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Dumitru CA, Walter N, Siebert CLR, Schäfer FTA, Rashidi A, Neyazi B, Stein KP, Mawrin C, Sandalcioglu IE. The Roles of AGTRAP, ALKBH3, DIVERSIN, NEDD8 and RRM1 in Glioblastoma Pathophysiology and Prognosis. Biomedicines 2024; 12:926. [PMID: 38672281 PMCID: PMC11048029 DOI: 10.3390/biomedicines12040926] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
This study determined the expression of five novel biomarker candidates in IDH wild-type glioblastoma (GBM) tissues compared to non-malign brain parenchyma, as well as their prognostic relevance for the GBM patients' outcomes. The markers were analysed by immunohistochemistry in tumour tissues (n = 186) and healthy brain tissues (n = 54). The association with the patients' overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan-Meier and log-rank test. The prognostic value of the markers was determined using multivariate Cox proportional hazard models. AGTRAP, DIVERSIN, cytoplasmic NEDD8 (NEDD8c) and RRM1 were significantly overexpressed in tumour tissues compared to the healthy brain, while the opposite was observed for ALKBH3. AGTRAP, ALKBH3, NEDD8c and RRM1 were significantly associated with OS in univariate analysis. AGTRAP and RRM1 were also independent prognostic factors for OS in multivariate analysis. For PFS, only AGTRAP and NEDD8c reached significance in univariate analysis. Additionally, AGTRAP was an independent prognostic factor for PFS in multivariate models. Finally, combined analysis of the markers enhanced their prognostic accuracy. The combination AGTRAP/ALKBH3 had the strongest prognostic value for the OS of GBM patients. These findings contribute to a better understanding of the GBM pathophysiology and may help identify novel therapeutic targets in this type of cancer.
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Affiliation(s)
| | - Nikolas Walter
- Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Germany (I.E.S.)
| | | | | | - Ali Rashidi
- Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Germany (I.E.S.)
| | - Belal Neyazi
- Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Germany (I.E.S.)
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Germany (I.E.S.)
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke University, 39120 Magdeburg, Germany
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Neyazi B, Swiatek VM, Stein KP, Hartmann K, Rashidi A, Zubel S, Amini A, Sandalcioglu IE. Enlarged tumefactive perivascular, or Virchow-Robin, spaces and hydrocephalus: do we need to treat? Illustrative cases. J Neurosurg Case Lessons 2024; 7:CASE23564. [PMID: 38408336 PMCID: PMC10901120 DOI: 10.3171/case23564] [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] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/27/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Perivascular spaces (PVSs) are spaces in brain parenchyma filled with interstitial fluid surrounding small cerebral vessels. Massive enlargements of PVSs are referred to as "giant tumefactive perivascular spaces" (GTPVSs), which can be classified into three types depending on their localization. These lesions are rare, predominantly asymptomatic, and often initially misinterpreted as cystic tumor formations. However, there are several reported cases in which GTPVSs have induced neurological symptoms because of their size, mass effect, and location, ultimately leading to obstructive hydrocephalus necessitating neurosurgical intervention. Presented here are three diverse clinical presentations of GTPVS. OBSERVATIONS Here, the authors observed an asymptomatic case of type 1 GTPVS and two symptomatic cases of type 3 GTPVS, one causing local mass effect and the other hydrocephalus. LESSONS GTPVSs are mostly asymptomatic lesions. Patients without symptoms should be closely monitored, and biopsy is discouraged. Hydrocephalus resulting from GTPVS necessitates surgical intervention. In these cases, third ventriculostomy, shunt implantation, or direct cyst fenestration are surgical options. For patients presenting with symptoms from localized mass effect, a thorough evaluation for potential neurosurgical intervention is imperative. Follow-up in type 3 GTPVS is recommended, particularly in untreated cases. Given the infrequency of GTPVS, definitive guidelines for neurosurgical treatment and subsequent follow-up remain elusive.
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Affiliation(s)
| | | | | | | | | | - Seraphine Zubel
- Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony-Anhalt, Germany
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Swiatek VM, Amini A, Sandalcioglu Ortuño CE, Spitz L, Hartmann K, Rashidi A, Stein KP, Saalfeld S, Sandalcioglu IE, Neyazi B. Unveiling rupture risk and clinical outcomes in midline aneurysms: A matched cohort analysis investigating the impact of localization within the anterior or posterior circulation. Neurosurg Rev 2024; 47:76. [PMID: 38324094 PMCID: PMC10850182 DOI: 10.1007/s10143-024-02310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
Intracranial aneurysms (IAs) located in the anterior and posterior circulations of the Circle of Willis present differential rupture risks. This study aimed to compare the rupture risk and clinical outcomes of anterior communicating artery aneurysms (AcomA) and basilar tip aneurysms (BAs); two IA types located along the midline within the Circle of Willis. We retrospectively collected data from 1026 patients presenting with saccular IAs. Only AcomA and BAs with a 3D angiography were included. Out of 186 included IAs, a cohort of 32 BAs was matched with AcomA based on the patients' pre-existing conditions and morphological parameters of IAs. Clinical outcomes, including rupture risk, hydrocephalus development, vasospasm incidence, and patients' outcome, were compared. The analysis revealed no significant difference in rupture risk, development of hydrocephalus, need for ventricular drainage, or vasospasm incidence between the matched AcomA and BA cohorts. Furthermore, the clinical outcomes post-rupture did not significantly differ between the two groups, except for a higher Fisher Grade associated with BAs. Once accounting for morphological and patient factors, the rupture risk between AcomA and BAs is comparable. These findings underscore the importance of tailored management strategies for specific IA types and suggest that further investigations should focus on the role of individual patient and aneurysm characteristics in IA rupture risk and clinical outcomes.
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Affiliation(s)
- Vanessa M Swiatek
- Department of Neurosurgery, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Saxony-Anhalt, Germany
| | - Amir Amini
- Department of Neurosurgery, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Saxony-Anhalt, Germany
| | - Celina E Sandalcioglu Ortuño
- Department of Neurosurgery, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Saxony-Anhalt, Germany
| | - Lena Spitz
- Department of Simulation and Graphics, Otto-Von-Guericke University, Universitätsplatz 2, 39106, Magdeburg, Saxony-Anhalt, Germany
- Research Campus STIMULATE, Otto-Hahn-Str. 2, 39106, Magdeburg, Saxony-Anhalt, Germany
| | - Karl Hartmann
- Department of Neurosurgery, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Saxony-Anhalt, Germany
| | - Ali Rashidi
- Department of Neurosurgery, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Saxony-Anhalt, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Saxony-Anhalt, Germany
| | - Sylvia Saalfeld
- Research Campus STIMULATE, Otto-Hahn-Str. 2, 39106, Magdeburg, Saxony-Anhalt, Germany
- Department of Informatics and Automatisation, Technical University Ilmenau, Ehrenbergstr. 29, 98693, Ilmenau, Thuringia, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Saxony-Anhalt, Germany
| | - Belal Neyazi
- Department of Neurosurgery, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Saxony-Anhalt, Germany.
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Dumitru CA, Schröder H, Schäfer FTA, Aust JF, Kreße N, Siebert CLR, Stein KP, Haghikia A, Wilkens L, Mawrin C, Sandalcioglu IE. Progesterone Receptor Membrane Component 1 (PGRMC1) Modulates Tumour Progression, the Immune Microenvironment and the Response to Therapy in Glioblastoma. Cells 2023; 12:2498. [PMID: 37887342 PMCID: PMC10604944 DOI: 10.3390/cells12202498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/04/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Progesterone Receptor Membrane Component 1 (PGRMC1) is a tumour-promoting factor in several types of cancer but its role in brain tumours is poorly characterized thus far. Our study aimed to determine the effect of PGRMC1 on glioblastoma (GBM) pathophysiology using two independent cohorts of IDH wild-type GBM patients and stable knockdown GBM models. We found that high levels of PGRMC1 significantly predicted poor overall survival in both cohorts of GBM patients. PGRMC1 promoted the proliferation, anchorage-independent growth, and invasion of GBM cells. We identified Integrin beta-1 (ITGB1) and TCF 1/7 as potential members of the PGRMC1 pathway in vitro. The levels of ITGB1 and PGRMC1 also correlated in neoplastic tissues from GBM patients. High expression of PGRMC1 rendered GBM cells less susceptible to the standard GBM chemotherapeutic agent temozolomide but more susceptible to the ferroptosis inducer erastin. Finally, PGRMC1 enhanced Interleukin-8 production in GBM cells and promoted the recruitment of neutrophils. The expression of PGRMC1 significantly correlated with the numbers of tumour-infiltrating neutrophils also in tissues from GBM patients. In conclusion, PGRMC1 enhances tumour-related inflammation and promotes the progression of GBM. However, PGRMC1 might be a promising target for novel therapeutic strategies using ferroptosis inducers in this type of cancer.
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Affiliation(s)
| | - Hannah Schröder
- Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Germany (I.E.S.)
| | | | - Jan Friedrich Aust
- Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Germany (I.E.S.)
| | - Nina Kreße
- Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Germany (I.E.S.)
| | | | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Germany (I.E.S.)
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Ludwig Wilkens
- Department of Pathology, Nordstadt Hospital Hannover, 30167 Hannover, Germany
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke University, 39120 Magdeburg, Germany
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Hartmann K, Neyazi B, Stein KP, Haghikia A, Sandalcioglu IE. Is the central nervous system enclosed by a mesothel? Ther Adv Neurol Disord 2023; 16:17562864231180335. [PMID: 37434877 PMCID: PMC10331068 DOI: 10.1177/17562864231180335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Affiliation(s)
| | - Belal Neyazi
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Klaus-Peter Stein
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Aiden Haghikia
- Universitätsklinik für Neurologie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - I. Erol Sandalcioglu
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
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Hartmann K, Neyazi B, Dumitru CA, Haghikia A, Sandalcioglu IE, Stein KP. Extravascular optical coherence tomography of cerebral vessel walls in vivo. PLoS One 2023; 18:e0276307. [PMID: 37195981 DOI: 10.1371/journal.pone.0276307] [Citation(s) in RCA: 1] [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] [Received: 07/23/2021] [Accepted: 10/04/2022] [Indexed: 05/19/2023] Open
Abstract
PURPOSE Evaluation of extravascular, microscope integrated OCT (iOCT) as an in vivo imaging modality of cerebral blood vessels and as an intraoperative imaging method. METHODS Microscope integrated optical coherence tomography of major cerebral arteries (n = 13) and superficial sylvian veins (n = 5) and one incidental cerebral vasospasm (n = 1) in (n = 10) patients. Post procedural analysis of OCT volume scans, microscopic images and videos during the time of scan as well as measurements of the diameter of vessel walls and its layers with an accuracy of 7.5 μm. RESULTS iOCT was feasible during vascular microsurgical procedures. In all scanned arteries a clear delineation of the physiological three layered vessel wall composition could be achieved. Pathological arteriosclerotic alterations of cerebral artery walls could precisely be demonstrated. Major superficial cortical veins conversely presented a mono layered composition. First in vivo measurements of vascular mean diameters were possible. Cerebral artery walls showed a diameter of 296 μm, tunica externa 78 μm, media 134 μm and interna 84 μm. CONCLUSION For the first time the microstructural composition of cerebral blood vessels could be illustrated in vivo. Due to an outstanding spatial resolution a clear definition of physiological and pathological characteristics was possible. Therefore, microscope integrated optical coherence tomography holds promise for basic research in the field of cerebrovascular arteriosclerotic diseases and for intraoperative guidance during microvascular surgery.
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Affiliation(s)
- Karl Hartmann
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Sachsen-Anhalt, Magdeburg, Deutschland
| | - Belal Neyazi
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Sachsen-Anhalt, Magdeburg, Deutschland
| | - Claudia A Dumitru
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Sachsen-Anhalt, Magdeburg, Deutschland
| | - Aiden Haghikia
- Universitätsklinik für Neurologie, Otto-von-Guericke-Universität Magdeburg, Sachsen-Anhalt, Magdeburg, Deutschland
| | - I Erol Sandalcioglu
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Sachsen-Anhalt, Magdeburg, Deutschland
| | - Klaus-Peter Stein
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Sachsen-Anhalt, Magdeburg, Deutschland
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Ardeshiri A, Shaffrey C, Stein KP, Sandalcioglu IE. Real World Evidence for Restorative Neurostimulation in Chronic Low Back Pain- a Consecutive Cohort Study. World Neurosurg 2022; 168:e253-e259. [PMID: 36184040 DOI: 10.1016/j.wneu.2022.09.104] [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: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Neuromuscular instability of the lumbar spine resulting from impaired motor control and degeneration of the multifidus muscle is a known root cause of refractory chronic low back pain (CLBP). An implantable neurostimulation system that aims to restore multifidus motor control by stimulating the L2 medial branch of the dorsal ramus (ReActiv8, Mainstay Medical) and thereby relieving pain and reducing disability has demonstrated clinically significant benefits in the clinical trial setting. The 1-year results of a single site real-world cohort study are presented here. METHODS Forty-four consecutive patients with refractory, predominantly nociceptive axial CLB, evidence of multifidus dysfunction and no surgical indications or history of surgical intervention for CLBP were recruited at a single site in Germany. Each patient was implanted with a neurostimulation device. Pain (NRS), disability (ODI) and quality of life (EQ-5D-5L) outcomes were collected at baseline, 3-, 6- and 12-months post-activation. RESULTS Statistically significant improvements in pain, disability, and quality of life from baseline were seen at all assessment times points. At 12 months post-activation, mean (±SE) NRS was reduced from 7.6±0.2 to 3.9±0.4 (p<0.001), mean ODI (±SE) from 43.0±2.8 to 25.8±3.9 (p<0.001) and mean EQ-5D-5L (±SE) index improved from 0.504±0.034 to 0.755±0.039 (p<0001). No lead migrations were observed. One patient required revision due to lead fracture. CONCLUSIONS Restorative neurostimulation is a new treatment option for well selected patients with refractory CLBP. The clinically meaningful improvements in pain, disability, and quality of life demonstrated in routine clinical practice are consistent with the published results of controlled trials.
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Affiliation(s)
| | - Christopher Shaffrey
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA
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Kohl J, König RE, Kraus A, Mawrin C, Paukisch H, Stein KP, Rashidi A, Luchtmann M, Sandalcioglu IE, Lilla N. Angiosarcoma on Top of a Meningioma Mimicking a Transosseous Meningioma: an Interdisciplinary Point of View. J Neurol Surg A Cent Eur Neurosurg 2022. [PMID: 36100236 DOI: 10.1055/s-0042-1751262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Cutaneous angiosarcoma is a rare type of sarcoma with poor prognosis. Meningioma is the most frequent benign intracranial tumor. Despite the fact that meningiomas are mostly benign, bone and skin can be infiltrated. We report the rare case of an angiosarcoma on top of a meningioma with hyperostosis at exactly the same location mimicking a transosseous growth of a meningioma. An 84-year-old man presented with progressive swelling and ulcerous lesion of the forehead. The patient underwent surgery in an interdisciplinary setting together with a plastic surgeon, including resection of the intracranial tumor and infiltrated bone and skin. To the best of our knowledge, this is the only reported case of a meningioma and angiosarcoma in direct neighborhood. A preoperative biopsy of the skin tumor would have led initially to the correct diagnosis of an angiosarcoma and would have allowed a better planning of the operation and extent of resection.
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Affiliation(s)
- Jana Kohl
- Department of Neurosurgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Rebecca E König
- Department of Neurosurgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Armin Kraus
- Department of Plastic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Harald Paukisch
- Department of Neuroradiology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Ali Rashidi
- Department of Neurosurgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Michael Luchtmann
- Department of Neurosurgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Nadine Lilla
- Department of Neurosurgery, Otto-von-Guericke-University, Magdeburg, Germany
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Amini A, Zeller Y, Stein KP, Hartmann K, Wartmann T, Wex C, Mirzaee E, Swiatek VM, Saalfeld S, Haghikia A, Dumitru CA, Sandalcioglu IE, Neyazi B. Overcoming Barriers in Neurosurgical Education: A Novel Approach to Practical Ventriculostomy Simulation. Oper Neurosurg (Hagerstown) 2022; 23:225-234. [PMID: 35972086 DOI: 10.1227/ons.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In the high-risk, high-stakes specialty of neurosurgery, traditional teaching methods often fail to provide young residents with the proficiency needed to perform complex procedures in stressful situations, with direct effects on patient outcomes. Physical simulators provide the freedom of focused, hands-on training in a more controlled environment. However, the adoption of simulators in neurosurgical training remains a challenge because of high acquisition costs, complex production processes, and lack of realism. OBJECTIVE To introduce an easily reproducible, cost-effective simulator for external ventricular drain placements through various ventriculostomy approaches with life-like tactile brain characteristics based on real patients' data. METHODS Whole brain and skull reconstruction from patient's computed tomography and MRI data were achieved using freeware and a desktop 3-dimensional printer. Subsequently, a negative brain silicone mold was created. Based on neurosurgical expertise and rheological measurements of brain tissue, gelatin in various concentrations was tested to cast tactilely realistic brain simulants. A sample group of 16 neurosurgeons and medical students tested and evaluated the simulator in respect to realism, haptics, and general usage, scored on a 5-point Likert scale. RESULTS We saw a rapid and significant improvement of accuracy among novice medical students. All participants deemed the simulator as highly realistic, effective, and superior to conventional training methods. CONCLUSION We were able to demonstrate that building and implementing a high-fidelity simulator for one of the most important neurosurgical procedures as an effective educational and training tool is achievable in a timely manner and without extensive investments.
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Affiliation(s)
- Amir Amini
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Yannic Zeller
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Karl Hartmann
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Wartmann
- Division of Experimental Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Cora Wex
- Division of Experimental Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Elyas Mirzaee
- Division of Experimental Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Vanessa M Swiatek
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Sylvia Saalfeld
- Faculty of Computer Science, Otto-von-Guericke University, Magdeburg, Germany.,Research Campus STIMULATE , Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Claudia A Dumitru
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Belal Neyazi
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
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Hartmann K, Stein KP, Neyazi B, Sandalcioglu IE. Theranostic applications of optical coherence tomography in neurosurgery? Neurosurg Rev 2021; 45:421-427. [PMID: 34398385 PMCID: PMC8827310 DOI: 10.1007/s10143-021-01599-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/11/2021] [Accepted: 06/27/2021] [Indexed: 12/14/2022]
Abstract
In light of our own experiences, we value the existing literature to critically point out possible “near” future applications of optical coherence tomography (OCT) as an intraoperative neurosurgical guidance tool. “Pub Med”, “Cochrane Library”, “Crossref Metadata Search”, and “IEEE Xplore” databases as well as the search engine “Google Scholar” were screened for “optical coherence tomography + neurosurgery”, “optical coherence tomography + intraoperative imaging + neurosurgery”, and “microscope integrated optical coherence tomography + neurosurgery”. n = 51 articles related to the use of OCT as an imaging technique in the field of neurosurgery or neurosurgical research. n = 7 articles documented the intraoperative use of OCT in patients. n = 4 articles documented the use of microscope-integrated optical coherence tomography as a neurosurgical guidance tool. The Results demonstrate that OCT is the first imaging technique to study microanatomy in vivo. Postoperative analysis of intraoperative scans holds promise to enrich our physiological and pathophysiological understanding of the human brain. No data exists to prove that OCT-guided surgery minimizes perioperative morbidity or extends tumor resection. But results suggest that regular use of microscope-integrated OCT could increase security during certain critical microsurgical steps like, e.g., dural dissection at cavernous sinus, transtentorial approaches, or aneurysm clip placement. Endoscopy integration could aid surgery in regions which are not yet accessible to real-time imaging modalities like the ventricles or hypophysis. Theranostic instruments which combine OCT with laser ablation might gain importance in the emerging field of minimal invasive tumor surgery. OCT depicts vessel wall layers and its pathologies uniquely. Doppler OCT could further visualize blood flow in parallel. These abilities shed light on promising future applications in the field of vascular neurosurgery.
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Affiliation(s)
- Karl Hartmann
- Universitätsklinik Für Neurochirurgie, Otto-Von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Klaus-Peter Stein
- Universitätsklinik Für Neurochirurgie, Otto-Von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Belal Neyazi
- Universitätsklinik Für Neurochirurgie, Otto-Von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - I Erol Sandalcioglu
- Universitätsklinik Für Neurochirurgie, Otto-Von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Neyazi B, Swiatek VM, Skalej M, Beuing O, Stein KP, Hattingen J, Preim B, Berg P, Saalfeld S, Sandalcioglu IE. Rupture risk assessment for multiple intracranial aneurysms: why there is no need for dozens of clinical, morphological and hemodynamic parameters. Ther Adv Neurol Disord 2020; 13:1756286420966159. [PMID: 33403004 PMCID: PMC7739206 DOI: 10.1177/1756286420966159] [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: 07/12/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction: A multitude of approaches have been postulated for assessing the risk of intracranial aneurysm rupture. However, the amount of potential predictive factors is not applicable in clinical practice and they are rejected in favor of the more practical PHASES score. For the subgroup of multiple intracranial aneurysms (MIAs), the PHASES score might severely underestimate the rupture risk, as only the aneurysm with the largest diameter is considered for risk evaluation. Methods: In this study, we investigated 38 patients harboring a total number of 87 MIAs with respect to their morphological and hemodynamical characteristics. For the determination of the best suited parameters regarding their predictive power for aneurysm rupture, we conducted three phases of statistical evaluation. The statistical analysis aimed to identify parameters that differ significantly between ruptured and unruptured aneurysms, show smallest possible correlations among each other and have a high impact on rupture risk prediction. Results: Significant differences between ruptured and unruptured aneurysms were found in 16 out of 49 parameters. The lowest correlation were found for gamma, aspect ratio (AR1), aneurysm maximal relative residence time (Aneurysm_RRT_max) and aneurysm mean relative residence time. The data-driven parameter selection yielded a significant correlation of only two parameters (AR1 and the Aneurysm_RRT_max) with rupture state (area under curve = 0.75). Conclusion: A high number of established morphological and hemodynamical parameters seem to have no or only low effect on prediction of aneurysm rupture in patients with MIAs. For best possible rupture risk assessment of patients with MIAs, only the morphological parameter AR1 and the hemodynamical parameter Aneurysm_RRT_max need to be included in the prediction model.
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Affiliation(s)
- Belal Neyazi
- Department of Neurosurgery, Otto-von-Guericke University, Leipziger Straße 44, Magdeburg, Saxony Anhalt 39120, Germany
| | - Vanessa M Swiatek
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Martin Skalej
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Oliver Beuing
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Jörg Hattingen
- Institute of Neuroradiology, KRH Klinikum Nordstadt, Hanover, Niedersachsen, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Philipp Berg
- Department of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
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Mueller O, Kasper E, Droege F, Goericke S, Stein KP, Sure U. Cerebral Arteriovenous Malformations in Pediatric Patients with Hereditary Hemorrhagic Telangiectasia: Re-evaluating Appearance, Bleeding Risk, and Treatment Necessity in a Selective Meta-analysis. Journal of Pediatric Neurology 2020. [DOI: 10.1055/s-0040-1715499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractPediatric patients suffering from cerebral nidal arteriovenous malformations are a unique population due to the rare occurrence of the disease. Diagnosis of hereditary hemorrhagic telangiectasia (HHT) in children is a rare event and mainly restricted to coincidental detection from screening of possibly afflicted family members. In patients with HHT, it is well known that the incidence of cerebral vascular malformations (CVMs) is higher than expected when compared with the nonafflicted population. Even though CVMs comprise a variety of different distinct anatomical and radiographic entities (e.g., capillary telangiectasia, nidal arteriovenous malformation [AVM], cavernous malformation, dural or pial as well as mixed fistula, and vein of Galen malformation), they are mostly summarized and analyzed all in one category due to the low number of individual cases identified in single centers. Nevertheless, the best treatment algorithm will likely vary significantly between different CVMs as does the clinical presentation and the natural course of the CVM. It is therefore the objective of this article to focus on nidal AVMs in pediatric patients suffering from HHT. To this end, we performed a systematic selective literature research to estimate incidence, clinical and radiological appearance, as well as classification according to established grading system, and to evaluate the necessity of treatment of these lesions in light of their respective outcomes. Our line of arguments explains why we recommend to follow these lesions expectantly and suggest to keep pediatric patients under surveillance with sequential scans until they reach adulthood.
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Affiliation(s)
- Oliver Mueller
- Department of Neurosurgery, University of Essen, Essen, Germany
- Department of Neurosurgery, Dortmund Hospital, Dortmund, Germany
| | - Ekkehard Kasper
- Division of Neurosurgery, Hamilton General Hospital, Hamilton, Canada
| | - Freya Droege
- Department of Oto-Rhino-Laryngology, University of Essen, Essen, Germany
| | - Sophia Goericke
- Institute of Radiology, Neuroradiology and Interventional Radiology, University of Essen, Essen, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, University of Essen, Essen, Germany
- Department of Neurosurgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University of Essen, Essen, Germany
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Hartmann K, Stein KP, Neyazi B, Sandalcioglu IE. Optical coherence tomography of cranial dura mater: Microstructural visualization in vivo. Clin Neurol Neurosurg 2020; 200:106370. [PMID: 33321416 DOI: 10.1016/j.clineuro.2020.106370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The study explores microscope integrated optical coherence tomography (OCT) as a intraoperative imaging technique to delineate the microstructural composition of human dura mater cranialis and underlying leptomeninges for surgical guidance. METHODS OCT volume scans, light microscopic pictures and light microscopic videos of the dura mater were acquired in patients (n = 20) with indication for craniotomy. OCT volume scans and corresponding light microscopic data were analyzed post procedural. Thickness of anatomical structures was measured during this phase. RESULTS OCT scanning of the human cranial dura mater was feasible during microsurgical dissection. A discrimination of the endosteal and inner meningeal layer of the cranial dura mater was possible in 70 % (n = 14) of the patients. Transdural OCT scans could further demonstrate subdural anatomical structures: subdural space 10 % (n = 2), subarachnoid space in 35 % (n = 7), arachnoid vessels in 80 % (n = 16) and brain cortex in 90 % (n = 16) of the patients. Orthogonal distance measurement was possible. The cranial dura mater showed a mean depth of 216 μm, the endosteal layer of 120 μm and the inner meningeal layer of 132 μm. Imaging quality of the dural segment was high - approaching spatial resolution of histopathology. Imaging quality of subdural segments was lower and demonstrated A-line artifacts in 45 % (n = 7). CONCLUSION These results illustrate - for the first time - strengths and weaknesses of three dimensional microscope integrated OCT as an in vivo imaging method of the human cranial dura mater, underlying leptomeninges and human brain cortex as a surgical guidance tool. OCT imaging of the cranial dura mater showed extensive details. Transdural imaging of subdural micro anatomical structures was possible, but showed lower image quality with intermittent A-line artifacts. OCT stated the first intraoperative imaging tool to measure the depth of micro anatomical structures with a high spatial resolution of 7,5 μm.
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Affiliation(s)
- Karl Hartmann
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Klaus-Peter Stein
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Belal Neyazi
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - I Erol Sandalcioglu
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Hartmann K, Stein KP, Neyazi B, Sandalcioglu IE. Microscope integrated optical coherence tomography of a cerebral arachnoid cyst: A new technique to increase intraoperative security. J Clin Neurosci 2020; 82:29-31. [PMID: 33317734 DOI: 10.1016/j.jocn.2020.10.008] [Citation(s) in RCA: 2] [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: 09/12/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This technical note illustrates microscope integrated optical coherence tomography (iOCT) as an imaging technique to delineate concealed micro anatomical structures not displayable by conventional intraoperative imaging methods in the context of a cerebral arachnoid cyst. METHODS iOCT was used for the first time to scan a cerebral arachnoid cyst in vivo. Scanning sites were defined at the outer membrane of the arachnoid cyst, the inner membrane at the temporal cortex as well as at the fenestration site to the basal cisterns - a point out of reach and resolution for conventional intraoperative imaging methods like e. g. ultrasound or neuroendoscopy. RESULTS iOCT was feasible during microsurgical fenestration of an arachnoid cyst. A clear delineation of the arachnoid cyst membrane was possible. The differentiation of the arachnoid cyst membrane and underlying arachnoid barrier cell membrane was possible. Trans cystic scanning at the temporal cortex could delineate the content of the subarachnoid space like subarachnoid blood vessels, trabecular sytem and vessel wall morphology of a M4 middle cerebral artery branch. Scanning of the inner membrane of the arachnoid cyst at site of fenestration to the basal cisterns excluded underlying micro anatomical structures. CONCLUSION This case demonstrates that iOCT achieved to delineate concealed micro anatomical structures which are occult to conventional intraoperative imaging methods. Further studies are necessary to value iOCT as a tool to improve intraoperative security.
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Affiliation(s)
- Karl Hartmann
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Klaus-Peter Stein
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Belal Neyazi
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - I Erol Sandalcioglu
- Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
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Rashidi A, Lilla N, Beuing O, Skalej M, Stein KP, Sandalcioglu IE, Luchtmann M. Late sudden death following subarachnoid hemorrhage during cerebral angiography - Was vasospasm to blame? Clin Neurol Neurosurg 2020; 198:106232. [DOI: 10.1016/j.clineuro.2020.106232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
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Neyazi B, Stein KP, Wilkens L, Maslehaty H, Dumitru CA, Sandalcioglu IE. Age-dependent changes of collagen alpha-2(IV) expression in the extracellular matrix of brain arteriovenous malformations. Clin Neurol Neurosurg 2019; 189:105589. [PMID: 31837516 DOI: 10.1016/j.clineuro.2019.105589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/18/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Brain arteriovenous malformations (bAVM) are rare vascular lesions. Recent observations challenge the congenital nature of these lesions. The underlying cellular and molecular mechanisms associated with dynamic changes of bAVM still remain unclear. The objective of this study was to explore the potential role of COL4A2 (Collagen alpha-2(IV)) in the pathophysiology of bAVM. PATIENTS AND METHODS Expression and localization of COL4A2 were analyzed on tissue microarrays from bAVM patients (n = 60) by immunohistochemistry. Correlations between COL4A2 levels and clinical parameters were examined with Pearson's test for normally- distibuted or Spearman's Rho for not normally distributed data. Comparison between different clinical parameters was performed using t-test, non-parametric Mann-Whitney U test or Kruskal- Wallis test. Fisher's exact test was used for categorical data. RESULTS COL4A2 was mainly expressed beneath the endothelium of vessels in the tunica media of bAVM. This pattern of expression indicates the basement membrane of the vessel walls. High levels of COL4A2 expression correlated with the age at surgery of patients (p = 0.005; R = 0.393; Spearman's Rho). The age at surgery in young (17-25 years) and old patients (55-76 years) showed a linear correlation; a greater variance of COL4A2 expression was observed in the age group between 26-54 years. CONCLUSION This study reports for the first time the expression of COL4A2 in bAVM and suggests a potential role of COL4A2 in bAVM pathophysiology. These findings contribute to a better understanding of the microenvironment of bAVM and may foster the development of improved therapeutic strategies for this disease.
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Affiliation(s)
- Belal Neyazi
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany.
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Ludwig Wilkens
- Department of Pathology, Nordstadt Hospital, Hanover, Germany
| | | | - Claudia A Dumitru
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
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Hartmann K, Stein KP, Neyazi B, Sandalcioglu I. Aneurysm Architecture: First in vivo Imaging of Human Cerebral Aneurysms with Extravascular Optical Coherence Tomography. Cerebrovasc Dis 2019; 48:26-31. [DOI: 10.1159/000502450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/01/2019] [Indexed: 11/19/2022] Open
Abstract
Objective: The present study was conducted to explore the value of 3-dimensional microscope integrated extravascular optical coherence tomography (OCT) as the first suitable intraoperative imaging modality of cerebral aneurysm (CA) and parent vessel wall morphology. Methods: Incidental CAs (n = 16) of the anterior circulation with indication for microsurgical clipping were scanned. Results: Analysis revealed that intraoperative OCT achieved to delineate the microstructural composition of the parent vessel in all cases and the CA wall in 68.8%. Clinical relevant characteristics such as thickness, calcification, residual tunica media, and atherosclerotic plaque of CA wall could be demonstrated with high image quality approaching the spatial resolution of histopathology. Conclusion: Our findings demonstrate that intraoperative OCT may hold promise as an additional imaging tool during neurovascular procedures.
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Hartmann K, Stein KP, Neyazi B, Felbor U, Hethey S, Sandalcioglu IE. CCM1/KRIT1 mutation in monozygotic twins of a polyzygotic triplet birth: genetic, clinical and radiological characteristics. Neurosurg Rev 2019; 42:765-768. [PMID: 31172378 DOI: 10.1007/s10143-019-01124-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/10/2019] [Accepted: 05/23/2019] [Indexed: 11/30/2022]
Abstract
Cerebral cavernous malformations are focal vascular lesions of the brain, occurring sporadically or as an autosomal dominant familial form. The genetic background influences not only the clinical course but also patients' consultation and the indication to treat. We here present the rare case of monozygotic male twins of a polyzygotic triplet birth, carrying a CCM1 mutation, inherited from the mother. Both twins showed an identical site and size of a large frontobasal lesion. The genetic segregation and the clinical course in affected family members are presented and discussed.
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Affiliation(s)
- Karl Hartmann
- Department of Neurosurgery, KRH Hospital Nordstadt, Haltenhoffstrasse 41, 30167, Hannover, Germany. .,Department of Neurosurgery, Otto-von-Guericke-Universität Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke-Universität Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Belal Neyazi
- Department of Neurosurgery, Otto-von-Guericke-Universität Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Ute Felbor
- Department of Human Genetics, University Medicine Greifswald, and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, Fleischmannstrasse 43, 17475, Greifswald, Germany
| | - Sven Hethey
- Department of Neuropediatrics, Kinderkrankenhaus auf der Bult, Janusz-Korczak-Allee 12, 30173, Hannover, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke-Universität Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
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Hartmann K, Stein KP, Neyazi B, Sandalcioglu IE. First in vivo visualization of the human subarachnoid space and brain cortex via optical coherence tomography. Ther Adv Neurol Disord 2019; 12:1756286419843040. [PMID: 31447933 PMCID: PMC6689907 DOI: 10.1177/1756286419843040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/14/2018] [Accepted: 03/10/2019] [Indexed: 11/17/2022] Open
Abstract
The present work explores optical coherence tomography (OCT) as a suitable in vivo neuroimaging modality of the subarachnoid space (SAS). Patients (n = 26) with frontolateral craniotomy were recruited. The temporal and frontal arachnoid mater and adjacent anatomical structures were scanned using microscope-integrated three-dimensional OCT, (iOCT). Analysis revealed a detailed depiction of the SAS (76.9%) with delineation of the internal microanatomical structures such as the arachnoid barrier cell membrane (ABCM; 96.2%), trabecular system (50.2%), internal blood vessels (96.2%), pia mater (26.9%) and the brain cortex (96.2%). Orthogonal distance measuring was possible. The SAS showed a mean depth of 570 µm frontotemporal. The ABCM showed a mean depth of 74 µm frontotemporal. These results indicate that OCT provides a dynamic, non-invasive tool for real-time imaging of the SAS and adjacent anatomical structures at micrometer spatial resolution. Further studies are necessary to evaluate the value of OCT during microsurgical procedures.
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Affiliation(s)
- Karl Hartmann
- Department of Neurosurgery, KRH Klinikum Nordstadt, Haltenhoffstraße 41, Hanover 30167, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, KRH Klinikum Nordstadt, Hanover, Germany
| | - Belal Neyazi
- Department of Neurosurgery, KRH Klinikum Nordstadt, Hanover, Germany
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Stein KP, Huetter BO, Goericke S, Oezkan N, Leyrer R, Sandalcioglu IE, Forsting M, Sure U, Mueller O. Cerebral arterio-venous malformations in the paediatric population: Angiographic characteristics, multimodal treatment strategies and outcome. Clin Neurol Neurosurg 2017; 164:164-168. [PMID: 29245106 DOI: 10.1016/j.clineuro.2017.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/26/2017] [Revised: 11/04/2017] [Accepted: 12/03/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cerebral arterio-venous malformations (AVM) are considered congenital lesions, emerging as an important cause of haemorrhagic stroke in children. The potential influence of age on clinical presentation and angio-architecture have been analysed extensively in the last years. Yet, comparative studies comprising ascending age groups may be limited in their conclusions, especially when comparing young children and adults. It is the aim of this study to evaluate characteristic clinical and angiographic features of AVM within a paediatric subgroup and their correlation to age at presentation. PATIENTS AND METHODS Between 1990-2015, 46 children harbouring AVMs were treated at our institution. Clinical presentation, radiological data, treatment strategies and outcome were evaluated retrospectively. RESULTS Of 46 consecutive patients, 18 were male and 28 female patients. Mean age was 11.6±4.3years, ranging from 2 to 17 years. 35 patients (76%) presented with haemorrhage. Seizures were found in 6 patients (13%) and progressive or transient focal neurological deficits in 4 individuals (9%). There was one incidental patient, only. Mean age of children presenting with haemorrhage was significantly lower as compared to those without a history of intracranial bleeding (p=0.1). The size of the AVM was small (n=27, 59%), corresponding a grade I AVM in the majority of patients (N=28, 61%). 41 patients (89%) underwent treatment of their AVM by an interdisciplinary approach achieving complete elimination of the lesion in 34 patients (83%). 34 patients (83%) showed at least a favourable outcome (mRS≤2) at last follow-up. An excellent recovery (mRS 0-1) was noted in 28 patients (68%). CONCLUSION From our data we suggest that patients' age impacts the clinical presentation. Particularly young children seem to bear a higher risk for haemorrhage from their AVM. Treatment of paediatric AVMs can be achieved safely in experienced hands with a high rate of complete elimination and good clinical outcome.
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Affiliation(s)
- Klaus-Peter Stein
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany; Department of Neurosurgery, KRH Hospital Nordstadt, Haltenhoffstr.41, 30167 Hannover, Germany.
| | - Bernd-Otto Huetter
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Sophia Goericke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Neriman Oezkan
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Rebecca Leyrer
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, KRH Hospital Nordstadt, Haltenhoffstr.41, 30167 Hannover, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Oliver Mueller
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
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Schott M, Stein KP, Bauer M. [Cerebral Emergency - Important Anesthesiological Aspects]. Anasthesiol Intensivmed Notfallmed Schmerzther 2017; 52:716-725. [PMID: 29050062 DOI: 10.1055/s-0042-120989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The anesthesiological management of cerebral emergency represents a great challenge for action under pressure and under time pressure and requires smooth interprofessional cooperation. The exact knowledge of the pathophysiological and pharmacological relationships is the basis for rapid identification of therapeutic influences and possible disturbing factors. In the acute situation, paCO2 and MAP are the central determinants for the anesthetist to ensure cerebral perfusion and the resulting cerebral oxygenation. Especially in patients with SHT, a difficult airway must always be expected. Knowledge of the appropriate steps and the necessary equipment must be available. In patients under anticoagulant therapy, written instructions for suspending this therapy are extremely helpful. Interventional thrombectomy is a new emergency situation for the anesthetist. The door-to-needle time has to be kept as short as possible by defined treatment paths and rapid goal-oriented work. Every emergency also creates a stressful reaction in those treating the patient - in a sense, the cerebral emergency "in us". This has a decisive influence on the perception and action of the individual and the entire team.
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Pierscianek D, Wolf S, Keyvani K, El Hindy N, Stein KP, Sandalcioglu IE, Sure U, Mueller O, Zhu Y. Study of angiogenic signaling pathways in hemangioblastoma. Neuropathology 2016; 37:3-11. [PMID: 27388534 DOI: 10.1111/neup.12316] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 04/04/2016] [Revised: 05/16/2016] [Accepted: 05/22/2016] [Indexed: 01/30/2023]
Abstract
Hemangioblastoma (HB) is mainly located in the brain and the spinal cord. The tumor is composed of two major components, namely neoplastic stromal cells and abundant microvessels. Thus, hyper-vascularization is the hallmark of this tumor. Despite the identification of germline and/or epigenetic mutations of Von Hippel Lindau (VHL) gene as an important pathogenic mechanism of HB, little is known about the molecular signaling involved in this highly vascularized tumor. The present study investigated the key players of multiple angiogenic signaling pathways including VEGF/VEGFR2, EphB4/EphrinB2, SDF1α/CXCR4 and Notch/Dll4 pathways in surgical specimens of 22 HB. The expression of key angiogenic factors was detected by RT2 -PCR and Western blot. Immunofluorescent staining revealed the cellular localization of these proteins. We demonstrated a massive upregulation of mRNA levels of VEGF and VEGFR2, CXCR4 and SDF1α, EphB4 and EphrinB2, as well as the main components of Dll4-Notch signaling in HB. An increase in the protein expression of VEGF, CXCR4 and the core-components of Dll4-Notch signaling was associated with an activation of Akt and Erk1/2 and accompanied by an elevated expression of PCNA. Immuofluorescent staining revealed the expression of VEGF and CXCR4 in endothelial cells as well as in tumor cells. Dll4 protein was predominantly found in tumor cells, whereas EphB4 immunoreactivity was exclusively detected in endothelial cells. We conclude that multiple key angiogenic pathways were activated in HB, which may synergistically contribute to the abundant vascularization in this tumor. Identification of these aberrant pathways provides potential targets for a possible future application of anti-angiogenic therapy for this tumor, particularly when a total surgical resection becomes difficult due to the localization or multiplicity of the tumor.
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Affiliation(s)
| | - Stefanie Wolf
- Department of Neurosurgery, Universitatsklinikum Essen, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, University Hospital Essen, Essen, Germany
| | | | - Klaus-Peter Stein
- Department of Neurosurgery, KRH Hospital Nordstadt, Hannover, Germany
| | | | - Ulrich Sure
- Department of Neurosurgery, Universitatsklinikum Essen, Germany
| | - Oliver Mueller
- Department of Neurosurgery, Universitatsklinikum Essen, Germany
| | - Yuan Zhu
- Department of Neurosurgery, Universitatsklinikum Essen, Germany
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Neyazi B, Herz A, Stein KP, Gawish I, Hartmann C, Wilkens L, Erguen S, Dumitru CA, Sandalcioglu IE. Brain arteriovenous malformations: implications of CEACAM1-positive inflammatory cells and sex on hemorrhage. Neurosurg Rev 2016; 40:129-134. [PMID: 27215911 DOI: 10.1007/s10143-016-0744-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 01/06/2016] [Revised: 04/11/2016] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
Brain arteriovenous malformations (bAVMs) are severe conditions which, upon rupture, cause debilitating neurological deficits and even death. The exact cellular and molecular mechanisms associated with bAVM rupture are currently unclear. The objective of this study was to explore the potential role of CEA-related cell adhesion molecule-1 (CEACAM1) in bAVM pathophysiology. Expression and localization of CEACAM1 were assessed immunohistochemically in tissue microarrays from bAVM patients (n = 60). The association of CEACAM1 with clinical parameters was analyzed with Spearman's rank correlation coefficient and chi-square test. The predictive value of CEACAM1 was tested using logistic regression analysis. CEACAM1 was highly expressed in tissue-infiltrating neutrophil granulocytes. High levels of CEACAM1-positive cells were associated with bAVM rupture (hemorrhage), but not with arteriovenous malformation (AVM) size, preoperative embolization, or seizure. This association was significant (p = 0.029, chi-square) in male but not in female patients, and high CEACAM1-positive immune infiltration showed predictive significance for hemorrhage in male bAVM patients only (OR = 6.50, 95 % CI 1.09-38.63, p = 0.040). Within the ruptured bAVM group, patients with a short hemorrhage to surgery (HTS) time interval had higher levels of CEACAM1 immune infiltration than patients with long HTS. This decrease in the levels of CEACAM1 immune infiltration between the HTS short and HTS long groups was, however, significant only in female patients (p = 0.022, chi-square). Our findings substantiate the role of inflammation in the pathophysiology of bAVM and suggest the presence of sexual dimorphism in this disease.
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Affiliation(s)
- Belal Neyazi
- Department of Neurosurgery, Nordstadt Hospital Hannover, Haltenhoffstrasse 41, 30167, Hannover, Germany
| | - Angelika Herz
- Department of Neurosurgery, Nordstadt Hospital Hannover, Haltenhoffstrasse 41, 30167, Hannover, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Nordstadt Hospital Hannover, Haltenhoffstrasse 41, 30167, Hannover, Germany
| | - Islam Gawish
- Department of Neurosurgery, Nordstadt Hospital Hannover, Haltenhoffstrasse 41, 30167, Hannover, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Ludwig Wilkens
- Department of Pathology, Nordstadt Hospital Hannover, Haltenhoffstrasse 41, 30167, Hannover, Germany
| | - Sueleyman Erguen
- Institute of Anatomy and Cell Biology, University of Wuerzburg, Koellikerstrasse 6, 97070, Wuerzburg, Germany
| | - Claudia A Dumitru
- Department of Neurosurgery, Nordstadt Hospital Hannover, Haltenhoffstrasse 41, 30167, Hannover, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Nordstadt Hospital Hannover, Haltenhoffstrasse 41, 30167, Hannover, Germany.
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Stein KP, Wanke I, Forsting M, Oezkan N, Huetter BO, Sandalcioglu IE, Sure U. Associated Aneurysms in Infratentorial Arteriovenous Malformations: Role of Aneurysm Size and Comparison with Supratentorial Lesions. Cerebrovasc Dis 2016; 41:219-25. [DOI: 10.1159/000443540] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/16/2015] [Indexed: 11/19/2022] Open
Abstract
Background: The natural history and treatment of brain arteriovenous malformations (AVMs) is the object of ongoing debates and discussions. To capture the entirety of these complex lesions, associated vascular pathologies, such as associated aneurysms (AAs), have to be implemented in future risk stratification models, as they are believed to represent additional risk factors for intracranial hemorrhage. The present study aims to determine AA characteristics in posterior fossa AVMs and to compare with AAs accompanying supratentorial AVMs, with special focus on aneurysm size. Methods: Patients with cerebral AVMs, treated in our department between 1990 and 2013, were analyzed retrospectively. Only patients with flow-related AAs of the feeding arteries were evaluated. Thus, patients harboring intranidal, venous or remote aneurysms were excluded. Results: Of 485 patients with cerebral AVM, 76 patients harbored an AVM of the posterior fossa. Among those, 22 individuals exhibited a total of 35 AAs (n = 8 patients with multiple AAs). Most common location of AAs was the posterior inferior cerebellar artery (n = 20, 57%) and mean AA diameter was 7.9 mm (SD 5.5). In the subgroup of patients with a single AA, mean aneurysm size in posterior fossa AVMs was with 7.8 mm (SD 6.0; range 2-25 mm) significantly larger than the mean size of AAs with supratentorial AVMs (4.8 mm, SD 3.0; range 2-20 mm; p = 0.048). Intracranial hemorrhage was found in 18 of 22 patients (82%) with infratentorial AVMs, and of these, 11 patients suffered from aneurysm rupture. In 14 patients bearing a single AA, 8 (57%) had sustained hemorrhage from aneurysm rupture. The mean diameter of AAs was as supposed in the ruptured group with 9.8 mm (SD 6.9; range 4-25 mm) significantly larger than in the unruptured AA group exhibiting a mean of 5.0 mm (SD 3.3; range 2-10 mm; p = 0.038). Patients with posterior fossa AVMs and AAs were significantly older as compared to those patients with supratentorial lesions (57.1, SD 12.6 vs. 45.8 years, SD 15.9 years; p = 0.004), which was also evident in the subgroup of patients with single AAs (55.2, SD 11.7 vs. 45.8 years, SD 14.9 years; p = 0.038). Conclusions: AAs of posterior fossa AVMs are larger in diameter than aneurysms accompanying supratentorial AVMs. AA size influences risk for hemorrhage, which, together with the high number of hemorrhagic events in posterior fossa AVMs, justifies treating these pathologies. The higher age of patients with AVMs of the posterior fossa might be one reason for larger AAs in this cohort, when compared to patients with supratentorial AVMs and AAs.
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Stein KP, Wanke I, Forsting M, Zhu Y, Moldovan AS, Dammann P, Sandalcioglu IE, Sure U. Associated Aneurysms in Supratentorial Arteriovenous Malformations: Impact of Aneurysm Size on Haemorrhage. Cerebrovasc Dis 2015; 39:122-9. [DOI: 10.1159/000369958] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
Background: Associated aneurysms (AAs) are presumed to represent an additional risk factor for intracranial haemorrhage from cerebral arterio-venous malformations (AVMs). To date, efforts to capture their natural history, as well as to identify aneurysms with the potential capability of regression after AVM treatment remain incomprehensive. As the aneurysm size represents an important aspect for the treatment indication of incidental saccular aneurysms, this factor has rarely been encountered for the treatment of AAs so far. The present study aims to determine the angiographic and clinical characteristics of AAs with special focus on aneurysm size and their consequences for treatment. Methods: Patients with cerebral AVMs, treated in our department between 1990 and 2013, were analyzed retrospectively. Only patients with supratentorial AVMs and flow-related AAs of the feeding arteries were evaluated. Thus, patients harboring AVMs of the cerebellum and the brain stem and patients with intranidal, venous or remote aneurysms were excluded. Treatment strategies were assessed with special attention on bleeding source and on AA size. Results: In 59 of 409 patients (14%) with supratentorial AVMs, a total of 85 AAs of the feeding arteries were identified. 14 of 59 individuals (24%) presented with multiple AAs. Of 85 AA, 58 aneurysms (68%) were classified as proximal and 27 aneurysms (32%) as distal. The most common location of AAs was the middle cerebral artery (MCA, 39%), followed by the internal carotid artery (ICA, 27%) and the anterior cerebral artery (ACA, 21%). The mean AA size was 4.4 mm ± 3.4 mm. Intracranial haemorrhage was found in 21 of 59 patients (36%) with coexisting AAs. Among these, 10 individuals (17%) suffered from rupture of an AA, accounting for nearly half of all bleedings in this subgroup. Among those patients bearing a single AA, the size of ruptured aneurysms differed significantly from those unruptured (6.6 mm vs. 4.4 mm, p = 0.0046). Nineteen patients (32%) received treatment of 22 AAs, whereas sole AVM treatment was adopted in 26 patients (44%) and conservative management in 14 patients (24%). The main reasons to leave AAs untreated were the small AA size (<5 mm), poor clinical state or treatment denial by the patients. Conclusions: The aneurysm size of AAs in AVM influences the risk of haemorrhage. Therefore, the treatment of larger (diameter ≥5 mm) AAs should be considered, even if a treatment indication of the associated AVM is not given.
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El Hindy N, Stein KP, Hagel V, Dammann P, Sure U, Mueller O. The role of decompressive craniectomy in children with severe traumatic brain injury. Eur J Trauma Emerg Surg 2014; 40:481-7. [PMID: 26816244 DOI: 10.1007/s00068-013-0337-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Severe traumatic brain injury (TBI) remains the leading cause of death in children. The present study analyses the outcome of children after severe TBI treated by decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) in a single centre. METHODS Fifty-six consecutive children (age < 16 years) were treated for severe TBI at our institution between 2001 and 2011. For study purposes, children with severe generalized traumatic brain swelling without concomitant mass lesion were further analysed. Descriptive statistics were used to report clinical conditions as well as outcome measurements after conservative treatment only in comparison to secondary decompressive craniectomy. RESULTS Of 56 children, a total of eight children presented with generalized and progressive traumatic brain swelling and impending brain herniation. Four children were treated conservatively following standardized local protocol for anti-oedematous management, with ICP amenable to intensified therapy. Four children required decompressive surgery due to progressive oedema refractory to intensified conservative management. Children receiving secondary DC had a longer stay in the intensive care unit as well as a longer average time of assisted ventilation compared to children treated conservatively. Concomitant injuries were more severe in the DC subgroup. Yet, Glasgow Outcome Scale was equally distributed in both groups. CONCLUSION In children with refractory ICP conditions due to severe TBI, decompressive surgery might lead to a similar favourable outcome compared to children in whom ICP can be controlled only by conservative management. Timing of surgery depends on the neurological deterioration of the patients and a continuous ICP monitoring.
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Affiliation(s)
- N El Hindy
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - K P Stein
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - V Hagel
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - P Dammann
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - U Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - O Mueller
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
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Dammann P, Breyer T, Wrede KH, Stein KP, Wanke I, Grams AE, Gizewski ER, Schlamann M, Forsting M, Sandalcioglu IE, Sure U. Treatment of complex neurovascular lesions: an interdisciplinary angio suite approach. Ther Adv Neurol Disord 2014; 7:60-70. [PMID: 24409203 DOI: 10.1177/1756285613496861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of this study was to analyse our initial experience using an interdisciplinary angio suite approach to neurosurgical treatment of complex neurovascular lesions and expound technical feasibility and possible applications. SUBJECTS Six out of 451 patients with cranial or spinal neurovascular lesions were surgically treated in the angio suite (biplane angiographic system) during a 28-month observation period. Clinical baseline data, radiological and intraoperative findings as well as clinical and radiological outcome were assessed. RESULTS A ventral spinal perimedullary arteriovenous malformation, a ventral spinal perimedullary fistula, two diffuse frontal dural arteriovenous fistulas, a multifocal temporal arteriovenous malformation and a partially embolized fronto-temporo-basal dural arteriovenous fistula were successfully treated with angiographically confirmed complete occlusion and unimpaired neurological condition of the patients at the 12-month follow up. CONCLUSION This study demonstrates the feasibility of this approach and points out possible indications, namely ventrally located spinal lesions and diffuse, deep seated cranial lesions.
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Affiliation(s)
- Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Tobias Breyer
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery, University Hospital Essen, Germany
| | | | - Isabel Wanke
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany Department of Neuroradiology, Hirslanden Clinic, Zurich, Switzerland
| | - Astrid E Grams
- Department of Neuroradiology, University Hospital Innsbruck, Medical University Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology, University Hospital Innsbruck, Medical University Innsbruck, Austria
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | | | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, Germany
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Möller-Hartmann W, Krings T, Stein KP, Dreeskamp A, Meetz A, Thiex R, Hans FJ, Gilsbach JM, Thron A. Aberrant origin of the superior thyroid artery and the tracheoesophageal branch from the common carotid artery: a source of failure in elastase-induced aneurysms in rabbits. AJR Am J Roentgenol 2003; 181:739-41. [PMID: 12933472 DOI: 10.2214/ajr.181.3.1810739] [Citation(s) in RCA: 12] [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: 11/18/2022]
Affiliation(s)
- W Möller-Hartmann
- Department of Neuroradiology, University Hospital of the Technical University, Pauwelsstr. 30, Aachen D-52057, Germany
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Hans FJ, Krings T, Möller-Hartmann W, Thiex R, Pfeffer J, Scherer K, Brunn A, Dreeskamp H, Stein KP, Meetz A, Gilsbach JM, Thron A. Endovascular treatment of experimentally induced aneurysms in rabbits using stents: a feasibility study. Neuroradiology 2003; 45:430-4. [PMID: 12761602 DOI: 10.1007/s00234-003-1008-y] [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] [Received: 02/05/2003] [Accepted: 04/03/2003] [Indexed: 11/29/2022]
Abstract
Although Guglielmi detachable coil (GDC) systems have been generally accepted for treatment of intracranial aneurysms, primary stenting of aneurysms using porous stents or implantation of coils after stent placement remains experimental. Testing of these new methods requires an animal model which imitates human aneurysms in size, configuration and neck morphology. We assessed in detail the technical requirements of and steps for transfemoral stent treatment of experimentally induced aneurysms at the top of the brachiocephalic trunk in rabbits. We created aneurysms in ten rabbits by distal ligation and intraluminal digestion of the right common carotid artery with elastase. We treated five animals with porous stents alone, and five with stents plus coiling via the meshes of the stent, which permitted dense packing of coils. No complications related to the procedures occurred. In all animals, even in those treated solely with porous stents, total occlusion of the aneurysm was achieved. Our animal model can be suitable for testing the biocompatibility and occlusion rate of new methods and devices for the treatment of experimental aneurysms.
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Affiliation(s)
- F J Hans
- Department of Neurosurgery, University Hospital of the University of Technology, Pauwelsstrasse 30, 52057, Aachen, Germany
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Krings T, Möller-Hartmann W, Hans FJ, Thiex R, Brunn A, Scherer K, Meetz A, Dreeskamp H, Stein KP, Gilsbach JM, Thron A. A refined method for creating saccular aneurysms in the rabbit. Neuroradiology 2003; 45:423-9. [PMID: 12774180 DOI: 10.1007/s00234-003-0976-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2002] [Accepted: 01/22/2003] [Indexed: 10/26/2022]
Abstract
We describe a refined animal model of human intracerebral aneurysms for testing endovascular devices for interventional neuroradiological procedures. Saccular aneurysms resulting from a stump of the right common carotid artery (CCA) were created in 15 New Zealand White rabbits by intraluminal incubation of elastase that was applied to the CCA after distal ligation of the CCA and proximal occlusion of the vessel using a pliable balloon. Subsequently a microcatheter was advanced to a position cranial to the balloon and the elastase was infused under fluoroscopic guidance to avoid retrograde flow to the trachea via aberrant vessels. Contrast-enhanced (CE) MRA at 1.5 T and conventional digital subtraction angiography was performed to test for aneurysm size, morphology and neck anatomy. In all 15 animals aneurysms resulted from the stump of the right CCA, ranging in size from 2.0 to 9.9 mm (mean 6.3 mm) in craniocaudal direction, 1.0 to 5.5 mm (mean 3.8 mm) in mediolateral direction and 1.0 to 3.8 mm (mean 2.4 mm) in neck diameter. Aneurysm morphology could be adequately demonstrated using CE MRA. On histological evaluation a loss of the internal elastic lamina was noted. The described method represents an easy, reliable, and reproducible method of aneurysm creation in the rabbit in an area of high shear stress. These aneurysms can be used for testing new endovascular devices for embolization of intracranial aneurysms.
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Affiliation(s)
- Timo Krings
- Department of Neuroradiology, University Hospital of the University of Technology Aachen, Pauwelsstrase 30, 52057, Aachen, Germany.
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Krings T, Hans FJ, Möller-Hartmann W, Thiex R, Brunn A, Scherer K, Stein KP, Meetz A, Dreeskamp H, Allery E, Thron A. Time-of-flight-, phase contrast and contrast enhanced magnetic resonance angiography for pre-interventional determination of aneurysm size, configuration, and neck morphology in an aneurysm model in rabbits. Neurosci Lett 2002; 326:46-50. [PMID: 12052535 DOI: 10.1016/s0304-3940(02)00308-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [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: 11/16/2022]
Abstract
We describe three different magnetic resonance (MR)-angiography techniques to evaluate aneurysm size, configuration, and neck morphology of experimentally created aneurysms in a rabbit model. In five New Zealand White rabbits an aneurysm was created by endovascular occlusion of the right common carotid artery (CCA) using a pliable balloon and subsequent endoluminal incubation of elastase within the proximal CCA above the balloon and distal ligation of the vessel. In all animals, time-of-flight (TOF), phase contrast and contrast enhanced (CE) MR angiographies (MRA) were performed and compared to conventional digital subtraction angiography results. We found, that aneurysms are best visualized employing CE MRA, however, neck morphology was also found to demonstrate interpretable results when evaluating the axial source data of the TOF MRA. The animal model we used can be employed for testing endovascular devices such as new coil material, or covered stents. The described MRA techniques might then be helpful for pre-interventional planning and maybe even for the follow-up of the thus treated aneurysms.
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Affiliation(s)
- Timo Krings
- Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
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