Publications by authors named "E Uhl"

202 Publications

Hemicraniectomy for Dominant vs Nondominant Middle Cerebral Artery Infarction: A Systematic Review and Meta-Analysis.

J Stroke Cerebrovasc Dis 2021 Sep 15;30(11):106102. Epub 2021 Sep 15.

Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Helsinki 00290, Finland.

Objectives: Decompressive hemicraniectomy decreases mortality and severe disability from space-occupying middle cerebral artery infarction in selected patients. However, attitudes towards hemicraniectomy for dominant-hemispheric stroke have been hesitant. This systematic review and meta-analysis examines the association of stroke laterality with outcome after hemicraniectomy.

Materials And Methods: We performed a systematic literature search up to 6th February 2020 to retrieve original articles about hemicraniectomy for space-occupying middle cerebral artery infarction that reported outcome in relation to laterality. The primary outcome was severe disability (modified Rankin Scale 4‒6 or 5‒6 or Glasgow Outcome Scale 1‒3) or death. A two-stage combined individual patient and aggregate data meta-analysis evaluated the association between dominant-lateralized stroke and (a) short-term (≤ 3 months) and (b) long-term (> 3 months) outcome. We performed sensitivity analyses excluding studies with sheer mortality outcome, second-look strokectomy, low quality, or small sample size, and comparing populations from North America/Europe vs Asia/South America.

Results: The analysis included 51 studies (46 observational studies, one nonrandomized trial, and four randomized controlled trials) comprising 2361 patients. We found no association between dominant laterality and unfavorable short-term (OR 1.00, 95% CI 0.69‒1.45) or long-term (OR 1.01, 95% CI 0.76‒1.33) outcome. The results were unchanged in all sensitivity analyses. The grade of evidence was very low for short-term and low for long-term outcome.

Conclusions: This meta-analysis suggests that patients with dominant-hemispheric stroke have equal outcome after hemicraniectomy compared to patients with nondominant stroke. Despite the shortcomings of the available evidence, our results do not support withholding hemicraniectomy based on stroke laterality.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.106102DOI Listing
September 2021

Serum biomarkers for risk assessment of intra-hospital transports in neurosurgical intensive care unit patients.

J Neurosurg Sci 2021 Aug 3. Epub 2021 Aug 3.

Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany.

Background: Intra-hospital transport (IHT) of neurosurgical intensive care (NICU) patients for cranial computed tomography (CCT) scans is associated with a high rate of complications. The potential of serum biomarkers to estimate the risk for complications associated with IHT and improve their safety remains underexplored. The present study investigated the influence of several serum biomarkers on IHT-associated complications in brain-injured NICU patients.

Methods: A total of 523 IHTs in 223 NICU patients were prospectively analysed (05/2019-05/2020). Haemoglobin, haematocrit, serum sodium, and albumin levels were evaluated as serum biomarkers. Each patient's demographic data, cranial computed tomography (CCT) scan, NICU parameters and modified Rankin Scale at discharge as well as indications, consequences, and complications of IHTs were analysed.

Results: In 58.7% of all IHTs, at least one IHT-associated complication was observed with 60.1% of all IHTs having no therapeutic consequence. Significantly lower rates of increased intracranial pressure (ICP; p<0.0001), decreased cerebral perfusion pressure (CPP; p=0.03) as well as hemodynamic (p<0.0001) and pulmonary events (p=0.01) were observed in patients with higher haemoglobin levels prior to IHT. Additionally, higher haematocrit levels before IHT were associated with a fewer rate of hemodynamic (p<0.0001), pulmonary (p=0.006), ICP (p<0.0001), and CPP (p=0.01) events.

Conclusions: Higher levels of haemoglobin and haematocrit are associated with less complications with respect to ICP, CPP, hemodynamic and pulmonary events during IHT in NICU patients. Therefore, these biomarkers may be helpful for risk assessment of potential complications prior to IHT.
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http://dx.doi.org/10.23736/S0390-5616.21.05409-6DOI Listing
August 2021

Intensive care medicine: a multidisciplinary competence-based approach.

Eur J Anaesthesiol 2021 07;38(7):679-681

From the Department of Anaesthesia, Intensive Care and Pain Medicine (MS), Department of Neurosurgery, Justus-Liebig-University, Gießen, Germany (EU); Department of Internal Medicine, Cardiology and Pulmonary Diseases, Wilhelminenspital, Wien, Medical University Vienna and Sigmund Freud University Vienna, Austria (MK), Department of Anaesthesia, Intensive Care and Pain Medicine, RKH Hospital Ludwigsburg, Germany (GG), Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery - University of Perugia, Italy (ED-R) and Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University, Germany (KZ).

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http://dx.doi.org/10.1097/EJA.0000000000001538DOI Listing
July 2021

CSF shunt valve occlusion-does CSF protein and cell count matter?

Acta Neurochir (Wien) 2021 07 3;163(7):1991-1996. Epub 2021 May 3.

Department of Neurosurgery, Klinikum Kassel, Moencheberg Str. 41-43, 34125, Kassel, Germany.

Background: Shunt obstruction is a common cause of shunt failure in the treatment of hydrocephalus. Valve occlusion is traditionally believed to originate from elevated CSF protein or cellular components, although detailed evidence is scarce and contradictory. Therefore, this study aimed to examine CSF protein and cell count as risk factors for valve obstruction.

Methods: We retrospectively examined 274 patients who underwent shunt placement for hydrocephalus between 2009 and 2018 and had at least 1 year follow-up. Age, aetiology of hydrocephalus, valve type, occurrence of revision, reason for revision and CSF protein and cell count at the time of shunt insertion and revision surgery were analysed.

Results: Thirty-two of 274 patients (11.7%) required revision surgery due to valve occlusion. Mean time to revision was 143 days. CSF white blood cell (WBC) count but not protein was associated with valve occlusion overall. Of all obstructed valve patients, 25% showed CSF protein level within the normal range, whereas 13.6% of the patients overall showed greatly elevated CSF protein level without evidence of valve obstruction. Persistently elevated CSF protein level at the time of shunt revision was significantly associated with valve obstruction within 90 days of initial insertion (early occlusion). Children with congenital malformations and post-haemorrhagic patients were significantly overrepresented in the occlusion group, particularly in the early occlusion group.

Conclusion: Pathological CSF values such as WBC count and persistently elevated protein level serves as a risk factor for early valve obstruction. Late obstruction occurs independent of normal CSF values. Infants are particularly prone to early and late valve obstructions. CSF protein level at shunt insertion is not predictive of valve occlusion.
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http://dx.doi.org/10.1007/s00701-021-04864-6DOI Listing
July 2021
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