Über lageabhängige Verschiebungen intracranieller Strukturen durch Pneumencephalographie und während stereotaktischer Hirnoperationen

Displacements of Brain Due to Positional Changes during Stereotactic Operations

“…Distortions of the normal hind brain with flexion and extension of the head at the atlanto-occipital junction have been documented both on cadavers and on liv ing subjects during encephalography [2], Similar shifts have also been demonstrated during encephalography with replacement of the subarach noid fluid by air and after taking roentgenograms with the patients in the sitting and supine positions [7], van B uren and Me C ubbin [3], on the other hand, were unable to find such a significant positional change of in tracerebral landmarks during encephalography. In an analysis of 14 ster eotactic operations performed after pneumoencephalography, Schmidt et al [14] found that air accumulating over the cerebral cortex leads not only to a separation of cortex from the skull vault, but also to a displace ment (up to 2-3 mm) of deeper intracerebral structures under the influ ence of gravity. Unfortunately, Schmidt et al [14], according to the rou tine technique used [12], evaluated positional displacements of the calci fied pineal body or the habenular commissure by two consecutive X-ray studies, the one consisting of lumbar pneumoencephalograms taken in the sitting position and the other of plain X-ray films taken in the supine pos ition 3-4 days later.…”

“…Schmidt et al [14] have considered the potential risks for positional displacement of deep-seated brain structures on two consecutive X-ray studies for target localization, when one consists of lumbar pneumoence phalograms with the patient in the sitting position, and the other plain X-ray films taken in the supine position 3-4 days later at the time of the surgical stereotactic intervention [14]. Comparison of X-ray films from studies so separated in time may contain sources of error, e.g.…”

The Pioneering and Unknown Stereotactic Approach of Roeder and Orthner from Göttingen. Part I. Surgical Technique for Tailoring Individualized Stereotactic Lesions

“…However, air accumulating in the peripheral CSF spaces resulted in suboptimal images due to blurred delineation of the ventricles or brain shift [19,20]. Even in the most experienced hands extracerebral air collections were observed in 13% of the patients, as shown in an evaluation of 1,800 patients operated on in Freiburg between 1952 and 1962 [19,20]. …”

“…In addition, presurgical lumbar pneumoencephalography was performed in the sitting position, whereas surgery took place in a prone position. It had been demonstrated that subdural air collections (moving frontally after repositioning) could lead to a significant shift (several millimeters) of deep brain structures, such as the pineal gland [19,20]. Over time the advantages of the one-stage approach became evident [39].…”

“…Until after 1973 the Freiburg group recommended such staged procedures. They referred to the great distress and repeatedly confused states following lumbar encephalography (with air or helium) in the often old and fragile Parkinsonian patients [20,37]. …”