1,721,002 research outputs found
Temporobasal, Transsphenoidal Meningoencephalocele Becoming Symptomatic with Spontaneous Cerebrospinal Fluid Rhinorrhea: Diagnostic Work-up and Microsurgical Strategy
No full textBackgroundWe report the rare case of an adult transsphenoidal meningoencephalocele and outline the microneurosurgical strategy. Clinical history, the findings of computerized tomography (CT) scans and magnetic resonance imaging (MRI), the microsurgical procedure, and histopathology are reported. Case ReportA 54-year-old female patient complained about cerebrospinal fluid (CSF) rhinorrhea; a transnasal biopsy of a mass in the maxillar sinus prior to diagnostic work-up was performed elsewhere. Persisting CSF leakage prompted CT and MRI, which showed brain tissue extending from the left middle cranial fossa into the left sphenoid sinus through several bony defects. The diagnosis of a transsphenoidal meningoencephalocele was made, and the lesion was targeted via a subtemporal intradural approach with resection of the herniated brain tissue and closure of the bony as well as of dural defects. The postoperative course was uneventful without recurrence of the CSF fistula. ConclusionThe transsphenoidal subtype of basal meningoencephaloceles is exceedingly rare. Nonetheless, it has to be considered as a differential diagnosis if a nasal or intrasphenoidal mass is diagnosed. Otherwise, unjustified biopsy or unsuccessful management of CSF leakage could not be avoided. The intradural subtemporal approach is effective to treat the transsphenoidal type of basal meningoencephaloceles
Image-guided Intracranial Endosonography
No full textBackground: Although the skull limits applicability of sonography, bedside intracranial endosonography might be an alternative to computed tomography scans to detect adverse events in sedated patients. However, the usefulness of intracranial endosonography for potential clinical application has not been evaluated. The present study was designed to investigate the suitability of an image-guided intracranial endosonography (IGIE) catheter for intracranial ultrasound imaging in an ex vivo phantom model and in a large animal model.Materials and Methods: IGIE was evaluated in a cranial phantom and a porcine intracranial hemorrhage (ICH) model. Two anesthetized animals underwent an initial magnetic resonance imaging (MRI) scan, followed by placement of an endosonography catheter in the frontal lobe. After anatomic imaging, an experimental ICH was placed in the contralateral hemisphere. B-scan imaging, duplex, Doppler sonography, and a second MRI were performed. A standard image-guiding device tracked the ultrasound catheter.Results: Endosonography provided high-definition imaging of intracranial structures. Image guidance allowed direction of the catheter to and intuitive identification of anatomic structures. Doppler imaging allowed analysis of blood flow in intracranial vessels. Ultrasound imaging was used to monitor evolution of ICH and the resulting brain edema in real time. Coregistration of ultrasound and MRI images acquired after ICH placement demonstrated the high accuracy of the spatial resolution of IGIE (largest mismatch <5 mm).Conclusions: IGIE provides high-definition images of intracranial structures, Doppler analysis of blood flow, and real-time monitoring of intracranial structural lesions. We suggest that IGIE might prove a valuable tool for intracranial monitoring of sedated patients over extended time periods
Die Effektivität der operativen Therapie auf den Distress von Hirntumorpatienten
Full text linkAmongst the population of cancer patients, brain tumor patients are one of the most severely affected by their illnesses. They suffer tremendous quality of life reductions due to functional impairment, neurocognitive dysfunction, and psychosocial distress. Psychosocial distress, despite having a large impact on quality of life, is often an afterthought and overlooked. Some patients do not receive supportive care until the palliative stage, if at all. Recognizing the need for psychosocial care and quantifying its different aspects is therefore important to integrate into standard neurooncological clinical practice. This can be done through questionnaires or interviews conducted by healthcare professionals or filled out by the patients themselves. This study aimed to explore how operative resection of brain tumors impacts patient distress, specifically their physical and psychosocial burdens, using the Distress Thermometer (DT) and Signaling Questions (SQ) as measuring instruments. Along with this, we also sought to determine how other factors such as socioeconomic status, treatment effectiveness or patient difficulties may impact distress. Using both measuring instruments before and after operations, we were able to collect data from 41 patients for analysis. Our results showed a post-operative increase in physical distress and a decrease in emotional distress. This was consistent across the entire population, even among severely distressed patients (DT≥6). DT and SQ correlated to each other significantly and SQ proved to be a good predictor for distress. Other factors that can significantly impact distress are sex, marital status, and occupational status. Difficulties with the interview did not seem to impact the data that we gathered and neither did treatment effectiveness. However, we must note that the parameters used to quantify both the aforementioned aspects are disputable. All in all, operative therapy does increase overall stress. Nevertheless, a nuanced view is worth looking into, as different aspects of stress behave differently. SQ and DT are suitable instruments to measure distress, however SQ may be better suited as a screening instrument, whereas DT is a proven instrument to quantify the different aspects of distress.XI, 61 Seiten ; Illustrationen, Diagramm
Image Guidance for Transcranial Doppler Ultrasonography
No full textBACKGROUND: Transcranial Doppler (TCD) ultrasonography is an important tool for noninvasive detection and monitoring of vasospasm and other pathological conditions of the intracranial vessels. OBJECTIVE: To demonstrate that image-guided TCD allows rapid identification and blood-flow analysis of specific sections of the vascular anatomy and provides excellent orientation, also allowing diagnostic procedures on pathological vascular structures. METHODS: Three patients who underwent computed tomographic angiography scanning for reasons not related to this study were examined by neuronavigated image-guided TCD. The Doppler probe was fitted with reflective markers and tracked by a commercially available Kolibri image guidance system. RESULTS: Image-guided TCD allowed identification of all major intracranial vessels. Unilateral acquisition of reliable Doppler signals for the internal carotid artery, carotid T, middle cerebral artery, middle cerebral artery bifurcation, and anterior cerebral artery required 14 +/- 6 minutes. Preregistration of these targets and detection by neuronavigation alone shortened examination times significantly to 8 +/- 2 minutes. Registering the optimal examination trajectories on the neuronavigational device and applying navigational pilot software shortened times for repetitive examination further to 4 +/- 1 minutes and ensured that the examination was done at the exact same spot under the same angle as in previous examinations. CONCLUSION: Image guidance can be applied easily and efficiently to TCD. It provides anatomic orientation and may help to standardize investigation protocols, define pathological vascular territories for repeat investigations, and thus reduce inter-investigator variations. Image guidance may also extend the use of TCD to situations of a pathological or variant vascular anatomy
Involuntary ambulatory triage during the COVID-19 pandemic – A neurosurgical perspective
No full textBACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to health-care systems around the world. As approximately one-third of the world´s population is living under “lockdown” conditions, medical resources are being reallocated and hospital admissions are limited to emergencies. We examined the decision-making impact of these actions and their effects on access to hospital treatment in patients with neurosurgical conditions. METHODS: This retrospective cohort study analyzes hospital admissions of two major neurosurgical services in Germany during the nationwide lockdown period (March 16th to April 16th, 2020). Spinal or cranial conditions requiring immediate hospital admission and treatment constituted emergencies. RESULTS: A total of 243 in-patients were treated between March 16th and April 16th 2020 (122 patients at the University Medical Center Mainz, 121 patients at the University Medical Center Göttingen). Of these, 38.0±16% qualified as emergency admission. Another 1,688 admissions were reviewed during the same periods in 2018 and 2019, providing a frame of reference. Overall, emergency admissions declined by 44.7±0.7% during lockdown. Admissions for cranial emergencies fell by 48.1±4.44%, spinal emergencies by 30.9±14.6%. CONCLUSION: Above findings indicate that in addition to postponing elective procedures, emergency admissions were dramatically curtailed during the COVID-19 lockdown. As this surely is unexpected and unintended, reasons are undoubtedly complex. As consequences in morbidity and mortality are still unpredictable, efforts should be made to accommodate all patients in need of hospital access going forward
Occlusion of surgical opening of the ventricular system with fibrinogen-coated collagen fleece: a case collection study
No full textImplantation of 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) wafer for malignant glioma is not recommended in the case of surgical opening of the ventricular system during microsurgical tumor resection because the wafer material may dislocate from the resection cavity into the ventricular system and cause obstructive hydrocephalus. TachoSil is an adhesive collagen fleece used in different surgical disciplines that provides an air- and liquid-tight seal closing communications between the ventricular system and the resection cavity after tumor removal. Occlusion of ventricular defects with TachoSil after microsurgical glioma resection was performed in two patients with newly diagnosed and seven patients with recurrent malignant glioma prior to BCNU wafer implantation into the resection cavity. Early postoperative cranial computed tomography (CCT)/MRI and follow-up MRI at 3 months' intervals were performed with a median follow-up of 10.4 months. The collagen fleece was identified as a linear structure hypodense/hypointense to white matter on postoperative CT/MRI separating the resection cavity from the ventricular lumen in all cases. In no case did early CCT/MRI or follow-up MRI reveal wafer material within the ventricular system. In no case did signs of obstructive hydrocephalus occur. Sealing of the ventricular system using a fibrinogen-coated collagen fleece effectively separates the resection cavity from the ventricular system and allows implantation of BCNU wafers into the resection cavity. No morphological evidence for wafer material dislocation into the ventricular system or obstruction of CSF pathways was found in nine patients who received 41 follow-up MRI over 10.4 months of follow-up
Tissue Plasminogen Activator Induced Delayed Edema in Experimental Porcine Intracranial Hemorrhage: Reduction with Plasminogen Activator Inhibitor-1 Administration
No full textHematoma puncture and subsequent clot lysis with recombinant tissue plasminogen activator (rtPA) emerged as an alternative therapy for spontaneous intracerebral hemorrhage (ICH) and is associated with delayed edema possibly counteracting the beneficial effects of hematoma volume reduction. We hypothesized that immediate reversal of rtPA activity after clot lysis and hematoma drainage diminishes edema formation. To test this hypothesis, we administered plasminogen activator inhibitor (PAI)-1 after rtPA lysis of experimentally induced ICH. A right frontal ICH was placed through a twist drill burr hole and autologous blood injection. Following creation of the frontal ICH, pigs received no further treatment (n=5), lysis with rtPA (n=7), or lysis with rtPA followed by administration of PAI-1 (n=6). Hematoma and edema volumes were assessed with magnetic resonance imaging on days 0, 4, and 10. The rtPA significantly reduced hematoma volume and contributed to edema on day 10 after experimentally induced ICH. Administration of PAI-1 attenuated the rtPA-induced edema volume on day 10, but the hematoma volume reduction was less pronounced. In conclusion, PAI-1 attenuated delayed cerebral edema after rtPA lysis of experimental ICH but also reduced the lytic activity of rtPA. The combination of rtPA clot lysis with PAI-1 might have the potential to further improve the effect of the lytic therapy of ICH, but additional studies to define the optimum time point for PAI-1 administration are required
Treatment outcome of IDH1/2 wildtype CNS WHO grade 4 glioma histologically diagnosed as WHO grade II or III astrocytomas
No full textAbstract
Background
Isocitrate dehydrogenase
(
IDH)1/2 wildtype (wt) astrocytomas formerly classified as WHO grade II or III have significantly shorter PFS and OS than IDH mutated WHO grade 2 and 3 gliomas leading to a classification as CNS WHO grade 4. It is the aim of this study to evaluate differences in the treatment-related clinical course of these tumors as they are largely unknown.
Methods
Patients undergoing surgery (between 2016–2019 in six neurosurgical departments) for a histologically diagnosed WHO grade 2–3 IDH1/2-wt astrocytoma were retrospectively reviewed to assess progression free survival (PFS), overall survival (OS), and prognostic factors.
Results
This multi-center study included 157 patients (mean age 58 years (20–87 years); with 36.9% females). The predominant histology was anaplastic astrocytoma WHO grade 3 (78.3%), followed by diffuse astrocytoma WHO grade 2 (21.7%). Gross total resection (GTR) was achieved in 37.6%, subtotal resection (STR) in 28.7%, and biopsy was performed in 33.8%. The median PFS (12.5 months) and OS (27.0 months) did not differ between WHO grades. Both, GTR and STR significantly increased PFS (P < 0.01) and OS (P < 0.001) compared to biopsy. Treatment according to Stupp protocol was not associated with longer OS or PFS compared to chemotherapy or radiotherapy alone. EGFR amplification (P = 0.014) and TERT-promotor mutation (P = 0.042) were associated with shortened OS. MGMT-promoter methylation had no influence on treatment response.
Conclusions
WHO grade 2 and 3 IDH1/2 wt astrocytomas, treated according to the same treatment protocols, have a similar OS. Age, extent of resection, and strong EGFR expression were the most important treatment related prognostic factors
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