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Petridis AK, Foinitsis S, Karataglis D, Karapavlos C, Doukas A, Kogias E. Traumatic carotid cavernous fistulas. Rare and life threatening. Trauma Case Rep 2023; 47:100884. [PMID: 37592956 PMCID: PMC10429264 DOI: 10.1016/j.tcr.2023.100884] [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] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Abstract
Purpose Carotid-cavernous fistulas (CCFs) are often underdiagnosed or misdiagnosed. In polytraumatized patients, the focus is primarily on treating potentially life-threatening conditions such as increased intracranial pressure and hemorrhages. This case report aims to identify common diagnostic mistakes in rare pathologies. Objective We present a case of a young female patient who was admitted to the emergency room after a motorbike accident. The patient's vital parameters were successfully stabilized, and she spent approximately four weeks in the ICU and neurosurgical ward. The patient exhibited limited communication, ophthalmoplegia, and a swollen, red left eye. After four weeks, the patient's parents initiated admission to our department due to the suspicious red swollen eye. Angiography revealed a complete rupture of the internal carotid artery (ICA) into the cavernous sinus, and occlusion of the ICA showed significant improvement in the eye edema and the patient's mental state. Two days later, the patient was able to communicate with complex sentences. Three months after the occlusion, the patient showed positive progress, posting dancing videos on TikTok. Conclusion and Importance A carotid-cavernous fistula presenting with a red swollen eye can be misdiagnosed as retrobulbar hematoma or conjunctivitis. Failure to recognize and treat it promptly can lead to severe morbidity.
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Affiliation(s)
- Athanasios K. Petridis
- St. Luke's Hospital, Thessaloniki, Greece
- Heinrich Heine University, Duesseldorf, Germany
- Yaounde General Hospital, Yaounde, Cameroon
| | - Stefanos Foinitsis
- St. Luke's Hospital, Thessaloniki, Greece
- Aristotle University Thessaloniki, Medical School, Greece
| | | | | | - Alexandros Doukas
- Department of Neurosurgery, University Clinics Schleswig Holstein, Campus Kiel, Germany
| | - Evangelos Kogias
- St. Luke's Hospital, Thessaloniki, Greece
- Aristotle University Thessaloniki, Medical School, Greece
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Trakolis L, Petridis AK. Interdisciplinary Therapeutic Approaches to Atypical and Malignant Meningiomas. Cancers (Basel) 2023; 15:4251. [PMID: 37686527 PMCID: PMC10486693 DOI: 10.3390/cancers15174251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Meningiomas have the highest incidence among brain tumors. In contrast to benign tumors that constitute the majority of this tumor entity, the treatment of aggressive meningiomas (WHO Grade 2 and 3) is more challenging, requiring gross total removal of the tumor and the affected dura and adjuvant radiotherapy. Sometimes the location and/or the configuration of the tumor do not favor radical surgical resection without endangering the patient's clinical condition after surgery and pharmacological therapy has, until now, not been proven to be a reliable alternative. Discussion: In this narrative review, we discuss the current literature with respect to the management of meningiomas, discussing the importance of the grade of resection in the overall prognosis of the patient and in the planning of adjuvant therapy. Conclusions: According to the location and size of the tumor, radical resection should be taken into consideration. In patients with aggressive meningiomas, adjuvant radiotherapy should be performed after surgery. In cases of skull base meningiomas, a maximal, though safe, resection should take place before adjuvant therapy. An interdisciplinary approach is beneficial for patients with primary or recurrent meningioma.
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Affiliation(s)
- Leonidas Trakolis
- Department of Neurosurgery, Agios Loukas Clinic Thessaloniki, 55236 Thessaloniki, Greece;
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Siebert HC, Eckert T, Bhunia A, Klatte N, Mohri M, Siebert S, Kozarova A, Hudson JW, Zhang R, Zhang N, Li L, Gousias K, Kanakis D, Yan M, Jiménez-Barbero J, Kožár T, Nifantiev NE, Vollmer C, Brandenburger T, Kindgen-Milles D, Haak T, Petridis AK. Blood pH Analysis in Combination with Molecular Medical Tools in Relation to COVID-19 Symptoms. Biomedicines 2023; 11:biomedicines11051421. [PMID: 37239092 DOI: 10.3390/biomedicines11051421] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
The global outbreak of SARS-CoV-2/COVID-19 provided the stage to accumulate an enormous biomedical data set and an opportunity as well as a challenge to test new concepts and strategies to combat the pandemic. New research and molecular medical protocols may be deployed in different scientific fields, e.g., glycobiology, nanopharmacology, or nanomedicine. We correlated clinical biomedical data derived from patients in intensive care units with structural biology and biophysical data from NMR and/or CAMM (computer-aided molecular modeling). Consequently, new diagnostic and therapeutic approaches against SARS-CoV-2 were evaluated. Specifically, we tested the suitability of incretin mimetics with one or two pH-sensitive amino acid residues as potential drugs to prevent or cure long-COVID symptoms. Blood pH values in correlation with temperature alterations in patient bodies were of clinical importance. The effects of biophysical parameters such as temperature and pH value variation in relation to physical-chemical membrane properties (e.g., glycosylation state, affinity of certain amino acid sequences to sialic acids as well as other carbohydrate residues and lipid structures) provided helpful hints in identifying a potential Achilles heel against long COVID. In silico CAMM methods and in vitro NMR experiments (including 31P NMR measurements) were applied to analyze the structural behavior of incretin mimetics and SARS-CoV fusion peptides interacting with dodecylphosphocholine (DPC) micelles. These supramolecular complexes were analyzed under physiological conditions by 1H and 31P NMR techniques. We were able to observe characteristic interaction states of incretin mimetics, SARS-CoV fusion peptides and DPC membranes. Novel interaction profiles (indicated, e.g., by 31P NMR signal splitting) were detected. Furthermore, we evaluated GM1 gangliosides and sialic acid-coated silica nanoparticles in complex with DPC micelles in order to create a simple virus host cell membrane model. This is a first step in exploring the structure-function relationship between the SARS-CoV-2 spike protein and incretin mimetics with conserved pH-sensitive histidine residues in their carbohydrate recognition domains as found in galectins. The applied methods were effective in identifying peptide sequences as well as certain carbohydrate moieties with the potential to protect the blood-brain barrier (BBB). These clinically relevant observations on low blood pH values in fatal COVID-19 cases open routes for new therapeutic approaches, especially against long-COVID symptoms.
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Affiliation(s)
- Hans-Christian Siebert
- RI-B-NT-Research Institute of Bioinformatics and Nanotechnology, Schauenburgerstr. 116, 24118 Kiel, Germany
| | - Thomas Eckert
- Department of Chemistry and Biology, University of Applied Sciences Fresenius, Limburger Str. 2, 65510 Idstein, Germany
- RISCC-Research Institute for Scientific Computing and Consulting, Ludwig-Schunk-Str. 15, 35452 Heuchelheim, Germany
- Institut für Veterinärphysiologie und Biochemie, Fachbereich Veterinärmedizin, Justus-Liebig Universität Gießen, Frankfurter Str. 100, 35392 Gießen, Germany
| | - Anirban Bhunia
- Department of Biophysics, Bose Institute, P-1/12 CIT Scheme VII (M), Kolkata 700054, India
| | - Nele Klatte
- Department of Chemistry and Biology, University of Applied Sciences Fresenius, Limburger Str. 2, 65510 Idstein, Germany
| | - Marzieh Mohri
- RI-B-NT-Research Institute of Bioinformatics and Nanotechnology, Schauenburgerstr. 116, 24118 Kiel, Germany
| | - Simone Siebert
- RI-B-NT-Research Institute of Bioinformatics and Nanotechnology, Schauenburgerstr. 116, 24118 Kiel, Germany
| | - Anna Kozarova
- Department of Biomedical Sciences, University of Windsor, Windsor, ON N9B 3P4, Canada
| | - John W Hudson
- Department of Biomedical Sciences, University of Windsor, Windsor, ON N9B 3P4, Canada
| | - Ruiyan Zhang
- Institute of BioPharmaceutical Research, Liaocheng University, Liaocheng 252059, China
| | - Ning Zhang
- Institute of BioPharmaceutical Research, Liaocheng University, Liaocheng 252059, China
| | - Lan Li
- Klinik für Neurochirurgie, Alfried Krupp Krankenhaus, Rüttenscheid, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Konstantinos Gousias
- Klinik für Neurochirurgie, Klinikum Lünen, St.-Marien-Hospital, Akad. Lehrkrankenhaus der Westfälische Wilhelms-Universität Münster, 44534 Lünen, Germany
| | - Dimitrios Kanakis
- Institute of Pathology, University of Nicosia Medical School, 2408 Egkomi, Cyprus
| | - Mingdi Yan
- Department of Chemistry, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA 01854, USA
| | | | - Tibor Kožár
- Center for Interdisciplinary Biosciences, Technology and Innovation Park, P. J. Šafárik University, Jesenná 5, 04001 Košice, Slovakia
| | - Nikolay E Nifantiev
- Laboratory of Glycoconjugate Chemistry, N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia
| | - Christian Vollmer
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Timo Brandenburger
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Thomas Haak
- Diabetes Klinik Bad Mergentheim, Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
| | - Athanasios K Petridis
- Medical School, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany
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Petridis AK, Fischer I, Maslehaty H. Association of aneurysmatic subarachnoid hemorrhage rate with environmental changes or emotional bursts. Chin Neurosurg J 2023; 9:8. [PMID: 37004110 PMCID: PMC10067275 DOI: 10.1186/s41016-023-00322-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION In the present letter we share the results of an analysis of more than 140,000 non traumatic arterial subarachnoid hemorrhages whereas the majority of them is expected to be after aneurysm rupture, in which we investigate a possible correlation of climatic changes and emotional bursts as correlating factors for such a rupture. METHODS We obtained the daily number of SAH from 2006 to 2018 for males and females from the German National statistics agency. The ICD codes provided to us were I60.1-I60.7, which are SAHs originating from intracranial arteries and excluding traumatic SAH and other not specified SAH. RESULTS An increase of mean SAH per day could be seen in winter compared to summer and family events seemed to have a protective effect against aneurysmal SAH. Additionally 6.55 more women per day suffer an SAH compared to men. CONCLUSION There is a statistical significant higher risk of aneurysm ruptures in winter and in females, and a statistical lower number in Mother's day.
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Affiliation(s)
- Athanasios K Petridis
- Heinrich Heine University, Medical School, Dusseldorf, Germany.
- Department of Neurosurgery, St. Luke Hospital, Thessaloniki, Greece.
| | - Igor Fischer
- Informatics and Data Science, Department of Neurosurgery, Heinrich Heine University, Moorenstr. 5, 40225, Dusseldorf, Germany
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Wetzel-Yalelis A, Karadag C, Li L, Turowski B, Bostelmann R, Abusabha Y, Hofmann BB, Gousias K, Agrawal R, König M, Kaiser M, Mijderwijk HJ, Petridis AK. The rupture of an anterior communicating artery aneurysm does not associate with an asymmetry in the A1 or A2 arteries: a retrospective study of radiological features. Br J Neurosurg 2021:1-6. [PMID: 34933612 DOI: 10.1080/02688697.2021.2016624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/24/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Although the formation and rupture risk of an anterior communicating artery (ACoA) aneurysm has been the subject of many studies, no previous study has primarily searched for the relationship of the parent and daughter vessels and the impact of their size/diameter ratio on the potential rupture risk of an AcoA aneurysm. The objective of this study is to explore this link and to further analyse the surrounding vasculature of the anterior communicating artery aneurysm. MATERIALS AND METHODS We conducted a retrospective analysis of 434 patients: 284 patients with an ACoA aneurysm (121 unruptured and 162 ruptured) and 150 control patients without an ΑCoA aneurysm. Radiological angiography investigations were used to assess the diameter ratios of the parent vessels in addition to ACoA aneurysm morphology parameters. RESULTS When comparing the ruptured to the unruptured cases, we observed no significant difference in the parent or daughter vessel diameter ratios. Younger patient age (OR 0.96, p = 0.00) and a higher aneurysm size ratio (OR 1.10, p = 0.02) were of prognostic importance concerning the rupture risk of the aneurysm. The A1 diameter ratio and the A2 diameter were not statistically significant (OR 1.00, p = 0.99, and OR 3.38, p = 0.25 respectively). CONCLUSIONS In our study, we focused on asymmetry in the parent and daughter vessels as well as traditional ACoA aneurysm morphological characteristics. We were able to label younger patient age and a greater size ratio as independent prognostic factors for ACoA aneurysm rupture. We were unable to label parent and daughter vessel asymmetry as prognostic factors. To validate our findings, parent and daughter vessel asymmetry should be subjected to future prospective studies.
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Affiliation(s)
| | - Cihat Karadag
- Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Lan Li
- Department of Neurosurgery, Alfried Krupp Hospital, Essen, Germany
| | - Bernd Turowski
- Medical Faculty, Department of Diagnostic and Interventional Radiology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Richard Bostelmann
- Department of Neurosurgery, Christliches Krankenhaus Quakenbrück gemeinnützige GmbH, Quakenbrück, Germany
| | - Yousef Abusabha
- Medical Faculty, Department of Neurosurgery, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Björn B Hofmann
- Medical Faculty, Department of Neurosurgery, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | | | - Rachit Agrawal
- Department of Neurosurgery, St. Marien Hospital, Luenen, Germany
| | - Matthias König
- Department of Diagnostic and Interventional Radiology and Neuroradiology, St. Marien Hospital, Luenen, Germany
| | - Marga Kaiser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, St. Marien Hospital, Luenen, Germany
| | - Hendrik-Jan Mijderwijk
- Medical Faculty, Department of Neurosurgery, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Athanasios K Petridis
- Medical Faculty, Department of Neurosurgery, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
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Eckert T, von Cosel J, Kamps B, Siebert HC, Zhang R, Zhang N, Gousias K, Petridis AK, Kanakis D, Falahati K. Evidence for Quantum Chemical Effects in Receptor-Ligand Binding Between Integrin and Collagen Fragments - A Computational Investigation With an Impact on Tissue Repair, Neurooncolgy and Glycobiology. Front Mol Biosci 2021; 8:756701. [PMID: 34869589 PMCID: PMC8637888 DOI: 10.3389/fmolb.2021.756701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
The collagen-integrin interactions are mediated by the doubly charged Mg2+ cation. In nature this cation seems to have the optimal binding strength to stabilize this complex. It is essential that the binding is not too weak so that the complex becomes unstable, however, it is also of importance that the ligand-receptor binding is still labile enough so that the ligand can separate from the receptor in a suited environment. In the case of crystal growing for experimentally useful integrin-collagen fragment complexes it turned out that Co2+ cations are ideal mediators to form stable complexes for such experiments. Although, one can argue that Co2+ is in this context an artificial cation, however, it is now of special interest to test the impact of this cation in cell-culture experiments focusing on integrin-ligand interactions. In order to examine, in particular, the role cobalt ions we have studied a Co2+ based model system using quantum chemical calculations. Thereby, we have shown that hybrid and long-range corrected functional, which are approximations provide already a sufficient level of accuracy. It is of interest to study a potential impact of cations on the binding of collagen-fragments including collagens from various species because different integrins have numerous biological functions (e.g. Integrin - NCAM (Neural cell adhesion molecule) interactions) and are triggered by intact and degraded collagen fragments. Since integrin-carbohydrate interactions play a key role when bio-medical problems such as tumor cell adhesion and virus-host cell infections have to be addressed on a sub-molecular level it is essential to understand the interactions with heavy-metal ions also at the sub-atomic level. Our findings open new routes, especially, in the fields of tissue repair and neuro-oncology for example for cell-culture experiments with different ions. Since Co2+ ions seem to bind stronger to integrin than Mg2+ ions it should be feasible to exchange these cations in suited tumor tissues although different cations are present in other metalloproteins which are active in such tissues. Various staining methods can be applied to document the interactions of integrins with carbohydrate chains and other target structures. Thereby, it is possible to study a potential impact of these interactions on biological functions. It was therefore necessary to figure out first which histological-glycobiological experimental settings of tumor cells are suited for our purpose. Since the interactions of several metalloproteins (integrin, ADAM12) with polysialic acid and the HNK-1 epitope play a crucial role in tumor tissues selected staining methods are proper tools to obtain essential information about the impact of the metal ions under study.
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Affiliation(s)
- Thomas Eckert
- RISCC Research Institute for Scientific Computing and Consulting, Heuchelheim, Germany
- Institut für Veterinärphysiologie und Biochemie, Fachbereich Veterinärmedizin, Justus-Liebig- Universität Gießen, Gießen, Germany
- Fachbereich Biologie und Chemie, Hochschule Fresenius University of Applied Sciences, Idstein, Germany
| | - Jan von Cosel
- RISCC Research Institute for Scientific Computing and Consulting, Heuchelheim, Germany
| | - Benedict Kamps
- RISCC Research Institute for Scientific Computing and Consulting, Heuchelheim, Germany
- Fachbereich Biologie und Chemie, Hochschule Fresenius University of Applied Sciences, Idstein, Germany
| | | | - Ruiyan Zhang
- RI-B-NT Research Institute of Bioinformatics and Nanotechnology, Kiel, Germany
- Institute of BioPharmaceutical Research, Liaocheng University, Liaocheng, China
| | - Ning Zhang
- RI-B-NT Research Institute of Bioinformatics and Nanotechnology, Kiel, Germany
- Institute of BioPharmaceutical Research, Liaocheng University, Liaocheng, China
| | - Konstantinos Gousias
- Klinik für Neurochirurgie, Klinikum Lünen, St.-Marien-Hospital, Akad. Lehrkrankenhaus der Westf. Wilhelms-Universität Münster, Lünen, Germany
| | | | - Dimitrios Kanakis
- Institute of Pathology, University of Nicosia Medical School, Nicosia, Cyprus
| | - Konstantin Falahati
- RISCC Research Institute for Scientific Computing and Consulting, Heuchelheim, Germany
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Behle B, Beseoglu K, Beez T, Petridis AK, Fischer I, Hänggi D, Steiger HJ. Profile and Prognosis of Spontaneous Lobar Intracerebral Hemorrhage: Comparison of 6-month Survival with STICH II and the MISTIE III Lobar Hemorrhage Subset. J Neurol Surg A Cent Eur Neurosurg 2021; 83:20-26. [PMID: 34030185 DOI: 10.1055/s-0041-1725957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Randomized trials on spontaneous lobar intracerebral hemorrhage (ICH) provided no convincing evidence of the superiority of surgical treatment. Since recruitment in the trials was under the premise of equipoise, a selection bias toward patients who did not need surgery or were in hopeless condition must be suspected. The aim of the actual analysis was to compare outcome and patient profile of an unselected hospital series with recent randomized trials and to develop a prognostic model. METHODS Of 821 patients with spontaneous ICH managed at the neurosurgical department of the University Hospital Düsseldorf between 2013 and 2018, 159 had lobar bleedings. Patient characteristics, hematoma volume, treatment modality, and 6-month survival were compared with STICH II and the subset of lobar hemorrhage in the MISTIE III trial. In addition, a prognostic model for 6-month survival in our patients was developed using a random forest classifier. RESULTS One hundred and seven patients were managed by surgical evacuation of the hematoma and 52 without surgical evacuation. Median hemorrhage volume in our surgical cohort was 66 and 42 mL in the conservative cohort, compared with 38 and 36 mL in the STICH II trial, and 46 and 47 mL in the surgical and conservative MISTIE III lobar hemorrhage subset. Median initial Glasgow Coma Scale (GCS) score was 12 in our surgical group and 11 in the conservative group, compared with 13 in the STICH II cohorts and 12 in the MISTIE III lobar hemorrhage subset. Median age in our surgical and conservative cohorts was 73 and 74 years, respectively, compared with 65 years in both STICH II cohorts and 68 years in the MISTIE II subsets. Twenty-nine percent of our surgical cohort and 55% of our conservatively managed patients deceased within the first 6 months, compared with 18 and 24%, respectively, in STICH II and 17 and 24% in the MISTIE III subset. Our prognostic model identified large hemorrhage volumes and low admission GCS score as main unfavorable prognostic factors for 6-month survival. The random forest classifier achieved a predictive accuracy of 78% and an area under curve (AUC)- value of 88% regarding survival at 6 months, on a test set independent of the training set. CONCLUSIONS In comparison with our surgical group, the STICH II and MISTIE III cohorts, recruited under the premise of physician equipoise, underrepresented patients with large ICHs. The cohorts in the randomized trials were therefore biased toward patients with a favorable perspective under conservative management. Initial hematoma volume and admission GCS were the main prognostic factors in our patients.
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Affiliation(s)
- Berthold Behle
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | - Kerim Beseoglu
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | - Thomas Beez
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Igor Fischer
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
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Zhang N, Liu C, Zhang R, Jin L, Yin X, Zheng X, Siebert HC, Li Y, Wang Z, Loers G, Petridis AK. Amelioration of clinical course and demyelination in the cuprizone mouse model in relation to ketogenic diet. Food Funct 2021; 11:5647-5663. [PMID: 32539054 DOI: 10.1039/c9fo02944c] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ketogenic diet (KD) is defined as a high-fat, low-carbohydrate diet with appropriate amounts of protein, which has broad neuroprotective effects. However, the mechanisms of ameliorating the demyelination and of the neuroprotective effects of KD have not yet been completely elucidated. Therefore, the present study investigated the protection mechanism of KD treatment in the cuprizone (bis-cyclohexanone oxalydihydrazone, CPZ)-induced demyelination mice model, with special emphasis on neuroinflammation. After the KD treatment, an increased ketone body level in the blood of mice was detected, and a significant increase in the distance traveled within the central area was observed in the open field test, which reflected the increased exploration and decreased anxiety of mice that received CPZ. The results of Luxol fast blue and myelin basic protein (MBP) immunohistochemistry staining for the evaluation of the myelin content within the corpus callosum revealed a noticeable increase in the number of myelinated fibers and myelin score after KD administration in these animals. Concomitant, the protein expressions of glial fibrillary acidic protein (GFAP, an astrocyte marker), ionized calcium-binding adaptor molecule 1 (Iba-1, a microglial marker), CD68 (an activated microglia marker) and CD16/32 (a M1 microglial marker) were down-regulated, while the expression of oligodendrocyte lineage transcription factor 2 (OLIG2, an oligodendrocyte precursor cells marker) was up-regulated by the KD treatment. In addition, the KD treatment not only reduced the level of the C-X-C motif chemokine 10 (CXCL10), which is correlated to the recruitment of activated microglia, but also inhibited the production of proinflammatory cytokines, including interleukin 1β (IL-1β) and tumor necrosis factor-α (TNF-α), which are closely correlated to the M1 phenotype microglia. It is noteworthy, that the expression levels of histone deacetylase 3 (HADC3) and nod-like receptor pyrin domain containing 3 (NLRP3) significantly decreased after KD administration. In conclusion, these data demonstrate that KD decreased the reactive astrocytes and activated the microglia in the corpus callosum, and that KD inhibited the HADC3 and NLRP3 inflammasome signaling pathway in CPZ-treated mice. This suggests that the inhibition of the HADC3 and NLRP3 signaling pathway may be a novel mechanism by which KD exerts its protective actions for the treatment of demyelinating diseases.
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Affiliation(s)
- Ning Zhang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China.
| | - Chunhong Liu
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China.
| | - Ruiyan Zhang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China.
| | - Li Jin
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China.
| | - Xiaohan Yin
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China.
| | - Xuexing Zheng
- Department of Virology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.
| | - Hans-Christian Siebert
- RI-B-NT - Research Institute of Bioinformatics and Nanotechnology, Schauenburgerstr. 116, 24118 Kiel, Germany
| | - Yubao Li
- College of agriculture, Liaocheng University, Liaocheng, Shandong 252000, China
| | - Zhengping Wang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China.
| | - Gabriele Loers
- Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf, University of Hamburg, Falkenried 94, 20251 Hamburg, Germany
| | - Athanasios K Petridis
- Neurosurgical Department, Heinrich Heine University of Düsseldorf, Moorenstraße 5, 40255 Düsseldorf, Germany
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Li L, Hofmann BB, Fischer I, Donaldson DM, Engel A, Karadag C, Wetzel-Yalelis A, Piedade GS, Mijderwijk HJ, Bostelmann R, Kaschner MG, Muhammad S, Hänggi D, Cornelius JF, Petridis AK. Asymmetry of P1 and vertebral arteries is not related to basilar tip aneurysm development or rupture. Acta Neurochir (Wien) 2021; 163:805-812. [PMID: 33025090 PMCID: PMC7886757 DOI: 10.1007/s00701-020-04593-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Lately, morphological parameters of the surrounding vasculature aside from aneurysm size, specific for the aneurysm location, e.g., posterior cerebral artery angle for basilar artery tip aneurysms, could be identified to correlate with the risk of rupture. We examined further image-based morphological parameters of the aneurysm surrounding vasculature that could correlate with the growth or the risk of rupture of basilar artery tip aneurysms. METHODS Data from 83 patients with basilar tip aneurysms (27 not ruptured; 56 ruptured) and 100 control patients were assessed (50 without aneurysms and 50 with aneurysms of the anterior circle of Willis). Anatomical parameters of the aneurysms were assessed and analyzed, as well as of the surrounding vasculature, namely the asymmetry of P1 and the vertebral arteries. RESULTS Patients with basilar tip aneurysm showed no significant increase in P1 or vertebral artery asymmetry compared with the control patients or patients with aneurysms of the anterior circulation, neither was there a significant difference in asymmetry between cases with ruptured and unruptured aneurysms. Furthermore, we observed no significant correlations between P1 asymmetry and the aneurysm size or number of lobuli in the aneurysms. CONCLUSION We observed no significant difference in aneurysm size, rupture, or lobulation associated with P1 or vertebral artery (surrounding vasculature) asymmetry. Therefore, the asymmetry of the surrounding vessels does not seem to be a promising morphological parameter for the evaluation of probability of rupture and growth in basilar tip aneurysms in future studies.
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Zhang N, Jin L, Liu C, Zhang R, Siebert HC, Li Y, Loers G, Petridis AK, Xia Z, Dong H, Zheng X. An antarctic krill oil-based diet elicits neuroprotective effects by inhibiting oxidative stress and rebalancing the M1/M2 microglia phenotype in a cuprizone model for demyelination. J Funct Foods 2021. [DOI: 10.1016/j.jff.2020.104309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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11
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Muhammad S, Petridis AK. Commentary: Subclavian Artery to Internal Carotid Artery Interpositional Bypass for Carotid Artery Occlusion: Technical Case Report. Oper Neurosurg (Hagerstown) 2020; 20:E72. [PMID: 32895717 DOI: 10.1093/ons/opaa273] [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] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 11/13/2022] Open
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12
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Steinmann J, Hartung B, Bostelmann R, Kaschner M, Husien MB, Karadag C, Li L, Steiger HJ, Petridis AK. Intracerebral aneurysm rupture due to head trauma. Forensic Science International: Reports 2020. [DOI: 10.1016/j.fsir.2020.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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13
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Liu C, Zhang N, Zhang R, Jin L, Petridis AK, Loers G, Zheng X, Wang Z, Siebert HC. Cuprizone-Induced Demyelination in Mouse Hippocampus Is Alleviated by Ketogenic Diet. J Agric Food Chem 2020; 68:11215-11228. [PMID: 32921051 DOI: 10.1021/acs.jafc.0c04604] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). Recently, ketogenic diet (KD) supplementation has attracted great interest. Therefore, we established the cuprizone (CPZ)-induced demyelination mouse model to investigate the possible neuroprotective effect of KD on the hippocampus of mice. We found that KD significantly elevated the level of serum β-hydroxybutyric acid, improved behavioral and motor abnormalities, and impaired the spatial learning and memory of CPZ-induced demyelination mice. Meanwhile, KD lessened the hippocampal demyelination by enhancing the expression of mature oligodendrocytes (OLs), which was revealed by the elevated expression of MBP and CNPase, as well as the luxol fast blue-staining intensity. Furthermore, KD inhibits the activation of microglia (especially M1-like microglia) and reactive astrocytes. Interestingly, KD attenuated the CPZ-induced oxidative stress by decreasing the malondialdehyde (MDA) content and restoring the glutathione (GSH) levels. In addition, the double immunofluorescence staining revealed that KD enhanced the expression of SIRT1 in astrocytes, microglia, and mature oligodendrocytes. Concomitantly, Western blot demonstrated that KD increased the expression of SIRT1, phosphorylated-AKT, mTOR, and PPAR-γ. In conclusion, KD exerted a neuroprotective effect on CPZ-induced demyelination mice, and this activity was associated with the modulation of the SIRT1/PPAR-γ and SIRT1/P-Akt/mTOR pathways.
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Affiliation(s)
- Chunhong Liu
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China
| | - Ning Zhang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China
| | - Ruiyan Zhang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China
| | - Li Jin
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China
| | - Athanasios K Petridis
- Heinrich Heine University, Neurosurgical Department, University of Düsseldorf, Moorenstraße 5, 40255 Düsseldorf, Germany
| | - Gabriele Loers
- Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf, University of Hamburg, Falkenried 94, 20251 Hamburg, Germany
| | - Xuexing Zheng
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China
| | - Zhengping Wang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, Shandong 252000, China
| | - Hans-Christian Siebert
- RI-B-NT-Research Institute of Bioinformatics and Nanotechnology, Schauenburgerstr. 116, 24118 Kiel, Germany
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14
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Steinmann J, Hartung B, Bostelmann R, Kaschner M, Karadag C, Muhammad S, Li L, Büttner A, Petridis AK. Rupture of intracranial aneurysms in patients with blunt head trauma: Review of the literature. Clin Neurol Neurosurg 2020; 199:106208. [PMID: 33069090 DOI: 10.1016/j.clineuro.2020.106208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION With a prevalence of 1-5 %, intracranial aneurysms are common. However, only 20-50 % of these aneurysms will rupture during a person's lifetime. This often happens spontaneously without exogenous factors. In the present study we reviewed the literature concerning the relation between trauma and rupture of a pre-existing aneurysm. METHODS All studies that reported a causal relation between trauma and rupture of a pre-existing aneurysm were included, irrespective of study design. They were limited though to those written in English or German. Excluded were studies with traumatic aneurysms, studies where the rupture of an aneurysm lead to trauma and studies with doubts about the order of events. RESULTS Thirteen studies with twenty-two cases of ruptured aneurysm in context with trauma and two unpublished cases were included. Fourteen patients were involved in a fight, seven patients in a bike/motorbike/bus accident and three got hit on the head in a setting outside of interpersonal violence. The aneurysm was located in internal carotid artery in most cases (7/24). The clear majority of patients (19/24) did not survive. CONCLUSION Arteries and aneurysms can rupture in context with head trauma although this is rarely the case. Patients after head trauma with typical blood pattern for aneurysmal SAH in the native CT scan should receive conventional angiography to exclude a vascular or aneurysmal rupture, even when CT-angiography is inconspicuous.
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Affiliation(s)
- Julia Steinmann
- Heinrich Heine University, Department of Neurosurgery, Duesseldorf, Germany.
| | - Benno Hartung
- Heinrich Heine University, Institute of Legal Medicine, Duesseldorf, Germany
| | - Richard Bostelmann
- Heinrich Heine University, Department of Neurosurgery, Duesseldorf, Germany
| | - Marius Kaschner
- University Duesseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany
| | - Cihat Karadag
- Heinrich Heine University, Department of Neurosurgery, Duesseldorf, Germany
| | - Sajjad Muhammad
- Heinrich Heine University, Department of Neurosurgery, Duesseldorf, Germany
| | - Lan Li
- Evangelisches Klinikum Niederrhein, Department of Neurosurgery, Duisburg, Germany
| | - Andreas Büttner
- Rostock University Medical Center, Institute of Legal Medicine, Rostock, Germany
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15
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Khan MO, Toro Arana V, Rubbert C, Cornelius JF, Fischer I, Bostelmann R, Mijderwijk HJ, Turowski B, Steiger HJ, May R, Petridis AK. Association between aneurysm hemodynamics and wall enhancement on 3D vessel wall MRI. J Neurosurg 2020; 134:565-575. [PMID: 31923894 DOI: 10.3171/2019.10.jns191251] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aneurysm wall enhancement (AWE) on 3D vessel wall MRI (VWMRI) has been suggested as an imaging biomarker for intracranial aneurysms (IAs) at higher risk of rupture. While computational fluid dynamics (CFD) studies have been used to investigate the association between hemodynamic forces and rupture status of IAs, the role of hemodynamic forces in unruptured IAs with AWE is poorly understood. The authors investigated the role and implications of abnormal hemodynamics related to aneurysm pathophysiology in patients with AWE in unruptured IAs. METHODS Twenty-five patients who had undergone digital subtraction angiography (DSA) and VWMRI studies from September 2016 to September 2017 were included, resulting in 22 patients with 25 IAs, 9 with and 16 without AWE. High-resolution CFD models of hemodynamics were created from DSA images. Univariate and multivariate analyses were performed to investigate the association between AWE and conventional morphological and hemodynamic parameters. Normalized MRI signal intensity was quantified and quantitatively associated with wall shear stresses (WSSs) for the entire aneurysm sac, and in regions of low, intermediate, and high WSS. RESULTS The AWE group had lower WSS (p < 0.01) and sac-averaged velocity (p < 0.01) and larger aneurysm size (p < 0.001) and size ratio (p = 0.0251) than the non-AWE group. From multivariate analysis of both hemodynamic and morphological factors, only low WSS was found to be independently associated with AWE. Sac-averaged normalized MRI signal intensity correlated with WSS and was significantly different in regions of low WSS compared to regions of intermediate (p = 0.018) and high (p < 0.001) WSS. CONCLUSIONS The presence of AWE was associated with morphological and hemodynamic factors related to rupture risk. Low WSS was found to be an independent predictor of AWE. Our findings support the hypothesis that low WSS in IAs with AWE may indicate a growth and remodeling process that may predispose such aneurysms to rupture; however, a causality between the two cannot be established.
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Affiliation(s)
- Muhammad Owais Khan
- 1Department of Pediatrics
- 2Institute for Computational and Mathematical Engineering, and
| | | | - Christian Rubbert
- 4Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Germany; and
| | | | - Igor Fischer
- 6Division of Informatics and Data Science, Department of Neurosurgery, University Hospital Düsseldorf, Germany
| | | | | | - Bernd Turowski
- 4Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Germany; and
| | | | - Rebecca May
- 4Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Germany; and
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16
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Dietrich C, van Lieshout J, Fischer I, Kamp MA, Cornelius JF, Tortora A, Steiger HJ, Petridis AK. Transcranial Doppler Ultrasound, Perfusion Computerized Tomography, and Cerebral Angiography Identify Different Pathological Entities and Supplement Each Other in the Diagnosis of Delayed Cerebral Ischemia. Acta Neurochir Suppl 2020; 127:155-160. [PMID: 31407077 DOI: 10.1007/978-3-030-04615-6_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION There is still controversial discussion of the value of transcranial Doppler (TCD) in predicting vasospasms in patients with aneurysmal SAH (aSAH). A newer method of predicting a delayed ischemic deficit (DCI) is CT perfusion (CTP), although it is not quite understood which kind of perfusion deficit is detected by this method since it seems to also identifying microcirculatory disturbances. We compared the TCD and CTP values with angiography and evaluated TCD and CTP changes before and after patients received intra-arterial spasmolytic therapy. MATERIAL AND METHODS Retrospective analysis of TCD, CTP, and angiographies of N = 77 patients treated from 2013 to 2016. In 38 patients intra-arterial spasmolysis had been performed, and in these cases TCD and CTP data were compared before and after lysis. Thirty-nine patients had a pathological CTP but no angiographically seen vasospasm. RESULTS There was no correlation between the known thresholds of mean transit time (MTT) in CTP and vasospasm or with mean velocities in TCD and vasospasm. After spasmolysis in patients with vasospasms, only the MTT showed significant improvement, whereas TCD velocities and Lindegaard index remained unaffected. CONCLUSION TCD and CTP seem to identify different pathological entities of DCI and should be used supplementary in order to identify as many patients as possible with vasospasms after aSAH.
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Affiliation(s)
- Caroline Dietrich
- Institute of Radiology, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Jasper van Lieshout
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Igor Fischer
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Jan F Cornelius
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Angelo Tortora
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Athanasios K Petridis
- Department of Neurosurgery, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
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17
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Zhang R, Zhang N, Mohri M, Wu L, Eckert T, Krylov VB, Antosova A, Ponikova S, Bednarikova Z, Markart P, Günther A, Norden B, Billeter M, Schauer R, Scheidig AJ, Ratha BN, Bhunia A, Hesse K, Enani MA, Steinmeyer J, Petridis AK, Kozar T, Gazova Z, Nifantiev NE, Siebert HC. Nanomedical Relevance of the Intermolecular Interaction Dynamics-Examples from Lysozymes and Insulins. ACS Omega 2019; 4:4206-4220. [PMID: 30847433 PMCID: PMC6398350 DOI: 10.1021/acsomega.8b02471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/28/2018] [Indexed: 06/01/2023]
Abstract
Insulin and lysozyme share the common features of being prone to aggregate and having biomedical importance. Encapsulating lysozyme and insulin in micellar nanoparticles probably would prevent aggregation and facilitate oral drug delivery. Despite the vivid structural knowledge of lysozyme and insulin, the environment-dependent oligomerization (dimer, trimer, and multimer) and associated structural dynamics remain elusive. The knowledge of the intra- and intermolecular interaction profiles has cardinal importance for the design of encapsulation protocols. We have employed various biophysical methods such as NMR spectroscopy, X-ray crystallography, Thioflavin T fluorescence, and atomic force microscopy in conjugation with molecular modeling to improve the understanding of interaction dynamics during homo-oligomerization of lysozyme (human and hen egg) and insulin (porcine, human, and glargine). The results obtained depict the atomistic intra- and intermolecular interaction details of the homo-oligomerization and confirm the propensity to form fibrils. Taken together, the data accumulated and knowledge gained will further facilitate nanoparticle design and production with insulin or lysozyme-related protein encapsulation.
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Affiliation(s)
- Ruiyan Zhang
- Institute
of Biopharmaceutical Research, Liaocheng
University, Liaocheng 252059, P. R. China
- RI-B-NT
Research Institute of Bioinformatics and Nanotechnology, Franziusallee 177, 24148 Kiel, Germany
- Institute
of Zoology, Department of Structural Biology, Christian-Albrechts-University, Am Botanischen Garten 1-9, 24118 Kiel, Germany
| | - Ning Zhang
- Institute
of Biopharmaceutical Research, Liaocheng
University, Liaocheng 252059, P. R. China
| | - Marzieh Mohri
- RI-B-NT
Research Institute of Bioinformatics and Nanotechnology, Franziusallee 177, 24148 Kiel, Germany
| | - Lisha Wu
- Department
of Chemical and Biological Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden
| | - Thomas Eckert
- Department
of Chemistry and Biology, University of
Applied Sciences Fresenius, Limburger Str. 2, 65510 Idstein, Germany
- Institut
für Veterinärphysiolgie und Biochemie, Fachbereich Veterinärmedizin, Justus-Liebig-Universität Gießen, Frankfurter Str. 100, 35392 Gießen, Germany
| | - Vadim B. Krylov
- Laboratory
of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky prospect 47, 119991 Moscow, Russian Federation
| | - Andrea Antosova
- Department
of Biophysics Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Slavomira Ponikova
- Department
of Biophysics Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Zuzana Bednarikova
- Department
of Biophysics Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Philipp Markart
- Medical
Clinic II, Justus-Liebig-University, Klinikstraße 33, 35392 Giessen, Germany
- Pneumology,
Heart-Thorax-Center Fulda, Pacelliallee 4, 36043 Fulda, Germany
| | - Andreas Günther
- Medical
Clinic II, Justus-Liebig-University, Klinikstraße 33, 35392 Giessen, Germany
| | - Bengt Norden
- Department
of Chemical and Biological Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden
| | - Martin Billeter
- Department
of Chemistry and Molecular Biology, University
of Gothenburg, 40530 Gothenburg, Sweden
| | - Roland Schauer
- Institute
of Biochemistry, Christian-Albrechts-University, Olshausenstrasse 40, 24098 Kiel, Germany
| | - Axel J. Scheidig
- Institute
of Zoology, Department of Structural Biology, Christian-Albrechts-University, Am Botanischen Garten 1-9, 24118 Kiel, Germany
| | - Bhisma N. Ratha
- Biomolecular
NMR and Drug Design Laboratory, Department of Biophysics, Bose Institute, P-1/12 CIT Scheme VII (M), 700054 Kolkata, India
| | - Anirban Bhunia
- Biomolecular
NMR and Drug Design Laboratory, Department of Biophysics, Bose Institute, P-1/12 CIT Scheme VII (M), 700054 Kolkata, India
| | - Karsten Hesse
- Tierarztpraxis
Dr. Karsten Hesse, Rathausstraße
16, 35460 Stauffenberg, Germany
| | - Mushira Abdelaziz Enani
- Infectious
Diseases Division, Department of Medicine, King Fahad Medical City, P.O. Box 59046, 11525 Riyadh, Kingdom of Saudi
Arabia
| | - Jürgen Steinmeyer
- Laboratory
for Experimental Orthopaedics, Department of Orthopaedics, Justus-Liebig-University, Paul-Meimberg-Str. 3, D-35392 Giessen, Germany
| | - Athanasios K. Petridis
- Neurochirurgische
Klinik, Universität Düsseldorf, Geb. 11.54, Moorenstraße 5, 40255 Düsseldorf, Germany
| | - Tibor Kozar
- Center
for Interdisciplinary Biosciences, TIP-UPJS, Jesenna 5, 04001 Kosice, Slovakia
| | - Zuzana Gazova
- Department
of Biophysics Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Nikolay E. Nifantiev
- Laboratory
of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky prospect 47, 119991 Moscow, Russian Federation
| | - Hans-Christian Siebert
- RI-B-NT
Research Institute of Bioinformatics and Nanotechnology, Franziusallee 177, 24148 Kiel, Germany
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Petridis AK, Kamp MA, Cornelius JF, Beez T, Beseoglu K, Turowski B, Steiger HJ. Aneurysmal Subarachnoid Hemorrhage. Dtsch Arztebl Int 2018; 114:226-236. [PMID: 28434443 DOI: 10.3238/arztebl.2017.0226] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 08/29/2016] [Accepted: 11/28/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) is associated with a mortality of more than 30%. Only about 30% of patients with SAB recover sufficiently to return to independent living. METHODS This article is based on a selective review of pertinent literature retrieved by a PubMed search. RESULTS Acute, severe headache, typically described as the worst headache of the patient's life, and meningismus are the characteristic manifestations of SAH. Computed tomog raphy (CT) reveals blood in the basal cisterns in the first 12 hours after SAH with approximately 95% sensitivity and specificity. If no blood is seen on CT, a lumbar puncture must be performed to confirm or rule out the diagnosis of SAH. All patients need intensive care so that rebleeding can be avoided and the sequelae of the initial bleed can be minimized. The immediate transfer of patients with acute SAH to a specialized center is crucially important for their outcome. In such centers, cerebral aneurysms can be excluded from the circulation either with an interventional endovascular procedure (coiling) or by microneurosurgery (clipping). CONCLUSION SAH is a life-threatening condition that requires immediate diagnosis, transfer to a neurovascular center, and treatment without delay.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, Düsseldorf University Hospital; Department of Diagnostic and Interventional Radiology, Düsseldorf University Hospital; Department of Diagnostic and Interventional Radiology, Düsseldorf University Hospital
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19
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Cornelius JF, Kamp MA, Tortora A, Knipps J, Krause-Molle Z, Beez T, Petridis AK, Sabel M, Schipper J, Steiger HJ. Surgery of Small Anterior Skull Base Meningiomas by Endoscopic 5-Aminolevulinic Acid Fluorescence Guidance: First Clinical Experience. World Neurosurg 2018; 122:e890-e895. [PMID: 30419399 DOI: 10.1016/j.wneu.2018.10.171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Minimally invasive surgery of small skull base meningiomas is technically challenging. We report the role of endoscopic 5-aminolevulinic acid fluorescence guidance (e-5-ALA-FGS) for small and deep-seated anterior skull base meningiomas. METHODS We report the cases of 2 patients. The first case was a small olfactory groove meningioma resected via a trans-eyebrow, subfrontal approach. The second case was a clinoid meningioma with invasion of the optic canal resected via a small frontolateral approach. Intraoperative documentation demonstrated the usefulness of 5-ALA endoscopy. In either case, residual fluorescing tumor tissue was detected. No complication was encountered. The clinical and radiological outcomes were good. No regrowth had occurred after 54 and 17 months of follow-up, respectively. RESULTS Residual meningioma tissue on the far side of a keyhole approach (e.g., in the olfactory groove or at the optic canal) can be difficult to visualize. Visualization can be improved by use of an endoscope. To date, fluorescence guidance with a microscope was limited by insufficient fluorescence signals in deep corridors. With a specially equipped 5-ALA fluorescence endoscope, one can combine the advantages of both endoscopic vision and fluorescence guidance. The results of present report have demonstrated the usefulness of 5-ALA endoscopy for difficult to visualize areas. CONCLUSION Endoscopic 5-ALA fluorescence guidance was shown to be feasible when resecting small and deep-seated skull base meningiomas via minimally invasive approaches. Based on this proof of principle, we encourage its evaluation for the middle or posterior fossa (e.g., internal auditory canal) and other difficult areas (e.g., behind neurovascular structures or the brainstem). The sensitivity and specificity of this method should be prospectively and systematically investigated.
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Affiliation(s)
- Jan Frederick Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
| | - Marcel A Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Angelo Tortora
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Johannes Knipps
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Zarela Krause-Molle
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Thomas Beez
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Athanasios K Petridis
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Jörg Schipper
- Department of Otorhinolaryngology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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20
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Vourla E, Filis A, Cornelius JF, Bostelmann R, Turowski B, Kalakoti P, Rubbert C, Suresh MP, Tortora A, Steiger HJ, Petridis AK. Natural History of De Novo Aneurysm Formation in Patients with Treated Aneurysmatic Subarachnoid Hemorrhage: A Ten-Year Follow-Up. World Neurosurg 2018; 122:e291-e295. [PMID: 30321678 DOI: 10.1016/j.wneu.2018.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND De novo aneurysm formation after completely occluded aneurysms via clipping or coiling has not been well studied. Although known to occur several years after initial aneurysm management, the natural history of de novo aneurysms is obscure. We investigated the formation of new aneurysms in patients who had previously undergone treatment of intracranial aneurysms. METHODS In a retrospective, single-institutional series, eligible patients who had undergone treatment of ruptured cerebral aneurysms from 2000 to 2011 were included. The primary outcome measure was the development of de novo aneurysms during long-term follow-up. RESULTS Overall, 130 patients (63% women) who had undergone microsurgical clipping (n = 63; 48.5%) or endovascular coiling (n = 67%; 51.5%) for ruptured aneurysms were included. The average follow-up time for our cohort was 10 ± 2.7 years. De novo aneurysms occurred in 10 of 130 patients (7.7%), with a mean time of 7.9 years for aneurysm detection. No association between the formation of de novo aneurysms and the location of the treated aneurysms, smoking status, hypertension, age, or gender was found. Follow-up imaging studies were performed every 2 years. De novo aneurysms had formed in 2 patients within 2-5 years, 7 patients after 5-10 years, and 1 patient after 10 years of follow-up. In 2 of 10 patients, the de novo aneurysm had ruptured and led to subarachnoid haemorrhage. CONCLUSION The rate of de novo aneurysm occurrence was 7.6%, with a mean time to development of 7.9 years. This underscores the significance of long-term monitoring of patients with intracranial aneurysms. In our series, most new aneurysms had occurred after 5 years of follow-up.
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Affiliation(s)
- Eleni Vourla
- Department of Neurosurgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Andreas Filis
- Department of Neurosurgery, imland Klinik Rendsburg, Rendsburg, Germany.
| | - Jan F Cornelius
- Department of Neurosurgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Richard Bostelmann
- Department of Neurosurgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Bernd Turowski
- Institute of Neuroradiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Piyush Kalakoti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Christian Rubbert
- Institute of Neuroradiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | | | - Angelo Tortora
- Department of Neurosurgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, University Hospital Duesseldorf, Duesseldorf, Germany
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Petridis AK, Filis A, Chasoglou E, Fischer I, Dibué-Adjei M, Bostelmann R, Steiger HJ, Turowski B, May R. Aneurysm wall enhancement in black blood MRI correlates with aneurysm size. Black blood MRI could serve as an objective criterion of aneurysm stability in near future. Clin Pract 2018; 8:1089. [PMID: 30101005 PMCID: PMC6068393 DOI: 10.4081/cp.2018.1089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/08/2018] [Accepted: 07/04/2018] [Indexed: 02/04/2023] Open
Abstract
The increasing number of incidental intracranial aneurysms creates a dilemma of which aneurysms to treat and which to observe. Clinical scoring systems consider risk factors for aneurysm rupture however objective parameters for assessment of aneurysms stability are needed. We retrospectively analysed contrast enhancing behaviour of un-ruptured aneurysms in the black blood magnetic resonance imaging (MRI) in N=71 patients with 90 aneurysms and assessed correlation between aneurysm wall contrast enhancement (AWCE) and aneurysm anatomy and clinical scoring systems. AWCE is associated with aneurysm height and height to width ratio in ICA aneurysms. AWCE is correlated to larger aneurysms in every anatomical location evaluated. However the mean size of the contrast enhancing aneurysms is significantly different between anatomical localizations indicating separate analyses for every artery. Clinical scoring systems like PHASES and UIATS correlate positively with AWCE in black blood MRI. MRI aneurysm wall contrast enhancement is a positive predictor for aneurysm instability and should be routinely assessed in follow up of incidental aneurysms. Aneurysms smaller than 7 mm with AWCE should be followed closely with focus on growth, as they may be prone to growth and rupture.
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Affiliation(s)
| | - Andreas Filis
- Department of Neurosurgery, Imland Hospital Rendsburg, Germany
| | - Elias Chasoglou
- Department of Neurosurgery, Heinrich Heine University Duesseldorf, Germany
| | - Igor Fischer
- Division of Informatics and Data Science, Department of Neurosurgery, University Hospital Duesseldorf, Germany
| | - Maxine Dibué-Adjei
- Department of Neurosurgery, Heinrich Heine University Duesseldorf, Germany
- LivaNova Deutschland GmbH (a LivaNova PLC-owned subsidiary), Munich, Germany
| | - Richard Bostelmann
- Department of Neurosurgery, Heinrich Heine University Duesseldorf, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, Heinrich Heine University Duesseldorf, Germany
| | - Bernd Turowski
- Diagnostic and Interventional Neuroradiology, Heinrich Heine University Duesseldorf, Germany
| | - Rebecca May
- Diagnostic and Interventional Neuroradiology, Heinrich Heine University Duesseldorf, Germany
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van Lieshout JH, Pumplün I, Fischer I, Kamp MA, Cornelius JF, Steiger HJ, Boogaarts HD, Petridis AK, Beseoglu K. Volume of cerebrospinal fluid drainage as a predictor for pretreatment aneurysmal rebleeding. J Neurosurg 2018; 128:1778-1784. [DOI: 10.3171/2017.2.jns162748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEInitiation of external CSF drainage has been associated with a significant increase in rebleeding probability after aneurysmal subarachnoid hemorrhage (aSAH). However, the implications for acute management are uncertain. The purpose of this study was to evaluate the role of the amount of drained CSF on aneurysmal rebleeding.METHODSConsecutive patients with aSAH were analyzed retrospectively. Radiologically confirmed cases of aneurysmal in-hospital rebleeding were identified and predictor variables for rebleeding were retrieved from hospital records. Clinical predictors were identified through multivariate analysis, and logistic regression analysis was performed to ascertain the cutoff value for the rebleeding probability.RESULTSThe study included 194 patients. Eighteen cases (9.3%) of in-hospital rebleeding could be identified. Using multivariate analysis, in-hospital rebleeding was significantly associated with initiation of CSF drainage (p = 0.001) and CSF drainage volume (63 ml [interquartile range (IQR) 55–69 ml] vs 25 ml [IQR 10–35 ml], p < 0.001). Logistic regression showed that 58 ml of CSF drainage within 6 hours results in a 50% rebleeding probability. The relative risk (RR) for rebleeding after drainage of more than 60 ml in 6 hours was 5.4 times greater compared with patients with less CSF drainage (RR 5.403, 95% CI 2.481–11.767; p < 0.001, number needed to harm = 1.687).CONCLUSIONSVolume of CSF drainage was highly correlated with the probability of in-hospital aneurysmal rebleeding. These findings suggest that the rebleeding probability can be affected in acute management should the placement of an external ventricular catheter be necessary. This finding necessitates meticulous control of the amount of drained CSF and the development of a definitive treatment protocol for this group of patients.
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Affiliation(s)
- Jasper H. van Lieshout
- 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; and
| | - Ina Pumplün
- 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; and
| | - Igor Fischer
- 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; and
| | - Marcel A. Kamp
- 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; and
| | - Jan F. Cornelius
- 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; and
| | - Hans J. Steiger
- 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; and
| | | | - Athanasios K. Petridis
- 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; and
| | - Kerim Beseoglu
- 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; and
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Petridis AK, Dibue-Adjei M, Cornelius JF, Suresh MP, Li L, Kamp MA, Abusabha Y, Turowski B, Steiger HJ, May R. Contrast enhancement of vascular walls of intracranial high flow malformations in black blood MRI indicates high inflammatory activity. Chin Neurosurg J 2018; 4:13. [PMID: 32922874 PMCID: PMC7398256 DOI: 10.1186/s41016-018-0120-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/09/2018] [Indexed: 11/15/2022] Open
Abstract
Background There are controversies concerning the natural history of arteriovenous malformations (AVMs) in literature and it is not clear which AVMs should be treated and which should be just observed. Objective criteria beyond growth in serial MRIs or angiographies are needed. The use of black blood MRI is currently under investigation for evaluating the rupture risk of cerebral aneurysms, however its use for assessment of AVMs has yet to be evaluated. We therefore conducted a feasibility study on the application of black blood MRI (bbMRI) in AVMs to assess rupture risk. Methods Retrospective study of 10 patients with intracranial AVMs and 4 patients with arteriovenous fistulas who received a black blood MRI before treatment. Results AVM niduses (9/10) show contrast enhancement irrespective of rupture or size. All arteriovenous fistulas (4 / 4) were contrast enhancing irrespective of rupture. Conclusion High flow malformations are in a permanent stage of inflammation which does not seem to allow conclusions on their rupture risk at the current stage. BbMRI is a feasible method of identifying inflammation in AVMs and arteriovenous fistulas. However, future prospective studies are needed to evaluate whether bbMRI contrast enhancement correlates with rupture risk.
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Affiliation(s)
| | - Maxine Dibue-Adjei
- LivaNova Deutschland GmbH (a LivaNova PLC-owned subsidiary), Lindberghstr 25, D-80939 Munich, Germany
| | - Jan F Cornelius
- Department of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany
| | | | - Lan Li
- Department of Neurosurgery, Niederrhein Hospital, Duisburg, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany
| | - Yousef Abusabha
- Department of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany
| | - Bernd Turowski
- Diagnostic and Interventional Neuroradiology,Heinrich Heine University, Duesseldorf, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany
| | - Rebecca May
- Diagnostic and Interventional Neuroradiology,Heinrich Heine University, Duesseldorf, Germany
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Petridis AK, Suresh MP, Cornelius JF, Bostelmann R, Dibué-Adjei M, Li L, Kamp MA, Steiger HJ, Turowski B, May R. Cavernous brain malformations and their relation to black blood MRI in respect to vessel wall contrast enhancement. Chin Neurosurg J 2018; 4:10. [PMID: 32922871 PMCID: PMC7398178 DOI: 10.1186/s41016-018-0116-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/04/2017] [Accepted: 04/16/2018] [Indexed: 11/25/2022] Open
Abstract
Background Inflammatory responses are implicated as crucial patho-mechanisms of vascular brain malformations. Inflammation is suggested to be a key contributor to aneurysm rupture; however it is unclear whether inflammation contributes similarly to bleeding of cerebral cavernous malformations (CCMs). Black blood MRI is a sequence which identifies inflammation in blood vessel walls and in the present study is used to detect inflammatory response in CCMs. Methods Fifteen patients with 17 CCMs treated in our department in 2017 were retrospectively analysed. All patients received black blood MRIs and the results were analysed in correlation with, size and bleeding of CCMs. Results Size and bleeding status of CCMs did not correlate with contrast enhancement in the CCM wall. One of 3 patients with bleeding displayed contrast enhancement in black blood MRI, whereas the others had non enhancing lesions. Because of the small number of cases a statistical analysis was not performed. Conclusion In this limited cohort, inflammatory reactions in CCMs could not be detected by black blood MRI suggesting that the level of inflammation is minimal in these lesions and those different patho-mechanisms play a more important role in the rupture of CCMs.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Marian P Suresh
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Jan F Cornelius
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Richard Bostelmann
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Maxine Dibué-Adjei
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany.,LivaNova Deutschland (a LivaNova PLC-owned subsidiary), Lindberghstr 25, 80939 Munich, Germany
| | - Lan Li
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Bernd Turowski
- Diagnostic and Interventional Neuroradiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Rebecca May
- Diagnostic and Interventional Neuroradiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Petridis AK, Suresh M, Cornelius JF, Tortora A, Steiger HJ, Turowski B, May R. Aneurysm treatment response prediction in follow up black blood magnetic resonance imaging. A case series study. Clin Pract 2018; 8:1047. [PMID: 29619161 PMCID: PMC5872804 DOI: 10.4081/cp.2018.1047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/29/2017] [Revised: 01/09/2018] [Accepted: 01/23/2018] [Indexed: 01/22/2023] Open
Abstract
Black blood magnetic resonance imaging (MRI)is a promising imaging tool in predicting aneurysm rupture. Could it be also valuable in evaluating the treatment effect of endovascular and conservative treated aneurysms? Two patients were treated with stent and coil and one with Aspirine (ASS). Correlation of treatment response and contrast enhancement of the aneurysm wall is examined. In the first case stenting failed to treat the aneurysm and contrast enhancement in the wall did never subside during follow up black blood MRI. In the second case the aneurysm responded well to stenting and decreased in size, which was correlating significantly with attenuation of contrast enhancement in black blood MRI. In the third case the aneurysm responded to ASS treatment by decreasing in size as shown in follow up MR-angiography and the contrast enhancement in its wall decreased after 8 months of therapy. Black blood MRI seems to be a promising tool not only in predicting aneurysms at risk of rupture, but also in observing treatment responses after endovascular procedures or even Aspirine administration. When contrast enhancement decreases, aneurysm treatment seems to be successful as can be shown in decreasing size in the follow up angiography.
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Affiliation(s)
| | | | | | | | | | - Bernd Turowski
- Institute of Neuroradiology, Heinrich Heine University, Duesseldorf, Germany
| | - Rebecca May
- Institute of Neuroradiology, Heinrich Heine University, Duesseldorf, Germany
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Petridis AK, Beseoglu K, Steiger HJ. The clinical examination in the patient with subarachnoid hemorrhage is still the most reliable parameter for predicting pathophysiological changes. Surg Neurol Int 2017; 8:294. [PMID: 29285410 PMCID: PMC5735437 DOI: 10.4103/sni.sni_332_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 11/04/2022] Open
Abstract
Background Macrovasospasms and delayed cerebral injury are factors which correlate with high morbidity in patients suffering a subarachnoid hemorrhage. Transcranial Doppler (TCD) ultrasonography and perfusion computed tomography (PCT) are diagnostic tools used to diagnose such pathologies. However, TCD is not very reliable and PCT exposes patients to radiation and cannot be performed daily. Case Description We present the case of a 47-year-old female with subarachnoid hemorrhage caused by rupture of an intracranial aneurysm. The aneurysm was coil embolized, and the clinical course of the patient was uncomplicated. She was writing notes about her stay in the intensive care unit. Without having any other complaints, she noticed that her writing became abruptly unrecognizable. TCD failed to show pathological signs, although PCT revealed decreased brain perfusion. Conclusion We rely more and more on our technical tools in medicine. However, clinical examination is and will stay the the first sign indicating cerebral pathologies and should remain the first priority to have an awake patient who can be examined routinely. In addition, we emphasize on the need of seeing the patient and not only the images. More than anything else, the patient is the first who shows signs of pathology and not the instruments (CT, TCD, etc.). The sentence "a fool with a tool is still a fool" should be present in every doctor's mind to avoid mistakes and react appropriately.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, University Hospital Dusseldorf, Heinrich Heine University, Dusseldorf, Germany
| | - Kerim Beseoglu
- Department of Neurosurgery, University Hospital Dusseldorf, Heinrich Heine University, Dusseldorf, Germany
| | - Hans J Steiger
- Department of Neurosurgery, University Hospital Dusseldorf, Heinrich Heine University, Dusseldorf, Germany
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Cornelius JF, Eismann L, Ebbert L, Senger B, Petridis AK, Kamp MA, Sorg RV, Steiger HJ. 5-Aminolevulinic acid-based photodynamic therapy of chordoma: In vitro experiments on a human tumor cell line. Photodiagnosis Photodyn Ther 2017; 20:111-115. [PMID: 28951177 DOI: 10.1016/j.pdpdt.2017.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 07/11/2017] [Revised: 08/14/2017] [Accepted: 09/17/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chordomas are very rare tumors of the skull base and the sacrum. They show infiltrating and destructive growth and are known to be chemo- and radio-resistant. After surgical resection, the recurrence rate is high and overall survival limited. As current adjuvant treatments are ineffective, new treatment concepts are urgently needed. 5-aminolevulinic acid-based photodynamic therapy (5-ALA based PDT) showed promising results for malignant gliomas. However, it is unknown so far, whether chordomas accumulate protoporphyrin IX (PPIX) after application of 5-ALA and whether they are sensitive to subsequent 5-ALA based PDT. METHODS The immortalized human chordoma cells U-CH2 were used as in vitro model. After incubation for 4h or 6h with different 5-ALA concentrations, PPIX accumulation was determined by flow cytometry. To assess sensitivity to PDT, chordoma cells were incubated at 30.000cells/well (high cell density) or 15.000cells/well (low cell density) with graded doses of 5-ALA (0-50μg/ml) in 96-well plates and subsequently exposed to laser light of 635nm wavelength (18.75J/cm2). Cell survival was measured 24h after exposure to laser light using the WST-1 assay. RESULTS U-CH2 cells dose-dependently accumulated PPIX (ANOVA; p<0.0001). PPIX fluorescence was significantly higher, when cells were incubated with 5-ALA for 6h compared to 4h at higher 5-ALA concentrations (ANOVA/Bonferroni; p≤0.05 for≥30μg/ml 5-ALA). For both cell densities, a 5-ALA dose-dependent decline in viability was observed (ANOVA; p<0.0001). Viability was significantly lower at higher 5-ALA concentrations, when 30.000 cells/wells were treated compared to 15.000cells/well (ANOVA/Bonferroni; p≤0.001 for≥30μg/ml 5-ALA). LD50 was 30.25μg/ml 5-ALA. CONCLUSION The human UCH-2 cell line was a very useful in vitro model to study different effects of 5-ALA based PDT. For the first time, it could be shown that human chordoma cells may be destroyed by 5-ALA/PDT.
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Affiliation(s)
- Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Lennert Eismann
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany; Neuro-oncological Research Laboratory, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Lara Ebbert
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Brigitte Senger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany; Neuro-oncological Research Laboratory, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Athanasios K Petridis
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Marcel Alexander Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Rüdiger V Sorg
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Maslehaty H, Schultheiss S, Scholz M, Petridis AK. Surgical Anatomy of the Orbit in Human Cadavers-An Endoscopic Pictorial Documentation. J Neurol Surg B Skull Base 2017; 79:173-176. [PMID: 29868323 DOI: 10.1055/s-0037-1606294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/09/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022] Open
Abstract
Background The aim of our study was a pictorial documentation of the anatomical structures of the orbit. Methods We performed a transmaxillary endoscopic approach in nine formalin-fixed human heads. We identified and documented the anatomy of the inferior part of the orbit. Results The first intraorbital anatomical landmark was the inferior rectus muscle, from which important structures medially and laterally could be identified. Anatomical structures and their relation to each other were documented and presented as illustrative figures. Conclusion Knowledge of the topographic anatomy of the inferior part of the orbit could be sufficiently imparted by our illustrations. The presented transmaxillary approach allowed a wide overview of the anatomical structures located in the inferior part of the orbit. Our pictorial documentation may provide neurosurgeons more safety and the opportunity to become familiar with the endoscopic anatomy.
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Affiliation(s)
| | - Saskia Schultheiss
- Department of Neurosurgery, Academic Teaching Hospital of University Essen-Duisburg, Klinikum Duisburg, Essen-Duisburg, Germany
| | - Martin Scholz
- Department of Neurosurgery, Academic Teaching Hospital of University Essen-Duisburg, Klinikum Duisburg, Essen-Duisburg, Germany
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Maslehaty H, Capone C, Frantsev R, Fischer I, Jabbarli R, Cornelius JF, Kamp MA, Cappabianca P, Sure U, Steiger HJ, Petridis AK. Predictive anatomical factors for rupture in middle cerebral artery mirror bifurcation aneurysms. J Neurosurg 2017; 128:1799-1807. [PMID: 28841119 DOI: 10.3171/2017.2.jns162705] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to define predictive factors for rupture of middle cerebral artery (MCA) mirror bifurcation aneurysms. METHODS The authors retrospectively analyzed the data in patients with ruptured MCA bifurcation aneurysms with simultaneous presence of an unruptured MCA bifurcation mirror aneurysm treated in two neurosurgical centers. The following parameters were measured and analyzed with the statistical software R: neck, dome, and width of both MCA aneurysms-including neck/dome and width/neck ratios, shape of the aneurysms (regular vs irregular), inflow angle of both MCA aneurysms, and the diameters of the bilateral A1 and M1 segments and the frontal and temporal M2 trunks, as well as the bilateral diameter of the internal carotid artery (ICA). RESULTS The authors analyzed the data of 44 patients (15 male and 29 female, mean age 50.1 years). Starting from the usual significance level of 0.05, the Sidak-corrected significance level is 0.0039. The diameter of the measured vessels was statistically not significant, nor was the inflow angle. The size of the dome was highly significant (p = 0.0000069). The size of the neck (p = 0.0047940) and the width of the aneurysms (p = 0.0056902) were slightly nonsignificant at the stated significance level of 0.0039. The shape of the aneurysms was bilaterally identical in 22 cases (50%). In cases of asymmetrical presentation of the aneurysm shape, 19 (86.4%) ruptured aneurysms were irregular and 3 (13.6%) had a regular shape (p = 0.001). CONCLUSIONS In this study the authors show that the extraaneurysmal flow dynamics in mirror aneurysms are nonsignificant, and the aneurysmal geometry also does not seem to play a role as a predictor for rupture. The only predictors for rupture were size and shape of the aneurysms. It seems as though under the same conditions, one of the two aneurysms suffers changes in its wall and starts growing in a more or less stochastic manner. Newer imaging methods should enable practitioners to see which aneurysm has an unstable wall, to predict the rupture risk. At the moment one can only conclude that in cases of MCA mirror aneurysms the larger one, with or without shape irregularities, is the unstable aneurysm and that this is the one that needs to be treated.
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Affiliation(s)
| | - Crescenzo Capone
- 2Department of Neurosurgery, University Hospital Düsseldorf.,3Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | | | - Igor Fischer
- 4Department of Neurosurgery, Statistical Analysis Office, Bio-Statistics, University Hospital Düsseldorf, Germany; and
| | | | | | - Marcel A Kamp
- 2Department of Neurosurgery, University Hospital Düsseldorf
| | - Paolo Cappabianca
- 3Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Ulrich Sure
- 1Department of Neurosurgery, University Hospital Essen
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Abusabha Y, Petridis AK, Kraus B, Kamp MA, Steiger HJ, Beseoglu K. Life-threatening posterior reversible encephalopathy syndrome in the cerebellum treated by posterior fossa decompression. Acta Neurochir (Wien) 2017; 159:1325-1328. [PMID: 28547518 DOI: 10.1007/s00701-017-3228-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinico-neuroradiological syndrome associated with various clinical conditions, such as headache, encephalopathy, and seizures. It is reversible if a prompt diagnosis is made and treatment undertaken. We report a 52-year-old male with hypertensive crisis. Progressing somnolence and an unresponsive left pupil occurred. MRI revealed an intra-axial hyperintensity of the cerebellum and brainstem and occlusive hydrocephalus suggestive of encephalitis or a tumor. Because of the life-threatening clinical picture, posterior fossa decompression was performed. Histopathology failed to identify any pathology. After decompression, the edema improved immediately. Under life-threatening conditions, a decompressive craniectomy in PRES seems to achieve the same results as supportive treatment.
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Petridis AK, Kaschner M, Cornelius JF, Kamp MA, Tortora A, Steiger HJ, Turowski B. A New Imaging Tool for Realtime Measurement of Flow Velocity in Intracranial Aneurysms. Clin Pract 2017; 7:975. [PMID: 28839527 PMCID: PMC5543827 DOI: 10.4081/cp.2017.975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/27/2017] [Accepted: 07/19/2017] [Indexed: 12/03/2022] Open
Abstract
With modern imaging modalities of the brain a significant number of unruptured aneurysms are detected. However, not every aneurysm is prone to rupture. Because treatment morbidity is about 10% it is crucial to identify unstable aneurysms for which treatment should be discussed. Recently, new imaging tools allow analysis of flow dynamics and wall stability have become available. It seems that they might provide additional data for better risk profiling. In this study we present a new imaging tool for analysis of flow dynamics, which calculates fluid velocity in an aneurysm (Phillips Electronics, N.V.). It may identify regions with high flow and calculate flow reduction after stenting of aneurysms. Contrast is injected with a stable injection speed of 2 mL/sec for 3 sec. Two clinical cases are illustrated. Velocity in aneurysms and areas of instability can be identified and calculated during angiography in real-time. After stenting and flow diverter deployment flow reduction in the internal carotid aneurysm was reduced by 60% and there was a reduction of about 65% in the posterior cerebral artery in the second case we are reporting. The dynamic flow software calculates the flow profile in the aneurysm immediately after contrast injection. It is a real-time, patient specific tool taking into account systole, diastole and flexibility of the vasculature. These factors are an improvement as compared to current models of computational flow dynamics. We think it is a highly efficient, user friendly tool. Further clinical studies are on their way.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery Institute of Neuroradiology, Heinrich Heine University Duesseldorf, Germany
| | - Marius Kaschner
- Institute of Neuroradiology, Heinrich Heine University Duesseldorf, Germany
| | - Jan F Cornelius
- Department of Neurosurgery Institute of Neuroradiology, Heinrich Heine University Duesseldorf, Germany
| | - Marcel A Kamp
- Department of Neurosurgery Institute of Neuroradiology, Heinrich Heine University Duesseldorf, Germany
| | - Angelo Tortora
- Department of Neurosurgery Institute of Neuroradiology, Heinrich Heine University Duesseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery Institute of Neuroradiology, Heinrich Heine University Duesseldorf, Germany
| | - Bernd Turowski
- Institute of Neuroradiology, Heinrich Heine University Duesseldorf, Germany
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Kamp MA, Sarikaya-Seiwert S, Petridis AK, Beez T, Cornelius JF, Steiger HJ, Turowski B, Slotty PJ. Intraoperative Indocyanine Green–Based Cortical Perfusion Assessment in Patients Suffering from Severe Traumatic Brain Injury. World Neurosurg 2017; 101:431-443. [DOI: 10.1016/j.wneu.2017.01.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 01/04/2023]
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Petridis AK, Cornelius JF, Kamp MA, Falahati S, Fischer I, Steiger HJ. Level of Headaches After Surgical Aneurysm Clipping Decreases Significantly Faster Compared to Endovascular Coiled Patients. Clin Pract 2017; 7:936. [PMID: 28567237 PMCID: PMC5432943 DOI: 10.4081/cp.2017.936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/28/2017] [Indexed: 11/25/2022] Open
Abstract
In incidental aneurysms, endovascular treatment can lead to post-procedural headaches. We studied the difference of surgical clipping vs. endovascular coiling in concern to post-procedural headaches in patients with ruptured aneurysms. Sixty-seven patients with aneurysmal subarachnoidal haemorrhage were treated in our department from September 1st 2015 - September 1st 2016. 43 Patients were included in the study and the rest was excluded because of late recovery or high-grade subarachnoid bleedings. Twenty-two were surgical treated and twenty-one were interventionally treated. We compared the post-procedural headaches at the time points of 24 h, 21 days, and 3 months after treatment using the visual analog scale (VAS) for pain. After surgical clipping the headache score decreased for 8.8 points in the VAS, whereas the endovascular treated population showed a decrease of headaches of 3.3 points. This difference was highly statistical significant and remained significant even after 3 weeks where the pain score for the surgically treated patients was 0.68 and for the endovascular treated 1.8. After 3 months the pain was less than 1 for both groups with surgically treated patients scoring 0.1 and endovascular treated patients 0.9 (not significant). Clipping is relieving the headaches of patients with aneurysm rupture faster and more effective than endovascular coiling. This effect stays significant for at least 3 weeks and plays a crucial role in stress relieve during the acute and subacute ICU care of such patients.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Germany
| | - Jan F Cornelius
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Germany
| | - Sina Falahati
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Germany
| | - Igor Fischer
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Germany
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van Lieshout JH, Dibué-Adjei M, Cornelius JF, Slotty PJ, Schneider T, Restin T, Boogaarts HD, Steiger HJ, Petridis AK, Kamp MA. An introduction to the pathophysiology of aneurysmal subarachnoid hemorrhage. Neurosurg Rev 2017; 41:917-930. [PMID: 28215029 DOI: 10.1007/s10143-017-0827-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/24/2017] [Accepted: 01/31/2017] [Indexed: 02/06/2023]
Abstract
Pathophysiological processes following subarachnoid hemorrhage (SAH) present survivors of the initial bleeding with a high risk of morbidity and mortality during the course of the disease. As angiographic vasospasm is strongly associated with delayed cerebral ischemia (DCI) and clinical outcome, clinical trials in the last few decades focused on prevention of these angiographic spasms. Despite all efforts, no new pharmacological agents have shown to improve patient outcome. As such, it has become clear that our understanding of the pathophysiology of SAH is incomplete and we need to reevaluate our concepts on the complex pathophysiological process following SAH. Angiographic vasospasm is probably important. However, a unifying theory for the pathophysiological changes following SAH has yet not been described. Some of these changes may be causally connected or present themselves as an epiphenomenon of an associated process. A causal connection between DCI and early brain injury (EBI) would mean that future therapies should address EBI more specifically. If the mechanisms following SAH display no causal pathophysiological connection but are rather evoked by the subarachnoid blood and its degradation production, multiple treatment strategies addressing the different pathophysiological mechanisms are required. The discrepancy between experimental and clinical SAH could be one reason for unsuccessful translational results.
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Affiliation(s)
- Jasper H van Lieshout
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Maxine Dibué-Adjei
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Philipp J Slotty
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Toni Schneider
- Institute for Neurophysiology, Medical Faculty, University of Cologne, Robert-Koch-Str. 39, 50931, Köln, Germany
| | - Tanja Restin
- Zurich Centre for Integrative Human Physiology, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Institute of Anesthesiology, Medical Faculty, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Medical Faculty, Radboud University Nijmegen, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Athanasios K Petridis
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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van Lieshout JH, Bruland I, Fischer I, Cornelius JF, Kamp MA, Turowski B, Tortora A, Steiger HJ, Petridis AK. Increased mortality of patients with aneurysmatic subarachnoid hemorrhage caused by prolonged transport time to a high-volume neurosurgical unit. Am J Emerg Med 2017; 35:45-50. [DOI: 10.1016/j.ajem.2016.09.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/07/2016] [Accepted: 09/29/2016] [Indexed: 01/03/2023] Open
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Bostelmann R, Leimert M, Steiger HJ, Gierga K, Petridis AK. The Importance of Surgery as Part of Multimodal Therapy in Rapid Progressive Primary Extraosseous Ewing Sarcoma of the Cervical Intra- and Epidural Space. Clin Pract 2016; 6:897. [PMID: 28176976 PMCID: PMC5294927 DOI: 10.4081/cp.2016.897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/30/2016] [Indexed: 11/23/2022] Open
Abstract
Primary extraosseous Ewing sarcomas (EESs) are an extremely rare pathological entity. Less than 32 cases have been reported in the literature. Here we report an uncommon case with very rapid progression in the cervical region with extra- and intradural involvement. We present a thorough review of the literature and discuss possible treatment modalities. The Medline database was searched using the search terms: Ewing sarcoma, extraosseus tumour, treatment, management, cervical spine. A previously healthy 29-year-old man complained of right-sided radiculopathy (C7). Magnetic resonance imaging showed an enhancing foraminal, sandglass shaped neurinoma-like lesion. Surgery revealed an intraand extra-dural lesion, which was histologically diagnosed as Ewing sarcoma. Despite gross total resection, there was a massive symptomatic tumor recurrence within 6 weeks. A second gross total resection was realized. The patient was treated according to the EURO E.W.I.N.G.-Protocol (VIDE) and recovered very well (progression-free interval during therapy). Several decompressive re-surgeries were realized with adjuvant radio-chemotherapy. At the last follow-up (17 months after initial surgery) the patient was in remission with a good quality of live. This case is to illustrate that despite extensive therapeutic efforts, the progression-free survival in case of primary EES may be very short. To maintain neurological function and good quality of live as long as possible, a multimodal strategy seems to be adequate. Like in the present case this implies several surgeries and adjuvant chemo-and radiotherapy. Whether this improves overall survival remains unclear.
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Affiliation(s)
| | - Mario Leimert
- Interdisciplinary Centre for Spinal Orthopedics, Hohwald Clinic , Neustadt in Sachsen, Dresden
| | | | - Kristin Gierga
- Institute of Neuropathology, Heinrich Heine Univesity , Duesseldorf, Germany
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Kursumovic A, Bostelmann R, Gollwitzer M, Rath S, Steiger HJ, Petridis AK. Intraspinal Lumbar Juxtaarticular Cyst Treatment Through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome. Clin Pract 2016; 6:866. [PMID: 27994840 PMCID: PMC5136736 DOI: 10.4081/cp.2016.866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 01/28/2023] Open
Abstract
Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years). Fifteen of twenty procedures were successful and cyst rupture was confirmed by CT-scans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints.
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Affiliation(s)
- Adisa Kursumovic
- Department of Neurosurgery, Donauisar Klinikum Deggendorf, University Hospital Duesseldorf , Germany
| | | | - Maria Gollwitzer
- Department of Neurosurgery, Donauisar Klinikum Deggendorf, University Hospital Duesseldorf , Germany
| | - Stefan Rath
- Department of Neurosurgery, Donauisar Klinikum Deggendorf, University Hospital Duesseldorf , Germany
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Petridis AK, Jung S, Cheko A, Scholz M. A Modified Mini-Pterional (Subfrontal-Suprapterional) Approach to MCA Bifurcation Aneurysms with Minimal Dissection of the Temporal Muscle. Turk Neurosurg 2016; 27:837-841. [PMID: 27509458 DOI: 10.5137/1019-5149.jtn.16472-15.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There are a number of different surgical approaches in middle cerebral artery (MCA) aneurysm surgery. Evolution from the classical pterional approach towards smaller modified approaches took place over the years. In the present report, we describe a new modified approach in the treatment of MCA aneurysms, which is almost exclusively subfrontal. A modified approach was used on three patients with MCA bifurcation aneurysms. Craniotomy was subfrontal and suprapterional with minimal dissection of the temporal muscle and no drilling of the pterion. In all three cases, after establishing proximal control and dissecting the M1 carefully, retraction of the frontal lobe elevated the sylvian fissure and allowed opening of the fissure. The aneurysm could be identified easily and clips were applied. There was no infection and complete aneurysm clipping was achieved in all 3 patients. The described minimal craniotomy to the MCA through a subfrontal-suprapterional approach allows dissection of peripheral MCA bifurcation aneurysms without any problems.
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Heymanns V, Oseni AW, Alyeldien A, Maslehaty H, Parvin R, Scholz M, Petridis AK. Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery. Clin Pract 2016; 6:824. [PMID: 27478578 PMCID: PMC4943098 DOI: 10.4081/cp.2016.824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 11/28/2022] Open
Abstract
Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.
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Affiliation(s)
- Verena Heymanns
- Department of Neurosurgery, Sana Kliniken , Duisburg, Germany
| | - Abidemi W Oseni
- Department of Neurosurgery, Sana Kliniken , Duisburg, Germany
| | - Ameer Alyeldien
- Department of Neurosurgery, Sana Kliniken , Duisburg, Germany
| | | | - Richard Parvin
- Department of Neurosurgery, Sana Kliniken , Duisburg, Germany
| | - Martin Scholz
- Department of Neurosurgery, Sana Kliniken , Duisburg, Germany
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Zhang R, Loers G, Schachner M, Boelens R, Wienk H, Siebert S, Eckert T, Kraan S, Rojas-Macias MA, Lütteke T, Galuska SP, Scheidig A, Petridis AK, Liang S, Billeter M, Schauer R, Steinmeyer J, Schröder JM, Siebert HC. Molecular Basis of the Receptor Interactions of Polysialic Acid (polySia), polySia Mimetics, and Sulfated Polysaccharides. ChemMedChem 2016; 11:990-1002. [PMID: 27136597 DOI: 10.1002/cmdc.201500609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/01/2016] [Indexed: 02/05/2023]
Abstract
Polysialic acid (polySia) and polySia glycomimetic molecules support nerve cell regeneration, differentiation, and neuronal plasticity. With a combination of biophysical and biochemical methods, as well as data mining and molecular modeling techniques, it is possible to correlate specific ligand-receptor interactions with biochemical processes and in vivo studies that focus on the potential therapeutic impact of polySia, polySia glycomimetics, and sulfated polysaccharides in neuronal diseases. With this strategy, the receptor interactions of polySia and polySia mimetics can be understood on a submolecular level. As the HNK-1 glycan also enhances neuronal functions, we tested whether similar sulfated oligo- and polysaccharides from seaweed could be suitable, in addition to polySia, for finding potential new routes into patient care focusing on an improved cure for various neuronal diseases. The knowledge obtained here on the structural interplay between polySia or sulfated polysaccharides and their receptors can be exploited to develop new drugs and application routes for the treatment of neurological diseases and dysfunctions.
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Affiliation(s)
- Ruiyan Zhang
- RI-B-NT: Research Institute of Bioinformatics and Nanotechnology, Franziusallee 177, 24148, Kiel, Germany
- Zoological Institute, Department of Structural Biology, Kiel University, Am Botanischen Garten 1-9, 24118, Kiel, Germany
| | - Gabriele Loers
- Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf, University of Hamburg, Falkenried 94, 20251, Hamburg, Germany
| | - Melitta Schachner
- Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf, University of Hamburg, Falkenried 94, 20251, Hamburg, Germany
- Center for Neuroscience, Shantou University Medical College, 22 Xin Ling Road, Shantou, Guangdong, 515041, China
| | - Rolf Boelens
- Bijvoet Center for Biomolecular Research, NMR Spectroscopy, Utrecht University, Padualaan 8, 3584 CH, Utrecht, The Netherlands
| | - Hans Wienk
- Bijvoet Center for Biomolecular Research, NMR Spectroscopy, Utrecht University, Padualaan 8, 3584 CH, Utrecht, The Netherlands
| | - Simone Siebert
- RI-B-NT: Research Institute of Bioinformatics and Nanotechnology, Franziusallee 177, 24148, Kiel, Germany
| | - Thomas Eckert
- Institute of Veterinary Physiology and Biochemistry, Fachbereich Veterinärmedizin, Justus-Liebig-Universität Gießen, Frankfurter Str. 100, 35392, Gießen, Germany
- Clinic for Obstetrics, Gynecology and Andrology of Large and Small Animals, Justus-Liebig-Universität Gießen, Frankfurter Str. 106, 35392, Gießen, Germany
| | - Stefan Kraan
- Ocean Harvest Technology Ltd., N17 Business Park, Milltown, County Galway, Ireland
| | - Miguel A Rojas-Macias
- Institute of Veterinary Physiology and Biochemistry, Fachbereich Veterinärmedizin, Justus-Liebig-Universität Gießen, Frankfurter Str. 100, 35392, Gießen, Germany
| | - Thomas Lütteke
- Institute of Veterinary Physiology and Biochemistry, Fachbereich Veterinärmedizin, Justus-Liebig-Universität Gießen, Frankfurter Str. 100, 35392, Gießen, Germany
| | - Sebastian P Galuska
- Institute of Biochemistry, Faculty of Medicine, Justus-Liebig-Universität Gießen, Friedrichstr. 24, 35392, Gießen, Germany
| | - Axel Scheidig
- Zoological Institute, Department of Structural Biology, Kiel University, Am Botanischen Garten 1-9, 24118, Kiel, Germany
| | - Athanasios K Petridis
- Neurosurgery Clinic, University Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Germany
| | - Songping Liang
- College of Life Sciences, Hunan Normal University, 410081, Changsha, China
| | - Martin Billeter
- Department of Chemistry and Molecular Biology, University of Gothenburg, Box 100, 40530, Gothenburg, Sweden
| | - Roland Schauer
- Institute of Biochemistry, Kiel University, Olshausenstr. 40, 24098, Kiel, Germany
| | - Jürgen Steinmeyer
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, University Hospital Giessen and Marburg GmbH, Paul-Meimberg-Str. 3, 35392, Gießen, Germany
| | - Jens-Michael Schröder
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Hans-Christian Siebert
- RI-B-NT: Research Institute of Bioinformatics and Nanotechnology, Franziusallee 177, 24148, Kiel, Germany.
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Bostelmann R, Zella S, Steiger HJ, Petridis AK. Could Spinal Canal Compression be a Cause of Polyneuropathy? Clin Pract 2016; 6:816. [PMID: 27162603 PMCID: PMC4844812 DOI: 10.4081/cp.2016.816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 11/30/2022] Open
Abstract
Causality between spinal cord compression and polyneuropathy is difficult to define, especially under the circumstances that polyneuropathy can have many causes. Seven patients with spinal cord compression and electrophysiological signs of polyneuropathy were treated surgically on decompression of their spinal canal stenosis in the time from April 2010 to January 2013. Median follow up time was 9 months (2-23 months). Causes of polyneuropathy were: 1 patient with methotrexate-induced polyneuropathy, 1 endocrine-dysfunction-induced, 2 with diabetic-polyneuropathy, and 3 patients had unknown reasons. The localization of the spinal canal stenosis was also varying: 2 patients suffered of cervical spinal canal stenosis and 5 of lumbar. Decompressive surgery led to pain relieve in all patients initially. Surprisingly, also symptoms of polyneuropathy seemed to regress in all 7 patients for the first 5 months after surgery, and in 5 patients for the time of 9 months after surgery. There are two points we would like to emphasize in this short report. Since 5/7 patients with polyneuropathy and spinal canal stenosis improved clinically after surgery, surgery has a place in the treatment of such a combined pathology. Since it seems to be a possible causality between polyneuropathy of unknown origin and spinal cord stenosis, decompression of the spinal canal could also be a therapeutic step in a specific kind of polyneuropathy. Which patients could possibly have a spinal canal stenosis induced polyneuropathy remains a subject of further studies.
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Affiliation(s)
- Richard Bostelmann
- Department of Neurosurgery, Medical Faculty, University Hospital Duesseldorf , Germany
| | - Samis Zella
- Department of Neurosurgery, Medical Faculty, University Hospital Duesseldorf , Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, Medical Faculty, University Hospital Duesseldorf , Germany
| | - Athanasios K Petridis
- Department of Neurosurgery, Medical Faculty, University Hospital Duesseldorf , Germany
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Petridis AK, Fischer I, Cornelius JF, Kamp MA, Ringel F, Tortora A, Steiger HJ. Demographic distribution of hospital admissions for brain arteriovenous malformations in Germany--estimation of the natural course with the big-data approach. Acta Neurochir (Wien) 2016; 158:791-796. [PMID: 26873715 DOI: 10.1007/s00701-016-2727-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Estimation of the natural history of arteriovenous malformations based on short-term observation is potentially biased by multiple factors. Retrieval of demographic information of all AVM patients of national data pools and comparison with the national demographic profile might be another way to approach the natural history. MATERIALS AND METHODS Upon request, the German Federal Statistical Office provided the numbers of patients admitted in Germany from 2009 through 2013 with ICD Q28.2 (brain AVM) as primary discharge diagnosis, and the corresponding age distribution. Age-related admission rates of AVM were calculated by comparison with the German demographic distribution. RESULTS A total of 6527 patients were hospitalized from 2009-2013 with brain AVM (Q28.2) as the principal diagnosis. Age-specific admission rate during the first year of life was high with 19.0/100,000 during the 5-year study period, corresponding to a yearly admission rate of 3.8 per 100,000 babies. Apart from the high admission rate during the first year of life, the admission rate was low, but steadily increasing during first decades of life reaching a plateau with 11.1/100,000 in the age group 30-34 years, corresponding to an annual admission rate of 2.2/100,000. After the age of 30-34 years, admission rates decreased continuously, reaching 0 in the age group 90-95 years. The lifetime risk of admission in terms of admission per 100,000 age-matched people was calculated by retrograde integration of the admission rates. At the age of 1 year, the cumulative number of future admissions for AVM during lifetime amounted to 131.3/100,000 children. For the older age groups, the chance of future admission for AVM decreased as expected, reaching 43.8/100,000 by the age of 50 and 0 by the age of 90. CONCLUSIONS Despite some open issues, the current data suggests that achieving old age with an untreated brain AVM is unlikely. Furthermore, the data support the concept that most brain AVMs are not necessarily a congenital entity but develop during the first decades of life.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Igor Fischer
- Division of Informatics and Statistics, Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Jan F Cornelius
- Department of Neurosurgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Florian Ringel
- Department of Neurosurgery, Technische Universität, Munich, Germany
| | - Angelo Tortora
- Department of Neurosurgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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Alyeldien A, Teuber-Hanselmann S, Cheko A, Höll T, Scholz M, Petridis AK. Diffuse Spinal Leptomeningeal Spread of a Pilocytic Astrocytoma in a 3-year-old Child. Clin Pract 2016; 6:813. [PMID: 27162602 PMCID: PMC4844811 DOI: 10.4081/cp.2016.813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/07/2016] [Accepted: 03/13/2016] [Indexed: 11/22/2022] Open
Abstract
Pilocytic astrocytomas correspond to low-grade gliomas and therefore metastasize exceedingly rare. However, pilocytic astrocytomas are able to and leptomeningeal dissemination may be seen. What are the treatment options of these cases? We present a case report of a 3-year-old child with a pilocytic astrocytoma of the optic chiasm with leptomeningeal dissemination of the spinal meninges. Partial resection of the cerebral tumor has been performed. Since the leptomeningeal dissemination was seen all over the spinal meninges, the child did not undergo further surgical treatment. A wait and watch strategy were followed. Chemotherapy was initiated, if a 25% tumor growth was seen. Leptomeningeal dissemination of a pilocytic astrocytoma is seen so infrequently that no standard therapy is established. Since these metastases may occur even up to 2 decades after primary tumor resection, long-term follow-up is indicated. In case of spinal metastases, surgical treatment should be performed if feasible. Otherwise observation should be possessed and/or chemotherapy should be initiated.
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Affiliation(s)
- Ameer Alyeldien
- Department of Neurosurgery, Sana Kliniken , Duisburg, Germany
| | | | - Azad Cheko
- Department of Neurosurgery, Sana Kliniken , Duisburg, Germany
| | - Tanja Höll
- Department of Pediatrics, Sana Kliniken , Duisburg, Germany
| | - Martin Scholz
- Department of Neurosurgery, Sana Kliniken , Duisburg, Germany
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Doukas A, Maslehaty H, Barth H, Hedderich J, Petridis AK, Mehdorn HM. A novel simple measure correlates to the outcome in 57 patients with intracerebellar hematomas. Results of a retrospective analysis. Surg Neurol Int 2015; 6:176. [PMID: 26673852 PMCID: PMC4665131 DOI: 10.4103/2152-7806.170246] [Citation(s) in RCA: 4] [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: 04/26/2015] [Accepted: 08/30/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The incidence of intracerebellar hemorrhages approaches 5-10% of all intracerebral hematomas. The clinical presentation varies from headaches and dizziness to rapid deterioration of consciousness to the point of coma in severe cases. In order to find some concrete criteria that could influence the prognosis of these patients, we performed this retrospective study. METHODS We retrospectively analyzed the factors influencing the outcome of 57 patients with intracerebellar hematomas treated in our clinic in the last 7 years. The Glasgow Coma Scale (GCS) on admission, as well as other parameters as hypertension, diabetes mellitus, presence of malign tumors in the medical history, or the intake of anticoagulants were assessed as independent factors influencing the outcome of the patients. On the other hand, various computed tomography parameters on admission were also correlated with the clinical outcome such as, tight posterior fossa (TPF), volume of the hematoma, hydrocephalus, compression of the fourth ventricle, intraventricular bleeding, as well as the ratio of the maximal width of the hematoma in comparison to the width of the PF were taken into consideration. RESULTS The results of the study showed that patients with poor GCS on admission had also a poor Glasgow Outcome Score. Interestingly there was a statistically significant correlation between the maximal width of the hematoma in comparison to the width of the PF and the outcome of the patients. It could be also shown that the patients with intraventricular hemorrhage, hydrocephalus, compression of the fourth ventricle over 50% of its maximal width and TPF, had a poor clinical outcome. Moreover, there was a statistically significant correlation of the volume of the hematoma and a poor clinical outcome. CONCLUSIONS We introduced as a new factor that is, the cerebellar hemorrhage/PF ratio and found out that the value >35% was associated to an unfavorable outcome.
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Affiliation(s)
- Alexandros Doukas
- Department of Neurosurgery, University Clinics Schleswig-Holstein, Campus Kiel, Germany
| | - Homajoun Maslehaty
- Department of Neurosurgery, University Clinic Essen, Campus Kiel, Germany
| | - Harald Barth
- Department of Neurosurgery, University Clinics Schleswig-Holstein, Campus Kiel, Germany
| | - Jürgen Hedderich
- Institute for Medical Informatics and Statistics, University Clinics Schleswig-Holstein, Campus Kiel, Germany
| | | | - H Maximilian Mehdorn
- Department of Neurosurgery, University Clinics Schleswig-Holstein, Campus Kiel, Germany
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Doukas A, Tallo A, Parvin R, Hans V, Daemi P, Cheko A, Scholz M, Petridis AK. Giant Dural Supratentorial Chondroma Generating the Question of How Large Can a Tumor Become Without Revealing Itself. Clin Pract 2015; 5:777. [PMID: 26918096 PMCID: PMC4745590 DOI: 10.4081/cp.2015.777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 11/25/2022] Open
Abstract
Chondromas usually affect the small bones of hand and feet and account for only 0.5% of all intracranial tumors. We present a case of a giant, supratentorial meningeal chondroma in a 19-year old male patient and discuss the preoperative diagnostic findings as well as the appropriate treatment options. A 19-old male presented with headache, new onset of focal seizures and paresis of left upper extremity. Magnetic resonance imaging revealed a large right parietal tumor in the precentral region with local mass effect. The patient underwent right parietal craniotomy and gross total resection of the tumor. The histopathological report revealed a chondroma. Intradural supratentorial chondromas are extremely rare. As with other slow growing intracranial masses, they often reach a relatively large size before generating symptoms. Maximal surgical resection is the treatment of choice and if this is achieved no adjuvant therapy is necessary.
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Affiliation(s)
| | | | - Richard Parvin
- Department of Neurosurgery, Wedau Kliniken, Duisburg; International Graduate School of Neuroscience, Ruhr-University, Bochum
| | - Volkmar Hans
- Institute of Neuropathology, University Hospital , Essen, Germany
| | - Pooya Daemi
- Department of Neurosurgery, Wedau Kliniken , Duisburg
| | - Azad Cheko
- Department of Neurosurgery, Wedau Kliniken , Duisburg
| | - Martin Scholz
- Department of Neurosurgery, Wedau Kliniken , Duisburg
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Petridis AK, Kinzel A, Blaeser K, Thissen J, Maslehaty H, Scholz M. Can Break-Dance Break Your Neck? C1/C2 Luxation with a Combined Dens Fracture Without Neurological Deficits in an 11-Year Old Boy After a Break-Dance Performance. Clin Pract 2015; 5:781. [PMID: 26664716 PMCID: PMC4653752 DOI: 10.4081/cp.2015.781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/14/2015] [Accepted: 06/26/2015] [Indexed: 11/29/2022] Open
Abstract
Atlantoaxial dislocation in children is a very rare condition. We present the case of a dislocation happened during a break-dance maneuver. The purpose of this report is describing dangers of break-dancing and discussing the treatment we chose. The patient was followed up until 12 months after surgery. Magnetic resonance imaging and computed tomography of the cervical spine were evaluated. Translaminar fixation of C1/C2 had been performed after manual reposition under X-ray illumination. After a 12-month follow-up, the patient shows a stable condition without neurological dysfunction. He is not allowed to perform any extreme sports.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg , Duisburg, Germany
| | - Adrian Kinzel
- Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg , Duisburg, Germany
| | - Klaus Blaeser
- Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg , Duisburg, Germany
| | - Joost Thissen
- Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg , Duisburg, Germany
| | | | - Martin Scholz
- Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg , Duisburg, Germany
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Petridis AK, Anokhin M, Vavruska J, Mahvash M, Scholz M. The value of intraoperative sonography in low grade glioma surgery. Clin Neurol Neurosurg 2015; 131:64-8. [PMID: 25704192 DOI: 10.1016/j.clineuro.2015.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is a number of different methods to localize a glioma intraoperatively. Neuronavigation, intraoperative MRI, 5-aminolevulinic acid, as well as intraoperative sonography. Every method has its advantages and disadvantages. Low grade gliomas do not show a specific signal with 5-aminolevulinic acid and are difficult to distinguish macroscopically from normal tissue. In the present study we stress out the importance of intraoperative diagnostic ultrasound for localization of low grade gliomas. METHODS We retrospectively evaluated the charts and MRIs of 34 patients with low grade gliomas operated in our department from 2011 until December 2014. The efficacy of ultrasound as an intraoperative navigational tool was assessed. In 15 patients ultrasound was used and in 19 not. Only histologically proven low grades gliomas (astrocytomas grade II) were evaluated. RESULTS In none of the patients where ultrasound (combined with neuronavigation) was used (N=15) to find the tumors, the target was missed, whereas the exclusive use of neuronavigation missed the target in 5 of 19 cases of small subcortical low grade gliomas. CONCLUSIONS Intraoperative ultrasound is an excellent tool in localizing low grade gliomas intraoperatively. It is an inexpensive, real time neuronavigational tool, which overcomes brain shift. Even when identifying the tumors with ultrasound is very reliable, the extend of resection and the decision to remove any residual tumor with the help of ultrasound is at the moment unreliable.
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Affiliation(s)
- Athanasios K Petridis
- Wedau Kliniken Duisburg, Sana Konzern, Department of Neurosurgery, Duisburg, Germany.
| | - Maxim Anokhin
- Wedau Kliniken Duisburg, Sana Konzern, Department of Neurosurgery, Duisburg, Germany
| | - Jan Vavruska
- Wedau Kliniken Duisburg, Sana Konzern, Department of Neurosurgery, Duisburg, Germany
| | - Mehran Mahvash
- Department of Neurosurgery, Clinic of Cologne University of Witten-Herdecke, Duisburg, Germany
| | - Martin Scholz
- Wedau Kliniken Duisburg, Sana Konzern, Department of Neurosurgery, Duisburg, Germany
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Abstract
BACKGROUND Accurate brain lesion and craniotomy localization is an essential step in neurosurgical procedures. Image guided techniques transfer the information of neuroimaging about brain lesion localization to the patient. A critical view is necessary to find out how safe and reliable it is to transfer this information to the patient's head without using image guided systems. The aim of this study was to investigate the value of image guided brain lesion and craniotomy localization compared to conventional methods. METHODS A new developed test was performed with 10 neurosurgeons from different clinics. The first task was to perform the conventional tumor localization, planning of craniotomy and skin incision using the MRI dataset of a patient with a left temporal brain tumor. Second, the neurosurgeons were asked to plan the craniotomy and skin incision using MRI based 3D visualization with the exact localization of the segmented brain tumor. Both plans of each neurosurgeon were compared and analyzed according to the calculated brain tumor localization, location, shape and size of craniotomy. RESULTS All neurosurgeons changed the craniotomy localization and skin incision in the second part of the task using the image guided tumor visualization. The mean error (±standard deviation) of tumor localization of the conventional planning was 11.45±5.09 mm in the anterior-posterior (AP) and 12±7.91 mm in the superior-inferior (SI) direction. The mean error of the craniotomy localization using conventional planning was 10.18±6.09 mm in the AP and 10.75±8.18 mm in the SI direction. The craniotomy size was significantly larger using conventional planning of the craniotomy (P=0.035). CONCLUSIONS Conventional brain tumor and craniotomy localization leads more frequently to errors and oversized craniotomy. Image guided surgery can reduce these errors and increase the safety and orientation for preoperative planning.
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Affiliation(s)
- Mehran Mahvash
- Department of Neurosurgery, Clinic of Köln-Merheim, University of Witten-Herdecke, Witten-Herdecke, Germany
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Liebig KN, Maslehaty H, Petridis AK, Konen W, Scholz M. Comparison of two algorithms for the application of real-time image mosaicking in neuroendoscopy. J Neurosurg 2014; 121:688-99. [PMID: 24995784 DOI: 10.3171/2014.5.jns121788] [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: 11/06/2022]
Abstract
OBJECT Neuroendoscopy is used more and more frequently in neurosurgical procedures and has become an important tool in the neurosurgical armamentarium. However, the main restriction of neuroendoscopy is the limited field of view. A better overview of the area of interest would increase surgical safety and decrease procedure-related morbidity rates. In the present study, the authors aimed to improve this restriction by using and comparing two algorithms to create endoscopic panoramic images, which increase the field of view during neuroendoscopic procedures. METHODS Different endoscopic methods with or without a stand and with linear or circular endoscope movements were performed in cadaveric ventricles. Video of the endoscopy was used to create image mosaics of the lateral ventricle with the help of the Kourogi or LogSearch (LS) algorithm. In the LS algorithm, different template sizes were used. Three observers graded the quality of the image mosaic in terms of usefulness in surgery. The fastest frame rate was 3-4 frames/second. RESULTS The LS algorithm with a larger template size showed significantly better results for the creation of image mosaics than the Kourogi algorithm in linear endoscopic movement with or without a stand. In circular endoscopic movements, the results seemed to be better with the LS algorithm but were not significantly different from those obtained with the Kourogi algorithm. In summary, image quality in the experimental paradigms was satisfying. CONCLUSIONS Results in the study showed that the creation of image mosaics is possible and reliable with the featured algorithms. Image mosaicking is an applicable device for neuroendoscopy and can increase the field of view during endoscopic procedures. Its use can increase the safety and the field of application of neuroendoscopy. However, faster frame rates will be required to create a smooth image for practical use during surgery.
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Affiliation(s)
- Kay Niklas Liebig
- Department of Neurosurgery, Klinikum Duisburg, SANA Kliniken, Academic Teaching Hospital of University Essen-Duisburg; and
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