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Abstract: A microprocessor-controlled infusion pump is described for the automatic control of hypotension or antihypertensive treatment with sodium nitroprussid. The system requires the continuous monitoring of blood pressure as an input signal to the microprocessor, the latter regulating blood pressure to the desired level by stepwise changes in infusion rate. The infusion pump proved valuable for intensive care and neurosurgery under controlled hypotension.

Summary Intraoperative real-time ultrasound imaging (US) was used in over 500 patients to investigate which of the previously considered applications are of practical use in everyday neurosurgery.

Summary Experience with the use of intraoperative ultrasound (US) imaging in over 300 patients are presented in this paper and discussed with special reference to various pathomorphologies as well as their identifiability within the brain/intracranium. In 201 of these patients, the pathomorphological peculiarities in US could be compared with preoperative CT findings.

Summary Among 1850 patients undergoing spinal cord surgery between 1966 and 1978, 14 suffered from spondylitis unrelated to previous myelography, discography or lumbar disc surgery. In 6 patients, infection was caused by staphylococcus aureus; 3 of them had an acute course of the disease, accompanied by formation of para- or praevertebral abscess, speticaemia and, finally, lethal outcome.

Summary Sodium nitroprusside (NiprideR) was administered intravenously to 24 patients for surgery under controlled hypotension or antihypertensive treatment postoperatively or after severe head injury. The prompt effect of the substance could be observed in all patients. Hypertensive patients turned out to be more sensitive than normotensives. In hypertensive head-injured patients, the substance can be helpful in lowering ICP parallel to blood pressure, provided that cerebral perfusion pressure is controlled continuously. These was, however, no correlation between dosage and blood pressure decrease, indicating that greatest care and slow dosage increase are necessary. After controlled hypotension, a slow dosage decrease is recommended to prevent a reactive hypertension.

Summary Flow property measurements were performed in a plexiglass model of six various types of end-to-side anastomosis (as clinically shown in extracranial to intracranial arterial bypass surgery). Three anastomoses were made without, another three anastomoses with a ringshaped stenosis restricting the lumen to between 25 and 46% of the cross-section as it occurs clinically by formation of thrombi out of the stitching canals. A rectangular type and two 45 degree oblique types—one directed centrally and one directed peripherally—were tested. Pressure head losses at the site of anastomosis were measured under various circumstances of different anastomoses and different flow speeds along the proximal portion of the middle cerebral artery and the superficial temporal artery. Flow resistance values originated by the different types of anastomoses were expressed in terms of additional recipient vessel length. Differences between different types of anastomoses with and without stenosis were very small and under no circumstances exceeded the equivalent of lengthening the recipient vessel by 2 cm. Theoretically, the optimal type of anastomosis is the oblique and centrally directed version; the worst type is the rectangular form. Practically, however, such differences are not relevant.

Zusammenfassung Quantitative Bestimmung der Serum-Proteine einschließlich des a2M-Globulins bei 34 Schädelhirntraumatikern, graphische Darstellung der Mittelwertverlaufskurven der ersten 2 Wochen nach dem Trauma.

Zusammenfassung Bericht über sieben Fälle von schwerem Schädel-Hirn-Trauma, bei denen im Verlaufe der ersten 8 Tage nach dem Unfall die proteolytische Aktivität im Ventrikelliquor gemessen wurde. Das Ergebnis war bei vier Fällen positiv und wird — soweit aus den bisherigen Daten möglich — zu klinischem Bild und morphologischen Veränderungen am Gehirn in Beziehung gesetzt. Die Bedeutung früherer Ergebnisse in diesem Zusammenhang wird diskutiert.

Summary This study in cats investigates the action of sodium nitroprusside on the pial vessels by systemic and local administration, with an intravital microscopic window technique and a photometric technique for graphic documentation of vessel diameter changes. Intravenous infusion caused vasodilatation parallel with decreasing blood pressure. Pial arterioles dilated more than venules, smaller vessels more than larger ones. Local administration caused maximal dilatation within 5–10 seconds.

Summary This prospective open study of 124 patients [80% with completed stroke (CS), 16% with TIAS, 4% with PRIND] consecutively admitted between 1976 and 1981 investigates the rates of reinfarction after surgical treatment (extra-intracranial arterial bypass, EIAB and/or carotid thrombendarterectomy, TEA). 34% of patients had unilateral carotid stenosis, 26% unilateral internal carotid artery occlusion, 17% had occlusion of one and stenosis of the contralateral internal carotid artery, 14% bilateral carotid stenosis. Combined surgical morbidity and mortality was 5% after 158 operations in 124 patients; 7 of the 8 complications occurred in patients with CS.

Summary This report summarizes the outcome of 56 patients with cerebellar lesions of vascular origin, 40 patients with cerebellar infarction, and 16 with spontaneous cerebellar haemorrhage. All patients had computerized tomography: occlusive hydrocephalus was diagnosed in 75% of patients with cerebellar haemorrhage and in 23% with cerebellar infarction.

Summary This is an investigation into thromboplastin time, partial thromboplastin time, plasma thrombin time, fibrinogen, and platelets in 30 patients with severe brain injury over 7–14 days. Platelets showed a very marked initial decrease and a slow return to normal around the seventh day. Fibrinogen was initially lowered in most of the cases, and raised from the second day onward. Changes in the other laboratory values were less definite.

Zusammenfassung Anwendung eines Anti-Gravitationsanzuges bei neurochirurgischen Patienten mit lagerungsbedingter Hypotonie. Akuter Blutdruckabfall bei Operationen in sitzender Lagerung kann mit Hilfe eines Luftdruckanzuges, der von den Sprunggelenken bis zum Xiphoid reicht, erfolgreich und rasch behoben werden. Der durchschnittlich gemessene Anstieg des systolischen Blutdrucks über den Ausgangswert betrug 60%, wobei ein reziprokes Verhältnis zwischen Ausgangswert und Blutdruckanstieg auffiel. Somit können im Gegensatz zu früher alle drucklabilen Patienten in schlechtem Allgemeinzustand dem indizierten Eingriff unterzogen werden. Die Wirkung äußerlichen Drucks auf die untere Körperhälfte wird mit Erhöhung des peripheren Widerstands und Abnahme der Durchströmung erklärt, aus denen Verbesserung des venösen Rückstromes, Verlagerung des zirkulierenden Volumens über das Diaphragma und Anstieg des systolischen Drucks resultieren.

Summary Experimental brain lesions were created by Nd:YAG laser (wave length 1.06 µm) irradiation on the cerebral cortex of anaesthesized adult cats with 20 Watts impacts of 0.5, 1.0, 2.5, and 5.0 seconds exposure time through cranial windows. Histological changes, disruption of the blood-brain barrier (Evans blue extravasation) and pial vessel reaction (large vessels more than 100 µm and vessels smaller than 100 µm) were studied under constant PaCO2, blood pH, and mean arterial pressure.

Summary Using parietal cranial windows and multichannel videoangiometry, pial vessel responses were studied in cats during stepwise elevation of superior sagittal sinus pressure (PSSS) to a level of 50 mmHg or reduction of CSF-pressure (PCSF). PCSF was monitored via a needle in the great cistern, known from previous studies to be identical to supratentorial CSF-pressure. During elevation of PSSS, large and small pial veins dilated by 14±6.1% from resting diameter. Small arteries remained unresponsive until they were dilated by 9±2.1% at the level of PSSS 50mmHg. Large arteries dilated by 18±5.5% at the level of PSSS 50 mmHg. PSSS was always approximately twice as high as PCSF during increase of PSSS. During reduction of PCSF to

Summary Fibrin glue (Beriplast, Behring or Tissucol, Immuno) was used for 126 sublabial transseptal transsphenoidal operations in 119 patients from April 1981 to March 1987 in a variety of sellar pathologies together with septal bone and spongycel to seal the sellar floor and the anterior wall of the sphenoid sinus.

Summary In a model of focal cerebral ischaemia in the cat (transorbital occlusion of the middle cerebral artery for 60 minutes, thereafter 6 hours reperfusion by clip removal), hydroxyethyl-starch (HAES) (ELOHES; Leopold Pharma GmbH, Graz, Austria) was administered intravenously before and during the ischaemic episode as a 6% or as a 10% solution in a randomised manner (6 animals each group).

Summary Among 302 patients with cerebral aneurysms admitted between 1981 and 1986, 63 had a large (45) or giant (18) aneurysm with a diameter of more than 12 mm and 24 mm, respectively. 24 of these 63 patients were admitted early after a subarachnoid haemorrhage (SAH) so as to allow surgical repair within 72 hours. Eight of them were inoperable for various reasons and could not undergo definitive surgical repair and died. 16 patients underwent craniotomy and clipping of the aneurysm. 77% of the patients in preoperative grades I-IV made a good recovery with no or minimal neurologic deficit. During the same period 84% of patients with small aneurysms made a good recovery.

Summary This paper describes an ultrasound-guided, laser-assisted, and TV-controlled endoscopic technique which has been used so far in 133 patients for a variety of intracranial lesions.

The authors report IUE observations of the Wolf-Rayet binary system HD 90657 which indicate that a major change in the properties of the W-R wind occurred on time scales of less than 90 minutes. These are very rapid variations when compared to those resulting from atmospheric eclipse effects, which are also observed in this system. The rapid change is attributed to wind instabilities, possibly induced by pulsations of the underlying helium-burning core.

Summary A treatment protocol for a controlled open study in patients with subarachnoid haemorrhage (SAH) from cerebral aneurysms is presented, applying acute surgery and pharmacological prevention of symptomatic vasospasm: In patients clinically graded I–III (Hunt and Hess), operation is performed within 48 to 72 hours. After aneurysm clipping, the calcium-antagonist Nimodipine is administered 1. topically during operation, 2. intravenously until day 14 after SAH, 3. perorally until day 21 after SAH.

Summary A 2.4×10-5M solution of the Calcium-antagonist Nimodipine was administered to the exposed cerebral vessels in 17 patients intraoperatively clipping of a ruptured aneurysm. The interval between subarachnoid haemorrhage and operation was 48 to 72 hours. The CT investigation had revealed blood accumulation in the basal cisterns in all cases. Vasodilatation was observed in all instances; the percentage being greater in small vessels as compared to large vessels. Postoperatively, a neurological deficit combined with angiographically verified vasospasm occurred in two patients, but was reversible in both. Fifteen patients remained free from symptomatic vasospasm and were discharged without neurological deficit. In 13 of these patients and 3 additional cases, a plastic cannula was placed intraoperatively so that postoperative topical administration of Nimodipine was possible. Postoperative control-angiograms after a mean interval of 7 days from SAH did not show severe spasm in any of the patients; localised moderate asymptomatic spasm was found in 8 cases and was reserved in 5. Moderate postoperative symptomatic spasm was observed in 2 patients, treated and reversed in one patient. In 5 of 7 cases without evidence of spasm in the angiogram postoperative topical administration of Nimodipine caused vasodilatation. It is concluded, that topical intracisternal administration of Nimodipine reverses intraoperative vascular spasm and decreases the probability of postoperative symptomatic vasospasm after early surgery.