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Nevzati E, Rey J, Spiessberger A, Moser M, Roethlisberger M, Grüter BE, Widmer HR, Coluccia D, Marbacher S. Aneurysm healing following treatment with biodegradable embolization materials: assessment in a rat sidewall aneurysm model. J Neurointerv Surg 2024:jnis-2023-021260. [PMID: 38262729 DOI: 10.1136/jnis-2023-021260] [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: 11/14/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Biodegradable materials that dissolve after aneurysm healing are promising techniques in the field of neurointerventional surgery. We investigated the effects of various bioabsorable materials in combination with degradable magnesium alloy stents and evaluated aneurysm healing in a rat aneurysm model. METHODS Saccular aneurysms were created by end-to-side anastomosis in the abdominal aorta of Wistar rats. Untreated arterial grafts were immediately transplanted (vital aneurysms) whereas aneurysms with loss of mural cells were chemically decellularized before implantation. All aneurysms were treated with biodegradable magnesium stents. The animals were assigned to vital aneurysms treated with stent alone or decellularized aneurysms treated with stent alone, detachable coil, or long-term or short-term biodegradable thread. Aneurysm healing, rated microscopically and macroscopically at follow-up days 7 and 21, was defined by both neointima formation and absence of aneurysm volume increase over time. RESULTS Of 56 animals included, significant increases in aneurysm volume 7 days after surgery were observed in aneurysms with vital and decellularized walls treated with a stent only (P=0.043 each group). Twenty-one days after surgery an increase in aneurysm volume was observed in decellularized aneurysms treated with long- and short-term biodegradable threads (P=0.027 and P=0.028, respectively). Histological changes associated with an increase in aneurysm volume were seen for aneurysm wall inflammation, periadventitial fibrosis, and luminal thrombus. CONCLUSIONS An increase in aneurysm volume was associated with an absence of intrasaccular embolization material (early phase) and the breakdown of intrasaccular biodegradable material over time (late phase). Thrombus remnant and aneurysm wall inflammation promote aneurysm volume increase.
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Affiliation(s)
- Edin Nevzati
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
- University of Basel, Faculty of Medicine, Basel, Switzerland
| | - Jeannine Rey
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Alexander Spiessberger
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Manuel Moser
- Neurosurgery, Cantonal Hospital of Graubuenden, Chur, Switzerland
| | - Michel Roethlisberger
- University of Basel, Faculty of Medicine, Basel, Switzerland
- Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Basil Erwin Grüter
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Division of Neuroradiology, Department of Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Hans Rudolf Widmer
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Daniel Coluccia
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Serge Marbacher
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
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Moser M, Coluccia D, Watermann C, Lehnick D, Marbacher S, Kothbauer KF, Nevzati E. Reducing morbidity associated with subdural drain placement after burr-hole drainage of unilateral chronic subdural hematomas: a retrospective series comparing conventional and modified Nelaton catheter techniques. Acta Neurochir (Wien) 2023; 165:3207-3215. [PMID: 36877329 DOI: 10.1007/s00701-023-05537-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Placement of a subdural drain after burr-hole drainage of chronic subdural hematoma (cSDH) significantly reduces risk of its recurrence and lowers mortality at 6 months. Nonetheless, measures to reduce morbidity related to drain placement are rarely addressed in the literature. Toward reducing drain-related morbidity, we compare outcomes achieved by conventional insertion and our proposed modification. METHODS In this retrospective series from two institutions, 362 patients underwent burr-hole drainage of unilateral cSDH with subsequent subdural drain insertion by conventional technique or modified Nelaton catheter (NC) technique. Primary endpoints were iatrogenic brain contusion or new neurological deficit. Secondary endpoints were drain misplacement, indication for computed tomography (CT) scan, re-operation for hematoma recurrence, and favorable Glasgow Outcome Scale (GOS) score (≥ 4) at final follow-up. RESULTS The 362 patients (63.8% male) in our final analysis included drains inserted in 56 patients by NC and 306 patients by conventional technique. Brain contusions or new neurological deficits occurred significantly less often in the NC (1.8%) than conventional group (10.5%) (P = .041). Compared with the conventional group, the NC group had no drain misplacement (3.6% versus 0%; P = .23) and significantly fewer non-routine CT imaging related to symptoms (36.5% versus 5.4%; P < .001). Re-operation rates and favorable GOS scores were comparable between groups. CONCLUSION We propose the NC technique as an easy-to-use measure for accurate drain positioning within the subdural space that may yield meaningful benefits for patients undergoing treatment for cSDH and vulnerable to complication risks.
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Affiliation(s)
- Manuel Moser
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
| | - Daniel Coluccia
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Christoph Watermann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen, Justus-Liebig-University, Gießen, Germany
| | - Dirk Lehnick
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Karl F Kothbauer
- Formerly Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland, and University of Basel, Basel, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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Grüter BE, Wanderer S, Strange F, Boillat G, Täschler D, Rey J, Croci DM, Grandgirard D, Leib SL, von Gunten M, Di Santo S, Widmer HR, Remonda L, Andereggen L, Nevzati E, Coluccia D, Fandino J, Marbacher S. Patterns of Neointima Formation After Coil or Stent Treatment in a Rat Saccular Sidewall Aneurysm Model. Stroke 2021; 52:1043-1052. [PMID: 33504186 DOI: 10.1161/strokeaha.120.032255] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular aneurysm treatment relies on a biological process, including cell migration for thrombus organization and growth of a neointima. To better understand aneurysm healing, our study explores the origin of neointima-forming and thrombus-organizing cells in a rat saccular sidewall aneurysm model. METHODS Saccular aneurysms were transplanted onto the abdominal aorta of male Lewis rats and endovascularly treated with coils (n=28) or stents (n=26). In 34 cases, GFP+ (green fluorescent protein)-expressing vital aneurysms were sutured on wild-type rats, and in 23 cases, decellularized wild-type aneurysms were sutured on GFP+ rats. Follow-up at 3, 7, 14, 21, and 28 days evaluated aneurysms by fluorescence angiography, macroscopic inspection, and microscopy for healing and inflammation status. Furthermore, the origin of cells was tracked with fluorescence histology. RESULTS In animals with successful functional healing, histological studies showed a gradually advancing thrombus organization over time characterized by progressively growing neointima from the periphery of the aneurysm toward the center. Cell counts revealed similar distributions of GFP+ cells for coil or stent treatment in the aneurysm wall (54.4% versus 48.7%) and inside the thrombus (20.5% versus 20.2%) but significantly more GFP+ cells in the neointima of coiled (27.2 %) than stented aneurysms (10.4%; P=0.008). CONCLUSIONS Neointima formation and thrombus organization are concurrent processes during aneurysm healing. Thrombus-organizing cells originate predominantly in the parent artery. Neointima formation relies more on cell migration from the aneurysm wall in coiled aneurysms but receives greater contributions from cells originating in the parent artery in stent-treated aneurysms. Cell migration, which allows for a continuous endothelial lining along the parent artery's lumen, may be a prerequisite for complete aneurysm healing after endovascular therapy. In terms of translation into clinical practice, these findings may explain the variability in achieving complete aneurysm healing after coil treatment and the improved healing rate in stent-assisted coiling.
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Affiliation(s)
- Basil E Grüter
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Fabio Strange
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Gwendoline Boillat
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Dominik Täschler
- Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Jeannine Rey
- Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Davide M Croci
- Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Denis Grandgirard
- Neuroinfection Laboratory, Institute for Infectious Diseases (D.G., S.L.L.), University of Bern, Switzerland.,Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland
| | - Stephen L Leib
- Neuroinfection Laboratory, Institute for Infectious Diseases (D.G., S.L.L.), University of Bern, Switzerland.,Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland
| | | | - Stefano Di Santo
- Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland.,Department of Neurosurgery, Bern University Hospital, Inselspital Bern, Switzerland (S.D.S., H.R.W.)
| | - Hans Rudolf Widmer
- Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland.,Department of Neurosurgery, Bern University Hospital, Inselspital Bern, Switzerland (S.D.S., H.R.W.)
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology (L.R.), Kantonsspital Aarau, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Daniel Coluccia
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Javier Fandino
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
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Grüter BE, Wanderer S, Strange F, Sivanrupan S, von Gunten M, Widmer HR, Coluccia D, Andereggen L, Fandino J, Marbacher S. Comparison of Aneurysm Patency and Mural Inflammation in an Arterial Rabbit Sidewall and Bifurcation Aneurysm Model under Consideration of Different Wall Conditions. Brain Sci 2020; 10:brainsci10040197. [PMID: 32230757 PMCID: PMC7226569 DOI: 10.3390/brainsci10040197] [Citation(s) in RCA: 4] [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: 02/22/2020] [Revised: 03/15/2020] [Accepted: 03/25/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Biological processes that lead to aneurysm formation, growth and rupture are insufficiently understood. Vessel wall inflammation and degeneration are suggested to be the driving factors. In this study, we aimed to investigate the natural course of vital (non-decellularized) and decellularized aneurysms in a rabbit sidewall and bifurcation model. Methods: Arterial pouches were sutured end-to-side on the carotid artery of New Zealand White rabbits (vital [n = 6] or decellularized [n = 6]), and into an end-to-side common carotid artery bifurcation (vital [n = 6] and decellularized [n = 6]). Patency was confirmed by fluorescence angiography. After 28 days, all animals underwent magnetic resonance and fluorescence angiography followed by aneurysm harvesting for macroscopic and histological evaluation. Results: None of the aneurysms ruptured during follow-up. All sidewall aneurysms thrombosed with histological inferior thrombus organization observed in decellularized compared to vital aneurysms. In the bifurcation model, half of all decellularized aneurysms thrombosed whereas the non-decellularized aneurysms remained patent with relevant increase in size compared to baseline. Conclusions: Poor thrombus organization in decellularized sidewall aneurysms confirmed the important role of mural cells in aneurysm healing after thrombus formation. Several factors such as restriction by neck tissue, small dimensions and hemodynamics may have prevented aneurysm growth despite pronounced inflammation in decellularized aneurysms. In the bifurcation model, rarefication of mural cells did not increase the risk of aneurysm growth but tendency to spontaneous thrombosis.
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Affiliation(s)
- Basil Erwin Grüter
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
- Correspondence: ; Tel.: +41-62-838-41-41
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Fabio Strange
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Sivani Sivanrupan
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | | | - Hans Rudolf Widmer
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inseslspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
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Nevzati E, Rey J, Coluccia D, Grüter BE, Wanderer S, vonGunten M, Remonda L, Frosen J, Widmer HR, Fandino J, Marbacher S. Aneurysm wall cellularity affects healing after coil embolization: assessment in a rat saccular aneurysm model. J Neurointerv Surg 2019; 12:621-625. [DOI: 10.1136/neurintsurg-2019-015335] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeDespite significant technical advances, recanalization rates after endovascular therapy of ruptured intracranial aneurysms (IAs) remain a clinical challenge. A histopathological hallmark of ruptured human IA walls is mural cell loss. Mural smooth muscle cells (SMCs) are known to promote intraluminal healing in thrombosed experimental aneurysms. In this rat model we assess the natural history and healing process after coil embolization in SMC-rich and decellularized aneurysms.MethodsSaccular aneurysms were created by end-to-side anastomosis of an arterial graft from the descending thoracic aorta of a syngeneic donor rat to the infrarenal abdominal aorta of recipient male Wistar rats. Untreated arterial grafts were immediately transplanted, whereas aneurysms with loss of mural cells were chemically decellularized before implantation. Aneurysms underwent coil implantation during aneurysm anastomosis. Animals were randomly assigned either to the non-decellularized or decellularized group and underwent macroscopic and histological analyses on days 3, 7, 21, or 90 post-coil implantation.ResultsA total of 55 rats underwent macroscopic and histologic analysis. After coil embolization, aneurysms with SMC-rich walls showed a linear course of thrombosis and neointima formation whereas decellularized aneurysms showed marked inflammatory wall degeneration with increased recanalization rates 21 days (p=0.002) and 90 days (p=0.037) later. The SMCs showed the ability to actively migrate into the intra-aneurysmal thrombus and participate in thrombus organization.ConclusionsCoil embolization of aneurysms with highly degenerated walls is prone to further wall degeneration, increased inflammation, and recanalization compared with aneurysms with vital SMC-rich walls.
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Grüter BE, Täschler D, Rey J, Strange F, Nevzati E, Fandino J, Marbacher S, Coluccia D. Fluorescence Video Angiography for Evaluation of Dynamic Perfusion Status in an Aneurysm Preclinical Experimental Setting. Oper Neurosurg (Hagerstown) 2019; 17:432-438. [DOI: 10.1093/ons/opz011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/29/2019] [Indexed: 01/08/2023] Open
Abstract
Abstract
BACKGROUND
Experimental studies to assess aneurysm occlusion or perfusion typically rely on macroscopic examination or histological analysis but cannot assess dynamic perfusion.
OBJECTIVE
To describe an easy-to-implement and inexpensive fluorescence angiographic technique for the in vivo assessment and imaging of the dynamic perfusion status of aneurysms and their underlying blood vessels in a rat model.
METHODS
In a rat sidewall aneurysm model, the angiographic setup included 2 bandpass filters, a video camera, and a bicycle spotlight. After 48 rats underwent fluorescein angiography, dissections were performed to confirm the perfusion status by macroscopic and histologic examination of the aneurysm.
RESULTS
Direct injection of 0.2 mL fluorescein 10% Faure achieved strong, clear visibility in all 48 aneurysms. Macro-/microscopic examination identified residual perfusion in 25 and complete healing in 23 aneurysms. Fluorescein imaging identified 21 of these 25 aneurysms (84%) with residual perfusion and 22 of 23 aneurysms (96%) with no residual perfusion.
CONCLUSION
Our fluorescein imaging technique proved efficient for the evaluation of aneurysm patency and parent artery integrity in this experimental setting. Fluorescein is nontoxic, can be re-administered if needed, and, in this technique, can expand the armamentarium for the preclinical evaluation of dynamic perfusion status.
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Affiliation(s)
- Basil Erwin Grüter
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Dominik Täschler
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Jeannine Rey
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Fabio Strange
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Edin Nevzati
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
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Grüter BE, Täschler D, Strange F, Rey J, von Gunten M, Grandgirard D, Leib SL, Remonda L, Widmer HR, Nevzati E, Fandino J, Marbacher S, Coluccia D. Testing bioresorbable stent feasibility in a rat aneurysm model. J Neurointerv Surg 2019; 11:1050-1054. [DOI: 10.1136/neurintsurg-2018-014697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/09/2019] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
BackgroundAdvances in stent-assisted coiling have incrementally expanded endovascular treatment options for complex cerebral aneurysms. After successful coil consolidation and aneurysm occlusion, endovascular scaffolds are no longer needed. Thus, bioresorbable stents that disappear after aneurysm healing could avoid future risks of in-stent thrombosis and the need for lifelong antiplatelet therapy.ObjectiveTo assess the applicability and compatibility of a bioresorbable magnesium- alloy stent (brMAS) for assisted coiling.MethodsSaccular sidewall aneurysms were created in 84 male Wistar rats and treated with brMAS alone, brMAS + aspirin, or brMAS + coils + aspirin. Control groups included no treatment (natural course), solely aspirin treatment, or conventional cobalt–chromium stent + coils + aspirin treatment. After 1 and 4 weeks, aneurysm specimens were harvested and macroscopically, histologically, and molecularly examined for healing, parent artery perfusion status, and inflammatory reactions. Stent degradation was monitored for up to 6 months with micro-computed and optical coherence tomography.ResultsAneurysms treated with brMAS showed advanced healing, neointima formation, and subsequent stent degradation. Additional administration of aspirin sustained aneurysm healing while reducing stent-induced intraluminal and periadventitial inflammatory responses. No negative interaction was detected between platinum coils and brMAS. Progressive brMAS degradation was confirmed.ConclusionsbrMAS induced appropriate healing in this sidewall aneurysm model. The concept of using bioresorbable materials to promote complete aneurysm healing and subsequent stent degradation seems promising. These results should encourage further device refinements and clinical evaluation of this treatment strategy for cerebrovascular aneurysms.
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Wanderer S, Coluccia D, Añon J, Fandino J, Berkmann S. Intraoperative Computed Tomography Versus Fluoroscopy for Ventriculoperitoneal Shunt Placement. World Neurosurg 2019; 124:e609-e615. [PMID: 30639491 DOI: 10.1016/j.wneu.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Catheter malposition represents one of the major causes of ventriculoperitoneal (VP) shunt dysfunction. The usefulness of intraoperative fluoroscopy using skull landmarks has already been proved to decrease catheter malposition and surgical revision rates. After introducing intraoperative computed tomography (iCT) in our department, our objective was to evaluate the accuracy of this imaging modality to decrease cranial catheter misplacement compared with intraoperative fluoroscopy. METHODS In our retrospective analysis of 152 patients, catheter placement was evaluated by iCT (n = 48) and biplane fluoroscopy (n = 57). A control group (n = 47) had no intraoperative imaging. Outcome measures included accuracy of ventricular catheter position, revision surgeries, and clinical outcomes. RESULTS Ventricular catheter placement was accurate in 24/48 patients with iCT and 45/57 patients with fluoroscopy (P = 0.002) versus 23/47 patients in the control group. Sensitivity and positive predictive value for estimating optimal catheter position with iCT were 100% and 54%. The specificity and negative predictive value were 50% and 100%. After intraoperative revision, 4 catheters remained malpositioned in the iCT group, whereas the fluoroscopy group had none (P = 0.03); 2 of these 4 catheters were revised postoperatively. CONCLUSIONS Fluoroscopy may be the method of choice to intraoperatively assess ventricular catheter positioning. In our experience, iCT shows a tendency to be more time consuming and, in the beginning, was not associated with a steeper learning curve. Another consideration was the significant higher radiation exposure per patient. iCT did not improve the accuracy of catheter placement and did not decrease early revisions for VP placement patients.
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Affiliation(s)
- Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Añon
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Sven Berkmann
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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Grüter B, Strange F, Täschler D, Rey J, von Gunten M, Grandgirard D, Leib S, Remonda L, Widmer H, Nevzati E, Fandino J, Marbacher S, Coluccia D. A Biodegradable Magnesium Stent for Aneurysm Healing in a Rat Sidewall Aneurysm Model. J Neurol Surg A Cent Eur Neurosurg 2018. [DOI: 10.1055/s-0038-1660694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- B. Grüter
- Kantonsspital Aarau, Aarau, Switzerland
| | | | | | - J. Rey
- Universität Bern, Bern, Switzerland
| | - M. von Gunten
- Institute of Pathology Laenggasse, Ittingen, Switzerland
| | - D. Grandgirard
- Neuroinfection Laboratory, Institute for Infectious Diseases, Bern, Switzerland
| | - S. Leib
- Neuroinfection Laboratory, Institute for Infectious Diseases, Bern, Switzerland
| | | | - H. Widmer
- Inselspital, Universitätsspital Bern, Bern, Switzerland
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10
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Alli S, Figueiredo CA, Golbourn B, Sabha N, Wu MY, Bondoc A, Luck A, Coluccia D, Maslink C, Smith C, Wurdak H, Hynynen K, O'Reilly M, Rutka JT. Brainstem blood brain barrier disruption using focused ultrasound: A demonstration of feasibility and enhanced doxorubicin delivery. J Control Release 2018; 281:29-41. [PMID: 29753957 DOI: 10.1016/j.jconrel.2018.05.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [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: 11/02/2017] [Revised: 04/04/2018] [Accepted: 05/06/2018] [Indexed: 12/29/2022]
Abstract
Magnetic Resonance Image-guided Focused Ultrasound (MRgFUS) has been used to achieve transient blood brain barrier (BBB) opening without tissue injury. Delivery of a targeted ultrasonic wave causes an interaction between administered microbubbles and the capillary bed resulting in enhanced vessel permeability. The use of MRgFUS in the brainstem has not previously been shown but could provide value in the treatment of tumours such as Diffuse Intrinsic Pontine Glioma (DIPG) where the intact BBB has contributed to the limited success of chemotherapy. Our primary objective was to determine whether the use of MRgFUS in this eloquent brain region could be performed without histological injury and functional deficits. Our secondary objective was to select an effective chemotherapeutic against patient derived DIPG cell lines and demonstrate enhanced brainstem delivery when combined with MRgFUS in vivo. Female Sprague Dawley rats were randomised to one of four groups: 1) Microbubble administration but no MRgFUS treatment; 2) MRgFUS only; 3) MRgFUS + microbubbles; and 4) MRgFUS + microbubbles + cisplatin. Physiological assessment was performed by monitoring of heart and respiratory rates. Motor function and co-ordination were evaluated by Rotarod and grip strength testing. Histological analysis for haemorrhage (H&E), neuronal nuclei (NeuN) and apoptosis (cleaved Caspase-3) was also performed. A drug screen of eight chemotherapy agents was conducted in three patient-derived DIPG cell lines (SU-DIPG IV, SU-DIPG XIII and SU-DIPG XVII). Doxorubicin was identified as an effective agent. NOD/SCID/GAMMA (NSG) mice were subsequently administered with 5 mg/kg of intravenous doxorubicin at the time of one of the following: 1) Microbubbles but no MRgFUS; 2) MRgFUS only; 3) MRgFUS + microbubbles and 4) no intervention. Brain specimens were extracted at 2 h and doxorubicin quantification was conducted using liquid chromatography mass spectrometry (LC/MS). BBB opening was confirmed by contrast enhancement on T1-weighted MR imaging and positive Evans blue staining of the brainstem. Normal cardiorespiratory parameters were preserved. Grip strength and Rotarod testing demonstrating no decline in performance across all groups. Histological analysis showed no evidence of haemorrhage, neuronal loss or increased apoptosis. Doxorubicin demonstrated cytotoxicity against all three cell lines and is known to have poor BBB permeability. Quantities measured in the brainstem of NSG mice were highest in the group receiving MRgFUS and microbubbles (431.5 ng/g). This was significantly higher than in mice who received no intervention (7.6 ng/g). Our data demonstrates both the preservation of histological and functional integrity of the brainstem following MRgFUS for BBB opening and the ability to significantly enhance drug delivery to the region, giving promise to the treatment of brainstem-specific conditions.
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Affiliation(s)
- Saira Alli
- Division of Neurosurgery, The Arthur and Sonia Labatt Brain Tumour Research Centre, Canada; The Leeds Institute of Cancer and Pathology, University of Toronto, Canada
| | - Carlyn A Figueiredo
- Division of Neurosurgery, The Arthur and Sonia Labatt Brain Tumour Research Centre, Canada; The Division of Laboratory Medicine and Pathobiology, The Hospital for Sick Children, Canada
| | - Brian Golbourn
- The Division of Laboratory Medicine and Pathobiology, The Hospital for Sick Children, Canada
| | - Nesrin Sabha
- Program for Genetics and Genome Biology, Hospital for Sick Children, Chile
| | - Megan Yijun Wu
- The Division of Laboratory Medicine and Pathobiology, The Hospital for Sick Children, Canada
| | - Andrew Bondoc
- Division of Neurosurgery, The Arthur and Sonia Labatt Brain Tumour Research Centre, Canada
| | - Amanda Luck
- Division of Neurosurgery, The Arthur and Sonia Labatt Brain Tumour Research Centre, Canada
| | - Daniel Coluccia
- Division of Neurosurgery, The Arthur and Sonia Labatt Brain Tumour Research Centre, Canada
| | - Colin Maslink
- Division of Neurosurgery, The Arthur and Sonia Labatt Brain Tumour Research Centre, Canada
| | - Christian Smith
- Division of Neurosurgery, The Arthur and Sonia Labatt Brain Tumour Research Centre, Canada
| | - Heiko Wurdak
- The Leeds Institute of Cancer and Pathology, University of Toronto, Canada
| | - Kullervo Hynynen
- Physical Sciences Platform, Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada
| | - Meaghan O'Reilly
- Physical Sciences Platform, Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, Canada
| | - James T Rutka
- Division of Neurosurgery, The Arthur and Sonia Labatt Brain Tumour Research Centre, Canada; The Division of Laboratory Medicine and Pathobiology, The Hospital for Sick Children, Canada; Department of Surgery, University of Toronto, Canada.
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11
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Coluccia D, Roth T, Marbacher S, Fandino J. Impact of Laterality on Surgical Outcome of Glioblastoma Patients: A Retrospective Single-Center Study. World Neurosurg 2018; 114:e121-e128. [PMID: 29510290 DOI: 10.1016/j.wneu.2018.02.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Resection of left hemisphere (LH) tumors is often complicated by the risks of causing language dysfunction. Although neurosurgeons' concerns when operating on the presumed dominant hemisphere are well known, literature evaluating laterality as a predictive surgical parameter in glioblastoma (GB) patients is sparse. We evaluated whether tumor laterality correlated with surgical performance, functional outcome, and survival. METHODS All patients with GB treated at our institution between 2006 and 2016 were reviewed. Analysis comprised clinical characteristics, extent of resection (EOR), neurologic outcome, and survival in relation to tumor lateralization. RESULTS Two hundred thirty-five patients were included. Right hemisphere (RH) tumors were larger and more frequently extended into the frontal lobe. Preoperatively, limb paresis was more frequent in RH, whereas language deficits were more frequent in LH tumors (P = 0.0009 and P < 0.0001, respectively). At 6 months after resection, LH patients presented lower Karnofsky Performance Status (KPS) score (P = 0.036). More patients with LH tumors experienced dysphasia (P < 0.0001), and no difference was seen for paresis. Average EOR was comparable, but complete resection was achieved less often in LH tumors (37.7 vs. 64.8%; P = 0.0028). Although overall survival did not differ between groups, progression-free survival was shorter in LH tumors (7.4 vs. 10.1 months; P = 0.0225). CONCLUSIONS Patients with LH tumors had a pronounced KPS score decline and shorter progression-free survival without effects on overall survival. This observation might partially be attributed to a more conservative surgical resection. Further investigation is needed to assess whether systematic use of awake surgery and intraoperative mapping results in increased EOR and improved quality survival of patients with GB.
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Affiliation(s)
- Daniel Coluccia
- Department of Neurosurgery and Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland.
| | - Tabitha Roth
- Department of Neurosurgery and Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Sciences and Technology, Zurich, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery and Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery and Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
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12
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Coluccia D, Figueiredo CA, Wu MY, Riemenschneider AN, Diaz R, Luck A, Smith C, Das S, Ackerley C, O'Reilly M, Hynynen K, Rutka JT. Enhancing glioblastoma treatment using cisplatin-gold-nanoparticle conjugates and targeted delivery with magnetic resonance-guided focused ultrasound. Nanomedicine 2018; 14:1137-1148. [PMID: 29471172 DOI: 10.1016/j.nano.2018.01.021] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 01/25/2023]
Abstract
Glioblastoma (GBM) is the most common and aggressive primary brain tumor resulting in high rates of morbidity and mortality. A strategy to increase the efficacy of available drugs and enhance the delivery of chemotherapeutics through the blood brain barrier (BBB) is desperately needed. We investigated the potential of Cisplatin conjugated gold nanoparticle (GNP-UP-Cis) in combination with MR-guided Focused Ultrasound (MRgFUS) to intensify GBM treatment. Viability assays demonstrated that GNP-UP-Cis greatly inhibits the growth of GBM cells compared to free cisplatin and shows marked synergy with radiation therapy. Additionally, increased DNA damage through γH2AX phosphorylation was observed in GNP-UP-Cis treated cells, along with enhanced platinum concentrations. In vivo, GNP-UP-Cis greatly reduced the growth of GBM tumors and MRgFUS led to increased BBB permeability and GNP-drug delivery in brain tissue. Our studies suggest that GNP-Cis conjugates and MRgFUS can be used to focally enhance the delivery of targeted chemotherapeutics to brain tumors.
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Affiliation(s)
- Daniel Coluccia
- Division of Neurosurgery, the Arthur and Sonia Labatt Brain Tumor Research Centre
| | - Carlyn A Figueiredo
- Division of Neurosurgery, the Arthur and Sonia Labatt Brain Tumor Research Centre; Division of Laboratory Medicine and Pathobiology, the Hospital For Sick Children
| | - Megan YiJun Wu
- Division of Neurosurgery, the Arthur and Sonia Labatt Brain Tumor Research Centre
| | | | - Roberto Diaz
- Division of Neurosurgery, the Arthur and Sonia Labatt Brain Tumor Research Centre
| | - Amanda Luck
- Division of Neurosurgery, the Arthur and Sonia Labatt Brain Tumor Research Centre
| | - Christian Smith
- Division of Neurosurgery, the Arthur and Sonia Labatt Brain Tumor Research Centre
| | - Sunit Das
- Division of Neurosurgery, the Arthur and Sonia Labatt Brain Tumor Research Centre; Division of Laboratory Medicine and Pathobiology, the Hospital For Sick Children
| | - Cameron Ackerley
- Division of Laboratory Medicine and Pathobiology, the Hospital For Sick Children
| | - Meaghan O'Reilly
- Sunnybrook Health Sciences Centre Research Institute, the University of Toronto
| | - Kullervo Hynynen
- Sunnybrook Health Sciences Centre Research Institute, the University of Toronto
| | - James T Rutka
- Division of Neurosurgery, the Arthur and Sonia Labatt Brain Tumor Research Centre; Division of Laboratory Medicine and Pathobiology, the Hospital For Sick Children.
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13
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Neidert MC, Maldaner N, Stienen MN, Roethlisberger M, Zumofen DW, D’Alonzo D, Marbacher S, Maduri R, Hostettler IC, Schatlo B, Schneider MM, Seule MA, Schöni D, Goldberg J, Fung C, Arrighi M, Valsecchi D, Bijlenga P, Schaller K, Bozinov O, Regli L, Burkhardt JK, Fandino J, Marbacher S, D'Alonzo D, Coluccia D, Schmid N, Zumofen D, Roethlisberger M, Mariani L, Guzman R, Monsch AU, Bläsi S, Fung C, Bervini D, Beck J, Raabe A, Goldberg J, Schöni D, Gralla J, Zweifel-Zehnder A, Gutbrod K, Müri R, Maduri R, Thomas Daniel R, Starnoni D, Messerer M, Levivier M, Beaud V, Valsecchi D, Arrighi M, Venier A, Reinert M, Kuhlen DE, Robert T, Rossi S, Sacco L, Bijlenga P, Corniola M, Schaller K, Chicherio C, Seule MA, Ferrari A, Weyerbrock A, Hlavica M, Fournier JY, Früh S, Schatlo B, Burkhardt JK, Stienen MN, Keller E, Regli L, Bozinov O, Maldaner N, Finkenstädt S, Neidert MC, Brugger P, Mondadori C. The Barrow Neurological Institute Grading Scale as a Predictor for Delayed Cerebral Ischemia and Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From a Nationwide Patient Registry (Swiss SOS). Neurosurgery 2018; 83:1286-1293. [DOI: 10.1093/neuros/nyx609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marian Christoph Neidert
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Donato D’Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Rodolfo Maduri
- Department Clinical Neurosciences, Service Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Michel M Schneider
- Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | | | - Christian Fung
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Marta Arrighi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Nevzati E, Rey J, Coluccia D, D'Alonzo D, Grüter B, Remonda L, Fandino J, Marbacher S. Biodegradable Magnesium Stent Treatment of Saccular Aneurysms in a Rat Model - Introduction of the Surgical Technique. J Vis Exp 2017. [PMID: 28994804 DOI: 10.3791/56359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The steady progess in the armamentarium of techniques available for endovascular treatment of intracranial aneurysms requires affordable and reproducable experimental animal models to test novel embolization materials such as stents and flow diverters. The aim of the present project was to design a safe, fast, and standardized surgical technique for stent assisted embolization of saccular aneurysms in a rat animal model. Saccular aneurysms were created from an arterial graft from the descending aorta.The aneurysms were microsurgically transplanted through end-to-side anastomosis to the infrarenal abdominal aorta of a syngenic male Wistar rat weighing >500 g. Following aneurysm anastomosis, aneurysm embolization was performed using balloon expandable magnesium stents (2.5 mm x 6 mm). The stent system was retrograde introduced from the lower abdominal aorta using a modified Seldinger technique. Following a pilot series of 6 animals, a total of 67 rats were operated according to established standard operating procedures. Mean surgery time, mean anastomosis time, and mean suturing time of the artery puncture site were 167 ± 22 min, 26 ± 6 min and 11 ± 5 min, respectively. The mortality rate was 6% (n=4). The morbidity rate was 7.5% (n=5), and in-stent thrombosis was found in 4 cases (n=2 early, n=2 late in stent thrombosis). The results demonstrate the feasibility of standardized stent occlusion of saccular sidewall aneurysms in rats - with low rates of morbidity and mortality. This stent embolization procedure combines the opportunity to study novel concepts of stent or flow diverter based devices as well as the molecular aspects of healing.
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Affiliation(s)
- Edin Nevzati
- Department of Neurosurgery, Kantonsspital Aarau; Neuro Lab, Research Group for Experimental Neurosurgery and Neurocritical Care, Department of Intensive Care Medicine, University Hospital and University of Bern;
| | - Jeannine Rey
- Neuro Lab, Research Group for Experimental Neurosurgery and Neurocritical Care, Department of Intensive Care Medicine, University Hospital and University of Bern
| | - Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau; Neuro Lab, Research Group for Experimental Neurosurgery and Neurocritical Care, Department of Intensive Care Medicine, University Hospital and University of Bern
| | - Donato D'Alonzo
- Department of Neurosurgery, Kantonsspital Aarau; Neuro Lab, Research Group for Experimental Neurosurgery and Neurocritical Care, Department of Intensive Care Medicine, University Hospital and University of Bern
| | - Basil Grüter
- Department of Neurosurgery, Kantonsspital Aarau; Neuro Lab, Research Group for Experimental Neurosurgery and Neurocritical Care, Department of Intensive Care Medicine, University Hospital and University of Bern
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau; Neuro Lab, Research Group for Experimental Neurosurgery and Neurocritical Care, Department of Intensive Care Medicine, University Hospital and University of Bern
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau; Neuro Lab, Research Group for Experimental Neurosurgery and Neurocritical Care, Department of Intensive Care Medicine, University Hospital and University of Bern
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15
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Nevzati E, Berberat J, Soleman J, Coluccia D, Muroi C, Schöpf S, Lukes A, Fischer I, Remonda L, Fandino J, Marbacher S. Magnetic Resonance Imaging Signal Characteristics of Medishield: Early Postoperative Profile in a Rabbit Interlaminotomy Model. World Neurosurg 2016; 98:704-710.e3. [PMID: 27965076 DOI: 10.1016/j.wneu.2016.12.002] [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: 08/22/2016] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Application of Medishield to the nerve root is common during spinal surgery to create a mechanical barrier from pain mediators and reduce scar formation. However, Medishield's signal characteristics on magnetic resonance imaging (MRI) have not yet been examined. METHODS Microsurgical interlaminotomy was performed on 2 lower lumbar segments in 17 adult New Zealand white rabbits. After dural exposure, applications of 1 mL (autologous blood clot or Medishield) were randomized for each level. On postoperative days 1 through 3, various MRI sequences in 1.5T were performed including T1-weighted, T2-w, T1-gadolinium-weighted, susceptibility-weighted and turbo inversion recovery magnitude (TIRM) sequence. Signaling characteristics were analyzed by 3 blinded observers. Inter-rater agreement was calculated using Fleiss's kappa coefficient (κ). Positive and negative likelihood ratios in detecting Medishield by MRI were determined. RESULTS Of 24 MRIs performed, TIRM sequence identified Medishield with the highest likelihood ratio. Medishield's positive likelihood ratio was highest (5.8) on postoperative day 1 with interobserver agreement of 93% (κ = 0.75); these rates declined to 2.5 and 1.4 on postoperative days 2 and 3 with interobserver agreements of 71% (κ = 0.43) and 83% (κ = 0.67), respectively. Medishield adherence was confirmed in each rabbit by histologic examinations. CONCLUSION Understanding that radiologic detection of Medishield diminished over time as its signal characteristics became less distinguishable from a blood clot is essential in clinical practice. Medishield was detected on postoperative day 1 but not 2 days later after hemodynamic changes had occurred. These results may provide a guide for postoperative findings, such as differential diagnosis of hematoma.
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Affiliation(s)
- Edin Nevzati
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland.
| | - Jatta Berberat
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Carl Muroi
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Salome Schöpf
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Anton Lukes
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Ingeborg Fischer
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Luca Remonda
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
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Abstract
Medulloblastoma is a malignant embryonic brain tumor arising in the posterior fossa and typically occurring in pediatric patients. Current multimodal treatment regimes have significantly improved the survival rates; however, a marked heterogeneity in therapy response is observed, and one third of all patients die within 5 years after diagnosis. Large-scale genetic and transcriptome analysis revealed four medulloblastoma subgroups (WNT, SHH, Group 3, and Group 4) associated with different demographic parameters, tumor manifestation, and clinical behavior. Future treatment protocols will integrate molecular classification schemes to evaluate subgroup-specific intensification or de-escalation of adjuvant therapies aimed to increase tumor control and reduce iatrogenic induced morbidity. Furthermore, the identification of genetic drivers allows assessing target therapies in order to increase the chemotherapeutic armamentarium. This review highlights the biology behind the current classification system and elucidates relevant aspects of the disease influencing forthcoming clinical trials.
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Affiliation(s)
- Daniel Coluccia
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Carlyn Figuereido
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Semra Isik
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Christian Smith
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - James T Rutka
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Nevzati E, Soleman J, Schöpf SA, Coluccia D, Fandino J, Marbacher S. An Interlaminotomy New Zealand White Rabbit Model to Evaluate Novel Epidural Strategies. J Neurol Surg A Cent Eur Neurosurg 2015; 76:466-72. [PMID: 26351871 DOI: 10.1055/s-0035-1558416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The New Zealand White (NZW) rabbit model is an established animal model for examining surgical methods to prevent epidural scar formation after spine surgery. As most approaches include complete laminectomy of the rabbit vertebra, this procedure is associated with high morbidity and mortality rates. We examined a less invasive technique, the microsurgical interlaminotomy, for testing epidural substance application in the rabbit spine. METHODS Surgery was performed in the cadaver rabbit spine to evaluate the approach before performing it in NZW rabbits. All surgical procedures were performed under an operation microscope. Female rabbits with a mean weight of 4770 g ± 240 g were used. Neurologic symptoms were analyzed based on predefined scores. After resection of the spinal process, the caudal part of the upper lamina was resected using a drill and a 1-mm Kerrison punch. The yellow ligament was resected resulting in a dural exposure of ∼ 5 × 10 mm. RESULTS Eight pilot interlaminotomies were performed on three cadaveric spines to establish the surgical approach. Twenty-one NZW rabbits were then operated on using the interlaminotomy model. Three rabbits (14.3%) died during surgery due to anesthesia-related complications. Two rabbits (9.5%) showed partial paresis of the lower extremities and one (4.8%) a complete paraplegia. The remaining 15 rabbits (71.4%) had an uneventful recovery without neurologic symptoms. The mean surgical duration was 88 +/- 28 minutes. CONCLUSION The rabbit interlaminotomy model is associated with few neurologic deficits and a relatively short operating time.
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Affiliation(s)
- Edin Nevzati
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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Coluccia D, Anon J, Rossi F, Marbacher S, Fandino J, Berkmann S. Intraoperative Fluoroscopy for Ventriculoperitoneal Shunt Placement. World Neurosurg 2015; 86:71-8. [PMID: 26344633 DOI: 10.1016/j.wneu.2015.08.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 05/01/2015] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Catheter malpositioning is one of the most frequent causes of ventriculoperitoneal shunt dysfunction and revision surgery. Most intraoperative tools used to improve the accuracy of catheter insertion are time consuming and expensive or do not display the final position. We evaluate the usefulness of intraoperative fluoroscopy to decrease catheter malpositioning, and define radiological landmarks to identify the correct localization. METHODS A total of 104 patients undergoing ventriculoperitoneal shunt placement were analyzed for shunt position, revision surgery and outcome. The results for patients operated on using intraoperative biplanar fluoroscopic assessment of catheter location (X-ray group, n = 57) were compared with a control group operated without intraoperative radiography (control, n = 47). In order to generate a surgical reference map for intraoperative validation of shunt location, different ventricular system landmarks were defined on three-dimensional computed tomography reconstructions of hydrocephalic patients (n = 60) and exported to a two-dimensional layer of the skull. RESULTS The use of intraoperative X-ray imaging correlated with a significant increase of optimal catheter positions (X-ray group, n = 45, 79%; control group, n = 23, 49%; P = 0.0018). The sensitivity and positive predictive value for estimating an optimal shunt catheter position on biplanar imaging was 96% (95% confidence interval, 87%-99%). The specificity and negative predictive value were both 92% (95% confidence interval, 78%-98%). CONCLUSIONS Intraoperative fluoroscopy is easy to perform and is a reliable method to assess correct catheter positioning. Based on its predictive value, corrections of malpositioned ventricular catheters can be performed during the same procedure. The use of intraoperative fluoroscopy decreases early surgical revisions in ventriculoperitoneal shunt treatment.
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Affiliation(s)
- Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - Javier Anon
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Frederic Rossi
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Sven Berkmann
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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Croci D, Nevzati E, Hornemann T, Hiroki D, Schöpf S, Coluccia D, Fandino J, Marbacher S, Muroi C. The Role of IL-6, ET-1 in the Pathophysiology of Vasospasm, Delayed Cerebral Injury after Subarachnoid Hemorrhage. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Schneider C, Kamaly-Asl I, Ramaswamy V, Lafay-Cousin L, Kulkarni AV, Rutka JT, Remke M, Coluccia D, Tabori U, Hawkins C, Bouffet E, Taylor MD. Neoadjuvant chemotherapy reduces blood loss during the resection of pediatric choroid plexus carcinomas. J Neurosurg Pediatr 2015; 16:126-33. [PMID: 25932777 DOI: 10.3171/2014.12.peds14372] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Choroid plexus carcinomas (CPCs) are rare brain tumors originating from the ventricular choroid plexus. They account for 2%-4% of all pediatric brain tumors and are most frequently seen in very young children. This pediatric proclivity, in combination with a marked vascularity, renders an aggressive resection a difficult and often dangerous endeavor. Blood losses of several total blood volumes in small children are not uncommon, sometimes forcing the neurosurgeon to abort the procedure, often leaving residual tumor. Great extent of tumor resection is an accepted beneficial factor for overall survival. Therefore, a second resection usually follows the administration of adjuvant chemotherapy. Second-look surgery appears to be associated with markedly decreased blood loss. Histological examination of specimens obtained at a second intervention shows decreased vascularity and fibrotic changes in tumor tissue. At the Hospital for Sick Children in Toronto, this empirical finding led to the strategy of neoadjuvant chemotherapy to minimize blood loss and maximize cytoreduction. The authors undertook this study to assess the potentially beneficial effect of neoadjuvant chemotherapy on blood loss during surgery for CPCs. METHODS In this retrospective cohort review, the demographic, clinical, and treatment parameters of 22 consecutive patients diagnosed with CPC are presented. All underwent surgical treatment at the Hospital for Sick Children from 1982 to 2013. Special attention was given to the impact of neoadjuvant chemotherapy on extent of resection and intraoperative blood loss. Extent of resection was calculated based on perioperative neuroimaging, and amount of blood loss was estimated based on transfusion parameters and perioperative changes in hematocrit. RESULTS Ten patients did not receive neoadjuvant chemotherapy, and 12 were treated with 2-5 cycles of ICE (ifosfamide, carboplatin, etoposide) chemotherapy in a neoadjuvant fashion. The 22 patients included in the study underwent a total of 37 tumor resection surgeries. In all of the cases in which neoadjuvant chemotherapy was used, at least a near-total resection (> 95% of tumor volume) was achieved. Patients who underwent gross-total resection had prolonged overall survival. Of the 37 resections, 18 were performed after chemotherapy. Mean blood loss in the neoadjuvant chemotherapy group was 22% of total estimated blood volume as opposed to 96% in patients without preoperative chemotherapy. CONCLUSIONS In children with CPC, the administration of neoadjuvant chemotherapy decreases intraoperative blood loss and increases extent of resection with a significant positive effect on overall survival.
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Affiliation(s)
| | - Ian Kamaly-Asl
- Division of Neurosurgery, Royal Manchester Children's Hospital, Manchester, England
| | - Vijay Ramaswamy
- Arthur and Sonia Labatt Brain Tumor Research Center, The Hospital for Sick Children, Toronto, Ontario
| | - Lucie Lafay-Cousin
- Department of Pediatric Oncology and Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, Alberta, Canada; and
| | | | - James T Rutka
- Divisions of 1 Neurosurgery.,Arthur and Sonia Labatt Brain Tumor Research Center, The Hospital for Sick Children, Toronto, Ontario
| | - Marc Remke
- Arthur and Sonia Labatt Brain Tumor Research Center, The Hospital for Sick Children, Toronto, Ontario
| | - Daniel Coluccia
- Arthur and Sonia Labatt Brain Tumor Research Center, The Hospital for Sick Children, Toronto, Ontario
| | - Uri Tabori
- Neurooncology, and.,Arthur and Sonia Labatt Brain Tumor Research Center, The Hospital for Sick Children, Toronto, Ontario
| | - Cynthia Hawkins
- Neuropathology.,Arthur and Sonia Labatt Brain Tumor Research Center, The Hospital for Sick Children, Toronto, Ontario
| | - Eric Bouffet
- Arthur and Sonia Labatt Brain Tumor Research Center, The Hospital for Sick Children, Toronto, Ontario
| | - Michael D Taylor
- Divisions of 1 Neurosurgery.,Arthur and Sonia Labatt Brain Tumor Research Center, The Hospital for Sick Children, Toronto, Ontario
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Fandino J, Coluccia D, Schwyzer L, Anon J, Remonda L, O’Gormann R, Martin E, Werner B. First non-invasive thermal ablation of a brain tumor with MR guided focused ultrasound. J Ther Ultrasound 2015. [PMCID: PMC4489582 DOI: 10.1186/2050-5736-3-s1-o11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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22
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Marbacher S, Fathi AR, Muroi C, Coluccia D, Andereggen L, Neuschmelting V, Widmer HR, Jakob SM, Fandino J. The rabbit blood shunt subarachnoid haemorrhage model. Acta Neurochir Suppl 2015; 120:337-42. [PMID: 25366648 DOI: 10.1007/978-3-319-04981-6_58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The recently introduced rabbit blood shunt subarachnoid haemorrhage model is based on the two standard procedures of subclavian artery cannulation and transcutaneous cisterna magna puncture. An extracorporeal shunt placed in between the arterial system and the subarachnoid space allows examiner-independent SAH in a closed cranium. Despite its straightforwardness, it is worth examining some specific features and characteristics of the model. We outline technical considerations to successfully perform the model with minimal mortality and morbidity. In addition, we discuss outcome measures, advantages and limitations, and the applicability of the model for the study of early brain injury and delayed cerebral vasospasm after SAH.
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland,
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23
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Coluccia D, Fandino J, Marbacher S, Erhardt S, Kienzler J, Martin E, Werner B. A microsurgical bifurcation rabbit model to investigate the effect of high-intensity focused ultrasound on aneurysms: a technical note. J Ther Ultrasound 2014; 2:21. [PMID: 25512871 PMCID: PMC4265988 DOI: 10.1186/2050-5736-2-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/18/2014] [Accepted: 09/23/2014] [Indexed: 11/21/2022] Open
Abstract
Background Recent clinical studies confirmed the high potential of MR-guided focused ultrasound (MRgFUS) in the field of functional neurosurgery. While its ability for precise thermo-ablation within soft tissue is widely recognized, the impact of high-intensity focused ultrasound (HIFU) on larger vessels is less explored. We used a bifurcation aneurysm model in rabbits to investigate the possible effects on the walls of vascular aneurysms and to assess the risk and prospect of this procedure for managing neurovascular disorders. Methods Experimental bifurcation aneurysms were microsurgically created in New Zealand white rabbits and sonicated using MRgFUS. Results A temperature of max. 54°C could be achieved close to the aneurysm, and the shape and size of the aneurysm were noticeably changed, as shown by MR angiography. Conclusions The presented rabbit model proved suitable and capable of being extended to acquire data on the effect of HIFU on aneurysms and larger vessels. The fact that HIFU led to an alteration of the aneurysm without inducing rupture encourages further investigations.
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Affiliation(s)
- Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Cerebrovascular Research Laboratory, Department of Intensive Care Medicine, University of Bern and Bern University Hospital, Bern, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Cerebrovascular Research Laboratory, Department of Intensive Care Medicine, University of Bern and Bern University Hospital, Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Cerebrovascular Research Laboratory, Department of Intensive Care Medicine, University of Bern and Bern University Hospital, Bern, Switzerland
| | - Salome Erhardt
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Cerebrovascular Research Laboratory, Department of Intensive Care Medicine, University of Bern and Bern University Hospital, Bern, Switzerland
| | - Jenny Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Cerebrovascular Research Laboratory, Department of Intensive Care Medicine, University of Bern and Bern University Hospital, Bern, Switzerland
| | - Ernst Martin
- Center for MR Research, University Children's Hospital, Zürich, Switzerland
| | - Beat Werner
- Center for MR Research, University Children's Hospital, Zürich, Switzerland
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Coluccia D, Fandino J, Schwyzer L, O'Gorman R, Remonda L, Anon J, Martin E, Werner B. First noninvasive thermal ablation of a brain tumor with MR-guided focused ultrasound. J Ther Ultrasound 2014; 2:17. [PMID: 25671132 PMCID: PMC4322509 DOI: 10.1186/2050-5736-2-17] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [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: 05/18/2014] [Accepted: 08/27/2014] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) allows for precise
thermal ablation of target tissues. While this emerging modality is increasingly
used for the treatment of various types of extracranial soft tissue tumors, it
has only recently been acknowledged as a modality for noninvasive neurosurgery.
MRgFUS has been particularly successful for functional neurosurgery, whereas its
clinical application for tumor neurosurgery has been delayed for various
technical and procedural reasons. Here, we report the case of a 63-year-old
patient presenting with a centrally located recurrent glioblastoma who was
included in our ongoing clinical phase I study aimed at evaluating the
feasibility and safety of transcranial MRgFUS for brain tumor ablation. Applying
25 high-power sonications under MR imaging guidance, partial tumor ablation
could be achieved without provoking neurological deficits or other adverse
effects in the patient. This proves, for the first time, the feasibility of
using transcranial MR-guided focused ultrasound to safely ablate substantial
volumes of brain tumor tissue.
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Affiliation(s)
- Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Brain Tumor Center, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Brain Tumor Center, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Lucia Schwyzer
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Brain Tumor Center, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Ruth O'Gorman
- Center for MR Research, University Children's Hospital, 8032 Zürich, Switzerland ; Children's Research Center, University Children's Hospital, 8032 Zürich, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Javier Anon
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Ernst Martin
- Center for MR Research, University Children's Hospital, 8032 Zürich, Switzerland ; Children's Research Center, University Children's Hospital, 8032 Zürich, Switzerland
| | - Beat Werner
- Center for MR Research, University Children's Hospital, 8032 Zürich, Switzerland ; Children's Research Center, University Children's Hospital, 8032 Zürich, Switzerland
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Marbacher S, Klinger E, Schwzer L, Fischer I, Nevzati E, Diepers M, Roelcke U, Fathi A, Coluccia D, Fandino J. Use of Fluorescence to Guide Resection or Biopsy of Primary Brain Tumors and Brain Metastases. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1383791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nevzati E, Berberat J, Soleman J, Coluccia D, Muroi C, Erhardt S, Lukes A, Fischer I, Remonda L, Fandino J, Marbacher S. MRI- Signaling Characteristics of Medishield in the Early Postoperative Phase: Evaluation in a Rabbit Interlaminotomy Model. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1383794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Coluccia D, Fandino J, Schwyzer L, O’Gorma R, Remonda L, Martins E, Werner B. First Non-invasive Thermal Ablation of a Brain Tumor with MR Guided Focused Ultrasound. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1383780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Danura H, Schatlo B, Marbacher S, Kerkeni H, Soleman J, Coluccia D, Diepers M, Remonda L, Fathi A, Fandino J. Does Intraoperative Angiographic Vasospasm during Aneurysm Clipping influence the Incidence of Delayed Cerebral Vasospasm and Delayed Neurological Deficit? J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1383757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Erhardt S, Marbacher S, Neuschmelting V, Coluccia D, Remonda L, Fandino J. Comparison between routine cylindrical cerebral aneurysm volume approximation and three-dimensional volume measurements in experimental aneurysms. Neurol Res 2014; 36:739-45. [PMID: 24620978 DOI: 10.1179/1743132813y.0000000316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Aneurysm volume is routinely approximated calculating cylindrical volumes. Exact aneurysm volume assessment is crucial for liquid polymer embolization. The aim of this study was to compare simple cylindrical volume approximations with direct multiplanar reconstruction (MPR) segmentational volumetry in a saccular/complex experimental rabbit bifurcation aneurysm model. METHODS In 12 female New Zealand white rabbits, saccular, broad-based, bilobular, and bisaccular aneurysms (three of each) were created using the rabbit venous pouch bifurcation model. Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed, and maximal intensity projection (MIP) reconstructions as well as an MPR dataset were acquired. Aneurysm width and length were measured in MIP images, and the volume was approximated calculating cylindrical volumes. Three-dimensional (3D) segmentational volumetry using the MPR dataset was performed in a semi-automated manner. RESULTS Maximal intensity projection cylindrical volumes ranged from 53·6 to 503·5 mm(3) (mean 186·5±118 mm(3)). Multiplanar reconstruction segmentation-based volumes ranged from 74·7 to 581·0 mm(3) (mean 202·2±133 mm(3)). The mean relative difference between MIP cylindrical and MPR segmentation volume calculation was 24·7% (range -77·5 to +50·8%). Only 4 of 12 MPR segmentational volumes were within a 10% range of results calculated for MIP cylindrical volume, and 3 of those were in broad-based aneurysms. CONCLUSION This descriptive study demonstrates that estimated MIP cylindrical volumes differ from those measured by MPR segmentation volumetry. With the increasing acquisition of 3D data as 3D-MRA and the increasing need for exact volume determination, studies on the accuracy of computational segmentational volumetry of CE-MRA are necessary.
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Marbacher S, Klinger E, Schwyzer L, Fischer I, Nevzati E, Diepers M, Roelcke U, Fathi AR, Coluccia D, Fandino J. Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases. Neurosurg Focus 2014; 36:E10. [DOI: 10.3171/2013.12.focus13464] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The accurate discrimination between tumor and normal tissue is crucial for determining how much to resect and therefore for the clinical outcome of patients with brain tumors. In recent years, guidance with 5-aminolevulinic acid (5-ALA)–induced intraoperative fluorescence has proven to be a useful surgical adjunct for gross-total resection of high-grade gliomas. The clinical utility of 5-ALA in resection of brain tumors other than glioblastomas has not yet been established. The authors assessed the frequency of positive 5-ALA fluorescence in a cohort of patients with primary brain tumors and metastases.
Methods
The authors conducted a single-center retrospective analysis of 531 patients with intracranial tumors treated by 5-ALA–guided resection or biopsy. They analyzed patient characteristics, preoperative and postoperative liver function test results, intraoperative tumor fluorescence, and histological data. They also screened discharge summaries for clinical adverse effects resulting from the administration of 5-ALA. Intraoperative qualitative 5-ALA fluorescence (none, mild, moderate, and strong) was documented by the surgeon and dichotomized into negative and positive fluorescence.
Results
A total of 458 cases qualified for final analysis. The highest percentage of 5-ALA–positive fluorescence in open resection was found in glioblastomas (96%, n = 99/103). Among other tumors, 5-ALA–positive fluorescence was detected in 88% (n = 21/32) of anaplastic gliomas (WHO Grade III), 40% (n = 8/19) of low-grade gliomas (WHO Grade II), no (n = 0/3) WHO Grade I gliomas, and 77% (n = 85/110) of meningiomas. Among metastases, the highest percentage of 5-ALA–positive fluorescence was detected in adenocarcinomas (48%, n = 13/27). Low rates or absence of positive fluorescence was found among pituitary adenomas (8%, n = 1/12) and schwannomas (0%, n = 0/7). Biopsies of high-grade primary brain tumors showed positive rates of fluorescence similar to those recorded for open resection. No clinical adverse effects associated with use of 5-ALA were observed. Only 1 patient had clinically silent transient elevation of liver enzymes.
Conclusions
Study findings suggest that the administration of 5-ALA as a surgical adjunct for resection and biopsy of primary brain tumors and brain metastases is safe. In light of the high rate of positive fluorescence in high-grade gliomas other than glioblastomas, meningiomas, and a variety of metastatic cancers, 5-ALA seems to be a promising tool for enhancing intraoperative identification of neoplastic tissue and optimizing the extent of resection.
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Affiliation(s)
- Serge Marbacher
- 1Departments of Neurosurgery,
- 5Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Lucia Schwyzer
- 1Departments of Neurosurgery,
- 5Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
| | | | | | - Michael Diepers
- 2Neuroradiology,
- 5Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
| | - Ulrich Roelcke
- 4Neurology, and
- 5Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
| | - Ali-Reza Fathi
- 1Departments of Neurosurgery,
- 5Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Coluccia
- 1Departments of Neurosurgery,
- 5Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- 1Departments of Neurosurgery,
- 5Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
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Marbacher S, Tastan I, Neuschmelting V, Erhardt S, Coluccia D, Sherif C, Remonda L, Fandino J. Long-term patency of complex bilobular, bisaccular, and broad-neck aneurysms in the rabbit microsurgical venous pouch bifurcation model. Neurol Res 2012; 34:538-46. [PMID: 22663895 DOI: 10.1179/1743132812y.0000000040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES In experimental aneurysm models, long-term patency without spontaneous thrombosis is the most important precondition for analyses of embolization devices. We recently reported the feasibility of creating complex venous pouch bifurcation aneurysms in the rabbit with low morbidity, low mortality, and high short-term aneurysm patency. In order to further evaluate our model, we examined the long-term patency rate. METHODS Various sizes of complex bilobular, bisaccular, and broad-neck venous pouch aneurysms were surgically formed at an artificially created bifurcation of both common carotid arteries in 17 rabbits. Early aggressive anticoagulation was continued for 1 month. The rabbits were followed up using contrast-enhanced three-dimensional 1.5-T magnetic resonance angiography (CE-3D-MRA) at 1 month and up to 1 year after creation of the bifurcation. RESULTS At 1-month follow-up, all but one of the created aneurysms and all parent vessels proved to be patent. Three animals (18%) were lost during follow-up for reasons unrelated to aneurysm surgery. At 1-year follow-up, one animal showed partial and one complete spontaneous aneurysm thrombosis (aneurysm patency rate: 86%). Six out of 42 parent vessels were occluded at that time (vessel patency rate: 86%). CONCLUSIONS Complex bilobular, bisaccular, and broad-neck microsurgical aneurysm formation in the rabbit bifurcation model demonstrates a high long-term patency rate but is complicated by high rates of unrelated procedural mortality and morbidity. There is no need for prolonged (>4 weeks) anticoagulation to achieve good long-term patency in complex venous pouch bifurcation aneurysms.
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Affiliation(s)
- Serge Marbacher
- Department of Intensive Care MedicineInselspital, Bern University Hospital, and University of Bern, Switzerland
- Department of NeurosurgeryKantonsspital Aarau, Switzerland
| | - Ilhan Tastan
- Department of NeurosurgeryKantonsspital Aarau, Switzerland
| | | | - Salome Erhardt
- Department of Intensive Care MedicineInselspital, Bern University Hospital, and University of Bern, Switzerland
- Department of NeurosurgeryKantonsspital Aarau, Switzerland
| | - Daniel Coluccia
- Department of Intensive Care MedicineInselspital, Bern University Hospital, and University of Bern, Switzerland
- Department of NeurosurgeryKantonsspital Aarau, Switzerland
| | - Camillo Sherif
- Department of NeurosurgeryRudolfstiftung, Vienna, Austria
- Department of Biomedical ResearchCerebrovascular Research Group, Medical University Vienna, Austria
| | - Luca Remonda
- Division of NeuroradiologyDepartment of Radiology, Kantonsspital Aarau, Switzerland
| | - Javier Fandino
- Department of Intensive Care MedicineInselspital, Bern University Hospital, and University of Bern, Switzerland
- Department of NeurosurgeryKantonsspital Aarau, Switzerland
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Erhardt S, Marbacher S, Neuschmelting V, Coluccia D, Remonda L, Fandino J. Aneurysm Volume in the Rabbit Bifurcation Model-Calculation with Cylindric Volume Formula versus Multiplanar Reconstruction-Volumetry in Contrast-Enhanced Magnet Resonance Angiography. J Neurol Surg A Cent Eur Neurosurg 2012. [DOI: 10.1055/s-0032-1316208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Muroi C, Bellut D, Coluccia D, Mink S, Fujioka M, Keller E. Systemic interleukin-6 concentrations in patients with perimesencephalic non-aneurysmal subarachnoid hemorrhage. J Clin Neurosci 2011; 18:1626-9. [DOI: 10.1016/j.jocn.2011.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 03/17/2011] [Accepted: 03/21/2011] [Indexed: 11/16/2022]
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Marbacher S, Erhardt S, Schläppi JA, Coluccia D, Remonda L, Fandino J, Sherif C. Complex bilobular, bisaccular, and broad-neck microsurgical aneurysm formation in the rabbit bifurcation model for the study of upcoming endovascular techniques. AJNR Am J Neuroradiol 2011; 32:772-7. [PMID: 21310858 DOI: 10.3174/ajnr.a2374] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite rapid advances in the development of materials and techniques for endovascular intracranial aneurysm treatment, occlusion of large broad-neck aneurysms remains a challenge. Animal models featuring complex aneurysm architecture are needed to test endovascular innovations and train interventionalists. MATERIALS AND METHODS Eleven adult female New Zealand rabbits were assigned to 3 experimental groups. Complex bilobular, bisaccular, and broad-neck venous pouch aneurysms were surgically formed at an artificially created bifurcation of both CCAs. Three and 5 weeks postoperatively, the rabbits underwent 2D-DSA and CE-3D-MRA, respectively. RESULTS Mortality was 0%. We observed no neurologic, respiratory, or gastrointestinal complications. The aneurysm patency rate was 91% (1 aneurysm thrombosis). There was 1 postoperative aneurysm hemorrhage (9% morbidity). The mean aneurysm volumes were 176.9 ± 63.6 mm(3), 298.6 ± 75.2 mm(3), and 183.4 ± 72.4 mm(3) in bilobular, bisaccular, and broad-neck aneurysms, respectively. The mean operation time was 245 minutes (range, 175-290 minutes). An average of 27 ± 4 interrupted sutures (range, 21-32) were needed to create the aneurysms. CONCLUSIONS This study demonstrates the feasibility of creating complex venous pouch bifurcation aneurysms in the rabbit with low morbidity, mortality, and high short-term aneurysm patency. The necks, domes, and volumes of the bilobular, bisaccular, and broad-neck aneurysms created are larger than those previously described. These new complex aneurysm formations are a promising tool for in vivo animal testing of new endovascular devices.
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Affiliation(s)
- S Marbacher
- Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
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Papassotiropoulos A, Henke K, Stefanova E, Aerni A, Müller A, Demougin P, Vogler C, Sigmund JC, Gschwind L, Huynh KD, Coluccia D, Mondadori CR, Hänggi J, Buchmann A, Kostic V, Novakovic I, van den Bussche H, Kaduszkiewicz H, Weyerer S, Bickel H, Riedel-Heller S, Pentzek M, Wiese B, Dichgans M, Wagner M, Jessen F, Maier W, de Quervain DJF. A genome-wide survey of human short-term memory. Mol Psychiatry 2011; 16:184-92. [PMID: 20038948 PMCID: PMC3030750 DOI: 10.1038/mp.2009.133] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent advances in the development of high-throughput genotyping platforms allow for the unbiased identification of genes and genomic sequences related to heritable traits. In this study, we analyzed human short-term memory, which refers to the ability to remember information over a brief period of time and which has been found disturbed in many neuropsychiatric conditions, including schizophrenia and depression. We performed a genome-wide survey at 909 622 polymorphic loci and report six genetic variations significantly associated with human short-term memory performance after genome-wide correction for multiple comparisons. A polymorphism within SCN1A (encoding the α subunit of the type I voltage-gated sodium channel) was replicated in three independent populations of 1699 individuals. Functional magnetic resonance imaging during an n-back working memory task detected SCN1A allele-dependent activation differences in brain regions typically involved in working memory processes. These results suggest an important role for SCN1A in human short-term memory.
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Affiliation(s)
- A Papassotiropoulos
- Division of Molecular Psychology, University of Basel, Basel, Switzerland. or
| | - K Henke
- Department of Psychology, University of Bern, Bern, Switzerland
| | - E Stefanova
- Institute of Neurology, CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Aerni
- Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - A Müller
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - P Demougin
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - C Vogler
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - J C Sigmund
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - L Gschwind
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - K-D Huynh
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - D Coluccia
- Division of Psychiatry Research, University of Zurich, Zurich, Switzerland
| | - C R Mondadori
- Division of Neuropsychology, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - J Hänggi
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - A Buchmann
- Division of Psychiatry Research, University of Zurich, Zurich, Switzerland
| | - V Kostic
- Institute of Neurology, CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - I Novakovic
- Institute of Biology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - H van den Bussche
- Institute of Primary Medical Care, University Medical Center, Hamburg-Eppendorf, Germany
| | - H Kaduszkiewicz
- Institute of Primary Medical Care, University Medical Center, Hamburg-Eppendorf, Germany
| | - S Weyerer
- Central Institute of Mental Health, Mannheim, Germany
| | - H Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - S Riedel-Heller
- Public Mental Health Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - M Pentzek
- Department of General Practice, Dusseldorf University Medical Center, Dusseldorf, Germany
| | - B Wiese
- Institute for Biometrics, Hannover Medical School, Hannover, Germany
| | - M Dichgans
- Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - M Wagner
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - F Jessen
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - W Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - D J-F de Quervain
- Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland,Division of Cognitive Neuroscience, University of Basel, Birmannsgasse 8, Basel 4055, Switzerland. E-mail:
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Papassotiropoulos A, Stephan DA, Huentelman MJ, Hoerndli FJ, Craig DW, Pearson JV, Huynh KD, Brunner F, Corneveaux J, Osborne D, Wollmer MA, Aerni A, Coluccia D, Hänggi J, Mondadori CRA, Buchmann A, Reiman EM, Caselli RJ, Henke K, de Quervain DJF. Common Kibra alleles are associated with human memory performance. Science 2006; 314:475-8. [PMID: 17053149 DOI: 10.1126/science.1129837] [Citation(s) in RCA: 323] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Human memory is a polygenic trait. We performed a genome-wide screen to identify memory-related gene variants. A genomic locus encoding the brain protein KIBRA was significantly associated with memory performance in three independent, cognitively normal cohorts from Switzerland and the United States. Gene expression studies showed that KIBRA was expressed in memory-related brain structures. Functional magnetic resonance imaging detected KIBRA allele-dependent differences in hippocampal activations during memory retrieval. Evidence from these experiments suggests a role for KIBRA in human memory.
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Papassotiropoulos A, Henke K, Aerni A, Coluccia D, Garcia E, Wollmer MA, Huynh KD, Monsch AU, Stähelin HB, Hock C, Nitsch RM, de Quervain DJF. Age-dependent effects of the 5-hydroxytryptamine-2a-receptor polymorphism (His452Tyr) on human memory. Neuroreport 2005; 16:839-42. [PMID: 15891581 DOI: 10.1097/00001756-200505310-00012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A polymorphism (His452Tyr) of the 5-hydroxytryptamine (5-HT)2a receptor is associated with episodic memory in healthy young humans. Because 5-HT2a-receptor density decreases with increasing age, we tested whether the 5-HT2a receptor genotype effect on memory is influenced by age. We investigated the association of the His452Tyr genotype with memory performance in 622 healthy study participants aged from 18 to 90 years. In young to middle-aged participants, age significantly influenced genotype effects on episodic memory: the His452Tyr genotype exerted a significant influence on memory only in young participants. In the group of elderly cognitively healthy participants, the His452Tyr genotype did not affect memory performance. We conclude that age strongly modulates the effect of the 5-HT2a receptor polymorphism at residue 452 on episodic memory.
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de Quervain DJF, Henke K, Aerni A, Coluccia D, Wollmer MA, Hock C, Nitsch RM, Papassotiropoulos A. A functional genetic variation of the 5-HT2a receptor affects human memory. Nat Neurosci 2003; 6:1141-2. [PMID: 14566344 DOI: 10.1038/nn1146] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [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: 07/08/2003] [Accepted: 09/29/2003] [Indexed: 11/08/2022]
Abstract
Human memory capacity is highly variable across individuals and is influenced by both genetic and environmental factors. A roughly 50% heritability estimate indicates that naturally occurring genetic variations have an important impact on this cognitive ability. Therefore, we investigated a functional variation of a memory-related serotonin receptor in 349 healthy young volunteers, and found 21% poorer memory performance in subjects with the rare variant.
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Mazzanti G, Mascellino MT, Battinelli L, Coluccia D, Manganaro M, Saso L. Antimicrobial investigation of semipurified fractions of Ginkgo biloba leaves. J Ethnopharmacol 2000; 71:83-88. [PMID: 10904149 DOI: 10.1016/s0378-8741(99)00179-8] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A total methanolic extract of Ginkgo biloba leaves was fractionated by solvent partition using ethyl acetate (fraction A), n-butanol (fraction B) and water (fraction C). The antimicrobial activity of the three fractions was evaluated using a number of Gram-positive and -negative bacteria and yeasts. The apolar fraction A appeared to be the most interesting because of its activity against several microorganisms; this fraction was further separated by high performance liquid chromatography, and shown to contain substances with strong inhibitory activity against Enterococcus faecalis 31, different from the major known chemical components of G. biloba leaves.
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Affiliation(s)
- G Mazzanti
- Dipartimento di Farmacologia delle Sostanze Naturali e Fisiologia Generale, Università di Roma 'La Sapienza', P. le Aldo Moro 5, 00185, Rome, Italy.
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