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Kranawetter B, Cho A, Hirschmann D, Göbl P, Dorfer C, Rössler K, Dodier P, Wang WT, Gatterbauer B, Gruber A, Kitz K, Frischer JM. Radiosurgery as a Stand-Alone Treatment Option for Cerebral Dural Arteriovenous Fistulas: the Vienna Series. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38151030 DOI: 10.1055/a-2235-5256] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND Gamma Knife radiosurgery (GKRS) has been demonstrated to be an effective and safe treatment method for dural arteriovenous fistulas (DAVFs). However, only few studies, mostly with limited patient numbers, have evaluated radiosurgery as a sole and upfront treatment option for DAVFs. METHODS Thirty-three DAVF patients treated with GKRS as a stand-alone management at our institution between January 1992 and January 2020 were included in this study. Obliteration rates, time to obliteration, neurologic outcome, and complications were evaluated retrospectively. RESULTS Complete overall obliteration was achieved in 20/28 (71%) patients. The postradiosurgery actuarial rates of obliteration at 2, 5, and 10 years were 53, 71, and 85%, respectively. No difference in time to obliteration between carotid-cavernous fistulas (CCFs; 14/28, 50%, 17 months; 95% confidence interval [CI]: 7.4-27.2) and non-CCFs (NCCFs; 14/28, 50%, 37 months; 95% CI: 34.7-38.5; p = 0.111) were found. Overall, the neurologic outcome in our series was highly favorable at the time of the last follow-up. A complete resolution of symptoms was seen in two-thirds (20/30, 67%) of patients. One patient with multiple DAVFs suffered from an intracranial hemorrhage of the untreated lesion and died during the follow-up period, resulting in a yearly bleeding risk of 0.5%. No complications after radiosurgery were observed in our series. CONCLUSION Our results show that GKRS is a safe and effective stand-alone management option for selected DAVF patients.
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Affiliation(s)
- Beate Kranawetter
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Göbl
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Wei-Te Wang
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital Linz, Linz, Austria
| | - Klaus Kitz
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Khalaveh F, Cho A, Shaltout A, Untersteiner H, Kranawetter B, Hirschmann D, Göbl P, Marik W, Gatterbauer B, Rössler K, Dorfer C, Frischer JM. Concomitant radiosurgical and targeted oncological treatment improves the outcome of patients with brain metastases from gastrointestinal cancer. Radiat Oncol 2023; 18:197. [PMID: 38071299 PMCID: PMC10710706 DOI: 10.1186/s13014-023-02383-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND So far, only limited studies exist that evaluate patients with brain metastases (BM) from GI cancer and associated primary cancers who were treated by Gamma Knife Radiosurgery (GKRS) and concomitant immunotherapy (IT) or targeted therapy (TT). METHODS Survival after GKRS was compared to the general and specific Graded Prognostic Assessment (GPA) and Score Index for Radiosurgery (SIR). Further, the influence of age, sex, Karnofsky Performance Status Scale (KPS), extracranial metastases (ECM) status at BM diagnosis, number of BM, the Recursive Partitioning Analysis (RPA) classes, GKRS1 treatment mode and concomitant treatment with IT or TT on the survival after GKRS was analyzed. Moreover, complication rates after concomitant GKRS and mainly TT treatment are reported. RESULTS Multivariate Cox regression analysis revealed IT or TT at or after the first Gamma Knife Radiosurgery (GKRS1) treatment as the only significant predictor for overall survival after GKRS1, even after adjusting for sex, KPS group, age group, number of BM at GKRS1, RPA class, ECM status at BM diagnosis and GKRS treatment mode. Concomitant treatment with IT or TT did not increase the rate of adverse radiation effects. There was no significant difference in local BM progression after GKRS between patients who received IT or TT and patients without IT or TT. CONCLUSION Good local tumor control rates and low rates of side effects demonstrate the safety and efficacy of GKRS in patients with BM from GI cancers. The concomitant radiosurgical and targeted oncological treatment significantly improves the survival after GKRS without increasing the rate of adverse radiation effects. To provide local tumor control, radiosurgery remains of utmost importance in modern GI BM management.
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Affiliation(s)
- Farjad Khalaveh
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Abdallah Shaltout
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Helena Untersteiner
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Beate Kranawetter
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Philipp Göbl
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Wolfgang Marik
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
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Dodier P, Kranawetter B, Hirschmann D, Dogan M, Cho A, Untersteiner H, Göbl P, Gatterbauer B, Wang WT, Dorfer C, Rössler K, Bavinzski G, Frischer JM. Outcome of 107 conservatively managed unruptured brain arteriovenous malformations: a single center's 30-year experience. J Neurosurg 2023; 139:1025-1035. [PMID: 36964736 DOI: 10.3171/2023.2.jns222675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/06/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Since the publication of A Randomized Trial of Unruptured Brain AVMs (ARUBA), the management of unruptured brain arteriovenous malformations (bAVMs) has been controversially discussed. Long-term follow-up data on the exclusively conservative management of unruptured bAVMs are scarce. The authors evaluated the long-term outcomes of patients with unruptured untreated bAVMs in a real-life cohort. METHODS A retrospective observational cohort of 107 patients (of 897 bAVM patients referred to the authors' institution) with a diagnosis of unruptured and conservatively managed bAVMs is presented. AVMs of all Spetzler-Martin grades were observed. The mean follow-up period was 84 months. In 44% of patients, a follow-up period of 5 years or longer was observed. A national death register comparison completed the outcome analysis. RESULTS The median age at diagnosis, sex distribution, neurological presentation, and modified Rankin Scale score were comparable to the patients in the medical management arm of the ARUBA study. Patients were mainly young, predominantly male, and in good clinical condition. Similar to the ARUBA cohort, 77% of this study's cohort presented in an excellent clinical status at the time of last follow-up. However, 17% of patients had at least one hemorrhage, resulting in an overall annual hemorrhage risk of 2.7% in the observation period. Moreover, the cumulative 1-, 5-, and 10-year overall hemorrhage rates were 3.0%, 11.3%, and 15.3%, respectively. Consequently, the long-term follow-up AVM-related mortality rate amounted to 8%. The estimated median overall survival after AVM diagnosis was 19.3 years (95% CI 14.0-24.6 years). A multivariate Cox regression model revealed temporal and deep-seated localization as an independent risk factor for AVM hemorrhage, while the presence of seizures reached borderline significance as a risk factor. CONCLUSIONS The authors' results represent the long-term course of unruptured untreated bAVMs. Their data support the conclusion that even in the post-ARUBA era, tailored active treatment options may be offered to patients with unruptured bAVMs. For patient counseling, individual risk factors should be weighed against the center's treatment-specific risks.
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Roessler K, Shawarba J, Strasser E, Hirschmann D, Hertha J, Reitbauer S, Novak K. 889 Significance of Cortico-Bulbar Motor Evoked Potential (CoMEP) Monitoring in Vestibular Schwannoma Surgery for Prediction of Postoperative Facial Nerve Palsy. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Vajkoczy P, Thomé C, Kerschbaumer J, Meyer B, Wostrack M, Adage T, Breitenbach J, Bavinzski G, Hirschmann D, Bendszus M, Rohde V, Mielke D, Wessels L. 104 A Safety and Efficacy Study of NicaPlant® in Aneurysmal Subarachnoid Haemorrhage Patients Undergoing Aneurysm Clipping. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Cho A, Medvedeva K, Kranawetter B, Untersteiner H, Hirschmann D, Lepilina O, Baulin A, Buschmann M, Ertl A, Marik W, Dorfer C, Rössler K, Gatterbauer B, Ilyalov S, Frischer JM. How to dose-stage large or high-risk brain metastases: an alternative two-fraction radiosurgical treatment approach. J Neurosurg 2022; 137:1666-1675. [DOI: 10.3171/2022.2.jns212440] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/14/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE
The authors sought to evaluate clinical outcome in patients with large, high-risk brain metastases (BMs) treated with different dose strategies by use of two-fraction dose-staged Gamma Knife radiosurgery (GKRS).
METHODS
A retrospective analysis was performed with data from 142 patients from two centers who had been treated with two-fraction dose-staged GKRS between June 2015 and January 2020. Depending on the changes in marginal dose between the first (GKRS1) and second (GKRS2) GKRS treatments, the study population was divided into three treatment groups: dose escalation, dose maintenance, and dose de-escalation.
RESULTS
The 142 study patients underwent two-fraction dose-staged GKRS treatments for 166 large, high-risk BMs. The median tumor volume of 7.4 cm3 decreased significantly from GKRS1 to GKRS2 (4.4 cm3; p < 0.001), and to the last follow-up (1.8 cm3; p < 0.001). These significant differences in BM volume reduction were achieved in all three treatment groups. However, differences according to the primary tumor histology were apparent: while dose maintenance seemed to be the most effective treatment strategy for BMs from lung cancer or melanoma, dose escalation was the most beneficial treatment option for BMs from breast, gastrointestinal, or genitourinary cancer. Of note, the vast majority of patients who underwent dose-staged BM treatment did not show any significant postradiosurgical complications.
CONCLUSIONS
In patients with large, high-risk BMs, dose-staged GKRS treatment represents an effective local treatment method with acceptable complication risks. Different dose-strategy options are available that may be chosen according to the primary tumor histology and treatment volume but may also be tailored to the findings at GKRS2.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Austria
| | | | | | | | | | | | | | - Martin Buschmann
- Department of Neurosurgery, Medical University of Vienna, Austria
- Department of Radiation Oncology, Medical University of Vienna; and
| | - Adolf Ertl
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Wolfgang Marik
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Austria
| | | | | | - Josa M. Frischer
- Department of Neurosurgery, Medical University of Vienna, Austria
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Cho A, Hennenberg J, Untersteiner H, Hirschmann D, Gatterbauer B, Zöchbauer-Müller S, Hochmair MJ, Preusser M, Rössler K, Dorfer C, Frischer JM, Furtner J. Influence of temporal muscle thickness on the outcome of radiosurgically treated patients with brain metastases from non-small cell lung cancer. J Neurosurg 2022; 137:1-7. [PMID: 35120324 DOI: 10.3171/2021.12.jns212193] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the impact of temporal muscle thickness (TMT), a surrogate marker for sarcopenia, in radiosurgically treated patients with brain metastases (BMs) from non-small cell lung cancer (NSCLC). METHODS For 566 patients with BMs from NSCLC in the period between June 2012 and December 2019, TMT values were retrospectively measured on the planning brain magnetic resonance imaging (MRI) studies that had been obtained before their first Gamma Knife radiosurgery treatment (GKRS1). Predefined sex-specific TMT cutoff values were used to stratify the study cohort into patients at risk for sarcopenia and patients with normal muscle status. Cox regression models adjusted for other prognostic parameters were used to evaluate sarcopenia as an independent prognostic factor. RESULTS In sarcopenia patients with a TMT below the sex-specific cutoff values, the risk of death was significantly increased (HR 1.908, 95% CI 1.550-2.349, p < 0.001). In addition, sarcopenia was revealed as an independent prognostic factor even after adjusting for age groups, sex, number of BMs, presence of extracranial metastases, NSCLC subtypes, Karnofsky Performance Status groups, recursive partitioning analysis classes, and concomitant immunotherapy or targeted therapy (HR 1.680, 95% CI 1.347-2.095, p < 0.001). However, patients at risk for sarcopenia showed no significant differences in the estimated mean time until local BM progression after GKRS1, compared to patients with normal muscle status (p = 0.639). CONCLUSIONS TMT obtained from planning MRI studies is an independent prognostic marker in radiosurgically treated patients with BMs from NSCLC and may aid patient stratification in future clinical trials.
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Affiliation(s)
| | - Juliane Hennenberg
- 2Biomedical Imaging and Image-guided Therapy, Medical University of Vienna
| | | | | | | | | | - Maximilian J Hochmair
- 4Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Matthias Preusser
- 3Department of Internal Medicine I, Division of Oncology, Medical University of Vienna; and
| | | | | | | | - Julia Furtner
- 2Biomedical Imaging and Image-guided Therapy, Medical University of Vienna
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Hirschmann D, Czech T, Roessler K, Krachsberger P, Paliwal S, Ciobanu-Caraus O, Cho A, Peyrl A, Feucht M, Frischer JM, Dorfer C. How can we optimize the long-term outcome in children with intracranial cavernous malformations? A single-center experience of 61 cases. Neurosurg Rev 2022; 45:3299-3313. [PMID: 35678924 PMCID: PMC9492558 DOI: 10.1007/s10143-022-01823-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 02/03/2023]
Abstract
The objective is to provide a treatment algorithm for pediatric patients with intracranial cavernous malformations (CMs) based on our experience. Patients < 18 years of age who were treated either surgically or conservatively at the authors' institution between 1982 and 2019 were retrospectively evaluated. A total of 61 pediatric patients were treated at the authors' institution: 39 with lobar CMs; 18 with deep CMs, including 12 in the brainstem and 6 in the basal ganglia; and 4 with CMs in the cerebellar hemispheres. Forty-two patients underwent surgery, and 19 were treated conservatively. The median follow-up time was 65 months (1-356 months). In surgically treated patients, lesions were larger (2.4 cm vs 0.9 cm, p < 0.001). In patients with lobar CMs, seizures were more common (72% vs 21%, p = 0.003) in the surgery group than in conservatively managed patients. In deep CMs, modified Rankin scale (mRS) was higher (4 vs 1, p = 0.003) in the surgery group than in conservatively treated patients. At the time of last follow-up, no differences in Wieser outcome class I were seen (86% vs 67%) in lobar CMs, and mRS scores had aligned between the treatment groups in deep CMs (1 vs 0). We encountered no new permanent neurological deficit at time of last follow-up. We propose a treatment algorithm according to lesion location and size, burden of symptoms, epilepsy workup, and further clinical course during observation. A conservative management is safe in pediatric patients with asymptomatic CMs. Gross total resection should be the aim in patients with symptomatic lobar CMs. A less aggressive approach with subtotal resection, when required to prevent neurological compromise, sustainably improves neurological outcome in patients with deep CMs.
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Affiliation(s)
- Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Paul Krachsberger
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Shivam Paliwal
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Martha Feucht
- Center for Rare and Complex Epilepsies, ERN EpiCARE. Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
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Winter F, Hasslinger S, Frueh A, Marik W, Raudner M, Hirschmann D, Kuess M, Salzmann SN, Rienmueller A, Roessler K, Dorfer C, Herta J. Incidence, risk factors, and treatment of incidental durotomy during decompression in degenerative lumbar spine conditions. J Neurosurg Sci 2021:S0390-5616.21.05404-7. [PMID: 34763388 DOI: 10.23736/s0390-5616.21.05404-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to identify independent risk factors for incidental durotomy (ID) during decompressive lumbar spine surgery and describe its treatment. METHODS This retrospective review includes 650 patients who underwent lumbar decompression at a tertiary institution between January 2015 and October 2019. Data collection was obtained through one independent researcher. The incidence rate and treatment of ID was evaluated by a chart review of operative notes, patient charts, physiotherapy reports, and nursing reports. RESULTS The incidence rate of ID was 12.6%. The most common reason for admission was disc herniation (63.2%), followed by vertebral stenosis (22.1%). ID resulted in significantly longer operation time (p=0.0001) and length of hospitalization (p=0.0001). A correlation between ID and patient's diagnosis (p=0.0078) as well as the chosen type of surgery (p=0.0404) with an odds ratio to cause ID of 1.9 for laminectomy and 1.6 for undercutting compared to microdiscectomy were found. However, age, sex, surgeon experience, lumbar level, revision surgery, as well as multilevel surgery were not significantly correlated with the incidence of ID. Dural tears were closed with dural sealant (47.2%), polyester 4-0 sutures (11.1%) or a combination of both (37.5%) and the majority of patients had bed rest of at least two days. By usage of these treatment methods no patient needed reoperation. CONCLUSIONS Diagnosis of vertebrostenosis as well as laminectomy were significantly correlated with the incidence of ID. Treatment with intraoperative closure and postoperative bed rest even though not standardized led to complication free outcomes.
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Affiliation(s)
- Fabian Winter
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | - Anton Frueh
- Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Marcus Raudner
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Magnus Kuess
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Stephan N Salzmann
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Anna Rienmueller
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Herta
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria -
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Dodier P, Wang WT, Hosmann A, Hirschmann D, Marik W, Frischer JM, Gruber A, Rössler K, Bavinzski G. Combined standard bypass and parent artery occlusion for management of giant and complex internal carotid artery aneurysms. J Neurointerv Surg 2021; 14:593-598. [PMID: 34353887 DOI: 10.1136/neurintsurg-2021-017673] [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: 04/21/2021] [Accepted: 06/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Complex aneurysms do not have a standard protocol for treatment. In this study, we investigate the safety and efficacy of microsurgical revascularization combined with parent artery occlusion (PAO) in giant and complex internal carotid artery (ICA) aneurysms. METHODS Between 1998 and 2017, 41 patients with 47 giant and complex ICA aneurysms were treated by an a priori planned combined treatment strategy. Clinical and radiological outcomes were stratified according to mRS and Raymond classification. Bypass patency was assessed. Median follow-up time was 3.9 years. RESULTS After successful STA-MCA bypass, staged endovascular (n=37) or surgical (n=1) PAO was executed in 38 patients following a negative balloon occlusion test. Intolerance to PAO led to stent/coil treatments in two patients. Perioperative bypass patency was confirmed in 100% of completed STA-MCA bypass procedures. Long-term overall bypass patency rate was 99%. Raymond 1 occlusion and good outcome were achieved in 95% and 97% (mRS 0-2) of cases, respectively. No procedure-related mortality was encountered. Eighty-four percent of patients with preoperative cranial nerve compression syndromes improved during follow-up. CONCLUSIONS The combined approach of STA-MCA bypass surgery followed by parent artery occlusion achieves high aneurysm occlusion and low morbidity rates in the management of giant and complex ICA aneurysms. This combined indirect approach represents a viable alternative to flow diversion in patients with cranial nerve compression syndromes or matricidal aneurysms, and may serve as a backup strategy in cases of peri-interventional complications or lack of suitable endovascular access.
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Affiliation(s)
- Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Wei-Te Wang
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Wolfgang Marik
- Department of Radiology, Medical University of Vienna, Wien, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler Universitätsklinikum GmbH, Linz, Oberösterreich, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
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Hirschmann D, Kranawetter B, Tomschik M, Wais J, Winter F, Frischer JM, Millesi M, Herta J, Roessler K, Dorfer C. New-onset seizures after cranioplasty-a different view on a putatively frequently observed phenomenon. Acta Neurochir (Wien) 2021; 163:1437-1442. [PMID: 33523299 PMCID: PMC8053646 DOI: 10.1007/s00701-021-04720-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/26/2020] [Accepted: 01/14/2021] [Indexed: 11/27/2022]
Abstract
Background New-onset seizures after cranioplasty (NOSAC) are reported to be a frequent complication of cranioplasty (CP) after decompressive hemicraniectomy (DHC). There are considerable differences in the incidence of NOSAC and contradictory data about presumed risk factors in the literature. We suggest NOSAC to be a consequence of patients’ initial condition which led to DHC, rather than a complication of subsequent CP. We conducted a retrospective analysis to verify our hypothesis. Methods The medical records of all patients ≥ 18 years who underwent CP between 2002 and 2017 at our institution were evaluated including incidence of seizures, time of seizure onset, and presumed risk factors. Indication for DHC, type of implant used, timing of CP, patient age, presence of a ventriculoperitoneal shunt (VP shunt), and postoperative complications were compared between patients with and without NOSAC. Results A total of 302 patients underwent CP between 2002 and 2017, 276 of whom were included in the outcome analysis and the incidence of NOSAC was 23.2%. Although time between DHC and CP differed significantly between DHC indication groups, time between DHC and seizure onset did not differ, suggesting the occurrence of seizures to be independent of the procedure of CP. Time of follow-up was the only factor associated with the occurrence of NOSAC. Conclusion New-onset seizures may be a consequence of the initial condition leading to DHC rather than of CP itself. Time of follow-up seems to play a major role in detection of new-onset seizures.
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Affiliation(s)
- Dorian Hirschmann
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Beate Kranawetter
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jonathan Wais
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Fabian Winter
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Matthias Millesi
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes Herta
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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12
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Hirschmann D, Kranawetter B, Kirchschlager C, Tomschik M, Wais J, Winter F, Millesi M, Herta J, Roessler K, Dorfer C. Cranioplasty following ventriculoperitoneal shunting: lessons learned. Acta Neurochir (Wien) 2021; 163:441-446. [PMID: 33009932 PMCID: PMC7815555 DOI: 10.1007/s00701-020-04597-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cranioplasty (CP) is considered as a straightforward and technically unchallenging operation; however, complication rates are high reaching up to 56%. Presence of a ventriculoperitoneal shunt (VPS) and timing of CP are reported risk factors for complications. Pressure gradients and scarring at the site of the cranial defect seem to be critical in this context. The authors present their experiences and lessons learned. METHODS A consecutive series of all patients who underwent CP at the authors' institution between 2002 and 2017 were included in this retrospective analysis. Complications were defined as all events that required reoperation. Logistic regression analysis and chi-squared test were conducted to evaluate the complication rates according to suspected risk factors. RESULTS A total of 302 patients underwent cranioplasty between 2002 and 2017. The overall complication rate was 17.5%. Complications included epi-/subdural fluid collection (7.3%) including hemorrhage (4.6%) and hygroma (2.6%), bone graft resorption (5.3%), bone graft infection (2.0%), and hydrocephalus (5.7%). Overall, 57 patients (18.9%) had undergone shunt implantation prior to CP. The incidence of epi-/subdural fluid collection was 19.3% in patients with VPS and 4.5% in patients without VPS, OR 5.1 (95% CI 2.1-12.4). Incidence of hygroma was higher in patients who underwent early CP. Patients with temporary shunt ligation for CP did not suffer from complications. CONCLUSION CP in patients with a VPS remains a high-risk procedure. Any effort to understand the pressure dynamics and to reduce factors that may trigger the formation of a large epidural space must be undertaken.
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Affiliation(s)
- Dorian Hirschmann
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Beate Kranawetter
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Constanze Kirchschlager
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Jonathan Wais
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Fabian Winter
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Matthias Millesi
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Johannes Herta
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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13
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Cho A, Untersteiner H, Hirschmann D, Shaltout A, Göbl P, Dorfer C, Rössler K, Marik W, Kirchbacher K, Kapfhammer I, Zöchbauer-Müller S, Gatterbauer B, Hochmair MJ, Frischer JM. Gamma Knife Radiosurgery for Brain Metastases in Non-Small Cell Lung Cancer Patients Treated with Immunotherapy or Targeted Therapy. Cancers (Basel) 2020; 12:cancers12123668. [PMID: 33297416 PMCID: PMC7762317 DOI: 10.3390/cancers12123668] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/03/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/28/2022] Open
Abstract
Simple Summary In non-small cell lung cancer patients with brain metastases, combined Gamma Knife radiosurgery and immunotherapy or targeted therapy showed an increase in overall survival. The combination of Gamma Knife radiosurgery and immunotherapy or targeted therapy did not increase complications related to radiosurgery. Therefore, the combined treatment seems to be a safe and powerful treatment option for non-small cell lung cancer patients with brain metastases. Abstract The combination of Gamma Knife radiosurgery (GKRS) and systemic immunotherapy (IT) or targeted therapy (TT) is a novel treatment method for brain metastases (BMs) in non-small cell lung cancer (NSCLC). To elucidate the safety and efficacy of concomitant IT or TT on the outcome after GKRS, 496 NSCLC patients with BMs, who were treated with GKRS were retrospectively reviewed. The median time between the initial lung cancer diagnosis and the diagnosis of brain metastases was one month. The survival after the initial BM diagnosis was significantly longer than the survival predicted by prognostic BM scores. After the first Gamma Knife radiosurgery treatment (GKRS1), the estimated median survival was 9.9 months (95% CI = 8.3–11.4). Patients with concurrent IT or TT presented with a significantly longer survival after GKRS1 than patients without IT or TT (p < 0.001). These significant differences in the survival were also apparent among the four treatment groups and remained significant after adjustment for Karnofsky performance status scale (KPS), recursive partitioning analysis (RPA) class, sex, and multiple BMs. About half of all our patients (46%) developed new distant BMs after GKRS1. Of note, no statistically significant differences in the occurrence of radiation reaction, radiation necrosis, or intralesional hemorrhage in association with IT or TT at or after GKRS1 were observed. In NSCLC-BM patients, the concomitant use of GKRS and IT or TT showed an increase in overall survival without increased complications related to GKRS. Therefore, the combined treatment with GKRS and IT or TT seems to be a safe and powerful treatment option and emphasizes the role of radiosurgery in modern BM treatment.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Helena Untersteiner
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Abdallah Shaltout
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Philipp Göbl
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Wolfgang Marik
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, 1090 Vienna, Austria;
| | | | | | - Sabine Zöchbauer-Müller
- Department of Internal Medicine I, Division of Oncology, Medical University Vienna, 1090 Vienna, Austria;
| | - Brigitte Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna North Hospital, 1210 Vienna, Austria;
| | - Josa M. Frischer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
- Correspondence: ; Tel.: +43-1-40400-45510
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14
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Gatterbauer B, Hirschmann D, Eberherr N, Untersteiner H, Cho A, Shaltout A, Göbl P, Fitschek F, Dorfer C, Wolfsberger S, Kasprian G, Höller C, Frischer JM. Toxicity and efficacy of Gamma Knife radiosurgery for brain metastases in melanoma patients treated with immunotherapy or targeted therapy-A retrospective cohort study. Cancer Med 2020; 9:4026-4036. [PMID: 32249551 PMCID: PMC7286469 DOI: 10.1002/cam4.3021] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 11/19/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background Few safety data of concurrent stereotactic radiosurgery and targeted therapy (TT) or immunotherapy (IT) are available. The aim of the study was to evaluate the outcome of melanoma patients with brain metastases (MBM) after Gamma Knife Radiosurgery (GKRS) in relation to IT/TT. Methods We evaluated 182 MBM patients, who were treated with GKRS in the modern radiosurgical and oncological era. Results The median time between the initial melanoma diagnosis and occurrence of MBM was 2.4 years. The median overall survival time was 5.4 years after melanoma diagnosis. The estimated median survival after the initial diagnosis of MBM was 1.0 year (95% CI = 0.7‐1.2 years). Patients treated with anti‐PD‐1 or a combination of anti‐CTLA‐4/PD‐1 showed a significantly longer survival after first GKRS compared to all other forms of treatment. In addition, patients treated with anti‐PD‐1, anti‐CTLA‐4, or a combination of anti‐CTLA‐4/PD‐1 showed a significantly longer time to new MBM after GKRS1 compared to patients treated with other forms and combinations of the oncological therapy. The occurrence of hemorrhage or radiation reaction/necrosis after GKRS did not show any statistically significant differences in relation to IT/TT. Conclusion In MBM patients, complications after GKRS are not significantly increased if IT/TT treatment is performed at the time of or after radiosurgery. Further, a clear benefit in distant control and survival is seen in MBM patients treated with GKRS and checkpoint inhibitors. Thus, concomitant treatment of MBM with GKRS and IT/TT seems to be a safe and powerful treatment option although further prospective studies should be conducted.
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Affiliation(s)
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Nadine Eberherr
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | | | | | - Abdallah Shaltout
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Philipp Göbl
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Fabian Fitschek
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | | | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Christoph Höller
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
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15
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Hirschmann D, Goebl P, Witte FH, Gatterbauer B, Wang WT, Dodier P, Bavinzski G, Ertl A, Marik W, Mallouhi A, Roetzer T, Dorfer C, Eisner W, Gruber A, Kitz K, Frischer JM. Evaluation of the radiosurgical treatment of cerebral arteriovenous malformations: a retrospective single-center analysis of three decades. J Neurointerv Surg 2019; 12:401-406. [PMID: 31558656 DOI: 10.1136/neurintsurg-2019-015332] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Gamma Knife radiosurgery (GKRS) in the treatment of arteriovenous malformations (AVMs) is still controversially discussed. OBJECTIVE To present long-term follow-up data on patients after Gamma Knife radiosurgery for cerebral AVMs. METHODS Overall, 516 patients received radiosurgery for cerebral AVMs between 1992 and 2018 at our department, of whom 265 received radiosurgery alone and 207 were treated with a combined endovascular-radiosurgical approach. Moreover, 45 patients were treated with a volume-staged approach. Two eras were analyzed, the pre-modern era between 1992 and 2002 and the modern era thereafter. RESULTS In GKRS-only treated patients, median time to nidus occlusion was 3.8 years. Spetzler-Ponce (SP) class was a significant predictor for time to obliteration in the whole sample. Median time to obliteration for the combined treatment group was 6.5 years. Patients in the pre-modern era had a significantly higher obliteration rate than those treated in the modern era. Overall, the calculated yearly hemorrhage risk in the observation period after first GKRS was 1.3%. Permanent post-radiosurgical complications occurred in 4.9% of cases but did not differ between the treatment groups or treatment eras. The obliteration rate was significantly lower and the hemorrhage rate was higher in volume-staged treated patients than in conventionally treated patients. CONCLUSION GKRS is an effective treatment option for SP class A and B cerebral AVMs. After combined endovascular-radiosurgical treatment, the outcome of selected SP class C AVMs aligns with that of SP class B lesions. Both the combined therapy and radiosurgery alone constitute sound methods for treatment of cerebral AVMs.
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Affiliation(s)
- Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Goebl
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Frederic H Witte
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | - Wei-Te Wang
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Adolf Ertl
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Ammar Mallouhi
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Wilhelm Eisner
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Johannes Kepler Universitat Linz, Linz, Austria
| | - Klaus Kitz
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Murphy WJ, Sun S, Chen Z, Yuhki N, Hirschmann D, Menotti-Raymond M, O'Brien SJ. A radiation hybrid map of the cat genome: implications for comparative mapping. Genome Res 2000; 10:691-702. [PMID: 10810092 PMCID: PMC310870 DOI: 10.1101/gr.10.5.691] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ordered gene maps of mammalian species are becoming increasingly valued in assigning gene variants to function in human and animal models, as well as recapitulating the natural history of genome organization. To extend this power to the domestic cat, a radiation hybrid (RH) map of the cat was constructed integrating 424 Type I-coding genes with 176 microsatellite markers, providing coverage over all 20 feline chromosomes. Alignment of parallel RH maps of human and cat reveal 100 conserved segments ordered (CSOs) between the species, nearly three times the number observed with reciprocal chromosome painting analyses. The observed number is equivalent to theoretical predictions of the number of conserved segments to be found between cat and human, implying that 300-400 Type I gene markers is sufficient to reveal nearly all conserved segments for species that exhibit the most frequently observed "slow" rate of genome reorganization. The cat-human RH map comparisons provide a new genomic tool for comparative gene mapping in the cat and related Felidae, and provide confirmation that the cat genome organization is remarkably conserved compared with human. These data demonstrate that ordered RH-based gene maps provide the most precise assessment of comparing genomes, short of contig construction or full-sequence determination.
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Affiliation(s)
- W J Murphy
- Laboratory of Genomic Diversity, National Cancer Institute, Frederick Cancer Research and Development Center, Frederick, Maryland 21702-1201 USA.
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17
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Huber P, Braun J, Hirschmann D, Agyeman JF. Incidence of berry aneurysms of the unpaired pericallosal artery: angiographic study. Neuroradiology 1980; 19:143-7. [PMID: 7383334 DOI: 10.1007/bf00342389] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The highest incidence of aneurysms at bifurcations of different configuration among all cerebral arteries occurs at the bifurcation of large unpaired pericallosal arteries. A berry aneurysm was present in seven (41%) of 17 unpaired pericallosal arteries in our material.
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