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3 1/2 years after two operations and radiation therapy of a biparietally, parasagittaly localised grade III oligoastrocytoma, a 34-year-old patient developed symptoms of the spinal cord. By performing magnetic resonance tomography and laminectomy, multiple metastases of the anaplastic part of the primary tumour could be identified. Spinal seedings of a tumour of this grading are even rarer than those sporadically reported on corresponding complications of a multiform glioblastoma. Risk factors for the development of such a complication are youth of the patient, primary site of the tumour near the midline and anaplastic parts of the tumour in adults. If such a constellation exists, one should definitely consider the possibility of a spinal seeding in a grade III glioma, especially because in these younger patients thus would be of greater relevance for therapy than in patients with multiform glioblastoma.

3 1/2 years after two operations and radiation therapy of a biparietally, parasagittaly localised grade III oligoastrocytoma, a 34-year-old patient developed symptoms of the spinal cord. By performing magnetic resonance tomography and laminectomy, multiple metastases of the anaplastic part of the primary tumour could be identified. Spinal seedings of a tumour of this grading are even rarer than those sporadically reported on corresponding complications of a multiform glioblastoma. Risk factors for the development of such a complication are youth of the patient, primary site of the tumour near the midline and anaplastic parts of the tumour in adults. If such a constellation exists, one should definitely consider the possibility of a spinal seeding in a grade III glioma, especially because in these younger patients thus would be of greater relevance for therapy than in patients with multiform glioblastoma.

Based on Cooper's good results implantation of a bilateral cerebellar stimulator was performed in 2 children with cerebral palsy. The patients suffered from marked hypertonia of all limbs and involuntary movements. The follow-up study of 8 months revealed a decrease of spasticity and a progressive improvement of fine motor control. Our preliminary results justify the clinical application of cerebellar stimulation for functional treatment of sensory-motor disorders.

Bei der infantilen Zerebralparese dominieren Spastik, Athetose und Ataxie als Ausdruck einer persistierenden Schadigung des pyramidalen und extrapyramidalmotorischen Systems. In besonders schweren Fallen hypertoner Bewegungsstorungen, die durch spezielle Krankengymnastik und orthopadische Masnahmen nicht gebessert werden konnen, wird der Neurochirurg mit der Behandlung konfrontiert.

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.

A technique is described (myotonography) for recording the centrally determined disturbances of muscle tone, whereby the mechanical and electro-myographic changes in the affected muscle groups are accessible to objective and quantitative study. The efficacity and reliability of the method are given and the clinically distinguishable forms of central disturbances of tonus are shown in typical tracings. These are of particular value for assessing the progress of an illness and the results of treatment. In addition it facilitates the interpretation of the patho-physiological processes. The apparatus is so constructed that in the same way as in a clinical examination, a passive extension and flexion of the elbow joint is reproduced over a range of about 100 degrees. In this way it is possible to record the stretch resistance of the extremities as well as the superficial electromyogram of the flexors and extensors.

66 patients with gunshot wounds were treated at the Department of Neurosurgery of Hanover University up to May 1982. These included wounds inflicted by bolt guns of the type used in slaughter houses, and by bolt-setting or nail-setting tools used in building construction work. The total mortality was 50%. Seventeen patients died directly after admission or within the first 24 hours. Operation was not indicated in cases which appeared hopeless. In patients with mild neurological deficits, only the superficial skin wounds were treated to avoid additional damage to the brain. CT scans performed in approximately one-half of the patients yielded valuable information on the path of the bullet and on haematomas. Postoperatively, there were several complications, mainly pneumonia and cerebrospinal fluid fistulas; in fact, pneumonia was responsible for the death of some patients. The mortality is compared with the findings by other authors. No patients remained in need of care after rehabilitation.

Based on Cooper's good results implantation of a bilateral cerebellar stimulator was performed in 2 children with cerebral palsy. The patients suffered from marked hypertonia of all limbs and involuntary movements. The follow-up study of 8 months revealed a decrease of spasticity and a progressive improvement of fine motor control. Our preliminary results justify the clinical application of cerebellar stimulation for functional treatment of sensory-motor disorders.

The experimentally well established protective effect of barbiturate anaesthesia in cerebral ischaemia and increased intracranial pressure (ICP) has been assumed to be primarily a consequence of the reduction in cerebral metabolic rate. We present the results of studies of the influence of pentobarbitone on the stability of lysosomal membranes in the grey and white matter of the cat brain. To indicate the grade of stability of share of free activity of the lysosomal enzyme beta-glucuronidase was assayed. Animals pretreated by pentobarbitone showed a significant decrease of the share of free activity in the white matter. This indicates an increase in lysosomal membrane stability. Increased lysosomal membrane stability is regarded as a protective effect of pentobarbitone against brain ischaemia and severe head injury.

The most common factors predisposing to the compression of the ulnar nerve at the elbow are fractures, arthrosis, abnormal strain of the elbow joint and recurrent dislocation or subluxation of the ulnar nerve from its groove of the humeral epicondyle (5, 7, 8). These disorders may result in a dysfunction termed “tardy ulnar palsy”. Fifty-one patients were treated for tardy ulnar palsy by anterior transposition at the Medical School of Hannover from 1971 to 1978. Thirty-one patients were followed from 4 months to 7 years. Particular attention was devoted to the age, sex, duration of symptoms, preoperative deficits, surgical findings, etiology, and EMG-findings. We classified our patients into a group of complete recovery, good improvement (= relief of pain, distinct improvement of motor and sensory function) and another group of no changes except relief of pain. There were no operative complications, no deteriorations.

In patients with benign intraspinal-extramedullary tumors the outcome is favorable, even when there is a severe neurological deficit pre-operatively. The question arises if old patients have the same good prognosis, although it often takes a long time to make a diagnosis. Other degenerative lesions may influence the typical clinical signs. Severe functional deficits are induced by the long-lasting compression of the spinal cord and recovery depends on the process of regeneration.

Spasticity, athetosis, and ataxia are the most frequent symptoms of persisting pyramidal and extrapyramidal lesions in cerebral palsy. The hypertonic movement disorders may be lessened by early physiotherapy or orthopedic interventions. In the majority of patients, motor ability worsens during puberty so that, in severe cases, no alternative but neurosurgical treatment exists.

31 patients with craniocerebral gunshot wounds were examined in the acute phase and 14 out of 22 survivors followed up for a period of up to 3 years. The clinical and CT findings as well as treatment measures are explained. The value of CT is convincingly demonstrated with this type of injury, as with others, but its prognostic value including prediction of follow-up results remains limited.