CT and MRI findings with pathological correlation of an intracerebral malignant fibrous histiocytoma (MFH): a case report.

The CT and MRI findings in a case of an intracranial malignant fibrous histiocytoma are reported. Pathological correlation was demonstrated and tumour vascularization was best seen at angiography. Despite its low incidence in brain, MFH is of special interest because of its ubiquitous location and poor prognosis.

Evaluation of patients with atypical trigeminal neuralgia for permanent electrode implant by test stimulation of the ganglion gasseri.

The treatment of so-called atypical trigeminal neuralgia, characterized by long-lasting burning pain sensations without any pain attacks was for a long time an unsolved problem in contrast to the so-called 'tic douloreux'. Following the experience with our own patients and other groups, destructive procedures in atypical trigeminal neuralgia frequently result in worsening of the clinical conditions. We have therefore transferred the well-established method in the periphery of therapeutic electrostimulation to the trigeminal region. The evaluation of the patients with atypical trigeminal neuralgia is the key for good therapeutic results. Therefore percutaneous test stimulation of the ganglion gasseri has to be performed during a hospital stay. 54% of 149 patients experienced pain relief during test stimulation. Therefore in 81 patients with positive test results, electrodes were implanted together with a neurological pulse generator (Itrel Medtronic).

Surgical treatment and results in patients suffering from lumbar spinal stenoses.

Stenosis of the lumbar spinal canal is contributing to 3-5% of all patients operated on a lumbar nerve root compression syndrome. Morphologically, a reduction of the midsagittal diameter of the spinal canal to less than 12 mm or stenoses of the lateral recessus or foramen intervertebrale have been described. In our department 37 patients with a lumbar spinal stenosis have been surgically treated between 1982 and 1987. Spinal stenosis is a disease of aged patients mostly suffering for a long history. The main symptoms are lumbar and sciatic pains, neurological deficits and a claudicatio intermittens spinalis. Neuroradiologically, the diagnosis can be confirmed by CT, myelography or MRI. These studies were demonstrating the stenosis in 69% at the level of L4/5, multiple stenoses have been found in 22% of all cases. An additional disc herniation existed in 35% of the patients. Concerning the specific complaints of the patients and their neuroradiological findings, the extent of the surgical decompression was decided on individually in each patient. We performed 22 laminectomies, 11 hemilaminectomies, in 3 cases an extended flavectomy and in one case an implantation of a dorsal column stimulation device. The postoperative follow-up period, ranging from 3 months to 3 years, demonstrated a complete recovery in 53%, a marked reduction of complaints in 44% of all cases. One patient did not respond to surgical treatment, but in the remaining cases surgical treatment led to satisfactory results.

Neurosurgical management of cerebellar hemorrhage.

Controversy remains concerning the management of patients with cerebellar hemorrhage. In this study the records of 42 patients were reviewed. In 60% of them the signs of brainstem compression and upward transtentorial herniation were found. The level of consciousness was found to be consistent with the radiologic finding of the ambient cistern on the CT scan. Complete compression of the ambient cistern was always associated with coma, a partially compressed ambient cistern with stupor or drowsiness, while a normally shaped ambient cistern was associated with a normal level of consciousness. Immediate surgical decompression of the posterior fossa was life-saving for patients with brainstem compression and upward transtentorial herniation. Mortality was 57% for comatose patients and 9% for drowsy or stuporous patients. Ventriculostomy alone is the treatment of choice in cases with only hydrocephalus without brainstem compression or transtentorial herniation.

Nd:YAG-laser in the microsurgery of frontobasal meningiomas.

Forty-three patients with big frontobasal meningiomas underwent a microsurgical removal of the tumor. The 1.32 microns Nd:YAG-laser has proved useful in this prospective series particularly with the contactless shrinkage of the tumors and the necrotization of the dural and bony attachments. Tumor shrinkage was achieved by radiating the tumor surface with the Nd:YAG-laser. This technique facilitated the microsurgical dissection and reduced the blood loss by half. The Nd:YAG-laser necrotization of the dural and bony attachments reduced the recurrence rate following grade two resections from 20% to zero. The postoperative quality of life was excellent with a complete rehabilitation in 76% of the patients. The use of the 1.32 microns Nd:YAG-laser improved significantly the results of microsurgery for frontobasal meningioma.