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Maldaner N, Tang M, Fatemi P, Leung C, Desai A, Tomkins-Lane C, Zygourakis C. Standardizing Physical Activity Monitoring in Patients With Degenerative Lumbar Disorders. Neurosurgery 2024; 94:788-796. [PMID: 37955445 DOI: 10.1227/neu.0000000000002755] [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: 07/24/2023] [Accepted: 09/22/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Degenerative thoracolumbar disorders (DTDs) typically cause pain and functional impairment. However, little is known regarding the DTD impact on patient's real-life physical activity. The objective of this study is to validate a wearable measure of physical activity monitoring in patients with DTD and to create gender- and sex-specific performance thresholds that are standardized to the mean of a control population. METHODS A commercially available smartwatch (Apple Watch) was used to monitor preoperative physical activity in patients undergoing surgery for DTD. Mean preoperative physical activity 2 weeks before the scheduled surgery was expressed as raw step count. Standardized z-scores were referenced to age- and sex-specific values of a control population from a large public database. Step counts were assessed for convergent validity with established patient-reported outcome measures, and impairment in activity was stratified into performance groups based on z-score cutoff values. RESULTS Sixty-five patients (62% female) with a mean (±SD) age of 63.8 (±12.8) years had a mean preoperative daily step count of 5556 (±3978). Physical activity showed significant correlation with patient-reported outcome measures, including Oswestry disability index (r = -0.26, 95% CI: -0.47-0.01), 36-Item Short Form Survey Physical Component Summary score (r = 0.30, 95% CI: 0.06-0.51), and Patient-Reported Outcomes Measurement Information System Physical Function (r = 0.49, 95% CI: 0.27-0.65). "No," "Mild," "moderate," and "severe impairment" in activity performance were defined as corresponding z-scores of >0, 0 to -0.99, -1 to -1.99, and ≤-2, accounting for 22%, 34%, 40%, and 5% of the study population. Each one-step category increase in activity impairment resulted in increased subjective disability as measured by the Oswestry Disability Index, 36-Item Short Form Survey Physical Component Summary, and Patient-Reported Outcomes Measurement Information System Physical Function (all P -values <.05). CONCLUSION We establish the first wearable objective measure of real-life physical activity for patients with DTD, with the first age- and sex-adjusted standard scores to enable clinicians and researchers to set treatment goals and directly compare activity levels between individual patients with DTD and normal controls.
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Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford , California , USA
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich , Switzerland
| | - Megan Tang
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford , California , USA
| | - Parastou Fatemi
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford , California , USA
| | - Chris Leung
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford , California , USA
| | - Atman Desai
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford , California , USA
| | - Christy Tomkins-Lane
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford , California , USA
- Department of Health & Physical Education, Mount Royal University, Calgary , Canada
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford , California , USA
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Haider G, Shah V, Johnstone T, Maldaner N, Stienen M, Veeravagu A. Accuracy of predicted postoperative segmental lumbar lordosis in spinal fusion using an intraoperative robotic planning and guidance system. J Neurosurg Sci 2023:S0390-5616.23.06142-8. [PMID: 37997323 DOI: 10.23736/s0390-5616.23.06142-8] [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: 11/25/2023]
Abstract
BACKGROUND Restoring lumbar lordosis is one of the main goals in lumbar spinal fusion surgery. The Mazor X-AlignTM software allows for the prediction of postoperative segmental lumbar lordosis based on preoperative imaging. There is limited data on the accuracy of this preoperative prediction, especially in patients undergoing short segment lumbar fusion. The objective of our study was to determine the accuracy of predicted postoperative segmental lumbar lordosis using the Mazor X-AlignTM software in patients requiring short segmental fusion. METHODS Retrospective analysis of adult patients undergoing pedicle screw spinal instrumentation of not more than four levels using the Mazor XTM Robot (Medtronic Inc., Minneapolis, MN, USA) between July 2017 to June 2020. The robotic guidance software, Mazor X-AlignTM (Medtronic Inc., Minneapolis, MN, USA) was used to calculate the predicted segmental lumbar lordosis based on preoperative CT-imaging and the plan was executed under intraoperative robotic guidance. Predicted segmental lumbar lordosis was compared to achieved segmental lumbar lordosis on 1-month postoperative x-rays using the Cobb angle methodology. RESULTS A total of 15 patients (46.6% female) with a mean age of 61.5±10.9 years were included. All patients underwent posterior lumbo-sacral spinal fusion with the Mazor XTM robotic system with 11 patients (73.3%) undergoing anterior column reconstruction prior to posterior fixation. Instrumentation was performed across a mean of 2.6 levels per case. Preoperative, the mean segmental lumbar lordosis was 30.2±13.6 degrees. The mean planned segmental lumbar lordosis was 35.5±17.0 degrees while the mean achieved segmental lumbar lordosis was 35.8±16.7 degrees. There was no significant mean difference between the planned and achieved segmental lumbar lordosis (P=0.334). CONCLUSIONS The Mazor XTM intraoperative robotic planning and guidance is accurate in predicting postoperative segmental lumbar lordosis after short segmental fusion. Our findings may assure surgical decision making and planning.
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Affiliation(s)
- Ghani Haider
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA -
| | - Vaibhavi Shah
- School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Nicolai Maldaner
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | - Martin Stienen
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
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Ziga M, Sosnova M, Zeitlberger AM, Regli L, Bozinov O, Weyerbrock A, Ratliff JK, Stienen MN, Maldaner N. Objective outcome measures may demonstrate continued change in functional recovery in patients with ceiling effects of subjective patient-reported outcome measures after surgery for lumbar degenerative disorders. Spine J 2023; 23:1314-1322. [PMID: 37182704 DOI: 10.1016/j.spinee.2023.05.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND CONTEXT The 6-minute walking test (6WT) has been previously shown to be a reliable and valid outcome measure. It is unclear if the 6WT may further help to detect differences in well performing patients that reach a ceiling effect in PROMs after surgery. PURPOSE To evaluate changes and timing of change in objective functional impairment (OFI) as measured with the smartphone-based 6WT in relation to patient-reported outcome measures (PROMs) after surgery for degenerative lumbar disorders (DLD). STUDY DESIGN Prospective observational cohort study. PATIENT SAMPLE Fifty consecutive patients undergoing surgery for DLD. OUTCOME MEASURES Patients self-determined their OFI using the 6WT application (6WT-app) and completed a set of paper-based PROMs before, 6 weeks and 3 months after surgery. METHODS Fifty patients undergoing surgery for DLD were assessed preoperatively (baseline), 6 weeks (6W) and 3 months (3M) postoperatively. Paired sample t-tests were used to establish significant changes in raw 6-minute walking distance (6WD) and standardized Z-scores, as well as PROMs. Pearson correlation coefficient was used to define the relationship between 6WT and PROMs. Floor and ceiling effects were assessed for each PROM (visual analogue scale [VAS], core outcome measure index [COMI], Zurich claudication questionnaire [ZCQ]). RESULTS Mean 6WT results improved from 377 m (standard deviation - SD 137; Z-score: 1.8, SD 1.8) to 490 m (SD 126; -0.7, SD 1.5) and 518 m (SD 112; -0.4, SD 1.41; all p<.05) at 6W and 3M follow-up. No significant improvement was observed between 6W and 3M for the ZCQ, VAS back and leg pain. While correlation between 6WT and all PROMs were weak at baseline, correlation coefficient increased to moderate at 3M. A considerable ceiling effect (best possible score) was observed, most notably for the ZCQ physical performance, VAS back and leg pain in 24%, 20%, and 16% of patient at 6W and in 30%, 24%, and 28% at 3M. CONCLUSIONS Objective functional tests can describe the continued change in the physical recovery of a patient and may help to detect differences in well performing groups as well as in cases where patients' PROM results cannot further improve because of a ceiling effect.
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Affiliation(s)
- Michal Ziga
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland; 1(st) Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Anna M Zeitlberger
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - John K Ratliff
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA, USA
| | - Martin N Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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El-Garci A, Zindel-Geisseler O, Dannecker N, Rothacher Y, Schlosser L, Zeitlberger A, Velz J, Sebök M, Eggenberger N, May A, Bijlenga P, Guerra-Lopez U, Maduri R, Beaud V, Starnoni D, Chiappini A, Rossi S, Robert T, Bonasia S, Goldberg J, Fung C, Bervini D, Gutbrod K, Maldaner N, Früh S, Schwind M, Bozinov O, Neidert MC, Brugger P, Keller E, Germans MR, Regli L, Hostettler IC, Stienen MN. Successful weaning versus permanent cerebrospinal fluid diversion after aneurysmal subarachnoid hemorrhage: post hoc analysis of a Swiss multicenter study. Neurosurg Focus 2023; 54:E3. [PMID: 37004134 DOI: 10.3171/2023.1.focus22638] [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: 09/25/2022] [Accepted: 01/17/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Acute hydrocephalus is a frequent complication after aneurysmal subarachnoid hemorrhage (aSAH). Among patients needing CSF diversion, some cannot be weaned. Little is known about the comparative neurological, neuropsychological, and health-related quality-of-life (HRQOL) outcomes in patients with successful and unsuccessful CSF weaning. The authors aimed to assess outcomes of patients by comparing those with successful and unsuccessful CSF weaning; the latter was defined as occurring in patients with permanent CSF diversion at 3 months post-aSAH. METHODS The authors included prospectively recruited alert (i.e., Glasgow Coma Scale score 13-15) patients with aSAH in this retrospective study from six Swiss neurovascular centers. Patients underwent serial neurological (National Institutes of Health Stroke Scale), neuropsychological (Montreal Cognitive Assessment), disability (modified Rankin Scale), and HRQOL (EuroQol-5D) examinations at < 72 hours, 14-28 days, and 3 months post-aSAH. RESULTS Of 126 included patients, 54 (42.9%) developed acute hydrocephalus needing CSF diversion, of whom 37 (68.5%) could be successfully weaned and 17 (31.5%) required permanent CSF diversion. Patients with unsuccessful weaning were older (64.5 vs 50.8 years, p = 0.003) and had a higher rate of intraventricular hemorrhage (52.9% vs 24.3%, p = 0.04). Patients who succeed in restoration of physiological CSF dynamics improve on average by 2 points on the Montreal Cognitive Assessment between 48-72 hours and 14-28 days, whereas those in whom weaning fails worsen by 4 points (adjusted coefficient 6.80, 95% CI 1.57-12.04, p = 0.01). They show better neuropsychological recovery between 48-72 hours and 3 months, compared to patients in whom weaning fails (adjusted coefficient 7.60, 95% CI 3.09-12.11, p = 0.02). Patients who receive permanent CSF diversion (ventriculoperitoneal shunt) show significant neuropsychological improvement thereafter, catching up the delay in neuropsychological improvement between 14-28 days and 3 months post-aSAH. Neurological, disability, and HRQOL outcomes at 3 months were similar. CONCLUSIONS These results show a temporary but clinically meaningful cognitive benefit in the first weeks after aSAH in successfully weaned patients. The resolution of this difference over time may be due to the positive effects of permanent CSF diversion and underlines its importance. Patients who do not show progressive neuropsychological improvement after weaning should be considered for repeat CT imaging to rule out chronic (untreated) hydrocephalus.
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Affiliation(s)
- Ahmed El-Garci
- 1Department of Neurosurgery, Cantonal Hospital St. Gallen
| | | | - Noemi Dannecker
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Yannick Rothacher
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Ladina Schlosser
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | | | - Julia Velz
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Martina Sebök
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Noemi Eggenberger
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Adrien May
- 5Department of Neurosurgery, University Hospital Geneva
| | | | | | | | - Valérie Beaud
- 8Neuropsychology Unit, Department of Neurology, University Hospital Lausanne
| | | | - Alessio Chiappini
- 10Department of Neurosurgery, Cantonal Hospital Lugano
- 11Department of Neurosurgery, University Hospital Basel
| | - Stefania Rossi
- 12Neuropsychology Unit, Department of Neurology, Cantonal Hospital Lugano
| | - Thomas Robert
- 10Department of Neurosurgery, Cantonal Hospital Lugano
| | - Sara Bonasia
- 1Department of Neurosurgery, Cantonal Hospital St. Gallen
| | - Johannes Goldberg
- 13Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Christian Fung
- 13Department of Neurosurgery, University Hospital Berne, Switzerland
- 14Department of Neurosurgery, University Hospital Freiburg, Germany
| | - David Bervini
- 13Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Klemens Gutbrod
- 15Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | - Nicolai Maldaner
- 1Department of Neurosurgery, Cantonal Hospital St. Gallen
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Severin Früh
- 16Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen; and
| | - Marc Schwind
- 16Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen; and
| | - Oliver Bozinov
- 1Department of Neurosurgery, Cantonal Hospital St. Gallen
| | | | - Peter Brugger
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
- 17Neuropsychology Unit, Rehabilitation Clinic Valens, Switzerland
| | - Emanuela Keller
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Menno R Germans
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Luca Regli
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
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5
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Maldaner N, Zeitlberger A, Ziga M, Bozinov O, Regli L, Stienen MN. 126 Objective Functional Outcome Measures Expose Relevant Ceiling Effects Inherent to Subjective Patient-Reported Outcome Measures in Patients Undergoing Surgery for Lumbar Degenerative Disorders. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_126] [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: 03/18/2023] Open
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Roethlisberger M, Aghlmandi S, Rychen J, Chiappini A, Zumofen DW, Bawarjan S, Stienen MN, Fung C, D'Alonzo D, Maldaner N, Steinsiepe VK, Corniola MV, Goldberg J, Cianfoni A, Robert T, Maduri R, Saliou G, Starnoni D, Weber J, Seule MA, Gralla J, Bervini D, Kulcsar Z, Burkhardt JK, Bozinov O, Remonda L, Marbacher S, Lövblad KO, Psychogios M, Bucher HC, Mariani L, Bijlenga P, Blackham KA, Guzman R. Impact of Very Small Aneurysm Size and Anterior Communicating Segment Location on Outcome after Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2023; 92:370-381. [PMID: 36469672 DOI: 10.1227/neu.0000000000002212] [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] [Received: 12/21/2021] [Accepted: 08/31/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Very small anterior communicating artery aneurysms (vsACoA) of <5 mm in size are detected in a considerable number of patients with aneurysmal subarachnoid hemorrhage (aSAH). Single-center studies report that vsACoA harbor particular risks when treated. OBJECTIVE To assess the clinical and radiological outcome(s) of patients with aSAH diagnosed with vsACoA after aneurysm treatment and at discharge. METHODS Information on n = 1868 patients was collected in the Swiss Subarachnoid Hemorrhage Outcome Study registry between 2009 and 2014. The presence of a new focal neurological deficit at discharge, functional status (modified Rankin scale), mortality rates, and procedural complications (in-hospital rebleeding and presence of a new stroke on computed tomography) was assessed for vsACoA and compared with the results observed for aneurysms in other locations and with diameters of 5 to 25 mm. RESULTS This study analyzed n = 1258 patients with aSAH, n = 439 of which had a documented ruptured ACoA. ACoA location was found in 38% (n = 144/384) of all very small ruptured aneurysms. A higher in-hospital bleeding rate was found in vsACoA compared with non-ACoA locations (2.8 vs 2.1%), especially when endovascularly treated (2.1% vs 0.5%). In multivariate analysis, aneurysm size of 5 to 25 mm, and not ACoA location, was an independent risk factor for a new focal neurological deficit and a higher modified Rankin scale at discharge. Neither very small aneurysm size nor ACoA location was associated with higher mortality rates at discharge or the occurrence of a peri-interventional stroke. CONCLUSION Very small ruptured ACoA have a higher in-hospital rebleeding rate but are not associated with worse morbidity or mortality.
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Affiliation(s)
- Michel Roethlisberger
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jonathan Rychen
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alessio Chiappini
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurological Surgery, Maimonides Medical Center, New York, USA
| | - Schatlo Bawarjan
- Department of Neurosurgery, University Hospital of Göttingen, Göttingen, Germany
| | - Martin N Stienen
- Department of Neurosurgery and Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland.,Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christian Fung
- Department of Neurosurgery, University Hospital of Freiburg, Freiburg Germany.,Departments of Neurosurgery and Neuroradiology, University Hospital of Bern, Bern Switzerland
| | - Donato D'Alonzo
- Departments of Neurosurgery and Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery and Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Valentin K Steinsiepe
- Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco V Corniola
- Departments of Neurosurgery and Neuroradiology, University Hospital of Geneva, Geneva Switzerland
| | - Johannes Goldberg
- Departments of Neurosurgery and Neuroradiology, University Hospital of Bern, Bern Switzerland
| | - Alessandro Cianfoni
- Departments of Neurosurgery and Neuroradiology, Neurocenter of Southern Switzerland, Ospedale regionale, Lugano, Switzerland
| | - Thomas Robert
- Departments of Neurosurgery and Neuroradiology, Neurocenter of Southern Switzerland, Ospedale regionale, Lugano, Switzerland
| | - Rodolfo Maduri
- Clinique de Genolier, Swiss Medical Network, Genolier, Switzerland
| | - Guillaume Saliou
- Departments of Neurosurgery and Neuroradiology, University Hospital of Lausanne, Switzerland
| | - Daniele Starnoni
- Departments of Neurosurgery and Neuroradiology, University Hospital of Lausanne, Switzerland
| | - Johannes Weber
- Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin A Seule
- Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan Gralla
- Departments of Neurosurgery and Neuroradiology, University Hospital of Bern, Bern Switzerland
| | - David Bervini
- Departments of Neurosurgery and Neuroradiology, University Hospital of Bern, Bern Switzerland
| | - Zsolt Kulcsar
- Department of Neurosurgery and Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oliver Bozinov
- Department of Neurosurgery and Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland.,Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Luca Remonda
- Departments of Neurosurgery and Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Departments of Neurosurgery and Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Karl-Olof Lövblad
- Departments of Neurosurgery and Neuroradiology, University Hospital of Geneva, Geneva Switzerland
| | - Marios Psychogios
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luigi Mariani
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philippe Bijlenga
- Departments of Neurosurgery and Neuroradiology, University Hospital of Geneva, Geneva Switzerland
| | - Kristine A Blackham
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Maldaner N, Visser V, Hostettler IC, Bijlenga P, Haemmerli J, Roethlisberger M, Guzman R, Daniel RT, Giammattei L, Stienen MN, Regli L, Verbaan D, Post R, Germans MR. External Validation of the HATCH (Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus) Score for Prediction of Functional Outcome After Subarachnoid Hemorrhage. Neurosurgery 2022; 91:906-912. [PMID: 36069543 DOI: 10.1227/neu.0000000000002128] [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] [Received: 03/01/2022] [Accepted: 06/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus (HATCH) Score has previously shown to predict functional outcome in aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To validate the HATCH score. METHODS This is a pooled cohort study including prospective collected data on 761 patients with aSAH from 4 different hospitals. The HATCH score for prediction of functional outcome was validated using calibration and discrimination analysis (area under the curve). HATCH score model performance was compared with the World Federation of Neurosurgical Societies and Barrow Neurological Institute score. RESULTS At the follow-up of at least 6 months, favorable (Glasgow Outcome Score 4-5) and unfavorable functional outcomes (Glasgow Outcome Score 1-3) were observed in 512 (73%) and 189 (27%) patients, respectively. A higher HATCH score was associated with an increased risk of unfavorable outcome with a score of 1 showing a risk of 1.3% and a score of 12 yielding a risk of 67%. External validation showed a calibration intercept of -0.07 and slope of 0.60 with a Brier score of 0.157 indicating good model calibration and accuracy. With an area under the curve of 0.81 (95% CI 0.77-0.84), the HATCH score demonstrated superior discriminative ability to detect favorable outcome at follow-up compared with the World Federation of Neurosurgical Societies and Barrow Neurological Institute score with 0.72 (95% CI 0.67-0.75) and 0.63 (95% CI 0.59-0.68), respectively. CONCLUSION This multicenter external validation analysis confirms the HATCH score to be a strong independent predictor for functional outcome. Its incorporation into daily practice may be of benefit for goal-directed patient care in aSAH.
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Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Victoria Visser
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Philippe Bijlenga
- Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
| | - Julien Haemmerli
- Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
| | | | - Raphael Guzman
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland
| | - Roy Thomas Daniel
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lorenzo Giammattei
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Dagmar Verbaan
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - René Post
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - Menno Robbert Germans
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
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Stienen MN, Germans MR, Zindel-Geisseler O, Dannecker N, Rothacher Y, Schlosser L, Velz J, Sebök M, Eggenberger N, May A, Haemmerli J, Bijlenga P, Schaller K, Guerra-Lopez U, Maduri R, Beaud V, Al-Taha K, Daniel RT, Chiappini A, Rossi S, Robert T, Bonasia S, Goldberg J, Fung C, Bervini D, Maradan-Gachet ME, Gutbrod K, Maldaner N, Neidert MC, Früh S, Schwind M, Bozinov O, Brugger P, Keller E, Marr A, Roux S, Regli L. Longitudinal neuropsychological assessment after aneurysmal subarachnoid hemorrhage and its relationship with delayed cerebral ischemia: a prospective Swiss multicenter study. J Neurosurg 2022; 137:1742-1750. [PMID: 35535839 DOI: 10.3171/2022.2.jns212595] [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: 11/10/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While prior retrospective studies have suggested that delayed cerebral ischemia (DCI) is a predictor of neuropsychological deficits after aneurysmal subarachnoid hemorrhage (aSAH), all studies to date have shown a high risk of bias. This study was designed to determine the impact of DCI on the longitudinal neuropsychological outcome after aSAH, and importantly, it includes a baseline examination after aSAH but before DCI onset to reduce the risk of bias. METHODS In a prospective, multicenter study (8 Swiss centers), 112 consecutive alert patients underwent serial neuropsychological assessments (Montreal Cognitive Assessment [MoCA]) before and after the DCI period (first assessment, < 72 hours after aSAH; second, 14 days after aSAH; third, 3 months after aSAH). The authors compared standardized MoCA scores and determined the likelihood for a clinically meaningful decline of ≥ 2 points from baseline in patients with DCI versus those without. RESULTS The authors screened 519 patients, enrolled 128, and obtained complete data in 112 (87.5%; mean [± SD] age 53.9 ± 13.9 years; 66.1% female; 73% World Federation of Neurosurgical Societies [WFNS] grade I, 17% WFNS grade II, 10% WFNS grades III-V), of whom 30 (26.8%) developed DCI. MoCA z-scores were worse in the DCI group at baseline (-2.6 vs -1.4, p = 0.013) and 14 days (-3.4 vs -0.9, p < 0.001), and 3 months (-0.8 vs 0.0, p = 0.037) after aSAH. Patients with DCI were more likely to experience a decline of ≥ 2 points in MoCA score at 14 days after aSAH (adjusted OR [aOR] 3.02, 95% CI 1.07-8.54; p = 0.037), but the likelihood was similar to that in patients without DCI at 3 months after aSAH (aOR 1.58, 95% CI 0.28-8.89; p = 0.606). CONCLUSIONS Aneurysmal SAH patients experiencing DCI have worse neuropsychological function before and until 3 months after the DCI period. DCI itself is responsible for a temporary and clinically meaningful decline in neuropsychological function, but its effect on the MoCA score could not be measured at the time of the 3-month follow-up in patients with low-grade aSAH with little or no impairment of consciousness. Whether these findings can be extrapolated to patients with high-grade aSAH remains unclear. Clinical trial registration no.: NCT03032471 (ClinicalTrials.gov).
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Affiliation(s)
- Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | - Menno R Germans
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | | | - Noemi Dannecker
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Yannick Rothacher
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Ladina Schlosser
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Julia Velz
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Martina Sebök
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Noemi Eggenberger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Adrien May
- 4Department of Neurosurgery, University Hospital Geneva
| | | | | | - Karl Schaller
- 4Department of Neurosurgery, University Hospital Geneva
| | | | - Rodolfo Maduri
- 6Avaton Surgical Group, Clinique de Genolier, Swiss Medical Network, Genolier
| | - Valérie Beaud
- 7Neuropsychology Unit, Department of Neurology, University Hospital Lausanne
| | - Khalid Al-Taha
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | - Roy Thomas Daniel
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | | | - Stefania Rossi
- 10Neuropsychology Unit, Department of Neurology, Cantonal Hospital Lugano
| | - Thomas Robert
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Sara Bonasia
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Johannes Goldberg
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Christian Fung
- 11Department of Neurosurgery, University Hospital Berne, Switzerland.,12Department of Neurosurgery, University Hospital Freiburg, Germany
| | - David Bervini
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | | | - Klemens Gutbrod
- 13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | | | | | - Severin Früh
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Marc Schwind
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Oliver Bozinov
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,14Department of Neurosurgery, Cantonal Hospital St. Gallen
| | - Peter Brugger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich.,16Neuropsychology Unit, Rehabilitation Clinic Valens; and
| | - Emanuela Keller
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Angelina Marr
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Sébastien Roux
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
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9
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Zeitlberger AM, Sosnova M, Ziga M, Gautschi OP, Regli L, Bozinov O, Weyerbrock A, Stienen MN, Maldaner N. Distance to first symptoms measured by the 6-min walking test differentiates between treatment success and failure in patients with degenerative lumbar disorders. Eur Spine J 2022; 31:596-603. [PMID: 35015137 DOI: 10.1007/s00586-021-07103-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The smartphone-based 6-min walking test (6WT) is an established digital outcome measure in patients undergoing surgery for degenerative lumbar disorders (DLD). In addition to the 6WTs primary outcome measure, the 6-min walking distance (6WD), the patient's distance to first symptoms (DTFS) and time to first symptoms (TTFS) can be recorded. This is the first study to analyse the psychometric properties of the DTFS and TTFS. METHODS Forty-nine consecutive patients (55 ± 15.8 years) completed the 6WT pre- and 6 weeks (W6) postoperative. DTFS and TTFS were assessed for reliability and content validity using disease-specific patient-reported outcome measures. The Zurich Claudication Questionnaire patient satisfaction subscale was used as external criterion for treatment success. Internal and external responsiveness for both measures at W6 was evaluated. RESULTS There was a significant improvement in DTFS and TTFS from baseline to W6 (p < 0.001). Both measures demonstrated a good test-retest reliability (β = 0.86, 95% CI 0.81-0.90 and β = 0.83, 95% CI 0.76-0.87, both p < 0.001). The DTFS exceeded the 6WD capability to differentiate between satisfied (82%) and unsatisfied patients (18%) with an AUC of 0.75 (95% CI 0.53-0.98) vs. 0.70 (95% CI 0.52-0.90). The TTFS did not demonstrate meaningful discriminative abilities. CONCLUSION Change in DTFS can differentiate between satisfied and unsatisfied patients after spine surgery. Digital outcome measures on the 6WT metric provide spine surgeons and researchers with a mean to assess their patient's functional disability and response to surgical treatment in DLD.
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Affiliation(s)
- Anna M Zeitlberger
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland. .,University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. .,Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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10
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Maldaner N, Sosnova M, Ziga M, Zeitlberger AM, Bozinov O, Gautschi OP, Weyerbrock A, Regli L, Stienen MN. External Validation of the Minimum Clinically Important Difference in the Timed-up-and-go Test After Surgery for Lumbar Degenerative Disc Disease. Spine (Phila Pa 1976) 2022; 47:337-342. [PMID: 34033596 DOI: 10.1097/brs.0000000000004128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective observational cohort study. OBJECTIVE The aim of this study was to provide external validation of the minimum clinically important difference (MCID) of the Timed-up-and-go (TUG) test. SUMMARY OF BACKGROUND DATA The TUG test is one of the best explored and most frequently applied objective task-based functional outcome measure in patients with lumbar degenerative disc disease (DDD). The increased use of the TUG test is based on its solid psychometric properties; however, an external validation of the originally determined MCID is lacking. METHODS Forty-nine patients with lumbar DDD, scheduled for elective spine surgery, were assessed pre- and 6-weeks (W6) postoperative. MCID values were calculate for raw TUG test times (seconds) and standardized TUG z scores using three different computation methods and the following established patient-reported outcome measures (PROMs) as anchors: Visual Analog Scales (VAS), Core Outcome Measures Index Back, Zurich Claudication Questionnaire (ZCQ). RESULTS The three computation methods generated a range of MCID values, depending on the PROM used as anchor, from 0.9 s (z score of 0.3) based on the VAS leg pain to 3.0 seconds (z score of 2.7) based on the ZCQ physical function scale. The average MCID of the TUG test across all anchors and computation methods was 2.1 s (z score of 1.5). According to the average MCID of raw TUG test values or TUG z scores, 41% and 43% of patients classified as W6 responders to surgery, respectively. CONCLUSION This study confirms the ordinally reported TUG MCID values in patients undergoing surgery for lumbar. A TUG test time change of 2.1 seconds (or TUG z score change of 1.5) indicates an objective and clinically meaningful change in functional status. This report facilitates the interpretation of TUG test results in clinical routine as well as in research.Level of Evidence: 3.
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Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | | | - Oliver Bozinov
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
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11
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Voglis S, Ziga M, Zeitlberger AM, Sosnova M, Bozinov O, Regli L, Bellut D, Weyerbrock A, Stienen MN, Maldaner N. Smartphone-based real-life activity data for physical performance outcome in comparison to conventional subjective and objective outcome measures after degenerative lumbar spine surgery. Brain and Spine 2022; 2:100881. [PMID: 36248147 PMCID: PMC9560683 DOI: 10.1016/j.bas.2022.100881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/22/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
Introduction Outcome assessments after surgery for degenerative lumbar disorders (DLDs) rely on subjective patient-reported outcomes (PROMs). New objective functional capacity tests, like the smartphone-based 6-min walking test (6WT), have been introduced but presumably also do not reflect the patient's real-life functional performance. Research question Pilot study to analyze changes in smartphone-based real-life activity data for physical performance outcome in patients undergoing surgery for DLD. Material and methods Prospective observational study of DLD patients. Objective functional capacity and subjective outcomes were measured using 6WT and PROMs. Real-life physical performance data were acquired retrospectively using Apple iPhone Health data and compared against objective capacity and subjective outcomes. Results Eight patients (mean 46 years, 62% male) provided 286.858 smartphone mile counts. PROMs and physical capacity (6WT) significantly improved postoperatively. 6WT results increased from 352m pre-to 555/567m at 6/12 weeks postoperatively (p = 0.03). For physical performance a linear mixed effect models showed an increase in daily distance in the first 4 months after surgery (slope +0.178; p < 0.001). However, those increases reversed from 4 until 12 months postoperatively (negative slope estimate of −0.076; p < 0.001). Smartphone-derived physical performance measures showed a positive correlation with corresponding physical capacity in the 6WT (R = 0.57,p = 0.004) and negative correlations with PROMs (COMI: R = −0.62p = 0.001; ZCQ-Physical-Function: R = −0.68,p < 0.001; ZCQ-Symptom-Severity: R = −0.52,p = 0.009). Discussion and conclusion Smartphone-based real-life activity data allows for longitudinal physical performance assessment. Physical performance correlated with physical capacity and patient's subjective perception of disability. However, physical performance may be more resistant to postoperative longtime change which should consult a more cautious use as objective outcome measure. Smartphone-based activity data allows for continuous longitudinal physical performance assessment after lumbar spine surgery. It captures both, a preoperative deterioration, and a postoperative improvement of patients' physical performance. Although smartphone-based performance correlated with physical capacity/PROMs, daily activity decreased again postoperatively This discrepancy indicates that smartphone-based performance may provide a more in-depth assessment of function over time.
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Affiliation(s)
- Stefanos Voglis
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Anna M. Zeitlberger
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - David Bellut
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
- Corresponding author. Department of Neurosurgery University Hospital Zurich, Clinical Neuroscience Center University of Zurich, Zurich, Switzerland.
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12
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Stienen MN, Maldaner N, Sosnova M, Zeitlberger AM, Ziga M, Weyerbrock A, Bozinov O, Gautschi OP. External Validation of the Timed Up and Go Test as Measure of Objective Functional Impairment in Patients With Lumbar Degenerative Disc Disease. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa441_s096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Maldaner N, Sosnova M, Zeitlberger AM, Ziga M, Gautschi OP, Regli L, Bozinov O, Weyerbrock A, Stienen MN. Responsiveness of the self-measured 6-minute walking test and the Timed Up and Go test in patients with degenerative lumbar disorders. J Neurosurg Spine 2021; 35:52-59. [PMID: 33974372 DOI: 10.3171/2020.11.spine201621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The 6-minute walking test (6WT) and the Timed Up and Go (TUG) test are two of the most commonly applied standardized measures of objective functional impairment that help support clinical decision-making for patients undergoing surgery for degenerative lumbar disorders. This study correlates smartphone-app-based 6WT and TUG results to evaluate their responsiveness. METHODS In a prospective study, 49 consecutive patients were assessed preoperatively and 6 weeks postoperatively using the 6WT, the TUG test, and commonly used patient-reported outcome measures. Raw values and standardized z-scores of both objective tests were correlated. An external criterion for treatment success was created based on the Zurich Claudication Questionnaire patient satisfaction subscale. Internal and external responsiveness for both functional tests was evaluated. RESULTS The mean preoperative 6WT results improved from 401 m (SD 129 m), z-score -1.65 (SD 1.6) to 495 m (SD 129 m), z-score -0.71 (SD 1.6, p < 0.001). The mean preoperative TUG test results improved from 10.44 seconds (SD 4.37, z-score: -3.22) to 8.47 seconds (SD 3.38, z-score: -1.93, p < 0.001). The 6WT showed a strong negative correlation with TUG test results (r = -66, 95% CI 0.76-0.53, p < 0.001). The 6WT showed higher internal responsiveness (standardized responsive mean = 0.86) compared to the TUG test (standardized responsive mean = 0.67). Evaluation of external responsiveness revealed that the 6WT was capable of differentiating between patients who were satisfied and those who were unsatisfied with their treatment results (area under the curve = 0.70), whereas this was not evident for the TUG test ( area under the curve = 0.53). CONCLUSIONS Both tests adequately quantified functional impairment in surgical candidates with degenerative lumbar disorders. The 6WT demonstrated better internal and external responsiveness compared with the TUG test. Clinical trial registration no.: NCT03977961 (clinicaltrials.gov). ABBREVIATIONS AUC = area under the curve; COMI = Core Outcome Measures Index; DLDs = degenerative lumbar disorders; LDH = lumbar disc herniation; LSS = lumbar spinal stenosis; PROM = patient-reported outcome measure; ROC = receiver operating characteristic; SRM = standardized responsive mean; TUG = Timed Up and Go; VAS = visual analog scale; 6WD = 6-minute walking distance; 6WT = 6-minute walking test; ZCQ = Zurich Claudication Questionnaire.
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Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
- Department of Neurosurgery, Kantonsspital St. Gallen
| | | | | | - Michal Ziga
- Department of Neurosurgery, Kantonsspital St. Gallen
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | | | | | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
- Department of Neurosurgery, Kantonsspital St. Gallen
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14
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Maldaner N, Zeitlberger AM, Sosnova M, Goldberg J, Fung C, Bervini D, May A, Bijlenga P, Schaller K, Roethlisberger M, Rychen J, Zumofen DW, D'Alonzo D, Marbacher S, Fandino J, Daniel RT, Burkhardt JK, Chiappini A, Robert T, Schatlo B, Schmid J, Maduri R, Staartjes VE, Seule MA, Weyerbrock A, Serra C, Stienen MN, Bozinov O, Regli L. Development of a Complication- and Treatment-Aware Prediction Model for Favorable Functional Outcome in Aneurysmal Subarachnoid Hemorrhage Based on Machine Learning. Neurosurgery 2021; 88:E150-E157. [PMID: 33017031 DOI: 10.1093/neuros/nyaa401] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Current prognostic tools in aneurysmal subarachnoid hemorrhage (aSAH) are constrained by being primarily based on patient and disease characteristics on admission. OBJECTIVE To develop and validate a complication- and treatment-aware outcome prediction tool in aSAH. METHODS This cohort study included data from an ongoing prospective nationwide multicenter registry on all aSAH patients in Switzerland (Swiss SOS [Swiss Study on aSAH]; 2009-2015). We trained supervised machine learning algorithms to predict a binary outcome at discharge (modified Rankin scale [mRS] ≤ 3: favorable; mRS 4-6: unfavorable). Clinical and radiological variables on admission ("Early" Model) as well as additional variables regarding secondary complications and disease management ("Late" Model) were used. Performance of both models was assessed by classification performance metrics on an out-of-sample test dataset. RESULTS Favorable functional outcome at discharge was observed in 1156 (62.0%) of 1866 patients. Both models scored a high accuracy of 75% to 76% on the test set. The "Late" outcome model outperformed the "Early" model with an area under the receiver operator characteristics curve (AUC) of 0.85 vs 0.79, corresponding to a specificity of 0.81 vs 0.70 and a sensitivity of 0.71 vs 0.79, respectively. CONCLUSION Both machine learning models show good discrimination and calibration confirmed on application to an internal test dataset of patients with a wide range of disease severity treated in different institutions within a nationwide registry. Our study indicates that the inclusion of variables reflecting the clinical course of the patient may lead to outcome predictions with superior predictive power compared to a model based on admission data only.
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Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Anna M Zeitlberger
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
| | - Christian Fung
- Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.,Department of Neurosurgery, Medical Center - University of Freiburg, Germany
| | - David Bervini
- Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
| | - Adrien May
- Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
| | | | - Jonathan Rychen
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, Neurology, and Radiology, Maimonides Medical Center, SUNY Downstate University, Brooklyn, NY, USA
| | - Donato D'Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Roy Thomas Daniel
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Alessio Chiappini
- Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Germany
| | | | - Rodolfo Maduri
- Neurosurgery, Clinique de Genolier, Swiss Medical Network, Genolier, Switzerland
| | - Victor E Staartjes
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
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15
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Stienen MN, Maldaner N, Sosnova M, Zeitlberger AM, Ziga M, Weyerbrock A, Bozinov O, Gautschi OP. External Validation of the Timed Up and Go Test as Measure of Objective Functional Impairment in Patients With Lumbar Degenerative Disc Disease. Neurosurgery 2021; 88:E142-E149. [PMID: 33040156 DOI: 10.1093/neuros/nyaa441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Timed Up and Go (TUG) test is the most commonly applied objective measure of functional impairment in patients with lumbar degenerative disc disease (DDD). OBJECTIVE To demonstrate external content validity of the TUG test. METHODS Consecutive adult patients, scheduled for elective lumbar spine surgery, were screened for enrollment into a prospective observational study. Disease severity was estimated by patient-reported outcome measures (PROMs; Visual Analog Scales [VAS], Core Outcome Measures Index [COMI] back, Zurich Claudication Questionnaire [ZCQ]) and the TUG test. Pearson correlation coefficients (PCCs) were used to describe the relationship between logarithmic TUG test raw values and PROMs. RESULTS A total of 70 patients (mean age 55.9 ± 15.4 yr; 38.6% female; 27.1% previous spine surgery; 28.6% lower extremity motor deficits) with lumbar disc herniation (50%), lumbar spinal stenosis (34.3%), or instability requiring spinal fusion (15.7%) were included. The mean TUG test time was 10.8 ± 4.4 s; age- and sex-adjusted objective functional impairment (OFI) T-score was 134.2 ± 36.9. A total of 12 (17.1%) patients had mild, 14 (20%) moderate, and 9 (12.9%) severe OFI, while 35 (50%) had TUG test results within the normal population range (no OFI). PCCs between TUG test time and VAS back pain were r = 0.37 (P = .002), VAS leg pain r = 0.37 (P = .002), COMI back r = 0.50 (P < .001), ZCQ symptom severity r = 0.41 (P < .001), and ZCQ physical function r = 0.36 (P = .002). CONCLUSION This external validation demonstrated similar OFI rates and PCCs between logarithmic TUG test results and PROMs compared to the original article from 2016. These findings support the TUG test being a quick, easy-to-use objective test, which provides the physician with a robust estimate of pain and functional impairment.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anna M Zeitlberger
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
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Sosnova M, Zeitlberger AM, Ziga M, Gautschi OP, Regli L, Weyerbrock A, Bozinov O, Stienen MN, Maldaner N. Patients undergoing surgery for lumbar degenerative spinal disorders favor smartphone-based objective self-assessment over paper-based patient-reported outcome measures. Spine J 2021; 21:610-617. [PMID: 33346155 DOI: 10.1016/j.spinee.2020.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/21/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Smartphone-based applications enable new prospects to monitor symptoms and assess functional outcome in patients with lumbar degenerative spinal disorders. However, little is known regarding patient acceptance and preference towards new modes of digital objective outcome assessment. PURPOSE To assess patient preference of an objective smartphone-based outcome measure compared to conventional paper-based subjective methods of outcome assessment. STUDY DESIGN Prospective observational cohort study. PATIENT SAMPLE Fourty-nine consecutive patients undergoing surgery for lumbar degenerative spinal disorder. OUTCOME MEASURES Patients completed a preference survey to assess different methods of outcome assessment. A 5-level Likert scale ranged from strong disagreement (2 points) over neutral (6 points) to strong agreement (10 points) was used. METHODS Patients self-determined their objective functional impairment using the 6-minute Walking Test application (6WT-app) and completed a set of paper-based patient-reported outcome measures (PROMs) before and 6 weeks after surgery. Patients were then asked to rate the methods of outcome assessment in terms of suitability, convenience, and responsiveness to their symptoms. RESULTS The majority of patients considered the 6WT-app a suitable instrument (median 8.0, interquartile range [IQR] 4.0). Patients found the 6WT more convenient (median 10.0, IQR 2.0) than the Zurich Claudication Questionnaire (ZCQ; median 8.0, IQR 4.0, p=.019) and Core Outcome Measure Index (COMI; median 8.0, IQR 4.0, p=.007). There was good agreement that the 6WT-app detects change in physical performance (8.0, IQR 4.0). 78 % of patients considered the 6WT superior in detecting differences in symptoms (vs. 22% for PROMs). Seventy-six percent of patients would select the 6WT over the other, 18% the ZCQ and 6% the COMI. Eighty-two percent of patients indicated their preference to use a smartphone app for the assessment and monitoring of their spine-related symptoms in the future. CONCLUSIONS Patients included in this study favored the smartphone-based evaluation of objective functional impairment over paper-based PROMs. Involving patients more actively by means of digital technology may increase patient compliance and satisfaction as well as diagnostic accuracy.
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Affiliation(s)
- Marketa Sosnova
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland.
| | | | - Michal Ziga
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
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17
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Schatlo B, Fung C, Stienen MN, Fathi AR, Fandino J, Smoll NR, Zumofen D, Daniel RT, Burkhardt JK, Bervini D, Marbacher S, Reinert M, D Alonzo D, Ahlborn P, Mendes Pereira V, Roethlisberger M, Seule M, Kerkeni H, Remonda L, Weyerbrock A, Woernle K, Venier A, Perren F, Sailer M, Robert T, Rohde V, Schöni D, Goldberg J, Nevzati E, Diepers M, Gralla J, Z'Graggen W, Starnoni D, Woernle C, Maldaner N, Kulcsar Z, Mostaguir K, Maduri R, Eisenring C, Bernays R, Ferrari A, Dan-Ura H, Finkenstädt S, Gasche Y, Sarrafzadeh A, Jakob SM, Corniola M, Baumann F, Regli L, Levivier M, Hildebrandt G, Landolt H, Mariani L, Guzman R, Beck J, Raabe A, Keller E, Bijlenga P, Schaller K. Incidence and Outcome of Aneurysmal Subarachnoid Hemorrhage: The Swiss Study on Subarachnoid Hemorrhage (Swiss SOS). Stroke 2020; 52:344-347. [PMID: 33272133 DOI: 10.1161/strokeaha.120.029538] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to assess nationwide incidence and outcomes of aneurysmal subarachnoid hemorrhage (aSAH). The Swiss SOS (Swiss Study on Subarachnoid Hemorrhage) was established in 2008 and offers the unique opportunity to provide this data from the point of care on a nationwide level. METHODS All patients with confirmed aneurysmal subarachnoid hemorrhage admitted between January 1, 2009 and December 31, 2014, within Switzerland were recorded in a prospective registry. Incidence rates were calculated based on time-matched population data. Admission parameters and outcomes at discharge and at 1 year were recorded. RESULTS We recorded data of 1787 consecutive patients. The incidence of aneurysmal subarachnoid hemorrhage in Switzerland was 3.7 per 100 000 persons/y. The number of female patients was 1170 (65.5%). With a follow-up rate of 91.3% at 1 year, 1042 patients (58.8%) led an independent life according to the modified Rankin Scale (0-2). About 1 in 10 patients survived in a dependent state (modified Rankin Scale, 3-5; n=185; 10.4%). Case fatality was 20.1% (n=356) at discharge and 22.1% (n=391) after 1 year. CONCLUSIONS The current incidence of aneurysmal subarachnoid hemorrhage in Switzerland is lower than expected and an indication of a global trend toward decreasing admissions for ruptured intracranial aneurysms. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03245866.
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Affiliation(s)
- Bawarjan Schatlo
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland.,Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland.,Neurosurgery, University Hospital Göttingen Germany (B.S., V.R.)
| | - Christian Fung
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland.,Department of Neurosurgery, Faculty of Medicine, Medical Center, University of Freiburg, Germany (J.B., C.F.)
| | - Martin N Stienen
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Ali R Fathi
- Neurosurgery, Hirslanden Klinik Aarau Switzerland (A.R.F.)
| | - Javier Fandino
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Nicolas R Smoll
- School of Population and Global, University of Melbourne Australia (N.R.S.)
| | - Daniel Zumofen
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Roy Thomas Daniel
- Neurosurgery, University Hospital Lausanne Switzerland (R.T.D., D. Starnoni, R.M., M.L.)
| | - Jan-Karl Burkhardt
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - David Bervini
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - Serge Marbacher
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Michael Reinert
- Neurosurgery, Ospedale Civico Lugano Switzerland (M. Reinert, A.V., T.R.)
| | - Donato D Alonzo
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Peter Ahlborn
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | | | - Michel Roethlisberger
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Martin Seule
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | | | - Luca Remonda
- Neuroradiology (L.R., M.D.), Kantonsspital Aarau Switzerland
| | - Astrid Weyerbrock
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | - Kerstin Woernle
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Alice Venier
- Neurosurgery, Ospedale Civico Lugano Switzerland (M. Reinert, A.V., T.R.)
| | | | - Martin Sailer
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Thomas Robert
- Neurosurgery, Ospedale Civico Lugano Switzerland (M. Reinert, A.V., T.R.)
| | - Veit Rohde
- Neurosurgery, University Hospital Göttingen Germany (B.S., V.R.)
| | - Daniel Schöni
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - Johannes Goldberg
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - Edin Nevzati
- Neurosurgery, Kantonsspital Luzern Switzerland (E.N., F.B.)
| | - Michael Diepers
- Neuroradiology (L.R., M.D.), Kantonsspital Aarau Switzerland
| | - Jan Gralla
- Neuroradiology (J. Gralla, W.Z.), University Hospital Bern Switzerland
| | - Werner Z'Graggen
- Neuroradiology (J. Gralla, W.Z.), University Hospital Bern Switzerland
| | - Daniele Starnoni
- Neurosurgery, University Hospital Lausanne Switzerland (R.T.D., D. Starnoni, R.M., M.L.)
| | - Christoph Woernle
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Nicolai Maldaner
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital Zürich, Switzerland (Z.K.)
| | - Khaled Mostaguir
- Clinical Research Centre, (K.M.), University Hospital Geneva, Switzerland
| | - Rodolfo Maduri
- Neurosurgery, University Hospital Lausanne Switzerland (R.T.D., D. Starnoni, R.M., M.L.)
| | - Christian Eisenring
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - René Bernays
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Andrea Ferrari
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | - Hiroki Dan-Ura
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Sina Finkenstädt
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Yvan Gasche
- Intensive Care Medicine (Y.G.), University Hospital Geneva, Switzerland
| | - Asita Sarrafzadeh
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland
| | - Stephan M Jakob
- Intensive Care Medicine (S.M.J.), University Hospital Bern Switzerland
| | - Marco Corniola
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland
| | - Fabian Baumann
- Neurosurgery, Kantonsspital Luzern Switzerland (E.N., F.B.)
| | - Luca Regli
- Neurosurgery (M.N.S., J.-K.B., C.W., N.M., R.B., S.F., L.R.), University Hospital Zürich Switzerland
| | - Marc Levivier
- Neurosurgery, University Hospital Lausanne Switzerland (R.T.D., D. Starnoni, R.M., M.L.)
| | - Gerhard Hildebrandt
- Neurosurgery, Kantonsspital St. Gallen Switzerland (P.A., M. Seule, A.W., A.F., G.H.)
| | - Hans Landolt
- Neurosurgery (B.S., J.F., S.M., D.D., K.W., H.D.U., H.L.), Kantonsspital Aarau Switzerland
| | - Luigi Mariani
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Raphael Guzman
- Neurosurgery, University Hospital Basel Switzerland (D.Z., M. Roethlisberger, M. Sailer, L.M., R.G.)
| | - Jürgen Beck
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland.,Department of Neurosurgery, Faculty of Medicine, Medical Center, University of Freiburg, Germany (J.B., C.F.)
| | - Andreas Raabe
- Neurosurgery (C.F., D.B., D. Schöni, J. Goldberg, C.E., J.B., A.R.), University Hospital Bern Switzerland
| | - Emanuela Keller
- Intensive Care Medicine (E.K.), University Hospital Zürich Switzerland
| | - Philippe Bijlenga
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland
| | - Karl Schaller
- Neurosurgery (B.S., A.S., M.C., P.B., K.S.), University Hospital Geneva, Switzerland
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Maldaner N, Sosnova M, Zeitlberger AM, Ziga M, Gautschi OP, Regli L, Weyerbrock A, Stienen MN, _ _. Evaluation of the 6-minute walking test as a smartphone app-based self-measurement of objective functional impairment in patients with lumbar degenerative disc disease. J Neurosurg Spine 2020; 33:779-788. [DOI: 10.3171/2020.5.spine20547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDigital transformation enables new possibilities to assess objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). This study examines the psychometric properties of an app-based 6-minute walking test (6WT) and determines OFI in patients with lumbar DDD.METHODSThe maximum 6-minute walking distance (6WD) was determined in patients with lumbar DDD. The results were expressed as raw 6WDs (in meters), as well as in standardized z-scores referenced to age- and sex-specific values of spine-healthy volunteers. The 6WT results were assessed for reliability and content validity using established disease-specific patient-reported outcome measures.RESULTSSeventy consecutive patients and 330 volunteers were enrolled. The mean 6WD was 370 m (SD 137 m) in patients with lumbar DDD. Significant correlations between 6WD and the Core Outcome Measures Index for the back (r = −0.31), Zurich Claudication Questionnaire (ZCQ) symptom severity (r = −0.32), ZCQ physical function (r = −0.33), visual analog scale (VAS) for back pain (r = −0.42), and VAS for leg pain (r = −0.32) were observed (all p < 0.05). The 6WT revealed good test-retest reliability (intraclass correlation coefficient 0.82), and the standard error of measurement was 58.3 m. A 4-tier severity stratification classified patients with z-scores > −1 (no OFI), −1 to −1.9 (mild OFI), −2 to −2.9 (moderate OFI), and ≤ −3 (severe OFI).CONCLUSIONSThe smartphone app-based self-measurement of the 6WT is a convenient, reliable, and valid way to determine OFI in patients with lumbar DDD. The 6WT app facilitates the digital evaluation and monitoring of patients with lumbar DDD.
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Affiliation(s)
- Nicolai Maldaner
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
- 2Department of Neurosurgery, Kantonsspital St. Gallen; and
| | | | | | - Michal Ziga
- 2Department of Neurosurgery, Kantonsspital St. Gallen; and
| | - Oliver P. Gautschi
- 3Neurological and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | | | - Martin N. Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
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Wessels L, Fekonja LS, Achberger J, Dengler J, Czabanka M, Hecht N, Schneider U, Tkatschenko D, Schebesch KM, Schmidt NO, Mielke D, Hosch H, Ganslandt O, Gräwe A, Hong B, Walter J, Güresir E, Bijlenga P, Haemmerli J, Maldaner N, Marbacher S, Nurminen V, Zitek H, Dammers R, Kato N, Linfante I, Pedro MT, Wrede K, Wang WT, Wostrack M, Vajkoczy P. Diagnostic reliability of the Berlin classification for complex MCA aneurysms-usability in a series of only giant aneurysms. Acta Neurochir (Wien) 2020; 162:2753-2758. [PMID: 32929543 PMCID: PMC7550378 DOI: 10.1007/s00701-020-04565-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Abstract
Background and objective The main challenge of bypass surgery of complex MCA aneurysms is not the selection of the bypass type but the initial decision-making of how to exclude the affected vessel segment from circulation. To this end, we have previously proposed a classification for complex MCA aneurysms based on the preoperative angiography. The current study aimed to validate this new classification and assess its diagnostic reliability using the giant aneurysm registry as an independent data set. Methods We reviewed the pretreatment neuroimaging of 51 patients with giant (> 2.5 cm) MCA aneurysms from 18 centers, prospectively entered into the international giant aneurysm registry. We classified the aneurysms according to our previously proposed Berlin classification for complex MCA aneurysms. To test for interrater diagnostic reliability, the data set was reviewed by four independent observers. Results We were able to classify all 51 aneurysms according to the Berlin classification for complex MCA aneurysms. Eight percent of the aneurysm were classified as type 1a, 14% as type 1b, 14% as type 2a, 24% as type 2b, 33% as type 2c, and 8% as type 3. The interrater reliability was moderate with Fleiss’s Kappa of 0.419. Conclusion The recently published Berlin classification for complex MCA aneurysms showed diagnostic reliability, independent of the observer when applied to the MCA aneurysms of the international giant aneurysm registry.
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Affiliation(s)
- Lars Wessels
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lucius Samo Fekonja
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Johannes Achberger
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Julius Dengler
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurosurgery, Helios Clinic, Bad Saarow, Germany
- Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Germany
| | - Marcus Czabanka
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ulf Schneider
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dimitri Tkatschenko
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Nils Ole Schmidt
- Department of Neurosurgery, University of Regensburg, Regensburg, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, Georg-August-University Goettingen, Göttingen, Germany
| | - Henning Hosch
- Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | - Alexander Gräwe
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Germany
| | - Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Jan Walter
- Department of Neurosurgery, University Hospital Jena, Jena, Germany
- Department of Neurosurgery, Medical Center Saarbrücken, Saarbrücken, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Philippe Bijlenga
- Service de Neurochirurgie, Faculté de Médecine de Genève and Hôpitaux Universitaire de Genève, Geneva, Switzerland
| | - Julien Haemmerli
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Service de Neurochirurgie, Faculté de Médecine de Genève and Hôpitaux Universitaire de Genève, Geneva, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital of Zurich, Zürich, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Ville Nurminen
- Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hynek Zitek
- Department of Neurosurgery, J. E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Ruben Dammers
- Erasmus Stroke Center, Erasmus MC University Hospital, Rotterdam, The Netherlands
| | - Naoki Kato
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Italo Linfante
- Interventional Neuroradiology and Endovascular Neurosurgery at Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, Miami, USA
| | | | - Karsten Wrede
- Department of Neurosurgery, University of Essen, Duisburg, Germany
| | - Wei-Te Wang
- Department of Neurosurgery, Medical University, Vienna, Austria
| | - Maria Wostrack
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Maldaner N, Stienen MN. Subjective and Objective Measures of Symptoms, Function, and Outcome in Patients With Degenerative Spine Disease. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:183-199. [DOI: 10.1002/acr.24210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/02/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Nicolai Maldaner
- University Hospital Zurich and University of Zurich, Zurich, Switzerland, and Cantonal Hospital St. Gallen St. Gallen Switzerland
| | - Martin Nikolaus Stienen
- University Hospital Zurich and University of Zurich, Zurich, Switzerland, and Stanford University Hospital and Clinics Stanford California
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Sosnova M, Zeitlberger AM, Ziga M, Gautschi OP, Weyerbrock A, Stienen MN, Maldaner N. Longitudinal smartphone-based self-assessment of objective functional impairment in patients undergoing surgery for lumbar degenerative disc disease: initial experience. Acta Neurochir (Wien) 2020; 162:2061-2068. [PMID: 32405670 DOI: 10.1007/s00701-020-04377-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The worldwide spread of smartphone usage enables new possibilities for longitudinal monitoring of objective functional impairment (OFI) in patients undergoing surgery for lumbar degenerative disc disease (DDD). METHODS Three patients, undergoing elective surgery for lumbar DDD, self-assessed OFI using a recently validated 6-min walking test (6WT) smartphone application. Results are presented as raw 6-min walking distance (6WD) as well as in reference to age- and sex-specific healthy population reference values using standardized z-scores (number of standard deviations). In parallel, patient-reported outcome measures (PROMs), including numeric rating scale (NRS) leg-pain and Core Outcome Measures Index (COMI) were obtained before (pre) and 6 weeks (6 W) as well as 3 months (3 M) after surgery. Descriptive analyses were used to compare PROMs with repeated 6WT measurements over time. The feasibility and benefits of the longitudinal OFI measurements using the 6WT app are discussed. RESULTS One patient presented a favorable outcome, reflected by a clinically meaningful improvement in PROMs. Correspondingly, the 6WT distance gradually improved above the normal population values ((pre 399 m (z-score - 1.96) vs. 6 W 494 m (- 0.85) vs. 3 M 557 m (- 0.1)). One patient experienced initial improvement at 6 W, followed by a decline in 6WD at 3 M which promoted further interventions with subsequent recovery ((358 m (z-score - 3.29) vs 440 m (- 2.2) vs 431 m (- 2.32) vs 471 m (- 1.78)). The last patient showed a lack of improvement in PROMs as well as in OFI (360 m (z-score 0.0) vs 401 m (0.30) vs 345 m (- 0.11)) resulting in secondary surgery. CONCLUSION The longitudinal assessment of OFI using the 6WT app was feasible and provided the physician with a detailed history of patients' postoperative walking capacity complementing commonly used PROMs.
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Serra C, Staartjes VE, Maldaner N, Holzmann D, Soyka MB, Gilone M, Schmid C, Tschopp O, Regli L. Assessing the surgical outcome of the "chopsticks" technique in endoscopic transsphenoidal adenoma surgery. Neurosurg Focus 2020; 48:E15. [PMID: 32480377 DOI: 10.3171/2020.3.focus2065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The "chopsticks" technique is a 3-instrument, 2-hand mononostril technique that has been recently introduced in endoscopic neurosurgery. It allows a dynamic surgical view controlled by one surgeon only while keeping bimanual dissection. Being a mononostril approach, it requires manipulation of the mucosa of one nasal cavity only. The rationale of the technique is to reduce nasal morbidity without compromising surgical results and complication rates. There are, however, no data available on its results in endoscopic surgery (transsphenoidal surgery [TSS]) for pituitary adenoma. METHODS The authors performed a cohort analysis of prospectively collected data on 144 patients (156 operations) undergoing TSS using the chopsticks technique with 3T intraoperative MRI. All patients had at least 3 months of postoperative neurosurgical, endocrinological, and rhinological follow-up (Sino-Nasal Outcome Test-20 [SNOT-20] and Sniffin' Sticks). The surgical technique is described, and the achieved gross-total resection (GTR) and extent of resection (EOR) together with patients' clinical outcomes and complications are descriptively reported. RESULTS On 3-month postoperative MRI, GTR was achieved in 71.2% of patients with a mean EOR of 96.7%. GTR was the surgical goal in 122 of 156 cases and was achieved in 106 of 122 (86.9%), with a mean EOR of 98.7% (median 100%, range 49%-100%). There was no surgical mortality. At a median follow-up of 15 months (range 3-70 months), there was 1 permanent neurological deficit. As of the last available follow-up, 11.5% of patients had a new pituitary single-axis deficit, whereas 26.3% had improvement in endocrinological function. Three patients had new postoperative hyposmia. One patient had severe impairment of sinonasal function (SNOT-20 score > 40). The operation resulted in endocrine remission in 81.1% of patients with secreting adenomas. CONCLUSIONS This study shows that the chopsticks technique confers resection and morbidity results that compare favorably with literature reports of TSS. This technique permits a single surgeon to perform effective endoscopic bimanual dissection through a single nostril, reducing manipulation of healthy tissue and thereby possibly minimizing surgical morbidity.
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Affiliation(s)
- Carlo Serra
- 1Department of Neurosurgery, Clinical Neuroscience Center
| | | | | | - David Holzmann
- 2Department of Otorhinolaryngology, Head and Neck Surgery; and
| | - Michael B Soyka
- 2Department of Otorhinolaryngology, Head and Neck Surgery; and
| | - Marco Gilone
- 3Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Christoph Schmid
- 4Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital of Zürich, University of Zürich, Switzerland; and
| | - Oliver Tschopp
- 3Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Luca Regli
- 1Department of Neurosurgery, Clinical Neuroscience Center
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Tosic L, Goldberger E, Maldaner N, Sosnova M, Zeitlberger AM, Staartjes VE, Gadjradj PS, Eversdijk HAJ, Quddusi A, Gandía-González ML, Sayadi JJ, Desai A, Regli L, Gautschi OP, Stienen MN. Normative data of a smartphone app-based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures. J Neurosurg Spine 2020; 33:480-489. [PMID: 32470938 DOI: 10.3171/2020.3.spine2084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The 6-minute walking test (6WT) is used to determine restrictions in a subject's 6-minute walking distance (6WD) due to lumbar degenerative disc disease. To facilitate simple and convenient patient self-measurement, a free and reliable smartphone app using Global Positioning System coordinates was previously designed. The authors aimed to determine normative values for app-based 6WD measurements. METHODS The maximum 6WD was determined three times using app-based measurement in a sample of 330 volunteers without previous spine surgery or current spine-related disability, recruited at 8 centers in 5 countries (mean subject age 44.2 years, range 16-91 years; 48.5% male; mean BMI 24.6 kg/m2, range 16.3-40.2 kg/m2; 67.9% working; 14.2% smokers). Subjects provided basic demographic information, including comorbidities and patient-reported outcome measures (PROMs): visual analog scale (VAS) for both low-back and lower-extremity pain, Core Outcome Measures Index (COMI), Zurich Claudication Questionnaire (ZCQ), and subjective walking distance and duration. The authors determined the test-retest reliability across three measurements (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and mean 6WD [95% CI]) stratified for age and sex, and content validity (linear regression coefficients) between 6WD and PROMs. RESULTS The ICC for repeated app-based 6WD measurements was 0.89 (95% CI 0.87-0.91, p < 0.001) and the SEM was 34 meters. The overall mean 6WD was 585.9 meters (95% CI 574.7-597.0 meters), with significant differences across age categories (p < 0.001). The 6WD was on average about 32 meters less in females (570.5 vs 602.2 meters, p = 0.005). There were linear correlations between average 6WD and VAS back pain, VAS leg pain, COMI Back and COMI subscores of pain intensity and disability, ZCQ symptom severity, ZCQ physical function, and ZCQ pain and neuroischemic symptoms subscores, as well as with subjective walking distance and duration, indicating that subjects with higher pain, higher disability, and lower subjective walking capacity had significantly lower 6WD (all p < 0.001). CONCLUSIONS This study provides normative data for app-based 6WD measurements in a multicenter sample from 8 institutions and 5 countries. These values can now be used as reference to compare 6WT results and quantify objective functional impairment in patients with degenerative diseases of the spine using z-scores. The authors found a good to excellent test-retest reliability of the 6WT app, a low area of uncertainty, and high content validity of the average 6WD with commonly used PROMs.
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Affiliation(s)
- Lazar Tosic
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Elior Goldberger
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Nicolai Maldaner
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anna M Zeitlberger
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Victor E Staartjes
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Pravesh S Gadjradj
- 3Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ayesha Quddusi
- 5Center for Neuroscience, Queens University, Kingston, Ontario, Canada
| | | | - Jamasb Joshua Sayadi
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
| | - Atman Desai
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Oliver P Gautschi
- 8Neuro and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
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24
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Zeitlberger AM, Sosnova M, Ziga M, Steinsiepe V, Gautschi OP, Stienen MN, Maldaner N. Smartphone-Based Self-Assessment of Objective Functional Impairment (6-Minute Walking Test) in Patients Undergoing Epidural Steroid Injection. Neurospine 2020; 17:136-142. [PMID: 32252164 PMCID: PMC7136089 DOI: 10.14245/ns.2040022.011] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/12/2020] [Indexed: 11/28/2022] Open
Abstract
Epidural steroid injection (ESI) represents a popular treatment option in patients with lumbar degenerative disc disease (DDD). The main objective of the article was to determine whether the 6-minute walking test (6WT) could assist in the discrimination between ESI responders and nonresponders. We used a validated 6WT smartphone application to assess self-measured objective functional impairment (OFI) in 3 patients with DDD undergoing ESI. Patient-reported outcome measures (PROMs), including the Core Outcome Measures Index and the Oswestry Disability Index, were obtained at baseline and at the 3-, 7-, and 28-day follow-up. Descriptive analyses were used to compare PROMs with OFI over time. Two patients responded well to the ESI, illustrated by clinically meaningful improvements in PROMs. This improvement was accompanied by a substantial increase in the 6WT distance (case I: 358 m vs. 517 m and case II: 296 m vs. 625 m). One patient reported only moderate improvement in leg pain and conflicting results in the other PROMs. The 6WT demonstrated a persistent OFI (487 m vs. 488 m). This patient was considered a nonresponder and underwent surgical treatment. This case series illustrates the feasibility of the smartphone-based 6WT as a tool to assess OFI in patients undergoing ESI for lumbar DDD.
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Affiliation(s)
| | - Marketa Sosnova
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Valentin Steinsiepe
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
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Maldaner N, Tomkins-Lane C, Desai A, Zygourakis CC, Weyerbrock A, Gautschi OP, Stienen MN. Digital transformation in spine research and outcome assessment. Spine J 2020; 20:310-311. [PMID: 32000961 DOI: 10.1016/j.spinee.2019.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
| | - Christy Tomkins-Lane
- Wearable Health Lab, Department of Physical Medicine and Rehabilitation, Stanford University Hospital and Clinics, Stanford, CA; Department of Physical Education and Recreation Studies, Mount Royal University, Calgary, Alberta, Canada
| | - Atman Desai
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA
| | - Astrid Weyerbrock
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
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Stienen MN, Maldaner N, Sosnova M, Joswig H, Corniola MV, Regli L, Hildebrandt G, Schaller K, Gautschi OP. Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures. Neurospine 2020; 17:270-280. [PMID: 32054148 PMCID: PMC7136100 DOI: 10.14245/ns.1938368.184] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/02/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today’s gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure.
Methods We evaluated patients with lumbar DDD from a prospective 2-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 [normal] –0 [no movement]). The PROM-based evaluation included pain (visual analogue scale), disability (Oswestry Disability Index [ODI] & Roland-Morris Disability Index [RMDI]), and health-related quality of life (HRQoL; Short-Form 12 physical component summary/mental component summary & EuroQol-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value.
Results One hundred five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI: 52.8 vs. 48.2, p = 0.025; RMDI: 12.6 vs. 11.3, p = 0.034) but similar pain and HRQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p = 0.006). When comparing patients with high- (BMRC 0–2) vs. low-grade LEMD (BMRC 3–4), no difference was evident for the PROM-based evaluation (all p > 0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p = 0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs.
Conclusion Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable.
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Affiliation(s)
- Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Holger Joswig
- Department of Neurosurgery, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Marco Vincenzo Corniola
- Division of Neurosurgery, Department of Clinical Neuroscience, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Gerhard Hildebrandt
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neuroscience, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Maldaner N, Desai A, Gautschi OP, Regli L, Ratliff JK, Park J, Stienen MN. Improving the Patient-Physician Relationship in the Digital Era - Transformation From Subjective Questionnaires Into Objective Real-Time and Patient-Specific Data Reporting Tools. Neurospine 2019; 16:712-714. [PMID: 31905462 PMCID: PMC6944997 DOI: 10.14245/ns.1938400.200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Atman Desai
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA, USA
| | - Oliver P. Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - John K. Ratliff
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA, USA
| | - Jon Park
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA, USA
| | - Martin N. Stienen
- Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA, USA
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
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Lenga P, Hohaus C, Hong B, Kursumovic A, Maldaner N, Burkhardt JK, Bijlenga P, Rüfenacht DA, Schmidt NO, Vajkoczy P, Dengler J. Giant intracranial aneurysms of the posterior circulation and their relation to the brainstem: analysis of risk factors for neurological deficits. J Neurosurg 2019; 131:403-409. [PMID: 30095339 DOI: 10.3171/2018.4.jns172343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Giant posterior circulation aneurysms (GPCirAs) usually cause substantial mass effect on the brainstem, which may lead to neurological deficits. So far, there has been no systematic investigation of factors associated with such deficits in GPCirA. The authors aim to examine the risk factors for cranial nerve deficit (CND), motor deficit, and disability in patients with GPCirA. METHODS Using MR images obtained in 30 patients with unruptured GPCirA, the authors examined GPCirA volume, presence of hydrocephalus or partial thrombosis (PT) of the aneurysm, and the degree of brainstem displacement measured by the distance between the McRae line and the tip of the GPCirA (∆MT). They evaluated associations between these factors and neurological deficits. RESULTS Thirty GPCirAs in 30 patients were included. The prevalence of CNDs was 50%. Patients with CNDs significantly differed from those without CNDs in terms of age (mean 51.0 years [SD 15.0 years] vs 69.0 years [SD 21.0 years], p = 0.01) and in ∆MT (median 50.7 mm [IQR 39.2-53.9 mm] vs 39.0 mm [IQR 32.3-45.9 mm], p = 0.02). The prevalence of motor deficits was 33.3%. Patients with motor deficits showed a larger ∆MT (median 50.5 mm [IQR 40.8-54.6 mm]) compared with those without (∆MT: median 39.1 mm [IQR 32.8-50.5 mm], p = 0.04). GPCirA volume was larger in patients with poor modified Rankin Scale (mRS) scores (median 14.9 cm3 [IQR 8.6-18.7 cm3]) than in those with mRS scores of 0-2 (median 6.8 cm3 [IQR 4.4-11.7 cm3], p = 0.03). After adjusting for patient age and the occurrence of hydrocephalus or PT, the authors found that higher degrees of disability were significantly associated with aneurysm volume (OR 1.13, 95% CI 1.0-1.3; p = 0.04), but not with ∆MT. The occurrence of CND or motor deficit was not associated with any of the examined variables. There was no correlation between GPCirA volume and ∆MT (rs = 0.01, p = 0.96). The prevalence of neurological deficits did not differ between GPCirA at the basilar apex, the basilar trunk, the vertebrobasilar junction, or the vertebral artery. CONCLUSIONS In this study, the neurological condition of the patients was associated only with GPCirA volume and not with the degree of brainstem displacement, the occurrence of PT or hydrocephalus, or the exact location of the GPCirA. These findings highlight the clinical relevance of GPCirA volume and suggest that factors such as brainstem displacement or PT should play less of a role when finding arguments for or against treatment of GPCirA.Clinical trial registration no.: NCT02066493 (clinicaltrials.gov).
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Affiliation(s)
- Pavlina Lenga
- 1Department of Neurosurgery, Charité-Universitaetsmedizin Berlin
| | | | - Bujung Hong
- 3Department of Neurosurgery, Hannover Medical School, Hannover
| | - Adisa Kursumovic
- 4Department of Neurosurgery and Interventional Neuroradiology, DONAUISAR Klinikum Deggendorf, Germany
| | | | | | | | - Daniel A Rüfenacht
- 7Department of Neuroradiology, Clinic Hirslanden, Zurich, Switzerland; and
| | - Nils O Schmidt
- 8Department of Neurosurgery, University Medical Center, Hamburg Eppendorf, Germany
| | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité-Universitaetsmedizin Berlin
| | - Julius Dengler
- 1Department of Neurosurgery, Charité-Universitaetsmedizin Berlin
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Maldaner N, Steinsiepe VK, Goldberg J, Fung C, Bervini D, May A, Bijlenga P, Schaller K, Roethlisberger M, Zumofen DW, D'Alonzo D, Marbacher S, Fandino J, Maduri R, Daniel RT, Burkhardt JK, Chiappini A, Robert T, Schatlo B, Seule MA, Weyerbrock A, Regli L, Stienen MN. Patterns of care for ruptured aneurysms of the middle cerebral artery: analysis of a Swiss national database (Swiss SOS). J Neurosurg 2019; 133:1811-1820. [PMID: 31731273 DOI: 10.3171/2019.9.jns192055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to determine patterns of care and outcomes in ruptured intracranial aneurysms (IAs) of the middle cerebral artery (MCA) in a contemporary national cohort. METHODS The authors conducted a retrospective analysis of prospective data from a nationwide multicenter registry of all aneurysmal subarachnoid hemorrhage (aSAH) cases admitted to a tertiary care neurosurgical department in Switzerland in the years 2009-2015 (Swiss Study on Aneurysmal Subarachnoid Hemorrhage [Swiss SOS]). Patterns of care and outcomes at discharge and the 1-year follow-up in MCA aneurysm (MCAA) patients were analyzed and compared with those in a control group of patients with IAs in locations other than the MCA (non-MCAA patients). Independent predictors of a favorable outcome (modified Rankin Scale score ≤ 3) were identified, and their effect size was determined. RESULTS Among 1866 consecutive aSAH patients, 413 (22.1%) harbored an MCAA. These MCAA patients presented with higher World Federation of Neurosurgical Societies grades (p = 0.007), showed a higher rate of concomitant intracerebral hemorrhage (ICH; 41.9% vs 16.7%, p < 0.001), and experienced delayed cerebral ischemia (DCI) more frequently (38.9% vs 29.4%, p = 0.001) than non-MCAA patients. After adjustment for confounders, patients with MCAA were as likely as non-MCAA patients to experience DCI (aOR 1.04, 95% CI 0.74-1.45, p = 0.830). Surgical treatment was the dominant treatment modality in MCAA patients and at a significantly higher rate than in non-MCAA patients (81.7% vs 36.7%, p < 0.001). An MCAA location was a strong independent predictor of surgical treatment (aOR 8.49, 95% CI 5.89-12.25, p < 0.001), despite statistical adjustment for variables traditionally associated with surgical treatment, such as (space-occupying) ICH (aOR 1.73, 95% CI 1.23-2.45, p = 0.002). Even though MCAA patients were less likely to die during the acute hospitalization (aOR 0.52, 0.30-0.91, p = 0.022), their rate of a favorable outcome was lower at discharge than that in non-MCAA patients (55.7% vs 63.7%, p = 0.003). At the 1-year follow-up, 68.5% and 69.6% of MCAA and non-MCAA patients, respectively, had a favorable outcome (p = 0.676). CONCLUSIONS Microsurgical occlusion remains the predominant treatment choice for about 80% of ruptured MCAAs in a European industrialized country. Although patients with MCAAs presented with worse admission grades and greater rates of concomitant ICH, in-hospital mortality was lower and long-term disability was comparable to those in patients with non-MCAA.
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Affiliation(s)
| | | | | | - Christian Fung
- 2Department of Neurosurgery, University Hospital Bern
- 13Department of Neurosurgery, University Hospital Freiburg, University of Freiburg, Germany
| | - David Bervini
- 2Department of Neurosurgery, University Hospital Bern
| | - Adrien May
- 3Department of Neurosurgery, University Clinic Geneva
| | | | - Karl Schaller
- 3Department of Neurosurgery, University Clinic Geneva
| | | | | | - Donato D'Alonzo
- 5Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel
- 6Department of Neurosurgery, Kantonsspital Aarau
| | - Serge Marbacher
- 5Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel
- 6Department of Neurosurgery, Kantonsspital Aarau
| | - Javier Fandino
- 5Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel
- 6Department of Neurosurgery, Kantonsspital Aarau
| | - Rodolfo Maduri
- 7Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Roy Thomas Daniel
- 7Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Alessio Chiappini
- 8Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Thomas Robert
- 9Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland
| | - Bawarjan Schatlo
- 10Department of Neurosurgery, University Hospital Göttingen, Germany
| | | | | | - Luca Regli
- 11Department of Neurosurgery, University Hospital Zurich
- 12Clinical Neuroscience Center, University of Zurich, Switzerland; and
| | - Martin Nikolaus Stienen
- 11Department of Neurosurgery, University Hospital Zurich
- 12Clinical Neuroscience Center, University of Zurich, Switzerland; and
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Staartjes VE, Serra C, Muscas G, Maldaner N, Akeret K, van Niftrik CHB, Fierstra J, Holzmann D, Regli L. Utility of deep neural networks in predicting gross-total resection after transsphenoidal surgery for pituitary adenoma: a pilot study. Neurosurg Focus 2019; 45:E12. [PMID: 30453454 DOI: 10.3171/2018.8.focus18243] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 05/19/2018] [Accepted: 08/20/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVEGross-total resection (GTR) is often the primary surgical goal in transsphenoidal surgery for pituitary adenoma. Existing classifications are effective at predicting GTR but are often hampered by limited discriminatory ability in moderate cases and by poor interrater agreement. Deep learning, a subset of machine learning, has recently established itself as highly effective in forecasting medical outcomes. In this pilot study, the authors aimed to evaluate the utility of using deep learning to predict GTR after transsphenoidal surgery for pituitary adenoma.METHODSData from a prospective registry were used. The authors trained a deep neural network to predict GTR from 16 preoperatively available radiological and procedural variables. Class imbalance adjustment, cross-validation, and random dropout were applied to prevent overfitting and ensure robustness of the predictive model. The authors subsequently compared the deep learning model to a conventional logistic regression model and to the Knosp classification as a gold standard.RESULTSOverall, 140 patients who underwent endoscopic transsphenoidal surgery were included. GTR was achieved in 95 patients (68%), with a mean extent of resection of 96.8% ± 10.6%. Intraoperative high-field MRI was used in 116 (83%) procedures. The deep learning model achieved excellent area under the curve (AUC; 0.96), accuracy (91%), sensitivity (94%), and specificity (89%). This represents an improvement in comparison with the Knosp classification (AUC: 0.87, accuracy: 81%, sensitivity: 92%, specificity: 70%) and a statistically significant improvement in comparison with logistic regression (AUC: 0.86, accuracy: 82%, sensitivity: 81%, specificity: 83%) (all p < 0.001).CONCLUSIONSIn this pilot study, the authors demonstrated the utility of applying deep learning to preoperatively predict the likelihood of GTR with excellent performance. Further training and validation in a prospective multicentric cohort will enable the development of an easy-to-use interface for use in clinical practice.
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Affiliation(s)
- Victor E Staartjes
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Carlo Serra
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Giovanni Muscas
- 2Department of Neurosurgery, Tuscany School of Neurosurgery, University of Firenze, Italy; and
| | - Nicolai Maldaner
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Kevin Akeret
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Christiaan H B van Niftrik
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Jorn Fierstra
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - David Holzmann
- 3Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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31
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Stienen MN, Gautschi OP, Staartjes VE, Maldaner N, Sosnova M, Ho AL, Veeravagu A, Desai A, Zygourakis CC, Park J, Regli L, Ratliff JK. Reliability of the 6-minute walking test smartphone application. J Neurosurg Spine 2019; 31:786-793. [PMID: 31518975 DOI: 10.3171/2019.6.spine19559] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 05/08/2019] [Accepted: 06/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Objective functional measures such as the 6-minute walking test (6WT) are increasingly applied to evaluate patients with degenerative diseases of the lumbar spine before and after (surgical) treatment. However, the traditional 6WT is cumbersome to apply, as it requires specialized in-hospital infrastructure and personnel. The authors set out to compare 6-minute walking distance (6WD) measurements obtained with a newly developed smartphone application (app) and those obtained with the gold-standard distance wheel (DW). METHODS The authors developed a free iOS- and Android-based smartphone app that allows patients to measure the 6WD in their home environment using global positioning system (GPS) coordinates. In a laboratory setting, the authors obtained 6WD measurements over a range of smartphone models, testing environments, and walking patterns and speeds. The main outcome was the relative measurement error (rME; in percent of 6WD), with |rME| < 7.5% defined as reliable. The intraclass correlation coefficient (ICC) for agreement between app- and DW-based 6WD was calculated. RESULTS Measurements (n = 406) were reliable with all smartphone types in neighborhood, nature, and city environments (without high buildings), as well as with unspecified, straight, continuous, and stop-and-go walking patterns (ICC = 0.97, 95% CI 0.97-0.98, p < 0.001). Measurements were unreliable indoors, in city areas with high buildings, and for predominantly rectangular walking courses. Walking speed had an influence on the ME, with worse accuracy (2% higher rME) for every kilometer per hour slower walking pace (95% CI 1.4%-2.5%, p < 0.001). Mathematical adjustment of the app-based 6WD for velocity-dependent error mitigated the rME (p < 0.011), attenuated velocity dependence (p = 0.362), and had a positive effect on accuracy (ICC = 0.98, 95% CI 0.98-0.99, p < 0.001). CONCLUSIONS The new, free, spine-specific 6WT smartphone app measures the 6WD conveniently by using GPS coordinates, empowering patients to independently determine their functional status before and after (surgical) treatment. Measurements of 6WD obtained for the target population under the recommended circumstances are highly reliable.
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Affiliation(s)
- Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Oliver P Gautschi
- 3Neurological and Spinal Surgery Centre, Hirslanden Klinik St. Anna, Lucerne; and
| | - Victor E Staartjes
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Nicolai Maldaner
- 4Department of Neurosurgery, Kantonsspital St. Gallen, Switzerland
| | - Marketa Sosnova
- 4Department of Neurosurgery, Kantonsspital St. Gallen, Switzerland
| | - Allen L Ho
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Anand Veeravagu
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Atman Desai
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Corinna C Zygourakis
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Jon Park
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - John K Ratliff
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
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32
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Haemmerli J, Lenga P, Hong B, Kursumovic A, Maldaner N, Burkhardt JK, Bijlenga P, Rüfenacht DA, Schmidt NO, Vajkoczy P, Dengler J. Clinical implications and radiographic characteristics of the relation between giant intracranial aneurysms of the posterior circulation and the brainstem. Acta Neurochir (Wien) 2019; 161:1747-1753. [PMID: 31359190 DOI: 10.1007/s00701-019-04016-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/27/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Giant intracranial aneurysms of the posterior circulation (GPCirA) are rare entities compressing the brainstem and adjacent structures. Previous evidence has shown that the amount of brainstem shift away from the cranial base is not associated with neurological deficits. This raises the question whether other factors may be associated with neurological deficits. METHODS All data were extracted from the Giant Intracranial Aneurysm Registry, an international multicenter prospective study on giant intracranial aneurysms. We grouped GPCirA according to the mass effect on the brainstem (lateral versus medial). Brainstem compression was evaluated with two indices: (a) brainstem compression ratio (BCR) or diameter of the compressed brainstem to the assumed normal diameter of the brainstem and (b) aneurysm to brainstem ratio (ABR) or diameter of the aneurysm to the diameter of the compressed brainstem. We examined associations between neurological deficits and GPCirA characteristics using binary regression analysis. RESULTS Twenty-eight GPCirA were included. Twenty GPCirA showed medial (71.4%) and 8 lateral compression of the brainstem (28.6%). Baseline characteristics did not differ between the groups for patient age, aneurysm diameter, aneurysm volume, modified Rankin Scale (mRS), motor deficit (MD), or cranial nerve deficits (CND). Mean BCR was 53.0 in the medial and 54.0 in the lateral group (p = 0.92). The mean ABR was 2.9 in the medial and 2.3 in the lateral group (p = 0.96). In the entire cohort, neither BCR nor ABR nor GPCirA volumes were associated with the occurrence of CND or MD. In contrast, disability (mRS) was significantly associated with ABR (OR 1.94 (95% CI 1.01-3.70; p = 0.045) and GPCirA volumes (OR 1.21 (95% CI 1.01-1.44); p = 0.035), but not with BCR. CONCLUSION In this cohort of patients with GPCirA, neither the degree of lateral projection nor the amount of brainstem compression predicted neurological deficits. Disability was associated only with aneurysm volume. When designing treatment strategies for GPCirA, aneurysm laterality or the amount of brainstem compression should be viewed as less relevant while the high risk of rupture of such giant lesions should be emphasized. TRIAL REGISTRATION The registry is listed at clinicaltrials.gov under the registration no. NCT02066493.
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Affiliation(s)
- Julien Haemmerli
- Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
- Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland.
| | - Pavlina Lenga
- Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Hanover, Germany
| | - Adisa Kursumovic
- Department of Neurosurgery and Interventional Neuroradiology, Donauisar Klinikum Deggendorf, Deggendorf, Germany
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland
| | | | - Nils-Ole Schmidt
- Department of Neurosurgery, University Medical Center, Eppendorf, Hamburg, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Julius Dengler
- Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
- Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany
- Department of Neurosurgery, Helios Clinic, Bad Saarow, Germany
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Stienen MN, Geisseler O, Velz J, Maldaner N, Sebök M, Dannecker N, Rothacher Y, Schlosser L, Smoll NR, Keller E, Brugger P, Regli L. Influence of the Intensive Care Unit Environment on the Reliability of the Montreal Cognitive Assessment. Front Neurol 2019; 10:734. [PMID: 31333576 PMCID: PMC6617738 DOI: 10.3389/fneur.2019.00734] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/21/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Neuropsychological screening becomes increasingly important for the evaluation of subarachnoid hemorrhage (SAH) and stroke patients. It is often performed during the surveillance period on the intensive (ICU), while it remains unknown, whether the distraction in this environment influences the results. We aimed to study the reliability of the Montreal Cognitive Assessment (MoCA) in the ICU environment. Methods: Consecutive stable patients with recent brain injury (tumor, trauma, stroke, etc.) were evaluated twice within 36 h using official parallel versions of the MoCA (ΔMoCA). The sequence of assessment was randomized into (a) busy ICU first or (b) quiet office first with subsequent crossover. For repeated MoCA, we determined sequence, period, location effects, and the intraclass correlation coefficient (ICC). Results: N = 50 patients were studied [n = 30 (60%) male], with a mean age of 57 years. The assessment's sequence ["ICU first" mean ΔMoCA -1.14 (SD 2.34) vs. "Office first" -0.73 (SD 1.52)] did not influence the MoCA (p = 0.47). On the 2nd period, participants scored 0.96 points worse (SD 2.01; p = 0.001), indicating no MoCA learning effect but a possible difference in parallel versions. There was no location effect (p = 0.31) with ΔMoCA between locations (Office minus ICU) of -0.32 (SD 2.21). The ICC for repeated MoCA was 0.87 (95% CI 0.79-0.92). Conclusions: The reliability of the MoCA was excellent, independent from the testing environment being ICU or office. This finding is helpful for patient care and studies investigating the effect of a therapeutic intervention on the neuropsychological outcome after SAH, stroke or traumatic brain injury.
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Affiliation(s)
- Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivia Geisseler
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Velz
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Noemi Dannecker
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yannick Rothacher
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ladina Schlosser
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas Roydon Smoll
- School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Emanuela Keller
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Brugger
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Starnoni D, Maduri R, Al Taha K, Bervini D, Zumofen DW, Stienen MN, Schatlo B, Fung C, Robert T, Seule MA, Burkhardt JK, Maldaner N, Roethlisberger M, Blackham KA, Marbacher S, D'Alonzo D, Remonda L, Machi P, Gralla J, Bijlenga P, Saliou G, Ballabeni P, Levivier M, Messerer M, Daniel RT. Correction to: Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study. Acta Neurochir (Wien) 2019; 161:1335-1336. [PMID: 31102005 DOI: 10.1007/s00701-019-03949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Incorrect authorgroup and authorname.
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Affiliation(s)
- Daniele Starnoni
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Rodolfo Maduri
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Khalid Al Taha
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Walter Zumofen
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.,Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland.,Department ofNeurosurgery, Baylor Medical Center and College of Medicine, Houston, TX, USA
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | | | - Kristine A Blackham
- Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Donato D'Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Paolo Machi
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Jan Gralla
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Guillaume Saliou
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierluigi Ballabeni
- Lausanne Institute for Clinical Epidemiology and Biostatistics, University Hospital Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne (UniL), Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.,University of Lausanne (UniL), Lausanne, Switzerland
| | | | - Mahmoud Messerer
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.,University of Lausanne (UniL), Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.,University of Lausanne (UniL), Lausanne, Switzerland
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Maldaner N, Sosnova M, Sarnthein J, Bozinov O, Regli L, Stienen MN. Predicting Functional Impairment in patients with chronic subdural hematoma treated with burr hole Trepanation—The FIT-score. Clin Neurol Neurosurg 2019; 182:142-147. [DOI: 10.1016/j.clineuro.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
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36
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Starnoni D, Maduri R, Al Taha K, Bervini D, Zumofen DW, Stienen MN, Schatlo B, Fung C, Robert T, Seule MA, Burkhardt JK, Maldaner N, Rothlisberger M, Blackham KA, Marbacher S, D'Alonzo D, Remonda L, Machi P, Gralla J, Bijlenga P, Saliou G, Ballabeni P, Levivier M, Messerer M, Daniel RT. Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study. Acta Neurochir (Wien) 2019; 161:1325-1334. [PMID: 31025178 DOI: 10.1007/s00701-019-03894-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysms of the posterior inferior cerebellar artery (PICA) are relatively uncommon and evidence is sparse about patients presenting with ruptured PICA aneurysms. We performed an analysis of the Swiss SOS national registry to describe clinical presentation, treatment pattern, and neurological outcome of patients with ruptured PICA aneurysms compared with other ruptured posterior circulation (PC) aneurysms. METHODS This was a retrospective analysis of anonymized data from the Swiss SOS registry (Swiss Study on Aneurysmal Subarachnoid Hemorrhage; 2009-2014). Patients with ruptured PC aneurysms were subdivided into a PICA and non-PICA group. Clinical, radiological, and treatment-related variables were identified, and their impact on the neurological outcome was determined in terms of modified Rankin score at discharge and at 1 year of follow-up for the two groups. RESULTS Data from 1864 aneurysmal subarachnoid hemorrhage patients were reviewed. There were 264 patients with a ruptured PC aneurysm. Seventy-four PICA aneurysms represented 28% of the series; clinical and radiological characteristics at admission were comparable between the PICA and non-PICA group. Surgical treatment was accomplished in 28% of patients in the PICA group and in the 4.8% of patients in the non-PICA group. No statistically significant difference was found between the two groups in terms of complications after treatment. Hydrocephalus requiring definitive shunt was needed in 21.6% of PICA patients (p = 0.6); cranial nerve deficit was present in average a quarter of the patients in both PICA and non-PICA group with no statistical difference (p = 0.3). A more favorable outcome (66.2%) was reported in the PICA group at discharge (p < 0.05) but this difference faded over time with a similar neurological outcome at 1-year follow-up (p = 0.09) between both PICA and non-PICA group. The Kaplan-Meyer estimation showed no significant difference in the mortality rate between both groups (p = 0.08). CONCLUSIONS In the present study, patients with ruptured PICA aneurysms had a favorable neurological outcome in more than two thirds of cases, similar to patients with other ruptured PC aneurysms. Surgical treatment remains a valid option in a third of cases with ruptured PICA aneurysms.
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Affiliation(s)
- Daniele Starnoni
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Rodolfo Maduri
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Khalid Al Taha
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Walter Zumofen
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland
- Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Baylor Medical Center and College of Medicine, Houston, TX, USA
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | | | - Kristine A Blackham
- Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Donato D'Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Paolo Machi
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Jan Gralla
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Guillaume Saliou
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierluigi Ballabeni
- Lausanne Institute for Clinical Epidemiology and Biostatistics, University Hospital Lausanne (CHUV), Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
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Staartjes VE, Zattra CM, Akeret K, Maldaner N, Muscas G, Bas van Niftrik CH, Fierstra J, Regli L, Serra C. Neural network-based identification of patients at high risk for intraoperative cerebrospinal fluid leaks in endoscopic pituitary surgery. J Neurosurg 2019; 133:329-335. [PMID: 31226693 DOI: 10.3171/2019.4.jns19477] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 02/19/2019] [Accepted: 04/08/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Although rates of postoperative morbidity and mortality have become relatively low in patients undergoing transnasal transsphenoidal surgery (TSS) for pituitary adenoma, cerebrospinal fluid (CSF) fistulas remain a major driver of postoperative morbidity. Persistent CSF fistulas harbor the potential for headache and meningitis. The aim of this study was to investigate whether neural network-based models can reliably identify patients at high risk for intraoperative CSF leakage. METHODS From a prospective registry, patients who underwent endoscopic TSS for pituitary adenoma were identified. Risk factors for intraoperative CSF leaks were identified using conventional statistical methods. Subsequently, the authors built a prediction model for intraoperative CSF leaks based on deep learning. RESULTS Intraoperative CSF leaks occurred in 45 (29%) of 154 patients. No risk factors for CSF leaks were identified using conventional statistical methods. The deep neural network-based prediction model classified 88% of patients in the test set correctly, with an area under the curve of 0.84. Sensitivity (83%) and specificity (89%) were high. The positive predictive value was 71%, negative predictive value was 94%, and F1 score was 0.77. High suprasellar Hardy grade, prior surgery, and older age contributed most to the predictions. CONCLUSIONS The authors trained and internally validated a robust deep neural network-based prediction model that identifies patients at high risk for intraoperative CSF. Machine learning algorithms may predict outcomes and adverse events that were previously nearly unpredictable, thus enabling safer and improved patient care and better patient counseling.
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Affiliation(s)
- Victor E Staartjes
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- 2Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; and
| | - Costanza M Zattra
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kevin Akeret
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giovanni Muscas
- 3Department of Neurosurgery, Tuscany School of Neurosurgery, University of Firenze, Firenze, Italy
| | | | - Jorn Fierstra
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carlo Serra
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Serra C, Staartjes VE, Maldaner N, Muscas G, Akeret K, Holzmann D, Soyka MB, Schmid C, Regli L. Response to "Going beyond scoring systems for cavernous sinus involvement in trans-sphenoidal pituitary surgery". Acta Neurochir (Wien) 2019; 161:1035-1036. [PMID: 30953155 DOI: 10.1007/s00701-019-03891-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse10, 8091, Zurich, Switzerland.
| | - Victor E Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse10, 8091, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse10, 8091, Zurich, Switzerland
| | - Giovanni Muscas
- Department of Neurosurgery, Tuscany School of Neurosurgery, University of Firenze, Florence, Italy
| | - Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse10, 8091, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Schmid
- Department of Endocrinology and Diabetes, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse10, 8091, Zurich, Switzerland
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Stienen MN, Maldaner N, Joswig H, Corniola MV, Bellut D, Prömmel P, Regli L, Weyerbrock A, Schaller K, Gautschi OP. Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis. Neurosurg Focus 2019; 46:E4. [DOI: 10.3171/2019.2.focus18618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPatient-reported outcome measures (PROMs) are standard of care for the assessment of functional impairment. Subjective outcome measures are increasingly complemented by objective ones, such as the “Timed Up and Go” (TUG) test. Currently, only a few studies report pre- and postoperative TUG test assessments in patients with lumbar spinal stenosis (LSS).METHODSA prospective two-center database was reviewed to identify patients with LSS who underwent lumbar decompression with or without fusion. The subjective functional status was estimated using PROMs for pain (visual analog scale [VAS]), disability (Roland-Morris Disability Index [RMDI] and Oswestry Disability Index [ODI]), and health-related quality of life (HRQoL; 12-Item Short-Form Physical Component Summary [SF-12 PCS] and the EQ-5D) preoperatively, as well as on postoperative day 3 (D3) and week 6 (W6). Objective functional impairment (OFI) was measured using age- and sex-standardized TUG test results.RESULTSSixty-four patients (n = 32 [50%] male, mean age 66.8 ± 11.7 years) were included. Preoperatively, they reported a mean VAS back pain score of 4.1 ± 2.7, VAS leg pain score of 5.4 ± 2.7, RMDI of 10.4 ± 5.3, ODI of 41.9 ± 16.2, SF-12 PCS score of 32.7 ± 8.3, and an EQ-5D index of 0.517 ± 0.226. The preoperative rates of severe, moderate, and mild OFI were 4.7% (n = 3), 12.5% (n = 8), and 7.8% (n = 5), respectively, and the mean OFI T-score was 116.3 ± 23.7. At W6, 60 (93.8%) of 64 patients had a TUG test result within the normal population range (no OFI); 3 patients (4.7%) had mild and 1 patient (1.6%) severe OFI. The mean W6 OFI T-score was significantly decreased (103.1 ± 13.6; p < 0.001). Correspondingly, the PROMs showed a decrease in subjective VAS back pain (1.6 ± 1.7, p < 0.001) and leg pain (1.0 ± 1.8, p < 0.001) scores, disability (RMDI 5.3 ± 4.7, p < 0.001; ODI 21.3 ± 16.1, p < 0.001), and increase in HRQoL (SF-12 PCS 40.1 ± 8.3, p < 0.001; EQ-5D 0.737 ± 0.192, p < 0.001) at W6. The W6 responder status (clinically meaningful improvement) ranged between 81.3% (VAS leg pain) and 29.7% (EQ-5D index) of patients.CONCLUSIONSThe TUG test is a quick and easily applicable tool that reliably measures OFI in patients with LSS. Objective tests incorporating longer walking time should be considered if OFI is suspected but fails to be proven by the TUG test, taking into account that neurogenic claudication may not clinically manifest during the brief TUG examination. Objective tests do not replace the subjective PROM-based assessment, but add valuable information to a comprehensive patient evaluation.
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Affiliation(s)
- Martin N. Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | | | - Holger Joswig
- 3Department of Clinical Neuroscience, Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, Geneva; and
| | - Marco V. Corniola
- 3Department of Clinical Neuroscience, Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, Geneva; and
| | - David Bellut
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | - Peter Prömmel
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | | | - Karl Schaller
- 3Department of Clinical Neuroscience, Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, Geneva; and
| | - Oliver P. Gautschi
- 3Department of Clinical Neuroscience, Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, Geneva; and
- 4Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
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Maduri R, Starnoni D, Rocca A, Bervini D, Zumofen DW, Stienen MN, Schatlo B, Fung C, Robert T, Seule MA, Burkhardt JK, Maldaner N, Rothlisberger M, Blackham KA, Marbacher S, D'Alonzo D, Remonda L, Machi P, Gralla J, Bijlenga P, Saliou G, Ballabeni P, Levivier M, Messerer M, Daniel RT. Correction to: Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry. Acta Neurochir (Wien) 2019; 161:781. [PMID: 30796586 DOI: 10.1007/s00701-019-03837-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The name of Roy Thomas Daniel was incorrectly captured in the original manuscript.
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Affiliation(s)
- Rodolfo Maduri
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Daniele Starnoni
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Alda Rocca
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Walter Zumofen
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.,Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital of Zurich & Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital of Zurich & Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Baylor Medical Center & College of Medicine, Houston, TX, USA
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital of Zurich & Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | | | - Kristine A Blackham
- Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Donato D'Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Paolo Machi
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Jan Gralla
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Guillaume Saliou
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierluigi Ballabeni
- Lausanne Institute for Clinical Epidemiology and Biostatistics, University Hospital Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne (UniL), Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.,University of Lausanne (UniL), Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.,University of Lausanne (UniL), Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.,University of Lausanne (UniL), Lausanne, Switzerland
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Maduri R, Starnoni D, Rocca A, Bervini D, Zumofen DW, Stienen MN, Schatlo B, Fung C, Robert T, Seule MA, Burkhardt JK, Maldaner N, Rothlisberger M, Blackham KA, Marbacher S, D’Alonzo D, Remonda L, Machi P, Gralla J, Bijlenga P, Saliou G, Ballabeni P, Levivier M, Messerer M, Daniel RT. Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry. Acta Neurochir (Wien) 2019; 161:769-779. [PMID: 30680461 DOI: 10.1007/s00701-019-03812-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/12/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques. OBJECTIVE To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes. METHODS This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined. RESULTS From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year. CONCLUSIONS In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.
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Staartjes VE, Stricker S, Muscas G, Maldaner N, Holzmann D, Burkhardt JK, Seifert B, Schmid C, Serra C, Regli L. Intraoperative unfolding and postoperative pruning of the pituitary gland after transsphenoidal surgery for pituitary adenoma: A volumetric and endocrinological evaluation. Endocrine 2019; 63:231-239. [PMID: 30242602 DOI: 10.1007/s12020-018-1758-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe the volumetric changes that the pituitary gland (PG) undergoes during and after transsphenoidal surgery (TSS), and to evaluate if unfolding and/or pruning are related to endocrinological outcome measures. METHODS Retrospective evaluation of data prospectively collected of a cohort of patients undergoing TSS for a pituitary adenoma with the adjunctive use of high field 3 Tesla intraoperative MRI. All patients underwent a full endocrinological workup preoperatively, as well as at 6 weeks and 1 year postoperatively. A decrease in PG volume ≥15% between the intraoperative and 3-month, or between the 3-month and 12-month measurements, was considered early and late pruning, respectively. RESULTS The PG unfolds significantly during TSS, and subsequently undergoes pruning up until 1 year postoperatively, in most cases returning to the preoperatively measured PG volume. A smaller baseline PG volume predicts intraoperative unfolding. Early pruning of the PG after surgery was associated with new functional deficits. Baseline pituitary compression also correlated to newly occurring deficits after surgery. A larger 1-year pituitary volume was associated with biochemical remission in secreting adenomas. CONCLUSIONS The PG shows dynamic change during and after TSS for pituitary adenoma. Small baseline and 3-month PG volumes, as well as early pruning were independently associated with new deficits. Our findings warrant prospective validation in a larger cohort with higher statistical power.
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Affiliation(s)
- Victor E Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sarah Stricker
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Giovanni Muscas
- Department of Neurosurgery, Tuscany School of Neurosurgery, University of Firenze, Firenze, Italy
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christoph Schmid
- Department of Endocrinology and Diabetes, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Akeret K, Serra C, Rafi O, Staartjes VE, Fierstra J, Bellut D, Maldaner N, Imbach LL, Wolpert F, Poryazova R, Regli L, Krayenbühl N. Anatomical features of primary brain tumors affect seizure risk and semiology. Neuroimage Clin 2019; 22:101688. [PMID: 30710869 PMCID: PMC6354289 DOI: 10.1016/j.nicl.2019.101688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 11/23/2022]
Abstract
Objective An epileptic seizure is the most common clinical manifestation of a primary brain tumor. Due to modern neuroimaging, detailed anatomical information on a brain tumor is available early in the diagnostic process and therefore carries considerable potential in clinical decision making. The goal of this study was to gain a better understanding of the relevance of anatomical tumor characteristics on seizure prevalence and semiology. Methods We reviewed prospectively collected clinical and imaging data of all patients operated on a supratentorial intraparenchymal primary brain tumor at our department between January 2009 and December 2016. The effect of tumor histology, anatomical location and white matter infiltration on seizure prevalence and semiology were assessed using uni- and multivariate analyses. Results Of 678 included patients, 311 (45.9%) presented with epileptic seizures. Tumor location within the central lobe was associated with higher seizure prevalence (OR 4.67, 95% CI: 1.90–13.3, p = .002), especially within the precentral gyrus or paracentral lobule (100%). Bilateral extension, location within subcortical structures and invasion of deeper white matter sectors were associated with a lower risk (OR 0.45, 95% CI: 0.25–0.78; OR 0.10, 95% CI: 0.04–0.21 and OR 0.39, 95% CI: 0.14–0.96, respectively). Multivariate analysis revealed the impact of a location within the central lobe on seizure risk to be highly significant and more relevant than histopathology (OR: 4.79, 95% CI: 1.82–14.52, p = .003). Seizures due to tumors within the central lobe differed from those of other locations by lower risk of secondary generalization (p < .001). Conclusions Topographical lobar and gyral location, as well as extent of white matter infiltration impact seizure risk and semiology. This finding may have a high therapeutic potential, for example regarding the use of prophylactic antiepileptic therapy. Brain tumor location affects seizure prevalence and semiology. Central lobe location is the strongest independent pro-epileptogenic factor. The precentral gyrus and paracentral lobule are most epileptogenic. Central lobe tumors rarely cause bilateral tonic-clonic seizures. Tumor location and white matter infiltration may guide antiepileptic therapy.
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Affiliation(s)
- Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Omar Rafi
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Victor E Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Bellut
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Wolpert
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rositsa Poryazova
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Division of Pediatric Neurosurgery, University Children's Hospital, Zurich, Switzerland
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Stienen MN, Smoll NR, Fung C, Goldberg J, Bervini D, Maduri R, Chiappini A, Robert T, May A, Bijlenga P, Zumofen D, Roethlisberger M, Seule MA, Marbacher S, Fandino J, Schatlo B, Schaller K, Keller E, Bozinov O, Regli L, Burkhardt JK, Neidert MC, Maldaner N, Finkenstädt S, Schöni D, Raabe A, Beck J, Mariani L, Guzman R, D’Alonzo D, Daniel RT, Reinert M, Ferrari A, Hildebrandt G, Weyerbrock A, Corniola M. Home-Time as a Surrogate Marker for Functional Outcome After Aneurysmal Subarachnoid Hemorrhage. Stroke 2018; 49:3081-3084. [DOI: 10.1161/strokeaha.118.022808] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin Nikolaus Stienen
- From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)
| | - Nicolas Roydon Smoll
- School of Population and Global Health, University of Melbourne, Australia (N.R.S.)
| | - Christian Fung
- Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., J.G., D.B.)
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., J.G., D.B.)
| | - David Bervini
- Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., J.G., D.B.)
| | - Rodolfo Maduri
- Department of Neurosurgery, University Hospital Lausanne, Switzerland (R.M.)
| | - Alessio Chiappini
- Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland (A.C., T.R.)
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland (A.C., T.R.)
| | - Adrien May
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland (A.M., P.B., K.S.)
| | - Philippe Bijlenga
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland (A.M., P.B., K.S.)
| | - Daniel Zumofen
- Department of Neurosurgery, University Hospital Basel, University of Basel, Switzerland (D.Z., M.R.)
- Section of Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, University of Basel, Switzerland (D.Z.)
| | - Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel, University of Basel, Switzerland (D.Z., M.R.)
| | | | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Switzerland (S.M., J.F.)
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Switzerland (S.M., J.F.)
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Germany (B.S.)
| | - Karl Schaller
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland (A.M., P.B., K.S.)
| | - Emanuela Keller
- From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)
| | - Oliver Bozinov
- From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)
| | - Luca Regli
- From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)
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45
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Serra C, Akeret K, Maldaner N, Staartjes VE, Regli L, Baltsavias G, Krayenbühl N. A White Matter Fiber Microdissection Study of the Anterior Perforated Substance and the Basal Forebrain: A Gateway to the Basal Ganglia? Oper Neurosurg (Hagerstown) 2018; 17:311-320. [DOI: 10.1093/ons/opy345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/02/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Studies detailing the anatomy of the basal forebrain (BF) from a neurosurgical perspective are missing.
OBJECTIVE
To describe the anatomy of the BF and of the anterior perforated substance (APS), the BF emphasizing surgical useful anatomical relationship between surface landmarks and deep structures.
METHODS
White matter fiber microdissection was performed on 5 brain specimens to analyze the topographic anatomy of the APS and expose layer-by-layer fiber tracts and nuclei of the BF.
RESULTS
The APS, as identified anatomically, surgically, and neuroradiologically, has clear borders measured 23.3 ± 3.4 mm (19-27) in the mediolateral and 12.5 ± 1.2 mm (11-14) in the anteroposterior directions. A detailed stratigraphy of the BF was performed from the APS up to basal ganglia and thalamus allowing identification and dissection of the main components of the BF (septum, nucleus accumbens, amygdala, innominate substance) and its white matter tracts (band of Broca, extracapsular thalamic peduncle, ventral amygdalohypothalamic fibers). The olfactory trigone together with diagonal gyrus and the APS proper is a relevant superficial landmark for the basal ganglia (inferior to the nucleus accumbens, lateral to the caudate head, and medial to the lentiform nucleus).
CONCLUSION
The findings in our study supplement available anatomic knowledge of APS and BF, providing reliable landmarks for precise topographic diagnosis of BF lesions and for intraoperative orientation. Surgically relevant relationships between surface and deep anatomic structures are highlighted offering thus a contribution to neurosurgeons willing to perform surgery in this delicate area.
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Affiliation(s)
- Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Victor E Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gerasimos Baltsavias
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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46
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Serra C, Staartjes VE, Maldaner N, Muscas G, Akeret K, Holzmann D, Soyka MB, Schmid C, Regli L. Predicting extent of resection in transsphenoidal surgery for pituitary adenoma. Acta Neurochir (Wien) 2018; 160:2255-2262. [PMID: 30267209 DOI: 10.1007/s00701-018-3690-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/21/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The extent of resection (EOR) is a crucial outcome parameter in transsphenoidal pituitary surgery (TSS), and is linked to endocrinological outcome, postoperative morbidity, and mortality. We aimed to build a robust, quantitative, and easily reproducible imaging score able to predict EOR in TSS. METHODS The ratio (R) between the maximum horizontal adenoma diameter and intercarotid distance at the horizontal C4 segment was used to stratify our patient series in four classes: class I R ≤ 0.75, class II 0.75 < R ≤ 1.25, and class III R ≥ 1.25. Class IV included adenomas which completely encased the internal carotid artery. The resulting score was internally validated for robustness. RESULTS One hundred sixteen patients were included in the study, of which 96 (83%) for derivation and 20 (17%) for validation. EOR showed significant differences between grades (grade I, 100%; II, 97.9%; III, 94.2%; IV, 87.2%; all P < 0.05). The same applied to residual volume (RV) (grade I, 0 cm3; II, 0.08 cm3; III, 1.11 cm3; IV, 1.63 cm3; all P < 0.05). Differences in gross total resection (GTR) were statistically significant among classes I, II, and III (P < 0.05). The incidence of residual adenoma in the cavernous sinus increased also constantly from grade I up to grade IV although a significant difference was only found between grades III and II (P = 0.004). The score performed equally well in the validation cohort. Inter-observer agreement was high, with intraclass correlation coefficients > 0.89 for measurement of both the horizontal tumor diameter and the ICD among two independent raters (P < 0.001). CONCLUSIONS The proposed score is a simple and reproducible tool which reliably predicts surgical outcome including EOR, RV, and GTR of pituitary adenoma patients undergoing TSS.
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Affiliation(s)
- Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Victor E Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Giovanni Muscas
- Department of Neurosurgery, Tuscany School of Neurosurgery, University of Firenze, Florence, Italy
| | - Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Schmid
- Department of Endocrinology and Diabetes, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
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47
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Roethlisberger M, Achermann R, Bawarjan S, Stienen MN, Fung C, D’Alonzo D, Maldaner N, Ferrari A, Corniola MV, Schöni D, Goldberg J, Valsecchi D, Robert T, Maduri R, Seule MA, Burkhardt JK, Marbacher S, Bijlenga P, Blackham KA, Bucher HC, Mariani L, Guzman R, Zumofen DW. Impact of Aneurysm Multiplicity on Treatment and Outcome After Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2018; 84:E334-E344. [DOI: 10.1093/neuros/nyy331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/21/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Rita Achermann
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Schatlo Bawarjan
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Donato D’Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Andrea Ferrari
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco V Corniola
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Rodolfo Maduri
- Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurological Surgery, NYU School of Medicine, NYU Langone Medical Center, New York, New York
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Kristine A Blackham
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
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Durner G, Piano M, Lenga P, Mielke D, Hohaus C, Guhl S, Maldaner N, Burkhardt JK, Pedro MT, Lehmberg J, Rufenacht D, Bijlenga P, Etminan N, Krauss JK, Boccardi E, Hänggi D, Vajkoczy P, Dengler J. Cranial nerve deficits in giant cavernous carotid aneurysms and their relation to aneurysm morphology and location. Acta Neurochir (Wien) 2018; 160:1653-1660. [PMID: 29948299 DOI: 10.1007/s00701-018-3580-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Giant cavernous carotid aneurysms (GCCAs) usually exert substantial mass effect on adjacent intracavernous cranial nerves. Since predictors of cranial nerve deficits (CNDs) in patients with GCCA are unknown, we designed a study to identify associations between CND and GCCA morphology and the location of mass effect. METHODS This study was based on data from the prospective clinical and imaging databases of the Giant Intracranial Aneurysm Registry. We used magnetic resonance imaging and digital subtraction angiography to examine GCCA volume, presence of partial thrombosis (PT), GCCA origins, and the location of mass effect. We also documented whether CND was present. RESULTS We included 36 GCCA in 34 patients, which had been entered into the registry by eight participating centers between January 2009 and March 2016. The prevalence of CND was 69.4%, with one CND in 41.7% and more than one in 27.5%. The prevalence of PT was 33.3%. The aneurysm origin was most frequently located at the anterior genu (52.8%). The prevalence of CND did not differ between aneurysm origins (p = 0.29). Intracavernous mass effect was lateral in 58.3%, mixed medial/lateral in 27.8%, and purely medial in 13.9%. CND occurred significantly more often in GCCA with lateral (81.0%) or mixed medial/lateral (70.0%) mass effect than in GCCA with medial mass effect (20.0%; p = 0.03). After adjusting our data for the effects of the location of mass effect, we found no association between the prevalence of CND and aneurysm volume (odds ratio (OR) 1.30 (0.98-1.71); p = 0.07), the occurrence of PT (OR 0.64 (0.07-5.73); p = 0.69), or patient age (OR 1.02 (95% CI 0.95-1.09); p = 0.59). CONCLUSIONS Distinguishing between medial versus lateral location of mass effect may be more helpful than measuring aneurysm volumes or examining aneurysm thrombosis in understanding why some patients with GCCA present with CND while others do not. CLINICAL TRIAL REGISTRATION NO NCT02066493 ( clinicaltrials.gov ).
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Maldaner N, Serra C, Tschopp O, Schmid C, Bozinov O, Regli L. [Modern Management of Pituitary Adenomas - Current State of Diagnosis, Treatment and Follow-Up]. Praxis (Bern 1994) 2018; 107:825-835. [PMID: 30043702 DOI: 10.1024/1661-8157/a003035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Modern Management of Pituitary Adenomas - Current State of Diagnosis, Treatment and Follow-Up Abstract. Pituitary adenomas (PA) are benign neoplasms originating from parenchymal cells of the anterior pituitary. Tumor mass effect can cause headaches, visual deficits by compression of the optic chiasm, and partial or complete hypopituitarism. Hormone secreting PA can cause several forms of specific syndromes such as Cushing's disease or acromegaly depending on the type of hormone. Endoscopic transsphenoidal resection is the preferred treatment option for most symptomatic or growing PA. Nowadays techniques like high definition intraoperative MRI can assist the surgeon in his goal of maximal safe resection. An exception are prolactinomas which can usually be treated medically with dopamine agonists. Therapy of PA is complex and should be managed in a high-volume center with an interdisciplinary team approach including neurosurgeons and endocrinologists.
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Affiliation(s)
- Nicolai Maldaner
- 1 Klinik für Neurochirurgie, Klinisches Neurozentrum, Universitätsspital Zürich
| | - Carlo Serra
- 1 Klinik für Neurochirurgie, Klinisches Neurozentrum, Universitätsspital Zürich
| | - Oliver Tschopp
- 2 Klinik für Endokrinologie, Diabetologie und klinische Ernährung, Universitätsspital Zürich
| | - Christoph Schmid
- 2 Klinik für Endokrinologie, Diabetologie und klinische Ernährung, Universitätsspital Zürich
| | - Oliver Bozinov
- 1 Klinik für Neurochirurgie, Klinisches Neurozentrum, Universitätsspital Zürich
| | - Luca Regli
- 1 Klinik für Neurochirurgie, Klinisches Neurozentrum, Universitätsspital Zürich
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50
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Roethlisberger M, Gut L, Zumofen DW, Fisch U, Boss O, Maldaner N, Croci DM, Taub E, Corti N, Burkhardt JK, Guzman R, Bozinov O, Mariani L. Cerebral venous thrombosis requiring invasive treatment for elevated intracranial pressure in women with combined hormonal contraceptive intake: risk factors, anatomical distribution, and clinical presentation. Neurosurg Focus 2018; 45:E12. [PMID: 29961388 DOI: 10.3171/2018.4.focus1891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Women taking combined hormonal contraceptives (CHCs) are generally considered to be at low risk for cerebral venous thrombosis (CVT). When it does occur, however, intensive care and neurosurgical management may, in rare cases, be needed for the control of elevated intracranial pressure (ICP). The use of nonsurgical strategies such as barbiturate coma and induced hypothermia has never been reported in this context. The objective of this study is to determine predictive factors for invasive or surgical ICP treatment and the potential complications of nonsurgical strategies in this population. METHODS The authors conducted a 2-center, retrospective chart review of 168 cases of CVT in women between 2000 and 2012. Eligible patients were classified as having had a mild or a severe clinical course, the latter category including all patients who underwent invasive or surgical ICP treatment and all who had an unfavorable outcome (modified Rankin Scale score ≥ 3 or Glasgow Outcome Scale score ≤ 3). The Mann-Whitney U-test was used for continuous parameters and Fisher's exact test for categorical parameters, and odds ratios were calculated with statistical significance set at p ≤ 0.05. RESULTS Of the 168 patients, 57 (age range 16-49 years) were determined to be eligible for the study. Six patients (10.5%) required invasive or surgical ICP treatment. Three patients (5.3%) developed refractory ICP > 30 mm Hg despite early surgical decompression; 2 of them (3.5%) were treated with barbiturate coma and induced hypothermia, with documented infectious, thromboembolic, and hemorrhagic complications. Coma on admission, thrombosis of the deep venous system with consecutive hydrocephalus, intraventricular hemorrhage, and hemorrhagic venous infarction were associated with a higher frequency of surgical intervention. Coma, quadriparesis on admission, and hydrocephalus were more commonly seen among women with unfavorable outcomes. Thrombosis of the transverse sinus was less common in patients with an unfavorable outcome, with similar distribution in patients needing invasive or surgical ICP treatment. CONCLUSIONS The need for invasive or surgical ICP treatment in women taking CHCs who have CVT is partly predictable on the basis of the clinical and radiological findings on admission. The use of nonsurgical treatments for refractory ICP, such as barbiturate coma and induced hypothermia, is associated with systemic infectious and hematological complications and may worsen morbidity in this patient population. The significance of these factors should be studied in larger multicenter cohorts.
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Affiliation(s)
| | | | - Daniel Walter Zumofen
- Departments of1Neurosurgery and
- 2Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel and University of Basel, Basel
| | | | | | | | | | | | | | - Jan-Karl Burkhardt
- 5Department of Neurological Surgery, NYU School of Medicine, NYU Langone Medical Center, New York, New York
- 6Neurosurgery, University Hospital Zürich and University of Zürich, Zürich, Switzerland; and
| | | | - Oliver Bozinov
- 6Neurosurgery, University Hospital Zürich and University of Zürich, Zürich, Switzerland; and
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