[Revision of the medical malpractice law? Need for action and reform from the viewpoint of the physician]. / Novellierung des Arztstrafrechts? Handlungs- bzw. Reformbedarf aus Sicht des Arztes.

With regard to the revision of the criminal code, the BJM has suggested two regulations concerning the lawsuit of medical malpractice. The text expounds the contence of section 229 E (wrongful treatment, personal injury) and section 230 E (unwillful negligence). It appears disturbing that constitutes for wrongful treatment in the context of assault upon the patient have been included in criminal law so the offence is now rated at the same level as (grievous) personal injury. The aim of the revision being further protection of personal rights and the right of self-determination. The proposed section 229 E and section 230 E are not able to guard the clinician against allegations of assault under criminal law prosecution. The code of civil law should suffice to balance most conditions of malpractice and assault upon the patient. Prosecution by criminal code should be held back for willful offences and wanton or reckless negligence.

[Fritz König (1866-1952), pioneer of modern neurosurgery in Germany]. / Fritz König (1866-1952), der Wegbereiter der modernen Neurochirurgie in Deutschland.

Till the thirties of our century surgery of the brain tumors in Germany was depressing. It's entirely the credit of Fritz König (Würzburg) having caused decisive change of the situation. He enabled his assistant Wilhelm Tönnis to be trained by Herbert Olivecrona in his Department of Neurosurgery in Stockholm. After his return from Sweden the first independent Department of Neurosurgery was founded for Wilhelm Tönnis at the Hospital of Fritz König in Würzburg, against the still existing opposition of the surgeons.

Factors influencing morbidity and mortality after cranial meningioma surgery--a multivariate analysis.

In a retrospective analysis 385 patients with a histologically defined cranial meningioma were studied to analyze the impact of characteristic factors on morbidity and mortality after modern cranial meningioma surgery. Mortality was 4.2% one month and 7.3% six months after operation. 15.6% of the patients stayed more than one month in the hospital (defined as criteria of operative morbidity). Age, poor preoperative clinical condition (ASA score), intra- and postoperative bleeding and CSF disturbances were significantly associated with a subsequent decrease of quality of life. First symptoms like intracranial hypertension, seizures, aphasia and hemiparesis were correlated with an increase of postoperative Karnowsky index. Postoperative quality of life decreased in patients with optic and other cranial nerve disturbances significantly. Tumour size, location (exception: medial sphenoid wing) and histological diagnosis did not influence surgical outcome. This information may be useful in management decisions regarding asymptomatic meningiomas in elderly and high risk patients.

["How it all came about". On the beginnings of current neurosurgery in Germany up to the beginning of the "Zentralblatt für Neurochirurgie"]. / "Wie es dazu kam". Von den Anfängen der neuzeitlichen Neurochirurgie in Deutschland bis zur Gründung des "Zentralblattes für Neurochirurgie".

Till the thirties of our century surgery of brain and spinal cord was done by general surgeons. At that time the activities of Ernst von Bergmann, Fedor Krause and the operative autodidact and Neurologist Otfried Foerster met with great response. These achievements, however, had no influence on the development and dissemination of Neurosurgery in Germany. The revolutionary work of Cushing concerning Neurosurgery had no effect on surgeons either. The results of the operative treatment of intracerebral tumors in Germany continued to be depressing. It's entirely the credit of Fritz König (Würzburg) having caused the decisive change of this situation. He enabled his resident Wilhelm Tönnis to be educated by Herbert Olivecrona in his Department of Neurosurgery in Stockholm. After his return from Sweden the first independent Department of Neurosurgery was founded for Wilhelm Tönnis in Würzburg. Wilhelm Tönnis tried to overcome the still existing opposition against the independence of Neurosurgery by the foundation of an own scientific journal. The "Zentralblatt für Neurochirurgie" was founded in 1936 at the newspaper Publisher Ambrosius Barth, Leipzig. This "Zentralblatt für Neurochirurgie" was the only scientific journal of the world till 1943. The consequences of war stopped its distribution abroad. This was the reason for the foundation of "The Journal of Neurosurgery" in 1944. Corresponding to its tradition the new beginning shall consolidate the scientific bond between all neurosurgeons of the world.

Maffucci's syndrome with bilateral cartilaginous tumors of the cerebellopontine angle.

Maffucci's syndrome is characterized by the combination of multiple enchondromas (Ollier's disease) and hemangiomatosis. These hemangiomas develop in the subcutaneous tissue and form red-blue tumors dispersed over the whole body. Intracranial involvement is rare, making a preoperative radiological diagnosis and differentiation from other tumors rather difficult. The radiological characteristics and successful removal of the intracranial part of a chondrosarcoma of the cerebellopontine angle in a case of Maffucci's syndrome are reported in this paper.

Eleven times recurrences of a parasagittal falxmeningioma. Case report.

Although meningiomas are of benign character and generally of encapsulated growth, recurrence is a known problem in treatment. The authors present the time course of a recurrent parasagittal meningioma of the falx, which recurred eleven times. Despite modern radiological diagnostic methods, which made early diagnosis of recurrent tumour possible, and the use of modern microsurgical techniques with radical tumour extirpation and followed by radiotherapy, the fatal course of benign tumour disease could not be stopped.

[Special developments in neurosurgery]. / Spezielle Entwicklungen in der Neurochirurgie.

Increase of intracranial pressure is an acute danger for the patient's life. Since direct measurement of ICP is used, early identification of dangerous dysfunctions of ICP is possible. Surgical treatment of vascular malformations involves less risks since microsurgical methods and "tailor made" clips have been applied together with controlled hypotension. Transrhinoseptal approach in surgery of hormonally inactive and active adenomas has lowered the lethality rate essentially and improved the functional results. New indication in spinal surgery: Treatment of spinal claudication resulting from a central spinal stenosis, by operative decompression of the spinal canal.

Extracranial-intracranial arterial bypass for giant aneurysms.

We describe in detail one case, and briefly mention another where occlusion of a main vessel was necessary for removal of an aneurysm sac. The combined surgery of extracranial-intracranial bypass and the removal of the aneurysm at a second operation four to five weeks later is reported. The two-stage procedure is preferable to the one-stage proceeding for better assessment of the patency of the anastomosis and the possibility of undertaking a second attempt at anastomosis if the first bypass should become occluded.

[Modified technique in transsphenoidal operations of pituitary adenomas. Technical note (author's transl)]. / Modifizierte Technik bei transnasaler Operation der Hypophysengeschwülste.

High pressure lumbar air insufflation and endoscopical surgical technique and control improve surgical results and widen indications for the transsphenoidal approach to pituitary adenomas. These complementary methods require a sitting position for the patient and an axial approach to the sella turcica. By lumbar high pressure insufflation even very big pituitary adenomas may often be brought into the operation field and make possible a complete extirpation by a transsphenoidal approach. This possibility is increased by an operative technique under endoscopic control, the latter contributing considerably to complete tumour extirpation, especially with endocrine-active tumours.

[Angio-tomographic aspects of cerebral aneurysms and angiomas (author's transl)]. / Angiotomographische Aspekte der zerebralen Aneurysmen und Angiome

Angio-tomography is a selective radiological method which can be used to complement serial angiographs in order to demonstrate better detail. This results from the fact that selective levels can be demonstrated without super-imposition of bone or other vessels. Angio-tomography combines the advantages of tomography, subtraction and selective procedures. The method has been used for all types of intracranial disease; aneurysms and angiomas are the most common conditions for which angio-tomography has been employed. The present paper is based on a total of 60 cerebral aneurysms and angiomas in various situations; angiotomography was indicated for these amongst a larger material of intracranial vascular malformations in which the diagnosis was possible without its use. The indications consist of: 1) Demonstration of very small aneurysms and their differentiation from vessel loops, 2) Demonstration of the origin of an aneurysm which is situated at the confluence of several major vessels, 3) Point of origin of a so-called hugeaneurysms which cannot otherwise be shown by oblique views, 4) Demonstration of so-called micro-angiomas and of the afferent and efferent vessels in central arterio-venous malformations. Unusual aneurysms of the internal carotid artery, of the anterior choroidal and vertebral arteries are described. Some new concepts in the localisation of aneurysms of the anterior communicating artery are discussed. Many of the examinations were carried out with an angio-tomographic apparatus made in the department.

[Long-Term Results of Surgical Treatment of Spinal Tumours in Children and Adolescents]. / Langzeitergebnisse in der Behandlung spinaler Tumoren des Kindes- und Jugendalters

Catamneses of children up to the age of 16, operated on spinal tumours, are reported. Spinal tumours of this age account for about 15% of the total (all ages). There are about 50% intradural and 50% extradural tumours. The most frequent extradural tumours are sarcomas, followed by lipomas and dysontogenetic tumours like teratomas. Intradural tumours consist of intramedullary and extramedullary ones, about 50% each. Intramedullary tumours are gliomas, extramedullary ones may be neurinomas, meningeomas and vascular tumours. Time from onset of first diffuse symptoms up to clinical diagnosis depends on growth tendency of the tumour as well as on its localization. Hence, case history in cases of intramedullary gliomas usually covers two years, of sarcomas only a couple of months. In half of the cases, pain was the first symptom, followed by disturbed motor function. In more than 50% of the cases, complete restoration or significant improvement could be achieved by surgery. In the remaining half, there was either no change or even deterioration of the disturbed function. It seems justified to replace the former pessimistic attitude towards therapy of spinal tumours in childhood by a discret optimism. If in addition other spinal diseases like disk herniation are taken into account, prognosis is even more favourable.