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Autio AH, Paavola J, Tervonen J, Lång M, Elomaa AP, Huuskonen TJ, Huttunen J, Kärkkäinen V, von Und Zu Fraunberg M, Lindgren AE, Koivisto T, Kurola J, Jääskeläinen JE, Kämäräinen OP. Acute evacuation of 54 intracerebral hematomas (aICH) during the microsurgical clipping of a ruptured middle cerebral artery bifurcation aneurysm-illustration of the individual clinical courses and outcomes with a serial brain CT/MRI panel until 12 months. Acta Neurochir (Wien) 2024; 166:17. [PMID: 38231317 PMCID: PMC10794262 DOI: 10.1007/s00701-024-05902-9] [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: 10/08/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE In aneurysmal intracerebral hemorrhage (aICH), our review showed the lack of the patient's individual (i) timeline panels and (ii) serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. METHODS Our retrospective cohort consists of 54 consecutive aICH patients from a defined population who acutely underwent the clipping of a middle cerebral artery bifurcation saccular aneurysm (Mbif sIA) with the aICH evacuation at Kuopio University Hospital (KUH) from 2010 to 2019. We constructed the patient's individual timeline panels since the emergency call and serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. The patients were indicated by numbers (1.-54.) in the pseudonymized panels, tables, results, and discussion. RESULTS The aICH volumes on KUH admission (median 46 cm3) plotted against the time from the emergency call to the evacuation (median 8 hours) associated significantly with the rebleeds (n=25) and the deaths (n=12). The serial CT/MRI slice panels illustrated the aICHs, intraventricular hemorrhages (aIVHs), residuals after the aICH evacuations, perihematomal edema (PHE), delayed cerebral injury (DCI), and in the 42 survivors, the clinical outcome (mRS) and the brain tissue outcome. CONCLUSIONS Regarding aICH evacuations, serial brain CT/MRI panels present more information than words, figures, and graphs. Re-bleeds associated with larger aICH volumes and worse outcomes. Swift logistics until the sIA occlusion with aICH evacuation is required, also in duty hours and weekends. Intraoperative CT is needed to illustrate the degree of aICH evacuation. PHE may evoke uncontrollable intracranial pressure (ICP) in spite of the acute aICH volume reduction.
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Affiliation(s)
- Anniina H Autio
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland.
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Juho Paavola
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Joona Tervonen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Maarit Lång
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Neurointensive Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Terhi J Huuskonen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Virve Kärkkäinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Antti E Lindgren
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jouni Kurola
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Center for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Autio AH, Paavola J, Tervonen J, Lång M, Huuskonen TJ, Huttunen J, Kärkkäinen V, von Und Zu Fraunberg M, Lindgren AE, Koivisto T, Kurola J, Jääskeläinen JE, Kämäräinen OP. Should individual timeline and serial CT/MRI panels of all patients be presented in acute brain insult cohorts? A pilot study of 45 patients with decompressive craniectomy after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2023; 165:3299-3323. [PMID: 36715752 PMCID: PMC10624760 DOI: 10.1007/s00701-022-05473-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/28/2022] [Accepted: 12/20/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Our review of acute brain insult articles indicated that the patients' individual (i) timeline panels with the defined time points since the emergency call and (ii) serial brain CT/MRI slice panels through the neurointensive care until death or final brain tissue outcome at 12 months or later are not presented. METHODS We retrospectively constructed such panels for the 45 aneurysmal subarachnoid hemorrhage (aSAH) patients with a secondary decompressive craniectomy (DC) after the acute admission to neurointensive care at Kuopio University Hospital (KUH) from a defined population from 2005 to 2018. The patients were indicated by numbers (1.-45.) in the pseudonymized panels, tables, results, and discussion. The timelines contained up to ten defined time points on a logarithmic time axis until death ([Formula: see text]; 56%) or 3 years ([Formula: see text]; 44%). The brain CT/MRI panels contained a representative slice from the following time points: SAH diagnosis, after aneurysm closure, after DC, at about 12 months (20 survivors). RESULTS The timelines indicated re-bleeds and allowed to compare the times elapsed between any two time points, in terms of workflow swiftness. The serial CT/MRI slices illustrated the presence and course of intracerebral hemorrhage (ICH), perihematomal edema, intraventricular hemorrhage (IVH), hydrocephalus, delayed brain injury, and, in the 20 (44%) survivors, the brain tissue outcome. CONCLUSIONS The pseudonymized timeline panels and serial brain imaging panels, indicating the patients by numbers, allowed the presentation and comparison of individual clinical courses. An obvious application would be the quality control in acute or elective medicine for timely and equal access to clinical care.
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Affiliation(s)
- Anniina H Autio
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland.
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Juho Paavola
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Joona Tervonen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Maarit Lång
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Neurointensive Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Terhi J Huuskonen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Virve Kärkkäinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Antti E Lindgren
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jouni Kurola
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Center for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Paavola JT, Jokimäki J, Huttunen TJ, Fraunberg MVUZ, Koivisto T, Kämäräinen OP, Lång M, Jääskeläinen JE, Kälviäinen R, Lindgren AE, Huttunen J. Long-term Risk of Epilepsy in Subarachnoid Hemorrhage Survivors With Positive Family History: A Population-Based Follow-up Study. Neurology 2023; 101:e1623-e1632. [PMID: 37643884 PMCID: PMC10585675 DOI: 10.1212/wnl.0000000000207737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating form of stroke affecting the working-age population, where epilepsy is a common complication and major prognostic factor for increased morbidity in aSAH survivors. The objective of this analysis was to assess whether epilepsy in first-degree relatives is a risk of developing epilepsy after aSAH. METHODS We used a region-specific database that includes all cases of unruptured and ruptured saccular intracranial aneurysm admitted to Kuopio University Hospital from its defined Eastern Finnish catchment population. We also retrieved data from Finnish national health registries for prescription drug purchases and reimbursement, hospital discharge, and cause of death and linked them to patients with aSAH, their first-degree relatives, and population controls matched 3:1 by age, sex, and birth municipality. Cox regression modeling and Kaplan-Meier survival curves were used for analysis. RESULTS We examined data for 760 consecutive 12-month survivors of aSAH, born in 1950 or after, with a first aSAH from January 1, 1995, to December 31, 2018. Of the 760 patients (median age, 47 years; 53% female; median follow-up, 11 years), 111 (15%) developed epilepsy at a median of 7 months (interquartile range, 2-14 months) after admission for aSAH. Of the 2,240 population controls and 4,653 first-degree relatives of patients with aSAH, 23 (0.9%) and 80 (1.7%), respectively, developed epilepsy during the follow-up period. Among 79 patients with epilepsy in first-degree relatives, 22 (28%) developed epilepsy after aSAH; by contrast, among 683 patients with no epilepsy in first-degree relatives, 89 (13%) developed epilepsy after aSAH. Having at least 1 relative with epilepsy was an independent risk factor of epilepsy after aSAH (hazard ratio, 2.44; 95% CI 1.51-3.95). Cumulative 1-year rates by first-degree relationship were 40% with 1 or more children with epilepsy, 38% with 1 or more affected parents, 5% with 1 or more affected siblings, and 10% with no relatives with epilepsy. DISCUSSION Patients who developed epilepsy after aSAH were significantly more likely to have first-degree relatives with epilepsy than those who did not develop epilepsy after the aSAH.
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Affiliation(s)
- Juho Tapio Paavola
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland.
| | - Jenna Jokimäki
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Terhi Johanna Huttunen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Mikael von Und Zu Fraunberg
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Timo Koivisto
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Olli-Pekka Kämäräinen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Maarit Lång
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Juha Eerik Jääskeläinen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Reetta Kälviäinen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Antti Elias Lindgren
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Jukka Huttunen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
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Lehtonen SJR, Vrzakova H, Paterno JJ, Puustinen S, Bednarik R, Hauta-Kasari M, Haneishi H, Immonen A, Jääskeläinen JE, Kämäräinen OP, Elomaa AP. Detection improvement of gliomas in hyperspectral imaging of protoporphyrin IX fluorescence - in vitro comparison of visual identification and machine thresholds. Cancer Treat Res Commun 2022; 32:100615. [PMID: 35905671 DOI: 10.1016/j.ctarc.2022.100615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/12/2022] [Revised: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND 5-aminolevulinic acid (5-ALA) - precursor of protoporphyrin IX (PpIX) - is utilized in fluorescence guided surgery (FGS) of high-grade gliomas. PpIX is used to identify traces of glioma during resection. Visual inspection of the fluorescence seems inaccurate in comparison to optic techniques such as hyperspectral imaging (HSI). AIM To characterize the limits of PpIX fluorescence detection of (i) visual evaluation and (ii) HSI analysis and to (iii) develop a classification system for visible and non-visible PpIX fluorescence. METHODS Samples with increasing concentrations (C) of PpIX and non-fluorescent controls were evaluated using a surgical microscope under blue light illumination. Similar samples were imaged with a HSI system tuned to PpIX fluorescence peak wavelength (635 nm) and control (RGB) channels. Samples' intensities were defined, leading to 96 analysed pixels after batching. RESULTS Three expert neurosurgeons assessed the PpIX samples (n = 16) and controls (n = 8) with unanimous decisions (ICC = 0.704), resulting in 63% recognition rate, 48% sensitivity, 92% specificity, 92% positive predictive value (PPV) and 47% negative predictive value (NPV). HSI image analysis, comparing mean relative values, resulted in 96%, 100%, 86%, 94%, 100%, respectively. Minimum PpIX concentration detection for experts was 0.6-1.8 μmol/l and HSI's 0.03-0.15 μmol/l. CONCLUSIONS PpIX concentrations of low-grade gliomas, and those reported on glioblastoma infiltration zones, are below experts' detection threshold. HSI analysis exceeds the performance of expert's visual inspection nearly by 20-fold. Hybrid FGS-HSI systems should be investigated in parallel to long-term outcomes. Described methods are applicable as a standard for calibration, testing and development of subvisual FGS techniques.
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Affiliation(s)
- Samu J R Lehtonen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland.
| | - Hana Vrzakova
- Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; School of Computing, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland; Institute of Photonics, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland
| | - Jussi J Paterno
- Ophthalmology Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211 Kuopio, Finland
| | - Sami Puustinen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Roman Bednarik
- School of Computing, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland; Institute of Photonics, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland
| | - Markku Hauta-Kasari
- School of Computing, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland; Institute of Photonics, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland
| | - Hideaki Haneishi
- Center for Frontier Medical Engineering (CFME), Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Arto Immonen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; Eastern Finland Neuro-Oncology Group, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; Eastern Finland Neuro-Oncology Group, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; Eastern Finland Neuro-Oncology Group, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Antti-Pekka Elomaa
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; Eastern Finland Neuro-Oncology Group, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
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Kämäräinen OP, Kemppainen T, Penttilä E, Varis J. Position-dependent pressure pneumocephalus after transsphenoidal surgery: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE21678. [PMID: 36303508 PMCID: PMC9379696 DOI: 10.3171/case21678] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/14/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intracranial air may become trapped inside the cranial vault after cranial surgery, causing tension pneumocephalus with a variety of possible neurological symptoms. The authors reported a unique case in which position-dependent tension pneumocephalus developed after standard pituitary adenoma resection, causing severe intermittent visual symptoms. OBSERVATIONS A tiny hole in the sellar floor after transsphenoidal surgery created a valve mechanism, allowing pressurized air accumulation inside the tumor capsule that periodically compressed the optic chiasm. This caused acute visual field defects only when the patient was in an upright position. Symptoms resolved when the patient lay down because pressurized air was allowed to escape from the cranial vault and compression of the optic chiasm was relieved. This phenomenon was verified with consecutive magnetic resonance imaging sequences demonstrating the relaxation of suprasellar space, after the intracranial air had escaped in a horizontal imaging position. LESSONS Imperfect sealing of the sellar floor after transsphenoidal surgery is not uncommon. Even a tiny defect may in rare cases work in a valve-like manner, leading to intermittent air accumulation in the suprasellar space and causing corresponding visual symptoms. Pressure pneumocephalus inside an empty tumor capsule should be kept in mind as a possible rare complication after transsphenoidal surgery.
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Affiliation(s)
- Olli-Pekka Kämäräinen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine–Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Tatu Kemppainen
- Department of Otorhinolaryngology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland; and
| | - Elina Penttilä
- Department of Otorhinolaryngology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland; and
| | - Joona Varis
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
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Tefre S, Lilja-Cyron A, Arvidsson L, Bartek J, Corell A, Forsse A, Glud AN, Hamdeh SA, Hansen FL, Huotarinen A, Johansson C, Kämäräinen OP, Korhonen T, Kotkansalo A, Mansoor NM, Mendoza Mireles EE, Miscov R, Munthe S, Nittby-Redebrandt H, Obad N, Pedersen LK, Posti J, Raj R, Satopää J, Ståhl N, Tetri S, Tobieson L, Juhler M. Endoscopic third ventriculostomy for adults with hydrocephalus: creating a prognostic model for success: protocol for a retrospective multicentre study (Nordic ETV). BMJ Open 2022; 12:e055570. [PMID: 35105647 PMCID: PMC8808390 DOI: 10.1136/bmjopen-2021-055570] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Endoscopic third ventriculostomy (ETV) is becoming an increasingly widespread treatment for hydrocephalus, but research is primarily based on paediatric populations. In 2009, Kulkarni et al created the ETV Success score to predict the outcome of ETV in children. The purpose of this study is to create a prognostic model to predict the success of ETV for adult patients with hydrocephalus. The ability to predict who will benefit from an ETV will allow better primary patient selection both for ETV and shunting. This would reduce additional second procedures due to primary treatment failure. A success score specific for adults could also be used as a communication tool to provide better information and guidance to patients. METHODS AND ANALYSIS The study will adhere to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis reporting guidelines and conducted as a retrospective chart review of all patients≥18 years of age treated with ETV at the participating centres between 1 January 2010 and 31 December 2018. Data collection is conducted locally in a standardised database. Univariate analysis will be used to identify several strong predictors to be included in a multivariate logistic regression model. The model will be validated using K-fold cross validation. Discrimination will be assessed using area under the receiver operating characteristic curve (AUROC) and calibration with calibration belt plots. ETHICS AND DISSEMINATION The study is approved by appropriate ethics or patient safety boards in all participating countries. TRIAL REGISTRATION NUMBER NCT04773938; Pre-results.
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Affiliation(s)
- Sondre Tefre
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Lisa Arvidsson
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Alba Corell
- Department of Neurosurgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Axel Forsse
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | | | - Sami Abu Hamdeh
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | | | - Antti Huotarinen
- Department of Neurosurgery NeuroCenter, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
| | - Conny Johansson
- Department of Neurosurgery, University Hospital of Umeå, Umeå, Sweden
| | - Olli-Pekka Kämäräinen
- Department of Neurosurgery NeuroCenter, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
| | - Tommi Korhonen
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Anna Kotkansalo
- Department of Neurosurgery and Brain Injury Centre, Turku University Hospital, Turku, Finland
| | - Nadia Mauland Mansoor
- Department of Neurosurgery, St Olavs Hospital Universitetssykehuset i Trondheim, Trondheim, Trøndelag, Norway
| | - Eduardo Erasmo Mendoza Mireles
- Department of Neurosurgery, Oslo University Hospital Ullevaal, Oslo, Norway
- Department of Neurosurgery, Rikshospitalet University Hospital, Oslo, Norway
| | - Rares Miscov
- Department of Neurosurgery, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | - Sune Munthe
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | | | - Nina Obad
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | | | - Jussi Posti
- Department of Neurosurgery and Brain Injury Centre, Turku University Hospital, Turku, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jarno Satopää
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Nils Ståhl
- Department of Neurosurgery, Lund University Hospital, Lund, Sweden
| | - Sami Tetri
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Lovisa Tobieson
- Department of Neurosurgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Östergötland, Sweden
| | - Marianne Juhler
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
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Kerttula S, Huttunen J, Leinonen V, Kämäräinen OP, Danner N. The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort. Acta Neurochir (Wien) 2022; 164:2699-2708. [PMID: 35972559 PMCID: PMC9519695 DOI: 10.1007/s00701-022-05337-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/02/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE To study the effect of antithrombotic therapy (ATT) on the outcome of operatively treated chronic subdural hematomas (CSDH). METHODS A retrospective population-based cohort study from Eastern Finland including all adult patients who underwent a burr-hole craniostomy (BHC) for CSDH during 2016 and 2017. The follow-up time for recurrence was 6 months and for mortality 3 years. RESULTS A total of 301 CSDH patients were included in the study. ATT (antithrombotic therapy; antiplatelet or anticoagulant medication) was used by 164 patients (54.5%) at the time of diagnosis. The hematoma was bilateral in 102 patients (33.9%). Forty-seven patients (15.8%) encountered hematoma recurrence. Bilateral CSDHs required reoperations more often than unilateral hematomas (12.6% vs. 22.0%; p = 0.036) regardless of the primary operation (uni- or bilateral). A bivariate logistic regression analysis showed that bilateral hematoma (OR 1.918; 95% CI 1.013-3.630; p = 0.045) and male gender (OR 2.363; 95% CI 1.089-5.128; p = 0.030) independently predicted hematoma recurrence. The overall three-year mortality was 27.9%. The use of ATT was not associated with CSDH recurrence, and the length of the temporary postoperative ATT discontinuation did not correlate with the rate of thromboembolic events. CONCLUSIONS ATT did not affect CSDH recurrence in our study population, and the duration of the temporary postoperative ATT discontinuation was not associated with the rate of thromboembolic complications. Male gender and bilateral hematomas were more frequently associated with recurrences.
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Affiliation(s)
- Santtu Kerttula
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.
| | - Jukka Huttunen
- Neurocenter - Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Ville Leinonen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland
- Neurocenter - Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland
- Neurocenter - Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Nils Danner
- Neurocenter - Neurosurgery, Kuopio University Hospital, Kuopio, Finland
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Tervonen J, Adams H, Lindgren A, Elomaa AP, Kämäräinen OP, Kärkkäinen V, von Und Zu Fraunberg M, Huttunen J, Koivisto T, Jääskeläinen JE, Leinonen V, Huuskonen TJ. Shunt performance in 349 patients with hydrocephalus after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2021; 163:2703-2714. [PMID: 34169389 PMCID: PMC8437876 DOI: 10.1007/s00701-021-04877-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/12/2021] [Accepted: 05/09/2021] [Indexed: 11/25/2022]
Abstract
Background Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequelae leading to poorer neurological outcomes and predisposing to various complications. Methods A total of 2191 consecutive patients with aSAH were acutely admitted to the Neurointensive Care at the Kuopio University Hospital between 1990 and 2018 from a defined population. A total of 349 (16%) aSAH patients received a ventriculoperitoneal shunt, 101 with an adjustable valve (2012–2018), 232 with a fixed pressure valve (1990–2011), and 16 a valveless shunt (2010–2013). Clinical timelines were reconstructed from the hospital records and nationwide registries until death (n = 120) or June 2019. Results Comparing the adjustable valves vs. the fixed pressure valves vs. the valveless shunts, intraventricular hemorrhage was present in 61%, 44% and 100%, respectively. The median times to the shunt were 7 days vs. 38 days vs. 10 days. The rates of the first revision were 25% vs. 32% vs. 69%. The causes included infection in 11% vs. 7% vs. 25% and overdrainage in 1% vs. 4% vs. 31%. The valveless shunt was the only independent risk factor (HR 2.9) for revision. After the first revision, more revisions were required in 48% vs. 52% vs. 45%. Conclusions The protocol to shunt evolved over time to favor earlier shunt. In post-aSAH hydrocephalus, adjustable valve shunts, without anti-siphon device, can be installed at an early phase after aSAH, in spite of intraventricular blood, with a modest risk (25%) of revision. Valveless shunts are not recommendable due to high risk of revisions.
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Affiliation(s)
- Joona Tervonen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Hadie Adams
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Antti Lindgren
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Virve Kärkkäinen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi J Huuskonen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Ylönen H, Danner N, Jyrkkänen HK, Kämäräinen OP, Leinonen V, Huttunen J. Surgically Treated C1 Fractures: A Population-Based Study. World Neurosurg 2021; 154:e333-e342. [PMID: 34284160 DOI: 10.1016/j.wneu.2021.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To characterize surgical treatment and outcomes of C1 fractures in a population-based setup. METHODS Patients with C1 fracture treated at Kuopio University Hospital Neurosurgery were retrospectively identified from January 1996 to June 2017. C1 fractures were classified according to the AO Spine Upper Cervical and Gehweiler classification systems. Patients were divided into 4 groups based on their treatment: group 1 (underwent C1 surgery as a primary option), group 2 (underwent C1 surgery as a secondary option after initial nonoperative treatment), group 3 (underwent surgery involving the C1 level with main indication being a concomitant cervical spine fracture), and group 4 (C1 fracture treatment was nonoperative). RESULTS We identified 47 patients with C1 fracture (mean age, 60.3 ± 18.2 years; 83.0% men; American Society of Anesthesiologists score, 2.3 ± 0.8). Concomitant cervical spine fractures were present in 89.4% of cases, most commonly in the C2 vertebra (75.4%). In group 2, 3 of 5 fractures changed from AO Spine type A to B in control imaging after nonoperative treatment, indicating fracture instability and requiring secondary surgery. Good C1 fracture alignment was achieved for 10 of 10 followed-up patients in groups 1 and 2, and for 10 of 11 followed-up patients in group 3. Residual neck pain and stiffness were present in all groups. Neurologic symptoms were rare and mild. CONCLUSIONS For unstable C1 fractures, surgery is safe treatment with good outcomes. Fractures initially determined as stable may require surgery if alignment is worsened in follow-up imaging. Magnetic resonance imaging is recommended to better detect unstable C1 fractures in diagnostic imaging.
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Affiliation(s)
- Henri Ylönen
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, North Savo, Finland.
| | - Nils Danner
- Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | | | - Olli-Pekka Kämäräinen
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, North Savo, Finland
| | - Ville Leinonen
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, North Savo, Finland
| | - Jukka Huttunen
- Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
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Karamanakos PN, Manousakis E, Rozakis D, Kämäräinen OP, Oikonomi E, Panteli ES. Intradiscal Platelet-Rich Plasma for Discogenic Low Back Pain Owing to a Degenerated and Previously Discectomized L5-S1 Disc. Pain Med 2021; 22:1235-1236. [PMID: 32783050 DOI: 10.1093/pm/pnaa241] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Petros N Karamanakos
- Department of Neurosurgery, Henry Dunant Hospital Center, Athens, Greece.,Department of Neurosurgery, Olympion General Hospital and Rehabilitation Center, Patras, Greece
| | | | - Dimitrios Rozakis
- Department of Anesthesiology, Henry Dunant Hospital Center, Athens, Greece
| | | | - Ekaterini Oikonomi
- Department of Neurosurgery, Olympion General Hospital and Rehabilitation Center, Patras, Greece
| | - Eleftheria S Panteli
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Patras, School of Medicine, University of Patras, Rion-Patras, Greece
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Nurmonen HJ, Huttunen T, Huttunen J, Kurtelius A, Kotikoski S, Junkkari A, Koivisto T, von Und Zu Fraunberg M, Kämäräinen OP, Lång M, Isoniemi H, Jääskeläinen JE, Lindgren AE. Lack of impact of polycystic kidney disease on the outcome of aneurysmal subarachnoid hemorrhage: a matched case-control study. J Neurosurg 2020; 134:1871-1878. [PMID: 32619983 DOI: 10.3171/2020.4.jns20544] [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: 02/28/2020] [Accepted: 04/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors set out to study whether autosomal dominant polycystic kidney disease (ADPKD), an established risk factor for intracranial aneurysms (IAs), affects the acute course and long-term outcome of aneurysmal subarachnoid hemorrhage (aSAH). METHODS The outcomes of 32 ADPKD patients with aSAH between 1980 and 2015 (median age 43 years; 50% women) were compared with 160 matched (age, sex, and year of aSAH) non-ADPKD aSAH patients in the prospectively collected Kuopio Intracranial Aneurysm Patient and Family Database. RESULTS At 12 months, 75% of the aSAH patients with ADPKD versus 71% of the matched-control aSAH patients without ADPKD had good outcomes (Glasgow Outcome Scale score 4 or 5). There was no significant difference in condition at admission. Hypertension had been diagnosed before aSAH in 69% of the ADPKD patients versus 27% of controls (p < 0.001). Multiple IAs were present in 44% of patients in the ADPKD group versus 25% in the control group (p = 0.03). The most common sites of ruptured IAs were the anterior communicating artery (47% vs 29%, p = 0.05) and the middle cerebral artery bifurcation (28% vs 31%), and the median size was 6.0 mm versus 8.0 mm (p = 0.02). During the median follow-up of 11 years, a second aSAH occurred in 3 of 29 (10%) ADPKD patients and in 4 of 131 (3%) controls (p = 0.11). A fatal second aSAH due to a confirmed de novo aneurysm occurred in 2 (6%) of the ADPKD patients but in none of the controls (p = 0.027). CONCLUSIONS The outcomes of ADPKD patients with aSAH did not differ significantly from those of matched non-ADPKD aSAH patients. ADPKD patients had an increased risk of second aSAH from a de novo aneurysm, warranting long-term angiographic follow-up.
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Affiliation(s)
- Heidi J Nurmonen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio.,2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio.,3Kuopio Health Center, Kuopio
| | - Terhi Huttunen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Jukka Huttunen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Arttu Kurtelius
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio.,2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Satu Kotikoski
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio.,2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Antti Junkkari
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Timo Koivisto
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio.,2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Mikael von Und Zu Fraunberg
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio.,2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Olli-Pekka Kämäräinen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio.,2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Maarit Lång
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio.,4Neurointensive Care and
| | - Helena Isoniemi
- 6Transplantation and Liver Surgery Clinic, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Juha E Jääskeläinen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio.,2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Antti E Lindgren
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio.,2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio.,5Department of Clinical Radiology, Kuopio University Hospital, Kuopio; and
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12
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Taha I, Hyvärinen A, Ranta A, Kämäräinen OP, Huttunen J, Mervaala E, Löppönen H, Rauramaa T, Ronkainen A, Jääskeläinen JE, Immonen A, Danner N. Facial nerve function and hearing after microsurgical removal of sporadic vestibular schwannomas in a population-based cohort. Acta Neurochir (Wien) 2020; 162:43-54. [PMID: 31494730 PMCID: PMC6942003 DOI: 10.1007/s00701-019-04055-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/29/2019] [Indexed: 10/29/2022]
Abstract
BACKGROUND Vestibular schwannoma (VS) is a benign tumor originating from the vestibulocochlear nerve. The optimal treatment strategy is debated, since surgery may result in iatrogenic facial nerve injury. We report the results of VS surgery in a population-based unselected cohort in a center with access to Cyber Knife (CK) radiosurgery. METHODS We reviewed 117 consecutive operations and found 95 patients who had their primary operation due to vestibular schwannoma between 2001 and 2017. Facial nerve function was evaluated with the House-Brackmann (HB) scale and hearing with the EU classification. RESULTS The population consisted of 37 males and 58 females with a median age of 54 years (range 19-79). One year after surgery 67% of patients had a good outcome (HB 1-2). The rate of good outcome was 90% if no facial nerve damage was observed during intraoperative monitoring, the size of the tumor was under 30 mm and no hydrocephalus was present. During the study period, the treatment strategy changed from total to near-total resection after the introduction of CK radiosurgery, which could be used as a second-line treatment in case of residual tumor regrowth. This resulted in an improvement of outcomes (0% HB 5-6) despite the larger tumor sizes (25 ± 14 mm vs. 31 ± 9 mm, p < 0.05). Hearing preservation rates did not increase. CONCLUSIONS Near-total resection and subsequent CK radiosurgery in case of residual tumor regrowth during follow-up seems to provide a good outcome of facial nerve function even in large VSs.
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Kurtelius A, Väntti N, Rezai Jahromi B, Tähtinen O, Manninen H, Koskenvuo J, Tulamo R, Kotikoski S, Nurmonen H, Kämäräinen OP, Huttunen T, Huttunen J, von Und Zu Fraunberg M, Koivisto T, Jääskeläinen JE, Lindgren AE. Association of Intracranial Aneurysms With Aortic Aneurysms in 125 Patients With Fusiform and 4253 Patients With Saccular Intracranial Aneurysms and Their Family Members and Population Controls. J Am Heart Assoc 2019; 8:e013277. [PMID: 31538843 PMCID: PMC6818001 DOI: 10.1161/jaha.119.013277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Varying degrees of co‐occurrence of intracranial aneurysms (IA) and aortic aneurysms (AA) have been reported. We sought to compare the risk for AA in fusiform intracranial aneurysms (fIA) and saccular intracranial aneurysms (sIA) disease and evaluate possible genetic connection between the fIA disease and AAs. Additionally, the characteristics and aneurysms of the fIA and sIA patients were compared. Methods and Results The Kuopio Intracranial Aneurysm Database includes all 4253 sIA and 125 fIA patients from its Eastern Finnish catchment population, and 13 009 matched population controls and 18 455 first‐degree relatives to the IA patients were identified, and the Finnish national registers were used to identify the individuals with AA. A total of 33 fIA patients were studied using an exomic gene panel of 37 genes associated with AAs. Seventeen (14.4%) fIA patients and 48 (1.2%) sIA patients had a diagnosis of AA. Both fIA and sIA patients had AAs significantly more often than their controls (1.2% and 0.5%) or relatives (0.9% and 0.3%). In a competing risks Cox regression model, the presence of fIA was the strongest risk factor for AA (subdistribution hazard ratio 7.6, 95% CI 3.9–14.9, P<0.0005). One likely pathogenic variant in COL5A2 and 3 variants of unknown significance were identified in MYH11,COL11A1, and FBN1 in 4 fIA patients. Conclusions The prevalence of AAs is increased slightly in sIA patients and significantly in fIA patients. fIA patients are older and have more comorbid diseases than sIA patients but this alone does not explain their clinically significant AA risk.
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Affiliation(s)
- Arttu Kurtelius
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Nelli Väntti
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery Helsinki University Hospital University of Helsinki Finland
| | - Olli Tähtinen
- Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland.,Department of Clinical Radiology Kuopio University Hospital Kuopio Finland
| | - Hannu Manninen
- Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland.,Department of Clinical Radiology Kuopio University Hospital Kuopio Finland
| | - Juha Koskenvuo
- Blueprint Genetics Helsinki Finland.,Department of Clinical Physiology and Nuclear Medicine Turku University Hospital Turku Finland
| | - Riikka Tulamo
- Department of Vascular Surgery Helsinki University Hospital University of Helsinki Finland
| | - Satu Kotikoski
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Heidi Nurmonen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Olli-Pekka Kämäräinen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Terhi Huttunen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Jukka Huttunen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Timo Koivisto
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Juha E Jääskeläinen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Antti E Lindgren
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
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Paavola JT, Väntti N, Junkkari A, Huttunen TJ, von und zu Fraunberg M, Koivisto T, Kämäräinen OP, Lång M, Meretoja A, Räikkönen K, Viinamäki H, Jääskeläinen JE, Huttunen J, Lindgren AE. Antipsychotic Use Among 1144 Patients After Aneurysmal Subarachnoid Hemorrhage. Stroke 2019; 50:1711-1718. [DOI: 10.1161/strokeaha.119.024914] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and Purpose—
At acute phase and neurointensive care, patients with aneurysmal subarachnoid hemorrhage (aSAH) may become agitated or delirious. We found no previous studies on psychotic disorders or antipsychotic drug (APD) use by long-term aSAH survivors. We defined the APD use and its risk factors among 12-month survivors of aSAH in an Eastern Finnish population–based cohort with long-term follow-up.
Methods—
We analyzed APD use in 1144 consecutive patients with aSAH alive at 12 months of the Kuopio intracranial aneurysm patient and family database and their age, sex, and birth municipality matched controls (3:1; n=3432) from 1995 to 2013 and median follow-up of 9 years. Using the Finish nationwide health registries, we obtained drug purchase and hospital discharge data.
Results—
In total, 140 (12%) of the 1144 patients started APD use first time after aSAH (index date), in contrast to 145 (4%) of the 3432 matched population controls. The cumulative rate of starting APD was 6% at 1 year and 9% at 5 years, in contrast to 1% and 2% in the controls, respectively. The rates at 1 and 5 years were only 1% and 2% in the 489 patients with a good condition (modified Rankin Scale score, 0 or 1 at 12 months; no shunt, intracerebral hemorrhage, or intraventricular hemorrhage). Instead, the highest rate of APD use, 23% at 5 years was among the 192 patients shunted for hydrocephalus after aSAH. Eighty-eight (63%) of the 140 aSAH patients with APD use had also concomitant antidepressant or antiepileptic drug use.
Conclusions—
The 12-month survivors of aSAH were significantly more likely to be started on APD after aSAH than their matched population controls. These patients often used antidepressant and antiepileptic drugs concomitantly. The use of APDs strongly correlated with signs of brain injury after aSAH, with low use if no signs of significant brain injury were present.
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Affiliation(s)
- Juho T. Paavola
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Nelli Väntti
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Antti Junkkari
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
| | - Terhi J. Huttunen
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
| | - Mikael von und zu Fraunberg
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
| | - Timo Koivisto
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
| | - Olli-Pekka Kämäräinen
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Maarit Lång
- Neurointensive Care, Institute of Clinical Medicine (M.L.), University of Eastern Finland, Kuopio
| | - Atte Meretoja
- Department of Neurology, Helsinki University Hospital, Finland (A.M.)
- Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (A.M.)
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Finland (K.R.)
| | - Heimo Viinamäki
- Psychiatry (H.V.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Juha E. Jääskeläinen
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Jukka Huttunen
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Antti E. Lindgren
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
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15
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Lindlöf M, Lindgren A, Paavola J, Väntti N, von und zu Fraunberg M, Koivisto T, Jääskeläinen JE, Kämäräinen OP, Huttunen J. Analgesic Use after Aneurysmal Subarachnoid Hemorrhage: A Population-Based Case−Control Study of 1187 Patients. World Neurosurg 2019; 126:e1276-e1286. [DOI: 10.1016/j.wneu.2019.02.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
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Skarp S, Kämäräinen OP, Wei GH, Jakkula E, Kiviranta I, Kröger H, Auvinen J, Lehenkari P, Ala-Kokko L, Männikkö M. Whole exome sequencing in Finnish families identifies new candidate genes for osteoarthritis. PLoS One 2018; 13:e0203313. [PMID: 30157244 PMCID: PMC6114922 DOI: 10.1371/journal.pone.0203313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/18/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is the most common degenerative joint disease and one of the major causes of disability worldwide. It is a multifactorial disorder with a significant genetic component. The heritability of OA has been estimated to be 60% for hip OA and 39% for knee OA. Genetic factors behind OA are still largely unknown. Studying families with strong history of OA, facilitates examining the co-segregation of genetic variation and OA. The aim of this study was to identify new, rare genetic factors and novel candidate genes for OA. METHODS Eight patients from three Finnish families with hip and knee OA were studied using whole exome sequencing. We focused on rare exonic variants with predicted pathogenicity and variants located in active promoter or strong enhancer regions. Expression of identified candidate genes were studied in bone and cartilage tissues and the observed variants were investigated using bioinformatic analyses. RESULTS Two rare variants co-segregated with OA in two families. In Family 8 a missense variant (c.628C>G, p.Arg210Gly) was observed in the OLIG3 gene that encodes a transcription factor known to be associated with rheumatoid arthritis and inflammatory polyarthritis. The Arg210Gly variant was estimated to be pathogenic by Polyphen-2 and Mutation taster and the locus is conserved among mammals. In Family 12 the observed variant (c.-127G>T) was located in the transcription start site of the FIP1L1 gene. FIP1L1 participates in the regulation of polyadenylation. The c.-127G>T is located in the transcription start site and may alter the DNA-binding of transcription factors. Both, OLIG3 and FIP1L1 were observed in human bone and cartilage. CONCLUSION The identified variants revealed novel candidate genes for OA. OLIG3 and FIP1L1 have specific roles in transcription and may effect expression of other genes. Identified variants in these genes may thus have a role in the regulatory events leading to OA.
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Affiliation(s)
- Sini Skarp
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
- * E-mail:
| | | | - Gong-Hong Wei
- Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
| | - Eveliina Jakkula
- Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics and Traumatology, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Heikki Kröger
- Department of Orthopaedics and Traumatology, Kuopio University Hospital and Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Petri Lehenkari
- Department of Anatomy and Cell biology and Surgery Clinic, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Leena Ala-Kokko
- Connective Tissue Gene Tests, Allentown, PA, United States of America
| | - Minna Männikkö
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
- Northern Finland Birth Cohort, Faculty of Medicine, University of Oulu, Oulu, Finland
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17
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Kämäräinen OP, Solovieva S, Vehmas T, Luoma K, Riihimäki H, Ala-Kokko L, Männikkö M, Leino-Arjas P. Common interleukin-6 promoter variants associate with the more severe forms of distal interphalangeal osteoarthritis. Arthritis Res Ther 2008; 10:R21. [PMID: 18257935 PMCID: PMC2374458 DOI: 10.1186/ar2374] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [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: 08/29/2007] [Revised: 12/20/2007] [Accepted: 02/08/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction The objective of this study was to investigate the relationship of the IL-6 promoter variants G-597A, G-572C and G-174C (rs1800797, rs1800796 and rs1800795, respectively), which have been shown to affect both the transcription and secretion of IL-6, to symptomatic distal interphalangeal (DIP) osteoarthritis (OA). Methods A total of 535 women aged 45 to 63 years were included. Radiographs of both hands were taken and each DIP joint was evaluated (grade 0 to 4) for the presence of OA. Information on symptoms (pain, tenderness) in each joint was collected by using a self-administered questionnaire. Symptomatic DIP OA was defined by the presence of both radiographic findings of grade 2 or more and symptoms in at least two DIP joints, and symmetrical DIP OA by the presence of radiographic findings of grade 2 or more in at least one symmetrical pair of DIP joints. Common polymorphic loci in the IL-6 gene were amplified and the promoter haplotypes were reconstructed from genotype data with the PHASE program. Logistic regression analysis was used to examine the association between the IL-6 genotypes/diplotypes and the DIP OA outcome. Results The G alleles of two promoter single nucleotide polymorphisms (SNPs) G-597A and G-174C were more common among the subjects with symptomatic DIP OA than among those with no disease (P = 0.020 and 0.024, corrected for multiple testing). In addition, the carriage of at least one G allele in these positions increased the risk of disease (P = 0.006 and P = 0.008, respectively). Carrying a haplotype with the G allele in all three promoter SNPs increased the risk of symptomatic DIP OA more than fourfold (odds ratio (OR) 4.45, P = 0.001). Carriage of the G-G diplotype indicated an increased risk of both symmetrical DIP OA (OR 1.52, 95% confidence interval 1.01 to 2.28) and symptomatic DIP OA (OR 3.67, 95% confidence interval 1.50 to 9.00). Conclusion The present study showed that the presence of G alleles at common IL-6 polymorphic promoter loci was associated with the more severe DIP OA outcomes, symmetrical and symptomatic.
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Affiliation(s)
- Olli-Pekka Kämäräinen
- Collagen Research Unit, Biocenter and Department of Medical Biochemistry and Molecular Biology, University of Oulu, 90220 Oulu, Finland.
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