Publications by authors named "Bedjan Behmanesh"

37 Publications

The Added Value of Cerebral Imaging in Patients With Pyogenic Spinal Infection.

Front Neurol 2021 4;12:628256. Epub 2021 May 4.

Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.

The incidence of pyogenic spinal infection has increased in recent years. In addition to treatment of the spinal infection, early diagnosis and therapy of coexisting infections, especially of secondary brain infection, are important. The aim of this study is to elucidate the added value of routine cerebral imaging in the management of these patients. This was a retrospective single-center study. Cerebral imaging consisting of cerebral magnetic resonance imaging (cMRI) was performed to detect brain infection in patients with a primary pyogenic spinal infection. We analyzed a cohort of 61 patients undergoing cerebral imaging after diagnosis of primary pyogenic spinal infection. The mean age in this cohort was 68.7 years and the gender distribution consisted of 44 males and 17 females. Spinal epidural abscess was proven in 32 (52.4%) patients. Overall positive blood culture was obtained in 29 (47.5%) patients, infective endocarditis was detected in 23 (37.7%) patients and septic condition at admission was present in 12 (19.7%) Patients. Coexisting brain infection was detected in 2 (3.3%) patients. Both patients revealed clinical signs of severe sepsis, reduced level of consciousness (GCS score 3), were intubated, and died due to multi-organ failure. Brain infection in patients with spinal infection is very rare. Of 61 patients with pyogenic spinal infection, two patients had signs of cerebral infection shown by imaging, both of whom were in a coma (GCS 3), and sepsis.
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http://dx.doi.org/10.3389/fneur.2021.628256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129560PMC
May 2021

Functional outcome and morbidity after microsurgical resection of spinal meningiomas.

Neurosurg Focus 2021 05;50(5):E20

Departments of1Neurosurgery and.

Objective: The aim of this study was to evaluate functional outcome, surgical morbidity, and factors that affect outcomes of surgically treated patients.

Methods: The authors retrospectively analyzed patients who underwent microsurgical resection for spinal meningiomas between 2009 and 2020. Patient data and potential variables were collected and evaluated consecutively. Functional outcomes were evaluated using univariate and multivariate analyses.

Results: A total of 119 patients underwent microsurgical resection of spinal meningioma within the study period. After a mean follow-up of 25.4 ± 37.1 months, the rates of overall complication, tumor recurrence, and poor functional outcome were 9.2%, 7.6%, and 5%, respectively. Age, sex, revision surgery, and tumor recurrence were identified as independent predictors of poor functional outcome. Obesity and surgeon's experience had an impact on the complication rate, whereas extent of resection and tumor calcification affected the rate of tumor recurrence.

Conclusions: Microsurgical resection of spinal meningiomas remains safe. Nevertheless, some aspects, such as obesity and experience of the surgeons that result in a higher complication rate and ultimately affect clinical outcome, should be considered when performing surgery.
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http://dx.doi.org/10.3171/2021.2.FOCUS201116DOI Listing
May 2021

Direct oral anticoagulants vs. low-molecular-weight heparin for pulmonary embolism in patients with glioblastoma.

Neurosurg Rev 2021 Apr 26. Epub 2021 Apr 26.

Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60598, Frankfurt, Germany.

Glioblastoma (GBM) is a cancer type with high thrombogenic potential and GBM patients are therefore at a particularly high risk for thrombotic events. To date, only limited data on anticoagulation management after pulmonary embolism (PE) in GBM is available and the sporadic use of DOACs remains off-label. A retrospective cohort analysis of patients with GBM and postoperative, thoracic CT scan confirmed PE was performed. Clinical course, follow-up at 6 and 12 months and the overall survival (OS) were evaluated using medical charts and neuroradiological data. Out of 584 GBM patients, 8% suffered from postoperative PE. Out of these, 30% received direct oral anticoagulants (DOACs) and 70% low-molecular-weight heparin (LMWH) for therapeutic anticoagulation. There was no significant difference in major intracranial hemorrhage (ICH), re-thrombosis, or re-embolism between the two cohorts. Although statistically non-significant, a tendency to reduced mRS at 6 and 12 months was observed in the LMWH cohort. Furthermore, patients receiving DOACs had a statistical benefit in OS. In our analysis, DOACs showed a satisfactory safety profile in terms of major ICH, re-thrombosis, and re-embolism compared to LMWH in GBM patients with postoperative PE. Prospective, randomized trials are urgent to evaluate DOACs for therapeutic anticoagulation in GBM patients with PE.
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http://dx.doi.org/10.1007/s10143-021-01539-9DOI Listing
April 2021

Association of Isocitrate Dehydrogenase (IDH) Status With Edema to Tumor Ratio and Its Correlation With Immune Infiltration in Glioblastoma.

Front Immunol 2021 25;12:627650. Epub 2021 Mar 25.

Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany.

Purpose: The extent of preoperative peritumoral edema in glioblastoma (GBM) has been negatively correlated with patient outcome. As several ongoing studies are investigating T-cell based immunotherapy in GBM, we conducted this study to assess whether peritumoral edema with potentially increased intracranial pressure, disrupted tissue homeostasis and reduced local blood flow has influence on immune infiltration and affects survival.

Methods: A volumetric analysis of preoperative imaging (gadolinium enhanced T1 weighted MRI sequences for tumor size and T2 weighted sequences for extent of edema (including the infiltrative zone, gliosis etc.) was conducted in 144 patients using the Brainlab® software. Immunohistochemical staining was analyzed for lymphocytic- (CD 3+) and myelocytic (CD15+) tumor infiltration. A retrospective analysis of patient-, surgical-, and molecular characteristics was performed using medical records.

Results: The edema to tumor ratio was neither associated with progression-free nor overall survival (p=0.90, p=0.74). However, GBM patients displaying IDH-1 wildtype had significantly higher edema to tumor ratio than patients displaying an IDH-1 mutation (p=0.01). Immunohistopathological analysis did not show significant differences in lymphocytic or myelocytic tumor infiltration (p=0.78, p=0.74) between these groups.

Conclusion: In our cohort, edema to tumor ratio had no significant correlation with immune infiltration and outcome. However, patients with an IDH-1wildtype GBM had a significantly higher edema to tumor ratio compared to their IDH-1 mutated peer group. Further studies are necessary to elucidate the underlying mechanisms.
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http://dx.doi.org/10.3389/fimmu.2021.627650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044904PMC
March 2021

Quality of Life Following Surgical and Conservative Therapy of Pyogenic Spinal Infection: A Study of Long-term Outcome in 210 Patients.

J Neurol Surg A Cent Eur Neurosurg 2021 Mar 9. Epub 2021 Mar 9.

Department of Neurosurgery, Goethe-Universitat Frankfurt am Main Fachbereich 16 Medizin, Schleusenweg, Frankfurt, Germany.

Object:  The management and recommendations for treatment strategies of pyogenic spinal infection are still a highly controversial issue. The purpose of this study was to evaluate patient's quality of life (QoL) after surgical and conservative treatment of spinal infection.

Materials And Methods:  We conducted a retrospective, single-center study. All patients treated between 2009 and 2016 were included in this study. For evaluation of QoL, we recorded each patient's satisfaction according to the 36-Item Short Form Health Survey (SF-36) questionnaire. Scores were compared with a U.S. standard population.

Results:  Two hundred and ten adult patients with spondylodiskitis were identified. Of these, 155 (74%) underwent surgery and 55 (26%) were treated conservatively. The mean overall age was 68.6 (23-98) years. Seventy-two patients were females and 138 patients were males. The mean outcome values in the surgical group did not reach the level of the normative sample in one of eight items, whereas the conservative group revealed a reduced QoL in all items. Intergroup comparison revealed significant differences in all items (< 0.05).

Conclusion:  In the patient population we investigated, QoL in surgically treated patients was better than that in conservatively managed patients.
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http://dx.doi.org/10.1055/s-0041-1722965DOI Listing
March 2021

Impact of Comorbidities and Frailty on Early Shunt Failure in Geriatric Patients With Normal Pressure Hydrocephalus.

Front Med (Lausanne) 2020 30;7:596270. Epub 2020 Nov 30.

Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.

Older patients are considered to bear a higher perioperative risk. Since idiopathic normal pressure hydrocephalus (NPH) predominantly concerns older patients, identifying risk factors for early shunt failure for preoperative risk/benefit assessment is indispensable for indication and/or consultation of patients for ventriculoperitoneal shunting (VPS). We performed a retrospective study design, including data acquired from two university hospital neurosurgical institutions between 2012 and 2019. Overall, 211 consecutive patients with clinical/radiological signs for NPH who additionally showed alleviation of symptoms after lumbar cerebrospinal fluid (CSF) drainage, received VPS and were included for further analysis. Frailty was measured using the Clinical Frailty Scale (CFS). Main outcome was early shunt failure or post-operative complications within 30 days after initial VPS surgery. The overall complication rate was 14%. Patient-related complications were observed in 13 patients (6%) and procedure-related complications in 16 patients (8%). Early post-operative complications resulted in a significantly prolonged length of hospital stay 6.9 ± 6.8 vs. 10.8 ± 11.8 days ( = 0.03). Diabetes mellitus with end-organ damage (OR 35.4, 95% CI 6.6 - 189.4, < 0.0001) as well as preexisting Parkinson's disease were associated with early patient-related post-surgical complications after VPS for NPH. Patients comorbidities but not frailty were associated with early post-operative patient-related complications in patients suffering NPH. While frailty may deter patients from other (neurosurgical) procedures, VPS surgery might contribute to treating NPH in these patients at a tolerable risk.
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http://dx.doi.org/10.3389/fmed.2020.596270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734184PMC
November 2020

Direct oral anticoagulants for therapeutic anticoagulation in postoperative pulmonary embolism after meningioma resection.

J Clin Neurosci 2020 Nov 16;81:265-269. Epub 2020 Oct 16.

Department of Neurosurgery, University Medicine of Rostock, Rostock, Germany.

Background: Acute postoperative pulmonary embolism (PE) is a dreaded complication with severe mortality rates. Brain tumor patients are at the highest risk for postoperative PE. The juxtaposition of low-molecular-weight heparin (LMWH), vitamin K antagonists (VKA) and direct oral anticoagulation (DOAC) in the treatment of postoperative PE in meningioma patients is largely unexplored.

Patients/methods: This is a single center observational analysis of meningioma patients who underwent neurosurgical resection with a thoracic CT scan confirmation of postoperative PE. The treatment modality, clinical course and outcome were investigated.

Results: Of 538 meningioma patients operated, 30 (6%) developed acute postoperative PE. After diagnosis, these patients received different long-term anticoagulation regimes. No significant difference in postoperative hemorrhage (p < 0.56), re-operation rate (p < 0.70) or Karnofsky performance scale (KPS) at 3 (p < 0.34) and 12 months (p = 1) were identified, when compared according to the different anticoagulation regimes.

Conclusion: DOACs were not associated with elevated risk for hemorrhage, recurrent thrombosis or poor outcome when compared with traditional anticoagulation regimes. Prospective randomized trials are necessary to verify the non-inferiority of DOACs for long-term anticoagulation in postoperative pulmonary embolism after meningioma resection.
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http://dx.doi.org/10.1016/j.jocn.2020.09.059DOI Listing
November 2020

Supervised Valsalva Maneuver after Burr Hole Evacuation of Chronic Subdural Hematomas: A Prospective Cohort Study.

J Neurotrauma 2021 Apr 14;38(7):911-917. Epub 2020 Dec 14.

Department of Neurosurgery, University Hospital, and Goethe University, Frankfurt, Germany.

Research on chronic subdural hematoma (cSDH) management has primarily focused on potential recurrence after surgical evacuation. Herein, we present a novel postoperative/non-invasive treatment that includes a supervised Valsalva maneuver (SVM), which may serve to reduce SDH recurrence. Accordingly, the aims of the study were to investigate the effects of SVM on SDH recurrence rates and functional outcomes. A prospective study was conducted from December 2016 until December 2019 at the Goethe University Hospital Frankfurt. Of the 204 adult patients with surgically treated cSDH who had subdural drains placed, 94 patients were assigned to the SVM group and 82 patients were assigned to the control group. The SVM was performed by having patients blow into a self-made SVM device at least two times/h for 12 h/day. The primary end-point was SDH recurrence rate, while secondary outcomes were morbidity and functional outcomes at 3 months of follow-up. SDH recurrence was observed in 16 of 94 patients (17%) in the SVM group, which was a significant reduction as compared with the control group, which had 24 of 82 patients (29.3%;  = 0.05) develop recurrent SDHs. Further, the infection rate (e.g., pneumonia) was significantly lower in the SVM group (1.1%) than in the control group (13.4%;  < 0.001; odds ratio [OR] 0.1). At the 3-month follow-up, 85 of 94 patients (90.4%) achieved favorable outcomes in the SVM group compared with 62 of 82 patients (75.6%) in the control group ( = 0.008; OR 3.0). Independent predictors for favorable outcome at follow-up were age (OR 0.9) and infection (OR 0.2). SVM appears to be safe and effective in the post-operative management of cSDHs, reducing both recurrence rates and infections after surgical evacuation, thereby resulting in favorable outcomes at follow-up.
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http://dx.doi.org/10.1089/neu.2020.7391DOI Listing
April 2021

Early versus Delayed Surgery for Spinal Epidural Abscess : Clinical Outcome and Health-Related Quality of Life.

J Korean Neurosurg Soc 2020 Nov 7;63(6):757-766. Epub 2020 Aug 7.

Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany.

Objective: Spinal epidural abscess (SEA) is a severe and life-threatening disease. Although commonly performed, the effect of timing in surgical treatment on patient outcome is still unclear. With this study, we aim to provide evidence for early surgical treatment in patients with SEA.

Methods: Patients treated for SEA in the authors' department between 2007 and 2016 were included for analysis and retrospectively analyzed for basic clinical parameters and outcome. Pre- and postoperative neurological status were assessed using the American Spinal Injury Association Impairment Scale (AIS). The self-reported quality of life (QOL) based on the Short-Form Health Survey 36 (SF-36) was assessed prospectively. Surgery was defined as "early", when performed within 12 hours after admission and "late" when performed thereafter. Conservative therapy was preferred and recommend in patients without neurological deficits and in patients denying surgical intervention.

Results: One hundred and twenty-three patients were included in this study. Forty-nine patients (39.8%) underwent early, 47 patients (38.2%) delayed surgery and 27 (21.9%) conservative therapy. No significant differences were observed regarding mean age, sex, diabetes, prior history of spinal infection, and bony destruction. Patients undergoing early surgery revealed a significant better clinical outcome before discharge than patients undergoing late surgery (p=0.001) and conservative therapy. QOL based on SF-36 were significantly better in the early surgery cohort in two of four physical items (physical functioning and bodily pain) and in one of four psychological items (role limitation) after a mean follow-up period of 58 months. Readmission to the hospital and failure of conservative therapy were observed more often in patients undergoing conservative therapy.

Conclusion: Our data on both clinical outcome and QOL provide evidence for early surgery within 12 hours after admission in patients with SEA.
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http://dx.doi.org/10.3340/jkns.2019.0230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671776PMC
November 2020

Reactive Thrombocytosis in Non-aneurysmal Subarachnoid Hemorrhage.

J Neurol Surg A Cent Eur Neurosurg 2020 Sep 21;81(5):412-417. Epub 2020 May 21.

Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany.

Background:  The role of reactive thrombocytosis in non-aneurysmal subarachnoid hemorrhage (NA-SAH) is largely unexplored to date. Therefore, the impact of a quantitative thrombocyte dynamic in patients with NA-SAH and its clinical relevance were analyzed in the present study.

Methods:  In this retrospective analysis, 113 patients with nontraumatic and NA-SAH treated between 2003 and 2015 at our institution were included. World Federation of Neurosurgical Societies admission status, cerebral vasospasm, delayed infarction, hydrocephalus, need for ventriculoperitoneal (VP) shunt, and Fisher grade were analyzed for their association with reactive thrombocytosis.

Results:  Reactive thrombocytosis was not associated with hydrocephalus ( ≥ 0.05), need for VP shunt implantation ( ≥ 0.05), cerebral vasospasm ( ≥ 0.05), or delayed cerebral ischemia ( ≥ 0.05).

Conclusion:  Our study is the first to investigate the role of thrombocyte dynamics, reactive thrombocytosis, and the clinical course of NA-SAH patients. Our analysis showed no significant impact of thrombocyte count on NA-SAH sequelae.
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http://dx.doi.org/10.1055/s-0040-1709167DOI Listing
September 2020

Pulmonary embolism in neurocritical care-introduction of a novel grading system for risk stratification: the Frankfurt AMBOS score.

Neurosurg Rev 2021 Apr 12;44(2):1165-1171. Epub 2020 May 12.

Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany.

Pulmonary embolism (PE) due to deep vein thrombosis is a complication with severe morbidity and mortality rates. Neurocritical care patients constitute an inhomogeneous cohort with often strict contraindications to conventional embolism treatment. The aim of the present study is to identify risk factors for pulmonary embolism for intensified risk stratification in this demanding cohort. In this retrospective analysis, 387 neurocritical care patients received computed tomography for clinical suspicion of PE (304 neurosurgical and 83 neurological patients). Analysed parameters included age, gender, disease pattern, the presence of deep vein thrombosis, resuscitation, in-hospital mortality, present anticoagulation, coronary artery disease, diabetes mellitus, smoking status, hypertension and ABO blood type. Computed tomography confirmed 165 cases of pulmonary embolism among 387 patients with clinical suspicion of pulmonary embolism (42%). Younger age (p < 0.0001), female gender (p < 0.006), neurooncological disease (p < 0.002), non-O blood type (p < 0.002) and the absence of Marcumar therapy (p < 0.003) were identified as significant risk factors for pulmonary embolism. On the basis of the identified risk factors, the AMBOS score system is introduced. Neurocritical care patients with high AMBOS score are at elevated risk for PE and should therefore be put under intensified monitoring for cardiovascular events in neurocritical care units.
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http://dx.doi.org/10.1007/s10143-020-01310-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035103PMC
April 2021

External validation and modification of the Oslo grading system for prediction of postoperative recurrence of chronic subdural hematoma.

Neurosurg Rev 2021 Apr 28;44(2):961-970. Epub 2020 Feb 28.

Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany.

Recently, Oslo grading system (OGS) for prediction of recurrence in chronic subdural hematoma (cSDH) was introduced. The aim of the study was to validate and if applicable to modify the grading system. Data of all patients admitted to the Goethe University Hospital between 2016 and 2018 with chronic subdural hematoma were prospectively entered into a database. Dataset of patients with uni- (n = 272) and bilateral cSDH (n = 177) were used for the validation of OGS via logistic regression analysis. Additional predictors were identified and integrated to build a modified OGS (mOGS). Internal validation of the modified OGS was performed using same dataset of patients. The OGS showed a significant good predictive value with correlating increase of recurrence rate depending on the level of score in unilateral cSDH (p = 0.002). Regarding bilateral cSDH, there was no significant predictive value found (p = 0.921). By performing uni- and multivariate analysis, additional predictors for recurrence in uni- and bilateral cSDH were identified and integrated into the score system. Accordingly, the mOGS for unilateral cSDH inherited 4 components: previous OGS with 3 components (OR1.6) and seizure (OR2.5) (0 point, 0% recurrence rate; 1-2 points, 17.4%; 3-4 points, 30.6%; ≥ 5 points, 80%). Regarding bilateral cSDH, the mOGS consisted of 4 components as well: hypodense/gradation subtypes (OR3.3), postoperative unilateral volume > 80 mL (OR7.4), postoperative unilateral air trapping > 80 mL (OR15.3), and seizure (OR5.5) (0 point, 3.6% recurrence rate; 1 point, 30.6%; 2 points, 53.5%; 3 points, 58.3%; ≥ 4 points, 100%). Furthermore, the mOGS was internally verified showing high significant predictive power for recurrent hematoma in uni- (p = 0.004) and bilateral cSDH (p < 0.001). External validation of OGS showed accurate risk stratification of recurrence in unilateral cSDH; however, the validation failed for bilateral cSDH. Thus, mOGS was developed to strengthen its clinical utility and applicability.
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http://dx.doi.org/10.1007/s10143-020-01271-wDOI Listing
April 2021

Return to work and clinical outcome after surgical treatment and conservative management of patients with intramedullary spinal cord ependymoma.

Sci Rep 2020 02 11;10(1):2335. Epub 2020 Feb 11.

Department of Neurosurgery, Goethe- University, Frankfurt am Main, Germany.

The ability to return to work after treatment of diseases is an important issue. Aim of this study is to compare surgery and conservative management focusing on clinical outcome and ability to return to work in patients with intramedullary spinal cord ependymoma. Retrospective, single center study. The neurological status at first presentation, as well as in long-term follow-up, were assessed using the modified McCormick Disability Scale and modified Rankin Scale. The study population consisted of 56 patients, 23 (41%) were managed conservatively and 33 (59%) underwent microsurgical resection. The median age was 47.5 years in the conservative group and 44.5 in the surgical group. At first admission 18 of conservatively treated and 28 of surgically treated patients were employed, p = 0.7. At the last follow-up 15 (83%) of conservatively and 10 (36%) of surgically treated patients returned to work, p = 0.002. The median modified McCormick score in both groups (conservative vs. surgical) was at admission 1 vs. 1, p = 1.0 and at last follow up 1 vs. 2.5, p = 0.001. Patients clinical outcome in the surgical group was significantly reduced at last follow up as assessed by the modified Rankin Scale (mRs score of 0-2) at admission 100% vs. 100% and last follow-up 94% vs. 57%, p = 0.007. In our investigated study population, conservatively managed patients revealed a significantly better outcome and were more often able to return to work.
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http://dx.doi.org/10.1038/s41598-020-59328-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012826PMC
February 2020

Academic productivity of neurosurgery residents in Europe.

Authors:
Bedjan Behmanesh

Acta Neurochir (Wien) 2020 02 21;162(2):243. Epub 2019 Dec 21.

Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.

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http://dx.doi.org/10.1007/s00701-019-04183-xDOI Listing
February 2020

Academic output of German neurosurgical residents in 35 academic neurosurgery residency programs.

Acta Neurochir (Wien) 2019 10 18;161(10):1969-1974. Epub 2019 Jul 18.

Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.

Background: The scientific activity of neurosurgeons and neurosurgery residents as measured by bibliometric parameters is of increased interest. While data about academic output for neurosurgeons in the USA, the UK, and Canada have been published, no similar results for German neurosurgical residents exist. Within this study, we aim to evaluate the academic output of German neurosurgery residents in 35 academic residency programs.

Methods: Data for each resident were collected from the departmental websites, Pubmed, and Scopus. Further analyses evaluated the relationship between publication productivity, sex, and academic degree (Dr. med.).

Results: Data from 424 neurosurgery residents were analyzed. A total of 1222 publications were considered. A total of 355 (29%) of the 1222 publications were first-author publications. The average number of publications per resident was 2.9; the average h-index and m-quotient was 1.1 and 0.4, respectively. There was a statistically significant difference in academic output and h-index among neurosurgical residents with a doctoral degree compared with residents without such degree (5.3 vs. 1.3, p < 0.0001 and 2.0 vs. 0.5, p < 0.0001).

Conclusion: This is the very first study evaluating the academic output of neurosurgical residents in academic neurosurgical departments in Germany.
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http://dx.doi.org/10.1007/s00701-019-04011-2DOI Listing
October 2019

Management of hydrocephalus after resection of posterior fossa lesions in pediatric and adult patients-predictors for development of hydrocephalus.

Neurosurg Rev 2020 Aug 9;43(4):1143-1150. Epub 2019 Jul 9.

Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany.

The surgical management of hydrocephalus in patients with posterior fossa lesions (PFL) is critical for optimal patient outcome(s). Accordingly, it is prudent to identify patients in need of aggressive surgical intervention (i.e., ventriculoperitoneal [VP] shunting). To analyze prevalence of, and risk factors associated with, the development of post-operative hydrocephalus in both pediatrics and adults. A retrospective institutional analysis and review of patient records in those who had undergone PFL surgery was performed. In so doing, the authors identified patients that went on to develop post-operative hydrocephalus. The study included pediatric and adult patients treated between 2009 and 2017. Fifteen of 40 pediatric (37.5%) and 18 of 262 adult (6.9%) patients developed hydrocephalus after PFL surgery. The most common tumor entity in pediatrics was medulloblastoma (34%), astrocytoma (24.4%), and pilocytic astrocytoma (22%), whereas in adults, metastasis (29.5%), meningioma (22%), and acoustic neuroma (17.8%) were most common. Young age ≤ 2 years, medulloblastoma (OR 13.9), and brain stem compression (OR 5.4) were confirmed as independent predictors for hydrocephalus in pediatrics and pilocytic astrocytoma (OR 15.4) and pre-operative hydrocephalus (OR 3.6) in adults, respectively. All patients received VP shunts for hydrocephalus management and the mean follow-up was 29.5 months in pediatrics vs 19.2 months in adults. Overall complication rates related to VP shunts were 33.3% in pediatrics and 16.7% in adults, respectively. Shunt dependency and associated complications in pediatrics were noted to be higher than in adults. Given the identification of predictors for hydrocephalus, it is authors' contention that certain patients with those predictors may ultimately benefit from an alternative treatment regimen (e.g., pre-operative interventions) prior to PFT surgery.
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http://dx.doi.org/10.1007/s10143-019-01139-8DOI Listing
August 2020

First clinical experience with the new noninvasive transfontanelle ICP monitoring device in management of children with premature IVH.

Neurosurg Rev 2020 Apr 11;43(2):681-685. Epub 2019 May 11.

Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.

We previously introduced a novel noninvasive technique of intracranial pressure (ICP) monitoring in children with open fontanelles. Within this study, we describe the first clinical implementation and results of this new technique in management of children with hydrocephalus caused by intraventricular hemorrhage (IVH). In neonates with posthemorrhagic hydrocephalus (PHH), an Ommaya reservoir was implanted for initial treatment of hydrocephalus. The ICP obtained noninvasively with our new device was measured before and after CSF removal and correlated to cranial ultra-sonographies. Six children with a mean age of 27.3 weeks and mean weight of 1082.3 g suffering from PHH were included in this study. We performed an overall of 30 aspirations due to ventricular enlargement. Before CSF removal, the mean ICP was 15.3 mmHg and after removal of CSF the mean ICP measured noninvasively decreased to 3.4 mmHg, p = 0.0001. The anterior horn width (AHW), which reflects early expansion of the ventricles, was before and after CSF removal 15.1 mm and 5.5 mm, respectively, p < 0.0006. There was a strong correlation between noninvasively measured ICP values and sonographically obtained AHW, r = 0.81. Ultimately, all children underwent ventriculoperitoneal shunt procedures. This is the first study providing proof for a noninvasively ICP-based approach for management of posthemorrhagic hydrocephalus in newborn children.
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http://dx.doi.org/10.1007/s10143-019-01105-4DOI Listing
April 2020

Significant Impact of Implantable Functional Electrical Stimulation on Gait Parameters: A Kinetic Analysis in Foot Drop Patients.

World Neurosurg 2019 Jul 5;127:e236-e241. Epub 2019 Apr 5.

Klinik und Poliklinik für Neurochirurgie der Goethe-Universität, Frankfurt am Main, Germany. Electronic address:

Objective: Neurogenic drop foot is a common result of acquired damage of the central nervous system and can cause severe restriction of mobility. ActiGait, an implantable functional electrical stimulation device, restores ankle dorsiflexion by active peroneal nerve stimulation. The aim of our study was to evaluate its effect on foot contact pattern during normal walk.

Methods: Eight patients with drop foot who used ActiGait in everyday life performed a 20-meter comfortable walk test. Gait parameters were evaluated with an insole system (Medilogic). Percentage of biped stance in a double-step, effective foot length, width of gait, and overall plantar load were measured in comparison with and without activated drop foot stimulation.

Results: Effective foot length increased in all patients on average from 46.0% to 60.2% (P = 0.038). However, percentage of biped stance in a double-step showed no significant difference (31.2% vs. 27.8% on average, P = 0.063), nor did width of gait (2.6% vs. 2.4% on average, P = 0.73) and overall plantar load (3.51 N/cm vs. 3.39 N/cm, P = 0.25).

Conclusion: The ActiGait implantable drop foot stimulator significantly improves effective foot length during normal walk of patients with neurogenic drop foot. Further investigation is needed to confirm whether ActiGait has no effect on the other parameters or whether it facilitates permanent gait adaptations that persist without the activated device.
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http://dx.doi.org/10.1016/j.wneu.2019.03.064DOI Listing
July 2019

Clinical Relevance of Seizure in Pediatric Patients with Isolated Acute Subdural Hematoma without Parenchymal Brain Injury.

J Neurol Surg A Cent Eur Neurosurg 2019 Jul 20;80(4):233-239. Epub 2019 Mar 20.

Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany.

Purpose:  Isolated acute subdural hematoma (aSDH) in pediatric patients is rare, but it has a major impact on outcome. The purpose of this study was to determine incidence, seizure risk factors, and the outcome of pediatric patients with aSDH.

Methods:  Within a 10-year period (2007-2016), 10 children with aSDH were identified. Baseline characteristics and these parameters were analyzed: pediatric Glasgow Coma Scale (pGCS) score at admission and 24 hours after the operation, hematoma volume/side, and midline shift. Functional outcome was assessed at 3-month follow-up using the King's Outcome Scale for Childhood Head Injury score.

Results:  Three subgroups were identified depending on age and etiology: birth-associated, nontraumatic, and traumatic aSDH. The overall incidence of seizures was 60%, and an even higher rate (75%) was observed in children < 1 month of age. Of those patients, two (67%) developed late seizures. Significant predictors for seizures were low pGCS score at admission ( = 0.03) and 24 hours after surgery ( = 0.03) as well as increased midline shift ( = 0.02). Patients with seizures tended to have an unfavorable outcome.

Conclusion:  Pediatric patients with aSDH are at high risk for seizures, particularly if the pGCS score is low at admission/24 hours after the operation and midline shows a shift. Determining seizure-prone pediatric patients may facilitate early antiepileptic treatment and promote better clinical outcomes.
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http://dx.doi.org/10.1055/s-0039-1677824DOI Listing
July 2019

Infective endocarditis in patients with pyogenic spondylodiscitis: implications for diagnosis and therapy.

Neurosurg Focus 2019 01;46(1):E2

1Department of Neurosurgery, and.

OBJECTIVEThe incidence of patients with pyogenic spinal infection is increasing. In addition to treatment of the spinal infection, early diagnosis of and therapy for coexisting infections, especially infective endocarditis (IE), is an important issue. The aim of this study was to evaluate the proportion of coexisting IE and the value of routine transesophageal echocardiography (TEE) in the management of these patients.METHODSThe medical history, laboratory data, radiographic findings, treatment modalities, and results of TEE of patients admitted between 2007 and 2017 were analyzed.RESULTSDuring the abovementioned period, 110 of 255 total patients underwent TEE for detection of IE. The detection rate of IE between those patients undergoing and not undergoing TEE was 33% and 3%, respectively (p < 0.0001). Thirty-six percent of patients with IE needed cardiac surgical intervention because of severe valve destruction. Chronic renal failure, heart failure, septic condition at admission, and preexisting heart condition were significantly associated with coexisting IE. The mortality rate in patients with IE was significantly higher than in patients without IE (22% vs 3%, p = 0.002).CONCLUSIONSTEE should be performed routinely in all patients with spondylodiscitis.
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http://dx.doi.org/10.3171/2018.10.FOCUS18445DOI Listing
January 2019

A novel grading system for the prediction of the need for cerebrospinal fluid drainage following posterior fossa tumor surgery.

J Neurosurg 2019 01;132(1):296-305

Departments of1Neurosurgery and.

Objective: Prophylactic placement of an external ventricular drain (EVD) is often performed prior to resection of a posterior fossa tumor (PFT); however, there is no general consensus regarding the indications. The purpose of this study was to establish a novel grading system for the prediction of required CSF drainage due to symptomatic elevated intracranial pressure (ICP) after resection of a PFT to identify patients who require an EVD.

Methods: The authors performed a retrospective analysis of data from a prospective database. All patients who had undergone resection of a PFT between 2012 and 2017 at the University Hospital, Goethe University Frankfurt, were identified and data from their cases were analyzed. PFTs were categorized as intraparenchymal (iPFT) or extraparenchymal (ePFT). Prior to resection, patients underwent EVD placement, prophylactic burr hole placement, or neither. The authors assessed the amount of CSF drainage (if applicable), rate of EVD placement at a later time point, and complication rate and screened for factors associated with CSF drainage. By applying those factors, they established a grading system to predict the necessity of CSF drainage for elevated ICP.

Results: A total of 197 patients met the inclusion criteria. Of these 197, 70.6% received an EVD, 15.7% underwent prophylactic burr hole placement, and 29.4% required temporary CSF drainage. In the prophylactic burr hole group, 1 of 32 patients (3.1%) required EVD placement at a later time. Independent predictors for postoperative need for CSF drainage due to symptomatic intracranial hypertension in patients with iPFTs were preoperative hydrocephalus (OR 2.9) and periventricular CSF capping (OR 2.9), whereas semi-sitting surgical position (OR 0.2) and total resection (OR 0.3) were protective factors. For patients with ePFTs, petroclival/midline tumor location (OR 12.2/OR 5.7), perilesional edema (OR 10.0), and preoperative hydrocephalus (OR 4.0) were independent predictors of need for CSF drainage. According to our grading system, CSF drainage after resection of iPFT or ePFT, respectively, was required in 16.7% and 5.1% of patients with a score of 0, in 21.1% and 12.5% of patients with a score of 1, in 47.1% and 26.3% of patients with a score of 2, and in 100% and 76.5% of patients with a score ≥ 3 (p < 0.0001). The rate of relevant EVD complications was 4.3%, and 10.1% of patients were shunt-dependent at 3-month follow-up.

Conclusions: This novel grading system for the prediction of need for CSF drainage following resection of PFT might be of help in deciding in favor of or against prophylactic EVD placement.
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http://dx.doi.org/10.3171/2018.8.JNS181005DOI Listing
January 2019

The clinical relevance of ABO blood type in 100 patients with acute subdural hematoma.

PLoS One 2018 4;13(10):e0204331. Epub 2018 Oct 4.

Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany.

Objective: The correlation of depleted blood through midline shift in acute subdural hematoma remains the most reliable clinical predictor to date. On the other hand, patient's ABO blood type has a profound impact on coagulation and hemostasis. We conducted this study to evaluate the role of patient's blood type in terms of incidence, clinical course and outcome after acute subdural hematoma bleeding.

Methods: 100 patients with acute subdural hematoma treated between 2010 and 2015 at the author's institution were included. Baseline characteristics and clinical findings including Glasgow coma scale, Glasgow outcome scale, hematoma volume, rebleeding, midline shift, postoperative seizures and the presence of anticoagulation were analyzed for their association with ABO blood type.

Results: Patient's with blood type O were found to have a lower midline shift (p<0.01) and significantly less seizures (OR: 0.43; p<0.05) compared to non-O patients. Furthermore, patients with blood type A had the a significantly higher midline shift (p<0.05) and a significantly increased risk for postoperative seizures (OR: 4.01; p<0.001). There was no difference in ABO blood type distribution between acute subdural hematoma patients and the average population.

Conclusion: The ABO blood type has significant influence on acute subdural hematoma sequelae. Patient's with blood type O benefit in their clinical course after acute subdural hematoma whereas blood type A patients are at highest risk for increased midline shift and postoperative seizures. Further studies elucidating the biological mechanisms of blood type depended hemostaseology and its role in acute subdural hematoma are required for the development of an appropriate intervention.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204331PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171832PMC
March 2019

The Value of Computed Tomography Imaging of the Head After Ventriculoperitoneal Shunt Surgery in Adults.

World Neurosurg 2019 Jan 20;121:e159-e164. Epub 2018 Sep 20.

Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany.

Background: Patients with a ventriculoperitoneal shunt for hydrocephalus often undergo multiple follow-up computed tomography (CT) scans of the head, increasing the risk for long-term effects of ionizing radiation. The purpose of our study was to evaluate the necessity as a routine diagnostic procedure and cost analysis of routine postoperative CT scan of the head after ventriculoperitoneal shunt surgery.

Methods: In this study, we comprised adults with ventriculoperitoneal shunt operations who underwent early CT scans within 48 hours postoperatively. We reviewed the correlation between revision surgery rate and the experience of surgeons who performed surgery and provided a cost analysis.

Results: In total, 479 surgeries were performed in 439 patients. Early revision surgery was performed in 11 (2.3%) patients. Reason for revision surgery was malposition in 9 cases and intracerebral hemorrhage in 2 patients. There was no significant correlation between the surgeon's experience and the rate of revision surgery. Placement of the ventricular catheter via an approach other than a standard right or left frontal burr hole resulted in risk of need for surgical shunt revision (P ≥ 0.002, odds ratio 54, confidence interval 13.5-223). A total of 468 CT scans of the head revealed a normal finding; thus, ∼$562,000 could be saved by omitting postoperative head CT scans.

Conclusions: Routine postoperative head CT scans after fentriculoperitoneal shunting are not necessary in all cases. The reduction of exposure to ionization radiation and the beneficial economic factor are main advantages.
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http://dx.doi.org/10.1016/j.wneu.2018.09.063DOI Listing
January 2019

The Impact of Early Corticosteroid Pretreatment Before Initiation of Chemotherapy in Patients With Primary Central Nervous System Lymphoma.

Neurosurgery 2019 08;85(2):264-272

Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany.

Background: The optimal timing of corticosteroid (CS) treatment in patients with primary central nervous system (CNS) lymphoma (PCNSL) remains controversial. While poor clinical presentation may justify early treatment with CS, this may ultimately result in reduced concentrations of chemotherapeutic agents via perturbations in the permeability of the blood-brain barrier.

Objective: To investigate whether early CS exposure is associated with beneficial outcomes and/or reduced occurrence of adverse events as opposed to delayed/concomitant administration.

Methods: Herein we performed a retrospective observational analysis using patients that were prospectively entered into a database. All patients whom were admitted to the University Hospital between 2009 and 2015 with newly diagnosed PCNSL were included within our study.

Results: Our cohort included 50 consecutive patients diagnosed with PCNSL; of these, in 30 patients CS administration was initiated prior to chemotherapy (early), whilst in the remaining 20 patients CS administration was initiated concomitantly with their chemotherapeutic regimen (concomitant). Within the early vs concomitant CS administration groups, no significant differences were observed with regard to progression-free survival (PFS) (P = .81), overall survival (OS) (P = .75), or remission (P = .68; odds ratio 0.76 and confidence interval [95%] 0.22-2.71). Critically, the timing of CS initiation was not associated with either PFS (P = .81) or PFS (P = .75).

Conclusion: Early CS administration was not associated with a deterioration in response to chemotherapy, PFS, or OS. As such, administration of CS prior to initiation of chemotherapy is both reasonable and safe for patients with newly diagnosed PCNSL.
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http://dx.doi.org/10.1093/neuros/nyy272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6904719PMC
August 2019

Influence of ABO blood type on the outcome after non-aneurysmal subarachnoid hemorrhage.

Acta Neurochir (Wien) 2018 04 17;160(4):761-766. Epub 2018 Feb 17.

Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60528, Frankfurt, Germany.

Background: In patients with non-aneurysmal subarachnoid hemorrhage (NA-SAH), the etiology is unknown and the bleeding source remains unidentified. However, the ABO blood type system has a profound role in patient's hemostasis and thrombosis. To date, the aspect of ABO blood type in incidence, clinical course, and outcome after NA-SAH has not been investigated.

Methods: In this retrospective analysis, 81 patients with non-traumatic and non-aneurysmal subarachnoid hemorrhage treated between 2010 and 2014 at the author's institution were included. WFNS admission status, cerebral vasospasm, delayed infarction, ventriculoperitoneal shunt necessity, the Fisher grade, and the modified Rankin Scale were analyzed for their association with ABO blood type. Four hundred seventy patients with aneurysmal subarachnoid hemorrhage served as a control group.

Results: The AB blood type is more frequent in NA-SAH compared to aneurysmal patients and the German population (OR 2.45, p ≤ 0.05). Furthermore, NA-SAH with AB blood type showed a similar sequelae compared to aneurysmal patients in terms of shunt necessity (OR 2.00, p ≥ 0.05), cerebral vasospasm (OR 1.66, p ≥ 0.05), and delayed infarctions (OR 1.07, p ≥ 0.05).

Conclusion: The clinical course of NA-SAH AB blood type patients shows similar severity as of aneurysmal subarachnoid hemorrhage. Therefore, patients with AB blood type should be under intensified observation.
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http://dx.doi.org/10.1007/s00701-018-3489-9DOI Listing
April 2018

Dexamethasone-induced leukocytosis is associated with poor survival in newly diagnosed glioblastoma.

J Neurooncol 2018 May 18;137(3):503-510. Epub 2018 Jan 18.

Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.

Despite its well-characterized side effects, dexamethasone is widely used in the pre-, peri- and postoperative neurosurgical setting due to its effective relief of tumor-induced symptoms through the reduction of tumor-associated edema. However, some patients show laboratory-defined dexamethasone induced elevation of white blood cell count, and its impact on glioblastoma progression is unknown. We retrospectively analyzed 113 patients with newly diagnosed glioblastoma to describe the incidence, risk factors and clinical features of dexamethasone-induced leukocytosis in primary glioblastoma patients. We further conducted an immunohistochemical analysis of the granulocyte and lymphocyte tumor-infiltration in the available corresponding histological sections. Patient age was identified to be a risk factor for the development of dexamethasone-induced leukocytosis (p < 0.05). The presence of dexamethasone-induced leukocytosis decreased overall survival (HR 2.25 95% CI [1.15-4.38]; p < 0.001) and progression-free survival (HR 2.23 95% CI [1.09-4.59]; p < 0.01). Furthermore, patients with dexamethasone-induced leukocytosis had significantly reduced CD15 + granulocytic- (p < 0.05) and CD3 + lymphocytic tumour infiltration (p < 0.05). We identified a subgroup of glioblastoma patients that are at particularly high risk for poor outcome upon dexamethasone treatment. Therefore, restrictive dosage or other edema reducing substances should be considered in patients with dexamethasone-induced leukocytosis.
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http://dx.doi.org/10.1007/s11060-018-2761-4DOI Listing
May 2018

"Two is not enough" - Impact of the number of tissue samples obtained from stereotactic brain biopsies in suspected glioblastoma.

J Clin Neurosci 2018 Jan 24;47:311-314. Epub 2017 Oct 24.

Department of Neurosurgery, Goethe University Frankfurt, Germany.

Objective: Stereotactic procedures are performed in many neurosurgical departments in order to obtain tumor tissue from brain lesions for histopathological evaluation. Biopsies can be performed frame-guided and frame less. Some departments use a biopsy needle (cylinder probe), others a forceps for repetitive smaller tissue samples. Although the applied techniques are somehow different, it is still unclear how many tissue samples have to be taken to establish reliably a final diagnosis based on histopathological and genetic examinations. Only precise histopathological diagnosis results in adequate therapy.

Methods: We included 43 consecutive patients who underwent stereotactic biopsy of a suspected glioblastoma between 02/2013 and 07/2015. All patients showed contrast enhancing tumors in the MRI. The patients underwent stereotactic biopsy with the Leksell frame attached to their head. All stereotactic procedures were performed in the presence of a neuropathologist. Target and Entry Points were calculated with BrainLab iplan software (BrainLab iplan 1.0, Munich, Germany). First the two samples 5mm before the Target (pre-target) and the "Targetpoint" itself were analyzed (group 1), then a histopathological evaluation of all samples was performed (group 2).

Results: Mean number of extracted samples was 14. Using classical hematoxylin-eosin stainings, in group 1 histopathological diagnosis was correct in only 30 cases accounting for 73%. Contrariwise a final diagnosis was made in 100% in group 2.

Conclusion: If only two tissue samples were evaluated in this group of patients with suspected glioblastoma, a correct diagnosis was possible in only 73% of the cases. We conclude that two samples are not enough to establish a final diagnosis even in a subgroup of suspected glioblastoma.
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http://dx.doi.org/10.1016/j.jocn.2017.09.032DOI Listing
January 2018

Noninvasive Transfontanelle Monitoring of the Intracerebral Pressure in Comparison With an Invasive Intradural Intracranial Pressure Device: A Prospective Study.

Oper Neurosurg (Hagerstown) 2017 10;13(5):609-613

Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany.

Background: We previously introduced a novel noninvasive technique of intracranial pressure (ICP) monitoring in children with open fontanelles.

Objective: To compare the ICP obtained by our new technique to the ICP derived from an intradurally implanted ICP measurement device (external ventricular drain, subdural ICP device).

Methods: Children with open fontanelles and need of intracranial monitoring were included in this study. A standard ICP probe was placed upon the frontal fontanelle and data were compared with the values recorded by an already invasively implanted subdural ICP technique. The 2 methods of ICP measurement were evaluated using the correlation coefficient, Bland and Altman method and method comparison by Carstensen.

Results: Five children under the age of 1 year with an open frontal fontanelle were included in this study. Three were male and 2 were female. Mean age was 7 months. A total of 139 pairs of measurements were assessed. Mean transfontanelle ICP was 7.6 mm Hg. Mean ICP measured subdurally was 5.4 mm Hg. The correlation analysis showed a correlation coefficient of 0.7. The Bland-Altman plot revealed a good accuracy of the new method with >95% of the values within the limits of agreement. An additional method comparison analysis confirmed the finding of accurate ICP measurements between both applied methods.

Conclusion: The noninvasive transfontanelle ICP monitoring method displayed a high validity and reliability as proven by correlation analysis. This novel technique might therefore be an interesting and promising tool for noninvasive ICP monitoring in children. But further research is necessary to evaluate the accuracy of this technique in children with elevated ICP.
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http://dx.doi.org/10.1093/ons/opx024DOI Listing
October 2017

Biopsies of pediatric brainstem lesions display low morbidity but strong impact on further treatment decisions.

J Clin Neurosci 2017 Oct 12;44:254-259. Epub 2017 Jul 12.

Department of Neurosurgery, University Hospital Frankfurt, Germany.

Objective: The course of malignant brain stem gliomas in childhood is rarely positive. Because of limited therapeutic options and potentially hazardous biopsies oncologist often relay on MRI diagnoses only for further therapy decisions. In this study we show that brain stem biopsies display a low morbidity rate and neuropathological assessment has a considerable impact on further treatment decision.

Methods: Within 18-months five children with brainstem symptoms and the radiological diagnosis of a malignant brainstem glioma, were identified. From this time point it was possible to analyze all samples with the 450K methylome analysis. Other neuropathological techniques included classical histology with immunohistochemistry. Surgery was performed as biopsy, either microsurgical, frame-guided (Leksell), robot-assisted (ROSA) or navigated (BrainLab, two children).

Results: Mean age of the children was 7.5years (range: newborn to 12years). There was no biopsy-related morbidity or mortality. The mean number of taken samples was 12 (range: 1-25). Histologic diagnosis could be established in all children, however, 450K methylome diagnosis was positive in only two out of five patients.

Conclusion: Despite the technically difficult biopsies, all specimens were sufficient for immunohistochemical diagnosis, however, 450K methylome analysis could only be better established where multiple small samples were taken, instead of few larger ones. Based on the preoperative radiological diagnosis suggesting malignant brainstem glioma, all children would have been treated with combined radiation and temozolomid chemotherapy. Nevertheless, due to the availability of histology and molecular diagnostics, individualized therapy could be performed, preventing in two out of five children from unnecessary radiation and chemotherapy.
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http://dx.doi.org/10.1016/j.jocn.2017.06.028DOI Listing
October 2017

Natural history of intramedullary spinal cord ependymoma in patients preferring nonoperative treatment.

J Neurooncol 2017 Oct 30;135(1):93-98. Epub 2017 Jun 30.

Department of Neurosurgery, Goethe- University, Frankfurt am Main, Germany.

Surgical resection of intramedullary spinal cord ependymoma still remains the standard of care but is challenging and occasionally associated with poor outcome. The aim of this study is therefore to provide additional information regarding the natural history of conservatively treated symptomatic intramedullary spinal cord ependymoma. Retrospective, single center review of all patients with intramedullary spinal cord ependymoma treated conservatively (wait and see) between 1980 and 2016. The neurological outcomes at first presentation, as well as in long-term follow-up, were assessed using the modified McCormick Disability Scale and modified Rankin Scale. Thirteen of 41 patients were managed conservatively and were included in the study. Mean age at the admission was 49 years. There were seven women and six men. All patients were symptomatic at the time of presentation. The mean follow-up from admission to the last neurological examination was 47.9 months. The mean modified McCormick score in conservatively treated patients was 1.3 at admission and 1.6 (p = 0.3) at last follow-up. There was no significant neurological detoriation over time in conservatively managed patients as assessed by the modified Rankin Scale at first presentation and last follow-up (mRS scores of 0-2, 100 vs 92%; p = 0.9). This cohort of conservatively managed patients with symptomatic intramedullary spinal cord ependymoma was clinically stable throughout the follow-up period. Our data provide additional information for counseling patients with intramedullary spinal cord tumors who chose a nonoperative treatment.
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http://dx.doi.org/10.1007/s11060-017-2552-3DOI Listing
October 2017
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