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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 2 (1998), S. S58 
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Schädelbasistumor ; Kraniofazialer Zugang ; Frontobasis ; Key words Skull-base tumor ; Craniofacial approach ; Anterior cranial base
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Most tumors of the anterior cranial base invade both the intra- and extracranial regions at the borderline of the cranial and facial skeleton. In surgical treatment of these lesions, combined craniofacial approaches are applied in accordance with the anatomical conditions. Surgery is performed by an interdisciplinary team of neurosurgeons and maxillofacial surgeons. To evaluate the effectiveness and the complications of this surgical concept, the data of 58 patients treated over a 10-year period were collected. In these patients, 60 operations were performed, including two operations for tumor recurrence. In 38 cases, complete tumor removal was achieved. One patient died in the early postoperative period because of pulmonary embolism. Significant neurological deficits occurred in three patients. In most cases, postoperative complications and functional disability were both due to intradural invasion of the tumor. Nevertheless, in the majority of the cases radical tumor removal is achieved with acceptable morbidity when microsurgical techniques are applied for the resection of the intradural tumor. Both the meticulous repair of dural defects and the reconstruction of the anterior cranial base and orbit contribute distinctly to a reduction in the rate of postoperative complications and to acceptable cosmetic results.
    Notes: Zusammenfassung Tumoren der frontalen Schädelbasis entwickeln sich im Grenzgebiet von Hirn- und Gesichtsschädel häufig mit einer Ausbreitung nach intra- und extrakranial. Bei der operativen Behandlung wird diesen anatomischen Gegebenheiten durch kombinierte kraniofaziale Zugangswege Rechnung getragen, die von einem interdisziplinären Operationsteam durchgeführt werden. Um die Effektivität und Komplikationen dieses Behandlungskonzepts zu überprüfen, wurden die Daten von 58 Patienten aus den letzten 10 Jahren zusammengestellt. Bei diesen Patienten wurden mit 2 Rezidiveingriffen 60 Operationen durchgeführt. Bei 38 Eingriffen gelang eine vollständige Tumorexstirpation. Durch eine Lungenembolie ereignete sich ein postoperativer Todesfall. Funktionell relevante neurologische Defizite traten bei 3 Patienten auf. Postoperative Komplikationen und funktionelle Beeinträchtigungen wurden v. a. durch eine intradurale Tumorinvasion verursacht. Mit der Anwendung mikrochirurgischer Operationstechniken bei der Resektion der intraduralen Tumoranteile läßt sich meist eine radikale Tumorexstirpation bei akzeptabler Morbidität erreichen. Rekonstruktive Maßnahmen bei Defekten im Bereich der Dura und des Knochens tragen entscheidend dazu bei, postoperative Komplikationen zu vermeiden und ein zufriedenstellendes kosmetisches Behandlungsergebnis zu erzielen.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. 245-248 
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Diagnose und Therapie von Erkrankungen der Schädelbasis ; Schädelbasischirurgie ; Interdisziplinäre Kooperation ; Keywords Diagnosis and treatment of skull base diseases ; Skull base surgery ; Interdisciplinary cooperation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: The treatment of complex tumorous, inflammatory, traumatic, vascular processes, or developmental disorders of the skull base increasingly needs the interdisciplinary cooperation of specialties involved in diagnostics or treatment. Due to this inevitable cooperation of different hospital specialties, institutionalization of skull base surgery, organized as a center or working group, seems recommendable. Moreover, such a center may have additional effects on the external representation of skull base surgery, which is also important. On the initiative of 11 departments and institutes of the university hospital of Leipzig, the Interdisciplinary Center of Skull Base Surgery (IZSL) was founded in March 1997. The following aims were proclaimed: improvement of the interdisciplinary clinical treatment of patients with skull base diseases, evaluation of the patient’s data, advancement of clinical and experimental research on the field of skull base surgery, as well as the organization of meetings for training and teaching and scientific meetings. Structure, concept, and first experiences of the interdisciplinary center of skull base surgery are discussed.
    Notes: Die Behandlung von komplexen tumorösen, entzündlichen, traumatischen, vaskulären Prozessen oder entwicklungsbedingten Störungen im Bereich der Schädelbasis erfordert in zunehmendem Maß die interdisziplinäre Zusammenarbeit der Fächer, die in dieser Region diagnostisch und therapeutisch tätig sind. Aufgrund dieser notwendigen Kooperation verschiedener Fachdisziplinen eines Klinikums erscheint die Institutionalisierung im Sinn einer Arbeitsgemeinschaft oder eines Zentrums sinnvoll, um so auf der Grundlage spezifischer Erfahrungen die bestmögliche Behandlung dieser Patienten zu ermöglichen. Darüber hinaus kann vom Aufbau eines solchen, als Gesamtheit auftretenden klinikgebundenen Zentrums für Schädelbasischirurgie auch eine nicht unwichtige Außenwirkung für die Vertretung dieser Disziplin erwartet werden. Auf Initiative von 11 Kliniken und Instituten erfolgte unter Federführung der ¶Kliniken für Neurochirurgie, Hals-Nasen-Ohren-Krankheiten sowie Mund-, Kiefer- und Plastische Gesichtschirurgie im März 1997 die Gründung des Interdisziplinären Zentrums für Schädelbasischirurgie der Universität Leipzig (IZSL). Folgende Ziele wurden definiert: Verbesserung der interdisziplinären klinischen Versorgung von Patienten mit Prozessen der Schädelbasis, eine begleitende wissenschaftliche Aufarbeitung und Auswertung des Patientenguts, die Förderung der klinischen und experimentellen Forschung auf dem Gebiet der Schädelbasischirurgie sowie die Durchführung von Ausbildungs- bzw. Fortbildungsveranstaltungen und wissenschaftlichen Tagungen. Aufbau, Konzept und erste Erfahrungen des Leipziger Zentrums für Schädelbasischirurgie werden dargestellt.
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  • 3
  • 4
    facet.materialart.
    Unknown
    Wiesbaden : Periodicals Archive Online (PAO)
    Geographische Zeitschrift. 77:1 (1989) 62 
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  • 5
    facet.materialart.
    Unknown
    Wiesbaden : Periodicals Archive Online (PAO)
    Geographische Zeitschrift. 77:1 (1989) 62 
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Neurosurgical review 23 (2000), S. 136-138 
    ISSN: 1437-2320
    Keywords: Key words Head injury ; Outcome ; S-100 protein
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The objective of our study was to investigate S-100B protein as a serum marker of brain cell damage after severe head injury. Eighty-three patients with severe head injury (Glasgow Coma Scale ≤8) were included in this prospective study. Venous blood samples for S-100B protein were taken after admission and every 24 h for a maximum of 10 consecutive days. Outcome was assessed at 6 months using the Glasgow Outcome Scale. In this study, we analysed the preliminary results from the outcomes of 25 patients at 6 months. Levels of S-100B were significantly higher in patients with unfavourable outcome compared to those with favourable outcome. In patients with favourable outcome, slightly increased initial levels of S-100B returned to normal within 3 to 4 days. In patients with unfavourable outcome, initial levels were markedly increased, with a tendency to decrease from day 1 to day 6. After day 6, there was a secondary increase in serum S-100B, indicating secondary brain cell damage. Our preliminary results suggest that serum S-100B protein might be a promising biochemical marker which may provide additional information on the extent of primary injury to the brain and the prediction of outcome after severe head injury.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 103 (1990), S. 5-10 
    ISSN: 0942-0940
    Keywords: Aneurysm rupture ; subarachnoid haemorrhage ; grade IV and V patients ; early aneurysm surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a retrospective study the clinical management of 74 patients with aneurysmal subarachnoid haemorrhage (SAH) admitted in grade IV and V Hunt and Hess was examined. 39 patients (53%) were admitted within 24 hours after SAH, 29 patients (39%) between 24 and 72 hours after SAH, and 6 patients 8%) later than this time interval. The ruptured aneurysms were located at the anterior communicating artery complex in 34 patients (46%), on the middle cerebral artery in 19 patients (26%), on the internal carotid artery in 12 patients (16%) and at the vertebro-basilar artery complex in 9 patients (12%). In 38 patients (51%) no surgical attack on the aneurysm was performed. 19 (50%) of these patients were in grade IV on admission and 19 (50%) in grade V. In 36 patients (49%) the aneurysm was clipped. Of these patients 29 (81%) were in grade IV and 7 (19%) in grade V. Of the 38 patients in whom no aneurysm surgery was done, 37 patients died, representing a mortality rate of 97%, one patient survived in grade III Glasgow Outcome Scale (GOS). Concerning the outcome in those patients with aneurysm clipping, of 19 patients in grade IV operated on early, 10 patients (53%) made a good recovery, 3 (16%) were left severely disabled and 6 patients (31%) remained in a vegetative state or died. Of the 10 patients in grade IV with delayed surgery 4 (40%) were in grade I and II postoperatively, 2 (20%) in grade III, and again 4 (40%) in grade IV and V GOS. None of the 4 patients in Hunt and Hess grade V in whom early surgery was done achieved a good postoperative outcome. 2 patients survived in grade III GOS, and another 2 patients died. Only three patients admitted in grade V survived long enough to be subjected to delayed surgery. Of these patients one survived without deficit, one survived severely disabled and one patient died. From the data presented the following conclusions are drawn: 1. Without surgery the chance of survival in poor-grade aneurysm patients is almost non existent 2. Patients admitted in grade V have a uniformly poor prognosis with a very high mortality whether surgery is done or not, and whether surgery is performed early or late. 3. Patients in grade IV represent a distinct group with a better prognosis than those in grade V, justifying an aggressive surgical management. 4. Early surgery in grade IV patients leads to better results than delayed surgery especially in terms of overall management morbidity and mortality. 5. In order to further improve the results of management of poor-grade aneurysm patients early referral to neurosurgical centres is mandatory.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 109 (1991), S. 20-25 
    ISSN: 0942-0940
    Keywords: Cranio-cervical instability ; cranio-cervical fusion ; rheumatoid arthritis ; spinal tumours ; spinal fusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Cranio-cervical stabilization using preformed Luque rectangles supplemented by autologous bone grafts was performed in 18 patients. Stability at the cranio-cervical junction had been impaired by a number of diseases including rheumatoid arthritis in 12 patients, metastatic tumour in 5 patients and post-operative swan neck deformity in one patient. In all patients immediate stabilization as well as long-term bony fusion could be achieved, paralleled by improvement of the preoperative neurological condition in differing degrees. Surgery related complications were rare, although, considering the patient population treated, medical and anaesthesiolgical complications as a result of accompanying diseases may pose serious problems. The technical details of the surgical procedure are discribed and its application for the treatment of cranio-cervical instability is discussed.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 114 (1992), S. 139-144 
    ISSN: 0942-0940
    Keywords: Skull base surgery ; skull base tumours ; microneurosurgery ; surgical approaches
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Neoplasms located along the antero-lateral skull base, with probable involvement of the orbit and with extension into the pterygoid and/or infratemporal fossa can usually not be sufficiently exposed using standard neurosurgical or otosurgical approaches, which is why combined approaches to these skull base targets have been developed in the recent past. In this report we describe our experience, using a combined orbito-frontal, sub- and infratemporal fossa approach which, starting with a pre-auricular incision and a standard pterional craniotomy, is extended to an extensive osteoplastic enbloc resection of the orbito-zygomatic area allowing for direct visualisation of the antero-temporo-lateral skull base from the orbital cavity to the depth of the infratemporal and pterygoid fossa. The surgical technique as well as the clinical experiences accumulated with this approach are described.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 115 (1992), S. 47-52 
    ISSN: 0942-0940
    Keywords: Intracranial pressure ; subarachnoid haemorrhage ; cerebral blood flow ; Cushing response
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The relationships of intracranial pressure (ICP), systemic blood pressure (SBP) and cerebral blood flow (CBF) during experimental subarachnoid haemorrhage were investigated in cats. Continuous monitoring of regional cerebral blood flow (rCBF) was done by a thermal diffusion method using a Peltier stack. During haemorrhage ICP rose within 5.4±0.97 minutes from 10.5±4.9 to 176.1±27.8 mmHg. This strong increase of ICP resulted in a temporary arrest of cerebral circulation. The Cushing response during the haemorrhage could not improve the cerebral circulation, but in contrast caused a further increase of ICP. After the haemorrhage the cerebral blood flow normalised within minutes. It is concluded, that the Cushing response during a subarachnoid haemorrhage should be regarded as a deleterious rather than a beneficial mechanism.
    Type of Medium: Electronic Resource
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