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Schick U.,Neurochirurgische Universitatsklinik
HNO | Year: 2010

Background: The purpose of this study was to present the findings on growth patterns in a large surgical series of sphenoorbital meningiomas. Patients and methods: A retrospective analysis was performed on 77 patients (61 f) harboring sphenoorbital meningiomas, who underwent surgery between 1991 and 2009. The standard surgical approach consisted of pterional craniotomy and extradural resection of any infiltrated bone. The intradural and orbital tumor was resected, with complete reconstruction of the dura while the lateral bone was partially reconstructed. The follow-up period ranged from 6 to 130 months (mean: 57.9 months). Results: Total macroscopic resection was achieved in 42 patients. Fifty-eight meningiomas extended to the orbital roof and/or lateral orbital wall, 42 involved the extraconal space, and 11 the intraconal space. Sixty-three tumors involved the superior orbital fissure, 54 the optic canal, and 24 the inferior orbital fissure. Seventeen tumors infiltrated the cavernous sinus and 37 involved the anterior clinoid process. The rate of minor morbidity was 14.3% (slight deficits) and the rate of major morbidity was 4% (significant deficits). Subtotal resections were performed on 35 patients because there was intraorbital tumor (n=8); tumor in the cavernous sinus (n=12); tumor invading the superior orbital fissure (n=12); and tumor of the skull base (n=3). Nine patients underwent postoperative three-dimensional conformal radiotherapy, which resulted in stable tumor volume at follow-up in eight patients. Tumor recurrence was identified in ten patients (12.9%) postoperatively (range of follow-up: 10-47 months). Conclusion: The goal of surgery is complete tumor removal without morbidity. Exact analysis of tumor growth and possible involvement of pertinent structures are mandatory in planning the procedure. © Springer Medizin Verlag 2009. Source

Maier W.,Universitatsklinik For Hals | Maier W.,Orbitazentrum am Universitatsklinikum | Ridder G.J.,Universitatsklinik For Hals | Ridder G.J.,Orbitazentrum am Universitatsklinikum | And 4 more authors.
Ophthalmologe | Year: 2011

Tumors of the posterior orbit require different therapeutic modalities, depending on the histological entity. In the orbit all structures are in close relationship and the endocranium is in the direct proximity. This requires profound knowledge of topographic anatomy and high therapeutic precision. The surgical approach to the posterior orbit via a ventral intraorbital approach is strongly restricted due to the ocular bulb which consumes most space in the anterior orbit. Therefore if the bulb and vision are to be retained extraorbital surgical corridors are predominantly preferred. These are classified into extracranial and intracranial approaches. In detail, the former are medial transethmoidal orbitotomy, caudal transmaxillar orbitotomy and lateral orbitotomy. Frontolateral and frontotemporal orbitotomy as well as frontal, bifrontal and subfrontal orbitotomy are intracranial approaches. Apart from surgical methods there are several forms of radiotherapy which can be applied to orbital tumors under certain indications. Radiotherapy may be performed with external fractionated photon radiation or as stereotactic radiation, with heavy ions or protons or as brachytherapy. In this article various therapeutic interventions to the posterior orbit and the indications and potential side-effects are described. © 2011 Springer-Verlag. Source

Gousias K.,University of Bonn | Gousias K.,Neurochirurgische Universitatsklinik | Schramm J.,University of Bonn | Simon M.,University of Bonn
Acta Neurochirurgica | Year: 2014

Background: Any correlation between the extent of resection and the prognosis of patients with supratentorial infiltrative low-grade gliomas may well be related to biased treatment allocation. Patients with an intrinsically better prognosis may undergo more aggressive resections, and better survival may then be falsely attributed to the surgery rather than the biology of the disease. The present study investigates the potential impact of this type of treatment bias on survival in a series of patients with low-grade gliomas treated at the authors' institution. Methods: We conducted a retrospective study of 148 patients with low-grade gliomas undergoing primary treatment at our institution from 1996-2011. Potential prognostic factors were studied in order to identify treatment bias and to adjust survival analyses accordingly. Results: Eloquence of tumor location proved the most powerful predictor of the extent of resection, i.e., the principal source of treatment bias. Univariate as well as multivariate Cox regression analyses identified the extent of resection and the presence of a preoperative neurodeficit as the most important predictors of overall survival, tumor recurrence and malignant progression. After stratification for eloquence of tumor location in order to correct for treatment bias, Kaplan-Meier estimates showed a consistent association between the degree of resection and improved survival. Conclusion: Treatment bias was not responsible for the correlation between extent of resection and survival observed in the present series. Our data seem to provide further support for a strategy of maximum safe resections for low-grade gliomas. © 2013 Springer-Verlag Wien. Source

Spinal cord stimulation is nowadays an established therapy for various neuropathic and vasculopathic pain syndromes after more conservative measures have failed. However, 40 years ago, only 5 years after the first worldwide implantation in the US, this therapy was promoted in Germany. In 1972, the first devices were implanted in the Departments of Neurosurgery at the Universities Hannover and Freiburg. These pioneering efforts and the establishment of the therapy are intimately associated with three names: Jörg-Ulrich Krainick, Uwe Thoden, and Wolfhard Winkelmüller. Nowadays about 1700 spinal cord stimulation systems are implanted annually in Germany. The development of spinal cord stimulation from the beginnings up to now taking into special consideration the early years in Germany are presented. © Deutsche Schmerzgesellschaft e.V. Published by Springer-Verlag Berlin Heidelberg - all rights reserved 2013. Source

Hopkins P.M.,St Jamess Hospital | Ruffert H.,University of Leipzig | Snoeck M.M.,Canisius Wilhelmina Ziekenhuis | Girard T.,University of Basel | And 19 more authors.
British Journal of Anaesthesia | Year: 2015

It is 30 yr since the British Journal of Anaesthesia published the first consensus protocol for the laboratory diagnosis of malignant hyperthermia susceptibility from the European Malignant Hyperthermia Group. This has subsequently been used in more than 10 000 individuals worldwide to inform use of anaesthetic drugs in these patients with increased risk of developing malignant hyperthermia during general anaesthesia, representing an early and successful example of stratified medicine. In 2001, our group also published a guideline for the use of DNA-based screening of malignant hyperthermia susceptibility. We now present an updated and complete guideline for the diagnostic pathway for patients potentially at increased risk of developing malignant hyperthermia. We introduce the new guideline with a narrative commentary that describes its development, the changes to previously published protocols and guidelines, and new sections, including recommendations for patient referral criteria and clinical interpretation of laboratory findings. © 2015 The Author 2015. Source

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