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43 cases of tumor resection followed by ventral stabilisation are reported in 42 patients with metastases in the spine. Indications for surgery were beginning or incomplete transversal lesion of the spinal cord, bedrest for at least 3 weeks, unsusceible pain caused by instability, or unsuccessful conservative and radiotherapeutic treatment. 46.5% of the cases can be rated as good considering the time of survival and life quality, 18.5% can be judged as a partial success. 7 patients hat to be reoperated in the same level, most of them because of local recurrence. Complications occurred in 40% of the cases. These operations should be performed by a "term of specialists". Postoperative treatment with isotope-, hormone- or radiotherapy is decisive to obtain good results.

42 cervical interbody fusions with iliac bone graft and titanium plate fixation were performed between October 1991 and March 1994. The mean follow up period in this study was 10.7 months. In 32 cases fusion was done for 1 and in 10 cases for 2 segments. 2 different types of plates were used. In 25 cases micro-osteosynthesis plates and screws with 2.7 mm diameter were used, and in 17 cases cervical H-plates and screws with 3.5 mm diameter. A favourable outcome was achieved in 31 of 42 cases (74%). Satisfactory pain relief was achieved in 90%. For radicular motor deficit good results were obtained in 84% and for cervical myelopathy in 54%. The 2 different types of plates showed a remarkable difference in the clinical outcome. The results were regarded favourable in 15 of 25 microplate fusions (60%) and in 16 of 17 H-plate fusions (94%). Compression of the bone graft was seen in 5 patients of the micro plate group, however, radiological signs for fusion were present in all 42 cases at follow up. Major surgical complications, damage to neural structures or neurological deterioration did not occur in this study. Plate fixation in cervical interbody fusions seems to be a safe procedure and may reduce graft related complications at the fusion site if the plates and screws are sufficiently well proportioned. A favourable impact upon the results for cervical interbody fusion might be expected and should be further investigated in a long term follow up study.

An intramedullary tumour of the cervical spinal cord, occurring in a female aged 45, was found to be composed of an isomorphous astrocytoma densely intermingled with desmoid tumour tissue.

In patients with carcinoma, resection of one or more adjacent destroyed vertebral bodies is indicated in selected cases to preserve or restore walking. Stabilization of the spine with bone cement and metal plating ensures early mobilization, which is desirable in patients with limited survival. In the upper thoracic spine the location and number of the destroyed vertebral bodies will dictate the operative approach. Anatomical studies in cadavers showed median sternotomy and high posterolateral thoracotomy to be equally unsuited as access for plating, if both the second and third thoracic vertebrae are destroyed.

Unter Berucksichtigung der Nachuntersuchungsergebnisse bei 21 Fallen wird uber Indikation und Ergebnisse der gekreuzten Anastomose zwischen dem Nervus facialis und dem Nervus accessorius bzw. Nervus hypoglossus bei Lasion des Nervus facialis nach Exstirpation eines Kleinhirnbruckenwinkeltumors berichtet. Der Bericht stutzt sich auf Erfahrungen, die an Hand von 31 Operationen gesammelt werden konnten. Auf Grund der Nachuntersuchungen kann keinem der zur gekreuzten Anastomose verwendeten Nerven ein besseres Operationsergebnis zugeschrieben werden.

In 40 postmortem specimens the cervical posterior roots were examined under the surgical microscope, and intradural communicating fibres between neighbouring segments were demonstrated. The implications of these frequent variants for the diagnosis of prolapsed cervical discs are discussed.

The paper is concerned with the investigation of 51 patients with alterations of cervical intervertebral disks and cervical osteochondrosis who have undergone surgical intervention. The examination included a psychiatric interview as well as the application of paper pencil tests. Seventeen patients indicated symptoms of an endogenous depression. The group of depressed patients offered a significantly slow onset of cervical symptoms and, in the period after the operation, complained more often than the group without depressive symptoms. The psychological test revealed an increased tendency for inhibition and anxiety of the depressed group. Lastly, methodical problems are discussed concerning the evaluation of the lapse of psychic conditions as tension over a long period.

Es wird eine neue Operationsmethode zur chirurgischen Behandlung der Karotis-Kavernosus-Fisteln beschrieben. Mittels eines Fogarty-Katheters wurde die A. carotis interna in Hohe der Fistel verschlossen. Die Vorteile dieser Methode gegenuber den bisher angewendeten operativen Verfahren werden diskutiert.

The ganglioside concentrations and the ganglioside patterns were investigated in 18 meningiomas of different histological type and in the meninges. The ganglioside concentration in the meningiomas ranged from 0.16 to 1.63 mg ganglioside N-acetylneuraminic acid per gram dry weight (mean 0.68 mg/g). The gangliosides GM3, GD3 and GD1a were found to be the major ganglioside fractions of the meningiomas. In the endotheliomatous meningiomas, on teh average, the percentage of GM3 was higher, and the percentage of GD3 lower than in the endotheliomatous-fibromatous tumours. However, none of the individual ganglioside patterns observed seemed to be specific of a certain histological type.

Bei einem 13 jahrigen Knaben mit 4 monatiger Krankheitsdauer fand sich ein groser, von der Pinealisregion ausgehender, maligner Tumor, der histologisch als embryonales Carcinom mit einfachen epithelialen (adenocarcinomatosen und acinaren) Differenzierungsformen, Endodermalsinus und germinom-(seminom-)artigen Anteilen imponierte. Diese Beobachtung bestatigt 1. die engen strukturellen Beziehungen zwischen embryonalem Carcinom, malignem Teratom und Germinom (Seminom) sowie 2. die Annahme einer morphologischen und histogenetischen Verwandtschaft der Stammzellgeschwulste des ZNS und der Gonaden. Fur beide Tumorgruppen wird die gleiche Nomenklatur vorgeschlagen.

Die Autoren berichten uber die kommissurale Myelotomie, die bei 9 Patienten mit heftigen beidseitigen Schmerzen im Unterbauch bzw. im Perineum und bei 1 Patienten mit Schmerzen in beiden unteren Extremitaten durchgefuhrt wurde.Die Vorteile des Operations-mikroskops und des bipolaren Koagulators werden hervorgehoben. Es werden die Vor- und Nachteile der Myelotomie und der beidseitigen Chordotomie diskutiert. Um das Ausmas der Kommissurotomie noch wahrend der Operation festzustellen, wird die reizsynchrone Computer-Analyse des EEGs vorgeschlagen, mit der die Perzeption eines zentripetalen Signales objektiv nachgewiesen werden kann.

Anhand von 101 wegen eines Akustikusneurinoms operierten Patienten werden die Vorteile der Seitenlagerung der Patienten auf dem Operationstisch gegenuber der Bauchlage und der sitzenden Position hervorgehoben. Auf Grund des besseren Einblickes in das Operationsgebiet konnte in der Mehrzahl der in Seitenlage operierten Falle die Totalexstirpation des Tumors durchgefuhrt werden.

1. Es wurde eine Methode zur Beobachtung oberflachlicher Hirngefase bei annahernd physiologischen Verhaltnissen beschrieben. 2. Um eine gleichbleibende Ausgangslage bei jedem Versuch sicherzustellen, wurden die Ventilationsversuche blutgasanalytisch gepruft und mittels blutiger Blutdruckmessung die Uberwachung und notwendige Korrektur des Blutdruckes sichergestellt. 3. An den kortikalen Hirngefasen wurden Lumenveranderungen bei Anwendung von Narkotika (Halothan) und bei Ventilationsunterschieden beobachtet. 4. Auf theoretische Einwande bezuglich der angewandten Methode wurde eingegangen. 5. Das Verfahren stellt, soweit bisher beurteilbar, eine Methode dar, welche die Beurteilung des Einflusses von Narkotika auf die Hirnzirkulation ermoglicht. In weiteren Versuchen soll die Wirkung anderer Narkotika vergleichend gepruft werden.

An Hand eines Beobachtungsgutes von sieben Patienten, bei denen eine zerebrale Perfusion zur chemotherapeutischen Behandlung des Glioblastoma multiforme durchgefuhrt worden war, werden die Probleme einer isolierten Perfusion einer Groshirnhemisphare diskutiert.

Among the potential complications following shunting procedures in hydrocephalic patients, those due to dynamic and hydraulic propterites of the system used are of major importance. Clinically, an excessive reduction in intraventricular pressure undoubtedly constitutes a significant problem. Table 1 shows those side effects and complications which we found to be most common.

43 cases of tumor resection followed by ventral stabilisation are reported in 42 patients with metastases in the spine. Indications for surgery were beginning or incomplete transversal lesion of the spinal cord, bedrest for at least 3 weeks, unsusceible pain caused by instability, or unsuccessful conservative and radiotherapeutic treatment. 46.5% of the cases can be rated as good considering the time of survival and life quality, 18.5% can be judged as a partial success. 7 patients hat to be reoperated in the same level, most of them because of local recurrence. Complications occurred in 40% of the cases. These operations should be performed by a "term of specialists". Postoperative treatment with isotope-, hormone- or radiotherapy is decisive to obtain good results.

Unter der Bezeichnung Spatoperationen sind jene operativen Eingriffe zu verstehen, die einerseits unmittelbar nach dem Unfall hatten durchgefuhrt werden sollen und andererseits aufgrund einer klinisch-neurologischen Verschlechterung erst zu einem spateren Zeitpunkt indiziert werden musten. Demzufolge rekrutiert sich das hier vorgestellte Krankengut aus 8 Patienten, bei denen der unmittelbar nach dem Unfall erhobenen neurologische Status einen Soforteingriff erfordert hatte und aus 2 Patienten, bei denen sich erst wahrend des Krankheitsverlaufes neurologische Ausfallssymptome bzw. konservativ therapieresistente Schmerzen entwickelten. Im folgenden sollen die Indikationen zur Spatoperation und ihre Ergebnisse aufgezeigt und beurteilt werden.

The surgical treatment of phantom limb pain is a problem which has not been solved so far. On account of the special pathophysiology of this phenomenon, most authors (1, 4, 5, 7, 8) disapprove of a surgical treatment of phantom limb pain. This opinion, however, is opposed by publications of some other authors (3, 6, 9). As we observed surprisingly good results after cordotomy in some of our patients suffering from phantom limb pain, we decided to check the effectiveness of anterolateral cordotomy in so far as it influences phantom limb pain.

The paper is concerned with the investigation of 51 patients with alterations of cervical intervertebral disks and cervical osteochondrosis who have undergone surgical intervention. The examination included a psychiatric interview as well as the application of paper pencil tests. Seventeen patients indicated symptoms of an endogenous depression. The group of depressed patients offered a significantly slow onset of cervical symptoms and, in the period after the operation, complained more often than the group without depressive symptoms. The psychological test revealed an increased tendency of inhibition and anxiety of the depressed group. Lastly, methodical problems are discussed concerning the evaluation of the lapse of psychic conduction as tension over a long period.

Following the diagnosis of an internal hydrocephalus in a child, parents and doctors alike are primarily concerned about the future development of the little patient. It is for this reason that we have investigated a number of factors that might be of assistance in obtaining the above information.

In patients with carcinoma, resection of one or more adjacent destroyed vertebral bodies is indicated in selected cases to preserve or restore walking. Stabilization of the spine with bone cement and metal plating ensures early mobilization, which is desirable in patients with limited survival. In the upper thoracic spine the location and number of the destroyed vertebral bodies will dictate the operative approach. Anatomical studies in cadavers showed median sternotomy and high posterolateral thoracotomy to be equally unsuited as access for plating, if both the second and third thoracic vertebrae are destroyed.

Herein we report on 39 patients, who were treated with the upper cervical cordotomy (C1/C2), because of intractable pain of the shoulder and arm region. 30 patients suffered from malignant tumors, 9 had a benign lesion. A simultaneous cordotomy and rhizotomy was performed in 9 tumor patients and in 2 patients with a benign lesion. The upper cervical cordotomy proofed successful in the treatment of pain of cancer bearing patients. However, our results demonstrated that the combination of cordotomy and rhizotomy did not provide further advantage than the cordotomy alone.

The problems of the spontaneous fusion after cervical discectomy were studied in 12 patients. An examination after the operation showed an improvement of the neurological-radicular symptoms, but 75% of the patients complained about severe pains in the area of neck and shoulders. The cause of these complaints was found by radiological examination to be an angular kyphosis of the cervical spine combined with the subluxation of the intervertebral joints in the operated segment. The mechanical results of the ventral fusion without using interponates are being experimentally reproduced and evaluated. By comparing both methods, the method using interponates showed better results. Therefore, the discectomy with fusion using interponates should be preferred.

Both in published series (1–8) and in our own material the surgical management of cervical spondylogenous myelopathies has been found to be rather disappointing, since it has no effect other than halting the progression of neurologic deficits in most of the cases. This prompted us to conduct a follow-up study, the purpose being to shed light on those factors which might improve postoperative results.

In view of the observation of tonic-clonic convulsions after the use of Propanidid in certan patients, a study was undertaken of the effects of this drug (7 mg/kg) on the EEG of 2 volunteers with a known history of epilepsy. Both subjects developed tonic-clonic convulsions and showed typical alterations of the EEG pattern even before the onset of hyperventilation. These EEG alterations were producible also during complete relaxation. The convulsions were easily stopped by the administration of short-acting barbiturates. Similar observations reported in the literature are briefly discussed. The conclusion is drawn that Propanidid should not be given to patients with a known history of epilepsy or any other convulsive disease.

In 1972, MAMO and HOUDART described radio-isotopic cisternography as being superior to conventional neuroradiological techniques in diagnosing cerebellopontine angle tumors down to a diameter of 1 cm. But the authors left aside the results obtained with the STENVERS’ technique and with cisternography using positive radiopaque substances, when assessing the merits of the isotope procedure.