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Kranawetter B, Cho A, Hirschmann D, Göbl P, Dorfer C, Rössler K, Dodier P, Wang WT, Gatterbauer B, Gruber A, Kitz K, Frischer JM. Radiosurgery as a Stand-Alone Treatment Option for Cerebral Dural Arteriovenous Fistulas: the Vienna Series. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38151030 DOI: 10.1055/a-2235-5256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND Gamma Knife radiosurgery (GKRS) has been demonstrated to be an effective and safe treatment method for dural arteriovenous fistulas (DAVFs). However, only few studies, mostly with limited patient numbers, have evaluated radiosurgery as a sole and upfront treatment option for DAVFs. METHODS Thirty-three DAVF patients treated with GKRS as a stand-alone management at our institution between January 1992 and January 2020 were included in this study. Obliteration rates, time to obliteration, neurologic outcome, and complications were evaluated retrospectively. RESULTS Complete overall obliteration was achieved in 20/28 (71%) patients. The postradiosurgery actuarial rates of obliteration at 2, 5, and 10 years were 53, 71, and 85%, respectively. No difference in time to obliteration between carotid-cavernous fistulas (CCFs; 14/28, 50%, 17 months; 95% confidence interval [CI]: 7.4-27.2) and non-CCFs (NCCFs; 14/28, 50%, 37 months; 95% CI: 34.7-38.5; p = 0.111) were found. Overall, the neurologic outcome in our series was highly favorable at the time of the last follow-up. A complete resolution of symptoms was seen in two-thirds (20/30, 67%) of patients. One patient with multiple DAVFs suffered from an intracranial hemorrhage of the untreated lesion and died during the follow-up period, resulting in a yearly bleeding risk of 0.5%. No complications after radiosurgery were observed in our series. CONCLUSION Our results show that GKRS is a safe and effective stand-alone management option for selected DAVF patients.
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Affiliation(s)
- Beate Kranawetter
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Göbl
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Wei-Te Wang
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital Linz, Linz, Austria
| | - Klaus Kitz
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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2
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Popov P, Steindl A, Wolff L, Bergen ES, Eckert F, Frischer JM, Widhalm G, Fuereder T, Raderer M, Berghoff AS, Preusser M, Kiesewetter B. Clinical characteristics, treatment, and outcome of patients with large cell neuroendocrine carcinoma of the lung and brain metastases - data from a tertiary care center. Clin Exp Metastasis 2024; 41:25-32. [PMID: 38064128 PMCID: PMC10830719 DOI: 10.1007/s10585-023-10250-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/21/2023] [Indexed: 02/02/2024]
Abstract
Large cell neuroendocrine carcinoma (LCNEC) of the lung is an aggressive malignancy, with brain metastases (BM) occurring in approximately 20% of cases. There are currently no therapy guidelines for this population as only few data on the management of LCNEC and BM have been published. For this retrospective single center study, patients with LCNEC and BM were identified from the Vienna Brain Metastasis Registry. Data on clinicopathological features, BM-specific characteristics, treatment, and outcome were extracted. In total, 52/6083 (0.09%) patients in the dataset had a diagnosis of LCNEC and radiologically verified BM. Median age at diagnosis of LCNEC and BM was 59.1 and 60.1 years, respectively. Twenty-seven (51.9%) presented with single BM, while 12 (23%) exhibited > 3 BM initially. Neurologic symptoms due to BM were present in n = 40 (76.9%), encompassing neurologic deficits (n = 24), increased intracranial pressure (n = 18), and seizures (n = 6). Initial treatment of BM was resection (n = 13), whole brain radiation therapy (n = 19), and/or stereotactic radiosurgery (n = 25). Median overall survival (mOS) from LCNEC diagnosis was 16 months, and mOS after BM diagnosis was 7 months. Patients with synchronous BM had reduced mOS from LCNEC diagnosis versus patients with metachronous BM (11 versus 27 months, p = 0.003). Median OS after BM diagnosis did not differ between LCNEC patients and a control group of small cell lung cancer patients with BM (7 versus 6 months, p = 0.17). Patients with LCNEC and BM have a poor prognosis, particularly when synchronous BM are present. Prospective trials are required to define optimal therapeutic algorithms.
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Affiliation(s)
- Petar Popov
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18 - 20, Vienna, A-1090, Austria
| | - Ariane Steindl
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18 - 20, Vienna, A-1090, Austria
| | - Ladislaia Wolff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18 - 20, Vienna, A-1090, Austria
| | - Elisabeth S Bergen
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18 - 20, Vienna, A-1090, Austria
| | - Franziska Eckert
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Thorsten Fuereder
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18 - 20, Vienna, A-1090, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18 - 20, Vienna, A-1090, Austria
| | - Anna S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18 - 20, Vienna, A-1090, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18 - 20, Vienna, A-1090, Austria
| | - Barbara Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18 - 20, Vienna, A-1090, Austria.
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Dodier P, Civilla L, Mallouhi A, Haider L, Cho A, Lederer P, Wang WT, Dorfer C, Hosmann A, Rössler K, Königshofer M, Unger E, Palumbo MC, Redaelli A, Frischer JM, Moscato F. An evaluation of physical and augmented patient-specific intracranial aneurysm simulators on microsurgical clipping performance and skills: a randomized controlled study. Neurosurg Focus 2024; 56:E9. [PMID: 38163349 DOI: 10.3171/2023.10.focus23640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE In the era of flow diversion, there is an increasing demand to train neurosurgeons outside the operating room in safely performing clipping of unruptured intracranial aneurysms. This study introduces a clip training simulation platform for residents and aspiring cerebrovascular neurosurgeons, with the aim to visualize peri-aneurysm anatomy and train virtual clipping applications on the matching physical aneurysm cases. METHODS Novel, cost-efficient techniques allow the fabrication of realistic aneurysm phantom models and the additional integration of holographic augmented reality (AR) simulations. Specialists preselected suitable and unsuitable clips for each of the 5 patient-specific models, which were then used in a standardized protocol involving 9 resident participants. Participants underwent four sessions of clip applications on the models, receiving no interim training (control), a video review session (video), or a video review session and holographic clip simulation training (video + AR) between sessions 2 and 3. The study evaluated objective microsurgical skills, which included clip selection, number of clip applications, active simulation time, wrist tremor analysis during simulations, and occlusion efficacy. Aneurysm occlusions of the reference sessions were assessed by indocyanine green videoangiography, as well as conventional and photon-counting CT scans. RESULTS A total of 180 clipping procedures were performed without technical complications. The measurements of the active simulation times showed a 39% improvement for all participants. A median of 2 clip application attempts per case was required during the final session, with significant improvement observed in experienced residents (postgraduate year 5 or 6). Wrist tremor improved by 29% overall. The objectively assessed aneurysm occlusion rate (Raymond-Roy class 1) improved from 76% to 80% overall, even reaching 93% in the extensively trained cohort (video + AR) (p = 0.046). CONCLUSIONS The authors introduce a newly developed simulator training platform combining physical and holographic aneurysm clipping simulators. The development of exchangeable, aneurysm-comprising housings allows objective radio-anatomical evaluation through conventional and photon-counting CT scans. Measurable performance metrics serve to objectively document improvements in microsurgical skills and surgical confidence. Moreover, the different training levels enable a training program tailored to the cerebrovascular trainees' levels of experience and needs.
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Affiliation(s)
- Philippe Dodier
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Lorenzo Civilla
- 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- 3Department of Electronics, Information and Bioengineering, Polimi, Milano, Italy
- 6Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; and
| | - Ammar Mallouhi
- 4Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology, Medical University of Vienna, Austria
| | - Lukas Haider
- 4Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology, Medical University of Vienna, Austria
- 5Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, London, United Kingdom
| | - Anna Cho
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Philip Lederer
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Wei-Te Wang
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Christian Dorfer
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Arthur Hosmann
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Karl Rössler
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Markus Königshofer
- 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Ewald Unger
- 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Maria-Chiara Palumbo
- 3Department of Electronics, Information and Bioengineering, Polimi, Milano, Italy
| | - Alberto Redaelli
- 3Department of Electronics, Information and Bioengineering, Polimi, Milano, Italy
| | - Josa M Frischer
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Francesco Moscato
- 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- 6Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; and
- 7Austrian Cluster for Tissue Regeneration, Vienna, Austria
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4
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Khalaveh F, Cho A, Shaltout A, Untersteiner H, Kranawetter B, Hirschmann D, Göbl P, Marik W, Gatterbauer B, Rössler K, Dorfer C, Frischer JM. Concomitant radiosurgical and targeted oncological treatment improves the outcome of patients with brain metastases from gastrointestinal cancer. Radiat Oncol 2023; 18:197. [PMID: 38071299 PMCID: PMC10710706 DOI: 10.1186/s13014-023-02383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND So far, only limited studies exist that evaluate patients with brain metastases (BM) from GI cancer and associated primary cancers who were treated by Gamma Knife Radiosurgery (GKRS) and concomitant immunotherapy (IT) or targeted therapy (TT). METHODS Survival after GKRS was compared to the general and specific Graded Prognostic Assessment (GPA) and Score Index for Radiosurgery (SIR). Further, the influence of age, sex, Karnofsky Performance Status Scale (KPS), extracranial metastases (ECM) status at BM diagnosis, number of BM, the Recursive Partitioning Analysis (RPA) classes, GKRS1 treatment mode and concomitant treatment with IT or TT on the survival after GKRS was analyzed. Moreover, complication rates after concomitant GKRS and mainly TT treatment are reported. RESULTS Multivariate Cox regression analysis revealed IT or TT at or after the first Gamma Knife Radiosurgery (GKRS1) treatment as the only significant predictor for overall survival after GKRS1, even after adjusting for sex, KPS group, age group, number of BM at GKRS1, RPA class, ECM status at BM diagnosis and GKRS treatment mode. Concomitant treatment with IT or TT did not increase the rate of adverse radiation effects. There was no significant difference in local BM progression after GKRS between patients who received IT or TT and patients without IT or TT. CONCLUSION Good local tumor control rates and low rates of side effects demonstrate the safety and efficacy of GKRS in patients with BM from GI cancers. The concomitant radiosurgical and targeted oncological treatment significantly improves the survival after GKRS without increasing the rate of adverse radiation effects. To provide local tumor control, radiosurgery remains of utmost importance in modern GI BM management.
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Affiliation(s)
- Farjad Khalaveh
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Abdallah Shaltout
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Helena Untersteiner
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Beate Kranawetter
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Philipp Göbl
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Wolfgang Marik
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
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Ciobanu-Caraus O, Czech T, Peyrl A, Haberler C, Kasprian G, Furtner J, Kool M, Sill M, Frischer JM, Cho A, Slavc I, Rössler K, Gojo J, Dorfer C. The Site of Origin of Medulloblastoma: Surgical Observations Correlated to Molecular Groups. Cancers (Basel) 2023; 15:4877. [PMID: 37835571 PMCID: PMC10571892 DOI: 10.3390/cancers15194877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Developmental gene expression data from medulloblastoma (MB) suggest that WNT-MB originates from the region of the embryonic lower rhombic lip (LRL), whereas SHH-MB and non-WNT/non-SHH MB arise from cerebellar precursor matrix regions. This study aimed to analyze detailed intraoperative data with regard to the site of origin (STO) and compare these findings with the hypothesized regions of origin associated with the molecular group. A review of the institutional database identified 58 out of 72 pediatric patients who were operated for an MB at our department between 1996 and 2020 that had a detailed operative report and a surgical video as well as clinical and genetic classification data available for analysis. The STO was assessed based on intraoperative findings. Using the intraoperatively defined STO, "correct" prediction of molecular groups was feasible in 20% of WNT-MB, 60% of SHH-MB and 71% of non-WNT/non-SHH MB. The positive predictive values of the neurosurgical inspection to detect the molecular group were 0.21 (95% CI 0.08-0.48) for WNT-MB, 0.86 (95% CI 0.49-0.97) for SHH-MB and 0.73 (95% CI 0.57-0.85) for non-WNT/non-SHH MB. The present study demonstrated a limited predictive value of the intraoperatively observed STO for the prediction of the molecular group of MB.
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Affiliation(s)
- Olga Ciobanu-Caraus
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria (T.C.); (A.C.)
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria (T.C.); (A.C.)
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria (I.S.)
- Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Gregor Kasprian
- Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria; (G.K.); (J.F.)
| | - Julia Furtner
- Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria; (G.K.); (J.F.)
| | - Marcel Kool
- Hopp Children’s Cancer Center (KiTZ), 69120 Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Princess Máxima Center for Pediatric Oncology, 3584 Utrecht, The Netherlands
| | - Martin Sill
- Hopp Children’s Cancer Center (KiTZ), 69120 Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Josa M. Frischer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria (T.C.); (A.C.)
| | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria (T.C.); (A.C.)
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria (I.S.)
- Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria (T.C.); (A.C.)
- Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria (I.S.)
- Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria (T.C.); (A.C.)
- Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
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6
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Dodier P, Kranawetter B, Hirschmann D, Dogan M, Cho A, Untersteiner H, Göbl P, Gatterbauer B, Wang WT, Dorfer C, Rössler K, Bavinzski G, Frischer JM. Outcome of 107 conservatively managed unruptured brain arteriovenous malformations: a single center's 30-year experience. J Neurosurg 2023; 139:1025-1035. [PMID: 36964736 DOI: 10.3171/2023.2.jns222675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/06/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Since the publication of A Randomized Trial of Unruptured Brain AVMs (ARUBA), the management of unruptured brain arteriovenous malformations (bAVMs) has been controversially discussed. Long-term follow-up data on the exclusively conservative management of unruptured bAVMs are scarce. The authors evaluated the long-term outcomes of patients with unruptured untreated bAVMs in a real-life cohort. METHODS A retrospective observational cohort of 107 patients (of 897 bAVM patients referred to the authors' institution) with a diagnosis of unruptured and conservatively managed bAVMs is presented. AVMs of all Spetzler-Martin grades were observed. The mean follow-up period was 84 months. In 44% of patients, a follow-up period of 5 years or longer was observed. A national death register comparison completed the outcome analysis. RESULTS The median age at diagnosis, sex distribution, neurological presentation, and modified Rankin Scale score were comparable to the patients in the medical management arm of the ARUBA study. Patients were mainly young, predominantly male, and in good clinical condition. Similar to the ARUBA cohort, 77% of this study's cohort presented in an excellent clinical status at the time of last follow-up. However, 17% of patients had at least one hemorrhage, resulting in an overall annual hemorrhage risk of 2.7% in the observation period. Moreover, the cumulative 1-, 5-, and 10-year overall hemorrhage rates were 3.0%, 11.3%, and 15.3%, respectively. Consequently, the long-term follow-up AVM-related mortality rate amounted to 8%. The estimated median overall survival after AVM diagnosis was 19.3 years (95% CI 14.0-24.6 years). A multivariate Cox regression model revealed temporal and deep-seated localization as an independent risk factor for AVM hemorrhage, while the presence of seizures reached borderline significance as a risk factor. CONCLUSIONS The authors' results represent the long-term course of unruptured untreated bAVMs. Their data support the conclusion that even in the post-ARUBA era, tailored active treatment options may be offered to patients with unruptured bAVMs. For patient counseling, individual risk factors should be weighed against the center's treatment-specific risks.
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Haider L, Hametner S, Endmayr V, Mangesius S, Eppensteiner A, Frischer JM, Iglesias JE, Barkhof F, Kasprian G. Post-mortem correlates of Virchow-Robin spaces detected on in vivo MRI. J Cereb Blood Flow Metab 2022; 42:1224-1235. [PMID: 35581687 PMCID: PMC9207491 DOI: 10.1177/0271678x211067455] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of our study is to quantify the extent to which Virchow-Robin spaces (VRS) detected on in vivo MRI are reproducible by post-mortem MRI.Double Echo Steady State 3T MRIs were acquired post-mortem in 49 double- and 32 single-hemispheric formalin-fixed brain sections from 12 patients, who underwent conventional diagnostic 1.5 or 3T MRI in median 22 days prior to death (25% to 75%: 12 to 134 days). The overlap of in vivo and post-mortem VRS segmentations was determined accounting for potential confounding factors.The reproducibility of VRS found on in vivo MRI by post-mortem MRI, in the supratentorial white matter was in median 80% (25% to 75%: 60 to 100). A lower reproducibility was present in the basal ganglia, with a median of 47% (25% to 75%: 30 to 50).VRS segmentations were histologically confirmed in one double hemispheric section.Overall, the majority of VRS found on in vivo MRI was stable throughout death and formalin fixation, emphasizing the translational potential of post-mortem VRS studies.
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Affiliation(s)
- Lukas Haider
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Institute of Neurology, London, UK.,Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Simon Hametner
- Clinical Institute of Neurology, Centre for Brain Research, Medical University of Vienna, Wien, Austria
| | - Verena Endmayr
- Clinical Institute of Neurology, Centre for Brain Research, Medical University of Vienna, Wien, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Eppensteiner
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Wien, Austria
| | - Juan Eugenio Iglesias
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Frederik Barkhof
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Institute of Neurology, London, UK.,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.,Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, Netherlands
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Wien, Austria
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8
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Ciobanu-Caraus O, Cho A, Kasprian G, Peyrl A, Haberler C, Slavc I, Frischer JM, Czech T, Rössler K, Gojo J, Dorfer C. SURG-02. The site of origin of medulloblastoma: Does the neurosurgical perspective support the current concept from molecular data? Neuro Oncol 2022. [PMCID: PMC9165133 DOI: 10.1093/neuonc/noac079.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Medulloblastoma (MB) are the most common malignant brain tumor in childhood. Developmental gene expression data supported by neuroradiological studies suggest that Wingless (WNT)-MB originate from the lower rhombic lip (LRL), Sonic-Hedgehog (SHH)-MB from the cerebellar hemispheres, and Group 3 and Group 4 MB from the cerebellar vermis. However, there is still insufficient evidence from a neurosurgical perspective supporting this proposed concept. METHODS: Clinical and molecular data from patients aged under 18 years at time of diagnosis who were operated on a histologically confirmed MB at the Department of Neurosurgery of the Medical University of Vienna between 1990 and 2020 were retrospectively analyzed. The location of the tumor origin was defined based on operative reports, surgical videos and preoperative imaging data by an experienced neurosurgeon blinded to the subgroup information. RESULTS: Sufficient data were available in 53 patients. In 28.6% (2 / 7) WNT-MB, 66.7% (6 / 9) SHH-MB and 70.3% (26 / 37) Group 3 and Group 4 MB, the intraoperatively defined site of origin corresponded well with the cellular origin suspected from the molecular subgroup. Within the WNT-subgroup, 57.1% (4 / 7) originated from the vermis, 28.6% (2 / 7) from the LRL and 14.3% (1 / 7) from the cerebellar hemisphere. The origin of SHH-MB was predominantly located in cerebellar hemispheres (66.7% (6 / 9)), while 33.3% (3 / 9) originated from the vermis. Of Group 3 and Group 4 MB, 70.3% (26 / 37) had their origin in the vermis and 29.7% (11 / 37) in the LRL.CONCLUSION: Our results indicate that there is a considerable level of inconsistency between the intraoperatively observed site of origin and the expected cellular origin based on the molecular subgroup, especially in WNT-MB. This discrepancy needs to be discussed when it comes to surgical decision-making accounting for risk stratification.
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Affiliation(s)
| | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - Gregor Kasprian
- Department of Radiology, Medical University of Vienna , Vienna , Austria
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna , Vienna , Austria
| | - Christine Haberler
- Department of Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna , Vienna , Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna , Vienna , Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
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9
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Cho A, Medvedeva K, Kranawetter B, Untersteiner H, Hirschmann D, Lepilina O, Baulin A, Buschmann M, Ertl A, Marik W, Dorfer C, Rössler K, Gatterbauer B, Ilyalov S, Frischer JM. How to dose-stage large or high-risk brain metastases: an alternative two-fraction radiosurgical treatment approach. J Neurosurg 2022; 137:1666-1675. [DOI: 10.3171/2022.2.jns212440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/14/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE
The authors sought to evaluate clinical outcome in patients with large, high-risk brain metastases (BMs) treated with different dose strategies by use of two-fraction dose-staged Gamma Knife radiosurgery (GKRS).
METHODS
A retrospective analysis was performed with data from 142 patients from two centers who had been treated with two-fraction dose-staged GKRS between June 2015 and January 2020. Depending on the changes in marginal dose between the first (GKRS1) and second (GKRS2) GKRS treatments, the study population was divided into three treatment groups: dose escalation, dose maintenance, and dose de-escalation.
RESULTS
The 142 study patients underwent two-fraction dose-staged GKRS treatments for 166 large, high-risk BMs. The median tumor volume of 7.4 cm3 decreased significantly from GKRS1 to GKRS2 (4.4 cm3; p < 0.001), and to the last follow-up (1.8 cm3; p < 0.001). These significant differences in BM volume reduction were achieved in all three treatment groups. However, differences according to the primary tumor histology were apparent: while dose maintenance seemed to be the most effective treatment strategy for BMs from lung cancer or melanoma, dose escalation was the most beneficial treatment option for BMs from breast, gastrointestinal, or genitourinary cancer. Of note, the vast majority of patients who underwent dose-staged BM treatment did not show any significant postradiosurgical complications.
CONCLUSIONS
In patients with large, high-risk BMs, dose-staged GKRS treatment represents an effective local treatment method with acceptable complication risks. Different dose-strategy options are available that may be chosen according to the primary tumor histology and treatment volume but may also be tailored to the findings at GKRS2.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Austria
| | | | | | | | | | | | | | - Martin Buschmann
- Department of Neurosurgery, Medical University of Vienna, Austria
- Department of Radiation Oncology, Medical University of Vienna; and
| | - Adolf Ertl
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Wolfgang Marik
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Austria
| | | | | | - Josa M. Frischer
- Department of Neurosurgery, Medical University of Vienna, Austria
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10
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Cho A, Hennenberg J, Untersteiner H, Hirschmann D, Gatterbauer B, Zöchbauer-Müller S, Hochmair MJ, Preusser M, Rössler K, Dorfer C, Frischer JM, Furtner J. Influence of temporal muscle thickness on the outcome of radiosurgically treated patients with brain metastases from non-small cell lung cancer. J Neurosurg 2022; 137:1-7. [PMID: 35120324 DOI: 10.3171/2021.12.jns212193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/25/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the impact of temporal muscle thickness (TMT), a surrogate marker for sarcopenia, in radiosurgically treated patients with brain metastases (BMs) from non-small cell lung cancer (NSCLC). METHODS For 566 patients with BMs from NSCLC in the period between June 2012 and December 2019, TMT values were retrospectively measured on the planning brain magnetic resonance imaging (MRI) studies that had been obtained before their first Gamma Knife radiosurgery treatment (GKRS1). Predefined sex-specific TMT cutoff values were used to stratify the study cohort into patients at risk for sarcopenia and patients with normal muscle status. Cox regression models adjusted for other prognostic parameters were used to evaluate sarcopenia as an independent prognostic factor. RESULTS In sarcopenia patients with a TMT below the sex-specific cutoff values, the risk of death was significantly increased (HR 1.908, 95% CI 1.550-2.349, p < 0.001). In addition, sarcopenia was revealed as an independent prognostic factor even after adjusting for age groups, sex, number of BMs, presence of extracranial metastases, NSCLC subtypes, Karnofsky Performance Status groups, recursive partitioning analysis classes, and concomitant immunotherapy or targeted therapy (HR 1.680, 95% CI 1.347-2.095, p < 0.001). However, patients at risk for sarcopenia showed no significant differences in the estimated mean time until local BM progression after GKRS1, compared to patients with normal muscle status (p = 0.639). CONCLUSIONS TMT obtained from planning MRI studies is an independent prognostic marker in radiosurgically treated patients with BMs from NSCLC and may aid patient stratification in future clinical trials.
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Affiliation(s)
| | - Juliane Hennenberg
- 2Biomedical Imaging and Image-guided Therapy, Medical University of Vienna
| | | | | | | | | | - Maximilian J Hochmair
- 4Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Matthias Preusser
- 3Department of Internal Medicine I, Division of Oncology, Medical University of Vienna; and
| | | | | | | | - Julia Furtner
- 2Biomedical Imaging and Image-guided Therapy, Medical University of Vienna
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11
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Tobin WO, Kalinowska-Lyszczarz A, Weigand SD, Guo Y, Tosakulwong N, Parisi JE, Metz I, Frischer JM, Lassmann H, Brück W, Linbo L, Lucchinetti CF. Clinical Correlation of Multiple Sclerosis Immunopathologic Subtypes. Neurology 2021; 97:e1906-e1913. [PMID: 34504026 DOI: 10.1212/wnl.0000000000012782] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/23/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The goal of this work was to compare clinical characteristics across immunopathologic subtypes of patients with multiple sclerosis. METHODS Immunopathologic subtyping was performed on specimens from 547 patients with biopsy- or autopsy-confirmed CNS demyelination. RESULTS The frequency of immunopathologic subtypes was 23% for pattern I, 56% for pattern II, and 22% for pattern III. Immunopatterns were similar in terms of age at autopsy/biopsy (median age 41 years, range 4-83 years, p = 0.16) and proportion female (54%, p = 0.71). Median follow-up after symptom onset was 2.3 years (range 0-38 years). In addition to being overrepresented among autopsy cases (45% vs 19% in biopsy cohort, p < 0.001), index attack-related disability was higher in pattern III vs II (median Expanded Disability Status Scale score 4 vs 3, p = 0.02). Monophasic clinical course was more common in patients with pattern III than pattern I or II (59% vs 33% vs 32%, p < 0.001). Similarly, patients with pattern III pathology were likely to have progressive disease compared to patients with patterns I or II when followed up for ≥5 years (24% overall, p = 0.49), with no differences in long-term survival, despite a more fulminant attack presentation. CONCLUSION All 3 immunopatterns can be detected in active lesions, although they are found less frequently later into the disease due to the lower number of active lesions. Pattern III is associated with a more fulminant initial attack than either pattern I or II. Biopsied patients appear to have similar long-term outcomes regardless of their immunopatterns. Progressive disease is less associated with the initial immunopattern and suggests convergence into a final common pathway related to the chronically denuded axon.
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Affiliation(s)
- W Oliver Tobin
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Alicja Kalinowska-Lyszczarz
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Stephen D Weigand
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Yong Guo
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Nirubol Tosakulwong
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Joseph E Parisi
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Imke Metz
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Josa M Frischer
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Hans Lassmann
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Wolfgang Brück
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Linda Linbo
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Claudia F Lucchinetti
- From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.), Germany; Medical University of Vienna (J.M.F., H.L.), Austria; and Departments of Neurosciences (C.F.L.), Neurology (C.F.L.), and Clinical and Translational Science (C.F.L.), Mayo Clinic, College of Medicine, Rochester, MN.
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12
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Dodier P, Wang WT, Hosmann A, Hirschmann D, Marik W, Frischer JM, Gruber A, Rössler K, Bavinzski G. Combined standard bypass and parent artery occlusion for management of giant and complex internal carotid artery aneurysms. J Neurointerv Surg 2021; 14:593-598. [PMID: 34353887 DOI: 10.1136/neurintsurg-2021-017673] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Complex aneurysms do not have a standard protocol for treatment. In this study, we investigate the safety and efficacy of microsurgical revascularization combined with parent artery occlusion (PAO) in giant and complex internal carotid artery (ICA) aneurysms. METHODS Between 1998 and 2017, 41 patients with 47 giant and complex ICA aneurysms were treated by an a priori planned combined treatment strategy. Clinical and radiological outcomes were stratified according to mRS and Raymond classification. Bypass patency was assessed. Median follow-up time was 3.9 years. RESULTS After successful STA-MCA bypass, staged endovascular (n=37) or surgical (n=1) PAO was executed in 38 patients following a negative balloon occlusion test. Intolerance to PAO led to stent/coil treatments in two patients. Perioperative bypass patency was confirmed in 100% of completed STA-MCA bypass procedures. Long-term overall bypass patency rate was 99%. Raymond 1 occlusion and good outcome were achieved in 95% and 97% (mRS 0-2) of cases, respectively. No procedure-related mortality was encountered. Eighty-four percent of patients with preoperative cranial nerve compression syndromes improved during follow-up. CONCLUSIONS The combined approach of STA-MCA bypass surgery followed by parent artery occlusion achieves high aneurysm occlusion and low morbidity rates in the management of giant and complex ICA aneurysms. This combined indirect approach represents a viable alternative to flow diversion in patients with cranial nerve compression syndromes or matricidal aneurysms, and may serve as a backup strategy in cases of peri-interventional complications or lack of suitable endovascular access.
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Affiliation(s)
- Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Wei-Te Wang
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Wolfgang Marik
- Department of Radiology, Medical University of Vienna, Wien, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler Universitätsklinikum GmbH, Linz, Oberösterreich, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, Wien, Austria
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13
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Metz I, Gavrilova RH, Weigand SD, Frischer JM, Popescu BF, Guo Y, Gloth M, Tobin WO, Zalewski NL, Lassmann H, Tillema JM, Erickson BJ, Parisi JE, Becker S, König FB, Brück W, Lucchinetti CF. Magnetic Resonance Imaging Correlates of Multiple Sclerosis Immunopathological Patterns. Ann Neurol 2021; 90:440-454. [PMID: 34231919 DOI: 10.1002/ana.26163] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Histology reveals that early active multiple sclerosis lesions can be classified into 3 main interindividually heterogeneous but intraindividually stable immunopathological patterns of active demyelination (patterns I-III). In patterns I and II, a T-cell- and macrophage-associated demyelination is suggested, with pattern II only showing signs of a humoral immune response. Pattern III is characterized by inflammatory lesions with an oligodendrocyte degeneration. Patterns suggest pathogenic heterogeneity, and we postulated that they have distinct magnetic resonance imaging (MRI) correlates that may serve as biomarkers. METHODS We evaluated in an international collaborative retrospective cohort study the MRI lesion characteristics of 789 conventional prebiopsy and follow-up MRIs in relation to their histopathologically classified immunopathological patterns (n = 161 subjects) and lesion edge features (n = 112). RESULTS A strong association of a ringlike enhancement and a hypointense T2-weighted (T2w) rim with patterns I and II, but not pattern III, was observed. Only a fraction of pattern III patients showed a ringlike enhancement, and this was always atypical. Ringlike enhancement and T2w rims colocalized, and ringlike enhancement showed a strong association with macrophage rims as shown by histology. A strong concordance of MRI lesion characteristics, meaning that different lesions showed the same features, was found when comparing biopsied and nonbiopsied lesions at a given time point, indicating lesion homogeneity within individual patients. INTERPRETATION We provide robust evidence that MRI characteristics reflect specific morphological features of multiple sclerosis immunopatterns and that ringlike enhancement and T2w hypointense rims might serve as a valuable noninvasive biomarker to differentiate pathological patterns of demyelination. ANN NEUROL 2021.
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Affiliation(s)
- Imke Metz
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Ralitza H Gavrilova
- Department of Neurology, Mayo Clinic, Rochester, MN.,Department of Clinical Genomics, Mayo Clinic, Rochester, MN
| | | | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Bogdan F Popescu
- Department of Anatomy, Physiology, and Pharmacology, and Cameco MS Neuroscience Research Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yong Guo
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Mareike Gloth
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - William Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, MN.,Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
| | - Nicholas L Zalewski
- Department of Neurology, Mayo Clinic, Rochester, MN.,Department of Neurology, Mayo Clinic, Scottsdale, AZ
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | | | | | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Stephanie Becker
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Fatima B König
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Institute of Pathology, Hospital Kassel, Kassel, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
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14
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Hirschmann D, Kranawetter B, Tomschik M, Wais J, Winter F, Frischer JM, Millesi M, Herta J, Roessler K, Dorfer C. New-onset seizures after cranioplasty-a different view on a putatively frequently observed phenomenon. Acta Neurochir (Wien) 2021; 163:1437-1442. [PMID: 33523299 PMCID: PMC8053646 DOI: 10.1007/s00701-021-04720-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/14/2021] [Indexed: 11/27/2022]
Abstract
Background New-onset seizures after cranioplasty (NOSAC) are reported to be a frequent complication of cranioplasty (CP) after decompressive hemicraniectomy (DHC). There are considerable differences in the incidence of NOSAC and contradictory data about presumed risk factors in the literature. We suggest NOSAC to be a consequence of patients’ initial condition which led to DHC, rather than a complication of subsequent CP. We conducted a retrospective analysis to verify our hypothesis. Methods The medical records of all patients ≥ 18 years who underwent CP between 2002 and 2017 at our institution were evaluated including incidence of seizures, time of seizure onset, and presumed risk factors. Indication for DHC, type of implant used, timing of CP, patient age, presence of a ventriculoperitoneal shunt (VP shunt), and postoperative complications were compared between patients with and without NOSAC. Results A total of 302 patients underwent CP between 2002 and 2017, 276 of whom were included in the outcome analysis and the incidence of NOSAC was 23.2%. Although time between DHC and CP differed significantly between DHC indication groups, time between DHC and seizure onset did not differ, suggesting the occurrence of seizures to be independent of the procedure of CP. Time of follow-up was the only factor associated with the occurrence of NOSAC. Conclusion New-onset seizures may be a consequence of the initial condition leading to DHC rather than of CP itself. Time of follow-up seems to play a major role in detection of new-onset seizures.
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Affiliation(s)
- Dorian Hirschmann
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Beate Kranawetter
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jonathan Wais
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Fabian Winter
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Matthias Millesi
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes Herta
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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15
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Cho A, Kranawetter B, Untersteiner H, Khalaveh F, Dorfer C, Rössler K, Zöchbauer-Müller S, Gatterbauer B, Hochmair MJ, Frischer JM. Neutrophil-to-Lymphocyte Ratio Is Superior to Other Leukocyte-Based Ratios as a Prognostic Predictor in Non-Small Cell Lung Cancer Patients with Radiosurgically Treated Brain Metastases Under Immunotherapy or Targeted Therapy. World Neurosurg 2021; 151:e324-e331. [PMID: 33878466 DOI: 10.1016/j.wneu.2021.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate predictive value of preradiosurgery leukocyte-based prognostic ratios in a selected cohort of non-small cell lung cancer (NSCLC) patients with radiosurgery-treated brain metastases (BM) and concomitant immunotherapy (IT) or targeted therapy (TT). METHODS We performed a retrospective analysis of 166 patients with NSCLC BM treated with Gamma Knife radiosurgery. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio were assessed within 14 days before radiosurgery. RESULTS In radiosurgically treated patients with NSCLC BM with concomitant IT or TT, estimated median survival after first Gamma Knife radiosurgery treatment was significantly longer in patients with NLR cutoff value <5 (P = 0.038). Consequently, the Cox regression model for NLR cutoff value groups revealed a significant hazard ratio of 1.519 (95% confidence interval 1.020-2.265, P = 0.040). In addition, each increase in NLR of 1 equaled an increase of 5.4% in risk of death (hazard ratio 1.054, 95% confidence interval 1.024-1.085, P < 0.001). After adjusting for sex, age, Karnofsky performance scale, and presence of extracranial metastases, NLR remained a significant and independent predictor for survival (hazard ratio 1.047, 95% confidence interval 1.017-1.078, P = 0.002). In contrast, platelet-to-lymphocyte ratio and lymphocyte-to-monocyte ratio did not exhibit the same predictive value among patients with radiosurgery-treated BM with concomitant IT or TT. CONCLUSIONS In patients with NSCLC BM treated with radiosurgery with concomitant IT or TT, preradiosurgery NLR represents a simple prognostic predictor for survival and is superior to other leukocyte-based ratios. NLR may be relevant for clinical decision making, therapeutic evaluation, patient counseling, and appropriate stratification of future clinical trials among patients with radiosurgery-treated BM.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Beate Kranawetter
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | | | - Farjad Khalaveh
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Sabine Zöchbauer-Müller
- Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | | | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna North Hospital, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
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Tham M, Frischer JM, Weigand SD, Fitz-Gibbon PD, Webb SM, Guo Y, Adiele RC, Robinson CA, Brück W, Lassmann H, Furber KL, Pushie MJ, Parisi JE, Lucchinetti CF, Popescu BF. Iron Heterogeneity in Early Active Multiple Sclerosis Lesions. Ann Neurol 2020; 89:498-510. [PMID: 33244761 PMCID: PMC7986227 DOI: 10.1002/ana.25974] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a heterogeneous inflammatory demyelinating disease. Iron distribution is altered in MS patients' brains, suggesting iron liberation within active lesions amplifies demyelination and neurodegeneration. Whether the amount and distribution of iron are similar or different among different MS immunopatterns is currently unknown. METHODS We used synchrotron X-ray fluorescence imaging, histology, and immunohistochemistry to compare the iron quantity and distribution between immunopattern II and III early active MS lesions. We analyzed archival autopsy and biopsy tissue from 21 MS patients. RESULTS Immunopattern II early active lesions contain 64% more iron (95% confidence interval [CI] = 17-127%, p = 0.004) than immunopattern III lesions, and 30% more iron than the surrounding periplaque white matter (95% CI = 3-64%, p = 0.03). Iron in immunopattern III lesions is 28% lower than in the periplaque white matter (95% CI = -40 to -14%, p < 0.001). When normalizing the iron content of early active lesions to that of surrounding periplaque white matter, the ratio is significantly higher in immunopattern II (p < 0.001). Microfocused X-ray fluorescence imaging shows that iron in immunopattern II lesions localizes to macrophages, whereas macrophages in immunopattern III lesions contain little iron. INTERPRETATION Iron distribution and content are heterogeneous in early active MS lesions. Iron accumulates in macrophages in immunopattern II, but not immunopattern III lesions. This heterogeneity in the two most common MS immunopatterns may be explained by different macrophage polarization, origin, or different demyelination mechanisms, and paves the way for developing new or using existing iron-sensitive magnetic resonance imaging techniques to differentiate among immunopatterns in the general nonbiopsied MS patient population. ANN NEUROL 2021;89:498-510.
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Affiliation(s)
- Mylyne Tham
- Department of Anatomy, Physiology, and Pharmacology/Cameco MS Neuroscience Research Centre, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Stephen D Weigand
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Patrick D Fitz-Gibbon
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samuel M Webb
- Stanford Synchrotron Radiation Lightsource, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - Yong Guo
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Reginald C Adiele
- Department of Anatomy, Physiology, and Pharmacology/Cameco MS Neuroscience Research Centre, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Christopher A Robinson
- Department of Pathology and Laboratory Medicine, Saskatoon Health Region/College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Wolfgang Brück
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Kendra L Furber
- Department of Anatomy, Physiology, and Pharmacology/Cameco MS Neuroscience Research Centre, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - M Jake Pushie
- Department of Surgery, Division of Neurosurgery, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Bogdan F Popescu
- Department of Anatomy, Physiology, and Pharmacology/Cameco MS Neuroscience Research Centre, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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17
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Cho A, Untersteiner H, Hirschmann D, Shaltout A, Göbl P, Dorfer C, Rössler K, Marik W, Kirchbacher K, Kapfhammer I, Zöchbauer-Müller S, Gatterbauer B, Hochmair MJ, Frischer JM. Gamma Knife Radiosurgery for Brain Metastases in Non-Small Cell Lung Cancer Patients Treated with Immunotherapy or Targeted Therapy. Cancers (Basel) 2020; 12:cancers12123668. [PMID: 33297416 PMCID: PMC7762317 DOI: 10.3390/cancers12123668] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/03/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/28/2022] Open
Abstract
Simple Summary In non-small cell lung cancer patients with brain metastases, combined Gamma Knife radiosurgery and immunotherapy or targeted therapy showed an increase in overall survival. The combination of Gamma Knife radiosurgery and immunotherapy or targeted therapy did not increase complications related to radiosurgery. Therefore, the combined treatment seems to be a safe and powerful treatment option for non-small cell lung cancer patients with brain metastases. Abstract The combination of Gamma Knife radiosurgery (GKRS) and systemic immunotherapy (IT) or targeted therapy (TT) is a novel treatment method for brain metastases (BMs) in non-small cell lung cancer (NSCLC). To elucidate the safety and efficacy of concomitant IT or TT on the outcome after GKRS, 496 NSCLC patients with BMs, who were treated with GKRS were retrospectively reviewed. The median time between the initial lung cancer diagnosis and the diagnosis of brain metastases was one month. The survival after the initial BM diagnosis was significantly longer than the survival predicted by prognostic BM scores. After the first Gamma Knife radiosurgery treatment (GKRS1), the estimated median survival was 9.9 months (95% CI = 8.3–11.4). Patients with concurrent IT or TT presented with a significantly longer survival after GKRS1 than patients without IT or TT (p < 0.001). These significant differences in the survival were also apparent among the four treatment groups and remained significant after adjustment for Karnofsky performance status scale (KPS), recursive partitioning analysis (RPA) class, sex, and multiple BMs. About half of all our patients (46%) developed new distant BMs after GKRS1. Of note, no statistically significant differences in the occurrence of radiation reaction, radiation necrosis, or intralesional hemorrhage in association with IT or TT at or after GKRS1 were observed. In NSCLC-BM patients, the concomitant use of GKRS and IT or TT showed an increase in overall survival without increased complications related to GKRS. Therefore, the combined treatment with GKRS and IT or TT seems to be a safe and powerful treatment option and emphasizes the role of radiosurgery in modern BM treatment.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Helena Untersteiner
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Abdallah Shaltout
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Philipp Göbl
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Wolfgang Marik
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, 1090 Vienna, Austria;
| | | | | | - Sabine Zöchbauer-Müller
- Department of Internal Medicine I, Division of Oncology, Medical University Vienna, 1090 Vienna, Austria;
| | - Brigitte Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna North Hospital, 1210 Vienna, Austria;
| | - Josa M. Frischer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
- Correspondence: ; Tel.: +43-1-40400-45510
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18
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Steindl A, Yadavalli S, Gruber K, Seiwald M, Gatterbauer B, Dieckmann K, Frischer JM, Klikovits T, Zöchbauer‐Müller S, Grisold A, Hoda MAR, Marosi C, Widhalm G, Preusser M, Berghoff AS. Neurological symptom burden impacts survival prognosis in patients with newly diagnosed non-small cell lung cancer brain metastases. Cancer 2020; 126:4341-4352. [PMID: 32678971 PMCID: PMC7540353 DOI: 10.1002/cncr.33085] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Brain metastases (BM) are a frequent complication of advanced cancer and are characterized by a variety of neurological symptoms. Although the presence of neurological symptoms is included in the response assessment in patients with primary brain tumors, to the authors' knowledge little is known regarding the prognostic impact of neurological symptoms in patients with BM. METHODS Patients with newly diagnosed BM from non-small cell lung cancer were identified from the Vienna Brain Metastasis Registry and were evaluated according to the incidence, distribution, and prognostic impact of neurological symptoms at the time of diagnosis of BM. RESULTS A total of 1608 patients (57.3% male and 42.7% female; median age, 62 years) were available for further analyses. Neurological symptoms including focal deficits (985 patients; 61.3%), signs of increased intracranial pressure (483 patients; 30.0%), epileptic seizures (224 patients; 13.9%), and neuropsychological symptoms (233 patients; 14.5%) were documented in 1186 of the 1608 patients (73.8%). Patients with asymptomatic BM presented with a longer median overall survival after the diagnosis of BM compared with patients with symptomatic BM (11 months vs 7 months; P < .001). In multivariate analysis with a diagnosis-specific graded prognostic assessment (hazard ratio, 1.41; 95% CI, 1.33-1.50 [P < .001]), the presence of neurological symptoms (hazard ratio, 1.39; 95% CI, 1.23-1.57 [P < .001]) was found to be independently associated with survival prognosis from the time of diagnosis of BM. CONCLUSIONS Neurological symptoms at the time of BM diagnosis demonstrated a strong and independent association with survival prognosis. The results of the current study have highlighted the need for the integration of the presence of neurological symptoms into the prognostic assessment of patients with BM from non-small cell lung cancer. LAY SUMMARY Neurological symptom evaluation is included regularly in the assessment of patients with primary brain tumors. However, to the authors' knowledge, little is known regarding the prognostic impact in patients with newly diagnosed brain metastases (BM). The current study has provided a detailed clinical characterization of the incidence, distribution, and prognostic impact of neurological symptoms in a large, real-life cohort of patients with BM from non-small cell lung cancer. In this cohort, neurological symptoms at the time of diagnosis of BM demonstrated a strong, independent prognostic impact on the survival prognosis. The results of the current study have highlighted the need for the integration of neurological symptom burden into the prognostic assessment of patients with BM from non-small cell lung cancer.
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Affiliation(s)
- Ariane Steindl
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Sarah Yadavalli
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Katharina‐Anna Gruber
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Maria Seiwald
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Brigitte Gatterbauer
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Karin Dieckmann
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of RadiotherapyMedical University of ViennaViennaAustria
| | - Josa M. Frischer
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Thomas Klikovits
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Division of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Sabine Zöchbauer‐Müller
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Anna Grisold
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Mir Ali Reza Hoda
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Division of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Christine Marosi
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Georg Widhalm
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Matthias Preusser
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Anna Sophie Berghoff
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
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19
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Dodier P, Winter F, Auzinger T, Mistelbauer G, Frischer JM, Wang WT, Mallouhi A, Marik W, Wolfsberger S, Reissig L, Hammadi F, Matula C, Baumann A, Bavinzski G. Single-stage bone resection and cranioplastic reconstruction: comparison of a novel software-derived PEEK workflow with the standard reconstructive method. Int J Oral Maxillofac Surg 2020; 49:1007-1015. [DOI: 10.1016/j.ijom.2019.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/07/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
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20
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Micko A, Rötzer T, Hoftberger R, Vila G, Oberndorfer J, Frischer JM, Knosp E, Wolfsberger S. Expression of additional transcription factors is of prognostic value for aggressive behavior of pituitary adenomas. J Neurosurg 2020; 134:1139-1146. [PMID: 32302984 DOI: 10.3171/2020.2.jns2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE According to the latest WHO classification of tumors of endocrine organs in 2017, plurihormonal adenomas are subclassified by their transcription factor (TF) expression. In the group of plurihormonal adenomas with unusual immunohistochemical combinations (PAWUC), the authors identified a large fraction of adenomas expressing TFs for gonadotroph adenoma (TFGA) cells in addition to other TFs. The aim of this study was to compare clinicopathological parameters of PAWUC with TFGA expression to gonadotroph adenomas that only express TFGA. METHODS This retrospective single-center series comprises 73 patients with TFGA-positive pituitary adenomas (SF1, GATA3, estrogen receptor α): 22 PAWUC with TFGA (TFGA-plus group) and 51 with TFGA expression only (TFGA-only group). Patient characteristics, outcome parameters, rate of invasiveness (assessed by direct endoscopic inspection), and MIB1 and MGMT status were compared between groups. RESULTS Patients in the TFGA-plus group were significantly younger than patients in the TFGA-only group (age 46 vs 56 years, respectively; p = 0.007). In the TFGA-only group, pituitary adenomas were significantly larger (diameter 25 vs 18.3 mm, p = 0.002). Intraoperatively, signs of invasiveness were significantly more common in the TFGA-plus group than in the TFGA-only group (50% vs 16%, p = 0.002). Gross-total resection was significantly lower in the nonfunctioning TFGA-plus group than in the TFGA-only group (44% vs 86%, p = 0.004). MIB1 and MGMT status showed no significant difference between groups. CONCLUSIONS These data suggest a more aggressive behavior of TFGA-positive adenomas if an additional TF is expressed within the tumor cells. Shorter radiographic surveillance and earlier consideration for retreatment should be recommended in these adenoma types.
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Affiliation(s)
| | | | | | - Greisa Vila
- 3Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Austria
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21
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Gatterbauer B, Hirschmann D, Eberherr N, Untersteiner H, Cho A, Shaltout A, Göbl P, Fitschek F, Dorfer C, Wolfsberger S, Kasprian G, Höller C, Frischer JM. Toxicity and efficacy of Gamma Knife radiosurgery for brain metastases in melanoma patients treated with immunotherapy or targeted therapy-A retrospective cohort study. Cancer Med 2020; 9:4026-4036. [PMID: 32249551 PMCID: PMC7286469 DOI: 10.1002/cam4.3021] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 11/19/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background Few safety data of concurrent stereotactic radiosurgery and targeted therapy (TT) or immunotherapy (IT) are available. The aim of the study was to evaluate the outcome of melanoma patients with brain metastases (MBM) after Gamma Knife Radiosurgery (GKRS) in relation to IT/TT. Methods We evaluated 182 MBM patients, who were treated with GKRS in the modern radiosurgical and oncological era. Results The median time between the initial melanoma diagnosis and occurrence of MBM was 2.4 years. The median overall survival time was 5.4 years after melanoma diagnosis. The estimated median survival after the initial diagnosis of MBM was 1.0 year (95% CI = 0.7‐1.2 years). Patients treated with anti‐PD‐1 or a combination of anti‐CTLA‐4/PD‐1 showed a significantly longer survival after first GKRS compared to all other forms of treatment. In addition, patients treated with anti‐PD‐1, anti‐CTLA‐4, or a combination of anti‐CTLA‐4/PD‐1 showed a significantly longer time to new MBM after GKRS1 compared to patients treated with other forms and combinations of the oncological therapy. The occurrence of hemorrhage or radiation reaction/necrosis after GKRS did not show any statistically significant differences in relation to IT/TT. Conclusion In MBM patients, complications after GKRS are not significantly increased if IT/TT treatment is performed at the time of or after radiosurgery. Further, a clear benefit in distant control and survival is seen in MBM patients treated with GKRS and checkpoint inhibitors. Thus, concomitant treatment of MBM with GKRS and IT/TT seems to be a safe and powerful treatment option although further prospective studies should be conducted.
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Affiliation(s)
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Nadine Eberherr
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | | | | | - Abdallah Shaltout
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Philipp Göbl
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Fabian Fitschek
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | | | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Christoph Höller
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
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22
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Dodier P, Auzinger T, Mistelbauer G, Wang WT, Ferraz-Leite H, Gruber A, Marik W, Winter F, Fischer G, Frischer JM, Bavinzski G. Novel Software-Derived Workflow in Extracranial–Intracranial Bypass Surgery Validated by Transdural Indocyanine Green Videoangiography. World Neurosurg 2020; 134:e892-e902. [DOI: 10.1016/j.wneu.2019.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/24/2022]
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23
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Hirschmann D, Goebl P, Witte FH, Gatterbauer B, Wang WT, Dodier P, Bavinzski G, Ertl A, Marik W, Mallouhi A, Roetzer T, Dorfer C, Eisner W, Gruber A, Kitz K, Frischer JM. Evaluation of the radiosurgical treatment of cerebral arteriovenous malformations: a retrospective single-center analysis of three decades. J Neurointerv Surg 2019; 12:401-406. [PMID: 31558656 DOI: 10.1136/neurintsurg-2019-015332] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Gamma Knife radiosurgery (GKRS) in the treatment of arteriovenous malformations (AVMs) is still controversially discussed. OBJECTIVE To present long-term follow-up data on patients after Gamma Knife radiosurgery for cerebral AVMs. METHODS Overall, 516 patients received radiosurgery for cerebral AVMs between 1992 and 2018 at our department, of whom 265 received radiosurgery alone and 207 were treated with a combined endovascular-radiosurgical approach. Moreover, 45 patients were treated with a volume-staged approach. Two eras were analyzed, the pre-modern era between 1992 and 2002 and the modern era thereafter. RESULTS In GKRS-only treated patients, median time to nidus occlusion was 3.8 years. Spetzler-Ponce (SP) class was a significant predictor for time to obliteration in the whole sample. Median time to obliteration for the combined treatment group was 6.5 years. Patients in the pre-modern era had a significantly higher obliteration rate than those treated in the modern era. Overall, the calculated yearly hemorrhage risk in the observation period after first GKRS was 1.3%. Permanent post-radiosurgical complications occurred in 4.9% of cases but did not differ between the treatment groups or treatment eras. The obliteration rate was significantly lower and the hemorrhage rate was higher in volume-staged treated patients than in conventionally treated patients. CONCLUSION GKRS is an effective treatment option for SP class A and B cerebral AVMs. After combined endovascular-radiosurgical treatment, the outcome of selected SP class C AVMs aligns with that of SP class B lesions. Both the combined therapy and radiosurgery alone constitute sound methods for treatment of cerebral AVMs.
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Affiliation(s)
- Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Goebl
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Frederic H Witte
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | - Wei-Te Wang
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Adolf Ertl
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Ammar Mallouhi
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Wilhelm Eisner
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Johannes Kepler Universitat Linz, Linz, Austria
| | - Klaus Kitz
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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24
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Mir Seyed Nazari P, Ay C, Steindl A, Gatterbauer B, Frischer JM, Dieckmann K, Widhalm G, Hainfellner JA, Pabinger I, Preusser M, Berghoff A. P14.97 High risk of venous thromboembolism in patients with brain metastases from non-small cell lung cancer. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Venous thromboembolism (VTE) is a common complication in patients with cancer. In general, patients with metastatic disease are at highest risk. Lung cancer belong to those tumor entities with a particularly high risk of VTE, ranging between 3–13.8%. However, little is known about the VTE rate in lung cancer patients with brain metastases.
MATERIAL AND METHODS
Our study was conducted in the framework of the Vienna Brain Metastasis Registry. Clinical data and VTE events during the course of the disease were recorded via retrospective chart review. In this analysis, non-small cell lung cancer (NSCLC) patients with a resection of brain metastases at the Medical University of Vienna between 2006 and 2010 were included.
RESULTS
In total, 69 NSCLC patients with brain metastases were analyzed. Overall, 69.6% (48/69) patients had an adenocarcinoma, 13% (9/69) a squamous cell carcinoma, 8.7% (6/69) a large cell carcinoma and 8.7% (6/69) other primary tumor histologies. After cancer diagnosis, 20.3% (14/69) patients developed VTE during the course of the disease. Of those, 85.7% (12/14) thromboembolic events occurred after the diagnosis of brain metastases.
CONCLUSION
Based on our data, patients with brain metastases from NSCLC have a very high VTE risk. Further investigations are needed in order to identify patients with distinct VTE risk profiles. Patients at high risk might potentially benefit from primary thromboprophylaxis over the high risk of intracerebral bleeding.
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Affiliation(s)
- P Mir Seyed Nazari
- Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - C Ay
- Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - A Steindl
- Division of Oncology, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - B Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - J M Frischer
- Department of Neurosurgery, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - K Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - J A Hainfellner
- Institute of Neurology, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - I Pabinger
- Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - M Preusser
- Division of Oncology, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - A Berghoff
- Division of Oncology, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
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Başaran AE, Kiesel B, Frischer JM, Furtner J, Wöhrer A, Dieckmann K, Dorfer C. Intrameningioma Metastasis: A Wolf in Sheep's Clothing? Experience from a Series of 7 Cases. World Neurosurg 2019; 132:169-172. [PMID: 31491578 DOI: 10.1016/j.wneu.2019.08.097] [Citation(s) in RCA: 5] [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: 07/05/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intrameningioma metastasis is a rare differential diagnosis. The clinical implications of these lesions are poorly understood. We screened our database to identify all patients who had been undergone surgery between January 2000 and December 2018 and had been diagnosed with intrameningioma metastasis. Medical charts and radiographic images were reviewed. Brain edema was related to tumor size on preoperative T2-weighted magnetic resonance imaging and classified as little (i.e., less than the tumor size), moderate (i.e., less than triple the size of the tumor), and extensive (i.e., more than triple the size of the tumor). CASE DESCRIPTIONS We identified 7 patients (3 men and 4 women) with a median age of 61 years (range, 33-63 years). A systemic cancer had been diagnosed preoperatively in all patients (lung adenocarcinoma, n = 5; breast adenocarcinoma, n = 1; pancreas adenocarcinoma, n = 1). Mean time interval between diagnosis of the systemic cancer and the intracranial dural mass was 32 months (SD 23.05). The preoperative working diagnosis was meningioma in 5 patients, and metastasis in 2 patients. All patients were symptomatic at the time of diagnosis with a short history of headache (n = 2), nausea (n = 1), and dizziness (n = 1), and 5 patients harbored neurologic deficits, including hemiparesis (n = 2), hemihypesthesia (n = 2), and paresthesia (n = 1). Preoperative images showed brain edema in all patients (extensive, n = 4; moderate, n = 3). CONCLUSIONS Intrameningioma metastases show an aggressive clinical behavior prompting early surgical intervention. Clinicians should be aware of this rare entity when counseling patients.
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Affiliation(s)
- Alim Emre Başaran
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
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Steindl A, Schlieter F, Klikovits T, Leber E, Gatterbauer B, Frischer JM, Dieckmann K, Widhalm G, Zöchbauer-Müller S, Hoda MAR, Preusser M, Berghoff AS. Prognostic assessment in patients with newly diagnosed small cell lung cancer brain metastases: results from a real-life cohort. J Neurooncol 2019; 145:85-95. [PMID: 31456143 PMCID: PMC6775039 DOI: 10.1007/s11060-019-03269-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 01/17/2023]
Abstract
Purposes Brain metastases (BM) are a frequent complication in small cell lung cancer (SCLC), resulting in a reduced survival prognosis. Precise prognostic assessment is an important foundation for treatment decisions and clinical trial planning. Methods Patients with newly diagnosed SCLC BM were identified from the Vienna Brain Metastasis Registry and evaluated concerning prognostic factors. Results 489 patients (male 62.2%, female 37.8%; median age 61 years) were included. Neurological symptoms were present in 297/489 (60.7%) patients. A- to oligosymptomatic patients (5 vs. 9 months, p = 0.030) as well as patients with synchronous diagnosis of BM and primary tumor (5 vs. 9 months, p = 0.008) presented with improved overall survival (OS) prognosis. RPA (HR 1.66; 95% CI 1.44–1.91; p < 0.001), GPA (HR 1.65; p < 0.001), DS-GPA (HR 1.60; p < 0.001) and LabBM score (HR 1.69; p < 0.001) were statistically significantly associated with OS. In multivariate analysis, DS-GPA (HR 1.59; p < 0.001), neurological deficits (HR 1.26; p = 0.021) and LabBM score (HR 1.57; p < 0.001) presented with statistical independent association with OS. Conclusion A- to oligosymptomatic BM as well as synchronous diagnosis of SCLC and BM were associated with improved OS. Established prognostic scores could be validated in this large SCLC BM real-life cohort. Electronic supplementary material The online version of this article (10.1007/s11060-019-03269-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariane Steindl
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Franziska Schlieter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Klikovits
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Elena Leber
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Brigitte Gatterbauer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Sabine Zöchbauer-Müller
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mir Ali Reza Hoda
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria. .,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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27
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Hosmann A, Micko A, Frischer JM, Roetzer T, Vila G, Wolfsberger S, Knosp E. Multiple Pituitary Apoplexy-Cavernous Sinus Invasion as Major Risk Factor for Recurrent Hemorrhage. World Neurosurg 2019; 126:e723-e730. [PMID: 30851467 DOI: 10.1016/j.wneu.2019.02.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pituitary apoplexy is a rare but potentially life-threatening disorder that occurs in up to 10% of adenomas. Whereas risk factors for the initial hemorrhagic event are well described, there is minor knowledge on clinical symptomatic recurrent pituitary apoplexies. METHODS At the Medical University of Vienna, 76 patients were surgically treated for clinical symptomatic pituitary apoplexy between 1990 and 2017. Four patients (5.3%) suffered multiple pituitary apoplexies after initial surgery. In this retrospective study, neuroradiologic images, clinical data, and intraoperative findings were reviewed for potential risk factors of multiple apoplexies in pituitary adenomas. RESULTS Patients with multiple apoplexies had significantly higher Knosp grading on preoperative imaging (median grade 4), and more frequently observed cavernous sinus invasion intraoperatively (P = 0.01). Consequently, all cases with multiple pituitary apoplexies remained with residual adenoma postoperatively. In cases of residual tumor within the cavernous sinus, recurrent apoplexy occurred in 23.5% of patients. A tumor recurrence/residual was resected significantly earlier in patients with single apoplexy (median 2.2 years) than in patients with multiple apoplexies (median 5.4 years; P = 0.05). Multiple pituitary apoplexies caused significantly greater rates of ophthalmoplegia (75% vs. 14.1%; P = 0.01) and long-term hormone-replacement therapy was necessary in all cases. CONCLUSIONS Cavernous sinus invasion and subtotal resection are high risk factors for multiple apoplexies in pituitary adenomas. Early treatment is recommended for residual tumor in the cavernous sinus to minimize the risk of recurrent apoplexy with subsequent worse clinical outcome.
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Affiliation(s)
- Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Alexander Micko
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Greisa Vila
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
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Dodier P, Frischer JM, Wang WT, Auzinger T, Mallouhi A, Serles W, Gruber A, Knosp E, Bavinzski G. Immediate Flow Disruption as a Prognostic Factor After Flow Diverter Treatment: Long-Term Experience with the Pipeline Embolization Device. World Neurosurg 2018; 113:e568-e578. [DOI: 10.1016/j.wneu.2018.02.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 01/21/2023]
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Frischer JM, Gruber E, Schöffmann V, Ertl A, Höftberger R, Mallouhi A, Wolfsberger S, Arnoldner C, Eisner W, Knosp E, Kitz K, Gatterbauer B. Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study. J Neurosurg 2018; 130:1-10. [PMID: 29498575 DOI: 10.3171/2017.8.jns171281] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors present long-term follow-up data on patients treated with Gamma Knife radiosurgery (GKRS) for acoustic neuroma. METHODS Six hundred eighteen patients were radiosurgically treated for acoustic neuroma between 1992 and 2016 at the Department of Neurosurgery, Medical University Vienna. Patients with neurofibromatosis and patients treated too recently to attain 1 year of follow-up were excluded from this retrospective study. Thus, data on 557 patients with spontaneous acoustic neuroma of any Koos grade are presented, as are long-term follow-up data on 426 patients with a minimum follow-up of 2 years. Patients were assessed according to the Gardner-Robertson (GR) hearing scale and the House-Brackmann facial nerve function scale, both prior to GKRS and at the times of follow-up. RESULTS Four hundred fifty-two patients (81%) were treated with radiosurgery alone and 105 patients (19%) with combined microsurgery-radiosurgery. While the combined treatment was especially favored before 2002, the percentage of cases treated with radiosurgery alone has significantly increased since then. The overall complication rate after GKRS was low and has declined significantly in the last decade. The risk of developing hydrocephalus after GKRS increased with tumor size. One case (0.2%) of malignant transformation after GKRS was diagnosed. Radiological tumor control rates of 92%, 91%, and 91% at 5, 10, and 15 years after GKRS, regardless of the Koos grade or pretreatment, were observed. The overall tumor control rate without the need for additional treatment was even higher at 98%. At the last follow-up, functional hearing was preserved in 55% of patients who had been classified with GR hearing class I or II prior to GKRS. Hearing preservation rates of 53%, 34%, and 34% at 5, 10, and 15 years after GKRS were observed. The multivariate regression model revealed that the GR hearing class prior to GKRS and the median dose to the cochlea were independent predictors of the GR class at follow-up. CONCLUSIONS In small to medium-sized spontaneous acoustic neuromas, radiosurgery should be recognized as the primary treatment at an early stage. Although minimizing the cochlear dose seems beneficial for hearing preservation, the authors, like others before, do not recommend undertreating intracanalicular tumors in favor of low cochlear doses. For larger acoustic neuromas, radiosurgery remains a reliable management option with tumor control rates similar to those for smaller acoustic neuromas; however, careful patient selection and counseling are recommended given the higher risk of side effects. Microsurgery must be considered in acoustic neuromas with significant brainstem compression or hydrocephalus.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Wilhelm Eisner
- Department of Neurosurgery, Medical University Innsbruck, Austria
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30
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Gatterbauer B, Gevsek S, Höftberger R, Lütgendorf-Caucig C, Ertl A, Mallouhi A, Kitz K, Knosp E, Frischer JM. Multimodal treatment of parasagittal meningiomas: a single-center experience. J Neurosurg 2017; 127:1249-1256. [DOI: 10.3171/2016.9.jns161859] [Citation(s) in RCA: 14] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVETreatment of parasagittal meningiomas is still considered a challenge in modern microsurgery. The use of microsurgical resection, radiosurgery, or a microsurgery-radiosurgery combination treatment strategy is often debated. The aim of this study was to evaluate the treatment of parasagittal meningioma and provide evidence that a multimodal approach reduces complication rates and achieves good tumor control rates.METHODSThe authors retrospectively reviewed long-term follow-up data on 117 patients who had been treated for parasagittal meningiomas at their institution between 1993 and 2013. Treatment included microsurgery, Gamma Knife radiosurgery (GKRS), and radiotherapy.RESULTSThe median tumor volume prior to the first microsurgical resection was largest in the microsurgery-radiosurgery combination treatment group. Invasion of the superior sagittal sinus was significantly associated with a Simpson Grade IV resection and subsequent radiosurgery treatment. The Simpson resection grade did not influence time to progression or recurrence in benign meningioma cases. Complete sinus occlusion was followed by microsurgical resection of the occluded sinus, by tumor resection without resection of the sinus, or by GKRS. Histopathology revealed WHO Grade I tumors in most patients. However, a high percentage (33%) of atypical or malignant meningiomas were diagnosed after the last microsurgical resection. The time to recurrence or progression after microsurgery was significantly longer in patients with WHO Grade I meningiomas than in those with Grade II or III meningiomas. At follow-up, tumor control rates after GKRS were 91% for presumed meningioma, 85% for benign meningioma, 71% for atypical meningioma, and 38% for malignant meningioma.CONCLUSIONSA multimodal treatment approach to parasagittal meningiomas reduces the rate of complications. Thus, microsurgery, radiotherapy, and radiosurgery are complementary treatment options. Gamma Knife radiosurgery is safe and effective in patients with meningiomas invading the superior sagittal sinus. The procedure can be part of a multimodal treatment plan or administered as a single treatment in well-selected patients.
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31
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Popescu BF, Frischer JM, Webb SM, Tham M, Adiele RC, Robinson CA, Fitz-Gibbon PD, Weigand SD, Metz I, Nehzati S, George GN, Pickering IJ, Brück W, Hametner S, Lassmann H, Parisi JE, Yong G, Lucchinetti CF. Pathogenic implications of distinct patterns of iron and zinc in chronic MS lesions. Acta Neuropathol 2017; 134:45-64. [PMID: 28332093 PMCID: PMC5486634 DOI: 10.1007/s00401-017-1696-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 12/19/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS) in which oligodendrocytes, the CNS cells that stain most robustly for iron and myelin are the targets of injury. Metals are essential for normal CNS functioning, and metal imbalances have been linked to demyelination and neurodegeneration. Using a multidisciplinary approach involving synchrotron techniques, iron histochemistry and immunohistochemistry, we compared the distribution and quantification of iron and zinc in MS lesions to the surrounding normal appearing and periplaque white matter, and assessed the involvement of these metals in MS lesion pathogenesis. We found that the distribution of iron and zinc is heterogeneous in MS plaques, and with few remarkable exceptions they do not accumulate in chronic MS lesions. We show that brain iron tends to decrease with increasing age and disease duration of MS patients; reactive astrocytes organized in large astrogliotic areas in a subset of smoldering and inactive plaques accumulate iron and safely store it in ferritin; a subset of smoldering lesions do not contain a rim of iron-loaded macrophages/microglia; and the iron content of shadow plaques varies with the stage of remyelination. Zinc in MS lesions was generally decreased, paralleling myelin loss. Iron accumulates concentrically in a subset of chronic inactive lesions suggesting that not all iron rims around MS lesions equate with smoldering plaques. Upon degeneration of iron-loaded microglia/macrophages, astrocytes may form an additional protective barrier that may prevent iron-induced oxidative damage.
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Affiliation(s)
- Bogdan F Popescu
- Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, 701 Queen Street, Saskatoon, SK, S7N 5E5, Canada.
- Cameco MS Neuroscience Research Center, University of Saskatchewan, 701 Queen Street, Saskatoon City Hospital, Rm 5800, Saskatoon, SK, S7K 0M7, Canada.
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Samuel M Webb
- Stanford Synchrotron Radiation Lightsource, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - Mylyne Tham
- Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, 701 Queen Street, Saskatoon, SK, S7N 5E5, Canada
- Cameco MS Neuroscience Research Center, University of Saskatchewan, 701 Queen Street, Saskatoon City Hospital, Rm 5800, Saskatoon, SK, S7K 0M7, Canada
| | - Reginald C Adiele
- Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, 701 Queen Street, Saskatoon, SK, S7N 5E5, Canada
- Cameco MS Neuroscience Research Center, University of Saskatchewan, 701 Queen Street, Saskatoon City Hospital, Rm 5800, Saskatoon, SK, S7K 0M7, Canada
| | - Christopher A Robinson
- Department of Pathology and Laboratory Medicine, Saskatoon Health Region/College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Patrick D Fitz-Gibbon
- Department of Health Sciences Research, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Imke Metz
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - Susan Nehzati
- Molecular and Environmental Science Research Group, Department of Geological Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Graham N George
- Molecular and Environmental Science Research Group, Department of Geological Sciences, University of Saskatchewan, Saskatoon, Canada
- Toxicology Center, University of Saskatchewan, Saskatoon, Canada
- Department of Chemistry, University of Saskatchewan, Saskatoon, Canada
| | - Ingrid J Pickering
- Molecular and Environmental Science Research Group, Department of Geological Sciences, University of Saskatchewan, Saskatoon, Canada
- Toxicology Center, University of Saskatchewan, Saskatoon, Canada
- Department of Chemistry, University of Saskatchewan, Saskatoon, Canada
| | - Wolfgang Brück
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - Simon Hametner
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Guo Yong
- Department of Neurology, Mayo Clinic, College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Claudia F Lucchinetti
- Department of Neurology, Mayo Clinic, College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
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Vogl UM, Öhler L, Rasic M, Frischer JM, Modak M, Stöckl J. Evaluation of Prognostic Immune Signatures in Patients with Breast, Colorectal and Pancreatic Cancer Receiving Chemotherapy. Anticancer Res 2017; 37:1947-1955. [PMID: 28373465 DOI: 10.21873/anticanres.11535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/04/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND CD97 is a member of the epidermal growth factor-seven transmembrane (EGF-TM7) receptor family and is dominantly expressed on immune cells and in a variety of malignant diseases. B7-H1 and B7-H3 are transmembrane proteins that are involved in suppression of the immune system. The aim of this study was to evaluate if these molecules are up-regulated in patients with cancer and change during chemotherapy. MATERIALS AND METHODS We analyzed cluster of differentiation (CD) protein expression levels on tumor cell lines and in blood samples of 37 patients with solid tumors at baseline and during chemotherapy; we correlated the serum levels of CD proteins with survival outcome. RESULTS Levels of soluble CD97 proteins were significantly elevated in all three cancer types compared to healthy controls. Patients with colorectal cancer and those with high CD97 levels had a significantly worse prognosis. CONCLUSION This study showed a marked elevation of soluble CD97 expression in patients with certain cancer types and demonstrated definite changes in CD protein expression during chemotherapy in one patient with metastatic breast cancer.
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Affiliation(s)
- Ursula M Vogl
- Internal Medicine I, Department of Oncology, St. Josef Hospital, Vienna, Austria
| | - Leopold Öhler
- Internal Medicine I, Department of Oncology, St. Josef Hospital, Vienna, Austria
| | - Masa Rasic
- Department of Immunology, Medical University Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Madhura Modak
- Department of Immunology, Medical University Vienna, Vienna, Austria
| | - Johannes Stöckl
- Department of Immunology, Medical University Vienna, Vienna, Austria
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Frischer JM, Marosi C, Woehrer A, Hainfellner JA, Dieckmann KU, Eiter H, Wang WT, Mallouhi A, Ertl A, Knosp E, Filipits M, Kitz K, Gatterbauer B. Gamma Knife Radiosurgery in Recurrent Glioblastoma. Stereotact Funct Neurosurg 2016; 94:265-272. [DOI: 10.1159/000448924] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 08/04/2016] [Indexed: 11/19/2022]
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34
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Frischer JM, Weigand SD, Guo Y, Kale N, Parisi JE, Pirko I, Mandrekar J, Bramow S, Metz I, Brück W, Lassmann H, Lucchinetti CF. Clinical and pathological insights into the dynamic nature of the white matter multiple sclerosis plaque. Ann Neurol 2015; 78:710-21. [PMID: 26239536 DOI: 10.1002/ana.24497] [Citation(s) in RCA: 422] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE An extensive analysis of white matter plaques in a large sample of multiple sclerosis (MS) autopsies provides insights into the dynamic nature of MS pathology. METHODS One hundred twenty MS cases (1,220 tissue blocks) were included. Plaque types were classified according to demyelinating activity based on stringent criteria. Early active, late active, smoldering, inactive, and shadow plaques were distinguished. A total of 2,476 MS white matter plaques were identified. Plaque type distribution was analyzed in relation to clinical data. RESULTS Active plaques were most often found in early disease, whereas at later stages, smoldering, inactive, and shadow plaques predominated. The presence of early active plaques rapidly declined with disease duration. Plaque type distribution differed significantly by clinical course. The majority of plaques in acute monophasic and relapsing-remitting MS (RRMS) were active. Among secondary progressive MS (SPMS) cases with attacks, all plaque types could be distinguished including active plaques, in contrast to SPMS without attacks, in which inactive plaques predominated. Smoldering plaques were frequently and almost exclusively found in progressive MS. At 47 years of age, an equilibrium was observed between active and inactive plaques, whereas smoldering plaques began to peak. Men displayed a higher proportion of smoldering plaques. INTERPRETATION Disease duration, clinical course, age, and gender contribute to the dynamic nature of white matter MS pathology. Active MS plaques predominate in acute and early RRMS and are the likely substrate of clinical attacks. Progressive MS transitions to an accumulation of smoldering plaques characterized by microglial activation and slow expansion of pre-existing plaques. Whether current MS therapeutics impact this pathological driver of disease progression remains uncertain.
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Affiliation(s)
- Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Stephen D Weigand
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN
| | - Yong Guo
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN
| | - Nilufer Kale
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN
| | - Joseph E Parisi
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Istvan Pirko
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN
| | - Jay Mandrekar
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN
| | - Stephan Bramow
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Denmark
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Imke Metz
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - Wolfgang Brück
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Haider L, Simeonidou C, Steinberger G, Hametner S, Grigoriadis N, Deretzi G, Kovacs GG, Kutzelnigg A, Lassmann H, Frischer JM. Multiple sclerosis deep grey matter: the relation between demyelination, neurodegeneration, inflammation and iron. J Neurol Neurosurg Psychiatry 2014; 85:1386-95. [PMID: 24899728 PMCID: PMC4251183 DOI: 10.1136/jnnp-2014-307712] [Citation(s) in RCA: 233] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In multiple sclerosis (MS), diffuse degenerative processes in the deep grey matter have been associated with clinical disabilities. We performed a systematic study in MS deep grey matter with a focus on the incidence and topographical distribution of lesions in relation to white matter and cortex in a total sample of 75 MS autopsy patients and 12 controls. In addition, detailed analyses of inflammation, acute axonal injury, iron deposition and oxidative stress were performed. MS deep grey matter was affected by two different processes: the formation of focal demyelinating lesions and diffuse neurodegeneration. Deep grey matter demyelination was most prominent in the caudate nucleus and hypothalamus and could already be seen in early MS stages. Lesions developed on the background of inflammation. Deep grey matter inflammation was intermediate between low inflammatory cortical lesions and active white matter lesions. Demyelination and neurodegeneration were associated with oxidative injury. Iron was stored primarily within oligodendrocytes and myelin fibres and released upon demyelination. In addition to focal demyelinated plaques, the MS deep grey matter also showed diffuse and global neurodegeneration. This was reflected by a global reduction of neuronal density, the presence of acutely injured axons, and the accumulation of oxidised phospholipids and DNA in neurons, oligodendrocytes and axons. Neurodegeneration was associated with T cell infiltration, expression of inducible nitric oxide synthase in microglia and profound accumulation of iron. Thus, both focal lesions as well as diffuse neurodegeneration in the deep grey matter appeared to contribute to the neurological disabilities of MS patients.
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Affiliation(s)
- Lukas Haider
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Constantina Simeonidou
- Department of Physiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Günther Steinberger
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Simon Hametner
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Nikolaos Grigoriadis
- Department of Neurology, Laboratory of Experimental Neurology and Neuroimmunology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Deretzi
- Department of Neurology, Laboratory of Experimental Neurology and Neuroimmunology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kutzelnigg
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Hans Lassmann
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Metz I, Weigand SD, Popescu BFG, Frischer JM, Parisi JE, Guo Y, Lassmann H, Brück W, Lucchinetti CF. Pathologic heterogeneity persists in early active multiple sclerosis lesions. Ann Neurol 2014; 75:728-38. [PMID: 24771535 DOI: 10.1002/ana.24163] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) lesions demonstrate immunopathological heterogeneity in patterns of demyelination. Previous cross-sectional studies reported immunopatterns of demyelination were identical among multiple active demyelinating lesions from the same individual, but differed between individuals, leading to the hypothesis of intraindividual pathological homogeneity and interindividual heterogeneity. Other groups suggested a time-dependent heterogeneity of lesions. The objective of our present study was to analyze tissue samples collected longitudinally to determine whether patterns of demyelination persist over time within a given patient. METHODS Archival tissue samples derived from patients with pathologically confirmed central nervous system inflammatory demyelinating disease who had undergone either diagnostic serial biopsy or biopsy followed by autopsy were analyzed immunohistochemically. The inclusion criteria consisted of the presence of early active demyelinating lesions--required for immunopattern classification--obtained from the same patient at 2 or more time points. RESULTS Among 1,321 surgical biopsies consistent with MS, 22 cases met the study inclusion criteria. Twenty-one patients (95%) showed a persistence of immunopathological patterns in tissue sampled from different time points. This persistence was demonstrated for all major patterns of demyelination. A single patient showed features suggestive of both pattern II and pattern III on biopsy, but only pattern II among all active lesions examined at autopsy. INTERPRETATION These findings continue to support the concept of patient-dependent immunopathological heterogeneity in early MS and suggest that the mechanisms and targets of tissue injury may differ among patient subgroups. These observations have potentially significant implications for individualized therapeutic approaches.
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Affiliation(s)
- Imke Metz
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany
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Frischer JM, Reindl M, Künz B, Berger T, Schmidt S, Milford EL, Knosp E, Lassmann H, Utku N. TIRC7 and HLA-DR axis contributes to inflammation in multiple sclerosis. Mult Scler 2014; 20:1171-81. [PMID: 24526664 DOI: 10.1177/1352458514521516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/30/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Interactions between TIRC7 (a novel seven-transmembrane receptor on activated lymphocytes) and its ligand HLA-DR might be involved in the inflammatory process in multiple sclerosis (MS). METHODS Methods comprised immunohistochemistry and microscopy on archival MS autopsies, proliferation-, cytokine-, and surface-staining assays using peripheral blood lymphocytes (PBLs) from MS patients and an in vitro model. RESULTS TIRC7 was expressed in brain-infiltrating lymphocytes and strongly correlated with disease activity in MS. TIRC7 expression was reduced in T cells and induced in B cells in PBLs obtained from MS patients. After ex vivo activation, T cell expression of TIRC7 was restored in patients with active MS disease. The interaction of TIRC7(+) T lymphocytes with cells expressing HLA-DR on their surface led to T cell proliferation and activation whereas an anti-TIRC7 mAb preventing interactions with its ligand inhibited proliferation and Th1 and Th17 cytokine expression in T cells obtained from MS patients and in myelin basic protein-specific T cell clone. CONCLUSION Our findings suggest that TIRC7 is involved in inflammation in MS and anti-TIRC7 mAb can prevent immune activation via selective inhibition of Th1- and Th17-associated cytokine expression. This targeting approach may become a novel treatment option for MS.
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Affiliation(s)
- J M Frischer
- Division of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Austria Department of Neurosurgery, Medical University of Vienna, Austria
| | - M Reindl
- Clinical Department of Neurology, Innsbruck Medical University, Austria
| | - B Künz
- Clinical Department of Neurology, Innsbruck Medical University, Austria
| | - T Berger
- Clinical Department of Neurology, Innsbruck Medical University, Austria
| | | | - E L Milford
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - E Knosp
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - H Lassmann
- Division of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Austria
| | - N Utku
- Institute for Medical Immunology, Charité, Germany
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Frischer JM, Gatterbauer B, Holzer S, Stavrou I, Gruber A, Novak K, Wang WT, Reinprecht A, Mert A, Trattnig S, Mallouhi A, Kitz K, Knosp E. Microsurgery and radiosurgery for brainstem cavernomas: effective and complementary treatment options. World Neurosurg 2014; 81:520-8. [PMID: 24440458 DOI: 10.1016/j.wneu.2014.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/20/2013] [Accepted: 01/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate treatment options for brainstem cavernous malformations (BSCMs) using the results from a center with long-standing experience in microsurgical resection and Gamma Knife radiosurgery (GKRS) treatment of BSCMs. METHODS Study participants were 67 symptomatic patients with BSCMs who were treated either microsurgically (n = 29) or radiosurgically (n = 38). Patients were followed for a minimum of 2 years (median, 7.7 years). A recent follow-up was performed. RESULTS Patients receiving surgical treatment had mainly large, superficially seated lesions and experienced preoperative hemorrhages more often and presented with higher preoperative modified Rankin Scale scores. Patients receiving GKRS harbored smaller, deep-seated lesions, reflecting a selection bias. In both treatment groups, patients presented with significantly better modified Rankin Scale scores at follow-up than before intervention. Overall annual preoperative hemorrhage rates were 3.2% in microsurgery patients and 2.3% in radiosurgery patients. In the preoperative observation period, the rehemorrhage rate was 25.1% for microsurgery patients and 7.2% for radiosurgery patients. Hemorrhage rate after GKRS decreased significantly to 0.6% after 2 years. The postoperative hemorrhage rate was 8.8% but only for microsurgery patients with residual lesions. Advancements in microsurgical techniques improved surgical outcomes, resulting in a high total excision rate in the modern era. CONCLUSIONS In the treatment of BSCM, patient selection and timing of surgery are crucial. If applied in a multidisciplinary neurosurgical center, microsurgery and radiosurgery are complementary treatment options that both result in reduced bleeding rates and improvement of clinical outcome.
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Affiliation(s)
- Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
| | | | - Sabrina Holzer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Ioannis Stavrou
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Klaus Novak
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Wei-Te Wang
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Andrea Reinprecht
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Ayguel Mert
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Department of Radiology, MR Centre of Excellence, Medical University Vienna, Vienna, Austria
| | - Ammar Mallouhi
- Department of Radiology, Medical University Vienna, Vienna, Austria
| | - Klaus Kitz
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
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Frischer JM, Göd S, Gruber A, Saringer W, Grabner G, Gatterbauer B, Kitz K, Holzer S, Kronnerwetter C, Hainfellner JA, Knosp E, Trattnig S. Susceptibility-weighted imaging at 7 T: Improved diagnosis of cerebral cavernous malformations and associated developmental venous anomalies. Neuroimage Clin 2012; 1:116-20. [PMID: 24179744 PMCID: PMC3757736 DOI: 10.1016/j.nicl.2012.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 11/12/2022]
Abstract
Background and aim In the diagnosis of cerebral cavernous malformations (CCMs) magnetic resonance imaging is established as the gold standard. Conventional MRI techniques have their drawbacks in the diagnosis of CCMs and associated venous malformations (DVAs). The aim of our study was to evaluate susceptibility weighted imaging SWI for the detection of CCM and associated DVAs at 7 T in comparison with 3 T. Patients and methods 24 patients (14 female, 10 male; median age: 38.3 y (21.1 y–69.1 y) were included in the study. Patients enrolled in the study received a 3 T and a 7 T MRI on the same day. The following sequences were applied on both field strengths: a T1 weighted 3D GRE sequence (MP-RAGE) and a SWI sequence. After obtaining the study MRIs, eleven patients underwent surgery and 13 patients were followed conservatively or were treated radio-surgically. Results Patients initially presented with haemorrhage (n = 4, 16.7%), seizures (n = 2, 8.3%) or other neurology (n = 18, 75.0%). For surgical resected lesions histopathological findings verified the diagnosis of CCMs. A significantly higher number of CCMs was diagnosed at 7 T SWI sequences compared with 3 T SWI (p < 0.05). Additionally diagnosed lesions on 7 T MRI were significantly smaller compared to the initial lesions on 3 T MRIs (p < 0.001). Further, more associated DVAs were diagnosed at 7 T MRI compared to 3 T MRI. Conclusion SWI sequences at ultra-high-field MRI improve the diagnosis of CCMs and associated DVAs and therefore add important pre-operative information.
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Affiliation(s)
- Josa M Frischer
- Medical University Vienna, Department of Neurosurgery, Vienna, Austria
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Fischer MT, Sharma R, Lim JL, Haider L, Frischer JM, Drexhage J, Mahad D, Bradl M, van Horssen J, Lassmann H. NADPH oxidase expression in active multiple sclerosis lesions in relation to oxidative tissue damage and mitochondrial injury. ACTA ACUST UNITED AC 2012; 135:886-99. [PMID: 22366799 PMCID: PMC3286337 DOI: 10.1093/brain/aws012] [Citation(s) in RCA: 357] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Multiple sclerosis is a chronic inflammatory disease of the central nervous system, associated with demyelination and neurodegeneration. The mechanisms of tissue injury are poorly understood, but recent data suggest that mitochondrial injury may play an important role in this process. Mitochondrial injury can be triggered by reactive oxygen and nitric oxide species, and we recently provided evidence for oxidative damage of oligodendrocytes and dystrophic axons in early stages of active multiple sclerosis lesions. In this study, we identified potential sources of reactive oxygen and nitrogen species through gene expression in carefully staged and dissected lesion areas and by immunohistochemical analysis of protein expression. Genome-wide microarrays confirmed mitochondrial injury in active multiple sclerosis lesions, which may serve as an important source of reactive oxygen species. In addition, we found differences in the gene expression levels of various nicotinamide adenine dinucleotide phosphate oxidase subunits between initial multiple sclerosis lesions and control white matter. These results were confirmed at the protein level by means of immunohistochemistry, showing upregulation of the subunits gp91phox, p22phox, p47phox, nicotinamide adenine dinucleotide phosphate oxidase 1 and nicotinamide adenine dinucleotide phosphate oxidase organizer 1 in activated microglia in classical active as well as slowly expanding lesions. The subunits gp91phox and p22phox were constitutively expressed in microglia and were upregulated in the initial lesion. In contrast, p47phox, nicotinamide adenine dinucleotide phosphate oxidase 1 and nicotinamide adenine dinucleotide phosphate oxidase organizer 1 expression were more restricted to the zone of initial damage or to lesions from patients with acute or early relapsing/remitting multiple sclerosis. Double labelling showed co-expression of the nicotinamide adenine dinucleotide phosphate oxidase subunits in activated microglia and infiltrated macrophages, suggesting the assembly of functional complexes. Our data suggest that the inflammation-associated oxidative burst in activated microglia and macrophages plays an important role in demyelination and free radical-mediated tissue injury in the pathogenesis of multiple sclerosis.
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Affiliation(s)
- Marie T Fischer
- Centre for Brain Research, Medical University of Vienna, A-1090 Wien, Austria
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Zambonin JL, Zhao C, Ohno N, Campbell GR, Engeham S, Ziabreva I, Schwarz N, Lee SE, Frischer JM, Turnbull DM, Trapp BD, Lassmann H, Franklin RJM, Mahad DJ. Increased mitochondrial content in remyelinated axons: implications for multiple sclerosis. ACTA ACUST UNITED AC 2011; 134:1901-13. [PMID: 21705418 DOI: 10.1093/brain/awr110] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Mitochondrial content within axons increases following demyelination in the central nervous system, presumably as a response to the changes in energy needs of axons imposed by redistribution of sodium channels. Myelin sheaths can be restored in demyelinated axons and remyelination in some multiple sclerosis lesions is extensive, while in others it is incomplete or absent. The effects of remyelination on axonal mitochondrial content in multiple sclerosis, particularly whether remyelination completely reverses the mitochondrial changes that follow demyelination, are currently unknown. In this study, we analysed axonal mitochondria within demyelinated, remyelinated and myelinated axons in post-mortem tissue from patients with multiple sclerosis and controls, as well as in experimental models of demyelination and remyelination, in vivo and in vitro. Immunofluorescent labelling of mitochondria (porin, a voltage-dependent anion channel expressed on all mitochondria) and axons (neurofilament), and ultrastructural imaging showed that in both multiple sclerosis and experimental demyelination, mitochondrial content within remyelinated axons was significantly less than in acutely and chronically demyelinated axons but more numerous than in myelinated axons. The greater mitochondrial content within remyelinated, compared with myelinated, axons was due to an increase in density of porin elements whereas increase in size accounted for the change observed in demyelinated axons. The increase in mitochondrial content in remyelinated axons was associated with an increase in mitochondrial respiratory chain complex IV activity. In vitro studies showed a significant increase in the number of stationary mitochondria in remyelinated compared with myelinated and demyelinated axons. The number of mobile mitochondria in remyelinated axons did not significantly differ from myelinated axons, although significantly greater than in demyelinated axons. Our neuropathological data and findings in experimental demyelination and remyelination in vivo and in vitro are consistent with a partial amelioration of the supposed increase in energy demand of demyelinated axons by remyelination.
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Affiliation(s)
- Jessica L Zambonin
- The Mitochondrial Research Group, Institute of Ageing and Health, Newcastle University, Framlington Place, Newcastle upon Tyne, NE24HH, UK
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Haider L, Fischer MT, Frischer JM, Bauer J, Höftberger R, Botond G, Esterbauer H, Binder CJ, Witztum JL, Lassmann H. Oxidative damage in multiple sclerosis lesions. Brain 2011; 134:1914-24. [PMID: 21653539 PMCID: PMC3122372 DOI: 10.1093/brain/awr128] [Citation(s) in RCA: 490] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis is a chronic inflammatory disease of the central nervous system, associated with demyelination and neurodegeneration. The mechanisms of tissue injury are currently poorly understood, but recent data suggest that mitochondrial injury may play an important role in this process. Since mitochondrial injury can be triggered by reactive oxygen and nitric oxide species, we analysed by immunocytochemistry the presence and cellular location of oxidized lipids and oxidized DNA in lesions and in normal-appearing white matter of 30 patients with multiple sclerosis and 24 control patients without neurological disease or brain lesions. As reported before in biochemical studies, oxidized lipids and DNA were highly enriched in active multiple sclerosis plaques, predominantly in areas that are defined as initial or ‘prephagocytic’ lesions. Oxidized DNA was mainly seen in oligodendrocyte nuclei, which in part showed signs of apoptosis. In addition, a small number of reactive astrocytes revealed nuclear expression of 8-hydroxy-d-guanosine. Similarly, lipid peroxidation-derived structures (malondialdehyde and oxidized phospholipid epitopes) were seen in the cytoplasm of oligodendrocytes and some astrocytes. In addition, oxidized phospholipids were massively accumulated in a fraction of axonal spheroids with disturbed fast axonal transport as well as in neurons within grey matter lesions. Neurons stained for oxidized phospholipids frequently revealed signs of degeneration with fragmentation of their dendritic processes. The extent of lipid and DNA oxidation correlated significantly with inflammation, determined by the number of CD3 positive T cells and human leucocyte antigen-D expressing macrophages and microglia in the lesions. Our data suggest profound oxidative injury of oligodendrocytes and neurons to be associated with active demyelination and axonal or neuronal injury in multiple sclerosis.
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Affiliation(s)
- Lukas Haider
- Centre for Brain Research, Medical University of Vienna, A-1090 Vienna, Austria
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Bramow S, Frischer JM, Lassmann H, Koch-Henriksen N, Lucchinetti CF, Sørensen PS, Laursen H. Demyelination versus remyelination in progressive multiple sclerosis. ACTA ACUST UNITED AC 2010; 133:2983-98. [PMID: 20855416 DOI: 10.1093/brain/awq250] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The causes of incomplete remyelination in progressive multiple sclerosis are unknown, as are the pathological correlates of the different clinical characteristics of patients with primary and secondary progressive disease. We analysed brains and spinal cords from 51 patients with progressive multiple sclerosis by planimetry. Thirteen patients with primary progressive disease were compared with 34 with secondary progressive disease. In patients with secondary progressive multiple sclerosis, we found larger brain plaques, more demyelination in total and higher brain loads of active demyelination compared with patients with primary progressive disease. In addition, the brain density of plaques with high-grade inflammation and active demyelination was highest in secondary progressive multiple sclerosis and remained ~18% higher than in primary progressive multiple sclerosis after adjustments for other plaque types and plaque number (P<0.05). Conversely, the proportion of remyelinated shadow plaques (P<0.05) and the overall remyelination capacity (P<0.01) per brain were higher in primary, compared with secondary, progressive multiple sclerosis. By contrast, there were no group differences in the brain load or frequency of low-grade inflammatory plaques with slowly expanding demyelination. Spinal cord lesion loads and remyelination capacity were also comparable in the two patient groups. Remyelinated areas were more vulnerable than the normal-appearing white matter to new demyelination, including active demyelination in secondary progressive multiple sclerosis. 'Recurrent' slowly expanding demyelination, affecting remyelinated areas, and the load of slowly expanding demyelination correlated with incomplete remyelination in both groups. In turn, incomplete remyelination in the spinal cord correlated with higher disease-related disability (determined retrospectively; r = -0.53; P<0.05 for remyelination capacity versus disease severity). By contrast, such a correlation was not observed in the brain. We propose that regulatory and reparative properties could protect the white matter of the brain in patients with primary progressive multiple sclerosis. These patients may, thereby, be spared symptoms until the spinal cord is affected. By contrast, recurrent active demyelination of repaired myelin could explain why similar symptoms often develop in consecutive relapses in relapsing-remitting/secondary progressive multiple sclerosis. Our data also indicate that slowly expanding demyelination may irreparably destroy normal and repaired myelin, supporting the concept of slowly expanding demyelination as an important pathological correlate of clinical progression.
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Affiliation(s)
- Stephan Bramow
- Laboratory of Neuropathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
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Vogl UM, Bojic M, Lamm W, Frischer JM, Pichelmayer O, Kramer G, Haitel A, Kitz K, Harmankaya K, Zielinski CC, Schmidinger M. Extracerebral metastases determine the outcome of patients with brain metastases from renal cell carcinoma. BMC Cancer 2010; 10:480. [PMID: 20819239 PMCID: PMC2942853 DOI: 10.1186/1471-2407-10-480] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 09/07/2010] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In the era of cytokines, patients with brain metastases (BM) from renal cell carcinoma had a significantly shorter survival than patients without. Targeted agents (TA) have improved the outcome of patients with metastatic renal cell carcinoma (mRCC) however, their impact on patients with BM is less clear. The aim of this analysis was to compare the outcome of patients with and without BM in the era of targeted agents. METHODS Data from 114 consecutive patients who had access to targeted agent were analyzed for response rates (ORR), progression free survival (PFS) and overall survival (OS). All patients diagnosed with BM underwent local, BM-specific treatment before initiation of medical treatment. RESULTS Data of 114 consecutive patients who had access to at least one type of targeted agents were analyzed. Twelve out of 114 renal cell carcinoma (RCC) patients (10.5%) were diagnosed with BM. Systemic treatment consisted of sunitinib, sorafenib, temsirolimus or bevacizumab. The median PFS was 8.7 months (95% CI 5.1 - 12.3) and 11.4 months (95% CI 8.7 - 14.1) for BM-patients and non-BM-patients, respectively (p = 0.232). The median overall survival for patients with and without BM was 13.4 (95% CI 1- 43.9) and 33.3 months (95% CI 18.6 - 47.0) (p = 0.358), respectively. No patient died from cerebral disease progression. ECOG Performance status and the time from primary tumor to metastases (TDM) were independent risk factors for short survival (HR 2.74, p = 0.001; HR: 0.552, p = 0.034). CONCLUSIONS Although extracerebral metastases determine the outcome of patients with BM, the benefit from targeted agents still appears to be limited when compared to patients without BM.
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Affiliation(s)
- Ursula M Vogl
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Marija Bojic
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Wolfgang Lamm
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Oskar Pichelmayer
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Gero Kramer
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Andrea Haitel
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Klaus Kitz
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Kaan Harmankaya
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Christoph C Zielinski
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Manuela Schmidinger
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
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Frischer JM, Bramow S, Dal-Bianco A, Lucchinetti CF, Rauschka H, Schmidbauer M, Laursen H, Sorensen PS, Lassmann H. The relation between inflammation and neurodegeneration in multiple sclerosis brains. ACTA ACUST UNITED AC 2009; 132:1175-89. [PMID: 19339255 PMCID: PMC2677799 DOI: 10.1093/brain/awp070] [Citation(s) in RCA: 985] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Some recent studies suggest that in progressive multiple sclerosis, neurodegeneration may occur independently from inflammation. The aim of our study was to analyse the interdependence of inflammation, neurodegeneration and disease progression in various multiple sclerosis stages in relation to lesional activity and clinical course, with a particular focus on progressive multiple sclerosis. The study is based on detailed quantification of different inflammatory cells in relation to axonal injury in 67 multiple sclerosis autopsies from different disease stages and 28 controls without neurological disease or brain lesions. We found that pronounced inflammation in the brain is not only present in acute and relapsing multiple sclerosis but also in the secondary and primary progressive disease. T- and B-cell infiltrates correlated with the activity of demyelinating lesions, while plasma cell infiltrates were most pronounced in patients with secondary progressive multiple sclerosis (SPMS) and primary progressive multiple sclerosis (PPMS) and even persisted, when T- and B-cell infiltrates declined to levels seen in age matched controls. A highly significant association between inflammation and axonal injury was seen in the global multiple sclerosis population as well as in progressive multiple sclerosis alone. In older patients (median 76 years) with long-disease duration (median 372 months), inflammatory infiltrates declined to levels similar to those found in age-matched controls and the extent of axonal injury, too, was comparable with that in age-matched controls. Ongoing neurodegeneration in these patients, which exceeded the extent found in normal controls, could be attributed to confounding pathologies such as Alzheimer's or vascular disease. Our study suggests a close association between inflammation and neurodegeneration in all lesions and disease stages of multiple sclerosis. It further indicates that the disease processes of multiple sclerosis may die out in aged patients with long-standing disease.
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Affiliation(s)
- Josa M Frischer
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Wien, Austria
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Stavrou I, Baumgartner C, Frischer JM, Trattnig S, Knosp E. Long-term seizure control after resection of supratentorial cavernomas: a retrospective single-center study in 53 patients. Neurosurgery 2008; 63:888-96; discussion 897. [PMID: 19005379 DOI: 10.1227/01.neu.0000327881.72964.6e] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine the long-term outcomes of 53 epilepsy patients who were surgically treated for supratentorial cavernomas in a single-center study and to assess both the duration of epilepsy and the resection of the hemosiderin rim for their prognostic relevance during extended follow-up. METHODS Fifty-three patients underwent microsurgical resection of radiologically diagnosed supratentorial cavernomas. For the outcome analysis, they were divided into 2 groups: Group A (33 patients) with a preoperative duration of epilepsy of less than 2 years, and Group B (20 patients) with a preoperative duration of epilepsy of 2 years or more. The natural history of the cavernomas, localization and size of the lesions, use of antiepileptic drugs, surgery timing, and technique (removal or not of the surrounding gliosis) were evaluated retrospectively. The outcome of epilepsy was based on Engel's classification and the International League Against Epilepsy classification. RESULTS After a mean follow-up period of 8.1 years, 45 (84.9%) of the 53 patients were free from disabling seizures (Engel Class I), including 37 patients (69.8%) who were completely free of postoperative seizures (Engel Class IA); 43 patients (81.1%) were categorized as International League Against Epilepsy Class 1. Outcome was statistically significantly improved in the patient subgroup of our study in which patients underwent a resection of the surrounding gliosis after a preoperative duration of epilepsy of less than 2 years (Group A). There was no mortality, and only minor postoperative neurological deficits occurred in 7.5% of patients. CONCLUSION In a long-term follow-up period, 84.9% of the patients in the study could be evaluated as Engel Class I. The analysis of outcome showed that patients benefited significantly from early surgery and excision of the hemosiderin rim.
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Affiliation(s)
- Ioannis Stavrou
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Frischer JM, Pipp I, Stavrou I, Trattnig S, Hainfellner JA, Knosp E. Cerebral cavernous malformations: congruency of histopathological features with the current clinical definition. J Neurol Neurosurg Psychiatry 2008; 79:783-8. [PMID: 17986498 DOI: 10.1136/jnnp.2007.132316] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [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] [Indexed: 11/04/2022]
Abstract
AIM Cerebral cavernous malformations (CCMs) are defined as a mulberry-like assembly of thin walled vascular sinusoids lined by a thin endothelium lacking smooth muscle and elastin, displaying no intervening brain parenchyma. In this study, we analyse the congruency of histopathological features with the current clinical definition on a large series of neuroradiologically verified CCMs. METHODS 87 patients who received no primary treatment prior to surgery were included. Preoperative MRIs of all patients were reviewed. 12 histopathological parameters were assessed systematically, using haematoxylin-eosin, Prussian blue, elastica van Gieson and congo red for amyloid detection. RESULTS 71/87 (81.6%) of the cases fulfilled the basic histological criteria of CCMs. However, the thickness of the vessel walls and the calibre of the malformed vessels were highly variable. 16/87 cases (18.4%) were histologically non-diagnostic. Non-diagnostic specimens were significantly associated with radiological signs of haemorrhage (p = 0.001). A few cases (4.6%) regionally contained capillary-like malformed vessels. Intervening brain parenchyma between malformed vessels throughout the lesion was seen in 50/71 (70.4%) diagnosable lesions. Haemosiderin deposits, gliosis, thrombosis, fibrotic changes, hyalinised vessel walls, calcification and cholesterol crystals were present in a considerable range. In addition, we found amyloid deposits in 14/87 (16.1%) specimens. CONCLUSION Contrary to the current clinical definition, the absence of intervening brain parenchyma does not represent an essential histopathological criterion of CCMs in our series. Furthermore, the diameter of the vessel lumina and the thickness of vessel walls varied considerably. Based on these findings, adaptation of the current definition on the basis of interdisciplinary interaction needs to be considered.
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Affiliation(s)
- J M Frischer
- Institute of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, A-1097 Vienna, Austria
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