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El Rahal A, Beck J, Ahlborn P, Bernasconi C, Marbacher S, Wanderer S, Burkhardt JK, Daniel RT, Ferrari A, Hausmann O, Kamenova M, Kothbauer K, Lutz K, Mariani L, Alfieri A, Schöni D, Schucht P, Raabe A, Regli L, Kuhlen D, Seule M, Soleman J, Starnoni D, Zaldivar J, Zweifel C, Schaller K, Fung C. Incidence, therapy, and outcome in the management of chronic subdural hematoma in Switzerland: a population-based multicenter cohort study. Front Neurol 2023; 14:1206996. [PMID: 37780710 PMCID: PMC10540067 DOI: 10.3389/fneur.2023.1206996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/19/2023] [Indexed: 10/03/2023] Open
Abstract
Background Chronic subdural hematoma (cSDH) is a disease affecting mainly elderly individuals. The reported incidence ranges from 2.0/100,000 to 58 per 100,000 person-years when only considering patients who are over 70 years old, with an overall incidence of 8.2-14.0 per 100,000 persons. Due to an estimated doubling of the population above 65 years old between 2000 and 2030, cSDH will become an even more significant concern. To gain an overview of cSDH hospital admission rates, treatment, and outcome, we performed this multicenter national cohort study of patients requiring surgical treatment of cSDH. Methods A multicenter cohort study included patients treated in 2013 in a Swiss center accredited for residency. Demographics, medical history, symptoms, and medication were recorded. Imaging at admission was evaluated, and therapy was divided into burr hole craniostomy (BHC), twist drill craniostomy (TDC), and craniotomy. Patients' outcomes were dichotomized into good (mRS, 0-3) and poor (mRS, 4-6) outcomes. A two-sided t-test for unpaired variables was performed, while a chi-square test was performed for categorical variables, and a p-value of <0.05 was considered to be statistically significant. Results A total of 663 patients were included. The median age was 76 years, and the overall incidence rate was 8.2/100,000. With age, the incidence rate increased to 64.2/100,000 in patients aged 80-89 years. The most prevalent symptoms were gait disturbance in 362 (58.6%) of patients, headache in 286 (46.4%), and focal neurological deficits in 252 (40.7%). CSDH distribution was unilateral in 478 (72.1%) patients, while 185 presented a bilateral hematoma with no difference in the outcome. BHC was the most performed procedure for 758 (97.3%) evacuations. CSDH recurrence was noted in 104 patients (20.1%). A good outcome was seen in almost 81% of patients. Factors associated with poor outcomes were age, GCS and mRS on admission, and the occurrence of multiple deficits present at the diagnosis of the cSDH. Conclusion As the first multicenter national cohort-based study analyzing the disease burden of cSDH, our study reveals that the hospital admission rate of cSDH was 8.2/100,000, while with age, it rose to 64.2/100,000. A good outcome was seen in 81% of patients, who maintained the same quality of life as before the surgery. However, the mortality rate was 4%.
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Affiliation(s)
- Amir El Rahal
- Department of Neurosurgery, University Hospital of Geneva, Faculty of Medicine, Geneva, Switzerland
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Ahlborn
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Corrado Bernasconi
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery, University Hospital Center of Lausanne, Lausanne, Switzerland
| | - Andrea Ferrari
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Oliver Hausmann
- Department of Neurosurgery, Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - Maria Kamenova
- Department of Neurosurgery, University Hospital Basel, Faculty of Medicine, Basel, Switzerland
| | - Karl Kothbauer
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Katharina Lutz
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital Basel, Faculty of Medicine, Basel, Switzerland
| | - Alex Alfieri
- Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Philippe Schucht
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Kuhlen
- Department of Neurosurgery, Regional Hospital Lugano (EOC), Lugano, Switzerland
| | - Martin Seule
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital Basel, Faculty of Medicine, Basel, Switzerland
| | - Daniele Starnoni
- Department of Neurosurgery, University Hospital Center of Lausanne, Lausanne, Switzerland
| | - Julien Zaldivar
- Department of Neurosurgery, University Hospital Center of Lausanne, Lausanne, Switzerland
| | - Christian Zweifel
- Department of Neurosurgery, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, University Hospital of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
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Schöni D, Halatsch ME, Alfieri A. The impact of reduced operating room capacity on the time delay of urgent surgical care for neurosurgical patients during the COVID-19 pandemic. Interdiscip Neurosurg 2022; 29:101544. [PMID: 35317492 PMCID: PMC8926944 DOI: 10.1016/j.inat.2022.101544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 01/09/2023] Open
Abstract
Background The COVID-19 pandemic raised major challenges to the management of patient flows and medical staff resource allocation. To prevent the collapse of medical facilities, elective diagnostic and surgical procedures were drastically reduced, canceled or rescheduled. Methods We recorded all in-hospital treated patients and outpatient clinics visits of our neurosurgical department from March 2017 to February 2021. Changes of OR capacity, in-hospital neurosurgical treatments and outpatient clinics visits during the pandemic episode was compared on a monthly bases to the previous years. Results A total of 3'214 data points from in-house treated patients and 11'400 outpatient clinics visits were collected. The ratio of elective (73.5% ± 1.5) to emergency surgeries (26.5% ± 1.5) remained unchanged from 2017 to 2021. Significantly less neurosurgical interventions were performed in April 2020 (-42%), significantly more in July 2020 (+36%). Number of outpatient clinics visits remained in the expected monthly range (mean n = 211 ± 67). Total OR capacity was reduced to 30% in April 2020 and 55% in January 2021. No significant delay of urgent surgical treatments was detected during restricted (<85%) OR capacity. On average, the delay of rescheduled consultations was 58 days (range 3 - 183 days), three (6.5%) were referred as emergencies. Conclusions Dynamic monitoring and adjustment of resources is essential to maintain surgical care. The sharp restrictions of surgical activities resulted in significant fluctuations and 5% decrease of treated neurosurgical patients during the COVID-19 pandemic. However, urgent neurosurgical care was assured without significant time delay during periods of reduced OR capacity.
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Affiliation(s)
- Daniel Schöni
- Neurosurgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland,Corresponding author at: Department of Neurosurgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, Postfach, Winterthur 8401, Zurich, Switzerland
| | | | - Alex Alfieri
- Neurosurgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland,Neurocenter of Southern Switzerland EOC, Faculty of Biomedical Sciences, USI, Lugano, Switzerland
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3
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Strulak L, Gronki F, Shariat K, Schöni D, Alfieri A. Eponyms of Cranial Neurosurgical Instruments: An International Collaboration to Optimize the Field of Neurosurgery. World Neurosurg 2021; 153:26-35. [PMID: 34174453 DOI: 10.1016/j.wneu.2021.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
The basic set of a cranial instrument tray is filled with eponyms of surgical instruments named after surgeons and physicians from all corners of the medical world. These include pioneers like Castroviejo, Doyen, Frazier, Gigli, Mayfield, Raney, Weitlaner, and Yaşargil. These innovators have always strived to enhance and simplify procedures, ultimately shaping the way we perform surgery today. It was a process, which took several generations of surgeons and trials of instruments before its current form could be established. In this paper, the authors provide background information through a historical perspective on the pioneering surgeons and physicians, after whom the instruments were named. Data were collected by searching PubMed, Google Scholar/Books, Google, and the HathiTrust Digital Library. Additional information was obtained via personal contact with American and European medical institutions, libraries, museums, as well as with the surgeons' family members and their perspective foundations. Remembering the life stories of the inventors behind commonly used eponyms in the operating theater reminds us of the long history of even the most rudimentary neurosurgical tool. This unrelenting strive for perfection reminds us, as surgeons, of our duty to continuously assess and improve our surgical tools and processes for the benefit of our patients.
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Affiliation(s)
- Lukasz Strulak
- Neurosurgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.
| | - Ferda Gronki
- Orthopedic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Kaveh Shariat
- Neurosurgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Daniel Schöni
- Neurosurgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Alex Alfieri
- Neurosurgery, Cantonal Hospital Winterthur, Winterthur, Switzerland; Neurosurgery, Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane, and the University of Potsdam, Potsdam, Germany
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4
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Schatlo B, Fung C, Stienen MN, Fathi AR, Fandino J, Smoll NR, Zumofen D, Daniel RT, Burkhardt JK, Bervini D, Marbacher S, Reinert M, D Alonzo D, Ahlborn P, Mendes Pereira V, Roethlisberger M, Seule M, Kerkeni H, Remonda L, Weyerbrock A, Woernle K, Venier A, Perren F, Sailer M, Robert T, Rohde V, Schöni D, Goldberg J, Nevzati E, Diepers M, Gralla J, Z'Graggen W, Starnoni D, Woernle C, Maldaner N, Kulcsar Z, Mostaguir K, Maduri R, Eisenring C, Bernays R, Ferrari A, Dan-Ura H, Finkenstädt S, Gasche Y, Sarrafzadeh A, Jakob SM, Corniola M, Baumann F, Regli L, Levivier M, Hildebrandt G, Landolt H, Mariani L, Guzman R, Beck J, Raabe A, Keller E, Bijlenga P, Schaller K. Incidence and Outcome of Aneurysmal Subarachnoid Hemorrhage: The Swiss Study on Subarachnoid Hemorrhage (Swiss SOS). Stroke 2020; 52:344-347. [PMID: 33272133 DOI: 10.1161/strokeaha.120.029538] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to assess nationwide incidence and outcomes of aneurysmal subarachnoid hemorrhage (aSAH). The Swiss SOS (Swiss Study on Subarachnoid Hemorrhage) was established in 2008 and offers the unique opportunity to provide this data from the point of care on a nationwide level. METHODS All patients with confirmed aneurysmal subarachnoid hemorrhage admitted between January 1, 2009 and December 31, 2014, within Switzerland were recorded in a prospective registry. Incidence rates were calculated based on time-matched population data. Admission parameters and outcomes at discharge and at 1 year were recorded. RESULTS We recorded data of 1787 consecutive patients. The incidence of aneurysmal subarachnoid hemorrhage in Switzerland was 3.7 per 100 000 persons/y. The number of female patients was 1170 (65.5%). With a follow-up rate of 91.3% at 1 year, 1042 patients (58.8%) led an independent life according to the modified Rankin Scale (0-2). About 1 in 10 patients survived in a dependent state (modified Rankin Scale, 3-5; n=185; 10.4%). Case fatality was 20.1% (n=356) at discharge and 22.1% (n=391) after 1 year. CONCLUSIONS The current incidence of aneurysmal subarachnoid hemorrhage in Switzerland is lower than expected and an indication of a global trend toward decreasing admissions for ruptured intracranial aneurysms. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03245866.
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Affiliation(s)
- Bawarjan Schatlo
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland.,Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland.,Neurosurgery, University Hospital Göttingen Germany (B.S., V.R.)
| | - Christian Fung
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland.,Department of Neurosurgery, Faculty of Medicine, Medical Center, University of Freiburg, Germany (J.B., C.F.)
| | - Martin N Stienen
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Ali R Fathi
- Neurosurgery, Hirslanden Klinik Aarau Switzerland (A.R.F.)
| | - Javier Fandino
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Nicolas R Smoll
- School of Population and Global, University of Melbourne Australia (N.R.S.)
| | - Daniel Zumofen
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Roy Thomas Daniel
- Neurosurgery, University Hospital Lausanne Switzerland (R.T.D., D. Starnoni, R.M., M.L.)
| | - Jan-Karl Burkhardt
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - David Bervini
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - Serge Marbacher
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Michael Reinert
- Neurosurgery, Ospedale Civico Lugano Switzerland (M. Reinert, A.V., T.R.)
| | - Donato D Alonzo
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Peter Ahlborn
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | | | - Michel Roethlisberger
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Martin Seule
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | | | - Luca Remonda
- Neuroradiology (L.R., M.D.), Kantonsspital Aarau Switzerland
| | - Astrid Weyerbrock
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | - Kerstin Woernle
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Alice Venier
- Neurosurgery, Ospedale Civico Lugano Switzerland (M. Reinert, A.V., T.R.)
| | | | - Martin Sailer
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Thomas Robert
- Neurosurgery, Ospedale Civico Lugano Switzerland (M. Reinert, A.V., T.R.)
| | - Veit Rohde
- Neurosurgery, University Hospital Göttingen Germany (B.S., V.R.)
| | - Daniel Schöni
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - Johannes Goldberg
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - Edin Nevzati
- Neurosurgery, Kantonsspital Luzern Switzerland (E.N., F.B.)
| | - Michael Diepers
- Neuroradiology (L.R., M.D.), Kantonsspital Aarau Switzerland
| | - Jan Gralla
- Neuroradiology (J. Gralla, W.Z.), University Hospital Bern Switzerland
| | - Werner Z'Graggen
- Neuroradiology (J. Gralla, W.Z.), University Hospital Bern Switzerland
| | - Daniele Starnoni
- Neurosurgery, University Hospital Lausanne Switzerland (R.T.D., D. Starnoni, R.M., M.L.)
| | - Christoph Woernle
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Nicolai Maldaner
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital Zürich, Switzerland (Z.K.)
| | - Khaled Mostaguir
- Clinical Research Centre, (K.M.), University Hospital Geneva, Switzerland
| | - Rodolfo Maduri
- Neurosurgery, University Hospital Lausanne Switzerland (R.T.D., D. Starnoni, R.M., M.L.)
| | - Christian Eisenring
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - René Bernays
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Andrea Ferrari
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | - Hiroki Dan-Ura
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Sina Finkenstädt
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Yvan Gasche
- Intensive Care Medicine (Y.G.), University Hospital Geneva, Switzerland
| | - Asita Sarrafzadeh
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland
| | - Stephan M Jakob
- Intensive Care Medicine (S.M.J.), University Hospital Bern Switzerland
| | - Marco Corniola
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland
| | - Fabian Baumann
- Neurosurgery, Kantonsspital Luzern Switzerland (E.N., F.B.)
| | - Luca Regli
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Marc Levivier
- Neurosurgery, University Hospital Lausanne Switzerland (R.T.D., D. Starnoni, R.M., M.L.)
| | - Gerhard Hildebrandt
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | - Hans Landolt
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Luigi Mariani
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Raphael Guzman
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Jürgen Beck
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland.,Department of Neurosurgery, Faculty of Medicine, Medical Center, University of Freiburg, Germany (J.B., C.F.)
| | - Andreas Raabe
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - Emanuela Keller
- Intensive Care Medicine (E.K.), University Hospital Zürich Switzerland
| | - Philippe Bijlenga
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland
| | - Karl Schaller
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland
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Kerscher SR, Schöni D, Neunhoeffer F, Wolff M, Haas-Lude K, Bevot A, Schuhmann MU. The relation of optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in pediatric neurosurgery practice - Part II: Influence of wakefulness, method of ICP measurement, intra-individual ONSD-ICP correlation and changes after therapy. Childs Nerv Syst 2020; 36:107-115. [PMID: 31392457 DOI: 10.1007/s00381-019-04336-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/30/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Previous studies correlating ultrasound (US)-based optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in children were performed under general anesthesia. To apply ONSD in daily clinical routine, it is necessary to investigate patients awake. It is furthermore essential for ICP-assessment with ONSD to know if ONSD-ICP correlation varies within individuals. In this study, we report on the influence of wakefulness, method of ICP measurement, intraindividual correlations, and dynamic changes of ONSD and ICP after ICP decreasing therapy. METHODS The overall study included 72 children with a median age of 5.2 years. US ONSD determination was performed immediately prior to invasive ICP measurement, and the mean binocular ONSD was compared to ICP. In 10 children, a minimum of 3 ONSD/ICP measurements were performed to investigate a correlation within subjects. In 30 children, measurements were performed before and after therapy. RESULTS Twenty-eight children were investigated awake with an excellent correlation of ONSD and ICP (r = 0.802, p < 0.01). In 10 children, at least three simultaneous ONSD and ICP measurements were performed. The intraindividual correlations were excellent (r = 0.795-1.0) however with strongly differing individual regression curves. The overall correlation within subjects was strong (r = 0.78, p < 0.01). After ICP decreasing therapy, all ONSD values decreased significantly (p < 0.01); however, there was no correlation between ∆ICP and ∆ONSD. CONCLUSION Awake investigation does not impair the correlation between ONSD and ICP. Even if there is a good overall ONSD-ICP correlation, every individual has its own distinctive and precise correlation line. The relationship between ONSD and ICP is furthermore not uniform between individuals. Strong ICP decreases can lead to smaller ONSD changes and vice versa. This should be kept in mind when using this technique in the clinical daily routine.
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Affiliation(s)
- Susanne R Kerscher
- Department of Neurosurgery, Pediatric Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany.
- Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany.
| | - Daniel Schöni
- Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
- Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland
| | - Felix Neunhoeffer
- Pediatric Intensive Care Unit, Childrens' Hospital, University Hospital of Tuebingen, Tuebingen, Germany
| | - Markus Wolff
- Department of Pediatric Neurology and Developmental Medicine, Childrens' Hospital, University Hospital of Tuebingen, Tuebingen, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, Childrens' Hospital, University Hospital of Tuebingen, Tuebingen, Germany
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, Childrens' Hospital, University Hospital of Tuebingen, Tuebingen, Germany
| | - Martin U Schuhmann
- Department of Neurosurgery, Pediatric Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany
- Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
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6
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Kerscher SR, Schöni D, Hurth H, Neunhoeffer F, Haas-Lude K, Wolff M, Schuhmann MU. The relation of optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in pediatric neurosurgery practice - Part I: Correlations, age-dependency and cut-off values. Childs Nerv Syst 2020; 36:99-106. [PMID: 31256241 DOI: 10.1007/s00381-019-04266-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/17/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE It is assumed that the width of the optic nerve sheath diameter (ONSD) is dependent on intracranial pressure (ICP) and pulsatility and thus constitutes a non-invasively accessible "window" for qualitative assessment of ICP. Data on the correlation to invasively measured ICP in children are scarce and have often been obtained from sedated patients in intensive care unit (ICU) or intraoperatively. We report on a mixed cohort of pediatric neurosurgical patients, ICP and ONSD measurements were available from both sedated and awake children, only a minority from ICU patients. METHODS Seventy-two children were investigated. Ultrasound ONSD determination was performed immediately prior to invasive ICP measurement and the mean binocular ONSD was compared with ICP. The investigations were performed in children awake, sedated, or under general anesthesia. RESULTS In the entire patient cohort, the correlation between ONSD and ICP was good (r = 0.52, p < 0.01). Children > 1 year revealed a better correlation (r = 0.63; p < 0.01) and those ≤ 1 year did worse (r = 0.21). Infants with open fontanelle had no correlation. In the entire cohort, the best ONSD cut-off value for detecting ICP ≥ 15 and ≥ 20 mmHg was 5.28 and 5.57 mm (OR 22.5 and 7.2, AUC 0.782 and 0.733). CONCLUSION Transorbital ultrasound measurement of ONSD is a reliable non-invasive technique to assess increased ICP in children in every clinical situation; however, the impact of age and fontanelle status needs to be considered. ONSD thresholds enable qualitative first orientation regarding ICP categories with a very satisfying diagnostic accuracy.
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Affiliation(s)
- Susanne R Kerscher
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany.
- Department of Neurosurgery, University Hospital of Tuebingen, 72076, Tuebingen, Germany.
| | - Daniel Schöni
- Department of Neurosurgery, University Hospital of Tuebingen, 72076, Tuebingen, Germany
- Department of Neurosurgery, University Hospital of Bern, 3010, Bern, Switzerland
| | - Helene Hurth
- Department of Neurosurgery, University Hospital of Tuebingen, 72076, Tuebingen, Germany
| | - Felix Neunhoeffer
- Pediatric Intensive Care Unit, Children's Hospital, University of Tuebingen, 72076, Tuebingen, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, Children's Hospital, University of Tuebingen, 72076, Tuebingen, Germany
| | - Markus Wolff
- Department of Pediatric Neurology and Developmental Medicine, Children's Hospital, University of Tuebingen, 72076, Tuebingen, Germany
| | - Martin U Schuhmann
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
- Department of Neurosurgery, University Hospital of Tuebingen, 72076, Tuebingen, Germany
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Fischer C, Goldberg J, Vulcu S, Wagner F, Schöni D, Söll N, Hänggi M, Schefold J, Fung C, Beck J, Raabe A, Z'Graggen WJ. Nimodipine-Induced Blood Pressure Changes Can Predict Delayed Cerebral Ischemia. Front Neurol 2019; 10:1161. [PMID: 31736865 PMCID: PMC6834786 DOI: 10.3389/fneur.2019.01161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Early diagnosis of delayed cerebral ischemia (DCI) in patients after aneurysmal subarachnoid hemorrhage (aSAH) still poses a leading problem in neurointensive care. The aim of this study was to analyze the effect of oral Nimodipine administration on systemic blood pressure in patients with evolving DCI compared to patients without DCI. Methods: Systolic (SBP), mean (MAP), and diastolic (DBP) blood pressures were analyzed at the time of Nimodipine administration and additionally 30, 60, and 120 min thereafter on days 1, 3, and 5 after aSAH. Additionally, the 24 h period preceding DCI and in patients without DCI day 10 after aSAH were analyzed. Statistical analysis was performed for SBP, MAP and DBP at time of Nimodipine administration and for the maximal drop in blood pressure after Nimodipine administration. Results: Thirty patients with aSAH were retrospectively analyzed with 17 patients developing DCI (“DCI”) and 13 patients who did not (“Non-DCI”). DCI patients showed a more pronounced rise in MAP and DBP over the examined time period as well as a higher decrease in SBP following Nimodipine administration. A fall of 18 mmHg in SBP after Nimodipine administration showed a sensitivity of 82.4% and specificity of 92.3% for occurrence of DCI. Conclusion: An increase of MAP and DBP after aSAH and a heightened sensitivity to Nimodipine administrations may serve as additional biomarkers for early detection of evolving DCI.
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Affiliation(s)
- Corinne Fischer
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sonja Vulcu
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Söll
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Hänggi
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jörg Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner J Z'Graggen
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Schucht P, Fischer U, Fung C, Bernasconi C, Fichtner J, Vulcu S, Schöni D, Nowacki A, Wanderer S, Eisenring C, Krähenbühl AK, Mattle HP, Arnold M, Söll N, Tochtermann L, Z'Graggen W, Jünger ST, Gralla J, Mordasini P, Dahlweid FM, Raabe A, Beck J. Follow-up Computed Tomography after Evacuation of Chronic Subdural Hematoma. N Engl J Med 2019; 380:1186-1187. [PMID: 30893542 DOI: 10.1056/nejmc1812507] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jan Gralla
- University Hospital Bern, Bern, Switzerland
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9
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Vulcu S, Wagner F, Santos AF, Reitmeir R, Söll N, Schöni D, Fung C, Wiest R, Raabe A, Beck J, Z’Graggen WJ. Repetitive Computed Tomography Perfusion for Detection of Cerebral Vasospasm–Related Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 121:e739-e746. [DOI: 10.1016/j.wneu.2018.09.208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 11/27/2022]
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10
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Stienen MN, Smoll NR, Fung C, Goldberg J, Bervini D, Maduri R, Chiappini A, Robert T, May A, Bijlenga P, Zumofen D, Roethlisberger M, Seule MA, Marbacher S, Fandino J, Schatlo B, Schaller K, Keller E, Bozinov O, Regli L, Burkhardt JK, Neidert MC, Maldaner N, Finkenstädt S, Schöni D, Raabe A, Beck J, Mariani L, Guzman R, D’Alonzo D, Daniel RT, Reinert M, Ferrari A, Hildebrandt G, Weyerbrock A, Corniola M. Home-Time as a Surrogate Marker for Functional Outcome After Aneurysmal Subarachnoid Hemorrhage. Stroke 2018; 49:3081-3084. [DOI: 10.1161/strokeaha.118.022808] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin Nikolaus Stienen
- From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)
| | - Nicolas Roydon Smoll
- School of Population and Global Health, University of Melbourne, Australia (N.R.S.)
| | - Christian Fung
- Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., J.G., D.B.)
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., J.G., D.B.)
| | - David Bervini
- Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., J.G., D.B.)
| | - Rodolfo Maduri
- Department of Neurosurgery, University Hospital Lausanne, Switzerland (R.M.)
| | - Alessio Chiappini
- Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland (A.C., T.R.)
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland (A.C., T.R.)
| | - Adrien May
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland (A.M., P.B., K.S.)
| | - Philippe Bijlenga
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland (A.M., P.B., K.S.)
| | - Daniel Zumofen
- Department of Neurosurgery, University Hospital Basel, University of Basel, Switzerland (D.Z., M.R.)
- Section of Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, University of Basel, Switzerland (D.Z.)
| | - Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel, University of Basel, Switzerland (D.Z., M.R.)
| | | | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Switzerland (S.M., J.F.)
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Switzerland (S.M., J.F.)
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Germany (B.S.)
| | - Karl Schaller
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland (A.M., P.B., K.S.)
| | - Emanuela Keller
- From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)
| | - Oliver Bozinov
- From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)
| | - Luca Regli
- From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)
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Schucht P, Fischer U, Fung C, Bernasconi C, Fichtner J, Vulcu S, Schöni D, Nowacki A, Wanderer S, Eisenring C, Jetzer AK, Soell N, Tochtermann L, Z'Graggen W, Raabe A, Beck J. 179 To Scan or Not to Scan: The Role of Follow-up CT Scanning for Management of Chronic Subdural Hematoma After Neurosurgical Evacuation (TOSCAN) a Randomized, Controlled Trial. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Roethlisberger M, Achermann R, Bawarjan S, Stienen MN, Fung C, D’Alonzo D, Maldaner N, Ferrari A, Corniola MV, Schöni D, Goldberg J, Valsecchi D, Robert T, Maduri R, Seule MA, Burkhardt JK, Marbacher S, Bijlenga P, Blackham KA, Bucher HC, Mariani L, Guzman R, Zumofen DW. Impact of Aneurysm Multiplicity on Treatment and Outcome After Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2018; 84:E334-E344. [DOI: 10.1093/neuros/nyy331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/21/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Rita Achermann
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Schatlo Bawarjan
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Donato D’Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Andrea Ferrari
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco V Corniola
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Rodolfo Maduri
- Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurological Surgery, NYU School of Medicine, NYU Langone Medical Center, New York, New York
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Kristine A Blackham
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
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Schöni D, Lauber L, Fung C, Goldberg J, Müri R, Raabe A, Nyffeler T, Beck J. Marriage and Partnership Integrity After Aneurysmal Subarachnoid Hemorrhage: Small Alterations in Neurologic Status Matter Most. World Neurosurg 2018; 113:e161-e165. [DOI: 10.1016/j.wneu.2018.01.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
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Roethlisberger M, Achermann R, Bawarjan S, Stienen MN, Fung C, D'Alonzo D, Maldaner N, Ferrari A, Corniola MV, Schöni D, Valsecchi D, Maduri R, Seule MA, Burkhardt JK, Marbacher S, Bijlenga P, Blackham KA, Bucher HC, Mariani L, Guzman R, Zumofen DW, Fandino J, Colluccia D, Arrighi M, Venier A, Kuhlen DE, Robert T, Reinert M, Weyerbrock A, Hlavica M, Fournier JY, Raabe A, Beck J, Bervini D, Schaller K, Daniel RT, Starnoni D, Messerer M, Levivier M, Keller E, Regli L, Bozinov O, Finkenstaedt S, Remonda L, Stippich C, Gralla J, Kulcsar Z, Mendes-Pereira V, Ahlborn P, Smoll NR, Rohde V, Tok S, Baumann F, Kothbauer K, Kerkeni H, Dan-Ura H, Landolt H, Mostaguir K, Gasche Y, Sarrafzadeh A, Hildebrandt G, Winkler K, Woernle C, Bernays R. Predictors of Occurrence and Anatomic Distribution of Multiple Aneurysms in Patients with Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2018; 111:e199-e205. [DOI: 10.1016/j.wneu.2017.12.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/29/2022]
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15
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Neidert MC, Maldaner N, Stienen MN, Roethlisberger M, Zumofen DW, D’Alonzo D, Marbacher S, Maduri R, Hostettler IC, Schatlo B, Schneider MM, Seule MA, Schöni D, Goldberg J, Fung C, Arrighi M, Valsecchi D, Bijlenga P, Schaller K, Bozinov O, Regli L, Burkhardt JK, Fandino J, Marbacher S, D'Alonzo D, Coluccia D, Schmid N, Zumofen D, Roethlisberger M, Mariani L, Guzman R, Monsch AU, Bläsi S, Fung C, Bervini D, Beck J, Raabe A, Goldberg J, Schöni D, Gralla J, Zweifel-Zehnder A, Gutbrod K, Müri R, Maduri R, Thomas Daniel R, Starnoni D, Messerer M, Levivier M, Beaud V, Valsecchi D, Arrighi M, Venier A, Reinert M, Kuhlen DE, Robert T, Rossi S, Sacco L, Bijlenga P, Corniola M, Schaller K, Chicherio C, Seule MA, Ferrari A, Weyerbrock A, Hlavica M, Fournier JY, Früh S, Schatlo B, Burkhardt JK, Stienen MN, Keller E, Regli L, Bozinov O, Maldaner N, Finkenstädt S, Neidert MC, Brugger P, Mondadori C. The Barrow Neurological Institute Grading Scale as a Predictor for Delayed Cerebral Ischemia and Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From a Nationwide Patient Registry (Swiss SOS). Neurosurgery 2018; 83:1286-1293. [DOI: 10.1093/neuros/nyx609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marian Christoph Neidert
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Donato D’Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Rodolfo Maduri
- Department Clinical Neurosciences, Service Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Michel M Schneider
- Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | | | - Christian Fung
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Marta Arrighi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Burkhardt JK, Neidert MC, Stienen MN, Schöni D, Fung C, Roethlisberger M, Corniola MV, Bervini D, Maduri R, Valsecchi D, Tok S, Schatlo B, Bijlenga P, Schaller K, Bozinov O, Regli L. Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage. Acta Neurochir (Wien) 2017; 159:1305-1312. [PMID: 28127657 DOI: 10.1007/s00701-016-3072-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To analyze whether the computed tomography angiography (CTA) spot sign predicts the intraprocedural rupture rate and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS From a prospective nationwide multicenter registry database, 1023 patients with aneurysmal subarachnoid hemorrhage (aSAH) were analyzed retrospectively. Descriptive statistics and logistic regression analysis were used to compare spot sign-positive and -negative patients with aneurysmal intracerebral hemorrhage (aICH) for baseline characteristics, aneurysmal and ICH imaging characteristics, treatment and admission status as well as outcome at discharge and 1-year follow-up (1YFU) using the modified Rankin Scale (mRS). RESULTS A total of 218 out of 1023 aSAH patients (21%) presented with aICH including 23/218 (11%) patients with spot sign. Baseline characteristics were comparable between spot sign-positive and -negative patients. There was a higher clip-to-coil ratio in patients with than without aICH (both spot sign positive and negative). Median aICH volume was significantly higher in the spot sign-positive group (50 ml, 13-223 ml) than in the spot sign-negative group (18 ml, 1-416; p < 0.0001). Patients with a spot sign-positive aICH thus were three times as likely as those with spot sign-negative aICH to show an intraoperative aneurysm rupture [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.04-8.92, p = 0.046]. Spot sign-positive aICH patients showed a significantly worse mRS at discharge (p = 0.039) than patients with spot sign-negative aICH (median mRS 5 vs. 4). Logistic regression analysis showed that the spot sign was an aICH volume-dependent predictor for outcome. Both spot sign-positive and -negative aICH patients showed comparable rates of hospital death, death at 1YFU and mRS at 1YFU. CONCLUSION In this multicenter data analysis, patients with spot sign-positive aICH showed higher aICH volumes and a higher rate of intraprocedural aneurysm rupture, but comparable long-term outcome to spot sign-negative aICH patients.
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Affiliation(s)
- Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Marian Christoph Neidert
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | | | | | - David Bervini
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Rodolfo Maduri
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Sina Tok
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Philippe Bijlenga
- Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Burkhardt J, Neidert M, Stienen M, Schöni D, Fung C, Röthlisberger M, Corniola M, Bervini D, Maduri R, Valsecchi D, Tok S, Schatlo B, Schaller K, Bozinov O, Regli L. Computed Tomography Angiography Spot Sign as a Predictor for Outcome for Patients with Intracerebral Hemorrhage and Aneurysmal Subarachnoid Hemorrhage. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Schatlo B, Fung C, Stienen M, Fathi A, Fandino J, Smoll N, Tok S, Daniel R, Zumofen D, Burkhard J, Dan-Ura H, Röthlisberger M, Reinert M, Winkler K, Ahlborn P, Mendes-Pereira V, D́Alonzo D, Seule M, Kerkeni H, Bervini D, Sailer M, Kuhlen D, Remonda L, Rohde V, Mostaguir K, Marbacher S, Valsecchi D, Corniola M, Schöni D, Woernle C, Regli L, Levivier M, Hildebrandt G, Mariani L, Beck J, Guzman R, Raabe A, Bijlenga P, Keller E, Schaller K. Incidence, Therapy, and Outcome of Aneurysmal Subarachnoid Hemorrhage. The Swiss Study on Aneurysmal Subarachnoid Hemorrhage (Swiss SOS). J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stienen M, Corniola MV, Smoll N, Burkhardt JK, Fung C, Schöni D, Röthlisberger M, Bervini D, Valsecchi D, Arrighi M, Maduri R, Danura H, Fathi AR, Keller E, Regli L, Fandino J, Hildebrandt G, Guzman R, Schatlo B, Schaller K, Bijlenga P. Decompressive Hemicraniectomy in Aneurysmal Subarachnoid Hemorrhage—Insights from a Swiss National Database (Swiss SOS). J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bogni S, Schöni D, Constantinescu M, Wirth A, Vajtai I, Bregy A, Raabe A, Pieles U, Frenz M, Reinert M. Tissue fusion, a new opportunity for sutureless bypass surgery. Acta Neurochir Suppl 2011; 112:45-53. [PMID: 21691987 DOI: 10.1007/978-3-7091-0661-7_9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Microsurgical suturing is the standard for cerebral bypass surgery, a technique where temporary occlusion is usually necessary. Non-occlusive techniques such as excimer laser-assisted non-occlusive anastomosis (ELANA) have certainly widened the spectrum of treatment of complex cerebrovascular situations, such as giant cerebral aneurysms, that were otherwise non-treatable. Nevertheless, the reduction of surgical risks while widening the spectrum of indications, such as a prophylactic cerebral bypass, is still a main aim, that we would like to pursue with our sutureless tissue fusion research. The primary concern in sutureless tissue fusion- and especially in tissue fusion of cerebral vessels- is the lack of reproducibility, often caused by variations in the thermal damage of the vessel. This has prevented this novel fusion technique from being applicable in daily surgical use. In this overview, we present three ways to further improve the laser tissue soldering technique.In the first section entitled "Laser Tissue Soldering Using a Biodegradable Polymer," a porous polymer scaffold doped with albumin (BSA) and indocyanine green (ICG) is presented, leading to strong and reproducible tensile strengths in tissue soldering. Histologies and future developments are discussed.In the section "Numerical Simulation for Improvement of Laser Tissue Soldering," a powerful theoretical simulation model is used to calculate temperature distribution during soldering. The goal of this research is to have a tool in hand that allows us to determine laser irradiation parameters that guarantee strong vessel fusion without thermally damaging the inner structures such as the intima and endothelium.In a third section, "Nanoparticles in Laser Tissue Soldering," we demonstrate that nanoparticles can be used to produce a stable and well-defined spatial absorption profile in the scaffold, which is an important step towards increasing the reproducibility. The risks of implanting nanoparticles into a biodegradable scaffold are discussed.Step by step, these developments in sutureless tissue fusion have improved the tensile strength and the reproducibility, and are constantly evolving towards a clinically applicable anastomosis technique.
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Affiliation(s)
- Serge Bogni
- Institute of Applied Physics, University of Bern, Bern, Switzerland
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