[Coiling vs. clipping: hospital stay and procedure time in intracranial aneurysm treatment]. / Coil vs. Clip: Verweildauer und Behandlungszeit bei der Therapie intrakranieller Aneurysmen.

PURPOSE: Evaluation of hospital resource allocation in intracranial aneurysm treatment in a medium-volume neurovascular center. MATERIALS AND METHODS: Retrospective data analysis included 653 procedures performed on 598 patients with 667 aneurysms (A) from 1990 to 2004. 515 treatments were carried out in ruptured A (clip: n = 370; coil: n = 145) and 138 procedures in non-ruptured A (clip: n = 51, coil: n = 87). Patient management data included procedure time (min), length of stay in the intensive care unit (days), total length of hospital stay (days), and discharge to home ratio. RESULTS: Clinical admission grade (rupt. A: Hunt and Hess grade 1 - 3: clip: 73 % coil: 72 %) and clinical outcome at discharge (good neurological outcome/mortality rate: rupt. A: clip: 51.1/13.8 % coil: 45.5 / 10.3 % non-rupt. A: 88.2/0 % coil: 88.5/1.3 %) were similar for both treatment modes. The coil procedure time was found to be significantly shorter (rupt. A: coil: 145 min; clip: 203 min; p < 0.01; non-rupt. A: coil: 164 min, clip: 200 min; p < 0.01). Coiling reduced the length of stay in the ICU (rupt. A: coil: 5.3 d; clip: 6 d, p < 0.01; non-rupt. A: coil: 1.5 d; clip: 2 d; p = 0.21) and coiling significantly reduced the length of hospital stay (rupt. A: coil: 21.4 d; clip: 26.8 d, p < 0.01; non-rupt. A: coil: 9.2 d; clip: 17.5 d; p = 0.01).The discharge to home ratio did not differ (rupt. A: clip: 31.6 % coil: 29.7 % non-rupt. A: clip: 74.5 % coil: 80.5 %). CONCLUSION: In a medium-volume neurovascular center, coiling significantly reduced the procedure time, the stay in the ICU, and the length of hospital stay suggesting favorable resource allocation in endovascular therapy.

Gadolinium-myelocisternography for cerebrospinal fluid rhinorrhoea.

Knowledge of the exact site of leakage of cerebrospinal fluid CSF leakage is important for planning surgery. We report our experience with myelocisternography with Gd-DTPA. We decided that intrathecal use of this contrast medium was justified in selected cases when other techniques have failed. After we had given detailed information to four patients with CSF leakage, they underwent five examinations. The images were interpreted by comparing those before and after injection. In all cases the contrast medium arrived at the basal cisterns, giving high contrast against adjacent structures. All patients tolerated the examination without complications or any indication of side effects.

[De novo formation of a cavernoma in association with a preformed venous malformation during immunosuppressive treatment]. / Neuformation eines Cavernoms bei begleitender, vorbestehender venöser Malformation unter immunsuppresiver Behandlung.

We report the clinical course of a 48 year old woman, who underwent a cranial MRI-examination in 1995, which confirmed the diagnosis of encephalomyelitis disseminata, but also showed a left temporal venous malformation without evidence of prior hemorrhage. Three month after immunosuppressive treatment with Methotrexate in 1997 begun, first hemorrhage in the left temporal lobe occurred with de novo formation of a cavernoma in association to the known venous malformation. The lesion was totally removed after stereotactic guided craniotomy without any complication. The pathogenetic relationship of de novo cavernomas and associated venous malformations and the remarkable association with immunosuppressive treatment will be discussed.

CT-findings of carotid-cavernous fistula. A case report.

A case of traumatic CCF is used to emphasize the need for thin slice and bolus CT for early diagnosis.