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Coucke B, De Vleeschouwer S, van Loon J, Van Calenbergh F, Van Hoylandt A, Van Gerven L, Theys T. Leukocyte- and platelet-rich fibrin in cranial surgery: a single-blinded, prospective, randomized controlled noninferiority trial. J Neurosurg 2024:1-9. [PMID: 38394657 DOI: 10.3171/2023.12.jns232125] [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: 09/15/2023] [Accepted: 12/05/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE CSF leakage is a major complication after cranial surgery, and although fibrin sealants are widely used for reinforcing dural closure, concerns exist regarding their safety, efficacy, and cost. Leukocyte- and platelet-rich fibrin (L-PRF), an autologous platelet concentrate, is readily available and inexpensive, making it a cost-effective alternative for commercially available fibrin sealants. This study aimed to demonstrate the noninferiority of L-PRF compared with commercially available fibrin sealants in preventing postoperative CSF leakage in supra- and infratentorial cranial surgery, with secondary outcomes focused on CSF leakage risk factors and adverse events. METHODS In a single-blinded, prospective, randomized controlled interventional trial conducted at a neurosurgery department of a tertiary care center (UZ Leuven, Belgium), patients undergoing elective cranial neurosurgery were randomly assigned to receive either L-PRF (active treatment) or commercially available fibrin sealants (control) for dural closure in a 1:1 ratio. RESULTS Among 350 included patients, 328 were analyzed for the primary endpoint (44.5% male, mean age 52.3 ± 15.1 years). Six patients (5 in the control group, 1 in the L-PRF group) presented with CSF leakage requiring any intervention (relative risk [RR] 0.20, one-sided 95% CI -∞ to 1.02, p = 0.11), confirming noninferiority. Of these 6 patients, 1 (in the control group) presented with CSF leakage requiring revision surgery. No risk factors for reconstruction failure in combination with L-PRF were identified. RRs for adverse events such as infection (0.72, 95% CI -∞ to 1.96) and meningitis (0.36, 95% CI -∞ to 1.25) favored L-PRF treatment, although L-PRF treatment showed slightly more bleeding events (1.44, 95% CI -∞ to 4.66). CONCLUSIONS Dural reinforcement with L-PRF proved noninferior to commercially available fibrin sealants, with no safety issues. Introducing L-PRF to standard clinical practice could result in important cost savings due to accessibility and lower cost. Clinical trial registration no.: NCT03812120 (ClinicalTrials.gov).
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Affiliation(s)
- Birgit Coucke
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven
- 2Department of Microbiology, Immunology, & Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven
| | - Steven De Vleeschouwer
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven
- 3Department of Neurosurgery, UZ Leuven
| | - Johannes van Loon
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven
- 3Department of Neurosurgery, UZ Leuven
| | - Frank Van Calenbergh
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven
- 3Department of Neurosurgery, UZ Leuven
| | | | - Laura Van Gerven
- 2Department of Microbiology, Immunology, & Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven
- 4Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven; and
- 5Department of Neurosciences, Laboratory of Experimental Otorhinolaryngology, KU Leuven, Belgium
| | - Tom Theys
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven
- 3Department of Neurosurgery, UZ Leuven
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Coucke B, Van Hoylandt A, Jorissen M, Meulemans J, Decramer T, van Loon J, Vander Poorten V, Theys T, Van Gerven L. Leukocyte- and platelet-rich fibrin in endoscopic endonasal skull base reconstruction: study protocol for a multicenter prospective, parallel-group, single-blinded randomized controlled non-inferiority trial. Trials 2023; 24:488. [PMID: 37525278 PMCID: PMC10388446 DOI: 10.1186/s13063-023-07492-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/01/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Recent advances in endoscopic endonasal transsphenoidal approaches (EETA) for skull base lesions have resulted in a significant increase in extent and complexity of skull base defects, demanding more elaborate and novel reconstruction techniques to prevent cerebrospinal fluid (CSF) leakage and to improve healing. Currently, commercially available fibrin sealants are often used to reinforce the skull base reconstruction. However, problems have been reported regarding hypersensitivity reactions, efficacy, and costs. This trial aims to investigate autologous leukocyte- and platelet-rich fibrin (L-PRF) membranes as an alternative for commercially available fibrin glues in EETA-related skull base reconstruction reinforcement. METHODS/DESIGN This multicenter, prospective randomized controlled trial aims to demonstrate non-inferiority of L-PRF membranes compared to commercially available fibrin sealants in EETA cases (1) without intra-operative CSF-leak as dural or sellar floor closure reinforcement and (2) in EETA cases with intra-operative CSF-leak (or very large defects) in which a classic multilayer reconstruction has been made, as an additional sealing. The trial includes patients undergoing EETA in three different centers in Belgium. Patients are randomized in a 1:1 fashion comparing L-PRF with commercially available fibrin sealants. The primary endpoint is postoperative CSF leakage. Secondary endpoints are identification of risk factors for reconstruction failure, assessment of rhinological symptoms, and interference with postoperative imaging. Additionally, a cost-effectiveness analysis is performed. DISCUSSION With this trial, we will evaluate the safety and efficacy of L-PRF compared to commercially available fibrin sealants. TRIAL REGISTRATION ClinicalTrials.gov NCT03910374. Registered on 10 April 2019.
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Affiliation(s)
- Birgit Coucke
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Department of Neurosciences, KU Leuven, Belgium.
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium.
| | | | - Mark Jorissen
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Thomas Decramer
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Department of Neurosciences, KU Leuven, Belgium
- Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Johannes van Loon
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Department of Neurosciences, KU Leuven, Belgium
- Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Tom Theys
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Department of Neurosciences, KU Leuven, Belgium
- Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Laura Van Gerven
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
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Coucke B, Van Hoylandt A, van Loon J, Van Calenbergh F, Van Gerven L, Theys T. Leukocyte- and platelet-rich fibrin in cranial surgery: study protocol for a prospective, parallel-group, single-blinded randomized controlled non-inferiority trial {1}. Trials 2023; 24:219. [PMID: 36959672 PMCID: PMC10034240 DOI: 10.1186/s13063-023-07252-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND CSF leakage is a major complication after cranial surgery, thus, adequate dural closure must be performed. Commercially available fibrin sealants are currently considered the gold standard for dural closure, but problems have been reported regarding safety, efficacy, and costs. This trial aims to investigate autologous leukocyte- and platelet-rich fibrin (L-PRF) as an alternative to commercially available fibrin sealants. METHODS/DESIGN This single-blinded, prospective randomized controlled interventional trial aims to demonstrate the non-inferiority of L-PRF compared to commercially available fibrin sealants for dural closure. This trial will include patients undergoing cranial neurosurgery (supratentorial and infratentorial) with intentional opening of the dura. Patients are randomized in a 1:1 fashion comparing L-PRF to commercially available fibrin sealants. The primary endpoint is postoperative CSF leakage within 12 weeks after surgery. Secondary endpoints are complications such as bleeding or wound infections. Additionally, a cost-effectiveness analysis is performed. DISCUSSION With this trial, we will evaluate the safety and efficiency of L-PRF compared to commercially available fibrin sealants. TRIAL REGISTRATION ClinicalTrials.gov NCT03812120. Registered on 22 January 2019.
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Affiliation(s)
- Birgit Coucke
- Research Group Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, Department of Neurosciences, KU Leuven, Leuven, Belgium.
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium.
| | - Anaïs Van Hoylandt
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Johannes van Loon
- Research Group Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van Calenbergh
- Research Group Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Laura Van Gerven
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven, Belgium
- Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Tom Theys
- Research Group Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Duerinck J, Van Der Veken J, Schuind S, Van Calenbergh F, van Loon J, Du Four S, Debacker S, Costa E, Raftopoulos C, De Witte O, Cools W, Buyl R, Van Velthoven V, D'Haens J, Bruneau M. Randomized Trial Comparing Burr Hole Craniostomy, Minicraniotomy, and Twist Drill Craniostomy for Treatment of Chronic Subdural Hematoma. Neurosurgery 2022; 91:304-311. [PMID: 35593710 DOI: 10.1227/neu.0000000000001997] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The mainstay of treatment for symptomatic or large chronic subdural hematoma (CSDH) is surgery, but controversy still exists regarding the best surgical technique. Three different techniques are commonly used: burr hole craniostomy (BHC), minicraniotomy (MC), and twist drill craniostomy (TDC). OBJECTIVE To determine which surgical technique for drainage of CSDH offers best results. METHODS We set up a multicenter prospective randomized trial (Comparison of Chronic Subdural Hematoma Treatment [COMPACT] trial) comparing BHC, MC, and TDC for the surgical treatment of CSDH. The primary end point was reoperation rate, and secondary end points included complication rates and clinical outcome. Patients were considered to have good outcome when they did not undergo reoperation, suffered no surgical or medical complication, and had no related mortality. Clinical outcome was also evaluated by evolution of the Markwalder score and the modified Rankin score. RESULTS Two-hundred forty-five patients were included in the final analysis: 79 BHC, 84 MC, and 82 TDC. Mean duration of surgery was shorter for TDC than for BHC and MC (P < .001). Reoperation rate was 7.6% for BHC, 13.1% for MC, and 19.5% for TDC (P = .07). This trend toward better results for BHC was not statistically significant in logistic regression analysis. The proportion of patients with good outcome was 78.5% for BHC group, 76.2% for MC, and 69.5% for TDC (P = .4). Evolution of the Markwalder score and modified Rankin score were not significantly different between treatment groups. CONCLUSION All 3 techniques are effective at treating patients with CSDH with eventual 6-month outcome being similar. Although not reaching statistical significance in our study, BHC offers the lowest recurrence rate combined with manageable complication rate.
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Affiliation(s)
| | - Jorn Van Der Veken
- Department of Neurosurgery, UZ Brussel, Brussels, Belgium.,Current affiliation: Department of Neurosurgery, Flinders Medical Centre, Adelaide, Australia
| | - Sophie Schuind
- Department of Neurosurgery, ULB Erasme, Brussels, Belgium
| | | | | | | | - Servaes Debacker
- Faculty of Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emmanuel Costa
- Department of Neurosurgery, UCL Saint-Luc, Brussels, Belgium
| | | | | | - Wilfried Cools
- Interfaculty Center Data Processing and Statistics, UZ Brussel/Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronald Buyl
- Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Jean D'Haens
- Department of Neurosurgery, UZ Brussel, Brussels, Belgium
| | - Michaël Bruneau
- Department of Neurosurgery, ULB Erasme, Brussels, Belgium.,Current affiliation: Department of Neurosurgery, UZ Brussel, Brussels, Belgium
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Coucke B, Van Gerven L, De Vleeschouwer S, Van Calenbergh F, van Loon J, Theys T. Correction to: The incidence of postoperative cerebrospinal fluid leakage after elective cranial surgery: a systematic review. Neurosurg Rev 2022; 45:2501. [PMID: 35513739 DOI: 10.1007/s10143-022-01797-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Birgit Coucke
- Department of Neurosciences, Laboratory for Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute (LBI), KU Leuven, Box 811, Herestraat 49, 3000, Leuven, Belgium. .,Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.
| | - Laura Van Gerven
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium
| | - Steven De Vleeschouwer
- Department of Neurosciences, Laboratory for Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute (LBI), KU Leuven, Box 811, Herestraat 49, 3000, Leuven, Belgium.,Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van Calenbergh
- Department of Neurosciences, Laboratory for Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute (LBI), KU Leuven, Box 811, Herestraat 49, 3000, Leuven, Belgium.,Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosciences, Laboratory for Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute (LBI), KU Leuven, Box 811, Herestraat 49, 3000, Leuven, Belgium.,Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- Department of Neurosciences, Laboratory for Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute (LBI), KU Leuven, Box 811, Herestraat 49, 3000, Leuven, Belgium.,Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Sprenghers L, Lemmens R, van Loon J. Usefulness of intraoperative monitoring in microvascular decompression for hemifacial spasm: a systematic review and meta-analysis. Br J Neurosurg 2022; 36:346-357. [PMID: 35313771 DOI: 10.1080/02688697.2022.2049701] [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] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To review the diagnostic accuracy and possible added value of Brainstem Auditory Evoked Potentials (BAEP) monitoring and Lateral Spread Response (LSR) monitoring in microvascular decompression surgery for hemifacial spasms. METHODS For this systematic review we followed the PRISMA guidelines. We searched different databases and bibliographies of articles. We included studies on BAEP and LSR monitoring that reported data on hearing outcome or efficacy. Selected studies were assessed for bias using the MINORS tool. RESULTS 64 articles were selected for qualitative synthesis, 42 met inclusion criteria for meta-analysis. The overall incidence of hearing loss was 3.4%. For BAEP monitoring AUC and pooled OR with 95% confidence interval were 0.911 (0.753-0.933) and 7.99 (3.85-16.60) respectively. Short-term data on LSR monitoring showed an overall spasm relief rate of 89% with pooled OR, sensitivity and specificity with a 95% confidence interval of 8.80 (4.82-16.08), 0.911 (0.863-0.943) and 0.451 (0.342-0.564) respectively. Long-term data on LSR monitoring showed an overall spasm relief rate of 95% with pooled OR, sensitivity and specificity with a 95% confidence interval of 4.06 (2.15-7.64), 0.871 (0.817-0.911) and 0.39 (0.294-0.495) respectively. CONCLUSION The alarm criteria, a wave V latency prolongation of 1ms or a wave V amplitude decrement of 50%, proposed by the 'American Clinical Neurophysiology Society' are a sensitive predictor for postoperative hearing loss. Other BAEP wave changes, for example, complete loss of wave V, are more specific but correspond to irreversible damage and are therefore not useful as warning criteria. LSR monitoring has high diagnostic accuracy at short-term follow-up. At long-term follow-up, diagnostic accuracy decreases because most patients get spasm relief regardless of their LSR status. LSR persistence after surgery has a good long-term outcome, as long as an extensive exploration of the facial nerve has been performed.
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Affiliation(s)
| | - Robin Lemmens
- Department of Neurology, University Hospital Leuven, University of Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospital Leuven and Laboratory of Experimental Neurosurgery and Neuroanatomy, University of Leuven, Leuven, Belgium
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Cornelissen SA, Heye S, Maleux G, Daenens K, van Loon J, De Vleeschouwer S. Treatment of ruptured subclavian steal flow-related vertebrobasilar junction aneurysms: Case report on surgical and endovascular considerations from two cases. Int J Surg Case Rep 2022; 90:106744. [PMID: 34991048 PMCID: PMC8741505 DOI: 10.1016/j.ijscr.2021.106744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Subclavian steal phenomenon causes retrograde flow through the vertebral artery, ipsilateral to the affected subclavian artery, which rarely leads to flow-related vertebrobasilar junction (VBJ) aneurysms. Case descriptions We describe two cases of subarachnoid hemorrhage from such ruptured aneurysms in which the retrograde flow direction in the vertebral artery complicated surgical and endovascular treatment. Discussion Reversed flow in the vertebral artery, ipsilateral to the stenotic subclavian artery leads to a lack of proximal control in surgical clipping of these VBJ aneurysms and jeopardizes stability of coil and stent placement in endovascular aneurysm treatments in this setting. Conclusion: From these 2 experiences over 7 years, treatment considerations emerged for future cases. Subclavian steal phenomenon can be associated with flow-related cerebral aneurysms. These aneurysms are located at the vertebrobasilar junction. If ruptured, treatment of these aneurysms is challenging. Reversed vertebral artery flow complicates any type of aneurysm repair. Recanalization of stenotic subclavian artery contributes sustainable solutions.
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Smeijers S, van Loon J, Maes H, Theys T. A most unusual diagnosis via an unusual route: tunneling through Meckel's cave. Br J Neurosurg 2021:1-3. [PMID: 34918614 DOI: 10.1080/02688697.2021.2016618] [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: 04/17/2021] [Revised: 08/23/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
A 73-year-old woman presented with progressive symptoms of cranial nerve (V, VI, VIII) palsies, ataxia and gait disturbance due to a rapidly growing atypical trigeminocavernous mass. Percutaneous stereotactic transoval biopsy via Hartel's route revealed an exceedingly rare solitary trigeminal metastasis of a clear cell renal cell carcinoma, treated 16 years earlier without any other evidence of systemic disease. A minimally invasive, intra-operatively navigated approach is presented with detailed description of the stereotactic technique and technical considerations. The transoval biopsy expands the surgical repertoire for atypical Meckel cave lesions with diagnostic uncertainty. A frameless navigated technique should be state-of-the-art in contemporary neurosurgical practice.
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Affiliation(s)
- Steven Smeijers
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Honorine Maes
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Decramer T, Premereur E, Zhu Q, Van Paesschen W, van Loon J, Vanduffel W, Taubert J, Janssen P, Theys T. Single-Unit Recordings Reveal the Selectivity of a Human Face Area. J Neurosci 2021; 41:9340-9349. [PMID: 34732521 PMCID: PMC8580152 DOI: 10.1523/jneurosci.0349-21.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022] Open
Abstract
The exquisite capacity of primates to detect and recognize faces is crucial for social interactions. Although disentangling the neural basis of human face recognition remains a key goal in neuroscience, direct evidence at the single-neuron level is limited. We recorded from face-selective neurons in human visual cortex in a region characterized by functional magnetic resonance imaging (fMRI) activations for faces compared with objects. The majority of visually responsive neurons in this fMRI activation showed strong selectivity at short latencies for faces compared with objects. Feature-scrambled faces and face-like objects could also drive these neurons, suggesting that this region is not tightly tuned to the visual attributes that typically define whole human faces. These single-cell recordings within the human face processing system provide vital experimental evidence linking previous imaging studies in humans and invasive studies in animal models.SIGNIFICANCE STATEMENT We present the first recordings of face-selective neurons in or near an fMRI-defined patch in human visual cortex. Our unbiased multielectrode array recordings (i.e., no selection of neurons based on a search strategy) confirmed the validity of the BOLD contrast (faces-objects) in humans, a finding with implications for all human imaging studies. By presenting faces, feature-scrambled faces, and face-pareidolia (perceiving faces in inanimate objects) stimuli, we demonstrate that neurons at this level of the visual hierarchy are broadly tuned to the features of a face, independent of spatial configuration and low-level visual attributes.
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Affiliation(s)
- Thomas Decramer
- Research Group Experimental Neurosurgery and Neuroanatomy, Katholieke Universiteit Leuven, Leuven Brain Institute, 3000 Leuven, Belgium
- Departments of Neurosurgery and
- Laboratory for Neuro- and Psychophysiology, Katholieke Universiteit Leuven, Leuven Brain Institute, 3000 Leuven, Belgium
| | - Elsie Premereur
- Laboratory for Neuro- and Psychophysiology, Katholieke Universiteit Leuven, Leuven Brain Institute, 3000 Leuven, Belgium
| | - Qi Zhu
- Laboratory for Neuro- and Psychophysiology, Katholieke Universiteit Leuven, Leuven Brain Institute, 3000 Leuven, Belgium
| | - Wim Van Paesschen
- Neurology, University Hospitals Leuven, 3000 Leuven, Belgium
- Laboratory for Epilepsy Research, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Johannes van Loon
- Research Group Experimental Neurosurgery and Neuroanatomy, Katholieke Universiteit Leuven, Leuven Brain Institute, 3000 Leuven, Belgium
- Departments of Neurosurgery and
| | - Wim Vanduffel
- Laboratory for Neuro- and Psychophysiology, Katholieke Universiteit Leuven, Leuven Brain Institute, 3000 Leuven, Belgium
| | - Jessica Taubert
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, Maryland 20892
| | - Peter Janssen
- Laboratory for Neuro- and Psychophysiology, Katholieke Universiteit Leuven, Leuven Brain Institute, 3000 Leuven, Belgium
| | - Tom Theys
- Research Group Experimental Neurosurgery and Neuroanatomy, Katholieke Universiteit Leuven, Leuven Brain Institute, 3000 Leuven, Belgium
- Departments of Neurosurgery and
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Oosterbos C, Decramer T, Rummens S, Weyns F, Dubuisson A, Ceuppens J, Schuind S, Groen J, van Loon J, Rasulic L, Lemmens R, Theys T. Evidence in peroneal nerve entrapment: A scoping review. Eur J Neurol 2021; 29:665-679. [PMID: 34662481 DOI: 10.1111/ene.15145] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Daily management of patients with foot drop due to peroneal nerve entrapment varies between a purely conservative treatment and early surgery, with no high-quality evidence to guide current practice. Electrodiagnostic (EDX) prognostic features and the value of imaging in establishing and supplementing the diagnosis have not been clearly established. METHODS We performed a literature search in the online databases MEDLINE, Embase, and the Cochrane Library. Of the 42 unique articles meeting the eligibility criteria, 10 discussed diagnostic performance of imaging, 11 reported EDX limits for abnormal values and/or the value of EDX in prognostication, and 26 focused on treatment outcome. RESULTS Studies report high sensitivity and specificity of both ultrasound (varying respectively from 47.1% to 91% and from 53% to 100%) and magnetic resonance imaging (MRI; varying respectively from 31% to 100% and from 73% to 100%). One comparative trial favoured ultrasound over MRI. Variable criteria for a conduction block (>20%-≥50) were reported. A motor conduction block and any baseline compound motor action potential response were identified as predictors of good outcome. Based predominantly on case series, the percentage of patients with good outcome ranged 0%-100% after conservative treatment and 40%-100% after neurolysis. No study compared both treatments. CONCLUSIONS Ultrasound and MRI have good accuracy, and introducing imaging in the standard diagnostic workup should be considered. Further research should focus on the role of EDX in prognostication. No recommendation on the optimal treatment strategy of peroneal nerve entrapment can be made, warranting future randomized controlled trials.
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Affiliation(s)
- Christophe Oosterbos
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium.,Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| | - Thomas Decramer
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium.,Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| | - Sofie Rummens
- Department of Physical Medicine and Rehabilitation, University Hospitals of Leuven, Leuven, Belgium.,Locomotor and Neurological Disorders, Catholic University of Leuven, Leuven, Belgium
| | - Frank Weyns
- Department of Neurosurgery, East Limburg Hospital, Genk, Belgium.,Neurosciences, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Annie Dubuisson
- Department of Neurosurgery, University Hospitals of Liège, Liège, Belgium
| | - Jeroen Ceuppens
- Department of Neurosurgery, Groeninge General Hospital, Kortrijk, Belgium
| | - Sophie Schuind
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - Justus Groen
- Nerve Centre, University of Leiden, Leiden, the Netherlands
| | - Johannes van Loon
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium.,Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| | - Lukas Rasulic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, Catholic University of Leuven, Leuven, Belgium.,Centre for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals of Leuven, Leuven, Belgium
| | - Tom Theys
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium.,Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
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11
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Van Gerven L, Qian Z, Starovoyt A, Jorissen M, Meulemans J, van Loon J, De Vleeschouwer S, Lambert J, Bex M, Vander Poorten V. Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients. Front Oncol 2021; 11:643550. [PMID: 34026618 PMCID: PMC8138557 DOI: 10.3389/fonc.2021.643550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/18/2020] [Accepted: 04/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The endoscopic endonasal transsphenoidal approach (EETA) is an established technique for the resection of a large variety of benign sellar and suprasellar lesions, mostly pituitary adenomas. It has clear advantages over the microscopic approach, like a superior close-up view of the relevant anatomy and the tumor-gland interface, an enlarged working angle, as well as an increased panoramic vision inside the surgical area. We have been performing the EETA for over a decade, and this study will focus on perioperative and postoperative outcomes and complications and their association with the learning curve. MATERIAL AND METHODS All patients in our tertiary referral center (n = 369) undergoing an EETA for a lesion of the sellar and suprasellar region between January 1st 2008 and December 31st 2018 were included, and data were retrospectively retrieved from the electronic patient records. RESULTS Median follow-up after surgery was 55 months. Pituitary adenomas (n = 322) were the most frequent pathology. Headache (43.4%) and loss of vision (29.3%) were the most common presenting symptoms. Median procedure duration was significantly longer during the initial 5 years (106 versus 79 minutes; p <0.0001), but incidence of peri- and postoperative CSF leaks in the early years was not significantly higher. Knosp grade >2 was associated with perioperative CSF leak (p =0.002), and perioperative CSF leak was associated with postoperative CSF leak (p <0.001). Almost all cases of meningitis were preceded by a postoperative CSF leak. In 22.4% of patients, tumor recurrence required additional therapy. Perioperative (iatrogenic) mortality was 0.8%. The overall hospital stay decreased over time from an average of 7 to 5 days, and the case load increased yearly (p =0.015). CONCLUSION The EETA is an excellent technique with complication rates comparable to or even lower than those in large microsurgical series in the literature. EETA has a significant learning curve affecting the procedure duration. Throughout the first 10 years following the transition from the microscopic approach to the EETA in our cohort, the caseload increased and hospital stay was reduced, while no increase in peri- and postoperative complications was observed.
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Affiliation(s)
- Laura Van Gerven
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Otorhinolaryngology, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium
| | - Zhen Qian
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Anastasiya Starovoyt
- Department of Neurosciences, Experimental Otorhinolaryngology, KU Leuven, Leuven, Belgium
| | - Mark Jorissen
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Leuven, Belgium
| | - Steven De Vleeschouwer
- Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Leuven, Belgium
| | - Julie Lambert
- Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Marie Bex
- Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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12
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van Loon J, Verhaar N, van den Berg E, Ross S, de Grauw J. Objective Assessment of Acute Pain in Foals Using a Facial Expression-Based Pain Scale. Animals (Basel) 2020; 10:ani10091610. [PMID: 32927590 PMCID: PMC7552134 DOI: 10.3390/ani10091610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Research has shown that objective assessment of pain in horses can be performed by subjectively scoring facial expressions. So far, no studies have been conducted to develop a pain measuring tool for the assessment of pain in foals. In other species like pigs and sheep, facial expressions have been shown to be good indicators of pain in neonatal animals. In this study, a pain scale that is already available for mature horses (EQUUS-FAP: Equine Utrecht University Scale for Facial Assessment of Pain) was adapted to measure different types of acute pain in neonatal and older foals with acute pain based on facial expressions. The scale was based on a pain scale that has been shown to be useful in mature horses with various types of acute pain (colic, orthopaedic, and head-related pain). This pain scale was tested in 20 patients with different types of acute pain (colic, laminitis, postoperative pain) and 39 healthy control animals. The authors found that the EQUUS-FAP FOAL (Equine Utrecht University Scale for Facial Assessment of Pain in Foals) is a reproducible pain scale that can be used to assess pain in neonatal and older foals. Abstract Pain assessment is very important for monitoring welfare and quality of life in horses. To date, no studies have described pain scales for objective assessment of pain in foals. Studies in other species have shown that facial expression can be used in neonatal animals for objective assessment of acute pain. The aim of the current study was to adapt a facial expression-based pain scale for assessment of acute pain in mature horses for valid pain assessment in foals. The scale was applied to fifty-nine foals (20 patients and 39 healthy controls); animals were assessed from video recordings (30–60 s) by 3 observers, who were blinded for the condition of the animals. Patients were diagnosed with acute health problems by means of clinical examination and additional diagnostic procedures. EQUUS-FAP FOAL (Equine Utrecht University Scale for Facial Assessment of Pain in Foals) showed good inter- and intra-observer reliability (Cronbach’s alpha = 0.95 and 0.98, p < 0.001). Patients had significantly higher pain scores compared to controls (p < 0.001) and the pain scores decreased after treatment with NSAIDs (meloxicam or flunixin meglumine IV) (p < 0.05). Our results indicate that a facial expression-based pain scale could be useful for the assessment of acute pain in foals. Further studies are needed to validate this pain scale.
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Affiliation(s)
- Johannes van Loon
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584CM Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-302531111
| | - Nicole Verhaar
- Clinic for Horses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany;
| | | | - Sarah Ross
- Anglesey Lodge Hospital, The Curragh, Kildare R56 YX98, Ireland;
| | - Janny de Grauw
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584CM Utrecht, The Netherlands;
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13
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Huang YA, Dupont P, Van de Vliet L, Jastorff J, Peeters R, Theys T, van Loon J, Van Paesschen W, Van den Stock J, Vandenbulcke M. Network level characteristics in the emotion recognition network after unilateral temporal lobe surgery. Eur J Neurosci 2020; 52:3470-3484. [PMID: 32618060 DOI: 10.1111/ejn.14849] [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: 10/11/2019] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
The human amygdala is considered a key region for successful emotion recognition. We recently reported that temporal lobe surgery (TLS), including resection of the amygdala, does not affect emotion recognition performance (Journal of Neuroscience, 2018, 38, 9263). In the present study, we investigate the neural basis of this preserved function at the network level. We use generalized psychophysiological interaction and graph theory indices to investigate network level characteristics of the emotion recognition network in TLS patients and healthy controls. Based on conflicting emotion processing theories, we anticipated two possible outcomes: a substantial increase of the non-amygdalar connections of the emotion recognition network to compensate functionally for the loss of the amygdala, in line with basic emotion theory versus only minor changes in network level properties as predicted by psychological construction theory. We defined the emotion recognition network in the total sample and investigated group differences on five network level indices (i.e. characteristic path length, global efficiency, clustering coefficient, local efficiency and small-worldness). The results did not reveal a significant increase in the left or right temporal lobectomy group (compared to the control group) in any of the graph measures, indicating that preserved behavioural emotion recognition in TLS is not associated with a massive connectivity increase between non-amygdalar nodes at network level. We conclude that the emotion recognition network is robust and functionally able to compensate for structural damage without substantial global reorganization, in line with a psychological construction theory.
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Affiliation(s)
- Yun-An Huang
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Patrick Dupont
- Department of Neurosciences, Laboratory for Cognitive Neurology, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Laura Van de Vliet
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jan Jastorff
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Ron Peeters
- Department of Imaging & Pathology, Radiology, KU Leuven, Leuven, Belgium
| | - Tom Theys
- Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Department of Neurosciences, Research Group Experimental Neurology, Laboratory for Epilepsy Research, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jan Van den Stock
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
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Nachtergaele P, Radwan A, Swinnen S, Decramer T, Uytterhoeven M, Sunaert S, van Loon J, Theys T. The temporoinsular projection system: an anatomical study. J Neurosurg 2020; 132:615-623. [DOI: 10.3171/2018.11.jns18679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 11/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEConnections between the insular cortex and the amygdaloid complex have been demonstrated using various techniques. Although functionally well connected, the precise anatomical substrate through which the amygdaloid complex and the insula are wired remains unknown. In 1960, Klingler briefly described the “fasciculus amygdaloinsularis,” a white matter tract connecting the posterior insula with the amygdala. The existence of such a fasciculus seems likely but has not been firmly established, and the reported literature does not include a thorough description and documentation of its anatomy. In this fiber dissection study the authors sought to elucidate the pathway connecting the insular cortex and the mesial temporal lobe.METHODSFourteen brain specimens obtained at routine autopsy were dissected according to Klingler’s fiber dissection technique. After fixation and freezing, anatomical dissections were performed in a stepwise progressive fashion.RESULTSThe insula is connected with the opercula of the frontal, parietal, and temporal lobes through the extreme capsule, which represents a network of short association fibers. At the limen insulae, white matter fibers from the extreme capsule converge and loop around the uncinate fasciculus toward the temporal pole and the mesial temporal lobe, including the amygdaloid complex.CONCLUSIONSThe insula and the mesial temporal lobe are directly connected through white matter fibers in the extreme capsule, resulting in the appearance of a single amygdaloinsular fasciculus. This apparent fasciculus is part of the broader network of short association fibers of the extreme capsule, which connects the entire insular cortex with the temporal pole and the amygdaloid complex. The authors propose the term “temporoinsular projection system” (TIPS) for this complex.
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Affiliation(s)
- Pieter Nachtergaele
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Ahmed Radwan
- 2Department of Imaging & Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | - Stijn Swinnen
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Thomas Decramer
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Mats Uytterhoeven
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Stefan Sunaert
- 2Department of Imaging & Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Tom Theys
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
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15
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Decramer T, Premereur E, Uytterhoeven M, Van Paesschen W, van Loon J, Janssen P, Theys T. Correction: Single-cell selectivity and functional architecture of human lateral occipital complex. PLoS Biol 2019; 17:e3000588. [PMID: 31809496 PMCID: PMC6897395 DOI: 10.1371/journal.pbio.3000588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Decramer T, Premereur E, Uytterhoeven M, Van Paesschen W, van Loon J, Janssen P, Theys T. Single-cell selectivity and functional architecture of human lateral occipital complex. PLoS Biol 2019; 17:e3000280. [PMID: 31513563 PMCID: PMC6759181 DOI: 10.1371/journal.pbio.3000280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/24/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023] Open
Abstract
The human lateral occipital complex (LOC) is more strongly activated by images of objects compared to scrambled controls, but detailed information at the neuronal level is currently lacking. We recorded with microelectrode arrays in the LOC of 2 patients and obtained highly selective single-unit, multi-unit, and high-gamma responses to images of objects. Contrary to predictions derived from functional imaging studies, all neuronal properties indicated that the posterior subsector of LOC we recorded from occupies an unexpectedly high position in the hierarchy of visual areas. Notably, the response latencies of LOC neurons were long, the shape selectivity was spatially clustered, LOC receptive fields (RFs) were large and bilateral, and a number of LOC neurons exhibited three-dimensional (3D)-structure selectivity (a preference for convex or concave stimuli), which are all properties typical of end-stage ventral stream areas. Thus, our results challenge prevailing ideas about the position of the more posterior subsector of LOC in the hierarchy of visual areas.
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Affiliation(s)
- Thomas Decramer
- Laboratory for Neuro- and Psychophysiology, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
- Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
| | - Elsie Premereur
- Laboratory for Neuro- and Psychophysiology, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
| | - Mats Uytterhoeven
- Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
| | - Wim Van Paesschen
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Laboratory for Epilepsy Research, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
- Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
| | - Peter Janssen
- Laboratory for Neuro- and Psychophysiology, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
| | - Tom Theys
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
- Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
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17
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Decramer T, Premereur E, Lagae L, van Loon J, Janssen P, Sunaert S, Theys T. Patient MW: transient visual hemi-agnosia. J Neurol 2019; 266:691-698. [DOI: 10.1007/s00415-019-09188-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023]
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18
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Theys T, Van Hoylandt A, Broeckx CE, Van Gerven L, Jonkergouw J, Quirynen M, van Loon J. Plasma-rich fibrin in neurosurgery: a feasibility study. Acta Neurochir (Wien) 2018; 160:1497-1503. [PMID: 29872915 DOI: 10.1007/s00701-018-3579-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage represents an important and sometimes challenging complication in both cranial and spinal surgery. Current available options for dural closure pose inherent problems regarding safety, efficacy, immunogenicity, cost, and invasiveness. In this article, the use of leukocyte- and platelet-rich fibrin (L-PRF) derived from the patient's own blood is proposed to facilitate dural closure. We aim to describe the safety, feasibility, and applicability of L-PRF membranes and plugs in cranial and spinal neurosurgery. METHODS A retrospective study reviewing clinical and surgical characteristics was conducted in 47 patients in whom the use of L-PRF was attempted to reinforce dural closure at a single institution during 1 year. Procedures included skull base, posterior fossa, and spinal revision surgeries. RESULTS L-PRF membranes and/or plugs were used in 44 surgeries. The preparation of L-PRF failed in three cases. L-PRF membranes were used as onlay grafts to augment sealing or sutured into a defect. No short-term complications related to the use of L-PRF were recorded. Postoperative CSF leakage was present in two endoscopic transsphenoidal pituitary surgeries and in one spinal CSF leak repair. CONCLUSION L-PRF is safe, inexpensive, and completely autologous and can be rapidly and non-invasively harvested to aid in dural closure. Theoretical advantages include a regenerative bioactive potential, which could lead to improved wound healing and reduced infection rates. These findings warrant larger prospective studies to determine the potential role of L-PRF in neurosurgery.
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Güvenç C, Dupont P, Van den Stock J, Seynaeve L, Porke K, Dries E, Van Bouwel K, van Loon J, Theys T, Goffin KE, Van Paesschen W. Correlation of neuropsychological and metabolic changes after epilepsy surgery in patients with left mesial temporal lobe epilepsy with hippocampal sclerosis. EJNMMI Res 2018; 8:31. [PMID: 29651571 PMCID: PMC5897268 DOI: 10.1186/s13550-018-0385-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/28/2018] [Indexed: 11/17/2022] Open
Abstract
Background Epilepsy surgery often causes changes in cognition and cerebral glucose metabolism. Our aim was to explore relationships between pre- and postoperative cerebral metabolism as measured with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and neuropsychological test scores in patients with left mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), who were rendered seizure-free after epilepsy surgery. Results Thirteen patients were included. All had neuropsychological testing and an interictal FDG-PET scan of the brain pre- and postoperative. Correlations between changes in neuropsychological test scores and metabolism were examined using statistical parametric mapping (SPM). There were no significant changes in the neuropsychological test scores pre- and postoperatively at the group level. Decreased metabolism was observed in the left mesial temporal regions and occipital lobe. Increased metabolism was observed in the bi-frontal and right parietal lobes, temporal lobes, occipital lobes, thalamus, cerebellum, and vermis. In these regions, we did not find a correlation between changes in metabolism and neuropsychological test scores. A significant negative correlation, however, was found between metabolic changes in the precuneus and Boston Naming Test (BNT) scores. Conclusions There are significant metabolic decreases in the left mesial temporal regions and increases in the bi-frontal lobes; right parietal, temporal, and occipital lobes; right thalamus; cerebellum; and vermis in patients with left MTLE-HS who were rendered seizure-free after epilepsy surgery. We could not confirm that these changes translate into significant cognitive changes. A significant negative correlation was found between changes in confrontation naming and changes in metabolism in the precuneus. We speculate that the precuneus may play a compensatory role in patients with postoperative naming difficulties after left TLE surgery. Understanding of these neural mechanisms may aid in designing cognitive rehabilitation strategies. Electronic supplementary material The online version of this article (10.1186/s13550-018-0385-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Canan Güvenç
- Department of Neurology, Laboratory for Epilepsy Research, University Hospitals and KU Leuven, Leuven, Belgium.
| | - Patrick Dupont
- Department of Neurology, Laboratory for Epilepsy Research, University Hospitals and KU Leuven, Leuven, Belgium.,Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium
| | - Jan Van den Stock
- Laboratory for Translational Neuropsychiatry, KU Leuven, Leuven, Belgium
| | - Laura Seynaeve
- Department of Neurology, Laboratory for Epilepsy Research, University Hospitals and KU Leuven, Leuven, Belgium
| | - Kathleen Porke
- Department of Neurology, Laboratory for Epilepsy Research, University Hospitals and KU Leuven, Leuven, Belgium
| | - Eva Dries
- Department of Neurology, Laboratory for Epilepsy Research, University Hospitals and KU Leuven, Leuven, Belgium
| | - Karen Van Bouwel
- Department of Neurology, Laboratory for Epilepsy Research, University Hospitals and KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals and KU Leuven, Leuven, Belgium
| | - Tom Theys
- Department of Neurosurgery, University Hospitals and KU Leuven, Leuven, Belgium
| | - Karolien E Goffin
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Department of Neurology, Laboratory for Epilepsy Research, University Hospitals and KU Leuven, Leuven, Belgium
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De Vloo P, Nijs S, Verelst S, van Loon J, Depreitere B. Prehospital and Intrahospital Temporal Intervals in Patients Requiring Emergent Trauma Craniotomy. A 6-Year Observational Study in a Level 1 Trauma Center. World Neurosurg 2018; 114:e546-e558. [PMID: 29548947 DOI: 10.1016/j.wneu.2018.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE According to level 2 evidence, earlier evacuation of acute subdural or epidural hematomas necessitating surgery is associated with better outcome. Hence, guidelines recommend performing these procedures immediately. Literature on the extent and causes of prehospital and intrahospital intervals in patients with trauma requiring emergent craniotomies is almost completely lacking. Studies delineating and refining the interval before thrombolytic agent administration in ischemic stroke have dramatically reduced the door-to-needle time. A similar exercise for trauma-to-decompression time might result in comparable reductions. We aim to map intervals in emergent trauma craniotomies in our level 1 trauma center, screen for associated factors, and propose possible ways to reduce these intervals. METHODS We analyzed patients who were primarily referred (1R; n = 45) and secondarily referred (after computed tomography imaging in a community hospital [2R; n = 22]) to our emergency department (ED) and underwent emergent trauma craniotomies between 2010 and 2016. RESULTS Median prehospital interval (between emergency call and arrival at the ED) was 42 minutes for 1R patients. Median intrahospital interval (between initial ED arrival and skin incision [SI]) was 140 minutes and 268 minutes for 1R and 2R patients, respectively. In 1R patients, ED-SI interval was positively correlated with Glasgow Coma Scale score (ρ=.49; P < 0.001), but not with age, time of ED arrival, or extended Glasgow Outcome Scale score at 6 months. Based on outlier analysis, we propose prehospital and intrahospital measures to improve performance. CONCLUSIONS This is the first report on emergency call-SI interval in emergent trauma craniotomy, with a median of 174 minutes and >297 minutes for 1R and 2R patients, respectively, in our center.
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Affiliation(s)
- Philippe De Vloo
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - Stefaan Nijs
- Department of Traumatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Sandra Verelst
- Department of Emergency Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Decramer T, Van Dyck-Lippens PJ, Franken TP, Demaerel P, van Loon J, Theys T. A Small Leak Will Sink the Brain: Targeted C1-C2 Patching. World Neurosurg 2017; 101:816.e1-816.e3. [DOI: 10.1016/j.wneu.2017.02.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
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Verhaeghe A, Decramer T, Naets W, Van Paesschen W, van Loon J, Theys T. Posterior Quadrant Disconnection: A Fiber Dissection Study. Oper Neurosurg (Hagerstown) 2017; 14:45-50. [DOI: 10.1093/ons/opx060] [Citation(s) in RCA: 9] [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: 06/20/2016] [Accepted: 03/01/2017] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDPosterior quadrant disconnection can be highly effective in the surgical treatment of selected cases of refractory epilepsy. The technique aims to deafferent extensive areas of epileptogenic posterior cortex from the rest of the brain by isolating the temporoparietooccipital cortex.OBJECTIVETo describe this procedure and relevant white matter tracts with a specific emphasis on the extent of callosotomy in an anatomic study.METHODSTwenty hemispheres were dissected according to Klingler's fiber dissection technique illustrating the peri-insular (temporal stem, superior longitudinal fasciculus, corona radiata) and mesial disconnection (mesiotemporal cortex, cingulum, and corpus callosum).RESULTSExtensive white matter tract disconnection is obtained after posterior quadrant disconnection. Callosal fibers connecting the anterior most part of the parietal cortex invariably ran through the isthmus of the corpus callosum and need to be disconnected, while frontal lobe connections including the corticospinal tract and the anterior two-thirds of the corpus callosum are spared during the procedure.CONCLUSIONOur findings suggest the involvement of both the splenium and the isthmus in interhemispheric propagation in posterior cortex epilepsies. Sectioning the total extent of the posterior one-third of the corpus callosum might therefore be necessary to achieve optimal outcomes in posterior quadrant epilepsy surgery.
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Affiliation(s)
| | - Thomas Decramer
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Naets
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Dejaegher J, Walraevens J, van Loon J, Van Calenbergh F, Demaerel P, Goffin J. 10-year follow-up after implantation of the Bryan Cervical Disc Prosthesis. Eur Spine J 2016; 26:1191-1198. [PMID: 27904963 DOI: 10.1007/s00586-016-4897-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 11/02/2016] [Accepted: 11/23/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Cervical arthroplasty is being used as an alternative for cervical fusion, but long-term follow-up results have rarely been reported. In this paper, we present 10-year follow-up results after implantation of the Bryan Cervical Disc Prosthesis in a single center. METHODS 89 patients underwent implantation of a single-level Bryan Cervical Disc Prosthesis to treat radiculopathy and/or myelopathy. Clinical (Neurological Success, Neck Disability Index (NDI), Neck- and Arm-Pain, and SF-36) and radiological follow-up was prospectively organized up to 10 years after surgery. Adverse events and second surgeries were recorded and evaluated. RESULTS Ten-year follow-up data were available for 72 (81%) patients. Maintenance or improvement of the neurological state was seen in 89% of patients after 10-year follow-up. SF-36 PCS scores improved significantly at all follow-up points. SF-36 MCS improvement was significant at 4 and 6 year, but not at 8- and 10-year follow-up. Significant improvement for NDI, and Neck- and Arm-Pain scores was found for the subgroup of patients in whom these data were available. Mean angular motion of the prosthesis at 10-year follow-up was 8.6°. Mobility of the device, defined as >2° of angular motion, was reached in 81% of patients. During the study period, 21 patients (24%) developed new or recurrent radiculopathy or myelopathy, the majority of these being treated conservatively. Seven patients (8%) required 8 additional spine surgeries to treat persistent or recurrent symptoms. Of these, 2 patients (2%) were reoperated at the index level and at 5 (6%) an adjacent level. CONCLUSION In this study, favorable long-term clinical outcome after implantation of the Bryan Cervical Disc Prosthesis was seen, with the majority of prostheses remaining mobile after 10-year follow-up. However, still 6% of patients required adjacent level surgery.
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Affiliation(s)
- Joost Dejaegher
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
| | | | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Philippe Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Goffin
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Niknejad HR, van Calenbergh F, Demaerel P, van Loon J. Accessory atlantoaxial ligament avulsion fracture of the axis: Are there any clinical implications? J Craniovertebr Junction Spine 2016; 7:273-275. [PMID: 27891038 PMCID: PMC5111330 DOI: 10.4103/0974-8237.193259] [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] [Indexed: 11/04/2022] Open
Abstract
Injuries to the craniocervical support structures are frequently observed in neurotrauma cases. Stability of this region is of vital importance. Literature has mainly focused on three major ligaments of the craniocervical junction: The tectorial membrane, the transverse ligament, and the alar ligaments. However, the accessory atlantoaxial ligament (ALL) also seems to be involved in craniocervical stability as shown in cadaveric specimens. Still, the biomechanical importance of this structure needs to be determined, especially in trauma settings. Here, we describe a case of isolated traumatic injury to this structure and discuss the clinical outcome. A 64-year-old polytrauma patient with a remarkable avulsion fracture at the site of the insertion of the ALL was admitted to our center. We evaluated the patient both clinical and radiological at admission, after 3 months and after 1 year. We clinically assessed the upper cervical rotational stability using the cervical flexion-rotation test. We observed no rotational instability or any other clinical repercussions at the long-term after an isolated ALL injury. This case shows that isolated traumatic damage to the ALL is possible. Unilateral damage to the ALL probably does not cause rotational instability of the craniocervical junction. In case a similar avulsion fracture is observed, we recommend performing a magnetic resonance imaging of the craniovertebral region to assess for any ligamentous lesions.
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Affiliation(s)
- Hamid Reza Niknejad
- Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Frank van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Philippe Demaerel
- Department of Neuroradiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
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Vermeulen L, van Loon J, Theys T, Goffin J, Porke K, Van Laere K, Goffin K, Vandenbulcke M, Thijs V, Van Paesschen W. Outcome after epilepsy surgery at the University Hospitals Leuven 1998-2012. Acta Neurol Belg 2016; 116:271-8. [PMID: 26848964 DOI: 10.1007/s13760-016-0605-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
We performed a retrospective outcome study of 199 patients who underwent resective epilepsy surgery from 1998 to 2012 and had a minimum of one-year follow-up at the University Hospitals Leuven. Our aim was to assess seizure outcome, prognostic factors for seizure outcome and complication rate. Good seizure outcome after surgery was 38 % at 5 years and 34 % at 10 years follow-up. Good seizure outcome over the previous year at last follow-up, however, was 77 %, which could be explained by the 'running-down phenomenon', i.e. seizure freedom after initial recurrent epilepsy in 32 % of the patients, mainly after temporal lobe surgery. Good seizure outcome for at least 1 year at the last visit was 82 % for temporal and 62 % for extra-temporal lobe interventions. Other variables predictive of a good seizure outcome were not identified. Permanent complications of epilepsy surgery were observed in 31 %. The most important were word finding difficulties (22 %), depression (18 %) and memory deficits (12 %). In conclusion, epilepsy surgery is an excellent treatment option for selected patients, with a good seizure outcome in around 80 % of patients and complications in about 30 %.
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Decramer T, Morlion B, Van Calenbergh F, Nuttin B, van Loon J, Theys T. Unexpected Symptomatic Catheter Tip Mass in Chronic Intrathecal Opioid Therapy. Pain Med 2016; 17:1571-3. [PMID: 26921887 DOI: 10.1093/pm/pnw025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas Decramer
- *Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Morlion
- *Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Bart Nuttin
- *Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Johannes van Loon
- *Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- *Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium; *Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Beneš V, Grotenhuis A, Schramm J, Buki A, Akalan N, Asser T, Brennum J, Constantini S, D'Avella D, Hutchinson P, van Loon J. Response to the future of the EANS neurosurgeons of Europe, unite! Acta Neurochir (Wien) 2015; 157:1829-30. [PMID: 26329735 DOI: 10.1007/s00701-015-2566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Vladimír Beneš
- Department of Neurosurgery, Charles University, Prague, Czech Republic.
| | - André Grotenhuis
- Department of Neurosurgery, Charles University, Prague, Czech Republic
| | - Johannes Schramm
- Department of Neurosurgery, Charles University, Prague, Czech Republic
| | - Andras Buki
- Department of Neurosurgery, Charles University, Prague, Czech Republic
| | - Nejat Akalan
- Department of Neurosurgery, Charles University, Prague, Czech Republic
| | - Toomas Asser
- Department of Neurosurgery, Charles University, Prague, Czech Republic
| | - Jannick Brennum
- Department of Neurosurgery, Charles University, Prague, Czech Republic
| | | | - Domenico D'Avella
- Department of Neurosurgery, Charles University, Prague, Czech Republic
| | - Peter Hutchinson
- Department of Neurosurgery, Charles University, Prague, Czech Republic
| | - Johannes van Loon
- Department of Neurosurgery, Charles University, Prague, Czech Republic
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Affiliation(s)
- Thomas Decramer
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Thijs
- KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven, Belgium4VIB-Vesalius Research Center, Leuven, Belgium5Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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Mertens F, Gremeaux L, Chen J, Fu Q, Willems C, Roose H, Govaere O, Roskams T, Cristina C, Becú-Villalobos D, Jorissen M, Poorten VV, Bex M, van Loon J, Vankelecom H. Pituitary tumors contain a side population with tumor stem cell-associated characteristics. Endocr Relat Cancer 2015; 22:481-504. [PMID: 25921430 DOI: 10.1530/erc-14-0546] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 02/02/2023]
Abstract
Pituitary adenomas cause significant endocrine and mass-related morbidity. Little is known about the mechanisms that underlie pituitary tumor pathogenesis. In the present study, we searched for a side population (SP) in pituitary tumors representing cells with high efflux capacity and potentially enriched for tumor stem cells (TSCs). Human pituitary adenomas contain a SP irrespective of hormonal phenotype. This adenoma SP, as well as the purified SP (pSP) that is depleted from endothelial and immune cells, is enriched for cells that express 'tumor stemness' markers and signaling pathways, including epithelial-mesenchymal transition (EMT)-linked factors. Pituitary adenomas were found to contain self-renewing sphere-forming cells, considered to be a property of TSCs. These sphere-initiating cells were recovered in the pSP. Because benign pituitary adenomas do not grow in vitro and have failed to expand in immunodeficient mice, the pituitary tumor cell line AtT20 was further used. We identified a SP in this cell line and found it to be more tumorigenic than the non-SP 'main population'. Of the two EMT regulatory pathways tested, the inhibition of chemokine (C-X-C motif) receptor 4 (CXCR4) signaling reduced EMT-associated cell motility in vitro as well as xenograft tumor growth, whereas the activation of TGFβ had no effect. The human adenoma pSP also showed upregulated expression of the pituitary stem cell marker SOX2. Pituitaries from dopamine receptor D2 knockout (Drd2(-/-)) mice that bear prolactinomas contain more pSP, Sox2(+), and colony-forming cells than WT glands. In conclusion, we detected a SP in pituitary tumors and identified TSC-associated characteristics. The present study adds new elements to the unraveling of pituitary tumor pathogenesis and may lead to the identification of new therapeutic targets.
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Affiliation(s)
- Freya Mertens
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Lies Gremeaux
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Jianghai Chen
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaborator
| | - Qiuli Fu
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaborator
| | - Christophe Willems
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Heleen Roose
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Olivier Govaere
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Tania Roskams
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Carolina Cristina
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Damasia Becú-Villalobos
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Mark Jorissen
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Marie Bex
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
| | - Hugo Vankelecom
- Department of Development and RegenerationCluster Stem Cell Biology and Embryology, Research Unit of Stem Cell Research, KU Leuven (University of Leuven), Campus Gasthuisberg O&N4, Herestraat 49, B-3000 Leuven, BelgiumDepartment of Hand SurgeryTongji Medical College, Union Hospital, Huazhong University of Science and Technology (HUST), Jiefang Avenue #1277, Wuhan, Hubei 430022, ChinaZhejiang Provincial Key Laboratory of OphthalmologyHangzhou, ChinaEye Center of the 2nd Affiliated HospitalMedical College of Zhejiang University, Hangzhou, ChinaDepartment of Imaging and PathologyKU Leuven, Leuven, BelgiumCITNOBA (National Research Council of Argentina)National University of the Northwest of Buenos Aires (CONICET-UNNOBA), Pergamino, Buenos Aires, ArgentinaLaboratory of Pituitary RegulationInstituto de Biologia y Medicina Experimental, CONICET, Buenos Aires, ArgentinaUnit Head and Neck OncologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Oto-Rhino-LaryngologyUniversity Hospitals Leuven, Leuven, BelgiumUnit Clinical and Experimental EndocrinologyUniversity Hospitals Leuven, Leuven, BelgiumResearch Group Experimental Neurosurgery and NeuroanatomyUniversity Hospitals Leuven, Leuven, Belgium
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Abstract
The primate visual system extracts object shape information for object recognition in the ventral visual stream. Recent research has demonstrated that object shape is also processed in the dorsal visual stream, which is specialized for spatial vision and the planning of actions. A number of studies have investigated the coding of 2D shape in the anterior intraparietal area (AIP), one of the end-stage areas of the dorsal stream which has been implicated in the extraction of affordances for the purpose of grasping. These findings challenge the current understanding of area AIP as a critical stage in the dorsal stream for the extraction of object affordances. The representation of three-dimensional (3D) shape has been studied in two interconnected areas known to be critical for object grasping: area AIP and area F5a in the ventral premotor cortex (PMv), to which AIP projects. In both areas neurons respond selectively to 3D shape defined by binocular disparity, but the latency of the neural selectivity is approximately 10 ms longer in F5a compared to AIP, consistent with its higher position in the hierarchy of cortical areas. Furthermore, F5a neurons were more sensitive to small amplitudes of 3D curvature and could detect subtle differences in 3D structure more reliably than AIP neurons. In both areas, 3D-shape selective neurons were co-localized with neurons showing motor-related activity during object grasping in the dark, indicating a close convergence of visual and motor information on the same clusters of neurons.
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Affiliation(s)
- Tom Theys
- Laboratorium voor Neuro- en Psychofysiologie, Katholieke Universiteit Leuven Leuven, Belgium ; Afdeling Experimentele Neurochirurgie en Neuroanatomie, Katholieke Universiteit Leuven Leuven, Belgium
| | - Maria C Romero
- Laboratorium voor Neuro- en Psychofysiologie, Katholieke Universiteit Leuven Leuven, Belgium
| | - Johannes van Loon
- Afdeling Experimentele Neurochirurgie en Neuroanatomie, Katholieke Universiteit Leuven Leuven, Belgium
| | - Peter Janssen
- Laboratorium voor Neuro- en Psychofysiologie, Katholieke Universiteit Leuven Leuven, Belgium
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31
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Coppiello G, Collantes M, Sirerol-Piquer MS, Vandenwijngaert S, Schoors S, Swinnen M, Vandersmissen I, Herijgers P, Topal B, van Loon J, Goffin J, Prósper F, Carmeliet P, García-Verdugo JM, Janssens S, Peñuelas I, Aranguren XL, Luttun A. Meox2/Tcf15 heterodimers program the heart capillary endothelium for cardiac fatty acid uptake. Circulation 2015; 131:815-26. [PMID: 25561514 DOI: 10.1161/circulationaha.114.013721] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [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: 12/11/2022]
Abstract
BACKGROUND Microvascular endothelium in different organs is specialized to fulfill the particular needs of parenchymal cells. However, specific information about heart capillary endothelial cells (ECs) is lacking. METHODS AND RESULTS Using microarray profiling on freshly isolated ECs from heart, brain, and liver, we revealed a genetic signature for microvascular heart ECs and identified Meox2/Tcf15 heterodimers as novel transcriptional determinants. This signature was largely shared with skeletal muscle and adipose tissue endothelium and was enriched in genes encoding fatty acid (FA) transport-related proteins. Using gain- and loss-of-function approaches, we showed that Meox2/Tcf15 mediate FA uptake in heart ECs, in part, by driving endothelial CD36 and lipoprotein lipase expression and facilitate FA transport across heart ECs. Combined Meox2 and Tcf15 haplodeficiency impaired FA uptake in heart ECs and reduced FA transfer to cardiomyocytes. In the long term, this combined haplodeficiency resulted in impaired cardiac contractility. CONCLUSIONS Our findings highlight a regulatory role for ECs in FA transfer to the heart parenchyma and unveil 2 of its intrinsic regulators. Our insights could be used to develop new strategies based on endothelial Meox2/Tcf15 targeting to modulate FA transfer to the heart and remedy cardiac dysfunction resulting from altered energy substrate usage.
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Affiliation(s)
- Giulia Coppiello
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Maria Collantes
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - María Salomé Sirerol-Piquer
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Sara Vandenwijngaert
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Sandra Schoors
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Melissa Swinnen
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Ine Vandersmissen
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Paul Herijgers
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Baki Topal
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Johannes van Loon
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Jan Goffin
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Felipe Prósper
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Peter Carmeliet
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Jose Manuel García-Verdugo
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Stefan Janssens
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Iván Peñuelas
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Xabier L Aranguren
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium
| | - Aernout Luttun
- From Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (G.C., I.V., X.L.A., A.L.), Department of Cardiovascular Sciences, Cardiology Unit (S.V., M.S., S.J.), Laboratory of Angiogenesis & Neurovascular link, Vesalius Research Center, VIB/Department of Oncology (S.S., P.C.), and Department of Cardiovascular Sciences, Experimental Cardiac Surgery Unit (P.H.), KULeuven, Belgium; Department of Nuclear Medicine, Clínica Universidad de Navarra/MicroPET Research Unit CIMA-CUN (M.C., I.P.), and Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Division of Oncology, Center for Applied Medical Research (F.P., X.L.A), University of Navarra, Pamplona, Spain; Laboratory of Comparative Neurobiology, Instituto Cavanilles, University of Valencia, CIBERNED, Spain (M.S.S.-P., J.M.G.-V.); and Departments of Abdominal Surgery (B.T.) and Neurosurgery (J.v.L., J.G.), University Hospitals Leuven/KULeuven, Belgium.
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De Vloo P, De Vlieger J, Vander Poorten V, Sciot R, van Loon J, Van Calenbergh F. Desmoid tumors in neurosurgery: a review of the literature. Clin Neurol Neurosurg 2014; 129:78-84. [PMID: 25576767 DOI: 10.1016/j.clineuro.2014.12.007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
Desmoid tumors (DTs) are rare myofibroblastic neoplasms, which are mostly sporadic, but sometimes associated with familial adenomatous polyposis syndrome. Neurosurgical cases of DT have been very scarce. We review the literature concerning neurosurgical DTs and describe the first case of a cicatricial DT after the resection of vestibular schwannoma, presenting as a painful swelling in the retrosigmoid scar. Contrary to other localizations in the body, standard-of-care wide margin resection cannot be performed in intracranial and spinal DTs. Therefore, maximally safe resection followed by radiotherapy when tumor margins are not free can be proposed as a treatment strategy in neurosurgical DTs.
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Affiliation(s)
- Philippe De Vloo
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - Jan De Vlieger
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Frank Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Theys T, Pani P, van Loon J, Goffin J, Janssen P. Three-dimensional Shape Coding in Grasping Circuits: A Comparison between the Anterior Intraparietal Area and Ventral Premotor Area F5a. J Cogn Neurosci 2013. [DOI: 10.1162/jocn_a_00332] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
Depth information is necessary for adjusting the hand to the three-dimensional (3-D) shape of an object to grasp it. The transformation of visual information into appropriate distal motor commands is critically dependent on the anterior intraparietal area (AIP) and the ventral premotor cortex (area F5), particularly the F5p sector. Recent studies have demonstrated that both AIP and the F5a sector of the ventral premotor cortex contain neurons that respond selectively to disparity-defined 3-D shape. To investigate the neural coding of 3-D shape and the behavioral role of 3-D shape-selective neurons in these two areas, we recorded single-cell activity in AIP and F5a during passive fixation of curved surfaces and during grasping of real-world objects. Similar to those in AIP, F5a neurons were either first- or second-order disparity selective, frequently showed selectivity for discrete approximations of smoothly curved surfaces that contained disparity discontinuities, and exhibited mostly monotonic tuning for the degree of disparity variation. Furthermore, in both areas, 3-D shape-selective neurons were colocalized with neurons that were active during grasping of real-world objects. Thus, area AIP and F5a contain highly similar representations of 3-D shape, which is consistent with the proposed transfer of object information from AIP to the motor system through the ventral premotor cortex.
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Wauters S, Somers J, De Vleeschauwer S, Verbeken E, Verleden GM, van Loon J, Van Raemdonck DEM. Evaluating lung injury at increasing time intervals in a murine brain death model. J Surg Res 2013; 183:419-26. [PMID: 23394934 DOI: 10.1016/j.jss.2013.01.011] [Citation(s) in RCA: 13] [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: 11/05/2012] [Revised: 11/05/2012] [Accepted: 01/04/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Only 15%-25% of brain death (BD) donors match the ideal donor criteria for lung transplantation. Lung injury may evolve in the hours after onset of brain death, but the evolution over time has not been well studied in lung. The aim of this study was to evaluate lung injury at different time points after BD using a murine model. MATERIALS AND METHODS Male C57BL6/J mice (8-10 wk) were anesthetized, tracheotomized, and mechanically ventilated. Mice were randomly assigned to six groups (n=8/group): 1 h, 3 h, and 6 h sham ([SH1], [SH3], [SH6]) and 1 h, 3 h, and 6 h brain death ([BD1], [BD3], [BD6]). BD was gradually induced by a subdural balloon catheter. Heart rate and mean arterial pressure were continuously monitored. At the end of the experiment, bronchoalveolar lavage was performed and the left lung was excised for histopathologic analysis. RESULTS The Cushing reflex was characterized by a rapid increase in heart rate and mean arterial pressure after balloon inflation in BD animals. An increase in percentage of neutrophils was seen with a longer follow-up period (P<0.05). Interleukin 6 and interleukin 10 levels in bronchoalveolar lavage progressively increased with longer time intervals after BD ([BD1] versus [BD6]; P<0.01). Histologic signs of lung injury (congestion, hemorrhage, and neutrophilic influx) were more pronounced in [BD3] and [BD6] compared with the other groups; however, this difference did not reach statistical significance. CONCLUSION Three hours after brain death, significant signs of inflammation and lung injury were seen compared with sham-operated animals. This murine BD model gives us opportunities for further mechanistic studies regarding treatment of BD-related donor lung injury.
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Affiliation(s)
- Shana Wauters
- Laboratory for Experimental Thoracic Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
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De Vleeschouwer S, Ardon H, Van Calenbergh F, Sciot R, Wilms G, van Loon J, Goffin J, Van Gool S. Stratification according to HGG-IMMUNO RPA model predicts outcome in a large group of patients with relapsed malignant glioma treated by adjuvant postoperative dendritic cell vaccination. Cancer Immunol Immunother 2012; 61:2105-12. [PMID: 22565485 PMCID: PMC11028672 DOI: 10.1007/s00262-012-1271-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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: 12/13/2011] [Accepted: 04/19/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Adult patients with relapsed high-grade glioma are a very heterogenous group with, however, an invariably dismal prognosis. We stratified patients with relapsed high-grade glioma treated with re-operation and postoperative dendritic cell (DC) vaccination according to a simple recursive partitioning analysis (RPA) model to predict outcome. PATIENTS AND METHODS Based on age, pathology, Karnofsky performance score, and mental status, 117 adult patients with relapsed malignant glioma, undergoing re-operation, and postoperative adjuvant dendritic cell (DC) vaccination were stratified into 4 classes. Kaplan-Meier survival estimates were generated for each class of this HGG-IMMUNO RPA model. Extent of resection was documented but not included in the prognostic model. RESULTS Kaplan-Meier overall survival estimates revealed significant (p < 0.0001) differences among the 4 HGG-IMMUNO RPA classes. Long-term survivors, surviving more than 24 months after the re-operation and vaccination, are seen in 54.5, 26.7, 11.5, and 0 % for the classes I, II, III, and IV respectively. CONCLUSION This HGG-IMMUNO RPA classification is able to predict overall survival in a large group of adult patients with a relapsed malignant glioma, treated with re-operation and postoperative adjuvant DC vaccination in the HGG-IMMUNO-2003 cohort comparison trial. The model appears useful for prognostic patient counseling for patients participating in DC vaccination trials. A substantial number of long-term survivors after relapse are seen in class I to III, but not in class IV patients.
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Affiliation(s)
- Steven De Vleeschouwer
- Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Theys T, Van Cauter S, Kho KH, Vijverman AC, Peeters RR, Sunaert S, van Loon J. Neural correlates of recovery from Foix–Chavany–Marie syndrome. J Neurol 2012; 260:415-20. [DOI: 10.1007/s00415-012-6641-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 07/17/2012] [Accepted: 07/28/2012] [Indexed: 11/30/2022]
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de Jong L, Calenbergh FV, Menten J, van Loon J, De Vleeschouwer S, Plets C, Didgar M, Sciot R, Goffin J. Ependymomas of the filum terminale: The role of surgery and radiotherapy. Surg Neurol Int 2012; 3:76. [PMID: 22937477 PMCID: PMC3424672 DOI: 10.4103/2152-7806.98509] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 06/19/2012] [Indexed: 11/30/2022] Open
Abstract
Background: Ependymomas of the filum terminale (EFT) form a specific and relatively uncommon subtype of spinal cord ependymomas. Most series in the literature are small, spanning a large time period. Up to date no consensus has been reached about the optimal treatment of these lesions. Some authors promote postoperative radiotherapy for all cases, others advocate postoperative radiotherapy only when a subtotal resection is performed or when metastasis are apparent. Methods: We performed a retrospective analysis of 22 patients with an EFT (mean age at diagnosis of 35.6 years). Results: In all patients (9/22) with lesions smaller than 4.5 cm no metastases were present and a complete resection could be obtained. No adjuvant radiotherapy was performed and at latest follow they had an excellent outcome. In our series, these initial tumor characteristics were more important regarding prognosis than either histology or treatment-related factors. For the larger tumors, total resection was obtained less frequently, more dissemination was diagnosed and a worse outcome was scored. Radiotherapy if indicated did lead to an acceptable disease control. Conclusion: In every case of EFT, an individual treatment protocol has to be outlined, but if an EFT is relatively small and can be resected completely, we would advocate to withhold radiotherapy.
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Affiliation(s)
- Lars de Jong
- Department of Neurosurgery, University Hospitals Leuven, Belgium
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Theys T, Srivastava S, van Loon J, Goffin J, Janssen P. Selectivity for three-dimensional contours and surfaces in the anterior intraparietal area. J Neurophysiol 2012; 107:995-1008. [DOI: 10.1152/jn.00248.2011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The macaque anterior intraparietal area (AIP) is crucial for visually guided grasping. AIP neurons respond during the visual presentation of real-world objects and encode the depth profile of disparity-defined curved surfaces. We investigated the neural representation of curved surfaces in AIP using a stimulus-reduction approach. The stimuli consisted of three-dimensional (3-D) shapes curved along the horizontal axis, the vertical axis, or both the horizontal and the vertical axes of the shape. The depth profile was defined solely by binocular disparity that varied along either the boundary or the surface of the shape or along both the boundary and the surface of the shape. The majority of AIP neurons were selective for curved boundaries along the horizontal or the vertical axis, and neural selectivity emerged at short latencies. Stimuli in which disparity varied only along the surface of the shape (with zero disparity on the boundaries) evoked selectivity in a smaller proportion of AIP neurons and at considerably longer latencies. AIP neurons were not selective for 3-D surfaces composed of anticorrelated disparities. Thus the neural selectivity for object depth profile in AIP is present when only the boundary is curved in depth, but not for disparity in anticorrelated stereograms.
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Affiliation(s)
- Tom Theys
- Laboratorium voor Neuro- en Psychofysiologie and
- Afdeling Experimentele Neurochirurgie en Neuroanatomie, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Johannes van Loon
- Afdeling Experimentele Neurochirurgie en Neuroanatomie, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Goffin
- Afdeling Experimentele Neurochirurgie en Neuroanatomie, Katholieke Universiteit Leuven, Leuven, Belgium
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Buelens E, Wilms G, van Loon J, van Calenbergh F. The oculomotor nerve: anatomic relationship with the floor of the third ventricle. Childs Nerv Syst 2011; 27:943-8. [PMID: 21240510 DOI: 10.1007/s00381-010-1317-5] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 10/14/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Endoscopic third ventriculostomy (ETV) has become first-line treatment for obstructive hydrocephalus. Many complications have been described, but the literature about oculomotor palsy after ETV is scarce. Therefore we undertook an anatomical study of the relationship of the oculomotor nerve to the floor of the third ventricle. METHODS Distances and angles between the third nerve and the bottom of the third ventricle were studied both in two cadaver heads and in high-definition CISS images in 16 MRI scans. The angles of the trajectories putting the nerve at risk or not were compared. Finally, in a retrospective analysis of intraoperative images the appearance of the membranous portion of the floor was defined and if visible, the distance of the third nerve to the midline was estimated by comparing with the 8-mm balloon catheter. RESULTS The course of the third nerve is approximately 8 mm laterally and approximately 17 mm caudally distant from the midpoint of the floor of the third ventricle. The angle of the trajectory to damage the third nerve is at least 12° greater than any safe angle of ETV trajectory through a normal burr hole. CONCLUSIONS The third nerve is not always visible during ETV procedures, but the angular and linear measurements imply that the risk to damage the nerve should be relatively small. Confirmation of these data in hydrocephalic patients with distorted anatomy is needed.
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Affiliation(s)
- Eveleen Buelens
- Department of Neurosurgery, University Hospital Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium.
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de Jong L, Thewissen L, van Loon J, Van Calenbergh F. Choroidal Fissure Cerebrospinal Fluid-Containing Cysts: Case Series, Anatomical Consideration, and Review of the Literature. World Neurosurg 2011; 75:704-8. [DOI: 10.1016/j.wneu.2010.12.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 11/06/2010] [Accepted: 12/17/2010] [Indexed: 11/24/2022]
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De Cocker LJL, De Cocker LML, van Loon J, Demaerel P. Discography for disc cysts is obsolete. Acta Neurochir (Wien) 2010; 152:1261-2. [PMID: 20221837 DOI: 10.1007/s00701-010-0617-6] [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] [Received: 08/24/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
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Peuskens D, van Loon J, Van Calenbergh F, van den Bergh R, Goffin J, Plets C. Anatomy of the Anterior Temporal Lobe and the Frontotemporal Region Demonstrated by Fiber Dissection. Neurosurgery 2004; 55:1174-84. [PMID: 15509324 DOI: 10.1227/01.neu.0000140843.62311.24] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [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: 08/15/2003] [Accepted: 06/07/2004] [Indexed: 01/02/2023] Open
Abstract
Abstract
OBJECTIVE:
The white matter structure of the anterior temporal lobe and the frontotemporal region is complex and not well appreciated from the available neurosurgical literature. The fiber dissection method is an excellent means of attaining a thorough knowledge of the three-dimensional structure of the white matter tracts. This study was performed to demonstrate the usefulness of the dissection technique in understanding the white matter anatomy and the effects of current surgical approaches on the subcortical structure of the region.
METHODS:
Seventeen brain specimens obtained at routine autopsy were dissected by use of Klingler's fiber dissection technique after preparation by fixation and freezing. The dissections were performed with an operating microscope and followed a stepwise pattern of progressive white matter dissection.
RESULTS:
The dissection is described in an orderly fashion showing the white matter tracts of the anterior temporal lobe and the frontotemporal region. An insight is gained into the three-dimensional course of the anterior loop of the optic radiation, the temporal stem, the anterior commissure, and the ansa peduncularis.
CONCLUSION:
The anterior temporal lobe and the frontotemporal region contain several important white matter tracts that can be uniquely understood by performing a white matter dissection of the region. Surgical procedures on the anterior temporal lobe differ substantially as to their repercussions on the subcortical white matter tract anatomy, as shown by the findings in this study.
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Affiliation(s)
- Diedrik Peuskens
- Department of Neurosurgery, University Hospital Leuven, and Laboratory of Experimental Neurosurgery and Neuroanatomy, University of Leuven, Leuven, Belgium
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Vankan Y, Demaerel P, Heye S, Van Calenbergh F, van Loon J, Maleux G, Wilms G. Dural arteriovenous fistula as a late complication of upper cervical spine fracture. J Neurosurg Spine 2004; 100:382-4. [PMID: 15070150 DOI: 10.3171/spi.2004.100.4.0382] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/06/2022]
Abstract
✓ The authors report an unusual case of a dural arteriovenous fistula (DAVF) in the cervical spine after a C1–2 fracture. The patient presented with a delayed epidural hematoma and quadriparesis. The DAVF was successfully treated by coil embolization and the patient made a full recovery. The possibility of a DAVF as a late complication of an upper cervical spine fracture should be considered when a patient presents with a spinal epidural hematoma.
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Affiliation(s)
- Yoeri Vankan
- Department of Radiology, University Hospitals Gasthuisberg, Leuven, Belgium
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Goffin J, Van Calenbergh F, van Loon J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C, Sgrambiglia R, Pointillart V. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine (Phila Pa 1976) 2003; 28:2673-8. [PMID: 14673368 DOI: 10.1097/01.brs.0000099392.90849.aa] [Citation(s) in RCA: 244] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, concurrently enrolled, multicenter trials of the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN) were conducted for the treatment of patients with single-level and two-level (bi-level) degenerative disc disease of the cervical spine. OBJECTIVES The studies were designed to determine whether new functional intervertebral cervical disc prosthesis can provide relief from objective neurologic symptoms and signs, improve the patient's ability to perform activities of daily living, decrease pain, and maintain stability and segmental motion. SUMMARY OF BACKGROUND DATA The concept of accelerated degeneration of adjacent disc levels as a consequence of increased stress caused by interbody fusion of the cervical spine has been widely postulated. Therefore, reconstruction of a failed intervertebral disc with functional disc prosthesis should offer the same benefits as fusion while simultaneously providing motion and thereby protecting the adjacent level discs from the abnormal stresses associated with fusion. METHODS Patients with symptomatic cervical radiculopathy and/or myelopathy underwent implantation with the Bryan prosthesis after a standard anterior cervical discectomy. At scheduled follow-up periods, the effectiveness of the device was characterized by evaluating each patient's pain, neurologic function, and radiographically measured range of motion at the implanted level. RESULTS Clinical success for both studies exceeded the study acceptance criteria of 85%. At 1-year follow-up, the flexion-extension range of motion per level: Discectomy and implantation of the device alleviates neurologic symptoms and signs similar to anterior cervical discectomy and fusion. Radiographic evidence supports maintenance of motion. The procedure is safe and the patients recover quickly. At least 5 years of follow-up will be needed to assess the long-term functionality of the prosthesis and protective influence on adjacent levels.
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Affiliation(s)
- Jan Goffin
- Department of Neurosurgery, University Hospital, Leuven, Belgium.
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van Loon J, Waerzeggers Y, Wilms G, Van Calenbergh F, Goffin J, Plets C. Endovascular treatment for poorest-grade subarachnoid hemorrage in the acute stage: has the outcome been improved? Neurosurgery 2003; 52:480-1; author reply 481-2. [PMID: 12575671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
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van Loon J, Waerzeggers Y, Wilms G, Van Calenbergh F, Goffin J, Plets C. Endovascular Treatment for Poorest-grade Subarachnoid Hemorrhage in the Acute Stage: Has the Outcome Been Improved? Neurosurgery 2003. [DOI: 10.1227/01.neu.0000045983.56852.e6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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van Loon J, Waerzeggers Y, Wilms G, Van Calenbergh F, Goffin J, Plets C. Endovascular Treatment for Poorest-grade Subarachnoid Hemorrhage in the Acute Stage: Has the Outcome Been Improved? Neurosurgery 2003. [DOI: 10.1227/01.neu.0000309192.44010.b1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Goffin J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C, Pointillart V, Van Calenbergh F, van Loon J. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery 2002; 51:840-5; discussion 845-7. [PMID: 12188968 DOI: 10.1227/00006123-200209000-00048] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [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: 03/05/2002] [Accepted: 05/29/2002] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The concept of accelerated degeneration of adjacent disc levels as a consequence of increased stress caused by interbody fusion of the cervical spine has been widely postulated. Therefore, reconstruction of a failed intervertebral disc with a functional disc prosthesis should offer the same benefits as fusion while simultaneously providing motion and thereby protecting the adjacent level discs from the abnormal stresses associated with fusion. This study was designed to determine whether a new, functional intervertebral cervical disc prosthesis can provide relief from objective neurological symptoms and signs, improve the patient's ability to perform activities of daily living, decrease pain, and provide stability and normal range of motion. METHODS We conducted a prospective, concurrently enrolled, multicenter trial of the Bryan Cervical Disc Prosthesis (Spinal Dynamics Corp., Mercer Island, WA) for the treatment of patients with single-level degenerative disc disease of the cervical spine. Patients with symptomatic cervical radiculopathy and/or myelopathy underwent implantation with the Bryan prosthesis after a standard anterior cervical discectomy. At scheduled follow-up periods, the effectiveness of the device was characterized by evaluating each patient's pain, neurological function, and range of motion at the implanted level. RESULTS Analysis included data regarding 60 patients at 6 months with 30 of those patients at 1 year. Clinical success at 6 months and 1 year after implantation was 86 and 90%, respectively, exceeding the study's acceptance criteria of 85%. These results compare favorably with the short-term clinical outcomes associated with anterior cervical discectomy and fusion reported in the literature. At 1 year, there was no measurable subsidence of the devices (based on a measurement detection threshold of 2 mm). Evidence of anterior and/or posterior device migration was detected in one patient and suspected in a second patient. There was no evidence of spondylotic bridging at the implanted disc space. The measured range of motion in flexion-extension, as determined by an independent radiologist, ranged from 1 to 21 degrees (mean range of motion, 9 +/- 5 degrees). No devices have been explanted or surgically revised. CONCLUSION Discectomy and implantation of the device alleviates neurological symptoms and signs similar to anterior cervical discectomy and fusion. Radiographic evidence supports normal range of motion. The procedure is safe and the patients recover quickly. Restrictive postoperative management is not necessary. However, only after long-term follow-up of at least 5 years will it become clear whether the device remains functional, thus confirming these early favorable results. In addition, the influence on adjacent motion segments can be assessed after at least 5 years of follow-up.
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Affiliation(s)
- Jan Goffin
- Department of Neurosurgery, University Hospital Gasthuisberg, Leuven, Belgium.
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