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With regard to the revision of the criminal code, the BJM has suggested two regulations concerning the lawsuit of medical malpractice. The text expounds the contence of section 229 E (wrongful treatment, personal injury) and section 230 E (unwillful negligence). It appears disturbing that constitutes for wrongful treatment in the context of assault upon the patient have been included in criminal law so the offence is now rated at the same level as (grievous) personal injury. The aim of the revision being further protection of personal rights and the right of self-determination. The proposed section 229 E and section 230 E are not able to guard the clinician against allegations of assault under criminal law prosecution. The code of civil law should suffice to balance most conditions of malpractice and assault upon the patient. Prosecution by criminal code should be held back for willful offences and wanton or reckless negligence.

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.

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.

Let me express my sincere appreciation for this honor, whose significance is apparent to me and which moves me deeply. Let me also include in this honor those who have gone with me a part of the way in the realization of our goals as neurosurgeons in Gottingen and in Wurzburg. Two of them, Hans-Jochim Weber and Horst Wenker, team members in the initial phase, are no longer among us.

Till the thirties of our century surgery of brain and spinal cord was done by general surgeons. At that time the activities of Ernst von Bergmann, Fedor Krause and the operative autodidact and Neurologist Otfried Foerster met with great response. These achievements, however, had no influence on the development and dissemination of Neurosurgery in Germany. The revolutionary work of Cushing concerning Neurosurgery had no effect on surgeons either. The results of the operative treatment of intracerebral tumors in Germany continued to be depressing. It's entirely the credit of Fritz König (Würzburg) having caused the decisive change of this situation. He enabled his resident Wilhelm Tönnis to be educated by Herbert Olivecrona in his Department of Neurosurgery in Stockholm. After his return from Sweden the first independent Department of Neurosurgery was founded for Wilhelm Tönnis in Würzburg. Wilhelm Tönnis tried to overcome the still existing opposition against the independence of Neurosurgery by the foundation of an own scientific journal. The "Zentralblatt für Neurochirurgie" was founded in 1936 at the newspaper Publisher Ambrosius Barth, Leipzig. This "Zentralblatt für Neurochirurgie" was the only scientific journal of the world till 1943. The consequences of war stopped its distribution abroad. This was the reason for the foundation of "The Journal of Neurosurgery" in 1944. Corresponding to its tradition the new beginning shall consolidate the scientific bond between all neurosurgeons of the world.

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.

Dieses Thema ist in den letzten Monaten, gemessen an dem Umfang und der Haufigkeit der Eingriffe mit dieser neuen Therapie, uberproportional abgehandelt worden, im Hinblick auf den kurzen Zeitraum der Erfahrung fast schon erschopfend. Ich erinnere hier an die Referate und Diskussionen bei der Jahrestagung der Deutschen Gesellschaft fur Neurochirurgie im Juni 1984 und an die Jahrestagung der Deutschen Gesellschaft fur Orthopadie und Traumatologie im September 1984 in Nurnberg, an zahlreiche ortliche und regionale Veranstaltungen der Anwender und Veroffentlichungen im Deutschen Arzteblatt und in anderen medizinischen Zeitschriften.

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).

High pressure lumbar air insufflation and endoscopical surgical technique and control improve surgical results and widen indications for the transsphenoidal approach to pituitary adenomas. These complementary methods require a sitting position for the patient and an axial approach to the sella turcica. By lumbar high pressure insufflation even very big pituitary adenomas may often be brought into the operation field and make possible a complete extirpation by a transsphenoidal approach. This possibility is increased by an operative technique under endoscopic control, the latter contributing considerably to complete tumour extirpation, especially with endocrine-active tumours.

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.

Angio-tomography is a selective radiological method which can be used to complement serial angiographs in order to demonstrate better detail. This results from the fact that selective levels can be demonstrated without super-imposition of bone or other vessels. Angio-tomography combines the advantages of tomography, subtraction and selective procedures. The method has been used for all types of intracranial disease; aneurysms and angiomas are the most common conditions for which angio-tomography has been employed. The present paper is based on a total of 60 cerebral aneurysms and angiomas in various situations; angiotomography was indicated for these amongst a larger material of intracranial vascular malformations in which the diagnosis was possible without its use. The indications consist of: 1) Demonstration of very small aneurysms and their differentiation from vessel loops, 2) Demonstration of the origin of an aneurysm which is situated at the confluence of several major vessels, 3) Point of origin of a so-called hugeaneurysms which cannot otherwise be shown by oblique views, 4) Demonstration of so-called micro-angiomas and of the afferent and efferent vessels in central arterio-venous malformations. Unusual aneurysms of the internal carotid artery, of the anterior choroidal and vertebral arteries are described. Some new concepts in the localisation of aneurysms of the anterior communicating artery are discussed. Many of the examinations were carried out with an angio-tomographic apparatus made in the department.

Catamneses of children up to the age of 16, operated on spinal tumours, are reported. Spinal tumours of this age account for about 15% of the total (all ages). There are about 50% intradural and 50% extradural tumours. The most frequent extradural tumours are sarcomas, followed by lipomas and dysontogenetic tumours like teratomas. Intradural tumours consist of intramedullary and extramedullary ones, about 50% each. Intramedullary tumours are gliomas, extramedullary ones may be neurinomas, meningeomas and vascular tumours. Time from onset of first diffuse symptoms up to clinical diagnosis depends on growth tendency of the tumour as well as on its localization. Hence, case history in cases of intramedullary gliomas usually covers two years, of sarcomas only a couple of months. In half of the cases, pain was the first symptom, followed by disturbed motor function. In more than 50% of the cases, complete restoration or significant improvement could be achieved by surgery. In the remaining half, there was either no change or even deterioration of the disturbed function. It seems justified to replace the former pessimistic attitude towards therapy of spinal tumours in childhood by a discret optimism. If in addition other spinal diseases like disk herniation are taken into account, prognosis is even more favourable.

Increase of intracranial pressure is an acute danger for the patient's life. Since direct measurement of ICP is used, early identification of dangerous dysfunctions of ICP is possible. Surgical treatment of vascular malformations involves less risks since microsurgical methods and "tailor made" clips have been applied together with controlled hypotension. Transrhinoseptal approach in surgery of hormonally inactive and active adenomas has lowered the lethality rate essentially and improved the functional results. New indication in spinal surgery: Treatment of spinal claudication resulting from a central spinal stenosis, by operative decompression of the spinal canal.

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.