[Spinal meningioma]. / Das spinale Meningiom.

The report contains an evaluation of the results obtained from the clinical examinations of 173 patients with surgically treated spinal meningiomas at the Leipzig Neurosurgical Clinic in the years 1953 to 1985. Particular attention is given to the case history, the initial symptoms, findings at the patient's admission to the clinic, instrumental findings, location, and many other factors. Our own results are compared as far as possible with the respective statements in the international literature. The distribution of the blood groups of the respective patients are also taken into consideration. Particularly noteworthy is the internationally confirmed long period of time between the appearance of the first symptoms and the surgical exposure, a period that should in any case be cut down, in order to ensure a positive use of modern instrumental methods in diagnostics and therapy.

[Neuropsychiatric-psychological findings in patients with hypophyseal adenoma following trans-sphenoidal surgery]. / Neuropsychiatrisch-psychologische Befunde bei transsphenoidal operierten Hypophysenadenom-Patienten.

Investigations carried out by Schuster, Bleuler, Fischer et al. pointed out the importance of the endocrine functions with respect to the psychopathological phenomena. On the basis of 98 catamnestically observed pituitary patients operated on transphenoidally observed pituitary patients operated on transphenoidally at our hospital in the years 1978 to 1987 we wanted to obtain the pre- and postoperative psychic findings by clinical-explorative and neuropsychological investigations and point out the importance of these disturbances.

[Neuropsychiatric-ophthalmologic and radiologic findings in sphenoid wing meningioma]. / Neuropsychiatrisch-ophthalmologische und radiologische Befunde beim Keilbeinflügel-Meningeom.

On the basis of 90 catamnestically pursued disease courses of surgically treated sphenoid bone wing meningioma of the years 1970 to 1987 the validity of the clinical-neuropsychiatric and neuro-ophthalmological examinations as well as the information value of the native X-ray pictures were ascertained. The aim of the work was to point out the possibility and necessity of an early clinical diagnosis by an intensified observation of the neuro-ophthalmological and neuro-psychiatric primary symptoms.

[Transverse syndrome in aneurysmal bone cyst]. / Querschnittssyndrom bei aneurysmatischer Knochenzyste.

Among the patients of the Hospital for Neurosurgery in Leipzig treated in the period from 1952 to 1986 66 per cent of 570 patients operated on because of spinal cord tumours showed a benign and 34 per cent a malignant nature of the tumours. The rate of primary bone tumours amounted to 6.5 per cent and that of secondary bone tumours was 5.8 per cent. The preoperative diagnostical and the differential-diagnostical as well as therapeutical problems were dealt with on the basis of the only case of an aneurysmal bone cyst.

[Results of surgical treatment of malignant brain tumors]. / Zu den Resultaten der chirurgischen Behandlung maligner Hirntumoren.

Although surgical treatment seldom cures any malignant brain tumours, it remains the basis of the management of these tumours. Studies by others and our own statistical studies demonstrate the absence of any real or significant improvement in survival time for most of the patients. Hence we must await progress in other oncological disciplines to provide a solution.

[Long-term behavior of ventricular fluid pressure in automatically controlled infusion therapy with sorbitol and relation to clinical and paraclinical parameters]. / Das Langzeitverhalten der VFP (ventricular fluid pressure) unter der automatisch gesteuerten Infusionstherapie mit Sorbitol und Relationen zu klinischen und paraklinischen Parametern.

104 patients of our clinic suffering from intra-cranial space-occupying cerebral processes were treated in the postoperative phase with a cerebral-pressure dependent automatic system for the control of the sorbitol infusion. On the one hand we compared the resulting long-term pressure behaviour of the VFP (ventricular fluid pressure) with clinical and paraclinical parameters and, on the other, with the consumed sorbitol dose. In this procedure advantages of the automatically dehydrating cerebral oedema therapy could be proved. Moreover, it was possible to find clear relations between the pre-operative general changes in the EEG, the degree of the cerebral oedema in the CT, pre-operatively diagnosed choked papillas and the osmotherapeutical expenditure in the postoperative phase.

[Neuroradiologic findings in tumors of ventricles I-III]. / Neuroradiologische Befunde bei Tumoren der Ventrikel I-III.

In the period from 1953-1983, apart from the computer tomography the following neurodiagnostic methods were employed for the diagnosis of ventricular tumours: native radiography of the skull, PEG, ventriculography, positive ventriculography, angiography and cerebral scintigraphy. This study shows that a clear change in the importance of the various methods has taken place in the above mentioned period of time. The X-ray pictures of the skull taken without a contrast medium have become less important in the last few years although they showed direct and indirect signs of the tumours in almost all ventricular tumours. The former paramount importance of the presentation of the tumours with negative or positive contrast media has decreased considerably. From 1980, for example, practically no pneumo-encephalograms and no air ventriculography have been carried out. The unreliable filling in PEG and the considerable stress for the patients, especially in classic ventriculography, and thus the relatively high rate of wrong diagnoses are the reasons for this change. Only the direct positive representation of the third ventricle, e.g. in case of pinealoma, are still attached the same importance as computer tomography. Carotid angiography which shows almost every ventricular tumour in our patients and can yield information about the vascular supply, has maintained its importance in the neuroradiological scheme of diagnostics.

[Processes of ventricles I-III. Review of the patient population of the Neurosurgery Clinic of the Karl Marx University 1953-1983]. / Prozesse der Ventrikel I-III. Ubersicht des Patientengutes der Neurochirurgischen Klinik der Karl-Marx-Universität 1953-1983.

Within three decades 254 patients with processes of the brain ventricles I-III have been treated at the Leipzig Neurosurgical Clinic. The article subdivides the patients in general and according to the histology, localisation, lateral differences, dignity, operability as well as the postoperative lethality. The evaluation gives many clues with respect to the diagnostics and therapy of these ventricular processes. Today, the improvements obtained by computer tomography and by microsurgery are well the to fore.

[Computer tomography of tumors of the lateral and 3d ventricle]. / Zur Computertomographie bei Tumoren der Seitenund des 3. Ventrikels.

In the diagnosis of tumours of the supratentorial ventricles, CT leaves some questions unanswered. This is true of the differential-diagnostic demarkation and the determination of the initial site of the tumour. Frequently, ventriculography cannot be renounced for an additional clearing-up of the last mentioned question.

[Experiences with the Janetta operation in patients with trigeminal neuralgia]. / Erfahrungen mit der Janetta-Operation bei Patienten mit Trigeminusneuralgie.

From a small group of 20 patients treated by us those 13 patients were selected for whom the permanent therapy results could be assessed with a certain reliability. This procedure made the value of a precise establishment of the case history with respect to the possibility of a trigeminal root alteration evident. Only in one operation there was no relation between trigeminal root and vessels, but there was a concomitant arachnoiditis. In 12 cases the immediate effect of the operation was excellent to good, and although the permanent effect reduced these figures after one year, it was still higher than that obtained by other methods. The absence of an additional damage of the nerve and/or the surrounding brain should be pointed out. Thus the Janetta method became the operation technique of first choice provided there are the general physical pre-requisites to an exposure of the cerebellopontile angle.

[Operative treatment of tumors of ventricles I-III following experiences 1953-1983]. / Die operative Behandlung von Tumoren der Ventrikel I-III nach Erfahrungen aus den Jahren 1953-1983.

A report is given on the experience gained in 254 patients presenting processes of the ventricles I-III at the Leipzig Hospital within a period of thirty years. The rate of radical operations rose from 29% to 60%. At present, however, inoperability is restricted almost exclusively to general surgical aspects. Palliative operations are carried out in the form of the V-A shunts. Of decisive importance is the use of microtechniques in conjunction with an optimum anesthesia and intensive care. The accesses used are shown in pictures. Special surgical aspects are benignity of many intraventricular tumours, pronounced vascularisation, localisation below functionally important corticocerebral regions as well as exact considerations with respect to the planning of the operation pathway.

[Meningioma of the posterior cranial fossa]. / Meningiome der hinteren Schädelgrube.

Within 30 years a total of 60 patients with infratentorial meningiomas have been treated at the Leipzig Neurosurgical clinic: Tentorium 9, cerebellopontine angle 27, Foramen magnum 10, cerebellar hemisphere 13, clivus 1. Case history, clinical data, instrumental diagnostics and change in the therapy are broken down. Present focal points are computer tomography and microsurgery. Both principles have led to a fundamental improvement of morbidity and lethality of these tumour diseases. This tendency has been corroborated by comparisons with the international literature. The individual problems that are dealt with are computer tomography, microtechniques, acusticus and facial nerve functions, vascularisation of the tumours, dural occlusion, the access pathways and the possible postoperative complications.

[Differential diagnosis of an intracranial tumor and aneurysm of cerebral vessels. Diagnostic value of angiography and computer tomography]. / Zur Differentialdiagnose zwischen intrakraniellem Tumor und Hirngefässaneurysma. Diagnostischer Stellenwert von Angiographie und Computertomographie.

On the basis of two patients with oversize aneurysms of the cerebral vessels , which in the preceding computer tomography had led to the diagnosis 'cerebral tumour' because of their localisation, size and enhancement tendency, the importance of cerebral angiography within modern diagnostics is discussed.

[Tumors of the 4th ventricle and the craniospinal transitional zone. Review of patients of the Neurosurgical Clinic of the Department of Medicine of the Karl Marx University]. / Tumoren des 4. Ventrikels und des kraniospinalen Uberganges--Ubersicht des Patientengutes der Neurochirurgischen Klinik des Bereichs Medizin der Karl-Marx-Universität.

From a total of 1,028 infratentorial tumours operated on at the Neurosurgical Hospital of the Section Medicine of the Karl-Marx University Leipzig in the last 30 years, 167 tumours in the region of the 4th ventrical have been selected. Their statistical processing was carried out with respect to specific localisation, average age, kind of tumour, sex, clinical findings, duration of case history, application of instrumental diagnostic procedures and radicality of operation, success and failure. Some fundamental conclussions are drawn. A subdivision in detail will be contained in the following articles based on this material.

[Special diagnostic and surgical problems in tumors of the 4th ventricle in adulthood]. / Spezielle diagnostische und operative Probleme bei Tumoren des 4. Ventrikels im Erwachsenenalter.

Within 30 years, 1028 operations because of cerebellar tumours have been carried out at the Neurosurgical University Hospital in Leipzig. Of these, 167 were related to tumours within the 4th ventricle or encroaching a little outside of it. In the group of the adults (from the 18th year), 54 observations were made. These patients are subdivided according to histology (ependymomas in the first place), according to clinical findings (high values of cerebral pressure symptoms), according to the duration of the case history in dependence upon histology (long duration of angioblastomas and ependymomas), according to the possibilities of radicality (somewhat below the values in child age), the condition at discharge (better than in child age) and the cause of death (absolute predominance of central causes). A comparison is made with the results obtained with the studied patients in child age. Subsequently, the operation tactics of the Leipzig hospital is dealt with and the respective value of microneurosurgery carried out 10 years before is emphasised. A striking improvement for benign tumours can now only be achieved by a considerably improved early diagnosis.

[Special problems in the diagnosis and therapy of craniospinal tumors]. / Zu einigen speziellen Problemen bei der Diagnostik und Therapie der kraniospinalen Tumoren.

Tumours in the region of the Foramen magnum are rare (34 cases among more than 1000 infratentorial and 400 spinal tumours). The clinical symptoms can be guiding but they sometimes involve differential-diagnostic difficulties. In dependence upon the starting point and the direction of the development, cerebellar signs or transverse paralysis in the cervical region of the medulla are in the fore. In most cases, supplementary examinations are indispensable (X-ray examinations of the skull and the cervical vertebral column, ventriculography and CT). Angiography is of lesser importance. The anatomical relations of the tumour to its environment not only form the clinical picture, but also bring about therapeutical problems. The use of microsurgical methods has improved the prognosis a little, but nevertheless these disease pictures should be considered to be very serious.

[Special diagnostic and surgical problems in tumors of the 4th ventricle in childhood]. / Spezielle diagnostische und operative Probleme bei Tumoren des 4. Ventrikels im Kindesalter.

A report is given on 113 tumours of the 4th ventricle in children (up to the age of 18 years) observed among a total of 1028 cerebellar operations. Of these, 87 (= 77%) tumours were exclusively tumours of the 4th ventricle, in 26 cases the tumour also encroached on adjacent structures (cerebellar hemisphere and vermis, pons and Medulla oblongata). Medulloblastomas were predominant (55%), they mainly occurred in school age. Leading clinical symptom of the tumours of the 4th ventricle - especially in child age - is the increase in intracranial pressure which can often be demonstrated radiologically in this age group. Besides there are coordination disturbances and disturbances of the cerebral nerves; relatively frequently one sees a "vermis syndrome". The initial symptoms, which are in most cases non-characteristic (nausea, headache, also ataxia), are more often than not misinterpreted. Surgically treatment aims at a radical removal of the tumour whenever of possible, which is frequently problematic in children, and the restoration of the pathways the cerebrospinal fluid. Microsurgical techniques clearly contributed to a decrease in the mortality rate which, however, still is very high. This stresses the importance of an improvement of early recognition of these tumours.

[Tumors of the 4th ventricle and the craniospinal transitional zone in the computer tomogram]. / Tumoren des 4. Ventrikels und kraniospinalen Uberganges im Computertomogramm.

Among 5000 computer-tomographic examinations of the brain, there were only 82 tumours located in the 4th ventricle and spinal space. The method is of value for the indication of the localisation and extension of the tumours. The relation of tumours to the rhomboid fossa cannot always be clearly recognised. In spite of good indications in case of some tumours, this method cannot replace the histological method. It contributed only little to the early diagnosis in the series of examinations; the majority of the tumours had a volume of 30 ml. This is due to the fact that characteristic clinical symptoms occur late.

[Interdisciplinary connections of neurosurgery in the past, present and future]. / Die interdisziplinären Verbindungen der Neurochirurgie in Vergangenheit, Gegenwart und Zukunft.

Giving examples derived from history, the development and the present level of neurosurgery as an expression of the close interdisciplinary co-operation are dealt with. Neurosurgery has shown to be useful in our days and will continue to do so the future as a link between the great number of medical and non-medical disciplines; it has integrative functions, the roots of which frequently reach back to the beginnings of the disciplines, and these functions call for a constant further maintenance of the interests of the people concerned reaching far beyond their own fields. In this way, the neurosurgeon can avoid to become only a marginal figure in the sense of the surgical assistant of other medical disciplines. Being conscious of the history of one's own field often gives surprisingly important information about one's future development and permits an analysis of one's daily work.