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Heckmann JG, Ernst S, Kempf B, Hebecker R, Reithmeier T, Wendtner CM. [A rare cause of a progressive speech impairment]. Med Klin Intensivmed Notfmed 2013; 109:48-51. [PMID: 23893010 DOI: 10.1007/s00063-013-0276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 07/05/2013] [Accepted: 07/09/2013] [Indexed: 11/24/2022]
Affiliation(s)
- J G Heckmann
- Neurologische Klinik, Klinikum Landshut, Robert-Koch Str. 1, 84034, Landshut, Deutschland,
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Reithmeier T, Lopez WO, Doostkam S, Machein MR, Pinsker MO, Trippel M, Nikkhah G. Intraindividual comparison of histopathological diagnosis obtained by stereotactic serial biopsy to open surgical resection specimen in patients with intracranial tumours. Clin Neurol Neurosurg 2013; 115:1955-60. [PMID: 23769864 DOI: 10.1016/j.clineuro.2013.05.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 03/16/2013] [Accepted: 05/18/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are concerns in the literature about the accuracy of histopathological diagnosis obtained by stereotactic biopsy in patients with brain tumours. The aim of this study was to analyse intraindividually the histopathological accuracy of stereotactic biopsies of intracerebral lesions in comparison to open surgical resection. MATERIALS AND METHODS Between 2007 and 2011 a total of 635 patients underwent stereotactic serial biopsy in our department. Among these patients we identified 51 patients, who underwent magnetic resonance (MR) based stereotactic biopsy and subsequent open resection within 30 days. Mortality and morbidity data as well as final histopathological diagnoses of both procedures were compared with regard to tumour grade and tumour cell type. Patients with discrepancies between the histological diagnosis obtained by biopsy and open resection were classified into three subgroups (same cell type but different grading; same grading but different cell type and different grading as well as different cell type). RESULTS The mean number of tissue samples taken by stereotactic serial biopsy from each patient was 12 (range 7-21). Minor morbidity was 6% and major morbidity was 14% after open surgery compared to no morbidity after stereotactic biopsy. Mortality was 2% after stereotactic biopsy (one patient died after stereotactic biopsy as a result of a fatal bleeding) compared to 0% in the resection group. Silent bleeding rate without any clinical symptoms was 8% in the biopsy group. A complete correlation of histopathological findings between the biopsy group and the resection group was achieved in 76% and was increased to 90% by analyzing clinical and neuroradiological information. In patients with recurrence the correlation was higher (94%) than for patients with primary brain lesions (67%). The discrepancies between the open resection group and biopsy group were analysed. CONCLUSION Stereotactic MR guided serial biopsy is a minimal invasive procedure with low morbidity and high diagnostic accuracy for diagnosis and grading of brain tumours. Diagnostic accuracy of stereotactic biopsy can be enhanced further by careful interpretation of neuroradiological and clinical information.
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Affiliation(s)
- T Reithmeier
- Division of Stereotactic and Functional Neurosurgery, Department of General Neurosurgery, University Freiburg - Medical Center, Breisacher Straße 64, 79106 Freiburg, Germany.
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Nguyen-Thanh T, Reisert M, Anastasopoulos C, Hamzei F, Reithmeier T, Vry MS, Kiselev VG, Weyerbrock A, Mader I. Global tracking in human gliomas: a comparison with established tracking methods. Clin Neuroradiol 2013; 23:263-75. [PMID: 23329237 PMCID: PMC3834168 DOI: 10.1007/s00062-013-0198-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 10/18/2012] [Accepted: 01/02/2013] [Indexed: 11/29/2022]
Abstract
Purpose Global tracking (GT) is a recently published fibre tractography (FT) method that takes simultaneously all fibres into account during their reconstruction. The purpose of this study was to compare this new method with fibre assignment by continuous tracking (FACT) and probabilistic tractography (PT) for the detection of the corticospinal tract (CST) in patients with gliomas. Methods Tractography of the CST was performed in 17 patients with eight low grade and nine anaplastic astrocytomas located in the motor cortex or the corticospinal tract. Diffusions metrics as fractional anisotropy (FA), mean (MD), axial (AD) and radial diffusivity (RD) were obtained. The methods were additionally applied on a physical phantom to assess their accuracy. Results PT was successful in all (100 %), GT in 16 (94 %) and FACT in 15 patients (88 %). The case where GT and FACT, both, missed the CST showed the highest AD and RD, whereas the one where FACT algorithm, alone, was not successfully showed the lowest AD and RD of the group. FA was reduced on the pathologic side (FApath 0.35 ± 0.16 (mean ± SD) versus FAcontralateral 0.51 ± 0.15, pcorr < 0.03). RD was increased on the pathologic side (RDpath 0.67 ± 0.29 × 10−3 mm2/s versus RDcontralateral 0.46 ± 0.08 × 10−3 mm2/s, pcorr < 0.03). In the phantom measurement, only GT did not detect false positive fibres at fibre crossings. Conclusion PT performed well even in areas of increased diffusivities indicating a severe oedema or disintegration of tissue. FACT was also susceptible to a decrease of diffusivities and to a susceptibility artefact, where GT was robust.
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Affiliation(s)
- T Nguyen-Thanh
- Department of Neuroradiology, University Medical Centre Freiburg, Breisacher St. 64, 79106, Freiburg, Germany,
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Reithmeier T, Lopez WOC, Spehl TS, Nguyen T, Mader I, Nikkhah G, Pinsker MO. Bevacizumab as salvage therapy for progressive brain stem gliomas. Clin Neurol Neurosurg 2012; 115:165-9. [PMID: 22652237 DOI: 10.1016/j.clineuro.2012.04.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/17/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE There is no standard of care for patients with progredient brain stem gliomas. Therefore, we report about clinical, radiological and metabolic response to anti-angiogenic treatment with bevacizumab in a series of 3 patients with gliomas involving the brain stem. PATIENTS AND METHODS Three patients with histologically confirmed gliomas involving the brain stem were treated with bevacizumab for tumor progression. The clinical data, histopathological findings as well as MRI and PET follow up examinations during bevacizumab therapy were retrospectively analyzed. RESULTS The histopathological diagnosis revealed an anaplastic astrocytoma WHO grade III in two patients and an astrocytoma WHO grade II in 1 patients with clinical and neuroradiological signs of malignization. One patient is still progression-free 97 weeks after initiation of bevacizumab therapy. Mean progression-free survival and overall survival for the other two patients after initiation of bevacizumab therapy was 34.5 weeks and 43.5 weeks. During bevacizumab therapy mean KPS improved from 60 to 80 and mean dosage of daily dexamathasone was reduced from 7.3 mg to 1.3 mg. MRI showed a decrease of T2 weighted hyperintense lesions in all patients and a decrease of contrast enhancement in two patients. (18)F-FET-PET showed a decrease of tracer uptake in all cases (mean maximum decrease: 25%). CONCLUSION In this series treatment of progressive gliomas involving the brain stem with bevacizumab resulted in an improved clinical condition of the patients as well as a reduction of the T2 weighted lesions and reduced amino acid uptake in the tumor area. It therefore may represent a therapeutic salvage option for this type of tumor.
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Affiliation(s)
- T Reithmeier
- Department of Neurosurgery, Division of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg im Breisgau, Germany.
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Reithmeier T, Rottenburger C, Doostkam S, Pinsker MO, Trippel M, Bosche B, Weber W, Prinz M, Nikkhah G. Treatment of progressive brain stem glioma with bevacizumab: radiological, metabolic and histopathological aspects. J Neurol Surg A Cent Eur Neurosurg 2011; 73:187-91. [PMID: 22048887 DOI: 10.1055/s-0032-1313633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T Reithmeier
- University Hospital Freiburg, Department of Stereotactic and Functional Neurosurgery, Freiburg, Germany.
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Baehr O, Hentschel B, Hattingen E, Nussbaum S, Berger H, Tatagiba M, Tonn JC, Schnell O, Simon M, Reithmeier T, Krex D, Pietsch T, Reifenberger G, Heese O, Weller M, Steinbach J, Loeffler M. Objective responses to chemotherapy in recurrent glioma: A prospective analysis from the German Glioma Network. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2037] [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] [Indexed: 11/20/2022] Open
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Heese O, Schmidt M, Nickel S, Berger H, Goldbrunner R, Tonn JC, Bähr O, Steinbach JP, Simon M, Schramm J, Krex D, Schackert G, Reithmeier T, Nikkhah G, Löffler M, Weller M, Westphal M. Complementary therapy use in patients with glioma: an observational study. Neurology 2011; 75:2229-35. [PMID: 21172846 DOI: 10.1212/wnl.0b013e31820202c6] [Citation(s) in RCA: 29] [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: 11/15/2022] Open
Abstract
OBJECTIVE Despite novel multimodal therapeutic approaches, the vast majority of glial tumors are not curable. Patients may search for complementary therapies in order to contribute to the fight against their disease or to relieve symptoms induced by their brain tumor. The extent of the use of complementary or alternative therapies, the patients' rationale behind it, and the cost of complementary therapy for gliomas are not known. We used a questionnaire and the database of the German Glioma Network to evaluate these questions. METHODS A total of 621 questionnaires were available for evaluation from patients with glial tumors of WHO grades II to grade IV. The patients were recruited from 6 neuro-oncologic centers in Germany. Complementary therapy was defined as methods or compounds not used in routine clinical practice and not scientifically evaluated. RESULTS Forty percent of the responding patients reported the use of complementary therapies. Significant differences between the group of complementary therapy users and nonusers were seen with respect to age (younger > older), gender (female > male), and education (high education level > low education level). The motivation for complementary therapy use was not driven by unsatisfactory clinical care by the neuro-oncologists, but by the wish to add something beneficial to the standard of care. CONCLUSIONS In clinical practice, patients' use of complementary therapies may be largely overseen and underestimated. The major motivation is not distrust in conventional therapies. Neuro-oncologists should be aware of this phenomenon and encourage an open but critical dialogue with their patients.
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Affiliation(s)
- O Heese
- Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.
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Reithmeier T, Löhr M, Pakos P, Ketter G, Ernestus RI. Relevance of ICP and ptiO2 for indication and timing of decompressive craniectomy in patients with malignant brain edema. Acta Neurochir (Wien) 2005; 147:947-51; discussion 952. [PMID: 15912256 DOI: 10.1007/s00701-005-0543-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Accepted: 03/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The exact effects of decompressive craniectomy on intracranial pressure (ICP) and cerebral tissue oxygenation (ptiO2) are still unclear. Therefore, we have monitored ICP and ptiO2 intra-operatively and correlated these values to different operative steps during craniectomy. METHODS ICP and ptiO2 values have been monitored both, simultaneously and continuously, in 15 patients with cerebral edema due to posttraumatic or postischemic brain swelling. Indications for craniectomy were an increase in ICP above 25 mmHg or a decrease in ptiO2 below 10 mmHg resistant to conservative treatment (e.g. mannitol, hyperventilation, adequate arterial blood oxygenation, etc.). In all cases, we performed a fronto-temporo-parietal craniectomy (15 x 12 cm) and dura enlargement with galea-periosteum. During craniectomy, monitoring of ICP and ptiO2 in the affected hemisphere was continued. Values were recorded and correlated with the different operative steps. FINDINGS We performed craniectomy according to our treatment protocol in 5 patients. Prior to surgery, mean ICP values were 25.6 mmHg (range: 23-29 mmHg), mean ptiO2 values were 5.9 mmHg (range: 2.4-9.5 mmHg), and mean CPP values were 66 mmHg (range: 60-70 mmHg). After removing the bone flap, ICP values dropped to physiological values (mean: 7.4 mmHg), whereas ptiO2 values increased only slightly (mean: 11 mmHg). Opening of the dura resulted in a further decrease of ICP (mean 4.8 mmHg) and an increase of ptiO2 to normal limits (mean: 18.8 mmHg). After skin closure, mean ICP was 6.8 mmHg and mean ptiO2 was 21.7 mmHg, respectively. We found a significant decrease of ICP after craniectomy (p<0.042) and after dura enlargement (p<0.039) as well as a statistically significant increase in ptiO2 after craniectomy (p<0.043) and after dura enlargement (p<0.041). CONCLUSION As a large bone flap in decompressive craniectomy is essential for adequate ICP reduction, the results of the presented cases suggest that dura enlargement is the crucial step to restore adequate brain tissue oxygenation and that ptiO2 monitoring could be an important tool for timing craniectomy in the future.
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Affiliation(s)
- T Reithmeier
- Department of Neurosurgery, University of Cologne, Cologne, Germany.
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Löhr M, Reithmeier T, Ernestus RI, Ebel H, Klug N. Spinal epidural abscess: prognostic factors and comparison of different surgical treatment strategies. Acta Neurochir (Wien) 2005; 147:159-66; discussion 166. [PMID: 15570436 DOI: 10.1007/s00701-004-0414-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Spinal epidural abscess (SEA) is a rare but potentially devastating disease requiring immediate surgical intervention and appropriate antibiotic treatment. The standard approach to decompress SEA is laminectomy. No report covers comprehensively the indications for the less invasive interlaminar approach, the usefulness of intra-operative ultrasonography and the suspected benefit of inserting a suction-irrigation drainage. METHOD A retrospective evaluation of the medical and radiological data was undertaken in 27 consecutive patients with SEA operated on during a period of 10 years by a dorsal approach. Factors influencing outcome were evaluated with special regard to different surgical strategies concerning the invasiveness of the operative approach, the use of intra-operative ultrasound and the use of different drainage systems. FINDINGS Outcome was mainly determined by the pre-operative neurological condition and the localization of the abscess. Recurrence rate was dependent on the longitudinal extent of the mass and the intra-operative finding of granulation tissue, but not on the administration of a postoperative suction-irrigation drainage. An interlaminar approach was equally matched to a decompression by laminectomy in lumbar SEA concerning the incidence of residual/recurrent abscess formation. In concomitant spondylodiscitis, laminectomy bore the risk of the formation of a postoperative kyphotic deformity. The use of intra-operative ultrasound allowed the visualization of hidden inflammatory masses and, thus, reduced the rate of residual abscess formation. CONCLUSION An interlaminar approach should be considered instead of laminectomy in lumbar SEA and in impending anterior column instability due to spondylitis. Intra-operative ultrasound is a beneficial aid for the determination of the extent of decompression during surgery and is practicable even through a narrow interlaminar bony window. The insertion of postoperative suction-irrigation drainage had no beneficial effect on outcome but bore the risk of epidural fluid congestion.
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Affiliation(s)
- M Löhr
- Department of Neurosurgery, University of Cologne, Cologne, Germany.
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Reithmeier T, Krammer M, Gumprecht H, Gerstner W, Lumenta CB. Neuronavigation combined with electrophysiological monitoring for surgery of lesions in eloquent brain areas in 42 cases: a retrospective comparison of the neurological outcome and the quality of resection with a control group with similar lesions. Minim Invasive Neurosurg 2003; 46:65-71. [PMID: 12761674 DOI: 10.1055/s-2003-39334] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to achieve a more radical resection of tumors in the area of the motor cortex via minimal craniotomy using a combination of neuronavigation and neurophysiological monitoring with direct electrical cortical stimulation and to compare retrospectively the clinical outcome and postoperative magnetic resonance imaging with a control group that was operated on in our service when the combination of these monitoring techniques was not available. A total of 42 patients with tumors in or near the central region underwent surgery with neuronavigation guidance and neurophysiological monitoring. The primary motor cortex was identified intraoperatively by the somatosensory evoked phase reversal method and direct cortical stimulation. The functional areas were transferred into the neuronavigation system. By stimulating the identified primary motor cortex and displaying the motor area in the operating microscope a permanent control of the motor function was possible during the whole operation. Using these techniques a more radical tumor resection - evaluated by postoperative MRI - was achieved in the study group (p = 0.04) and also a trend toward a better neurological outcome.
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Affiliation(s)
- T Reithmeier
- Department of Neurosurgery, Academic Hospital Munich-Bogenhausen, Technical University of Munich, Munich, Germany.
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Reithmeier T, Trost HA, Wolf S, Stölzle A, Feiden W, Lumenta CB. Xanthogranuloma of the Erdheim-Chester type within the sellar region: case report. Clin Neuropathol 2002; 21:24-8. [PMID: 11846041] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Manifestations of Erdheim-Chester disease in the central nervous system are very rare. Cases with localization in the retroorbital space, hypothalamic area and posterior pituitary as well as intracerebral lesions are known. In our neurosurgical unit, a 51-year-old male patient with a history of hypophyseal insufficiency and visual deficits underwent surgery for a pituitary lesion. Histological and immunohistochemical examination revealed a xanthogranulomatous lesion composed of very large CD68-positive foam cells with small nuclei and some Touton-like giant cells, histiocytes, as well as loci with small lymphocytes and isolated eosinophilic granuolcytes, embedded in fibrotic tissue. Based on these findings, the histological diagnosis was a xanthogranuloma of the Erdheim-Chester type.
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Affiliation(s)
- T Reithmeier
- Department of Neurosurgery, Academic Hospital Bogenhausen, Technical University of Munich, Germany.
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Abstract
Paragangliomas of the CNS are relatively rare. Cases of location in the pineal and pituitary glands, cerebellopontine angle, cauda equina and filum terminale are known. In our neurosurgical unit a 42-year-old male patient with a history of vertigo and a generalized seizure underwent an operation for a fronto-temporal tumour. The histological diagnosis was paraganglioma.
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Affiliation(s)
- T Reithmeier
- Department of Neurosurgery, Academic Hospital Bogenhausen, Technical University of Munich, Germany
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Leskovar P, Reithmeier T, Siegmund F, Mattele N. Influence of some intracellular cAMP-level increasing substances (a) on resting and (b) on proliferating immunocytes. Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)89399-9] [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] [Indexed: 10/17/2022]
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Leskovar P, Siegmund F, Mattele N, Reithmeier T, Hesch H. Immune regulation via non-immunological receptors on immunocompetent cells: Strong immunosuppression, induced by adenosine and epinephrine. Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)89400-2] [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] [Indexed: 11/29/2022]
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