1,721,004 research outputs found
Mini review: impedance measurement in neuroscience and its prospective application in the field of surgical neurooncology
Full text linkImpedance measurement of human tissue can be performed either in vivo or ex vivo . The majority of the in-vivo approaches are non-invasive, and few are invasive. To date, there is no gold standard for impedance measurement of intracranial tissue. In addition, most of the techniques addressing this topic are still experimental and have not found their way into clinical practice. This review covers available impedance measurement approaches in the neuroscience in general and specifically addresses recent advances made in the application of impedance measurement in the field of surgical neurooncology. It will provide an understandable picture on impedance measurement and give an overview of limitations that currently hinders clinical application and require future technical and conceptual solutions.Open-Access-Publikationsfonds 202
Retroperitoneal and pelvic schwannoma/neurofibroma resection: surgical strategies and outcomes in a neurosurgical cohort
No full textAbstract Background Retroperitoneal and pelvic schwannomas and neurofibromas account about 10% of all retroperitoneal tumors. These tumors are almost invariably benign and slow growing. They are either asymptomatic or cause radicular or abdominal pain. The radiologic findings cannot distinguish schwannomas from other retroperitoneal neoplasms. To our knowledge, this study is the first neurosurgical series of this size to employ intraoperative electrophysiological monitoring during resection of schwannomas and neurofibromas arising in the retroperitoneal and pelvic regions. Methods A retrospective study conducted at the University Hospital Göttingen from 2015 to 2024 included 13 patients who underwent surgical treatment for schwannomas and neurofibromas arising in the retroperitoneal and pelvic regions. The study incorporated detailed surgical descriptions of the resection techniques and the approaches used for these tumors. Results The mean age was 51 ± 12 years. Symptomatic presentations included abdominal discomfort in 6 patients (46%), unilateral radicular pain in 5 patients (38%), and 4 patients (31%) were asymptomatic. Tumors exhibited a mean diameter of 6.2 ± 2.9 cm (range: 3.3–14 cm). Anatomic distribution included 7 cases (54%) in the presacral region, 5 cases (38%) in the lesser pelvis, and 4 cases (31%) involving the L5 or S1 neuroforamen with extension into the ventral prevertebral space. Transretroperitoneal approaches were utilized in 8 cases (62%), while 5 (38%) underwent transperitoneal resection. Gross total resection was achieved in 10 patients (77%). In one patient, a transient intraoperative decline in sphincter MEPs was observed, with a 48% drop in amplitude, followed by full postoperative recovery. Direct electrical stimulation of the tumor capsule elicited active motor responses in 5 patients (38%). In 3 of these cases, complete resection was not feasible due to intraoperative changes in MEPs signals. The mean operative duration was 271.8 ± 64.5 min (range: 180–400 min), with a mean blood loss of 700 ± 400 mL. Postoperatively, no motor or sensory deficits occurred, and symptoms resolved within one week. The mean hospital stay was 9.2 ± 3.5 days (range: 5–15 days). Histopathology confirmed benign tumors in all cases: 8 schwannomas (62%), 3 neurofibromas (23%), and 1 ganglioneuroma (8%). No recurrences were observed during a mean follow-up period of 24 ± 6 months. Conclusion Surgical resection of retroperitoneal and pelvic schwannomas and neurofibromas, while technically challenging, is safe and effective when performed by experienced surgeons and multidisciplinary preoperative planning. None of our patients experienced postoperative complications, which may, in part, be attributable to the use of intraoperative neuromonitoring. However, comparative and prospective studies are recommended to further validate these findings
Radiofrequency thermocoagulation under neuromonitoring guidance and general anesthesia for treatment of refractory trigeminal neuralgia
Full text linkObjective
Radiofrequency thermocoagulation (RFT) for refractory trigeminal neuralgia is usually performed in awake patients to localize the involved trigeminal branches. It is often a painful experience. Here, we present RFT under neuromonitoring guidance and general anesthesia.
Method
Stimulation of trigeminal branches at the foramen ovale with the tip of the RFT cannula is performed under short general anesthesia. Antidromic sensory–evoked potentials (aSEP) are recorded from the 3 trigeminal branches. The cannula is repositioned until the desired branch can be stimulated and lesioned.
Conclusion
aSEP enable accurate localization of involved trigeminal branches during RFT and allow performing the procedure under general anesthesia
Wounded glioma with fatal outcome: A report on biopsy of anaplastic glioma in two patients
No full textComplications, length of hospital stay and cost of care after surgery for pyogenic spondylodiscitis
No full textObjective: Infectious spondylodiscitis is a heterogeneous disease usually affecting a fragile patient population with multiple comorbidities. Therefore, surgical and medical complications are important considerations before initiating treatment. Methods: This retrospective analysis included data of 218 patients who underwent surgical treatment for pyogenic spondylodiscitis between 2008 and 2016. Groups were divided into length of hospital stay (LOS) of >21 days (Group I = 21days). Analysis included patient age, gender, Charlson Comorbidity Index, smoking, obesity, osteoporosis, colonization with multidrug-resistant bacteria, preoperative neurological deficit, pre- und postoperative inflammation markers (CRP and WBC), duration of surgery, number of operated segments, vertebrectomy, postoperative medical and surgical complications. The case value for each patient expressed in Euro was retrieved from hospital records and included in the analysis. Results: Duration of stay after surgical treatment of spondylodiscitis was = 21 days (22 to 162, mean 41 days) in 59% of the patients. Multivariate analysis showed that both medical complications (OR 2.62, 95% CI 1.24-5.56, p=0.012) and surgical site infection (OR 6.04, 95% CI 2.35-15.51, p<0.001) were independently associated with a long hospital stay. Case values averaged at 21,667 ± 1,579 Euro (min: 2,888 and max: 203,802 Euro) and correlated significantly with the length of hospital stay (Pearson correlation coefficient 0.681, p<0.05). The occurrence of a postoperative complication increased the cost of care significantly from 17,790 to 24,527 Euro on average (p=0.025). Conclusions: This study provides benchmark data for patients treated surgically for spondylodiscitis. Surgical site infection and medical complications are the main drivers of prolonged hospital stays and cost of care
Surgical practices in decompressive hemicraniectomy for malignant middle cerebral artery infarction with hemorrhagic transformation: results from an international survey
No full textA comparison between threshold criterion and amplitude criterion in transcranial motor evoked potentials during surgery for supratentorial lesions
No full textDetermining the applicability of the RSNA radiology lexicon (RadLex) in high-grade glioma MRI reporting—a preliminary study on 20 consecutive cases with newly diagnosed glioblastoma
No full textAbstract
Background
The implementation of a collective terminology in radiological reporting such as the RSNA radiological lexicon (RadLex) yields many benefits including unambiguous communication of findings, improved education, and fostering data mining for research purposes. While some fields in general radiology have already been evaluated so far, this is the first exploratory approach to assess the applicability of the RadLex terminology to glioblastoma (GBM) MRI reporting.
Methods
Preoperative brain MRI reports of 20 consecutive patients with newly diagnosed GBM (mean age 68.4 ± 10.8 years; 12 males) between January and October 2010 were retrospectively identified. All terms related to the tumor as well as their frequencies of mention were extracted from the MRI reports by two independent neuroradiologists. Every item was subsequently analyzed with respect to an equivalent RadLex representation and classified into one of four groups as follows: 1. verbatim RadLex entity, 2. synonymous/multiple equivalent(s), 3. combination of RadLex concepts, or 4. no RadLex equivalent. Additionally, verbatim entities were categorized using the hierarchical RadLex Tree Browser.
Results
A total of 160 radiological terms were gathered. 123/160 (76.9%) items showed literal RadLex equivalents, 9/160 (5.6%) items had synonymous (non-verbatim) or multiple counterparts, 21/160 (13.1%) items were represented by means of a combination of concepts, and 7/160 (4.4%) entities could not eventually be transferred adequately into the RadLex ontology.
Conclusions
Our results suggest a sufficient term coverage of the RadLex terminology for GBM MRI reporting. If applied extensively, it may improve communication of radiological findings and facilitate data mining for large-scale research purposes.Open-Access-Publikationsfonds 202
Mini review: Current status and perspective of S100B protein as a biomarker in daily clinical practice for diagnosis and prognosticating of clinical outcome in patients with neurological diseases with focus on acute brain injury
Full text linkAbstract Prognosticating the clinical outcome of neurological diseases is essential to guide treatment and facilitate decision-making. It usually depends on clinical and radiological findings. Biomarkers have been suggested to support this process, as they are deemed objective measures and can express the extent of tissue damage or reflect the degree of inflammation. Some of them are specific, and some are not. Few of them, however, reached the stage of daily application in clinical practice. This mini review covers available applications of the S100B protein in prognosticating clinical outcome in patients with various neurological disorders, particularly in those with traumatic brain injury, spontaneous subarachnoid hemorrhage and ischemic stroke. The aim is to provide an understandable picture of the clinical use of the S100B protein and give a brief overview of the current limitations that require future solutions
Positioning of epidural electrode for motor cortex stimulation in general anesthesia based on intraoperative electrophysiological monitoring to treat refractory trigeminal neuropathic pain
Full text linkAbstract Background Motor cortex stimulation (MCS) represents a treatment option for refractory trigeminal neuralgia (TGN). Usually, patients need to be awake during surgery to confirm a correct position of the epidural electrode above the motor cortex, reducing patient’s comfort. Method Epidural cortical mapping (ECM) and motor evoked potentials (MEPs) were intraoperatively performed for correct localization of motor cortex under general anesthesia that provided comparable results to test stimulation after letting the patient to be awake during the operation. Conclusion Intraoperative ECM and MEPs facilitate a confirmation of correct MCS-electrode position above the motor cortex allowing the MCS-procedure to be performed under general anesthesia
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