A total of 21 cats survived experimental microsurgical craniotomies with demonstration of the third cranial nerve via a previously described subtemporal route. In one cat the nerve was resected and no adequate regeneration was observed after three months. In five cases the nerve stumps of the transected third nerve were glued together with Aron Alpha. The results were unfavourable due to atrophy and scar adhesions. Ten cats were treated with lateral slit silicone cuffs around the transected third nerve to keep the stumps together. Good results were obtained after three months. Fibrin glue was used for approximation of the stumps of the third nerve in five additional cases. This was followed by superior results with good regeneration and reinnervation. In 19 cases clinical investigation, photographic records, EMG and caloric nystagmus tests, as well as histological and necropsy studies, proved regeneration after primary repair of the cut third cranial nerve.
Operations were carried out on eight cats using a transcervical, transclival approach to expose the sixth cranial nerve just beside the basilar artery. In one case 5 mm of the nerve were resected; three months later no reinnervation was seen. In another cat the nerve ends were merely adapted, and good regeneration was seen despite slight neuroma formation. In a third case TabotampR and Aron-Alpha R were used to repair the skull base; this resulted in a neuroma and in atrophy of the sixth cranial nerve with scar adhesions rendering regeneration impossible. In five cases the transsected nerves were glued together with a fibrin adhesive, with excellent results: very good regeneration and reinnervation occurred within three months with ideal parallel alignment of the nerve fibres at the site of the lesion.
We present a series of 22 patients who were treated between 1997 and 2000 for mono- or bisegmental disc degeneration and spondylolisthesis grade I using Brantigan I/F ALIF cages. A ventral approach was chosen and no dorsal instrumentation was performed. Special emphasis was put on the preoperative evaluation of the individual lower back pain and it's causes. At least 5 (average 17,6) months postoperatively patients were questioned regarding the amelioration of lower back pain. Out of these 18, four reported pain reduction as very good, nine as good, four as satisfactory and one patient as worse. Clinical success after 33,4 months (17-56) was defined according to an expanded Prolo scale. The five-point Likert scales for pain, function, economic status, and medication usage were added to a combined 4-20 point scale. There was an improvement observed from 8,0 points to 12,0 points postoperatively. The ascertained 21 patients were in average on regular pain medication according WHO II before surgery, and WHO I postoperatively. Radiological follow up revealed reconstruction of the preoperatively narrowed disc space and a high rate of fusion. Complications were few and will be outlined in detail. Patient acceptance of the anterior approach was high.
Kluger's "Fixateur Interne" proved to be an excellent tool not only in spinal trauma for repositioning of impacted fractures and transpedicular stabilization of the dorsal column but also in other forms of thoracic or lumbar instability. After spinal tumor excision from a dorsal approach and vertebral replacement with methylmethacrylate additional stability through dorsal fixation was achieved with this device. Spondylodiscitis, symptomatic spondylolisthesis, spinal instability from degenerative disc disease as well as "non-union" following previous surgery could be cured using Kluger's internal fixation. Rare complications, i.e. from broken screws or rods (5%) caused no problems, but some patients required a second operation for readjustment of malpositioned screws which were causing pain or neurological deficit.
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