| 1. |
- Hernández-Durán, S., et al.
(författare)
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European women in neurosurgery: I – A chronology of trailblazers
- 2021
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Ingår i: Journal of Clinical Neuroscience. - : Elsevier BV. - 0967-5868. ; 86, s. 316-323
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Tidskriftsartikel (refereegranskat)abstract
- Neurosurgery as a distinct speciality has been around for 100 years. Some of the earliest women neurosurgeons were European, emerging from the 1920′s onwards. Here we detail the rise of women in neurosurgery across Europe with a decade by decade account of big events and firsts across the continent. The emerging themes are seen in stories of pioneers with enormous resilience, camaraderie, trailblazing and triumphing in a system with great obstacles and challenges. Our journey through this chronology brings us to the modern day, where most European countries have or have had a woman neurosurgeon and the future for women in neurosurgery in the continent is very bright. © 2021
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| 2. |
- Jaraj, Daniel, et al.
(författare)
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Estimated ventricle size using Evans index: reference values from a population-based sample.
- 2017
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 24:3, s. 468-474
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Evans index is an estimate of ventricular size used in the diagnosis of idiopathic normal-pressure hydrocephalus (iNPH). Values >0.3 are considered pathological and are required by guidelines for the diagnosis of iNPH. However, there are no previous epidemiological studies on Evans index, and normal values in adults are thus not precisely known. We examined a representative sample to obtain reference values and descriptive data on Evans index. Methods A population-based sample (n = 1235) of men and women aged ≥70 years was examined. The sample comprised people living in private households and residential care, systematically selected from the Swedish population register. Neuropsychiatric examinations, including head computed tomography, were performed between 1986 and 2000. Results Evans index ranged from 0.11 to 0.46. The mean value in the total sample was 0.28 (SD, 0.04) and 20.6% (n = 255) had values >0.3. Among men aged ≥80 years, the mean value of Evans index was 0.3 (SD, 0.03). Individuals with dementia had a mean value of Evans index of 0.31 (SD, 0.05) and those with radiological signs of iNPH had a mean value of 0.36 (SD, 0.04). Conclusions A substantial number of subjects had ventricular enlargement according to current criteria. Clinicians and researchers need to be aware of the range of values among older individuals.
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| 3. |
- Jaraj, Daniel, et al.
(författare)
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Mortality and risk of dementia in normal-pressure hydrocephalus: A population study.
- 2017
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Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 13:8, s. 850-857
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Tidskriftsartikel (refereegranskat)abstract
- Introduction We examined mortality, dementia, and progression of hydrocephalic symptoms among untreated individuals with idiopathic normal-pressure hydrocephalus (iNPH) in a population-based sample. Methods A total of 1235 persons were examined between 1986 and 2012. Shunted individuals were excluded. We examined 53 persons with hydrocephalic ventricular enlargement (probable iNPH: n = 24, asymptomatic or possible iNPH: n = 29). Comparisons were made with individuals without hydrocephalic ventricular enlargement. Results The 5-year mortality was 87.5% among those with probable iNPH. The hazard ratio (HR) for death was 3.8 (95% confidence interval [CI]: 2.5–6.0) for probable iNPH. Those with possible iNPH and asymptomatic hydrocephalic ventricular enlargement had increased risk of developing dementia, HR 2.8 (95% CI: 1.5–5.2). Only two individuals with hydrocephalic ventricular enlargement remained asymptomatic. Discussion In the present sample, persons with clinical and imaging signs of iNPH had excess mortality and an increased risk of dementia. The data also suggest that radiological signs of iNPH might be more important than previously supposed.
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| 4. |
- Jaraj, Daniel, et al.
(författare)
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Prevalence of idiopathic normal-pressure hydrocephalus
- 2014
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Ingår i: Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 0028-3878 .- 1526-632X. ; 82:16, s. 1449-1454
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:The aim of this study was to determine the prevalence of idiopathic normal-pressure hydrocephalus (iNPH) in elderly persons in a large population-based sample using radiologic and clinical examinations.Methods:We examined representative elderly populations aged 70 years and older that had undergone neuropsychiatric evaluations and CT of the brain between 1986 and 2000 (n = 1,238). Gait was evaluated by clinical examination and history of walking difficulty. Cognitive function was evaluated with the Mini-Mental State Examination and urinary incontinence by self-report. iNPH was diagnosed in concordance with the American-European iNPH guidelines. Exclusion criteria were history of meningitis, severe head trauma, and subarachnoid hemorrhage.Results:The prevalence of probable iNPH was 0.2% in those aged 70-79 years (n = 2) and 5.9% (n = 24) in those aged 80 years and older, with no difference between men and women. Only 2 of these persons had been treated for iNPH. Hydrocephalic ventricular enlargement, i.e., a CT image consistent with NPH, was found in 56 persons (4.5%). An Evans Index >0.3 was found in 256 (20.7%) and occluded sulci at the high convexity in 67 persons (5.4%). All of these findings were more common in the older age groups.Conclusions:Many elderly possess clinical and imaging features of iNPH, especially those older than 80 years. The number of persons with iNPH is probably much higher than the number of persons currently treated.
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| 5. |
- Jaraj, Daniel, et al.
(författare)
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Vascular factors in suspected normal pressure hydrocephalus. A population-based study
- 2016
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Ingår i: Neurology. - 0028-3878. ; 86:7, s. 592-599
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We examined clinical and imaging findings of suspected idiopathic normal pressure hydrocephalus (iNPH) in relation to vascular risk factors and white matter lesions (WMLs), using a nested case-control design in a representative, population-based sample. Methods: From a population-based sample, 1,235 persons aged 70 years or older were examined with CT of the brain between 1986 and 2000. We identified 55 persons with hydrocephalic ventricular enlargement, i.e., radiologic findings consistent with iNPH. Among these, 26 had clinical signs that fulfilled international guideline criteria for probable iNPH. These cases were labeled suspected iNPH. Each case was matched to 5 controls from the same sample, based on age, sex, and study cohort. Data on risk factors were obtained from clinical examinations and the Swedish Hospital Discharge Register. History of hypertension, diabetes mellitus (DM), smoking, overweight, history of coronary artery disease, stroke/TIA, and WMLs on CT were examined. Risk factors associated with iNPH with a p value <0.1 in χ2 tests were included in conditional logistic regression models. Results: In the regression analyses, suspected iNPH was related to moderate to severe WMLs (odds ratio [OR] 5.2; 95% confidence interval [CI]: 1.5–17.6), while hydrocephalic ventricular enlargement was related to hypertension (OR 2.7; 95% CI: 1.1–6.8), moderate to severe WMLs (OR 6.5; 95% CI: 2.1–20.3), and DM (OR 4.3; 95% CI: 1.1–16.3). Conclusions: Hypertension, WMLs, and DM were related to clinical and imaging features of iNPH, suggesting that vascular mechanisms are involved in the pathophysiology. These findings might have implications for understanding disease mechanisms in iNPH and possibly prevention.
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| 6. |
- Murphy, M., et al.
(författare)
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European women in neurosurgery: II – Historical characters and living legends
- 2021
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Ingår i: Journal of Clinical Neuroscience. - : Elsevier BV. - 0967-5868. ; 86, s. 324-331
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Tidskriftsartikel (refereegranskat)abstract
- A collaborative global working group of women neurosurgeons in multiple countries at different stages of their neurosurgical careers undertook the task of researching the history of European women in neurosurgery. While doing so, we happened upon many remarkable female neurosurgeons who overcame great adversity, made tremendous contributions to society and institutional neurosurgery, and displayed numerous talents beyond the operating room. In the first part of this paper, we recounted a chronology of female neurosurgeons in Europe, highlighting the most remarkable achievements of women in every decade, from the 1920’s to 2020. In this paper, we honor fascinating women in European neurosurgery, both historical characters and living legends. These women have overcome great adversity and have also excelled in a huge variety of pursuits. While some were themselves refugees, we also have uncovered noteworthy examples of women who immersed themselves in humanitarian missions and who tried to better the world through political action. There are stories of women beating the odds, taking on biased institutions and proving their worth, in spite of the prevailing system. Most inspirational, we have discovered through our comprehensive research on the history of women in European neurosurgery that the future is increasingly female. © 2021 Elsevier Ltd
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| 7. |
- Rabiei, Katrin, 1979, et al.
(författare)
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Diverse arachnoid cyst morphology indicates different pathophysiological origins
- 2014
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Ingår i: Fluids and Barriers of the CNS. - : Springer Science and Business Media LLC. - 2045-8118. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background There are few, limited, and to some extent contradictory, reports on the cellular and subcellular morphology of arachnoid cysts. In the literature cyst membranes are described as similar to, or as vastly different from, normal arachnoid membranes. Methods This paper reports electron microscopic analyses of symptomatic cysts from 24 patients (12 males and 12 females; age 10–79), that underwent fenestration surgery. Fourteen cysts were located in the middle cranial fossa (temporal), one in the interpeduncular cistern, five in the posterior fossa, and four were overlying the frontal cortex. Results Microscopic findings confirmed the diverse nature of this clinical condition. Twelve cyst walls resembled normal arachnoid, four had a conspicuous core of dense fibrous tissue with a simple epithelial lining, and the remaining aberrant cysts exhibited non-arachnoid luminal epithelia with plentiful microvilli and/or cilia, and also nervous tissue components in the wall. The possible identity and origin of various cyst types are discussed. We hypothesize that cysts are formed mostly at an early stage of embryonic development, as a teratological event. Conclusions Cysts with various epithelial linings and extracellular components most likely have different barrier properties and fluid turnover characteristics. Further studies are needed to elucidate relations between cyst morphology, fluid composition, pathogenesis, and clinical behaviour including growth rate and relapse tendency.
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| 8. |
- Rabiei, Katrin, 1979, et al.
(författare)
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Does subjective improvement in adults with intracranial arachnoid cysts justify surgical treatment?
- 2018
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Ingår i: Journal of Neurosurgery. - 0022-3085. ; 128:1, s. 250-257
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Subjective improvement of patients who have undergone surgery for intracranial arachnoid cysts has justifed surgical treatment. The current study aimed to evaluate the outcome of surgical treatment for arachnoid cysts using standardized interviews and assessments of neuropsychological function and balance. The relationship between arachnoid cyst location, postoperative improvement, and arachnoid cyst volume was also examined. METHODS The authors performed a prospective, population-based study. One hundred nine patients underwent neurological, neuropsychological, and physiotherapeutic examinations. The arachnoid cysts were considered symptomatic in 75 patients, 53 of whom agreed to undergo surgery. In 32 patients, results of the differential diagnosis revealed that the symptoms were due to a different underlying condition and were unrelated to an arachnoid cyst. Neuropsychological testing included target reaction time, Grooved Pegboard, Rey Auditory Verbal Learning, Rey Osterrieth complex fgure, and Stroop tests. Balance tests included the extended Falls Effcacy Scale, Romberg, and sharpened Romberg with open and closed eyes. The tests were repeated 5 months postoperatively. Cyst volume was pre-and postoperatively measured using OsiriX software. RESULTS Patients who underwent surgery did not have results on balance and neuropsychological tests that were different from patients who declined or had symptoms unrelated to the arachnoid cyst. Patients with a temporal arachnoid cyst performed within the normal range on the neuropsychological tests. Seventy-seven percent of the patients who underwent surgery reported improvement, yet there were no differences in test results before and after surgery. Arachnoid cysts in the temporal region and posterior fossa did not influence the preoperative results of neuropsychological and motor tests. The arachnoid cyst volume decreased postoperatively (p <∗0.0001), but there was no relationship between volume reduction and clinical improvement. CONCLUSIONS The results of this study speak against objectively verifable improvement following surgical treatment in adults with intracranial arachnoid cysts. © AANS 2018.
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| 9. |
- Rabiei, Katrin, 1979
(författare)
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Intracranial Arachnoid Cysts. Epidemiology, Morphology and Surgical Outcome
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Intracranial arachnoid cysts (AC) are malformations of the arachnoid membrane. They may cause symptoms, either by obstruction of the CSF flow or by compression of adjacent neural tissues. The aim of this thesis was to study the prevalence of AC and its relationship with the most common symptoms and signs, the morphology of AC, and the outcome after surgical treatment in children and adults. Patients and methods: The prevalence of AC and its relationship with the most common symptoms ascribed to it were examined in a population of 1235 individuals. For each case, ten age-matched controls were chosen from the same cohort for comparison of symptoms. The clinical studies comprised two prospective studies: one in adults and one in children. Twenty-seven children and 125 adults were consecutively included. Of these, 22 children and 53 adults underwent surgery. Adults were investigated with a neuropsychological, clinical and physiotherapeutic test battery. Surgically treated adults underwent neuropsychological and balance tests five months postoperatively. Children were followed up both three months and 8.6 years (7-10.5 years) postoperatively. Volumetric measurements were performed for all included patients. AC morphology was investigated in tissue samples by light and electron microscopy in 24 consecutive patients included in/operated on in Study II and III. Results: The prevalence of AC in the general population was 2.3 % with no difference between men and women. No relationship with the most common symptoms ascribed to AC was detected. In surgically treated children, 59 % reported improvement after three months and 77 % after the long-term follow-up. Fifty-nine per cent still experienced remaining symptoms. In adults, 77 % reported improvement after the short-term follow-up; however, no improvement in the test results was seen postoperatively. No correlation was found between the reduction in AC volume and improvement, neither in adults, nor in children. ACs could be divided into three groups, based on their diverse morphology. Conclusion: ACs are a common finding in the general population. The diverse morphology in AC suggests more than one pathophysiological origin of these cysts. The results after surgical treatment, together with the difficulties to link what has been considered characteristic symptoms in the presence of AC, suggest that a restrictive approach should be taken with regard to surgical treatment of AC in the absence of hydrocephalus.
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