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Grauvogel J, Scheiwe C, Masalha W, Grauvogel T, Kaminsky J, Vasilikos I. Piezosurgery-, neuroendoscopy-, and neuronavigation-assisted intracranial approach for removal of a recurrent petrous apex cholesteatoma: technical note. J Neurosurg Pediatr 2018; 21:322-328. [PMID: 29271730 DOI: 10.3171/2017.8.peds17327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current approaches for resection of petrous bone cholesteatomas (PBCs), such as canal wall up (closed) and canal wall down (open) mastoidectomies, in the pediatric population present recurrence rates ranging between 17% and 70% with a high rate of postoperative complications involving hearing loss and facial nerve weakness. This technical note illustrates an alternative intracranial approach that was used in combination with the techniques of piezoelectric surgery, neuroendoscopy, and neuronavigation for safe and effective removal in a difficult pediatric case of recurrent PBC. The third recurrence of a PBC in a 14-year-old girl was diagnosed by CT and MRI. A retrosigmoid approach gave access to the petrous apex, allowing for the safe and complete removal of the lesion and decompression of the facial nerve and internal carotid artery. The intraoperative implementation of piezoelectric surgery, neuronavigation, neuroendoscopy, and neuromonitoring ensured better intraoperative visualization, safer bone removal, and preservation of nerve function, facilitating a macroscopically total resection of the pathology without additional neurological damage of the adjacent tissues. Cholesteatoma extension could be clearly verified by intraoperative neuronavigation. Neuroendoscopy and piezoelectric surgery provided good support in the safe bone removal in close vicinity to neurovascular structures and in full vision inside the cholesteatoma cavity beyond the line of sight of the microscope. Hearing and facial nerve function could be preserved. The presented intracranial retrosigmoid approach combined with multiple intraoperative assisting techniques proved to be effective for the safe and complete removal of recurrent PBC, providing excellent intraoperative visualization and the possibility of preserving cranial nerve function.
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Affiliation(s)
| | | | | | - Tanja Grauvogel
- 2Otorhinolaryngology-Head and Neck Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; and
| | - Jan Kaminsky
- 3Department of Neurosurgery, St. Gertrauden Hospital, Berlin, Germany
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Wang X, Gkogkidis CA, Iljina O, Fiederer LDJ, Henle C, Mader I, Kaminsky J, Stieglitz T, Gierthmuehlen M, Ball T. Mapping the fine structure of cortical activity with different micro-ECoG electrode array geometries. J Neural Eng 2017; 14:056004. [DOI: 10.1088/1741-2552/aa785e] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cinibulak Z, Aschoff A, Apedjinou A, Kaminsky J, Trost HA, Krauss JK. Current practice of external ventricular drainage: a survey among neurosurgical departments in Germany. Acta Neurochir (Wien) 2016; 158:847-53. [PMID: 26928728 DOI: 10.1007/s00701-016-2747-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/16/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are various recommendations, but no generally accepted guidelines, to reduce the risk of external ventricular drainage (EVD)-associated infections. The primary objective of the present study was to evaluate the current practice of EVD in a European country and to set the results in perspective to published data. METHOD A standardised questionnaire prepared by the Commission of Technical Standards and Norms of the German Society of Neurosurgery was sent to 127 neurosurgical units in Germany. RESULTS Data were analysed from 99 out of 127 neurosurgical units which had been contacted. Overall, more than 10,000 EVD procedures appear to be performed in Germany annually. There is disagreement about the location where the EVD is inserted, and most EVDs are still inserted in the operation theatre. Most units apply subcutaneous tunnelling. Impregnated EVD catheters are used regularly in only about 20 % of units. Single-shot antibiotic prophylaxis is given in more than half of the units, while continued antibiotic prophylaxis is installed in only 15/99 units at a regular basis. There are discrepancies in the management of prolonged EVD use with regard to replacement policies. Regular cerebrospinal fluid (CSF) sampling is still performed widely. There were no statistical differences in policies with regard to academic versus non-academic units. CONCLUSIONS This survey clearly shows that some newer recommendations drawn from published studies penetrate much slower into clinical routine, such as the use of impregnated catheters, for example. It remains unclear how different policies actually impact quality and outcome in daily routine.
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Affiliation(s)
- Zafer Cinibulak
- Department of Neurosurgery, Medical School Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
- Commission of Technical Standards and Norms, German Society of Neurosurgery, Messe-Allee 1, 04356, Leipzig, Germany.
| | - Alfred Aschoff
- Commission of Technical Standards and Norms, German Society of Neurosurgery, Messe-Allee 1, 04356, Leipzig, Germany
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Anani Apedjinou
- Department of Neurosurgery, Medical School Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Jan Kaminsky
- Commission of Technical Standards and Norms, German Society of Neurosurgery, Messe-Allee 1, 04356, Leipzig, Germany
- Department of Neurosurgery, Sankt Gertrauden Hospital, Berlin, Germany
| | - Hans A Trost
- Commission of Technical Standards and Norms, German Society of Neurosurgery, Messe-Allee 1, 04356, Leipzig, Germany
- Department of Neurosurgery, Bayreuth Hospital, Bayreuth, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Germany
- Commission of Technical Standards and Norms, German Society of Neurosurgery, Messe-Allee 1, 04356, Leipzig, Germany
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Sievert KD, Amend B, Roser F, Badke A, Toomey P, Baron C, Kaminsky J, Stenzl A, Tatagiba M. Challenges for Restoration of Lower Urinary Tract Innervation in Patients with Spinal Cord Injury: A European Single-center Retrospective Study with Long-term Follow-up. Eur Urol 2015; 69:771-4. [PMID: 26651989 DOI: 10.1016/j.eururo.2015.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022]
Abstract
UNLABELLED Xiao and colleagues in China reported successful restoration of bladder control in patients with spinal cord injury (SCI) by establishing a somatic-autonomic reflex pathway through lumbar-to-sacral ventral root nerve rerouting. We evaluated long-term results in eight patients who underwent this procedure at a German university clinic between 2005 and 2007. The primary outcome was the occurrence of voiding upon stimulation of the skin, with normalization of bladder pressure when filling, as assessed with videourodynamics at each visit. Videourodynamic variables, urinary tract infections, and bladder/stool events recorded in a patient diary were stored in a prospective database and reviewed retrospectively. Intraoperative testing indicated successful nerve rerouting in all eight patients. Duration of follow-up was 71 mo (range: 56-86). No patient reached the primary goal of voluntary voiding with normalization of detrusor pressure at any point during follow-up. No improvements in videourodynamic or diary variables regarding bladder function were observed. In view of the lack of short (12-18 mo) and long-term (71 mo) success in our patients and others, the risks of any surgical procedure using general anesthesia, and potential for unmet expectations to wreak havoc on patient emotional well-being, we cannot recommend this procedure for patients with SCI. PATIENT SUMMARY Although the hope was to improve long-term outcomes of spinal cord injury patients, intraspinal nerve rerouting did not improve or normalize bladder function. In view of the lack of success, we cannot recommend this procedure until proven in clinical studies.
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Affiliation(s)
- Karl-Dietrich Sievert
- Department of Urology, University of Tubingen, Tubingen, Germany; Department of Urology and Andrology, SALK University Clinic/Paracelsus Medical University (PMU), Salzburg, Austria.
| | - Bastian Amend
- Department of Urology, University of Tubingen, Tubingen, Germany
| | - Florian Roser
- Department of Neurosurgery, University of Tubingen, Tubingen, Germany
| | - Andreas Badke
- Spinal Cord Unit, BG Trauma Center, Tubingen, Germany
| | - Patricia Toomey
- Department of Urology, University of Tubingen, Tubingen, Germany
| | | | - Jan Kaminsky
- Department of Neurosurgery, Sankt Gertrauden-Krankenhaus, Berlin, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tubingen, Tubingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tubingen, Tubingen, Germany
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Ridder GJ, Breunig C, Kaminsky J, Pfeiffer J. Central skull base osteomyelitis: new insights and implications for diagnosis and treatment. Eur Arch Otorhinolaryngol 2014; 272:1269-76. [DOI: 10.1007/s00405-014-3390-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
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Grauvogel J, Scheiwe C, Kaminsky J. Use of Piezosurgery for removal of retrovertebral body osteophytes in anterior cervical discectomy. Spine J 2014; 14:628-36. [PMID: 24314765 DOI: 10.1016/j.spinee.2013.06.085] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/30/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The relatively new technique of Piezosurgery is based on microvibrations, generated by the piezoelectrical effect, which results in selective bone cutting with preservation of adjacent soft tissue. PURPOSE To study the applicability of Piezosurgery in anterior cervical discectomy with fusion (ACDF) surgery. STUDY DESIGN/SETTING Prospective clinical study at the neurosurgical department of the University of Freiburg, Germany. PATIENT SAMPLE Nine patients with cervical disc herniation and retrovertebral osteophytes who underwent ACDF surgery. OUTCOME MEASURES Piezosurgery was evaluated with respect to practicability, safety, preciseness of bone cutting, and preservation of adjacent neurovascular tissue. Pre- and postoperative clinical and radiological data were assessed. METHODS Piezosurgery was supportively used in ACDF in nine patients with either radiculopathy or myelopathy from disc herniation or ventral osteophytes. After discectomy, osteophytes were removed with Piezosurgery to decompress the spinal canal and the foramina. Angled inserts were used, allowing for cutting even retrovertebral osteophytes. RESULTS In all nine cases, Piezosurgery cut bone selectively with no damage to nerve roots, dura, or posterior longitudinal ligament. None of the patients experienced any new neurological deficit after the operation. The handling of the instrument was safe and the cut precise. Osteophytic spurs, even retrovertebral ones that generally only can be approached via corpectomies, could be safely removed because of the angled inserts through the disc space. Currently, a slightly prolonged operation time was observed for Piezosurgery. Furthermore, the design of the handpiece could be further improved to facilitate the intraoperative handling in ACDF. CONCLUSIONS Piezosurgery proved to be a useful and safe technique for selective bone cutting and removal of osteophytes with preservation of neuronal and soft tissue in ACDF. In particular, the angled inserts were effective in cutting bone spurs behind the adjacent vertebra which cannot be reached with conventional rotating burs.
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Affiliation(s)
- Juergen Grauvogel
- Department of Neurosurgery, Albert-Ludwigs-University, Breisacherstr. 64, 79106 Freiburg, Germany.
| | - Christian Scheiwe
- Department of Neurosurgery, Albert-Ludwigs-University, Breisacherstr. 64, 79106 Freiburg, Germany
| | - Jan Kaminsky
- Department of Neurosurgery, Sankt Gertrauden Hospital, Paretzer Straße 12, 10713 Berlin, Germany
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Grauvogel J, Grauvogel TD, Kaminsky J. Piezosurgical lateral suboccipital craniectomy and opening of the internal auditory canal in the rat. J Neurosurg Sci 2014; 58:17-22. [PMID: 24614788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Rotating burs (RB), routinely used in skull base and cerebellopontine angle (CPA) surgery for craniotomy and opening of the internal auditory canal (IAC) carry some risks for neurovascular tissue due to their rotating power. This paper describes the use of piezosurgery (PS), which selectively cuts bone with preservation of soft tissue, in lateral suboccipital craniectomy and opening of the IAC in the rat. METHODS A lateral suboccipital craniectomy and opening of the bony IAC were performed with the Mectron® piezosurgical device under microsurgical conditions in the anesthezised rat. The piezosurgical device was evaluated with respect to practicability, safety, preciseness of craniectomy and IAC opening, and preservation of adjacent neurovascular tissue. The operation procedure is described in detail. RESULTS The present work shows that PS allows easy, safe and precise bone cutting with no injury to neurovascular tissue, such as dura, transverse or sigmoid sinus, brain, and cranial nerves. No complications were noted during the procedure. Due to the absence of rotating power near neurovascular structures the drilling process was easy and comfortable for the surgeon. CONCLUSION PS proved to be a safe, precise and easy to handle tool to perform suboccipital craniectomy and opening of IAC in the rat. Since PS makes the drilling process safer and more comfortable compared to a rotating bur it may be used instead of rotating burs in all scientific applications in animal models where a safe removal of bone near delicate nervous or soft tissue structures is essential.
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Affiliation(s)
- J Grauvogel
- Department of Neurosurgery Albert Ludwigs University, Freiburg, Germany -
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Kaminsky J, Bienert-Zeit A, Hellige M, Ohnesorge B. 3 Tesla magnetic resonance imaging of the nasal cavities, paranasal sinuses and adjacent anatomical structures in 13 healthy horses. PFERDEHEILKUNDE 2014. [DOI: 10.21836/pem20140407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gierthmuehlen M, Freiman TM, Haastert-Talini K, Mueller A, Kaminsky J, Stieglitz T, Plachta DTT. Computational tissue volume reconstruction of a peripheral nerve using high-resolution light-microscopy and reconstruct. PLoS One 2013; 8:e66191. [PMID: 23785485 PMCID: PMC3681936 DOI: 10.1371/journal.pone.0066191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 05/07/2013] [Indexed: 11/18/2022] Open
Abstract
The development of neural cuff-electrodes requires several in vivo studies and revisions of the electrode design before the electrode is completely adapted to its target nerve. It is therefore favorable to simulate many of the steps involved in this process to reduce costs and animal testing. As the restoration of motor function is one of the most interesting applications of cuff-electrodes, the position and trajectories of myelinated fibers in the simulated nerve are important. In this paper, we investigate a method for building a precise neuroanatomical model of myelinated fibers in a peripheral nerve based on images obtained using high-resolution light microscopy. This anatomical model describes the first aim of our "Virtual workbench" project to establish a method for creating realistic neural simulation models based on image datasets. The imaging, processing, segmentation and technical limitations are described, and the steps involved in the transition into a simulation model are presented. The results showed that the position and trajectories of the myelinated axons were traced and virtualized using our technique, and small nerves could be reliably modeled based on of light microscopy images using low-cost OpenSource software and standard hardware. The anatomical model will be released to the scientific community.
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Grauvogel J, Scheiwe C, Kaminsky J. Use of piezosurgery for internal auditory canal drilling in acoustic neuroma surgery. Acta Neurochir (Wien) 2011; 153:1941-7; discussion 1947. [PMID: 21792697 DOI: 10.1007/s00701-011-1092-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 07/14/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Piezosurgery is based on microvibrations generated by the piezoelectrical effect and has a selective bone-cutting ability with preservation of soft tissue. This study examined the applicability of Piezosurgery compared to rotating drills (RD) for internal auditory canal (IAC) opening in acoustic neuroma (AN) surgery. MATERIALS AND METHODS Piezosurgery was used in eight patients for IAC drilling in AN surgery. After exposition of the IAC and tumor, the posterior wall of the IAC was drilled using Piezosurgery instead of RD. Piezosurgery was evaluated with respect to practicability, safety, preciseness of bone cutting, preservation of cranial nerves, influences on neurophysiological monitoring, and facial nerve and hearing outcome. RESULTS Piezosurgery was successfully used for selective bone cutting, while cranial nerves were structurally and functionally preserved, which could be measured by means of neuromonitoring. Piezosurgery guaranteed a safe and precise cut by removing bone layer by layer in a shaping way. Compared to RD, limited influence on neurophysiological monitoring attributable to Piezosurgery was noted, allowing for continuous neuromonitoring. No disadvantage due to microvibrations was noticed concerning hearing function. The angled tip showed better handling in right-sided than in left-sided tumors in the hands of a right-handed surgeon. The short, thick handpiece may be improved for more convenient handling. CONCLUSION Piezosurgery is a safe tool for selective bone cutting for opening of the IAC with preservation of facial nerve and hearing function in AN surgery. Piezosurgery has the potential to replace RD for this indication because of its safe and precise bone-cutting properties.
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Affiliation(s)
- Juergen Grauvogel
- Department of Neurosurgery, Albert Ludwig University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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Gierthmuehlen M, Ball T, Henle C, Wang X, Rickert J, Raab M, Freiman T, Stieglitz T, Kaminsky J. Evaluation of μECoG electrode arrays in the minipig: experimental procedure and neurosurgical approach. J Neurosci Methods 2011; 202:77-86. [PMID: 21896285 DOI: 10.1016/j.jneumeth.2011.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 08/10/2011] [Accepted: 08/12/2011] [Indexed: 11/20/2022]
Abstract
Emerging research on brain-machine interfaces (BMIs) requires the development of animal models for testing implantable BMI electrodes. New models are necessary in order to characterize and test newly constructed electrodes in an acute environment, and their properties and performance need to be evaluated in long-term, chronic implantations. Owing to their availability, small size and neuroanatomical similarity to the human brain, minipigs are frequently used for neurological studies. Despite this fact, there are still no standardized experimental and neurosurgical procedures available for recording of cortical potentials using implantable BMI electrodes in minipigs, and, until now, it was unclear whether these animals could also be used for long-term subdural electrode implantations. We have therefore evaluated the potential use of minipigs for acute and chronic implantation of micro-electrocorticogram (μECoG) electrodes we newly developed for BMI applications and we present a standardized neurosurgical approach to the minipig's cerebral cortex. A neurophysiological setup is described which is suitable to perform recordings of somatosensory evoked potentials (SEPs) with high spatial resolution - down to approx. 1-mm inter-electrode distance. Perioperative management, anesthesia and anatomical landmarks for electrode placement are discussed and common surgical pitfalls are described. While, due to their specific cranial anatomy, minipigs appear not optimally suited for chronic subdural implantations, the findings of the present study indicate that μECoG recording from the minipig cortex is a valuable new approach for acute in vivo characterization of subdural BMI electrode function.
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Affiliation(s)
- Mortimer Gierthmuehlen
- Department of Neurosurgery, Breisacher Strasse 64, University of Freiburg, D-79106 Freiburg, Germany.
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Abstract
Tumors of the posterior orbit require different therapeutic modalities, depending on the histological entity. In the orbit all structures are in close relationship and the endocranium is in the direct proximity. This requires profound knowledge of topographic anatomy and high therapeutic precision. The surgical approach to the posterior orbit via a ventral intraorbital approach is strongly restricted due to the ocular bulb which consumes most space in the anterior orbit. Therefore if the bulb and vision are to be retained extraorbital surgical corridors are predominantly preferred. These are classified into extracranial and intracranial approaches. In detail, the former are medial transethmoidal orbitotomy, caudal transmaxillar orbitotomy and lateral orbitotomy. Frontolateral and frontotemporal orbitotomy as well as frontal, bifrontal and subfrontal orbitotomy are intracranial approaches. Apart from surgical methods there are several forms of radiotherapy which can be applied to orbital tumors under certain indications. Radiotherapy may be performed with external fractionated photon radiation or as stereotactic radiation, with heavy ions or protons or as brachytherapy. In this article various therapeutic interventions to the posterior orbit and the indications and potential side-effects are described.
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Affiliation(s)
- W Maier
- Universitätsklinik für Hals-, Nasen-, Ohrenheilkunde, Plastische Operationen, Killianstrasse 5, Freiburg, Germany.
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Grauvogel J, Kaminsky J, Rosahl SK. The impact of tinnitus and vertigo on patient-perceived quality of life after cerebellopontine angle surgery. Neurosurgery 2011; 67:601-9; discussion 609-10. [PMID: 20647966 DOI: 10.1227/01.neu.0000374725.19259.ea] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quality of life (QOL) has come into focus after treatment for cerebellopontine angle (CPA) lesions. OBJECTIVE This study compared subjective (tinnitus, vertigo) and objective (hearing loss, facial palsy) results of CPA surgery with patient-perceived impairment of QOL. METHODS A retrospective analysis of a consecutive series of 48 patients operated on for either a vestibular schwannoma or a meningioma in the CPA was performed. Patient's subjective impairment of QOL by tinnitus, vertigo, hearing loss, and facial nerve palsy was assessed by a visual analog scale (VAS). Objective facial nerve and hearing function were determined using House-Brackmann and Gardner-Robertson classification systems, respectively. RESULTS The return rate of questionnaires was 64.4%, with mean follow-up time of 417.2 (+/- 46.4) days. Mean preoperative tinnitus score was 2.5 (+/- 0.5) and increased to 4.6 (+/- 0.7) postoperatively (P < .01). The vertigo score increased from 2.0 (+/- 0.3) to 5.8 (+/- 0.6) (P < .001). Pre- and postoperative values for hearing loss were 3.4 (+/- 0.6) and 5.9 (+/- 0.7), respectively (P < .01), and for facial nerve palsy 0.7 (+/- 0.4) compared with 3.1 (+/- 0.6) postoperatively (P < .01). House-Brackmann grade 1 or 2 was determined in 87.1% of patients before and in 80.6% after surgery. Serviceable hearing (Gardner-Robertson classes I-III) was found in 75% before and in 64.3% after surgery. CONCLUSION Preservation of facial nerve and hearing function are not the only important criteria defining QOL after CPA surgery. Tinnitus and vertigo may have a significant underestimated impact on the patient's postoperative course and QOL.
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Affiliation(s)
- Juergen Grauvogel
- Department of Neurosurgery, Albert-Ludwigs University, Freiburg, Germany.
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Abstract
Surgical therapy of Graves' orbitopathy comprises orbital decompression as well as strabismus and lid surgery. The former is primarily carried out during active disease, the latter during inactive disease. Orbital decompression abates increased intraorbital pressure and is thus applicable against dysthyroid optic neuropathy and also reduces exophthalmos. The choice of a specific procedure depends mainly on the experience of the respective center. In this article, the pterional transcranial, transnasal transethmoidal, transconjunctival and swinging eyelid approaches are presented. Eye muscle recession relieves the abnormal tension of fibrotic muscles and thus corrects diplopia. Compared to normal strabismus surgery, the dose-response relationship is increased. Lid lengthening surgery is applied to counter upper or lower lid retraction. If several of these operations are necessary the order is chosen in such a way that downstream procedures cannot change specific results of upstream operations.
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Affiliation(s)
- J Kaminsky
- Neurochirurgie, Sankt-Gertrauden-Krankenhaus, Berlin, Deutschland
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Abstract
In the unusual case of a 68-year-old woman with one-sided painless lateral neck swelling, the ENT examination showed a firm nuchal mass (4 × 4 cm) on the right side with no other pathological findings. Angio-MRI confirmed a solid, sharply demarcated tumor with arterial hyperperfusion. Core needle aspiration biopsy was performed, revealing well-circumscribed tufts showing the typical "cannonball" aspect. After preoperative embolisation we performed extirpation of the mass. Histological examination showed an acquired tufted angioma. Clinical as well as radiological follow-up examination detected neither local relapse nor metastases.
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Affiliation(s)
- C Breunig
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Killianstrasse 5, 79106, Freiburg, Deutschland.
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Grauvogel J, Grauvogel TD, Taschner C, Baumgartner S, Maier W, Kaminsky J. A Rare Case of Radiologically Not Distinguishable Coexistent Meningioma and Vestibular Schwannoma in the Cerebellopontine Angle - Case Report and Literature Review. Case Rep Neurol 2010; 2:111-117. [PMID: 21045938 PMCID: PMC2968772 DOI: 10.1159/000320213] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The simultaneous occurrence of cerebellopontine angle (CPA) meningioma and vestibular schwannoma (VS) in the absence of neurofibromatosis type 2 or history of irradiation is very rare. We report a case with coexistent CPA meningioma and VS, which were radiologically not distinguishable in preoperative imaging. Case Description A 46-year-old female presented with acute hearing loss, tinnitus and gait ataxia. Otorhinolaryngological diagnostic workup and imaging studies showed an intra- and extrameatal homogenous contrast enhancing lesion. The neuroradiological diagnosis was VS. The patient was operated via the retrosigmoid approach. Intraoperatively two distinct tumors were found: a small, mainly intrameatally located VS and a larger meningioma originating from the dura of the petrous bone. Both tumors were completely microsurgically removed. The patient experienced no new neurological deficit after surgery; particularly facial nerve function was completely preserved. Histopathological examination revealed a fibromatous meningioma and a VS, respectively. Conclusions The coincidental occurrence of CPA meningioma and VS is very rare. Careful interpretation of imaging studies before surgery is crucial. Even such rare cases should be kept in mind when discussing the therapeutic options with the patient. More studies are needed for a better understanding of mechanisms leading to multiple tumor growth.
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Affiliation(s)
- Juergen Grauvogel
- Department of Neurosurgery, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Gierthmuehlen M, Freiman TM, Elverfeldt D, Kaminsky J. Microsurgical approach to the spinal canal in rats. J Neurosci Methods 2010; 188:295-301. [PMID: 20153369 DOI: 10.1016/j.jneumeth.2010.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 01/23/2010] [Accepted: 02/07/2010] [Indexed: 10/19/2022]
Abstract
The spinal cord of the rat has become a widely used model for biodynamic, pharmaceutical and neurological experiments. However, no standard procedure to approach the spinal cord in rats has been published in detail. We present a description of a dorsal approach to the spine, spinal canal and myelon of the rat. This approach provides sufficient exposure of the neural structures to perform extended microsurgery at the spinal nerve-roots, the lateral and dorsal myelon and vertebral structures under a surgical microscope. Perioperative management, anaesthesia and anatomical landmarks are discussed and common pitfalls are described.
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Affiliation(s)
- Mortimer Gierthmuehlen
- Department of Neurosurgery, University of Freiburg, Breisacher Strasse 64, D-79106 Freiburg, Germany.
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Schmidt W, Kaminsky J, Behrens P, Schmitz KP. STENTDEFORMATION BEI BESCHLEUNIGTER RADIALER GEFÄßBELASTUNG IN ABHÄNGIGKEIT VON DER BELASTUNGSFREQUENZ. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.2003.48.s1.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
The paracondylar process is a rare congenital abnormality of the craniocervical junction that has been identified as a causative agent for severe headache, neck pain, and restricted head movement. Although conservative treatment is usually sufficient, the authors report the case of a symptomatic paracondylar process in a young patient who required surgical intervention.
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Affiliation(s)
- Mukesch J Shah
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
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Kaminsky J, Shah M, Petrick M. Endoscopic Resection of Midline Pathologies of the Skull Base. Skull Base 2009. [DOI: 10.1055/s-2009-1222243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Menge M, Maier W, Feuerhake F, Kaminsky J, Pfeiffer J. Giant cell reparative granuloma of the temporal bone. Acta Neurochir (Wien) 2009; 151:397-9. [PMID: 19224123 DOI: 10.1007/s00701-009-0191-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
Abstract
Giant cell reparative granuloma (GCRG) is an uncommon non-neoplastic reactive tumor that occurs almost exclusively within the mandible and maxilla and can be locally aggressive. Only sporadic cases involving the skull base have been reported. However, this lesion is probably underappreciated because it might be unrecognized or misdiagnosed. We present a case of GCRG of the left temporal bone that was treated surgically via a combined transtemporal-subtemporal approach. A short literature review about diagnosis, clinical behavior and treatment of this tumor entity is given.
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Kaminsky J, Maier W, Ridder G, Löwenheim H. Interdisciplinary Treatment of Jugular Foramen Pathologies Using a Juxtacondylar Approach. Skull Base 2009. [DOI: 10.1055/s-2009-1222287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schoen R, Kaminsky J, Maier W, Gellrich NC, Schmelzeisen R. Interdisciplinary Management of Long-Term Complications Following Trauma of the Anterior Skull Base. Skull Base 2009. [DOI: 10.1055/s-2009-1222147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Kaminsky J, Grauvogel J, Petrick M, Shah M. Intraoperative 3D C-Arm Imaging in Skull Base Surgery. Skull Base 2009. [DOI: 10.1055/s-2009-1222189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Hoffmann J, Kaminsky J, Schuck N, Besch D, Reinert S. O.344 Reconstructive strategies in case of orbital tumors. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Shah M, Kaminsky J, Vougioukas VI. Minimally invasive removal of an extradural intraradicular lumbar schwannoma. Acta Neurochir (Wien) 2008; 150:691-3; discussion 693-4. [PMID: 18548188 DOI: 10.1007/s00701-008-1607-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 04/21/2008] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Surgical exposure of peripheral lumbar schwannomas often requires extensive muscle mobilization which results in significant postoperative pain. We describe an alternative minimally invasive surgical technique for the treatment of such lesions. METHODS We report the case of a patient with an extradural intraradicular schwannoma of the L4 root that was treated with a minimally invasive transmuscular approach by using tubular retractors. RESULTS Muscle trauma and intraoperative blood loss were negligible. The postoperative course was uneventfull. There was no additional morbidity associated with the approach. The patient was discharged 72 h after the procedure. CONCLUSIONS In selected cases extradural intraradicular lumbar schwannomas can be treated adequately with a minimally invasive transmuscular approach.
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Affiliation(s)
- M Shah
- Department of Neurosurgery, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
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Abstract
Abstract
OBJECTIVE
The duration of preexisting profound deafness in patients with bilateral retrocochlear lesions is known to correlate negatively to the extent of auditory restoration after auditory brainstem implantation. There is, therefore, a lack of information regarding the potential of the central auditory system to mediate hearing perception after long-term deafness.
METHODS
The authors evaluated auditory perception in a case of auditory brainstem implantation after 35 years of deafness.
RESULTS
Electrically evoked auditory brainstem potentials could be elicited by both stimulus polarities and were consistent with auditory brainstem origin. Discrimination between temporal and spectral patterns in speech could be achieved. This permitted us to distinguish various voice qualities, especially of familiar speakers in quiet surroundings.
CONCLUSION
The potential of the deafferentiated central auditory system to mediate auditory brainstem implant-induced hearing perception even after very long-term deafness has been demonstrated. Those patients with complete dysfunction of Cranial Nerve VIII for a long period may be considered as candidates for auditory brainstem implantation in the future.
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Affiliation(s)
- Alireza Gharabaghi
- Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
| | - Hubert Löwenheim
- Department of Otorhinolarhangology, Eberhard Karls University Hospital, Tübingen, Germany
| | - Stefan Heckl
- Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
| | - Andrei Koerbel
- Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
| | - Jan Kaminsky
- Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
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Beschorner R, Koerbel A, Schittenhelm J, Kaminsky J, Loewenheim H, Bueltmann E, Tatagiba M, Meyermann R, Wehrmann M. 47-year-old woman with a clival mass. Brain Pathol 2008; 18:100-2, 141. [PMID: 18226101 PMCID: PMC8095634 DOI: 10.1111/j.1750-3639.2007.00115_3.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Beschorner R, Koerbel A, Schittenhelm J, Kaminsky J, Loewenheim H, Bueltmann E, Tatagiba M, Meyermann R, Wehrmann M. 47-YEAR-OLD WOMAN WITH A CLIVAL MASS. Brain Pathol 2008. [DOI: 10.1111/j.1750-3639.2007.00125_3.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Westendorff C, Kaminsky J, Ernemann U, Reinert S, Hoffmann J. Image-guided sphenoid wing meningioma resection and simultaneous computer-assisted cranio-orbital reconstruction: technical case report. Neurosurgery 2007; 60:ONSE173-4; discussion ONSE174. [PMID: 17297354 DOI: 10.1227/01.neu.0000249235.97612.52] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Resection of large intraosseous sphenoid wing meningiomas is traditionally associated with significant morbidity. Rapid prototyping techniques have become widely used for treatment planning. Yet, the transfer of a treatment plan into the intraoperative situs strongly depends on the experience of the individual surgeon. CLINICAL PRESENTATION Extensive resection with orbital decompression was planned and performed on the basis of rapid prototyping and surgical navigation techniques in a 44-year-old woman presenting with a large sphenoid wing meningioma on the right infiltrating the orbit. RESULTS Tumor resection was simulated on a stereolithography model of the patient's head. The stereolithography model was scanned using computed tomography (CT) and the defect geometry was used to create a custom-made titanium implant. The implant consisted of a solid titanium core and a spot-welded titanium mesh surrounding the core, allowing for minor intraoperative adjustments of the implant size by reducing the mesh size. The stereolithography model with the incorporated implant was CT scanned again and the CT data were fused with the patient's original CT data. The implant borders indicating the resection borders were marked within the patient's CT data set. This treatment plan was transferred to an optical navigation system. Intraoperatively, tumor resection was performed using surgical navigation. CONCLUSION In the presented case report, the combination of computer-assisted planning using rapid prototyping techniques and image-guided surgery allowed for an extensive tumor resection precisely according to a preoperative treatment plan in a patient presenting with a large intraosseous sphenoid wing meningioma. A larger clinical series with a long-term follow-up period will be needed to determine the reproducibility.
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Affiliation(s)
- Carsten Westendorff
- Department of Oral and Maxillofacial Surgery, Tübingen University Hospital, Tübingen, Germany.
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Schittenhelm J, Kaminsky J, Meyermann R, Mittelbronn M. Inflammatory myofibroblastic tumor of the ulnar nerve. Case report and review of the literature. J Neurosurg 2007; 106:1075-9. [PMID: 17564182 DOI: 10.3171/jns.2007.106.6.1075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Inflammatory myofibroblastic tumors with involvement of cranial and peripheral nerves are exceedingly rare. The authors present the case of a 67-year-old man with an inflammatory myofibroblastic tumor of the left ulnar nerve, which was identified intraoperatively and mimicked a malignant neoplastic lesion. Histopathological examination revealed loosely structured fibrous tissue and collagen deposits intermingled with patchy infiltrates of lymphocytes, plasma cells, and histiocytes penetrating the endo- and epineurium of the affected nerve fascicles. There was strong expression of vimentin and actin in spindle cells throughout the lesion. The histiocytes were CD68- and major histocompatibility complex class II-positive, but lacked CD1a expression. A review of the literature revealed nine histopathologically confirmed cases of inflammatory myofibroblastic tumors involving peripheral or cranial nerves in which slight differences in histopathological features and surgical management were found, which are discussed here.
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Rodt T, Köppen G, Lorenz M, Majdani O, Leinung M, Bartling S, Kaminsky J, Krauss JK. Placement of Intraventricular Catheters Using Flexible Electromagnetic Navigation and a Dynamic Reference Frame: A New Technique. Stereotact Funct Neurosurg 2007; 85:243-8. [PMID: 17534137 DOI: 10.1159/000103263] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Catheterization of narrow ventricles may prove difficult resulting in misplacement or inefficient trials with potential damage to brain tissue. MATERIAL AND METHODS The application of a new module for navigated ventricular catheterization using flexible electromagnetic navigation and a dynamic reference frame is presented. RESULTS Navigated catheter placement was successful and accurate in a pilot study. Electromagnetic interferences had to be taken into consideration. CONCLUSION Flexible electromagnetic navigation with a dynamic reference frame is a useful tool for catheter placement as it reduces the risk of misplacement or repeated catheterization trials.
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Affiliation(s)
- Thomas Rodt
- Department of Neurosurgery, Hannover University Medical School, Hannover, Germany.
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Gharabaghi A, Heckl S, Kaminsky J, Torka W, Nägele T, Tatagiba M, Löwenheim H. Hirnnervenausfälle durch ungewöhnliche Schädelbasisläsionen des Sinus cavernosus. HNO 2007; 55:278-80. [PMID: 17410393 DOI: 10.1007/s00106-006-1459-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Gharabaghi
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
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Kaminsky J, Löwenheim H, Preyer S, Hoffmann J, Tatagiba M. Rekonstruktion der Frontobasis mit autologen Materialien. Skull Base 2007. [DOI: 10.1055/s-2006-957303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hoffmann J, Kaminsky J, Will B, Besch D, Westendorff C, Tatagiba M, Reinert S. Multimodale und interdisziplinäre Therapie von Raumforderungen im Bereich der Orbita und Periorbita. Skull Base 2007. [DOI: 10.1055/s-2006-957269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kaminsky J, Löwenheim H, Preyer S, Hoffmann J, Tatagiba M. Reconstruction of the Frontal Skull Base Using Autologous Materials. Skull Base 2007. [DOI: 10.1055/s-2006-957302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Hoffmann J, Westendorff C, Kaminsky J, Reinert S. Verwendung eines hybriden CAD-/CAM-Implantats zur Rekonstruktion nach Resektion eines ausgedehnten Keilbeinflügelmeningeoms. Skull Base 2007. [DOI: 10.1055/s-2006-957266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Löwenheim H, Koerbel A, Nohé B, Bültmann E, Hirt B, Kaminsky J, Tatagiba M, Ernemann U. [Massive epistaxis with haemorrhagic shock in the late phase after skull-base fracture]. HNO 2007; 54:768-71. [PMID: 16283130 DOI: 10.1007/s00106-005-1343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Löwenheim
- Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Tübingen
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Ebner FH, Koerbel A, Kirschniak A, Roser F, Kaminsky J, Tatagiba M. Endoscope-assisted retrosigmoid intradural suprameatal approach to the middle fossa: Anatomical and surgical considerations. Eur J Surg Oncol 2007; 33:109-13. [PMID: 17110074 DOI: 10.1016/j.ejso.2006.09.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 09/29/2006] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Lesions involving the posterior and middle fossa may be reached by several surgical approaches depending mostly on tumors' location and characteristics. The retrosigmoid intradural suprameatal approach has been used to remove tumors of the posterior fossa extending into Meckel's cave and the middle fossa. With large tumors, this approach may allow exposure of the oculomotor and optic nerves, the supraclinoid internal carotid and communicating posterior arteries. METHODS Three formaldehyde-fixed specimens have been prepared on both sides using the conventional retrosigmoidal-suprameatal approach. The entire endoscopic preparations have been documented via a digital recording system, using a 5mm endoscope with a 25 degrees perspective. The authors describe the anatomical corridor and technique of the endoscope-assisted retrosigmoid intradural suprameatal approach to lesions that are located predominantly within the posterior fossa and supratentorial extension into Meckel's cave, sellar and parasellar region. CONCLUSIONS The endoscope-assisted suprameatal approach provides exposure of the antero-medial middle fossa even in cases of skull base lesions that have not caused significant displacement of neurovascular structures.
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Affiliation(s)
- F H Ebner
- Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
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Grauvogel J, Kaminsky J, Rosahl S. Tinnitus and Vertigo before and after Microsurgery in the Cerebellopontine Angle: Assessment of Patient-Perceived Impairment. Skull Base 2007. [DOI: 10.1055/s-2007-984023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kaminsky J, Will B, Schuck N, Westendorff C, Hoffmann J. Multimodal and Interdisciplinary Treatment of Orbital Tumors. Skull Base 2007. [DOI: 10.1055/s-2007-984158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Arndt S, Dämmrich T, Aschendorff A, Kaminsky J, Maier W. Rare Extracranial Localization of Primary Intracranial Neoplasm. Skull Base 2007. [DOI: 10.1055/s-2007-984282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kaminsky J, Westendorff C, Hoffmann J. Image Data-Based Resection of a Sphenoid Wing Meningioma Resection with Simultaneous CAD-CAM-Reconstruction of the Cranio-orbital Region. Skull Base 2007. [DOI: 10.1055/s-2007-984258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gharabaghi A, Heckl S, Kaminsky J, Paasch S, Nägele T, Tatagiba M, Löwenheim H. [Intracranial complications of sinusitis sphenoidalis]. HNO 2006; 55:202-5. [PMID: 17082958 DOI: 10.1007/s00106-006-1464-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A Gharabaghi
- Klinik für Neurochirurgie, Universitätsklinikum, Tübingen
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Gharabaghi A, Koerbel A, Löwenheim H, Kaminsky J, Samii M, Tatagiba M. The impact of petrosal vein preservation on postoperative auditory function in surgery of petrous apex meningiomas. Neurosurgery 2006; 59:ONS68-74; discussion ONS68-74. [PMID: 16888554 DOI: 10.1227/01.neu.0000219821.34450.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The importance of preserving the superior petrosal vein has received increasing attention in the surgical treatment of pathologies involving the petrous apex. Recent reports have associated postoperative auditory nerve dysfunction with petrosal vein sacrifice. However, there is no systematic clinical study available thus far focusing on the postoperative auditory function after petrosal vein obliteration. METHODS In 55 patients with meningiomas involving the petrous apex, pre- and intraoperative findings including petrosal vein sectioning were analyzed retrospectively concerning their impact on postoperative auditory function. RESULTS The petrosal vein was preserved in 26 (47%) cases. In 27 (49%) cases, this vein was not preserved. Hearing loss occurred in 11% of all cases. In the preserved-vein group, postoperative hearing loss occurred in 3 of 26 (11%) cases and in the sacrificed-vein group in 3 of 27 (11%) cases. CONCLUSION Sacrifice of the petrosal vein during surgery of petrous apex meningiomas seems not to have an impact on postoperative auditory function.
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MESH Headings
- Adult
- Aged
- Audiometry/standards
- Brain Edema/etiology
- Brain Edema/physiopathology
- Brain Edema/prevention & control
- Brain Stem/blood supply
- Brain Stem/pathology
- Brain Stem/surgery
- Cerebellopontine Angle/anatomy & histology
- Cerebellopontine Angle/pathology
- Cerebellopontine Angle/surgery
- Cochlear Nerve/blood supply
- Cochlear Nerve/physiopathology
- Cranial Fossa, Middle/anatomy & histology
- Cranial Fossa, Middle/pathology
- Cranial Fossa, Middle/surgery
- Cranial Fossa, Posterior/anatomy & histology
- Cranial Fossa, Posterior/pathology
- Cranial Fossa, Posterior/surgery
- Cranial Sinuses/anatomy & histology
- Cranial Sinuses/injuries
- Cranial Sinuses/surgery
- Dura Mater/pathology
- Dura Mater/surgery
- Female
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/physiopathology
- Hearing Loss, Sensorineural/prevention & control
- Humans
- Male
- Meningioma/physiopathology
- Meningioma/surgery
- Middle Aged
- Monitoring, Physiologic/methods
- Monitoring, Physiologic/standards
- Petrous Bone/anatomy & histology
- Petrous Bone/surgery
- Postoperative Complications/etiology
- Postoperative Complications/physiopathology
- Postoperative Complications/prevention & control
- Preoperative Care/methods
- Preoperative Care/standards
- Skull Base Neoplasms/physiopathology
- Skull Base Neoplasms/surgery
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Affiliation(s)
- Alireza Gharabaghi
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany.
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Rodt T, Bartling SO, Zajaczek JE, Vafa MA, Kapapa T, Majdani O, Krauss JK, Zumkeller M, Matthies H, Becker H, Kaminsky J. Evaluation of surface and volume rendering in 3D-CT of facial fractures. Dentomaxillofac Radiol 2006; 35:227-31. [PMID: 16798916 DOI: 10.1259/dmfr/22989395] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Three-dimensional computed tomography (3D-CT) of facial fractures has been reported as beneficial using surface (SR) and volume rendering (VR). There are controversial statements concerning the preferable algorithm. The purpose of this study was to evaluate and compare SR and VR for clinical 3D-CT in facial fractures on an experimental basis. METHODS Multislice CT was obtained in 22 patients with facial fractures using two data acquisition protocols. Five SR and VR post-processing protocols were applied. Five assessors independently evaluated the quality of visualization of the fracture gap and dislocated fragments as well as the overall image quality using a five-point rating scale. The potential benefit of the 3D-images for radiological diagnosis and presentation was evaluated. The influence of the data acquisition protocol was analysed. RESULTS SR in general achieved better evaluation scores than VR at corresponding thresholds. Variation of evaluation scores for all criteria was found for SR and VR depending on the segmentation threshold. Apart from the overall image quality no significant influence of the data acquisition technique was found for the evaluated criteria. CONCLUSIONS SR provided sufficient and time efficient means for 3D-visualization of facial fractures in this study. No diagnostic benefit of VR over SR was found.
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Affiliation(s)
- T Rodt
- Department of Neurosurgery, Hannover University Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Gharabaghi A, Koerbel A, Samii A, Kaminsky J, von Goesseln H, Tatagiba M, Samii M. The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery. J Neurosurg 2006; 104:369-75. [PMID: 16572648 DOI: 10.3171/jns.2006.104.3.369] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Surgical manipulation of the fifth cranial nerve during its intra- or extracranial course may lead to bradycardia or even asystole as well as arterial hypotension, a phenomenon described as the trigeminocardiac reflex (TCR). The authors studied the impact of this reflex on postoperative auditory function in patients undergoing vestibular schwannoma (VS) surgery.
Methods
One hundred patients scheduled for VS surgery were studied prospectively for parameters influencing the postoperative auditory function. The evaluation included sex, age, pre- and postoperative auditory function, preoperative mean arterial blood pressure, preoperative medical diseases or medication (for example, antiarrhythmia drugs), tumor size and localization, and the intraoperative occurrence of the TCR.
The TCR, which occurred in 11% of the patients, influenced the postoperative hearing function in the patients with Hannover Class T3 and T4 VSs.
With an overall hearing preservation of 47%, 11.1% of the patients in the TCR group and 51.4% of those in the non-TCR group experienced preserved hearing function postoperatively. In cases involving larger tumors (Hannover Class T3 and T4), an intraoperative TCR was associated with a significantly worse postoperative hearing function during VS surgery (p = 0.005).
Conclusions
The hypotension following TCR is a negative prognostic factor for hearing preservation in patients undergoing VS surgery. Patients’ knowledge of this can be increased pre- and postoperatively. Further study of this phenomenon will advance the understanding of the underlying mechanisms and may help to improve hearing preservation by controlling the occurrence of the TCR.
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Affiliation(s)
- Alireza Gharabaghi
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany.
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Stieglitz LH, Samii A, Kaminsky J, Gharabaghi A, Samii M, Lüdemann WO. Nausea and Dizziness after Vestibular Schwannoma Surgery: A Multivariate Analysis of Preoperative Symptoms. Neurosurgery 2005; 57:887-90; discussion 887-90. [PMID: 16284559 DOI: 10.1227/01.neu.0000179920.21593.1b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
Nausea and dizziness are very discomforting for patients after vestibular schwannoma surgery and they impair recovery.
METHODS:
To identify preoperative symptoms and conditions that increase the risk of development of nausea after vestibular schwannoma surgery, a multivariate analysis was performed. One hundred fifteen patients with vestibular schwannoma had a microsurgical tumor removal in a standardized procedure in 2001 and 2002. Eighteen patients were excluded from the study because of previous surgery (recurrent tumors, 7 patients) or bilateral tumor occurrence (neurofibromatosis, 11 patients). Analysis was performed regarding postoperative amount of antiemetic medication, vomiting, and subjective feeling of the patient. Tumor grading, body mass index, sex, previous complaints, examination at admission, and side of the tumor were taken in consideration.
RESULTS:
Women had significant longer postoperative complaints (mean, 3.0 d; standard error, 0.47) and needed longer antiemetic therapy (mean, 3.3 d; standard error, 0.49) than men (mean, 1.72 d; standard error, 0.21). Patients developing no significant postoperative complaints were all in the higher tumor grading group, Grades 3a, 4a, and 4b. There was a significant difference in the duration of antiemetic therapy between tumors graded 1 and tumors graded 3 or 4. Patients with a positive stepping test preoperatively had a tendency to demand less antiemetic medication. Women with small tumors are most likely to develop significant complaints after vestibular schwannoma surgery.
CONCLUSION:
It is possible to identify patients with a higher risk of postoperative nausea and dizziness after vestibular schwannoma surgery. This allows one to inform these patients preoperatively and to initiate an early postoperative drug therapy to ease their symptoms.
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Kaminsky J, Hoffmann J, Troitzsch D, Ernemann U, Westendorff C, Reinert S, Tatagiba M. Resection of a Fronto-orbital Skull Base Tumor and Subsequent Orbital Wall Reconstruction Using Navigational Planning and Guidance. Skull Base 2005. [DOI: 10.1055/s-2005-916542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kaminsky J, Hoffmann J, Löwenheim H, Niemeyer T, Ernemann U, Gharabaghi A, Tatagiba M. Transoral Translabial Transmandibular Approach to the Clivus and High Cervical Region: Indications and Surgical Technique. Skull Base 2005. [DOI: 10.1055/s-2005-916575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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