[Malignant brain glioma--a catamnestic study of 100 operated patients]. / Das maligne Hirngliom--eine katamnestische Studie über 100 operierte Patienten.

For 100 operated patients with malignant gliomas of the brain (63 malignant gliomas WHO grade IV--including 50 glioblastoma multiforme- and 37 astrocytomas WHO grade III-IV) the average survival time is 332 days. The survival rates show 6, 12 and 24 months after operation 55%, 32% and 12% of the patients alive. In addition to therapy there are some favourable prognostic factors: Young patients age at the onset of illness, localization in the non-dominant hemisphere, minor preoperative neurological deficit. On the other side unfavourable prognostic factors are: parietal localization (average survival time = 120 days), tumorous infiltration of the brain stem (average survival time = 143 days), preoperative clouding of consciousness (average survival time = 185 days). These factors influence survival time. The most important prognostic factor of therapy is the extent of operation: In case of macroscopical total resection of the tumor the mean survival time amounts to 554 days as compared to 202 days in subtotal tumor resection. The well known positive influence of postoperative radiation therapy is demonstrated by the high mean survival time of 456 days. In case of recurrent operation of the tumor (28 patients), the average survival time amounts to 443 days. In contrast to the literature our own analysis shows no prognostic value of histological variants in case of malignant glioma WHO grade IV. Two patients, whose histological slide preparations were neuropathologically graded a second time independent from the first view (1 anaplastic ependymoma WHO grade III and 1 glioblastoma multiforme WHO grade IV), are still alive more than 8 years after operation without any neurological deficit.

[Diagnosis and interdisciplinary therapy of spinal cord compression caused by spinal metastases]. / Diagnostik und interdisziplinäre Therapie bei Rückenmarkskompression durch Wirbelsäulenmetastasen.

Metastatic tumours of the bone system occur up to 60% in the spinal cord. The epidural spinal cord compression is also found by metastatic tumour, so patients with metastatic disease in this localisation carry a poor prognosis. From 1986 to 1988 35 patients with symptomatic spine metastasis are operated upon. 43% of these patients recover their capability of walking. 90% from the operated collective show a reduction of pain. The primary tumour is first found from cancer of the lung and second from the kidneys. The most common localisation of metastatic tumour is the thoracic spine. The ratio from male to female is 2:1. If the risk of operation and differential therapy is discussed, the decompression and tumour resection will be the first. The concept for postoperative mobilisation and therapy concludes the stabilisation of spinal cord with internal fixation. Treatment of metastatic tumours takes aim at the improvement of life quality.

Risk factors of recurrent disc herniation.

The causes of 100 disc herniation reoperations are analyzed and discussed in a review: we find a recurrence of disc herniation at the same level in 62% of the reoperated cases, a pseudorecurrence in 24% and a closely connected nerve route in 14%. We reoperated on 44% within the first two years and on 69% within the first five years. The interval between the operations is longer, when there is a short painfree interval following surgery and also a long history of pre-operative symptoms. The variables of risk of prolapse recurrence are recorded as a risk score. Retrospectively, 64% belonged to a risk group according to this score. The correlation between operation intervals and scores show, that patients with a short interval have high scores.

[Etiology of the recurrence of lumbar intervertebral disk displacement]. / Atiologie lumbaler Bandscheibenvorfallrezidive.

In a review for reasons of 100 disc prolapses reoperations we found in 62% a recurrence of disc prolapse at the same level, in 24% a recurrence at a different level, whereas in 14% we found that the nerve route was closely connected. We reoperated 44% in the first two years and 69% in the first five years. The time between the operations was prolonged if there was a short period of time for relief of pain after operation and a long period of preoperative symptoms. The variables of risk of a disk prolapse recurrence are recorded in a risk score, in which 64% of the patients belonged retrospectively to a risk group. The correlation between operation interval and score points showed that patients with short interval had high score ratings.

Initial experience with MR-imaging of intracranial midline-lesions and lesions of the cervical spine at half Tesla.

Fifty-two patients were examined both with computed tomography using a different third generation scanner and by magnetic resonance imaging (MRI) at half Tesla field strength (Philips Gyroscan 5 S). Excellent contrast and spatial resolution as well as initial comparative results of normal anatomy and also selected clinical cases were demonstrated with the spin-echo (SE) and/or inversion recovery (IR) technique. The clinical material included a residual prolactinoma after transphenoidal surgery, follow-up of a recurrent partly calcified solid and cystic intra-/supra-sellar craniopharyngioma, low-grade glioma under stereotactic-like conditions, suspected pinealoma, recurrent astrocytoma (II-III) and ganglioneuroma at the posterior aspect of the middle and/or lower brain stem, small scar after lower brain stem infarction, stenosing degenerative disease of the cervical spine and multicystic lesion with an underlying benign ependymoma of the cervical spinal cord. MRI--although duplicating some CT results--provided better two- or three-dimensional anatomical detail as well as display of relevant vessels without need of contrast agent. It also gave more specific information in suprasellar tumours containing fat, afforded uniquely specific diagnosis in a bleeding venous malformation of the midbrain and defined more sensitively extra-/intra-axial lesions of the brain stem and cervical spinal cord. Small bony structures (erosions) and punctate calcifications may be missed by MRI. Although ferromagnetic material distorts the MR image, compared with CT, it is not impaired by non-ferromagnetic clips. This is an advantage with respect to postoperative control examinations.

[Pathophysiological aspects of the brain stem in closed head injuries (author's transl)]. / Pathophysiologische Aspekte des Hirnstammes beim gedeckten Schädelhirntrauma.

In a case of severe head injury, there is a disturbance of the functional cycle between hypothalamus/mesencephalon and the cortex cerebri. In this article, the causes and the pathophysiological, functional disturbances of primary and secondary unconsciousness will be discussed. In a case of a posttraumatic intracranial hypertension, the following causes are to be considered: cerebral oedema, intracerebral haematomas and the so-called pneumatocephalus: the collection of air in the ventricle system when open head injuries of the base of the skull occur. The midbrain syndrome which is caused by the compression of the midbrain is characterized by the disturbed reaction of the pupils, convulsive seizures and vegetative dysregulation of respiration, circulation and temperature. When the above-mentioned syndrome persists, it can develop into bulbar syndrome. This is recognized through a severe functional disturbance, which can lead to central brain if the cause of the rise of intracranial pressure is not overcome within one hour.