Biography:

In the past Jeremy Christopher Ganz has collaborated on articles with Bente Sandvei Skeie. One of their most recent publications is Chapter 1 - Introduction. Which was published in journal .

More information about Jeremy Christopher Ganz research including statistics on their citations can be found on their Copernicus Academic profile page.

Jeremy Christopher Ganz's Articles: (7)

Chapter 1 - Introduction

AbstractThis chapter outlines the elements of cranial and intracranial structure and function which are relevant to the development of an epidural hematoma. The relevant anatomy is the structure and interrelationships of the skull and the underlying meninges. The broad outline of cerebral anatomy is considered together with the production and passage of cerebrospinal fluid. The blood supply to the brain is also considered. Finally, the anatomy of the cranial nerves is important. There is a brief mention of the structure of the book.

Chapter 5 - The Renaissance

AbstractEvery medically trained person remembers the year 1543 during which Vesalius great work on anatomy was published. However, there were other distinguished people in this century. Earlier, an irascible, eccentric genius, Giacomo Berengario Da Carpi (1460–1530) had prospered in Bologna. Contributions of importance also came from France and Scotland from respectively Ambroise Paré (1510–90) and his successor as surgeon to the French kings, Peter Lowe (1550–1610). All made contributions and it is perhaps worth noting that while Vesalius showed up Galen’s mistake with the Circle of Willis, he perpetuated Galen’s errors with regard to the anatomy of the cranial nerves and the attachment of the dura to the skull.

Chapter 7 - The 18th Century

AbstractThe 18th century was a period of increasingly scientific surgery. Twelve texts were written concerning cranial trauma. It was finally understood that the symptoms involving level of consciousness, epilepsy, paralysis, and vomiting were due brain damage and not as previously thought to injury of the cranium and meninges. Symptoms might be due to primary brain damage or secondary damage following intracranial extravasations of blood. This understanding was a precursor the development of modern head injury management. Arguments persisted about whom to operate and when and patterns of infection were seen which are not seen today. However, at the end of the century there was understanding of contralateral pareses and dilated pupils. The first real lucid intervals had been described.

Chapter 15 - Intracranial Effects of Epidural Bleeding

AbstractThis chapter considers the effect of epidural hematoma (EDH) on the intracranial contents and its function. Diverse experimental models show the essential effect for an EDH to the development of tentorial herniation. A lethal bleed is associated with ischemia affecting the cerebrum and the brainstem down to the pons. The medulla is spared. One of the consequences of this ischemia is an isoelectric electroencephalogram. This is not of itself lethal reflecting as it does the cerebrum. However, the ischemia to the pons is associated with hypoventilation which precedes hypertension followed by cardiovascular collapse and apnea and death. In surviving animals, no herniation developed. Maintenance of the cerebral blood flow in the medulla matching the magnetic resonance imaging (MRI) revealed anatomical changes in which there is no foramen magnum herniation at the time of death. The MRI also revealed that herniation was followed by secondary hydrocephalus and cerebral edema, which exacerbate the volume loading from the hematoma itself.

Chapter 16 - Terminal Changes in Epidural Bleeding

AbstractIn 1902, Cushing published the sequence of events following extreme rises in intracranial pressure which has come to bear his name; after some variations, it is currently known as the Cushing response (CR). It consists of bradypnea, bradycardia, and hypertension. It is known that the three components involve separate pathways. Almost all scientific works done to examine the pathways that stimulate and affect the response have used unphysiological methods applying pressure from outside animals where the animal’s body had no effect on the application of pressure. In a series of recent experiments, the author and colleagues used a physiological source to raise the intracranial pressure. This was bleeding from the femoral artery into an epidural balloon. These experiments confirmed earlier work that a CR is associated with brain stem ischemia which involves the pons but spares the medulla. This is paradoxical since the hypertension and heart rate changes in the CR have their origin in the medulla. It has been suggested that pontine ischemia can produce a respiratory disturbance by and effect on the pneumotaxic center in the pons. The current work shows that a respiratory disturbance producing hypoxia is a necessary trigger for a CR. This leads to the suggestion that the ischemia of the pons causes a bradypnea which produces hypoxia or asphyxia which in turn trigger the hypertension and bradypnea from the medulla.

Chapter 17 - Status Quo Vadis

AbstractThe state of current knowledge about epidural hematoma is summarized. The possibilities for some future improvements in management are outlined.

Peer-Review ReportGamma Knife Surgery of Colorectal Brain Metastases: A High Prescription Dose of 25 Gy May Improve Growth Control

ObjectiveThere are few reports on the effect of gamma knife surgery (GKS) for brain metastases from colorectal cancer. The purpose of this study was to identify prognostic factors for local control, complications, and survival in our series of patients treated with GKS.MethodsEighty patients (36 males, 44 females) with 140 metastases who received GKS between 1996 and 2008 were retrospectively reviewed. The mean tumor volume was 6.13 (0.01–35.5) cm3; the prescription dose was 21.1 (10–25.1) Gy and the maximum dose 42.7 (17.2–66.7) Gy; and the tumor cover was 95.0% (72%–100%).ResultsGrowth control was achieved in 93 of 121 tumors (76.9%) and 42 of 68 (61.8%) patients, while treatment failure was seen in 28 of 121 tumors (23.1%). Local control was better if a high prescription dose of 25 Gy was used, 88.4% vs. 71.4% (P = 0.017), or if tumor volume was <5 cm3 (86.4%), compared with 69.9% for 5–20 cm3 and 51.9% for >20 cm3 (P = 0.002). The hazard ratio for local failure with lower prescription doses was 2.8 (P = 0.026) in the unadjusted, and 8.5 (P = 0.055) in the adjusted multivariate analysis (tumor volumes >5 cm3). The median survival was 6 months (range 0–75) after GKS. Age <70 years (P < 0.001) and high RPA class (P = 0.032) were associated with longer survival. Fifteen patients (22.1%) had persistent edema on follow-up MRI, possibly because of radiation damage to the tumor. Radiation-induced edema was asymptomatic in 93.8%. We found neither a decrease in the incidence of new metastases nor improved survival when whole-brain radiation therapy was given prior to GKS.ConclusionsGKS provides reasonable local tumor control. Local control rate is highest if the margin dose is 25 Gy and the tumor volume <5 cm3. Radiation edema was common but rarely symptomatic. Survival is longest for young, well-functioning patients.

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