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Plontke SK, Hoffmann K, Caye-Thomasen P, Baasanjav S, Kösling S, Leisz S, Liebau A, Mawrin C, Rahne T, Scheffler J, Strauss C, Siebolts U. Unilateral Multifocal Inner Ear and Internal Auditory Canal or Cerebellopontine Angle Cochleovestibular Schwannomas-Genetic Analysis and Management by Surgical Resection and Cochlear Implantation. Otol Neurotol 2024; 45:580-586. [PMID: 38437842 DOI: 10.1097/mao.0000000000004163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To describe the genetic characteristics and the management of two very rare cases of unilateral multifocal inner ear and internal auditory canal or cerebellopontine angle cochleovestibular schwannomas not being associated to full neurofibromatosis type 2-related schwannomatosis. PATIENTS In a 29-year-old man and a 55-year-old woman with single-sided deafness multifocal unilateral cochleovestibular schwannomas were surgically resected, and hearing was rehabilitated with a cochlear implant (CI). Unaffected tissue was analyzed using next generation sequencing of the NF2 gene. Tumor tissue was analyzed using a 340-parallel sequencing gene panel. MAIN OUTCOME MEASURES Mutations in the NF2 gene, word recognition score for monosyllables at 65 dB SPL (WRS 65 ) with CI. RESULTS No disease-causing mutation was detected in the examined sequences in blood leucokytes. All tumor samples revealed, among others, somatic pathogenic NF2 mutations. While the anatomically separate tumors in case 1 were likely molecular identical, the tumors in case 2 showed different genetic patterns. WRS 65 was 55% at 6 years of follow-up and 60% at 4.5 years of follow-up, respectively. CONCLUSIONS The occurrence of multifocal unilateral cochleovestibular schwannomas without pathogenic variants in NF2 in non-affected blood leucocytes can be associated with mosaic NF2 -related schwannomatosis (case 1), or with likely sporadic mutations (case 2) and may be overlooked due to their extreme rarity. Although challenging, successful hearing rehabilitation could be achieved through surgical resection of the tumors and cochlear implantation.
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Affiliation(s)
- Stefan K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Katrin Hoffmann
- Institute of Human Genetics, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Per Caye-Thomasen
- Department of Otorhinolaryngology, Head and Neck Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sevjidmaa Baasanjav
- Institute of Human Genetics, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Sabrina Kösling
- Department of Radiology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Sandra Leisz
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Arne Liebau
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Christian Mawrin
- Institute of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Jonas Scheffler
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Christian Strauss
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
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Barba L, Carrubba C, Spindler K, Weise CM, Sachs T, Foschi M, D'Anna L, Sehm B, Ibe R, Elolf E, Strauss C, Otto M, Mensch A, Abu-Rumeileh S. Posterior reversible encephalopathy syndrome associated with antibiotic therapy: a case report and systematic review. Neurol Sci 2024:10.1007/s10072-024-07545-1. [PMID: 38679625 DOI: 10.1007/s10072-024-07545-1] [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: 03/01/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition associated with different etiologies, including antibiotic therapy. To date, most data regarding antibiotic-related PRES are limited to case reports and small case series. Here, we report a novel case description and provide a systematic review of the clinico-radiological characteristics and prognosis of available cases of PRES associated with antibiotic therapy. We performed a systematic literature search in PubMed and Scopus from inception to 10 January 2024, following PRISMA guidelines and a predefined protocol. The database search yielded 12 subjects (including our case). We described the case of a 55-year-old female patient with PRES occurring one day after administration of metronidazole and showing elevated serum neurofilament light chain protein levels and favorable outcome. In our systematic review, antibiotic-associated PRES was more frequent in female patients (83.3%). Metronidazole and fluoroquinolones were the most reported antibiotics (33.3% each). Clinical and radiological features were comparable to those of PRES due to other causes. Regarding the prognosis, about one third of the cases were admitted to the intensive care unit, but almost all subjects (90.0%) had a complete or almost complete clinical and radiological recovery after prompt cessation of the causative drug. Antibiotic-associated PRES appears to share most of the characteristics of classic PRES. Given the overall good prognosis of the disease, it is important to promptly diagnose antibiotic-associated PRES and discontinue the causative drug.
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Affiliation(s)
- Lorenzo Barba
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Carmelo Carrubba
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Kai Spindler
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Christopher M Weise
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Torben Sachs
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
- Division of Brain Sciences, Department of Medicine, Hammersmith Campus, Imperial College London, London, UK
| | - Bernhard Sehm
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Richard Ibe
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Erck Elolf
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Markus Otto
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexander Mensch
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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Thomas M, Scheer M, Rampp S, Strauss C, Schönfeld R, Leplow B. Psychological factors and long-term tinnitus handicap in vestibular schwannoma patients after retrosigmoid microsurgery - a cross-sectional study. Int J Audiol 2024:1-8. [PMID: 38613519 DOI: 10.1080/14992027.2024.2339351] [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: 10/03/2023] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE This study aimed to investigate the connection between psychological factors and postoperative tinnitus in vestibular schwannoma (VS) patients following retrosigmoid microsurgery. DESIGN Cross-sectional study. STUDY SAMPLE Ninety-three VS patients participated, completing questionnaires on demographics, tinnitus severity (THI-12), personality traits (TIPI-G), dizziness impact (DHI), perceived health benefits (GBI), somatisation tendencies (SOMS-2), and psychological distress (HADS-D). Our analysis involved Mann-Whitney U-tests, Spearman's rank-order correlations, and false discovery rate correction. RESULTS Most participants reported postoperative tinnitus (77/93), with 41 experiencing it preoperatively. Emotional stability correlated negatively with tinnitus presence, while tinnitus severity was associated with emotional distress. Preoperative somatisation tendencies were also positively linked to tinnitus severity. Postoperative Tinnitus was further linked to reduced perceived health benefits and increased anxiety and depression levels. Notably, age and gender showed no significant associations. CONCLUSION This study uncovers the interplay between postoperative tinnitus and psychological factors in VS patients, highlighting emotional and cognitive dimensions. Tailored psychological interventions addressing tinnitus's psychosomatic impact may enhance patients quality of life.
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Affiliation(s)
- M Thomas
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Scheer
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
| | - S Rampp
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - C Strauss
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
| | - R Schönfeld
- Department of Psychology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - B Leplow
- Department of Psychology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Allera H, Cohu M, Maley K, Crabot D, Karila-Cohen P, Strauss C, Lidove O, Cotto E. [Thoracic calcifications]. Rev Med Interne 2024; 45:176-177. [PMID: 37833151 DOI: 10.1016/j.revmed.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 10/15/2023]
Affiliation(s)
- H Allera
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - M Cohu
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - K Maley
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - D Crabot
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - P Karila-Cohen
- Service de radiologie, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - C Strauss
- Service de radiologie, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - O Lidove
- Service de médecine interne, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
| | - E Cotto
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
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Thomas M, Führes H, Scheer M, Rampp S, Strauss C, Schönfeld R, Leplow B. Perceived Health Benefits in Vestibular Schwannoma Patients with Long-Term Postoperative Headache: Insights from Personality Traits and Pain Coping-A Cross-Sectional Study. J Pers Med 2024; 14:75. [PMID: 38248776 PMCID: PMC10817612 DOI: 10.3390/jpm14010075] [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: 12/07/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
Postoperative headaches (POHs) following retrosigmoid microsurgery for vestibular schwannoma (VS) can significantly impact patients' perceived health benefits (PHBs). In this cross-sectional observational study, 101 VS patients were investigated. For the assessment of pain, the Rostock Headache Compendium (RoKoKo) and the German pain processing questionnaire (FESV) were used. The perceived health benefits (PHBs) were assessed by the Glasgow Benefit Inventory (GBI) and Big Five personality traits were measured using the Ten-Item Personality Inventory (TIPI-G). We showed that 55% of the participants experienced POHs, leading to a marked reduction in overall PHBs compared to those without POHs. The correlation analysis revealed an association between decreased PHBs and elevated levels of pain-related helplessness, depression, anxiety, and anger. Positive correlations were identified between PHBs and action-planning competence, cognitive restructuring, and the experience of competence. Low emotional stability and openness yielded associations with pain-related psychological impairment. Hearing loss and facial paresis did not exert a significant impact on PHBs. The study highlights the influence of pain-related coping strategies on PHBs in long-term POH patients. Thus, coping mechanisms and personality traits should be assessed even before surgery for post-surgery pain prevention. The limitations of this study include a relatively small sample size, potential biases introduced by the overrepresentation of female patients, and the use of an online survey methodology. In conclusion, this research highlights that the interplay between headaches, PHBs, and psychological factors is also relevant in VS patients undergoing microsurgery. Short-term psychological interventions should therefore be taken into account to improve post-surgery adaptive coping strategies.
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Affiliation(s)
- Mareike Thomas
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Hannah Führes
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Maximilian Scheer
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Robby Schönfeld
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Emil-Abderhalden-Straße 26-27, 06108 Halle, Germany
| | - Bernd Leplow
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Emil-Abderhalden-Straße 26-27, 06108 Halle, Germany
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Schildhauer P, Selke P, Staege MS, Harder A, Scheller C, Strauss C, Horstkorte R, Scheer M, Leisz S. Glycation Interferes with the Expression of Sialyltransferases and Leads to Increased Polysialylation in Glioblastoma Cells. Cells 2023; 12:2758. [PMID: 38067186 PMCID: PMC10706364 DOI: 10.3390/cells12232758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Glioblastoma (GBM) is a highly aggressive brain tumor that often utilizes aerobic glycolysis for energy production (Warburg effect), resulting in increased methylglyoxal (MGO) production. MGO, a reactive dicarbonyl compound, causes protein alterations and cellular dysfunction via glycation. In this study, we investigated the effect of glycation on sialylation, a common post-translational modification implicated in cancer. Our experiments using glioma cell lines, human astrocytes (hA), and primary glioma samples revealed different gene expressions of sialyltransferases among cells, highlighting the complexity of the system. Glycation has a differential effect on sialyltransferase expression, upregulating ST8SIA4 in the LN229 and U251 cell lines and decreasing the expression in normal hA. Subsequently, polysialylation increased in the LN229 and U251 cell lines and decreased in hA. This increase in polysialylation could lead to a more aggressive phenotype due to its involvement in cancer hallmark processes such as immune evasion, resistance to apoptosis, and enhancing invasion. Our findings provide insights into the mechanisms underlying GBM aggressiveness and suggest that targeting glycation and sialylation could be a potential therapeutic strategy.
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Affiliation(s)
- Paola Schildhauer
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (P.S.); (M.S.)
| | - Philipp Selke
- Institute for Physiological Chemistry, Medical Faculty, Martin Luther University Halle-Wittenberg, 06114 Halle (Saale), Germany
| | - Martin S. Staege
- Department of Surgical and Conservative Pediatrics and Adolescent Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Anja Harder
- Institute of Neuropathology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- CURE-NF Research Group, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Christian Scheller
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (P.S.); (M.S.)
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (P.S.); (M.S.)
| | - Rüdiger Horstkorte
- Institute for Physiological Chemistry, Medical Faculty, Martin Luther University Halle-Wittenberg, 06114 Halle (Saale), Germany
| | - Maximilian Scheer
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (P.S.); (M.S.)
| | - Sandra Leisz
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (P.S.); (M.S.)
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Hohmann U, Ghadban C, Prell J, Strauss C, Dehghani F, Hohmann T. A toolbox to analyze collective cell migration, proliferation and cellular organization simultaneously. Cell Adh Migr 2023; 17:1-11. [PMID: 37938930 PMCID: PMC10773533 DOI: 10.1080/19336918.2023.2276615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Analyses of collective cell migration and orientation phenomena are needed to assess the behavior of multicellular clusters. While some tools to the authors' knowledge none is capable to analyze collective migration, cellular orientation and proliferation in phase contrast images simultaneously. METHODS We provide a tool based to analyze phase contrast images of dense cell layers. PIV is used to calculatevelocity fields, while the structure tensor provides cellular orientation. An artificial neural network is used to identify cell division events, allowing to correlate migratory and organizational phenomena with cell density. CONCLUSION The presented tool allows the simultaneous analysis of collective cell behavior from phase contrast images in terms of migration, (self-)organization and proliferation.
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Affiliation(s)
- Urszula Hohmann
- Department of Anatomy and Cell Biology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Chalid Ghadban
- Department of Anatomy and Cell Biology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Prell
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Faramarz Dehghani
- Department of Anatomy and Cell Biology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Tim Hohmann
- Department of Anatomy and Cell Biology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Porschen C, Strauss C, Meersch M, Zarbock A. Personalized acute kidney injury treatment. Curr Opin Crit Care 2023; 29:551-558. [PMID: 37861191 DOI: 10.1097/mcc.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is a complex syndrome that might be induced by different causes and is associated with an increased morbidity and mortality. Therefore, it is a very heterogeneous syndrome and establishing a "one size fits all" treatment approach might not work. This review aims to examine the potential of personalized treatment strategies for AKI. RECENT FINDINGS The traditional diagnosis of AKI is based on changes of serum creatinine and urine output, but these two functional biomarkers have several limitations. Recent research identified different AKI phenotypes based on clinical features, biomarkers, and pathophysiological pathways. Biomarkers, such as Cystatin C, NGAL, TIMP2∗IGFBP7, CCL14, and DKK-3, have shown promise in predicting AKI development, renal recovery, and prognosis. Biomarker-guided interventions, such as the implementation of the KDIGO bundle, have demonstrated an improvement in renal outcomes in specific patient groups. SUMMARY A personalized approach to AKI treatment as well as research is becoming increasingly important as it allows the identification of distinct AKI phenotypes and the potential for targeted interventions. By utilizing biomarkers and clinical features, physicians might be able to stratify patients into subphenotypes, enabling more individualized treatment strategies. This review highlights the potential of personalized AKI treatment, emphasizing the need for further research and large-scale clinical trials to validate the efficacy of these approaches.
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Affiliation(s)
- Christian Porschen
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Germany
| | - Christian Strauss
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Germany
| | - Melanie Meersch
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Germany
| | - Alexander Zarbock
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Germany
- Outcomes Research Consortium, Cleveland, Ohio, USA
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Kolbe MR, Hohmann T, Hohmann U, Maronde E, Golbik R, Prell J, Illert J, Strauss C, Dehghani F. Elucidation of GPR55-Associated Signaling behind THC and LPI Reducing Effects on Ki67-Immunoreactive Nuclei in Patient-Derived Glioblastoma Cells. Cells 2023; 12:2646. [PMID: 37998380 PMCID: PMC10670585 DOI: 10.3390/cells12222646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
GPR55 is involved in many physiological and pathological processes. In cancer, GPR55 has been described to show accelerating and decelerating effects in tumor progression resulting from distinct intracellular signaling pathways. GPR55 becomes activated by LPI and various plant-derived, endogenous, and synthetic cannabinoids. Cannabinoids such as THC exerted antitumor effects by inhibiting tumor cell proliferation or inducing apoptosis. Besides its effects through CB1 and CB2 receptors, THC modulates cellular responses among others via GPR55. Previously, we reported a reduction in Ki67-immunoreactive nuclei of human glioblastoma cells after GPR55 activation in general by THC and in particular by LPI. In the present study, we investigated intracellular mechanisms leading to an altered number of Ki67+ nuclei after stimulation of GPR55 by LPI and THC. Pharmacological analyses revealed a strongly involved PLC-IP3 signaling and cell-type-specific differences in Gα-, Gβγ-, RhoA-ROCK, and calcineurin signaling. Furthermore, immunochemical visualization of the calcineurin-dependent transcription factor NFAT revealed an unchanged subcellular localization after THC or LPI treatment. The data underline the cell-type-specific diversity of GPR55-associated signaling pathways in coupling to intracellular G proteins. Furthermore, this diversity might determine the outcome and the individual responsiveness of tumor cells to GPR55 stimulation by cannabin oids.
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Affiliation(s)
- Marc Richard Kolbe
- Department of Anatomy and Cell Biology, Medical Faculty, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108 Halle (Saale), Germany; (M.R.K.); (T.H.); (U.H.)
| | - Tim Hohmann
- Department of Anatomy and Cell Biology, Medical Faculty, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108 Halle (Saale), Germany; (M.R.K.); (T.H.); (U.H.)
| | - Urszula Hohmann
- Department of Anatomy and Cell Biology, Medical Faculty, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108 Halle (Saale), Germany; (M.R.K.); (T.H.); (U.H.)
| | - Erik Maronde
- Department of Anatomy II, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany;
| | - Ralph Golbik
- Charles Tanford Protein Centre, Martin Luther University Halle-Wittenberg, Kurt-Mothes-Straße 3a, 06120 Halle (Saale), Germany;
| | - Julian Prell
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (J.P.); (J.I.); (C.S.)
| | - Jörg Illert
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (J.P.); (J.I.); (C.S.)
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (J.P.); (J.I.); (C.S.)
| | - Faramarz Dehghani
- Department of Anatomy and Cell Biology, Medical Faculty, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108 Halle (Saale), Germany; (M.R.K.); (T.H.); (U.H.)
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Abu‐Rumeileh S, Barba L, Bache M, Halbgebauer S, Oeckl P, Steinacker P, Güttler A, Keßler J, Illert J, Strauss C, Vordermark D, Otto M. Plasma β-synuclein, GFAP, and neurofilaments in patients with malignant gliomas undergoing surgical and adjuvant therapy. Ann Clin Transl Neurol 2023; 10:1924-1930. [PMID: 37608748 PMCID: PMC10578894 DOI: 10.1002/acn3.51878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/17/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023] Open
Abstract
We analyzed the longitudinal concentrations and prognostic roles of plasma β-synuclein (β-syn), glial fibrillary acidic protein (GFAP), and neurofilament proteins (NfL and NfH) in 33 patients with malignant gliomas, who underwent surgical and adjuvant therapy. GFAP and NfL levels were increased in patients with glioblastoma compared to cases with other tumors. β-syn, NfL and NfH increased after surgery, whereas GFAP decreased at long-term follow-up. β-syn and neurofilament concentrations were influenced by surgery and/or radiotherapy regimens. GFAP and neurofilament levels were significantly associated with survival. Plasma neuronal and astrocytic biomarkers are differentially altered in malignant glioma types and displayed distinct trajectories after surgical and adjuvant therapy.
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Affiliation(s)
- Samir Abu‐Rumeileh
- Department of NeurologyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
| | - Lorenzo Barba
- Department of NeurologyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
| | - Matthias Bache
- Department of RadiotherapyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
| | - Steffen Halbgebauer
- Department of NeurologyUlm University HospitalUlmGermany
- German Center for Neurodegenerative Diseases Ulm (DZNE e. V.)UlmGermany
| | - Patrick Oeckl
- Department of NeurologyUlm University HospitalUlmGermany
- German Center for Neurodegenerative Diseases Ulm (DZNE e. V.)UlmGermany
| | - Petra Steinacker
- Department of NeurologyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
| | - Antje Güttler
- Department of RadiotherapyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
| | - Jacqueline Keßler
- Department of RadiotherapyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
| | - Jörg Illert
- Department of NeurosurgeryMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
| | - Christian Strauss
- Department of NeurosurgeryMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
| | - Dirk Vordermark
- Department of RadiotherapyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
| | - Markus Otto
- Department of NeurologyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)06120Germany
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Leisz S, Klause CH, Becker AL, Scheer M, Simmermacher S, Strauss C, Scheller C. Establishment of vestibular schwannoma primary cell cultures obtained from cavitron ultrasonic surgical aspirator tissue material. J Neurosci Methods 2023; 397:109955. [PMID: 37611876 DOI: 10.1016/j.jneumeth.2023.109955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/03/2023] [Accepted: 08/19/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Vestibular schwannoma (VS) is a benign tumor arising from the Schwann cells of the eighth cranial nerve. The complexity in treatment is associated with unpredictable progression of this tumor. Some of the VS do not alter for years, while others rapidly increase in size. The mechanisms behind size progression are not well studied. Furthermore, despite several studies, there is no pharmacological treatment available for sporadic VS. Therefore, in vitro models are essential tools to study the cellular and molecular processes of VS. In addition, patient-derived cell cultures are important for substance screening to investigate pharmacological approaches in vitro. NEW METHOD This study presents a simple and fast method for culturing VS cells from patient tissue material obtained using a cavitron ultrasonic surgical aspirator (CUSA). In addition, the cells were characterized based on the expression of schwannoma markers, growth properties and screened for fibroblast contamination. RESULT We could show that CUSA obtained material is a suitable resource for isolation of VS primary cultures and enables real time analysis on living cells. COMPARISON WITH EXISTING METHODS To date, only a few protocols are available for culturing VS cells from patient tissue material. A disadvantage of these methods is the relatively large amount of tissue needed to obtain the primary cells, which can be difficult, especially in small VS. By obtaining the cells from the CUSA, there is the possibility to establish a primary culture even with limited material. CONCLUSION This approach could be particularly useful for testing substances that represent candidates for drug therapy of vestibular schwannoma.
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Affiliation(s)
- Sandra Leisz
- Martin Luther University Halle-Wittenberg, Medical Faculty, Department of Neurosurgery, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
| | - Clara Helene Klause
- Martin Luther University Halle-Wittenberg, Medical Faculty, Department of Neurosurgery, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Anna-Louisa Becker
- Martin Luther University Halle-Wittenberg, Medical Faculty, Department of Neurosurgery, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Maximilian Scheer
- Martin Luther University Halle-Wittenberg, Medical Faculty, Department of Neurosurgery, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Sebastian Simmermacher
- Martin Luther University Halle-Wittenberg, Medical Faculty, Department of Neurosurgery, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Christian Strauss
- Martin Luther University Halle-Wittenberg, Medical Faculty, Department of Neurosurgery, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Christian Scheller
- Martin Luther University Halle-Wittenberg, Medical Faculty, Department of Neurosurgery, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
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Thomas M, Rampp S, Scheer M, Strauss C, Prell J, Schönfeld R, Leplow B. Premorbid Psychological Factors Associated with Long-Term Postoperative Headache after Microsurgery in Vestibular Schwannoma-A Retrospective Pilot Study. Brain Sci 2023; 13:1171. [PMID: 37626527 PMCID: PMC10452443 DOI: 10.3390/brainsci13081171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Associations between premorbid psychological factors and postoperative headache (POH) after microsurgical treatment via the retrosigmoid approach for vestibular schwannoma (VS) were investigated in this retrospective single-center study. A total of 101 VS patients completed the Rostock headache questionnaire (RoKoKo), the hospital and anxiety scale (HADS-D), and the screening for somatoform disorders (SOMS-2), all of which were used as short self-assessed questionnaires. Fifty-four patients with POH were compared with 47 non-POH patients in terms of premorbid psychological factors, somatization tendencies, and psychological burden using the chi2-test and Mann-Whitney U-test. Regression analyses were conducted to assess the weighted contribution of psychological and procedural factors to POH. In individuals with POH, mental ailments, preexisting headaches, premorbid chronic pain syndromes, and higher somatization tendencies were found to be significantly more common. POH was predicted by the number of premorbid psychosomatic symptoms, preexisting mental ailments, and premorbid chronic pain syndromes. Depression and anxiety were predicted by low emotional stability. Additionally, the number of premorbid psychosomatic symptoms predicted depression, anxiety, and overall psychological burden. It was observed that the reported symptoms of headache might fit into the classification of chronic postsurgical pain (CPSP) rather than being classified as secondary headaches after craniotomy. Premorbid psychological factors were found to play an important role in the emergence of POH in VS, particularly after microsurgery via the retrosigmoid approach. Therefore, it is suggested that psychological screening be incorporated into the treatment process.
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Affiliation(s)
- Mareike Thomas
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;
- Department of Psychology, Martin-Luther-Universität Halle-Wittenberg, Emil-Abderhalden-Straße 26–27, 06108 Halle, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Maximilian Scheer
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Robby Schönfeld
- Department of Psychology, Martin-Luther-Universität Halle-Wittenberg, Emil-Abderhalden-Straße 26–27, 06108 Halle, Germany
| | - Bernd Leplow
- Department of Psychology, Martin-Luther-Universität Halle-Wittenberg, Emil-Abderhalden-Straße 26–27, 06108 Halle, Germany
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Scheer M, Spindler K, Strauss C, Schob S, Dietzel CT, Leisz S, Prell J, Rampp S. Surgical Site Infections in Glioblastoma Patients-A Retrospective Analysis. J Pers Med 2023; 13:1117. [PMID: 37511730 PMCID: PMC10381691 DOI: 10.3390/jpm13071117] [Citation(s) in RCA: 4] [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: 06/19/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Surgical site infections (SSIs) after craniotomy lead to additional morbidity and mortality for patients, which are related to higher costs for the healthcare system. Furthermore, SSIs are associated with a longer hospital stay for the patient, which is particularly detrimental in glioblastoma patients due to their limited life expectancy. Risk factors for SSIs have already been described for craniotomies in general. However, there is limited data available for glioblastoma patients. As postoperative radiation influences wound healing, very early radiation is suspected to be a risk factor for SSI. Nevertheless, there are no data on the optimal timing of radiotherapy. To define risk factors for these patients, we analyzed our collective. We performed a retrospective analysis of all operations with histological evidence of a glioblastoma between 2012 and 2021. Open biopsy and tumor removal (gross total resection, subtotal resection) were included. Stereotactic biopsies were excluded. Demographic data such as age and gender, as well as duration of surgery, diameter of the trepanation, postoperative radiation with interval, postoperative chemotherapy, highest blood glucose level, previous surgery, ASA score, foreign material introduced, subgaleal suction drainage, ventricle opening and length of hospital stay, were recorded. The need for surgical revision due to infection was registered as an SSI. A total of 177 patients were included, of which 14 patients (7.9%) suffered an SSI. These occurred after a median of 45 days. The group with SSIs tended to include more men (57.1%, p = 0.163) and more pre-operated patients (50%, p = 0.125). In addition, foreign material and subgaleal suction drains had been implanted more frequently and the ventricles had been opened more frequently, without reaching statistical significance. Surprisingly, significantly more patients without SSIs had been irradiated (80.3%, p = 0.03). The results enable a better risk assessment of SSIs in glioblastoma patients. Patients with previous surgery, introduced foreign material, subgaleal suction drain and opening of the ventricle may have a slightly higher for SSIs. However, because none of these factors were significant, we should not call them risk factors. A less radical approach to surgery potentially involving these factors is not justified. The postulated negative role of irradiation was not confirmed, hence a rapid chemoradiation should be induced to achieve the best possible oncologic outcome.
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Affiliation(s)
- Maximilian Scheer
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Kai Spindler
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Stefan Schob
- Department of Radiology, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Christian T Dietzel
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Sandra Leisz
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
- Department of Neurosurgery, Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
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Scheer M, Simmermacher S, Prell J, Leisz S, Scheller C, Mawrin C, Strauss C, Rampp S. Recurrences and progression following microsurgery of vestibular schwannoma. Front Surg 2023; 10:1216093. [PMID: 37416504 PMCID: PMC10322218 DOI: 10.3389/fsurg.2023.1216093] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Background The treatment approach of vestibular schwannoma (VS) has seen a change in recent years, with a trend away from radical surgery towards preservation of cranial nerve function. A recent study reported recurrences as long as 20 years after complete removal of VS. Objective To report the risk of recurrence and progression in our patient population the authors retrospectively reviewed outcomes of patients. Methods Cases with unilateral VS who had undergone primary microsurgery via retrosigmoidal approach between 1995 and 2021 were investigated. Complete tumor removal was defined as gross total resection (GTR), a capsular remnant was categorized as near total resection (NTR) and residual tumor was designated as subtotal resection (STR). The primary endpoint was radiological recurrence-free survival. Results 386 patients fulfilled the inclusion criteria of the study and were evaluated. GTR was achieved in 284 patients (73.6%), NTR was achieved in 63 patients (10.1%) and STR was present in 39 patients (16.3%). A total of 28 patients experienced recurrences with significant differences in the three subgroups. The strongest predictor of recurrence was the extent of resection, with patients who underwent STR having an almost 10-fold higher risk of recurrence and patients who had undergone NTR having an almost 3-fold higher risk than those treated with GTR. More than 20% of recurrences (6/28) occured after more than 5 years. Conclusion The degree of resection is an important guide to the interval of follow-up, but long-term follow-up should be considered also in the case of GTR. The majority of recurrences occurs after 3-5 years. Nevertheless, a follow-up of at least 10 years should be carried out.
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Affiliation(s)
- Maximilian Scheer
- Department of Neurosurgery, Medical Faculty, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Sebastian Simmermacher
- Department of Neurosurgery, Medical Faculty, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Prell
- Department of Neurosurgery, Medical Faculty, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Sandra Leisz
- Department of Neuropathology, University Magdeburg, Magdeburg, Germany
| | | | - Christian Mawrin
- Department of Neuropathology, University Magdeburg, Magdeburg, Germany
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stefan Rampp
- Department of Neurosurgery, Medical Faculty, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Schildhauer P, Selke P, Scheller C, Strauss C, Horstkorte R, Leisz S, Scheer M. Glycation Leads to Increased Invasion of Glioblastoma Cells. Cells 2023; 12:cells12091219. [PMID: 37174618 PMCID: PMC10177211 DOI: 10.3390/cells12091219] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/20/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Glioblastoma (GBM) is a highly aggressive and invasive brain tumor with a poor prognosis despite extensive treatment. The switch to aerobic glycolysis, known as the Warburg effect, in cancer cells leads to an increased production of methylglyoxal (MGO), a potent glycation agent with pro-tumorigenic characteristics. MGO non-enzymatically reacts with proteins, DNA, and lipids, leading to alterations in the signaling pathways, genomic instability, and cellular dysfunction. In this study, we investigated the impact of MGO on the LN229 and U251 (WHO grade IV, GBM) cell lines and the U343 (WHO grade III) glioma cell line, along with primary human astrocytes (hA). The results showed that increasing concentrations of MGO led to glycation, the accumulation of advanced glycation end-products, and decreasing cell viability in all cell lines. The invasiveness of the GBM cell lines increased under the influence of physiological MGO concentrations (0.3 mmol/L), resulting in a more aggressive phenotype, whereas glycation decreased the invasion potential of hA. In addition, glycation had differential effects on the ECM components that are involved in the invasion progress, upregulating TGFβ, brevican, and tenascin C in the GBM cell lines LN229 and U251. These findings highlight the importance of further studies on the prevention of glycation through MGO scavengers or glyoxalase 1 activators as a potential therapeutic strategy against glioma and GBM.
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Affiliation(s)
- Paola Schildhauer
- Department of Neurosurgery, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Philipp Selke
- Institute for Physiological Chemistry, Medical Faculty, Martin-Luther-University Halle-Wittenberg, 06114 Halle (Saale), Germany
| | - Christian Scheller
- Department of Neurosurgery, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Rüdiger Horstkorte
- Institute for Physiological Chemistry, Medical Faculty, Martin-Luther-University Halle-Wittenberg, 06114 Halle (Saale), Germany
| | - Sandra Leisz
- Department of Neurosurgery, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Maximilian Scheer
- Department of Neurosurgery, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
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Rampp S, Holze M, Scheller C, Strauss C, Prell J. Neural networks for estimation of facial palsy after vestibular schwannoma surgery. J Clin Monit Comput 2023; 37:575-583. [PMID: 36333576 PMCID: PMC10068649 DOI: 10.1007/s10877-022-00928-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Facial nerve damage in vestibular schwannoma surgery is associated with A-train patterns in free-running EMG, correlating with the degree of postoperative facial palsy. However, anatomy, preoperative functional status, tumor size and occurrence of A-trains clusters, i.e., sudden A-trains in most channels may further contribute. In the presented study, we examine neural networks to estimate postoperative facial function based on such features. METHODS Data from 200 consecutive patients were used to train neural feed-forward networks (NN). Estimated and clinical postoperative House and Brackmann (HB) grades were compared. Different input sets were evaluated. RESULTS Networks based on traintime, preoperative HB grade and tumor size achieved good estimation of postoperative HB grades (chi2 = 54.8), compared to using tumor size or mean traintime alone (chi2 = 30.6 and 31.9). Separate intermediate nerve or detection of A-train clusters did not improve performance. Removal of A-train cluster traintime improved results (chi2 = 54.8 vs. 51.3) in patients without separate intermediate nerve. CONCLUSION NN based on preoperative HB, traintime and tumor size provide good estimations of postoperative HB. The method is amenable to real-time implementation and supports integration of information from different sources. NN could enable multimodal facial nerve monitoring and improve postoperative outcomes.
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Affiliation(s)
- Stefan Rampp
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany.
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Magdalena Holze
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany
| | - Christian Scheller
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany
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Nützel R, Brandt S, Rampp S, Leisz S, Simmermacher S, Prell J, Strauss C, Scheller C. Subarachnoid Hemorrhage with Negative Initial Digital Subtraction Angiography: Subsequent Detection of Aneurysms and Complication Rates of Repeated Angiography. J Neurol Surg A Cent Eur Neurosurg 2023; 84:167-173. [PMID: 36302519 DOI: 10.1055/s-0042-1748771] [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: 11/06/2022]
Abstract
BACKGROUND The data on handling of spontaneous, nontraumatic subarachnoid hemorrhage (SAH) with negative initial digital subtraction angiography (DSA) are still inconclusive. The intention of this study was to evaluate the requirement of repeat DSA in patients with negative initial DSA and to compare the clinical outcomes of these cases. METHODS In a retrospective study, we reviewed patients with SAH and negative initial DSA treated in our department from January 2006 until December 2017. The patients were divided according to an established radiographic classification into perimesencephalic (pm) and nonperimesencephalic (npm) SAH. An interventional neuroradiologist and a neurosurgeon reviewed all DSA scans. RESULTS In all, 52 patients with negative initial DSA, comprising 36 (69.2%) patients with pm and 16 (30.8%) patients with npm bleeding pattern, were included. All patients underwent a second and 23 of these patients underwent a third DSA. In these 23 patients, subarachnoid blood distribution in the initial computed tomography (CT) scan was suspicious for the presence of aneurysm. In total, two aneurysms were detected during the second DSA (diagnostic yield: 3.85%). Both were in the pm group (diagnostic yield: 5.6%). The second repeat DSA did not show any causative vascular lesion. Complications after the DSA occurred in only 2 of 127 patients (1.6%). The rate of complications concerning vasospasm (pm 52.8%, npm 56.3%), hydrocephalus (pm 47.2%, npm 50%), and the need for temporary or permanent shunt (pm 44.4%, npm 50%) was similar in both groups and there was no statistically significant difference. CONCLUSION Repeat DSA after negative initial DSA in pm SAH had a diagnostic yield of 5.6%. However, a second repeat DSA cannot be recommended in case of SAH with initial negative DSA. The pm SAH should not be underrated concerning the occurrence of complications and cared with a high level of surveillance.
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Affiliation(s)
- Regina Nützel
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Silvio Brandt
- Department of Radiology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany.,Department of Radiology and Neuroradiology, Chemnitz Hospital, Chemnitz, Germany
| | - Stefan Rampp
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Sandra Leisz
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Sebastian Simmermacher
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Julian Prell
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Christian Scheller
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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Dengler NF, Scholz C, Beck J, Uerschels AK, Sure U, Scheller C, Strauss C, Martin D, Schackert G, Heinen C, Woitzik J, McLean AL, Rosahl SK, Kolbenschlag J, Heinzel J, Schuhmann M, Tatagiba MS, Guerra WKW, Schroeder HWS, Vetrano IG, Ahmadi R, Unterberg A, Reinsch J, Zdunczyk A, Unteroberdoerster M, Vajkoczy P, Wehner S, Becker M, Matthies C, Pérez-Tejón J, Dubuisson A, Barrone DG, Trivedi R, Capone C, Ferraresi S, Kraschl J, Kretschmer T, Dombert T, Staub F, Ronellenfitsch M, Marquardt G, Prinz V, Czabanka M, Carolus A, Braun V, König R, Antoniadis G, Wirtz CR, Rasulic L, Pedro MT. Rationale and design of the peripheral nerve tumor registry: an observational cohort study. Neurol Res 2023; 45:81-85. [PMID: 36208460 DOI: 10.1080/01616412.2022.2129762] [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: 01/14/2023]
Abstract
AIM Peripheral nerve tumors (PNT) are rare lesions. To date, no systematic multicenter studies on epidemiology, clinical symptoms, treatment strategies and outcomes, genetic and histopathologic features, as well as imaging characteristics of PNT were published. The main goal of our PNT Registry is the systematic multicenter investigation to improve our understanding of PNT and to assist future interventional studies in establishing hypotheses, determining potential endpoints, and assessing treatment efficacy. METHODS Aims of the PNT registry were set at the 2015 Meeting of the Section of Peripheral Nerve Surgery of the German Society of Neurosurgery. A study protocol was developed by specialists in PNT care. A minimal data set on clinical status, treatment types and outcomes is reported by each participating center at initial contact with the patient and after 1 year, 2 years, and 5 years. Since the study is coordinated by the Charité Berlin, the PNR Registry was approved by the Charité ethics committee (EA4/058/17) and registered with the German Trials Registry (www.drks.de). On a national level, patient inclusion began in June 2016. The registry was rolled out across Europe at the 2019 meeting of the European Association of Neurosurgery in Dublin. RESULTS Patient recruitment has been initiated at 10 centers throughout Europe and 14 additional centers are currently applying for local ethics approval. CONCLUSION To date, the PNT registry has grown into an international study group with regular scientific and clinical exchange awaiting the first results of the retrospective study arm.
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Affiliation(s)
- Nora F Dengler
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Christoph Scholz
- Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg i.B, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg i.B, Germany
| | - Anne-Kathrin Uerschels
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Ullrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christian Scheller
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06120 Halle, Germany
| | - Christian Strauss
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06120 Halle, Germany
| | - Daniel Martin
- Department of Neurosurgery, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Christian Heinen
- Department of Neurosurgery, Evangelisches Krankenhaus, Carl von Ossietzky University Oldenburg, Marienstr. 11, 26121 Oldenburg, Germany.,Department of Neurosurgery, PeripheralNerveUnit Nord, Christliches Krankenhaus Quakenbrück GmbH, Quakenbrück, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Evangelisches Krankenhaus, Carl von Ossietzky University Oldenburg, Marienstr. 11, 26121 Oldenburg, Germany
| | - Anna Lawson McLean
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Steffen K Rosahl
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive, and Burn Surgery, BG Klinik Tübingen, Schnarrenbergstraße 95, 72076 Tübingen Germany
| | - Johannes Heinzel
- Department of Hand-, Plastic, Reconstructive, and Burn Surgery, BG Klinik Tübingen, Schnarrenbergstraße 95, 72076 Tübingen Germany
| | - Martin Schuhmann
- Department of Neurosurgery, Universitätsklinikum Tübingen, Hippe-Seyler-Straße 3, 72076 Tübingen Germany
| | - Marco Soares Tatagiba
- Department of Neurosurgery, Universitätsklinikum Tübingen, Hippe-Seyler-Straße 3, 72076 Tübingen Germany
| | | | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Sauerbruchstr. 1, 17475 Greifswald, Germany
| | - Ignazio Gaspare Vetrano
- Department of Neurosurgery, Fondazione I.R.C.C.S Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133 Milano, Italy
| | - Rezvan Ahmadi
- Department of Neurosurgery, Heidelberg University Hospital, Berlin, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Berlin, Germany
| | - Jennifer Reinsch
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna Zdunczyk
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Meike Unteroberdoerster
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sarah Wehner
- Department of Plastic, Reconstructive, and Hand Surgery, Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Becker
- Department of Plastic, Reconstructive, and Hand Surgery, Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Cordula Matthies
- Department of Neurosurgery, Würzburg University Hospital, Würzburg, Germany
| | - Jose Pérez-Tejón
- Department of Neurosurgery, Würzburg University Hospital, Würzburg, Germany
| | - Annie Dubuisson
- Department of Neurosurgery, CHU Liège, Avenue de L'Hôpital 1, Liège, Belgium
| | - Damiano G Barrone
- Department of Clinical Neurosciences, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Rikin Trivedi
- Department of Clinical Neurosciences, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Crescenzo Capone
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University Napoli "Frederico II", Naples, Italy
| | - Stefano Ferraresi
- Department of Neurosurgery, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Jakob Kraschl
- Department of Neurosurgery and Neurorestoration, Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Thomas Kretschmer
- Department of Neurosurgery and Neurorestoration, Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | | | - Frank Staub
- Center for Peripheral Neurosurgery, Dossenheim, Germany
| | - Michael Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg, Frankfurt am Main, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Siegen, Germany
| | - Vincent Prinz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Siegen, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Siegen, Germany
| | - Anne Carolus
- Department of Neurosurgery, Diakonie Klinikum Jung-Stilling-Krankenhaus Neurochriurgische Klinik, Siegen, Germany
| | - Veit Braun
- Department of Neurosurgery, Diakonie Klinikum Jung-Stilling-Krankenhaus Neurochriurgische Klinik, Siegen, Germany
| | - Ralph König
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Ulm University, District Hospital, Günzburg, Germany
| | - Gregor Antoniadis
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Ulm University, District Hospital, Günzburg, Germany
| | - Christian Rainer Wirtz
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Ulm University, District Hospital, Günzburg, Germany
| | - Lukas Rasulic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Maria Teresa Pedro
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Ulm University, District Hospital, Günzburg, Germany
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Mauhin W, Brassier A, London J, Subran B, Zeggane A, Besset Q, Jammal C, Montardi C, Mellot C, Strauss C, Borie R, Lidove O. Manifestations pulmonaires des maladies héréditaires du métabolisme. Rev Mal Respir 2022; 39:758-777. [DOI: 10.1016/j.rmr.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022]
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Leisz S, Klause CH, Vital Dos Santos T, Haenel P, Scheer M, Simmermacher S, Mawrin C, Strauss C, Scheller C, Rampp S. Vestibular Schwannoma Volume and Tumor Growth Correlates with Macrophage Marker Expression. Cancers (Basel) 2022; 14:cancers14184429. [PMID: 36139588 PMCID: PMC9496830 DOI: 10.3390/cancers14184429] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The variable growth behavior of vestibular schwannomas (VS) makes therapy decisions very difficult. These benign tumors, which originate from the eighth cranial nerve, partly show a very slow growth rate over many years. Nevertheless, VS can lead to severe symptoms such as hearing loss and dizziness within a short time due to their increase in size. Despite numerous preliminary studies, no apparent influencing factor on size progression could be found so far. In our study, we consider the influence of growth factors and macrophage markers on the volume and growth rate of VS. While growth factors show no effect on tumor growth, higher expression of macrophage markers indicates an infiltration of macrophages. They may thus enhance the growth of VS and therefore represent a potential therapeutic target. Abstract Vestibular schwannoma is the most common benign tumor of the cerebellopontine angle and originates from Schwann cells surrounding the vestibulocochlear nerve. Since the size of the VS varies widely, affected patients suffer from symptoms of varying severity. It is often difficult to determine the optimal time for therapy, due to the unpredictability of the growth rate. Despite many investigations on influencing factors, no mechanism responsible for the increase in the growth rate of certain VS has been identified so far. Therefore, the present study investigates the influence of the seven markers: Ki-67, cyclooxygenase 2 (COX2), vascular endothelial growth factor (VEGF), macrophage colony-stimulating factor (M-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), CD163, and CD68 on tumor progression and tumor size in a cohort of 173 VS. The markers were determined by quantitative PCR and correlated with tumor volume and VS growth rate. The analysis showed a significantly negative correlation of the Ki-67, COX2, and VEGF on tumor volume. Moreover, with a higher volume of VS, the expression of the macrophage markers CD68, CD163, and GM-CSF increased significantly. Our results suggest that the increase in VS size is not primarily due to Schwann cell growth but to an infiltration of macrophages. This may have an impact on non-invasive therapy to preserve the hearing function of affected patients.
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Affiliation(s)
- Sandra Leisz
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
- Correspondence: ; Tel.: +49-(0)-345-557-7014
| | - Clara Helene Klause
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Tania Vital Dos Santos
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Pia Haenel
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Maximilian Scheer
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Sebastian Simmermacher
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Christian Mawrin
- Department of Neuropathology, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Christian Scheller
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Stefan Rampp
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
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21
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Scheller C, Prell J, Simmermacher S, Strauss C, Doenitz C, Schmidt NO, Schebesch KM. Insufficient Closing Forces of Yasargil Titanium Clips in Two Small Aneurysms Detected with Intraoperative Indocyanine Green Videoangiography. J Neurol Surg A Cent Eur Neurosurg 2022; 83:481-485. [DOI: 10.1055/s-0041-1740378] [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: 10/18/2022]
Abstract
Abstract
Background and Study Aims Aneurysm clips must have adequate closing forces because residual blood flow in clipped aneurysms may result in aneurysm recurrence. Such flow can be intraoperatively detected by visual inspection, microvascular Doppler sonography, indocyanine green videoangiography (ICG-V), angiography, and puncture.
Patients We present two patients with ruptured very small middle cerebral artery aneurysms (3 and 2.9 mm). The necks of both aneurysms were microsurgically clipped with Yasargil aneurysm clips without any complications.
Results In both aneurysms, visual inspection suggested complete occlusion, but ICG-V showed persistent residual blood flow between the middle parts of the clip blades.The first patient was treated with a 5.4-mm FT744T clip (closing force of 1.47 N). After the ICG-V finding, a second 3.9-mm FT714T clip (closing force of 1.08 N) was placed on the tips of the already implanted clip to increase the closing forces. Subsequent ICG-V did not show any further residual blood flow. In the second patient, the aneurysm was clipped with an 8.0-mm FE764K clip (closing force of 1.77 N). Intraoperative ICG-V showed persistent residual blood flow within the aneurysmal dome despite complete closure of the clip. The clip was repositioned closer to the parent vessel. Consecutive ICG-V did not show any residual blood flow.
Conclusion Visually undetected incomplete aneurysm occlusion can be revealed with ICG-V. In very small aneurysms, standard closing forces of clips may not be sufficient and complete closure of the clip branches should be intraoperatively validated with ICG-V.
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Affiliation(s)
- Christian Scheller
- Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
| | - Julian Prell
- Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
| | | | - Christian Strauss
- Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
| | - Christian Doenitz
- Department of Neurosurgery, University of Regensburg, Regensburg, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University of Regensburg, Regensburg, Germany
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Mauhin W, Belmatoug N, Berger M, Besset Q, Boitiaux J, Brassier A, Douillard C, Gousseff M, Lavigne C, Martis N, Mellot C, Nguyen A, Subran B, Klein E, Strauss C, Guillot E, Lidove O. Accès compassionnel à l’enzymothérapie chez les patients adultes avec déficit en sphingomyélinase acide (Niemann-Pick B) en France : expérience multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fritzsche S, Strauss C, Scheller C, Leisz S. Nimodipine Treatment Protects Auditory Hair Cells from Cisplatin-Induced Cell Death Accompanied by Upregulation of LMO4. Int J Mol Sci 2022; 23:ijms23105780. [PMID: 35628594 PMCID: PMC9145067 DOI: 10.3390/ijms23105780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/04/2022] Open
Abstract
Ototoxicity is one of the main dose-limiting side effects of cisplatin chemotherapy and impairs the quality of life of tumor patients dramatically. Since there is currently no established standard therapy targeting hearing loss in cisplatin treatment, the aim of this study was to investigate the effect of nimodipine and its role in cell survival in cisplatin-associated hearing cell damage. To determine the cytotoxic effect, the cell death rate was measured using undifferentiated and differentiated UB/OC−1 and UB/OC−2 cells, after nimodipine pre-treatment and stress induction by cisplatin. Furthermore, immunoblot analysis and intracellular calcium measurement were performed to investigate anti-apoptotic signaling, which was associated with a reduced cytotoxic effect after nimodipine pre-treatment. Cisplatin’s cytotoxic effect was significantly attenuated by nimodipine up to 61%. In addition, nimodipine pre-treatment counteracted the reduction in LIM Domain Only 4 (LMO4) by cisplatin, which was associated with increased activation of Ak strain transforming/protein kinase B (Akt), cAMP response element-binding protein (CREB), and signal transducers and activators of transcription 3 (Stat3). Thus, nimodipine presents a potentially well-tolerated substance against the ototoxicity of cisplatin, which could result in a significant improvement in patients’ quality of life.
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Hohmann U, Ghadban C, Hohmann T, Kleine J, Schmidt M, Scheller C, Strauss C, Dehghani F. Nimodipine Exerts Time-Dependent Neuroprotective Effect after Excitotoxical Damage in Organotypic Slice Cultures. Int J Mol Sci 2022; 23:ijms23063331. [PMID: 35328753 PMCID: PMC8954806 DOI: 10.3390/ijms23063331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023] Open
Abstract
During injuries in the central nervous system, intrinsic protective processes become activated. However, cellular reactions, especially those of glia cells, are frequently unsatisfactory, and further exogenous protective mechanisms are necessary. Nimodipine, a lipophilic L-type calcium channel blocking agent is clinically used in the treatment of aneurysmal subarachnoid haemorrhage with neuroprotective effects in different models. Direct effects of nimodipine on neurons amongst others were observed in the hippocampus as well as its influence on both microglia and astrocytes. Earlier studies proposed that nimodipine protective actions occur not only via calcium channel-mediated vasodilatation but also via further time-dependent mechanisms. In this study, the effect of nimodipine application was investigated in different time frames on neuronal damage in excitotoxically lesioned organotypic hippocampal slice cultures. Nimodipine, but not nifedipine if pre-incubated for 4 h or co-applied with NMDA, was protective, indicating time dependency. Since blood vessels play no significant role in our model, intrinsic brain cell-dependent mechanisms seems to strongly be involved. We also examined the effect of nimodipine and nifedipine on microglia survival. Nimodipine seem to be a promising agent to reduce secondary damage and reduce excitotoxic damage.
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Affiliation(s)
- Urszula Hohmann
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Chalid Ghadban
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Tim Hohmann
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Joshua Kleine
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Miriam Schmidt
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Christian Scheller
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (C.S.); (C.S.)
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (C.S.); (C.S.)
| | - Faramarz Dehghani
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
- Correspondence: ; Tel.: +49-3455571707
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Scheer M, Harder A, Wagner S, Ibe R, Prell J, Scheller C, Strauss C, Simmermacher S. Case report of a fulminant non-aneurysmal convexity subarachnoid hemorrhage after COVID-19. Interdiscip Neurosurg 2022; 27:101437. [PMID: 34868884 PMCID: PMC8628370 DOI: 10.1016/j.inat.2021.101437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/09/2021] [Accepted: 11/20/2021] [Indexed: 01/08/2023]
Abstract
We report on a case of a fulminant non-aneurysmal subarachnoid hemorrhage after COVID-19 in a patient without previous medical history or known previous illness despite a COVID-19 infection one month prior. We saw rarefied vessels in the area of the left middle cerebral artery besides a massive left frontal hemorrhage on cranial imaging. We concluded that these rarefied vessels are the expression of an RCVS, which fits the history of progressive headaches for one month. The RCVS might be caused by the COVID-19 infection and is related to the hemorrhage. Unfortunately, due to preoperative entrapment, brain death occurred a few days later.
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Affiliation(s)
- Maximilian Scheer
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Anja Harder
- Institute of Pathology, University Hospital Halle, Magdeburger Str. 14, 06112 Halle, Germany
| | - Sabine Wagner
- Department of Radiology, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Richard Ibe
- Department of Neurology, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Christian Scheller
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Sebastian Simmermacher
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
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Spindler K, Mawrin C, Strauss C, Prell J. Cranial and Spinal Metastasis of a Nonfunctioning Pituitary Adenoma: Report of a Case. J Neurol Surg A Cent Eur Neurosurg 2021; 84:394-398. [PMID: 34856620 DOI: 10.1055/s-0041-1739229] [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: 10/19/2022]
Abstract
Pituitary carcinoma is a rare disease with surgical, radiotherapeutic, and chemotherapeutic treatment options. We present the case of a female patient diagnosed with a nonfunctioning pituitary adenoma who underwent several surgical procedures, radiations, and chemotherapeutic treatments with various substances. Sixteen years after the first diagnosis, a cranial and spinal metastatic spread of the tumor occurred. We opted for an individual therapy based on anecdotal evidence. Unfortunately, the recommended off-label treatment with a somatostatin analog substance was never given due to bureaucratic delays. This case report is about the challenging aspects of individual decision-making in rare neurosurgical diseases.
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Affiliation(s)
- Kai Spindler
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
| | - Christian Mawrin
- Institut fuer Neuropathologie, Otto-von-Guericke-Universitaet, Magdeburg, Germany
| | - Christian Strauss
- Department of Neurosurgery, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Prell
- Department of Neurosurgery, University of Halle-Wittenberg, Halle (Saale), Germany
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Kleine J, Leisz S, Ghadban C, Hohmann T, Prell J, Scheller C, Strauss C, Simmermacher S, Dehghani F. Variants of Oxidized Regenerated Cellulose and Their Distinct Effects on Neuronal Tissue. Int J Mol Sci 2021; 22:ijms222111467. [PMID: 34768900 PMCID: PMC8584153 DOI: 10.3390/ijms222111467] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022] Open
Abstract
Based on oxidized regenerated cellulose (ORC), several hemostyptic materials, such as Tabotamp®, Equicel® and Equitamp®, have been developed to approach challenging hemostasis in neurosurgery. The present study compares ORC that differ in terms of compositions and properties, regarding their structure, solubility, pH values and effects on neuronal tissue. Cytotoxicity was detected via DNA-binding fluorescence dye in Schwann cells, astrocytes, and neuronal cells. Additionally, organotypic hippocampal slice cultures (OHSC) were analyzed, using propidium iodide, hematoxylin-eosin, and isolectin B4 staining to investigate the cellular damage, cytoarchitecture, and microglia activation. Whereas Equicel® led to a neutral pH, Tabotamp® (pH 2.8) and Equitamp® (pH 4.8) caused a significant reduction of pH (p < 0.001). Equicel® and Tabotamp® increased cytotoxicity significantly in several cell lines (p < 0.01). On OHSC, Tabotamp® and Equicel® led to a stronger and deeper damage to the neuronal tissue than Equitamp® or gauze (p < 0.01). Equicel® increased strongly the number of microglia cells after 24 h (p < 0.001). Microglia cells were not detectable after Tabotamp® treatment, presumably due to an artifact caused by strong pH reduction. In summary, our data imply the use of Equicel®, Tabotamp® or Equitamp® for specific applications in distinct clinical settings depending on their localization or tissue properties.
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Affiliation(s)
- Joshua Kleine
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (J.K.); (C.G.); (T.H.); (F.D.)
| | - Sandra Leisz
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (J.P.); (C.S.); (C.S.); (S.S.)
- Correspondence: ; Tel.: +49-(0)-345-557-7014
| | - Chalid Ghadban
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (J.K.); (C.G.); (T.H.); (F.D.)
| | - Tim Hohmann
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (J.K.); (C.G.); (T.H.); (F.D.)
| | - Julian Prell
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (J.P.); (C.S.); (C.S.); (S.S.)
| | - Christian Scheller
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (J.P.); (C.S.); (C.S.); (S.S.)
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (J.P.); (C.S.); (C.S.); (S.S.)
| | - Sebastian Simmermacher
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (J.P.); (C.S.); (C.S.); (S.S.)
| | - Faramarz Dehghani
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (J.K.); (C.G.); (T.H.); (F.D.)
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Scheer M, Strauss C, Scheller C, Kubelt C, Skalej M, Mawrin C, Prell J. Case report of recurrent anaplastic oligodendroglioma with mixed astrocytic components and pathological discordance of tumor progression. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Scheer M, Griesler B, Ottlik E, Strauss C, Mawrin C, Kunze C, Prell J, Rampp S, Simmermacher S, Illert J, Kielstein H, Scheller C. Variability in the distance from the end of the gray matter to the end of the conus medullaris: a case-triggered histological investigation. J Neurosurg Spine 2021; 35:446-453. [PMID: 34359036 DOI: 10.3171/2020.12.spine201890] [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: 10/15/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The background for this investigation was the dramatic course of a 14-year-old girl with a spontaneous hemorrhage in the area of the conus medullaris resulting in a complete cross-sectional syndrome with bladder and bowel dysfunction. Despite immediate surgical treatment, the patient showed close to no postoperative improvement. Subsequent histopathological examination of the removed masses revealed a cavernoma. To better understand the link between the site and symptoms of conus medullaris lesions, the authors performed a literature search and then histological examination of the conus medullaris of 18 cadaveric specimens from body donors. METHODS After a literature search regarding the histological features of the structure of the conus medullaris did not lead to satisfying results, the authors performed histological examination of the conus medullaris in 18 cadaveric specimens from body donors. The largest (a) and smallest (b) diameters of the conus medullaris were measured, noting individual variations in the distance from the caudal ending of the gray matter to the macroscopically visible end of the conus medullaris. Correlations of these differences with sex, body height, gray matter transverse diameter, and cross-sectional area at the end of the gray matter were analyzed. RESULTS Gray matter displayed in the form of a butterfly figure was found along almost the entire length of the conus medullaris. The specific slide containing the end of the gray matter was noted. The distance between the caudal ending of the gray matter in the conus and the macroscopical end of the conus medullaris was defined as the gray matter to cone termination (GMCT) distance. There were great individual variations in the distance from the caudal ending of the gray matter to the macroscopically visible end of the conus medullaris. Analysis of the correlations of these differences with sex, body height, gray matter transverse diameter, and cross-sectional area at the end of the gray matter showed no significant sex-specific differences in the GMCT distance. Patient body height and transverse diameter at the end of the gray matter were found to be correlated positively with the GMCT distance. Moreover, greater height also correlated positively with the cross-sectional area at the end of the gray matter. CONCLUSIONS This report is, to the authors' knowledge, the first published description of the histological structure of the conus medullaris and can serve as the basis for a better understanding of neurological deficits in patients with a conus medullaris syndrome. Findings that gray matter can be detected far into the conus medullaris, with large individual differences in the endpoint of the gray matter, are important for operative care of intramedullary masses and vascular malformations in this area. It is therefore important to use electrophysiological monitoring during these operations.
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Affiliation(s)
| | - Bruno Griesler
- 2Institute of Anatomy and Cell Biology, Medical Faculty, and
| | | | | | | | - Christian Kunze
- 3Department of Radiology, Martin Luther University Halle-Wittenberg, Halle; and
| | | | | | | | | | - Heike Kielstein
- 2Institute of Anatomy and Cell Biology, Medical Faculty, and
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Scheller C, Strauss C, Leisz S, Hänel P, Klemm A, Kowoll S, Böselt I, Rahne T, Wienke A. Prophylactic nimodipine treatment for hearing preservation after vestibular schwannoma surgery: study protocol of a randomized multi-center phase III trial-AkniPro 2. Trials 2021; 22:475. [PMID: 34294114 PMCID: PMC8296656 DOI: 10.1186/s13063-021-05417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/02/2021] [Indexed: 11/11/2022] Open
Abstract
Background A previously performed phase III trial on 112 subjects investigating prophylactic nimodipine treatment in vestibular schwannoma (VS) surgery showed no clear beneficial effects on preservation of facial and cochlear nerve functions, though it should be considered that protection of facial nerve function was the primary outcome. However, the risk for postoperative hearing loss was halved in the nimodipine group compared to the control group (OR 0.49; 95% CI 0.18–1.30; p = 0.15). Accordingly, this phase III extension trial investigates the efficacy and safety of prophylactic nimodipine for hearing preservation in VS surgery. Methods This is a randomized, multi-center, two-armed, open-label phase III trial with blinded expert review and two-stage with interim analysis. Three hundred thirty-six adults with the indication for microsurgical removal of VS (Koos I–IV) and serviceable preoperative hearing (Gardner-Robertson scale (GR) 1–3) are assigned to either the therapy (intravenous nimodipine 1–2 mg/h from the day before surgery until the fifth postoperative day and standard of care) or the control group (surgery only and standard of care). The primary endpoint of the trial is postoperative cochlear nerve function measured before discharge according to GR 1–3 versus GR 4–5 (binary). Hearing function will be determined by pre- and postoperative audiometry with speech discrimination, which will be evaluated by a blinded expert reviewer. Furthermore, patient-reported outcomes using standardized questionnaires will be analyzed. Discussion Prophylactic parenteral nimodipine treatment may have a positive effect on hearing preservation in VS surgery and would improve patient’s quality of life. Further secondary analyses are planned. Except for dose-depending hypotension, nimodipine is known as a safe drug. In the future, prophylactic nimodipine treatment may be recommended as a routine medication in VS surgery. VS can be considered as an ideal model for clinical evaluation of neuroprotection, since hearing outcome can be classified by well-recognized criteria. The beneficial effect of nimodipine may be transferable to other surgical procedures with nerves at risk and may have impact on basic research. Trial registration EudraCT 2019-002317-19, DRKS00019107. 8th May 2020.
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Affiliation(s)
- Christian Scheller
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany.
| | - Christian Strauss
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany
| | - Sandra Leisz
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany
| | - Pia Hänel
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany
| | - Ariane Klemm
- Coordination Centre for Clinical Trials, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Simone Kowoll
- Coordination Centre for Clinical Trials, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Iris Böselt
- Coordination Centre for Clinical Trials, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Strauss C, Rampp S, Scheller C, Prell J, Strauss C, Doerfler A, Engelhorn T. Volumetry and Surgical Grading Systems for Vestibular Schwannoma Size Assessment and their Relationship to Postoperative Facial Nerve Function. J Neurol Surg A Cent Eur Neurosurg 2021; 83:39-45. [PMID: 34100269 DOI: 10.1055/s-0041-1725951] [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 AND STUDY AIMS Treatment modalities in vestibular schwannoma (VS) are difficult to compare since different techniques for size measurements are used. The purpose of this study was to evaluate the relation between different tumor size grading systems regarding their compatibility as well as the relationship to facial nerve outcome facilitating comparisons of different studies. MATERIAL AND METHODS In this retrospective study, preoperative magnetic resonance imaging of 100 patients with surgically treated VS was evaluated regarding total tumor volume and anatomical extension based on the Koos and Samii classification, as well as volumetric and maximal diameter measures. Three-dimensional constructive interference in steady state (3D-CISS) and T1 postcontrast volumetric interpolated breath-hold examination (VIBE) sequences were used. Facial nerve function was evaluated according to the House-Brackmann (HB) scale 6 months following complete tumor removal via the retrosigmoid approach. RESULTS Tumor size showed a moderate influence on postsurgical facial nerve function with correlations not exceeding 0.4. Severe palsy was observed mainly in patients with large tumors with Koos grade 4, Samii grade 4b, respectively a volume of at least 6 cm3 or a maximum diameter of 2.4 cm for HB ≥ 3 and a volume of 7.5 cm3 and maximum diameter of 3.2 cm for HB ≥ 4. In regard to volumetry, the Koos and Samii grading systems were highly comparable, whereas the maximal diameter showed consistently lower correlation values. CONCLUSIONS The results of our study allow direct comparison of studies on surgery versus radiotherapy of VS. The data allow for translation of tumor sizes based on different grading systems. Comparison of microsurgical, radiotherapeutic and radiosurgical approaches should concentrate on patients with large tumors. Whereas smaller tumors were rarely associated with severe facial palsy, large tumors did not exclude the possibility of weak or no palsy 6 months after surgery.
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Affiliation(s)
- Catharina Strauss
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Christian Scheller
- Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
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Rahne T, Plontke SK, Fröhlich L, Strauss C. Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma. Sci Rep 2021; 11:8608. [PMID: 33883565 PMCID: PMC8060325 DOI: 10.1038/s41598-021-87515-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
In vestibular schwannoma (VS) patients hearing outcome and surgery related risks can vary and depend on the nerve of origin. Preoperative origin differentiation between inferior or superior vestibular nerve may influence the decision on treatment, and the selection of optimal treatment and counselling modalities. A novel scoring system based on functional tests was designed to predict the nerve of origin for VS and was applied to a large number of consecutive patients. A prospective, double blind, cohort study including 93 patients with suspected unilateral VS was conducted at a tertiary referral centre. Preoperatively before tumor resection a functional test battery [video head-impulse test (vHIT) of all semicircular canals (SCC)], air-conducted cervical/ocular vestibular evoked myogenic potential tests (cVEMP, oVEMP), pure-tone audiometry, and speech discrimination was applied. Sensitivity and specificity of prediction of intraoperative finding by a preoperative score based on vHIT gain, cVEMP and oVEMP amplitudes and asymmetry ratios was calculated. For the prediction of inferior vestibular nerve origin, sensitivity was 73% and specificity was 80%. For the prediction of superior vestibular nerve origin, sensitivity was 60% and specificity was 90%. Based on the trade-off between sensitivity and specificity, optimized cut-off values of - 0.32 for cVEMP and - 0.11 for oVEMP asymmetry ratios and vHIT gain thresholds of 0.77 (anterior SCC), 0.84 (lateral SCC) and 0.80 (posterior SCC) were identified by receiver operator characteristic curves. The scoring system based on preoperative functional tests improves prediction of nerve of origin and can be applied in clinical routine.
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Affiliation(s)
- Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
- Universitäts-HNO-Klinik, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Laura Fröhlich
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Scheller C, Rampp S, Prell J, Strauss C, John E, Jörg U, Diessel L, Brandt S, Müller T. Epithelioid Hemangioendothelioma in the Area of the Neurovascular Bundle of the Upper Arm Mimicking a Schwannoma of the Ulnar Nerve. J Neurol Surg A Cent Eur Neurosurg 2021; 83:294-297. [PMID: 33845503 DOI: 10.1055/s-0041-1722969] [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
Epithelioid hemangioendothelioma (EH) is a rare vascular malignant sarcoma. To date, there are only two published case reports of EH mimicking nerve sheath tumors of a peripheral nerve. A 41-year-old woman presented with a painful node on the inside of the upper arm and motor deficits of the ulnar nerve. Magnetic resonance imaging (MRI) follow-up and neurosonography revealed a slowly progressive, contrast-enhancing tumor in the area of the neurovascular bundle. A schwannoma of the ulnar nerve was suspected. At surgery, the tumor was adherent to the brachial artery, but not to nerves. Pathology revealed an EH. EH may mimic a nerve sheath tumor and should be taken into consideration, especially because of its potential for metastasis and fatal progression.
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Affiliation(s)
- Christian Scheller
- Department of Neurosurgery, University of Halle-Wittenberg, Sachsen-Anhalt, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University of Halle-Wittenberg, Sachsen-Anhalt, Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, University of Halle-Wittenberg, Sachsen-Anhalt, Germany
| | - Endres John
- Department of Neurosurgery, University of Halle-Wittenberg, Sachsen-Anhalt, Germany
| | - Ukkat Jörg
- Department of General Surgery, University of Halle-Wittenberg, Halle (Saale), Sachsen-Anhalt, Germany
| | - Linda Diessel
- Department of Pathology, University of Halle-Wittenberg, Halle (Saale), Sachsen-Anhalt, Germany
| | - Silvio Brandt
- Department of Neuroradiology, University of Halle-Wittenberg, Halle (Saale), Sachsen-Anhalt, Germany
| | - Tobias Müller
- Department of Neurology, University of Halle-Wittenberg, Halle (Saale), Sachsen-Anhalt, Germany
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Selke P, Rosenstock P, Bork K, Strauss C, Horstkorte R, Scheer M. Glycation of benign meningioma cells leads to increased invasion. Biol Chem 2021; 402:849-859. [PMID: 33725749 DOI: 10.1515/hsz-2020-0376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/26/2021] [Indexed: 12/21/2022]
Abstract
Meningiomas are the most common non-malignant intracranial tumors. Like most tumors, meningiomas prefer anaerobic glycolysis for energy production (Warburg effect). This leads to an increased synthesis of the metabolite methylglyoxal (MGO). This metabolite is known to react with amino groups of proteins. This reaction is called glycation, thereby building advanced glycation endproducts (AGEs). In this study, we investigated the influence of glycation on two meningioma cell lines, representing the WHO grade I (BEN-MEN-1) and the WHO grade III (IOMM-Lee). Increasing MGO concentrations led to the formation of AGEs and decreased growth in both cell lines. When analyzing the influence of glycation on adhesion, chemotaxis and invasion, we could show that the glycation of meningioma cells resulted in increased invasive potential of the benign meningioma cell line, whereas the invasive potential of the malignant cell line was reduced. In addition, glycation increased the E-cadherin- and decreased the N-cadherin-expression in BEN-MEN-1 cells, but did not affect the cadherin-expression in IOMM-Lee cells.
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Affiliation(s)
- Philipp Selke
- Medical Faculty, Institute for Physiological Chemistry, Martin-Luther-University Halle-Wittenberg, D-06114Halle/Saale, Germany
| | - Philip Rosenstock
- Medical Faculty, Institute for Physiological Chemistry, Martin-Luther-University Halle-Wittenberg, D-06114Halle/Saale, Germany
| | - Kaya Bork
- Medical Faculty, Institute for Physiological Chemistry, Martin-Luther-University Halle-Wittenberg, D-06114Halle/Saale, Germany
| | - Christian Strauss
- Department for Neurosurgery, University Hospital Halle, D-06120Halle/Saale, Germany
| | - Rüdiger Horstkorte
- Medical Faculty, Institute for Physiological Chemistry, Martin-Luther-University Halle-Wittenberg, D-06114Halle/Saale, Germany
| | - Maximilian Scheer
- Medical Faculty, Institute for Physiological Chemistry, Martin-Luther-University Halle-Wittenberg, D-06114Halle/Saale, Germany
- Department for Neurosurgery, University Hospital Halle, D-06120Halle/Saale, Germany
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Kolbe MR, Hohmann T, Hohmann U, Ghadban C, Mackie K, Zöller C, Prell J, Illert J, Strauss C, Dehghani F. THC Reduces Ki67-Immunoreactive Cells Derived from Human Primary Glioblastoma in a GPR55-Dependent Manner. Cancers (Basel) 2021; 13:cancers13051064. [PMID: 33802282 PMCID: PMC7959141 DOI: 10.3390/cancers13051064] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/11/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022] Open
Abstract
Glioblastoma (GBM) is the most frequent malignant tumor of the central nervous system in humans with a median survival time of less than 15 months. ∆9-Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the best-characterized components of Cannabis sativa plants with modulating effects on cannabinoid receptors 1 and 2 (CB1 and CB2) and on orphan receptors such as GPR18 or GPR55. Previous studies have demonstrated anti-tumorigenic effects of THC and CBD in several tumor entities including GBM, mostly mediated via CB1 or CB2. In this study, we investigated the non-CB1/CB2 effects of THC on the cell cycle of GBM cells isolated from human tumor samples. Cell cycle entry was measured after 24 h upon exposure by immunocytochemical analysis of Ki67 as proliferation marker. The Ki67-reducing effect of THC was abolished in the presence of CBD, whereas CBD alone did not cause any changes. To identify the responsible receptor for THC effects, we first characterized the cells regarding their expression of different cannabinoid receptors: CB1, CB2, GPR18, and GPR55. Secondly, the receptors were pharmacologically blocked by application of their selective antagonists AM281, AM630, O-1918, and CID16020046 (CID), respectively. All examined cells expressed the receptors, but only in presence of the GPR55 antagonist CID was the THC effect diminished. Stimulation with the GPR55 agonist lysophosphatidylinositol (LPI) revealed similar effects as obtained for THC. The LPI effects were also inhibited by CBD and CID, confirming a participation of GPR55 and suggesting its involvement in modifying the cell cycle of patient-derived GBM cells.
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Affiliation(s)
- Marc Richard Kolbe
- Department of Anatomy and Cell Biology, Medical Faculty of Martin-Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108 Halle (Saale), Germany; (M.R.K.); (T.H.); (U.H.); (C.G.)
| | - Tim Hohmann
- Department of Anatomy and Cell Biology, Medical Faculty of Martin-Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108 Halle (Saale), Germany; (M.R.K.); (T.H.); (U.H.); (C.G.)
| | - Urszula Hohmann
- Department of Anatomy and Cell Biology, Medical Faculty of Martin-Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108 Halle (Saale), Germany; (M.R.K.); (T.H.); (U.H.); (C.G.)
| | - Chalid Ghadban
- Department of Anatomy and Cell Biology, Medical Faculty of Martin-Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108 Halle (Saale), Germany; (M.R.K.); (T.H.); (U.H.); (C.G.)
| | - Ken Mackie
- Department of Psychological & Brain Sciences, Indiana University, 1101E. 10th, Bloomington, IN 47405, USA;
| | - Christin Zöller
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (C.Z.); (J.P.); (J.I.); (C.S.)
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (C.Z.); (J.P.); (J.I.); (C.S.)
| | - Jörg Illert
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (C.Z.); (J.P.); (J.I.); (C.S.)
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (C.Z.); (J.P.); (J.I.); (C.S.)
| | - Faramarz Dehghani
- Department of Anatomy and Cell Biology, Medical Faculty of Martin-Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108 Halle (Saale), Germany; (M.R.K.); (T.H.); (U.H.); (C.G.)
- Correspondence: ; Tel.: +49-345-557-1707
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Plontke SK, Caye-Thomasen P, Strauss C, Kösling S, Götze G, Siebolts U, Vordermark D, Wagner L, Fröhlich L, Rahne T. Management of transmodiolar and transmacular cochleovestibular schwannomas with and without cochlear implantation. HNO 2021; 69:7-19. [PMID: 33044580 PMCID: PMC7862215 DOI: 10.1007/s00106-020-00919-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Hearing rehabilitation with cochlear implants has attracted increasing interest also for patients with cochleovestibular schwannoma. The authors report their experience with the surgical management of tumors with rare transmodiolar or transmacular extension and outcomes after cochlear implantation (CI). Methods This retrospective case series included nine patients with either primary intralabyrinthine tumors or secondary invasion of the inner ear from the internal auditory canal. The primary endpoint with CI, performed in six patients, was word recognition score at 65 dB SPL (sound pressure level). Secondary endpoints were intra- and postoperative electrophysiological parameters, impedance measures, the presence of a wave V in the electrically evoked (via the CI) auditory brainstem responses, the specifics of postoperative CI programming, and adverse events. Results Hearing rehabilitation with CI in cases of transmodiolar tumor growth could be achieved only with incomplete tumor removal, whereas tumors with transmacular growth could be completely removed. All six patients with CI had good word recognition scores for numbers in quiet conditions (80–100% at 65 dB SPL, not later than 6 to 12 months post CI activation). Four of these six patients achieved good to very good results for monosyllabic words within 1–36 months (65–85% at 65 dB SPL). The two other patients, however, had low scores for monosyllables at 6 months (25 and 15% at 65 dB SPL, respectively) with worsening of results thereafter. Conclusions Cochleovestibular schwannomas with transmodiolar and transmacular extension represent a rare entity with specific management requirements. Hearing rehabilitation with CI is a principal option in these patients. Video online The online version of this article (10.1007/s00106-020-00919-9) includes a video (2D and 3D versions) of the described surgical technique. Article and supplementary material are available at www.springermedizin.de. Please enter the title of the article in the search field, the supplementary material can be found under “Ergänzende Inhalte”. ![]()
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Affiliation(s)
- S K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - P Caye-Thomasen
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C Strauss
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - S Kösling
- Department of Radiation Medicine, Clinic for Radiology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - G Götze
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - U Siebolts
- Institute of Pathology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - D Vordermark
- Department of Radiation Medicine, Clinic for Radiotherapy, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - L Wagner
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - L Fröhlich
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - T Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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Berry C, Newcombe H, Strauss C, Rammou A, Schlier B, Lincoln T, Hayward M. Validation of the Hamilton Program for Schizophrenia Voices Questionnaire: Associations with emotional distress and wellbeing, and invariance across diagnosis and sex. Schizophr Res 2021; 228:336-343. [PMID: 33540145 DOI: 10.1016/j.schres.2020.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/02/2020] [Accepted: 12/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Voice-hearing is a transdiagnostic experience with evident negative effects on patients. Good quality measurement is needed to further elucidate the nature, impact and treatment of voice-hearing experiences across patient groups. The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is a brief self-report measure which requires further psychometric evaluation. METHODS Using data from a transdiagnostic sample of 401 adult UK patients, the fit of a conceptual HPSVQ measurement model, proposing a separation between physical and emotional voice-hearing characteristics, was tested. A structural model was examined to test associations between voice-hearing, general emotional distress (depression, anxiety, stress) and wellbeing. The invariance of model parameters was examined across diagnosis and sex. RESULTS The final measurement model comprised two factors named 'voice severity' and 'voice-related distress'. The former comprised mainly physical voice characteristics and the latter mainly distress and other negative impacts. Structural model results supported voice-related distress as mediating the associations between voice severity and emotional distress and wellbeing. Model parameters were invariant across psychosis versus non-psychosis diagnosis and partially invariant across sex. Females experienced more severe and distressing voices and a more direct association between voice severity and general anxiety was evident. CONCLUSIONS The HPSVQ is a useful self-report measure of voice-hearing with some scope for further exploration and refinement. Voice-related distress appears a key mechanism by which voice severity predicts general distress and wellbeing. Whilst our data broadly support interventions targeting voice-related distress for all patients, females may benefit especially from interventions targeting voice severity and strategies for responding.
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Affiliation(s)
- C Berry
- Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Falmer, Brighton, BN1 9PH, United Kingdom of Great Britain and Northern Ireland; School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland.
| | - H Newcombe
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland
| | - C Strauss
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland; Research & Development, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital, Nevill Avenue, Hove, BN3 7HZ, United Kingdom of Great Britain and Northern Ireland
| | - A Rammou
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland
| | - B Schlier
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Fakultät für Psychologie und Bewegungswissenschaft, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - T Lincoln
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Fakultät für Psychologie und Bewegungswissenschaft, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - M Hayward
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland; Research & Development, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital, Nevill Avenue, Hove, BN3 7HZ, United Kingdom of Great Britain and Northern Ireland
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Prell J, Scheller C, Simmermacher S, Strauss C, Rampp S. Facial Nerve EMG: Low-Tech Monitoring with a Stopwatch. J Neurol Surg A Cent Eur Neurosurg 2021; 82:308-316. [PMID: 33418594 DOI: 10.1055/s-0040-1701616] [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: 10/22/2022]
Abstract
OBJECTIVE The quantity of A-trains, a high-frequency pattern of free-running facial nerve electromyography, is correlated with the risk for postoperative high-grade facial nerve paresis. This correlation has been confirmed by automated analysis with dedicated algorithms and by visual offline analysis but not by audiovisual real-time analysis. METHODS An investigator was presented with 29 complete data sets measured during actual surgeries in real time and without breaks in a random order. Data were presented either strictly via loudspeaker (audio) or simultaneously by loudspeaker and computer screen (audiovisual). Visible and/or audible A-train activity was then quantified by the investigator with the computerized equivalent of a stopwatch. The same data were also analyzed with quantification of A-trains by automated algorithms. RESULTS Automated (auto) traintime (TT), known to be a small, yet highly representative fraction of overall A-train activity, ranged from 0.01 to 10.86 s (median: 0.58 s). In contrast, audio-TT ranged from 0 to 1,357.44 s (median: 29.69 s), and audiovisual-TT ranged from 0 to 786.57 s (median: 46.19 s). All three modalities were correlated to each other in a highly significant way. Likewise, all three modalities correlated significantly with the extent of postoperative facial paresis. As a rule of thumb, patients with visible/audible A-train activity < 1 minute presented with a more favorable clinical outcome than patients with > 1 minute of A-train activity. CONCLUSION Detection and even quantification of A-trains is technically possible not only with intraoperative automated real-time calculation or postoperative visual offline analysis, but also with very basic monitoring equipment and real-time good quality audiovisual analysis. However, the investigator found audiovisual real-time-analysis to be very demanding; thus tools for automated quantification can be very helpful in this respect.
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Affiliation(s)
- Julian Prell
- Department of Neurosurgery, University of Halle, Halle, Germany
| | | | | | | | - Stefan Rampp
- Department of Neurosurgery, University of Halle, Halle, Germany
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Zech J, Leisz S, Göttel B, Syrowatka F, Greiner A, Strauss C, Knolle W, Scheller C, Mäder K. Electrospun Nimodipine-loaded fibers for nerve regeneration: Development and in vitro performance. Eur J Pharm Biopharm 2020; 151:116-126. [PMID: 32283212 DOI: 10.1016/j.ejpb.2020.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
Nimodipine is a 1,4-Dihydropyridine type calcium antagonist routinely used to control blood pressure and reduce the risk of secondary ischemia after aneurismal subarachnoid hemorrhage. Additionally, Nimodipine has unique neuroprotective properties. With respect to brain related applications, the full potential of the desired local effect can often not be realized after systemic administration due to systemic side effects. Therefore, it was our aim to develop a biodegradable drug delivery system for the local controlled release of the drug inside the brain. As a suitable and biodegradable system we successfully electrospun PLGA fibers containing 1 and 10% drug. The results of DSC and X-Ray diffractometry measurements indicate that Nimodipine was incorporated in the polymer matrix in the amorphous state. No drug recrystallization was detected for up to 6 months. Electron-beam sterilization was tried but reduced the drug content of the fiber mats considerably. A sustained drug release over 4-8 days was observed, highly depended on release conditions. The Nimodipine fiber mats exhibited no cell toxicity. In contrast, the electrospun fibers were able to significantly reduce cell death in in vitro cell models of oxidative, osmotic and heat-induced cell stress in Schwann cells, neuronal cells as well as immortalized and primary astrocytes. Therefore, electrospun Nimodipine loaded PLGA fibers represent a promising drug delivery system to realize the druǵs benefits for its intracranial use.
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Affiliation(s)
- Johanna Zech
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sandra Leisz
- Department of Neurosurgery, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Benedikt Göttel
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Frank Syrowatka
- Interdisciplinary Center of Materials Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Greiner
- Macromolecular Chemistry II, University of Bayreuth, Germany
| | - Christian Strauss
- Department of Neurosurgery, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Wolfgang Knolle
- Leibniz Institute of Surface Engineering (IOM) Leipzig, Germany
| | - Christian Scheller
- Department of Neurosurgery, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Karsten Mäder
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Prell J, Strauss C, Rampp S, Szelenyi A. Neurophysiologisches Monitoring des Nervus facialis bei Operationen an Vestibularisschwannomen: Der aktuelle Stand. KLIN NEUROPHYSIOL 2019. [DOI: 10.1055/a-1009-4083] [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: 10/25/2022]
Abstract
Zusammenfassung
Hintergrund Nach Operationen an Vestibularisschwannomen gehören funktionelle Defizite des Nervus facialis zu den bedeutendsten Komplikationen. Mit Hilfe des intraoperativen neurophysiologischen Monitorings (IONM) sollen diese möglichst verhindert werden.
Fragestellung Welche Methoden zur Intraoperativen Funktionsüberwachung sind aktuell in Gebrauch, welche Ziele können damit sinnvoll verfolgt werden und welche Schwachpunkte bedürfen einer weiteren wissenschaftlichen Aufarbeitung?
Material und Methoden Auswertung und Zusammenfassung der Literatur, Diskussion der vorhandenen Methoden und ihrer Fähigkeiten, die gesteckten Ziele zu erreichen.
Ergebnisse Aus dem IONM abgeleitete Methoden des sogenannten „Mappings“ sollen den Nervus Facialis intraoperativ sicher identifizieren. IONM soll potenziell schädigende Ereignisse anzeigen und eine Einschätzung über den zu erwartenden postoperativen Funktionszustand des Nervs erlauben. Derzeit verwendet werden die elektrische Direktstimulation, das freilaufende EMG, Evozierte Potenziale des Nervus Facialis (MEP) und das prozessierte EMG. Vor allem in der Ergebnisprognostik haben alle vorhandenen Methoden deutliche Schwächen.
Schlussfolgerungen Das „Mapping“ der Nerven im OP-Situs kann mittels der elektrischen Direktstimulation gut realisiert werden. Nervenschädigungen während der Präparation können mit den anderen Methoden des IONM entweder in Echtzeit (freilaufendes EMG; prozessiertes EMG) oder nahezu in Echtzeit (MEP) angezeigt werden. Die Vorhersage des postoperativen, funktionellen Ergebnisses wird derzeit bei allen verfügbaren Methoden durch falsch positive Untersuchungsergebnisse mit konsekutiv niedrigem positiv prädiktivem Wert belastet.
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Affiliation(s)
- Julian Prell
- Neurochirurgische Klinik, Universitätsklinikum Halle (Saale)
| | | | - Stefan Rampp
- Neurochirurgische Klinik, Universitätsklinikum Halle (Saale)
| | - Andrea Szelenyi
- Neurochirurgische Klinik, Klinikum der Universität München, Standort Großhadern
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Abstract
BACKGROUND Vestibular schwannoma (VS) is a benign tumor that develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and surgical decision-making and planning. The aim of this study was to introduce a novel scoring system that was designed to determine the nerve of origin. METHODS The nerve of origin was predicted based on video head impulse assessments of all semicircular channels, together with cervical/ocular vestibular-evoked myogenic potential tests. The acquired data were entered into a scoring system developed to allocate the tumor origin. Finally, the nerve of origin was definitively determined intraoperatively. RESULTS The novel scoring system was applied to 5 consecutive patients undergoing surgical VS treatment. In one case, no determination was possible. In all other cases, the preoperatively predicted tumor origin was the same as the origin determined during surgery. CONCLUSION The scoring system predicts the nerve of origin and will be evaluated in a larger prospective cohort study of VS patients in the near future.
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Affiliation(s)
- T Rahne
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - S Plößl
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - S K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - C Strauss
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Abstract
This article presents a case of malignant transformation of vestibular schwannoma 13 years after stereotactic radiation therapy, which lead to an acute life-threatening condition. Although the observation is currently only based on case reports, an increasing number of these support the hypothesis that there is a relevant risk of malignant transformation in the long-term course of previously irradiated vestibular schwannomas. Therefore, long-term MRI follow-up should be considered.
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Affiliation(s)
- S Simmermacher
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
| | - D Vordermark
- Klinik für Strahlentherapie, Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - T Kegel
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - C Strauss
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
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Anker AM, Miranda BH, Prantl L, Kehrer A, Strauss C, Brébant V, Klein SM. 50 Shades of Red: The Predictive Value of Closed Suction Drains for the Detection of Postoperative Bleeding in Breast Surgery. Aesthetic Plast Surg 2019; 43:608-615. [PMID: 30903252 DOI: 10.1007/s00266-019-01345-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/08/2018] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND While closed suction drains (CSDs) are still frequently employed in clinical practice, the supporting evidence is limited with some studies demonstrating a failure of routine CSD use in preventing hematoma or seroma. Nonetheless, CSD quantity and quality fluid assessment is still appreciated by clinicians to detect postoperative bleeding. This study investigates the value of routine CSD use, in breast surgery, to predict postoperative bleeding. METHODS A retrospective, intra-individual analysis, of CSD fluid volumes between the hematoma side and the unaffected contralateral breast, was undertaken in patients (n = 20) with unilateral postoperative bleeding following bilateral breast surgery (2003-2018). Statistical analysis was undertaken to establish a minimum cutoff fluid volume that might assist in the detection of postoperative bleeding. To determine the usefulness of quality assessment of CSD fluid output by visual inspection, surgeons (n = 56) prospectively matched six eligible hemoglobin concentrations corresponding to pre-filled CSDs. RESULTS Statistical analysis did not yield a clinically reliable cutoff fluid volume indicating postoperative bleeding. All six eligible hemoglobin concentrations were completely successfully matched to pre-filled CSDs by 30.4% (17/56) of surgeons. CONCLUSIONS This study questions the significance of routine CSD use to assist in the decision-making process to return to the theater and address postoperative bleeding. Quantity as well as quality analysis of CSD fluid output failed the reliability and diagnostic validity tests. Hemoglobin measurements in drain fluid specimens via blood gas analysis might contribute to the detection of postoperative bleeding. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- A M Anker
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - B H Miranda
- Plastic and Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, NW3 2QG, UK
| | - L Prantl
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - A Kehrer
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - C Strauss
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - V Brébant
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - S M Klein
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Scheller C, Rampp S, Tatagiba M, Gharabaghi A, Ramina KF, Ganslandt O, Bischoff B, Matthies C, Westermaier T, Pedro MT, Rohde V, von Eckardstein K, Strauss C. A critical comparison between the semisitting and the supine positioning in vestibular schwannoma surgery: subgroup analysis of a randomized, multicenter trial. J Neurosurg 2019; 133:249-256. [PMID: 31051465 DOI: 10.3171/2019.1.jns181784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/21/2018] [Accepted: 01/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patient positioning in vestibular schwannoma (VS) surgery is a matter of ongoing discussion. Factors to consider include preservation of cranial nerve functions, extent of tumor resection, and complications. The objective of this study was to determine the optimal patient positioning in VS surgery. METHODS A subgroup analysis of a randomized, multicenter trial that investigated the efficacy of prophylactic nimodipine in VS surgery was performed to investigate the impact of positioning (semisitting or supine) on extent of resection, functional outcomes, and complications. The data of 97 patients were collected prospectively. All procedures were performed via a retrosigmoid approach. The semisitting position was chosen in 56 patients, whereas 41 patients were treated while supine. RESULTS Complete resection was obtained at a higher percentage in the semisitting as compared to the supine position (93% vs 73%, p = 0.002). Logistic regression analysis revealed significantly better facial nerve function in the early postoperative course in the semisitting group (p = 0.004), particularly concerning severe facial nerve paresis (House-Brackmann grade IV or worse; p = 0.002). One year after surgery, facial nerve function recovered. However, there was still a tendency for better facial nerve function in the semisitting group (p = 0.091). There were no significant differences between groups regarding hearing preservation rates. Venous air embolism with the necessity to terminate surgery occurred in 2 patients in the semisitting position (3.6%). Supplementary analysis with a 2-tailed permutation randomization with 10,000 permutations of treatment choice and a propensity score matching showed either a tendency or significant results for better facial nerve outcomes in the early postoperative course and extent of resection in the semisitting group. CONCLUSIONS Although the results of the various statistical analyses are not uniform, the data indicate better results concerning both a higher rate of complete removal (according to the intraoperative impression of the surgeon) and facial nerve function after a semisitting as compared to the supine position. These advantages may justify the potential higher risk for severe complications of the semisitting position in VS surgery. The choice of positioning has to consider all individual patient parameters and risks carefully.
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Affiliation(s)
- Christian Scheller
- 1Department of Neurosurgery, University of Halle-Wittenberg, Halle (Saale)
| | - Stefan Rampp
- 1Department of Neurosurgery, University of Halle-Wittenberg, Halle (Saale)
| | | | | | | | | | | | - Cordula Matthies
- 4Department of Neurosurgery, Würzburg University Hospital, Würzburg
| | | | - Maria Teresa Pedro
- 5Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm, Baden-Württemberg; and
| | - Veit Rohde
- 6Department of Neurosurgery, University of Göttingen, Germany
| | | | - Christian Strauss
- 1Department of Neurosurgery, University of Halle-Wittenberg, Halle (Saale)
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Rampp S, Illert J, Krempler K, Strauss C, Prell J. A-train clusters and the intermedius nerve in vestibular schwannoma patients. Clin Neurophysiol 2019; 130:722-726. [PMID: 30901633 DOI: 10.1016/j.clinph.2019.02.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/25/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE EMG "A-train" activity correlates with postoperative facial palsy after vestibular schwannoma (VS) surgery. An intermedius nerve separate from the facial nerve increases A-trains without significant impact on function. We investigate occurrence of A-train "clusters", A-trains over a majority of channels within a short time frame. METHODS Data from 217 patients with first surgery for VS were evaluated retrospectively. Continuous EMG recorded with 9 channels was evaluated for A-train patterns. "Clusters" of A-trains were identified, i.e. A-trains within 3 seconds over a majority of channels. Relation to a separate intermedius, tumor size and facial palsy was evaluated. RESULTS Correlations between A-trains and postoperative facial palsy were higher in patients without separate intermedius (r = 0.562 versus r = 0.194). Clusters were identified in 107 patients (49.3%), separate intermedius in 109 (50.2%), with significant association of both (p < 0.001, Chi-Square test). Excluding clusters slightly increased correlation of A-trains to facial nerve function. CONCLUSIONS A-train clusters have limited relevance for predicting postoperative paresis. However, they should be regarded as warning signs, suggesting the presence of a separate intermedius nerve. SIGNIFICANCE A-train "clusters" are a sign of hyperactivity of the facial nerve due to a separate intermedius nerve and may confound intraoperative monitoring during VS surgery.
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Affiliation(s)
- Stefan Rampp
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
| | - Jörg Illert
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Katja Krempler
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
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Aung T, Heidekrueger P, Geis S, Von Kunow F, Taeger C, Strauss C, Wendl C, Brebant V, Broer P, Prantl L, Hillmann A. A novel indication for indocyanine green (ICG): Intraoperative monitoring of limb and sciatic nerve perfusion during rotationplasty for sarcoma patients. Clin Hemorheol Microcirc 2019; 70:441-447. [DOI: 10.3233/ch-189309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- T. Aung
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
- Department of Orthopedics, University of Medicine Mandalay, Mandalay, Myanmar
| | - P.I. Heidekrueger
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
| | - S. Geis
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
| | - F. Von Kunow
- Klinik und Poliklinik für Orthopädie der Universität Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Deutschland
| | - C. Taeger
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
| | - C. Strauss
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
| | - C. Wendl
- Department of Neuroradiology, Regensburg University Medical Center, Regensburg, Germany
| | - V. Brebant
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
| | - P.N. Broer
- Department of Plastic Surgery, Klinikum München Bogenhausen, München, Germany
| | - L. Prantl
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
| | - A. Hillmann
- Klinik und Poliklinik für Orthopädie der Universität Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Deutschland
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Bauer M, Wickenhauser C, Haak A, Pazaitis N, Siebolts U, Mawrin C, Strauss C, Rickerts V, Stoevesandt D, Cornely OA, Meis JF, Hagen F. Case report: A fatal case of cryptococcosis in an immunocompetent patient due to Cryptococcus deuterogattii (AFLP6/VGII). JMM Case Rep 2018; 5:e005168. [PMID: 30479782 PMCID: PMC6249430 DOI: 10.1099/jmmcr.0.005168] [Citation(s) in RCA: 8] [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: 11/02/2017] [Accepted: 09/07/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Cryptococcosis in immunocompetent adults is a rare disease in Europe, mostly induced by members of the Cryptococcus gattii species complex. The diagnosis can be challenging due to its rarity, unspecific symptoms and long symptomless latency. Case presentation A 49-year-old woman with a three weeks history of headache was admitted to the hospital due to discrete ataxia and impaired vision. Cranial magnetic resonance imaging (MRI) showed a contrast-enhancing mass in the cerebellum. Further investigations detected a slight leukocytosis and a single subpleural nodule in the right inferior lung lobe. The cerebral lesion was surgically removed, and a direct frozen section only showed an unspecific inflammation. In the course of her admission she developed non-treatable cerebral edema and died ten days after surgical intervention. Histopathological examination of the surgical specimen and postmortem evaluation of the lung and the cerebrum demonstrated fungal elements. Molecular identification of the fungal elements in formalin-fixed paraffin-embedded tissue lead to the diagnosis of cryptococcosis induced by C. gattii sensu lato. Molecular genetic analysis identified the involved cryptococcal species as genotype AFLP6/VGII, recently described as Cryptococcus deuterogattii, which is known to be endemic to the west-coast of Canada and the USA. Additional heteroanamnestic information revealed that she had spent her holidays on Vancouver Island, Canada, two years before disease onset, indicating that infection during this stay seems to be plausible. Conclusion Cryptococcosis due to C. deuterogattii is a rarely encountered fungal disease in Europe, not particularly associated with immunodeficiency, and infection is likely to be contracted in endemic areas. Due to its rarity, long symptomless latency, unspecific symptoms and misleading radiological features the diagnosis can be challenging. Physicians need to be aware of this differential diagnosis in immunocompetent patients, as early adequate therapy can be lifesaving.
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Affiliation(s)
- M Bauer
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - C Wickenhauser
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - A Haak
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - N Pazaitis
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - U Siebolts
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - C Mawrin
- Institute of Neuropathology, Otto-von-Guericke-University, Magdeburg, Germany
| | - C Strauss
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - V Rickerts
- FG 16, Consultant Laboratory for Cryptococcosis, Scedosporiosis and Imported Systemic Mycoses, Robert-Koch-Institute, Berlin, Germany
| | - D Stoevesandt
- Institute of Radiology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - O A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - J F Meis
- Department Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - F Hagen
- Department Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
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Anker A, Prantl L, Strauss C, Brébant V, Heine N, Lamby P, Geis S, Schenkhoff F, Pawlik M, Klein S. Vasopressor support vs. liberal fluid administration in deep inferior epigastric perforator (DIEP) free flap breast reconstruction – a randomized controlled trial. Clin Hemorheol Microcirc 2018; 69:37-44. [DOI: 10.3233/ch-189129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A.M. Anker
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L. Prantl
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C. Strauss
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - V. Brébant
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - N. Heine
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - P. Lamby
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S. Geis
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - F. Schenkhoff
- Department of Anaesthesiology, Caritas Hospital St. Josef, Regensburg, Germany
| | - M. Pawlik
- Department of Anaesthesiology, Caritas Hospital St. Josef, Regensburg, Germany
| | - S.M. Klein
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Prell J, Schenk G, Taute BM, Scheller C, Marquart C, Strauss C, Rampp S. Reduced risk of venous thromboembolism with the use of intermittent pneumatic compression after craniotomy: a randomized controlled prospective study. J Neurosurg 2018; 130:622-628. [PMID: 29600912 DOI: 10.3171/2017.9.jns17533] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/25/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The term "venous thromboembolism" (VTE) subsumes deep venous thrombosis (DVT) and pulmonary embolism. The incidence of DVT after craniotomy was reported to be as high as 50%. Even clinically silent DVT may lead to potentially fatal pulmonary embolism. The risk of VTE is correlated with duration of surgery, and it appears likely that it develops during surgery. The present study aimed to evaluate intraoperative use of intermittent pneumatic compression (IPC) of the lower extremity for prevention of VTE in patients undergoing craniotomy. METHODS A total of 108 patients undergoing elective craniotomy for intracranial pathology were included in a single-center controlled randomized prospective study. In the control group, conventional compression stockings were worn during surgery. In the treatment group, IPC of the calves was used in addition. The presence of DVT was evaluated by Doppler sonography pre- and postoperatively. RESULTS Intraoperative use of IPC led to a significant reduction of VTE (p = 0.029). In logistic regression analysis, the risk of VTE was approximately quartered by the use of IPC. Duration of surgery was confirmed to be correlated with VTE incidence (p < 0.01); every hour of surgery increased the risk by a factor of 1.56. CONCLUSIONS Intraoperative use of IPC significantly lowers the incidence of potentially fatal VTE in patients undergoing craniotomy. The method is easy to use and carries no additional risks.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: class I.Clinical trial registration no.: DRKS00011783 (https://www.drks.de).
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Abstract
BACKGROUND Surgical procedures in the cerebello-pontine angle (CPA), e. g. for vestibular schwannoma, have an increased risk for damage to the cochlear nerve. Consequently, hearing deterioration up to complete deafness may result with severe impact on quality of life. Methods for intraoperative monitoring of function may minimize such risks. OBJECTIVE Review of current methods for intraoperative monitoring of the cochelar nerve and summary of new developments. MATERIALS AND METHODS Analysis and summary of literature, discussion of new methods. RESULTS Early auditory evoked potentials using click stimuli remain the standard method for intraoperative monitoring of cochlear nerve function. Amplitude and latency changes indicate a risk of postoperative hearing deterioration; however demonstrate only limited further differentiation of hearing quality. As novel methods, near-field recordings may allow faster feedback and auditory steady state responses potentially enable frequency specific testing. CONCLUSIONS Intraoperative monitoring of the cochlear nerve is an integral component of CPA surgery. It enables detection of potential nerve damage and thus contributes to avoiding postoperative functional deficits. Development and implementation of novel and additional approaches may further improve its clinical value.
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Affiliation(s)
- S Rampp
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinik Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - T Rahne
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik Halle (Saale), Halle (Saale), Deutschland
| | - S K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik Halle (Saale), Halle (Saale), Deutschland
| | - C Strauss
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinik Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - J Prell
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinik Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
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