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ObjectiveThe goal of awake craniotomy in glioma patients is sparing of cognitive function. Previous investigations suggest that patients in the postoperative state may reach their preoperative level regarding domain-based criteria. Data on significant postoperative improvement beyond the preoperative level is sparse. This article examines the prospective neuropsychological assessment of a glioma patient who underwent awake craniotomy and has shown functional improvement exceeding preoperative levels.MethodsA 34-year-old patient with high premorbid cognitive function level who underwent awake craniotomy for left frontal oligodendroglioma was neuropsychologically assessed and took part in a fMRI-examination at 3 different time points.ResultsPreoperative examination revealed severe isolated impairment of working memory, long-term narrative memory in free recall and recognition, and alertness with intact language production and comprehension. After transient global aphasia in the postoperative state, the follow-up examination showed significant improvement in memory and attention exceeding the preoperative level.ConclusionsTumor location is an important factor in terms of surgical procedures. Cognitive impairment is, however, not always associated with a specific location. Mechanical pressure of the tumor might have led to the isolated consolidation deficit which fully recovered after tumor removal. Psychological disorders should be taken into account regarding prodromal symptoms of neurooncological diseases.

Objective: Vestibular schwannoma (VS) is the most common benign tumor of the cerebellopontine angle. The size of the VS varies widely regardless of the patient's age. While patients with a small, not growing VS undergo regular observational MRI examinations (wait and scan), larger rapidly growing [for full text, please go to the a.m. URL]

Objective: Vestibular schwannomas (VS) are the most common tumors of the cerebellopontine angle. Typical symptoms are vertigo, tinnitus, hearing loss and facial nerve paresis. Beside scan and wait, current therapeutic strategies are limited to tumor resection and/or radiotherapy. The molecular [for full text, please go to the a.m. URL], 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Objective: Reoperations in patients with failed epilepsy surgery are still challenging although a reasonably good seizure outcome seems possible. Advanced imaging and intraoperative MR tomography may contribute to a better postoperative seizure outcome in this patient group. Methods: We investigated[for full text, please go to the a.m. URL], 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Objective: Reoperations in patients with failed epilepsy surgery are still challenging although a reasonable good seizure outcome seems possible. Advanced imaging and intraoperative MR tomography may contribute to a better postoperative seizure outcome in this patient group. Methods: We investigated[for full text, please go to the a.m. URL], 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Objective: Intraoperative awakening is a rare event with considerable risks for the patient due to sudden movements. A number of methods have been proposed to monitor depth of anesthesia, such as the Bispectral Index (BIS) and the Analgesia Nociception Index (ANI). In a pilot study, we had shown, that[for full text, please go to the a.m. URL], 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Objective: There are ongoing discussions concerning the positioning of the patient in vestibular schwannoma surgery. Factors to consider include preservation of cranial nerve functions, extent of tumor resection, and complications. Methods: 97 patients of a randomized, multi-center trial investigating[for full text, please go to the a.m. URL], 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Objective: Motor learning plays an important role for rehabilitation after intracranial surgery in a variety of cortical and subcortial regions. Already for planning of surgery, identification of essential functional areas is crucial. However, currently available methods are regarded as too conservative.[for full text, please go to the a.m. URL], 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Objective: Epilepsy surgery for focal cortical dysplasia type II (FCD II) leads to high percentages of seizure free patients, but remains a challenge with respect to lesion detection, defining the epileptogenic zone and the optimal resection strategy. Integrating results from magnetic source imaging[for full text, please go to the a.m. URL], 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Background: About 23 million people worldwide suffer from medically refractory epilepsy. Surgery might be the best treatment option with a reasonable chance of seizure freedom. Surgical success depends on the exact definition of the epileptogenic zone (EZ). Magnetoencephalography (MEG) is one of the newer additions to the noninvasive presurgical work-up. Objectives: This study gives an overview of the impact of MEG on the management of epilepsy patients, focusing on (1) the influence on presurgical evaluation, (2) the identification of patients with the greatest benefit, and (3) possible surgical outcome predictors. Methods: An extensive Medline literature search was conducted for studies published from 1990. Results: MEG is in clinical use in the presurgical evaluation of epilepsies for the identification of the EZ and outcome prediction. In cases of failed surgery, it serves as a means to locate the remaining epileptogenic cortex. The usefulness of MEG has been reported for a wide range of localizations including challenging areas like the insula. In cases of multiple possible culprit lesions, MEG can mark the epileptogenic lesion, whereas in cases of nonlesional magnetic resonance imaging (MRI) findings, MEG can pinpoint a lesional or nonlesional epileptogenic cortex area. The role of MEG in the presurgical evaluation of epilepsy was shown with rates of modified approaches in 2035% of cases. This holds true especially for cases with extratemporal epilepsy. Discussion: The value of MEG source localization is highest in extratemporal epilepsy, in MRI-negative or multilesional cases, if other modalities yield contradictory or inconclusive results, or in cases of suspected multifocal epilepsy. There is clear evidence that MEG yields nonredundant information and influences the therapeutic course of patients. Various patient groups likely to benefit from MEG were identified. Considering the poor chances of seizure freedom with continued medical treatment, these patients should not be denied source localization, which could result in surgery with favorable outcomes. (VLID)2639844

Beamformers are a widely-used tool in brain analysis with magnetoencephalography (MEG) and electroencephalography (EEG). For the construction of the beamformer filters realistic head volume conductor modeling is necessary for accurately computing the EEG and MEG leadfields, i.e., for solving the EEG and MEG forward problem. In this work, we investigate the influence of including realistic head tissue compartments into a finite element method (FEM) model on the beamformer's localization ability. Specifically, we investigate the effect of including cerebrospinal fluid, gray matter, and white matter distinction, as well as segmenting the skull bone into compacta and spongiosa, and modeling white matter anisotropy. We simulate an interictal epileptic measurement with white sensor noise. Beamformer filters are constructed with unit gain, unit array gain, and unit noise gain constraint. Beamformer source positions are determined by evaluating power and excess sample kurtosis (g2) of the source-waveforms at all source space nodes. For both modalities, we see a strong effect of modeling the cerebrospinal fluid and white and gray matter. Depending on the source position, both effects can each be in the magnitude of centimeters, rendering their modeling necessary for successful localization. Precise skull modeling mainly effected the EEG up to a few millimeters, while both modalities could profit from modeling white matter anisotropy to a smaller extent of 5–10 mm. The unit noise gain or neural activity index beamformer behaves similarly to the array gain beamformer when noise strength is sufficiently high. Variance localization seems more robust against modeling errors than kurtosis.

Objective: Specific pathophysiologic activity in the EMG of the facial muscles, so called “A-trains”, correlate with the degree of postoperative facial palsy after vestibular schwannoma surgery in the cerebello-pontine angle (CPA). However, it has been demonstrated that a separate intermedius[for full text, please go to the a.m. URL], 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS)

Objective: Voxel-based morphometry (VBM) is an important post-processing MRI technique to identify occult malformations in epilepsy patients. We investigated our surgical results in patients operated on for focal cortical dysplasia (FCD) who suffered from refractory epilepsy with the aid of VBM, neuronavigation[for full text, please go to the a.m. URL], 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS)

Objective: The term venous thromboembolism (VTE) subsumes deep venous thrombosis (DVT) and pulmonary embolism. The incidence of deep venous thrombosis (DVT) after craniotomy is reported to be as high as 50%. Even clinically silent DVT may lead to potentially fatal pulmonary embolism. The risk for[for full text, please go to the a.m. URL], 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS)

Objective: Frontal lobe epilepsy (FLE) still remains challenging for surgery. Long-term seizure outcome ranges between 13-47% seizure free patients. The main difficulties are localization of the epileptic zone, protection of eloquent brain areas, and definition of resection borders in MRI negative[for full text, please go to the a.m. URL], 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)