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Rýdlo O, Bubeníková A, Häcklová K, Skalický P, Leško R, Ebelová A, Netuka D, IIIrd VB, Beneš V, Bradáč O. Comparison of decline in different cognitive domain in patients with normal pressure hydrocephalus. Neurosurg Rev 2024; 47:167. [PMID: 38632175 PMCID: PMC11024017 DOI: 10.1007/s10143-024-02410-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/20/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
We sought to describe the cognitive profile of patients with Idiopathic Normal Pressure Hydrocephalus (iNPH) using a comprehensive neuropsychological battery. Based on age and education correlated norms, we aimed to compare performance in each measured cognitive domain: executive functions (EFs), verbal memory (VM), non-verbal memory (nVM), visuoconstructional abilities (VA) and attention/psychomotor speed (A/PS). Patients diagnosed with iNPH underwent comprehensive neuropsychological evaluation before shunting. Their performance was compared to the age and education correlated norms. Correlation of different cognitive domains in iNPH profile was performed. A total of 53 iNPH patients (73.21 ± 5.48 years) were included in the study. All of the measured cognitive domains were significantly damaged. The most affected domains were EFs and VM (p<0.001 and p<0.001, respectively). A/PS domain was affected milder than EFs and VM (p<0.001). The least affected domains were nVM (p<0.001) and VA (p<0.001). Patients with iNPH are affected in all cognitive domains and the cognitive decline is uneven across these domains. The impairment of memory was shown to depend on the presented material. VM was shown to be much more severely affected than nVM and along with VM, EFs were shown to be the most affected. A/PS speed was shown to be less affected than VM and EFs and the least affected domains were nVM and VA.
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Affiliation(s)
- Ondřej Rýdlo
- Department of Neuropsychology, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Adéla Bubeníková
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic.
- Department of Neurosurgery and Neurooncology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Klára Häcklová
- Department of Neuropsychology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic
| | - Petr Skalický
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Róbert Leško
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Adéla Ebelová
- Department of Anaesthesiology and Intensive Care, Sligo University Hospital, Sligo, Ireland
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš IIIrd
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Neurosurgery and Neurooncology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic
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Kaiser R, Svoboda N, Waldauf P, Netuka D. The economic and psychological impact of cancellations of elective spinal surgeries in the COVID-19 era. Br J Neurosurg 2024; 38:322-326. [PMID: 33459075 DOI: 10.1080/02688697.2020.1868404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/13/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The adoption of health care restrictions due to the COVID-19 pandemic led to the cancellation of elective surgical care. However, the impact on patients is unknown. OBJECTIVE To evaluate the psychological and economic impact of the cancellation of scheduled spinal operations. METHODS We identified 50 patients with cancelled surgeries between 16 March 2020 and 24 April 2020. Forty-nine (98%) participants were contacted, with whom the modified WES-Pi questionnaire was filled in during a telephone interview. RESULTS Of the 49 respondents, 28 (57.2%) were aged <65 years. The most often reported problem (85.7%) was an ongoing limitation in basic daily activities. At least moderate sadness was experienced by 65.3% and disappointment by 73.5% of the patients. More than 80% reported concerns about the continuation and 73.5% about the progression of their symptoms. Out of 27 employees (55.1%), 63% could not work due to severe pain or movement limitation (p < .001). The inability to work was associated with anger (p = .037). The work-related impact of the cancellation was associated with stress (p < .0001) and concerns about continuing the symptoms (p = .004). Two-third of patients would undergo immediate surgery despite the current epidemic situation. CONCLUSIONS The cancellations of elective spinal surgeries have a serious psychological impact on patients. This together with potential economic consequences is especially evident in employees unable to work due to pain or movement disability. The information is beneficial for health management. Every effort should be made to resume planned surgical treatment if the epidemiological situation allows it.
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Affiliation(s)
- Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Norbert Svoboda
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University and Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
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Konečná D, Výmola P, Ternerová N, Výmolová B, Garcia-Borja E, Mateu R, Šroubek F, Pankrác J, Widen JC, Bogyo M, Netuka D, Bušek P, Šedo A. Molecularly targeted protease-activated probes for visualization of glioblastoma: a comparison with 5-ALA. J Neurosurg 2024:1-12. [PMID: 38552239 PMCID: PMC11010726 DOI: 10.3171/2024.1.jns231137] [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: 05/19/2023] [Accepted: 01/12/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The highly infiltrative growth of glioblastoma (GBM) makes distinction between the tumor and normal brain tissue challenging. Therefore, fluorescence-guided surgery is often used to improve visual identification of radiological tumor margins. The aim of this study was to evaluate the ability of recently developed molecularly targeted near-infrared (NIR) protease-activated probes to visualize GBM tissue and to compare the most promising candidate with the gold standard, 5-aminolevulinic acid (5-ALA). METHODS Single-substrate probes 6QC-ICG and 6QC-Cy5 (cysteine cathepsin cleavable), double-substrate probes AG2-FNIR and AG2-Cy5 (cysteine cathepsin and caspase 3 cleavable), and 5-ALA were administered intravenously to mice with orthotopic tumors. Activation of the probes was also evaluated in cell cultures in vitro and in biopsy material from patients with GBM ex vivo. The tumor to normal brain tissue fluorescence ratio (TNR) was quantified in brain sections using preclinical and clinical visualization platforms, and in tissue homogenates and cell suspensions using spectrofluorimetry. Subcellular localization of the fluorophores was visualized by confocal microscopy. RESULTS In vitro, the single-substrate probe 6QC-ICG was cleaved in glioma cells and macrophages, and the resulting fluorophore accumulated intracellularly. In experimental GBMs, both single- and double-substrate probes visualized tumor tissue, while in healthy brain tissue the signal was minimal. TNR was highest for 6QC-ICG and AG2-FNIR, but the signal intensity was higher for 6QC-ICG. Using xenograft and syngeneic mouse models, as well as human GBM biopsy material ex vivo, the authors confirmed the ability of 6QC-ICG to specifically visualize the glioma tissue using preclinical and clinical visualization platforms. Finally, a comparison with 5-ALA in animals coadministered with both compounds revealed a higher TNR for 6QC-ICG in experimental GBMs. CONCLUSIONS The cysteine cathepsin-cleavable probe 6QC-ICG is activated by glioma cells and tumor-associated macrophages, leading to a high contrast between tumor and nontumorous brain tissue that is superior to that of the current standard, 5-ALA. In addition to a well-defined mechanism of action, protease-activated probes that use NIR fluorophores (e.g., indocyanine green) have the advantage of low absorption and scattering of the NIR light and lower tissue autofluorescence. These results suggest that 6QC-ICG has the potential to become the targeted agent in intraoperative detection of GBM tissue using fluorescence imaging.
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Affiliation(s)
- Dora Konečná
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine and Military University Hospital, Prague
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague
| | - Petr Výmola
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague
| | - Nikola Ternerová
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague
| | - Barbora Výmolová
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague
| | - Elena Garcia-Borja
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague
| | - Rosana Mateu
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague
| | - Filip Šroubek
- Institute of Information Theory and Automation, Czech Academy of Sciences, Prague
| | - Jan Pankrác
- Center of Advanced Preclinical Imaging, First Faculty of Medicine, Charles University, Prague, Czech Republic; and
| | - John C. Widen
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Matthew Bogyo
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine and Military University Hospital, Prague
| | - Petr Bušek
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague
| | - Aleksi Šedo
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague
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Soukup J, Manethova M, Stejskal V, Novakova M, Duskova J, Hornychova H, Hacova M, Staniczkova-Zambo I, Zelinka T, Kosak M, Cesak T, Netuka D, Ryska A, Gabalec F. Hand2 Immunohistochemistry in the Diagnosis of Paragangliomas and Other Neuroendocrine Neoplasms. Endocr Pathol 2024; 35:14-24. [PMID: 38416360 DOI: 10.1007/s12022-024-09803-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
Hand2 is a core transcription factor responsible for chromaffin cell differentiation. However, its potential utility in surgical pathology has not been studied. Thus, we aimed to investigate its expression in paragangliomas, other neuroendocrine neoplasms (NENs), and additional non-neuroendocrine tumors. We calibrated Hand2 immunohistochemistry on adrenal medulla cells and analyzed H-scores in 46 paragangliomas (PGs), 9 metastatic PGs, 21 cauda equina neuroendocrine tumors (CENETs), 48 neuroendocrine carcinomas (NECs), 8 olfactory neuroblastomas (ONBs), 110 well-differentiated NETs (WDNETs), 10 adrenal cortical carcinomas, 29 adrenal cortical adenomas, 8 melanomas, 41 different carcinomas, and 10 gastrointestinal stromal tumors (GISTs). Both tissue microarrays (TMAs) and whole sections (WSs) were studied. In 171 NENs, previously published data on Phox2B and GATA3 were correlated with Hand2. Hand2 was positive in 98.1% (54/55) PGs, but only rarely in WDNETs (9.6%, 10/104), CENETs (9.5%, 2/21), NECs (4.2%, 2/48), or ONBs (12.5%, 1/8). Any Hand2 positivity was 98.1% sensitive and 91.7% specific for the diagnosis of PG. The Hand2 H-score was significantly higher in primary PGs compared to Hand2-positive WDNETs (median 166.3 vs. 7.5; p < 0.0001). Metastatic PGs were positive in 88.9% (8/9). No Hand2 positivity was observed in any adrenal cortical neoplasm or other non-neuroendocrine tumors, with exception of 8/10 GISTs. Parasympathetic PGs showed a higher Hand2 H-score compared to sympathetic PGs (median H-scores 280 vs. 104, p < 0.0001). Hand2 positivity in NENs serves as a reliable marker of primary and metastatic PG, since other NENs only rarely exhibit limited Hand2 positivity.
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Affiliation(s)
- Jiri Soukup
- Department of Pathology, Military University Hospital Prague, U Vojenske Nemocnice 1200, Praha 6, 169 02, Prague, Czech Republic.
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 582, 500 05, Hradec Kralove, Czech Republic.
- Department of Pathology, Charles University, First Faculty of Medicine and General University Hospital in Prague, Studnickova, 2039, 128 00, Nové Mesto, Prague, Czech Republic.
| | - Monika Manethova
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 582, 500 05, Hradec Kralove, Czech Republic
| | - Vaclav Stejskal
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 582, 500 05, Hradec Kralove, Czech Republic
| | - Marie Novakova
- Department of Pathology, Military University Hospital Prague, U Vojenske Nemocnice 1200, Praha 6, 169 02, Prague, Czech Republic
| | - Jaroslava Duskova
- Department of Pathology, Charles University, First Faculty of Medicine and General University Hospital in Prague, Studnickova, 2039, 128 00, Nové Mesto, Prague, Czech Republic
| | - Helena Hornychova
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 582, 500 05, Hradec Kralove, Czech Republic
| | - Maria Hacova
- Department of Pathology, The Regional Hospital Pardubice, Pardubice, Czech Republic
| | - Iva Staniczkova-Zambo
- 1st Department of Pathology, St. Anne's University Hospital and Faculty of Medicine , Masaryk University, Pekarská 664/53, 602 00, Brno-stred, Brno, Czech Republic
| | - Tomas Zelinka
- Centre for Hypertension, 3rd Department of Medicine, Charles University, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Mikulas Kosak
- Department of Internal Medicine, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Tomas Cesak
- Department of Neurosurgery, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 582, 500 05, Hradec Kralove, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Medical Faculty, Charles University, Military University Hospital Prague, U Vojenske Nemocnice 1200, Praha 6, 169 02, Prague, Czech Republic
| | - Ales Ryska
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 582, 500 05, Hradec Kralove, Czech Republic
| | - Filip Gabalec
- 4th Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 582, 500 05, Hradec Kralove, Czech Republic
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Voldřich R, Charvát F, Netuka D. Indications for alternative endovascular techniques in carotid-cavernous fistulas: A 20-year single-center experience. Interv Neuroradiol 2024:15910199231217549. [PMID: 38173239 DOI: 10.1177/15910199231217549] [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] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND While coiling is considered the standard treatment for carotid-cavernous fistulas (CCFs), studies demonstrating excellent results using new materials, especially flow diverter (FD) stents and liquid embolisates, are becoming more frequent. The indications and effectiveness of these alternative endovascular techniques remain unclear. METHODS A total of 22 direct and 20 indirect CCFs were included in the study. These were further subdivided based on the embolic material used: coils versus FD stents for direct and coils versus liquid embolisates for indirect CCFs. The subgroups were subjected to statistical analysis. RESULTS An angiographic cure was achieved in 88% of all CCFs, 93% of patients' experienced clinical improvement or remained stable. Direct CCFs were treated with coiling (41%) or with both coils and FD stents (55%). One (4%) patient with a direct CCF was treated with FD stent alone. Statistical analysis comparing these subgroups revealed a significantly higher complete occlusion rate immediately after treatment in the coiling subgroup (67% vs. 23%, p = 0.0409). The occlusion rates at the last follow-up were similar (89% vs. 85%). Indirect CCFs were treated with coiling (35%) or liquid embolisates (65%). All three periprocedural ischemic complications were recorded within the liquid subgroup, resulting in a significantly higher clinical deterioration rate (p = 0.0333). CONCLUSION FD stents in direct and liquid embolisates in indirect fistulas did not demonstrate better angiographic or clinical outcomes compared to convetional coiling. Liquid agents carried a higher risk of ischemic complications. Alternative embolization materials should be reserved for CCFs that cannot be treated with simple coiling.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neurooncology, Military University Hospital, Charles University, First Faculty of Medicine in Prague, Prague, Czech Republic
| | - František Charvát
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Military University Hospital, Charles University, First Faculty of Medicine in Prague, Prague, Czech Republic
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Vanek P, Svoboda N, Bradac O, Malik J, Kaiser R, Netuka D. Clinical and radiological results of TLIF surgery with titanium-coated PEEK or uncoated PEEK cages: a prospective single-centre randomised study. Eur Spine J 2024; 33:332-338. [PMID: 37737497 DOI: 10.1007/s00586-023-07947-3] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/30/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND A comparison of fusion rates and clinical outcomes of instrumented transforaminal interbody fusion (TLIF) between polyetheretherketone (PEEK) and titanium-coated PEEK (Ti-PEEK) cages is not well documented. METHODS A single-centre, prospective, randomised study included patients who underwent one-level TLIF between L3-S1 segments. Patients were randomised into one of two groups: TLIF surgery with the PEEK cage and TLIF surgery with the Ti-PEEK cage. Clinical results were measured. All patients were assessed by repeated X-rays and 3D CT scans. Cage integration was assessed using a modified Bridwell classification. The impact of obesity and smoking on fusion quality was also analysed. Patients in both groups were followed up for 2 years. RESULTS Altogether 87 patients were included in the study: of these 87 patients, 81 (93.1%) completed the 2-year follow-up. A significant improvement in clinical outcome was found in the two measurements scales in both groups (RM: p = 0.257, VAS: p = 0.229). There was an increase in CobbS and CobbL angle in both groups (p = 0.172 for CobbS and p = 0.403for CobbL). Bony fusion was achieved in 37 of 40 (92.5%) patients in the TiPEEK group and 35 of 41 (85.4%) in the PEEK group (p = 0.157). Cage subsided in 2 of 40 patients (5%) in the TiPEEK group and 11 of 41 (26.8%) in the PEEK group (p = 0.007). Body mass index > 30 and smoking were not predictive factors of bony fusion achievement. CONCLUSION There is no significant advantage of TiPEEK cages over PEEK cages in clinical outcome and fusion rate 2 years after surgery.
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Affiliation(s)
- P Vanek
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenskénemocnice 1200/2, 16000, Prague 6, Czech Republic
| | - N Svoboda
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenskénemocnice 1200/2, 16000, Prague 6, Czech Republic.
| | - O Bradac
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenskénemocnice 1200/2, 16000, Prague 6, Czech Republic
| | - J Malik
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenskénemocnice 1200/2, 16000, Prague 6, Czech Republic
| | - R Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenskénemocnice 1200/2, 16000, Prague 6, Czech Republic
| | - D Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenskénemocnice 1200/2, 16000, Prague 6, Czech Republic
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Černý M, Lesáková V, Soukup J, Sedlák V, Šíma L, May M, Netuka D, Štěpánek F, Beneš V. Utility of texture analysis for objective quantitative ex vivo assessment of meningioma consistency: method proposal and validation. Acta Neurochir (Wien) 2023; 165:4203-4211. [PMID: 38044374 DOI: 10.1007/s00701-023-05867-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Tumor consistency is considered to be a critical factor for the surgical removal of meningiomas and its preoperative assessment is intensively studied. A significant drawback in the research of predictive methods is the lack of a clear shared definition of tumor consistency, with most authors resorting to subjective binary classification labeling the samples as "soft" and "hard." This classification is highly observer-dependent and its discrete nature fails to capture the fine nuances in tumor consistency. To compensate for these shortcomings, we examined the utility of texture analysis to provide an objective observer-independent continuous measure of meningioma consistency. METHODS A total of 169 texturometric measurements were conducted using the Brookfield CT3 Texture Analyzer on meningioma samples from five patients immediately after the removal and on the first, second, and seventh postoperative day. The relationship between measured stiffness and time from sample extraction, subjectively assessed consistency grade and histopathological features (amount of collagen and reticulin fibers, presence of psammoma bodies, predominant microscopic morphology) was analyzed. RESULTS The stiffness measurements exhibited significantly lower variance within a sample than among samples (p = 0.0225) and significant increase with a higher objectively assessed consistency grade (p = 0.0161, p = 0.0055). A significant negative correlation was found between the measured stiffness and the time from sample extraction (p < 0.01). A significant monotonic relationship was revealed between stiffness values and amount of collagen I and reticulin fibers; there were no statistically significant differences between histological phenotypes in regard to presence of psammoma bodies and predominant microscopic morphology. CONCLUSIONS We conclude that the values yielded by texture analysis are highly representative of an intrinsic consistency-related quality of the sample despite the influence of intra-sample heterogeneity and that our proposed method can be used to conduct quantitative studies on the role of meningioma consistency.
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Affiliation(s)
- Martin Černý
- Department of Neurosurgery and Neurooncology, Military University Hospital, Prague, Czech Republic.
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Veronika Lesáková
- Department of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Jiří Soukup
- Department of Pathology, Military University Hospital, Prague, Czech Republic
| | - Vojtěch Sedlák
- Department of Radiodiagnostics, Military University Hospital, Prague, Czech Republic
| | - Luděk Šíma
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michaela May
- Department of Neurosurgery and Neurooncology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Military University Hospital, Prague, Czech Republic
| | - František Štěpánek
- Department of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, Military University Hospital, Prague, Czech Republic
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Voldřich R, Charvát F, Netuka D. Copolymer liquid embolization of dural arteriovenous fistulas: A 20-year single-center experience. J Neuroimaging 2023; 33:926-932. [PMID: 37602898 DOI: 10.1111/jon.13148] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Dural arteriovenous fistulas (DAVFs) with cortical venous drainage (CVD) carry significant risks of cerebral ischemia and intracranial hemorrhage. Endovascular treatment (EVT) using Onyx, a copolymer-based liquid embolic material, has become the preferred approach. However, the optimal treatment strategy for anterior cranial fossa DAVFs remains debated. METHODS This retrospective study analyzed outcomes of EVT for DAVFs in a single center from 2002 to 2023. Patient data including demographics, clinical status, angiographic findings, embolization techniques, and outcomes were recorded. The results of the anterior fossa malformations were analyzed separately afterward. RESULTS A total of 195 DAVFs were included in the study. The most common presenting symptom was hemorrhage (41%), most fistulas were located in the transverse and sigmoid sinus region (48%), and the majority of DAVFs had direct CVD (78%). Transarterial embolization with Onyx was the preferred treatment strategy in majority of cases (92%). Overall, 94% of patients showed improvement or stability on the modified Rankin Scale. Two patients died due to rebleeding after partial DAVF embolization. Onyx demonstrated higher immediate complete occlusion rate compared to other embolic materials (88% vs. 35%). Overall, 91% of fistulas were closed at the last follow-up. Ten anterior fossa DAVFs were treated, resulting in clinical improvement and complete occlusion in all cases. CONCLUSION Based on the results of our study, we believe that a cure of DAVFs, including those in the anterior fossa, can be achieved in more than 90% of cases through transarterial Onyx embolization, given long-term clinical experience.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neurooncology, Charles University in Prague, First Medical Faculty, Military University Hospital, Prague, Czech Republic
| | - František Charvát
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Charles University in Prague, First Medical Faculty, Military University Hospital, Prague, Czech Republic
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Hrbáč T, Fiedler J, Procházka V, Jonszta T, Roubec M, Pakizer D, Václavík D, Netuka D, Heryán T, Školoudík D. Comparison of carotid endarterectomy and repeated carotid angioplasty and stenting for in-stent restenosis (CERCAS trial): a randomised study. Stroke Vasc Neurol 2023; 8:399-404. [PMID: 36972920 PMCID: PMC10648045 DOI: 10.1136/svn-2022-002075] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND AND AIM In-stent restenosis (ISR) belongs to an infrequent but potentially serious complication after carotid angioplasty and stenting in patients with severe carotid stenosis. Some of these patients might be contraindicated to repeat percutaneous transluminal angioplasty with or without stenting (rePTA/S). The purpose of the study is to compare the safety and effectiveness of carotid endarterectomy with stent removal (CEASR) and rePTA/S in patients with carotid ISR. METHODS Consecutive patients with carotid ISR (≥80%) were randomly allocated to the CEASR or rePTA/S group. The incidence of restenosis after intervention, stroke, transient ischaemic attack myocardial infarction and death 30 days and 1 year after intervention and restenosis 1 year after intervention between patients in CEASR and rePTA/S groups were statistically evaluated. RESULTS A total of 31 patients were included in the study; 14 patients (9 males; mean age 66.3±6.6 years) were allocated to CEASR and 17 patients (10 males; mean age 68.8±5.6 years) to the rePTA/S group. The implanted stent in carotid restenosis was successfully removed in all patients in the CEASR group. No clinical vascular event was recorded periproceduraly, 30 days and 1 year after intervention in both groups. Only one patient in the CEASR group had asymptomatic occlusion of the intervened carotid artery within 30 days and one patient died in the rePTA/S group within 1 year after intervention. Restenosis after intervention was significantly greater in the rePTA/S group (mean 20.9%) than in the CEASR group (mean 0%, p=0.04), but all stenoses were <50%. Incidence of 1-year restenosis that was ≥70% did not differ between the rePTA/S and CEASR groups (4 vs 1 patient; p=0.233). CONCLUSION CEASR seems to be effective and save procedures for patients with carotid ISR and might be considered as a treatment option. TRIAL REGISTRATION NUMBER NCT05390983.
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Affiliation(s)
- Tomáš Hrbáč
- Department of Neuroscience, Faculty of Medicine, Univerzity of Ostrava, Ostrava, Czech Republic
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jiří Fiedler
- Department of Neurosurgery, České Budějovice Hospital, České Budějovice, Czech Republic
| | - Václav Procházka
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Tomáš Jonszta
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Roubec
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Pakizer
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Daniel Václavík
- Department of Neurology, Vítkovice Hospital, Ostrava, Czech Republic
| | - David Netuka
- Department of Neurosurgery, Military University Hospital Prague, Praha, Czech Republic
| | - Tomáš Heryán
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - David Školoudík
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Belhajová M, Vícha A, Burgert L, Brožková I, Michalíčková L, Hrdina R, Moravec T, Netuka D, Musil Z, Hrdina R. En route to local glioblastoma treatment with temozolomide doped hyaluronan fibres: formulation and in vitro cell studies. RSC Med Chem 2023; 14:1662-1666. [PMID: 37731694 PMCID: PMC10507811 DOI: 10.1039/d3md00261f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/02/2023] [Indexed: 09/22/2023] Open
Abstract
We report the preparation, characterisation and in vitro tests of hyaluronan fibres containing up to 50 w/w% of temozolomide for local glyoblastoma treatment. These fibres form a hydrogel upon contact with cerebrospinal fluid on the treatment spot.
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Affiliation(s)
- Marie Belhajová
- Charles University, Faculty of Medicine, Department of paediatric haematology and oncology V Úvalu 84/1 150 00 Praha 5 Czech Republic
| | - Aleš Vícha
- Charles University, Faculty of Medicine, Department of paediatric haematology and oncology V Úvalu 84/1 150 00 Praha 5 Czech Republic
| | - Ladislav Burgert
- University of Pardubice, Faculty of Chemical Technology Studentská 573 53210 Pardubice Czech Republic
| | - Iveta Brožková
- University of Pardubice, Faculty of Chemical Technology Studentská 573 53210 Pardubice Czech Republic
| | - Ludmila Michalíčková
- University of Pardubice, Faculty of Chemical Technology Studentská 573 53210 Pardubice Czech Republic
| | - Radim Hrdina
- University of Pardubice, Faculty of Chemical Technology Studentská 573 53210 Pardubice Czech Republic
| | - Tomáš Moravec
- Charles University, Faculty of Medicine, Department of neurosurgery and neurooncology U Vojenské nemocnice 1200 Praha 6 Czech Republic
| | - David Netuka
- Charles University, Faculty of Medicine, Department of neurosurgery and neurooncology U Vojenské nemocnice 1200 Praha 6 Czech Republic
| | - Zdeněk Musil
- Charles University, Faculty of Medicine, Institute of biology and medical genetics Albertov 4 Praha 2 Czech Republic
| | - Radim Hrdina
- Charles University, Faculty of Science, Department of Organic Chemistry Hlavova 8 12843 Praha 2 Czech Republic
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Kaiser R, Varga M, Lang O, Waldauf P, Vaněk P, Saur K, Beneš V, Netuka D. Spinal fusion for single-level SPECT/CT positive lumbar degenerative disc disease: the SPINUS I study. Acta Neurochir (Wien) 2023; 165:2633-2640. [PMID: 37347294 PMCID: PMC10477220 DOI: 10.1007/s00701-023-05666-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION AND PURPOSE With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD). MATERIAL AND METHODS This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery. RESULTS During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work. CONCLUSION Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04876586.
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Affiliation(s)
- Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 16902, Prague, Czech Republic.
| | - Michal Varga
- Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Otto Lang
- Department of Nuclear Medicine, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anaesthesia and Intensive Care Medicine, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Vaněk
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 16902, Prague, Czech Republic
| | - Karel Saur
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 16902, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 16902, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 16902, Prague, Czech Republic
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Soukup J, Manethova M, Stejskal V, Hornychova H, Cesak T, Netuka D, Ryska A, Gabalec F. Immunoreactivity of HOXB13 in Neuroendocrine Neoplasms Is a Sensitive and Specific Marker of Rectal Well-Differentiated Neuroendocrine Tumors. Endocr Pathol 2023; 34:333-341. [PMID: 37552455 DOI: 10.1007/s12022-023-09779-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
HoxB13 is a transcription factor involved in defining of posterior endodermal derivatives, including prostate and rectum. While it is used as a marker of prostatic adenocarcinoma, it has not been studied systematically in neuroendocrine neoplasms. Thus, we performed HoxB13 immunohistochemistry in tissue microarrays and the whole sections of 232 neuroendocrine neoplasms. These included 34 paragangliomas (PGs), 20 cauda equina neuroendocrine tumors (CENETs), 123 well-differentiated neuroendocrine tumors (WDNETs), and 55 neuroendocrine carcinomas (NECs). WDNETs were additionally analyzed with SATB2, and colorectal WDNETs with CDX2 and serotonin immunohistochemistry. In total, HoxB13 immunoreactivity was observed in 95% (19/20) CENETs, 10.6% (13/123) WDNETs, and 12.9% (7/54) NECs. No PGs were positive. Large intestine WDNETs expressed HoxB13 in 68.4% (13/19); five negative tumors originated in cecum and one in rectum. In rectum, 92.9% (13/14) WDNETs expressed HoxB13. HoxB13 was 92.9% sensitive and 100% specific, showing 100% positive predictive value for the rectal origin of WDNET. In NECs, HoxB13 was positive in 15.4% (2/13) GIT tumors and 80% (4/5) prostatic NECs, but in none of urinary bladder NECs (0/8). SATB2 was positive in 17.1% (21/123) WDNETs, including 78.9% (15/19) of colorectal WDNETs, 71.4% (5/7) appendiceal WDNETs, and 2.9% (1/34) small intestine WDNETs. All 4 SATB2-negative large bowel tumors originated in the cecum. When both markers combined, HoxB13+/SATB2+ immunoprofile was seen exclusively in rectal WDNETs (positive predictive value 100%), while HoxB13-/SATB2+ immunoprofile was highly suggestive of the appendiceal origin (positive predictive value 71.4%). Therefore, HoxB13 can be useful as an immunohistochemical marker of rectal WDNETs and prostatic NECs.
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Affiliation(s)
- Jiri Soukup
- Department of Pathology, Military University Hospital Prague, Prague, Czech Republic.
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Prague, 500 05, Czech Republic.
| | - Monika Manethova
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Prague, 500 05, Czech Republic
| | - Vaclav Stejskal
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Prague, 500 05, Czech Republic
| | - Helena Hornychova
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Prague, 500 05, Czech Republic
| | - Tomas Cesak
- Department of Neurosurgery, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Medical Faculty, Military University Hospital Prague, Charles University, Prague, Czech Republic
| | - Ales Ryska
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Prague, 500 05, Czech Republic
| | - Filip Gabalec
- 4th Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Prague, Czech Republic
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Májovský M, Mikolov T, Netuka D. AI Is Changing the Landscape of Academic Writing: What Can Be Done? Authors' Reply to: AI Increases the Pressure to Overhaul the Scientific Peer Review Process. Comment on "Artificial Intelligence Can Generate Fraudulent but Authentic-Looking Scientific Medical Articles: Pandora's Box Has Been Opened". J Med Internet Res 2023; 25:e50844. [PMID: 37651175 PMCID: PMC10502592 DOI: 10.2196/50844] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Martin Májovský
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Mikolov
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Scheichel F, Popadic B, Pinggera D, Jaskolski DJ, Lubrano V, Foroglou N, Netuka D, Iliescu B, Novak L, Sherif C, Marhold F, Freyschlag CF. European survey on neurosurgical management of primary central nervous system lymphomas and preoperative corticosteroid therapy. Brain Spine 2023; 3:101791. [PMID: 38020980 PMCID: PMC10668066 DOI: 10.1016/j.bas.2023.101791] [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] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/29/2023] [Accepted: 08/11/2023] [Indexed: 12/01/2023]
Abstract
Introduction Preoperative corticosteroid therapy (CST) is common in primary central nervous system lymphoma (PCNSL) and may complicate histopathological diagnosis. There is an ongoing debate on the best management after preoperative CST. Research question We aimed to survey how different European neurosurgical units treat PCNSL patients after preoperative CST. Methods An English-language survey consisting of 21 questions addressing the management of patients with suspected PCNSL and preoperative CST was sent to European hospitals. The survey also included three clinical cases to assess the decision-making process in a clinical setting. Results The survey was completed by 74 European hospitals. There was no clear consensus on how to treat a patient with PCNSL after CST. Accordingly, 24.3% responded that they would generally defer surgery regardless of a possible radiological response, 47.3% would defer surgery only if there is regression in preoperative MRI and the remaining 28.4% would defer surgery only if the tumor had completely vanished. Furthermore, there were distinct discrepancies in responses of neurosurgical units regarding their general management approach and their case-based decision in the three example cases. The results of our survey also showed regional differences and differences in treatment decisions between high-, intermediate- and low-volume centers. Discussion and conclusion There was no clear consensus on how to treat patients with suspected PCNSL and preoperative CST. Furthermore, most centers also showed inconsistencies in their responses regarding their general approach as well as individual patient treatment. More high-quality evidence-based recommendations are needed to improve consensus and thus patient care.
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Affiliation(s)
- Florian Scheichel
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Branko Popadic
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dariusz J. Jaskolski
- Department of Neurosurgery and Neurooncology Medical University of Lodz, Norbert Barlicki University Hospital, Lodz, Poland
| | - Vincent Lubrano
- Clinique de l'Union, Saint Jean, France
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Nicolas Foroglou
- Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - David Netuka
- Central Military Hospital, Prague, Czech Republic
| | - Bogdan Iliescu
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Laszlo Novak
- Department of Neurosurgery, Clinical Centre, University of Debrecen, Debrecen, Hungary
| | - Camillo Sherif
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Franz Marhold
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
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Kaiser R, Kantorová L, Langaufová A, Slezáková S, Tučková D, Klugar M, Klézl Z, Barsa P, Cienciala J, Hajdúk R, Hrabálek L, Kučera R, Netuka D, Prýmek M, Repko M, Smrčka M, Štulík J. Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials. J Neurol Neurosurg Psychiatry 2023; 94:657-666. [PMID: 36849239 PMCID: PMC10359551 DOI: 10.1136/jnnp-2022-330158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE). RESULTS We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0-100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI -4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD -5·92 points (95% CI -11.00 to -0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD -1.25 points (95% CI -6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE). CONCLUSIONS Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion. PROSPERO REGISTRATION NUMBER CRD42022308267.
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Affiliation(s)
- Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Military University Hospital Prague, Prague, Czech Republic
| | - Lucia Kantorová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Czech Health Research Council, Prague, Czech Republic
| | - Alena Langaufová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Simona Slezáková
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Dagmar Tučková
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Czech Health Research Council, Prague, Czech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Zdeněk Klézl
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Pavel Barsa
- Department of Neurosurgery, Regional Hospital Liberec, Liberec, Czech Republic
| | - Jan Cienciala
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Richard Hajdúk
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Lumír Hrabálek
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- University Hospital Olomouc, Olomouc, Czech Republic
| | - Roman Kučera
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Military University Hospital Prague, Prague, Czech Republic
| | - Martin Prýmek
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Martin Repko
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Martin Smrčka
- University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Štulík
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
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Sedlák V, Bubeníková A, Skalický P, Vlasák A, Whitley H, Netuka D, Beneš V, Beneš V, Bradáč O. Diffusion tensor imaging helps identify shunt-responsive normal pressure hydrocephalus patients among probable iNPH cohort. Neurosurg Rev 2023; 46:173. [PMID: 37442856 PMCID: PMC10344981 DOI: 10.1007/s10143-023-02078-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
The aim of this study was to investigate whether white matter changes as measured by diffusion tensor imaging (DTI) can help differentiate shunt-responsive idiopathic normal pressure hydrocephalus (iNPH) patients from patients with other causes of gait disturbances and/or cognitive decline with ventriculomegaly whose clinical symptoms do not improve significantly after cerebrospinal fluid derivation (non-iNPH). Between 2017 and 2022, 85 patients with probable iNPH underwent prospective preoperative magnetic resonance imaging (MRI) and comprehensive clinical workup. Patients with clinical symptoms of iNPH, positive result on lumbar infusion test, and gait improvement after 120-h lumbar drainage were diagnosed with iNPH and underwent shunt-placement surgery. Fractional anisotropy (FA) and mean diffusivity (MD) values for individual regions of interest were extracted from preoperative MRI, using the TBSS pipeline of FSL toolkit. These FA and MD values were then compared to results of clinical workup and established diagnosis of iNPH. An identical MRI protocol was performed on 13 age- and sex-matched healthy volunteers. Statistically significant differences in FA values of several white matter structures were found not only between iNPH patients and healthy controls but also between iNPH and non-iNPH patients. ROI that showed best diagnostic ability when differentiating iNPH among probable iNPH cohort was uncinate fasciculus, with AUC of 0.74 (p < 0.001). DTI methods of white matter analysis using standardised methods of ROI extraction can help in differentiation of iNPH patients not only from healthy patients but also from patients with other causes of gait disturbances with cognitive decline and ventriculomegaly.
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Affiliation(s)
- Vojtěch Sedlák
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Adéla Bubeníková
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - Petr Skalický
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Aleš Vlasák
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Helen Whitley
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Májovský M, Černý M, Kasal M, Komarc M, Netuka D. Artificial Intelligence Can Generate Fraudulent but Authentic-Looking Scientific Medical Articles: Pandora's Box Has Been Opened. J Med Internet Res 2023; 25:e46924. [PMID: 37256685 PMCID: PMC10267787 DOI: 10.2196/46924] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [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: 03/02/2023] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) has advanced substantially in recent years, transforming many industries and improving the way people live and work. In scientific research, AI can enhance the quality and efficiency of data analysis and publication. However, AI has also opened up the possibility of generating high-quality fraudulent papers that are difficult to detect, raising important questions about the integrity of scientific research and the trustworthiness of published papers. OBJECTIVE The aim of this study was to investigate the capabilities of current AI language models in generating high-quality fraudulent medical articles. We hypothesized that modern AI models can create highly convincing fraudulent papers that can easily deceive readers and even experienced researchers. METHODS This proof-of-concept study used ChatGPT (Chat Generative Pre-trained Transformer) powered by the GPT-3 (Generative Pre-trained Transformer 3) language model to generate a fraudulent scientific article related to neurosurgery. GPT-3 is a large language model developed by OpenAI that uses deep learning algorithms to generate human-like text in response to prompts given by users. The model was trained on a massive corpus of text from the internet and is capable of generating high-quality text in a variety of languages and on various topics. The authors posed questions and prompts to the model and refined them iteratively as the model generated the responses. The goal was to create a completely fabricated article including the abstract, introduction, material and methods, discussion, references, charts, etc. Once the article was generated, it was reviewed for accuracy and coherence by experts in the fields of neurosurgery, psychiatry, and statistics and compared to existing similar articles. RESULTS The study found that the AI language model can create a highly convincing fraudulent article that resembled a genuine scientific paper in terms of word usage, sentence structure, and overall composition. The AI-generated article included standard sections such as introduction, material and methods, results, and discussion, as well a data sheet. It consisted of 1992 words and 17 citations, and the whole process of article creation took approximately 1 hour without any special training of the human user. However, there were some concerns and specific mistakes identified in the generated article, specifically in the references. CONCLUSIONS The study demonstrates the potential of current AI language models to generate completely fabricated scientific articles. Although the papers look sophisticated and seemingly flawless, expert readers may identify semantic inaccuracies and errors upon closer inspection. We highlight the need for increased vigilance and better detection methods to combat the potential misuse of AI in scientific research. At the same time, it is important to recognize the potential benefits of using AI language models in genuine scientific writing and research, such as manuscript preparation and language editing.
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Affiliation(s)
- Martin Májovský
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Černý
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Matěj Kasal
- Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Komarc
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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May M, Sedlak V, Pecen L, Priban V, Buchvald P, Fiedler J, Vaverka M, Lipina R, Reguli S, Malik J, Netuka D, Benes V. Role of risk factors, scoring systems, and prognostic models in predicting the functional outcome in meningioma surgery: multicentric study of 552 skull base meningiomas. Neurosurg Rev 2023; 46:124. [PMID: 37219634 PMCID: PMC10205827 DOI: 10.1007/s10143-023-02004-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/20/2023] [Accepted: 04/16/2023] [Indexed: 05/24/2023]
Abstract
Despite the importance of functional outcome, only a few scoring systems exist to predict neurologic outcome in meningioma surgery. Therefore, our study aims to identify preoperative risk factors and develop the receiver operating characteristics (ROC) models estimating the risk of a new postoperative neurologic deficit and a decrease in Karnofsky performance status (KPS). A multicentric study was conducted in a cohort of 552 consecutive patients with skull base meningiomas who underwent surgical resection from 2014 to 2019. Data were gathered from clinical, surgical, and pathology records as well as radiological diagnostics. The preoperative predictive factors of functional outcome (neurologic deficit, decrease in KPS) were analyzed in univariate and multivariate stepwise selection analyses. Permanent neurologic deficits were present in 73 (13.2%) patients and a postoperative decrease in KPS in 84 (15.2%). Surgery-related mortality was 1.3%. A ROC model was developed to estimate the probability of a new neurologic deficit (area 0.74; SE 0.0284; 95% Wald confidence limits (0.69; 0.80)) based on meningioma location and diameter. Consequently, a ROC model was developed to predict the probability of a postoperative decrease in KPS (area 0.80; SE 0.0289; 95% Wald confidence limits (0.74; 0.85)) based on the patient's age, meningioma location, diameter, presence of hyperostosis, and dural tail. To ensure an evidence-based therapeutic approach, treatment should be founded on known risk factors, scoring systems, and predictive models. We propose ROC models predicting the functional outcome of skull base meningioma resection based on the age of the patient, meningioma size, and location and the presence of hyperostosis and dural tail.
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Affiliation(s)
- Michaela May
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenske nemocnice 1200, 16902, Prague, Czech Republic.
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | - Vojtech Sedlak
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Ladislav Pecen
- Institute of Computer Science, The Czech Academy of Sciences, Prague, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Pavel Buchvald
- Department of Neurosurgery, Liberec Hospital, Liberec, Czech Republic
| | - Jiri Fiedler
- Department of Neurosurgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - Miroslav Vaverka
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Stefan Reguli
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jozef Malik
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenske nemocnice 1200, 16902, Prague, Czech Republic
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenske nemocnice 1200, 16902, Prague, Czech Republic
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Černý M, Kybic J, Májovský M, Sedlák V, Pirgl K, Misiorzová E, Lipina R, Netuka D. Fully automated imaging protocol independent system for pituitary adenoma segmentation: a convolutional neural network-based model on sparsely annotated MRI. Neurosurg Rev 2023; 46:116. [PMID: 37162632 DOI: 10.1007/s10143-023-02014-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/08/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
This study aims to develop a fully automated imaging protocol independent system for pituitary adenoma segmentation from magnetic resonance imaging (MRI) scans that can work without user interaction and evaluate its accuracy and utility for clinical applications. We trained two independent artificial neural networks on MRI scans of 394 patients. The scans were acquired according to various imaging protocols over the course of 11 years on 1.5T and 3T MRI systems. The segmentation model assigned a class label to each input pixel (pituitary adenoma, internal carotid artery, normal pituitary gland, background). The slice segmentation model classified slices as clinically relevant (structures of interest in slice) or irrelevant (anterior or posterior to sella turcica). We used MRI data of another 99 patients to evaluate the performance of the model during training. We validated the model on a prospective cohort of 28 patients, Dice coefficients of 0.910, 0.719, and 0.240 for tumour, internal carotid artery, and normal gland labels, respectively, were achieved. The slice selection model achieved 82.5% accuracy, 88.7% sensitivity, 76.7% specificity, and an AUC of 0.904. A human expert rated 71.4% of the segmentation results as accurate, 21.4% as slightly inaccurate, and 7.1% as coarsely inaccurate. Our model achieved good results comparable with recent works of other authors on the largest dataset to date and generalized well for various imaging protocols. We discussed future clinical applications, and their considerations. Models and frameworks for clinical use have yet to be developed and evaluated.
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Affiliation(s)
- Martin Černý
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University, Central Military Hospital Prague, U Vojenské nemocnice 1200, 169 02, Praha 6, Czech Republic.
- 1st Faculty of Medicine, Charles University Prague, Kateřinská 1660/32, 121 08, Praha 2, Czech Republic.
| | - Jan Kybic
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 166 27, Praha 6, Czech Republic
| | - Martin Májovský
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University, Central Military Hospital Prague, U Vojenské nemocnice 1200, 169 02, Praha 6, Czech Republic
| | - Vojtěch Sedlák
- Department of Radiodiagnostics, Central Military Hospital Prague, U Vojenské nemocnice 1200, 169 02, Praha 6, Czech Republic
| | - Karin Pirgl
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University, Central Military Hospital Prague, U Vojenské nemocnice 1200, 169 02, Praha 6, Czech Republic
- 3rd Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Eva Misiorzová
- Department of Neurosurgery, Faculty of Medicine, University of Ostrava, University Hospital Ostrava, 17. listopadu 1790/5, 708 52, Ostrava-Poruba, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, Faculty of Medicine, University of Ostrava, University Hospital Ostrava, 17. listopadu 1790/5, 708 52, Ostrava-Poruba, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University, Central Military Hospital Prague, U Vojenské nemocnice 1200, 169 02, Praha 6, Czech Republic
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Ottenhausen M, Conrad J, Kalasauskas D, Netuka D, Ringel F. Pituitary Surgery in Germany - Findings from the European Pituitary Adenoma Surgery Survey. Exp Clin Endocrinol Diabetes 2023. [PMID: 36958349 DOI: 10.1055/a-2061-1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Background Surgery is, next to medical and radiation therapy, the mainstay therapy for pituitary adenomas. While scientific consensus regarding the key aspects of pituitary surgery exists among neurosurgeons, procedures are not standardized and might vary significantly between hospitals and surgeons. Objective Providing an overview of how neurosurgical departments in Germany manage pituitary surgery. Methods Responses from the European Pituitary Adenoma Surgery Survey (EU-PASS) were analyzed. The survey contained 60 questions regarding demographics, training, surgical aspects, endocrinological aspects and patient management. Results 60 neurosurgical centers from Germany responded to the survey. 35.3% (n=18) of centers exclusively use the microscopic and 31.1% (n=14) the endoscopic technique exclusively, all other centers (n=28) use both approaches. 20% (n=12) of responding centers perform less than 10 transsphenoidal pituitary surgeries per year and 1,7% (n=1) more than 100 operations. The number of transcranial pituitary operations is significantly smaller 53,3% of centers performing only 0-2 per year, 35% performing 3-5 and only one center (1,7%) performing more than 15 transcranial operations per year. In 8 centers (13,3%) surgeries are always performed together with an ENT surgeon, in 29 center (48,4%) ENT surgeons are never involved. . In most centers (n=54, 90%) intraoperative MRI is not available. Image guidance (with preoperative CT and/or MRI data) is used by 91.7% of respondents (n=55). 42 centers (72.4%) prescribe hydrocortisone after pituitary surgery routinely. 75% (n=45) have pituitary board meetings with endocrinologists, radiologists and radiosurgeons. 52 (86.7%) respondents perform the first follow-up scan by MRI 3-4 months after surgery. Conclusions The data showed differences as well as similarities between centers and could help to discuss standardization of methods as well as the formation of networks and certification to improve patient care.
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Affiliation(s)
- Malte Ottenhausen
- Neurosurgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jens Conrad
- Neurosurgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Darius Kalasauskas
- Neurosurgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Charles University and Military Hospital, Prague, Czech Republic
| | - Florian Ringel
- Neurosurgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Svoboda N, Malik J, Charvat F, Netuka D. Transcirculation Approach for Matricidal Carotid Cavernous Aneurysm: Not a Good Choice - A Case Report of Unsuccessful Endovascular Treatment of Matricidal Carotid Cavernous Aneurysm. Case Rep Neurol 2023; 15:215-221. [PMID: 37901130 PMCID: PMC10601690 DOI: 10.1159/000533832] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/29/2023] [Indexed: 10/31/2023] Open
Abstract
Matricidal carotid cavernous aneurysm (CCA) is a rare and dangerous condition. The treatment failure of the endovascular approach like flow diversion, coiling, or stent-coiling is relatively high with considerable morbidity and mortality. The transcirculation approach is an alternative treatment option, but in case of matricidal CCAs, the results are not well documented in the literature. The authors present a complicated case of an unsuccessful transcirculation approach for matricidal CCA finally treated with sacrifice of the parent artery and high-flow bypass.
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Affiliation(s)
- Norbert Svoboda
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Military University Hospital and Charles University, Prague, Czech Republic
| | - Jozef Malik
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Military University Hospital and Charles University, Prague, Czech Republic
| | - Frantisek Charvat
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Military University Hospital and Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Military University Hospital and Charles University, Prague, Czech Republic
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Kaiser R, Kantorová L, Langaufová A, Slezáková S, Tučková D, Klugar M, Klézl Z, Barsa P, Cienciala J, Hajdúk R, Hrabálek L, Kučera R, Netuka D, Prýmek M, Repko M, Smrčka M, Štulík J. [Surgical Treatment of Degenerative Lumbar Stenosis and Spondylolisthesis: Clinical Practice Guideline]. Acta Chir Orthop Traumatol Cech 2023; 90:157-167. [PMID: 37395422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part of the Czech Clinical Practice Guideline (CPG) "The Surgical Treatment of the Degenerative Diseases of the Spine". MATERIAL AND METHODS The Guideline was drawn up in line with the Czech National Methodology of the CPG Development, which is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We used an innovative GRADE-adolopment method that combines adoption and adaptation of the existing guidelines with de novo development of recommendations. In this paper, we present three adapted recommendations on DLS and a recommendation on spondylolisthesis developed de novo by the Czech team. RESULTS Open surgical decompression in DLS patients has been evaluated in three randomized controlled trials (RCTs). A recommendation in favour of decompression was made based on a statistically significant and clinically evident improvement in the Oswestry Disability Index (ODI) and leg pain. Decompression may be recommended for patients with symptoms of DLS in the event of correlation of significant physical limitation and the finding obtained via imaging. The authors of a systematic review of observational studies and one RCT conclude that fusion has a negligible role in the case of a simple DLS. Thus, spondylodesis should only be chosen as an adjunct to decompression in selected DLS patients. Two RCTs compared supervised rehabilitation with home or no exercise, showing no statistically significant difference between the procedures. The guideline group considers the post-surgery physical activity beneficial and suggests supervised rehabilitation in patients who have undergone surgery for DLS for the beneficial effects of exercise in the absence of known adverse effects. Four RCTs were found comparing simple decompression and decompression with fusion in patients with degenerative lumbar spondylolisthesis. None of the outcomes showed clinically significant improvement or deterioration in favour of either intervention. The guideline group concluded that for stable spondylolisthesis the results of both methods are comparable and, when other parameters are considered (balance of benefits and risks, or costs), point in favour of simple decompression. Due to the lack of scientific evidence, no recommendation has been formulated regarding unstable spondylolisthesis. The certainty of the evidence was rated as low for all recommendations. DISCUSSION Despite the unclear definition of stable/unstable slip, the inclusion of apparently unstable cases of DS in stable studies limits the conclusions of the studies. Based on the available literature, however, it can be summarized that in simple degenerative lumbar stenosis and static spondylolisthesis, fusion of the given segment is not justified. However, its use in the case of unstable (dynamic) vertebral slip is undisputable for the time being. CONCLUSIONS The guideline development group suggests decompression in patients with DLS in whom previous conservative treatment did not lead to improvement, spondylodesis only in selected patients, and post-surgical supervised rehabilitation. In patients with degenerative lumbar stenosis and spondylolisthesis with no signs of instability, the guideline development group suggests simple decompression (without fusion). Key words: degenerative lumbar stenosis, degenerative spondylolisthesis, spinal fusion, Clinical Practice Guideline, GRADE, adolopment.
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Affiliation(s)
- R Kaiser
- Neurochirurgická a neuroonkologická klinika 1. lékařské fakulty Univerzity Karlovy a Ústřední vojenské nemocnice, Praha
| | - L Kantorová
- České národní centrum Evidence-Based Healthcare a Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institut biostatistiky a analýz, Lékařská fakulta, Masarykova univerzita, Brno
- Agentura pro zdravotnický výzkum České republiky, Praha
| | - A Langaufová
- České národní centrum Evidence-Based Healthcare a Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institut biostatistiky a analýz, Lékařská fakulta, Masarykova univerzita, Brno
- Ústav zdravotnických informací a statistiky České republiky, Praha
| | - S Slezáková
- České národní centrum Evidence-Based Healthcare a Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institut biostatistiky a analýz, Lékařská fakulta, Masarykova univerzita, Brno
- Agentura pro zdravotnický výzkum České republiky, Praha
- Ústav zdravotnických informací a statistiky České republiky, Praha
| | - D Tučková
- České národní centrum Evidence-Based Healthcare a Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institut biostatistiky a analýz, Lékařská fakulta, Masarykova univerzita, Brno
- Agentura pro zdravotnický výzkum České republiky, Praha
| | - M Klugar
- České národní centrum Evidence-Based Healthcare a Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institut biostatistiky a analýz, Lékařská fakulta, Masarykova univerzita, Brno
- Agentura pro zdravotnický výzkum České republiky, Praha
- Ústav zdravotnických informací a statistiky České republiky, Praha
| | - Z Klézl
- Klinika spondylochirurgie 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
| | - P Barsa
- Neurochirurgické oddělení, Neurocentrum, Krajská nemocnice Liberec, Liberec
| | - J Cienciala
- Ortopedická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno, Brno
| | - R Hajdúk
- Klinika spondylochirurgie 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
| | - L Hrabálek
- Neurochirurgická klinika Lékařské fakulty Univerzity Palackého a Fakultní nemocnice Olomouc, Olomouc
| | - R Kučera
- Neurochirurgické oddělení, Nemocnice Na Homolce, Praha
| | - D Netuka
- Neurochirurgická a neuroonkologická klinika 1. lékařské fakulty Univerzity Karlovy a Ústřední vojenské nemocnice, Praha
| | - M Prýmek
- Ortopedická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno, Brno
| | - M Repko
- Ortopedická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno, Brno
| | - M Smrčka
- Neurochirurgická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno, Brno
| | - J Štulík
- Klinika spondylochirurgie 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
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Černý M, Sedlák V, Lesáková V, Francůz P, Netuka D. Methods of preoperative prediction of pituitary adenoma consistency: a systematic review. Neurosurg Rev 2022; 46:11. [PMID: 36482215 DOI: 10.1007/s10143-022-01909-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aims to review the current literature on methods of preoperative prediction of pituitary adenoma consistency. Pituitary adenoma consistency may be a limiting factor for successful surgical removal of tumors. Efforts have been made to investigate the possibility of an accurate assessment of the preoperative consistency to allow for safer and more effective surgery planning. We searched major scientific databases and systematically analyzed the results. A total of 54 relevant articles were identified and selected for inclusion. These studies evaluated methods based on either MRI intensity, enhancement, radiomics, MR elastometry, or CT evaluation. The results of these studies varied widely. Most studies used the average intensity of either T2WI or ADC maps. Firm tumors appeared hyperintense on T2WI, although only 55% of the studies reported statistically significant results. There are mixed reports on ADC values in firm tumors with findings of increased values (28%), decreased values (22%), or no correlation (50%). Multiple contrast enhancement-based methods showed good results in distinguishing between soft and firm tumors. There were mixed reports on the utility of MR elastography. Attempts to develop radiomics and machine learning-based models have achieved high accuracy and AUC values; however, they are prone to overfitting and need further validation. Multiple methods of preoperative consistency assessment have been studied. None demonstrated sufficient accuracy and reliability in clinical use. Further efforts are needed to enable reliable surgical planning.
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Affiliation(s)
- Martin Černý
- Department of Neurosurgery, Central Military Hospital Prague, Prague, Czech Republic.
- 1st Faculty of Medicine, Charles University Prague, Prague, Czech Republic.
| | - Vojtěch Sedlák
- Department of Radiodiagnostics, Central Military Hospital Prague, Prague, Czech Republic
| | - Veronika Lesáková
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Prague, Czech Republic
| | - Peter Francůz
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery, Central Military Hospital Prague, Prague, Czech Republic
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Voldřich R, Charvát F, Beneš V, Netuka D. What is the most effective method to treat indirect carotid-cavernous fistula? Neurosurg Rev 2022; 46:9. [PMID: 36482213 DOI: 10.1007/s10143-022-01923-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
To review the most relevant treatment options for indirect carotid-cavernous fistulas (iCCF), cohorts of 20 patients or more published after 2000 were analyzed. Clinical and radiological outcomes, as well as embolization techniques and material, had to be clarified in the study to be considered. Statistical analysis was based on calculating the relative percentage of therapeutic methods or embolic material, followed by calculating parametric and nonparametric correlations. Some 22 studies and 1550 patients were included. Transvenous embolization (TVE) was used in 53% of the patients and was strongly associated with coiling (rw = 0.66, p = 0.0.0012; rs = 0.53, p = 0.0138), transarterial embolization (TAE) was preferred in 11% of the patients and was strongly linked to liquid embolics (rw = 0.44, p = 0.0434;rs = 0.64, p = 0.0018). A combination of TAE and TVE treatment was used in 7% and a combination of embolic materials in 13% of the patients. None of the endovascular techniques or embolization materials showed significant superiority over the others in clinical outcome and obliteration rate. Radiosurgery in 22% and mechanical compression in 5% of patients showed a lower obliteration rate (rw = - 0.48, p = 0.0254; rs = - 0.45, p = 0.0371). The clinical outcomes were comparable to endovascular treatment (EVT). The remaining 2% of the patients were treated by open surgery or a combination of EVT and radiosurgery. Transvenous coiling is the preferred EVT method for iCCF. However, comparable results may be accomplished with TAE using liquid. Radiosurgery may achieve a lower percentage of fistula occlusion, but the clinical results are equal to EVT.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic.
| | - František Charvát
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
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Svoboda N, Bradac O, Mandys V, Netuka D, Benes V. Diagnostic accuracy of DSA in carotid artery stenosis: a comparison between stenosis measured on carotid endarterectomy specimens and DSA in 644 cases. Acta Neurochir (Wien) 2022; 164:3197-3202. [PMID: 35945355 DOI: 10.1007/s00701-022-05332-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE DSA (digital subtraction angiography) is the gold standard for measuring carotid artery stenosis (CS). Yet, the correlation between DSA and stenosis is not well documented. MATERIAL AND METHODS We compared CS as measured by DSA to carotid artery specimens obtained from carotid endarterectomy surgery. Patients were divided into three groups according to NASCET criteria (North American Symptomatic Carotid Endarterectomy Trial): stenosis of 30-49% (mild), stenosis of 50-69% (moderate), and stenosis of 70-99% (severe). RESULTS This prospective cohort study involved 644 patients. The mean stenosis in the mild stenosis group (n = 128 patients) was 54% ECST (European Carotid Surgery Trial), 40% NASCET, and 72% ESs (endarterectomy specimens). The mean absolute difference between ECST and NASCET was 14%. The mean stenosis in the moderate stenosis group (n = 347 patients) was 66% ECST, 60% NASCET, and 77% ES. The mean absolute difference between ECST and NASCET was 6%. The mean stenosis in the severe group (n = 169 patients) was 80% ECST, 76% NASCET, and 79% ES. No significant correlation coefficients were found between DSA and ES methods. In the mild group, the CC was 0.16 (ESCT) and 0.13 (NASCET); in the moderate group, the CC was 0.05 (ESCT) and 0.01 (NASCET); and in the severe group, the CC was 0.23 (ESCT) and 0.10 (NASCET). For all groups combined, CC was 0.22 for the ECST and 0.20 for the NASCET method. CONCLUSION The relationship between DSA and ES methods to measure CS is almost random. This lack of a relationship between the DSA and ES techniques questions the validity of current DSA-based guidelines.
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Affiliation(s)
- Norbert Svoboda
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenské nemocnice 1200/2, Prague 6, 16000, Czech Republic.
| | - Ondrej Bradac
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenské nemocnice 1200/2, Prague 6, 16000, Czech Republic
| | - Vaclav Mandys
- Department of Pathology, Third Faculty of Medicine - Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenské nemocnice 1200/2, Prague 6, 16000, Czech Republic
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenské nemocnice 1200/2, Prague 6, 16000, Czech Republic
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Soukup J, Manethova M, Faistova H, Krbal L, Vitovcova B, Hornychova H, Drugda J, Cesak T, Netuka D, Gabalec F, Ryska A. Pitx2 is a useful marker of midgut‐derived neuroendocrine tumours ‐ an immunohistochemical study of 224 cases. Histopathology 2022; 81:799-807. [DOI: 10.1111/his.14789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/03/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jiri Soukup
- The Fingerland Department of Pathology, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Czech Republic
| | - Monika Manethova
- The Fingerland Department of Pathology, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Czech Republic
| | - Hana Faistova
- The Fingerland Department of Pathology, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Czech Republic
| | - Lukas Krbal
- The Fingerland Department of Pathology, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Czech Republic
| | - Barbora Vitovcova
- Department of Medical Biology and Genetics Charles University Faculty of Medicine Hradec Kralove Czech Republic
| | - Helena Hornychova
- The Fingerland Department of Pathology, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Czech Republic
| | - Jan Drugda
- 4th Department of Internal Medicine, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Czech Republic
| | - Tomas Cesak
- Department of Neurosurgery, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Medical Faculty, Charles University Military University Hospital Prague Prague Czech Republic
| | - Filip Gabalec
- 4th Department of Internal Medicine, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Czech Republic
| | - Ales Ryska
- The Fingerland Department of Pathology, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Czech Republic
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Etminan N, de Sousa DA, Tiseo C, Bourcier R, Desal H, Lindgren A, Koivisto T, Netuka D, Peschillo S, Lémeret S, Lal A, Vergouwen MDI, Rinkel GJE. European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms. Eur Stroke J 2022; 7:V. [PMID: 36082246 PMCID: PMC9446328 DOI: 10.1177/23969873221099736] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/25/2022] [Indexed: 07/30/2023] Open
Abstract
Unruptured intracranial aneurysms (UIA) occur in around 3% of the population. Important management questions concern if and how to perform preventive UIA occlusion; if, how and when to perform follow up imaging and non-interventional means to reduce the risk of rupture. Using the Standard Operational Procedure of ESO we prepared guidelines according to GRADE methodology. Since no completed randomised trials exist, we used interim analyses of trials, and meta-analyses of observational and case-control studies to provide recommendations to guide UIA management. All recommendations were based on very low evidence. We suggest preventive occlusion if the estimated 5-year rupture risk exceeds the risk of preventive treatment. In general, we cannot recommend endovascular over microsurgical treatment, but suggest flow diverting stents as option only when there are no other low-risk options for UIA repair. To detect UIA recurrence we suggest radiological follow up after occlusion. In patients who are initially observed, we suggest radiological monitoring to detect future UIA growth, smoking cessation, treatment of hypertension, but not treatment with statins or acetylsalicylic acid with the indication to reduce the risk of aneurysm rupture. Additionally, we formulated 15 expert-consensus statements. All experts suggest to assess UIA patients within a multidisciplinary setting (neurosurgery, neuroradiology and neurology) at centres consulting >100 UIA patients per year, to use a shared decision-making process based on the team recommendation and patient preferences, and to repair UIA only in centres performing the proposed treatment in >30 patients with (ruptured or unruptured) aneurysms per year per neurosurgeon or neurointerventionalist. These UIA guidelines provide contemporary recommendations and consensus statement on important aspects of UIA management until more robust data come available.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, University
Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Diana Aguiar de Sousa
- Stroke Centre, Centro Hospitalar
Universitário Lisboa Central, Lisbon, Portugal
- CEEM and Institute of Anatomy,
Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Cindy Tiseo
- Department of Neurology and Stroke
Unit, SS Filippo e Nicola Hospital, Avezzano, Italy
| | - Romain Bourcier
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nantes, INSERM, CNRS, Université
de Nantes, l’institut du thorax, France
| | - Hubert Desal
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nantes, INSERM, CNRS, Université
de Nantes, l’institut du thorax, France
| | - Anttii Lindgren
- Department of Clinical Radiology,
Kuopio University Hospital, Kuopio, Finland
- Department of Neurosurgery, Kuopio
University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School
of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio
University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School
of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - David Netuka
- Department of Neurosurgery and
Neurooncology, 1st Medical Faculty, Charles University, Praha, Czech Republic
| | - Simone Peschillo
- Department of Surgical Medical
Sciences and Advanced Technologies ‘G.F. Ingrassia’ - Endovascular Neurosurgery,
University of Catania, Catania, Italy
- Endovascular Neurosurgery, Pia
Fondazione Cardinale Giovanni Panico Hospital, Tricase, LE, Italy
| | | | - Avtar Lal
- European Stroke Organisation, Basel,
Switzerland
| | - Mervyn DI Vergouwen
- Department of Neurology and
Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
University, Utrecht, The Netherlands
| | - Gabriel JE Rinkel
- Department of Neurosurgery, University
Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
- Department of Neurology and
Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
University, Utrecht, The Netherlands
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28
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Petr O, Grassner L, Warner FM, Dedeciusová M, Voldřich R, Geiger P, Brawanski K, Gsellmann S, Meiners LC, Bauer R, Freigang S, Mokry M, Resch A, Kretschmer T, Rossmann T, Navarro FR, Stefanits H, Gruber A, Spendel M, Schwartz C, Griessenauer C, Marhold F, Sherif C, Wais JP, Rössler K, Zagata JJ, Ortler M, Pfisterer W, Mühlbauer M, Trivik-Barrientos FA, Burtscher J, Krška L, Lipina R, Kerekanič M, Fiedler J, Kasík P, Přibáň V, Tichý M, Beneš V, Krůpa P, Česák T, Kroupa R, Callo A, Haninec P, Pohlodek D, Krahulík D, Sejkorová A, Sameš M, Dvořák J, Juričeková A, Buchvald P, Tomáš R, Klener J, Juráň V, Smrčka M, Linzer P, Kaiser M, Hrabovský D, Jančálek R, Kramer JLK, Thomé C, Netuka D. Current trends and outcomes of non-elective neurosurgical care in Central Europe during the second year of the COVID-19 pandemic. Sci Rep 2022; 12:14631. [PMID: 36030282 PMCID: PMC9420122 DOI: 10.1038/s41598-022-18426-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Abstract
Reflecting the first wave COVID-19 pandemic in Central Europe (i.e. March 16th–April 15th, 2020) the neurosurgical community witnessed a general diminution in the incidence of emergency neurosurgical cases, which was impelled by a reduced number of traumatic brain injuries (TBI), spine conditions, and chronic subdural hematomas (CSDH). This appeared to be associated with restrictions imposed on mobility within countries but also to possible delayed patient introduction and interdisciplinary medical counseling. In response to one year of COVID-19 experience, also mapping the third wave of COVID-19 in 2021 (i.e. March 16 to April 15, 2021), we aimed to reevaluate the current prevalence and outcomes for emergency non-elective neurosurgical cases in COVID-19-negative patients across Austria and the Czech Republic. The primary analysis was focused on incidence and 30-day mortality in emergency neurosurgical cases compared to four preceding years (2017–2020). A total of 5077 neurosurgical emergency cases were reviewed. The year 2021 compared to the years 2017–2019 was not significantly related to any increased odds of 30 day mortality in Austria or in the Czech Republic. Recently, there was a significant propensity toward increased incidence rates of emergency non-elective neurosurgical cases during the third COVID-19 pandemic wave in Austria, driven by their lower incidence during the first COVID-19 wave in 2020. Selected neurosurgical conditions commonly associated with traumatic etiologies including TBI, and CSDH roughly reverted to similar incidence rates from the previous non-COVID-19 years. Further resisting the major deleterious effects of the continuing COVID-19 pandemic, it is edifying to notice that the neurosurgical community´s demeanor to the recent third pandemic culmination keeps the very high standards of non-elective neurosurgical care alongside with low periprocedural morbidity. This also reflects the current state of health care quality in the Czech Republic and Austria.
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Affiliation(s)
- Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria. .,Department of Neurosurgery and Neuro-Oncology, 1st Medical Faculty, Central Military Hospital, Charles University, Prague, Czech Republic.
| | - Lukas Grassner
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Freda M Warner
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Michaela Dedeciusová
- Department of Neurosurgery and Neuro-Oncology, 1st Medical Faculty, Central Military Hospital, Charles University, Prague, Czech Republic
| | - Richard Voldřich
- Department of Neurosurgery and Neuro-Oncology, 1st Medical Faculty, Central Military Hospital, Charles University, Prague, Czech Republic
| | - Philipp Geiger
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | | | - Sina Gsellmann
- Department of Neurosurgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Laura C Meiners
- Department of Neurosurgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Richard Bauer
- Department of Neurosurgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Sascha Freigang
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Michael Mokry
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Alexandra Resch
- Department of Neurosurgery & Neurorestauration, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Thomas Kretschmer
- Department of Neurosurgery & Neurorestauration, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Tobias Rossmann
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | - Francisco Ruiz Navarro
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | - Harald Stefanits
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | - Mathias Spendel
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Christoph Schwartz
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Christoph Griessenauer
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Franz Marhold
- Department of Neurosurgery, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Camillo Sherif
- Department of Neurosurgery, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Jonathan P Wais
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Jakob J Zagata
- Unit of Neurosurgery, Klinik Landstrasse, Vienna, Austria
| | - Martin Ortler
- Unit of Neurosurgery, Klinik Landstrasse, Vienna, Austria
| | | | | | | | - Johannes Burtscher
- Department of Neurosurgery, General Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Lukáš Krška
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Kerekanič
- Department of Neurosurgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - Jiří Fiedler
- Department of Neurosurgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - Petr Kasík
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Vladimír Přibáň
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Michal Tichý
- Department of Neurosurgery, Motol University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery, Motol University Hospital, Prague, Czech Republic
| | - Petr Krůpa
- Department of Neurosurgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Tomáš Česák
- Department of Neurosurgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Robert Kroupa
- Unit of Neurosurgery, Municipal Hospital - Ostrava Fifejdy, Ostrava, Czech Republic
| | - Andrej Callo
- Department of Neurosurgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Haninec
- Department of Neurosurgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Daniel Pohlodek
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - David Krahulík
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Alena Sejkorová
- Department of Neurosurgery, Usti Nad Labem Hospital, Usti Nad Labem, Czech Republic
| | - Martin Sameš
- Department of Neurosurgery, Usti Nad Labem Hospital, Usti Nad Labem, Czech Republic
| | - Josef Dvořák
- Department of Neurosurgery, Liberec Hospital, Liberec, Czech Republic
| | | | - Pavel Buchvald
- Department of Neurosurgery, Liberec Hospital, Liberec, Czech Republic
| | - Robert Tomáš
- Unit of Neurosurgery, Homolka Hospital, Prague, Czech Republic
| | - Jan Klener
- Unit of Neurosurgery, Homolka Hospital, Prague, Czech Republic
| | - Vilém Juráň
- Department of Neurosurgery, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Martin Smrčka
- Department of Neurosurgery, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Petr Linzer
- Unit of Neurosurgery, Zlin Hospital, Zlin, Czech Republic
| | - Miroslav Kaiser
- Unit of Neurosurgery, Pardubice Hospital, Pardubice, Czech Republic
| | - Dušan Hrabovský
- Department of Neurosurgery, St. Anne's University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Radim Jančálek
- Department of Neurosurgery, St. Anne's University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - David Netuka
- Department of Neurosurgery and Neuro-Oncology, 1st Medical Faculty, Central Military Hospital, Charles University, Prague, Czech Republic
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Školoudík D, Kešnerová P, Hrbáč T, Netuka D, Vomáčka J, Langová K, Herzig R, Belšan T. Risk factors for carotid plaque progression after optimising the risk factor treatment: substudy results of the Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the carotid Bifurcation Plaque Study (ANTIQUE). Stroke Vasc Neurol 2022; 7:132-139. [PMID: 34853082 PMCID: PMC9067273 DOI: 10.1136/svn-2021-001068] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Carotid plaque progression contributes to increasing stroke risk. The study aims to identify factors influencing carotid plaque thickness progression after changing the preventive treatment to the 'treating arteries instead of risk factors' strategy, that is, change in treatment depending on the progression of atherosclerosis. METHODS The study participants who completed sonographic controls over the course of 3 years were enrolled to the analysis. Duplex sonography of cervical arteries was performed in 6-month intervals with measurement of carotid plaque thickness. Plaque thickness measurement error (σ) was set as 3 SD. Only evidently stable and progressive plaques (defined as plaque thickness difference between initial and final measurements of ˂σ and >2σ, respectively) were included to analysis. Univariate and multivariate logistic regression analysis was performed to identify factors influencing plaque progression. RESULTS A total of 1391 patients (466 males, age 67.2±9.2 years) were enrolled in the study. Progressive plaque in at least one carotid artery was detected in 255 (18.3%) patients. Older age, male sex, greater plaque thickness, coronary heart disease, vascular surgery/stenting history and smoking were more frequently present in patients with progressive plaque (p˂0.05 in all cases). Multivariate logistic regression analysis identified only the plaque thickness (OR 1.850 for left side, 95% CI 1.398 to 2.449; and OR 1.376 for right side, 95% CI 1.070 to 1.770) as an independent factor influencing plaque progression. CONCLUSION Carotid plaque thickness corresponding to stenosis severity is the only independent risk factor for plaque thickness progression after optimising the prevention treatment. TRIAL REGISTRATION NUMBER NCT02360137.
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Affiliation(s)
- David Školoudík
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Petra Kešnerová
- Department of Neurology, Second Faculty of Medicine, Charles University, Praha, Czech Republic
- Department of Neurology, Motol University Hospital, Praha, Czech Republic
| | - Tomáš Hrbáč
- Department of Neurosurgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Netuka
- Department of Neurosurgery, Military University Hospital Prague, Praha, Czech Republic
| | - Jaroslav Vomáčka
- Department of Radiological Assistance, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
- Deaprtment of Radiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Kateřina Langová
- Department of Biophysics, Faculty of Medicine, Palacký University Olomouc, Olomouc, Czech Republic
| | - Roman Herzig
- Department of Neurology, University Hospital Hradec Králové, Hradec Kralove, Czech Republic
- Department of Neurology, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Tomáš Belšan
- Department of Radiology, Military University Hospital Prague, Praha, Czech Republic
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Svoboda N, Voldřich R, Mandys V, Hrbáč T, Kešnerová P, Roubec M, Školoudík D, Netuka D. Histological analysis of carotid plaques: The predictors of stroke risk. J Stroke Cerebrovasc Dis 2022; 31:106262. [DOI: 10.1016/j.jstrokecerebrovasdis.2021.106262] [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: 10/19/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
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31
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Kešnerová P, Školoudík D, Herzig R, Netuka D, Szegedi I, Langová K. Peripheral Vascular Resistance in Cerebral Arteries in Patients With Carotid Atherosclerosis - Substudy Results of the Atherosclerotic Plaque Characteristics Associated With a Progression Rate of the Plaque and a Risk of Stroke in Patients With the Carotid Bifurcation Plaque Study (ANTIQUE). J Ultrasound Med 2022; 41:237-246. [PMID: 33792942 DOI: 10.1002/jum.15703] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/23/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Transcranial color-coded duplex sonography (TCCS) enables to measure blood flow characteristics in cerebral vessels, including vascular resistance and pulsatility. The study aims to identify factors influencing pulsatility (PI) and resistance (RI) indices measured using TCCS in patients with carotid atherosclerosis. METHODS Self-sufficient patients with atherosclerotic plaque causing 20-70% carotid stenosis were consecutively enrolled to the study. All patients underwent duplex sonography of cervical arteries and TCCS with measurement of PI and RI in the middle cerebral artery, neurological, and physical examinations. Following data were recorded: age, gender, height, weight, body mass index, systolic and diastolic blood pressure, occurrence of current and previous diseases, surgery, medication, smoking, and daily dose of alcohol. Univariant and multivariant logistic regression analysis were used for identification of the factors influencing RI and PI. RESULTS Totally 1863 subjects were enrolled to the study: 139 healthy controls (54 males, age 55.52 ± 7.05 years) in derivation cohort and 1724 patients (777 males, age 68.73 ± 9.39 years) in validation cohort. The cut off value for RI was 0.63 and for PI 1.21. Independent factors for increased RI/PI were age (odds ratio [OR] = 1.108/1.105 per 1 year), occurrence of diabetes mellitus (OR = 1.767/2.170), arterial hypertension (OR = 1.700 for RI only), width of the carotid plaque (OR = 1.260 per 10% stenosis for RI only), and male gender (OR = 1.530 for PI only; P ˂.01 in all cases). CONCLUSIONS The independent predictors of increased cerebral arterial resistance and/or pulsatility in patients with carotid atherosclerosis were age, arterial hypertension, diabetes mellitus, carotid plaque width, and male gender.
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Affiliation(s)
- Petra Kešnerová
- Department of Neurology, Comprehensive Stroke Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Neurology, Comprehensive Stroke Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Školoudík
- Department of Neurology, Comprehensive Stroke Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Center for Health Research, Ostrava University Medical Faculty, Ostrava, Czech Republic
- Department of Neurology, Stroke Center, Vítkovice Hospital, Ostrava, Czech Republic
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - David Netuka
- Department of Neurosurgery, First Faculty of Medicine and University Military Hospital Prague, Prague-Střešovice, Czech Republic
| | - Istvan Szegedi
- Department of Neurology, Debrecen University Faculty of Medicine and University Hospital Debrecen, Debrecen, Hungary
| | - Kateřina Langová
- Department of Biophysics, Faculty of Medicine and Dentistry, Institute of Molecular and Translational Medicine, Palacký University, Olomouc, Czech Republic
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Netuka D, Grotenhuis A, Foroglou N, Zenga F, Froehlich S, Ringel F, Sampron N, Thomas N, Komarc M, Majovsky M. Pituitary Adenoma Surgery Survey: Neurosurgical Centers and Pituitary Adenomas. Int J Endocrinol 2022; 2022:7206713. [PMID: 35449513 PMCID: PMC9017568 DOI: 10.1155/2022/7206713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Pituitary adenoma surgery has evolved rapidly in recent decades. This study aims to determine current practice across a wide range of European neurosurgical centers. METHODS A list of eligible departments performing pituitary adenoma surgery was created. The survey consisted of 58 questions. For analysis, the departments were divided into four subgroups: academic/nonacademic, high-volume/low-volume, "mainly endoscopic/mainly microscopic practice," and geographical regions. RESULTS Data from 254 departments from 34 countries were obtained. In 108 centers (42.5%), <30 pituitary adenomas were operated per year. Twenty (7.9%) centers performed >100 adenoma surgeries per year. Number of neurosurgeons performing endonasal surgeries are as follows: 1 in 24.9% of centers and 2 in 49.8% of centers. All residents assisted endonasal surgeries in 126 centers (49.8%). In 28 centers (21.1%), all residents performed endonasal surgery under supervision during residency. In 141 centers (56.8%), the endoscopic approach was used in >90% of the surgeries. Regular pituitary board (either weekly or once a month) meetings were held in 147 centers (56.3%). Nonfunctioning adenomas represent >70% of pituitary caseload in 149 centers (58.7%). CONCLUSIONS In our survey, most centers perform less than 100 surgeries for pituitary adenomas. In most centers, pituitary surgeries are performed by one or two neurosurgeons. Residents have a limited exposure to this type of surgery, and the formal pituitary board is not a standard. Nonfunctioning adenomas make up most of surgically treated adenomas. This study can serve as a benchmark for further analyses of pituitary adenoma centers in Europe.
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Affiliation(s)
- David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Andre Grotenhuis
- Department of Neurosurgery, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
| | - Nicolas Foroglou
- 1st Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Francesco Zenga
- Department of Neuroscience “Rita Levi Montalcini”, Neurosurgery Unit, University of Turin, Turin, Italy
| | | | - Florian Ringel
- Department of Neurosurgery, Johannes Gutenberg-Universitat Mainz, Mainz, Germany
| | - Nicolas Sampron
- Neurosurgery Department, University Hospital Donostia, San Sebastian, Donostia, Spain
| | - Nick Thomas
- Department of Neurosurgery, Kings College, London, UK
| | - Martin Komarc
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Martin Majovsky
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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Balaziova E, Vymola P, Hrabal P, Mateu R, Tomas R, Netuka D, Zemanova Z, Svobodova K, Sedo A, Busek P. P16.12 Proangiogenic effect of fibroblast activation protein positive stromal cells derived from human glioblastomas. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Increased expression of fibroblast activation protein (FAP) is characteristic for several cancer types including human glioblastomas (GBM). FAP is expressed on both cancer as well as stromal cells which were demonstrated in extracranial tumors to maintain a microenvironment permissive for tumor growth and thus to contribute to tumor progression. FAP is considered a potential diagnostic and therapeutic target and several approaches for its targeting have been recently developed. In this work, we investigated the role of FAP+ stromal cells in glioblastoma angiogenesis.
MATERIAL AND METHODS
Expression of FAP and other phenotypic markers was assessed by immunocytochemistry and immunohistochemistry. FAP+ stromal cells and primary microvascular endothelial cells were isolated using magnetic activated cell sorting (MACS). Genetic aberrations were assayed by comparative genomic hybridization/single-nucleotide polymorphism analysis. Angiogenesis was evaluated using a 3D spheroid-based sprouting assay and a chorioallantoic membrane assay. A cytokine array was used to analyze soluble mediators released by FAP+ stromal cells.
RESULTS
FAP+ stromal cells were predominantly localized around activated CD105+ endothelial cells and their quantity positively correlated with glioblastoma vascularization. FAP+ stromal cells derived from human GBMs had a mesenchymal phenotype, were non-tumorigenic and in most cases lacked cytogenetic aberrations characteristic of GBMs. Conditioned media derived from FAP+ stromal cells induced angiogenic sprouting of both macrovascular HUVEC as well as microvascular primary endothelial cells derived from human GBMs. In a chorioallantoic membrane assay, admixture of FAP+ stromal cells to glioma cells was associated with increased angiogenesis and more frequent occurrence of hemorrhages. Cytokine array revealed a significant disbalance between several proangiogenic and antiangiogenic mediators compared to normal pericytes, and an increased Angiopoietin 2/1 ratio in conditioned media from FAP+ stromal cells.
CONCLUSION
Our results bring new evidence that GBM associated FAP+ stromal cell promote angiogenesis by changing the balance between proangiogenic and antiangiogenic mediators and thus they may contribute to glioblastoma progression.
ACKNOWLEDGEMENT
Supported by Progres Q28/1LFUK and grant LM2015064 of the EATRIS-CZ and the Center for Tumor Ecology (CZ.02.1.01/0.0/0.0/16_019/0000785).
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Affiliation(s)
- E Balaziova
- First faculty of medicine, Prague 2, Czech Republic
| | - P Vymola
- First faculty of medicine, Prague 2, Czech Republic
| | - P Hrabal
- Department of Pathology, Military University Hospital Prague, Prague 6, Czech Republic
| | - R Mateu
- First faculty of medicine, Prague 2, Czech Republic
| | - R Tomas
- Departments of Neurosurgery, Na Homolce Hospital, Prague 5, Czech Republic
| | - D Netuka
- Department of Neurosurgery, Military University Hospital, Prague 6, Czech Republic
| | - Z Zemanova
- Center of oncocytogenetics, Institute of medical biochemistry and laboratory diagnostics of the General university hospital and of the First faculty of medicine of Charles university, Prague 2, Czech Republic
| | - K Svobodova
- Center of oncocytogenetics, Institute of medical biochemistry and laboratory diagnostics of the General university hospital and of the First faculty of medicine of Charles university, Prague 2, Czech Republic
| | - A Sedo
- First faculty of medicine, Prague 2, Czech Republic
| | - P Busek
- First faculty of medicine, Prague 2, Czech Republic
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Májovský M, Grotenhuis A, Foroglou N, Zenga F, Froehlich S, Ringel F, Sampron N, Thomas N, Komarc M, Netuka D. What is the current clinical practice in pituitary adenoma surgery in Europe? European Pituitary Adenoma Surgery Survey (EU-PASS) results-technical part. Neurosurg Rev 2021; 45:831-841. [PMID: 34337683 DOI: 10.1007/s10143-021-01614-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/13/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Pituitary adenoma surgery has evolved rapidly in recent decades, changing clinical practice markedly and raising new challenges. There is no current consensus or guidelines for perioperative care that includes possible complication management. This study aims to determine current practice across European neurosurgical centres. We created a list of eligible departments performing pituitary adenoma surgery based on cooperation with EANS, national neurosurgical societies, and personal communication with local neurosurgeons. We contacted the chairpersons from each department and asked them (or another responsible neurosurgeon) to fill out the survey. The survey consisted of 58 questions. For further analysis, departments were divided into subgroups: "academic"/ "non-academic centre", "high-volume"/"low-volume", "mainly endoscopic"/ "mainly microscopic"/ "mixed practise", and by geographical regions. Data from 254 departments from 34 countries were obtained. The average time to complete the survey was 18 min. Notably, the endoscopic approach is the predominant surgical approach in Europe, used in 56.8% of the centres. In routine cases without intraoperative cerebrospinal fluid leak, high-volume centres are less pedantic with sellar closure when compared with low-volume centres (p < 0.001). On the other hand, when a postoperative cerebrospinal fluid leak occurs, high-volume centres are more active and indicate early reoperation (p = 0.013). Less than 15% of the participating centres perform early postoperative MRI scans. Marked variation was noted among different groups of respondents and some contentious issues are discussed. Such information can encourage useful debate about the reasons for the variations seen and perhaps help develop standardised protocols to improve patient outcomes. A future research focus is to compare European results with other regions.
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Affiliation(s)
- Martin Májovský
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Andre Grotenhuis
- Neurosurgery Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicolas Foroglou
- 1St Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Francesco Zenga
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | - Florian Ringel
- Department of Neurosurgery, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Nicolas Sampron
- Neurosurgery Department, University Hospital Donostia, San Sebastian, Spain
| | - Nick Thomas
- Department of Neurosurgery, King's College, London, UK
| | - Martin Komarc
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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Balaziova E, Vymola P, Hrabal P, Mateu R, Zubal M, Tomas R, Netuka D, Kramar F, Zemanova Z, Svobodova K, Brabec M, Sedo A, Busek P. Fibroblast Activation Protein Expressing Mesenchymal Cells Promote Glioblastoma Angiogenesis. Cancers (Basel) 2021; 13:cancers13133304. [PMID: 34282761 PMCID: PMC8267680 DOI: 10.3390/cancers13133304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/31/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary The perivascular niche in glioblastoma is crucial for maintaining a tumour- permissive microenvironment. In various extracranial cancers, mesenchymal cells that express fibroblast activation protein (FAP) are an important stromal component and a potential therapeutic target. In this study, we examine their functions in the glioblastoma microenvironment where their role is so far largely unexplored. Glioblastoma-associated FAP+ mesenchymal cells are localised around activated endothelial cells and their presence positively correlates with vascular density. They represent a subpopulation of stromal, non-tumorigenic cells which mostly lack the chromosomal aberrations characteristic of glioma cells. By soluble factors they induce angiogenic sprouting, chemotaxis of endothelial cells, contribute to destabilisation of blood vessels, and increase the migration and growth of glioma cells. Taken together, we identified a subpopulation of FAP+ mesenchymal cells in the perivascular niche in glioblastoma that may contribute to tumour progression by promoting angiogenesis and supporting dissemination of transformed cells into the surrounding tissue. Abstract Fibroblast activation protein (FAP) is a membrane-bound protease that is upregulated in a wide range of tumours and viewed as a marker of tumour-promoting stroma. Previously, we demonstrated increased FAP expression in glioblastomas and described its localisation in cancer and stromal cells. In this study, we show that FAP+ stromal cells are mostly localised in the vicinity of activated CD105+ endothelial cells and their quantity positively correlates with glioblastoma vascularisation. FAP+ mesenchymal cells derived from human glioblastomas are non-tumorigenic and mostly lack the cytogenetic aberrations characteristic of glioblastomas. Conditioned media from these cells induce angiogenic sprouting and chemotaxis of endothelial cells and promote migration and growth of glioma cells. In a chorioallantoic membrane assay, co-application of FAP+ mesenchymal cells with glioma cells was associated with enhanced abnormal angiogenesis, as evidenced by an increased number of erythrocytes in vessel-like structures and higher occurrence of haemorrhages. FAP+ mesenchymal cells express proangiogenic factors, but in comparison to normal pericytes exhibit decreased levels of antiangiogenic molecules and an increased Angiopoietin 2/1 ratio. Our results show that FAP+ mesenchymal cells promote angiogenesis and glioma cell migration and growth by paracrine communication and in this manner, they may thus contribute to glioblastoma progression.
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Affiliation(s)
- Eva Balaziova
- Laboratory of Cancer Cell Biology, Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (E.B.); (P.V.); (R.M.); (M.Z.)
| | - Petr Vymola
- Laboratory of Cancer Cell Biology, Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (E.B.); (P.V.); (R.M.); (M.Z.)
| | - Petr Hrabal
- Department of Pathology, Military University Hospital, 169 02 Prague, Czech Republic;
| | - Rosana Mateu
- Laboratory of Cancer Cell Biology, Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (E.B.); (P.V.); (R.M.); (M.Z.)
| | - Michal Zubal
- Laboratory of Cancer Cell Biology, Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (E.B.); (P.V.); (R.M.); (M.Z.)
| | - Robert Tomas
- Departments of Neurosurgery, Na Homolce Hospital, 150 00 Prague, Czech Republic;
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, 168 02 Prague, Czech Republic; (D.N.); (F.K.)
| | - Filip Kramar
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, 168 02 Prague, Czech Republic; (D.N.); (F.K.)
| | - Zuzana Zemanova
- Center of Oncocytogenomics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (Z.Z.); (K.S.)
| | - Karla Svobodova
- Center of Oncocytogenomics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (Z.Z.); (K.S.)
| | - Marek Brabec
- Institute of Computer Science, The Czech Academy of Sciences, 128 00 Prague, Czech Republic;
| | - Aleksi Sedo
- Laboratory of Cancer Cell Biology, Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (E.B.); (P.V.); (R.M.); (M.Z.)
- Correspondence: (A.S.); (P.B.)
| | - Petr Busek
- Laboratory of Cancer Cell Biology, Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (E.B.); (P.V.); (R.M.); (M.Z.)
- Correspondence: (A.S.); (P.B.)
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Školoudík D, Kešnerová P, Vomáčka J, Hrbáč T, Netuka D, Forostyak S, Roubec M, Herzig R, Belšan T. Shear-Wave Elastography Enables Identification of Unstable Carotid Plaque. Ultrasound Med Biol 2021; 47:1704-1710. [PMID: 33931284 DOI: 10.1016/j.ultrasmedbio.2021.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
Shear-wave elastography (SWE) is a novel ultrasound technique for quantifying tissue elasticity. The aim of this study was to identify differences in atherosclerotic plaque elasticity measured using SWE among individuals with symptomatic, asymptomatic progressive and asymptomatic stable carotid plaques. Consecutive patients from the Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the Carotid Bifurcation Plaque Study were screened for this research. Neurosonography examination of carotid arteries was performed to identify plaque stenosis of ≥50% using B-mode ultrasound and SWE imaging to measure the mean, maximal and minimal elasticity. The set consisted of 97 participants-74 with asymptomatic stable stenosis, 12 with asymptomatic progressive stenosis and 11 with symptomatic stenosis. The mean elasticity in the asymptomatic stable plaque group was significantly higher than in the asymptomatic progressive (52.2 vs. 30.4 kPa; p < 0.001) and symptomatic (52.2 vs. 36.4 kPa; p = 0.033) plaque groups. No significant differences were found between asymptomatic progressive and symptomatic (p > 0.1) plaque groups. Asymptomatic stable, asymptomatic progressive and symptomatic plaques did not differ in echogenicity, calcifications, homogeneity, occurrence of ulcerated surface, or intra-plaque hemorrhage (p > 0.05 in all cases). SWE was a helpful modality for differentiating between stable and unstable atherosclerotic plaques in carotid arteries.
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Affiliation(s)
- David Školoudík
- Center for Health Research, Ostrava University Medical Faculty, Ostrava, Czech Republic; Stroke Center, Vítkovice Hospital, Ostrava, Czech Republic; Comprehensive Stroke Center, Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic; Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic.
| | - Petra Kešnerová
- Comprehensive Stroke Center, 2(nd) Medical Faculty, Charles University Prague and University Hospital Motol, Prague, Czech Republic
| | - Jaroslav Vomáčka
- Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Tomáš Hrbáč
- Comprehensive Stroke Center, Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Netuka
- Comprehensive Stroke Center, Department of Neurosurgery, Military Teaching Hospital Prague, Prague, Czech Republic
| | | | - Martin Roubec
- Comprehensive Stroke Center, Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Tomáš Belšan
- Comprehensive Stroke Center, Department of Radiology, Military Teaching Hospital Prague, Prague, Czech Republic
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Voldřich R, Netuka D, Charvát F, Beneš V. Long-term stability of Onyx: is there any indication for repeated angiography after dural arteriovenous fistula embolization? J Neurosurg 2021; 136:175-184. [PMID: 34171837 DOI: 10.3171/2020.12.jns203811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/19/2020] [Accepted: 12/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The natural course of dural arteriovenous fistulas (DAVFs) is unfavorable. Transarterial embolization with Onyx is currently the therapeutic method of choice, although the long-term stability of Onyx has been questioned. The literature reports a significant difference in the recurrence rate after complete DAVF occlusion and lacks larger series with long-term follow-up. The authors present the largest series to date with a long-term follow-up to determine the stability of Onyx, prospectively comparing magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) as follow-up diagnostic methods. METHODS Demographics, clinical symptomatology, length of follow-up, diagnostic methods, and angiographic findings of DAVFs were recorded and retrospectively evaluated in 112 patients. A prospective group of 15 patients with more than 5 years of follow-up after complete DAVF occlusion was established. All 15 patients in the prospective group underwent a clinical examination and MRA; 10 of these patients also underwent DSA. The recurrences and the correlation between the two diagnostic methods were evaluated. RESULTS Among the 112 patients, 71 were men and 41 were women, with an average age of 60 years. Intracranial hemorrhage (40%) was the most common clinical presentation of DAVF. At the last follow-up, 73% of the patients experienced clinical improvement, 21% remained unchanged, and 6% worsened. Overall, 87.5% of the DAVFs were occluded entirely with endovascular treatment, and 93% of the DAVFs were classified as cured at the last follow-up (i.e., completely embolized DAVFs and DAVFs that thrombosed spontaneously or after Gamma Knife surgery). Two recurrences of DAVFs were recorded in the entire series. Both were first diagnosed by MRA and confirmed with DSA. The mean follow-up was 27.7 months. In the prospective group, a small asymptomatic recurrence was diagnosed. The mean follow-up of the prospective group was 96 months. CONCLUSIONS Onyx is a stable embolic material, although recurrence of seemingly completely occluded DAVFs may develop because of postembolization hemodynamic changes that accentuate primarily graphically absent residual fistula. These residuals can be diagnosed with MRA at follow-up. The authors' data suggest that MRA could be sufficient as the follow-up diagnostic method after complete DAVF occlusion with Onyx. However, larger prospective studies on this topic are needed.
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Affiliation(s)
- Richard Voldřich
- 1Department of Neurosurgery and Neurooncology, Charles University in Prague, First Medical Faculty, Central Military Hospital; and
| | - David Netuka
- 1Department of Neurosurgery and Neurooncology, Charles University in Prague, First Medical Faculty, Central Military Hospital; and
| | - František Charvát
- 2Department of Neuroradiology, Central Military Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- 1Department of Neurosurgery and Neurooncology, Charles University in Prague, First Medical Faculty, Central Military Hospital; and
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Abstract
BACKGROUND Pineal apoplexy is a rare condition, with unknown incidence and clinical significance. To elucidate this clinical condition, we analyzed our own case series and performed a review of the literature. METHODS We enrolled all patients with a hemorrhagic pineal apoplexy who were referred to our department between January 2000 and January 2020. Hemorrhagic pineal apoplexy was defined as the presence of fluid-fluid levels inside the pineal cyst (PC) on an axial or sagittal magnetic resonance scan. In one patient, after PC apoplexy, we performed a circadian melatonin sampling from peripheral blood to determine the function of the pineal gland. The PubMed database was searched for publications using the terms "pineal" and "apoplexy." RESULTS Eight patients were enrolled, of which three patients underwent surgical treatment and five patients were managed conservatively. One patient was tested for circadian melatonin secretion. Results confirmed melatonin secretion with preserved physiologic circadian rhythm.Our search of the literature led us to 31 studies that comprised 30 patients with apoplectic PC, 9 with apoplectic pineal tumor, and 1 with bleeding into the normal pineal gland. Most patients presented with headache, nausea, and vomiting, less frequently with acute hydrocephalus and gaze palsy. Twenty patients with a PC underwent resection or aspiration. Two patients underwent shunt placement as the only procedure and five received both shunt and surgical removal. Six patients with a PC were observed without surgical treatment. All the nine patients with a pineal tumor were operated on. In indicated cases, four patients received radiation therapy and one received chemotherapy. CONCLUSION Clinical significance of hemorrhagic pineal apoplexy ranges from an asymptomatic course to rapid deterioration and death. In patients with mild symptoms, observation is indicated, whereas surgical treatment is reserved for severe cases presenting with obstructive hydrocephalus and includes cerebrospinal fluid diversion, resection of apoplectic pineal lesions, or both.
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Affiliation(s)
- Martin Majovsky
- Department of Neurosurgery and Neurooncology, First Medical School, Charles University, Military University Hospital Prague, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Medical School, Charles University, Military University Hospital Prague, Prague, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jan Mraček
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen - Pilsen, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, First Medical School, Charles University, Military University Hospital Prague, Prague, Czech Republic
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Soukup J, Cesak T, Hornychova H, Manethova M, Michnova L, Netuka D, Vitovcova B, Cap J, Ryska A, Gabalec F. Cytokeratin 8/18-negative somatotroph pituitary neuroendocrine tumours (PitNETs, adenomas) show variable morphological features and do not represent a clinicopathologically distinct entity. Histopathology 2021; 79:406-415. [PMID: 33738859 DOI: 10.1111/his.14366] [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: 02/08/2021] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
AIMS In somatotroph pituitary neuroendocrine tumours (adenomas), a pattern of cytokeratin (CK) 18 expression is used for tumour subclassification, with possible clinical implications. Rare somatotroph tumours do not express CK 18. We aimed to characterise this subset clinically and histologically. METHODS AND RESULTS Clinical and pathological data for the study were derived from a previously published data set of a cohort of 110 patients with acromegaly. Data included serum levels of insulin-like growth factor 1 (IGF1), growth hormone (GH), prolactin and thyroid-stimulating hormone (TSH), tumour diameter, tumour invasion defined by Knosp grade and immunohistochemical data concerning the expression of Ki67, p53, E-cadherin, somatostatin receptor (SSTR)1, SSTR2A, SSTR3, SSTR5 and D2 dopamine receptor. Additional immunohistochemical analysis (AE1/3, CK 8/18, vimentin, neurofilament light chain, internexin-α) was performed. CK 18 was negative in 10 of 110 (9.1%) tumours. One of these tumours was immunoreactive with CK 8/18 antibody, while the remainder expressed only internexin-α intermediate filament in patterns similar to CK 18 (perinuclear fibrous bodies). CK-negative tumours showed no significant differences with respect to biochemical, radiological or pathological features. They showed significantly higher expression of SSTR2A compared to the sparsely granulated subtype and significantly lower expression of E-cadherin compared to the non-sparsely granulated subtypes of tumours. The tumours showed divergent morphology and hormonal expression: two corresponded to densely granulated tumours and three showed co-expression of prolactin and morphology of either mammosomatotroph or somatotroph-lactotroph tumours. Four tumours showed morphology and immunoprofile compatible with plurihormonal Pit1-positive tumours. CONCLUSIONS CK-negative somatotroph tumours do not represent a distinct subtype of somatotroph tumours, and can be further subdivided according to their morphology and immunoprofile.
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Affiliation(s)
- Jiri Soukup
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Tomas Cesak
- Department of Neurosurgery, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Helena Hornychova
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Monika Manethova
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Ludmila Michnova
- Department of Pathology, Military University Hospital Prague, Praha, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Medical Faculty, Charles University, Military University Hospital Prague, Prague, Czech Republic
| | - Barbora Vitovcova
- Department of Medical Biology and Genetics, Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jan Cap
- 4th Department of Internal Medicine, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Ales Ryska
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Filip Gabalec
- 4th Department of Internal Medicine, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
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Masopust V, Holubová J, Skalický P, Rokyta R, Fricová J, Lacman J, Netuka D, Patríková J, Janoušková K. Neuromodulation in the treatment of postoperative epidural fibrosis: comparison of the extent of epidural fibrosis and the effect of stimulation. Physiol Res 2021; 70:461-468. [PMID: 33982586 DOI: 10.33549/physiolres.934617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The goal was to prove that when a cohort of patients is chosen precisely, dorsal column stimulation provides significant improvement to quality of life. We studied a cohort of 50 patients with the history of failed back surgery syndrome coupled with epidural fibrosis (EF). A percutaneous implantation technique was used in each of the 50 patients. The study group was composed of 20 women and 28 men aged 26-67 years (mean age 49). A prospective observational questionnaire-based study was used. According to the methods, Ross's classification was adjusted to four degrees of scar size for our study objective. Despite this adjustment, it was not possible to statistically evaluate our research, due to very similar results in Groups I, III and IV. Patients without epidural fibrosis were assigned to Group 0, and patients with EF of different ranges were assigned to Group 1. The mean change in visual analogue scale DeltaVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and DeltaVAS correlation by paired t-test shows a statistically higher effect of spinal cord stimulation (SCS) in the epidural fibrosis group, compared to group 0 without postoperative epidural fibrosis (p=0.008). The extent of epidural fibrosis is an important factor for Failed back surgery syndrome (FBSS). FBSS is the basis for the existence of neuropathic pain after lumbar spinal surgery. There is clear evidence of a correlation between patients with epidural scar formation on MR scan and the effect of dorsal column stimulation.
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Affiliation(s)
- V Masopust
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague 6, Czech Republic.
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Dedeciusova M, Terrier LM, Netuka D, Benes V, Velut S. Hydrogen Peroxide Skull Base Specimen Preparation: Singular View of Hidden Topographic Anatomy. Turk Neurosurg 2021; 31:962-966. [PMID: 34542901 DOI: 10.5137/1019-5149.jtn.32790-20.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM The technical principles of the hydrogen peroxide head preparation method were recently presented. This article aims to demonstrate the high quality of anatomical studies performed using these specimens, particularly for arachnoid exploration. MATERIAL AND METHODS Five cadaveric heads were set with a 10% formalin solution and then injected with coloured latex. Thereafter, the heads were bleached with hydrogen peroxide solution 20%. Anatomical dissection of all specimens was performed. The skull base was drilled, dura mater gradually resected and outer arachnoid membranes examined and opened. The topographical anatomy was studied. RESULTS All soft tissues, the brain, cranial nerves, the vasculature, the dura mater and even the arachnoid, were macroscopically intact, which enabled high-quality skull base specimens. In addition, the bone was softened, facilitating the drilling process. The topographical anatomy of anterior clinoid process was selected as an example and depicted in photos. CONCLUSION High-quality anatomical specimens were obtained using the hydrogen peroxide head preparation. The topographic anatomy was studied from a unique downside-up angle, as well as by following the passage of the key neurovascular structures during its course. We propose the use of this method in neurosurgical training, especially to practice extradural approaches. Moreover, this method seems promising as a complementary method for arachnoid studies.
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Affiliation(s)
- Michaela Dedeciusova
- Military University Hospital Prague, Department of Neurosurgery and Neurooncology, The Czech Republic
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Turnovcova K, Marekova D, Sursal T, Krupova M, Gandhi R, Krupa P, Kaiser R, Herynek V, Netuka D, Jendelova P, Jhanwar-Uniyal M. Understanding the Biological Basis of Glioblastoma Patient-derived Spheroids. Anticancer Res 2021; 41:1183-1195. [PMID: 33788709 DOI: 10.21873/anticanres.14875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/16/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Resistance to glioblastoma (GB) therapy is attributed to the presence of glioblastoma stem cells (GSC). Here, we defined the behavior of GSC as it pertains to proliferation, migration, and angiogenesis. MATERIALS AND METHODS Human-derived GSC were isolated and cultured from GB patient tumors. Xenograft GSC were extracted from the xenograft tumors, and spheroids were created and compared with human GSC spheroids by flow cytometry, migration, proliferation, and angiogenesis assays. Oct3/4 and Sox2, GFAP, and Ku80 expression was assessed by immunoanalysis. RESULTS The xenograft model showed the formation of two different tumors with distinct characteristics. Tumors formed at 2 weeks were less aggressive with well-defined margins, whereas tumors formed in 5 months were diffuse and aggressive. Expression of Oct3/4 and Sox2 was positive in both human and xenograft GSC. Positive Ku80 expression in xenograft GSC confirmed their human origin. Human and xenograft GSC migrated vigorously in collagen and Matrigel, respectively. Xenograft GSC displayed a higher rate of migration and invasion than human GSC. CONCLUSION Human GSC were more aggressive in growth and proliferation than xenograft GSC, while xenograft GSC had increased invasion and migration compared to human GSC. A simple in vitro spheroid system for GSC provides a superior platform for the development of precision medicine in the treatment of GB.
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Affiliation(s)
- Karolína Turnovcova
- Department of Neuroregeneration Institute of Experimental Medicine Czech Academy of Science, Prague, Czech Republic
| | - Dana Marekova
- Department of Neuroregeneration Institute of Experimental Medicine Czech Academy of Science, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tolga Sursal
- Department of Neurosurgery, New York Medical College/Westchester Medical Center, Valhalla, NY, U.S.A
| | - Marketa Krupova
- The Fingerland Department of Pathology, Faculty of Medicine and University Hospital in Hradec Kralové, Charles University, Hradec Kralové, Czech Republic
| | - Ronan Gandhi
- Department of Neurosurgery, New York Medical College/Westchester Medical Center, Valhalla, NY, U.S.A
| | - Petr Krupa
- Department of Neuroregeneration Institute of Experimental Medicine Czech Academy of Science, Prague, Czech Republic.,Department of Neurosurgery Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Vit Herynek
- Center for Advanced Preclinical Imaging, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Pavla Jendelova
- Department of Neuroregeneration Institute of Experimental Medicine Czech Academy of Science, Prague, Czech Republic; .,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Meena Jhanwar-Uniyal
- Department of Neurosurgery, New York Medical College/Westchester Medical Center, Valhalla, NY, U.S.A
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Malucelli A, Skoch A, Ostry S, Tomek A, Urbanova B, Martinkovic L, Buksakowska I, Mohapl M, Netuka D, Hort J, Sroubek J, Vrana J, Moravec T, Bartos R, Sames M, Hajek M, Horinek D. Magnetic resonance markers of bilateral neuronal metabolic dysfunction in patients with unilateral internal carotid artery occlusion. MAGMA 2021; 34:141-151. [PMID: 32594274 DOI: 10.1007/s10334-020-00864-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate cerebral hemodynamic, metabolic and anatomic changes occurring in patients with unilateral occlusion of the internal carotid artery (ICA). MATERIALS AND METHODS Twenty-two patients with unilateral occlusion of ICA and twenty age and sex matched healthy subjects were included in the study. Single voxel proton magnetic resonance spectroscopy (1H-MRS) of the centrum semiovale, semi-automated hippocampal volumetry in T1-weighted scans and transcranial Doppler examination (TCD) with calculation of Breath Holding Index (BHI) were performed in both groups. Metabolic, anatomic, and hemodynamic features were compared between the two groups. RESULTS The N-acetylaspartate (NAA)/choline (Cho) ratio was significantly lower in both hemispheres of enrolled patients compared to controls (p = 0.005 for the side with occlusion, p = 0.04 for the side without occlusion). The hippocampus volume was significantly reduced bilaterally in patients compared to healthy subjects (p = 0.049). A statistically significant difference in BHI values was observed between the side with occlusion and without occlusion (p = 0.037) of the patients, as well as between BHI values of the side with occlusion and healthy volunteers (p = 0.014). DISCUSSION Patients with unilateral ICA occlusion have reduced NAA/Cho ratio in the white matter of both hemispheres and have bilateral atrophy of hippocampus. The alteration of hemodynamics alone cannot explain these changes.
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Affiliation(s)
- Alberto Malucelli
- Department of Neurosurgery, Masaryk Hospital, J.E. Purkyne University, Usti nad Labem, Czech Republic.
| | - Antonin Skoch
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Svapotluk Ostry
- Department of Neurology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - Ales Tomek
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Barbora Urbanova
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Lukas Martinkovic
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Irena Buksakowska
- Department of Radiology, University Hospital Motol, Prague, Czech Republic
| | - Milan Mohapl
- Department of Neurosurgery, Central Military Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery, Central Military Hospital, Prague, Czech Republic
| | - Jakub Hort
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Jan Sroubek
- Department of Neurosurgery, Hospital Na Homolce, Prague, Czech Republic
| | - Jiri Vrana
- Department of Radiology, Central Military Hospital, Prague, Czech Republic
| | - Tomas Moravec
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Robert Bartos
- Department of Neurosurgery, Masaryk Hospital, J.E. Purkyne University, Usti nad Labem, Czech Republic
| | - Martin Sames
- Department of Neurosurgery, Masaryk Hospital, J.E. Purkyne University, Usti nad Labem, Czech Republic
| | - Milan Hajek
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Daniel Horinek
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
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Soukup J, Hornychova H, Manethova M, Michalova K, Michnova L, Popovska L, Skarkova V, Cesak T, Netuka D, Ryska A, Cap J, Hána V, Hána V, Kršek M, Dvořáková E, Krčma M, Lazurova I, Olšovská V, Starý K, Vaňuga P, Gabalec F. Predictive and prognostic significance of tumour subtype, SSTR1-5 and e-cadherin expression in a well-defined cohort of patients with acromegaly. J Cell Mol Med 2021; 25:2484-2492. [PMID: 33491286 PMCID: PMC7933931 DOI: 10.1111/jcmm.16173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/21/2020] [Indexed: 12/11/2022] Open
Abstract
In somatotroph pituitary tumours, somatostatin analogue (SSA) therapy outcomes vary throughout the studies. We performed an analysis of cohort of patients with acromegaly from the Czech registry to identify new prognostic and predictive factors. Clinical data of patients were collected, and complex immunohistochemical assessment of tumour samples was performed (SSTR1‐5, dopamine D2 receptor, E‐cadherin, AIP). The study included 110 patients. In 31, SSA treatment outcome was evaluated. Sparsely granulated tumours (SGST) differed from the other subtypes in expression of SSTR2A, SSTR3, SSTR5 and E‐cadherin and occurred more often in young. No other clinical differences were observed. Trouillas grading system showed association with age, tumour size and SSTR2A expression. Factors significantly associated with SSA treatment outcome included age, IGF1 levels, tumour size and expression of E‐cadherin and SSTR2A. In the group of SGST, poor SSA response was observed in younger patients with larger tumours, lower levels of SSTR2A and higher Ki67. We observed no relationship with expression of other proteins including AIP. No predictive value of E‐cadherin was observed when tumour subtype was considered. Multiple additional factors apart from SSTR2A expression can predict treatment outcome in patients with acromegaly.
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Affiliation(s)
- Jiri Soukup
- The Fingerland Department of Pathology, Faculty of Medicine, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Helena Hornychova
- The Fingerland Department of Pathology, Faculty of Medicine, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Monika Manethova
- The Fingerland Department of Pathology, Faculty of Medicine, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Kvetoslava Michalova
- Department of Pathology, Faculty of Medicine, Charles University, Plzen, Czech Republic.,Bioptical Laboratory, Ltd., Plzen, Czech Republic
| | - Ludmila Michnova
- Department of Pathology, Military University Hospital Prague, Prague, Czech Republic
| | - Lenka Popovska
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Kralove, Czech Republic
| | - Veronika Skarkova
- Department of Medical Biology and Genetics, Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Tomas Cesak
- Department of Neurosurgery, Faculty of Medicine, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Medical Faculty, Charles University, Military University Hospital Prague, Prague, Czech Republic
| | - Ales Ryska
- The Fingerland Department of Pathology, Faculty of Medicine, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Jan Cap
- 4th Department of Internal medicine, Faculty of Medicine, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Václav Hána
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Václav Hána
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michal Kršek
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Dvořáková
- 1st Department of Internal Medicine, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Michal Krčma
- 1st Department of Internal Medicine, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Ivica Lazurova
- 1st Internal Clinic, Louis Pasteur University Hospital, Kosice, Slovakia
| | - Věra Olšovská
- 2nd Department of Internal Medicine, Faculty of Medicine, St. Ann University Hospital Brno, Masaryk University Brno, Brno, Czech Republic
| | - Karel Starý
- Department of Internal Medicine and Gastroenterology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Peter Vaňuga
- National Institute of Endocrinology and Diabetology, Lubochňa, Slovakia
| | - Filip Gabalec
- 4th Department of Internal medicine, Faculty of Medicine, University Hospital, Charles University, Hradec Kralove, Czech Republic
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Soukup J, Česák T, Hornychová H, Michalová K, Michnová Ľ, Netuka D, Čáp J, Gabalec F. Stem Cell Transcription Factor Sox2 Is Expressed in a Subset of Folliculo-stellate Cells of Growth Hormone-Producing Pituitary Neuroendocrine Tumours and Its Expression Shows No Association with Tumour Size or IGF1 Levels: a Clinicopathological Study of 109 Cases. Endocr Pathol 2020; 31:337-347. [PMID: 32632839 DOI: 10.1007/s12022-020-09634-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 02/06/2023]
Abstract
Sox2 is one of the transcription factors responsible for the maintenance of stem cell phenotype. It has been implicated as a marker of stem cells in normal pituitaries and pituitary neuroendocrine tumours. To explore the clinical significance of Sox2 expression in histological sections, we performed immunohistochemical detection of Sox2 in 113 pituitary neuroendocrine tumours from 109 patients with acromegaly. In 11 tumours, we performed double immunostaining for Sox2, annexin A1 and S100 protein. Tumours were characterised using the WHO classification system. Proliferative activity and invasion were assessed. The amount of immunoreactive cells was evaluated and correlated with tumour size and biochemical features (levels of IGF1, GH, prolactin, βTSH). Sox2+ cells were identified in 35/38 normal pituitaries adjacent to the tumours. In 36 tumours (33%), ≥ 1% of the cells expressed Sox2, in 24 cases (22%), Sox2+ cells comprised < 1% and 49 cases (45%) were negative. We found no significant differences between Sox2+ and Sox2- groups with respect to the age, initial levels of GH, IGF1, prolactin, βTSH, tumour size, invasion, proliferative activity or histological features. We observed a positive correlation between Sox2+ cell count and βTSH immunoreactive cells (r = 0.459, p < 0.001) that was further verified by multivariate analysis. Using double stain, the majority of Sox2+ cells coexpressed annexin A1 (average 89%) and S100 protein (average 76.2%) and showed morphological features of folliculo-stellate cells. Sox2+ cells are thus commonly present in growth hormone-producing tumours and normal pituitaries, and their amount does not have any prognostic significance. Most of these cells represent a subpopulation of folliculo-stellate cells, pointing out to their role as a possible stem cell population.
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Affiliation(s)
- Jiri Soukup
- The Fingerland Department of Pathology, University Hospital and Faculty of Medicine Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic.
| | - Tomáš Česák
- Department of Neurosurgery, University Hospital and Faculty of Medicine Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - Helena Hornychová
- The Fingerland Department of Pathology, University Hospital and Faculty of Medicine Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - Květoslava Michalová
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
- Bioptical Laboratory, Ltd., Plzen, Czech Republic
| | - Ľudmila Michnová
- Department of Pathology, Military University Hospital Prague, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Medical Faculty, Charles University, Military University Hospital Prague, Prague, Czech Republic
| | - Jan Čáp
- 4th Department of Internal Medicine, University Hospital and Faculty of Medicine Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - Filip Gabalec
- 4th Department of Internal Medicine, University Hospital and Faculty of Medicine Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
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Ganau M, Netuka D, Broekman M, Zoia C, Tsianaka E, Schwake M, Balak N, Sekhar A, Ridwan S, Clusmann H. Neurosurgeons and the fight with COVID-19: a position statement from the EANS Individual Membership Committee. Acta Neurochir (Wien) 2020; 162:1777-1782. [PMID: 32472377 PMCID: PMC7258601 DOI: 10.1007/s00701-020-04360-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Netuka
- Department of Neurosurgery and Neuro-oncology, 1st Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
| | - Marike Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, & Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eleni Tsianaka
- Department of Neurosurgery, Dar Al Shifa Hospital, Kuwait City, Kuwait
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University Göztepe Education and Research Hospital, Istanbul, Turkey
| | - Amitendu Sekhar
- Department of Neurosurgery, Paras Hospital, Udaipur, Rajasthan India
| | - Sami Ridwan
- Department of Neurosurgery, Paracelsus-Klinik, Osnabrück, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - EANS IM Committee
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Neurosurgery and Neuro-oncology, 1st Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, & Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Neurosurgery, Dar Al Shifa Hospital, Kuwait City, Kuwait
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
- Department of Neurosurgery, Istanbul Medeniyet University Göztepe Education and Research Hospital, Istanbul, Turkey
- Department of Neurosurgery, Paras Hospital, Udaipur, Rajasthan India
- Department of Neurosurgery, Paracelsus-Klinik, Osnabrück, Germany
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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Voldřich R, Netuka D, Beneš V. Spinal meningiomas: is Simpson grade II resection radical enough? Acta Neurochir (Wien) 2020; 162:1401-1408. [PMID: 32166387 DOI: 10.1007/s00701-020-04280-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/19/2019] [Accepted: 02/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The optimal treatment for spinal meningioma is complete resection. The radicality of resection is the most important predictive factor for future tumor recurrence. Although clinical series dedicated to spinal meningiomas are relatively frequent, only a minimum of these defines the length of the required follow-up and difference in tumor recurrence in the context of Simpson grade I and II resection. Therefore, we propose reconsideration of surgical treatment and long-term follow-up based on a retrospective analysis of 84 patients who underwent Simpson grade II resection. METHODS The study included 84 patients operated between 1998 and 2018. Clinical symptomatology, age, sex, risk of comorbidities, spinal level, duration of symptoms, surgical resection radicality, tumor recurrence, and complications associated with treatment were recorded and evaluated. RESULTS We encountered the diagnosis of spinal meningioma considerably more often in women (81%) than in men (19%). The average age of all patients was 65 years. Most meningiomas were located in the thoracic spine (82%) while the rest (18%) were located in the cervical spine. The most common symptoms were motor deficit (80%) and sensation disorders (70%). Of the symptomatic patients, 71% clinically improved, 27% showed no change and 2% worsened postoperatively. The mean follow-up was 32 months (range 1-204). During this period, there was a 5% tumor recurrence rate. However, when we analyzed a subgroup of nine patients who were monitored for more than 6 years, tumor recurrence was diagnosed in 44%, all of whom were women (mean age 51 years). CONCLUSION Our results indicate that tumor recurrence after Simpson II resection could be significantly higher than previously thought if the follow-up is long enough, especially in younger patients. This finding suggests we consider using radical Simpson grade I resection more frequently. The study also demonstrates that after spinal meningioma surgery the patients should be followed and monitored on a long-term basis.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neuro-oncology, First Medical Faculty, Central Military Hospital, Charles University in Prague, U Vojenské nemocnice 1200/1, 169 02, Prague 6, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neuro-oncology, First Medical Faculty, Central Military Hospital, Charles University in Prague, U Vojenské nemocnice 1200/1, 169 02, Prague 6, Czech Republic.
| | - Vladimír Beneš
- Department of Neurosurgery and Neuro-oncology, First Medical Faculty, Central Military Hospital, Charles University in Prague, U Vojenské nemocnice 1200/1, 169 02, Prague 6, Czech Republic
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Abstract
BACKGROUND Clinical examination, including pre- and postoperative assessment of olfaction, is essential in evaluating surgical outcomes in patients with olfactory groove meningiomas (OGMs). A review of a recent series revealed a lack of assessment of olfaction in most of the studies. Tests determining olfactory detection should be used to reveal olfactory dysfunction. Specialized examination techniques (e.g., electro-olfactography, olfactory evoked potentials, and functional magnetic resonance imaging) are currently used in research. METHODS Prospective analysis of 13 patients who underwent surgical resection of OGMs from December 2013 to December 2017 was performed. Data on clinical presentation, pre- and postoperative neurologic examinations, complications, recurrences, adjuvant treatment, and follow-up outpatient examinations were recorded. Olfactory function was assessed using the Sniffin' Sticks odor identification test preoperatively, postoperatively, and 1 year after surgery. RESULTS All the meningiomas were resected via unilateral craniotomy, and gross total resection was achieved in all cases. Surgery-related permanent morbidity was 7.7% and overall mortality 0%. For the eight patients with preoperative normosmia, five remained normosmic (62.5%), one deteriorated to hyposmia (12.5%), and two deteriorated to anosmia (25%). For the two patients with preoperative hyposmia, one remained hyposmic and one deteriorated to anosmia. For the three anosmic patients, two remained anosmic, and one improved to hyposmia.The intact olfactory function preoperatively was associated with a better olfactory outcome. Overall, 62.5% of these patients remained normosmic, and none of the hyposmic or anosmic patients normalized their olfaction.Higher meningioma volume is associated with worse olfactory function before surgery (normosmia in 16.7% versus 100.0% in less voluminous) and following the surgery (normosmia in 16.7% versus 57.1% less voluminous).The unilateral surgical approach enabled the anatomical preservation of the contralateral olfactory nerve in 76.9% of our patients. Functional normosmia was achieved in 50% and hyposmia in 30% of these cases. CONCLUSIONS Assessment of olfactory function is both vital in preoperative decision making (surgical approach, radicality of resection) and when evaluating surgical outcome. Preoperative normosmia seems to be the most important prognostic factor for functional olfactory outcome. In normosmic patients the olfaction was preserved in 62.5% of cases. Moreover, higher meningioma volume is associated with worse olfactory function before and following the surgery. The greatest advantage of the unilateral surgical approach is anatomical preservation of the contralateral olfactory nerve with a satisfactory functional outcome. These results support a proactive approach, with early surgical resection using a unilateral approach even in cases with less voluminous OGMs that enables the preservation of olfactory function in a significant proportion of patients.
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Affiliation(s)
- Michaela Dedeciusova
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Norbert Svoboda
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Jaromir Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Third Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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Májovský M, Netuka D, Beneš V, Kučera P. Burr-Hole Evacuation of Chronic Subdural Hematoma: Biophysically and Evidence-Based Technique Improvement. J Neurosci Rural Pract 2019; 10:113-118. [PMID: 30765981 PMCID: PMC6337972 DOI: 10.4103/jnrp.jnrp_167_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 12/04/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Despite ongoing efforts, recurrence and reoperation rates after surgical treatment remain high. We synthesize scientific evidence on the treatment of CSDH with biophysical principles and then propose a simple and effective surgical technique aiming to reduce the recurrence rate. Under local anesthesia, one burr hole is placed in the area above the maximum hematoma thickness. One drain is inserted into the dorsal direction to the deepest point of the hematoma cavity, and a second drain is inserted frontally into the highest point. Next, saline is gently instilled to the dorsal drain to eliminate air from the hematoma cavity through the frontal drain. Once saline has filled the frontal drain, the frontal drain is removed. The dorsal drain is left in situ for 48 h, and the pressure within the cavity may be adapted hydrostatically. We implemented evidence-based conclusions of previous studies and modified the classical burr-hole technique to reduce the recurrence rate. As a result, we developed a straightforward surgical procedure that is possible to perform under local anesthesia, suitable for everyday practice in rural and remote areas while working with limited resources. The novelty of this technique is in the purposeful reduction of postoperative pneumocephalus, a known independent factor of recurrence. Subdural air is eliminated during surgery using a two-drain system. Safety and efficacy of the technique need to be evaluated in future clinical trials.
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Affiliation(s)
- Martin Májovský
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic
| | - Pavel Kučera
- Department of Natural Sciences, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic.,Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Netuka D, Masopust V, Fundová P, Astl J, Školoudík D, Májovský M, Beneš V. Olfactory Results of Endoscopic Endonasal Surgery for Pituitary Adenoma: A Prospective Study of 143 Patients. World Neurosurg 2019; 129:e907-e914. [PMID: 31103759 DOI: 10.1016/j.wneu.2019.05.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/28/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Clinical examination, including pre- and postoperative assessment of olfaction function, should be included in evaluating surgical outcomes in patients with pituitary adenomas. Most of the studies are lacking assessment of olfactory function. METHODS A prospective study of 143 patients who underwent surgical resection of pituitary adenomas from January 2014 to December 2017 was performed. Data on clinical presentation, pre- and postoperative neurologic, endocrinologic, and ophthalmologic examinations, complications, and follow-up outpatient examinations were recorded. Olfactory function was assessed using the Sniffin' Sticks odor identification test preoperatively, postoperatively (3 months), and 1 year after surgery. RESULTS Normosmia was present preoperatively in 93.7% of patients, postoperatively in 95.8% of patients, and in 95.1% 1 year postsurgery. Hyposmia was present preoperatively in 4.2% of patients, postoperatively in 2.1% of patients, and in 1.4% 1 year after surgery. Anosmia was present preoperatively in 2.1% of patients, postoperatively in 2.1% of patients, and in 3.5% 1 year after surgery. In patients with preoperative normosmia, postoperative hyposmia and anosmia were present in 1.5% of patients. There were no differences according to age, sex, size, or type of pituitary adenoma. CONCLUSIONS Assessment of olfactory function should be included in the analysis of pituitary adenoma surgery results. This prospective study showed low risk of olfaction deterioration if an endoscopic endonasal approach is used without any mucosal flaps for skull base reconstruction. Further studies that include objective olfaction assessment are warranted.
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Affiliation(s)
- David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Václav Masopust
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Petra Fundová
- Department of Otorhinolaryngology and Maxillofacial Surgery, Third Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Jaromír Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Third Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - David Školoudík
- Center for Science and Research, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Martin Májovský
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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