Stabilizing Craniocervical Operations Calcium Antagonists in SAH Current Legal Issues : Proceedings of the 40th Annual Meeting of the Deutsche Gesellschaft für Neurochirurgie, Würzburg, May 7-10, 1989

Demands on a Neurosurgeon Under Routine Clinical Conditions' "Hardly any other field of surgery requires such meticulous asepsis. No other field requires such a protection of the tissue and such reliable hemostasis. No one will question that neurosurgery makes exceedingly high demands. However, the degree of the demands on the personal­ ity of the surgeon who has to carry out very serious operations to the exclusion of all others and has little opportuinity to recover psycholog­ ically by working on simpler cases is concealed from the outer world. The mental strain which the coworkers and staff have to tolerate may not be denied". So wrote Wilhelm Tonnis in 1939. Although fifty years have now elapsed, his appraisal is still relevant today - hence my intention to discuss the everyday demands placed on neurosurgeons. My aim is not self-glorification to engender sympathy; rather it is to highlight the effects and repercussions of such demands for the well-being of the patients entrusted to us. The major onerous demands include: - those in the operating theater - those resulting from staff problems in nursing - those resulting from legal developments - those resulting from the increasing administrative tasks that cost valuable time and energy which are lost to our actual work in look­ ing after patients: science and research also suffer from this. I shall not go into the latter point within this preface. Let me first turn to the strains occurring in the operating theater.

Reflections on the Future of German Neurosurgery: Further Development on the Foundations Laid by Tönnis.- Decompression and Stabilization of the Cervical Spine.- Indications and Complications of Cervical Spine Stabilization.- Osteosynthesis of the Upper Cervical Spine and the Craniocervical Junction.- Surgical Treatments to Stabilize the Upper Cervical Spine.- The Caspar Plate as a Means of Stabilizing the Upper, Middle, and Lower Cervical Spine ― Results in 45 Cases.- Anterior Reconstruction and Stabilization After Cervical Vertebral Body Resection.- Long-Term Results After Cervical Interbody Fusion with Polymethylmethacrylate.- Cervical Spine Injuries in Childhood: Long-Term Results After Surgical and Conservative Therapy; Morphological and Functional Aspects.- Bracing of the Dens Axis.- The Surgical Treatment of Atlas, Axis, and Combined CI and C2 Fractures.- Association of Injuries to the Head and Spine: 34 Consecutive Cases over a 3-Year Period.- Operative Treatment of Metastatic Cervical Spine Instability.- On the Symptomatology and Neurosurgical Treatment of Senile Ankylosing Hyperostosis of the Spine (Forestier).- Cervical Spine Fractures in Ankylosing Spondylitis ― An Imperative Indication for Surgical Spondylodesis.- Primary Autologous Bone Transplantation in the Treatment of Cervical Spondylitis.- Treatment of Craniocervical Instabilities with the Halo-fixateur.- The Natural History of Unstable Traumatic Injuries of the Cervical Spine.- Syringomyelia.- Evolution of the Neurosurgical Management of Syringomyelia in the Last Two Decades.- Syringomyelia: Aspects of Therapeutic Decisions.- Pathogenesis and Operative Treatment of Syringomyelia.- Magnetic Resonance Imaging of Syringomyelia: Idiopathic and Tumor-Associated Cases.- Comparison of Syringoperitoneal and Syringopleural Shunting in Patients with Syringomyelia.- Microsurgical Treatment of Syringomyelia: Intraoperative Findings and Results.- SEPs and Evoked Muscle Responses After Noninvasive Magnetic Stimulation in Patients with Syringomyelia.- Lumbosacral Lipomas and Lipomyelomeningoceles: Operability and Long-Term Follow-up.- The Optimal Time for Operative Treatment of the Tethered Cord Syndrome.- Tethered Cord Syndrome Following Spina Bifida Aperta.- Intraspinal Lipomas with Tethered Cord Syndrome ― Results of Operative Treatment in 30 Children.- The Use of Calcium Antagonists Following Subarachnoid Hemorrhage.- Pharmacology of Nimodipine ― A Review.- The Prognostic Significance of the Concentration of Nimodipine in the CSF and Plasma in Subarachnoid Hemorrhage.- Is High Dose Nimodipine Therapy Necessary Following Subarachnoid Hemorrhage? A Retrospective Study of 80 Patients with Aneurysmal Subarachnoid Hemorrhage over the Past 2 Years.- Interactions Between Nimodipine and Anesthetics Used in Neurosurgical Procedures.- Influence of Nimodipine on Pulmonary Function.- Tolerability of Calcium Antagonists.- Nimodipine in the Treatment of Subarachnoid Hemorrhage Secondary to Aneurysm Rupture: Five Years’ Experience.- Experience with Deliberate Early Aneurysm Surgery and Nimodipine.- Effect of Nimodipine on the Outcome Following Operation for Ruptured Intracranial Aneurysms.- Parenteral Nimodipine Therapy After Subarachnoid Hemorrhage: A Randomized Clinical Study.- Postoperative Long-Term Results After Aneurysm Surgery Among Patients Treated with Nimodipine.- The Acute Effect of Nimodipine on Intracranial Pressure and Cerebral Blood Flow.- Clinical Significance of TCD Pulsatility Indices in Subarachnoid Hemorrhage and Arteriovenous Malformations.- Development of Vasospasm After Subarachnoid Hemorrhage Under Nimodipine Therapy Before and After Aneurysm Surgery.- Prevention of Vasospasm with Nimodipine.- The Clinical Value of Transcranial Doppler Sonography in Aneurysmal Subarachnoid Hemorrhage as an Indication for Cerebral Angiography and a Means of Controlling Nimodipine Treatment.- Clinical and Transcranial Doppler Sonography Evaluation During Treatment with Calcium Antagonists After Subarachnoid Hemorrhage.- CBF Dynamics ― Vasospasm After Subarachnoid Hemorrhage.- Discrepancy Between the Results of TCD and the Clinical Status of Patients After SAH.- Aktuelle Rechtsfragen in der Neurochirurgie in Forschung und Klinik.- Current Legal Issues in Neurosurgical Research and Treatment.- Zur Verwendung menschlichen Gewebes, insbesondere von foetalem Gewebe in der Neurochirurgie.- Risiko und erforderlicher Standard in der Neurochirurgie ― Überholtes, Notwendiges, Unerprobtes ― (Neurochirurgisches Referat).- Risiko und erforderlicher Standard in der Neurochirurgie ― Überholtes, Notwendiges, Unerprobtes ― (Juristisches Referat).- Neuere Entwicklung in der Rechtsprechung zur Aufklärung.- Die ärztliche Aufklärung ― Eine Gratwanderung zwischen juristischem Muß und ärztlichem Tun?.- Straf- und zivilrechtliche Aspekte neurochirurgischer Tätigkeit.- Erfahrungen einer „Gutachterkommission für Ärztliche Behandlungsfehler” mit Behandlungsfehlern im neurochirurgischen Fachgebiet.- Sorgfaltsmangel oder typische Komplikation ― Auswertung der Begutachtungen für die Schlichtungsstelle für Arzthaftpflichtfragen unter besonderer Berücksichtigung der Bandscheibenoperation.- Zur Begutachtung von traumatischen Hirnschlagaderverletzungen.- Kann ein Schädelhirntrauma ein Akustikusneurinom auslösen? Rechtsmedizinische Überlegungen anhand eines Falles.- Gibt es histologische Beweise für eine traumatisch bedingte Bandscheibenschädigung?.- Versicherungsrechtliche Bewertung von Traumen für die Entstehung und den Verlauf zervikaler und lumbaler Bandscheibenvorfälle.- Eine seltene Komplikation nach Bandscheibenoperation in Knie-Ellenbogenlage.- Gesprächsführung in der Neurochirurgie.- Gutachtertätigkeit in Sozialgerichtsverfahren.- Notwendigkeit und Voraussetzungen einer Gebrechlichkeitspflegschaft bei neurochirurgischen Patienten.