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ter Wengel PV, Reith F, Adegeest CY, Fehlings MG, Kwon BK, Vandertop WP, Öner CF. Under pressure - A historical vignette on surgical timing in traumatic spinal cord injury. Brain Spine 2024; 4:102825. [PMID: 38756860 PMCID: PMC11096936 DOI: 10.1016/j.bas.2024.102825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
Introduction It was not even a century ago when a spinal cord injury (SCI) would inevitably result in a fatal outcome, particularly for those with complete SCI. Throughout history, there have been extensive endeavours to change the prospects for SCI patients by performing surgery, even though many believed that there was no way to alter the catastrophic course of SCI. To this day, the debate regarding the efficacy of surgery in improving the neurological outcome for SCI patients persists, along with discussions about the timing of surgical intervention. Research question How have the historical surgical results shaped our perspective on the surgical treatment of SCI? Material and methods Narrative literature review. Results Throughout history there have been multiple surgical attempts to alter the course of SCI, with conflicting results. While studies suggest a potential link between timing of surgery and neurological recovery, the exact impact of immediate surgery on individual cases remains ambiguous. It is becoming more evident that, alongside surgical intervention, factors specific to both the patient and their surgical treatment will significantly influence neurological recovery. Conclusion Although a growing number of studies indicates a potential correlation of surgical timing and neurological outcome, the precise influence of urgent surgery on an individual basis remains uncertain. It is increasingly apparent that, despite surgery, patient- and treatment-specific factors will also play a role in determining the neurological outcome. Notably, these very factors have influenced the results in previous studies and our views concerning surgical timing.
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Affiliation(s)
| | - Florence Reith
- Department of Neurosurgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Charlotte Y. Adegeest
- Department of Neurosurgery, Haaglanden Medical Center, the Hague, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - W. Peter Vandertop
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Cumhur F. Öner
- Department of Orthopedic Surgery, University Medical Center, Utrecht, the Netherlands
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Labib H, Tjerkstra MA, Coert BA, Post R, Vandertop WP, Verbaan D, Müller MCA. Sodium and Its Impact on Outcome After Aneurysmal Subarachnoid Hemorrhage in Patients With and Without Delayed Cerebral Ischemia. Crit Care Med 2024; 52:752-763. [PMID: 38206089 PMCID: PMC11008454 DOI: 10.1097/ccm.0000000000006182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To perform a detailed examination of sodium levels, hyponatremia and sodium fluctuations, and their association with delayed cerebral ischemia (DCI) and poor outcome after aneurysmal subarachnoid hemorrhage (aSAH). DESIGN An observational cohort study from a prospective SAH Registry. SETTING Tertiary referral center focused on SAH treatment in the Amsterdam metropolitan area. PATIENTS A total of 964 adult patients with confirmed aSAH were included between 2011 and 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 277 (29%) developed DCI. Hyponatremia occurred significantly more often in DCI patients compared with no-DCI patients (77% vs. 48%). Sodium levels, hyponatremia, hypernatremia, and sodium fluctuations did not predict DCI. However, higher sodium levels were significantly associated with poor outcome in DCI patients (DCI onset -7, DCI +0, +1, +2, +4, +5, +8, +9 d), and in no-DCI patients (postbleed day 6-10 and 12-14). Also, hypernatremia and greater sodium fluctuations were significantly associated with poor outcome in both DCI and no-DCI patients. CONCLUSIONS Sodium levels, hyponatremia, and sodium fluctuations were not associated with the occurrence of DCI. However, higher sodium levels, hypernatremia, and greater sodium fluctuations were associated with poor outcome after aSAH irrespective of the presence of DCI. Therefore, sodium levels, even with mild changes in levels, warrant close attention.
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Affiliation(s)
- Homeyra Labib
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Maud A Tjerkstra
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Bert A Coert
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - René Post
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Marcella C A Müller
- Department of Intensive Care, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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Kempeneers MA, Buis D, Feller RE, Roosendaal S, Slot KM, Wolf N, Vandertop WP. Torticollis with Atlantoaxial Rotatory Subluxation in Children: A clinical review. Neuropediatrics 2024. [PMID: 38657679 DOI: 10.1055/a-2312-9994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
A small proportion of children with a sudden onset torticollis ('wry neck') presents with an atlanto-axial rotatory subluxation, usually after mild trauma or recent head or neck infection. Torticollis is a clinical diagnosis and imaging is usually not indicated, though often performed in clinical practice. Atlanto-axial rotatory subluxation on imaging is often a physiological phenomenon in torticollis and concomitant neurological symptoms are therefore rare. Treatment is primarily conservative, with analgesics, a rigid neck collar and if needed benzodiazepines to counteract muscle spasms and anxiety. In case of treatment failure or chronic subluxation, cervical repositioning and fixation under general anesthesia may be considered. Surgical treatment is only indicated in a small percentage of patients with chronic refractory subluxation, concomitant cervical fractures or congenital anomalies. Early diagnosis and treatment are important, since this is associated with a more successful conservative outcome than a prolonged approach.
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Affiliation(s)
| | - Dennis Buis
- Neurosurgery, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | | | | | - Nicole Wolf
- Child Neurology, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
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Germans MR, Tjerkstra MA, Post R, Brenner A, Vergouwen MDI, Rinkel GJ, Roos YB, van den Berg R, Coert BA, Vandertop WP, Verbaan D. Impact of time to start of tranexamic acid treatment on rebleed risk and outcome in aneurysmal subarachnoid hemorrhage. Eur Stroke J 2024:23969873241246591. [PMID: 38606724 DOI: 10.1177/23969873241246591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION The ULTRA-trial investigated effectiveness of ultra-early administration of tranexamic acid (TXA) in subarachnoid hemorrhage (SAH) and showed that TXA reduces the risk of rebleeding without concurrent improvement in clinical outcome. Previous trials in bleeding conditions, distinct from SAH, have shown that time to start of antifibrinolytic treatment influences outcome. This post-hoc analysis of the ULTRA-trial investigates whether the interval between hemorrhage and start of TXA impacts the effect of TXA on rebleeding and functional outcome following aneurysmal SAH. PATIENTS AND METHODS A post-hoc comparative analysis was conducted between aneurysmal SAH patients of the ULTRA-trial, receiving TXA and usual care to those receiving usual care only. We assessed confounders, hazard ratio (HR) of rebleeding and odds ratio (OR) of good outcome (modified Rankin Scale 0-3) at 6 months, and investigated the impact of time between hemorrhage and start of TXA on the treatment effect, stratified into time categories (0-3, 3-6 and >6 h). RESULTS Sixty-four of 394 patients (16.2%) in the TXA group experienced a rebleeding, compared to 83 of 413 patients (19.9%) with usual care only (HR 0.86, 95% confidence interval (CI): 0.62-1.19). Time to start of TXA modifies the effect of TXA on rebleeding rate (p < 0.001), with a clinically non-relevant reduction observed only when TXA was initiated after 6 h (absolute rate reduction 1.4%). Tranexamic acid treatment showed no effect on good outcome (OR 0.96, 95% CI: 0.72-1.27) with no evidence of effect modification on the time to start of TXA (p = 0.53). DISCUSSION AND CONCLUSIONS This study suggests that the effect of TXA on rebleeding is modified by time to treatment, providing a protective, albeit clinically non-relevant, effect only when started after 6 h. No difference in functional outcome was seen. Routine TXA treatment in the aneurysmal SAH population, even within a specified time frame, is not recommended to improve functional outcome.
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Affiliation(s)
- Menno R Germans
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Maud A Tjerkstra
- Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - René Post
- Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Amy Brenner
- Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mervyn DI Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gabriël Je Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yvo Bwem Roos
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, The Netherlands
| | - René van den Berg
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands
| | - Bert A Coert
- Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
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Staartjes VE, Klukowska AM, Stumpo V, Vandertop WP, Schröder ML. Identifying clusters of objective functional impairment in patients with degenerative lumbar spinal disease using unsupervised learning. Eur Spine J 2024; 33:1320-1331. [PMID: 38127138 DOI: 10.1007/s00586-023-08070-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/22/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The five-repetition sit-to-stand (5R-STS) test was designed to capture objective functional impairment (OFI), and thus provides an adjunctive dimension in patient assessment. It is conceivable that there are different subsets of patients with OFI and degenerative lumbar disease. We aim to identify clusters of objectively functionally impaired individuals based on 5R-STS and unsupervised machine learning (ML). METHODS Data from two prospective cohort studies on patients with surgery for degenerative lumbar disease and 5R-STS times of ≥ 10.5 s-indicating presence of OFI. K-means clustering-an unsupervised ML algorithm-was applied to identify clusters of OFI. Cluster hallmarks were then identified using descriptive and inferential statistical analyses. RESULTS We included 173 patients (mean age [standard deviation]: 46.7 [12.7] years, 45% male) and identified three types of OFI. OFI Type 1 (57 pts., 32.9%), Type 2 (81 pts., 46.8%), and Type 3 (35 pts., 20.2%) exhibited mean 5R-STS test times of 14.0 (3.2), 14.5 (3.3), and 27.1 (4.4) seconds, respectively. The grades of OFI according to the validated baseline severity stratification of the 5R-STS increased significantly with each OFI type, as did extreme anxiety and depression symptoms, issues with mobility and daily activities. Types 1 and 2 are characterized by mild to moderate OFI-with female gender, lower body mass index, and less smokers as Type I hallmarks. CONCLUSIONS Unsupervised learning techniques identified three distinct clusters of patients with OFI that may represent a more holistic clinical classification of patients with OFI than test-time stratifications alone, by accounting for individual patient characteristics.
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Affiliation(s)
- Victor E Staartjes
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.
| | - Anita M Klukowska
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
- Department of Surgery, Royal Derby Hospital, Derby, UK
| | - Vittorio Stumpo
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - W Peter Vandertop
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
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Lequin MB, Verbaan D, Schuurman PR, Tasche S, Peul WC, Vandertop WP, Bouma GJ. The long-term outcome of revision microdiscectomy for recurrent sciatica. Eur Spine J 2024:10.1007/s00586-024-08199-5. [PMID: 38512504 DOI: 10.1007/s00586-024-08199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/29/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To study the long-term outcome of revision microdiscectomy after classic microdiscectomy for lumbosacral radicular syndrome (LSRS). METHODS Eighty-eight of 216 patients (41%) who underwent a revision microdiscectomy between 2007 and 2010 for MRI disc-related LSRS participated in this study. Questionnaires included visual analogue scores (VAS) for leg pain, RDQ, OLBD, RAND-36, and seven-point Likert scores for recovery, leg pain, and back pain. Any further lumbar re-revision operation(s) were recorded. RESULTS Mean (SD) age was 59.8 (12.8), and median [IQR] time of follow-up was 10.0 years [9.0-11.0]. A favourable general perceived recovery was reported by 35 patients (40%). A favourable outcome with respect to perceived leg pain was present in 39 patients (45%), and 35 patients (41%) reported a favourable outcome concerning back pain. The median VAS for leg and back pain was worse in the unfavourable group (48.0/100 mm (IQR 16.0-71.0) vs. 3.0/100 mm (IQR 2.0-5.0) and 56.0/100 mm (IQR 27.0-74.0) vs. 4.0/100 mm (IQR 2.0-17.0), respectively; both p < 0.001). Re-revision operation occurred in 31 (35%) patients (24% same level same side); there was no significant difference in the rate of favourable outcome between patients with or without a re-revision operation. CONCLUSION The long-term results after revision microdiscectomy for LSRS show an unfavourable outcome in the majority of patients and a high risk of re-revision microdiscectomy, with similar results. Based on also the disappointing results of alternative treatments, revision microdiscectomy for recurrent LSRS seems to still be a valid treatment. The results of our study may be useful to counsel patients in making appropriate treatment choices.
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Affiliation(s)
- M B Lequin
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - D Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Saskia Tasche
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - W C Peul
- Department of Neurosurgery, University Neurosurgical Center Holland, UMC | HMC | HAGA, Leiden, The Hague, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - G J Bouma
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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Lodewijkx R, Draijer L, de Ridder R, Eikelenboom MJ, Coert BA, Meeuwes M, Vandertop WP. [Subarachnoid hemorrhage in a young girl]. Ned Tijdschr Geneeskd 2024; 168:D7943. [PMID: 38512273] [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] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Subarachnoid hemorrhage in children is rare. The most common cause is trauma, followed by an arteriovenous malformation, aneurysm or tumor. CASE DESCRIPTION We describe the case of an 11-year-old girl who developed sudden headache with nausea and vomiting during athletics training. Her neurological exam was normal. With imaging and a lumbar puncture a subarachnoid hemorrhage was diagnosed, based on a ruptured saccular aneurysm of the right middle cerebral artery. Endovascular treatment was unsuccessful, after which the aneurysm was treated surgically. Postoperative recovery was uneventful. Additional tests for underlying conditions were negative. CONCLUSION Also in a child with acute headache, nausea, and vomiting, the diagnosis of a subarachnoid hemorrhage should be considered, even if neurological examination is normal. Expeditious diagnosis and treatment are important in order to prevent rebleeding.
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Affiliation(s)
| | - Laura Draijer
- Dijklander Ziekenhuis, afd. Kindergeneeskunde, Hoorn
| | | | | | - B A Coert
- Amsterdam UMC, afd. Neurochirurgie, Amsterdam
| | - Merel Meeuwes
- Dijklander Ziekenhuis, afd. Kindergeneeskunde, Hoorn
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Klukowska AM, Staartjes VE, Dol M, Vandertop WP, Schröder ML. Predictive value of the five-repetition sit-to-stand test for outcomes after surgery for lumbar disc herniation: prospective study. Eur Spine J 2024; 33:956-963. [PMID: 37993742 DOI: 10.1007/s00586-023-08046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/22/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE It is unknown whether presence of pre-operative objective functional impairment (OFI) can predict post-operative outcomes in patients with lumbar disc herniation (LDH). We aimed to determine whether pre-operative OFI measured by the five-repetition sit-to-stand test (5R-STS) could predict outcomes at 12-months post-discectomy. METHODS Adult patients with LDH scheduled for surgery were prospectively recruited from a Dutch short-stay spinal clinic. The 5R-STS time and patient reported outcome measures (PROMs) including Oswestry Disability Index, Roland-Morris Disability Questionnaire, Visual Analogue Scale (VAS) for back and leg pain, EQ-5D-3L health-related quality of life, EQ5D-VAS and ability to work were recorded pre-operatively and at 12-months. A 5R-STS time cut-off of ≥ 10.5 s was used to determine OFI. Mann-Whitney and Chi-square tests were employed to determine significant differences in post-operative outcomes between groups stratified by presence of pre-operative OFI. RESULTS We recruited 134 patients in a prospective study. Twelve-month follow-up was completed by 103 (76.8%) patients. Mean age was 53.2 ± 14.35 years and 50 (48.5%) patients were female. Pre-operatively, 53 (51.5%) patients had OFI and 50 (48.5%) did not. Post-operatively, patients with OFI experienced a significantly greater mean change (p < 0.001) across all PROMs compared to patients without OFI, except leg pain (p = 0.176). There were no significant differences in absolute PROMs between groups at 12-months (all p > 0.05). CONCLUSIONS The presence of OFI based on 5R-STS time does not appear to decrease a patient's likelihood of experiencing satisfactory post-operative outcomes. The 5R-STS cannot predict how a patient with LDH will respond to surgery at 12-month follow-up.
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Affiliation(s)
- Anita M Klukowska
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands
| | - Victor E Staartjes
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.
- MICN Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Manon Dol
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
- Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands
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Mensing LA, van Tuijl RJ, Greving JP, Velthuis BK, van der Schaaf IC, Wermer MJH, Verbaan D, Vandertop WP, Zuithoff NPA, Rinkel GJE, Ruigrok YM. Aneurysm Prevalence and Quality of Life During Screening in Relatives of Patients With Unruptured Intracranial Aneurysms: A Prospective Study. Neurology 2023; 101:e904-e912. [PMID: 37414571 PMCID: PMC10501091 DOI: 10.1212/wnl.0000000000207475] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/17/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Screening for unruptured intracranial aneurysms (UIAs) is effective for first-degree relatives (FDRs) of patients with aneurysmal subarachnoid hemorrhage (aSAH). Whether screening is also effective for FDRs of patients with UIA is unknown. We determined the yield of screening in such FDRs, assessed rupture risk and treatment decisions of aneurysms that were found, identified potential high-risk subgroups, and studied the effects of screening on quality of life (QoL). METHODS In this prospective cohort study, we included FDRs, aged 20-70 years, of patients with UIA without a family history of aSAH who visited the Neurology outpatient clinic in 1 of 3 participating tertiary referral centers in the Netherlands. FDRs were screened for UIA with magnetic resonance angiography between 2017 and 2021. We determined UIA prevalence and developed a prediction model for UIA risk at screening using multivariable logistic regression. QoL was evaluated with questionnaires 6 times during the first year after screening and assessed with a linear mixed-effects model. RESULTS We detected 24 UIAs in 23 of 461 screened FDRs, resulting in a 5.0% prevalence (95% CI 3.2-7.4). The median aneurysm size was 3 mm (interquartile range [IQR] 2-4 mm), and the median 5-year rupture risk assessed with the PHASES score was 0.7% (IQR 0.4%-0.9%). All UIAs received follow-up imaging, and none were treated preventively. After a median follow-up of 24 months (IQR 13-38 months), no UIA had changed. Predicted UIA risk at screening ranged between 2.3% and 14.7% with the highest risk in FDRs who smoke and have excessive alcohol consumption (c-statistic: 0.76; 95% CI 0.65-0.88). At all survey moments, health-related QoL and emotional functioning were comparable with those in a reference group from the general population. One FDR with a positive screening result expressed regret about screening. DISCUSSION Based on the current data, we do not advise screening FDRs of patients with UIA because all identified UIAs had a low rupture risk. We observed no negative effect of screening on QoL. A longer follow-up should determine the risk of aneurysm growth requiring preventive treatment.
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Affiliation(s)
- Liselore A Mensing
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands.
| | - Rick J van Tuijl
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Jacoba P Greving
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Birgitta K Velthuis
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Irene C van der Schaaf
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Marieke J H Wermer
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Dagmar Verbaan
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - W Peter Vandertop
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Nicolaas P A Zuithoff
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Gabriël J E Rinkel
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Ynte M Ruigrok
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
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10
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Cornelissen FMG, Markert G, Deutsch G, Antonara M, Faaij N, Bartelink I, Noske D, Vandertop WP, Bender A, Westerman BA. Explaining Blood-Brain Barrier Permeability of Small Molecules by Integrated Analysis of Different Transport Mechanisms. J Med Chem 2023. [PMID: 37217193 DOI: 10.1021/acs.jmedchem.2c01824] [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: 05/24/2023]
Abstract
The blood-brain barrier (BBB) represents a major obstacle to delivering drugs to the central nervous system (CNS), resulting in the lack of effective treatment for many CNS diseases including brain cancer. To accelerate CNS drug development, computational prediction models could save the time and effort needed for experimental evaluation. Here, we studied BBB permeability focusing on active transport (influx and efflux) as well as passive diffusion using previously published and self-curated data sets. We created prediction models based on physicochemical properties, molecular substructures, or their combination to understand which mechanisms contribute to BBB permeability. Our results show that features that predicted passive diffusion over membranes overlap with features that explain endothelial permeation of approved CNS-active drugs. We also identified physical properties and molecular substructures that positively or negatively predicted BBB transport. These findings provide guidance toward identifying BBB-permeable compounds by optimally matching physicochemical and molecular properties to BBB transport mechanisms.
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Affiliation(s)
- Fleur M G Cornelissen
- Department of Neurosurgery, Amsterdam UMC, location VUMC, Cancer Center, Amsterdam 1105, AZ, the Netherlands
| | - Greta Markert
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Rd, Cambridge CB2 1EW, U.K
| | - Ghislaine Deutsch
- Department of Neurosurgery, Amsterdam UMC, location VUMC, Cancer Center, Amsterdam 1105, AZ, the Netherlands
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Rd, Cambridge CB2 1EW, U.K
| | - Maria Antonara
- Department of Neurosurgery, Amsterdam UMC, location VUMC, Cancer Center, Amsterdam 1105, AZ, the Netherlands
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Rd, Cambridge CB2 1EW, U.K
| | - Noa Faaij
- Department of Neurosurgery, Amsterdam UMC, location VUMC, Cancer Center, Amsterdam 1105, AZ, the Netherlands
| | - Imke Bartelink
- Department of Pharmacy, Amsterdam UMC, location VUMC, Cancer Center, Amsterdam 1105, AZ, the Netherlands
| | - David Noske
- Department of Neurosurgery, Amsterdam UMC, location VUMC, Cancer Center, Amsterdam 1105, AZ, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam UMC, location VUMC, Cancer Center, Amsterdam 1105, AZ, the Netherlands
| | - Andreas Bender
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Rd, Cambridge CB2 1EW, U.K
| | - Bart A Westerman
- Department of Neurosurgery, Amsterdam UMC, location VUMC, Cancer Center, Amsterdam 1105, AZ, the Netherlands
- Window Consortium (www.window-consortium.org)
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11
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Tjerkstra MA, Müller MCA, Coert BA, Hoefnagels FWA, Vergouwen MDI, van Vliet P, Ooms L, Rinkel GJE, Slooter AJC, Moojen WA, Jellema K, Vandertop WP, Verbaan D. Clinical Response following Hypertension-Induction for clinical Delayed Cerebral Ischemia following Subarachnoid Haemorrhage - a retrospective multicentre cohort study. Eur J Neurol 2023. [PMID: 37151098 DOI: 10.1111/ene.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Hypertension-induction is often used for treating delayed cerebral ischemia (DCI) following aneurysmal subarachnoid haemorrhage (aSAH), however, high-quality studies on its efficacy are lacking. We studied immediate and 3-/6-month clinical efficacy of hypertension-induction in aSAH patients with clinical DCI. METHODS A retrospective, multicentre, comparative, observational cohort study in aSAH patients with clinical deterioration due to DCI, admitted to three tertiary referral hospitals in the Netherlands from 2015-2019. Two hospitals used a strategy of hypertension-induction (HTI group) and one hospital had no such strategy (control group). We calculated adjusted relative risks (aRR) using Poisson regression analyses for the two primary (clinical improvement of DCI-symptoms at day 1 and 5 after DCI-onset) and secondary outcomes (DCI-related cerebral infarction, in-hospital mortality and poor clinical outcome (modified Rankin Scale 4-6) assessed at 3 or 6 months), using the intention-to-treat principle. We also performed as-treated and per-protocol analyses. RESULTS The aRR for clinical improvement on day 1 after DCI in the HTI group was 1.63, 95% C.I. 1.17-2.27 and at day 5 after DCI 1.04, 95% C.I. 0.84 to 1.29. Secondary outcomes were comparable between the groups. The as-treated and per-protocol analyses yielded similar results. CONCLUSIONS No clinical benefit of hypertension-induction is observed five days after DCI due to spontaneous reversal of DCI-symptoms in patients treated without hypertension-induction. 3-/6-Month clinical outcome was similar between both groups. Therefore, these data suggest that one may consider to not apply hypertension-induction in aSAH patients with clinical DCI.
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Affiliation(s)
- Maud A Tjerkstra
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands
- Neuroscience Amsterdam, Neurovascular disorders, Amsterdam, the Netherlands
| | - Marcella C A Müller
- Amsterdam UMC location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, the Netherlands
| | - Bert A Coert
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands
- Neuroscience Amsterdam, Neurovascular disorders, Amsterdam, the Netherlands
| | - Friso W A Hoefnagels
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter van Vliet
- Department of Intensive Care, Haaglanden Medical Center, The Hague, the Netherlands
| | - Lizzy Ooms
- Department of Intensive Care, Haaglanden Medical Center, The Hague, the Netherlands
| | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arjen J C Slooter
- Departments of Psychiatry and Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands, Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | - Wouter A Moojen
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Department of Neurosurgery, Haga Teaching Hospital; Department of Neurosurgery, Leiden University Medical Center, the Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - W Peter Vandertop
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands
- Neuroscience Amsterdam, Neurovascular disorders, Amsterdam, the Netherlands
| | - Dagmar Verbaan
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands
- Neuroscience Amsterdam, Neurovascular disorders, Amsterdam, the Netherlands
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12
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Sondag L, Schreuder FHBM, Pegge SAH, Coutinho JM, Dippel DWJ, Janssen PM, Vandertop WP, Boogaarts HD, Dammers R, Klijn CJM. Safety and technical efficacy of early minimally invasive endoscopy-guided surgery for intracerebral haemorrhage: the Dutch Intracerebral haemorrhage Surgery Trial pilot study. Acta Neurochir (Wien) 2023; 165:1585-1596. [PMID: 37103585 PMCID: PMC10134719 DOI: 10.1007/s00701-023-05599-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Previous randomised controlled trials could not demonstrate that surgical evacuation of intracerebral haemorrhage (ICH) improves functional outcome. Increasing evidence suggests that minimally invasive surgery may be beneficial, in particular when performed early after symptom onset. The aim of this study was to investigate safety and technical efficacy of early minimally invasive endoscopy-guided surgery in patients with spontaneous supratentorial ICH. METHODS The Dutch Intracerebral Haemorrhage Surgery Trial pilot study was a prospective intervention study with blinded outcome assessment in three neurosurgical centres in the Netherlands. We included adult patients with spontaneous supratentorial ICH ≥10mL and National Institute of Health Stroke Scale (NIHSS) score ≥2 for minimally invasive endoscopy-guided surgery within 8 h after symptom onset in addition to medical management. Primary safety outcome was death or increase in NIHSS ≥4 points at 24 h. Secondary safety outcomes were procedure-related serious adverse events (SAEs) within 7 days and death within 30 days. Primary technical efficacy outcome was ICH volume reduction (%) at 24 h. RESULTS We included 40 patients (median age 61 years; IQR 51-67; 28 men). Median baseline NIHSS was 19.5 (IQR 13.3-22.0) and median ICH volume 47.7mL (IQR 29.4-72.0). Six patients had a primary safety outcome, of whom two already deteriorated before surgery and one died within 24 h. Sixteen other SAEs were reported within 7 days in 11 patients (of whom two patients that already had a primary safety outcome), none device related. In total, four (10%) patients died within 30 days. Median ICH volume reduction at 24 h was 78% (IQR 50-89) and median postoperative ICH volume 10.5mL (IQR 5.1-23.8). CONCLUSIONS Minimally invasive endoscopy-guided surgery within 8 h after symptom onset for supratentorial ICH appears to be safe and can effectively reduce ICH volume. Randomised controlled trials are needed to determine whether this intervention also improves functional outcome. TRIAL REGISTRATION Clinicaltrials.gov : NCT03608423, August 1st, 2018.
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Affiliation(s)
- Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO-box 9101, 6500HB, Nijmegen, The Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO-box 9101, 6500HB, Nijmegen, The Netherlands
| | - Sjoert A H Pegge
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paula M Janssen
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - W Peter Vandertop
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neurosciences, Neurovascular Disorders, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neurosciences, Neurovascular Disorders, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO-box 9101, 6500HB, Nijmegen, The Netherlands.
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13
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Tjerkstra M, Labib H, Coert BA, Spijker R, Coutinho JM, Vandertop WP, Verbaan D. Laboratory biomarkers of delayed cerebral ischemia following subarachnoid hemorrhage: A systematic review. J Circ Biomark 2023; 12:17-25. [PMID: 37056917 PMCID: PMC10087563 DOI: 10.33393/jcb.2023.2502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
Delayed cerebral ischemia (DCI) substantially contributes to disability and death in subarachnoid hemorrhage (SAH) patients; however, its pathophysiology is incompletely understood and diagnostic and therapeutic strategies are lacking. Biomarkers may help to elucidate the pathophysiology, optimize early diagnosis, or provide treatment targets. We systematically searched PubMed and Embase on October 13, 2021, for studies that evaluated at least one laboratory biomarker in patients with DCI, using the most up-to-date definition of DCI as proposed by a panel of experts in 2010. Quality of studies was assessed using the Newcastle-Ottawa Scale or Cochrane Collaboration’s risk of bias assessment tool. Biomarkers of clinical and radiological DCI were analyzed separately. Results were meta-analyzed if possible, otherwise narratively reviewed. Biomarkers were classified as significant, inconclusive, or nonsignificant. We defined validated biomarkers as those with significant results in meta-analyses, or in at least two studies using similar methodologies within the same time interval after SAH. The search yielded 209 articles with 724 different biomarkers; 166 studies evaluated 646 biomarkers of clinical DCI, of which 141 were significant and 7 were validated biomarkers (haptoglobulin 2-1 and 2-2, ADAMTS13, vWF, NLR, P-selectin, F2-isoprostane); 78 studies evaluated 165 biomarkers of radiological DCI, of which 63 were significant and 1 was a validated biomarker (LPR). Hence, this review provides a selection of seven biomarkers of clinical DCI and one biomarker of radiological DCI as most promising biomarkers of DCI. Future research should focus on determining the exact predictive, diagnostic, and therapeutic potentials of these biomarkers.
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14
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Tjerkstra MA, Wolfs AE, Verbaan D, Vandertop WP, Horn J, Müller MCA, Juffermans NP. A systematic review on viscoelastic testing in subarachnoid haemorrhage patients. World Neurosurg 2023:S1878-8750(23)00430-8. [PMID: 37004882 DOI: 10.1016/j.wneu.2023.03.108] [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: 01/16/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Bleeding and thromboembolic complications frequently occur following subarachnoid haemorrhage (SAH) and substantially contribute to poor outcome. Viscoelastic testing could be used for detection of coagulopathies following SAH. This review summarizes literature on the utility of viscoelastic testing to detect coagulopathy in SAH patients and explores whether viscoelastic parameters are associated with SAH-related complications and clinical outcome. MATERIALS AND METHODS PUBMED, EMBASE and Google Scholar were systematically searched on August 18th, 2022. Two authors independently selected studies which performed viscoelastic testing in SAH patients and assessed the quality of studies using the Newcastle Ottawa Scale or a previously published framework for quality assessment. Data was meta-analysed if methodologically possible. RESULTS The search yielded 19 studies (1160 SAH patients). Pooling of data including all relevant studies was not possible for any of the outcome measurements due to methodological differences. Thirteen of 19 studies evaluated the association of coagulation profiles and SAH, of which 11 studies showed a hypercoagulable profile. Rebleeding was associated with platelet dysfunction, deep venous thrombosis was associated with faster clot initiation and both delayed cerebral ischemia and poor outcome were associated with increased clot strength. CONCLUSIONS This explorative review shows that SAH patients frequently have a hypercoagulable profile. TEG- and ROTEM-parameters are associated with rebleeding, delayed cerebral ischemia, deep venous thrombosis and poor clinical outcome after SAH, however more research on the subject is needed. Future studies should focus on determining the optimal time frame and cut-off values for TEG or ROTEM to predict these complications.
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Affiliation(s)
- Maud A Tjerkstra
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - Anne E Wolfs
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Dagmar Verbaan
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Janneke Horn
- Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Marcella C A Müller
- Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Nicole P Juffermans
- Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam Neuroscience, Amsterdam, the Netherlands; Department of Intensive Care, OLVG Hospital, Amsterdam, the Netherlands
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15
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Scheepbouwer C, Aparicio-Puerta E, Gomez-Martin C, Verschueren H, van Eijndhoven M, Wedekind LE, Giannoukakos S, Hijmering N, Gasparotto L, van der Galien HT, van Rijn RS, Aronica E, Kibbelaar R, Heine VM, Wesseling P, Noske DP, Vandertop WP, de Jong D, Pegtel DM, Hackenberg M, Wurdinger T, Gerber A, Koppers-Lalic D. ALL-tRNAseq enables robust tRNA profiling in tissue samples. Genes Dev 2023; 37:243-257. [PMID: 36810209 PMCID: PMC10111867 DOI: 10.1101/gad.350233.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/26/2023] [Indexed: 02/23/2023]
Abstract
Transfer RNAs (tRNAs) are small adaptor RNAs essential for mRNA translation. Alterations in the cellular tRNA population can directly affect mRNA decoding rates and translational efficiency during cancer development and progression. To evaluate changes in the composition of the tRNA pool, multiple sequencing approaches have been developed to overcome reverse transcription blocks caused by the stable structures of these molecules and their numerous base modifications. However, it remains unclear whether current sequencing protocols faithfully capture tRNAs existing in cells or tissues. This is specifically challenging for clinical tissue samples that often present variable RNA qualities. For this reason, we developed ALL-tRNAseq, which combines the highly processive MarathonRT and RNA demethylation for the robust assessment of tRNA expression, together with a randomized adapter ligation strategy prior to reverse transcription to assess tRNA fragmentation levels in both cell lines and tissues. Incorporation of tRNA fragments not only informed on sample integrity but also significantly improved tRNA profiling of tissue samples. Our data showed that our profiling strategy effectively improves classification of oncogenic signatures in glioblastoma and diffuse large B-cell lymphoma tissues, particularly for samples presenting higher levels of RNA fragmentation, further highlighting the utility of ALL-tRNAseq for translational research.
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Affiliation(s)
- Chantal Scheepbouwer
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands;
- Brain Tumor Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | | | - Cristina Gomez-Martin
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Heleen Verschueren
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Monique van Eijndhoven
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Laurine E Wedekind
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Stavros Giannoukakos
- Genetics Department, Faculty of Science, University of Granada, 18071 Granada, Spain
| | - Nathalie Hijmering
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Lisa Gasparotto
- Department of Child and Adolescent Psychiatry, Emma Children's Hospital, Amsterdam UMC, Neuroscience, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Hilde T van der Galien
- Department of Hematology, Medical Center Leeuwarden, 8934 AD Leeuwarden, the Netherlands
- HemoBase Population Registry Consortium, 8934 AD Leeuwarden, the Netherlands
| | - Roos S van Rijn
- Department of Hematology, Medical Center Leeuwarden, 8934 AD Leeuwarden, the Netherlands
- HemoBase Population Registry Consortium, 8934 AD Leeuwarden, the Netherlands
| | - Eleonora Aronica
- Department of (Neuro)Pathology Amsterdam Neuroscience, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Robby Kibbelaar
- HemoBase Population Registry Consortium, 8934 AD Leeuwarden, the Netherlands
- Department of Pathology, Pathology Friesland, 8917 EN Leeuwarden, the Netherlands
| | - Vivi M Heine
- Department of Child and Adolescent Psychiatry, Emma Children's Hospital, Amsterdam UMC, Neuroscience, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Pieter Wesseling
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
- Laboratory for Childhood Cancer Pathology, Princess Máxima Center for Pediatric Oncology, University Medical Center Utrecht, 3584 CS Utrecht, the Netherlands
| | - David P Noske
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Daphne de Jong
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - D Michiel Pegtel
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Michael Hackenberg
- Genetics Department, Faculty of Science, University of Granada, 18071 Granada, Spain
| | - Tom Wurdinger
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Alan Gerber
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Danijela Koppers-Lalic
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands;
- Brain Tumor Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
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16
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Klukowska AM, Staartjes VE, Vandertop WP, Schröder ML. Predictors of five-repetition sit-to-stand test performance in patients with lumbar degenerative disease. Acta Neurochir (Wien) 2023; 165:107-115. [PMID: 36477416 PMCID: PMC9840589 DOI: 10.1007/s00701-022-05441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The five-repetition sit-to-stand test (5R-STS) has recently been validated as an objective measure of functional impairment in patients with lumbar degenerative disease (LDD). Knowledge of factors influencing 5R-STS performance is useful to correct for confounders, create personalized adjusted test times, and potentially identify prognostic subgroups. We evaluate factors predicting the 5R-STS performance in patients with LDD. METHODS Patients with LDD requiring surgery were included. Each participant performed the 5R-STS and completed a questionnaire that included their age, gender, weight, height, body mass index (BMI), smoking status, education level, employment type, ability to work, analgesic drug usage, history of previous spinal surgery, and EQ5D depression and anxiety domain. Surgical indication and index level of the spinal pathology were also recorded. Predictors of 5R-STS were identified through multivariable linear regression. RESULTS The cohort consisted of 240 patients, 47.9% being female (mean age, 47.7 ± 13.6 years). In the final multivariable model incorporating confounders, height (regression coefficient (RC), 0.08; 95% confidence interval (CI), 0.003/0.16, p = 0.042) and being an active smoker (RC, 2.44; 95%CI, 0.56/4.32, p = 0.012) were significant predictors of worse 5R-STS performance. Full ability to work (RC, - 2.39; 95%CI, - 4.39/ - 0.39, p = 0.020) was associated with a better 5R-STS performance. Age, height, surgical indication, index level of pathology, history of previous spine surgery, history of pain, analgesic drug use, employment type, and severity of anxiety and depression symptoms demonstrated confounding effect on the 5R-STS time. CONCLUSIONS Greater height, being an active smoker, and inability to work are significant predictors of worse 5R-STS performance in patients with LDD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03303300 and NCT03321357.
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Affiliation(s)
- Anita M Klukowska
- Department of Neurosurgery, Bergman Clinics, Amsterdam, Netherlands
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Victor E Staartjes
- Department of Neurosurgery, Bergman Clinics, Amsterdam, Netherlands.
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - W Peter Vandertop
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics, Amsterdam, Netherlands
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Tjerkstra MA, Post R, Germans MR, Vergouwen MDI, Jellema K, Koot RW, Kruyt ND, Willems PWA, Wolfs JFC, de Beer FC, Kieft H, Nanda D, van der Pol B, Roks G, de Beer F, Halkes PHA, Reichman LJA, Brouwers PJAM, Van den Berg-Vos RM, Kwa VIH, van der Ree TC, Bronner I, Bienfait HP, Boogaarts H, Klijn CJM, van den Berg R, Coert BA, Horn J, Majoie CBLM, Rinkel GJE, Roos YBWM, Vandertop WP, Verbaan D. Tranexamic Acid After Aneurysmal Subarachnoid Hemorrhage: Post Hoc Analysis of the ULTRA Trial. Neurology 2022; 99:e2605-e2614. [PMID: 36266046 DOI: 10.1212/wnl.0000000000201160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The ULTRA trial showed that ultra-early and short-term tranexamic acid treatment after subarachnoid hemorrhage did not improve clinical outcome at 6 months. An expected proportion of the included patients experienced nonaneurysmal subarachnoid hemorrhage. In this post hoc study, we will investigate whether ultra-early and short-term tranexamic acid treatment in patients with aneurysmal subarachnoid hemorrhage improves clinical outcome at 6 months. METHODS The ULTRA trial is a multicenter, prospective, randomized, controlled, open-label trial with blinded outcome assessment, conducted between July 24, 2013, and January 20, 2020. After confirmation of subarachnoid hemorrhage on noncontrast CT, patients were allocated to either ultra-early and short-term tranexamic acid treatment with usual care or usual care only. In this post hoc analysis, we included all ULTRA participants with a confirmed aneurysm on CT angiography and/or digital subtraction angiography. The primary endpoint was clinical outcome at 6 months, assessed by the modified Rankin scale (mRS), dichotomized into good (0-3) and poor (4-6) outcomes. RESULTS Of the 813 ULTRA trial patients who experienced an aneurysmal subarachnoid hemorrhage, 409 (50%) were assigned to the tranexamic acid group and 404 (50%) to the control group. In the intention-to-treat analysis, 233 of 405 (58%) patients in the tranexamic acid group and 238 of 399 (60%) patients in the control group had a good clinical outcome (adjusted odds ratio [aOR] 0.92; 95% CI 0.69-1.24). None of the secondary outcomes showed significant differences between the treatment groups: excellent clinical outcome (mRS 0-2) (aOR 0.76; 95% CI 0.57-1.03), all-cause mortality at 30 days (aOR 0.91; 95% CI 0.65-1.28), and all-cause mortality at 6 months (aOR 1.10; 95% CI 0.80-1.52). DISCUSSION Ultra-early and short-term tranexamic acid treatment did not improve clinical outcomes at 6 months in patients with aneurysmal subarachnoid hemorrhage and therefore cannot be recommended. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov (NCT02684812; submission date February 18, 2016, first patient enrollment on July 24, 2013). CLASSIFICATION OF EVIDENCE This study provides Class II evidence that tranexamic acid does not improve outcomes in patients presenting with aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- Maud A Tjerkstra
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands.
| | - René Post
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Menno R Germans
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Mervyn D I Vergouwen
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Korné Jellema
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Radboud W Koot
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Nyika D Kruyt
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Peter W A Willems
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Jasper F C Wolfs
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Frits C de Beer
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Hans Kieft
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Dharmin Nanda
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Bram van der Pol
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Gerwin Roks
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Frank de Beer
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Patricia H A Halkes
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Loes J A Reichman
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Paul J A M Brouwers
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Renske M Van den Berg-Vos
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Vincent I H Kwa
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Taco C van der Ree
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Irene Bronner
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Henri P Bienfait
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Hieronymus Boogaarts
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Catharina J M Klijn
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - René van den Berg
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Bert A Coert
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Janneke Horn
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Charles B L M Majoie
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Gabriël J E Rinkel
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Yvo B W M Roos
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - W Peter Vandertop
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
| | - Dagmar Verbaan
- From the Department of Neurosurgery (M.A.T., R.P., B.A.C., W.V., D.V.), Amsterdam Neuroscience Research Institute, Amsterdam University Medical Centres, the Netherlands; Department of Neurosurgery (M.R.G.), Clinical Neuroscience Centre, University Hospital Zurich, Switzerland; Department of Neurology and Neurosurgery (M.D.I.V., P.W.A.W., G.J.E.R.), UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University; Department of Neurology (K.J.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (R.W.K.), Leids University Medical Centre; Department of Neurology (N.D.K.), Leids University Medical Centre; Department of Neurosurgery (J.F.C.W.), Haaglanden Medical Centre, the Hague; Department of Neurosurgery (F.C.B., D.N.), Isala Hospital, Zwolle; Department of Intensive Care (H.K.), Isala Hospital, Zwolle; Department of Neurosurgery (B.P.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (G.R.), Elisabeth Tweesteden Ziekenhuis, Tilburg; Department of Neurology (F.B.), Spaarne Gasthuis, Haarlem; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep, Alkmaar; Department of Neurology (L.J.A.R.), Ziekenhuisgroep Twente, Almelo; Department of Neurology (P.J.A.M.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (R.M.V.B.-V., V.I.H.K.), OLVG, Amsterdam; Department of Neurology (R.M.V.B.-V., Y.B.W.M.R.), Amsterdam University Medical Centres, Llocation AMC; Department of Neurology (T.C.R.), Dijklander Hospital, Hoorn; Department of Neurology (I.B.), Flevo Hospital, Almere; Department of Neurology (H.P.B.), Gelre Hospital, Apeldoorn; Department of Neurosurgery (H.B.), Radboud University Medical Centre, Nijmegen; Department of Neurology (C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Department of Radiology and Nuclear Medicine (R.B., C.B.L.M.M.), Amsterdam University Medical Centres, Location AMC; and Department of Intensive Care (J.H.), Amsterdam University Medical Centres, Location AMC, the Netherlands
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18
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Affiliation(s)
| | - Dennis R Buis
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ricardo Feller
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
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19
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In 't Veld SGJG, Arkani M, Post E, Antunes-Ferreira M, D'Ambrosi S, Vessies DCL, Vermunt L, Vancura A, Muller M, Niemeijer ALN, Tannous J, Meijer LL, Le Large TYS, Mantini G, Wondergem NE, Heinhuis KM, van Wilpe S, Smits AJ, Drees EEE, Roos E, Leurs CE, Tjon Kon Fat LA, van der Lelij EJ, Dwarshuis G, Kamphuis MJ, Visser LE, Harting R, Gregory A, Schweiger MW, Wedekind LE, Ramaker J, Zwaan K, Verschueren H, Bahce I, de Langen AJ, Smit EF, van den Heuvel MM, Hartemink KJ, Kuijpers MJE, Oude Egbrink MGA, Griffioen AW, Rossel R, Hiltermann TJN, Lee-Lewandrowski E, Lewandrowski KB, De Witt Hamer PC, Kouwenhoven M, Reijneveld JC, Leenders WPJ, Hoeben A, Verdonck-de Leeuw IM, Leemans CR, Baatenburg de Jong RJ, Terhaard CHJ, Takes RP, Langendijk JA, de Jager SC, Kraaijeveld AO, Pasterkamp G, Smits M, Schalken JA, Łapińska-Szumczyk S, Łojkowska A, Żaczek AJ, Lokhorst H, van de Donk NWCJ, Nijhof I, Prins HJ, Zijlstra JM, Idema S, Baayen JC, Teunissen CE, Killestein J, Besselink MG, Brammen L, Bachleitner-Hofmann T, Mateen F, Plukker JTM, Heger M, de Mast Q, Lisman T, Pegtel DM, Bogaard HJ, Jassem J, Supernat A, Mehra N, Gerritsen W, de Kroon CD, Lok CAR, Piek JMJ, Steeghs N, van Houdt WJ, Brakenhoff RH, Sonke GS, Verheul HM, Giovannetti E, Kazemier G, Sabrkhany S, Schuuring E, Sistermans EA, Wolthuis R, Meijers-Heijboer H, Dorsman J, Oudejans C, Ylstra B, Westerman BA, van den Broek D, Koppers-Lalic D, Wesseling P, Nilsson RJA, Vandertop WP, Noske DP, Tannous BA, Sol N, Best MG, Wurdinger T. Detection and localization of early- and late-stage cancers using platelet RNA. Cancer Cell 2022; 40:999-1009.e6. [PMID: 36055228 DOI: 10.1016/j.ccell.2022.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/06/2022] [Accepted: 08/08/2022] [Indexed: 01/12/2023]
Abstract
Cancer patients benefit from early tumor detection since treatment outcomes are more favorable for less advanced cancers. Platelets are involved in cancer progression and are considered a promising biosource for cancer detection, as they alter their RNA content upon local and systemic cues. We show that tumor-educated platelet (TEP) RNA-based blood tests enable the detection of 18 cancer types. With 99% specificity in asymptomatic controls, thromboSeq correctly detected the presence of cancer in two-thirds of 1,096 blood samples from stage I-IV cancer patients and in half of 352 stage I-III tumors. Symptomatic controls, including inflammatory and cardiovascular diseases, and benign tumors had increased false-positive test results with an average specificity of 78%. Moreover, thromboSeq determined the tumor site of origin in five different tumor types correctly in over 80% of the cancer patients. These results highlight the potential properties of TEP-derived RNA panels to supplement current approaches for blood-based cancer screening.
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Affiliation(s)
- Sjors G J G In 't Veld
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Clinical Chemistry, Neurochemistry Lab, Boelelaan 1117, Amsterdam, the Netherlands; Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Mohammad Arkani
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Boelelaan 1117, Amsterdam, the Netherlands
| | - Edward Post
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Mafalda Antunes-Ferreira
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Silvia D'Ambrosi
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Daan C L Vessies
- Department of Laboratory Medicine, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Lisa Vermunt
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Clinical Chemistry, Neurochemistry Lab, Boelelaan 1117, Amsterdam, the Netherlands; Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Adrienne Vancura
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Mirte Muller
- Department of Thoracic Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Anna-Larissa N Niemeijer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Boelelaan 1117, Amsterdam, the Netherlands
| | - Jihane Tannous
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Neuroscience Program, Harvard Medical School, Boston, MA, USA
| | - Laura L Meijer
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Boelelaan 1117, Amsterdam, the Netherlands
| | - Tessa Y S Le Large
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Boelelaan 1117, Amsterdam, the Netherlands
| | - Giulia Mantini
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Medical Oncology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Niels E Wondergem
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Otolaryngology and Head and Neck Surgery, Boelelaan 1117, Amsterdam, the Netherlands
| | - Kimberley M Heinhuis
- Department of Medical Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Clinical Pharmacology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Sandra van Wilpe
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A Josien Smits
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Boelelaan 1117, Amsterdam, the Netherlands
| | - Esther E E Drees
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pathology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Eva Roos
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Boelelaan 1117, Amsterdam, the Netherlands
| | - Cyra E Leurs
- Neuroscience Campus Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurology, Boelelaan 1117, Amsterdam, the Netherlands; MS Center Amsterdam, Amsterdam, the Netherlands
| | | | - Ewoud J van der Lelij
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Govert Dwarshuis
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Maarten J Kamphuis
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Lisanne E Visser
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Romee Harting
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Annemijn Gregory
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Markus W Schweiger
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Neuroscience Program, Harvard Medical School, Boston, MA, USA
| | - Laurine E Wedekind
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Jip Ramaker
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Kenn Zwaan
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Heleen Verschueren
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Idris Bahce
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Boelelaan 1117, Amsterdam, the Netherlands
| | - Adrianus J de Langen
- Department of Thoracic Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Egbert F Smit
- Department of Thoracic Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Michel M van den Heuvel
- Department of Thoracic Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Respiratory Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen J Hartemink
- Department of Thoracic Surgery, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marijke J E Kuijpers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; Thrombosis Expertise Centre, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mirjam G A Oude Egbrink
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Arjan W Griffioen
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Medical Oncology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Rafael Rossel
- Translational Research Unit, Dr. Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain; Pangaea Biotech SL, Barcelona, Spain; Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain; Molecular Oncology Research (MORe) Foundation, Barcelona, Spain
| | - T Jeroen N Hiltermann
- University of Groningen, Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Kent B Lewandrowski
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Philip C De Witt Hamer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Mathilde Kouwenhoven
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Jaap C Reijneveld
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurology, Boelelaan 1117, Amsterdam, the Netherlands; Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - William P J Leenders
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Ann Hoeben
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Otolaryngology and Head and Neck Surgery, Boelelaan 1117, Amsterdam, the Netherlands; Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - C René Leemans
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Otolaryngology and Head and Neck Surgery, Boelelaan 1117, Amsterdam, the Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Saskia C de Jager
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adriaan O Kraaijeveld
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Minke Smits
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jack A Schalken
- Urological Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sylwia Łapińska-Szumczyk
- Department of Gynaecology, Gynaecological Oncology and Gynaecological Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Łojkowska
- Department of Gynaecology, Gynaecological Oncology and Gynaecological Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna J Żaczek
- Laboratory of Translational Oncology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Henk Lokhorst
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Hematology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Niels W C J van de Donk
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Hematology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Inger Nijhof
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Hematology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Henk-Jan Prins
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Hematology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Josée M Zijlstra
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Hematology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Sander Idema
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Johannes C Baayen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Clinical Chemistry, Neurochemistry Lab, Boelelaan 1117, Amsterdam, the Netherlands; Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Joep Killestein
- Neuroscience Campus Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurology, Boelelaan 1117, Amsterdam, the Netherlands; MS Center Amsterdam, Amsterdam, the Netherlands
| | - Marc G Besselink
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Boelelaan 1117, Amsterdam, the Netherlands
| | - Lindsay Brammen
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Farrah Mateen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John T M Plukker
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michal Heger
- Department of Pharmaceutics, Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China; Department of Pathology, Laboratory Experimental Oncology, Erasmus MC, Rotterdam, the Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ton Lisman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Surgical Research Laboratory, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - D Michiel Pegtel
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pathology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Harm-Jan Bogaard
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Boelelaan 1117, Amsterdam, the Netherlands
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Supernat
- Laboratory of Translational Oncology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Winald Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cornelis D de Kroon
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Christianne A R Lok
- Department of Gynaecological Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Center of Gynaecologic Oncology Amsterdam, the Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Jurgen M J Piek
- Department of Obstetrics and Gynaecology and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Clinical Pharmacology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ruud H Brakenhoff
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Otolaryngology and Head and Neck Surgery, Boelelaan 1117, Amsterdam, the Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Henk M Verheul
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elisa Giovannetti
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Medical Oncology, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Pharmacology Lab, AIRC Start-Up Unit, Fondazione Pisana per La Scienza, Pisa, Italy
| | - Geert Kazemier
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Boelelaan 1117, Amsterdam, the Netherlands
| | - Siamack Sabrkhany
- Department of Physiology, Maastricht University, Maastricht, the Netherlands
| | - Ed Schuuring
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Erik A Sistermans
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Clinical Genetics, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Rob Wolthuis
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Clinical Genetics, Boelelaan 1117, Amsterdam, the Netherlands
| | - Hanne Meijers-Heijboer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Clinical Genetics, Boelelaan 1117, Amsterdam, the Netherlands
| | - Josephine Dorsman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Clinical Genetics, Boelelaan 1117, Amsterdam, the Netherlands
| | - Cees Oudejans
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Clinical Chemistry, Boelelaan 1117, Amsterdam, the Netherlands
| | - Bauke Ylstra
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pathology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Bart A Westerman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Daan van den Broek
- Department of Laboratory Medicine, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Danijela Koppers-Lalic
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Pieter Wesseling
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pathology, Boelelaan 1117, Amsterdam, the Netherlands; Department of Pathology, Princess Máxima Center for Pediatric Oncology and University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Jonas A Nilsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - W Peter Vandertop
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - David P Noske
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands
| | - Bakhos A Tannous
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Neuroscience Program, Harvard Medical School, Boston, MA, USA
| | - Nik Sol
- Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Myron G Best
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands.
| | - Thomas Wurdinger
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Neurosurgery, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam and Liquid Biopsy Center, Amsterdam, the Netherlands; Brain Tumor Center Amsterdam, Amsterdam, the Netherlands.
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20
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Buis DR, Slot KM, Bakker DP, Post R, Wolf NI, Vandertop WP. [Ventriculoperitoneal shunt dysfunction in children: various clinical presentations]. Ned Tijdschr Geneeskd 2022; 166:D6660. [PMID: 36036683] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The clinical presentation of a ventriculoperitoneal shunt (VP-shunt) dysfunction depends on whether the cranial sutures are still unfused, and on the cause and severity of the VP-shunt obstruction. A suspicion of a VP-shunt dysfunction is always reason to consult with a neurosurgeon. A patient with a suspected VP-shunt dysfunction that presents with elevated intracranial pressure should be urgently assessed at the emergency department of a neurosurgical center. Conclusions about whether the ventricular system is enlarged should be based on comparison between the imaging made to demonstrate the VP-shunt dysfunction and a reference scan of the brain, made when the patient was in a good clinical condition. In a patient with small ventricles, but clinical indications of elevated intracranial pressure, a VP-shunt dysfunction can't be ruled out. In that case fundoscopy may be very valuable to rule out papilledema.
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Affiliation(s)
- Dennis R Buis
- Amsterdam UMC, Amsterdam. Afd. Neurochirurgie
- Contact: Dennis R. Buis
| | | | | | - René Post
- Amsterdam UMC, Amsterdam. Afd. Neurochirurgie
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21
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Wolters WPG, Dreijerink KMA, Giles RH, van der Horst‐Schrivers ANA, van Nesselrooij B, Zandee WT, Timmers HJLM, Seute T, de Herder WW, Verrijn Stuart AA, Kilic E, Brinkman WM, Zondervan PJ, Vandertop WP, Daniels AB, Wolbers T, Links TP, van Leeuwaarde RS. Multidisciplinary integrated care pathway for von Hippel-Lindau disease. Cancer 2022; 128:2871-2879. [PMID: 35579632 PMCID: PMC9542729 DOI: 10.1002/cncr.34265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/14/2022] [Accepted: 04/22/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Clinical pathways are care plans established to describe essential steps in the care of patients with a specific clinical problem. They translate (inter)national guidelines into local applicable protocols and clinical practice. The purpose of this article is to establish a multidisciplinary integrated care pathway for specialists and allied health care professionals in caring for individuals with von Hippel-Lindau (VHL) disease. METHODS Using a modified Delphi consensus-making process, a multidisciplinary panel from 5 Dutch University Medical Centers produced an integrated care pathway relating to the provision of care for patients with VHL by medical specialists, specialized nurses, and associated health care professionals. Patient representatives cocreated the pathway and contributed quality criteria from the patients' perspective. RESULTS The panel agreed on recommendations for the optimal quality of care for individuals with a VHL gene mutation. These items were the starting point for the development of a patient care pathway. With international medical guidelines addressing the different VHL-related disorders, this article presents a patient care pathway as a flowchart that can be incorporated into VHL expertise clinics or nonacademic treatment clinics. CONCLUSIONS Medical specialists (internists, urologists, neurosurgeons, ophthalmologists, geneticists, medical oncologists, neurologists, gastroenterologists, pediatricians, and ear-nose-throat specialists) together with specialized nurses play a vital role alongside health care professionals in providing care to people affected by VHL and their families. This article presents a set of consensus recommendations, supported by organ-specific guidelines, for the roles of these practitioners in order to provide optimal VHL care. This care pathway can form the basis for the development of comprehensive, integrated pathways for multiple neoplasia syndromes.
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Affiliation(s)
- Wendy P. G. Wolters
- Department of Endocrine OncologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Koen M. A. Dreijerink
- Department of EndocrinologyAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Rachel H. Giles
- Dutch VHL OrganizationUtrechtthe Netherlands,International Kidney Cancer CoalitionAmsterdam‐Duivendrechtthe Netherlands
| | | | | | - Wouter T. Zandee
- Department of EndocrinologyUniversity Medical Center GroningenGroningenthe Netherlands
| | | | - Tatjana Seute
- Department of NeurologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Wouter W. de Herder
- Department of Internal MedicineErasmus Medical CenterRotterdamthe Netherlands
| | | | - Emine Kilic
- Department of OphthalmologyErasmus Medical CenterRotterdamthe Netherlands
| | - Willem M. Brinkman
- Department of Oncological UrologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - W. Peter Vandertop
- Department of NeurosurgeryAmsterdam NeuroscienceAmsterdamthe Netherlands
| | - Anthony B. Daniels
- Division of Ocular Oncology and PathologyDepartment of Ophthalmology and Visual Sciences, Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennessee
| | | | - Thera P. Links
- Department of EndocrinologyUniversity Medical Center GroningenGroningenthe Netherlands
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22
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Post R, Germans MR, Buis DR, Coert BA, Vandertop WP, Verbaan D. Interventions in Acute Intracranial Surgery: An Evidence-Based Perspective. World Neurosurg 2022; 161:432-440. [PMID: 35505564 DOI: 10.1016/j.wneu.2022.02.049] [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: 09/14/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
From a pathophysiological point of view, early neurosurgical treatment seems essential to prevent secondary brain injury and has been stated as the "time-is-brain" concept. However, the question immediately rises: "Is there an optimal time window for acute intracranial neurosurgical interventions?" In neurosurgery, treatment modality has been studied far more extensively than timing to surgery ("time-to-surgery"). The majority of acute intracranial neurosurgical interventions are carried out for traumatic brain injury and hemorrhagic or ischemic stroke. Current guidelines for traumatic brain injury, spontaneous intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, and middle cerebral artery infarction are reviewed and lessons learned from the randomized controlled trials mentioned are discussed. In acute intracranial neurosurgical interventions, "delayed consent" procedures could play an important role for this field of research. Whether there is an optimal time window for acute intracranial neurosurgical interventions seems difficult to be answered with randomized controlled trials referred to in the current guidelines. Observational designs, such as comparative effectiveness research, and special statistical techniques, may provide a better understanding in the optimal "time-to-surgery."
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Affiliation(s)
- René Post
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
| | - Menno R Germans
- Department of Neurosurgery, Clinical Neuroscience Centre, University Hospital Zurich, Zurich, Switzerland
| | - Dennis R Buis
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Bert A Coert
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, the Netherlands
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23
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van Roessel IMAA, van Schaik J, Meeteren AYNSV, Boot AM, der Grinten HLCV, Clement SC, van Iersel L, Han KS, van Trotsenburg ASP, Vandertop WP, Kremer LCM, van Santen HM. Body mass index at diagnosis of a childhood brain tumor; a reflection of hypothalamic-pituitary dysfunction or lifestyle? Support Care Cancer 2022; 30:6093-6102. [PMID: 35416504 PMCID: PMC9135856 DOI: 10.1007/s00520-022-07031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Childhood brain tumor survivors (CBTS) are at risk of becoming overweight, which has been shown to be associated with hypothalamic-pituitary (HP) dysfunction during follow-up. Body mass index (BMI) at diagnosis is related to BMI at follow-up. It is uncertain, however, whether aberrant BMI at brain tumor diagnosis reflects early hypothalamic dysfunction or rather reflects genetic and sociodemographic characteristics. We aimed to examine whether BMI at childhood brain tumor diagnosis is associated with HP dysfunction at diagnosis or its development during follow-up. METHODS The association of BMI at diagnosis of a childhood brain tumor to HP dysfunction at diagnosis or during follow-up was examined in a Dutch cohort of 685 CBTS, excluding children with craniopharyngioma or a pituitary tumor. Individual patient data were retrospectively extracted from patient charts. RESULTS Of 685 CTBS, 4.7% were underweight, 14.2% were overweight, and 3.8% were obese at diagnosis. Being overweight or obese at diagnosis was not associated with anterior pituitary deficiency or diabetes insipidus at diagnosis or during follow-up. In children with suprasellar tumors, being obese at diagnosis was associated with central precocious puberty. CONCLUSION Overweight or obesity at diagnosis of a childhood brain tumor seems not to be associated with pituitary deficiencies. These results suggest that genetics and lifestyle may be more important etiologic factors for higher BMI at diagnosis in these children than hypothalamic dysfunction. To improve the long-term outcome of CBTS with regards to overweight and obesity, more attention should be given to lifestyle already at the time of brain tumor treatment.
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Affiliation(s)
- I M A A van Roessel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - J van Schaik
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - A Y N Schouten-van Meeteren
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A M Boot
- Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H L Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Children's Hospital, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - S C Clement
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - L van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K S Han
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Amsterdam University Medical Centers, University of Amsterdam, and VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. .,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.
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24
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Goedemans T, Verberk JDM, van den Munckhof P, Buis DR, Vandertop WP, de Korte AM. Neurological update: consult the neurosurgical oracle for a standard operating procedure. J Neurol 2022; 269:5179-5186. [PMID: 35381880 PMCID: PMC9363322 DOI: 10.1007/s00415-022-11090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
Abstract
Standard operating procedures (SOPs) contain general instructions and principles to standardize care, to improve effective and safe healthcare. Developing new, or updating current, SOPs is, however, challenging in fields where high-level evidence is limited. Still, SOPs alone have been shown to result in less complications. In this narrative review, we describe the process of creating a consensus-based SOP that is pragmatic for clinical practice since it can be created regardless of the current level of evidence. Through live audience engagement platforms, a group of experts will be able to both anonymously respond to a created questionnaire, and (subsequently) discuss the results within the same meeting. This modified Digital Delphi method as described here can be used as a tool toward consensus-based healthcare.
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Affiliation(s)
- Taco Goedemans
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Janneke D M Verberk
- Department of Medical Microbiology and Infection Prevention, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Dennis R Buis
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Antonius M de Korte
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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25
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Tjerkstra MA, Verbaan D, Coert BA, Post R, van den Berg R, Coutinho JM, Horn J, Vandertop WP. Large practice variations in diagnosis and treatment of delayed cerebral ischemia after subarachnoid hemorrhage. World Neurosurg 2022; 160:e412-e420. [PMID: 35033694 DOI: 10.1016/j.wneu.2022.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Delayed cerebral ischemia (DCI) contributes to poor outcomes after subarachnoid hemorrhage (SAH). The pathophysiology of DCI is not fully understood, which has hindered the adoption of a uniform definition. Furthermore, a reliable diagnostic test and an effective evidence-based treatment are lacking. This could lead to variations in care. METHODS A web-based survey on the variations in the definition, diagnosis, and treatment of DCI was designed and sent to 314 intensivists, neurologists, and neurosurgeons of all 9 hospitals in the Netherlands who care for patients with SAH. The responders were categorized into physicians responsible for the coordination of SAH care and those who were not. For questions on the definition and diagnosis, only the responses from the coordinating physicians were evaluated. For the treatment questions, all the responses were evaluated. RESULTS The response rate was 34% (106 of 314). All 9 hospitals were represented. Of the responses, 27 did not provide answers for the definition, diagnosis, or treatment questions; 79 responses were used for analysis. Signs of vasospasm were required by 21 of the 47 coordinating physicians (44%) when considering DCI. Of the 47 coordinating physicians, 24 (51%) did not use a diagnostic test results for a positive diagnosis of DCI. When patients were discharged within 21 days, 33 of the 73 responders (45%) did not provide a prescription for nimodipine continuation. Finally, all but one hospital had treated DCI with hypertension induction. CONCLUSIONS We found large variations in the definition, diagnosis, and treatment of DCI in the Netherlands. In the absence of evidence-based treatment, standardization of management seems warranted in an effort to optimize DCI care.
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Affiliation(s)
- Maud A Tjerkstra
- Department of Neurosurgery, Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Bert A Coert
- Department of Neurosurgery, Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - René Post
- Department of Neurosurgery, Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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26
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Buis DR, Arnts H, Slot KM, Best MG, Vandertop WP. Uncommon presentations of a neurosurgical site infection: impaired wound healing with hypergranulation and crust formation. Acta Neurochir (Wien) 2022; 164:875-879. [PMID: 34859306 DOI: 10.1007/s00701-021-05041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
Hypergranulation and crust formation after cranial neurosurgery is rare. We report three patients with an uncommon form of hypergranulation with extensive crust formation after cranial neurosurgery, associated with a St. Aureus infection of the scalp, and propose that this is a form of pyogenic dermatitis, as is commonly seen among domestic animals with a coat of fur. It can be treated conservatively. We propose a treatment algorithm.
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Affiliation(s)
- Dennis R Buis
- Dept. of Pediatric Neurosurgery, Amsterdam University Medical Centers, Location AMC, H2-237, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Hisse Arnts
- Dept. of Pediatric Neurosurgery, Amsterdam University Medical Centers, Location AMC, H2-237, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - K Mariam Slot
- Dept. of Pediatric Neurosurgery, Amsterdam University Medical Centers, Location AMC, H2-237, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Myron G Best
- Dept. of Pediatric Neurosurgery, Amsterdam University Medical Centers, Location AMC, H2-237, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Dept. of Pediatric Neurosurgery, Amsterdam University Medical Centers, Location AMC, H2-237, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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27
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Immenga S, Lodewijkx R, Roos YBWEM, Middeldorp S, Majoie CBLM, Willems HC, Vandertop WP, Verbaan D. Tranexamic acid to prevent operation in chronic subdural haematoma (TORCH): study protocol for a randomised placebo-controlled clinical trial. Trials 2022; 23:56. [PMID: 35042560 PMCID: PMC8767703 DOI: 10.1186/s13063-021-05907-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Chronic subdural haematoma (cSDH) occurs mainly in the elderly. Surgical evacuation is effective, but in these old, often frail, patients with multi-comorbidity, surgery carries significant risks for future cognitive functioning and loss of independency. Therefore, a growing interest is noted for a non-surgical treatment with medication such as tranexamic acid (TXA). In five small retrospective series, this antifibrinolytic drug showed a beneficial effect on the spontaneous resolution of the haematoma, and with that, the necessity for surgery. Methods For this randomised, placebo-controlled clinical multicentre trial, all cSDH patients, over 50 years old with mild symptoms (Glasgow Coma Score (GCS) ≥ 14, modified National Institutes of Health Stroke Scale (mNIHSS) ≤ 4), a midline shift of ≤ 10 mm and in whom a primary conservative treatment is chosen, are eligible for study participation. After informed consent, 140 patients will be randomised to receive either TXA 500 mg or placebo two times daily for 28 days. The primary outcome is the necessity for surgery within 12 weeks; secondary outcomes are cSDH volume, neurological impairment (mNIHSS), falling incidents, cognitive functioning (Montreal Cognitive Assessment (MOCA)), performance in activities of daily living (Barthel and Lawton score), functional outcome (modified Rankin Scale (mRS)), quality of life (Short Form Health Survey (SF-36) and EuroQol 5-Dimension Health Survey (EQ-5D)), mortality and the use of care and health-related costs (Medical Consumption Questionnaire (iMCQ) and Productivity Cost Questionnaire (iPCQ)) at 12 weeks and 6 months. Discussion This phase III trial investigating the efficacy of TXA to prevent surgery for cSDH is the first in including patients using anticoagulants and mentally incompetent patients, since these comprise a significant part of the target population. Also, this study is one of the first to prospectively measure functional outcome and quality of life in cSDH patients. Final results of this study are expected in 2024. Trial registration Dutch Trial Registry (Nederlands Trial Register) NL6584. Registered on 11 November 2017 ClinicalTrials.govNCT03582293. Registered on 11 July 2018 EU Clinical Trials Register 2017-004311-40. Registered on 29 March 2018
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Affiliation(s)
- S Immenga
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - R Lodewijkx
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y B W E M Roos
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Middeldorp
- Department of Vascular Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C B L M Majoie
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H C Willems
- Department of Internal Medicine, Geriatrics Section, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - D Verbaan
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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28
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Klukowska AM, Staartjes VE, Vandertop WP, Schröder ML. Five-Repetition Sit-to-Stand Test Performance in Healthy Individuals: Reference Values and Predictors From 2 Prospective Cohorts. Neurospine 2022; 18:760-769. [PMID: 35000330 PMCID: PMC8752709 DOI: 10.14245/ns.2142750.375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023] Open
Abstract
Objective The 5-repetition-sit-to-stand (5R-STS) test is an objective test of functional impairment- commonly used in various diseases, including lumbar degenerative disc diseases. It is used to measure the severity of disease and to monitor recovery. We aimed to evaluate reference values for the test, as well as factors predicting 5R-STS performance in healthy adults.
Methods Healthy adults (> 18 years of age) were recruited, and their 5R-STS time was measured. Their age, sex, weight, height, body mass index (BMI), smoking status, education level, work situation and EuroQOL-5D Healthy & Anxiety category were recorded. Linear regression analysis was employed to identify predictors of 5R-STS performance.
Results We included 172 individuals with mean age of 39.4±14.1 years and mean BMI of 24.0 ±4.0 kg/m2. Females constituted 57%. Average 5R-STS time was 6.21 ±1.92 seconds, with an upper limit of normal of 12.39 seconds. In a multivariable model, age (regression coefficient [RC], 0.07; 95% confidence interval [CI], 0.05/0.09; p<0.001), male sex (RC, -0.87; 95% CI, -1.50 to -0.23; p=0.008), BMI (RC, 0.40; 95% CI, 0.10–0.71; p=0.010), height (RC, 0.13; 95% CI, 0.04–0.22; p=0.006), and houseworker status (RC, -1.62; 95% CI, -2.93 to -0.32; p=0.016) were significantly associated with 5R-STS time. Anxiety and depression did not influence performance significantly (RC, 0.82; 95% CI, -0.14 to 1.77; p=0.097).
Conclusion The presented reference values can be applied as normative data for 5R-STS in healthy adults, and are necessary to judge what constitutes abnormal performance. We identified several significant factors associated with 5R-STS performance that may be used to calculate individualized expected test times.
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Affiliation(s)
- Anita M Klukowska
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.,Queen's Medical Center, University of Nottingham, Nottingham, UK.,Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Victor E Staartjes
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - W Peter Vandertop
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
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Staartjes VE, Klukowska AM, Vieli M, Niftrik CHBV, Stienen MN, Serra C, Regli L, Vandertop WP, Schröder ML. Machine learning-augmented objective functional testing in the degenerative spine: quantifying impairment using patient-specific five-repetition sit-to-stand assessment. Neurosurg Focus 2021; 51:E8. [PMID: 34724641 DOI: 10.3171/2021.8.focus21386] [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: 06/30/2021] [Accepted: 08/25/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE What is considered "abnormal" in clinical testing is typically defined by simple thresholds derived from normative data. For instance, when testing using the five-repetition sit-to-stand (5R-STS) test, the upper limit of normal (ULN) from a population of spine-healthy volunteers (10.5 seconds) is used to identify objective functional impairment (OFI), but this fails to consider different properties of individuals (e.g., taller and shorter, older and younger). Therefore, the authors developed a personalized testing strategy to quantify patient-specific OFI using machine learning. METHODS Patients with disc herniation, spinal stenosis, spondylolisthesis, or discogenic chronic low-back pain and a population of spine-healthy volunteers, from two prospective studies, were included. A machine learning model was trained on normative data to predict personalized "expected" test times and their confidence intervals and ULNs (99th percentiles) based on simple demographics. OFI was defined as a test time greater than the personalized ULN. OFI was categorized into types 1 to 3 based on a clustering algorithm. A web app was developed to deploy the model clinically. RESULTS Overall, 288 patients and 129 spine-healthy individuals were included. The model predicted "expected" test times with a mean absolute error of 1.18 (95% CI 1.13-1.21) seconds and R2 of 0.37 (95% CI 0.34-0.41). Based on the implemented personalized testing strategy, 191 patients (66.3%) exhibited OFI. Type 1, 2, and 3 impairments were seen in 64 (33.5%), 91 (47.6%), and 36 (18.8%) patients, respectively. Increasing detected levels of OFI were associated with statistically significant increases in subjective functional impairment, extreme anxiety and depression symptoms, being bedridden, extreme pain or discomfort, inability to carry out activities of daily living, and a limited ability to work. CONCLUSIONS In the era of "precision medicine," simple population-based thresholds may eventually not be adequate to monitor quality and safety in neurosurgery. Individualized assessment integrating machine learning techniques provides more detailed and objective clinical assessment. The personalized testing strategy demonstrated concurrent validity with quality-of-life measures, and the freely accessible web app (https://neurosurgery.shinyapps.io/5RSTS/) enabled clinical application.
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Affiliation(s)
- Victor E Staartjes
- 1Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,2Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Movement Sciences, Amsterdam.,3Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
| | - Anita M Klukowska
- 2Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Movement Sciences, Amsterdam.,3Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.,4Department of Surgery, Royal Derby Hospital, Derby, United Kingdom; and
| | - Moira Vieli
- 1Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christiaan H B van Niftrik
- 1Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin N Stienen
- 5Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Carlo Serra
- 1Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- 1Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - W Peter Vandertop
- 2Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Movement Sciences, Amsterdam
| | - Marc L Schröder
- 3Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
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30
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van der Kamp LT, Rinkel GJE, Verbaan D, van den Berg R, Vandertop WP, Murayama Y, Ishibashi T, Lindgren A, Koivisto T, Teo M, St George J, Agid R, Radovanovic I, Moroi J, Igase K, van den Wijngaard IR, Rahi M, Rinne J, Kuhmonen J, Boogaarts HD, Wong GKC, Abrigo JM, Morita A, Shiokawa Y, Hackenberg KAM, Etminan N, van der Schaaf IC, Zuithoff NPA, Vergouwen MDI. Risk of Rupture After Intracranial Aneurysm Growth. JAMA Neurol 2021; 78:1228-1235. [PMID: 34459846 DOI: 10.1001/jamaneurol.2021.2915] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Unruptured intracranial aneurysms not undergoing preventive endovascular or neurosurgical treatment are often monitored radiologically to detect aneurysm growth, which is associated with an increase in risk of rupture. However, the absolute risk of aneurysm rupture after detection of growth remains unclear. Objective To determine the absolute risk of rupture of an aneurysm after detection of growth during follow-up and to develop a prediction model for rupture. Design, Setting, and Participants Individual patient data were obtained from 15 international cohorts. Patients 18 years and older who had follow-up imaging for at least 1 untreated unruptured intracranial aneurysm with growth detected at follow-up imaging and with 1 day or longer of follow-up after growth were included. Fusiform or arteriovenous malformation-related aneurysms were excluded. Of the 5166 eligible patients who had follow-up imaging for intracranial aneurysms, 4827 were excluded because no aneurysm growth was detected, and 27 were excluded because they had less than 1 day follow-up after detection of growth. Exposures All included aneurysms had growth, defined as 1 mm or greater increase in 1 direction at follow-up imaging. Main Outcomes and Measures The primary outcome was aneurysm rupture. The absolute risk of rupture was measured with the Kaplan-Meier estimate at 3 time points (6 months, 1 year, and 2 years) after initial growth. Cox proportional hazards regression was used to identify predictors of rupture after growth detection. Results A total of 312 patients were included (223 [71%] were women; mean [SD] age, 61 [12] years) with 329 aneurysms with growth. During 864 aneurysm-years of follow-up, 25 (7.6%) of these aneurysms ruptured. The absolute risk of rupture after growth was 2.9% (95% CI, 0.9-4.9) at 6 months, 4.3% (95% CI, 1.9-6.7) at 1 year, and 6.0% (95% CI, 2.9-9.1) at 2 years. In multivariable analyses, predictors of rupture were size (7 mm or larger hazard ratio, 3.1; 95% CI, 1.4-7.2), shape (irregular hazard ratio, 2.9; 95% CI, 1.3-6.5), and site (middle cerebral artery hazard ratio, 3.6; 95% CI, 0.8-16.3; anterior cerebral artery, posterior communicating artery, or posterior circulation hazard ratio, 2.8; 95% CI, 0.6-13.0). In the triple-S (size, site, shape) prediction model, the 1-year risk of rupture ranged from 2.1% to 10.6%. Conclusion and Relevance Within 1 year after growth detection, rupture occurred in approximately 1 of 25 aneurysms. The triple-S risk prediction model can be used to estimate absolute risk of rupture for the initial period after detection of growth.
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Affiliation(s)
- Laura T van der Kamp
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Yuichi Murayama
- Department of Neurosurgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Antti Lindgren
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Mario Teo
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Jerome St George
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging and Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neuroradiology, Joint Department of Medical Imaging and Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Junta Moroi
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Keiji Igase
- Department of Advanced Neurosurgery, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
| | | | - Melissa Rahi
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Jaakko Rinne
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Johanna Kuhmonen
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - George K C Wong
- Department of Surgery, Prince of Wales Hospital, Hong Kong, China
| | - Jill M Abrigo
- Department of Imaging and Interventional Radiology, Basement, Yue Kong Pao Centre for Cancer and the Lady Pao Children's Cancer Centre, Prince of Wales Hospital, Hong Kong, China
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Irene C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
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van der Vegt AN, de Vries R, Osinga J, Grun N, Postma TJ, de Haan PF, van Linde ME, Vandertop WP, Schuur M, Kouwenhoven MCM. P14.51 Can patients with a suspected high-grade glioma receive tumor treatment during pregnancy safely? Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.163] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Diagnosis of a glioma during pregnancy has ethical and medical dilemmas; treatment of the mother may harm the unborn child, but a too conservative approach towards tumor treatment can compromise the survival of the mother. In patients with a suspected high-grade glioma, postponing tumor treatment is undesirable. We collected published cases to describe the given treatments during pregnancy and the outcomes for mother and child.
METHODS
From Pubmed, Embase and Web of Science, 122 cases were extracted from 65 reports published between 1999 and 2020. We added 7 cases from our center. Cases came from: North-America (54/129), Europe (47/129), Asia (13/129), Middle-East (3/129) and one from Oceania and Africa each; 10 cases were from an unspecified country. The data were analysed with descriptive statistics.
RESULTS
The median age of the pregnant women was 30 (range 17–48) years; at the time of publication 42% of mothers had deceased. Most frequent symptoms at presentation were high intracranial pressure (35%), seizures (30%) or focal deficits (19%). Patients were diagnosed in each phase of the pregnancy - 30% in the first, 35% in the second and 35% in the last trimester. Twenty-two women decided to terminate the pregnancy (North America 9; Europe 9; international unspecified, Africa, Asia and Middle-East each one case). In sixty-seven percent of women, tumors were operated while pregnant, 70% of those were planned surgery, while in 30% surgery was in performed in an emergency setting. Most women received a resection. In 6 patients tumor surgery was combined with a caesarian section. Histological diagnosis of the tumor was available in 112 patients: anaplastic oligodendroglioma (n=10), anaplastic astrocytoma (n=30), glioblastoma (n=66) or high-grade glioma NOS (n=6). In 10 patients there was a suspected high grade glioma based on MRI imaging. Only 20 patients were treated after surgery whilst still pregnant with either radiotherapy (15/20, 75%), chemotherapy (2/20, 10%) or a combination of radiotherapy and chemotherapy (3/20, 15%) Other patients received additional treatment after delivery (109/129; 84%). Delivery method was a caesarian section in 60% and vaginal delivery in 21%- in 19% delivery method was not described. In 63% of cesarean sections were brought forward either because of rapid maternal deterioration or to enable maternal treatment after delivery. In 92% a healthy child was born, 7% had a intrauterine fetal death and 1% the child was stillborn. None of the patients who experienced intrauterine fetal death had received radio- or chemotherapy during pregnancy.
CONCLUSIONS
The majority of pregnant women continue their pregnancy when facing a diagnosis of a high grade glioma. Tumor surgery seemed safe during pregnancy. No adverse events were reported in the limited patients who received radiotherapy (n=15) during pregnancy. For chemotherapy we could not draw any conclusions.
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Affiliation(s)
- A N van der Vegt
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - R de Vries
- Medical Library, Vrije Universiteit, Amsterdam, Netherlands
| | - J Osinga
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - N Grun
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - T J Postma
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - P F de Haan
- Department of Radiotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M E van Linde
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M Schuur
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M C M Kouwenhoven
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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32
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Lebbink CA, Ringers TP, Schouten-van Meeteren AYN, van Iersel L, Clement SC, Boot AM, Claahsen-van der Grinten HL, Janssens GO, van Vuurden DG, Michiels EM, Han KS, van Trotsenburg ASP, Vandertop WP, Kremer LCM, van Santen HM. Prevalence and risk factors of hypothalamic-pituitary dysfunction in infant and toddler childhood brain tumor survivors. Eur J Endocrinol 2021; 185:597-606. [PMID: 34324432 DOI: 10.1530/eje-21-0137] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Childhood brain tumor survivors (CBTS) are at risk to develop hypothalamic-pituitary (HP) dysfunction (HPD). The risk for HPD may vary between different age groups due to maturation of the brain and differences in oncologic treatment protocols. Specific studies on HPD in infant brain tumor survivors (infant-BTS, 0-1 years at diagnosis) or toddler brain tumor survivors (toddler-BTS, ≥1-3 years) have not been performed. PATIENTS AND METHODS A retrospective nationwide cohort study in CBTS was performed. Prevalence and risk factors for HPD were compared between infant-, toddler-, and older-BTS. Subgroup analysis was performed for all non-irradiated CBTS (n = 460). RESULTS In total, 718 CBTS were included, with a median follow-up time of 7.9 years. Overall, despite the less frequent use of radiotherapy (RT) in infants, no differences in the prevalence of HPD were found between the three groups. RT (OR: 16.44; 95% CI: 8.93-30.27), suprasellar tumor location (OR: 44.76; 95% CI: 19.00-105.49), and younger age (OR: 1.11; 95% CI: 1.05-1.18) were associated with HP dysfunction. Infant-BTS and toddler-BTS showed more weight gain (P < 0.0001) and smaller height SDS (P = 0.001) during follow-up. In non-irradiated CBTS, infant-BTS and toddler-BTS were significantly more frequently diagnosed with TSH-, ACTH-, and ADH deficiency, compared to older-BTS. CONCLUSION Infant and toddler brain tumor survivors seem to be more vulnerable to develop HP dysfunction than older children. These results emphasize the importance of special infant and toddler brain tumor treatment protocols and the need for endocrine surveillance in children treated for a brain tumor at a young age.
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Affiliation(s)
- C A Lebbink
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - T P Ringers
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | | | - L van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - S C Clement
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - A M Boot
- Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H L Claahsen-van der Grinten
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - G O Janssens
- Department of Radiation Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - D G van Vuurden
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - E M Michiels
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - K S Han
- Department of Neurosurgery, University Medical Center Utrecht, The Netherlands
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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33
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van Someren Gréve F, Spijkerman IJB, Slot KM, Schultsz C, Vandertop WP. Letter: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines. Neurosurgery 2021; 88:E575-E576. [PMID: 33693854 DOI: 10.1093/neuros/nyab074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/24/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Frank van Someren Gréve
- Department of Medical Microbiology Amsterdam University Medical Center Amsterdam, the Netherlands
| | - Ingrid J B Spijkerman
- Department of Medical Microbiology Amsterdam University Medical Center Amsterdam, the Netherlands
| | - K Mariam Slot
- Department of Neurosurgery Amsterdam University Medical Center Amsterdam, the Netherlands
| | - Constance Schultsz
- Department of Medical Microbiology Amsterdam University Medical Center Amsterdam, the Netherlands.,Department of Global Health Amsterdam Institute for Global Health and Development Amsterdam University Medical Center Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery Amsterdam University Medical Center Amsterdam, the Netherlands
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Sondag L, Jacobs FA, Schreuder FH, Boogaarts JD, Peter Vandertop W, Dammers R, Klijn CJ. Variation in medical management and neurosurgical treatment of patients with supratentorial spontaneous intracerebral haemorrhage. Eur Stroke J 2021; 6:134-142. [PMID: 34414288 PMCID: PMC8370071 DOI: 10.1177/23969873211005915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The role of surgery in spontaneous intracerebral haemorrhage (sICH) remains controversial. This leads to variation in the percentage of patients who are treated with surgery between countries. Patients and methods We sent an online survey to all neurosurgeons (n = 140) and to a sample of neurologists (n = 378) in Dutch hospitals, with questions on management in supratentorial sICH in general, and on treatment in six patients, to explore current variation in medical and neurosurgical management. We assessed patient and haemorrhage characteristics influencing treatment decisions. Results Twenty-nine (21%) neurosurgeons and 92 (24%) neurologists responded. Prior to surgery, neurosurgeons would more frequently administer platelet-transfusion in patients on clopidogrel (64% versus 13%; p = 0.000) or acetylsalicylic acid (61% versus 11%; p = 0.000) than neurologists. In the cases, neurosurgeons and neurologists were similar in their choice for surgery as initial treatment (24% and 31%; p = 0.12), however variation existed amongst physicians in specific cases. Neurosurgeons preferred craniotomy with haematoma evacuation (74%) above minimally-invasive techniques (5%). Age, Glasgow Coma Scale score and ICH location were important factors influencing decisions on treatment for neurosurgeons and neurologists. 69% of neurosurgeons and 80% of neurologists would randomise patients in a trial evaluating the effect of minimally-invasive surgery on functional outcome. Discussion Our results reflect the lack of evidence about the right treatment strategy in patients with sICH. Conclusion New high quality evidence is needed to guide treatment decisions for patients with ICH. The willingness to randomise patients into a clinical trial on minimally-invasive surgery, contributes to the feasibility of such studies in the future.
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Affiliation(s)
- Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Floor Ae Jacobs
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Floris Hbm Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jeroen D Boogaarts
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - W Peter Vandertop
- Neurosurgical Centre Amsterdam, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, the Netherlands.,Neurosurgical Centre Amsterdam, Amsterdam University Medical Centres, Academic Medical Centre, Amsterdam, the Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Rotterdam, the Netherlands
| | - Catharina Jm Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
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35
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Schembri M, Verbaan D, Emmer BJ, Coert BA, Majoie CBLM, Vandertop WP, van den Berg R. Cerebral circulation time on DSA during endovascular treatment in WFNS grade I aneurysmal SAH patients-a predictor of DCI? Neuroradiology 2021; 63:2131-2138. [PMID: 34263336 DOI: 10.1007/s00234-021-02749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Delayed cerebral ischemia (DCI) remains a contributor to poor outcome following aneurysmal subarachnoid hemorrhage (aSAH). We evaluated cerebral circulation time (CCT) on digital subtraction angiography (DSA) during endovascular treatment (EVT) in WFNS grade I aSAH patients as a predictor of DCI. METHODS Of 135 consecutive WNFS grade I aSAH patients, 90 were included. Age, gender, time of DSA from ictus (< 72 h or > 72 h), Fisher scale, severe vasospasm, development of DCI, EVD-dependent hydrocephalus, re-bleeding, and procedural complications were recorded. CCT was calculated retrospectively from multiphase DSA. Association with DCI was established through univariate and, subsequently, multivariable logistic regression. An optimal threshold value was identified using ROC curve analysis. Patient groups defined by threshold CCT value, DCI, and, subsequently, time of DSA from ictus were analyzed using χ2 and Fisher's exact test. RESULTS CCT was the only significant factor in the multivariable logistic regression for the outcome development of DCI (OR/second increase in CCT = 1.46 [95% CI 1.14-1.86, p = .003]). When CCT was dichotomized at 8.5 s, the odds ratio for developing DCI was 7.12 (95% CI 1.93-26.34, p = .003) for CCT > 8.5 s compared with < 8.5 s. There was a significant difference for DCI in all patient groups dichotomized by CCT < 8.5 s and > 8.5 s (all patients, p = .001; patients imaged before and after 72 h of ictus, p = .024 and p = .034, respectively). CONCLUSION A CCT > 8.5 s on DSA during EVT in WFNS grade I aSAH patients is associated with an increased risk of developing DCI and may aid in the management of high-risk patients.
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Affiliation(s)
- Mark Schembri
- Department of Neuroradiology, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
| | - Dagmar Verbaan
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - Bart J Emmer
- Department of Neuroradiology, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - Bert A Coert
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - Charles B L M Majoie
- Department of Neuroradiology, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - René van den Berg
- Department of Neuroradiology, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
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Müller DMJ, Robe PA, Ardon H, Barkhof F, Bello L, Berger MS, Bouwknegt W, Van den Brink WA, Conti Nibali M, Eijgelaar RS, Furtner J, Han SJ, Hervey-Jumper SL, Idema AJS, Kiesel B, Kloet A, Mandonnet E, De Munck JC, Rossi M, Sciortino T, Vandertop WP, Visser M, Wagemakers M, Widhalm G, Witte MG, Zwinderman AH, De Witt Hamer PC. On the cutting edge of glioblastoma surgery: where neurosurgeons agree and disagree on surgical decisions. J Neurosurg 2021; 136:45-55. [PMID: 34243150 DOI: 10.3171/2020.11.jns202897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of glioblastoma surgery is to maximize the extent of resection while preserving functional integrity. Standards are lacking for surgical decision-making, and previous studies indicate treatment variations. These shortcomings reflect the need to evaluate larger populations from different care teams. In this study, the authors used probability maps to quantify and compare surgical decision-making throughout the brain by 12 neurosurgical teams for patients with glioblastoma. METHODS The study included all adult patients who underwent first-time glioblastoma surgery in 2012-2013 and were treated by 1 of the 12 participating neurosurgical teams. Voxel-wise probability maps of tumor location, biopsy, and resection were constructed for each team to identify and compare patient treatment variations. Brain regions with different biopsy and resection results between teams were identified and analyzed for patient functional outcome and survival. RESULTS The study cohort consisted of 1087 patients, of whom 363 underwent a biopsy and 724 a resection. Biopsy and resection decisions were generally comparable between teams, providing benchmarks for probability maps of resections and biopsies for glioblastoma. Differences in biopsy rates were identified for the right superior frontal gyrus and indicated variation in biopsy decisions. Differences in resection rates were identified for the left superior parietal lobule, indicating variations in resection decisions. CONCLUSIONS Probability maps of glioblastoma surgery enabled capture of clinical practice decisions and indicated that teams generally agreed on which region to biopsy or to resect. However, treatment variations reflecting clinical dilemmas were observed and pinpointed by using the probability maps, which could therefore be useful for quality-of-care discussions between surgical teams for patients with glioblastoma.
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Affiliation(s)
- Domenique M J Müller
- 1Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam
| | - Pierre A Robe
- 2Department of Neurology and Neurosurgery, University Medical Center Utrecht
| | - Hilko Ardon
- 3Department of Neurosurgery, St. Elisabeth Hospital, Tilburg
| | - Frederik Barkhof
- 4Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,5Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom
| | - Lorenzo Bello
- 6Neurosurgical Oncology Unit, Department of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Mitchel S Berger
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Wim Bouwknegt
- 8Department of Neurosurgery, Medical Center Slotervaart, Amsterdam
| | | | - Marco Conti Nibali
- 6Neurosurgical Oncology Unit, Department of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Roelant S Eijgelaar
- 10Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Julia Furtner
- 11Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Austria
| | - Seunggu J Han
- 12Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon
| | - Shawn L Hervey-Jumper
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Albert J S Idema
- 13Department of Neurosurgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Barbara Kiesel
- 14Department of Neurological Surgery, Medical University Vienna, Austria
| | - Alfred Kloet
- 15Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - Emmanuel Mandonnet
- 16Department of Neurological Surgery, Hôpital Lariboisière, Paris, France
| | - Jan C De Munck
- 4Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marco Rossi
- 6Neurosurgical Oncology Unit, Department of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Tommaso Sciortino
- 6Neurosurgical Oncology Unit, Department of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - W Peter Vandertop
- 1Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam
| | - Martin Visser
- 4Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Michiel Wagemakers
- 17Department of Neurosurgery, University of Groningen, University Medical Center Groningen; and
| | - Georg Widhalm
- 14Department of Neurological Surgery, Medical University Vienna, Austria
| | - Marnix G Witte
- 10Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- 18Department of Clinical Epidemiology and Biostatistics, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
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Post R, Germans MR, Vandertop WP, Verbaan D. Tranexamic acid for subarachnoid haemorrhage - Authors' reply. Lancet 2021; 398:25. [PMID: 34217394 DOI: 10.1016/s0140-6736(21)00574-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Affiliation(s)
- René Post
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, 1100 DD, Amsterdam, Netherlands.
| | - Menno R Germans
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, 1100 DD, Amsterdam, Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, 1100 DD, Amsterdam, Netherlands
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Denneman N, Biginski J, Odekerken VJJ, Vandertop WP. [Ruptured spleen after subarachnoid haemorrhage]. Ned Tijdschr Geneeskd 2021; 165:D5409. [PMID: 34346589] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Subarachnoid hemorrhage is a severe neurological condition which can cause a broad range of symptoms. Often, these symptoms are the direct consequence of the hemorrhage. CASE DESCRIPTION A 58-year-old female was admitted to the emergency department with extreme headache and a sudden and brief loss of consciousness. She was diagnosed with aneurysmal subarachnoid hemorrhage and underwent endovascular treatment. Seven days after admission she developed hypotension, bilateral fixed and dilated pupils and a second sudden and brief loss of consciousness. A CT scan of the brain was unchanged compared to the initial CT scan. An external ventricular drain was placed and the patient was admitted to the ICU where she was diagnosed with hemorrhagic shock due to a ruptured spleen. CONCLUSION Bilateral fixed and dilated pupils can in rare cases be caused by hemorrhagic shock due to strong sympathetic activity or parasympathetic inactivity. When a patient presents with loss of consciousness and/or pupil deviation, extracranial diagnoses should be considered after intracranial causes have been excluded.
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Affiliation(s)
- N Denneman
- Amsterdam UMC, locatie AMC, afd. Neurochirurgie
| | - J Biginski
- Amsterdam UMC, locatie AMC, afd. Intensive Care
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Lebbink CA, Ringers TP, Schouten-van Meeteren AYN, van Iersel L, Clement SC, Boot AM, Claahsen-van der Grinten HL, Janssens GOR, van Vuurden DG, Michiels EM, Han KS, van Trotsenburg ASP, Vandertop WP, Kremer LCM, van Santen HM. Prevalence and Risk Factors of Hypothalamic-Pituitary Dysfunction in Infant and Toddler Brain Tumor Survivors. J Endocr Soc 2021. [PMCID: PMC8090318 DOI: 10.1210/jendso/bvab048.1463] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Childhood brain tumor survivors (CBTS) are at risk for hypothalamic-pituitary (HP) dysfunction, mainly caused by radiation exposure or tumor involvement of the HP-region. The risk for HP dysfunction (HPD) may vary between different age groups due to maturation of the brain and differences in oncologic treatment protocols. The aim of this study was to determine the prevalence and risk factors of HPD in infant (IBTS) and toddler brain tumor survivors (TBTS) compared to older childhood brain tumor survivors (OCBTS). Patients and Methods: A retrospective analysis in a nationwide cohort of CBTS was performed. Prevalence and risk factors for HPD were compared between IBTS (aged 0-1 years at diagnosis), TBTS (aged 1-3 years at diagnosis) and OCBTS (aged >3-18 years at diagnosis). Results: In 718 included CBTS, with a median follow-up time of 7.9 years, overall no differences in percentage of HPD were found between the three age groups. Treatment with radiotherapy (RT) (OR 15.41; 95%CI 8.33 to 28.48), suprasellar tumor location (OR 46.62; 95%CI 19.64 to 110.66) and younger age (OR 1.09; 95%CI 1.02 to 1.15) were associated with HP dysfunction. Because IBTS were significantly less often treated with RT, subanalyses were performed for all CBTS not treated with radiation (n=459). In non-irradiated CBTS, IBTS and TBTS were significantly more frequently diagnosed with TSH-, ACTH- and ADH deficiency, compared to ECBTS. IBTS and TBTS showed significantly more weight gain (p<0.0001) and smaller height SDS (p=0.001) during follow-up. Conclusion: Infant and toddler brain tumor survivors seem to be more vulnerable to develop HP dysfunction than when compared to older children. These results emphasize the importance of special infant and toddlers brain tumor treatment protocols and endocrine surveillance in children treated for a brain tumor at young age.
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Affiliation(s)
- Chantal A Lebbink
- Wilhelmina Children’s Hospital, University Medical Center Utrecht & Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Tiara P Ringers
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Laura van Iersel
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sarah C Clement
- Emma Children’s Hospital, Academical Medical Center, Amsterdam, Netherlands
| | | | | | | | | | - Erna M Michiels
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - K Sen Han
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | - Hanneke M van Santen
- Wilhelmina Children’s Hospital, Univerisity Medical Center Utrecht & Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
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Müller DMJ, De Swart ME, Ardon H, Barkhof F, Bello L, Berger MS, Bouwknegt W, Van den Brink WA, Conti Nibali M, Eijgelaar RS, Furtner J, Han SJ, Hervey-Jumper S, Idema AJS, Kiesel B, Kloet A, Mandonnet E, Robe PAJT, Rossi M, Sciortino T, Vandertop WP, Visser M, Wagemakers M, Widhalm G, Witte MG, De Witt Hamer PC. Timing of glioblastoma surgery and patient outcomes: a multicenter cohort study. Neurooncol Adv 2021; 3:vdab053. [PMID: 34056605 PMCID: PMC8156977 DOI: 10.1093/noajnl/vdab053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The impact of time-to-surgery on clinical outcome for patients with glioblastoma has not been determined. Any delay in treatment is perceived as detrimental, but guidelines do not specify acceptable timings. In this study, we relate the time to glioblastoma surgery with the extent of resection and residual tumor volume, performance change, and survival, and we explore the identification of patients for urgent surgery. Methods Adults with first-time surgery in 2012–2013 treated by 12 neuro-oncological teams were included in this study. We defined time-to-surgery as the number of days between the diagnostic MR scan and surgery. The relation between time-to-surgery and patient and tumor characteristics was explored in time-to-event analysis and proportional hazard models. Outcome according to time-to-surgery was analyzed by volumetric measurements, changes in performance status, and survival analysis with patient and tumor characteristics as modifiers. Results Included were 1033 patients of whom 729 had a resection and 304 a biopsy. The overall median time-to-surgery was 13 days. Surgery was within 3 days for 235 (23%) patients, and within a month for 889 (86%). The median volumetric doubling time was 22 days. Lower performance status (hazard ratio [HR] 0.942, 95% confidence interval [CI] 0.893–0.994) and larger tumor volume (HR 1.012, 95% CI 1.010–1.014) were independently associated with a shorter time-to-surgery. Extent of resection, residual tumor volume, postoperative performance change, and overall survival were not associated with time-to-surgery. Conclusions With current decision-making for urgent surgery in selected patients with glioblastoma and surgery typically within 1 month, we found equal extent of resection, residual tumor volume, performance status, and survival after longer times-to-surgery.
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Affiliation(s)
- Domenique M J Müller
- Amsterdam University Medical Centers, location VU University Medical Center, Neurosurgical Center Amsterdam, Amsterdam, Netherlands
| | - Merijn E De Swart
- Department of Surgery, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, Netherlands
| | - Hilko Ardon
- Department of Neurosurgery, St Elisabeth Hospital, Tilburg, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Lorenzo Bello
- Department of Neurological Surgery, Humanitas Research Hospital Milano, Milan, Italy
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Wim Bouwknegt
- Department of Neurosurgery, Medical Center Slotervaart, Amsterdam, Netherlands
| | | | - Marco Conti Nibali
- Department of Neurological Surgery, Humanitas Research Hospital Milano, Milan, Italy
| | - Roelant S Eijgelaar
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Julia Furtner
- Department of Biomedical Imaging and image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Seunggu J Han
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Albert J S Idema
- Department of Neurosurgery, Northwest Clinics, Alkmaar, Netherlands
| | - Barbara Kiesel
- Department of Neurological Surgery, Medical University Vienna, Vienna, Austria
| | - Alfred Kloet
- Department of Neurosurgery, Medical Center Haaglanden, the Hague, Netherlands
| | | | - Pierre A J T Robe
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marco Rossi
- Department of Neurological Surgery, Humanitas Research Hospital Milano, Milan, Italy
| | - Tommaso Sciortino
- Department of Neurological Surgery, Humanitas Research Hospital Milano, Milan, Italy
| | - W Peter Vandertop
- Amsterdam University Medical Centers, location VU University Medical Center, Neurosurgical Center Amsterdam, Amsterdam, Netherlands
| | - Martin Visser
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Michiel Wagemakers
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Georg Widhalm
- Department of Neurological Surgery, Medical University Vienna, Vienna, Austria
| | - Marnix G Witte
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Philip C De Witt Hamer
- Amsterdam University Medical Centers, location VU University Medical Center, Neurosurgical Center Amsterdam, Amsterdam, Netherlands
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Bos EM, van der Lee K, Haumann J, de Quelerij M, Vandertop WP, Kalkman CJ, Hollmann MW, Lirk P. Intracranial hematoma and abscess after neuraxial analgesia and anesthesia: a review of the literature describing 297 cases. Reg Anesth Pain Med 2021; 46:337-343. [PMID: 33441431 PMCID: PMC7982926 DOI: 10.1136/rapm-2020-102154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Besides spinal complications, intracranial hematoma or abscess may occur after neuraxial block. Risk factors and outcome remain unclear. OBJECTIVE This review evaluates characteristics, treatment and recovery of patients with intracranial complications after neuraxial block. EVIDENCE REVIEW We systematically searched MEDLINE, Embase and the Cochrane Library from their inception to May 2020 for case reports/series, cohort studies and reviews of intracranial hematoma or abscess associated with neuraxial block. Quality of evidence was assessed using the critical appraisal of a case study checklist by Crombie. FINDINGS We analyzed 232 reports, including 291 patients with hematoma and six patients with abscess/empyema. The major part of included studies comprised single case reports with a high risk of bias. Of the patients with hematoma, 48% concerned obstetric patients, the remainder received neuraxial block for various perioperative indications or pain management. Prior dural puncture was reported in 81%, either intended (eg, spinal anesthesia) or unintended (eg, complicated epidural catheter placement). Headache was described in 217 patients; in 101 patients, symptoms resembled postdural puncture headache (PDPH). After treatment, 11% had partial or no recovery and 8% died, indicating the severity of this complication. Intracranial abscess after neuraxial block is seldom reported; six reports were found. CONCLUSION Diagnosis of intracranial hematoma is often missed initially, as headache is assumed to be caused by cerebrospinal hypotension due to cerebrospinal fluid leakage, known as PDPH. Prolonged headache without improvement, worsening symptoms despite treatment or epidural blood patch, change of headache from postural to non-postural or new neurological signs should alert physicians to alternative diagnoses.
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Affiliation(s)
- Elke Me Bos
- Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Koen van der Lee
- Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - Marcel de Quelerij
- Anesthesiologie, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - W Peter Vandertop
- Neurosurgical Center Amsterdam, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Cor J Kalkman
- Anesthesiology, UMC Utrecht, Utrecht, The Netherlands
| | - Markus W Hollmann
- Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Philipp Lirk
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Post R, Germans MR, Tjerkstra MA, Vergouwen MDI, Jellema K, Koot RW, Kruyt ND, Willems PWA, Wolfs JFC, de Beer FC, Kieft H, Nanda D, van der Pol B, Roks G, de Beer F, Halkes PHA, Reichman LJA, Brouwers PJAM, van den Berg-Vos RM, Kwa VIH, van der Ree TC, Bronner I, van de Vlekkert J, Bienfait HP, Boogaarts HD, Klijn CJM, van den Berg R, Coert BA, Horn J, Majoie CBLM, Rinkel GJE, Roos YBWEM, Vandertop WP, Verbaan D. Ultra-early tranexamic acid after subarachnoid haemorrhage (ULTRA): a randomised controlled trial. Lancet 2021; 397:112-118. [PMID: 33357465 DOI: 10.1016/s0140-6736(20)32518-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [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] [Received: 10/06/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with aneurysmal subarachnoid haemorrhage, short-term antifibrinolytic therapy with tranexamic acid has been shown to reduce the risk of rebleeding. However, whether this treatment improves clinical outcome is unclear. We investigated whether ultra-early, short-term treatment with tranexamic acid improves clinical outcome at 6 months. METHODS In this multicentre prospective, randomised, controlled, open-label trial with masked outcome assessment, adult patients with spontaneous CT-proven subarachnoid haemorrhage in eight treatment centres and 16 referring hospitals in the Netherlands were randomly assigned to treatment with tranexamic acid in addition to care as usual (tranexamic acid group) or care as usual only (control group). Tranexamic acid was started immediately after diagnosis in the presenting hospital (1 g bolus, followed by continuous infusion of 1 g every 8 h, terminated immediately before aneurysm treatment, or 24 h after start of the medication, whichever came first). The primary endpoint was clinical outcome at 6 months, assessed by the modified Rankin Scale, dichotomised into a good (0-3) or poor (4-6) clinical outcome. Both primary and safety analyses were according to intention to treat. This trial is registered at ClinicalTrials.gov, NCT02684812. FINDINGS Between July 24, 2013, and July 29, 2019, we enrolled 955 patients; 480 patients were randomly assigned to tranexamic acid and 475 patients to the control group. In the intention-to-treat analysis, good clinical outcome was observed in 287 (60%) of 475 patients in the tranexamic acid group, and 300 (64%) of 470 patients in the control group (treatment centre adjusted odds ratio 0·86, 95% CI 0·66-1·12). Rebleeding after randomisation and before aneurysm treatment occurred in 49 (10%) patients in the tranexamic acid and in 66 (14%) patients in the control group (odds ratio 0·71, 95% CI 0·48-1·04). Other serious adverse events were comparable between groups. INTERPRETATION In patients with CT-proven subarachnoid haemorrhage, presumably caused by a ruptured aneurysm, ultra-early, short-term tranexamic acid treatment did not improve clinical outcome at 6 months, as measured by the modified Rankin Scale. FUNDING Fonds NutsOhra.
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Affiliation(s)
- René Post
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Menno R Germans
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Maud A Tjerkstra
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Radboud W Koot
- Department of Neurosurgery, Leids University Medical Center, Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Leids University Medical Center, Netherlands
| | - Peter W A Willems
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jasper F C Wolfs
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Netherlands
| | - Frits C de Beer
- Department of Neurosurgery, Isala Hospital, Zwolle, Netherlands
| | - Hans Kieft
- Department of Intensive Care, Isala Hospital, Zwolle, Netherlands
| | - Dharmin Nanda
- Department of Neurosurgery, Isala Hospital, Zwolle, Netherlands
| | - Bram van der Pol
- Department of Neurosurgery, Elisabeth Tweesteden ziekenhuis, Tilburg, Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth Tweesteden ziekenhuis, Tilburg, Netherlands
| | - Frank de Beer
- Department of Neurology, Spaarne Gasthuis, Haarlem, Netherlands
| | | | - Loes J A Reichman
- Department of Neurology, Ziekenhuisgroep Twente, Almelo, Netherlands
| | | | | | - Vincent I H Kwa
- Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | | | - Irene Bronner
- Department of Neurology, Flevo Hospital, Almere, Netherlands
| | | | | | | | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bert A Coert
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Slot KM, Verbaan D, Buis DR, Schoonmade LJ, Berckel BNM, Vandertop WP. Prediction of Meningioma WHO Grade Using PET Findings: A Systematic Review and Meta-Analysis. J Neuroimaging 2021; 31:6-19. [PMID: 33135239 PMCID: PMC7894181 DOI: 10.1111/jon.12795] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND PURPOSE World Health Organization (WHO) grading of meningiomas reflects recurrence rate and prognosis. Positron emission tomography (PET) investigates metabolic activity, allowing for distinction between low- and high-grade tumors. As preoperative suspicion for malignant meningioma will influence surgical strategy in terms of timing, extent of resection, and risks taken to achieve a total resection, we systematically reviewed the literature on PET-imaging in meningiomas and relate these findings to histopathological analysis. METHODS Searches in PubMed, EMBASE, and The Cochrane Library, from inception to September 2019, included studies of patients who had undergone surgery for a histologically verified intracranial meningioma, with a PET-scan prior to surgery and description of (semi)quantitative PET values for meningiomas from two different WHO groups. Studies comparing more than 1 patient per WHO group were included in the meta-analysis. RESULTS Twenty-two studies (432 patients) were included. 18fluor-fluorodesoxyglucose (18F-FDG) PET was mostly described to differentiate benign from malignant meningiomas. Pooled data showed differences in mean (95% CI) Standardized Uptake Value (SUV) for WHO II/III compared to WHO I of 2.51 (1.36, 3.66), and in tumor-to-normal (T/N) ratio (T/N ratio) for WHO II/III versus WHO I of .42 (.12, .73). CONCLUSIONS We found that SUV and T/N ratio in 18F-FDG PET may be useful to noninvasively differentiate benign from malignant meningiomas. T/N ratio seems to have a high specificity for the detection of high-grade meningiomas. Other PET tracers were studied too infrequently to draw definitive conclusions. Before treatment strategies can be adapted based on 18F-FDG PET, prospective studies in larger cohorts are warranted to validate the optimal T/N ratio cutoff point.
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Affiliation(s)
- K. Mariam Slot
- Department of NeurosurgeryAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Dagmar Verbaan
- Department of NeurosurgeryAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Dennis R. Buis
- Department of NeurosurgeryAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | - Bart N. M. Berckel
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - W. Peter Vandertop
- Department of NeurosurgeryAmsterdam University Medical CentersAmsterdamThe Netherlands
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Staartjes VE, Seevinck PR, Vandertop WP, van Stralen M, Schröder ML. Magnetic resonance imaging-based synthetic computed tomography of the lumbar spine for surgical planning: a clinical proof-of-concept. Neurosurg Focus 2021; 50:E13. [PMID: 33386013 DOI: 10.3171/2020.10.focus20801] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 09/01/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Computed tomography scanning of the lumbar spine incurs a radiation dose ranging from 3.5 mSv to 19.5 mSv as well as relevant costs and is commonly necessary for spinal neuronavigation. Mitigation of the need for treatment-planning CT scans in the presence of MRI facilitated by MRI-based synthetic CT (sCT) would revolutionize navigated lumbar spine surgery. The authors aim to demonstrate, as a proof of concept, the capability of deep learning-based generation of sCT scans from MRI of the lumbar spine in 3 cases and to evaluate the potential of sCT for surgical planning. METHODS Synthetic CT reconstructions were made using a prototype version of the "BoneMRI" software. This deep learning-based image synthesis method relies on a convolutional neural network trained on paired MRI-CT data. A specific but generally available 4-minute 3D radiofrequency-spoiled T1-weighted multiple gradient echo MRI sequence was supplemented to a 1.5T lumbar spine MRI acquisition protocol. RESULTS In the 3 presented cases, the prototype sCT method allowed voxel-wise radiodensity estimation from MRI, resulting in qualitatively adequate CT images of the lumbar spine based on visual inspection. Normal as well as pathological structures were reliably visualized. In the first case, in which a spiral CT scan was available as a control, a volume CT dose index (CTDIvol) of 12.9 mGy could thus have been avoided. Pedicle screw trajectories and screw thickness were estimable based on sCT findings. CONCLUSIONS The evaluated prototype BoneMRI method enables generation of sCT scans from MRI images with only minor changes in the acquisition protocol, with a potential to reduce workflow complexity, radiation exposure, and costs. The quality of the generated CT scans was adequate based on visual inspection and could potentially be used for surgical planning, intraoperative neuronavigation, or for diagnostic purposes in an adjunctive manner.
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Affiliation(s)
- Victor E Staartjes
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam.,2Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam.,3Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Centre, University of Zurich, Switzerland
| | - Peter R Seevinck
- 4Image Sciences Institute, University Medical Center Utrecht; and.,5MRIguidance B.V., Utrecht, The Netherlands; and
| | - W Peter Vandertop
- 2Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam
| | - Marijn van Stralen
- 4Image Sciences Institute, University Medical Center Utrecht; and.,5MRIguidance B.V., Utrecht, The Netherlands; and
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Sol N, In 't Veld SGJG, Vancura A, Tjerkstra M, Leurs C, Rustenburg F, Schellen P, Verschueren H, Post E, Zwaan K, Ramaker J, Wedekind LE, Tannous J, Ylstra B, Killestein J, Mateen F, Idema S, de Witt Hamer PC, Navis AC, Leenders WPJ, Hoeben A, Moraal B, Noske DP, Vandertop WP, Nilsson RJA, Tannous BA, Wesseling P, Reijneveld JC, Best MG, Wurdinger T. Tumor-Educated Platelet RNA for the Detection and (Pseudo)progression Monitoring of Glioblastoma. Cell Rep Med 2020; 1:100101. [PMID: 33103128 PMCID: PMC7576690 DOI: 10.1016/j.xcrm.2020.100101] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/23/2020] [Accepted: 09/10/2020] [Indexed: 01/09/2023]
Abstract
Tumor-educated platelets (TEPs) are potential biomarkers for cancer diagnostics. We employ TEP-derived RNA panels, determined by swarm intelligence, to detect and monitor glioblastoma. We assessed specificity by comparing the spliced RNA profile of TEPs from glioblastoma patients with multiple sclerosis and brain metastasis patients (validation series, n = 157; accuracy, 80%; AUC, 0.81 [95% CI, 0.74–0.89; p < 0.001]). Second, analysis of patients with glioblastoma versus asymptomatic healthy controls in an independent validation series (n = 347) provided a detection accuracy of 95% and AUC of 0.97 (95% CI, 0.95–0.99; p < 0.001). Finally, we developed the digitalSWARM algorithm to improve monitoring of glioblastoma progression and demonstrate that the TEP tumor scores of individual glioblastoma patients represent tumor behavior and could be used to distinguish false positive progression from true progression (validation series, n = 20; accuracy, 85%; AUC, 0.86 [95% CI, 0.70–1.00; p < 0.012]). In conclusion, TEPs have potential as a minimally invasive biosource for blood-based diagnostics and monitoring of glioblastoma patients. TEP RNA enables blood-based brain tumor diagnostics TEP RNA is dynamic throughout anti-tumor treatment TEP RNA may be employed for therapy monitoring
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Affiliation(s)
- Nik Sol
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Sjors G J G In 't Veld
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Adrienne Vancura
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Maud Tjerkstra
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Cyra Leurs
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,MS Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - François Rustenburg
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Pepijn Schellen
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Heleen Verschueren
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Edward Post
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Kenn Zwaan
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Jip Ramaker
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Laurine E Wedekind
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Jihane Tannous
- Department of Neurology, Massachusetts General Hospital and Neuroscience Program, Harvard Medical School, Boston, MA, USA
| | - Bauke Ylstra
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Joep Killestein
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,MS Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Farrah Mateen
- Department of Neurology, Massachusetts General Hospital and Neuroscience Program, Harvard Medical School, Boston, MA, USA
| | - Sander Idema
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Philip C de Witt Hamer
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Anna C Navis
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - William P J Leenders
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Ann Hoeben
- Department of Medical Oncology, Maastricht Academical Medical Center, Maastricht, the Netherlands
| | - Bastiaan Moraal
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - David P Noske
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - R Jonas A Nilsson
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Bakhos A Tannous
- Department of Neurology, Massachusetts General Hospital and Neuroscience Program, Harvard Medical School, Boston, MA, USA
| | - Pieter Wesseling
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jaap C Reijneveld
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Myron G Best
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Thomas Wurdinger
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
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Goedemans T, Verbaan D, Coert BA, Kerklaan B, van den Berg R, Coutinho JM, van Middelaar T, Nederkoorn PJ, Vandertop WP, van den Munckhof P. Outcome After Decompressive Craniectomy for Middle Cerebral Artery Infarction: Timing of the Intervention. Neurosurgery 2020; 86:E318-E325. [PMID: 31943069 PMCID: PMC7061200 DOI: 10.1093/neuros/nyz522] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 03/21/2019] [Accepted: 09/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Based on randomized controlled trials (RCTs), clinical guidelines for the treatment of space-occupying hemispheric infarct employ age (≤60 yr) and time elapsed since stroke onset (≤48 h) as decisive criteria whether to perform decompressive craniectomy (DC). However, only few patients in these RCTs underwent DC after 48 h. OBJECTIVE To study the association between the timing of DC and (un)favorable outcome in patients with space-occupying middle cerebral artery (MCA) infarct undergoing DC. METHODS We performed a single-center cohort study from 2007 to 2017. Unfavorable outcome at 1 yr was defined as a Glasgow outcome scale 1 to 3. Additionally, we systematically reviewed the literature up to November 2018, including studies reporting on the timing of DC and other predictors of outcome. We performed Firth penalized likelihood and random-effects meta-analysis with odds ratio (OR) on unfavorable outcome. RESULTS A total of 66 patients were enrolled. A total of 26 (39%) patients achieved favorable and 40 (61%) unfavorable outcomes (13 [20%] died). DC after 48 h since stroke diagnosis did not significantly increase the risk of unfavorable outcome (OR 0.8, 95% CI 0.3-2.3). Also, in the meta-analysis, DC after 48 h of stroke onset was not associated with a higher risk of unfavorable outcome (OR 1.11; 95% CI 0.89-1.38). CONCLUSION The outcome of DC performed after 48 h in patients with malignant MCA infarct was not worse than the outcome of DC performed within 48 h. Contrary to current guidelines, we, therefore, advocate not to set a restriction of ≤48 h on the time elapsed since stroke onset in the decision whether to perform DC.
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Affiliation(s)
- Taco Goedemans
- Neurosurgical Centre Amsterdam, Amsterdam Medical Centre, Amsterdam University Medical Centres (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Dagmar Verbaan
- Neurosurgical Centre Amsterdam, Amsterdam Medical Centre, Amsterdam University Medical Centres (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Bert A Coert
- Neurosurgical Centre Amsterdam, Amsterdam Medical Centre, Amsterdam University Medical Centres (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Bertjan Kerklaan
- Department of Neurology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, and Zaans Medical Centre (ZMC), Zaandam, the Netherlands
| | - René van den Berg
- Department of Radiology, Amsterdam Medical Centre, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam Medical Centre, Amsterdam UMC, Amsterdam, the Netherlands
| | - Tessa van Middelaar
- Department of Neurology, Amsterdam Medical Centre, Amsterdam UMC, Amsterdam, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam Medical Centre, Amsterdam UMC, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Neurosurgical Centre Amsterdam, Amsterdam Medical Centre, Amsterdam University Medical Centres (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Pepijn van den Munckhof
- Neurosurgical Centre Amsterdam, Amsterdam Medical Centre, Amsterdam University Medical Centres (UMC), University of Amsterdam, Amsterdam, the Netherlands
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Goedemans T, Verbaan D, Vandertop WP, van den Munckhof P. Letter to the Editor regarding "Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis". Surg Neurol Int 2020; 11:198. [PMID: 32754369 PMCID: PMC7395465 DOI: 10.25259/sni_311_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Taco Goedemans
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, Netherlands, Europe
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, Netherlands, Europe
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, Netherlands, Europe
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, Netherlands, Europe
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48
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van der Steen WE, Marquering HA, Ramos LA, van den Berg R, Coert BA, Boers AMM, Vergouwen MDI, Rinkel GJE, Velthuis BK, Roos YBWEM, Majoie CBLM, Vandertop WP, Verbaan D. Prediction of Outcome Using Quantified Blood Volume in Aneurysmal SAH. AJNR Am J Neuroradiol 2020; 41:1015-1021. [PMID: 32409315 DOI: 10.3174/ajnr.a6575] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/26/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In patients with SAH, the amount of blood is strongly associated with clinical outcome. However, it is commonly estimated with a coarse grading scale, potentially limiting its predictive value. Therefore, we aimed to develop and externally validate prediction models for clinical outcome, including quantified blood volumes, as candidate predictors. MATERIALS AND METHODS Clinical and radiologic candidate predictors were included in a logistic regression model. Unfavorable outcome was defined as a modified Rankin Scale score of 4-6. An automatic hemorrhage-quantification algorithm calculated the total blood volume. Blood was manually classified as cisternal, intraventricular, or intraparenchymal. The model was selected with bootstrapped backward selection and validated with the R 2, C-statistic, and calibration plots. If total blood volume remained in the final model, its performance was compared with models including location-specific blood volumes or the modified Fisher scale. RESULTS The total blood volume, neurologic condition, age, aneurysm size, and history of cardiovascular disease remained in the final models after selection. The externally validated predictive accuracy and discriminative power were high (R 2 = 56% ± 1.8%; mean C-statistic = 0.89 ± 0.01). The location-specific volume models showed a similar performance (R 2 = 56% ± 1%, P = .8; mean C-statistic = 0.89 ± 0.00, P = .4). The modified Fisher models were significantly less accurate (R 2 = 45% ± 3%, P < .001; mean C-statistic = 0.85 ± 0.01, P = .03). CONCLUSIONS The total blood volume-based prediction model for clinical outcome in patients with SAH showed a high predictive accuracy, higher than a prediction model including the commonly used modified Fisher scale.
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Affiliation(s)
- W E van der Steen
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
- Neurology (W.E.v.d.S., Y.B.W.E.M.R.)
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H A Marquering
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
| | - L A Ramos
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
- Clinical Epidemiology, Biostatistics and Bioinformatics (L.A.R.)
| | - R van den Berg
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
| | - B A Coert
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A M M Boers
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
| | - M D I Vergouwen
- Departments of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.D.I.V., G.J.E.R.)
| | - G J E Rinkel
- Departments of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.D.I.V., G.J.E.R.)
| | - B K Velthuis
- Radiology (B.K.V.), University Medical Center, Utrecht University, Utrecht, the Netherlands
| | | | - C B L M Majoie
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
| | - W P Vandertop
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - D Verbaan
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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49
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Sondag L, Schreuder FHBM, Boogaarts HD, Rovers MM, Vandertop WP, Dammers R, Klijn CJM. Neurosurgical Intervention for Supratentorial Intracerebral Hemorrhage. Ann Neurol 2020; 88:239-250. [PMID: 32239722 PMCID: PMC7497162 DOI: 10.1002/ana.25732] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/11/2020] [Accepted: 03/22/2020] [Indexed: 11/30/2022]
Abstract
Objective The effect of surgical treatment for supratentorial spontaneous intracerebral hemorrhage (ICH) and whether it is modified by key baseline characteristics and timing remains uncertain. Methods We performed a systematic review and meta‐analysis of randomized controlled trials of surgical treatment of supratentorial spontaneous ICH aimed at clot removal. We searched MEDLINE, Embase, and Cochrane databases up to February 21, 2019. Primary outcome was good functional outcome at follow‐up; secondary outcomes were death and serious adverse events. We analyzed all types of surgery combined and minimally invasive approaches separately. We pooled risk ratios with 95% confidence intervals and assessed the modifying effect of age, Glasgow Coma Scale, hematoma volume, and timing of surgery with meta‐regression analysis. Results We included 21 studies with 4,145 patients; 4 (19%) were of the highest quality. Risk ratio of good functional outcome after any type of surgery was 1.40 (95% confidence interval [CI] = 1.22–1.60, I2 = 46%, 20 studies), and after minimally invasive surgery it was 1.47 (95% CI = 1.26–1.72, I2 = 47%, 12 studies). For death, the risk ratio for any type of surgery was 0.77 (95% CI = 0.68–0.85, I2 = 23%, 21 studies), and for minimally invasive surgery it was 0.68 (95% CI = 0.56–0.83, I2 = 14%, 13 studies). Serious adverse events were reported infrequently. Surgery seemed more effective when performed sooner after symptom onset (p = 0.04, 12 studies). Age, Glasgow Coma Scale, and hematoma volume did not modify the effect of surgery. Interpretation Surgical treatment of supratentorial spontaneous ICH may be beneficial, in particular with minimally invasive procedures and when performed soon after symptom onset. Further well‐designed randomized trials are needed to demonstrate whether (minimally invasive) surgery improves functional outcome after ICH and to determine the optimal time window of the treatment after symptom onset. ANN NEUROL 2020;88:239–250.
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Affiliation(s)
- Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maroeska M Rovers
- Departments of Operating Rooms and Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, the Netherlands.,Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
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50
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Müller DMJ, Robe PA, Ardon H, Barkhof F, Bello L, Berger MS, Bouwknegt W, Van den Brink WA, Conti Nibali M, Eijgelaar RS, Furtner J, Han SJ, Hervey-Jumper SL, Idema AJS, Kiesel B, Kloet A, De Munck JC, Rossi M, Sciortino T, Vandertop WP, Visser M, Wagemakers M, Widhalm G, Witte MG, Zwinderman AH, De Witt Hamer PC. Quantifying eloquent locations for glioblastoma surgery using resection probability maps. J Neurosurg 2020; 134:1091-1101. [PMID: 32244208 DOI: 10.3171/2020.1.jns193049] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Decisions in glioblastoma surgery are often guided by presumed eloquence of the tumor location. The authors introduce the "expected residual tumor volume" (eRV) and the "expected resectability index" (eRI) based on previous decisions aggregated in resection probability maps. The diagnostic accuracy of eRV and eRI to predict biopsy decisions, resectability, functional outcome, and survival was determined. METHODS Consecutive patients with first-time glioblastoma surgery in 2012-2013 were included from 12 hospitals. The eRV was calculated from the preoperative MR images of each patient using a resection probability map, and the eRI was derived from the tumor volume. As reference, Sawaya's tumor location eloquence grades (EGs) were classified. Resectability was measured as observed extent of resection (EOR) and residual volume, and functional outcome as change in Karnofsky Performance Scale score. Receiver operating characteristic curves and multivariable logistic regression were applied. RESULTS Of 915 patients, 674 (74%) underwent a resection with a median EOR of 97%, functional improvement in 71 (8%), functional decline in 78 (9%), and median survival of 12.8 months. The eRI and eRV identified biopsies and EORs of at least 80%, 90%, or 98% better than EG. The eRV and eRI predicted observed residual volumes under 10, 5, and 1 ml better than EG. The eRV, eRI, and EG had low diagnostic accuracy for functional outcome changes. Higher eRV and lower eRI were strongly associated with shorter survival, independent of known prognostic factors. CONCLUSIONS The eRV and eRI predict biopsy decisions, resectability, and survival better than eloquence grading and may be useful preoperative indices to support surgical decisions.
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Affiliation(s)
- Domenique M J Müller
- 1Brain Tumor Center & Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Pierre A Robe
- 2Department of Neurology & Neurosurgery, University Medical Center Utrecht, The Netherlands
| | - Hilko Ardon
- 3Department of Neurosurgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Frederik Barkhof
- 4Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, University Medical Center, Amsterdam, The Netherlands.,5Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom
| | - Lorenzo Bello
- 6Neurosurgical Oncology Unit, Departments of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Mitchel S Berger
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Wim Bouwknegt
- 8Department of Neurosurgery, Medical Center Slotervaart, Amsterdam, The Netherlands
| | | | - Marco Conti Nibali
- 6Neurosurgical Oncology Unit, Departments of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Roelant S Eijgelaar
- 10Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Julia Furtner
- 11Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Austria
| | - Seunggu J Han
- 12Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon
| | - Shawn L Hervey-Jumper
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Albert J S Idema
- 13Department of Neurosurgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Barbara Kiesel
- 14Department of Neurosurgery, Medical University Vienna, Austria
| | - Alfred Kloet
- 15Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - Jan C De Munck
- 4Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, University Medical Center, Amsterdam, The Netherlands
| | - Marco Rossi
- 6Neurosurgical Oncology Unit, Departments of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Tommaso Sciortino
- 6Neurosurgical Oncology Unit, Departments of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - W Peter Vandertop
- 1Brain Tumor Center & Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Martin Visser
- 4Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, University Medical Center, Amsterdam, The Netherlands
| | - Michiel Wagemakers
- 16Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands; and
| | - Georg Widhalm
- 14Department of Neurosurgery, Medical University Vienna, Austria
| | - Marnix G Witte
- 10Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- 17Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Philip C De Witt Hamer
- 1Brain Tumor Center & Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
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