The differential influence of fixation and directed visual attention on reaction times of goal-directed saccades and especially on the occurrence of express saccades was investigated. In all the experiments the subjects were instructed first to keep their direction of gaze at the center of a translucent screen with or without a central fixation point. When a new stimulus appeared, the subjects had to look at it as soon as possible. In some control experiments the subjects had to direct their gaze to the screen center and simultaneously direct their attention to a peripheral light spot before the target for the saccade appeared. Many express saccades occurred when either active fixation of a central fixation point or attention directed to a peripheral visual target (regardless of its position) was interrupted 200 ms before the target for the saccade appeared. Express saccades were almost completely abolished in the presence of fixation and/or directed visual attention at the moment in which the saccade target appeared. We conclude that express saccades occur if visual attention has already been released at the moment when the target for the saccade appears. This disengagement needs some time which adds to the reaction time.

SOMD and MAMD allow achievement of significant improvement of pain and neurological deficits in patients with lumbar disc herniations. Differences in operative time, blood loss, and complication rates were statistically not significant in MAMD compared with SOMD, indicating that, at least in lumbar disc surgery, minimal access trocar techniques are a viable alternative to standard spinal approaches.

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Eighteen consecutive patients with olfactory groove meningiomas, with diameters ranging from 1.5 to 7 cm, underwent microsurgical tumour resection using a unilateral frontal interhemispheric approach. Unilateral frontal craniotomy, superior to the frontal sinus, exposing the superior sagittal sinus was performed. The ipsilateral frontal lobe was gently retracted laterally, and the tumour resected through the gap between the falx and the medial aspect of the frontal lobe, anteriorly to the genu of the corpus callosum. Gross total tumour resection was achieved in all the patients. There was no evidence of damage to the frontal lobes, the anterior cerebral arteries or the optic system. Compared with the more commonly applied subfrontal route, the interhemispheric approach has the advantages of sparing the frontal sinuses and providing excellent overview of the dissection of the anterior cerebral arteries and the optic system, as well as for the resection of tumour invading the frontal cranial base.

In a series of 10 patients with stereotactically treated basal ganglia haematoma rtPA was used to dissolve remaining clots. Pre-operative haematoma volume ranged between 39 and 111 cm3 (average 56 cm3). Stereotactic aspiration alone yielded an average volume reduction of 60% (range 23 to 78%). Haematoma cavity was instillated with rtPA repeatedly beginning 24 hours after the stereotactic intervention. At the end of rtPA therapy between 2 and 4 days after onset of the haemorrhage 67 to 92% (average 84%) of the initial haematoma was removed in all patients. More than 80% of the pre-operative clot could be removed in 8 out of 10 patients between day 2 and 4. There were no signs of rtPA related toxicity. At the end of the follow-up period (between 4 and 17 months--mean 8 months) 6 patients were awake, oriented and with a residual hemiparesis able to live in their familiar environment. It is concluded that local rtPA instillation is an effective additional treatment to further resolution of deep seated intracerebral haematomas after stereotactic aspiration.

OBJECTIVE To integrate spatial three-dimensional information concerning the pyramidal tracts into a customized system for frameless neuronavigation during brain tumor surgery. METHODS Four consecutive patients with intracranial tumors in eloquent areas underwent diffusion-weighted and anatomic magnetic resonance imaging studies within 48 hours before surgery. Diffusion-weighted datasets were merged with anatomic data for navigation purposes. The pyramidal tracts were segmented and reconstructed for three-dimensional visualization. The reconstruction results, together with the fused-image dataset, were available during surgery in the environment of a customized neuronavigation system. RESULTS In all four patients, the combination of reconstructed data and fused images was a helpful additional source of information concerning the tumor seat and topographical interaction with the pyramidal tract. In two patients, intraoperative motor cortex stimulation verified the tumor seat with regard to the precentral gyrus. CONCLUSION Diffusion-weighted magnetic resonance imaging allows individual estimation of large fiber tracts applicable as important information in intraoperative neuronavigation and in planning brain tumor resection. A three-dimensional representation of fibers associated with the pyramidal tract during brain tumor surgery is feasible with the presented technique and is a helpful adjunct for the neurosurgeon. The main drawbacks include the length of time required for the segmentation procedure, the lack of direct intraoperative control of the pyramidal tract position, and brain shift. However, mapping of large fiber tracts and its intraoperative use for neuronavigation have the potential to increase the safety of neurosurgical procedures and to reduce surgical morbidity.

Frame-based and frameless stereotactic hematoma aspirations with subsequent fibrinolysis are effective in volume reduction of intracerebral hemorrhage with comparable clinical outcome. The frameless procedure is associated with a higher risk for malpositioning of the catheter. Despite effective hematoma reduction with both techniques, the percentage of patients with a good clinical outcome remained limited especially in the elder subpopulation.