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Worm J, Noory N, Smilkov EA, Heinskou TB, Andersen ASS, Springborg JB, Rochat P, Frederiksen JL, Bendtsen L, Maarbjerg S. Efficacy of surgical treatment in patients with trigeminal neuralgia secondary to multiple sclerosis: A prospective study of 18 cases with evaluation of outcome and complications by independent evaluators. Cephalalgia 2023; 43:3331024231167130. [PMID: 37072908 DOI: 10.1177/03331024231167130] [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] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Medical treatments for trigeminal neuralgia secondary to multiple sclerosis have low efficacy and tolerability and scientific evidence regarding efficacy of neurosurgery is scarce. We aimed to assess neurosurgical outcome and complications in trigeminal neuralgia secondary to multiple sclerosis. METHODS Patients with trigeminal neuralgia secondary to multiple sclerosis who underwent microvascular decompression, glycerol rhizolysis or balloon compression were prospectively and consecutively included from 2012 to 2019. Preoperatively, we systematically obtained clinical characteristics and performed a 3.0 Tesla MRI. Follow-up at three, six and 12 months was performed by independent assessors. RESULTS We included 18 patients. Of the seven patients treated with microvascular decompression, two patients (29%) had an excellent outcome (both had neurovascular contact with morphological changes), three patients (43%) had a good outcome, one patient (14%) had treatment failure and one patient (14%) had a fatal outcome. Three patients (43%) had major complications. Of 11 patients treated with percutaneous procedures, seven patients (64%) had an excellent or good outcome with major complications in three patients (27%). CONCLUSION Percutaneous procedures provided acceptable outcome and complication rates and should be offered to the majority of patients with trigeminal neuralgia secondary to multiple sclerosis who need surgery. Microvascular decompression is less effective and has a higher complication rate in trigeminal neuralgia secondary to multiple sclerosis compared to microvascular decompression in classical and idiopathic trigeminal neuralgia. Microvascular decompression should only be considered in patients with trigeminal neuralgia secondary to multiple sclerosis when they have neurovascular contact with morphological changes.
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Affiliation(s)
- Jacob Worm
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Denmark
| | - Navid Noory
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Denmark
| | | | - Tone Bruvik Heinskou
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Denmark
| | | | | | - Per Rochat
- Department of Neurosurgery, Rigshospitalet Blegdamsvej, Denmark
| | - Jette Lautrup Frederiksen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Denmark
| | - Stine Maarbjerg
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Denmark
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Andersen ASS, Heinskou TB, Rochat P, Springborg JB, Noory N, Smilkov EA, Bendtsen L, Maarbjerg S. Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients. J Headache Pain 2022; 23:145. [PMCID: PMC9675260 DOI: 10.1186/s10194-022-01520-x] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Trigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD. Objectives We aimed to assess outcome and complications after microvascular decompression from our center. Methods We prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors. Results Of 115 included patients, 86% had a clinically significant outcome (i.e., BNI I – BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9–12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1–6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others. Conclusion Microvascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively. Trial registration Clinical.trials.gov registration no. NCT04445766. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01520-x.
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Affiliation(s)
- Anne Sofie Schott Andersen
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Tone Bruvik Heinskou
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Per Rochat
- grid.4973.90000 0004 0646 7373Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet – Blegdamsvej, 2100 Copenhagen, Denmark
| | - Jacob Bertram Springborg
- grid.4973.90000 0004 0646 7373Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet – Blegdamsvej, 2100 Copenhagen, Denmark
| | - Navid Noory
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Emil Andonov Smilkov
- grid.475435.4Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet – Glostrup, 2600 Glostrup, Denmark
| | - Lars Bendtsen
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Stine Maarbjerg
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
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Kofoed Lauridsen E, Ciochon UM, Tolver A, Bech Knudsen M, Giraldi L, Springborg JB, Bøgeskov L, Poulsgaard L, Mathiesen T, Piil K, Fugleholm K. Long-term postoperative health-related quality of life in patients with subfrontal meningiomas. J Neurosurg 2022:1-10. [PMID: 36681993 DOI: 10.3171/2022.9.jns22826] [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: 04/10/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Subfrontal meningiomas grow insidiously in areas with high cerebral compliance and a relative scarcity of eloquent function. Symptoms develop progressively, are nonspecific, and include anosmia, changes in personality and cognition, depressive symptoms, headaches, visual disturbances, and seizures. Patients with subfrontal meningiomas carry the highest risk of developing psychological symptoms, which makes patient-reported outcome in terms of long-term health-related quality of life (HRQOL), anxiety, and depression of particular importance. This observational study aimed to investigate long-term HRQOL, anxiety, and depression in patients with subfrontal meningiomas who underwent a bifrontal craniotomy (subfrontal) approach between 2008 and 2017 at a single tertiary center. Correlations between preoperative, perioperative, and postoperative factors and HRQOL, anxiety, and depression were analyzed to detect prognostic factors. METHODS Seventy-seven consecutive patients who underwent operations at Rigshospitalet, Copenhagen, Denmark, between 2008 and 2017 were retrospectively analyzed. Patients were prospectively invited to respond to the Functional Assessment of Cancer Therapy-General, Functional Assessment of Cancer Therapy-Brain, and Hospital Anxiety and Depression Scale. Information regarding preoperative, perioperative, and postoperative factors were collected from the patients' medical records and scans. RESULTS Patients with subfrontal meningiomas exhibited better HRQOL and lower levels of anxiety and depression than general populations and other meningioma and glioblastoma cohorts. The only statistically significant prognostic factors for long-term HRQOL were number of symptoms at diagnosis and whether patients were discharged home or to a local hospital postoperatively. Tumor and peritumoral brain edema volumes were not prognostic factors. CONCLUSIONS Patients with subfrontal meningiomas exhibited better long-term postoperative HRQOL and were less likely to have anxiety or depression than the reference populations. This information on long-term prognosis is very valuable for patients, next of kin, and neurosurgeons and has not been previously studied in detail.
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Affiliation(s)
- Emma Kofoed Lauridsen
- 1Department of Neurosurgery, Section 6031, Copenhagen University Hospital, Rigshospitalet, Copenhagen
- 5Faculty of Health & Medical Sciences, University of Copenhagen; and
| | - Urszula Maria Ciochon
- 3Department of Diagnostic Radiology, Section 6001, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Anders Tolver
- 4Department of Mathematical Sciences, University of Copenhagen
| | | | - Laura Giraldi
- 1Department of Neurosurgery, Section 6031, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Jacob Bertram Springborg
- 1Department of Neurosurgery, Section 6031, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Lars Bøgeskov
- 1Department of Neurosurgery, Section 6031, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Lars Poulsgaard
- 1Department of Neurosurgery, Section 6031, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Tiit Mathiesen
- 1Department of Neurosurgery, Section 6031, Copenhagen University Hospital, Rigshospitalet, Copenhagen
- 5Faculty of Health & Medical Sciences, University of Copenhagen; and
| | - Karin Piil
- 2Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen
- 6Aarhus University, Department of Public Health, Aarhus, Denmark
| | - Kåre Fugleholm
- 1Department of Neurosurgery, Section 6031, Copenhagen University Hospital, Rigshospitalet, Copenhagen
- 5Faculty of Health & Medical Sciences, University of Copenhagen; and
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Pedersen MB, Dukanovic S, Springborg JB, Andreassen M, Krogh J. Endocrine Function after Transsphenoidal Surgery in Patients with Non-Functioning Pituitary Adenomas: A Systematic Review and Meta-Analysis. Neuroendocrinology 2022; 112:823-834. [PMID: 35172314 DOI: 10.1159/000522090] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/13/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Transsphenoidal surgery is the current treatment for mass reduction in patients with non-functional pituitary adenomas (NFPAs). The surgical procedure may deteriorate or recover pituitary endocrine function. The aim of this study was to systematically assess the benefits and harms of transsphenoidal surgery on pituitary endocrine function in patients with NFPAs. METHODS This systematic review and meta-analysis was registered with PROSPERO (registration No. CRD42020210853). We searched Pubmed and EMBASE for studies reporting on pituitary function before and after transsphenoidal surgery in patients with NFPAs having a minimum follow-up of 1 month. The prespecified primary outcomes were the proportions of patients with improved or deteriorated pituitary function after surgery reported as weighted mean using random effects meta-analysis or in case of considerable heterogeneity, i.e., I2 ≥ 75%, as a range of reported proportions. Subgroup analyses were planned for the primary outcomes on study level. RESULTS Of the 6,597 identified records, 24 studies enrolling 3,816 participants were eligible for assessment. Twenty-three studies were judged to have serious or critical risk of bias. The range of proportions of patients with recovery of at least one pituitary axis was between 10.2% and 97.7% (I2 = 93%), while the range of proportions of patients experiencing loss of at least one axis after pituitary surgery was between 0.0% and 36.6% (I2 = 91%). None of the a priori planned subgroup analyses explained the observed heterogeneity associated with deterioration of pituitary function after surgery, and the proportion of patients may be underestimated due to publication bias. CONCLUSIONS The current systematic review finds that the endocrine effect of pituitary surgery is unclear both in terms of the chance of recovery and in terms of the risk of pituitary failure and hypopituitarism should be considered only a relative indication for surgery. However, the range of effects does include potentially clinically relevant rates of pituitary recovery calling for more systematic collection of data in future studies.
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Affiliation(s)
- Mathias Brown Pedersen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan Dukanovic
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mikkel Andreassen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Krogh
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Staby I, Krogh J, Klose M, Baekdal J, Feldt-Rasmussen U, Poulsgaard L, Springborg JB, Andreassen M. Pituitary function after transsphenoidal surgery including measurement of basal morning cortisol as predictor of adrenal insufficiency. Endocr Connect 2021; 10:750-757. [PMID: 34137733 PMCID: PMC8346196 DOI: 10.1530/ec-21-0155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/16/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Patients with pituitary adenomas undergoing transsphenoidal surgery require pre- and post-surgery examination of pituitary hormones. There is currently no consensus on how to evaluate the adrenal axis post-surgery. The aims of this study were to investigate factors that may predict postoperative adrenal insufficiency (AI) and to investigate the overall effect of transsphenoidal surgery on pituitary function. METHODS One hundred and forty-three consecutive patients who had undergone transsphenoidal surgery for pituitary adenomas were included. Data on tumour size, pituitary function pre-surgery, plasma basal cortisol measured within 48 h post-surgery and pituitary function 6 months post-surgery were collected. Patients with AI prior to surgery, perioperative glucocorticoid treatment, Cushing's disease and no re-evaluation after 1 month were excluded (n = 93) in the basal cortisol analysis. RESULTS Low plasma basal cortisol post-surgery, tumour size and previous pituitary surgery were predictors of AI (all P < 0.05). A basal cortisol cut-off concentration of 300 nmol/L predicted AI 6 months post-surgery with sensitivity and negative predictive value of 100%, specificity of 81% and positive predictive value of 25%. New gonadal, thyroid and adrenal axis insufficiencies accounted for 2, 10 and 10%, respectively. The corresponding recovery rates were 17, 7 and 24%, respectively. CONCLUSION Transsphenoidal surgery had an overall beneficial effect on pituitary endocrine function. Low basal plasma cortisol measured within 48 h after surgery, tumour size and previous surgery were identified as risk factors for AI. Measurement of basal cortisol post-surgery may help to identify patients at risk of developing AI.
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Affiliation(s)
- Ida Staby
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Krogh
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jonas Baekdal
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mikkel Andreassen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
- Correspondence should be addressed to M Andreassen:
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Springborg JB, Lang JM, Fugleholm K, Poulsgaard L. Face-to-face four hand technique in vestibular schwannoma surgery: results from 256 Danish patients with larger tumors. Acta Neurochir (Wien) 2020; 162:61-69. [PMID: 31768756 DOI: 10.1007/s00701-019-04148-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to investigate the clinical outcome after microsurgical treatment of vestibular schwannomas using face-to-face four hand technique in 256 Danish patients treated in the Department of Neurosurgery at the Copenhagen University Hospital from 2009 to 2018. METHODS Data were retrospectively collected from patient records. RESULTS The mean tumor size was 30.6 mm and approximately 46% of the patients had tumors >30 mm. In around 1/3 of the patients a retrosigmoid approach was used and in 2/3 a translabyrinthine. In 50% of the patients, the tumor was completely removed, and in 38%, only smaller remnants were left to preserve facial function. The median operative time was approximately 2.5 h for retrosigmoid approach, and for translabyrinthine approach, it was around 3.5 h. One year after surgery, 84% of the patients had a good facial nerve function (House-Brackmann grade 1-2). In tumors ≤ 30 mm approximately 89% preserved good facial function, whereas this was only the case for around 78% of the patients with tumors > 30 mm. In 60% of the patients who had poor facial nerve function at hospital discharge, the function improved to good facial function within the 1 year follow-up period. Four patients died within 30 days after surgery, and 6% underwent reoperation for cerebrospinal fluid leakage. CONCLUSION Surgery for vestibular schwannomas using face-to-face four hand technique may reduce operative time and can be performed with lower risk and excellent facial nerve outcome. The risk of surgery increases with increasing tumor size.
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Affiliation(s)
| | - Jeppe Mathias Lang
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
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Forsse A, Eskesen V, Springborg JB. [Bicycle helmet prevents brain damage]. Ugeskr Laeger 2015; 177:V10140560. [PMID: 25786847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The relatively small and declining incidence of traffic-related death accidents in Scandinavia is a result of targeted infra-structural measures and policies. Bicycle accidents represent a large fraction of the total traffic accident load and are often underreported in statistics. We argue that there is scientific evidence of bicycle helmet efficacy with a protective effect on serious brain injury of 63-88%. There is no consensus in favour of the effect of bicycle helmet legislation, although a Cochrane review from 2007 showed a significant reduction of injuries among children.
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Affiliation(s)
- Axel Forsse
- Neurokirurgisk Afdeling, Odense Universitets-hospital.
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Springborg JB. [Not Available]. Ugeskr Laeger 2014; 176:V66692. [PMID: 25316354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Staalsø JM, Edsen T, Kotinis A, Romner B, Springborg JB, Olsen NV. Association of the NOS3 intron-4 VNTR polymorphism with aneurysmal subarachnoid hemorrhage. J Neurosurg 2014; 121:587-92. [PMID: 24972130 DOI: 10.3171/2014.5.jns131572] [Citation(s) in RCA: 8] [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] [Indexed: 11/06/2022]
Abstract
OBJECT The nitric oxide system has been linked to the pathogenesis of aneurysmal subarachnoid hemorrhage (SAH). The authors performed a case-control study to investigate the association between SAH and common genetic variants within the endothelial nitric oxide synthase gene (NOS3). METHODS Three hundred thirty-three Caucasian SAH patients and 498 controls were genotyped for the -922A > G (rs 1800779), -786T > C (rs2070744), and 894G > T (rs1799983) single nucleotide polymorphisms and the intron-4 27-bp variable number of tandem repeats polymorphism (27-bp-VNTR). RESULTS The b/b (5 repeats) genotype of the 27-bp-VNTR was overrepresented in cases (77%) versus controls (69%) (p = 0.02). In male patients the b/b genotype was found in 85% compared with 67% in male controls, whereas in women, the frequencies were 73% and 72%, respectively. This corresponds to an odds ratio of 2.8 (95% CI 1.5-5.6, p = 0.0005) for SAH in men with the b/b genotype versus men with a/b or a/a. In women, no such association was found (OR 1.1, 95% CI 0.7-1.6, p = 0.76). Stepwise logistic regression including arterial hypertension, smoking, sex, and age with interactions yielded similar effect estimates of the 27-bp-VNTR. Haplotype analysis revealed that no single haplotype containing the b-allele was responsible for the observed genotype effect. CONCLUSIONS The authors' results suggest that the NOS3 27-bp-VNTR b/b genotype independent of other risk factors act in concert with male sex to substantially increase risk of SAH. This effect is not mediated by any single NOS3 haplotype.
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Eskesen V, Springborg JB, Unden J, Romner B. [Guidelines for the initial management of adult patients with minimal to moderate head injury]. Ugeskr Laeger 2014; 176:V09130559. [PMID: 25096558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mild to moderate head injuries are very common. Often diagnostics and symptomatic treatment is relatively uncomplicated and the clinical challenge is identification of patients who will later develop a potentially life-threatening complication. Based on updated knowledge, the Scandinavian Neurotrauma Committee has published new guidelines for the initial management of adult patients with minimal to moderate head injury. These categorize patients into five risk groups that should be handled by three different strategies: admission for observation, computed tomography or assessment of the biomarker S100B.
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Affiliation(s)
- Vagn Eskesen
- Neurokirurgisk Klinik 2092, Rigshospitalet, Blegdamsvej 9, 2100 København Ø.
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Bergdal O, Springborg JB, Holst AV, Hauerberg J, Way S, Breum P, Romner B. Accuracy of tunnelated vs. bolt-connected external ventricular drains. Clin Neurol Neurosurg 2013; 115:1972-5. [DOI: 10.1016/j.clineuro.2013.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/26/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
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Springborg JB, Fugleholm K, Poulsgaard L, Cayé-Thomasen P, Thomsen J, Stangerup SE. Outcome after translabyrinthine surgery for vestibular schwannomas: report on 1244 patients. J Neurol Surg B Skull Base 2013; 73:168-74. [PMID: 23730545 DOI: 10.1055/s-0032-1301403] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 11/04/2011] [Accepted: 11/13/2011] [Indexed: 10/28/2022] Open
Abstract
The objective of this article is to study the outcome after translabyrinthine surgery for vestibular schwannomas, with special focus on the facial nerve function. The study design is a case series from a national centralized database and it is set in two University Hospitals in Denmark. Participants were 1244 patients who underwent translabyrinthine surgery during a period of 33 years from 1976 to 2009. Main outcome measures were tumor removal, intraoperative facial nerve preservation, complications, and postoperative facial nerve function. In 84% patients, the tumor was totally resected and in ~85% the nerve was intact during surgery. During 33 years, 12 patients died from complications to surgery and ~14% had cerebrospinal fluid leakage. Before surgery, 74 patients had facial paresis and 46% of these improved after surgery. In patients with normal facial function, overall ~70% had a good outcome (House-Brackmann grade 1 or 2). The chance of a good outcome was related to tumor size with a higher the chance the smaller the tumor, but not to the degree of tumor removal. In ~78% of the patients with facial paresis at discharge the paresis improved over time, in ~42% from a poor to a good function. The translabyrinthine approach is generally efficient in tumor control and with satisfactory facial nerve outcome. With larger tumors the risk of a poor outcome is evident and more data on patients managed with alternative strategies are warranted.
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Springborg JB, Springborg KK, Romner B. First Clinical Experience with Intranasal Cooling for Hyperthermia in Brain-Injured Patients. Neurocrit Care 2013; 18:400-5. [DOI: 10.1007/s12028-012-9806-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Springborg JB, Åstrand R, Eskesen V, Hansen K, Romner B. [Can CT be omitted after light trauma to the head?]. Ugeskr Laeger 2012; 174:972-974. [PMID: 22574323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Springborg JB, Poulsgaard L, Thomsen J. Nonvestibular schwannoma tumors in the cerebellopontine angle: a structured approach and management guidelines. Skull Base 2011; 18:217-27. [PMID: 19119337 DOI: 10.1055/s-2007-1016959] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [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: 10/21/2022]
Abstract
The most common cerebellopontine angle (CPA) tumor is a vestibular schwannoma, but one in five CPA tumors are not vestibular schwannomas. These tumors may require different management strategies. Compared with vestibular schwannomas, symptoms and signs from cranial nerve VIII are less frequent: other cranial nerve and cerebellar symptoms and signs predominate in patients with these less common CPA tumors. Computed tomography and magnetic resonance imaging often show features leading to the correct diagnosis. Treatment most often includes surgery, but a policy of observation or subtotal resection is often wiser. This review provides a structured approach to the diagnosis of nonvestibular schwannoma CPA lesions and also management guidelines.
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Springborg JB, Møller C, Gideon P, Jørgensen OS, Juhler M, Olsen NV. Erythropoietin in patients with aneurysmal subarachnoid haemorrhage: a double blind randomised clinical trial. Acta Neurochir (Wien) 2007; 149:1089-101; discussion 1101. [PMID: 17876497 DOI: 10.1007/s00701-007-1284-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 04/24/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Erythropoietin (EPO) is neuroprotective in experimental models of stroke and subarachnoid haemorrhage (SAH) and possibly in patients with thromboembolic stroke. We studied the efficacy and safety of EPO in patients with SAH. METHODS A larger scale clinical trial was planned but preliminarily terminated because of a lower than expected inclusion rate. However, 73 patients were randomised to treatment with EPO (500 IU/kg/day for three days) or placebo. The primary endpoint was Glasgow Outcome Score at six months. We further studied surrogate measures of secondary ischaemia, i.e. transcranial Doppler (TCD) flow velocity, symptomatic vasospasm, cerebral metabolism (microdialysis) and jugular venous oximetry, biochemical markers of brain damage (S-100beta and neuron specific enolase) and blood-brain barrier integrity. FINDINGS The limited sample size precluded our primary hypotheses being verified and refuted. However, data from this study are important for any other study of SAH and as much raw data as possible are presented and can be included in future meta analyses. On admission the proportion of patients in a poor condition was higher in the EPO group compared with the placebo group but the difference was statistically insignificant. In the EPO-treated patients the CSF concentration of EPO increased 600-fold. Except for a higher extracelullar concentration of glycerol in the EPO group probably caused by the poorer clinical condition of these patients, there were no statistically significant group differences in the primary or secondary outcome measures. EPO was well tolerated. CONCLUSIONS Beneficial effects of EPO in patients with SAH cannot be excluded or concluded on the basis of this study and larger scale trials are warranted.
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Affiliation(s)
- J B Springborg
- Department of Neuroanaesthesia, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
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Springborg JB, Eskesen V, Olsen NV, Gjerris F. Cranio-Cerebral Injuries Caused by Nail Guns: Report on Two Cases, Review of the Literature and Treatment Algorithm. ACTA ACUST UNITED AC 2007; 63:E59-64. [PMID: 17308488 DOI: 10.1097/01.ta.0000246885.00727.37] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jacob Bertram Springborg
- University Clinics of Neuroanaesthesia and Neurosurgery, The Neuroscience Center, Copenhagen University Hospital, Copenhagen, Denmark.
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Springborg LK, Springborg JB, Thomsen J. Hearing preservation after classical translabyrinthine removal of a vestibular schwannoma: case report and literature review. J Laryngol Otol 2006; 121:76-9. [PMID: 17052366 DOI: 10.1017/s0022215106003598] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2006] [Indexed: 11/06/2022]
Abstract
The translabyrinthine approach is one of the favoured access routes for removal of vestibular schwannomas; however, total hearing loss in the operated ear is a predictable consequence. Here, we report a case in which a patient maintained serviceable hearing almost six years after classic translabyrinthine surgery. Possible explanations for the hearing preservation are discussed, as well as the feasibility of a modified translabyrinthine approach in attempting preservation of hearing following vestibular schwannoma surgery.
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Affiliation(s)
- L K Springborg
- Department of Otolaryngology, Head and Neck Surgery, Hillerød University Hospital, Hillerød, Denmark
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Abstract
After aneurysmal subarachnoid haemorrhage (SAH), the clinical outcome depends upon the primary haemorrhage and a number of secondary insults in the acute post-haemorrhagic period. Some secondary insults are potentially preventable but prevention requires prompt recognition of cerebral or systemic complications. Currently, several neuro-monitoring techniques are available; this review describes the most frequently used techniques and discusses indications for their use, and their value in diagnosis and prognosis. None of the techniques, when considered in isolation, has proved sufficient after SAH. Furthermore, the use of multi-modality monitoring is hampered by a lack of clinical studies that identify combinations of specific techniques in terms of clinical information and reliability. However, ischaemia at the tissue level can be detected by intracerebral microdialysis technique. Used together with the conventional monitoring systems, for example intracranial pressure measurements, transcranial Doppler ultrasound and modern neuro-imaging, direct assessment of biochemical markers by intracerebral microdialysis is promising in the advancement of neurointensive care of patients with SAH. A successfully implemented monitoring system provides answers but it also raises valuable new questions challenging our current understanding of the brain injury after SAH.
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Affiliation(s)
- J B Springborg
- Department of Neuroanaesthesia, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
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Mogensen J, Miskowiak K, Sørensen TA, Lind CT, Olsen NV, Springborg JB, Malá H. Erythropoietin improves place learning in fimbria–fornix-transected rats and modifies the search pattern of normal rats. Pharmacol Biochem Behav 2004; 77:381-90. [PMID: 14751468 DOI: 10.1016/j.pbb.2003.11.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The acquisition of a water-maze-based allocentric place learning task was studied in four groups of rats: two groups subjected to bilateral transections of the fimbria-fornix and two groups undergoing a sham control operation. At the moment of surgery all animals were given one systemic (intraperitoneal) injection of either human recombinant erythropoietin (EPO) (at a dosage of 5000 IU/kg body weight), given to one of the fimbria-fornix-transected groups and one of the sham-operated groups, or vehicle (saline), given to the two remaining groups. The 25-day task acquisition period (one session/day) began 6 or 7 days after the day of surgery. The fimbria-fornix-transected and saline-injected group exhibited a pronounced and long-lasting impairment of task acquisition. In contrast, the fimbria-fornix-transected and EPO-treated group demonstrated a less pronounced and more transient lesion-associated impairment. The two sham-operated groups did not differ with respect to the proficiency of task acquisition. But administration of EPO to intact animals caused a significant modification of swim patterns-apparently reflecting a somewhat modified strategy of task solution. It is concluded that systemic administration of EPO significantly improves the posttraumatic functional recovery of the presently studied place learning task after transections of the fimbria-fornix. Additionally, administration of EPO influences the strategy, although not quality, of task solution in normal (sham-operated) rats.
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Affiliation(s)
- Jesper Mogensen
- Department of Psychology, University of Copenhagen, Amager, Njalsgade 88, DK-2300 S, Copenhagen, Denmark.
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Springborg JB, Sonne B, Frederiksen HJ, Foldager N, Poulsgaard L, Klausen T, Jørgensen OS, Olsen NV. Erythropoietin in the cerebrospinal fluid of patients with aneurysmal subarachnoid haemorrhage originates from the brain. Brain Res 2003; 984:143-8. [PMID: 12932848 DOI: 10.1016/s0006-8993(03)03124-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/29/2022]
Abstract
Recent years' research has revealed a specific, neuroprotective erythropoietin (EPO) system in the central nervous system (CNS) that is upregulated by hypoxia. The presence and dynamics of EPO in the cerebrospinal fluid (CSF) of patients with subarachnoid haemorrhage (SAH) has not been investigated. We collected a total of 83 corresponding serum and CSF samples from 18 patients with aneurysmal SAH and compared the concentrations of EPO with those of blood-derived markers of blood-brain barrier function (albumin, transferrin, alpha(2)-macroglobulin) and with those of proteins with well-known CNS synthesis (prealbumin, apolipoprotein E). The EPO concentration in CSF was 0.93 (0.82) mU/ml (median and inter-quartile range). Nine patients presented CSF-EPO values above 1 mU/ml. CSF levels did not correlate with serum concentrations and were independent of blood-brain barrier integrity suggesting a synthesis in CNS rather than a blood-derived origin. Furthermore, the median CSF:serum ratio (Q(protein)) of EPO was similar to those of prealbumin and apolipoprotein E, and much higher than those of albumin, transferrin and alpha(2)-macroglobulin. When the Q(protein) of all proteins were plotted against Q(albumin), EPO showed dynamics similar to CNS-derived proteins. Our data indicate that EPO in the CSF of patients with aneurysmal SAH originates mainly from the CNS.
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Affiliation(s)
- Jacob Bertram Springborg
- Department of Neuroanaesthesia, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
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Springborg JB, Ma X, Rochat P, Knudsen GM, Amtorp O, Paulson OB, Juhler M, Olsen NV. A single subcutaneous bolus of erythropoietin normalizes cerebral blood flow autoregulation after subarachnoid haemorrhage in rats. Br J Pharmacol 2002; 135:823-9. [PMID: 11834631 PMCID: PMC1573185 DOI: 10.1038/sj.bjp.0704521] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [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: 11/09/2022] Open
Abstract
Systemic administration of recombinant erythropoietin (EPO) has been demonstrated to mediate neuroprotection. This effect of EPO may in part rely on a beneficial effect on cerebrovascular dysfunction leading to ischaemic neuronal damage. We investigated the in vivo effects of subcutaneously administered recombinant EPO on impaired cerebral blood flow (CBF) autoregulation after experimental subarachnoid haemorrhage (SAH). Four groups of male Sprague-Dawley rats were studied: group A, sham operation plus vehicle; group B, sham operation plus EPO; group C, SAH plus vehicle; group D, SAH plus EPO. SAH was induced by injection of 0.07 ml of autologous blood into the cisterna magna. EPO (400 iu kg(-1) s.c.) or vehicle was given immediately after the subarachnoid injection of blood or saline. Forty-eight hours after the induction of SAH, CBF autoregulatory function was evaluated using the intracarotid (133)Xe method. CBF autoregulation was preserved in both sham-operated groups (lower limits of mean arterial blood pressure: 91+/-3 and 98+/-3 mmHg in groups A and B, respectively). In the vehicle treated SAH-group, autoregulation was abolished and the relationship between CBF and blood pressure was best described by a single linear regression line. A subcutaneous injection of EPO given immediately after the induction of SAH normalized autoregulation of CBF (lower limit in group D: 93+/-4 mmHg, NS compared with groups A and B). Early activation of endothelial EPO receptors may represent a potential therapeutic strategy in the treatment of cerebrovascular perturbations after SAH.
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Affiliation(s)
- Jacob Bertram Springborg
- Department of Neuroanaesthesia, The Neuroscience Center, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - XiaoDong Ma
- Department of Neurosurgery, The Neuroscience Center, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Per Rochat
- Department of Neurosurgery, The Neuroscience Center, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Gitte Moos Knudsen
- The Neurobiology Research Unit, The Neuroscience Center, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ole Amtorp
- Department of Pharmacology, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- The Neurobiology Research Unit, The Neuroscience Center, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, The Neuroscience Center, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Niels Vidiendal Olsen
- Department of Neuroanaesthesia, The Neuroscience Center, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Author for correspondence:
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Springborg JB, Nielsen LB, Nielsen OA. [Endoscopic decompression of the carpal tunnel]. Ugeskr Laeger 2000; 162:1735-8. [PMID: 10766654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of the study was to evaluate the efficiency and safety of endoscopic carpal tunnel release using the Wolf one-portal system. The case records for all decompressions performed between January 1995 and June 1998 were reviewed retrospectively. Preoperative complaints, intraoperative findings and postoperative results were recorded for a total of 168 procedures in 138 patients. The median follow-up period was 10.4 weeks (1.1-170.9). An improvement in symptoms was noted after 82.9% of the procedures. The complication rate was 8.9% at the time of follow-up. Nine procedures were converted to open release. No patients sustained nerve or vascular injury. The findings in this study indicate that carpal tunnel release performed using the Wolf one-portal system provides a safe and effective treatment for carpal tunnel syndrome. The technique is today used as a routine in the department in uncomplicated cases of carpal tunnel syndrome.
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