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Metz C, Holzschuh M, Bein T, Woertgen C, Frey A, Frey I, Taeger K, Brawanski A. Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects. J Neurosurg 1996; 85:533-41. [PMID: 8814152 DOI: 10.3171/jns.1996.85.4.0533] [Citation(s) in RCA: 181] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cerebral and extracerebral effects of moderate hypothermia (core temperature 32.5 degrees C-33.0 degrees C) were prospectively studied in 10 patients with severe closed head injury (Glasgow Coma Scale score < 7) in the intensive care unit of a university hospital. Hypothermia was induced by cooling the patient's body surface with water-circulating blankets. Before cooling, a conventional intracranial pressure (ICP) reduction therapy was applied, which remained unchanged throughout the study. Cerebral blood flow (CBF), cerebral metabolic rates for oxygen (CMRO2) and lactate (CMRL), and ICP were simultaneously measured prior to inducing hypothermia, after obtaining hypothermia, after 24 hours of hypothermia, and after rewarming. With respect to extracerebral effects, supplemental investigations were conducted 24 and 72 hours after rewarming. The median delay between injury and induction of hypothermia was 16 hours. Hypothermia reduced CMRO2 by 45% (p < 0.01), whereas CBF did not change significantly. Before cooling, six patients had elevated CMRL indicating cerebral ischemia. Cooling normalized CMRL in all patients (p < 0.01). The intracranial hypertension present prior to cooling declined markedly during hypothermia (p < 0.01) without significant rebound effects after rewarming. Cardiac index decreased by 18% after hypothermia was reached (p < 0.05), recovered at 24 hours of hypothermia, and surpassed baseline values after rewarming. Platelet counts dropped continuously up to 24 hours after rewarming (p < 0.01). Plasma coagulation tests did not show significant worsening. Creatinine clearance decreased during cooling (p < 0.01) and recovered by 24 hours after rewarming. Twenty-four hours after cooling had begun, eight patients had elevated serum lipase activity (p < 0.01) and four of them acquired pancreatitis. Rewarming normalized both pancreatic alterations. Seven patients made a good recovery; one survived severely disabled; and two patients died. Moderate hypothermia is effective in preventing secondary brain damage while reducing cerebral ischemia. However, there are potentially hazardous side effects that require additional monitoring.
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Woertgen C, Rothoerl RD, Holzschuh M, Metz C, Brawanski A. Comparison of serial S-100 and NSE serum measurements after severe head injury. Acta Neurochir (Wien) 1998; 139:1161-4; discussion 1165. [PMID: 9479423 DOI: 10.1007/bf01410977] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We investigated the time course of neuron specific enolase (NSE) and S-100 protein after severe head injury in correlation to outcome. We included 30 patients (GCS < 9), who had been admitted within 5 hours after injury, in a prospective study. Blood samples were taken on admission, 6, 12, and 24 hours and every 24 hours up to the fifth day after injury. The outcome was estimated on discharge using the Glasgow Outcome Scale. 70% reached a good outcome. All concentrations of NSE and 83% of the S-100 samples were elevated concerning the first probe (30.2 micrograms/l NSE mean and 2.6 micrograms/l S-100 mean). Patients with bad outcome had an NSE concentration of 38 micrograms/l (mean) compared with 26.9 micrograms/l (mean) in patients with good outcome. Patients with bad outcome had an S-100 concentration of 4.9 micrograms/l (mean) compared with 1.7 micrograms/l (mean) in patients with good outcome (p < 0.05). The mean values of NSE and S-100 decreased during the first 5 days. Four patients with increasing intracranial pressure showed a quick increasing concentration of NSE, in two patients the S-100 level showed a slower rise. The NSE serum levels did not correlate with intracranial pressure values. Our results show that the first serum concentration of S-100 seems to be predictive for outcome after severe head injury.
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Comparative Study |
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Woertgen C, Rothoerl RD, Metz C, Brawanski A. Comparison of clinical, radiologic, and serum marker as prognostic factors after severe head injury. THE JOURNAL OF TRAUMA 1999; 47:1126-30. [PMID: 10608545 DOI: 10.1097/00005373-199912000-00026] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND S-1OOB, a protein of astroglial cells, is described as a marker for neuronal damage. Reliable outcome prediction from severe head injury is still unresolved. Clinical scores such as the Glasgow Coma Scale score (GCS) and diagnostic scores such as the Marshall Computed Tomographic Classification are well established and investigated, but there are still some concerns about these tools. The aim of this study was to investigate the predictive value of the initial serum level of S-100B compared with the predictive value of the GCS score and the Marshall Computed Tomographic Classification to outcome after severe head injury. METHODS Forty-four patients with severe head injury (GCS score < 9) were included. Blood samples were drawn within 1 to 6 hours of injury. After a period of 11 months, their outcome was correlated by using the Glasgow Outcome Scale. Patients with an S-100B serum level above 2 microg/L, a GCS score between 3 and 5, and a computed tomographic scan in the categories 4 to 6 are predicted to have an unfavorable outcome. The predictive values of these tools were calculated according to these definitions. RESULTS The protein S-100B had with 17% the lowest total misclassification rate. When compared with the GCS score and Marshall Computed Tomographic Classification the S-100B serum level calculated on admission had the highest positive predictive value (87%) and negative predictive value (77%). CONCLUSION The serum level of S-100B calculated within 1 to 6 hours of a severe head injury is a useful additional outcome predictor.
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Comparative Study |
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Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus--evaluation of risk factors. Neurosurgery 1992; 31:898-903; discussion 903-4. [PMID: 1436414 DOI: 10.1227/00006123-199211000-00011] [Citation(s) in RCA: 97] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Experience with a continuous-pressure controlled, external ventricular drainage system (EVD) in 100 patients (n = 49 female, n = 51 male; mean age, 56.3 yr) with acute hydrocephalus is reported. Cerebrospinal fluid circulation disturbances resulted from hemorrhages caused by subarachnoid hemorrhage (n = 45), parenchymal hemorrhages from angioma (n = 4), anticoagulants (n = 7), or hypertension or other reasons (n = 30); in addition, hydrocephalus developed from infections (n = 3), tumors (n = 2), infratentorial infarction (n = 5), or unknown reasons (n = 4); 52 patients had ventricular hemorrhages. No patient died of system-associated morbidity. Mean time of EVD treatment was 9.5 days, with 40 patients being treated for 10 to 29 days; routine refobacin (5 mg) flushing of the system was performed three times a day. Patients without cerebrospinal fluid leakage had a 2% rate of secondary infection compared with 13% in patients with cerebrospinal fluid leakage due to ventricular catheter placement (P < 0.05; overall infection rate, 5%). A clinical mortality rate of 29% during EVD treatment was observed in subarachnoid hemorrhage patients (Hunt and Hess Grades II, III, IV, and V; n = 9, 9, 18, and 9, respectively); recurrent hemorrhages during EVD treatment occurred in 19 patients (26 hemorrhages), and of these, 10 patients died. System occlusion was seen in 19 cases (12 of 45 patients with subarachnoid hemorrhage), requiring catheter and system renewal in 1 case; system extraction was seen in 3 cases, misplacement was seen in 11 cases, and disconnection was seen in 5 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Rothoerl RD, Woertgen C, Holzschuh M, Metz C, Brawanski A. S-100 serum levels after minor and major head injury. THE JOURNAL OF TRAUMA 1998; 45:765-7. [PMID: 9783618 DOI: 10.1097/00005373-199810000-00025] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND S-100, a protein of astroglial cells, is described as a marker for central nervous system damage. The aim of this study was to evaluate whether the marker could give information about the severity and possibility of functional recovery after minor and severe head injury. METHODS Thirty patients after severe head injury (Glasgow Coma Scale score < 9) and 11 patients after minor head injury (Glasgow Coma Scale score > 12) were included. In each case, blood samples were drawn within 6 hours after injury. Outcome was estimated at hospital discharge using the Glasgow Outcome Scale. RESULTS All patients who sustained minor head injury had reached a favorable outcome by the time they were discharged from the hospital. Their mean S-100 serum level was 0.35 microg/L. Patients who sustained severe head injury and were classified as having an unfavorable outcome (31%) showed a mean serum concentration of 4.9 microg/L, whereas patients classified as having a favorable outcome (69%) had a mean S-100 level of 1.2 microg/L. All groups differed significantly (p < 0.05). CONCLUSION S-100 appears to be a promising marker for the severity of head injury and neuronal damage.
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Schlaier J, Warnat J, Brawanski A. Registration Accuracy and Practicability of Laser-Directed Surface Matching. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929080209146037] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Woertgen C, Erban P, Rothoerl RD, Bein T, Horn M, Brawanski A. Quality of life after decompressive craniectomy in patients suffering from supratentorial brain ischemia. Acta Neurochir (Wien) 2004; 146:691-5. [PMID: 15197612 DOI: 10.1007/s00701-004-0280-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Decompressive craniectomy in patients suffering from severe ischemic stroke in the middle cerebral artery territory (MCA) decreases mortality to near 30%. Additionally functional outcome in patients after early craniectomy seems to be better than in patients without surgery. The aim of this study was to investigate the quality of life of patients who were treated with a decompressive craniectomy for severe ischemic stroke. METHODS We retrospectively investigated the patient records of 48 patients (26 men, mean age 48 years) suffering from ischemic strokes who underwent craniectomy since 1993. We registrated the preoperative neurological status, the diagnostic data as well as the operative procedure. The outcome was assessed using the Barthel Index, the Glasgow outcome score and a questionnaire to assess the quality of life according to Blau consisting of eleven items at follow-up. FINDINGS The mortality rate was 26%, age correlated to mortality (44.5 versus 60.3 years GOS 1, mean, p<0.0006). Craniectomy without dura patch correlated to mortality (58% versus 14% GOS 1 with dura patch, p<0.005). The quality of life index was 6 points mean. The quality of life index did neither differ significantly between patients with left or right sided lesions nor in patients with and without aphasia. 83% of the surviving patients and/or dependents would agree to surgery in the future. CONCLUSION Despite the fact that some patients remain in a poor neurological condition, quality of life after decompressive surgery for ischemic stroke seems to be acceptable to the patients.
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Becker G, Greiner K, Kaune B, Winkler J, Brawanski A, Warmuth-Metz M, Bogdahn U. Diagnosis and Monitoring of Subarachnoid Hemorrhage by Transcranial Color-Coded Real-Time Sonography. Neurosurgery 1991. [DOI: 10.1227/00006123-199106000-00005] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Thirty-six patients with acute spontaneous subarachnoid hemorrhage (26 caused by rupture of an aneurysm) were examined by transcranial color-coded real-time sonography by using a 2.25-MHz ultrasound transducer. In 20 of these 26 patients (76%), the aneurysm could be identified by a characteristic abnormal blood flow pattern within the aneurysm in coronal and axial scanning planes by transcranial color-coded real-time sonography. Blood within the basal cisterns, on top of the tentorium, and within the ventricles and parenchyma was sonographically detected by increased echodensity in 75%. In addition, cerebrospinal fluid circulation disturbances and cerebral vasospasm were detected in two-dimensional B-mode images in 85% and 100%, respectively. In Doppler mode, intravascular blood flow velocity could be quantified. We conclude that transcranial color-coded real-time sonography, a new, noninvasive method for diagnosis and follow-up of patients with subarachnoid hemorrhage, allows detection of the primary vascular lesion and monitoring of complications.
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Loibl M, Stoyanov L, Doenitz C, Brawanski A, Wiggermann P, Krutsch W, Nerlich M, Oszwald M, Neumann C, Salzberger B, Hanses F. Outcome-related co-factors in 105 cases of vertebral osteomyelitis in a tertiary care hospital. Infection 2014; 42:503-10. [DOI: 10.1007/s15010-013-0582-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/26/2013] [Indexed: 12/15/2022]
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Metz C, Holzschuh M, Bein T, Woertgen C, Rothoerl R, Kallenbach B, Taeger K, Brawanski A. Monitoring of cerebral oxygen metabolism in the jugular bulb: reliability of unilateral measurements in severe head injury. J Cereb Blood Flow Metab 1998; 18:332-43. [PMID: 9498850 DOI: 10.1097/00004647-199803000-00012] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To investigate the reliability of unilateral jugular venous monitoring and to determine the appropriate side, we performed bilateral jugular venous monitoring in 22 head-injured patients. Fiberoptic catheters were placed in both jugular bulbs. Arterial and bilateral jugular venous blood samples were obtained simultaneously for in vitro determination of jugular venous oxygen saturation (SJO2), arterial minus jugular venous lactate content difference (AJDL), and modified lactate-oxygen index (mLOI). Ischemia was assumed if one of the following pathologic values occurred at least unilaterally: SJO2 <54%, AJDL <-0.37 mmol/L, mLOI >0.08. The sensitivity of calculated unilateral monitoring in detecting ischemia was evaluated by comparing the incidence detected unilaterally with that disclosed bilaterally. The mean and maximum bilateral SJO2 differences varied between 1.4% and 21.0%, and 8.1% and 44.3%, respectively. The bias and limits of agreement (mean differences +/- 2 SD) between paired samples were 0.4% +/- 12.8%. There was no significant variation in bilateral SJO2 differences with time. Decreasing cerebral perfusion pressure (r = -0.559, P < 0.001) and arterial PCO2 (r = -0.342, P < 0.001) were associated with increasing bilateral SJO2 differences. Regarding AJDL, the maximum bilateral differences varied between 0.04 mmol/L and 1.52 mmol/L. The bias and limits of agreement were -0.01 +/- 0.18 mmol/L. At best, 87% of ischemic events were disclosed by monitoring on the side of predominant lesion or, in diffuse injuries, on the side of the larger jugular foramen (computed tomographic [CT] approach). We conclude that in severe head injury, even calculated unilateral jugular venous monitoring has an unpredictable risk for misleading or missing data. Therefore, the reliability of unilateral jugular venous monitoring appears suspicious. For diagnosing ischemia the CT approach is recommended.
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Woertgen C, Holzschuh M, Rothoerl RD, Haeusler E, Brawanski A. Prognostic factors of posterior cervical disc surgery: a prospective, consecutive study of 54 patients. Neurosurgery 1997; 40:724-8; discussion 728-9. [PMID: 9092845 DOI: 10.1097/00006123-199704000-00012] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To our knowledge, there is no prospective study to date about the prognostic factors of dorsal foraminotomy. The aim of this prospective study was to provide further information in this field. METHODS From January 1994 to January 1995, we performed a prospective, consecutive study of 54 patients, each of whose lateral herniated cervical disc was operated on via a dorsal foraminotomy. We analyzed the general data, the case history, the neurological examination at admission, and all data from imaging examinations and therapy. Most of the patients (93%) were followed up at 1 year, postoperatively. The patients were divided into one group with good results and another group with bad results, according to their ratings on a pain scale. The groups were analyzed in relation to the patients' initial condition. RESULTS At follow-up, 94% of the patients had completely recovered or their condition had improved. CONCLUSION A long duration of preoperative complaints and a long-standing neurological deficit seem to be important prognostic factors for a bad outcome after dorsal foraminotomy.
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Woertgen C, Rothoerl RD, Breme K, Altmeppen J, Holzschuh M, Brawanski A. Variability of outcome after lumbar disc surgery. Spine (Phila Pa 1976) 1999; 24:807-11. [PMID: 10222533 DOI: 10.1097/00007632-199904150-00013] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, consecutive study of patients' outcome at three subsequent follow-up times after lumbar disc surgery. OBJECTIVES To evaluate how consistent outcome remained in a group of patients after lumbar disc surgery. SUMMARY OF BACKGROUND DATA Despite similar results concerning the overall outcome, results in most studies show different prognostic factors for lumbar disc surgery at different follow-up times. A reason for this observation could be that patients shift to a different outcome group during the observation period. METHODS Before surgery and at the three follow-ups (3, 12, and 28 months after surgery) the Low Back Outcome Score was calculated. Groups with favorable and unfavorable outcome were determined after each follow-up according to the scores. RESULTS Ninety-eight patients were studied. Forty percent showed an unstable outcome at different follow-up times. For each follow-up, three prognostic factors were determined. No prognostic factor showed significance at all follow-up examinations. CONCLUSIONS Patients whose outcome after lumbar disc surgery does not remain stable present a major problem in the calculation of prognostic factors.
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Comparative Study |
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Woertgen C, Rothoerl RD, Brawanski A. Influence of macrophage infiltration of herniated lumbar disc tissue on outcome after lumbar disc surgery. Spine (Phila Pa 1976) 2000; 25:871-5. [PMID: 10751300 DOI: 10.1097/00007632-200004010-00017] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An immunohistochemical examination of the presence of inflammatory cells in routinely processed resection specimens of the lumbar disc, and a comparison of the histologic results with clinical data collected prospectively before and after surgery. OBJECTIVES To assess the influence of inflammatory reactions in herniated lumbar disc specimens on the outcome after lumbar disc surgery. SUMMARY OF BACKGROUND DATA Histologic and biochemical studies on herniated lumbar disc tissue led to the notion of inflammation-induced sciatic pain. At this writing, no investigations have sought to discover how outcome after lumbar disc surgery is influenced by histologically described inflammation. METHODS Disc specimens from 79 patients who underwent surgery for lumbar disc herniation were studied immunohistologically with regard to the presence of inflammatory reactions. Of these, 92% were followed up approximately 7 months after surgery. The histologic results were compared with the outcome at follow-up evaluation. RESULTS A statistically significant correlation was found between the histologically proven inflammation and the outcome, as shown by the pain grading scale. CONCLUSIONS The results from this study seem to support the theory of a foreign body reaction to the herniated material. This reaction may result in inflammation-induced sciatic pain.
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Schlaier JR, Warnat J, Dorenbeck U, Proescholdt M, Schebesch KM, Brawanski A. Image fusion of MR images and real-time ultrasonography: evaluation of fusion accuracy combining two commercial instruments, a neuronavigation system and a ultrasound system. Acta Neurochir (Wien) 2004; 146:271-6; discussion 276-7. [PMID: 15015050 DOI: 10.1007/s00701-003-0155-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate MRI/Ultrasonography fusion accuracy depending on three ultrasonographic parameters. METHOD An ultrasonography and MRI compatible model was created, consisting of a plastic box, which contained 3 objects. MRI scans were performed with 128 sagittal slices. The objects were segmented and 3D reconstructions were created. A special ultrasound adapter with 3 reflective markers was fixed to the ultrasound probe. Thus, the probe could be tracked by the navigation system (Vector Vision(2), BrainLab, Heimstetten, Germany) and the segmented shape of the 3D-objects obtained from the MR images were overlaid onto the ultrasound display (Elegra, Siemens, Erlangen, Germany). The dependency of fusion accuracy on different depth of ultrasound display, different distances between probe and objects and different angles between the axis of the ultrasound probe and the centre of the spheres was evaluated. 435 single measurements were performed. FINDINGS Overall fusion accuracy was 1.08 mm+/-0.61 mm (mean +/- standard deviation) for spheres and 1.6 mm+/-1.1 mm for arrow heads. If the ultrasound probe was directed more tangentially to the surface of the spheres the fusion became increasingly inaccurate (P<0.05). Fusion accuracy decreased the more distant the US probe was held to the object (P<0.05). Different depth of ultrasound display had no significant effect on fusion accuracy. CONCLUSIONS Highly accurate fusion of MR images and real-time ultrasonography could be achieved. However, careful interpretation of the fused data is necessary, when different angles and distances of the US probe to the object are concerned.
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Evaluation Study |
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Abstract
Lipomas are very common, but osseous changes within these tumours are rare. A lipoma with osseous components is presented, with an overview of the literature and pathogenesis of this unusual lesion and considerations relating to the differential diagnosis.
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Case Reports |
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Aebert H, Brawanski A, Philipp A, Behr R, Ullrich OW, Keyl C, Birnbaum DE. Deep hypothermia and circulatory arrest for surgery of complex intracranial aneurysms. Eur J Cardiothorac Surg 1998; 13:223-9. [PMID: 9628370 DOI: 10.1016/s1010-7940(98)00018-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Some intracranial aneurysms may not be operable by conventional neurosurgery due to their location or morphology. Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest renders surgery of these complex aneurysms possible. Brain temperatures can be measured directly in this setting. METHODS Eight patients with complex intracranial aneurysms were operated on with the aid of CPB. Femoro-femoral bypass with heparin-coated circuit components was used in all cases. Venous drainage was augmented by a centrifugal pump in six patients and by a newly developed vacuum technique in two patients. Temperatures were monitored by probes in brain, tympanum, nasopharynx, bladder, rectum, arterial and venous blood. These measurements were recorded on-line together with those of cerebral oxygen saturation, AP, CVP and PAP. Blood gas analyses and an EEG were also performed continuously. RESULTS Outcome was excellent in seven patients, in one patient moderate neurological disability occurred. Mean time on cardiopulmonary bypass was 160 (117-215) min, for cooling to a brain temperature of 18 degrees C 33 (20-47) min, and for total circulatory arrest 27 (15-45) min. Additionally, terminal brain arteries were clamped for up to 68 min in four patients. No cardiac complications were observed. Actual brain temperatures were best reflected by the tympanum probes (max. deviation 2 degrees C), whereas temperatures measured in bladder or rectum exhibited deviations of up to 10 degrees C. EEG activities were arrested between brain temperatures of 19 and 26 degrees C. CONCLUSIONS Complex intracranial aneurysms can be treated successfully using deep hypothermic circulatory arrest. Extensive monitoring adds to the speed and safety of the procedure. The resulting comparative measurements of temperatures at different body sites including brain, EEG, and other variables may be of general relevance for operations employing deep hypothermia and circulatory arrest.
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Holzschuh M, Woertgen C, Metz C, Brawanski A. Dynamic changes of cerebral oxygenation measured by brain tissue oxygen pressure and near infrared spectroscopy. Neurol Res 1997; 19:246-8. [PMID: 9192374 DOI: 10.1080/01616412.1997.11740807] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this study was to find out whether a correlation exists between changes in brain tissue oxygen pressure (ti-pO2) and hemoglobin oxygenation (HbO2) measured by near-infrared spectroscopy. We studied 10 patients with severe head injury. A ti-pO2 monitoring device was introduced in the frontal white matter as soon as possible after administration. Additionally a NIRS sensor was placed at the forehead. All data were recorded simultaneously. Changes of the ti-pO2 curve were defined as events with the following criteria: > 10% change from the baseline value, > 3 min duration, clearly not an artifact. 137 events were found with a mean change of ti-pO2 of 8.3 +/- 10.2 mmHg. In 77.4% we observed a corresponding change of the HbO2. In 7 patients we found a good correlation (r > 0.7) between change ti-pO2 and change HbO2. In 3 patients the correlation was poor. The reason for poor correlation might be poor signal quality of the NIRS sensor or inhomogenous distribution of ischemic areas in the whole brain. We conclude that under the condition of a stable NIRS signal and a diffuse brain lesion, changes of ti-pO2 are well reflected by NIRS.
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Krone A, Schaal KP, Brawanski A, Schuknecht B. Nocardial cerebral abscess cured with imipenem/amikacin and enucleation. Neurosurg Rev 1989; 12:333-40. [PMID: 2687724 DOI: 10.1007/bf01780852] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 72 year old female with cerebral abscess due to Nocardia farcinica is reported. Needle aspiration, antimicrobial therapy using a new combination of imipenem and amikacin, and, finally, surgical excision led to prompt and complete recovery. This is the oldest patient to survive cerebral nocardiosis reported in the literature. This infection, is usually regarded as opportunistic and is encountered with increasing frequency in immunocompromised conditions (organ transplantation, chemotherapy, underlying disabling disorder, acquired immunodeficiency syndrome, etc.). The literature is extensively reviewed for various aspects of this disease including prognostic factors, recent developments in antibiotic therapy (imipenem, amikacin, minocycline etc.) and the essential role of surgery in the treatment strategy.
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Case Reports |
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Rothoerl R, Woertgen C, Holzschuh M, Brehme K, Rüschoff J, Brawanski A. Macrophage tissue infiltration, clinical symptoms, and signs in patients with lumbar disc herniation. A clinicopathological study on 179 patients. Acta Neurochir (Wien) 1999; 140:1245-8. [PMID: 9932124 DOI: 10.1007/s007010050245] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is postulated that in addition to nerve-root compression, an inflammatory stimulus of the herniated lumbar disc is responsible for sciatic pain and radiculopathy. The clinical relevance of the histologically described inflammatory infiltrates is, however, not clearly defined [8, 22]. It was the aim of this study to assess the clinical relevance of inflammatory cells in herniated lumbar disc specimens. The presence of inflammatory cells was examined immunohistochemically in routinely processed resection specimens of the lumbar disc. The histological results were compared to prospectively obtained clinical data. Disc specimens of 179 patients who underwent surgery for lumbar disc herniation were studied immunohistologically. Preoperatively each patient received a visual analogue scale for classification of the pain level and general clinical data were recorded prospectively. Varying amounts of inflammatory cells could be demonstrated in the resected disc tissue. In the statistical workup no statistically significant correlation between the histological evidence of macrophage infiltrates and the pain grading scale or the clinical data could be found. In our study there is no statistically significant correlation between macrophage infiltrates in herniated lumbar disc specimen and the obtained clinical data.
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Comparative Study |
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Rothoerl RD, Woertgen C, Holzschuh M, Rueschoff J, Brawanski A. Is there a clinical correlate to the histologic evidence of inflammation in herniated lumbar disc tissue? Spine (Phila Pa 1976) 1998; 23:1197-200; discussion 1200-1. [PMID: 9636971 DOI: 10.1097/00007632-199806010-00002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN The presence of inflammatory cells was examined immunohistochemically in routinely processed resection specimens of the lumbar disc. The histologic results were compared with prospectively obtained clinical data. OBJECTIVES To assess the clinical relevance of inflammatory cells in herniated lumbar disc specimens. SUMMARY OF BACKGROUND DATA It is postulated that in addition to nerve root compression, an inflammatory stimulus of the herniated lumbar disc is responsible for sciatic pain and radiculopathy. However, the clinical relevance of the histologically described inflammatory infiltrates is not defined clearly. METHODS Disc specimens from 44 patients who underwent surgery for lumbar disc herniation were studied immunohistologically. Before surgery, severity of pain was classified in each patient according to a visual analog scale, and general clinical data were recorded prospectively. RESULTS Varying amounts of inflammatory cells could be demonstrated in the resected disc tissue. In the statistical analysis, no statistically significant correlation between the histologic evidence of macrophage infiltrates and the pain grading scale or the clinical data was noted. CONCLUSIONS There is no statistically significant correlation between macrophage infiltrates in herniated lumbar disc specimens and the obtained clinical data.
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Comparative Study |
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Rothoerl RD, Brawanski A, Woertgen C. S-100B protein serum levels after controlled cortical impact injury in the rat. Acta Neurochir (Wien) 2000; 142:199-203. [PMID: 10795895 DOI: 10.1007/s007010050024] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
S-100B is described to provide information about the severity of brain damage in man. Estimation of serum markers appears to be an easy method of obtaining information regarding severity and outcome after head injury. However less is known about the post traumatic time course of this protein in the serum. The aim of this study was to provide further information about the posttraumatic enzymekinetik. 65 male Wistar rats were subjected to severe cortical impact injury (100 PSI, 2 mm deformation). Blood samples were drawn directly after trauma, then after 1 h, 6 h, 12 h, 24 h, and 48 h. In sham operated animals blood samples were drawn directly after craniotomy, then after 6 h and after 48 h. Also compared were S-100B serum levels at different severities in 20 rats (45 PSI, 75 PSI; 2 mm deformity) after controlled cortical impact to sham operated animals. S-100B serum levels were estimated with a commercially available enzyme immuno-assay (DAKO). The mean serum level in the sham group was 0.38 microg/l. Serum levels at 100 PSI differed statistically significantly directly after trauma up to 24 h. The 48 h S-100B levels showed no significant difference in the sham group. Serum levels at different severities differed significantly from the sham group, but did not differ concerning level of severity. The controlled cortical impact model is able to produce a raised serum level of the S-100B protein for 24 hours. Different trauma severities were not reflected.
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Woertgen C, Rothoerl RD, Brawanski A. Neuron-specific enolase serum levels after controlled cortical impact injury in the rat. J Neurotrauma 2001; 18:569-73. [PMID: 11393260 DOI: 10.1089/089771501300227378] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to investigate the time course and the correlation of neuron-specific enolase (NSE) serum levels to the severity of traumatic brain injury in rats. Sixty-five male Wistar rats were subjected to severe cortical impact injury (100 PSI, 2 mm deformation). Blood samples were drawn directly after trauma and after 1, 6, 12, 24, and 48 h in the trauma group. In the sham operated levels animals samples were drawn directly after craniotomy and after 6 and 48 h. Additionally, NSE serum levels after controlled cortical impact at different levels of severity samples (45 PSI, 75 PSI; 2 mm deformity) were compared to sham-operated animals. The severity of the injury was not validated histopathologically. NSE serum levels were estimated with a commercially available enzyme immunoassay (LIA mat Sangtec). The control animals showed a NSE serum level of 8.82 microg/L (mean, n = 10) and the injured animals demonstrated a time-dependent release of NSE into the serum. The highest NSE serum values were detected 6 h after trauma (31.5 microg/L mean, n = 10). In addition, we found a close relationship between NSE serum levels and the severity of traumatic brain injury in the cortical impact model. NSE serum levels reflect in a time-dependent manner the severity of brain trauma induced by cortical impact model in rat.
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Woertgen C, Holzschuh M, Rothoerl RD, Brawanski A. Does the choice of outcome scale influence prognostic factors for lumbar disc surgery? A prospective, consecutive study of 121 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1997; 6:173-80. [PMID: 9258635 PMCID: PMC3454614 DOI: 10.1007/bf01301432] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
From January to June 1994, we operated conventionally on 121 consecutive hemiated lumbar disc patients as part of a prospective study. We analysed general data, case histories, neurological findings on admission and all data from imaging investigations and therapy. In addition, all patients received a questionnaire based on the Low Back Outcome Score. Most of the patients (93%) were followed-up for 1 year postoperatively in the same manner. On the Prolo Scale, we obtained a good result in 70%; 76% had a good Low Back Outcome Score. Predictive factors are different for different outcome scales. The preoperative duration of pain, the preoperative duration of paresis and smoking seem to be general predictive factors.
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Schlaier J, Schoedel P, Lange M, Winkler J, Warnat J, Dorenbeck U, Brawanski A. Reliability of atlas-derived coordinates in deep brain stimulation. Acta Neurochir (Wien) 2005; 147:1175-80; discussion 1180. [PMID: 16133776 DOI: 10.1007/s00701-005-0606-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Accepted: 06/28/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND In deep brain stimulation the way to define and localize the optimal target for the individual patient is still under debate. The objective of our study was to investigate the reliability of atlas derived data by comparing them with direct targeting on MR images. METHOD We investigated 28 STN targets in 14 volunteers. The stereotactic coordinates of the dorso-lateral subthalamic nucleus (STN), were determined in 5 different ways for both STNs of each individual volunteer: 1. directly, on axial T2WI spin echo slices, 2. directly, on coronal T2WI spin echo slices and after fusion of data sets: 3. indirectly, on an axial atlas plate, 4. indirectly, on a coronal atlas plate, 5. indirectly, 12 mm lateral, 3 mm posterior and 3 mm inferior to mid-AC-PC. FINDINGS The differences between MRI derived targets on axial vs. coronal slices were not statistically significant. After detection of the atlas derived targets the resulting x-coordinates were found more lateral than after direct detection on both, axial and coronal T2-weighted images (p < 0.001). On axial images y-coordinates were located more anterior (p = 0.240) on atlas derived targets and more posterior when target localizations were compared on coronal slices (p < 0.001). z-Coordinates were more superior after atlas targeting compared to MRI targeting (p < 0.001). Differences up to 6.21 mm occurred. CONCLUSIONS Despite the limitations concerning image distortions and slice thickness, direct target planning on MRI, regarding our results, is more reliable than targeting solely based on atlas derived data. Only MRI gives us detailed information about the individual configurations of central structures in every single patient. However, targets, which are not detectable on MRI like the nucleus ventralis intermedius have to be planned using stereotactic atlas information. In these cases intra-operative micro-electrode recording might help to better define the target region.
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Evaluation Study |
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Woertgen C, Rothoerl RD, Henkel J, Brawanski A. Long term outcome after cervical foraminotomy. J Clin Neurosci 2000; 7:312-5. [PMID: 10938608 DOI: 10.1054/jocn.1999.0669] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We recently demonstrated the effectiveness of dorsal foraminotomy in lateral herniated cervical disc after 1 year follow-up in a prospective study.(1) The goal of this paper is to confirm these results concerning long term outcome. We carried out a prospective, consecutive study on 54 patients, operated on for lateral herniated cervical disc. We analysed demographic data, the case history, the neurological examination on admission and imaging data. Ninety per cent were followed up for 3.5 years postoperatively. According to their ratings on a pain scale the group were divided into favourable and unfavourable outcomes. These groups were analysed in relation to the patient's initial condition. At follow up, 90% of patients showed complete recovery or improvement. A long standing preoperative neurological deficit seems to be an important prognostic factor for unfavourable long term outcome after cervical foraminotomy.
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