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Baumgarten P, Prange G, Kamp MA, Monden D, Neef V, Schwarzer F, Dubinski D, Dinc N, Weber KJ, Czabanka M, Hattingen E, Ronellenfitsch MW, Steinbach JP, Senft C. Treatment of very elderly glioblastoma patients ≥ 75 years of age: whom to treat. J Neurooncol 2023; 165:509-515. [PMID: 38032426 PMCID: PMC10752837 DOI: 10.1007/s11060-023-04518-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE The prognosis of patients ≥ 75 years suffering from glioblastoma is poor. Novel therapies are usually reserved for patients ≤ 70 years. In an aging population, treatment of very elderly patients remains a challenge. METHODS Between 2010 and 2018, a total of 977 glioblastoma patients were treated at our institution. Of these, 143 patients were ≥ 75 years at diagnosis. Primary procedure was surgical resection or biopsy followed by adjuvant treatment, whenever possible. We retrospectively investigated overall survival (OS) and potential prognostic factors influencing survival, including Karnofsky Performance Status (KPS), surgical therapy, adjuvant therapy as well as MGMT promotor status. RESULTS In very elderly patients, median age was 79 years (range: 75-110). Biopsy only was performed in 104 patients; resection was performed in 39 patients. Median OS for the entire cohort was 5.9 months. Univariate analysis showed that KPS at presentation (≥ 70 vs. ≤60), surgery vs. biopsy, adjuvant chemotherapy and adjuvant radiotherapy were significantly associated with OS (6 vs. 3, p < 0.0111; 12 vs. 4, p = 0.0011; 11 vs. 4, p = 0.0003 and 10 vs. 1.5 months, p < 0.0001, respectively). Multivariate analysis confirmed adjuvant radiotherapy (p < 0.0001) and chemotherapy (p = 0.0002) as independent factors influencing OS. CONCLUSION For very elderly patients, the natural course of disease without treatment is devastating. These patients benefit from multimodal treatment including adjuvant radiotherapy and chemotherapy. A beneficial effect of resection has not been demonstrated. Treatment options and outcomes should be thoughtfully discussed before treatment decisions are made.
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Affiliation(s)
- Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, D-07747, Jena, Germany.
| | - Georg Prange
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
- Centre for Palliative and Neuro-palliative Care, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Campus Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Daniel Monden
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Franziska Schwarzer
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Nazife Dinc
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Katharina J Weber
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK), partner site Frankfurt/Mainz, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt, Germany
- University Cancer Center (UCT), Goethe University Hospital, Frankfurt, Germany
| | - Markus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael W Ronellenfitsch
- Department of Neuro-Oncology, University Hospital Frankfurt - Goethe-University, Frankfurt, Germany
| | - Joachim P Steinbach
- Department of Neuro-Oncology, University Hospital Frankfurt - Goethe-University, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, D-07747, Jena, Germany
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Mertens R, Acker G, Kersting K, Lange C, Furth C, Beyaztas D, Truckenmueller P, Moedl L, Spruenken ED, Czabanka M, Vajkoczy P. Validation of the Berlin Grading System for moyamoya angiopathy with the use of [ 15O]H 2O PET. Neurosurg Rev 2022; 46:25. [PMID: 36574089 PMCID: PMC9794537 DOI: 10.1007/s10143-022-01920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/05/2022] [Accepted: 11/30/2022] [Indexed: 12/28/2022]
Abstract
The Berlin Grading System assesses clinical severity of moyamoya angiopathy (MMA) by combining MRI, DSA, and cerebrovascular reserve capacity (CVRC). Our aim was to validate this grading system using [15O]H2O PET for CVRC. We retrospectively identified bilateral MMA patients who underwent [15O]H2O PET examination and were treated surgically at our department. Each hemisphere was classified using the Suzuki and Berlin Grading System. Preoperative symptoms and perioperative ischemias were collected, and a logistic regression analysis was performed. A total of 100 hemispheres in 50 MMA patients (36 women, 14 men) were included. Using the Berlin Grading System, 2 (2.8%) of 71 symptomatic hemispheres were categorized as grade I, 14 (19.7%) as grade II, and 55 (77.5%) as grade III. The 29 asymptomatic hemispheres were characterized as grade I in 7 (24.1%) hemispheres, grade II in 12 (41.4%), and grade III in 10 (34.5%) hemispheres. Berlin grades were independent factors for identifying hemispheres as symptomatic and higher grades correlated with increasing proportion of symptomatic hemispheres (p < 0.01). The Suzuki grading did not correlate with preoperative symptoms (p = 0.26). Perioperative ischemic complications occurred in 8 of 88 operated hemispheres. Overall, complications did not occur in any of the grade I hemispheres, but in 9.1% (n = 2 of 22) and 9.8% (n = 6 of 61) of grade II and III hemispheres, respectively. In this study, we validated the Berlin Grading System with the use of [15O]H2O PET for CVRC as it could stratify preoperative symptomatology. Furthermore, we highlighted its relevance for predicting perioperative ischemic complications.
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Affiliation(s)
- R Mertens
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Kersting
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Lange
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Furth
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - D Beyaztas
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - P Truckenmueller
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - L Moedl
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - E D Spruenken
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - M Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - P Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
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Kashefiolasl S, Qasem L, Brawanski N, Funke M, Keil F, Hattingen E, Foerch C, Seifert V, Prinz V, Czabanka M, Konczalla J. Impact of COVID-19 pandemic on treatment management and clinical outcome of aneurysmal subarachnoid hemorrhage – A single center experience. Brain and Spine 2022. [PMCID: PMC9576212 DOI: 10.1016/j.bas.2022.101412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- S. Kashefiolasl
- University Hospital Frankfurt, Neurosurgery, Frankfurt am Main, Germany
| | - L.E. Qasem
- University Hospital Frankfurt, Neurosurgery, Frankfurt am Main, Germany
| | - N. Brawanski
- University Hospital Frankfurt, Neurosurgery, Frankfurt am Main, Germany
| | - M. Funke
- University Hospital Frankfurt, Departments of Anesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt am Main, Germany
| | - F. Keil
- University Hospital Frankfurt, Institute of Neuroradiology, Frankfurt am Main, Germany
| | - E. Hattingen
- University Hospital Frankfurt, Institute of Neuroradiology, Frankfurt am Main, Germany
| | - C. Foerch
- University Hospital Frankfurt, Neurology, Frankfurt am Main, Germany
| | - V. Seifert
- University Hospital Frankfurt, Neurosurgery, Frankfurt am Main, Germany
| | - V. Prinz
- University Hospital Frankfurt, Neurosurgery, Frankfurt am Main, Germany
| | - M. Czabanka
- University Hospital Frankfurt, Neurosurgery, Frankfurt am Main, Germany
| | - J. Konczalla
- University Hospital Frankfurt, Neurosurgery, Frankfurt am Main, Germany
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Qasem LE, Al-Hilou A, Zacharowski K, Funke M, Strouhal U, Jussen D, Konczalla J, Forster MT, Prinz V, Lucia K, Czabanka M. Implementation of the “No ICU – Unless” approach in postoperative neurosurgical management in times of Covid-19. Brain and Spine 2022. [PMCID: PMC9576213 DOI: 10.1016/j.bas.2022.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L.-E. Qasem
- Universitätsklinik Frankfurt am Main, Neurosurgery, Frankfurt am Main, Germany
| | - A. Al-Hilou
- Universitätsklinik Frankfurt am Main, Neurosurgery, Frankfurt am Main, Germany
| | - K. Zacharowski
- Universitätsklinik Frankfurt am Main, Anesthesiology, Frankfurt am Main, Germany
| | - M. Funke
- Universitätsklinik Frankfurt am Main, Anesthesiology, Frankfurt am Main, Germany
| | - U. Strouhal
- Universitätsklinik Frankfurt am Main, Anesthesiology, Frankfurt am Main, Germany
| | - D. Jussen
- Universitätsklinik Frankfurt am Main, Neurosurgery, Frankfurt am Main, Germany
| | - J. Konczalla
- Universitätsklinik Frankfurt am Main, Neurosurgery, Frankfurt am Main, Germany
| | - M.-T. Forster
- Universitätsklinik Frankfurt am Main, Neurosurgery, Frankfurt am Main, Germany
| | - V. Prinz
- Universitätsklinik Frankfurt am Main, Neurosurgery, Frankfurt am Main, Germany
| | - K. Lucia
- Universitätsklinik Frankfurt am Main, Neurosurgery, Frankfurt am Main, Germany
| | - M. Czabanka
- Universitätsklinik Frankfurt am Main, Neurosurgery, Frankfurt am Main, Germany
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Czabanka M, Thomé C, Ringel F, Meyer B, Eicker SO, Rohde V, Stoffel M, Vajkoczy P. [Operative treatment of degenerative diseases of the lumbar spine]. Nervenarzt 2018; 89:639-647. [PMID: 29679129 DOI: 10.1007/s00115-018-0523-3] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Degenerative diseases of the lumbar spine and associated lower back pain represent a major epidemiological and health-related economic challenge. A distinction is made between specific and unspecific lower back pain. In specific lower back pain lumbar disc herniation and spinal canal stenosis with or without associated segment instability are among the most frequent pathologies. Diverse conservative and operative strategies for treatment of these diseases are available. OBJECTIVES The aim of this article is to present an overview of current data and an evidence-based assessment of the possible forms of treatment. MATERIAL AND METHODS An extensive literature search was carried out via Medline plus an additional evaluation of the authors' personal experiences. RESULTS Conservative and surgical treatment represent efficient treatment options for degenerative diseases of the lumbar spine. Surgical treatment of lumbar disc herniation shows slight advantages compared to conservative treatment consisting of faster recovery of neurological deficits and a faster restitution of pain control. Surgical decompression is superior to conservative measures for the treatment of spinal canal stenosis and degenerative spondylolisthesis. In this scenario conservative treatment represents an important supporting measure for surgical treatment in order to improve the mobility of patients and the outcome of surgical treatment. CONCLUSION The treatment of specific lower back pain due to degenerative lumbar pathologies represents an interdisciplinary challenge, requiring both conservative and surgical treatment strategies in a synergistic treatment concept in order to achieve the best results for patients.
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Affiliation(s)
- M Czabanka
- Klinik und Poliklinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Thomé
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - F Ringel
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - B Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, München, Deutschland
| | - S-O Eicker
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - V Rohde
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - M Stoffel
- Klinik für Neurochirurgie, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland.
| | - P Vajkoczy
- Klinik und Poliklinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Finger T, Bayerl S, Bertog M, Czabanka M, Woitzik J, Vajkoczy P. Impact of sacropelvic fixation on the development of postoperative sacroiliac joint pain following multilevel stabilization for degenerative spine disease. Clin Neurol Neurosurg 2016; 150:18-22. [DOI: 10.1016/j.clineuro.2016.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/30/2016] [Accepted: 08/07/2016] [Indexed: 11/29/2022]
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Acker G, Palumbo A, Neri D, Vajkoczy P, Czabanka M. F8-SIP mediated targeted photodynamic therapy leads to microvascular dysfunction and reduced glioma growth. J Neurooncol 2016; 129:33-8. [PMID: 27188647 DOI: 10.1007/s11060-016-2143-8] [Citation(s) in RCA: 8] [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: 01/26/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
The extra domain A (ED A) of fibronectin has been identified as a tumor vessel specific neovascular marker in glioma. Antibody based vascular targeting against ED A of fibronectin allows precise accumulation of photosensitizer in glioma microvasculature and thereby promises to overcome drawbacks of current photodynamic therapy (PDT) for glioma treatment. Our aim was to characterize microcirculatory consequences of F8-small immunoprotein (SIP) mediated PDT by intravital microscopy (IVM) and to analyze the effects on glioma growth. For IVM SF126 glioma cells were implanted into dorsal skinfold-chamber of nude mice. PDT was performed after intravenous injection of photosensitizer (PS)-coupled F8-SIP or PBS (n = 4). IVM was performed before and after PDT for 4 days. Analysis included total and functional (TVD, FVD) vessel densities, perfusion index (PI), microvascular permeability and blood flow rate (Q). To assess tumor growth SF126 glioma cells were implanted subcutaneously. PDT was performed as a single and repetitive treatment after PS-F8-SIP injection (n = 5). Subcutaneous tumors were treated after uncoupled F8-SIP injection as control group (n = 5). PDT induced microvascular stasis and thrombosis with reduced FVD (24 h: 115.98 ± 0.7 vs. 200.8 ± 61.9 cm/cm(2)) and PI (39 ± 11 vs. 70 ± 10 %), whereas TVD was not altered (298 ± 39.2 vs. 278.2 ± 51 cm/cm(2)). Microvascular dysfunction recovered 4 days after treatment. Microvascular dysfunction led to a temporary reduction of glioma growth in the first 48 h after treatment with complete recovery 5 days after treatment. Repetitive PDT resulted in sustained reduction of tumor growth. F8-SIP mediated PDT leads to microvascular dysfunction and reduced glioma growth in a preclinical glioma model with recovery of microcirculation 4 days after treatment. Repetitive application of PDT overcomes microvascular recovery and leads to prolonged antiglioma effects.
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Affiliation(s)
- G Acker
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Palumbo
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH, Zurich, Switzerland
| | - D Neri
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH, Zurich, Switzerland
| | - P Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - M Czabanka
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Bersano A, Guey S, Bedini G, Nava S, Hervé D, Vajkoczy P, Tatlisumak T, Sareela M, van der Zwan A, Klijn CJM, Braun KPJ, Kronenburg A, Acerbi F, Brown MM, Calviere L, Cordonnier C, Henon H, Thines L, Khan N, Czabanka M, Kraemer M, Simister R, Prontera P, Tournier-Lasserve E, Parati E. Research Progresses in Understanding the Pathophysiology of Moyamoya Disease. Cerebrovasc Dis 2016; 41:105-18. [PMID: 26756907 DOI: 10.1159/000442298] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The pathogenesis of moyamoya disease (MMD) is still unknown. The detection of inflammatory molecules such as cytokines, chemokines and growth factors in MMD patients' biological fluids supports the hypothesis that an abnormal angiogenesis is implicated in MMD pathogenesis. However, it is unclear whether these anomalies are the consequences of the disease or rather causal factors as well as these mechanisms remain insufficient to explain the pathophysiology of MMD. The presence of a family history in about 9-15% of Asian patients, the highly variable incidence rate between different ethnic and sex groups and the age of onset support the role of genetic factors in MMD pathogenesis. However, although some genetic loci have been associated with MMD, few of them have been replicated in independent series. Recently, RNF213 gene was shown to be strongly associated with MMD occurrence with a founder effect in East Asian patients. However, the mechanisms leading from RNF213 mutations to MMD clinical features are still unknown. SUMMARY The research on pathogenic mechanism of MMD is in its infancy. MMD is probably a complex and heterogeneous disorder, including different phenotypes and genotypes, in which more than a single factor is implicated. KEY MESSAGE Since the diagnosis of MMD is rapidly increasing worldwide, the development of more efficient stratifying risk systems, including both clinical but also biological drivers became imperative to improve our ability of predict prognosis and to develop mechanism-tailored interventions.
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Affiliation(s)
- Anna Bersano
- Cerebrovascular Disease Unit, IRCCS Foundation C. Besta, Neurological Institute, Milan, Italy
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Acker G, Goerdes S, Schneider UC, Schmiedek P, Czabanka M, Vajkoczy P. Distinct clinical and radiographic characteristics of moyamoya disease amongst European Caucasians. Eur J Neurol 2015; 22:1012-7. [DOI: 10.1111/ene.12702] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- G. Acker
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Goerdes
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - U. C. Schneider
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - P. Schmiedek
- Department of Neurosurgery; University Hospital Mannheim; Medical Faculty of the University of Heidelberg; Mannheim Germany
| | - M. Czabanka
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - P. Vajkoczy
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB); Charité - Universitätsmedizin Berlin; Berlin Germany
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Parmaksız G, Czabanka M, Vinci M, Vajkoczy P. Antiangiogenic Therapy Inhibits the Recruitment of Vascular Accessory Cells to the Perivascular Niche in Glioma Angiogenesis. J Vasc Res 2014; 51:102-9. [DOI: 10.1159/000357620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/23/2013] [Indexed: 11/19/2022] Open
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Finger T, Bayerl S, Onken J, Czabanka M, Woitzik J, Vajkoczy P. Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative spine disease. Eur Spine J 2014; 23:1013-20. [PMID: 24448893 DOI: 10.1007/s00586-014-3165-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/02/2014] [Accepted: 01/04/2014] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative spine disease. METHODS A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0 ± 3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5-S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. RESULTS The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous spine surgeries, or postoperative complication rate. The incidence of L5-S1 pseudarthrosis after 1 year in the S1, iliac, and plate groups was 19, 0, and 29 %, respectively (p < 0.05 iliac vs. plate). The incidence of screw loosening after 1 year in the S1, iliac, and plate groups was 22, 4, and 43 %, respectively (p < 0.05 iliac vs. plate). Average Oswestry scores after 1 year in the S1, iliac, and plate groups were 40 ± 18, 42 ± 20, and 58 ± 18, respectively (p < 0.05 both S1 and iliac vs. plate). CONCLUSION The surgical treatment of multilevel degenerative spine disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of an iliosacral plate resulted in an inferior surgical and clinical outcome when compared to iliac screws.
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Affiliation(s)
- T Finger
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Czabanka M, Bruenner J, Parmaksiz G, Broggini T, Topalovic M, Bayerl S, Auf G, Kremenetskaia I, Nieminen M, Jabouille A, Mueller S, Harms U, Harms C, Koch A, Heppner F, Vajkoczy P. Combined temozolomide and sunitinib treatment leads to better tumour control but increased vascular resistance in O6-methylguanine methyltransferase-methylated gliomas. Eur J Cancer 2013; 49:2243-52. [DOI: 10.1016/j.ejca.2013.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/07/2013] [Accepted: 02/14/2013] [Indexed: 12/11/2022]
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Kleber C, Gesslein M, Czabanka M, Arnholdt J, Schaser KD. [Traumatic brain injury]. MMW Fortschr Med 2011; 153:38-39. [PMID: 21991835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- C Kleber
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin-Campus Virchow Klinikum, Berlin.
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14
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Czabanka M, Peña-Tapia P, Schubert GA, Heppner FL, Martus P, Horn P, Schmiedek P, Vajkoczy P. Proposal for a new grading of Moyamoya disease in adult patients. Cerebrovasc Dis 2011; 32:41-50. [PMID: 21576942 DOI: 10.1159/000326077] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 02/17/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Moyamoya disease (MMD) is graded based on digital subtraction angiography (DSA) with limited clinical applications. The aim was to identify clinically relevant parameters that may be used to develop a novel MMD grading system. METHODS In 40 MMD patients bilateral revascularization surgery was performed. Clinical data including DSA, MRI and regional cerebral blood flow studies were assessed. χ(2) test corrected for dependency of measurements at the same subject and analysis of receiver operating characteristics were used to identify key parameters. Grading system included: DSA (stenosis/occlusion = 1 point; stenosis/occlusion + intracranial compensation = 2 points; stenosis/occlusion + intracranial compensation + extra-intracranial compensation = 3 points), MRI (no sign of ischemia = 0 points; signs of ischemia = 1 point) and cerebrovascular reserve capacity (CVRC > -5% = 0 points; CVRC < -5% = 2 points). MMD grade I referred to 1-2 points, grade II to 3-4 and grade III to 5-6 points. RESULTS DSA, MRI and CVRC were dependent factors associated with the occurrence of clinical symptoms. Receiver operating characteristics analysis indentified the grading system as superior to each single parameter in predicting clinical symptoms. Fourteen hemispheres were graded as mild (grade I), 35 as moderate (grade II) and 31 as severe (grade III); 21% of grade I, 63% of grade II and 93% of grade III hemispheres were clinically symptomatic. CONCLUSIONS The proposed grading system allows to stratify for clinical symptomatology in MMD patients. Future studies will have to investigate its value for assessing clinical symptoms and treatment risks.
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Affiliation(s)
- M Czabanka
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Czabanka M, Peña-Tapia P, Scharf J, Schubert G, Münch E, Horn P, Schmiedek P, Vajkoczy P. Characterization of Direct and Indirect Cerebral Revascularization for the Treatment of European Patients with Moyamoya Disease. Cerebrovasc Dis 2011; 32:361-9. [DOI: 10.1159/000330351] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/08/2011] [Indexed: 11/19/2022] Open
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