Creatine-Kinase-BB (CK-BB) is a brain specific enzyme, with a prognostic value for the patient's outcome after head-injury. We have investigated 76 brain injured patients and attempted to show a correlation of the concentrations of CK-BB and the Glasgow-Outcome-Scale (GOS). Patients with a CK-BB concentration of more than 50 ng/ml died. Patients, who had a CK-BB concentration less than 25 ng/ml showed only minimal neurological deficits.

Determination of the prognosis of patients with severe head injury is a very frequent topic of discussion and is still extremely difficult even after the advent of computer tomography. This is especially true of the first 2 days after injury, when the duration of unconsciousness, an important parameter of clinical progress [1], is not known.

Four patients with intracerebral vascular malformations underwent preoperative butylcyanoacrylate embolization via a calibrated leak catheter, in order to reduce the risks of surgery alone. In three cases the malformation was removed without causing neurological deficits. One patient died later from recurrent bleeding.

If blood supply to the brain hemisphere is disturbed following closure of internal homolateral carotid artery tumors of the skull base with involvement of this artery should not be operated on radically. The authors describe the electrophysiological monitoring of cortical evoked somato-sensory potentials. If there is no alteration of the evoked potentials after preliminary reversible blockade of the internal carotid artery this vessel can be definitely closed using a detachable balloon. Thereafter the whole tumor including the carotid artery can be removed. The authors describe a case of juvenile angiofibroma operated on in this way. The combined interventional-neuroradiological and surgical management widens the range of skull base surgery.

Die Operabilität von Tumoren der Schädelbasis wird sehr stark eingeschränkt, wenn die A. carotis interna an der Tumorversorgung unmittelbar beteiligt ist. Das intraoperative elektrophysiologische Monitoring gestattet eine rasche und verläßliche Aussage darüber, ob die A. carotis interna ohne Funktionsausfälle nach probatorischem Verschluß definitiv verschlossen werden kann. Die Verwendung von absprengbaren Ballons zum Verschluß der A. carotis interna ermöglicht die gefahrlose Embolisation der Tumorversorgungsgefäße, die aus der A. Carotis interna entspringen. Das kombiniert neuroradiologisch-chirurgische Vorgehen mit Wiederherstellung der Operabilität im Falle des Rezidivs eine Angiofibroms zeigt grundsätzliche Möglichkeiten für die Erweiterung des Behandlungsspielraums bei Tumoren der Schädelbasis auf.

In cases of multiple cerebral injuries it may be difficult to distinguish between the clinical pictures of supra- and infratentorial traumatic lesions. Intracranial epidural pressure measurements taken in the usual fashion at certain points distributed over an entire cerebral hemisphere may not be helpful when it comes to identifying infratentorial pressure increases at an early stage. In cases of infratentorial lesion, continuous BAEP surveillance of the functions of the brain stem may furnish some reliable supplementary information.

In 43 patients with arterio-venous malformations and one patient with a cavernous haemangioma, whose angiomas were completely removed by the same Surgeon, pre- and postoperative angiograms were reviewed and the clinical results documented in a follow-up study. Mortality rate (7%) and severe disability (7%) are significantly lower than in untreated patients.

Some vertebro-basilar aneurysm may not be treatable at a reasonable risk by direct clipping. A possible alternative is transvascular obliteration, using the means of modern interventional neuroradiology in combination with neurophysiological monitoring.