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Background: There is level 1 evidence for cerebral thrombectomy with thrombolysis in acute large vessel occlusion. Many hospitals are now contemplating setting up this life-saving service. For the hospital, however, the first treatment is associated with an initial high cost to cover the procedure. Whilst the health economic benefit of treating stroke is documented, this is the only study to date performing matched-pair, patient-level costing to determine treatment cost within the first hospital episode and up to 90 days post-event., Methods: We conducted a retrospective coarsened exact matched-pair analysis of 50 acute stroke patients eligible for thrombectomy., Results: Thrombectomy resulted in significantly more good outcomes (mRS 0-2) compared to matched controls (56% vs 8%, p = 0.001). More patients in the thrombectomy group could be discharged home (60% vs 28%), fewer were discharged to nursing homes (4% vs 16%), residential homes (0% vs 12%) or rehabilitation centres (8% vs 20%). Thrombectomy patients had fewer serious adverse events (n = 30 vs 86) and were, on average, discharged 36 days earlier. They required significantly fewer physiotherapy sessions (18.72 vs 46.49, p = 0.0009) resulting in a median reduction in total rehabilitation cost of £4982 (p = 0.0002) per patient. The total cost of additional investigations was £227 lower (p = 0.0369). Overall, the median cost without thrombectomy was £39,664 per case vs £22,444, resulting in median savings of £17,221 (p = 0.0489)., Conclusions: Mechanical thrombectomy improved patient outcome, reduced length of hospitalisation and, even without procedural reimbursement, significantly reduced cost to the thrombectomy providing hospital., (© 2022. The Author(s).)

Introduction: U- and H-shaped fragility fractures of the sacrum (FFP IVb) are unstable fractures. Non-operative treatment may be associated with impaired walking abilities, chronic pain and the potential loss of independency. However, different treatment options are still controversially debated. The aim of surgical treatment includes sufficient fracture stability for immediate full weight bearing and good pain control postoperatively. A new surgical treatment algorithm was developed. This algorithm was evaluated in a cohort of geriatric patients with FFP type IVb regarding surgical complications and patient-related outcome., Methods: Retrospective case series. Patients ≥65 years, admitted with FFP IVb between 01/2017 and 12/2020 were included. Pelvic CT was performed and the surgical technique was chosen according to the proposed surgical treatment algorithm. For this algorithm, the technique of fracture stabilisation was adapted to sacral anatomy and the specific fracture pattern to minimize the impact of surgery and postoperative complications without compromising a sufficient fracture stability. Pain levels, complications and surgical revisions were recorded. Level of independency, walking abilities and -aids were compared 3- and 12- months postoperatively to the pre-injury situation., Results: Twenty-three patients were included. Outcome parameters could be obtained in 20 patients (85%) after three months and in 18 patients (78%) patients one year postoperatively. All patients were treated according to the algorithm. Sixteen patients received two transilio-transsacral screws (TI-TSS), whereas either lumbopelvic fixation (LPF) combined with a TI-TSS or bilateral ilio-sacral screws (ISS) was performed four times. Three patients underwent bilateral ISS into S1 with one TI-TSS into S2. Three days postoperatively, median pain VAS was 2 (0-8) compared to 7 (4-10) before surgery. One loosened TI-TSS was removed six weeks postoperatively. Three-month mortality was 14% (n=3). At one-year follow-up, all patients regained their pre-injury level of walking abilities., Conclusions: Restoration of walking abilities, preservation of independency and efficient pain control can be achieved with surgical fixation of FFP type IVb fractures. With the proposed surgical algorithm, the fixation techniques are adapted to the fracture pattern to minimize the surgical burden., Level of Evidence: IV., Competing Interests: Conflict of interest Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Clinical/methodical Issue: Cavernous malformations or cavernomas belong to the angiodysplasias. They may be sporadic or familial and cause symptoms (epilepsy) despite the absence of a left-to-right shunt. In addition to intracranial locations, spinal cavernomas are also found., Standard Radiological Methods: Magnetic resonance imaging (MRI) and computed tomography (CT) are used for diagnosis PERFORMANCE: MRI, except for acutely or subacutely hemorrhaged cavernomas, is superior to CT for lesion detection., Achievements: CT is reserved for acute diagnosis. MRI, especially susceptibility-sensitive gradient echo sequences, can also detect cavernomas without (sub-)acute hemorrhage or calcifications., Practical Recommendations: MRI is also useful for differentiating the familial form vs. sporadic form. Digital subtraction angiography (DSA) is used for differential diagnosis in rare cases, as cavernomas show no correlate here., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In recent years, convolutional neural networks and deep neural networks have been used extensively in various fields of analytical chemistry. The use of these models for calibration tasks has been highly effective; however, few reports have been published on their properties and characteristics of analytical figures of merit. Currently, most performance measures for these types of networks only incorporate some function of prediction error. While useful, these measures are incomplete and cannot be used as an objective comparison among different models. In this report, a new method for calculating the sensitivity of any type of neural network is proposed and studied on both simulated and real datasets. Generalized analytical sensitivity is defined and calculated for neural networks as an additional figure of merit. Moreover, the dependence of convolutional neural networks on regularization dataset size is studied and compared with other conventional calibration methods., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The basic set of a cranial instrument tray is filled with eponyms of surgical instruments named after surgeons and physicians from all corners of the medical world. These include pioneers like Castroviejo, Doyen, Frazier, Gigli, Mayfield, Raney, Weitlaner, and Yaşargil. These innovators have always strived to enhance and simplify procedures, ultimately shaping the way we perform surgery today. It was a process, which took several generations of surgeons and trials of instruments before its current form could be established. In this paper, the authors provide background information through a historical perspective on the pioneering surgeons and physicians, after whom the instruments were named. Data were collected by searching PubMed, Google Scholar/Books, Google, and the HathiTrust Digital Library. Additional information was obtained via personal contact with American and European medical institutions, libraries, museums, as well as with the surgeons' family members and their perspective foundations. Remembering the life stories of the inventors behind commonly used eponyms in the operating theater reminds us of the long history of even the most rudimentary neurosurgical tool. This unrelenting strive for perfection reminds us, as surgeons, of our duty to continuously assess and improve our surgical tools and processes for the benefit of our patients., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Clinical Problem: Intracerebral cysts are common findings in imaging of the neurocranium and are not always clinically significant. The pathological spectrum of intracerebral cysts is, however, very broad and in addition to incidental findings includes developmental disorders, malformation tumors, primary and secondary neoplasms and infectious etiologies, such as cerebral abscess formation, cysticercosis or residuals after congenital cytomegalovirus infections. Intracerebral cystic defects may be caused by inflammatory central nervous system (CNS) diseases, such as multiple sclerosis as well as by mitochondriopathies, leukodystrophy, electrolyte disturbances or osmotic demyelination syndrome or brain infarctions, e.g. after lacunar infarctions or as encephalomalacic changes after severe traumatic brain injury., Radiological Standard Procedures: In addition to the radiological findings of cysts in magnetic resonance imaging (MRI) or in computed tomography (CT), the localization, patient age, patient medical history and laboratory diagnostics are helpful for the differential diagnostics., Methodical Innovation: In addition to the morphological assessment, advanced MRI techniques, such as diffusion-weighted imaging for epidermoids or the use of MR spectroscopy, can provide valuable information for the differential diagnosis., Performance/assessment: Intracranial cysts can be subdivided into intraventricular and periventricular cysts, intra-axial cysts and cysts in the external fluid-filled spaces. Associated tumor nodules and the contrast medium behavior of the cyst walls and/or associated soft tissue components as well as the reaction of the adjacent parenchyma are helpful for the diagnosis and assessment.

Background: Most studies evaluating long-term efficacy after coil embolisation of intracranial aneurysms have not differentiated between ruptured and unruptured aneurysms., Objectives: The aim of this study was to analyse factors that influence recanalisation in ruptured and unruptured aneurysms., Methods: We performed a retrospective analysis of 182 (98 ruptured, 84 unruptured) aneurysms, treated with coil embolisation alone that received follow-up with digital substraction angiography (DSA)., Results: At 6 months 26% of the aneurysms showed recanalisation. Multivariate variance analysis revealed that different factors influenced recanalisation in ruptured and unruptured aneurysms. In ruptured aneurysms patient age was a determinant, with younger patients recanalising more frequently than older ones (p = 0.016). Also, low initial packing density led to higher recanalisation rates (p = 0.015) than higher packing. In the unruptured aneurysm group these factors were not significant. Here, only a larger aneurysm volume led to higher recanalisation rates (p = 0.027)., Conclusions: Our data suggest that in ruptured aneurysms, high packing density is a key factor to prevent recanalisation, while in unruptured aneurysms, aneurysm volume is the main predictor for recanalisation.

Background: This study investigates the effects of rosiglitazone (a peroxisome proliferator-activated receptor-gamma) on the histological parameters of the dorsal root ganglion (DRG) and the recovery potential of the injured sciatic nerve in rats using stereological methods., Methods: The rats were divided into four groups including control, sham-operated, sciatic nerve crush (SNC), and SNC + rosiglitazone treatment (5 mg/kg body weight/day). The sciatic functional index (SFI) was used to evaluate functional recovery. The main DRG neurons were defined as either A cells (the larger cell with a central nucleolus in the nucleus and granulated cytoplasm) or B cells (the smaller cell with multiple peripherally located nucleoli and homogenous cytoplasm). Satellite cells (supporting) surround the neuron cell body., Results: The volume and surface of A and B cells decreased in the SNC group compared to the sham-operated group. In the SNC + rosiglitazone group, the volume of A and B cells decreased to a lesser extent, and was 30% and 48% higher in comparison with the SCN group. In the SNC + rosiglitazone rats the surface of the A and B cells decreased to a minor extent, and was 45% and 21% higher in comparison with the SNC animals. In rosiglitazone-treated rats the number of the A, B, and satellite cells decreased less, and was 38%, 34%, and 29% higher than in the SNC rats. The SFI score improved in SNC + rosiglitazone rats in comparison with non-treated animals., Conclusion: Rosiglitazone has an ameliorative effect on the DRG and enhances the functional recovery after SNC in rats.

The aim of this study was to investigate the histological changes in the dorsal root ganglion (DRG) and the sciatic nerve in rats after sciatic nerve crush (SNC) and treatment with rosiglitazone. The rats were divided into four groups, each including seven animals, and underwent the following intervention. Group I: control animals which received carboxy methyl cellulose (0.5 w/v, p.o.). Group II: sham operated animals whose skin of the posterior thigh was opened, closed and the animals received the vehicle (carboxy methyl cellulose). Group III: SNC animals; the animals received the vehicle. Group IV: SNC with rosiglitazone (5 mg/kg body weight/day) dissolved in the vehicle. On the 28th day the fifth lumbar DRG and sciatic nerve were removed. Volume of the dorsal root ganglion, total volume and number of cells (A and B cells) of DRG, total surface area of the cells, and total number, diameter and cross-sectional area of the myelinated nerve fibres were estimated using stereological techniques. No change was observed in volume of the DRG, but all of the other parameters were decreased after nerve crush. In SNC+ rosiglitazone treated rats, the parameters decreased but to a lesser extent in comparison with the non-treated SNC group. It can be concluded that rosiglitazone has a protective effect on the DRG cells and sciatic nerve after crush in rats.

Background: In spinal instrumentation the misplacement of screws, cages and rods may cause neurovascular complications. Therefore a large variety of methods have been used in recent years to reduce such complications especially by navigation techniques and intraoperative three-dimensional fluoroscopy. The aim of this study is to answer the question: will intraoperative CT improve the efficiency of the treatment as well as the safety for the patient at the spinal instrumentation? Specific questions were: are the implants placed correctly and has decompression been performed sufficiently?, Methods: This is a prospective study in 100 patients mostly with degenerative diseases, tumours and trauma. 80 patients were treated by spinal instrumentation. A helical CT (Somatom Emotion 2003) was used, which is firmly bound to the OR table by a track system., Results: 569 implants were used: 159 vertebra body screws and plates, 88 cages, 154 pedicle screws, 73 facet joint screws and 95 rods. There was malpositioning in seven patients (8.75%). 18 of 154 pedicle screws were misplaced, 2 of 88 cages, and 4 of 73 facet joint screws, for a total of 24 (7.6%)., Conclusions: Intraoperative CT is a useful tool to check the correct position of the implants used, the extent of decompression and the realignment as early as possible. It therefore reduces second operations. A postoperative CT is no longer necessary.

The purpose of this prospective, randomised and controlled study was to evaluate which kind of operative technique for treatment of cubital tunnel syndrome is favourable: subcutaneous anterior transposition or nerve decompression without transposition. This study included 66 patients suffering from pain and/either neurological deficits with clinically and electrographically proven cubital tunnel syndrome. 32 patients underwent nerve decompression without transposition, whereas 34 underwent subcutaneous transposition of the nerve. Follow-up examinations evaluating pain, motor and sensory deficits as well as motor nerve conduction velocities were performed three, nine and 24 months postoperatively. Irrespectively of operative procedures (simple decompression vs. subcutaneous anterior transposition) there were no significant differences between the outcomes of the two groups at either postoperative follow-up examination (p > 0.05).

Modern imaging techniques have great importance in the diagnosis and therapy of skull-base pathologies. Many of these lesions, especially in relation to their specific location, can be evaluated using CT and MR imaging. Tumors commonly found in the anterior skull base include carcinoma, rhabdomyosarcoma, esthesioneuroblastoma and meningioma. In the central cranial fossa, nasopharyngeal carcinoma, metastases, meningioma, pituitary adenoma and neurinoma have to be considered. The most common neoplasms of the posterior skull base, including the CP angle, are neurinoma, meningioma, nasopharyngeal carcinoma, chordoma and paraganglioma. One major task of imaging is the evaluation of the exact tumor extent as well as its relationship to the neighboring neurovascular structures. The purpose of this review is to recapitulate the most important anatomical landmarks of the skull base. The typical imaging findings of the most common tumors involving the skull base are also presented.