[Wilhelm Brüggemann--a neurosurgeon in the Ruhr district (1925-1990)]. / Wilhelm Brüggemann--ein Neurochirurg im Ruhrgebiet (1925-1990).

Wilhelm Josef Brüggemann, born January 25, 1925, established Neurosurgery in the City of Gelsenkirchen, city of 300,000 inhabitants in the industrial area of the Ruhr District of Germany. After his neurosurgical training with W. Tönnis in Cologne, he worked as Neurosurgeons at the Knappschafts-Hospital "Bergmannsheil" in Gelsenkirchen-Buer from 1967 to 1983. His life and work are commemorated. He died from vascular disease on April 1, 1990.

Malformation of a cervical facet joint with inclusion of an arthrolith. Case report.

The authors present the case of a 49-year-old man with an isolated malformation of the left cervical facet joint at C5-6, with secondary spondylarthrotic hypertrophy of the joint leading to involvement of the C-6 nerve root. The etiology of this cervical joint malformation is discussed.

[Criteria for expert assessment of the injured cervical spine from the neurosurgical viewpoint]. / Kriterien zur Begutachtung der verletzten Halswirbelsüle aus neurochirurgischer Sicht.

The assessment of cervical injuries in medical expertises can be difficult, because there are sometimes little objective clinical symptoms and radiological signs though the patients pretend to suffer from multiple complaints. A series of 40 neurosurgical expertises has been evaluated: 19 patients (47.5%) had clinical signs of cervical myelopathy, 13 patients (32.5%) had clear radicular syndromes, 7 patients (17.5%) suffered from local cervical syndromes. Clinical symptoms can be objectified by radiological methods, such as MRI, which occasionally can directly show lesions of the cervical cord or the brain stem. Sometimes even in patients with severe neurological deficits there are little radiological alterations. Local pain syndromes were assessed at a reduction in earning capacity of about 20%, radicular syndromes at 20 to 30%, minor grades of myelopathy at 30 to 40% respectively disability, and severe grades of myelopathy at up to 100% resp. incapacity of gainful employment. In our opinion adequate assessment of cervical cord injuries should predominantly base on clinical neurological findings, secondarily on radiological findings.

Tolerance of iotrolan 190 and cerebrospinal fluid-diluted iotrolan 300 at the same iodine concentration in lumbar myelography.

Iotrolan, the radiologically effective ingredient of the contrast medium Isovist, has so little osmotic activity that only solutions of about 300 mg I/ml are isotonic to cerebrospinal fluid (CSF). The osmolality of the contrast medium at lower iodine concentrations has to be increased through additives. Theoretically, iotrolan 300 diluted with CSF is the most physiologic. Therefore, the commercial preparation iotrolan 190 (adaptation of the osmolality through the addition of saline and sodium bicarbonate) was tested in a randomized, single-blind study against a diluted contrast medium solution, iotrolan 190 (produced from iotrolan 300). The dilution was performed with the patient's own CSF. The test was carried out in lumbar myelography in two groups of 50 patients each. There were neither statistical nor tendency differences between the two preparations in either the opacification or the tolerance. Therefore, there is no suggestion that a contrast medium solution prepared with the patient's own CSF is better tolerated.

Survival and quality of life after continuous accelerated radiotherapy of glioblastomas.

One hundred and thirty three patients were given radiotherapy after subtotal resection of glioblastoma with different total doses and fractionation schedules including 38 patients receiving continuous accelerated fractionation with 3 fractions of 1.6 Gy per day up to 60 Gy in 2 weeks. Tolerance of the accelerated schedule was as good as of the conventional schedules but overall survival was not improved.

The transcervical cardiac catheter: its transverse pretracheal placement in the treatment of cardiac catheter complications with ventriculo-atrial shunts in infantile hydrocephalus.

In 40 hydrocephalic children with ventriculo-atrial shunts 58 operative revisions of the cardiac catheter were evaluated. The review of the patients with cardiac catheter complications showed that the majority (68%) had undergone the primary shunting procedure as newborn or as prematurely born within the first 6 months of life. Most frequently the revisions had become necessary because of obstruction of the cardiac catheter at its distal end (22 times) and the slipping of the catheter from the valve (21 times). Other revisions were carried out for too long (2 times) or too short (once) cardiac catheter, rupture (5 times), kinking or coiling (7 times) of the catheter. The transcervical cardiac catheter, which was given particular attention, used for insertion in revisions for venous obliteration on the side of the previous catheter placement, was performed in 11 patients. It yielded good results in respect of practicability and prognosis and can be recommended as a useful method for shunt revision in venous obstruction.

[Treatment results in brain metastases with primary irradiation and after surgery and postoperative irradiation]. / Behandlungsergebnisse bei Hirnmetastasen mit primärer Bestrahlung und nach Operation und Nachbestrahlung.

61 patients with cerebral metastases were treated between 1977 and 1982, 32 out of them were operated and postoperatively irradiated, 29 only irradiated. The irradiations were given for curative purposes. Sixteen patients were alive at the date of December 31, 1982. The survival times calculated with the method of Kaplan-Mayer were 10 months after surgery and irradiation and 5 months after irradiations alone. In case of metastases of the mammary carcinoma, surgery with irradiation seems to be an especially effective method, as is suggested by the median survival time of 35 months and the total absence of local recurrences. In most of the other cases, too, the prolonged survival time was accompanied by a good quality of life which lasted for a considerable period of time. Younger patients had a longer survival time than older patients. The results of a high-dosed therapy with several daily fractions, namely 60 Gy within 17 days or 1825 ret NSD, respectively, were not (yet) better than those of conventional fractionation and dosage with 50 to 60 Gy in 5 to 6 weeks or 1572 to 1768 ret NSD, respectively. However, the value of this method was the same, its advantage lying in the shorter treatment time. Only in patients over 60 years, above all if they had received a total-brain irradiation with this method, we think to have seen a more frequent development of psychosyndromes. (The calculation of the survival times includes all cases, even patients who died during or shortly after radiotherapy).

[Postoperative radiotherapy of astrocytomas grade 3 and 4 with the radiosensitizer misonidazole. -End results of a multicentric controlled German study]. / Die postoperative Strahlenbehandlung von Astrozytomen Grad 3 und 4 mit dem Strahlensensibilisator Misonidazol. Endergebnis einer multizentrischen und kontrollierten deutschen Studie.

102 patients entered a multicentric randomized study from May 1978 till December 1980. After an operative removal of a supratentorial astrocytoma grade 3 or 4 all patients were treated by radiotherapy of the whole brain with 40 Gy, and after a rest of 1 to 2 weeks with a boost dose of 20 Gy to the tumor region. By randomization the patients got misonidazole (400 mg/m2) to each of the 30 fractions or a placebo. The overall tolerance was good. A mild transient peripheral neuropathy was seen only in 2 patients. The median of survival time was not significantly different for both groups with 16 months (grade 3) and 10 months (grade 4). Thus a radiosensitizing effect of misonidazole was not proven.

[Stereotaxic brain operations in erethitic imbecility (author's transl)]. / Stereotaktische Hirnoperationen bei erethischer Imbecillität.

Long-term results of stereotaxic operations in 23 patients with severe erethitic (aggressive-destructive) imbecility were evaluated. Target areas in the thalamus, electrocoagulated in separate bilateral operations, were the dorsomedial nucleus and the internal medullary lamina. Definite tranquilization was achieved in 50% and acquiescence in 27% of patients, resulting in a positive effect on more than 75% of patients. The postoperative course showed a constant level of quiet behavior in only 25% of patients ("static course"), whereas 50% of patients showed an oscillating course leading to subsequent improvement and later stabilization ("undulant course"). The final outcome was improvement and later stabilization ("undulant course"). The final outcome was not improved in 25% of patients. Additional therapeutic measures involving adaptation of psychopharmacotherapy improvements in surroundings, and play and working therapy were occasionally effective (Fig 3). In the pneumoencephalograms of these patients a new distinctive variant was encountered that awaits confirmation: typically, a definite increase in thalamic height, a decrease in ventricular width, and a relative diminution of base line length was found. Stereotaxic thalamotomy in erethitic imbeciles is a therapeutic method with a 75% long-term effectiveness and should be considered a proven therapeutic alternative.

[Positive ventriculography with metrizamide (Amipaque)(author's transl)]. / Die positive Ventrikulographie mit Metrizamide (Amipaque).

Our experience with the water-soluble contrast medium metrizamide (Amipaque) for ventriculography is described. No significant side effects were observed in our 27 patients, of whom 12 were children. A mild increase in CSF cell count disappeared after a few days. In 24 of the 27 patients, very good or adequate, and in any case diagnostic, information was obtained regarding the third and fourth ventricles, aqueduct, as well as sometimes the basal cisterns and outline of the cerebellum.

Explusion of SALIBI-clamp from the internal carotied artery in the neck by infection.

A left infraclinoid carotid aneurysm (3 x 2-5 x 2 cm) in a 60-year old woman presented with total ophthalmoplegia and trigeminal symptoms. A staged internal carotied occlusion in the neck was performed using a SALIBI-clamp. A chronic infectious fistula developed (Klebsiella aerogenes). When superficial debridement failed, operative removal of the SALIBI-clamp was planned seven months after its insertion. The clamp was found subcutaneously without any relation to the internal carotid artery and was easily removed. Subsequent catheter angiography proved the left internal carotied to be completely occluded in the neck. No cross filling of the aneurysm could be demonstrated from the right carotied nor the vertebro-basilar arteries. The neurological deficit remained unchanged. The wound closed promptly without further signs of infection.