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Sandmann ACA, Kempeneers MA, van den Berg R, Verbaan D, Vandertop WP, Coutinho JM. Clinical course of patients with conservatively managed cerebral cavernous malformations. Eur Stroke J 2024:23969873241246868. [PMID: 38624046 DOI: 10.1177/23969873241246868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION There is uncertainty whether patients with a cerebral cavernous malformation (CCM) should undergo conservative or surgical treatment, resulting in practice variation among hospitals. Our objective was to report clinical outcomes of patients with primarily conservatively managed CCMs. PATIENTS AND METHODS This single-center cohort study included consecutive adult CCM patients, diagnosed in 2000-2023, who underwent conservative management as primary treatment strategy. Data were extracted from medical records, and we systematically conducted telephone and questionnaire follow-up. Functional status was assessed on the modified Rankin Scale (mRS). RESULTS Of 345 patients, we included 265 patients with a CCM (median age 46 years; 45% male). At baseline, 131 (49%) patients presented with symptomatic hemorrhage (SH), and 134 (51%) with other symptoms or asymptomatically. During 58 months (IQR 35-94) median follow-up, 51 (19%) patients experienced a SH, 33 (12%) a seizure, and 13 (5%) focal neurological deficits. Fourteen (5%) patients underwent intervention (surgery n = 11, radiosurgery n = 4). Presentation with SH was associated with higher annual bleeding rates (6.0% vs 1.5%, p < 0.001), and higher cumulative 5-/10-year bleeding risks (31%/41% vs 7%, p < 0.001). Brainstem CCM was associated with higher cumulative 5-/10-year bleeding risks (27%/38% vs 17%/21%, p = 0.038). Nineteen (7%) patients died; two (0.8%) directly attributable to CCM. Of 246 surviving patients, 205 (83%) completed the questionnaire. At follow-up, 172/224 (77%) patients were functionally independent (mRS score ⩽2). DISCUSSION AND CONCLUSION The majority of conservatively managed CCM patients remained free of a SH during follow-up. Few patients required intervention, and death attributable to the CCM was rare. These data may help patient counseling and treatment decisions.
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Affiliation(s)
| | | | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - William Peter Vandertop
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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2
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Lequin MB, Verbaan D, Schuurman PR, Tasche S, Peul WC, Vandertop WP, Bouma GJ. The long-term outcome of revision microdiscectomy for recurrent sciatica. Eur Spine J 2024:10.1007/s00586-024-08199-5. [PMID: 38512504 DOI: 10.1007/s00586-024-08199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/29/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To study the long-term outcome of revision microdiscectomy after classic microdiscectomy for lumbosacral radicular syndrome (LSRS). METHODS Eighty-eight of 216 patients (41%) who underwent a revision microdiscectomy between 2007 and 2010 for MRI disc-related LSRS participated in this study. Questionnaires included visual analogue scores (VAS) for leg pain, RDQ, OLBD, RAND-36, and seven-point Likert scores for recovery, leg pain, and back pain. Any further lumbar re-revision operation(s) were recorded. RESULTS Mean (SD) age was 59.8 (12.8), and median [IQR] time of follow-up was 10.0 years [9.0-11.0]. A favourable general perceived recovery was reported by 35 patients (40%). A favourable outcome with respect to perceived leg pain was present in 39 patients (45%), and 35 patients (41%) reported a favourable outcome concerning back pain. The median VAS for leg and back pain was worse in the unfavourable group (48.0/100 mm (IQR 16.0-71.0) vs. 3.0/100 mm (IQR 2.0-5.0) and 56.0/100 mm (IQR 27.0-74.0) vs. 4.0/100 mm (IQR 2.0-17.0), respectively; both p < 0.001). Re-revision operation occurred in 31 (35%) patients (24% same level same side); there was no significant difference in the rate of favourable outcome between patients with or without a re-revision operation. CONCLUSION The long-term results after revision microdiscectomy for LSRS show an unfavourable outcome in the majority of patients and a high risk of re-revision microdiscectomy, with similar results. Based on also the disappointing results of alternative treatments, revision microdiscectomy for recurrent LSRS seems to still be a valid treatment. The results of our study may be useful to counsel patients in making appropriate treatment choices.
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Affiliation(s)
- M B Lequin
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - D Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Saskia Tasche
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - W C Peul
- Department of Neurosurgery, University Neurosurgical Center Holland, UMC | HMC | HAGA, Leiden, The Hague, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - G J Bouma
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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Lodewijkx R, Draijer L, de Ridder R, Eikelenboom MJ, Coert BA, Meeuwes M, Vandertop WP. [Subarachnoid hemorrhage in a young girl]. Ned Tijdschr Geneeskd 2024; 168:D7943. [PMID: 38512273] [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] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Subarachnoid hemorrhage in children is rare. The most common cause is trauma, followed by an arteriovenous malformation, aneurysm or tumor. CASE DESCRIPTION We describe the case of an 11-year-old girl who developed sudden headache with nausea and vomiting during athletics training. Her neurological exam was normal. With imaging and a lumbar puncture a subarachnoid hemorrhage was diagnosed, based on a ruptured saccular aneurysm of the right middle cerebral artery. Endovascular treatment was unsuccessful, after which the aneurysm was treated surgically. Postoperative recovery was uneventful. Additional tests for underlying conditions were negative. CONCLUSION Also in a child with acute headache, nausea, and vomiting, the diagnosis of a subarachnoid hemorrhage should be considered, even if neurological examination is normal. Expeditious diagnosis and treatment are important in order to prevent rebleeding.
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Affiliation(s)
| | - Laura Draijer
- Dijklander Ziekenhuis, afd. Kindergeneeskunde, Hoorn
| | | | | | - B A Coert
- Amsterdam UMC, afd. Neurochirurgie, Amsterdam
| | - Merel Meeuwes
- Dijklander Ziekenhuis, afd. Kindergeneeskunde, Hoorn
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Dusoswa SA, Verhoeff J, van Asten S, Lübbers J, van den Braber M, Peters S, Abeln S, Crommentuijn MH, Wesseling P, Vandertop WP, Twisk JWR, Würdinger T, Noske D, van Kooyk Y, Garcia-Vallejo JJ. The immunological landscape of peripheral blood in glioblastoma patients and immunological consequences of age and dexamethasone treatment. Front Immunol 2024; 15:1343484. [PMID: 38318180 PMCID: PMC10839779 DOI: 10.3389/fimmu.2024.1343484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Background Glioblastomas manipulate the immune system both locally and systemically, yet, glioblastoma-associated changes in peripheral blood immune composition are poorly studied. Age and dexamethasone administration in glioblastoma patients have been hypothesized to limit the effectiveness of immunotherapy, but their effects remain unclear. We compared peripheral blood immune composition in patients with different types of brain tumor to determine the influence of age, dexamethasone treatment, and tumor volume. Methods High-dimensional mass cytometry was used to characterise peripheral blood mononuclear cells of 169 patients with glioblastoma, lower grade astrocytoma, metastases and meningioma. We used blood from medically-refractory epilepsy patients and healthy controls as control groups. Immune phenotyping was performed using FlowSOM and t-SNE analysis in R followed by supervised annotation of the resulting clusters. We conducted multiple linear regression analysis between intracranial pathology and cell type abundance, corrected for clinical variables. We tested correlations between cell type abundance and survival with Cox-regression analyses. Results Glioblastoma patients had significantly fewer naive CD4+ T cells, but higher percentages of mature NK cells than controls. Decreases of naive CD8+ T cells and alternative monocytes and an increase of memory B cells in glioblastoma patients were influenced by age and dexamethasone treatment, and only memory B cells by tumor volume. Progression free survival was associated with percentages of CD4+ regulatory T cells and double negative T cells. Conclusion High-dimensional mass cytometry of peripheral blood in patients with different types of intracranial tumor provides insight into the relation between intracranial pathology and peripheral immune status. Wide immunosuppression associated with age and pre-operative dexamethasone treatment provide further evidence for their deleterious effects on treatment with immunotherapy.
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Affiliation(s)
- Sophie A. Dusoswa
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Cancer Center Amsterdam, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
- Department of Neurosurgery, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Jan Verhoeff
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Cancer Center Amsterdam, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Saskia van Asten
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Cancer Center Amsterdam, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Joyce Lübbers
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Cancer Center Amsterdam, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Marlous van den Braber
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Cancer Center Amsterdam, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Sophie Peters
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Cancer Center Amsterdam, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Sanne Abeln
- Department of Computer Science, Free University, Amsterdam, Netherlands
| | - Matheus H.W. Crommentuijn
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Cancer Center Amsterdam, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Pieter Wesseling
- Department of Pathology, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam and Princes Máxima Center for Pediatric Oncology, Amsterdam UMC, VU Amsterdam, Utrecht, Netherlands
| | | | - Jos W. R. Twisk
- Department of Epidemiology and Biostatistics and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Thomas Würdinger
- Department of Neurosurgery, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - David Noske
- Department of Neurosurgery, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Yvette van Kooyk
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Cancer Center Amsterdam, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
| | - Juan J. Garcia-Vallejo
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Cancer Center Amsterdam, Amsterdam UMC, VU Amsterdam, Amsterdam, Netherlands
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Lodewijkx R, Foppen M, Slot KAM, Vandertop WP, Verbaan D. Recurrent Chronic Subdural Hematoma After Burr-Hole Surgery and Postoperative Drainage: A Systematic Review and Meta-Analysis. Oper Neurosurg (Hagerstown) 2023; 25:216-241. [PMID: 37387582 PMCID: PMC10389757 DOI: 10.1227/ons.0000000000000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/18/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Reported recurrence rates of chronic subdural hematoma treated by burr-hole surgery with postoperative drainage vary considerably in the literature. We performed a systematic review and meta-analysis to define the recurrence rate of burr-hole surgery with postoperative drainage. METHODS PubMed and EMBASE were searched, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. We used the Newcastle-Ottawa scale and Cochrane risk-of-bias tool for quality assessment of included studies and the random-effects model to calculate pooled incidence rates in R with the metaprop function if appropriate. RESULTS The search yielded 2969 references; 709 were screened full text, and 189 met the inclusion criteria. In 174 studies (34 393 patients), the number of recurrences was reported as per patient and 15 studies (3078 hematomas) reported the number of recurrences per hematoma, for a pooled incidence of 11.2% (95% CI: 10.3-12.1; I 2 = 87.7%) and 11.0% (95% CI: 8.6-13.4; I 2 = 78.0%), respectively. The pooled incidence of 48 studies (15 298 patients) with the highest quality was 12.8% (95% CI 11.4-14.2; I 2 = 86.1%). Treatment-related mortality (56 patients) has a pooled incidence of 0.7% (95% CI 0.0-1.4; I 2 = 0.0%). CONCLUSION The recurrence rate of chronic subdural hematoma treated by burr-hole surgery and postoperative drainage is 12.8%.
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Affiliation(s)
- Roger Lodewijkx
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Merijn Foppen
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Kari-Anne Mariam Slot
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - William Peter Vandertop
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
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6
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Vergouwen MDI, Germans MR, Post R, Tjerkstra MA, Coert BA, Rinkel GJE, Peter Vandertop W, Verbaan D. Aneurysm treatment within 6 h versus 6-24 h after rupture in patients with subarachnoid hemorrhage. Eur Stroke J 2023; 8:802-807. [PMID: 37641555 PMCID: PMC10472949 DOI: 10.1177/23969873231173273] [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: 02/19/2023] [Accepted: 04/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The risk of rebleeding after aneurysmal subarachnoid hemorrhage (aSAH) is the highest during the initial hours after rupture. Emergency aneurysm treatment may decrease this risk, but is a logistic challenge and economic burden. We aimed to investigate whether aneurysm treatment <6 h after rupture is associated with a decreased risk of poor functional outcome compared to aneurysm treatment 6-24 h after rupture. METHODS We used data of patients included in the ULTRA trial (NCT02684812). All patients in ULTRA were admitted within 24 h after aneurysm rupture. For the current study, we excluded patients in whom the aneurysm was not treated <24 h after rupture. We calculated crude and adjusted risk ratios (aRR) with 95% confidence intervals using Poisson regression analyses for poor functional outcome (death or dependency, assessed by the modified Rankin Scale) after aneurysm treatment <6 h versus 6-24 h after rupture. Adjustments were made for age, sex, clinical condition on admission (WFNS scale), amount of extravasated blood (Fisher score), aneurysm location, tranexamic acid treatment, and aneurysm treatment modality. RESULTS We included 497 patients. Poor outcome occurred in 63/110 (57%) patients treated within 6 h compared to 145/387 (37%) patients treated 6-24 h after rupture (crude RR: 1.53, 95% CI: 1.24-1.88; adjusted RR: 1.36, 95% CI: 1.11-1.66). CONCLUSION Aneurysm treatment <6 h is not associated with better functional outcome than aneurysm treatment 6-24 h after rupture. Our results do not support a strategy aiming to treat every patient with a ruptured aneurysm <6 h after rupture.
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Affiliation(s)
- Mervyn DI Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Menno R Germans
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - René Post
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Maud A Tjerkstra
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Bert A Coert
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Gabriel JE Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - William Peter Vandertop
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
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7
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van Roessel IMAA, van Schaik J, Meeteren AYNSV, Boot AM, der Grinten HLCV, Clement SC, van Iersel L, Han KS, van Trotsenburg ASP, Vandertop WP, Kremer LCM, van Santen HM. Body mass index at diagnosis of a childhood brain tumor; a reflection of hypothalamic-pituitary dysfunction or lifestyle? Support Care Cancer 2022; 30:6093-6102. [PMID: 35416504 PMCID: PMC9135856 DOI: 10.1007/s00520-022-07031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Childhood brain tumor survivors (CBTS) are at risk of becoming overweight, which has been shown to be associated with hypothalamic-pituitary (HP) dysfunction during follow-up. Body mass index (BMI) at diagnosis is related to BMI at follow-up. It is uncertain, however, whether aberrant BMI at brain tumor diagnosis reflects early hypothalamic dysfunction or rather reflects genetic and sociodemographic characteristics. We aimed to examine whether BMI at childhood brain tumor diagnosis is associated with HP dysfunction at diagnosis or its development during follow-up. METHODS The association of BMI at diagnosis of a childhood brain tumor to HP dysfunction at diagnosis or during follow-up was examined in a Dutch cohort of 685 CBTS, excluding children with craniopharyngioma or a pituitary tumor. Individual patient data were retrospectively extracted from patient charts. RESULTS Of 685 CTBS, 4.7% were underweight, 14.2% were overweight, and 3.8% were obese at diagnosis. Being overweight or obese at diagnosis was not associated with anterior pituitary deficiency or diabetes insipidus at diagnosis or during follow-up. In children with suprasellar tumors, being obese at diagnosis was associated with central precocious puberty. CONCLUSION Overweight or obesity at diagnosis of a childhood brain tumor seems not to be associated with pituitary deficiencies. These results suggest that genetics and lifestyle may be more important etiologic factors for higher BMI at diagnosis in these children than hypothalamic dysfunction. To improve the long-term outcome of CBTS with regards to overweight and obesity, more attention should be given to lifestyle already at the time of brain tumor treatment.
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Affiliation(s)
- I M A A van Roessel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - J van Schaik
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - A Y N Schouten-van Meeteren
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A M Boot
- Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H L Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Children's Hospital, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - S C Clement
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - L van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K S Han
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Amsterdam University Medical Centers, University of Amsterdam, and VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. .,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.
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8
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Immenga S, Lodewijkx R, Roos YBWEM, Middeldorp S, Majoie CBLM, Willems HC, Vandertop WP, Verbaan D. Tranexamic acid to prevent operation in chronic subdural haematoma (TORCH): study protocol for a randomised placebo-controlled clinical trial. Trials 2022; 23:56. [PMID: 35042560 PMCID: PMC8767703 DOI: 10.1186/s13063-021-05907-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Chronic subdural haematoma (cSDH) occurs mainly in the elderly. Surgical evacuation is effective, but in these old, often frail, patients with multi-comorbidity, surgery carries significant risks for future cognitive functioning and loss of independency. Therefore, a growing interest is noted for a non-surgical treatment with medication such as tranexamic acid (TXA). In five small retrospective series, this antifibrinolytic drug showed a beneficial effect on the spontaneous resolution of the haematoma, and with that, the necessity for surgery. Methods For this randomised, placebo-controlled clinical multicentre trial, all cSDH patients, over 50 years old with mild symptoms (Glasgow Coma Score (GCS) ≥ 14, modified National Institutes of Health Stroke Scale (mNIHSS) ≤ 4), a midline shift of ≤ 10 mm and in whom a primary conservative treatment is chosen, are eligible for study participation. After informed consent, 140 patients will be randomised to receive either TXA 500 mg or placebo two times daily for 28 days. The primary outcome is the necessity for surgery within 12 weeks; secondary outcomes are cSDH volume, neurological impairment (mNIHSS), falling incidents, cognitive functioning (Montreal Cognitive Assessment (MOCA)), performance in activities of daily living (Barthel and Lawton score), functional outcome (modified Rankin Scale (mRS)), quality of life (Short Form Health Survey (SF-36) and EuroQol 5-Dimension Health Survey (EQ-5D)), mortality and the use of care and health-related costs (Medical Consumption Questionnaire (iMCQ) and Productivity Cost Questionnaire (iPCQ)) at 12 weeks and 6 months. Discussion This phase III trial investigating the efficacy of TXA to prevent surgery for cSDH is the first in including patients using anticoagulants and mentally incompetent patients, since these comprise a significant part of the target population. Also, this study is one of the first to prospectively measure functional outcome and quality of life in cSDH patients. Final results of this study are expected in 2024. Trial registration Dutch Trial Registry (Nederlands Trial Register) NL6584. Registered on 11 November 2017 ClinicalTrials.govNCT03582293. Registered on 11 July 2018 EU Clinical Trials Register 2017-004311-40. Registered on 29 March 2018
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Affiliation(s)
- S Immenga
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - R Lodewijkx
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y B W E M Roos
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Middeldorp
- Department of Vascular Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C B L M Majoie
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H C Willems
- Department of Internal Medicine, Geriatrics Section, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - D Verbaan
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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9
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Ter Wengel PV, de Gendt EEA, Martin E, Adegeest CY, Stolwijk-Swüste J, Fehlings MG, Oner FC, Vandertop WP. The impact of surgical timing on motor level lowering in motor complete traumatic spinal cord injury patients. J Neurotrauma 2022; 39:651-657. [PMID: 35019765 DOI: 10.1089/neu.2021.0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients with motor complete traumatic spinal cord injury (tSCI) have a low potential to recover ambulation. Motor level recovery, adjacent to the level of injury, could influence functional independency. This study addresses whether surgical timing influences motor level recovery in patients with sensorimotor complete (AIS A) and motor complete sensory incomplete (AIS B) tSCI. A retrospective cohort study was performed in the Netherlands in patients with motor complete tSCI (C2-L2), who consecutively underwent surgery between January 2010 and April 2020. Neurological examination was performed directly at presentation to the ER and at discharge from the rehabilitation facility. Motor level lowering, AIS grade and Upper and Lower Extremity Motor Score (UEMS and LEMS) recovery were calculated for patients who underwent early (<24h) and late (24h+) surgery. A total of 96 patients met the inclusion criteria. In the multivariate analysis late surgical decompression (24h+) was negatively associated with ≥1 motor level lowering and ≥2 AIS grade improvement (Odds Ratio (OR) 0.11 (95% CI: 0.01, 0.67) p=0.046, OR 0.06 (95% CI: 0.00, 047) p=0.030). The presence of sacral sparing (AIS B) at initial examination, and cervical level of the tSCI were associated with ≥1 motor level lowering. In addition, AOSpine C-type injuries were negatively associated with any type of neurological recovery, except motor level lowering. Although sensorimotor complete injuries as well as thoracolumbar injuries negatively influence neurological recovery, early surgical decompression (<24h) appears independently associated with enhanced neurological recovery in patients with traumatic spinal cord injury despite level and severity of injury.
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Affiliation(s)
- Paula Valerie Ter Wengel
- Amsterdam UMC Locatie VUmc, 1209, Neurosurgery, Amsterdam, Noord-Holland, Netherlands.,Medisch Centrum Haaglanden Westeinde, 2901, Neurosurgery, Den Haag, Zuid-Holland, Netherlands;
| | | | - Enrico Martin
- UMC Utrecht, 8124, Plastic and reconstructive surgery, Utrecht, Utrecht, Netherlands;
| | - Charlotte Y Adegeest
- Medisch Centrum Haaglanden Westeinde, 2901, Den Haag, Zuid-Holland, Netherlands.,Leiden Universitair Medisch Centrum, 4501, Leiden, Zuid-Holland, Netherlands;
| | - Janneke Stolwijk-Swüste
- UMC Utrecht Brain Center Rudolf Magnus, 36512, Center of Excellence for Rehabilitation Medicine, Heidelberglaan 100, Utrecht, Utrecht, Netherlands, 3584 CX.,Revalidation Centre De Hoogstraat, 84896, Center of Excellence for Rehabilitation Medicine, Rembrandtkade 10, Utrecht, Utrecht, Netherlands, 3583 TM;
| | - Michael G Fehlings
- Toronto Western Hospital, 26625, Neurosurgery, Toronto, Ontario, Canada;
| | - F Cumhur Oner
- Universitair Medisch Centrum Utrecht, 8124, Utrecht, Utrecht, Netherlands;
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10
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van der Vegt AN, de Vries R, Osinga J, Grun N, Postma TJ, de Haan PF, van Linde ME, Vandertop WP, Schuur M, Kouwenhoven MCM. P14.51 Can patients with a suspected high-grade glioma receive tumor treatment during pregnancy safely? Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.163] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Diagnosis of a glioma during pregnancy has ethical and medical dilemmas; treatment of the mother may harm the unborn child, but a too conservative approach towards tumor treatment can compromise the survival of the mother. In patients with a suspected high-grade glioma, postponing tumor treatment is undesirable. We collected published cases to describe the given treatments during pregnancy and the outcomes for mother and child.
METHODS
From Pubmed, Embase and Web of Science, 122 cases were extracted from 65 reports published between 1999 and 2020. We added 7 cases from our center. Cases came from: North-America (54/129), Europe (47/129), Asia (13/129), Middle-East (3/129) and one from Oceania and Africa each; 10 cases were from an unspecified country. The data were analysed with descriptive statistics.
RESULTS
The median age of the pregnant women was 30 (range 17–48) years; at the time of publication 42% of mothers had deceased. Most frequent symptoms at presentation were high intracranial pressure (35%), seizures (30%) or focal deficits (19%). Patients were diagnosed in each phase of the pregnancy - 30% in the first, 35% in the second and 35% in the last trimester. Twenty-two women decided to terminate the pregnancy (North America 9; Europe 9; international unspecified, Africa, Asia and Middle-East each one case). In sixty-seven percent of women, tumors were operated while pregnant, 70% of those were planned surgery, while in 30% surgery was in performed in an emergency setting. Most women received a resection. In 6 patients tumor surgery was combined with a caesarian section. Histological diagnosis of the tumor was available in 112 patients: anaplastic oligodendroglioma (n=10), anaplastic astrocytoma (n=30), glioblastoma (n=66) or high-grade glioma NOS (n=6). In 10 patients there was a suspected high grade glioma based on MRI imaging. Only 20 patients were treated after surgery whilst still pregnant with either radiotherapy (15/20, 75%), chemotherapy (2/20, 10%) or a combination of radiotherapy and chemotherapy (3/20, 15%) Other patients received additional treatment after delivery (109/129; 84%). Delivery method was a caesarian section in 60% and vaginal delivery in 21%- in 19% delivery method was not described. In 63% of cesarean sections were brought forward either because of rapid maternal deterioration or to enable maternal treatment after delivery. In 92% a healthy child was born, 7% had a intrauterine fetal death and 1% the child was stillborn. None of the patients who experienced intrauterine fetal death had received radio- or chemotherapy during pregnancy.
CONCLUSIONS
The majority of pregnant women continue their pregnancy when facing a diagnosis of a high grade glioma. Tumor surgery seemed safe during pregnancy. No adverse events were reported in the limited patients who received radiotherapy (n=15) during pregnancy. For chemotherapy we could not draw any conclusions.
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Affiliation(s)
- A N van der Vegt
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - R de Vries
- Medical Library, Vrije Universiteit, Amsterdam, Netherlands
| | - J Osinga
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - N Grun
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - T J Postma
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - P F de Haan
- Department of Radiotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M E van Linde
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M Schuur
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M C M Kouwenhoven
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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11
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Lebbink CA, Ringers TP, Schouten-van Meeteren AYN, van Iersel L, Clement SC, Boot AM, Claahsen-van der Grinten HL, Janssens GO, van Vuurden DG, Michiels EM, Han KS, van Trotsenburg ASP, Vandertop WP, Kremer LCM, van Santen HM. Prevalence and risk factors of hypothalamic-pituitary dysfunction in infant and toddler childhood brain tumor survivors. Eur J Endocrinol 2021; 185:597-606. [PMID: 34324432 DOI: 10.1530/eje-21-0137] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Childhood brain tumor survivors (CBTS) are at risk to develop hypothalamic-pituitary (HP) dysfunction (HPD). The risk for HPD may vary between different age groups due to maturation of the brain and differences in oncologic treatment protocols. Specific studies on HPD in infant brain tumor survivors (infant-BTS, 0-1 years at diagnosis) or toddler brain tumor survivors (toddler-BTS, ≥1-3 years) have not been performed. PATIENTS AND METHODS A retrospective nationwide cohort study in CBTS was performed. Prevalence and risk factors for HPD were compared between infant-, toddler-, and older-BTS. Subgroup analysis was performed for all non-irradiated CBTS (n = 460). RESULTS In total, 718 CBTS were included, with a median follow-up time of 7.9 years. Overall, despite the less frequent use of radiotherapy (RT) in infants, no differences in the prevalence of HPD were found between the three groups. RT (OR: 16.44; 95% CI: 8.93-30.27), suprasellar tumor location (OR: 44.76; 95% CI: 19.00-105.49), and younger age (OR: 1.11; 95% CI: 1.05-1.18) were associated with HP dysfunction. Infant-BTS and toddler-BTS showed more weight gain (P < 0.0001) and smaller height SDS (P = 0.001) during follow-up. In non-irradiated CBTS, infant-BTS and toddler-BTS were significantly more frequently diagnosed with TSH-, ACTH-, and ADH deficiency, compared to older-BTS. CONCLUSION Infant and toddler brain tumor survivors seem to be more vulnerable to develop HP dysfunction than older children. These results emphasize the importance of special infant and toddler brain tumor treatment protocols and the need for endocrine surveillance in children treated for a brain tumor at a young age.
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Affiliation(s)
- C A Lebbink
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - T P Ringers
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | | | - L van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - S C Clement
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - A M Boot
- Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H L Claahsen-van der Grinten
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - G O Janssens
- Department of Radiation Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - D G van Vuurden
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - E M Michiels
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - K S Han
- Department of Neurosurgery, University Medical Center Utrecht, The Netherlands
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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12
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Lodewijkx R, Immenga S, van den Berg R, Post R, Westerink LG, Nabuurs RJA, Can A, Vandertop WP, Verbaan D. Tranexamic acid for chronic subdural hematoma. Br J Neurosurg 2021; 35:564-569. [PMID: 34334070 DOI: 10.1080/02688697.2021.1918328] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is no consensus on optimal treatment for a chronic subdural hematoma (cSDH). In patients with only moderate symptoms treatment with tranexamic acid (TXA) has been suggested. We report off-label use of TXA in seven patients. METHODS Between August 2016 and May 2018 we identified seven patients for primary conservative treatment with TXA until satisfactory clinical and radiological status was achieved. Primary outcome was surgery for cSDH evacuation. Radiological follow-up was performed at regular intervals for hematoma volume measurements. RESULTS Five patients experienced complete resolution of symptoms, one patient had a burr-hole craniostomy five days after initiation of TXA treatment due to an increase of left-sided weakness and dysarthria and in one patient symptoms did not improve. Median follow-up was 15 weeks (range 6-25, without the operated patient). The median total volume before start of treatment was 83 mL (range 11-137) for all patients. At the last follow-up, the median total volume in the non-operated patients decreased by 73% to 33 mL (range 0-77). CONCLUSIONS TXA could be considered as primary medical treatment in patients with a cSDH and mild symptoms. The results of current randomized clinical trials must be awaited.
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Affiliation(s)
- Roger Lodewijkx
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - Steven Immenga
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - René van den Berg
- Department of Radiology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - René Post
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - Lucas G Westerink
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Rob J A Nabuurs
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Anil Can
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - William Peter Vandertop
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
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13
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Lodewijkx R, Holl DC, Slot KAM, Volovici V, Franciscus Dirven CM, Dammers R, Peter Vandertop W, Verbaan D. Effect of Steroids as an Adjunct to Surgical Treatment in Patients with Chronic Subdural Hematoma. J Neurotrauma 2021; 38:2572-2579. [PMID: 33787346 DOI: 10.1089/neu.2020.7564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The role of steroids as an adjunct to surgery for chronic subdural hematoma (cSDH) remains unclear. We evaluated the effect of steroids as an adjunct to surgery on recurrence rates, complications, and mortality. We retrospectively collected data of 525 patients operated on for cSDH between January 2010 and April 2015 at the Amsterdam University Medical Centers and Erasmus Medical Center Rotterdam. Data from patients with and without steroid use as an adjunct to surgery were obtained from medical records and compared using the chi-square test, independent-samples t-test, and Mann-Whitney U test, where applicable. Associations between adjuvant steroid use and complications were analyzed with univariable (penalized likelihood) logistic regression analysis. Multi-variate logistic regression was performed to analyze the influence of adjuvant steroid use on recurrence. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. Two hundred seventy-eight of the 525 patients (53%) were treated with adjuvant steroids. Surgery for recurrences occurred less in patients of the steroid group (9% vs. 14%; odds ratio [OR] 0.57; 95% confidence interval [CI], 0.33-0.99), but the effect was not significant after correction for confounders (adjusted aOR, 0.59; 95% CI, 0.33-1.05). In the steroid group, delirium (10% vs. 3%; OR, 3.99; 95% CI, 1.72-9.29) and dysregulated glucose levels occurred more frequently (2% vs. 0%; OR, 11.81; 95% CI, 1.38-1542.79), but multi-variate analysis was not possible. After propensity-score matching, McNemar's chi-square test showed that adjuvant steroid use was not significantly associated with recurrence rate (p = 0.10). Steroids as an adjunct to surgery in patients with cSDH did not have a favorable effect on the recurrence rate in our data after controlling for confounders.
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Affiliation(s)
- Roger Lodewijkx
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Dana Catharina Holl
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kari-Anne Mariam Slot
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - William Peter Vandertop
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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14
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Denneman N, Biginski J, Odekerken VJJ, Vandertop WP. [Ruptured spleen after subarachnoid haemorrhage]. Ned Tijdschr Geneeskd 2021; 165:D5409. [PMID: 34346589] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Subarachnoid hemorrhage is a severe neurological condition which can cause a broad range of symptoms. Often, these symptoms are the direct consequence of the hemorrhage. CASE DESCRIPTION A 58-year-old female was admitted to the emergency department with extreme headache and a sudden and brief loss of consciousness. She was diagnosed with aneurysmal subarachnoid hemorrhage and underwent endovascular treatment. Seven days after admission she developed hypotension, bilateral fixed and dilated pupils and a second sudden and brief loss of consciousness. A CT scan of the brain was unchanged compared to the initial CT scan. An external ventricular drain was placed and the patient was admitted to the ICU where she was diagnosed with hemorrhagic shock due to a ruptured spleen. CONCLUSION Bilateral fixed and dilated pupils can in rare cases be caused by hemorrhagic shock due to strong sympathetic activity or parasympathetic inactivity. When a patient presents with loss of consciousness and/or pupil deviation, extracranial diagnoses should be considered after intracranial causes have been excluded.
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Affiliation(s)
- N Denneman
- Amsterdam UMC, locatie AMC, afd. Neurochirurgie
| | - J Biginski
- Amsterdam UMC, locatie AMC, afd. Intensive Care
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15
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van der Steen WE, Marquering HA, Ramos LA, van den Berg R, Coert BA, Boers AMM, Vergouwen MDI, Rinkel GJE, Velthuis BK, Roos YBWEM, Majoie CBLM, Vandertop WP, Verbaan D. Prediction of Outcome Using Quantified Blood Volume in Aneurysmal SAH. AJNR Am J Neuroradiol 2020; 41:1015-1021. [PMID: 32409315 DOI: 10.3174/ajnr.a6575] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/26/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In patients with SAH, the amount of blood is strongly associated with clinical outcome. However, it is commonly estimated with a coarse grading scale, potentially limiting its predictive value. Therefore, we aimed to develop and externally validate prediction models for clinical outcome, including quantified blood volumes, as candidate predictors. MATERIALS AND METHODS Clinical and radiologic candidate predictors were included in a logistic regression model. Unfavorable outcome was defined as a modified Rankin Scale score of 4-6. An automatic hemorrhage-quantification algorithm calculated the total blood volume. Blood was manually classified as cisternal, intraventricular, or intraparenchymal. The model was selected with bootstrapped backward selection and validated with the R 2, C-statistic, and calibration plots. If total blood volume remained in the final model, its performance was compared with models including location-specific blood volumes or the modified Fisher scale. RESULTS The total blood volume, neurologic condition, age, aneurysm size, and history of cardiovascular disease remained in the final models after selection. The externally validated predictive accuracy and discriminative power were high (R 2 = 56% ± 1.8%; mean C-statistic = 0.89 ± 0.01). The location-specific volume models showed a similar performance (R 2 = 56% ± 1%, P = .8; mean C-statistic = 0.89 ± 0.00, P = .4). The modified Fisher models were significantly less accurate (R 2 = 45% ± 3%, P < .001; mean C-statistic = 0.85 ± 0.01, P = .03). CONCLUSIONS The total blood volume-based prediction model for clinical outcome in patients with SAH showed a high predictive accuracy, higher than a prediction model including the commonly used modified Fisher scale.
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Affiliation(s)
- W E van der Steen
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
- Neurology (W.E.v.d.S., Y.B.W.E.M.R.)
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H A Marquering
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
| | - L A Ramos
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
- Clinical Epidemiology, Biostatistics and Bioinformatics (L.A.R.)
| | - R van den Berg
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
| | - B A Coert
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A M M Boers
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
| | - M D I Vergouwen
- Departments of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.D.I.V., G.J.E.R.)
| | - G J E Rinkel
- Departments of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.D.I.V., G.J.E.R.)
| | - B K Velthuis
- Radiology (B.K.V.), University Medical Center, Utrecht University, Utrecht, the Netherlands
| | | | - C B L M Majoie
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
| | - W P Vandertop
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - D Verbaan
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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16
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Abstract
STUDY DESIGN A narrative literature review. OBJECTIVES To review the neurological recovery patterns in traumatic spinal cord injury (tSCI) patients with a complete lack of motor and sensory function below the level of injury (ie, ASIA A [American Spinal Injury Association scale]), as well as the impact of level of injury and timing of surgical intervention. RESULTS Spontaneous neurological recovery in patients with complete tSCI differs per level of injury: patients with cervical and thoracolumbar tSCI recover ≥1 ASIA grade in 17.3% to 34.0% 1 year after injury, compared with 10.7% to 18.6% in thoracic tSCI. Surgical decompression within 24 hours has a beneficial effect on neurological recovery in patients with complete cervical tSCI, whereas this effect is less clear for thoracic and thoracolumbar tSCI. A 1- or 2-grade improvement in the ASIA scale does not necessarily result in functional recovery. CONCLUSION In complete tSCI, the level of injury as well as surgical timing affect neurological recovery. There appears to be a beneficial effect of early surgical decompression in patients with complete cervical tSCI, more so than for thoracic and thoracolumbar tSCI. Frequently, the effect of surgical intervention is evaluated by an improvement in ASIA grade, but it is unclear whether this scale is sensitive enough to evaluate meaningful effectiveness of the intervention and desired outcome for patients with tSCI.
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Affiliation(s)
- Paula Valerie ter Wengel
- VU University Medical Center, Amsterdam, Netherlands,Leiden University Medical Center, Leiden, Netherlands,Paula Valerie ter Wengel, De Boelelaan 1117,
Amsterdam 1081 HV, Netherlands.
| | | | | | | | - William Peter Vandertop
- VU University Medical Center, Amsterdam, Netherlands,Academic Medical Center, Amsterdam, Netherlands
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17
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Post R, Tjerkstra MA, Middeldorp S, Van den Berg R, Roos YBWEM, Coert BA, Verbaan D, Vandertop WP. Platelet transfusion in patients with aneurysmal subarachnoid hemorrhage is associated with poor clinical outcome. Sci Rep 2020; 10:856. [PMID: 31964972 PMCID: PMC6972790 DOI: 10.1038/s41598-020-57683-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/04/2019] [Accepted: 01/06/2020] [Indexed: 12/21/2022] Open
Abstract
Patients with subarachnoid hemorrhage (SAH) who are using antiplatelet drugs prior to their hemorrhage, often receive platelet transfusions to reverse antiplatelet effects prior to life-saving surgical interventions. However, little is known about the effect of platelet transfusion on patient outcome in these patients. The aim of this study is to investigate the effect of platelet transfusion on clinical outcome in patients with aneurysmal SAH (aSAH) who use antiplatelet agents. Consecutive adult patients with an aSAH admitted between 2011 and 2015 to the Academic Medical Center (Amsterdam, the Netherlands) were included. Demographic characteristics and in-hospital complications were compared and clinical outcome was assessed after six months. Multivariable logistic regression analysis was performed to correct for confounding variables. A total of 364 patients with an aSAH were included. Thirty-eight (10%) patients underwent platelet transfusion during admission. Patients receiving platelet transfusion had worse clinical outcome (modified Rankin Scale score 4–6) at six months compared to patients without platelet transfusion (65% versus 32%, odds ratio 4.0, 95% confidence interval:1.9–8.1). Multivariable logistic regression analysis showed that platelet transfusion during admission was associated with unfavorable clinical outcome after six months; adjusted for age, treatment modality, modified Fisher and WFNS on admission (adjusted odds ratio 3.3, 95% confidence interval: 1.3–8.4). In this observational study, platelet transfusion was associated with poor clinical outcome at six months after correcting for confounding influences. In aSAH patients who need surgical treatment at low risk of bleeding, the indication for platelet transfusion needs careful weighing of the risk-benefit-balance.
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Affiliation(s)
- R Post
- Department of Neurosurgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - M A Tjerkstra
- Department of Neurosurgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - S Middeldorp
- Department of Vascular Medicine, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - R Van den Berg
- Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Y B W E M Roos
- Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - B A Coert
- Department of Neurosurgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - D Verbaan
- Department of Neurosurgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
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18
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ter Wengel PV, Martin E, De Witt Hamer PC, Feller RE, van Oortmerssen JAE, van der Gaag NA, Oner FC, Vandertop WP. Impact of Early (<24 h) Surgical Decompression on Neurological Recovery in Thoracic Spinal Cord Injury: A Meta-Analysis. J Neurotrauma 2019; 36:2609-2617. [DOI: 10.1089/neu.2018.6277] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Paula Valerie ter Wengel
- Neurosurgical Center Amsterdam, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Martin
- Neurosurgical Center Amsterdam, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
| | | | - Ricardo E. Feller
- Neurosurgical Center Amsterdam, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
| | | | - Niels A. van der Gaag
- Department of Neurosurgery, HagaZiekenhuis, the Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - F. Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - William Peter Vandertop
- Neurosurgical Center Amsterdam, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
- Neurosurgical Center Amsterdam, Amsterdam University Medical Center, AMC, Amsterdam, The Netherlands
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19
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Staartjes VE, de Wispelaere MP, Vandertop WP, Schröder ML. Deep learning-based preoperative predictive analytics for patient-reported outcomes following lumbar discectomy: feasibility of center-specific modeling. Spine J 2019; 19:853-861. [PMID: 30453080 DOI: 10.1016/j.spinee.2018.11.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There is considerable variability in patient-reported outcome measures following surgery for lumbar disc herniation. Individualized prediction tools that are derived from center- or even surgeon-specific data could provide valuable insights for shared decision-making. PURPOSE To evaluate the feasibility of deriving robust deep learning-based predictive analytics from single-center, single-surgeon data. STUDY DESIGN Derivation of predictive models from a prospective registry. PATIENT SAMPLE Patients who underwent single-level tubular microdiscectomy for lumbar disc herniation. OUTCOME MEASURES Numeric rating scales for leg and back pain severity and Oswestry Disability Index scores at 12 months postoperatively. METHODS Data were derived from a prospective registry. We trained deep neural network-based and logistic regression-based prediction models for patient-reported outcome measures. The primary endpoint was achievement of the minimum clinically important difference (MCID) in numeric rating scales and Oswestry Disability Index, defined as a 30% or greater improvement from baseline. Univariate predictors of MCID were also identified using conventional statistics. RESULTS A total of 422 patients were included (mean [SD] age: 48.5 [11.5] years; 207 [49%] female). After 1 year, 337 (80%), 219 (52%), and 337 (80%) patients reported a clinically relevant improvement in leg pain, back pain, and functional disability, respectively. The deep learning models predicted MCID with high area-under-the-curve of 0.87, 0.90, and 0.84, as well as accuracy of 85%, 87%, and 75%. The regression models provided inferior performance measures for each of the outcomes. CONCLUSIONS Our study demonstrates that generating personalized and robust deep learning-based analytics for outcome prediction is feasible even with limited amounts of center-specific data. With prospective validation, the ability to preoperatively and reliably inform patients about the likelihood of symptom improvement could prove useful in patient counselling and shared decision-making.
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Affiliation(s)
- Victor E Staartjes
- Department of Neurosurgery, Bergman Clinics Amsterdam, Rijksweg 69, 1411 GE Naarden, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland.
| | - Marlies P de Wispelaere
- Department of Clinical Informatics, Bergman Clinics Amsterdam, Rijksweg 69, 1411 GE Naarden, The Netherlands
| | - William Peter Vandertop
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics Amsterdam, Rijksweg 69, 1411 GE Naarden, The Netherlands
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20
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Leemans EL, Cornelissen BMW, Rosalini G, Verbaan D, Schneiders JJ, van den Berg R, Vandertop WP, van Bavel ET, Slump CH, Majoie CBLM, Marquering HA. Impact of Intracranial Aneurysm Morphology and Rupture Status on the Particle Residence Time. J Neuroimaging 2019; 29:487-492. [PMID: 31002750 PMCID: PMC6618041 DOI: 10.1111/jon.12618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Aneurysm hemodynamics play an important role in aneurysm growth and subsequent rupture. Within the available hemodynamic characteristics, particle residence time (PRT) is relatively unexplored. However, some studies have shown that PRT is related to thrombus formation and inflammation. The goal of this study is to evaluate the association between PRT and aneurysm rupture and morphology. METHODS We determined the PRT for 113 aneurysms (61 unruptured, 53 ruptured) based on computational fluid dynamic models. Virtual particles were injected into the parent vessel and followed during multiple cardiac cycles. PRT was defined as the time needed for 99% of the particles that entered an aneurysm to leave the aneurysm. Subsequently, we evaluated the association between PRT, rupture, and morphology (aneurysm type, presence of blebs, or multiple lobulations). RESULTS PRT showed no significant difference between unruptured (1.1 seconds interquartile range [IQR .39-2.0 seconds]) and ruptured aneurysms (1.2 seconds [IQR .47-2.3 seconds]). PRT was influenced by aneurysm morphology. Longer PRTs were seen in bifurcation aneurysms (1.3 seconds [IQR .54-2.4 seconds], P = .01) and aneurysms with blebs or multiple lobulations (1.92 seconds [IQR .94-2.8 seconds], P < .001). Four of five partially thrombosed aneurysms had a long residence time (>1.9 seconds). CONCLUSIONS Our study shows an influence of aneurysm morphology on PRT. Nevertheless, it suggests that PRT cannot be used to differentiate unruptured and ruptured aneurysms.
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Affiliation(s)
- E L Leemans
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - B M W Cornelissen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - G Rosalini
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Industrial Engineering and Information, University of Pavia, Pavia, Italy
| | - D Verbaan
- Neurosurgical Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J J Schneiders
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - R van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W P Vandertop
- Neurosurgical Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - E T van Bavel
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C H Slump
- MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - C B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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21
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ter Wengel PV, De Witt Hamer PC, Pauptit JC, van der Gaag NA, Oner FC, Vandertop WP. Early Surgical Decompression Improves Neurological Outcome after Complete Traumatic Cervical Spinal Cord Injury: A Meta-Analysis. J Neurotrauma 2019; 36:835-844. [DOI: 10.1089/neu.2018.5974] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Paula Valerie ter Wengel
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurosurgery, Slotervaart Hospital, Amsterdam, The Netherlands
| | | | - Jonah Charley Pauptit
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels A. van der Gaag
- Department of Neurosurgery, HagaZiekenhuis, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - F. Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - William Peter Vandertop
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
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22
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van de Vijfeijken SECM, Groot C, Ubbink DT, Vandertop WP, Depauw PRAM, Nout E, Becking AG. Factors related to failure of autologous cranial reconstructions after decompressive craniectomy. J Craniomaxillofac Surg 2019; 47:1420-1425. [PMID: 31353299 DOI: 10.1016/j.jcms.2019.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/16/2018] [Accepted: 02/11/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Cranioplasty is customary after decompressive craniectomy. Many different materials have been developed and used for this procedure. The ideal material does not yet exist, while complication rates in cranioplasties remain high. This study aimed to determine factors related to autologous bone flap failure. MATERIALS AND METHODS In this two-center retrospective cohort study, 276 patients underwent autologous bone cranioplasty after initial decompressive craniectomy between 2004 and 2014. Medical records were reviewed regarding patient characteristics and factors potentially related to bone flap failure. Data were analyzed using univariable and multivariable regression analysis. RESULTS Independent factors related to overall bone flap failure were: duration of hospitalization after decompressive craniectomy [OR: 1.012 (95%CI: 1.003-1.022); p = 0.012], time interval between decompressive craniectomy and cranioplasty [OR: 1.018 (95%CI: 1.004-1.032); p = 0.013], and follow-up duration [OR: 1.034 (95%CI: 1.020-1.047); p < 0.001]. In patients with bone flap infection, neoplasm as initial diagnosis occurred significantly more often (29.2% vs. 7.8%; RD 21.3%; 95%CI 8.4 -38.3%; NNH 5; 95%CI 3 -12) and duration of hospitalization after decompressive craniectomy tended to be longer (means 54 vs. 28 days, MD 26.2 days, 95%CI -8.6 to 60.9 days). Patients with bone flap resorption were significantly younger (35 vs. 43 years, MD 7.7 years, 95%CI 0.8-14.6 years) and their cranial defect size tended to be wider than in patients without bone flap resorption (mean circumference 39 vs. 37 cm; MD 2.4 cm, 95% CI -0.43-5.2 cm) and follow-up duration was significantly longer (44 vs. 14 months, MD 29 months, 95%CI 17-42 months). CONCLUSION A neoplasm as initial diagnosis, longer hospitalization after decompressive craniectomy, larger time interval between decompressive craniectomy and cranioplasty, and longer follow-up duration are associated with a higher risk of failure of autologous bone flaps for cranioplasty. Patients with these risk factors may be better served with an early recovery program after decompressive surgery or an alloplastic material for cranioplasty.
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Affiliation(s)
- S E C M van de Vijfeijken
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - C Groot
- Department of Oral and Maxillofacial Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - D T Ubbink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - W P Vandertop
- Neurosurgical Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Neurosurgical Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - P R A M Depauw
- Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - E Nout
- Department of Oral and Maxillofacial Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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23
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de Lande RSV, Maurice-Stam H, Marchal JP, Vuurden DGV, Vandertop WP, Grootenhuis MA, Schouten-van Meeteren AYN. Adaptive behavior impaired in children with low-grade glioma. Pediatr Blood Cancer 2019; 66:e27419. [PMID: 30152099 DOI: 10.1002/pbc.27419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adaptive behavior, i.e., the performance on daily activities required for personal and social independence, is essential to estimate in children with low-grade glioma (LGG) since most of them are long-term survivors. Our aim was to investigate adaptive behavior in children with LGG. METHODS In a cross-sectional study, adaptive behavior was assessed using the paper pencil version of the Parent Form of the Vineland Adaptive Behavior Scales 2nd edition (VABS-II) testing communication, daily living skills, social skills, and motor skills. Scores of children with LGG, younger than 20 years, and diagnosed between 2004 and 2014 were compared with family controls. Correlations between clinical variables and adaptive behavior were explored. RESULTS Fifty-six children with LGG (median age, 12.1 years; 52% male) and 46 controls (median age, 11.0 years; 43% male) were included in the analyses. Compared with controls, the LGG group was more impaired on total adaptive behavior, communication, and motor skills and in the subdomain gross motor skills (effect sizes d, 0.64-0.86, P < 0.003). Younger age at diagnosis (r = -0.357, P < 0.01) and chemotherapy (r = -0.342, P < 0.05) were associated with poorer motor skills. Residual disease was associated with poorer total adaptive behavior (r = -0.282, P < 0.05). No other significant correlations were found. CONCLUSION At the group level, adaptive functioning of children with LGG is impaired compared with family controls. Regular structured monitoring of adaptive behavior is recommended to be able to define the needs for tailored rehabilitation in daily life at home as well as at school.
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Affiliation(s)
- R S van de Lande
- Department of Pediatric Oncology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - H Maurice-Stam
- Pediatric Psychosocial Department, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - J P Marchal
- Pediatric Psychosocial Department, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - D G van Vuurden
- Department of Pediatric Oncology, University Hospital Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Neurosurgical Center Amsterdam, The Netherlands
| | - M A Grootenhuis
- Pediatric Psychosocial Department, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - A Y N Schouten-van Meeteren
- Department of Pediatric Oncology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
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24
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Cornelissen BMW, Schneiders JJ, Sprengers ME, van den Berg R, van Ooij P, Nederveen AJ, van Bavel E, Vandertop WP, Slump CH, Marquering HA, Majoie CBLM. Aneurysmal Parent Artery-Specific Inflow Conditions for Complete and Incomplete Circle of Willis Configurations. AJNR Am J Neuroradiol 2018; 39:910-915. [PMID: 29599169 DOI: 10.3174/ajnr.a5602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/31/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hemodynamics are thought to play a role in intracranial aneurysm growth and rupture. Computational fluid dynamics is frequently performed to assess intra-aneurysmal hemodynamics, using generalized flow waveforms of healthy volunteers as inflow boundary conditions. The purpose of this study was to assess differences in inflow conditions for different aneurysmal parent artery locations and variations of circle of Willis configurations. MATERIALS AND METHODS In a series of 96 patients with 103 aneurysms, velocity measurements were acquired using 2D phase-contrast MR imaging perpendicular to the aneurysmal parent arteries in the circle of Willis. Circle of Willis configurations were inspected for variations using multiple overlapping thin-slab-acquisition MRAs. Flow rates, velocity magnitudes, and pulsatility indices were calculated for each parent artery location in subgroups of complete and incomplete circle of Willis configurations. RESULTS Flow rates, velocity magnitudes, and pulsatility indices were significantly different among aneurysmal parent arteries. Incomplete circle of Willis configurations were observed in 24% of the cases. Significantly lower basilar artery flow rates were observed in configurations with hypoplastic P1 segments. Significantly higher A1 flow rates were observed in configurations with a hypoplastic contralateral A1 segment. CONCLUSIONS Inflow conditions vary substantially between aneurysmal parent arteries and circle of Willis configurations. We have created a collection of parent artery-specific inflow conditions tailored to the patient-specific circle of Willis configuration that can be used in future computational fluid dynamics studies analyzing intra-aneurysmal hemodynamics.
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Affiliation(s)
- B M W Cornelissen
- From the Departments of Radiology and Nuclear Medicine (B.M.W.C., J.J.S., M.E.S., R.v.d.B., P.v.O., A.J.N., H.A.M., C.B.L.M.M.) .,Biomedical Engineering and Physics (B.M.W.C., E.v.B., H.A.M.).,MIRA Institute for Biomedical Technology and Technical Medicine (B.M.W.C., C.H.S.), University of Twente, Enschede, the Netherlands
| | - J J Schneiders
- From the Departments of Radiology and Nuclear Medicine (B.M.W.C., J.J.S., M.E.S., R.v.d.B., P.v.O., A.J.N., H.A.M., C.B.L.M.M.).,Department of Radiology (J.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M E Sprengers
- From the Departments of Radiology and Nuclear Medicine (B.M.W.C., J.J.S., M.E.S., R.v.d.B., P.v.O., A.J.N., H.A.M., C.B.L.M.M.)
| | - R van den Berg
- From the Departments of Radiology and Nuclear Medicine (B.M.W.C., J.J.S., M.E.S., R.v.d.B., P.v.O., A.J.N., H.A.M., C.B.L.M.M.)
| | - P van Ooij
- From the Departments of Radiology and Nuclear Medicine (B.M.W.C., J.J.S., M.E.S., R.v.d.B., P.v.O., A.J.N., H.A.M., C.B.L.M.M.)
| | - A J Nederveen
- From the Departments of Radiology and Nuclear Medicine (B.M.W.C., J.J.S., M.E.S., R.v.d.B., P.v.O., A.J.N., H.A.M., C.B.L.M.M.)
| | - E van Bavel
- Biomedical Engineering and Physics (B.M.W.C., E.v.B., H.A.M.)
| | - W P Vandertop
- Neurosurgery (W.P.V.), Academic Medical Center, Amsterdam, the Netherlands
| | - C H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine (B.M.W.C., C.H.S.), University of Twente, Enschede, the Netherlands
| | - H A Marquering
- From the Departments of Radiology and Nuclear Medicine (B.M.W.C., J.J.S., M.E.S., R.v.d.B., P.v.O., A.J.N., H.A.M., C.B.L.M.M.).,Biomedical Engineering and Physics (B.M.W.C., E.v.B., H.A.M.)
| | - C B L M Majoie
- From the Departments of Radiology and Nuclear Medicine (B.M.W.C., J.J.S., M.E.S., R.v.d.B., P.v.O., A.J.N., H.A.M., C.B.L.M.M.)
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25
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Zijlstra IA, van der Steen WE, Verbaan D, Majoie CB, Marquering HA, Coert BA, Vandertop WP, van den Berg R. Ruptured middle cerebral artery aneurysms with a concomitant intraparenchymal hematoma: the role of hematoma volume. Neuroradiology 2018; 60:335-342. [PMID: 29356856 PMCID: PMC5799354 DOI: 10.1007/s00234-018-1978-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 09/25/2017] [Accepted: 01/09/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To study whether clinical outcome data from our patient cohort could give support to the new recommendation in the AHA/ASA guidelines for the management of aneurysmal subarachnoid hemorrhage that states "that microsurgical clipping may receive increased consideration in patients with ruptured middle cerebral artery (MCA) aneurysms and large (>50 mL) intraparenchymal hematomas", while clinical outcome data supporting this recommendation are sparse. METHODS We reviewed the clinical and radiological data of 81 consecutive patients with MCA aneurysms and concomitant hematomas admitted between January 2006 and December 2015. The relation between (semi-automatically quantified) hematoma volume (< or > 50 ml), neurological condition on admission (poor: GCS < 8 or non-reactive pupils), treatment strategies (no treatment, coiling, or clipping with or without decompression and/or clot removal), and outcome (favorable: mRS score 0-3) was evaluated. RESULTS Clinical outcome data were available for 76 patients. A significant difference in favorable outcome (17 vs 68%) was seen when comparing patients with poor and good neurological condition on admission (p < 0.01). Patients with hematomas > 50 ml had similar outcomes for coiling and clipping, all underwent decompression. Patients with hematomas < 50 ml did not show differences in favorable outcome when comparing coiling and clipping with (33 and 31%) or without decompression (90 and 88%). CONCLUSION Poor neurological condition on admission, and not large intraparenchymal hematoma volume, was associated with poor clinical outcome. Therefore, even in patients with large hematomas, the neurological condition on admission and the aneurysm configuration seem to be equally important factors to determine the most appropriate treatment strategy.
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Affiliation(s)
- I A Zijlstra
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - W E van der Steen
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - D Verbaan
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - C B Majoie
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - H A Marquering
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - B A Coert
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R van den Berg
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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26
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Müller DMJ, Robe P, Han SJ, Barkhof F, Vandertop WP, Berger MS, Hamer PCDW. NIMG-38. QUALITY OF SURGICAL DECISION MAKING FOR PATIENTS WITH A GLIOBLASTOMA IS SIMILAR BETWEEN NEURO-ONCOLOGICAL CARE TEAMS FROM THE UNITED STATES OF AMERICA AND THE NETHERLANDS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.613] [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: 11/13/2022] Open
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27
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Verburg N, Hoefnagels FWA, Barkhof F, Boellaard R, Goldman S, Guo J, Heimans JJ, Hoekstra OS, Jain R, Kinoshita M, Pouwels PJW, Price SJ, Reijneveld JC, Stadlbauer A, Vandertop WP, Wesseling P, Zwinderman AH, De Witt Hamer PC. Diagnostic Accuracy of Neuroimaging to Delineate Diffuse Gliomas within the Brain: A Meta-Analysis. AJNR Am J Neuroradiol 2017; 38:1884-1891. [PMID: 28882867 DOI: 10.3174/ajnr.a5368] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 01/15/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Brain imaging in diffuse glioma is used for diagnosis, treatment planning, and follow-up. PURPOSE In this meta-analysis, we address the diagnostic accuracy of imaging to delineate diffuse glioma. DATA SOURCES We systematically searched studies of adults with diffuse gliomas and correlation of imaging with histopathology. STUDY SELECTION Study inclusion was based on quality criteria. Individual patient data were used, if available. DATA ANALYSIS A hierarchic summary receiver operating characteristic method was applied. Low- and high-grade gliomas were analyzed in subgroups. DATA SYNTHESIS Sixty-one studies described 3532 samples in 1309 patients. The mean Standard for Reporting of Diagnostic Accuracy score (13/25) indicated suboptimal reporting quality. For diffuse gliomas as a whole, the diagnostic accuracy was best with T2-weighted imaging, measured as area under the curve, false-positive rate, true-positive rate, and diagnostic odds ratio of 95.6%, 3.3%, 82%, and 152. For low-grade gliomas, the diagnostic accuracy of T2-weighted imaging as a reference was 89.0%, 0.4%, 44.7%, and 205; and for high-grade gliomas, with T1-weighted gadolinium-enhanced MR imaging as a reference, it was 80.7%, 16.8%, 73.3%, and 14.8. In high-grade gliomas, MR spectroscopy (85.7%, 35.0%, 85.7%, and 12.4) and 11C methionine-PET (85.1%, 38.7%, 93.7%, and 26.6) performed better than the reference imaging. LIMITATIONS True-negative samples were underrepresented in these data, so false-positive rates are probably less reliable than true-positive rates. Multimodality imaging data were unavailable. CONCLUSIONS The diagnostic accuracy of commonly used imaging is better for delineation of low-grade gliomas than high-grade gliomas on the basis of limited evidence. Improvement is indicated from advanced techniques, such as MR spectroscopy and PET.
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Affiliation(s)
- N Verburg
- From the Neurosurgical Center Amsterdam (N.V., F.W.A.H., W.P.V., P.C.D.W.H.)
| | - F W A Hoefnagels
- From the Neurosurgical Center Amsterdam (N.V., F.W.A.H., W.P.V., P.C.D.W.H.)
| | - F Barkhof
- Departments of Radiology and Nuclear Medicine (F.B., R.B., O.S.H.)
- Institutes of Neurology and Healthcare Engineering (F.B.), University College London, London, UK
| | - R Boellaard
- Departments of Radiology and Nuclear Medicine (F.B., R.B., O.S.H.)
| | - S Goldman
- Service of Nuclear Medicine and PET/Biomedical Cyclotron Unit (S.G.), l'université libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - J Guo
- Shanghai Medical College (J.G.), Fudan University, Shanghai, China
| | | | - O S Hoekstra
- Departments of Radiology and Nuclear Medicine (F.B., R.B., O.S.H.)
| | - R Jain
- Department of Radiology (R.J.), New York University School of Medicine, New York, New York
| | - M Kinoshita
- Department of Neurosurgery (M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - S J Price
- Academic Neurosurgery Division (S.J.P.), Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, UK
| | | | - A Stadlbauer
- Department of Neurosurgery (A.S.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - W P Vandertop
- From the Neurosurgical Center Amsterdam (N.V., F.W.A.H., W.P.V., P.C.D.W.H.)
| | - P Wesseling
- Pathology (P.W.), VU University Medical Center, Amsterdam, the Netherlands
- Department of Pathology (P.W.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - A H Zwinderman
- Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - P C De Witt Hamer
- From the Neurosurgical Center Amsterdam (N.V., F.W.A.H., W.P.V., P.C.D.W.H.)
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Goedemans T, Verbaan D, Coert BA, Kerklaan BJ, van den Berg R, Coutinho JM, van Middelaar T, Nederkoorn PJ, Vandertop WP, van den Munckhof P. Neurologic Outcome After Decompressive Craniectomy: Predictors of Outcome in Different Pathologic Conditions. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hoogmoed J, van den Berg R, Coert BA, Rinkel GJE, Vandertop WP, Verbaan D. A strategy to expeditious invasive treatment improves clinical outcome in comatose patients with aneurysmal subarachnoid haemorrhage. Eur J Neurol 2016; 24:82-89. [PMID: 27670264 DOI: 10.1111/ene.13134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with poor clinical condition after aneurysmal subarachnoid haemorrhage (aSAH), treatment is often deferred until patients show signs of improvement. Early external ventricular drainage and aneurysm occlusion may improve prognosis also in poor grade patients. The clinical outcome of an expeditious approach was compared with that of a conservative approach. METHODS In all, 285 consecutive World Federation of Neurological Surgeons (WFNS) grade V aSAH patients admitted to three university hospitals between January 2000 and June 2007 were included. Two hospitals followed an expeditious approach, one a more conservative approach. Groups were compared with respect to demographic and clinical characteristics and outcome. Univariable and multivariable analyses were performed to determine the associations with good outcome (Glasgow Outcome Scale scores 4-5), using logistic regression models. RESULTS Good outcome was seen more often in expeditiously treated patients [22% vs. 11%; odds ratio (OR) 2.24, 95% confidence interval (CI) 1.17-4.27]. Expeditiously treated patients more often underwent aneurysm occlusion than conservatively treated patients (64% vs. 27%; OR 4.86, 95% CI 2.93-8.05) and placement of an external ventricular catheter (82% vs. 31%; OR 10.05, CI 5.72-10.66). There was no significant difference in rebleeding between patient groups. Occlusion of the aneurysm was the only variable that remained significant in the multivariable model with an OR of 43.73 (95% CI 10.34-184.97). CONCLUSIONS An expeditious invasive treatment strategy in WFNS grade V aSAH patients can lead to a better outcome. Hesitance in the early stages seems a self-fulfilling prophecy for a poor outcome.
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Affiliation(s)
- J Hoogmoed
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands
| | - R van den Berg
- Department of Neuroradiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B A Coert
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands
| | - G J E Rinkel
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands
| | - D Verbaan
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands
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Dorhout Mees SM, Algra A, Wong GKC, Poon WS, Bradford CM, Saver JL, Starkman S, Rinkel GJE, van den Bergh WM, van Kooten F, Dirven CM, van Gijn J, Vermeulen M, Rinkel GJE, Boet R, Chan MTV, Gin T, Ng SCP, Zee BCY, Al-Shahi Salman R, Boiten J, Kuijsten H, Lavados PM, van Oostenbrugge RJ, Vandertop WP, Finfer S, O'Connor A, Yarad E, Firth R, McCallister R, Harrington T, Steinfort B, Faulder K, Assaad N, Morgan M, Starkman S, Eckstein M, Stratton SJ, Pratt FD, Hamilton S, Conwit R, Liebeskind DS, Sung G, Kramer I, Moreau G, Goldweber R, Sanossian N. Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage: Individual Patient Data Meta-Analysis. Stroke 2015; 46:3190-3. [PMID: 26463689 DOI: 10.1161/strokeaha.115.010575] [Citation(s) in RCA: 20] [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: 06/24/2015] [Accepted: 09/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be more effective, but individual trials had not enough power for such a subanalysis. We performed an individual patient data meta-analysis to study whether magnesium is effective when given within different time frames within 24 hours after the SAH. METHODS Patients were divided into categories according to the delay between symptom onset and start of the study medication: <6, 6 to 12, 12 to 24, and >24 hours. We calculated adjusted risk ratios with corresponding 95% confidence intervals for magnesium versus placebo treatment for poor outcome and DCI. RESULTS We included 5 trials totaling 1981 patients; 83 patients started treatment<6 hours. For poor outcome, the adjusted risk ratios of magnesium treatment for start <6 hours were 1.44 (95% confidence interval, 0.83-2.51); for 6 to 12 hours 1.03 (0.65-1.63), for 12 to 24 hours 0.84 (0.65-1.09), and for >24 hours 1.06 (0.87-1.31), and for DCI, <6 hours 1.76 (0.68-4.58), for 6 to 12 hours 2.09 (0.99-4.39), for 12 to 24 hours 0.80 (0.56-1.16), and for >24 hours 1.08 (0.88-1.32). CONCLUSIONS This meta-analysis suggests no beneficial effect of magnesium treatment on poor outcome or DCI when started early after SAH onset. Although the number of patients was small and a beneficial effect cannot be definitively excluded, we found no justification for a new trial with early magnesium treatment after SAH.
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Affiliation(s)
- Sanne M Dorhout Mees
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Ale Algra
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - George K C Wong
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Wai S Poon
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Celia M Bradford
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Jeffrey L Saver
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Sidney Starkman
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Gabriel J E Rinkel
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Walter M van den Bergh
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.).
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Schneiders JJ, Marquering HA, van Ooij P, van den Berg R, Nederveen AJ, Verbaan D, Vandertop WP, Pourquie M, Rinkel GJE, vanBavel E, Majoie CBLM. Additional Value of Intra-Aneurysmal Hemodynamics in Discriminating Ruptured versus Unruptured Intracranial Aneurysms. AJNR Am J Neuroradiol 2015. [PMID: 26206812 DOI: 10.3174/ajnr.a4397] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hemodynamics are thought to play an important role in the rupture of intracranial aneurysms. We tested whether hemodynamics, determined from computational fluid dynamics models, have additional value in discriminating ruptured and unruptured aneurysms. Such discriminative power could provide better prediction models for rupture. MATERIALS AND METHODS A cross-sectional study was performed on patients eligible for endovascular treatment, including 55 ruptured and 62 unruptured aneurysms. Association with rupture status was tested for location, aneurysm type, and 4 geometric and 10 hemodynamic parameters. Patient-specific spatiotemporal velocities measured with phase-contrast MR imaging were used as inflow conditions for computational fluid dynamics. To assess the additional value of hemodynamic parameters, we performed 1 univariate and 2 multivariate analyses: 1 traditional model including only location and geometry and 1 advanced model that included patient-specific hemodynamic parameters. RESULTS In the univariate analysis, high-risk locations (anterior cerebral arteries, posterior communicating artery, and posterior circulation), daughter sacs, unstable inflow jets, impingements at the aneurysm body, and unstable complex flow patterns were significantly present more often in ruptured aneurysms. In both multivariate analyses, only the high-risk location (OR, 3.92; 95% CI, 1.77-8.68) and the presence of daughter sacs (OR, 2.79; 95% CI, 1.25-6.25) remained as significant independent determinants. CONCLUSIONS In this study population of patients eligible for endovascular treatment, we found no independent additional value of aneurysmal hemodynamics in discriminating rupture status, despite high univariate associations. Only traditional parameters (high-risk location and the presence of daughter sacs) were independently associated with ruptured aneurysms.
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Affiliation(s)
- J J Schneiders
- From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.)
| | - H A Marquering
- From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.) Biomedical Engineering and Physics (H.A.M., E.V.)
| | - P van Ooij
- From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.)
| | - R van den Berg
- From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.)
| | - A J Nederveen
- From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.)
| | - D Verbaan
- Neurosurgery (D.V., W.P.V.), Academic Medical Center, Amsterdam, the Netherlands
| | - W P Vandertop
- Neurosurgery (D.V., W.P.V.), Academic Medical Center, Amsterdam, the Netherlands
| | - M Pourquie
- Department of Aero- and Hydrodynamics (M.P.), Delft University of Technology, Delft, the Netherlands
| | - G J E Rinkel
- Department of Neurology and Neurosurgery (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - E vanBavel
- Biomedical Engineering and Physics (H.A.M., E.V.)
| | - C B L M Majoie
- From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.)
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Caretti V, Jansen MHA, van Vuurden DG, Lagerweij T, Bugiani M, Horsman I, Wessels H, van der Valk P, Cloos J, Noske DP, Vandertop WP, Wesseling P, Wurdinger T, Hulleman E, Kaspers GJL. Implementation of a multi-institutional diffuse intrinsic pontine glioma autopsy protocol and characterization of a primary cell culture. Neuropathol Appl Neurobiol 2013; 39:426-36. [PMID: 22845849 DOI: 10.1111/j.1365-2990.2012.01294.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS Diffuse intrinsic pontine glioma (DIPG) is a fatal paediatric malignancy. Tumour resection is not possible without serious morbidity and biopsies are rarely performed. The resulting lack of primary DIPG material has made preclinical research practically impossible and has hindered the development of new therapies for this disease. The aim of the current study was to address the lack of primary DIPG material and preclinical models by developing a multi-institutional autopsy protocol. METHODS An autopsy protocol was implemented in the Netherlands to obtain tumour material within a brief post mortem interval. A team of neuropathologists and researchers was available at any time to perform the autopsy and process the material harvested. Whole brain autopsy was performed and primary DIPG material and healthy tissue were collected from all affected brain areas. Finally, the study included systematic evaluation by parents. RESULTS Five autopsies were performed. The mean time interval between death and time of autopsy was 3 h (range 2-4). All tumours were graded as glioblastoma. None of the parents regretted their choice to participate, and they all derived comfort in donating tissue of their child in the hope to help future DIPG patients. In addition, we developed and characterized one of the first DIPG cell cultures from post mortem material. CONCLUSION Here we show that obtaining post mortem DIPG tumour tissue for research purposes is feasible with short delay, and that the autopsy procedure is satisfying for participating parents and can be suitable for the development of preclinical DIPG models.
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Affiliation(s)
- V Caretti
- Department of Pediatric Oncology, VU University Medical Center, 1081 HZ Amsterdam, The Netherlands
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Veringa SJE, Biesmans D, van Vuurden DG, Jansen MHA, Wedekind LE, Horsman I, Wesseling P, Vandertop WP, Noske DP, Kaspers GJL, Hulleman E. In vitro drug response and efflux transporters associated with drug resistance in pediatric high grade glioma and diffuse intrinsic pontine glioma. PLoS One 2013; 8:e61512. [PMID: 23637844 PMCID: PMC3639279 DOI: 10.1371/journal.pone.0061512] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/09/2013] [Indexed: 12/04/2022] Open
Abstract
Pediatric high-grade gliomas (pHGG), including diffuse intrinsic pontine gliomas (DIPG), are the leading cause of cancer-related death in children. While it is clear that surgery (if possible), and radiotherapy are beneficial for treatment, the role of chemotherapy for these tumors is still unclear. Therefore, we performed an in vitro drug screen on primary glioma cells, including three DIPG cultures, to determine drug sensitivity of these tumours, without the possible confounding effect of insufficient drug delivery. This screen revealed a high in vitro cytotoxicity for melphalan, doxorubicine, mitoxantrone, and BCNU, and for the novel, targeted agents vandetanib and bortezomib in pHGG and DIPG cells. We subsequently determined the expression of the drug efflux transporters P-gp, BCRP1, and MRP1 in glioma cultures and their corresponding tumor tissues. Results indicate the presence of P-gp, MRP1 and BCRP1 in the tumor vasculature, and expression of MRP1 in the glioma cells themselves. Our results show that pediatric glioma and DIPG tumors per se are not resistant to chemotherapy. Treatment failure observed in clinical trials, may rather be contributed to the presence of drug efflux transporters that constitute a first line of drug resistance located at the blood-brain barrier or other resistance mechanism. As such, we suggest that alternative ways of drug delivery may offer new possibilities for the treatment of pediatric high-grade glioma patients, and DIPG in particular.
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Affiliation(s)
- Susanna J. E. Veringa
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Dennis Biesmans
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Dannis G. van Vuurden
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Marc H. A. Jansen
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Laurine E. Wedekind
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Ilona Horsman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter Wesseling
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - David P. Noske
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands
| | - GertJan J. L. Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Hulleman
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
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Sierink JC, van Lieshout WAM, Beenen LFM, Schep NWL, Vandertop WP, Goslings JC. Systematic review of flexion/extension radiography of the cervical spine in trauma patients. Eur J Radiol 2013; 82:974-81. [PMID: 23489979 DOI: 10.1016/j.ejrad.2013.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/08/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this review was to investigate whether Flexion/Extension (F/E) radiography adds diagnostic value to CT or MRI in the detection of cervical spine ligamentous injury and/or clinically significant cervical spine instability of blunt trauma patients. METHODS A systematic search of literature was done in Pubmed, Embase and Cochrane Library databases. Primary outcome was sensitivity and specificity of F/E radiography. Secondary outcomes were the positive predicting value (PPV) and negative predicting value (NPV) (with CT or MRI as reference tests due to the heterogeneity of the included studies) of each modality and the quality of F/E radiography. RESULTS F/E radiography was overall regarded to be inferior to CT or MRI in the detection of ligamentous injury. This was reflected by the high specificity and NPV for CT with F/E as reference test (ranging from 97 to 100% and 99 to 100% respectively) and the ambiguous results for F/E radiography with MRI as its reference test (0-98% and 0-83% for specificity and NPV respectively). Image quality of F/E radiography was reported to have 31 to 70% adequacy, except in two studies which reported an adequacy of respectively 4 and 97%. CONCLUSION This systematic review of the literature shows that F/E radiography adds little diagnostic value to the evaluation of blunt trauma patients compared to CT and MRI, especially in those cases where CT or MRI show no indication of ligamentous injury.
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Affiliation(s)
- J C Sierink
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Idema S, Buis DR, Idema AJ, Vandertop WP. Higher Complications and No Improvement in Mortality in the ACGME Resident Duty-Hour Restriction Era. Neurosurgery 2013; 72:E142-3. [DOI: 10.1227/neu.0b013e318276064f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Buis DR, Bot JCJ, Barkhof F, Knol DL, Lagerwaard FJ, Slotman BJ, Vandertop WP, van den Berg R. The predictive value of 3D time-of-flight MR angiography in assessment of brain arteriovenous malformation obliteration after radiosurgery. AJNR Am J Neuroradiol 2011; 33:232-8. [PMID: 22095967 DOI: 10.3174/ajnr.a2744] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of radiosurgery of bAVMs is complete angiographic obliteration of its nidus. We assessed the diagnostic accuracy of 1.5T T2-weighted MR imaging and TOF-MRA images for detecting nidus obliteration after radiosurgery. MATERIALS AND METHODS The pre- and postradiosurgery MR images and DSA images from 120 patients who were radiosurgically treated for a bAVM were re-evaluated by 2 observers for patency of the nidus (preradiosurgery) and obliteration (postradiosurgery: final follow-up MR imaging), by using a 3-point scale of confidence. Consensus reading of the DSA after radiosurgery was considered the criterion standard for obliteration. Sensitivity, specificity, PPVs, and NPVs, and overall diagnostic performance by using ROC were determined. RESULTS Mean bAVM volume during radiosurgery was 3.4 mL (95% CI, 2.6-4.3 mL). Sixty-six patients (55%) had undergone previous endovascular embolization. The mean intervals between radiosurgery and follow-up MR imaging and for DSA, respectively, were 35.6 months (95% CI, 32.3-38.9 months) and 42.1 months (95% CI, 40.3-44.0 months). With ROC, an area under curve of 0.81-0.83 was found. PPVs of final follow-up MR-imaging for definitive obliteration varied between 0.89 [corrected] and 0.95. NPV was 0.52 [corrected] . An average false-positive rate, meaning overestimation of nidus obliteration of 0.10 [corrected] and an average false-negative rate, meaning underestimation of nidus obliteration of 0.42 [corrected] were found. CONCLUSIONS MRA is insufficient to diagnose obliteration in the follow-up of bAVMs after radiosurgery. A remaining nidus diameter <10 mm seems to be the major limiting factor for reliable assessment of obliteration. We highly recommend follow-up DSA for definitive diagnosis of complete obliteration.
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Affiliation(s)
- D R Buis
- Department of Neurosurgery, Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
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Buis DR, Van Den Berg R, Lagerwaard FJ, Vandertop WP. Brain arteriovenous malformations: from diagnosis to treatment. J Neurosurg Sci 2011; 55:39-56. [PMID: 21464809] [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: 05/30/2023]
Abstract
Brain arteriovenous malformations (bAVM) are a major cause of morbidity in young people. The main mode of presentation is with a cerebral bleeding or seizures, although nowadays, due to the increased use of MRI, more asymptomatic bAVMs are encountered. The clinical course of asymptomatic bAVMs seems to be mild in comparison to bAVMs that presented with a cerebral hemorrhage. This finding may lead to a paradigm shift regarding treatment of asymptomatic bAVMs. This review discusses the latest findings in bAVM epidemiology and natural history, and compares the optimal imaging modalities and best treatment options.
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Affiliation(s)
- D R Buis
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
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Mandl ES, Vandertop WP, Meijer OWM, Peerdeman SM. Imaging-documented repeated intratumoral hemorrhage in vestibular schwannoma: a case report. Acta Neurochir (Wien) 2009; 151:1325-7. [PMID: 19255715 PMCID: PMC2760714 DOI: 10.1007/s00701-009-0213-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Accepted: 02/07/2009] [Indexed: 11/30/2022]
Abstract
Intratumoral hemorrhage in vestibular schwannomas is rare. Symptoms often have an acute onset and include headache, nausea, vomiting, vertigo, and depressed consciousness. Intratumoral hemorrhage is probably caused by vascular fragility associated with tumor characteristics and growth. With hemorrhage in VS being rare, repeated hemorrhage has only been reported twice, and on clinical grounds only. The present report details the case of acute neurological deterioration in a patient with repeated intratumoral hemorrhage inside a vestibular schwannoma with computed tomography and magnetic resonance imaging confirmation. To our knowledge, repeated hemorrhage in vestibular schwannoma with radiological confirmation has not been reported before.
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Affiliation(s)
- E S Mandl
- Department of Neurosurgery, 1F-002, Neurosurgical Center Amsterdam, VU University Medical Center, 7057, Amsterdam 1007 MB, The Netherlands.
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Dijkstra M, van Nieuwenhuizen D, Stalpers LJA, Wumkes M, Waagemans M, Vandertop WP, Heimans JJ, Leenstra S, Dirven CM, Reijneveld JC, Klein M. Late neurocognitive sequelae in patients with WHO grade I meningioma. J Neurol Neurosurg Psychiatry 2009; 80:910-5. [PMID: 18653549 DOI: 10.1136/jnnp.2007.138925] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Information on neurocognitive outcome following treatment of benign meningiomas is virtually lacking. This is remarkable considering that survival in these patients is the most favourable of all intracranial tumours. The aim of the present study was therefore to document the extent and nature of neurocognitive deficits in patients with World Health Organization (WHO) grade I meningioma after treatment. METHODS 89 patients with WHO grade I meningioma who underwent surgery with or without adjuvant radiotherapy were individually matched to 89 healthy controls for age, sex and educational level. Neurocognitive functioning of patients was assessed at least 1 year following treatment and compared with that of healthy controls using the Student's t test. Additionally, associations between tumour characteristics (size, lateralisation and localisation), treatment characteristics (radiotherapy) and epilepsy burden (based on seizure frequency and antiepileptic drug use) and neurocognitive functioning were investigated. RESULTS Compared with healthy controls, patients with meningioma showed significant impairments in executive functioning (p<0.001), verbal memory (p<0.001), information processing capacity (p = 0.001), psychomotor speed (p = 0.001) and working memory (p = 0.006). Patients with skull base meningiomas performed significantly lower on three out of six neurocognitive domains compared with convexity meningiomas. Left-sided as opposed to right-sided meningiomas were related to verbal memory deficits. A higher epilepsy burden was significantly associated with lower executive functioning which primarily could be attributed to antiepileptic drug use. No significant associations were established between neurocognitive status and radiotherapy or tumour volume. CONCLUSIONS Meningioma patients are characterised by long term deficits in neurocognitive functioning that can partly be attributed to the use of antiepileptic drugs and tumour location but not to the use of radiotherapy.
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Affiliation(s)
- M Dijkstra
- Department of Medical Psychology, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Saltzherr TP, Fung Kon Jin PHP, Beenen LFM, Vandertop WP, Goslings JC. Diagnostic imaging of cervical spine injuries following blunt trauma: a review of the literature and practical guideline. Injury 2009; 40:795-800. [PMID: 19523626 DOI: 10.1016/j.injury.2009.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 12/31/2008] [Accepted: 01/08/2009] [Indexed: 02/02/2023]
Abstract
Patients with a (potential) cervical spine injury can be subdivided into low-risk and high-risk patients. With a detailed history and physical examination the cervical spine of patients in the "low-risk" group can be "cleared" without further radiographic examinations. X-ray imaging (3-view series) is currently the primary choice of imaging for patients in the "low-risk" group with a suspected cervical spine injury after blunt trauma. For patients in the "high-risk"group because of its higher sensitivity a computed tomography scan is primarily advised or, alternatively, the cervical spine is immobilised until the patient can be reliably questioned and examined again. For the imaging of traumatic soft tissue injuries of the cervical spine magnetic resonance imaging is the technique of choice.
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Affiliation(s)
- T P Saltzherr
- Trauma Unit Department of Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
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van der Bilt IAC, Hasan D, Vandertop WP, Wilde AAM, Algra A, Visser FC, Rinkel GJE. Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a meta-analysis. Neurology 2009; 72:635-42. [PMID: 19221297 DOI: 10.1212/01.wnl.0000342471.07290.07] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [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
UNLABELLED Impact of cardiac complications after aneurysmal subarachnoid hemorrhage (SAH) remains controversial. We performed a meta-analysis to assess whether EKG changes, myocardial damage, or echocardiographic wall motion abnormalities (WMAs) are related to death, poor outcome (death or dependency), or delayed cerebral ischemia (DCI) after SAH. METHODS Articles on cardiac abnormalities after aneurysmal SAH that met predefined criteria and were published between 1960 and 2007 were retrieved. We assessed the quality of reports and extracted data on patient characteristics, cardiac abnormalities, and outcome measurements. Poor outcome was defined as death or dependence by the Glasgow Outcome Scale (dichotomized at < or = 3) or the modified Rankin scale (dichotomized at > 3). If studies used another dichotomy or another outcome scale, we used the numbers of patients with poor outcome provided by the authors. We calculated pooled relative risks (RRs) with corresponding 95% confidence intervals for the relation between cardiac abnormalities and outcome measurements. RESULTS We included 25 studies (16 prospective) with a total of 2,690 patients (mean age 53 years; 35% men). Mortality was associated with WMAs (RR 1.9), elevated troponin (RR 2.0) and brain natriuretic peptide (BNP) levels (RR 11.1), tachycardia (RR 3.9), Q waves (RR 2.9), ST-segment depression (RR 2.1), T-wave abnormalities (RR 1.8), and bradycardia (RR 0.6). Poor outcome was associated with elevated troponin (RR 2.3) and creatine kinase MB (CK-MB) levels (RR 2.3) and ST-segment depression (RR 2.4). Occurrence of DCI was associated with WMAs (RR 2.1), elevated troponin (RR 3.2), CK-MB (RR 2.9), and BNP levels (RR 4.5), and ST-segment depression (RR 2.4). All RRs were significant. CONCLUSION Markers for cardiac damage and dysfunction are associated with an increased risk of death, poor outcome, and delayed cerebral ischemia after subarachnoid hemorrhage. Future research should establish whether these cardiac abnormalities are independent prognosticators and should be directed toward pathophysiologic mechanisms and potential treatment options.
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Affiliation(s)
- I A C van der Bilt
- Academic Medical Centre, Department of Cardiology, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Germans MR, Pennings FA, Sprengers MES, Vandertop WP. Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage. J Neurol 2009; 255:1910-5. [PMID: 19159064 DOI: 10.1007/s00415-009-0021-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 05/28/2008] [Accepted: 06/03/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In patients with non-traumatic subarachnoid hemorrhage (SAH) and no evidence for a cerebral aneurysm on angiography, a frequent cause of the hemorrhage is perimesencephalic hemorrhage or other cerebral vascular pathology. In some patients no cause is found. The exact incidence of a spinal vascular malformation (SVM) as the origin for the SAH is not known. We assessed the occurrence of SVM in angiogram-negative, non-perimesencephalic subarachnoid hemorrhage (NPSAH). METHODS 47 patients (from a consecutive cohort of 632) were identified with an angiogramnegative, non-perimesencephalic subarachnoid hemorrhage and 42 of these were analyzed by performing MR-imaging of the complete spinal neuraxis with additional spinal angiography on indication. RESULTS In four patients a spinal vascular malformation was identified as the cause of the SAH, indicating an incidence of 9 % of SVM in NPSAH, and an incidence of 1 % of SVM in all patients with SAH. INTERPRETATION Systematic analysis of angiogram-negative, non-perimesencephalic subarachnoid hemorrhage by MR imaging of the complete spinal neuraxis yields a higher incidence of SVM than previously documented. We recommend MR imaging of the complete spinal neuraxis in patients with a non-perimesencephalic subarachnoid hemorrhage in whom no cause for the hemorrhage has been found.
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Affiliation(s)
- M R Germans
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Idema S, Geldof AA, Dirven CMF, van der Jagt M, Gerritsen WR, Vandertop WP, Lamfers MLM. Evaluation of adenoviral oncolytic effect on glioma spheroids by 18F-DG positron-emission tomography. Oncol Res 2008; 16:471-7. [PMID: 18196871 DOI: 10.3727/096504007783338304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Multicellular tumor spheroids are used as a model to assess the efficacy of replicating oncolytic adenoviruses. As most assays used to assess cellular viability are unsuitable for oncolytic viruses because of ongoing viral replication, we have used positron emission tomography (PET) to sequentially determine the incorporation of 18F-labeled deoxyglucose (18F-DG) as a measure of viability and compared the results to more commonly used assays for measuring the effect of oncolytic therapy. Glioma monolayer cultures and spheroids were infected with wild-type replicating adenovirus and viability was measured by 18F-DG incorporation, WST-1 assay, crystal violet assay, and spheroid volume 2 to 10 days following infection. Results show that volume measurements in adenovirus-infected spheroids are confounded by the cytopathic effect occurring in infected cells. 18F-DG PET provides a useful method to assess small differences in cell number and viability following oncolytic viral therapy in glioma monolayer cultures and spheroids without the need for disintegration of these cultures. Moreover, using 18F-DG PET, repeated sequential measurements of spheroid viability can be made, decreasing the required number of spheroids per experiment. This is a valuable feature when using spheroids derived from limited amounts of patient material.
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Affiliation(s)
- S Idema
- Department of Neurosurgery, VU University Medical Center, Amsterdam, 1007 MB, The Netherlands.
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Meijer OWM, Weijmans EJ, Knol DL, Slotman BJ, Barkhof F, Vandertop WP, Castelijns JA. Tumor-volume changes after radiosurgery for vestibular schwannoma: implications for follow-up MR imaging protocol. AJNR Am J Neuroradiol 2008; 29:906-10. [PMID: 18296549 DOI: 10.3174/ajnr.a0969] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The outcome of radiosurgery for vestibular schwannoma (VS) is assessed by posttreatment measurement of tumor size and could be influenced by the timing and quality of the assessment. This study evaluates the volumetric changes of VS after radiosurgery and proposes a radiologic follow-up program. MATERIALS AND METHODS Of 142 patients with VS treated with radiosurgery, we selected patients who were followed at least 3 times during a minimum of 32 months with a T1-weighted gadolinium-enhanced high-resolution 3D MR imaging examination identical to the pretreatment MR imaging. Forty-five patients were identified with a mean follow-up of 50 months (range, 32-78 months). Pre- and posttreatment tumor volumes were calculated by using BrainSCAN software by manually contouring tumors on each MR imaging study. Volume changes of >13% were defined as events. RESULTS At last follow-up MR imaging, volumes were smaller in 37 (82.2%) of the 45 patients. Eleven (29.7%) of these 37 tumors showed transient swelling preceding regression, with a median time to regression of 34 months (range, 20-55 months). Seven (15.6%) of the 45 tumors had volume progression compared with the tumor on pretreatment MR imaging studies. Of these 7 tumors, 3, however, had volume regression compared with the preceding MR imaging study, and in 4, volume progression was ongoing. One tumor remained the same. CONCLUSIONS Tumor-volume measurements by standardized T1-weighted gadolinium-enhanced high-resolution 3D MR imaging follow-up protocols revealed good local control of VS after radiosurgery. The first-follow-up MR imaging at 2 years and the second at 5 years postradiosurgery differentiated transient progression from ongoing progression and may prevent unnecessary therapeutic interventions.
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Affiliation(s)
- O W M Meijer
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
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Buis DR, Dirven CMF, Lagerwaard FJ, Mandl ES, Lycklama A Nijeholt GJ, Eshghi DS, van den Berg R, Baayen JC, Meijer OWM, Slotman BJ, Vandertop WP. Radiosurgery of brain arteriovenous malformations in children. J Neurol 2008; 255:551-60. [PMID: 18283398 DOI: 10.1007/s00415-008-0739-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 07/31/2007] [Accepted: 09/05/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors describe their experience in treating 22 children with a single brain arteriovenous malformation (bAVM) using a dedicated LINAC stereotactic radiosurgery unit. METHODS The findings of 22 consecutive patients < or = 18 years of age who underwent radiosurgery for a single bAVM and with at least 24 months of follow-up, or earlier proven obliteration,were reviewed. The median age at radiosurgery was 13.8 years,with a hemorrhagic presentation in 86%. Median bAVM-volume was 1.8 ml, with a median prescribed marginal dose of 19.0 Gy. RESULTS The crude complete obliteration-rate was 68% (n = 15) after a median follow-up of 24 months. The actuarial obliteration- rate was 45 % after two years and 64 % after three years. Patients with a radiosurgery-based AVM score < or = 1 more frequently had an excellent outcome than patients with a bAVM score > 1 (71% vs. 20%, P = 0.12), as well as an increased obliteration rate (P = 0.03) One patient died from a bAVM-related hemorrhage 27 months after radiosurgery, representing a postradiosurgery hemorrhage rate of 1.3%/year for the complete followup interval. Overall outcome was good to excellent in 68% (n = 15). Radiation-induced changes on MR imaging were seen in 36% (n = 8) after a median interval of 12.5 months, resulting in deterioration of pre-existing neurological symptoms in one patient. CONCLUSIONS Radiosurgery is a relatively effective, minimally invasive treatment for small bAVMs in children. The rebleeding rate is low, provided that known predilection places for bleeding had been endovascularly eliminated.Our overall results compare unfavourably to recent pediatric microsurgical series, although comparison between series remains imprecise. Nevertheless, when treatment is indicated in a child with a bAVM that is amenable to both microsurgery or radiosurgery, microsurgery should carefully be advocated over radiosurgery, because of its immediate risk reduction.
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Affiliation(s)
- D R Buis
- Dept. of Neurosurgery, Neurosurgical Center Amsterdam, VU University Medical Center, 2F-005, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Kubben PL, van Santbrink H, Spincemaille GHJJ, Vandertop WP. [Intraoperative MRI in brain surgery]. Ned Tijdschr Geneeskd 2007; 151:2877-2882. [PMID: 18257432] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Neuronavigation is a frequently used method in the planning of intracranial neurosurgical procedures. During surgery however, due to anatomical changes such as loss of cerebrospinal fluid, tumour resection and oedema, preoperative data become inaccurate. Updated data acquisition during the procedure using intraoperative MRI (iMRI) overcomes this problem, as it enables maximum tumour resection or accurate tumour biopsy, whilst minimizing the risk of damaging healthy brain tissue. The choice between low field and high field strength systems depends on the desired image quality and integration into the regular workflow. In spite of its high costs, iMRI surgery seems to be cost-effective, due to reduced length of hospital stay, reduced repeat resection, and reduced hospital charges. In the future, intraoperative imaging combined with virtual planning stations, is expected to play an important role in implementing robotization into neurosurgery.
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Affiliation(s)
- P L Kubben
- Academisch Ziekenhuis Maastricht, afd. Neurochirurgie, Postbus 5800, 6202 AZ Maastricht.
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Noske DP, van Royen BJ, Bron JL, Vandertop WP. Basilar impression in osteogenesis imperfecta: can it be treated with halo traction and posterior fusion? Acta Neurochir (Wien) 2006; 148:1301-5; discussion 1305. [PMID: 16969623 DOI: 10.1007/s00701-006-0870-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 02/17/2006] [Accepted: 07/03/2006] [Indexed: 10/24/2022]
Abstract
Basilar impression (BI) and hydrocephalus complicating osteogenesis imperfecta (OI) is usually treated by anterior transoral decompression and posterior fixation. Nevertheless, it may be questioned if posterior fusion following axial halo traction is adequate in patients with symptomatic BI complicating OI. We report on a case with progressive symptomatic hydrocephalus and BI complicating OI that was successfully treated by halo traction followed by posterior occipitocervical fusion. However, after a symptom free interval of 2 years the patient suffered from recurrence of symptomatic hydrocephalus needing additional ventriculoperitoneal (VP) shunt placement. In conclusion, posterior fusion without additional VP shunt placement may not be effective in the long term for ameliorating symptoms and signs and halting progressive hydrocephalus in BI complicating OI.
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Affiliation(s)
- D P Noske
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands
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Buis DR, van Ouwerkerk WJR, Takahata H, Vandertop WP. Intracranial aneurysms in children under 1 year of age: a systematic review of the literature. Childs Nerv Syst 2006; 22:1395-409. [PMID: 16807726 DOI: 10.1007/s00381-006-0142-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Intracranial aneurysms are very rare in early childhood. Because the location, morphology as well as the clinical and radiological presentation of these aneurysms seem to be different from those in adults, we performed a systematic review of the literature to discuss the clinical, morphological, and radiological features of intracranial aneurysms in the first year of life. MATERIALS AND METHODS A computerized search of both Pubmed and EMBASE from before 1966 to 2005 was performed. Included were all articles that dealt with cases in which an intracranial aneurysm was demonstrated in children under 1 year of age. RESULTS We found 110 articles in which 131 cases of an intracranial aneurysm in children under 1 year were presented. The mean age at diagnosis of the aneurysm was 4.9+/-3.5 months with a male to female ratio of 1.1. There was a hemorrhagic presentation in 73% (n=96). The patients presenting with a hemorrhage were younger (mean 4.3 vs 6.7 months, P<0.001) and tended to have smaller-sized (i.e.<2.5 cm) aneurysms (P=0.07). The aneurysm was defined as traumatic or infectious in 15 and 13 cases, respectively. In 21% (n=27), there was various vascular or congenital co-morbidity. In 76%, the aneurysm was located in the anterior circulation. The prevalence of aneurysms on the middle cerebral artery (MCA) was nearly three times higher than on any other vessel. The mean aneurysm size was 1.8+/-1.4 cm, with 30 giant aneurysms (>2.5 cm). The giant aneurysms were significantly more often located in the posterior circulation (43 vs 16%, P=0.01). The mean period of follow-up was 13.6+/-24.8 months. The Glasgow Outcome Scale (GOS) could be derived in 106 cases: 50% had an excellent outcome (GOS of 5). CONCLUSIONS The presentation of arterial aneurysms in children under the age of 1 year differs from that in adults with a significantly higher prevalence of giant aneurysms in the posterior circulation. The prevalence of aneurysms on the MCA is nearly three times higher than on any other vessel. The patients presenting with a hemorrhage were younger and tended to have smaller-sized aneurysms. Our study did not confirm the male predominance that has thus far been associated with pediatric aneurysms. The outcome is comparable or slightly better than in adults.
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Affiliation(s)
- D R Buis
- Department of Pediatric Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands.
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Buis DR, Dirven CMF, van den Berg R, Manoliu RA, Vandertop WP. Air in the carotid canal as a predictor of distal internal carotid artery laceration. Acta Neurochir (Wien) 2006; 148:1201-3; discussion 1203. [PMID: 17031471 DOI: 10.1007/s00701-006-0900-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 08/16/2006] [Indexed: 11/24/2022]
Abstract
The authors describe a 25-year old patient with blunt trauma-induced bilateral, distal segment internal carotid artery (ICA) lacerations, resulting in a left-sided direct carotid-cavernous sinus fistula (CCF) and presenting with massive oronasal bleeding. The combination of severe oronasal bleeding, with air in the carotid canal should alarm the treating physician to the presence of a distal internal carotid artery laceration.
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MESH Headings
- Accidents, Traffic
- Adult
- Bicycling
- Carotid Artery Injuries/diagnosis
- Carotid Artery Injuries/etiology
- Carotid Artery, Internal/pathology
- Carotid Artery, Internal/physiopathology
- Cavernous Sinus/diagnostic imaging
- Cavernous Sinus/injuries
- Cavernous Sinus/pathology
- Central Nervous System Vascular Malformations/diagnosis
- Central Nervous System Vascular Malformations/etiology
- Central Nervous System Vascular Malformations/physiopathology
- Cerebral Angiography
- Embolism, Air/diagnosis
- Embolism, Air/etiology
- Embolism, Air/physiopathology
- Embolization, Therapeutic
- Epistaxis/etiology
- Facial Bones/diagnostic imaging
- Facial Bones/injuries
- Facial Bones/pathology
- Fatal Outcome
- Head Injuries, Closed/complications
- Humans
- Lacerations/diagnosis
- Lacerations/etiology
- Lacerations/physiopathology
- Male
- Mouth/physiopathology
- Paranasal Sinuses/diagnostic imaging
- Paranasal Sinuses/injuries
- Paranasal Sinuses/pathology
- Predictive Value of Tests
- Skull Base/diagnostic imaging
- Skull Base/injuries
- Skull Base/pathology
- Skull Fracture, Basilar/diagnostic imaging
- Skull Fracture, Basilar/etiology
- Skull Fracture, Basilar/pathology
- Tomography, X-Ray Computed
- Treatment Failure
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Affiliation(s)
- D R Buis
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands.
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Vandertop WP. Short-term dexamethasone treatment. Childs Nerv Syst 2006; 22:102. [PMID: 16378225 DOI: 10.1007/s00381-005-1275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Indexed: 10/25/2022]
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