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Schieferdecker S, Hunsche S, El Majdoub F, Maarouf M. Robot-Assisted Stereotactic Shunting as a Novel Treatment for Pontine Glioependymal Cysts. J Neurol Surg A Cent Eur Neurosurg 2021; 83:85-88. [PMID: 34030189 DOI: 10.1055/s-0041-1726109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this case report, the authors describe the first case of a glioependymal cyst of the brainstem managed by robot-assisted, stereotactic, cysto-ventricular shunting. Glioependymal cysts are rare congenital cystic lesions that are thought to form by displacement of ependymal cells during the embryonal period. Glioependymal cysts have been reported in a variety of different locations within the central nervous system. However, glioependymal cysts of the brainstem have only been described once before. Here, we report the case of a 53-year-old man who was referred to our department due to hemiparesis, hemihypesthesia, and hemidysesthesia, as well as facial and abducens nerve palsy. A large pontine glioependymal cyst was confirmed via magnetic resonance imaging (MRI) scans. The cyst was subsequently decompressed by connecting the cyst with the fourth ventricle via robot-assisted stereotactic shunt placement. In the postoperative course, the patient made a quick recovery and did not report any permanent neurologic deficits.
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Affiliation(s)
- Simon Schieferdecker
- Department of Medicine, Heinrich Heine University Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Stefan Hunsche
- Department of Stereotactic and Functional Neurosurgery, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - Faycal El Majdoub
- Department of Stereotactic and Functional Neurosurgery, Cologne Merheim Medical Center (CMMC), Cologne, Germany
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Schieferdecker S, Neudorfer C, El Majdoub F, Maarouf M. A Retrospective Case Series of High-Frequency Spinal Cord Stimulation (HF10-SCS) in Neurogenic Bladder Incontinence. Oper Neurosurg (Hagerstown) 2020; 17:14-20. [PMID: 30169840 DOI: 10.1093/ons/opy236] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 07/26/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Current treatment options for bladder disorders of neurogenic etiology often leave unsatisfactory results. Therefore, new and effective treatments must be investigated. High-frequency spinal cord stimulation (HF-SCS) at 10 kHz has proven to be effective in the treatment of refractory chronic back and leg pain. OBJECTIVE To evaluate the efficacy of HF-SCS at 10 kHz in alleviating lower urinary tract dysfunction and bladder incontinence in 5 patients with underlying neurological disease or spinal cord injury, through retrospective study. METHODS Urodynamic parameters such as voiding frequency, residual volume, episodes of incontinence, and the patients' subjective impression impairment of life were assessed and compared pre- and postoperatively. Reduction in pain intensity was assessed as change on the Numeric Rating Scale (NRS). RESULTS All 5 patients had significantly positive outcomes. Episodes of leakage per day improved by 83% on average. Quality of life questionnaires and subjective bother scale revealed an improvement of 36% and 57%, respectively. Individual symptoms among the patient group such as residual volume also responded to the treatment as well. Mean pain NRS of 8.6 cm was reduced to 3.9 cm (55%) at 6 mo follow-up. CONCLUSION HF-SCS at 10 kHz significantly alleviated symptoms of neurogenic bladder incontinence in patients suffering from neurological disease or spinal cord injury. However, larger and prospective, randomized studies are necessary to make a clear statement regarding the efficacy of this therapy in lower urinary tract dysfunction and bladder incontinence.
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Affiliation(s)
| | - Clemens Neudorfer
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Faycal El Majdoub
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Mohammad Maarouf
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
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El Majdoub F, Neudorfer C, Richter R, Schieferdecker S, Maarouf M. 10 kHz cervical SCS for chronic neck and upper limb pain: 12 months' results. Ann Clin Transl Neurol 2019; 6:2223-2229. [PMID: 31595717 PMCID: PMC6856764 DOI: 10.1002/acn3.50915] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 12/29/2022] Open
Abstract
Objective Spinal Cord Stimulation (SCS) overlaps painful areas with paresthesia to alleviate pain. Ten kHz High‐Frequency SCS (HF10 cSCS) constitutes a treatment option that can provide pain relief without inducing paresthesia. In this retrospective, open‐label study, we evaluated the efficacy of HF10 cSCS in chronic neck and/or upper limb pain. Methods Between May 2015 and August 2017, 24 consecutive patients with neck and/or upper limb pain were treated with HF10 cSCS. The patients’ mean age was 61.4 years (range: 40.1–82.6 years). The mean neck and upper limb pain at baseline was 8.8 (range: 7.0–10) and 7.5 (range: 6.0–9.0) according to the visual analog scale (VAS). Functionality was evaluated using the Oswestry Disability Index (ODI). To assess health‐related psychological impairment, we used the Global Assessment of Functioning questionnaire. Results Twenty‐three patients responded to treatment. Pain intensity reduced significantly to a mean score of VAS 2.5 (range: 2.0–4.0) for neck and 2.0 (range: 1.0–3.0) for upper limb pain after 6 months. At 12 months, VAS scores for neck and upper limb pain reduced to 2.2 (range: 1.0–3.0) and 1.7 (range: 1.0–3.0), respectively. Mean ODI scores decreased from 31 (range: 21–42) at baseline to 19.9 (range: 8–26) after 12 months. In three patients, infection of the IPG pocket occurred r and 8.7 months after surgery. One patient has had lead migration resulting in a surgical revision. Interpretation HF10 cSCS therapy has proven to be effective in reducing neck and upper limb pain significantly and increasing functional capacity. These results warrant further studies with larger patient series and longer follow‐ups.
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Affiliation(s)
- Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Clemens Neudorfer
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Ronald Richter
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Simon Schieferdecker
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany.,Heinrich-Heine-University, Duesseldorf, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
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Neudorfer C, Hinzke M, Hunsche S, El Majdoub F, Lozano A, Maarouf M. Combined Deep Brain Stimulation of Subthalamic Nucleus and Ventral Intermediate Thalamic Nucleus in Tremor‐Dominant Parkinson's Disease Using a Parietal Approach. Neuromodulation 2019; 22:493-502. [DOI: 10.1111/ner.12943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/05/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Clemens Neudorfer
- Department of Stereotaxy and Functional Neurosurgery Cologne‐Merheim Medical Center (CMMC), University of Witten/Herdecke Cologne Germany
- Division of Neurosurgery, Department of Surgery University of Toronto Toronto ON Canada
| | - Markus Hinzke
- Department of Neurology Cologne‐Merheim Medical Center (CMMC), University of Witten/Herdecke Cologne Germany
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery Cologne‐Merheim Medical Center (CMMC), University of Witten/Herdecke Cologne Germany
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery Cologne‐Merheim Medical Center (CMMC), University of Witten/Herdecke Cologne Germany
| | - Andres Lozano
- Division of Neurosurgery, Department of Surgery University of Toronto Toronto ON Canada
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery Cologne‐Merheim Medical Center (CMMC), University of Witten/Herdecke Cologne Germany
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Stauss T, El Majdoub F, Sayed D, Surges G, Rosenberg WS, Kapural L, Bundschu R, Lalkhen A, Patel N, Gliner B, Subbaroyan J, Rotte A, Edgar DR, Bettag M, Maarouf M. A multicenter real-world review of 10 kHz SCS outcomes for treatment of chronic trunk and/or limb pain. Ann Clin Transl Neurol 2019; 6:496-507. [PMID: 30911573 PMCID: PMC6414485 DOI: 10.1002/acn3.720] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/20/2018] [Accepted: 12/22/2018] [Indexed: 01/11/2023] Open
Abstract
Objectives High-frequency spinal cord stimulation (HF-SCS) at 10 kHz has proven to be efficacious in the treatment of chronic back and leg pain in a randomized, controlled, trial (SENZA-RCT). However, large observational studies have yet to be published. Therefore, we performed a real-world, multicenter, retrospective, review of therapy efficacy in 1660 patients with chronic trunk and/or limb pain. Methods Data were collected in a real-world environment and retrospectively sourced from a global database. Included patients were trialed and/or permanently implanted with HF-SCS at 10 kHz between April 2014 and January 2018. We evaluated responder rates at 3, 6, and 12 months post-implantation. Response was defined as ≥50% pain relief from baseline. A last visit analysis included responder rate along with overall change in function, sleep, quality of life, and medication intake versus baseline. Results Eighty-four percent of our HF-SCS-treated patients had both chronic back and leg pain. At least 70% of patients reported response to therapy throughout 12 months of follow-up. This sustained responder rate was corroborated by the last visit value (74.1%). Most patients reported concomitant improvements in function (72.3%), sleep (68.0%), and quality of life (90.3%) at their last visit versus baseline. Thirty-two percent of patients reported decreased medication intake at their last visit. Interpretation Sustained and effective pain relief was experienced by >70% of our HF-SCS-treated patients, consistent with the findings of a previously published randomized, controlled, trial. Our review provides complementary evidence to support the treatment of chronic back and leg pain with this therapy.
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Affiliation(s)
| | - Faycal El Majdoub
- Department of Stereotactic and Functional NeurosurgeryCologne Merheim Medical CenterUniversity of Witten/HerdeckeCologneGermany
| | - Dawood Sayed
- Department of Anesthesiology and Pain MedicineUniversity of Kansas Medical CenterKansas CityKansas
| | | | | | | | | | - Abdul Lalkhen
- The Manchester and Salford Pain CentreSalfordUnited Kingdom
| | | | | | | | | | | | | | - Mohammad Maarouf
- Department of Stereotactic and Functional NeurosurgeryCologne Merheim Medical CenterUniversity of Witten/HerdeckeCologneGermany
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Hunsche S, Neudorfer C, Majdoub FE, Maarouf M, Sauner D. Determining the Rotational Orientation of Directional Deep Brain Stimulation Leads Employing Flat-Panel Computed Tomography. Oper Neurosurg (Hagerstown) 2018; 16:465-470. [DOI: 10.1093/ons/opy163] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/28/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Directional deep brain stimulation (DBS) constitutes an emerging technology that allows selective stimulation of target structures via partitioned electrode contacts. In order to effectively perform target-tailored stimulation, knowledge of the rotational orientation of the segmented leads is imperative.
OBJECTIVE
To develop a universally applicable and reliable method for determination of lead orientation angles in DBS using flat-panel computed tomography (fpCT).
METHODS
A binary template of directional leads DB-2202-30 (Boston Scientific, Natick, Massachusetts) and 6170 (Abbott, Plano, Texas) was imported into the 2-dimensional raw data set of a conventional fpCT scan. The template was aligned with and manually rotated around the predetermined lead trajectory. The overall orientation of the segmented lead can be deduced by transferring position and orientation of the lead orientation marker into the 3-dimensional volume. Accuracy of the method was investigated by two raters in a phantom study.
RESULTS
Accuracy were 5.4° ± 4.1° (range: 0.4°-11.9°) for rater 1 and 5.2° ± 3.0° (range: 0.3°-10.2°) for rater 2, when investigating DB-2202-30. For 6170 observed deviations were 2.5° ± 1.7° (range: 0.2°-5.2°) and 4.3° ± 3.6° (range: 0.2°-11.2°) for raters 1 and 2, respectively.
CONCLUSION
fpCT imaging constitutes a precise and accurate means to determine the rotational orientation of directional leads. The approach is universally transferable to different electrode designs as the template can easily be adjusted to the electrodes’ specific measures. The approach is independent from polar implantation angles owing to fpCT- and methodological features.
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Affiliation(s)
- Stefan Hunsche
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Clemens Neudorfer
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Faycal El Majdoub
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Mohammad Maarouf
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Dieter Sauner
- Department of Radiologic Diagnostics, University Hospital, Technical University Dresden, Dresden, Germany
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Pauls KAM, Krauss JK, Kämpfer CE, Kühn AA, Schrader C, Südmeyer M, Allert N, Benecke R, Blahak C, Boller JK, Fink GR, Fogel W, Liebig T, El Majdoub F, Mahlknecht P, Kessler J, Mueller J, Voges J, Wittstock M, Wolters A, Maarouf M, Moro E, Volkmann J, Bhatia KP, Timmermann L. Causes of failure of pallidal deep brain stimulation in cases with pre-operative diagnosis of isolated dystonia. Parkinsonism Relat Disord 2017; 43:38-48. [PMID: 28690015 DOI: 10.1016/j.parkreldis.2017.06.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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] [Received: 12/09/2016] [Revised: 05/22/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pallidal deep brain stimulation (GPi-DBS) is an effective therapy for isolated dystonia, but 10-20% of patients show improvement below 25-30%. We here investigated causes of insufficient response to GPi-DBS in isolated dystonia in a cross-sectional study. METHODS Patients with isolated dystonia at time of surgery, and <30% improvement on the Burke-Fahn-Marsden dystonia-rating-scale (BFMDRS) after ≥6 months of continuous GPi-DBS were videotaped ON and OFF stimulation, and history, preoperative videos, brain MRI, medical records, stimulation settings, stimulation system integrity, lead location, and genetic information were obtained and reviewed by an expert panel. RESULTS 22 patients from 11 centres were included (8 men, 14 women; 9 generalized, 9 segmental, 3 focal, 1 bibrachial dystonia; mean (range): age 48.7 (25-72) years, disease duration 22.0 (2-40) years, DBS duration 45.5 (6-131) months). Mean BFMDRS-score was 31.7 (4-93) preoperatively and 32.3 (5-101) postoperatively. Half of the patients (n = 11) had poor lead positioning alone or in combination with other problems (combined with: other disease n = 6, functional dystonia n = 1, other problems n = 2). Other problems were disease other than isolated inherited or idiopathic dystonia (n = 5), fixed deformities (n = 2), functional dystonia (n = 3), and other causes (n = 1). Excluding patients with poor lead location from further analysis, non-isolated dystonia accounted for 45.5%, functional dystonia for 27.3%, and fixed deformities for 18.2%. In patients with true isolated dystonia, lead location was the most frequent problem. CONCLUSION After exclusion of lead placement and stimulation programming issues, non-isolated dystonia, functional dystonia and fixed deformities account for the majority of GPi-DBS failures in dystonia.
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Affiliation(s)
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Andrea A Kühn
- Department of Neurology, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Schrader
- Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Martin Südmeyer
- Department of Neurology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Niels Allert
- Neurological Rehabilitation Center Godeshöhe, Bonn, Germany
| | - Rainer Benecke
- Department of Neurology, Universitätsmedizin Rostock, Rostock, Germany
| | - Christian Blahak
- Department of Neurology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Jana K Boller
- Department of Neurology, Uniklinik Köln, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Uniklinik Köln, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Wolfgang Fogel
- Department of Neurology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Uniklinik Köln, Cologne, Germany
| | - Faycal El Majdoub
- Department of Stereotaxic and Functional Neurosurgery, Uniklinik Köln, Cologne, Germany
| | - Philipp Mahlknecht
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Kessler
- Department of Neurology, Uniklinik Köln, Cologne, Germany
| | - Joerg Mueller
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Juergen Voges
- Department for Stereotactic Neurosurgery, Universitätsklinikum Magdeburg, Magdeburg, Germany; Leibniz Institute of Neurobiology, Magdeburg, Germany
| | | | - Alexander Wolters
- Department of Neurology, Universitätsmedizin Rostock, Rostock, Germany
| | - Mohammad Maarouf
- Department of Stereotaxic and Functional Neurosurgery, Uniklinik Köln, Cologne, Germany
| | - Elena Moro
- Division of Neurology, University Hospital Center of Grenoble, Grenoble, France
| | - Jens Volkmann
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
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Neudorfer C, El Majdoub F, Hunsche S, Richter K, Sturm V, Maarouf M. Deep Brain Stimulation of the H Fields of Forel Alleviates Tics in Tourette Syndrome. Front Hum Neurosci 2017; 11:308. [PMID: 28659777 PMCID: PMC5468420 DOI: 10.3389/fnhum.2017.00308] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 01/23/2017] [Accepted: 05/29/2017] [Indexed: 12/29/2022] Open
Abstract
The current rationale for target selection in Tourette syndrome revolves around the notion of cortico-basal ganglia circuit involvement in the pathophysiology of the disease. However, despite extensive research, the ideal target for deep brain stimulation (DBS) is still under debate, with many structures being neglected and underexplored. Based on clinical observations and taking into account the prevailing hypotheses of network processing in Tourette syndrome, we chose the fields of Forel, namely field H1, as a target for DBS. The fields of Forel constitute the main link between the striatopallidal system and the thalamocortical network, relaying pallidothalamic projections from core anatomical structures to the thalamic ventral nuclear group. In a retrospective study we investigated two patients suffering from chronic, medically intractable Tourette syndrome who underwent bilateral lead implantation in field H1 of Forel. Clinical scales revealed significant alleviation of tics and comorbid symptoms, namely depression and anxiety, in the postoperative course in both patients.
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Affiliation(s)
- Clemens Neudorfer
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Klaus Richter
- Department of Psychiatry and Psychotherapy, LVR Clinics CologneCologne, Germany
| | - Volker Sturm
- Department of Neurosurgery, University Hospital of WürzburgWürzburg, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
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Rezk EM, El Majdoub F, Kocher M, Treuer H, Sturm V, Maarouf M. Micro-Multileaf Collimator LINAC Radiosurgery for Vestibular Schwannomas. World Neurosurg 2017:S1878-8750(17)30337-6. [PMID: 28323186 DOI: 10.1016/j.wneu.2017.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/07/2017] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study evaluates the efficacy of linear accelerator (LINAC) radiosurgery using micro multi-leaf collimator technique (μMLC) in the treatment of a consecutive series of patients with vestibular schwannomas. PATIENTS AND METHODS In this retrospective study, we enrolled 50 patients with non-neurofibromatosis type 2 vestibular schwannoma who were treated with μMLC LINAC-based SRS at University Hospital of Cologne, Germany. A minimum clinical follow-up of 24 months was conducted. Thirty-nine out of the 50 tumors (78 %) were treated with μMLC LINAC as a primary treatment (a newly diagnosed tumor). The remaining 11 vestibular schwannomas (22%) were treated as a salvage treatment (5 patients with a residual tumor; and 6 patients with a recurrent tumor following a microsurgical resection). The median tumor volume was 1.4 ml. The median tumor surface dose, median maximal dose and median therapeutic isodose were 12 Gy, 16 Gy and 77% respectively. RESULTS Follow-up MR images showed that a tumor progression-free status was achieved for 95.7% of patients. Partial tumor shrinkage was observed after μMLC LINAC SRS for 21.3% of patients. No change in tumor size (a stable tumor) was noted for 74.5% of patients. Tumor progression was observed for 4.3% of patients. At the end of follow-up, the actuarial 5- year and 10 year progression-free survival after radiosurgery were both 95.7%. CONCLUSIONS LINAC radiosurgery using a micro multi-leaf collimator for vestibular schwannomas smaller than 3 cm is effective in yielding a high local tumor control, whereas the treatment-related morbidity remains low.
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Affiliation(s)
- Essam M Rezk
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Germany; Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt.
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Germany
| | - Martin Kocher
- Department of Radiation Oncology, University Hospital of Cologne, Germany
| | - Harald Treuer
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Germany
| | - Volker Sturm
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Germany
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Hunsche S, Sauner D, Majdoub FE, Neudorfer C, Poggenborg J, Goßmann A, Maarouf M. Intensity-based 2D 3D registration for lead localization in robot guided deep brain stimulation. Phys Med Biol 2017; 62:2417-2426. [DOI: 10.1088/1361-6560/aa5ecd] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Maarouf M, Neudorfer C, El Majdoub F, Lenartz D, Kuhn J, Sturm V. Deep Brain Stimulation of Medial Dorsal and Ventral Anterior Nucleus of the Thalamus in OCD: A Retrospective Case Series. PLoS One 2016; 11:e0160750. [PMID: 27504631 PMCID: PMC4978440 DOI: 10.1371/journal.pone.0160750] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The current notion that cortico-striato-thalamo-cortical circuits are involved in the pathophysiology of obsessive-compulsive disorder (OCD) has instigated the search for the most suitable target for deep brain stimulation (DBS). However, despite extensive research, uncertainty about the ideal target remains with many structures being underexplored. The aim of this report is to address a new target for DBS, the medial dorsal (MD) and the ventral anterior (VA) nucleus of the thalamus, which has thus far received little attention in the treatment of OCD. METHODS In this retrospective trial, four patients (three female, one male) aged 31-48 years, suffering from therapy-refractory OCD underwent high-frequency DBS of the MD and VA. In two patients (de novo group) the thalamus was chosen as a primary target for DBS, whereas in two patients (rescue DBS group) lead implantation was performed in a rescue DBS attempt following unsuccessful primary stimulation. RESULTS Continuous thalamic stimulation yielded no significant improvement in OCD symptom severity. Over the course of thalamic DBS symptoms improved in only one patient who showed "partial response" on the Yale-Brown Obsessive Compulsive (Y-BOCS) Scale. Beck Depression Inventory scores dropped by around 46% in the de novo group; anxiety symptoms improved by up to 34%. In the de novo DBS group no effect of DBS on anxiety and mood was observable. CONCLUSION MD/VA-DBS yielded no adequate alleviation of therapy-refractory OCD, the overall strategy in targeting MD/VA as described in this paper can thus not be recommended in DBS for OCD. The magnocellular portion of MD (MDMC), however, might prove a promising target in the treatment of mood related and anxiety disorders.
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Affiliation(s)
- Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
- * E-mail:
| | - Clemens Neudorfer
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Doris Lenartz
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Jens Kuhn
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Volker Sturm
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
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Maarouf M, Majdoub FE, Fuetsch M, Hoevels M, Lehrke R, Berthold F, Voges J, Sturm V. Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children. Strahlenther Onkol 2015; 192:157-65. [DOI: 10.1007/s00066-015-0910-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
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El-Khatib M, El Majdoub F, Hunsche S, Hoevels M, Kocher M, Sturm V, Maarouf M. Stereotactic LINAC radiosurgery for the treatment of typical intracranial meningiomas. Efficacy and safety after a follow-up of over 12 years. Strahlenther Onkol 2015; 191:921-7. [PMID: 26253788 DOI: 10.1007/s00066-015-0880-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The efficacy and safety of stereotactic radiosurgery (SRS) for treatment of intracranial meningiomas has been demonstrated in numerous studies with short- and intermediate-term follow-up. In this retrospective single-center study, we present long-term outcomes of SRS performed with a linear accelerator (LINAC) for typical intracranial meningiomas. PATIENTS AND METHODS Between August 1990 and December 2007, 148 patients with 168 typical intracranial meningiomas were treated with stereotactic LINAC-SRS, either as primary treatment or after microsurgical resection. A median tumor surface dose of 12 Gy (range 7-20 Gy) and a median maximum dose of 24.1 Gy (range 11.3-58.6 Gy) was applied. The median target volume was 4.7 ml (range 0.2-32.8 ml, SD ± 4.8 ml). RESULTS Overall mean radiological follow-up was 12.6 years. Tumor shrinkage was seen in 75 (44.6 %) and stable disease in 85 (50.6 %) cases. Eight of 168 meningiomas (4.8 %) showed local tumor progression. The tumor control rate (TCR) after 5, 10, and 15 years was 93.6 % at each time point, and the progression-free survival (PSF) rates were 92, 89, and 89 %, respectively. The neurological symptoms existing prior to LINAC-SRS improved in 77 patients (59.7 %), remained unchanged in 42 (32.6 %), and deteriorated in 10 (7.8 %) patients. CONCLUSION Our study emphasizes the efficacy of LINAC-SRS for de novo, residual and recurrent typical intracranial meningiomas. A high long-term local TCR with a low morbidity rate could be achieved. LINAC-SRS should thus be considered as a primary treatment option, as one arm of a combined treatment approach for incompletely resected meningiomas, or as a salvage therapy for recurrences.
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Affiliation(s)
- Mustafa El-Khatib
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany. .,Department of Neurosurgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany. .,Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany.
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany. .,Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany.
| | - Mauritius Hoevels
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany.
| | - Martin Kocher
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany.
| | - Volker Sturm
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany. .,Department of Neurosurgery, University Hospital of Wurzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany. .,Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany.
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El Majdoub F, Hunsche S, Igressa A, Kocher M, Sturm V, Maarouf M. Stereotactic LINAC-Radiosurgery for Glomus Jugulare Tumors: A Long-Term Follow-Up of 27 Patients. PLoS One 2015; 10:e0129057. [PMID: 26069957 PMCID: PMC4466539 DOI: 10.1371/journal.pone.0129057] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/04/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The optimal treatment of glomus jugulare tumors (GJTs) remains controversial. Due to the critical location, microsurgery still provides high treatment-related morbidity and a decreased quality of life. Thus, we performed stereotactical radiosurgery (SRS) for the treatment of GJTs and evaluated the long-term outcome. METHODS Between 1991 and 2011, 32 patients with GJTs underwent SRS using a linear accelerator (LINAC) either as primary or salvage therapy. Twenty-seven patients (median age 59.9 years, range 28.7-79.9 years) with a follow-up greater than five years (median 11 years, range 5.3-22.1 years) were selected for retrospective analysis. The median therapeutic single dose applied to the tumor surface was 15 Gy (range 11-20 Gy) and the median tumor volume was 9.5 ml (range 2.8-51 ml). RESULTS Following LINAC-SRS, 10 of 27 patients showed a significant improvement of their previous neurological complaints, whereas 12 patients remained unchanged. Five patients died during follow-up due to old age or other, not treatment-related reasons. MR-imaging showed a partial remission in 12 and a stable disease in 15 patients. No tumor progression was observed. The actuarial overall survival rates after five, ten and 20 years were 100%, 95.2% and 79.4%, respectively. CONCLUSIONS Stereotactic LINAC-Radiosurgery can achieve an excellent long-term tumor control beside a low rate of morbidity in the treatment of GJTs. It should be considered as an alternative therapy regime to surgical resection or fractionated external beam radiation either as primary, adjuvant or salvage therapy.
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Affiliation(s)
- Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
- Department of Stereotaxy and Functional Neurosurgery, University of Witten-Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
- * E-mail:
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
- Department of Stereotaxy and Functional Neurosurgery, University of Witten-Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
| | - Alhadi Igressa
- Department of Neurosurgery, University of Witten-Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
| | - Martin Kocher
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Volker Sturm
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
- Department of Neurosurgery, University Hospital of Wurzburg, Wurzburg, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
- Department of Stereotaxy and Functional Neurosurgery, University of Witten-Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
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El Majdoub F, Rezk E, Hunsche S, Bührle C, Sturm V, Maarouf M. Intracranial ganglioglioma WHO I: results in a series of eight patients treated with stereotactic interstitial brachytherapy. J Neurooncol 2014; 118:345-350. [PMID: 24771287 DOI: 10.1007/s11060-014-1438-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 04/05/2014] [Indexed: 11/30/2022]
Abstract
In this retrospective study we evaluated the efficacy of interstitial brachytherapy (IBT) using (125)Iodine seeds ((125)I) for intracranial ganglioglioma WHO I. Between October 1994 and March 2010, eight patients (m/f = 5/3, median age 30.4 years, age range 7-42.5 years) with intracranial ganglioglioma WHO I were treated with IBT using stereotactically implanted (125)I seeds. The median follow-up time was 41.5 months (range 16.7-140.1 months). Prior to interstitial brachytherapy one patient underwent microsurgical resection for three times; seven patients were treated with IBT primarily. In all patients we implanted the (125)I seeds stereotactically guided. The cumulative tumor surface dose ranged between 50 and 65 Gy (permanent implantation) and the median tumor volume was 5.6 ml (range 0.9-26 ml). After brachytherapy, follow-up MR imaging revealed complete remission in one patient, partial remission in three and stable disease in the remaining four patients. Five of eight patients presented with seizures were either seizure-free (1/5) or improved (4/5). Temporary treatment-related morbidity occurred in one patient only (headache, nausea/vomiting) and resolved completely under steroid medication after 4 weeks. No treatment-related mortality was observed. This study indicates that interstitial brachytherapy for the treatment of intracranial ganglioglioma WHO I is safe and provides a high rate of local tumor control. Due to the limited number of cases, it is not possible to conduct a rigorous statistical evaluation. Thus, larger numbers of patients are required.
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Affiliation(s)
- Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, Hospital of Cologne-Merheim, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany. .,Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany.
| | - Essam Rezk
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery, Hospital of Cologne-Merheim, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Christian Bührle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Volker Sturm
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany.,Department of Neurosurgery, University Hospital of Würzburg, 97080, Würzburg, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Hospital of Cologne-Merheim, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
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Pauls KAM, Hammesfahr S, Moro E, Moore AP, Binder E, El Majdoub F, Fink GR, Sturm V, Krauss JK, Maarouf M, Timmermann L. Deep brain stimulation in the ventrolateral thalamus/subthalamic area in dystonia with head tremor. Mov Disord 2014; 29:953-9. [DOI: 10.1002/mds.25884] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/28/2014] [Accepted: 03/06/2014] [Indexed: 11/05/2022] Open
Affiliation(s)
- K. Amande M. Pauls
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
| | - Sven Hammesfahr
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
| | - Elena Moro
- Division of Neurology; Toronto Western Hospital, University of Toronto; Toronto Canada
| | - A. Peter Moore
- The Walton Centre NHS Foundation Trust; Liverpool United Kingdom
| | - Ellen Binder
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
- Cognitive Neuroscience; Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Jülich Germany
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery; Uniklinik Köln, University of Cologne; Cologne Germany
| | - Gereon R. Fink
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
- Cognitive Neuroscience; Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Jülich Germany
| | - Volker Sturm
- Department of Stereotaxy and Functional Neurosurgery; Uniklinik Köln, University of Cologne; Cologne Germany
| | - Joachim K. Krauss
- Department of Neurosurgery; Medical School Hannover; Hannover Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery; Uniklinik Köln, University of Cologne; Cologne Germany
| | - Lars Timmermann
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
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17
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Hunsche S, Sauner D, Runge MJR, Lenartz D, El Majdoub F, Treuer H, Sturm V, Maarouf M. Tractography-guided stimulation of somatosensory fibers for thalamic pain relief. Stereotact Funct Neurosurg 2013; 91:328-34. [PMID: 23969597 DOI: 10.1159/000350024] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 02/04/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The spinothalamocortical tract (STC) is seen as a neural tract responsible for or involved in the generation or transmission of thalamic pain. Either the thalamus itself or the posterior limb of the internal capsule (PLIC) are targets for deep brain stimulation (DBS) in patients with thalamic pain, but due to its low contrast, conventional MRI cannot visualize the STC directly. OBJECTIVES To show the feasibility of integrating diffusion tensor imaging-based tractography into the stereotactic treatment planning for identification of an object-oriented lead trajectory that allows STC-DBS with multiple electrode contacts. METHODS Diffusion tensor imaging was performed in 4 patients with thalamic pain. The STC was modeled and integrated into the stereotactic treatment planning for DBS. DBS-lead implantation was done according to trajectory planning along the modeled STC at the level of the PLIC. RESULTS After implantation, electrode stimulation was possible over a length of more than 20 mm with a tractography-based trajectory along the PLIC part of the STC. After a follow-up of 12 months, pain relief of more than 40% was achieved in 3 of 4 patients with rating on a visual analogue scale. In 1 patient, stimulation failed to reach any long-lasting positive effects. CONCLUSIONS Integrating tractography data into stereotactic planning of DBS in thalamic pain is technically feasible. It can be used to identify a lead trajectory that allows for multiple contact stimulation along the STC at the level of the PLIC. Due to long-lasting positive stimulation effect, tractography-guided stimulation of sensory fibers seems to be beneficial for thalamic pain relief.
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Affiliation(s)
- Stefan Hunsche
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
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18
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Molcanyi M, Bosche B, Kraitsy K, Patz S, Zivcak J, Riess P, El Majdoub F, Hescheler J, Goldbrunner R, Schäfer U. Pitfalls and fallacies interfering with correct identification of embryonic stem cells implanted into the brain after experimental traumatic injury. J Neurosci Methods 2013; 215:60-70. [PMID: 23454685 DOI: 10.1016/j.jneumeth.2013.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
Abstract
Cell-therapy was proposed to be a promising tool in case of death or impairment of specific cell types. Correct identification of implanted cells became crucial when evaluating the success of transplantation therapy. Various methods of cell labeling have been employed in previously published studies. The use of intrinsic signaling of green fluorescent protein (GFP) has led to a well known controversy in the field of cardiovascular research. We encountered similar methodological pitfalls after transplantation of GFP-transfected embryonic stem cells into rat brains following traumatic brain injury (TBI). As the identification of implanted graft by intrinsic autofluorescence failed, anti-GFP labeling coupled to fluorescent and conventional antibodies was needed to visualize the implanted cells. Furthermore, different cell types with strong intrinsic autofluorescence were found at the sites of injury and transplantation, thus mimicking the implanted stem cells. GFP-positive stem cells were correctly localized, using advanced histological techniques. The activation of microglia/macrophages, accompanying the transplantation post TBI, was shown to be a significant source of artefacts, interfering with correct identification of implanted stem cells. Dependent on the strategy of stem cell tracking, the phagocytosis of implanted cells as observed in this study, might also impede the interpretation of results. Critical appraisal of previously published data as well as a review of different histological techniques provide tools for a more accurate identification of transplanted stem cells.
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Affiliation(s)
- Marek Molcanyi
- Clinic of Neurosurgery, University of Cologne, Kerpener Strasse 62, 50937 Köln, Germany
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Bosche B, Molcanyi M, Noll T, Kochanek M, Kraus B, Rieger B, El Majdoub F, Dohmen C, Löhr M, Goldbrunner R, Brinker G. Occurrence and recurrence of spontaneous chronic subdural haematoma is associated with a factor XIII deficiency. Clin Neurol Neurosurg 2013; 115:13-8. [DOI: 10.1016/j.clineuro.2012.03.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/12/2012] [Accepted: 03/25/2012] [Indexed: 12/22/2022]
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Kickingereder P, Maarouf M, El Majdoub F, Fuetsch M, Lehrke R, Wirths J, Luyken K, Schomaecker K, Treuer H, Voges J, Sturm V. Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for treatment of cystic craniopharyngiomas in 53 patients. J Neurooncol 2012; 109:365-74. [DOI: 10.1007/s11060-012-0902-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 05/28/2012] [Indexed: 11/28/2022]
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El Majdoub F, Blau T, Hoevels M, Bührle C, Deckert M, Treuer H, Sturm V, Maarouf M. Papillary tumors of the pineal region: a novel therapeutic option-stereotactic 125iodine brachytherapy. J Neurooncol 2012; 109:99-104. [PMID: 22528796 DOI: 10.1007/s11060-012-0870-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 03/31/2012] [Indexed: 11/30/2022]
Abstract
We evaluated the efficacy of interstitial brachytherapy (IBT) using (125)Iodine ((125)I) seeds for treatment of papillary tumors of the pineal region. Between September 2003 and September 2010, four patients (M/F = 2/2; median age, 57.3 years; range 29.2-69.1 years) with papillary tumors of the pineal region underwent IBT using (125)I seeds. Before brachytherapy two patients underwent endoscopic ventriculo-cisternotomy, because of occlusive hydrocephalus, and subsequent microsurgical resection was performed on one; three patients were primarily treated with IBT. Median tumor volume was 3.3 ml (range 1.6-4 ml), the tumor surface dose ranged between 50 and 65 Gy. For three patients the seeds were implanted permanently whereas one patient received temporary implants (28 days). The median follow-up time was 53.6 months (range 13-103.4 months). After brachytherapy, follow-up MR images revealed complete remission in one patient, partial remission in two, and stable disease in the remaining patient. Neurological status improved in all patients (reduced headache and nausea/vomiting for four patients; improvement of oculomotor dysfunction for two of three patients partially and for one of three patients completely). Neither treatment-related morbidity nor mortality was observed. Our results are indicative of good local control of papillary tumors of the pineal region after IBT, without treatment-related morbidity.
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Affiliation(s)
- Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpenerstrasse 62, 50937, Cologne, Germany.
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El Majdoub F, Elawady M, Bührle C, El-Khatib M, Hoevels M, Treuer H, Müller RP, Sturm V, Maarouf M. μMLC-LINAC radiosurgery for intracranial meningiomas of complex shape. Acta Neurochir (Wien) 2012; 154:599-604. [PMID: 22286691 DOI: 10.1007/s00701-012-1278-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 01/10/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND We present the long-term results of a consecutive series of patients with meningiomas treated by LINAC-radiosurgery using the micro-multi-leaf collimator technique (μMLC). METHODS Between May 2001 and July 2009, 78 patients (m: f = 024:54; median age, 56.8 years; range, 20.1-81 years) with 87 intracranial meningiomas (78 WHO I, seven WHO II, two WHO III) were treated with μMLC-LINAC radiosurgery at our institution, either as a primary or salvage treatment following one or more microsurgical procedures. Fifty-eight of 87 tumors (66.7%) were located in the skull base. The remaining 29 meningiomas (33.3%) were located in the convexity of the brain. The median tumor volume was 4.8 ml (range, 0.2-18.3 ml). The median tumor surface dose, maximal dose, and therapeutic isodose were 12 Gy, 16 Gy, and 75%, respectively. RESULTS For retrospective evaluation, we included 70 patients (78 tumors) with a minimum radiological follow-up of 24 months. After a median follow-up of 79.7 months (range, 24.2-109.1 months), 24 patients (34.3%) improved in their clinical status (paresis of N. abducens 18/48, facial paresis 4/8, and hemiparesis 2/9), 41 patients remained stable (58.6%), three patients had treatment-related temporary complaints (4.3%); two patients developed vertigo, and one had a left-sided hemihypesthesia. All complaints recovered completely after steroid medication within 2 weeks. Two patients (2.8%) developed permanent trigeminal neuralgia. Follow-up MR images showed a partial remission in 21 tumors (26.9%) and a stable tumor size in 55 cases (70.5%). Two patients with high-grade meningiomas showed a tumor progression (one WHO II and one WHO III meningioma). At the end of follow-up (July 2010), the actuarial 5- and 9-year progression-free survival after radiosurgery were 98 and 96%, respectively. There was no treatment-related mortality. CONCLUSIONS LINAC radiosurgery using a micro multi-leaf collimator for complex shaped intracranial meningiomas is effective yielding a high local tumor control, whereas the treatment-related morbidity remains low.
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Affiliation(s)
- Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Germany
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El-Khatib M, El Majdoub F, Hoevels M, Kocher M, Müller RP, Steiger HJ, Sturm V, Maarouf M. Stereotactic LINAC radiosurgery for incompletely resected or recurrent atypical and anaplastic meningiomas. Acta Neurochir (Wien) 2011; 153:1761-7. [PMID: 21706274 DOI: 10.1007/s00701-011-1073-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 06/09/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND The optimal management of subtotally resected or recurrent malignant meningiomas remains controversial. We evaluated the efficacy of linear accelerator (LINAC) radiosurgery for atypical and anaplastic meningiomas after incomplete resection or treatment of recurrences. METHODS Between August 1990 and December 2003, 16 patients with 28 meningiomas WHO II and III were treated by stereotactic LINAC radiosurgery at our institution. The median radiological follow-up was 60.3 months, respectively (range: 7.2-173.9 months). Fourteen tumors in nine patients were classified as WHO II and 14 tumors in seven patients as WHO III. The median surface dose was 14 Gy (range: 10-15 Gy) with a median tumor volume of 4.8 ml (range: 0.51-51.4 ml). RESULTS Clinical condition improved in four patients, remained unchanged in nine and deteriorated in one. Tumor shrinkage was seen in eight of 28 meningiomas and a stable disease in 12. Eight of 28 meningiomas showed local tumor progression. The overall tumor control rate (TCR) was 84%, 70%, 70% after 3, 5, 10 years. According to grading the corresponding TCR after 3, 5, 10 years was 91%, 81%, 81% for grade II and 77%, 60%, 60% for grade III meningiomas. Overall progression-free survival (PFS) was 74%, 67%, 58% after 3, 5, 10 years. According to grading the PFS after 3, 5, 10 years was 88%, 75%, 75% for grade II meningiomas and 57%, 57%, 43% for grade III meningiomas. CONCLUSION Our results show the efficacy and safety of LINAC radiosurgery for incompletely resected or recurrent malignant meningiomas with a relatively high local tumor control and low morbidity.
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Affiliation(s)
- Mustapha El-Khatib
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Germany
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Maarouf M, El Majdoub F, Bührle C, Voges J, Lehrke R, Kocher M, Hunsche S, Treuer H, Sturm V. Pineal parenchymal tumors. Management with interstitial iodine-125 radiosurgery. Strahlenther Onkol 2010; 186:127-34. [PMID: 20339824 DOI: 10.1007/s00066-010-2096-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 11/26/2009] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate the efficacy of interstitial radiosurgery (IRS) for pineal parenchymal tumors (PPTs). PATIENTS AND METHODS 18 consecutively admitted patients (twelve male and six female, age range 6-68 years, median age 34 years) with PPTs (eight pineocytomas, ten malignant PPTs) were treated at the authors' institution with IRS using stereotactically guided iodine-125 seed implantation ((125)I-IRS) as either primary or salvage therapy. The cumulative tumor surface dose ranged from 40 to 64 Gy. Adjuvant radiotherapy of the whole brain or the craniospine was done in patients with grade III and grade IV PPT. The median follow-up period was 57.4 months (range 6-134 months). RESULTS Overall actuarial 5- and 8-year survival rates after IRS were 100% and 86% for pineocytomas, and the overall actuarial 5-year survival rate was 78% for high-grade PPTs. Follow-up magnetic resonance imaging showed complete remission in 72% (13/18) and partial remission in 28% (5/18) of the cases. One patient developed an out-of-field relapse 4 years after partial remission of a pineocytoma, which had already been treated with IRS. There was no treatment-related mortality. Treatment-related morbidity occurred in two patients only. CONCLUSION This study indicates that stereotactic (125)I-IRS for the management of PPTs is quite efficient and safe. Due to the low rate of side effects, IRS may develop into an attractive alternative to microsurgery in de novo diagnosed pineocytomas. In malignant PPTs, IRS may be routinely applied in a multimodality treatment schedule supplementary to conventional irradiation.
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Affiliation(s)
- Mohammad Maarouf
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Kerpener Strasse 62, Köln, Germany.
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El Majdoub F, Brunn A, Berthold F, Sturm V, Maarouf M. Stereotactic interstitial radiosurgery for intracranial Rosai-Dorfman disease. A novel therapeutic approach. Strahlenther Onkol 2009; 185:109-12. [PMID: 19240997 DOI: 10.1007/s00066-009-1911-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 10/22/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rosai-Dorfman disease is an idiopathic, histoproliferative disorder characterized by massive painless lymphadenopathy. The favorable treatment of Rosai-Dorfman disease affecting the central nervous system is surgical resection. Histological and immunohistochemical confirmation is essential for a definitive diagnosis. CASE REPORT The authors report on a 10-year-old patient with Rosai-Dorfman disease of the central nervous system who presented with increased intracranial pressure. She was treated by stereotactic interstitial irradiation using iodine-125 seeds (interstitial radiosurgery). RESULT Stereotactic surgery was performed without complications. The patient recovered well to a normal neurologic status. MR images showed a complete remission 49 months after treatment. CONCLUSION The presented case demonstrates the high efficacy and safety of interstitial irradiation for intracranial Rosai-Dorfman disease. Hence, interstitial radiosurgery could be an appropriate therapeutic option for high-risk resectable intracranial Rosai-Dorfman disease.
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Affiliation(s)
- Faycal El Majdoub
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Köln, Germany
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