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In a retrospective analysis 385 patients with a histologically defined cranial meningioma were studied to analyze the impact of characteristic factors on morbidity and mortality after modern cranial meningioma surgery. Mortality was 4.2% one month and 7.3% six months after operation. 15.6% of the patients stayed more than one month in the hospital (defined as criteria of operative morbidity). Age, poor preoperative clinical condition (ASA score), intra- and postoperative bleeding and CSF disturbances were significantly associated with a subsequent decrease of quality of life. First symptoms like intracranial hypertension, seizures, aphasia and hemiparesis were correlated with an increase of postoperative Karnowsky index. Postoperative quality of life decreased in patients with optic and other cranial nerve disturbances significantly. Tumour size, location (exception: medial sphenoid wing) and histological diagnosis did not influence surgical outcome. This information may be useful in management decisions regarding asymptomatic meningiomas in elderly and high risk patients.

Meningiomas of the sellar region represent approximately 4%–10% of all intracranial meningiomas [3, 7, 9], involving the tuberculum sellae, anterior clinoid processes, diaphragma sellae, and planum sphenoidale. Because of their association with important vascular and functional regions their treatment causes some major problems. Besides endocrinological disturbances, headaches, seizures, and mental disorders, visual loss and bitemporal hemianopsia are common symptoms. Operative mortality and mobidity have been improved by microsurgical methods and progress in neuroanesthesia and intensive care [10]. The postoperative visual outcome is an important problem for the patient and may worsen the prognosis of these tumors. In this study 40 tumors of the sellar region presenting visual symptoms were reviewed to evaluate the postoperative course of visual disturbances and prognostic criteria.

Although meningiomas are of benign character and generally of encapsulated growth, recurrence is a known problem in treatment. The authors present the time course of a recurrent parasagittal meningioma of the falx, which recurred eleven times. Despite modern radiological diagnostic methods, which made early diagnosis of recurrent tumour possible, and the use of modern microsurgical techniques with radical tumour extirpation and followed by radiotherapy, the fatal course of benign tumour disease could not be stopped.

Reflections on the Future of German Neurosurgery: Further Development on the Foundations Laid by Toennis.- Decompression and Stabilization of the Cervical Spine.- Indications and Complications of Cervical Spine Stabilization.- Osteosynthesis of the Upper Cervical Spine and the Craniocervical Junction.- Surgical Treatments to Stabilize the Upper Cervical Spine.- The Caspar Plate as a Means of Stabilizing the Upper, Middle, and Lower Cervical Spine - Results in 45 Cases.- Anterior Reconstruction and Stabilization After Cervical Vertebral Body Resection.- Long-Term Results After Cervical Interbody Fusion with Polymethylmethacrylate.- Cervical Spine Injuries in Childhood: Long-Term Results After Surgical and Conservative Therapy Morphological and Functional Aspects.- Bracing of the Dens Axis.- The Surgical Treatment of Atlas, Axis, and Combined CI and C2 Fractures.- Association of Injuries to the Head and Spine: 34 Consecutive Cases over a 3-Year Period.- Operative Treatment of Metastatic Cervical Spine Instability.- On the Symptomatology and Neurosurgical Treatment of Senile Ankylosing Hyperostosis of the Spine (Forestier).- Cervical Spine Fractures in Ankylosing Spondylitis - An Imperative Indication for Surgical Spondylodesis.- Primary Autologous Bone Transplantation in the Treatment of Cervical Spondylitis.- Treatment of Craniocervical Instabilities with the Halo-fixateur.- The Natural History of Unstable Traumatic Injuries of the Cervical Spine.- Syringomyelia.- Evolution of the Neurosurgical Management of Syringomyelia in the Last Two Decades.- Syringomyelia: Aspects of Therapeutic Decisions.- Pathogenesis and Operative Treatment of Syringomyelia.- Magnetic Resonance Imaging of Syringomyelia: Idiopathic and Tumor-Associated Cases.- Comparison of Syringoperitoneal and Syringopleural Shunting in Patients with Syringomyelia.- Microsurgical Treatment of Syringomyelia: Intraoperative Findings and Results.- SEPs and Evoked Muscle Responses After Noninvasive Magnetic Stimulation in Patients with Syringomyelia.- Lumbosacral Lipomas and Lipomyelomeningoceles: Operability and Long-Term Follow-up.- The Optimal Time for Operative Treatment of the Tethered Cord Syndrome.- Tethered Cord Syndrome Following Spina Bifida Aperta.- Intraspinal Lipomas with Tethered Cord Syndrome - Results of Operative Treatment in 30 Children.- The Use of Calcium Antagonists Following Subarachnoid Hemorrhage.- Pharmacology of Nimodipine - A Review.- The Prognostic Significance of the Concentration of Nimodipine in the CSF and Plasma in Subarachnoid Hemorrhage.- Is High Dose Nimodipine Therapy Necessary Following Subarachnoid Hemorrhage? A Retrospective Study of 80 Patients with Aneurysmal Subarachnoid Hemorrhage over the Past 2 Years.- Interactions Between Nimodipine and Anesthetics Used in Neurosurgical Procedures.- Influence of Nimodipine on Pulmonary Function.- Tolerability of Calcium Antagonists.- Nimodipine in the Treatment of Subarachnoid Hemorrhage Secondary to Aneurysm Rupture: Five Years' Experience.- Experience with Deliberate Early Aneurysm Surgery and Nimodipine.- Effect of Nimodipine on the Outcome Following Operation for Ruptured Intracranial Aneurysms.- Parenteral Nimodipine Therapy After Subarachnoid Hemorrhage: A Randomized Clinical Study.- Postoperative Long-Term Results After Aneurysm Surgery Among Patients Treated with Nimodipine.- The Acute Effect of Nimodipine on Intracranial Pressure and Cerebral Blood Flow.- Clinical Significance of TCD Pulsatility Indices in Subarachnoid Hemorrhage and Arteriovenous Malformations.- Development of Vasospasm After Subarachnoid Hemorrhage Under Nimodipine Therapy Before and After Aneurysm Surgery.- Prevention of Vasospasm with Nimodipine.- The Clinical Value of Transcranial Doppler Sonography in Aneurysmal Subarachnoid Hemorrhage as an Indication for Cerebral Angiography and a Means of Controlling Nimodipine Treatment.- Clinical and Transcranial Doppler Sonography Evaluation During Treatment with Calcium Antagonists After Subarachnoid Hemorrhage.- CBF Dynamics - Vasospasm After Subarachnoid Hemorrhage.- Discrepancy Between the Results of TCD and the Clinical Status of Patients After SAH.- Aktuelle Rechtsfragen in der Neurochirurgie in Forschung und Klinik.- Current Legal Issues in Neurosurgical Research and Treatment.- Zur Verwendung menschlichen Gewebes, insbesondere von foetalem Gewebe in der Neurochirurgie.- Risiko und erforderlicher Standard in der Neurochirurgie - UEberholtes, Notwendiges, Unerprobtes - (Neurochirurgisches Referat).- Risiko und erforderlicher Standard in der Neurochirurgie - UEberholtes, Notwendiges, Unerprobtes - (Juristisches Referat).- Neuere Entwicklung in der Rechtsprechung zur Aufklarung.- Die arztliche Aufklarung - Eine Gratwanderung zwischen juristischem Muss und arztlichem Tun?.- Straf- und zivilrechtliche Aspekte neurochirurgischer Tatigkeit.- Erfahrungen einer "Gutachterkommission fur AErztliche Behandlungsfehler" mit Behandlungsfehlern im neurochirurgischen Fachgebiet.- Sorgfaltsmangel oder typische Komplikation - Auswertung der Begutachtungen fur die Schlichtungsstelle fur Arzthaftpflichtfragen unter besonderer Berucksichtigung der Bandscheibenoperation.- Zur Begutachtung von traumatischen Hirnschlagaderverletzungen.- Kann ein Schadelhirntrauma ein Akustikusneurinom ausloesen? Rechtsmedizinische UEberlegungen anhand eines Falles.- Gibt es histologische Beweise fur eine traumatisch bedingte Bandscheibenschadigung?.- Versicherungsrechtliche Bewertung von Traumen fur die Entstehung und den Verlauf zervikaler und lumbaler Bandscheibenvorfalle.- Eine seltene Komplikation nach Bandscheibenoperation in Knie-Ellenbogenlage.- Gesprachsfuhrung in der Neurochirurgie.- Gutachtertatigkeit in Sozialgerichtsverfahren.- Notwendigkeit und Voraussetzungen einer Gebrechlichkeitspflegschaft bei neurochirurgischen Patienten.

We describe in detail one case, and briefly mention another where occlusion of a main vessel was necessary for removal of an aneurysm sac. The combined surgery of extracranial-intracranial bypass and the removal of the aneurysm at a second operation four to five weeks later is reported. The two-stage procedure is preferable to the one-stage proceeding for better assessment of the patency of the anastomosis and the possibility of undertaking a second attempt at anastomosis if the first bypass should become occluded.

Bei transnasal durchgefuhrten mikrochirurgischen Operationen von Hypophysentumoren last sich durch die zusatzliche Anwendung von lumbaler Uberdruckluftfullung und endoskopischer Operationstechnik und -kontrolle eine weitere Verbesserung der Operationsergebnisse sowie eine Erweiterung der Indikationen fur den nasalen Zugangsweg erreichen. Die sitzende Lagerung des Patienten mit achsengerechtem Zugangsweg zur Sella turcica schafft, wie oben angefuhrt, die Voraussetzungen zum Einsatz dieser erganzenden Methoden. Durch die lumbale Luftinsufflation unter Uberdruck lassen sich auch sehr grose Hypophysentumoren haufig so in das vorgegebene Operationsfeld verlagern, das eine vollstandige Operation vom transnasalen Zugang aus moglich ist. Diese Moglichkeit wird durch den Einsatz der operativen Technik unter endoskopischer Kontrolle noch erweitert; letztere tragt auch wesentlich zur vollstandigen Tumorentfernung, insbesondere bei endokrin aktiven Tumoren, bei.

Die Erhohung des intrakraniellen Drucks bedeutet akute Lebensgefahr. Durch Einfuhrung der direkten Messung des intrakraniellen Drucks werden bedrohliche Druckentgleisungen fruher erkannt. Mikrochirurgische Operationsmethoden und Anwendung masgeschneiderter Clips unter gleichzeitiger kontrollierter Hypotonie machen chirurgische Behandlung von Gefasmisbildungen risikoarmer. Bei Operation hormonell inaktiver und aktiver Hypophysenadenome senkt transnasaler Zugang Letalitatsrate wesentlich und verbessert funktionelle Ergebnisse. Neue Indiktion in der spinalen Chirurgie: Behandlung der spinalen Claudicatio infolge zentraler Stenose des Spinalkanals durch operative Dekompression der Cauda equina.

Das Referat beschaftigt sich mit der Diagnostik und Therapie intrakranieller Metastasen. Die Bedeutung der Isotopendiagnostik und der Angiographie fur die Diagnostik wird besonders herausgestellt. Eine Indikation zur Operation einer intrakraniellen Metastase ist nur dann gegeben, wenn im Gehirn eine solitare Metastase vorliegt und das zur Metastasierung fuhrende Grundleiden beherrscht ist.

Verletzte mit Schadel-Hirntraumen, die ein extradurales Hamatom entwickeln, durchlaufen gewohnlich 3 Stadien: Der Ruckfall in tiefe Bewustlosigkeit weist auf eine akute intracranielle Drucksteigerung infolge Entwicklung eines komprimierenden extraduralen Hamatoms hin und verlangt bei diesem foudroyanten Verlauf sofortige chirurgische Masnahmen.

1. Bei 28 Patienten mit Durchtrennung peripherer Nerven, bei welchen eine direkte Nervennaht nicht moglich war, wurden homologe Transplantationen durchgefuhrt. Eine Reinnervation war nur bei 2 Fallen zu verzeichnen: Bei einem Saugling mit Durchtrennung des Plexus brachialis im Gefolge der operativen Entfernung eines Lymphangioms der Supraclavicularegion sind 3 Transplantate interponiert worden. Hier trat — wahrscheinlich uber die Transplantate — Reinnervation des M. deltoideus, M. biceps brachii, M. brachioradialis und der Fingerbeuger ein. Hingegen wird man die Wiederherstellung des M. supra- und infraspinam und wohl auch des M. pectoralis major und M. serratus anterior auf eine Reinnervation in den entsprechenden direkt aus dem Plexus brachialis hervorgehenden Nerven beziehen mussen. — Bei einem 6jahrigen Jungen mit Durchtrennung des N. medianus in der Mitte des Oberarms trat eine sehr befriedigende Reneurotisation der abhangigen Muskulatur am Unterarm und partiell zuletzt auch des M. abductor pollicis brevis ein, die lt. EMG (polyphasische Einheiten) nicht auf atypische Innervation bezogen werden kann. Schlieslich liesen sich bei einem Erwachsenen mit Durchtrennung des Ramus profundus des N. radialis im EMG vorubergehend wenige kleine Einheitpotentiale registrieren, die bei einer Kontrolle nicht mehr nachzuweisen waren. Hier mus eine sekundare narbige Umschnurung der wenigen Axone im Transplantat stattgefunden haben. In allen ubrigen Fallen wurde eine Reinnervation vermist.

Between 1980 and 1985, 24 children and adolescents (age range 1.9–18 years) suffering from pharmacoresistant epilepsies, predominantly complex partial seizures, were treated in our institution. Nearly all patients were admitted from epilepsy centers.

The problem as to the extent of clearance of the disc affected by degeneration falls within the scope of disc surgery. It is discussed in many publications in relation to recurrence, discitis and aseptic necrosis as well as to the intra- and retroperitonal complications which may be caused by the operation. In 1971, we altered our method of clearing the intravertebral space in lumbar disc operations. In this paper we compare one year’s patients before (1969) with another year’s patients after (1972) alteration of the surgical method by evaluating the clinical record material and discuss the three major points specified above.

In contrast to aneurysms with subarachnoid hemorrhage or intracerebral hematomas, the timing of surgery in cases of large aneurysms is not primarily dependent on the rupture or the danger of recurrent bleeding. Giant aneurysms are defined as aneurysms with a diameter of more than 2.5 cm according to MORLEY (12). Normally these aneurysms do not attract attention because of a rupture but because they lead to signs of a space-occupying lesions and brain compression (9, 18).

32 cases of negative exploration in a joint follow-up series of 3,032 lumbar disc operations are described. Data from 15 hospitals were analyzed by means of questionnaires and computer-aided analysis. Detailed information is given about pre as well as intraoperative findings. The causes of negative lumbar disc exploration can be divided into two groups. The most important causes in the first group were osteochondrotic compression, distended epidural veins, and root tension. The results are less favourable in these patients than in the overall series but, compared to the other complicated courses, the results were markedly better. A review of the literature is given, the possible causes for negative explorations are discussed, and a directive is established for the surgical procedure in cases where an expected prolapse is not found at operation.

In 1974 at the Symposium on Cerebral Angiomas in Giesen (1, 2), we made reference to 20 cases of deep-seated arteriovenous angiomas situated in or near to the midline. We had operated on 17, three of whom subsequently died. In two cases, this was due to the necessity of operating in a state of acute progressive hemorrhage. In the meantime significant progress in both neurosurgery and neuroradiology has expanded therapy of A-V malformations and made it safer.

In clinical practice assessment of coma and registration of its development is based successfully upon recording of both the patient’s spontaneous activity and the responiveness to external stimulation.

In an unselected series of cases at the University Neurosurgical Clinic of Gottingen we have seen 56 angioma cases, 20 of which were located in or near the midline of the brain.

Von den peripheren Nerven wird der N. ulnaris auf Grund seiner exponierten Lage am Ellenbogengelenk durch stumpfe Traumen, knocherne Umbauvorgange und starkere Beanspruchungen des Ellenbogengelenks am haufigsten geschadigt. Ein ganz besonderes Interesse wurde von jeher seinen sog. Spatlahmungen zuteil, da nur schwer verstandlich ist, warum noch 30 und mehr Jahre nach einer Ellenbogenverletzung Storungen der Nervenleitung ohne Bruckensymptome auftreten. Es handelt sich dabei um eine chronische Druckschadigung, die zu einer kompletten oder partiellen Axonotmesis fuhrt und nach Beseitigung ihrer Ursache vollstandig ruckbildungsfahig ist. Die Verlagerung des Nerven auf die Beugeseite des Gelenks, subcutan oder unter die Flexorenansatze, ist daher bei Annahme einer Schadigung am Ellenbogen die Therapie der Wahl.

An account is given of investigations on 31 patients with space-occupying lesions in the pituitary and in the suprasellar regions of the hypothalamus near the pituitary. Estimations of the peripheral hormones were performed in these patients, and also central loading tests. About 70% of all patients who had received treatment before the investigation (operation, radiation or both) showed a reduction in the gonadotropic, thyrotropic and adrenotropic function of the pituitary, but this was only revealed when central function tests were carried out.