MRI perfusion studies have focussed mainly on acute ischaemia and characterisation in ischaemia. Our purpose was to analyse regional brain haemodynamic information in acute, subacute, and chronic ischaemia. We performed 16 examinations of 11 patients on a 1.5 T MR images. Conventional and dynamic contrast-enhanced imaging were employed in all examinations. For the dynamic susceptibility sequences, a bolus (0.2 mmol/kg) of gadopentetate dimeglumine was injected. Reconstructed regional relative cerebral blood volume (rCBV) maps, bolus maps, and conventional images were analysed by consensus reading. In all examinations decreases in rCBV were observed in the lesions. The distribution of regional rCBV in lesions was heterogeneous. The rCBV of the periphery of the lesions was higher than that at their center. There was a correlation between the time since onset and abnormalities on the rCBV map and T2-weighted images (T2WI). In the early stage of acute stroke, the abnormalities tended to be larger on the rCBV than on T2WI. Many patterns of bolus passage were observed in ischaemic regions. rCBV maps provide additional haemodynamic information in patients with brain infarcts.
Techniques for vascularized reconstruction of the anterior cranial fossa floor defects causing recurrent cerebrospinal fluid fistula are discussed in this report. The closure employs the use of local random- or axial-pattern vascularized flaps in simple cases. In complicated cases (for instance, status after repeated exploration) the tissue of the cranial base is severely compromised and shows low potential for healing. Non-vascularized grafts only add avital scars to the already present ones leading to recurrent fistulas. Free vascularized flaps show more mechanical strength and less scar contraction, resistance to infections and survive better in a compromised surrounding, thus leading to long term sealing in such cases. The technical issues of vascularized closure of defects of the frontal skull base are discussed in this report.
Maps of relative regional cerebral BV provide hemodynamic information in meningiomas and monitor the treatment effect of embolization in meningiomas more precisely than T1-weighted contrast-enhanced imaging.
ThE NEUROSURGICAL CLINIC at the Ludwig-Maximilians University in Munich began as a small unit of the university's surgical clinic. Eduard Weber, who in 1952 became the first surgeon fully trained in the specialty of neurosurgery to join the surgical clinic's faculty, worked, until his death in 1962, to advance the new specialty. Neurosurgery became an independent department of the university in 1965, and the neurosurgical clinic moved to a new location at Beethovenplatz. Further expansion led the neurosurgical clinic to move again, in 1975, to the newly constructed Klinikum Grosshadern at the periphery of Munich. Frank Marguth, chairman of the department of neurosurgery from 1964 to 1991, had superb skill as an organizer and greatly enhanced the reputation of the department of neurosurgery. Today, the faculty of the department consists of 10 full-time staff members, 10 joint appointment staff members, and 16 residents and fellows. Annually, 2200 to 2300 procedures are performed in the neurosurgical clinic. The current philosophy in the department places heavy emphasis on subspecialization and academic training. Political and economic changes in Germany during recent years have affected the nation's public health system and pose major challenges to the department of neurosurgery.
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