Search

Background: Hemorrhage rates of conservatively managed brainstem cavernous malformations (BSCMs) vary widely in the literature. We aimed to elucidate the reason for the variation and to add the results of our experience of BSCMs management over the past decade., Methods: We performed a review of consecutive patients with BSCMs referred to our department in the period 2006-2018. A hemorrhagic event was defined as a radiographically verified intralesional and extralesional hemorrhage. Both retrospective and prospective hemorrhage rates were calculated based on the patient age in years, counted either from birth or from the time of initial presentation until the last contact (or until surgical resection). In addition, we retrieved and reviewed publications with a clear definition of hemorrhagic event and a detailed description of BSCM hemorrhage rate., Results: In total, 118 patients with BSCMs were reviewed, and 78 patients (mean age on admission 45.9 years) were included in the final analysis. The retrospective and prospective hemorrhage rates were 1.9% (95% confidence interval 1.6%-2.3%) per year and 11.9% (95% confidence interval 7.5%-17.8%), respectively. The retrospective hemorrhage rate in the literature review ranged from 1.9% to 6.8% per year with a median value of 3.8%, whereas the prospective hemorrhage rate ranged between 4.1% and 21.5%, with a median value of 10.2%., Conclusions: The reported hemorrhage rates are calculated in 2 different ways. In our patient cohort, both the retrospective and prospective hemorrhage rates were in accordance with those in the literature. The long-term hemorrhage rate lies between the prospective and retrospective rate., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: High-field intraoperative magnetic resonance imaging (MRI) has become increasingly available in neurosurgery centers. There is little experience with combined intraoperative MRI and intraoperative neurophysiologic monitoring (IONM). We report the first series, to our knowledge, of pediatric patients undergoing brain tumor surgery with 3T intraoperative MRI and IONM., Methods: This pilot study included all consecutive children operated on for brain tumors between October 2013 and April 2016 in whom concomitant intraoperative MRI and somatosensory evoked potentials and motor evoked potentials were used. Neuromonitoring findings and related complications of all cases were retrospectively analyzed., Results: During a 30-month period, 17 children (mean age 8.4 years; 3 girls) undergoing surgery met the study criteria. During intraoperative MRI, 483 IONM needles were left in place. Of these needles, 119 were located on the scalp, 94 were located above the chest, and 270 were located below the chest. Two complications with skin burns (first degree) were observed. In all patients, neuromonitoring was still reliable after MRI. In 1 case, a threshold increase for motor evoked potential stimulation (20 mA) was necessary after intraoperative MRI; in 2 cases, a reduction of 50% of the somatosensory evoked potential amplitude at the end of the surgery was observed compared with the values obtained before intraoperative MRI., Conclusions: The combination of intraoperative MRI and IONM can be safely used in pediatric patients. IONM data acquisition after intraoperative MRI was feasible and remained reliable., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: The aging population in industrialized countries shifts the age limit for neurosurgical interventions toward increasingly older patients. This study investigates whether octogenarians (≥80 years) stand out in outcome and incidence of perioperative complications., Methods: Consecutive patients ≥80 years operated on between January 2013 and August 2016 were compared against a control group of patients aged 55-75 years matched by indication for surgery. Status at admission, perioperative complications, functional outcome, and mortality were assessed in a prospective patient registry. Complications were classified in the therapy-oriented Clavien-Dindo grading (CDG) system., Results: We compared 266 octogenarians (median age, 83 years; interquartile range, 81-86 years; 154 men) with 232 controls (median age, 67 years; interquartile range, 60-71 years; 151 men). At follow-up (median, 53 vs. 49 days), median modified Ranking Scale scores were 2 versus 1 and median Karnofsky Performance Status was 80 versus 90; both improved significantly compared to baseline (P < 0.0001). Only admission Karnofsky Performance Status was significantly associated with clinical outcome at follow-up (odds ratio, 1.05; P < 0.0001). Pharmacologic treatment (CDG 2) was sufficient in 56% of all complications in octogenarians (controls, 43%). Octogenarians were more prone to complications as an inpatient (36% vs. 28%; P = 0.04) because of a higher incidence of CDG 2 complications (20% vs. 12%; P = 0.02). The rate of complications that required more extensive therapy did not differ significantly between cohorts., Conclusions: Neurosurgery in octogenarians had a similar rate of severe complications, morbidity, and mortality as in matched controls. Therefore, age alone should not serve as a contraindication for neurosurgery., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To determine interrater agreement in the initial radiologic characterization of ruptured intracranial aneurysms based on computed tomography angiography (CTA) with special emphasis on the rater's level of experience., Methods: One junior and one senior rater of 5 high-volume neurovascular tertiary centers evaluated anonymized CTA images of 30 consecutive patients with aneurysmal subarachnoid hemorrhage. Each rater described location, side, size, and morphology in a standardized manner. Interrater variability was analyzed using intraclass correlation and Fleiss' kappa analysis., Results: There was a high level of agreement for location (κ = 0.76, 95% confidence interval [CI] 0.74-0.79), side (κ = 0.95, CI 0.91-0.99), maximum diameter (intraclass correlation coefficient [ICC] 0.81, CI 0.70-0.90), and dome (ICC 0.78, CI 0.66-0.88) of intracranial aneurysms. In contrast, a lower level of agreement was observed for aneurysms' neck diameter (ICC 0.39, CI 0.28-0.58), the presence of multiple aneurysms (κ = 0.35, CI 0.30-0.40), and aneurysm morphology (blister κ = 0.11, CI -0.05 to 0.07; fusiform κ = 0.54, CI 0.48-0.60; multilobular, κ = 0.39 CI 0.33-0.45). The interrater agreement in the senior rater group was greater than in the junior rater group., Conclusions: Interrater agreement confirms the benefit of CTA as initial diagnostic imaging in ruptured intracranial aneurysms but not for aneurysm morphology and presence of multiple aneurysms. A trend towards greater interrater agreement between more experienced raters was noticed., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To investigate the influence of meteorological factors on the incidence of intracerebral hemorrhage (ICH)., Methods: We included 295 ICH admissions between 2005 and 2013. The hourly meteorological parameters considered were surface pressure, temperature, relative humidity, wind gusts, and precipitation. To minimize confounding effects of seasonality, data were analyzed with the following 3 complementary statistical approaches: 1) deviation of daily measure from the 10-year monthly mean at the day of ictus; 2) deviation from monthly average with respect to changes in daily measures between the day of ictus and 2 days before; and 3) evolution of daily measures from 5 days before to 5 days after the ICH occurred. For 1) and 2), the statistical significance of the results was determined with a Monte Carlo simulation combined with a resampling technique (1000×)., Results: Regarding all patients, no statistically significant and meteorologically meaningful signal could be found. With respect to subgroup-analysis, ICH related to vascular pathologies occurred significantly more frequently at days with especially low relative humidity, whereas an opposite relation was present in patients with cerebral amyloid angiopathy. However, as absolute deviations were small, a strong functional effect is questionable. With respect to seasonal distribution, a greater incidence of ICH could be detected during the cold season, in line with previous reports., Conclusions: By using high-quality meteorological data analyzed with a sophisticated and robust statistical method that minimizes the confounding effect of seasonality, no clearly identifiable meteorological influence for the ICH events considered can be found., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To establish an arteriovenous malformation (AVM) grading score for patients with ruptured AVM and associated intracerebral hemorrhage (ICH) to predict clinical outcome., Methods: Patient data from January 2006 to December 2013 with newly diagnosed ICH caused by ruptured AVM and a modified Rankin Scale (mRS) score <2 before ICH were included for this analysis. Clinical outcome was dichotomized in favorable (mRS score, 0-2) and unfavorable (mRS score, 3-6) to find predictors for outcome and to establish a new score based on the areas under the receiver-operating characteristic curves (AUROC) at 3 months, 1 year, and at last follow-up (mean, 31 months)., Results: A total of 67 patients (mean age, 41 years; 66% male) were analyzed including 39 patients with favorable and 28 with unfavorable outcome. Intraventricular hemorrhage (P = 0.048), ICH score (P = 0.003), AVM size (P < 0.001), Spetzler-Martin grade (P < 0.001), nidus structure (P = 0.005), Lawton-Young grade (P = 0.015), and supplemented Spetzler-Martin score (P < 0.001) were significant predictors for clinical outcome in ruptured AVMs. Based on these results, we created a new score named the AVICH (AVM-related ICH) score, which showed an AUROC of 0.842 compared to 0.789 for the supplemented Spetzler-Martin grading system and 0.703 for the ICH score regarding clinical outcome at last follow-up., Conclusions: Based on the AUROC analysis, the AVICH score predicts outcome of patients with ruptured AVM and associated ICH better than the ICH score, the Spetzler-Martin, or the supplemented Spetzler-Martin grading system. An external validation is needed before the AVICH score is tested in a prospective multicenter cohort., (Copyright © 2016 Elsevier Inc. All rights reserved.)