Spinal cord stimulation for the treatment of chronic non-malignant pain.

Over the past four decades, techniques and devices for spinal cord stimulation have undergone considerable refinement. Currently, percutaneous implantable electrodes are placed in the epidural space and a low-frequency electrical current is used to modify the transmission of chronic pain signals in the dorsal columns of the spinal cord. Before permanent implantation, the spinal cord stimulation will be examined during a test phase to determine its analgesic effect and tolerability. We have reviewed our experience in 88 patients with chronic nonmalignant pain. The follow-up of our study ranged from 15 to 75 months, with an average of 60 months. The indication for SCS in these 88 patients was mainly neuropathic pain syndromes. The patients were followed up by the Visual Analog Scale (VAS), level of activity and subjective assessment of the quality of life. On the basis of the patients' self-assessments using the VAS, the degree of pain relief was excellent/good in 72 of 88 patients (82%). At the end of the follow-up period, 50% of the patients were in a better psychological status and 86% of the patients reported an improvement in activities of their daily living and a reduction in the use of analgesic medication. Ninety percent of the patients stated that they would go through the procedure again for the same result. The findings of the present study indicate that spinal cord stimulation is an efficacious therapy for the treatment of chronic non-malignant pain.

LINAC radiosurgery in skull base meningiomas.

LINAC radiosurgery has provided increasing access and changed treatment strategies in patients with benign skull base meningiomas in recent years. From January 1996 to January 2003, 37 patients with skull base meningiomas were treated with LINAC radiosurgery. A combination of the University of Florida system and the X Knife System, developed by Radionics, was used in all patients. Eight patients were treated by microsurgical resection before radiosurgery, in two patients tumor recurrence was treated and in 29 patients LINAC radiosurgery was the initial treatment procedure. The median treatment volume was 5.9 mL (0.7 to 22 mL) and the median given dose was 14.6 Gy (12.8 to 18 Gy) prescribed to the 80 percent isodose line. The follow-up period is between 12 and 96 months, median 66 months. 12 patients (32.4 %) showed a significant reduction in tumor size, in 11 patients (29.7 %) there was significantly less contrast enhancement and in 13 patients (35.1 %) the skull base meningioma was without any change. In one patient (2.8 %) there was tumor growth 48 months after radiosurgery, so the tumor control rate was 97.2 %. Two patients (5.6 %) showed neurological worsening after radiosurgery, whereas the symptoms were transient in one patient. LINAC radiosurgery offers us an effective treatment modality and changes treatment strategies in skull base meningiomas towards a less aggressive surgical approach. By combining microsurgery and radiosurgery we can achieve high tumor control rates with an acceptable low morbidity and a high level of quality of life.

Cerebral primitive neuro-ectodermal tumour following treatment of a unilateral retinoblastoma.

Cerebral primitive neuro-ectodermal tumour (PNET) occurring as a second primary malignancy in childhood is exceedingly rare. We present a 7-year-old boy who developed a proven supratentorial PNET five years after enucleation and radio-/chemotherapy for a sporadic, unilateral retinoblastoma with optic nerve invasion. The association with this malignant eye disease as well as the effect of irradiation and multi-agent chemotherapy on second tumour induction are evaluated.

Operative treatment of trigeminal neuralgia.

From January 1, 1986, to June 30, 1996, 240 patients were operated on for trigeminal neuralgia: 182 patients were treated by thermocoagulation of the gasserian ganglion after Sweet and 58 patients by decompression of the trigeminal nerve after Janetta. In the thermocoagulation group, followed up for 6 months to 10 years 95.2% of the cases showed freedom from pain, in the Janetta operation group, followed up for 6 months to 6 years 98.5% showed freedom from pain. Thermocoagulation is the preferred therapy, especially in older patients in whom general anesthesia is risky, while the Janetta operation is the therapy of choice in younger patients.

[Treatment of severe craniocerebral trauma]. / Zur Behandlung des schweren Schädel-Hirn-Traumas.

As a result of increased traffic and enlarged leisure offers the number of severe head injuries climbed significantly in the last years. Due to the improvement of preclinic care, including the transport of severe head injured patients to a neurosurgical clinic as well as the availability of modern neuroradiological techniques such as CT and MRI and the performance of ICP-monitoring at an early stage the prognosis of severe head injured patients was significantly improved.

[Primary amenorrhea, a symptom of occlusive hydrocephalus]. / Primäre Amenorrhoe, ein Symptom des okklusiven Hydrozephalus.

A report is given on the syndrom: primary amenorrhea, gliosis of the aqueduct and hydrocephalus internus of non-tumoral and non-inflammatory origin. In all three cases a cyclic menstruation was induced by performing shunting procedures.

[New methods and findings in the measurement of intracranial pressure]. / Neue Methoden und Erkenntnisse der Hirndruckmessung.

For measuring and continuous recording of intracranial pressure a small telemetric pressure transducer, called "Teleceptor" was developed and energized by inductive energy transmission. Technical problems with regard to in vitro calibration stability, zero-point drift and tissue reaction were examined and discussed. Clinically the "Teleceptor" has so far successfully been used in twentsix patients.

[Continuous telemetric recording of intracranial pressure]. / Fortlaufende telemetrische registrierung des Schädelinnendrucks

A report is given on the development of a telemetric system for continuous recording of intracranial pressure, using an external energy source. The pressure transducer, called Teleceptor, is placed in the subdural space through a burr hole. The resonance frequencies of the transmitter and receiver circuits in the implanted transducer are influenced by a pressure-sensitive membrane in such a way that pressure variations result in resonance point displacement and energy transfer reduction. The necessary tuning of the transmitter frequency to maximum energy transfer is in direct proportion to the magnitude of pressure modification.

Telemetry of intracranial pressure.

A new technique is described for telemetric measurement of intracranial pressure in man using an external energy source and a small pressure transducer, called a TELECEPTOR, implanted in the skull. The method presents advantages, especially for long term recordings.