[Tumor-induced medullary compression--experiences with 570 patients]. / Die tumorbedingte medulläre Kompression--Erfahrungen an 570 Patienten.

On the basis of patients treated at the Clinic for Neurosurgery in Leipzig in the period from 1952 to 1986 with a total of 570 suffering from spinal tumours, the nature of non-traumatic medullary compression is discussed, taking into consideration the relative frequency of the individual kinds of tumours as well as the distribution and the level of the location. The clinical aspects of medullary compression is elaborated, the differential-diagnostic of the demarkation possibilities between intra- and extramedullary tumour sites are discussed. In a retrospective consideration it must be stated that only 25 per cent of all patients with spinal tumours are operated on in an early stage (I and II) and only 60 per cent in the stage of incomplete transverse lesion of the with paraplegia (III). The remaining 15 per cent only get in the hands of the neurosurgeon in the stage of complete transverse lesion of the cord (IV). From this results the stringent conclusion to concentrate all efforts on the improvement of the early diagnosis.

[Neuroradiologic findings in tumors of ventricles I-III]. / Neuroradiologische Befunde bei Tumoren der Ventrikel I-III.

In the period from 1953-1983, apart from the computer tomography the following neurodiagnostic methods were employed for the diagnosis of ventricular tumours: native radiography of the skull, PEG, ventriculography, positive ventriculography, angiography and cerebral scintigraphy. This study shows that a clear change in the importance of the various methods has taken place in the above mentioned period of time. The X-ray pictures of the skull taken without a contrast medium have become less important in the last few years although they showed direct and indirect signs of the tumours in almost all ventricular tumours. The former paramount importance of the presentation of the tumours with negative or positive contrast media has decreased considerably. From 1980, for example, practically no pneumo-encephalograms and no air ventriculography have been carried out. The unreliable filling in PEG and the considerable stress for the patients, especially in classic ventriculography, and thus the relatively high rate of wrong diagnoses are the reasons for this change. Only the direct positive representation of the third ventricle, e.g. in case of pinealoma, are still attached the same importance as computer tomography. Carotid angiography which shows almost every ventricular tumour in our patients and can yield information about the vascular supply, has maintained its importance in the neuroradiological scheme of diagnostics.

[Electroencephalographic findings in tumors of ventricles I-III]. / Elektroenzephalographische Befunde bei Prozessen der Ventrikel I-III.

The EEG findings in 177 patients with mainly malignant tumours in the region of the ventricles I-III have been evaluated. The changes were dependent upon the size of the tumours and the kind and direction of their infiltration growth into the paraventricular structure. In case of purely intraventricular spreading of the disturbance of the cerebral fluid circulation normal curves were found. In processes of the third ventricle we found to a greater extent theta-delta paroxysms whereas tumours in lateral ventricles rather caused localised disturbances in the sense of focal findings. Tumours with a growth in a basal direction frequently showed sw-patterns or steep waves. General changes only occurred in an advanced stage of the disease as an expression of the intracranial increase of the pressure.

[Neuro-ophthalmologic findings in tumors of ventricles I-III]. / Neuroophthalmologische Befunde bei Prozessen der Ventrikel I-III.

The ophthalmological findings obtained in 254 patients with space occupying processes of the lateral and third ventricles are analysed. Visual disturbances (78%), defects of the visual field (69%), findings of the fundus of the eye (67%) and motility restrictions (24%) were identified. Only in eight per cent the findings of the eye-ground no particular findings were observed. As was expected, signs of cerebral compression were frequently found. Postoperative improvements were found in the choked papilla and motility restrictions were seen where as defects of the visual field and a decrease of the visual acuity were in most cases unchanged or had even increased.

[Processes of ventricles I-III. Review of the patient population of the Neurosurgery Clinic of the Karl Marx University 1953-1983]. / Prozesse der Ventrikel I-III. Ubersicht des Patientengutes der Neurochirurgischen Klinik der Karl-Marx-Universität 1953-1983.

Within three decades 254 patients with processes of the brain ventricles I-III have been treated at the Leipzig Neurosurgical Clinic. The article subdivides the patients in general and according to the histology, localisation, lateral differences, dignity, operability as well as the postoperative lethality. The evaluation gives many clues with respect to the diagnostics and therapy of these ventricular processes. Today, the improvements obtained by computer tomography and by microsurgery are well the to fore.

[Operative treatment of tumors of ventricles I-III following experiences 1953-1983]. / Die operative Behandlung von Tumoren der Ventrikel I-III nach Erfahrungen aus den Jahren 1953-1983.

A report is given on the experience gained in 254 patients presenting processes of the ventricles I-III at the Leipzig Hospital within a period of thirty years. The rate of radical operations rose from 29% to 60%. At present, however, inoperability is restricted almost exclusively to general surgical aspects. Palliative operations are carried out in the form of the V-A shunts. Of decisive importance is the use of microtechniques in conjunction with an optimum anesthesia and intensive care. The accesses used are shown in pictures. Special surgical aspects are benignity of many intraventricular tumours, pronounced vascularisation, localisation below functionally important corticocerebral regions as well as exact considerations with respect to the planning of the operation pathway.

[Clinical aspects of intracranial epidermoids and dermoids]. / Zur Klinik der intrakraniellen Epidermoide und Dermoide.

The authors discuss 21 epidermoids and 6 dermoids of the craniocerebral region, which occurred in patients of the Leipzig Neurosurgical Clinic within a period of ten years. Main localisation was the sellar region. The clinical symptoms (frequently with lacking signs of brain pressure), the diagnosis and prognosis of the malformation tumours are dealt with.

[Tumors of the 4th ventricle and the craniospinal transitional zone. Review of patients of the Neurosurgical Clinic of the Department of Medicine of the Karl Marx University]. / Tumoren des 4. Ventrikels und des kraniospinalen Uberganges--Ubersicht des Patientengutes der Neurochirurgischen Klinik des Bereichs Medizin der Karl-Marx-Universität.

From a total of 1,028 infratentorial tumours operated on at the Neurosurgical Hospital of the Section Medicine of the Karl-Marx University Leipzig in the last 30 years, 167 tumours in the region of the 4th ventrical have been selected. Their statistical processing was carried out with respect to specific localisation, average age, kind of tumour, sex, clinical findings, duration of case history, application of instrumental diagnostic procedures and radicality of operation, success and failure. Some fundamental conclussions are drawn. A subdivision in detail will be contained in the following articles based on this material.

[Angioarchitecture of gliomas. 1: Models of cerebral vessels, casting materials, preparation methods, changes in tumor vessels]. / Die Angioarchitektur der Gliome. I. Mitteilung: Hirngefässmodelle-Ausgussmaterialien--Präparationsmethoden--Tumorgefässveränderungen.

A report is given on the study of cerebrovascular systems in experimental animals and corpses and the demonstration of cerebral tumours be means of models of vascular system. After a survey of the development of model representation, the technique of the vessel injection, the various injection materials and methods of preparation are described in detail. Advantages and disadvantages of the individual methods and certain peculiarities in model representations of transplantation tumours and various human brain tumours are presented. Besides, a multitude of pictures which document the results of the experiments, general laws of the tumour development, angioarchitectufe of the cerebral tumours and the changes in pre-existing and newly formed vessels in and around the tumour are briefly dealth with. The individual results of systematic investigations into the vascular system of cerebral tumours--of human brain vessel models, of transplantation tumours and special angioarchitecture of gliomatous brain tumours--will be published in individual articles appearing later.

[Filling of the Circle of Willis in carotid angiography using halothane anesthesia]. / Zur Frage der Mitfüllung des Circulus arteriosus Willisi bei der Karotisangiographie unter Halothannarkose.

A comparative study of 150 carotid angiographies carried out under local anaesthesia and the same number under halothane anaesthesia did not show any great deviation from the well-known filling rates of the counter-lateral carotid region and the ipsilateral A. cerebri posterior nor any striking differences in the two methods of anaesthesia which could convince of a favourable influence of halothane on the demonstration of the vessels. The causative factors of the filling of adjacent vascularisation regions can certainly only be explained from the complex co-action of physiological and any external factors in cerebral angiography.

[The influence on water-electrolyte balance through osmotherapy for decreasing intracranial pressure]. / Die Beeinflussung des Wasser- und Elektrolythaushalts durch die Osmotherapie zur Senkung des intrakraniellen Druckes.

On the basis of a group of neurosurgical patients showing a differing composition, various procedures of the dehydrating therapy in the pre- and postoperative phases for decreasing the increased intracranial pressure were studied. In addition to the continuous recording of the intracranial pressure, the electrolyte and water balance was measured by recording the plasma, urinary, and cerebrospinal-fluid electrolytes and their osmolarities and the urinary output was determined. Besides, specific measurements of the haematocrit, of the central venous pressure and the arterial mean pressure brought pathophysiological findings on the dehydration. The comparison of conventional substances such as mannite and sorbite of different concentrations per time showed various disturbances of the electrolyte and water balance; therapeutic guiding rules could be elaborated under consideration of these experiences. On the basis of the intracranial pressure/volume relationship, the effectiveness of the dehydration should not only be assessed by the reduction of the intracranial pressure since the extent of the alteration of the electrolyte and water balance and the haemodynamically active changes are quite different. Finally, disease pictures should be taken into consideration in which the basic morphological and functional conditions have been lost and the limits of the therapeutic procedure are exceeded.

[400 intraspinal space-narrowing processes--a clinical study]. / 400 intraspinale raumbeengende Prozesse--eine klinische Studie.

Among 400 observations by the authors, 2 per cent were admitted without and another 22 per cent with slight neurological disturbances. An incomplete transverse lesion of the cord with paraplegia was found in 61.7 per cent, a complete paralysis in 14.3 per cent of the cases. Meningiomas and neurinomas were found in 60 per cent of the patients. The average age of the tumour patients was 43,8 years. Meningiomas and metastases show a tendency to occur in older age groups. The "Glioma Age" was around 25 years. The majority of the tumours were located at the level of the thoracic cord. When breaking down according to the kinds of tumours, a different picture is obtained: neurinomas are chiefly located in the region of the cervical medulla and the thoracolumbar region; gliomas are mainly found in the cervical part of the medulla up to the central thoracic cord. A dissociation of the cerebrospinal fluid was found in 90 per cent of the examinations; in 50 per cent of the patients it was above 200 mg%. Within a period of four weeks after the operation, the following results were obtained: 5 per cent free from complaints, improvement in 39 per cent, aggravation in 10 per cent and 46 per cent still uninfluenced. Meningiomas and neurinomas showed the highest degree of improvement. 24 per cent of the patients suffered from transitory rectovesical disturbances, 15 per cent from urinary tract infections, 12 per cent from decubitus, 9 per cent from wound healing disturbances and another 9 per cent from pneumonia. Meningitis was found in 2 per cent. Within four weeks post operationem, the death rate was 10.5 per cent, but this was in the phase before the introduction of microsurgery. On the accuracy of the diagnoses: in 18 per cent the neurological findings were in agreement with the diagnosis and in 49 per cent they showed differences of 1 to 3 segments; in 11 per cent no definite diagnosis could be made. In 46 per cent the native X-ray picture showed pathological changes. Myelography with positive contrast media showed positive findings in 97 per cent and 98 per cent of positive findings were obtained with myeloscintigraphy.

[Reperfusion following cerebrovascular arrest]. / Reperfusion nach zerebralem Kreislaufstillstand.

An account is given of a case of artificial perfusion of isolated organ after operative correction of an angiographically recorded standstill of the circulatory system. Criteria of cerebral death and determination of the time of death are discussed.