Publications by authors named "Valeri Borger"

36 Publications

Predictive Relevance of Baseline Lactate and Glucose Levels in Patients with Spontaneous Deep-Seated Intracerebral Hemorrhage.

Brain Sci 2021 May 14;11(5). Epub 2021 May 14.

Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany.

(1) Background: As elements of the standard admission blood panel, lactate and glucose represent potential biomarkers for outcome prediction. In patients with intracranial hemorrhage (ICH), data on the predictive value of these blood values is exceedingly sparse. (2) Methods: Between 2014 and August 2020, all patients with deep-seated ICH referred to the neurovascular center at the authors' institution were included in the subsequent study. Serum levels of lactate and glucose at the time of admission were compared with mortality at 90 days. In addition, a multivariate analysis was performed in order to identify independent admission predictors for 90-day mortality. (3) Results: Among the 102 patients with deep-seated ICH, elevated lactate and glucose levels on admission were significantly associated with increased mortality at 90 days. Multivariate logistic regression analysis identified "ICH score ≥3" ( = 0.004) along with "admission hyperlactatemia" ( = 0.025) and "admission hyperglycemia" ( = 0.029) as independent and significant predictors of 90-day mortality in patients with deep-seated ICH. (4) Conclusions: Initially elevated lactate and glucose levels after spontaneous intracerebral hemorrhage are associated with poor outcome, suggesting a potential application for future prognostic models when considered in conjunction with other parameters.
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http://dx.doi.org/10.3390/brainsci11050633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156008PMC
May 2021

Tumor-associated epilepsy in patients with brain metastases: necrosis-to-tumor ratio forecasts postoperative seizure freedom.

Neurosurg Rev 2021 May 14. Epub 2021 May 14.

Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Surgical resection is highly effective in the treatment of tumor-related epilepsy (TRE) in patients with brain metastases (BM). Nevertheless, some patients suffer from postoperative persistent epilepsy which negatively impacts health-related quality of life. Therefore, early identification of patients with potentially unfavorable seizure outcome after BM resection is important. Patients with TRE that had undergone surgery for BM at the authors' institution between 2013 and 2018 were analyzed with regard to preoperatively identifiable risk factors for unfavorable seizure outcome. Tumor tissue and tumor necrosis ratios were assessed volumetrically. According to the classification of the International League Against Epilepsy (ILAE), seizure outcome was categorized as favorable (ILAE 1) and unfavorable (ILAE 2-6) after 3 months in order to avoid potential interference with adjuvant cancer treatment. Among all 38 patients undergoing neurosurgical treatment for BM with concomitant TRE, 34 patients achieved a favorable seizure outcome (90%). Unfavorable seizure outcome was significantly associated with larger tumor volumes (p = 0.012), a midline shift > 7 mm (p = 0.025), and a necrosis/tumor volume ratio > 0.2 (p = 0.047). The present study identifies preoperatively collectable risk factors for unfavorable seizure outcome in patients with BM and TRE. This might enable to preselect for highly vulnerable patients with postoperative persistent epilepsy who might benefit from accompanying neuro-oncological expertise during further systemical treatment regimes.
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http://dx.doi.org/10.1007/s10143-021-01560-yDOI Listing
May 2021

T cell numbers correlate with neuronal loss rather than with seizure activity in medial temporal lobe epilepsy.

Epilepsia 2021 Jun 6;62(6):1343-1353. Epub 2021 May 6.

Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria.

Objective: Medial temporal lobe epilepsy (MTLE) is a drug-resistant focal epilepsy that can be caused by a broad spectrum of different inciting events, including tumors, febrile seizures, and viral infections. In human epilepsy surgical resections as well as in animal models, an involvement of the adaptive immune system was observed. We here analyzed the presence of T cells in various subgroups of MTLE. We aimed to answer the question of how much inflammation was present and whether the presence of T cells was associated with seizures or associated with hippocampal neurodegeneration.

Methods: We quantified the numbers of CD3 T cells and CD8 cytotoxic T cells in the hippocampus of patients with gangliogliomas (GGs; intrahippocampal and extrahippocampal, with and without sclerosis), febrile seizures, and postinfectious encephalitic epilepsy and compared this with Rasmussen encephalitis, Alzheimer disease, and normal controls.

Results: We could show that T cell numbers were significantly elevated in MTLE compared to healthy controls. CD3 as well as CD8 T cell numbers, however, varied highly among MTLE subgroups. By comparing GG patients with and without hippocampal sclerosis (HS), we were able to show that T-cell numbers were increased in extrahippocampal GG patients with hippocampal neuronal loss and HS, whereas extrahippocampal GG cases without hippocampal neuronal loss (i.e., absence of HS) did not differ from healthy controls. Importantly, T cell numbers in MTLE correlated with the degree of neuronal loss, whereas no correlation with seizure frequency or disease duration was found. Finally, we found that in nearly all MTLE groups, T cell numbers remained elevated even years after the inciting event.

Significance: We here provide a detailed histopathological investigation of the involvement of T cells in various subgroups of MTLE, which suggests that T cell influx correlates to neuronal loss rather than seizure activity.
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http://dx.doi.org/10.1111/epi.16914DOI Listing
June 2021

The Impact of Prolonged Mechanical Ventilation on Overall Survival in Patients With Surgically Treated Brain Metastases.

Front Oncol 2021 18;11:658949. Epub 2021 Mar 18.

Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany.

Objective: Surgical resection represents a common treatment modality in patients with brain metastasis (BM). Postoperative prolonged mechanical ventilation (PMV) might have an enormous impact on the overall survival (OS) of these patients suffering from advanced cancer disease. We therefore have analyzed our institutional database with regard to a potential impact of PMV on OS of patients who had undergone surgery for brain metastases.

Methods: 360 patients with surgically treated brain metastases were included. The definition of PMV consisted of postoperative mechanical ventilation lasting for more than 48 hours. Analysis of survival incorporating established prognostic factors such as age, location of BM, and preoperative physical status was performed.

Results: 14 of 360 patients with BM (4%) suffered from postoperative PMV after surgical treatment of BM. Patients with PMV presented in a significantly more impaired neurological condition preoperatively than patients without (p<0.0001). Multivariate analysis determined PMV to be a significant prognostic factor for OS after surgical treatment in patients with BM, independent of other predictive factors (p<0.0001).

Conclusions: The present study demonstrates postoperative PMV as significantly related to poor OS in patients with surgically treated BM. Postoperative PMV is a so far underestimated prognostic predictor, but might be utilized for optimized patient management early in the postoperative phase. For this purpose, the results of the present study should encourage the initiation of further scientific efforts.
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http://dx.doi.org/10.3389/fonc.2021.658949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013703PMC
March 2021

Auditory Beat Stimulation Modulates Memory-Related Single-Neuron Activity in the Human Medial Temporal Lobe.

Brain Sci 2021 Mar 12;11(3). Epub 2021 Mar 12.

Department of Epileptology, Venusberg-Campus 1, University Hospital Bonn, 53127 Bonn, Germany.

Auditory beats are amplitude-modulated signals (monaural beats) or signals that subjectively cause the perception of an amplitude modulation (binaural beats). We investigated the effects of monaural and binaural 5 Hz beat stimulation on neural activity and memory performance in neurosurgical patients performing an associative recognition task. Previously, we had reported that these beat stimulation conditions modulated memory performance in opposite directions. Here, we analyzed data from a patient subgroup, in which microwires were implanted in the amygdala, hippocampus, entorhinal cortex and parahippocampal cortex. We identified neurons responding with firing rate changes to binaural versus monaural 5 Hz beat stimulation. In these neurons, we correlated the differences in firing rates for binaural versus monaural beats to the memory-related differences for remembered versus forgotten items and associations. In the left hemisphere, we detected statistically significant negative correlations between firing rate differences for binaural versus monaural beats and remembered versus forgotten items/associations. Importantly, such negative correlations were also observed between beat stimulation-related firing rate differences in the pre-stimulus window and memory-related firing rate differences in the post-stimulus windows. In line with concepts of homeostatic plasticity, our findings suggest that beat stimulation is linked to memory performance via shifting baseline firing levels.
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http://dx.doi.org/10.3390/brainsci11030364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000797PMC
March 2021

Prolonged Mechanical Ventilation in Patients with Deep-Seated Intracerebral Hemorrhage: Risk Factors and Clinical Implications.

J Clin Med 2021 Mar 2;10(5). Epub 2021 Mar 2.

Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany.

While management of patients with deep-seated intracerebral hemorrhage (ICH) is well established, there are scarce data on patients with ICH who require prolonged mechanical ventilation (PMV) during the course of their acute disease. Therefore, we aimed to determine the influence of PMV on mortality in patients with ICH and to identify associated risk factors. From 2014 to May 2020, all patients with deep-seated ICH who were admitted to intensive care for >3 days were included in further analyses. PMV is defined as receiving mechanical ventilation for more than 7 days. A total of 42 out of 94 patients (45%) with deep-seated ICH suffered from PMV during the course of treatment. The mortality rate after 90 days was significantly higher in patients with PMV than in those without (64% versus 22%, < 0.0001). Multivariate analysis identified "ICH volume >30 mL" ( = 0.001, OR 5.3) and "admission SOFA score > 5" ( = 0.007, OR 4.2) as significant and independent predictors for PMV over the course of treatment in deep-seated ICH. With regard to the identified risk factors for PMV occurrence, these findings might enable improved guidance of adequate treatment at the earliest possible stage and lead to a better estimation of prognosis in the course of ICH treatment.
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http://dx.doi.org/10.3390/jcm10051015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958618PMC
March 2021

Much ado about nothing? Off-target amplification can lead to false-positive bacterial brain microbiome detection in healthy and Parkinson's disease individuals.

Microbiome 2021 03 26;9(1):75. Epub 2021 Mar 26.

Gut Microbes & Health, Quadram Institute Bioscience, Norwich Research Park, Norwich, Norfolk, NR4 7UA, UK.

Background: Recent studies suggested the existence of (poly-)microbial infections in human brains. These have been described either as putative pathogens linked to the neuro-inflammatory changes seen in Parkinson's disease (PD) and Alzheimer's disease (AD) or as a "brain microbiome" in the context of healthy patients' brain samples.

Methods: Using 16S rRNA gene sequencing, we tested the hypothesis that there is a bacterial brain microbiome. We evaluated brain samples from healthy human subjects and individuals suffering from PD (olfactory bulb and pre-frontal cortex), as well as murine brains. In line with state-of-the-art recommendations, we included several negative and positive controls in our analysis and estimated total bacterial biomass by 16S rRNA gene qPCR.

Results: Amplicon sequencing did detect bacterial signals in both human and murine samples, but estimated bacterial biomass was extremely low in all samples. Stringent reanalyses implied bacterial signals being explained by a combination of exogenous DNA contamination (54.8%) and false positive amplification of host DNA (34.2%, off-target amplicons). Several seemingly brain-enriched microbes in our dataset turned out to be false-positive signals upon closer examination. We identified off-target amplification as a major confounding factor in low-bacterial/high-host-DNA scenarios. These amplified human or mouse DNA sequences were clustered and falsely assigned to bacterial taxa in the majority of tested amplicon sequencing pipelines. Off-target amplicons seemed to be related to the tissue's sterility and could also be found in independent brain 16S rRNA gene sequences.

Conclusions: Taxonomic signals obtained from (extremely) low biomass samples by 16S rRNA gene sequencing must be scrutinized closely to exclude the possibility of off-target amplifications, amplicons that can only appear enriched in biological samples, but are sometimes assigned to bacterial taxa. Sequences must be explicitly matched against any possible background genomes present in large quantities (i.e., the host genome). Using close scrutiny in our approach, we find no evidence supporting the hypothetical presence of either a brain microbiome or a bacterial infection in PD brains. Video abstract.
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http://dx.doi.org/10.1186/s40168-021-01012-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004470PMC
March 2021

Inhibition of Intercellular Cytosolic Traffic via Gap Junctions Reinforces Lomustine-Induced Toxicity in Glioblastoma Independent of MGMT Promoter Methylation Status.

Pharmaceuticals (Basel) 2021 Feb 27;14(3). Epub 2021 Feb 27.

Brain Tumor Translational Research Affiliation, University Hospital Bonn, 53127 Bonn, Germany.

Glioblastoma is a malignant brain tumor and one of the most lethal cancers in human. Temozolomide constitutes the standard chemotherapeutic agent, but only shows limited efficacy in glioblastoma patients with unmethylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter status. Recently, it has been shown that glioblastoma cells communicate via particular ion-channels-so-called gap junctions. Interestingly, inhibition of these ion channels has been reported to render MGMT promoter-methylated glioblastoma cells more susceptible for a therapy with temozolomide. However, given the percentage of about 65% of glioblastoma patients with an unmethylated MGMT promoter methylation status, this treatment strategy is limited to only a minority of glioblastoma patients. In the present study we show that-in contrast to temozolomide-pharmacological inhibition of intercellular cytosolic traffic via gap junctions reinforces the antitumoral effects of chemotherapeutic agent lomustine, independent of MGMT promoter methylation status. In view of the growing interest of lomustine in glioblastoma first and second line therapy, these findings might provide a clinically-feasible way to profoundly augment chemotherapeutic effects for all glioblastoma patients.
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http://dx.doi.org/10.3390/ph14030195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997332PMC
February 2021

MR-Imaging and Histopathological Diagnostic Work-Up of Patients with Spontaneous Lobar Intracerebral Hemorrhage: Results of an Institutional Prospective Registry Study.

Diagnostics (Basel) 2021 Feb 22;11(2). Epub 2021 Feb 22.

Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.

Intracerebral hemorrhage (ICH) is a frequently disabling or fatal disease. The localization of ICH often allows an etiological association. However, in atypical/lobar ICH, the cause of bleeding is less obvious. Therefore, we present prospective histopathological and radiological studies which were conducted within the diagnostic workup to identify causes for lobar ICH other than hypertension. From 2016 to 2018, 198 patients with spontaneous, non-traumatic ICH requiring neurosurgical monitoring were enrolled in an institutional prospective patient registry. Patients with deep-seated ICH and/or hemorrhagically transformed cerebral infarcts were excluded from further analysis. Data to evaluate the source of bleeding based on histopathological and/or radiological workup were prospectively evaluated and analyzed. After applying the inclusion criteria and excluding patients with incomplete diagnostic workup, a total of 52 consecutive patients with lobar ICH were further analyzed. Macrovascular disease was detected in 14 patients with lobar ICH (27%). In 11 patients, diagnostic workup identified cerebral amyloid angiopathy-related ICH (21%). In addition, five patients with tumor-related ICH (10%) and six patients with ICH based on infectious pathologies (11%) were identified. In four patients, the cause of bleeding remained unknown despite extensive diagnostic workup (8%). The present prospective registry study demonstrates a higher probability to identify a cause of bleeding other than hypertension in patients with lobar ICH. Therefore, a thorough diagnostic work-up in patients with ICH is essential to accelerate treatment and further improve outcome or prevent rebleeding.
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http://dx.doi.org/10.3390/diagnostics11020368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926429PMC
February 2021

Prognostic Value of Preoperative Inflammatory Markers in Melanoma Patients with Brain Metastases.

J Clin Med 2021 Feb 7;10(4). Epub 2021 Feb 7.

Center of Integrated Oncology (CIO) Bonn, Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany.

Background: Metastatic melanoma disease is accompanied by highly systemic inflammatory responses. The prognostic value of preoperative laboratory inflammation markers in brain metastatic melanoma patients has not been adequately investigated so far.

Methods: Preoperative inflammatory blood parameters were correlated to overall survival (OS) rates in melanoma patients that underwent surgery for brain metastasis (BM) between 2013 and 2019 at the authors' institution. Receiver operating characteristic (ROC) analyses were used for cutoff determination of routine laboratory parameters.

Results: Median OS in the present cohort of 30 melanoma patients with surgically treated BM was 7 months (95% confidence interval (CI) 5.7-8.3). Initial elevated C-reactive protein (CRP) levels (>10 mg/L), neutrophil-to-lymphocyte ratio (NLR) ≥ 4, platelet-to-lymphocyte ratio (PLR) ≥ 145, and lymphocyte-to-monocyte ratio (LMR) < 2 were associated with significantly reduced OS rates.

Conclusions: The present study identifies several preoperative peripheral inflammatory markers as indicators for poor prognosis in melanoma patients with BM undergoing neurosurgical treatment. Elevated initial CRP values, higher NLR and PLR, and lower LMR were associated with reduced OS and, thus, might be incorporated into preoperative interdisciplinary treatment planning and counseling for affected patients.
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http://dx.doi.org/10.3390/jcm10040634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915758PMC
February 2021

Seizure outcome in temporal glioblastoma surgery: lobectomy as a supratotal resection regime outclasses conventional gross-total resection.

J Neurooncol 2021 Apr 7;152(2):339-346. Epub 2021 Feb 7.

Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Introduction: The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures.

Methods: Between 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors' institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2-6).

Results: Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4-515.9).

Conclusions: ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.
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http://dx.doi.org/10.1007/s11060-021-03705-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997820PMC
April 2021

Resection of piriform cortex predicts seizure freedom in temporal lobe epilepsy.

Ann Clin Transl Neurol 2021 01 2;8(1):177-189. Epub 2020 Dec 2.

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

Objective: Transsylvian selective amygdalo-hippocampectomy (tsSAHE) represents a generally recognized surgical procedure for drug-resistant mesial temporal lobe epilepsy (mTLE). Although postoperative seizure freedom can be achieved in about 70% of tsSAHE, there is a considerable amount of patients with persisting postoperative seizures. This might partly be explained by differing extents of resection of various tsSAHE target volumes. In this study we analyzed the resected proportions of hippocampus, amygdala as well as piriform cortex in regard of postoperative seizure outcome.

Methods: Between 2012 and 2017, 82 of 103 patients with mTLE who underwent tsSAHE at the authors' institution were included in the analysis. Resected proportions of hippocampus, amygdala and temporal piriform cortex as target structures of tsSAHE were volumetrically assessed and stratified according to favorable (International League Against Epilepsy (ILAE) class 1) and unfavorable (ILAE class 2-6) seizure outcome.

Results: Patients with favorable seizure outcome revealed a significantly larger proportion of resected temporal piriform cortex volumes compared to patients with unfavorable seizure outcome (median resected proportional volumes were 51% (IQR 42-61) versus (vs.) 13 (IQR 11-18), P = 0.0001). Resected proportions of hippocampus and amygdala did not significantly differ for these groups (hippocampus: 81% (IQR 73-88) vs. 80% (IQR 74-92) (P = 0.7); amygdala: 100% (IQR 100-100) vs. 100% (IQR 100-100) (P = 0.7)).

Interpretation: These results strongly suggest temporal piriform cortex to constitute a key target resection volume to achieve seizure freedom following tsSAHE.
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http://dx.doi.org/10.1002/acn3.51263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818082PMC
January 2021

Outcome of Tumor-Associated Proptosis in Patients With Spheno-Orbital Meningioma: Single-Center Experience and Systematic Review of the Literature.

Front Oncol 2020 7;10:574074. Epub 2020 Oct 7.

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

Tumor-associated proptosis comprises a frequent phenomenon that negatively impacts quality of life in patients suffering from spheno-orbital meningioma (SOM). Therefore, proptosis outcome represents an important measure in meningioma surgery. In the current study, we analyzed our institutional database in order to evaluate the recovery of tumor-associated proptosis in patients with SOM. Between 2009 and 2019, 32 patients with SOM underwent surgical treatment at the authors' institution. The exophthalmos index (EI) was calculated by means of preoperative and postoperative tumor-associated proptosis. Patients with preoperative EI ≥ 1.1 were included in further analysis. Further, we performed a systematic review of the contemporary literature. Favorable proptosis outcome was defined as postoperative decreased EI compared with preoperative EI. Overall, 25 of 32 patients with SOM (78%) suffered from preoperative proptosis in the present series. Preoperative mean EI of 1.37 ± 0.18 decreased after surgical treatment to a postoperative mean EI of 1.15 ± 0.1 during follow-up ( < 0.0001). Systematic review of the literature revealed three studies with individual data on preoperative and postoperative EI measurements leading to a total of 103 patients; 100 of 103 patients (97%) with SOM and preoperative proptosis achieved favorable outcome. The EI provides a comparable standard in evaluation of surgical outcome in patients with tumor-associated proptosis due to SOMs. The large dataset consisting of pooled individual patient data from the systematic review of the literature and the present case series support the assumption that surgical treatment is highly effective in the treatment of tumor-associated proptosis in SOM.
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http://dx.doi.org/10.3389/fonc.2020.574074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576116PMC
October 2020

Safety metric profiling in surgery for temporal glioblastoma: lobectomy as a supra-total resection regime preserves perioperative standard quality rates.

J Neurooncol 2020 Sep 29;149(3):455-461. Epub 2020 Sep 29.

Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Introduction: Supra-total resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma. However, aggressive onco-surgical approaches-geared beyond conventional gross total resections (GTR)-may be associated with peri- and postoperative unfavorable events which significantly worsen initial favorable postoperative outcome. In the current study we analyzed our institutional database with regard to patient safety indicators (PSIs), hospital-acquired conditions (HACs) and specific cranial surgery-related complications (CSC) as high standard quality metric profiles in patients that had undergone surgery for temporal glioblastoma.

Methods: Between 2012 and 2018, 61 patients with temporal glioblastoma underwent GTR or temporal lobectomy at the authors' institution. Both groups of differing resection modalities were analyzed with regard to the incidence of PSIs, HACs and CSCs.

Results: Overall, we found 6 PSI and 2 HAC events. Postoperative hemorrhage (3 out of 61 patients; 5%) and catheter-associated urinary tract infection (2 out 61 patients; 3%) were identified as the most frequent PSIs and HACs. PSIs were present in 1 out of 41 patients (5%) for the temporal GTR and 2 out of 20 patients for the lobectomy group (p = 1.0). Respective rates for PSIs were 5 of 41 (12%) and 1 of 20 (5%) (p = 0.7). Further, CSCs did not yield significant differences between these two resection modalities (p = 1.0).

Conclusion: With regard to ATL and GTR as differing onco-surgical approaches these data suggest ATL in terms of an aggressive supra-total resection strategy to preserve perioperative standard safety metric profiles.
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http://dx.doi.org/10.1007/s11060-020-03629-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609430PMC
September 2020

Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes.

J Neurol Surg A Cent Eur Neurosurg 2021 Jan 23;82(1):64-74. Epub 2020 Sep 23.

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

Background:  The objective of this meta-analysis was to analyze the impact of intraoperative magnetic resonance imaging (iMRI) on pediatric brain tumor surgery with regard to the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections (GTR) in glioma surgery, extent of resection (EoR) in supra- and infratentorial compartment, surgical site infections (SSIs), and neurologic outcome after surgery.

Methods:  MEDLINE/PubMed Service was searched for the terms "intraoperative MRI," "pediatric," "brain," "tumor," "glioma," and "surgery." The review produced 126 potential publications; 11 fulfilled the inclusion criteria, including 584 patients treated with iMRI-guided resections. Studies reporting about patients <18 years, setup of iMRI, surgical workflow, and extent of resection of iMRI-guided glioma resections were included.

Results:  IMRI-guided surgery is mainly used for pediatric low-grade gliomas. The mean rate of GTR in low- and high-grade gliomas was 78.5% (207/254; 95% confidence interval [CI]: 64.6-89.7,  < 0.001). The mean rate of GTR in iMRI-assisted low-grade glioma surgery was 74.3% (35/47; 95% CI: 61.1-85.5,  = 0.759). The rate of SSI in surgery assisted by iMRI was 1.6% (6/482; 95% CI: 0.7-2.9). New onset of transient postoperative neurologic deficits were observed in 37 (33.0%) of 112 patients.

Conclusion:  IMRI-guided surgery seems to improve the EoR in pediatric glioma surgery. The rate of SSI and the frequency of new neurologic deficits after IMRI-guided surgery are within the normal range of pediatric neuro-oncologic surgery.
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http://dx.doi.org/10.1055/s-0040-1714413DOI Listing
January 2021

Ventriculostomy with subsequent ventriculoperitoneal shunt placement after subarachnoid hemorrhage: the effect of implantation site on postoperative complications-a single-center series.

Acta Neurochir (Wien) 2020 08 15;162(8):1831-1836. Epub 2020 May 15.

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

Background: Patients suffering from aneurysmal subarachnoid hemorrhage (SAH) with shunt-dependent hydrocephalus require subsequent placement of a ventriculoperitoneal shunt (VPS) after ventriculostomy. However, in patients with previous ventriculostomy, the site for proximal VPS catheter placement is still controversial. We investigated the effect of catheter placement on postoperative complications by analyzing patients with ventriculostomy and subsequent VPS placement after SAH.

Methods: From January 2004 to December 2018, 164 of 1128 patients suffering from SAH underwent subsequent VPS placement after ventriculostomy in the authors' institution. Patients were divided into two groups according to the position of the ventriculostomy and the site of the proximal VPS catheter ("same site" group versus "contralateral site" group). VPS-related infectious and bleeding complications following VPS placement were assessed and analyzed.

Results: Overall, VPS-related infections occurred in 11 of the 164 patients (7%). Furthermore, five of the 164 patients (3%) suffered from VPS-related hemorrhage. However, VPS infection rate was lower 5% (6/115) in the same site compared to 10% (5/49) in the contralateral site group, although without reaching statistical significance (OR = 0.48 (0.14, 1.67) 95% confidence interval, p = 0.3). VPS-related hemorrhage rate did not differ significantly between patients in the same site group (3.5%, 4/115) and the contralateral site group (2.0%, 1/49; OR = 1.73 (0.18, 15.9), p = 1.0).

Conclusions: Our study suggests that the use of the ventriculostomy site for VPS placement does not significantly increase the risk of either VPS-related infections or VPS-related hemorrhages.
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http://dx.doi.org/10.1007/s00701-020-04362-1DOI Listing
August 2020

MRI follow-up after magnetic resonance-guided focused ultrasound for non-invasive thalamotomy: the neuroradiologist's perspective.

Neuroradiology 2020 Sep 3;62(9):1111-1122. Epub 2020 May 3.

Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Purpose: Magnetic resonance-guided focused ultrasound (MRgFUS) systems are increasingly used to non-invasively treat tremor; consensus on imaging follow-up is poor in these patients. This study aims to elucidate how MRgFUS lesions evolve for a radiological readership with regard to clinical outcome.

Methods: MRgFUS-induced lesions and oedema were retrospectively evaluated based on DWI, SWI, T2-weighted and T1-weighted 3-T MRI data acquired 30 min and 3, 30 and 180 days after MRgFUS (n = 9 essential tremor, n = 1 Parkinson's patients). Lesions were assessed volumetrically, visually and by ADC measurements and compared with clinical effects using non-parametric testing.

Results: Thirty minutes after treatment, all lesions could be identified on T2-weighted images. Immediate oedema was rare (n = 1). Lesion volume as well as oedema reached a maximum on day 3 with a mean lesion size of 0.4 ± 0.2 cm and an oedema volume 3.7 ± 1.2 times the lesion volume. On day 3, a distinct diffusion-restricted rim was noted that corresponded well with SWI. Lesion shrinkage after day 3 was observed in all sequences. Lesions were no longer detectable on DWI in n = 7/10, on T2-weighted images in n = 4/10 and on T1-weighted images in n = 4/10 on day 180. No infarcts or haemorrhage were observed. There was no correlation between lesion size and initial motor skill improvement (p = 0.99). Tremor reduction dynamics correlated strongly with lesion shrinkage between days 3 and 180 (p = 0.01, R = 0.76).

Conclusion: In conclusion, cerebral MRgFUS lesions variably shrink over months. SWI is the sequence of choice to identify lesions after 6 months. Lesion volume is arguably associated with intermediate-term outcome.
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http://dx.doi.org/10.1007/s00234-020-02433-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410861PMC
September 2020

Cavernoma-related epilepsy in cavernous malformations located within the temporal lobe: surgical management and seizure outcome.

Neurosurg Focus 2020 04;48(4):E6

Departments of1Neurosurgery and.

Objective: Cavernoma-related epilepsy (CRE) is a frequent symptom in patients with cerebral cavernous malformations (CCMs). Reports on surgical management and seizure outcome of epileptogenic CCM often focus on intracranial cavernoma in general. Therefore, data on CCMs within the temporal lobe are scarce. The authors therefore analyzed their institutional data.

Methods: From 2003 to 2018, 52 patients suffering from CCMs located within the temporal lobe underwent surgery for CRE at University Hospital Bonn. Information on patient characteristics, preoperative seizure history, preoperative evaluation, surgical strategies, postoperative complications, and seizure outcome was assessed and further analyzed. Seizure outcome was assessed 12 months after surgery according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class I) versus unfavorable (ILAE classes II-VI).

Results: Overall, 47 (90%) of 52 patients with CCMs located in the temporal lobe and CRE achieved favorable seizure outcome. Pure lesionectomy was performed in 5 patients, extended lesionectomy with resection of the hemosiderin rim in 38 patients, and anterior temporal lobectomy in 9 patients with temporal lobe CCM. Specifically, 36 patients (69%) suffered from drug-resistant epilepsy (DRE), 3 patients (6%) from chronic CRE, and 13 patients (25%) sustained sporadic CRE. In patients with DRE, favorable seizure outcome was achieved in 32 (89%) of 36 patients. Patients with DRE were significantly older than patients with CCM-associated chronic or sporadic seizures (p = 0.02). Furthermore, patients with DRE more often underwent additional amygdalohippocampectomy following the recommendation of presurgical epileptological evaluation.

Conclusions: Favorable seizure outcome is achievable in a substantial number of patients with epileptogenic CCM located in the temporal lobe, even if patients suffered from drug-resistant CRE. For adequate counseling and monitoring, patients with CRE should undergo a thorough pre- and postsurgical evaluation in dedicated epilepsy surgery programs.
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http://dx.doi.org/10.3171/2020.1.FOCUS19920DOI Listing
April 2020

Elevated body mass index facilitates early postoperative complications after surgery for intracranial meningioma.

Neurosurg Rev 2021 Apr 24;44(2):1023-1029. Epub 2020 Mar 24.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.

Surgical resection represents the primary treatment option for patients suffering from intracranial meningioma. However, early postoperative complications significantly worsen initial favorable postoperative outcomes. Therefore, the ability to preoperatively assess potential risk factors for early postoperative unfavorable events is important to preselect critical patients who might require special attention during clinical management. In the current study, we therefore analyzed our institutional database in order to identify risk factors associated with early postoperative complications after initial meningioma resection. Between 2014 and 2017, 202 patients with intracranial supratentorial meningioma were surgically treated at the authors' institution. Early postoperative complications were defined as any postoperative event requiring further surgical measures within 30 days following initial meningioma resection. A multivariate analysis was performed to identify independent risk factors associated with postoperative complications after surgical meningioma therapy. Overall, 13 out of 202 meningioma patients developed early postoperative complications (6%). The multivariate analysis revealed obesity in terms of elevated body mass index (BMI ≥ 30 kg/m) (p = 0.03), the presence of atrial fibrillation (p = 0.001) as well as the preoperative Karnofsky Performance Status Scale < 70% (p = 0.004) as independent predictors for early postoperative complications in the course of supratentorial meningioma resection. Obesity is associated with a higher risk of postoperative unfavorable events that require further surgical treatment. Furthermore, the present study identifies several additional risk factors for the development of early postoperative complications after intracranial meningioma resection enabling to preoperatively select for high-risk patients that might require special attention in clinical and surgical management.
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http://dx.doi.org/10.1007/s10143-020-01281-8DOI Listing
April 2021

Surgery for posterior fossa meningioma: elevated postoperative cranial nerve morbidity discards aggressive tumor resection policy.

Neurosurg Rev 2021 Apr 27;44(2):953-959. Epub 2020 Feb 27.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms University, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.

Radical excision of meningioma is suggested to provide for the best tumor control rates. However, aggressive surgery for meningiomas located at the posterior cranial fossa may lead to elevated postoperative morbidity of adjacent cranial nerves which in turn worsens patients' postoperative quality of life. Therefore, we analyzed our institutional database with regard to new cranial nerve dysfunction as well as postoperative cerebrospinal fluid (CSF) leakage depending on the extent of tumor resection. Between 2009 and 2017, 89 patients were surgically treated for posterior fossa meningioma at the authors' institution. Postoperative new cranial nerve dysfunction as well as CSF leakage were stratified into Simpson grade I resections with excision of the adjacent dura as an aggressive resection regime versus Simpson grade II-IV tumor removal. Simpson grade I resections revealed a significantly higher percentage of new cranial nerve dysfunction immediately after surgery (39%) compared with Simpson grade II (11%, p = 0.01) and Simpson grade II-IV resections (14%, p = 0.02). These observed differences were also present for the 12-month follow-up (27% Simpson grade I, 3% Simpson grade II (p = 0.004), 7% Simpson grades II-IV (p = 0.01)). Postoperative CSF leakage was present in 21% of Simpson grade I and 3% of Simpson grade II resections (p = 0.04). Retreatment rates did not significantly differ between these two groups (6% versus 8% (p = 1.0)). Elevated levels of postoperative new cranial nerve deficits as well as CSF leakage following radical tumor removal strongly suggest a less aggressive resection policy to constitute the surgical modality of choice for posterior cranial fossa meningiomas.
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http://dx.doi.org/10.1007/s10143-020-01275-6DOI Listing
April 2021

High Mib-1-score correlates with new cranial nerve deficits after surgery for frontal skull base meningioma.

Neurosurg Rev 2021 Feb 13;44(1):381-387. Epub 2019 Dec 13.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.

Postoperative new cranial nerve deficits comprise severe concomitant morbidity in skull base meningioma surgery. Therefore, long-term cranial nerve integrity represents an important outcome measure. In the current study, we analyzed our institutional database in order to identify risk factors for postoperative new cranial nerve morbidity in the course of frontobasal meningioma surgery. Between 2009 and 2017, 195 patients were surgically treated for frontobasal meningioma at the authors' institution. Postoperative cranial nerve function was assessed immediately after surgery as well as 12 months postoperatively. A univariate and multivariate analysis was performed to identify factors influencing favorable postoperative cranial nerve outcome. Tumors with histological Mib-1-labeling indices > 5% were associated with a significantly higher percentage of new cranial nerve deficits immediately after surgery compared with those with Mib-1-labeling indices ≤ 5% (39% versus 20%, p = 0.029). Elevated Mib-1-labeling indices could be correlated with high CD68-positive macrophage staining (54% for Mib-1 index > 5% versus 19% for Mib-1 index ≤ 5%, p = 0.001). Elevated Mib-1-labeling index correlates with initial new cranial nerve dysfunction after resection of frontal skull base meningioma. With regard to elevated CD68-positive macrophage staining in high Mib-1-positive meningiomas, initial postoperative new cranial nerve morbidity might partly reflect macrophage-based inflammatory immune responses.
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http://dx.doi.org/10.1007/s10143-019-01222-0DOI Listing
February 2021

Preoperative tumor-associated epilepsy in patients with supratentorial meningioma: factors influencing seizure outcome after meningioma surgery.

J Neurosurg 2019 Oct 11:1-7. Epub 2019 Oct 11.

Departments of1Neurosurgery and.

Objective: Both pre- and postoperative seizures comprise common side effects that negatively impact patient quality of life in those suffering from intracranial meningioma. Therefore, seizure freedom represents an important outcome measure in meningioma surgery. In the current study the authors analyzed their institutional database to identify risk factors for postoperative seizure occurrence after surgical meningioma therapy in patients with preoperative symptomatic epilepsy.

Methods: Between February 2009 and April 2017, 187 patients with preoperative seizures underwent resection of supratentorial meningioma at the authors' institution. Seizure outcome was assessed retrospectively 12 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class I) versus unfavorable (ILAE classes II-VI). A univariate and multivariate analysis was performed to identify factors influencing seizure outcome.

Results: Overall 169 (90%) of 187 patients with preoperative seizures achieved favorable outcome in terms of seizure freedom after meningioma resection. Multivariate analysis revealed peritumoral edema > 1 cm in maximal diameter and WHO grade II and III tumors, as well as a low extent of resection (Simpson grades III-V) as independent predictors for postoperative unfavorable seizure outcome.

Conclusions: Surgery is highly effective in the treatment of seizures as common side effects of supratentorial meningioma. Furthermore, the present study identified several significant and independent risk factors for postoperative seizure occurrence, enabling one to select for high-risk patients that require special attention in clinical and surgical management.
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http://dx.doi.org/10.3171/2019.7.JNS19455DOI Listing
October 2019

Surgery for temporal glioblastoma: lobectomy outranks oncosurgical-based gross-total resection.

J Neurooncol 2019 Oct 4;145(1):143-150. Epub 2019 Sep 4.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.

Objective: Supra-total glioblastoma resection has gained growing attention with regard to superior long-term disease control. However, aggressive onco-surgical approaches-geared beyond conventional gross total resections (GTR)-are limited by the impairment of adjacent eloquent areas at risk that may entail severe postoperative functional morbidity. Against this backdrop we analyzed our institutional database with regard to potential survival benefits of anterior temporal lobectomy as a paradigm for supra-total resection in patients with precisely temporal-located, non-eloquent glioblastoma.

Methods: Between 2012 and 2017, 38 patients with isolated temporal glioblastoma underwent GTR or temporal lobectomy at the authors' institution. Both groups of differing resection modalities were compared with regard to postoperative Karnofsky performance score (KPS), progression-free survival (PFS), and overall survival (OS).

Results: Patients with temporal lobectomy exhibited significantly superior median KPS at the 12 months follow-up compared to the GTR group (median KPS of 80 vs. 60, p = 0.04). Temporal lobectomy was associated with significantly prolonged PFS (p = 0.005) and OS (p = 0.002) coming up to 15 months (95% CI 9.7-22.1) and 23 months (95% CI 14.8-34.5) compared to 7 months (95% CI 3.3-8.3) and 11 months (95% CI 9.2-17.9) for the GTR group. Multivariate analysis revealed temporal lobectomy as the only predictor for both superior PFS (p = 0.037, OR 7.3, 95% CI 1.1-47.4) and OS (p = 0.04, OR 7.8, 95% CI 1.1-55.2).

Conclusions: These results strongly suggest temporal lobectomy as an aggressive supra-total resection policy to constitute the surgical modality of choice for isolated temporal-located glioblastoma.
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http://dx.doi.org/10.1007/s11060-019-03281-1DOI Listing
October 2019

Treatment of Partially Thrombosed Intracranial Aneurysms: Single-Center Series and Systematic Review.

World Neurosurg 2018 Oct 17;118:e834-e841. Epub 2018 Jul 17.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.

Objective: Partially thrombosed intracranial aneurysms (PTIAs) represent a challenging subgroup of aneurysms, with an organized intraluminal thrombus and a solid mass, in which the optimal therapeutic strategy is discussed controversially because of limited data. We therefore analyzed the results of surgical and endovascular treatment in patients with PTIAs treated in our department and combined the results with a systematic literature review.

Methods: Between January 2006 and October 2016, data from 996 patients with intracranial aneurysms were prospectively entered into a database. Twenty-five consecutive patients harbored PTIAs and were treated in the authors' institution. The degree of aneurysm occlusion, the degree of recurrence, and the necessity of aneurysm retreatment were assessed and analyzed. PubMed was searched for published studies of PTIAs to gain a larger population. Multivariate regression models were performed on the pooled data.

Results: Literature data, including the present series, revealed a total of 157 patients. Overall, 64 patients (41%) were treated by clipping, and 93 patients (59%) were treated by endovascular treatment. In the multivariate analysis, surgical treatment of PTIAs was an independent predictor for complete aneurysm occlusion (P < 0.001). In a second multivariate model, endovascular treatment was independently associated with aneurysm recurrence (P < 0.001). In a third multivariate model, endovascular treatment was associated with a higher rate of retreatment (P < 0.001).

Conclusions: In this study, surgical treatment of PTIAs showed superior initial radiologic results and better long-term stability than endovascular treatment. Therefore, surgical treatment should be considered in those patients harboring PTIAs who are qualified as suitable surgical candidates after interdisciplinary consensus.
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http://dx.doi.org/10.1016/j.wneu.2018.07.063DOI Listing
October 2018

Risk factors for shunt dependency in patients suffering from spontaneous, non-aneurysmal subarachnoid hemorrhage.

Neurosurg Rev 2019 Mar 29;42(1):139-145. Epub 2018 Mar 29.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.

Patients presenting with spontaneous, non-aneurysmal subarachnoid hemorrhage (SAH) achieve better outcomes compared to patients with aneurysmal SAH. Nevertheless, some patients develop shunt-dependent hydrocephalus during treatment course. We therefore analyzed our neurovascular database to identify factors determining shunt dependency after non-aneurysmal SAH. From 2006 to 2016, 131 patients suffering from spontaneous, non-aneurysmal SAH were admitted to our department. Patients were stratified according to the distribution of cisternal blood into patients with perimesencephalic SAH (pSAH) versus non-perimesencephalic SAH (npSAH). Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months and stratified into favorable (mRS 0-2) versus unfavorable (mRS 3-6). A multivariate analysis was performed to identify predictors of shunt dependency in patients suffering from non-aneurysmal SAH. Overall, 18 of 131 patients suffering from non-aneurysmal SAH developed shunt dependency (14%). In detail, patients with npSAH developed significantly more often shunt dependency during treatment course, when compared to patients with pSAH (p = 0.02). Furthermore, patients with acute hydrocephalus, presence of intraventricular hemorrhage, presence of clinical vasospasm, and anticoagulation medication prior SAH developed significantly more often shunt dependency, when compared to patients without (p < 0.0001). However, "acute hydrocephalus" was the only significant and independent predictor for shunt dependency in all patients with non-aneurysmal SAH in the multivariate analysis (p < 0.0001). The present study identified acute hydrocephalus with the necessity of CSF diversion as significant and independent risk factor for the development of shunt dependency during treatment course in patients suffering from non-aneurysmal SAH.
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http://dx.doi.org/10.1007/s10143-018-0970-0DOI Listing
March 2019

Decompressive craniectomy for intracerebral haematoma: the influence of additional haematoma evacuation.

Neurosurg Rev 2018 Apr 27;41(2):649-654. Epub 2017 Sep 27.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.

Intracerebral haemorrhage (ICH) may lead to intractable elevation of intracranial pressure (ICP), which may lead to decompressive craniectomy (DC). In this setting, surgical evacuation of ICH is controversially discussed. We therefore analysed radiological and clinical parameters to investigate the influence of additional haematoma evacuation to DC in patients with ICH. Forty-four patients suffering from spontaneous, hypertensive ICH between August 2007 and February 2016 underwent DC with and without ICH evacuation at the author's institution. Patients were stratified into two groups (DC without ICH evacuation versus DC with ICH evacuation). Patient characteristics, clinical and radiological findings were assessed and retrospectively analysed. Fifteen (34%) patients underwent DC with additional ICH evacuation and 29 (66%) underwent DC without ICH evacuation. Mean ICH volume was 60 ± 38 ml with no significant difference between both groups (p = 0.8). Midline shift (MLS) reduction after DC did not significantly differ between both groups (p = 0.4). Overall, 13 patients (30%) achieved a favourable outcome. DC can be performed in cases of spontaneous supratentorial ICH and pathological elevated ICP despite best medical treatment. However, additional ICH evacuation does not seem to be beneficial according to the present study and may therefore be omitted.
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http://dx.doi.org/10.1007/s10143-017-0909-xDOI Listing
April 2018

Accuracy and Safety of Ventriculostomy Using Two Different Procedures of External Ventricular Drainage: A Single-Center Series.

J Neurol Surg A Cent Eur Neurosurg 2018 May 22;79(3):206-210. Epub 2017 Sep 22.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.

Background And Study Aims:  Patients with acute hydrocephalus are treated by either insertion of a conventional external ventricular drain (EVD) or percutaneous needle trephination (PNT) at our institution, depending on the acuteness of intervention and the severity of illness. We compared both procedures regarding accuracy and safety necessitating surgical revision of EVD or PNT.

Methods:  Between January 2012 and January 2014, 451 ventriculostomies were performed in 301 patients at our institution. All patients underwent routine computed tomography after insertion of the ventricular drain during the treatment course. Patient characteristics, underlying pathology, ventriculostomy modality, radiologic features, catheter tip location, and treatment-related complications were analyzed.

Results:  A total of 307 of 451 ventriculostomy procedures (68%) were performed as conventional EVD, and 144 (32%) were performed as PNT. Overall, 11% of patients with conventional EVD underwent surgical revision due to lacking accuracy, infection, or hemorrhage; 7% of patients with PNT underwent surgical revision ( = 0.2). However, multivariate analysis revealed that only "hospital stay > 21 days" as an independent variable was significantly associated with surgical revision after ventriculostomy.

Conclusion:  The present data indicate that PNT has a similar safety profile in emergency situations in critically ill patients who need immediate treatment for acute hydrocephalus when compared with the conventional EVD procedure.
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http://dx.doi.org/10.1055/s-0037-1606544DOI Listing
May 2018

Anticoagulation Therapy in Patients Suffering from Aneurysmal Subarachnoid Hemorrhage: Influence on Functional Outcome-a Single-Center Series and Multivariate Analysis.

World Neurosurg 2017 Mar 21;99:348-352. Epub 2016 Dec 21.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.

Introduction: Favorable outcome in patients presenting with aneurysmal subarachnoid hemorrhage (SAH) is determined by several factors. Nevertheless, data on the influence of prior use of oral anticoagulation drugs on functional outcome in patients suffering from SAH are scarce. We therefore analyzed our institutional data.

Methods: From January 2009 to October 2015, 480 patients suffering from aneurysmal SAH were admitted to our institution. Information including patient characteristics, treatment modality, aneurysm size and location, radiologic features, and functional neurologic outcome was assessed and further analyzed. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months and stratified into favorable (mRS 0-2) versus unfavorable (mRS 3-6).

Results: Overall, 17 of 480 patients suffering from aneurysmal SAH were on anticoagulation therapy before ictus (4%). Patients without anticoagulation therapy were significantly younger compared with patients with anticoagulation therapy before SAH (P = 0.005). Furthermore, patients without anticoagulation therapy presented in a significantly better clinical condition compared with patients with anticoagulation therapy before SAH (P = 0.02). Additionally, patients without anticoagulation therapy achieved significantly more often favorable functional outcome compared with patients with anticoagulation therapy before SAH (P = 0.02). However, anticoagulation therapy was not identified as a significant and independent predictor for unfavorable outcome in the multivariate logistic regression analysis.

Conclusion: Anticoagulation therapy has not been identified as a significant and independent factor influencing functional outcome in patients suffering from SAH. Therefore treatment should not be omitted. Nevertheless, cautious management is necessary in patients with known anticoagulation therapy before SAH.
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http://dx.doi.org/10.1016/j.wneu.2016.12.036DOI Listing
March 2017

Acute Traumatic Subdural Hematoma: Surgical Management in the Presence of Cerebral Herniation-A Single-Center Series and Multivariate Analysis.

World Neurosurg 2016 Oct 25;94:501-506. Epub 2016 Jul 25.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.

Background: Traumatic acute subdural hematoma (aSDH) is a severe disease. Surgical treatment is still controversially discussed, especially in patients with additional signs of cerebral herniation. However, previously investigated patient populations were heterogeneous. We therefore performed an analysis of our institutional data in a large homogenous selection of patients with traumatic aSDH to analyze factors determining clinical outcome.

Methods: Between 2010 and 2014, 196 patients with aSDH underwent surgical treatment in our department. Information including patient characteristics, treatment modality, radiologic features, and functional outcome were analyzed. Outcome was assessed according to the Glasgow Outcome Scale (GOS) at 6 months and was dichotomized into favorable (GOS score, 1-3) and unfavorable (GOS score 4-5) outcome. Furthermore, a multivariate analysis was performed to identify independent predictors of functional outcome.

Results: Overall, 26% of patients with aSDH achieved favorable outcome. In further analysis, unilateral or bilateral dilated pupils as a sign of cerebral herniation were present in 47% of the included patients. In the multivariate analysis, age >70 years and the presence of cerebral herniation were significant prognostic predictors for unfavorable outcome in patients with aSDH. However, 15% of patients with aSDH and signs of cerebral herniation achieved favorable outcome during follow-up.

Conclusions: We provide detailed data on patients with aSDH and signs of cerebral herniation. Despite mydriasis, favorable outcome may be achieved in many patients. Nevertheless, careful individual decision making is necessary for each patient, especially when signs of cerebral herniation have persisted for a long time.
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http://dx.doi.org/10.1016/j.wneu.2016.07.061DOI Listing
October 2016

Decompressive Craniectomy for Stroke: Early Cranioplasty Is a Predictor for Postoperative Complications.

World Neurosurg 2016 Aug 6;92:83-88. Epub 2016 May 6.

Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.

Background: Previous clinical studies assumed that early cranioplasty (CP) was mandatory for a favorable neurologic recovery after decompressive craniectomy (DC) for malignant stroke. However, the appropriate timing of the CP procedure after DC remains controversial. This study assessed patients who underwent DC because of cerebral ischemia to determine the appropriate time point of CP and surgical-associated complications.

Methods: Data from the period 2007-2014 were retrospectively evaluated. CP was performed in 75 patients who previously underwent DC because of supratentorial cerebral infarction. Patients were divided into 2 groups (early CP vs. late CP) according to the time from DC to CP (<3 months vs. ≥3 months). Patient characteristics, timing of CP, and postoperative complications associated with CP were analyzed.

Results: CP was performed early in 12 patients (16%) and late in 63 patients (84%). The complication rate after CP was 18%; complications included wound healing disturbance in 8 patients (11%), epidural hematoma or subdural hematoma in 4 patients (4%), and others in 2 patients (3%). Patients with early CP experienced significantly more complications compared with patients with late CP after initial DC (5 of 12 patients [42%] vs. 8 of 63 patients [13%]; P = 0.02). In multivariate analysis, early CP was a significant predictor of postoperative complications after CP (odds ratio = 6.04; 95% confidence interval, 1.4-24.9; P = 0.01).

Conclusions: The present data suggest that patients who underwent DC for stroke might benefit from CP performed >3 months after DC owing to a lower rate of wound infection.
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http://dx.doi.org/10.1016/j.wneu.2016.04.113DOI Listing
August 2016