Intracranial Aneurysms and Vascular Malformations: Diagnosis for Therapy. A Long-Term Study at a Central Hospital. A Neuroradiological Approach. Part II: 2000-2008. The Time of the Beginning with Newer Diagnostic Developments in CT, MR, DSA for Endovascular Intervention, Microneurosurgery, Radiotherapy.

In the second part of our overviewstudy the diagnosis for the treatment of our patients with intracranial vascular malformations (aneurysms / AVMF - arteriovenous malformations) is again shown in a region of about 500.000 inhabitants and just an overview of the outcome. This second part will be an overall comparison between the former diagnostic for the treatment and the here described diagnostic for the treatment (CTA, MRA, DSA rot / microsurgery, endovascular interventional techniques etc.), concerning also the topography and the demography. The future trends are also outlined.

Intracranial Aneurysms and Vascular Malformations: Diagnosis and Therapy. A Long-Term Study at a Central Hospital. Part I: 1972-1997. The Time before Endovascular Intervention, Microneurosurgery and Radiotherapy.

The first part of our study describes the treatment of our patients with intracranial vascular malformations (aneurysms/AVMF - arteriovenous malformations) in a region of about 500,000 inhabitants. The second part will compare currrent treatment and the changes in treatment (microsurgery, endovascular interventional techniques, etc.) also in relation to topography and demography.

[Examples of controlled use of computerized tomography in soft tissue injuries of the area of the head and neck]. / Beispiele zum gezielten Gebrauch der Computertomographie bei Weichteilverletzungen im Kopf-Hals-Schulterbereich.

CT can be utilised in a selective manner in soft tissue injuries presented in the head, neck and shoulder regions.

[Spinal subdural space-occupying lesions--hematomas]. / Spinale subdurale Raumforderungen--Hämatome.

The rare spinal subdural masses, usually haematomas, are described in 5 patients and the importance of ascending myelography in addition to computed tomography in radiological diagnosis is emphasised.

[Radiation dosage and clinical value of conventional tomography and high resolution computerized tomography of the nose and ear]. / Dosisbelastung und klinische Wertigkeit bei konventioneller Tomographie und HR-Computertomographie der Rhino-und Otobasis.

Hypocycloidal (frontal and temporal) tomography of the base of the skull is compared with high resolution computed tomography (HR-CT) with respect to dose and clinical usefulness. In most cases HR-CT is indicated because of its better density resolution in comparison with conventional hypocycloidal tomography. As the X-ray beam is directed at the slice plane the dosage is noticeably less than when using conventional tomography. Slice thickness depends on the required geometric resolution. This is an additional factor in radiation protection.

[Computed tomography and the clinical picture of suicidal CO poisoning]. / Computertomographie und Klinik bei suizidalen CO-Vergiftungen.

Cranial CT is important to exclude the presence of a mass in the cavum cranii in case of an unclear suicide attempt, particularly a traumatic mass. It can be helpful also in cases of carbon monoxide intoxications.

[Synopsis of a standardized, schematic analysis of the ossicles and tympanic walls, visualized with high-resolution computed tomography (using help lines and pictograms)]. / Synopsis einer standardisierten, schematischen Analyse der Ossikula und der Tympanonwände, dargestellt mit der hochauflösenden Computertomographie (unter Anwendung von Hilfslinien und Piktogrammen).

As in other radiological examinations there is an essay to show the ossicles and their surrounding tympanic walls of the petrous bone in the high resolution computed tomography. This should be standardized to simplify the interpretation and to allow the comparison. For the axial imaging of the ossicles corresponding to their particular topographic situation the head is tilted to the non-examined side and a little bit dorsally flected to turn especially the stapes in the scanning plane and to image the malleus and incus axially. The standard slices of the tympanon were schematized with the help of pictogramms. This allows a faster orientation and an easier recognition of a changed topographical situation meaning a pathological condition. The coronary view is as the important second part of the HR CT of the petrous bone integrated.

[Dislocations and fractures of the ossicles--high resolution computerized tomography of the petrous bone]. / Dislokationen und Frakturen der Ossikula--HR Pyramiden Computertomographie.

As in traumatology of the head the HR-CT of the injured petrous bone is now the imaging method of choice. With axial and coronary slices one can show not only the different parts of the ear but also the course of the facial nerve and particularly the ossicles in the tympanon. The fractures are nice to show, also the soft tissue lesions like brainprolaps in the tympanon or hematotympanon because of the better density resolution in comparison to the conventional tomography with rather higher radiation dose especially for the eye lenses. Important are the slice thickness of 1.5 mm with special examination technique, that also small fractures of the pyramid particularly the labyrinthous organ and of the ossicles mostly associated with dislocations are detectable. Regarding that with the clinical possibilities there are particular consequences for the otosurgeon. The ossicular dislocations of other than traumatic cause are rare.

[Excluding a recurrence of cholesteatoma using high resolution computerized tomography. Can one dispense with the second-look operation?]. / Ausschluss eines Cholesteatomrezidives mittels HR-Computertomographie. Kann man auf den "Second-Look" verzichten?

In a prospective study 20 patients were examined by high-resolution computed tomography of the temporal bone (HR-CT) before an early or late second-look operation. One year earlier 8 of the patients had undergone a posterior tympanotomy ("intact canal wall" technique) for a cholesteatoma and if necessary a one-stage ossicular reconstruction. In 4 other patients a two-stage ossicular reconstruction was carried out. In the remaining 8 patients a one stage operation had been carried out several years before. After a cholesteatoma operation three typical X-ray findings can be observed in HR-CT: 1. Normal findings (no granulation tissue in the middle ear space, antrum or mastoid) 2. Granulation tissue without destruction 3. Cholesteatoma recurrence (homogeneous soft tissue mass with bony destruction) Based on previous experience we forego an early second-look 1 year later and suggest the following plan: 1. Providing the post-operative follow up proves normal, a HR-CT examination is carried out 2 years, after a cholesteatoma operation. 1.1 If the HR-CT, the clinical and audiological examinations are normal a HR-CT investigation is necessary a further 2 years later. 1.2 In the case of granulation tissue a further HR-CT must be carried out 1 year later. Should the granulations become progressively worse a second-look is mandatory. 1.3 Homogeneous soft tissue mass and destruction are signs of cholesteatoma recurrence. Immediate operation is necessary. 2. If audiological or clinical findings suggest a recurrent cholesteatoma within the first 2 years after the operation, HR-CT should be carried out at once.(ABSTRACT TRUNCATED AT 250 WORDS)

[Differential diagnosis of hyperdense space-occupying lesions of the cerebral hemisphere in computerized tomography]. / Differentialdiagnose von hyperdensen Raumforderungen im Bereich der Grosshirnhemisphäre in der Computertomographie.

A CT survey of the most frequently encountered hyperdense space-occupying lesions in the region of the cerebral hemispheres. Description of differential diagnostic deliberations.

[Identification of middle ear implants in high-resolution computerized tomography]. / Zur Identifikation von Mittelohrimplantaten in der HR-Computer-tomographie.

As a result of the increase in the use of computed tomography and the possibility of demonstrating very small structures, x-ray diagnosis is becoming more and more important in investigating complications after examined in patients as well as cadaver temporal bones by using high resolution middle ear computed tomography: 1. autologous/allogenic ossicular implants, 2. alloplastic implants made of ceramic, plastic or metal. As can be seen from our investigations the homografts and some of the implants are easily identifiable (autologous/allogenic ossicular implants, Ceravital and Frialit PORP/TORP and metal devices), are only partly identifiable (Fisch-Tef Platinum and Stainless Steel as well as Titan stapes pistons), hardly or not at all identifiable (PORP/TORP and stapes pistons made of plastic, e.g. teflon, silicone, plasti-pore). The same applies to ventilating tubes. Thus the position in the middle ear of metal tubes which have slipped can be seen clearly, whereas plastic tubes cannot be seen so well. It is of clinical importance that prosthesis dislocation is visible in CT so that should complications occur it is better possible to determine whether revision surgery is necessary. As, however, identification of various devices in CT is still not satisfactory, the manufactures must soon fulfil our demands for a contrast agent to be added to prosthesis.

Evaluation of the carotid bifurcation by duplex ultrasound, intravenous and intra-arterial digital subtraction angiography.

In 167 patients with cerebrovascular disorders 323 carotid bifurcations were investigated by Duplex ultrasound. In 100 of these patients, additionally intravenous digital subtraction angiography (DSA) was performed and in 35 patients, also intra-arterial DSA was carried out. In 32 patients all three procedures were performed. Comparing the results of Duplex scan and intravenous DSA with intra-arterial DSA it can be concluded that Duplex scan and intravenous DSA are comparable as screening methods for the evaluation of haemodynamically relevant stenoses and occlusions in extracranial artery disease. However, for the evaluation of stenotic vessels of less than 50% lumen reduction the Duplex scan showed a higher agreement rate with a contingency coefficient of 0.957 in comparison to intravenous DSA with a contingency coefficient of 0.903.

[Dosage load and value of cranial angiography. A digital intravenous/intra-arterial camera (105 mm) and imaging plates]. / Dosisbelastung und Wertigkeit bei der kranialen Angiographie. Digital i. v., i. a., Kamera (105 mm) und Imaging-Plates.

The integral dose and the dose to the organ at risk were calculated using the following angiographic techniques: 1. Intravenous DSA in the neck, 2. Intravenous DSA in the skull, 3. Intra-arterial DSA in the skull in searching for an aneurysm. This was compared with 4. 105 mm. camera technique and 5. An imaging plate technique. These methods have been compared with reference to dose and diagnostic value. Desirable developments for angiography in the future are discussed.

[The eustachian tube in HR computerized tomography. Imaging in the fetus, newborn infant and infant]. / Die Eustachische Röhre in der HR-Computertomographie. Darstellung beim Fetus, Neugeborenen und Säugling.

The lumen of the eustachian tube in foetuses, neonates and infants was demonstrated in cadaver temporal bones immediately after death by air and contrast medium using high-resolution computed tomography with axial and coronal projections. Special consideration was given to the deviation of the tube from the sagittal and horizontal plane and the functional unit consisting of the processes of tensor palatini muscle. At this stage of development the lumen of the cartilaginous portion shows a constant almost circular form, quite unlike the shape in adults. A well developed isthmus between the bony and cartilaginous part is absent. In a 6-month-old foetus the tube is horizontal to the base of the skull, whereas in a 6-month-old infant it forms an angle of approximately 10 degrees. The angle to the sagittal plane changes in the same period from approximately 37 degrees to 40 degrees. In a 6-month-old foetus the fibres of the tensor palatini muscle also run in an almost horizontal line because of the tiny processus pterygoideus and are forced into a steeper direction as a result of its gradual growth. As there is almost no fulcrum function, a tubal opening effect or mechanism of the muscle fibres at this stage of development seems extremely doubtful.

[The Eustachian tube in HR computerized tomography. Imaging in the adult]. / Die Eustachische Röhre in der HR-Computertomographie. Darstellung beim Erwachsenen.

Until now the lumen of the Eustachian tube (ET) has always been shown by using histological sections of temporal bones, which were after decalcification embedded in paraffin blocks and serially sectioned. In order to avoid changes caused by this preparations, we applied contrast medium or air to the lumen of the ET of cadaver temporal bones resected immediately after exitus. It was therefore possible to demonstrate the lumen of the tube in high resolution computed tomography. In this way we could find clear variations of the lumen in the total length of the ET and divide it into five different topographically specific regions. Whereas the pars ossea is formed by certain bone formations and structures in various ways, the picture of the cartilaginous portion remains the same: At the connection of the pars ossea to the isthmus the lumen shows an almost circular form which becomes oval towards the end of the isthmus. This can also be found in the preisthmus portion. In the intermediate section the oval shape is interrupted and replaced by a double curve in the form of a reverse "S". We find once again in the pharyngeal section a well-formed oval lumen, which however is more pronounced than in the preisthmus portion. The intermediate section with its double curve is defined by us beside the isthmus region, as a further, second physiological isthmus in the course of the ET. Apart from that the demonstration of the lumen, that of the function unit of the tensor palatine muscle, processus pterygoideus and hamulus is also of special interest.(ABSTRACT TRUNCATED AT 250 WORDS)

[Goldenhar syndrome and other ear abnormalities in HR-PCT]. / Goldenhar-Syndrom und andere Ohrmissbildungen im HR-PCT.

The use of CT in hospitals in which also ENT departments are located will be useful in cases of osseous congenital disorders of the ear. In combination with the clinical and audiometric investigations CT of the temporal bone will be helpful for the indication of the operations to ameliorate the hearing.

[High-resolution computed tomography in stapes surgery]. / Die hochauflösende Mittelohr-Computertomographie in der Stapes-Chirurgie.

Early and delayed complications in the inner or middle ear may follow stapedectomy or stapedotomy and may require revision surgery. Nowadays high resolution middle ear computed tomography (HR-MCT) using a special interpolation technique can demonstrate the smallest structures of the middle ear space, such as the long process of the incus and stapes. Stapes prostheses can also be seen in this way, but to identify the prothesis exactly it is necessary to determine the position of the piston hook in relation to the incus and of the piston shaft to the foot plate and scala vestibuli. Two points were of particular interest to us: HR-MCT identification of various metal and plastic pistons. Clinical significance of HR-MCT in complications following surgery. As the result of our experimental research on cadaver temporal bones, pistons must still be divided into four groups based on their demonstration by HR-MCT: Group I (e.g. Stainless Steel Cup Piston): whole piston visible. Group II (e.g. McGee Stainless Steel Piston): only piston shaft. Group III (Fisch Teflon-Platinum Piston): only hook visible. Group IV (e.g. Fisch Teflon-Wire Piston): piston hardly visible or not at all. In groups I-III it is possible to discover whether the piston is too long or too short, whether it is dislocated or has slipped. Group IV pistons, hooks from group II and the shaft from group III must be changed to allow detection by x-rays. With plastic pistons it might be possible to add an x-ray agent.2+ improvements in manufacture appear to be necessary, dislocation of various prostheses can now be shown.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and computerized tomography findings in Bourneville-Pringle phakomatosis]. / Klinik und computertomographische Befunde bei der Phakomatose Bourneville-Pringle.

The various clinical patterns of Bourneville's disease and/or Pringle's disease (pharkomatosis, or tuberous sclerosis combined with adenoma sebaceum) are described and compared with CT morphology of the neurocranium.