhibitors to achieve recanalization. This review focuses on current developments in the diagnosis and treatment of acute basilar artery occlusion.

Thrombolysis of Basilar Artery Occlusion—Intra-Arterial or Intravenous: Is There Really No Difference?

To the Editor: With great interest we read the meta-analysis on the therapy of basilar artery occlusion (BAO) by Lindsbergh and Mattle1 published in the March issue of Stroke . The authors compared the pooled data from 13 retrospective studies (3 studies including 76 patients treated by intravenous thrombolysis [IVT], and 10 studies including 344 patients treated by intra-arterial thrombolysis [IAT]) in patients with BAO. The authors draw the conclusions that the route of drug delivery for treatment of BAO does not make a difference in clinical outcome and that the odds for survival without a handicap improve equally after IVT and IAT. We agree with the authors that the recanalization …

Functional outcome after severe cerebral venous thrombosis

Severe cerebral venous thrombosis (CVT) is a rare cerebrovascular condition which in the more severe cases warrants intensive care treatment. While the outcome in the majority of uncomplicated CVT cases is good, it may be fatal in more affected patients. We provide long-term functional and quality of life (QOL) outcome data in the form of a retrospective analysis of 10 patients admitted to a neurological ICU with severe CVT. Outcome measures used were the modified Rankin Scale, the 36-item Short Form Health Survey, and the Psychological General Well-Being index. The mortality rate was 50% but 4 out 5 survivors had a good functional outcome with normal QOL despite a very severe clinical course. This finding justifies extensive life-sustaining therapy as the prognosis even of severe cases may be good if the acute phase is survived.

Congratulations Hartmut Brückmann

on 09 april 2011 Prof. dr. med. Hartmut Brückmann head of the department of neuroradiology of the university Clinic Munich will become 60 years old. at the same time his department at the Großhadern Clinic will have been in existence for 15 years. Hartmut Brückmann was born in Freinsheim in Rhineland and grew up in Kevelaer on the Lower Rhine. after completing school he studied medicine and ethnology in aachen and Bonn. He had already become interested in radiology during his doctoral studies and deepened this interest during his further education in radiology at the Knappschaftskrankenhaus Bardenberg under Prof. Medini Cen. Subsequently, in 1985 Hartmut Brückmann moved to the neurological university Clinic aachen (Prof. dr. K. Poeck) which was already taking a pioneering role in the diagnostics and treatment of stroke. during this time he was inspired by Hermann Zeumer, later to become professor of neuroradiology at the university Clinic Hamburg-Eppendorf in diagnostic and especially interventional neuroradiology. together they carried out endovascular recanalizing interventions in the vertebrobasilar vascular territory as early as the 1980s. With the establishment of a teaching and research department of neuroradiology at the university Clinic aachen, Hartmut Brückmann became Vice Medical director under his former boss, Prof. armin thron in 1987. in 1990 he moved to the Medical university of Lübeck, where he completed his postdoctoral studies in 1993. in his postdoctoral thesis “Classification of infarcts of the pons and of the medulla oblongata” he investigated the vascularization of the brain stem on the basis of microradiographical preparations. Since 01 april 1996 H. Brückmann is head of the department for neuroradiology at the Ludwig-Maximilans-university Munich-Großhadern as a university professor. Hartmut Brückmann’s scientific and clinical focal points are neurovascular diseases, particularly ischemic infarctions in the vertebrobasilar vascular territory. His pioneering Clin neuroradiol (2011) 21:3–4 doi 10.1007/s00062-011-0060-y