A novel technique for the measurement of CBF and CBV with robot-arm-mounted flat panel CT in a large-animal model.

BACKGROUND AND PURPOSE: Endovascular therapy is an emerging treatment option in patients with acute ischemic stroke and especially in cases presenting late after symptom onset. Information about remaining viable tissue as measured with perfusion imaging is crucial for proper patient selection. The aim of this study was to investigate whether perfusion imaging with C-arm CT in the angiography suite is feasible and provides measurements comparable with ones made by CTP. MATERIALS AND METHODS: The MCA was occluded surgically in 6 sheep. Perfusion studies were performed before surgery, immediately after, and at 3 hours after MCA occlusion by using a robotic flat panel detector C-arm angiographic system. For comparison, conventional CTP was performed at the same time points. Two different protocols with the C-arm CT were tested. Images were analyzed by 2 readers with regard to the presence and size of perfusion abnormalities. RESULTS: With C-arm CT, perfusion abnormalities were detected with a high sensitivity and specificity when vessel occlusion was confirmed by criterion standard DSA. No difference was found between lesions sizes measured with the 2 C-arm CT protocols and CTP. Growth of the CBV lesions with time was captured with C-arm CT and CTP. CONCLUSIONS: In this small study, it was feasible to qualitatively measure CBV and CBF by using a flat panel detector angiographic system.

Early experiences with cervical disc prostheses.

UNLABELLED: The standard cervical disc surgery includes removal of the disc and fusion using an anterior approach. The loss of motion associated with fusion has prompted a search for other options. Early experiences and results after implantation of disc prostheses allowing for biomechanical motion of healthy discs are evaluated in this study. PATIENTS AND METHODS: 51 prostheses were implanted in 50 patients using an anterior approach. Follow-up ranged from one month to 14 months. RESULTS: The only significant complications were haemorrhages in two cases requiring surgical removal but otherwise all patients had an uneventful recovery. No infection or dislocation of the implants or formation of new spondylophytes have been noted yet. Resolution of pain and neurological disorders were excellent with a back-to-work rate of 80 % at three months after surgery. CONCLUSION: As the implantation of cervical disc prostheses carries no obvious risk higher than the risk of conventional anterior fusion, further analysis of its practicability and long-term outcome is recommended.

Titanium or polymethylmethacrylate in cervical disc surgery? A prospective study.

In 200 patients with either isolated protrusion of disc or with spondylosis a cervical discectomy in one or two levels was performed from a ventral approach. In 100 patients the removed disc was replaced with an implant of polymethylmethacrylat (PMMA). In 100 patients interbodyfusion was done with a titanium cage. Both groups were analysed in a prospective study. Clinical outcome was assessed after surgery. Results were similar in terms of complications and clinical outcome. As the PMMA surgery took longer and the costs of titanium are higher, there is no marked advantage of one implant material over the other.

[Experience with intra- and perioperative high-dosage steroids in microneursurgical revision operations on lumbar discs.]. / Erfahrungen mit der intra- und perioperativen Steroidapplikation bei mikroneurochirurgischen lumbalen Rezidivbandscheibenoperationen.

UNLABELLED: A consecutive series of 100 microneurosurgical revision operations on lumbar discs has been evaluated in a prospective and randomized clinical trial analyzing the influence of dexamethasone on postoperative clinical outcome. METHODS: Of the 100 patients, 50 received dexamethasone 8 mg by local intrathecal injection during the operation and perioperative dexamethasone by a systemic route for 7 days. A reference group of 50 patients did not receive any steroids. The two groups were compared with reference to postoperative lumbar and radicular pain, regression of paresis, analgesic requirements during hospitalization and duration of stay in hospital. One year after the end of the study clinical results and ability to work in the two groups were compared. RESULTS: A significantly lower analgesic requirement was found in the dexamethasone-treated group. We found no evidence that steroids had ameliorate the regression of paresis or lumbar and radicular pain at the end of hospitalization. There was no difference in the clinical outcome 1 year after reoperation. CONCLUSIONS: After revision operations on lumbar discs, corticosteroids are a helpful adjuvant drug for relief of lumbar or radicular pain, but they do not significantly improve the final clinical outcome.

[Differential diagnosis of lumbar intervertebral disk syndrome from the neurosurgical viewpoint--personal surgical experiences with over 3,000 lumbar operations]. / Differentialdiagnosen des lumbalen Bandscheibensyndroms aus neurochirurgischer Sicht--eigene operative Erfahrungen mit über 3000 Lumbaloperationen.

Lumbar syndromes belong to the most frequent complaints in medical practice. In a series of 3110 lumbar spine operations differential diagnoses of neurosurgical relevance are represented. Diagnostic measures and operative indications are discussed.