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Introduction: Videoendoscopic endonasal-transsphenoidal pituitary surgery is a modern minimally invasive surgical technique, which requires interdisciplinary cooperation between ENT and neurosurgery., Patients and Methods: Between December 2006 and July 2008, 25 patients (13 male, 12 female, average age 55 years old) suffering from pituitary adenomas were operated on with the abovementioned method. All operations were done four-handed with the ENT surgeon carrying out the sphenoidectomy and the neurosurgeon the adenomectomy. An optoelectronic system (Vector Vision) was used for navigation using CT and MRI scans that were fused together., Results: Of the patients 21 suffered from a macroadenoma and 3 from a microadenoma. Primary surgery was carried out on 22 patients and 3 underwent recurrence surgery. The adenoma could be resected without any intraoperative complications in all cases. In five cases postoperative liquorrhoea occurred, which in one case was combined with a pneumocephalus due to strong nose blowing and revision surgery was required in three cases. Oculomotor nerve palsy due to neuroborreliosis was observed in one case on the third postoperative day, which receded completely under antibiotics within 1 week. Navigation worked well in all cases, thus there was no need for a C-bow. Additional functional endoscopic sinus surgery (FESS) was necessary in one case due to nasal polyposis. The endoscopic panorama view was advantageous because of the possibility to view the operation cavity. The changeover from microscopic to endoscopic techniques was performed due to the interdisciplinary approach without an intensive learning phase., Conclusions: The newly developed videoendoscopic endonasal pituitary surgery as an interdisciplinary operation between neurosurgery and rhinosurgery by means of modern navigation systems proved to be an excellent method.

Objective: In recent years, new devices for epidural pressure (EDP) measurement have been developed, with claims of improved accuracy. However, there have been no new data from simultaneous pressure measurements to reverse the skepticism regarding this technique., Methods: The reliability of EDP recording was investigated in 26 patients with severe head injuries, during simultaneous measurement of ipsilateral intraventricular pressure (IVP) or intraparenchymal pressure (IPP)., Results: Periods of simultaneous measurement ranged from 3.3 to 168 hours. Technical failure occurred in five cases. Clinically significant erroneous pressure values (defined as differences of >10 mm Hg between EDP and IVP or IPP, lasting for >10 min) occurred in 7 of 21 measurements (33%). In three of these seven cases (43%) the difference between the EDP and the IVP or IPP remained nearly stable throughout the period of observation, whereas in four cases (57%) significant drifting over time was observed. Analysis of the transfer function calculated for the first to sixth harmonics between the EDP and the IVP or IPP showed no significant differences between the pulse pressure waveforms, even when significant drifting of more than 20 mm Hg occurred., Conclusion: The reliability of EDP measurement has not improved, compared with 10 years ago. Using this technique, one must be aware of the possibility of overestimating intracranial pressure by more than 10 mm Hg and the possibility of significant drifting of EDP over time, which argues against the use of this method even for trend analysis.

Objective: The failure of intraventricular pressure measurement in cases of catheter blockage or dislodgement is thought to be eliminated by using intraventricular microtransducers. We report on an avoidable methodological error that may affect the reliability of intraventricular pressure measurement with these devices., Methods: Intraventricular fiberoptic or solid-state devices were implanted in 43 patients considered to be at risk for developing catheter occlusion. Two different types were used, i.e., devices in which the transducer is placed inside the ventriculostomy catheter (Type A) and devices in which the transducer is integrated in the external surface of the catheter (Type B). Type A devices were used in 15 patients and Type B devices in 28 patients. Pressure recordings were checked at bedside for the validity and reliability of the measurement., Results: Of the 15 patients treated with Type A devices, no reliable pressure recordings were able to be obtained in three patients in whom ventricular punctures were not successful. In 4 of the remaining 12 patients, periods of erroneous pressure readings were detected. After opening of cerebrospinal fluid drainage, all Type A devices failed to reflect real intraventricular pressure. In patients treated with Type B devices, no erroneous pressure recordings were able to be identified, irrespective of whether cerebrospinal fluid drainage was performed. Even when ventricular puncture failed, pressure measurement was correct each time., Conclusion: Transducers that are simply placed inside the ventriculostomy catheter require fluid-coupling. They may fail, either during cerebrospinal fluid drainage or when the catheter is blocked or placed within the parenchyma.

On the basis of experience gained in operations for cerebral tumours rich in blood vessels in 50 patients the advantages of the combination of a pharmacological-physical reduction of the metabolism and hypotension is dealt with. Nitroprusside sodium hypotension is inferior to this procedure. The experience gained in the different groups is broken down in detail.

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.

A report is given on long-term results after the removal of spinal mengiomas and neurinomas. A total of 150 patients with meningiomas and 80 patients with spinal neurinomas were operated on within a period of 25 years at the Neurosurgical Clinic in the Division Medicine of the Karl-Marx-University Leipzig. The primary results of the operations are secertained by a comparison of the preand portoperative ability to walk. Improvements were found in one third of all patients after meningioma operations and in more than ten per cent of the patients after removal of a neurinoma. The long-term rests were ascertained by means of questioning all patients that could be contracted after 2 to 25 years, sending them a questionaire in the form of a reply card. The number of patients who had become able to walk had doubles as compared with the condition before the operation: 56 per cent of all patients after meningioma operations and 64 per cent of all patients after removal of a spinal neurinoma. The long-term results have not been mainly influenced by the age of the patients and by the duration of the anamnesis. The greatest threat for patients with benign spinal tumours are the misjudging of the disease and a certain loss of time when paralysis was threatening. The prognosis in operations for relapses was considerably worse. So radical surgery in the first intervention must be attached the greatest importance. A tendency to infiltrations in case of meningiomas, especially in juvenile patients, and the overlooking of the smallest parts of extradural tumours in case of neuromas are frequent causes of the development of relapses and should be taken into account when carrying out the first ingervention.

Among 65 patients operated by lumbar disc in 1977 we encountered 5 women after gynecological tumour operations. 4 of those patients not became symptom free. The relation of mechanical factors, obstruction and circulation changes seemed to be of importance for the evaluation of ischialgia in those cases and led to spinal root and root sheath damages.

The postoperative prognosis of malignant extradural spinal tumours still is unfavourable with regard to both functional restitution and postoperative survival time. Short anamnestic times and severe neurological attacks developing within a short period of time up to a complete transverse paraplegia syndrome characterise the clinical picture. In addition to the usually existing increase in the lumbar cerebrospinal protein level (86 per cent), pathological native X-ray findings are found condierably more frequently than in processes of other topical localisations (72 per cent). In three quarters of the cases the pantopaque myelogram shows complete contrast medium passage disturbances. In 10.8 per cent of the cases, an improvement of the findings could be achieved by an operation, 76.9 per cent showed an unchanged condition up to four weeks post operationem and in 12.3 per cent a deterioration of the condition had occurred. The average survival times of the deceased patients was 4.1 months. Prolonged survival times between three and six years were only seen in two retothelial sarcoma patients and one sarcoma patient. The cause of the unfavourable functional results are believed to be due to medullary circulation disturbances which are caused by the tumour and can non longer be influenced by an operation. In spite of the results being frequently unfavourable, a general rejection of the operation does not seem to be justified. It should, however, be rejected when (I) a complete transverse lesion syndrome has been present for several months, (2) extensive vertebral destruction can be demonstrated, (3) multiple destruction foci are present and (4) there ist an advanced stage of the primary process with a highly reduced general condition.

A report is given on the application of an ultrasound aspirator for the removal of cerebral tumours. After the description of physical and surgical fundamentals, a report is given on the respective patients. Then hazards an advantages are described as far as they can be summarized already today.

Hooded rats (Long-Evans-strain) were not able to elaborate conditioned avoidance responses in a simple runway respectively in a jumping test after bilateral lesions of the anterior part of the nucleus ventralis lateralis thalami. When the number of the CS-US-combinations was increased from 10 to 25 per session, then during the last ten combinations the punishing electrical foot shocks were correctly avoided, but the animals showed no retention in their long-term memory.

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.

Among the patients of the Hospital for Neurosurgery in Leipzig treated in the period from 1952 to 1986 66 per cent of 570 patients operated on because of spinal cord tumours showed a benign and 34 per cent a malignant nature of the tumours. The rate of primary bone tumours amounted to 6.5 per cent and that of secondary bone tumours was 5.8 per cent. The preoperative diagnostical and the differential-diagnostical as well as therapeutical problems were dealt with on the basis of the only case of an aneurysmal bone cyst.

Among 5000 computer-tomographic examinations of the brain, there were only 82 tumours located in the 4th ventricle and spinal space. The method is of value for the indication of the localisation and extension of the tumours. The relation of tumours to the rhomboid fossa cannot always be clearly recognised. In spite of good indications in case of some tumours, this method cannot replace the histological method. It contributed only little to the early diagnosis in the series of examinations; the majority of the tumours had a volume of 30 ml. This is due to the fact that characteristic clinical symptoms occur late.

Within a period of 35 years a total of 570 spinal tumours included 77 intramedullary gliomas (44 astrocytomas and 33 ependymomas including those located in the conuscada region). Initial symptoms, neurological findings at the time of the admittance to the clinic as well as results of the operation are presented. The importance of an early diagnosis is pointed out.

A report is given on the method of the tumour aspiration of cerebral tumours by means of power ultrasound. After classical exposure of the tumour--obligatory performance with physical-pharmacological reduction of the metabolism and in most cases under hypotension--the tumour is destroyed by ultrasonic power and simultaneously aspirated. A report is given on 50 cerebral tumour operations, which were carried out in Karl-Marx-Stadt within two years, using the tumour aspiration system "Aspirus 120". Finally the advantages of the method are summarised and dangers interpreted. At the end a valuation of the method is attempted and an outlook is given.