Background context Comparison of measured clinical deficits and outcomes is vital for international discussion about the identification and treatment of cervical spondylotic myelopathy (CSM). There is currently little information comparing outcomes as assessed by different CSM scoring systems. Purpose To qualitatively and quantitatively analyze five specific CSM outcome scores that are frequently used to assess the grade of severity and outcome after operative decompression. Study design This retrospective study evaluated the Nurick score, the Japanese Orthopedic Association score (JOA score), the Cooper myelopathy scale (CMS), the Prolo score, and the European myelopathy score (EMS). Patient sample The study included 43 patients with clinical and morphological signs of CSM, who underwent ventral decompression. Data were evaluated in sufficient detail to objectively assess the scores. Outcome measures Clinical findings (funicular and radicular symptoms), recovery rate, symptom duration, age, economic situation, time away from employment, somatic-evoked potentials, and radiological findings were assessed. Methods Scores were assessed using both pre- and postoperative clinical data. Correlations between scores, score improvement, and how well the scores reflected the clinical, diagnostic, and anamnestic data were analyzed using nonparametric, descriptive statistical tests. The recovery rate, as a measure of cumulative outcome, was also assessed and compared for each scoring system. Results All five scores were suitable for qualitatively assessing the clinical characteristics and progression of cervical myelopathy. All showed a statistically significant correlation (p<.05), and measured postoperative improvement (p<.001). All scores also reflected clinical deficits except for the Prolo score, which rates the severity of CSM with an emphasis on data related to the economic impact on the patient's situation rather than on clinical symptoms per se. Quantitative assessment of clinical symptom improvement varied greatly among the scores, for example, Nurick score (33%) versus JOA score (81%). The recovery rates, as a measure of cumulative improvement, showed less variation among most of the scores. The Nurick score and the EMS measured clinical deficit improvements in significantly fewer patients than did the JOA score (p<.05). Conclusions Evaluating the recovery rate is essential for comparing the results of the five CSM scores evaluated in this study. There was a large quantitative difference among the scores as the result of the different criteria used to produce each score. Qualitatively, all five scores allowed evaluation of cervical myelopathy, but only the recovery rate allowed for statistical comparison. Advancements in the treatment of CSM depend on the ability of clinicians to evaluate the therapeutic results of CSM studies. This study suggests that using the recovery rate to assess outcome is best for comparing studies that use different scores.

The ability to compare various results that measure clinical deficits and outcome is a necessity for successful worldwide discussion about cervical spondylogenic myelopathy (CSM) and its treatment. There is hardly any information in literature how to value and compare outcome assessed by different scores. In a retrospective study we objectively evaluated the Nurick-score, Japanese-orthopaedic-association-score (JOA-Score), Cooper-myelopathy-scale (CMS), Prolo-score and European-myelopathy-score (EMS) using the data of 43 patients, all of whom showed clinical and morphological signs of CSM and underwent operative decompression. The scores were assessed pre- and postoperatively. The correlation between the score-results, anamnesis, clinical and diagnostic data was investigated. All the scores show a statistically significant correlation and measure postoperative improvement. With exception of the Prolo-score all scores reflect clinical deficits of CSM. The Prolo-score rates the severity of CSM on the state of the economic situation above clinical symptoms. The main differences of the scores are shown in the number of patients showing postoperative improvement, varying between 33% (Nurick-score) and 81% (JOA-score). The recovery-rates, as a measure of the cumulative improvement of all the symptoms, show less variation (23-37%). The differences of the recovery-rate were only statistically significant between JOA-score, Nurick-score and EMS (P < 0.05), whereas all the other scores showed no significant differences. To assess the postoperative successes, the evaluation of the recovery-rate is essential. There is no significant difference in the recovery-rate amongst the majority of the scores, which allows a good comparison of the results from different studies. Nevertheless, it is always important to differentiate the therapy results of CSM published worldwide.

Introduction: Changes in somatosensory evoked potentials (SEPs) were used to identify cerebral ischemia and to predict neurological outcome during the application of temporary clips in aneurysm surgery.

Desmoids are tumours of the connective tissue cells with aggressive growth. Frequent recurrences of these tumours have often been described. Genetic and endocrine factors as well as local tissue biomechanics are thought to be responsible for the pathogenesis. This case report should contribute to the discussion about possible pathogenetic factors.

The authors report on the handling and the practicability of a newly developed MR-compatible device, the NEUROGATE (Daum GmbH, Germany), which allows precise planning, simulation and control of stereotactic biopsy in patients with suspect intracranial lesions, and which allows minimally invasive maneuvers to be performed in a comfortable way. Twenty-eight patients were examined stereotactically in the Signa SP interventional 0.5 Tesla MRI (General Electric Medical Systems, USA), including 15 patients with malignant intracerebral tumors and poor general medical conditions (8 gliomas, 7 metastases) who were treated by laser-induced interstitial thermotherapy (LITT) after definite intraoperative neuropathological diagnosis. As a special stereotactic holding device, the NEUROGATE was favored as a reliable tool for stereotaxy and minimally invasive procedures.

Cryodestruction of tissue is influenced by cooling and thawing rates, absolute tissue temperature, number of freeze-thaw cycles, and type of tissue. However, under clinical conditions a MRT visualization of the temperature distribution during cryo-procedures is not possible. Thus, the extent of necrotic areas within the cryo-influenced regions are not precisely predictable. This limitation is particularly relevant for the application of cryoablation in the brain. The present paper proposes the concept of a local, cryo-induced ischemic necrosis. The basic concept is that the MRT-observable and surgically well-manageable frozen region is ischemic. This cryo-induced ischemia causes a necrosis. The extent of the necrotic region is exclusively determined by the ischemia tolerance of the tissue. The effectiveness of this method is demonstrated on sheep brain in vivo. Compared to the freeze-thaw method, histological examinations show a sharper demarcation between regions of necrosis and healthy tissue. In conclusion, the method of MR-controlled local, cryo-induced ischemia enables an exact definition of the region of necrosis in the brain.

Die Kryodestruktion von Gewebe ist abhängig von den Abkühl- und Taugeschwindigkeiten, von der absoluten Gewebetemperatur, der Anzahl der Gefrier-Tau-Zyklen sowie vom Gewebetyp. Da es unter klinischen Bedingungen nicht möglich ist, während einer kryochirurgischen Intervention die Temperaturverteilung im Gewebe unter MRT-Kontrolle zu verfolgen, ist der Grad der Gewebedestruktion innerhalb des kältebeeinflussten Gebiets nicht sicher voraussagbar. Dies jedoch ist speziell für die Anwendung im Hirn wesentlich. In der vorliegenden Arbeit wird das Konzept der lokalen, kälteinduzierten ischämischen Nekrose vorgestellt: Dabei erfolgt eine Abkühlung des intrazerebralen Zielbereichs bis zum Einfrieren des Gewebes. Es resultiert eine im MRT-Bild als signalfreie Zone sichtbare und damit intraoperativ gut zu steuernde Ischämiezone. Das Destruktionsgebiet wird allein durch die Ischämietoleranz des gefrorenen Hirnbereichs bestimmt. Die Effektivität des Verfahrens wird am Hirn des Schafes in vivo demonstriert. Histologische Auswertungen zeigen im Vergleich zur Gefrier-Tau-Technik eine schärfere Abgrenzung der Nekroseregion. Schlussfolgerung: Die Methode der MR-gesteuerten lokalen kryoinduzierten Ischämie ermöglicht eine regional definierte, intraoperativ gut kontrollierbare Gewebedestruktion im Hirn.