| 1. |
- Al Masri, Mohammad, 2001, et al.
(författare)
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The glymphatic system for neurosurgeons: a scoping review
- 2024
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Ingår i: NEUROSURGICAL REVIEW. - 0344-5607 .- 1437-2320. ; 47:1
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Tidskriftsartikel (refereegranskat)abstract
- The discovery of the glymphatic system has revolutionized our understanding of cerebrospinal fluid (CSF) circulation and interstitial waste clearance in the brain. This scoping review aims to synthesize the current literature on the glymphatic system's role in neurosurgical conditions and its potential as a therapeutic target. We conducted a comprehensive search in PubMed and Scopus databases for studies published between January 1, 2012, and October 31, 2023. Studies were selected based on their relevance to neurosurgical conditions and glymphatic function, with both animal and human studies included. Data extraction focused on the methods for quantifying glymphatic function and the main results. A total of 67 articles were included, covering conditions such as idiopathic normal pressure hydrocephalus (iNPH), idiopathic intracranial hypertension (IIH), subarachnoid hemorrhage (SAH), stroke, intracranial tumors, and traumatic brain injury (TBI). Significant glymphatic dysregulation was noted in iNPH and IIH, with evidence of impaired CSF dynamics and delayed clearance. SAH studies indicated glymphatic dysfunction with the potential therapeutic effects of nimodipine and tissue plasminogen activator. In stroke, alterations in glymphatic activity correlated with the extent of edema and neurological recovery. TBI studies highlighted the role of the glymphatic system in post-injury cognitive outcomes. Results indicate that the regulation of aquaporin-4 (AQP4) channels is a critical target for therapeutic intervention. The glymphatic system plays a critical role in the pathophysiology of various neurosurgical conditions, influencing brain edema and CSF dynamics. Targeting the regulation of AQP4 channels presents as a significant therapeutic strategy. Although promising, the translation of these findings into clinical practice requires further human studies. Future research should focus on establishing non-invasive biomarkers for glymphatic function and exploring the long-term effects of glymphatic dysfunction.
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| 2. |
- Bartek, Jiri, Jr., et al.
(författare)
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Scandinavian Multicenter Acute Subdural Hematoma (SMASH) Study : Study Protocol for a Multinational Population-Based Consecutive Cohort
- 2019
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Ingår i: Neurosurgery. - : Ovid Technologies (Wolters Kluwer Health). - 0148-396X .- 1524-4040. ; 84:3, s. 799-803
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDTraumatic acute subdural hematomas (ASDHs) are associated with high rate of morbidity and mortality, especially in elderly individuals. However, recent reports indicate that the morbidity and mortality rates might have improved.OBJECTIVETo evaluate postoperative (30-d) mortality in younger vs elderly (70 yr) patients with ASDH. Comparing younger and elderly patients, the secondary objectives are morbidity patterns of care and 6 mo outcome according to Glasgow outcome scale (GOS). Finally, in patients with traumatic ASDH, we aim to provide prognostic variables.METHODS This is a large-scale population-based Scandinavian study including all neurosurgical departments in Denmark and Sweden. All adult (18 yr) patients surgically treated between 2010 and 2014 for a traumatic ASDH in Denmark and Sweden will be included. Identification at clinicaltrials.gov is NCT03284190.EXPECTED OUTCOMESWe expect to provide data on potential differences between younger vs elderly patients in terms of mortality and morbidity. We hypothesize that elderly patients selected for surgery have a similar pattern of care as compared with younger patients. We will provide functional outcome in terms of GOS at 6 mo in younger vs elderly patients undergoing ASDH evacuation. Finally, clinical useful prognostic factors for favorable (GOS 4-5) vs unfavorable (GOS 1-3) will be identified.DISCUSSION An improved understanding of the clinical outcome, treatment and resource allocation, clinical course, and the prognostic factors of traumatic ASDH will allow neurosurgeons to make better treatment decisions.
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| 3. |
- Carstam, Louise, et al.
(författare)
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Neurosurgical patterns of care for diffuse low-grade gliomas in Sweden between 2005 and 2015
- 2018
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Ingår i: Neuro-Oncology Practice. - : Oxford University Press. - 2054-2577 .- 2054-2585. ; 6:2, s. 124-133
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the last decade, increasing evidence has evolved for early and maximal safe resection of diffuse low-grade gliomas (LGGs) regarding survival. However, changes in clinical practice are known to occur slowly and we do not know if the scientific evidence has yet resulted in changes in neurosurgical patterns of care.Methods: The Swedish Brain Tumor Registry was used to identify all patients with a first-time histopathological diagnosis of LGG between 2005 and 2015. For analysis of surgical treatment patterns, we subdivided assessed time periods into 2005-2008, 2009-2012, and 2013-2015. Population-based data on patient and disease characteristics, surgical management, and outcomes were extracted.Results: A total of 548 patients with diffuse World Health Organization grade II gliomas were identified: 142 diagnosed during 2005-2008, 244 during 2009-2012, and 162 during 2013-2015. Resection as opposed to biopsy was performed in 64.3% during 2005-2008, 74.2% during 2009-2012, and 74.1% during 2013-2015 (P = .08). There was no difference among the 3 periods regarding overall survival (P = .11). However, post hoc analysis of data from the 4 (out of 6) centers that covered all 3 time periods demonstrated a resection rate of 64.3% during 2005-2008, 77.4% during 2009-2012, and 75.4% during 2013-2015 (P = .02) and longer survival of patients diagnosed 2009 and onward (P = .04).Conclusion: In this nationwide, population-based study we observed a shift over time in favor of LGG resection. Further, a positive correlation between the more active surgical strategy and longer survival is shown, although no causality can be claimed because of possible confounding factors.
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| 4. |
- Carstam, Louise, et al.
(författare)
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WHO Grade Loses Its Prognostic Value in Molecularly Defined Diffuse Lower-Grade Gliomas.
- 2021
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Ingår i: Frontiers in Oncology. - : Frontiers Media S.A.. - 2234-943X. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: While molecular insights to diffuse lower-grade glioma (dLGG) have improved the basis for prognostication, most established clinical prognostic factors come from the pre-molecular era. For instance, WHO grade as a predictor for survival in dLGG with isocitrate dehydrogenase (IDH) mutation has recently been questioned. We studied the prognostic role of WHO grade in molecularly defined subgroups and evaluated earlier used prognostic factors in the current molecular setting.Material and Methods: A total of 253 adults with morphological dLGG, consecutively included between 2007 and 2018, were assessed. IDH mutations, codeletion of chromosomal arms 1p/19q, and cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B) deletions were analyzed.Results: There was no survival benefit for patients with WHO grade 2 over grade 3 IDH-mut dLGG after exclusion of tumors with known CDKN2A/B homozygous deletion (n=157) (log-rank p=0.97). This was true also after stratification for oncological postoperative treatment and when astrocytomas and oligodendrogliomas were analyzed separately. In IDH-mut astrocytomas, residual tumor volume after surgery was an independent prognostic factor for survival (HR 1.02; 95% CI 1.01-1.03; p=0.003), but not in oligodendrogliomas (HR 1.02; 95% CI 1.00-1.03; p=0.15). Preoperative tumor size was an independent predictor in both astrocytomas (HR 1.03; 95% CI 1.00-1.05; p=0.02) and oligodendrogliomas (HR 1.05; 95% CI 1.01-1.09; p=0.01). Age was not a significant prognostic factor in multivariable analyses (astrocytomas p=0.64, oligodendrogliomas p=0.08).Conclusion: Our findings suggest that WHO grade is not a robust prognostic factor in molecularly well-defined dLGG. Preoperative tumor size remained a prognostic factor in both IDH-mut astrocytomas and oligodendrogliomas in our cohort, whereas residual tumor volume predicted prognosis in IDH-mut astrocytomas only. The age cutoffs for determining high risk in patients with IDH-mut dLGG from the pre-molecular era are not supported by our results.
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| 5. |
- Corell, Alba, et al.
(författare)
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Age and surgical outcome of low-grade glioma in Sweden.
- 2018
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Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 138:4, s. 359-368
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Tidskriftsartikel (refereegranskat)abstract
- Low-grade gliomas (LGG) are slow-growing primary brain tumors that typically affect young adults. Advanced age is widely recognized as a poor prognostic factor in LGG. The impact of age on postoperative outcome in this patient group has not been systemically studied.We performed a nationwide register-based study with data from the Swedish Brain Tumor Registry (SBTR) for all adults diagnosed with a supratentorial LGG (WHO grade II astrocytoma, oligoastrocytoma, or oligodendroglioma) during 2005-2015. Patient- and tumor-related characteristics, postoperative complications, and survival were compared between three different age groups (18-39years, 40-59years, and ≥60years).We identified 548 patients; 204 patients (37.2%) aged 18-39years, 227 patients (41.4%) aged 40-59years, and 117 patients (21.4%) ≥60years of age. Unfavorable preoperative prognostic factors (eg, functional status and neurological deficit) were more common with increased age (P<.001). In addition, overall survival was significantly impaired in those 60years and above (P<.001). We observed a clear dose-response for age with separation of survival curves at 50years. Biopsy was more common in patients ≥60years (P<.001). Subgroup analysis of patients with resection revealed a higher amount of postoperative neurological deficits in older patients (P=.029).In general, older patients with LGG have several unfavorable prognostic factors compared with younger patients but seem to tolerate surgery in a comparable fashion. However, more neurological deficits were observed following resections in elderly. Our data further support a cutoff at 50years rather than 40years for selection of high-risk patients.
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| 6. |
- Corell, Alba, et al.
(författare)
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Intracranial Manifestation of Melioidosis: A Case Report and Long-Term Follow-Up
- 2020
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Ingår i: Cureus. - : Cureus, Inc.. - 2168-8184. ; 12:12
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Tidskriftsartikel (refereegranskat)abstract
- Primary neurological melioidosis is rare with fewer than 50 cases reported world-wide. We report the first documented case of primary neurological melioidosis in Sweden, a 32-year old male who previously lived in Thailand for six years and recently moved to Sweden. He presented with headache, irritability and lack of concentration. Investigation with computerized tomography (CT) and subsequent magnetic resonance imaging (MRI) showed epidural fluid that was interpreted as a chronic epidural hematoma. He underwent surgical evacuation of the epidural collection that was found to be a white collection mixed with pus and bacterial culture results were positive for Burkholderia pseudomallei.
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| 7. |
- Corell, Alba, et al.
(författare)
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Neurosurgical treatment and outcome patterns of meningioma in Sweden: a nationwide registry-based study.
- 2019
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Ingår i: Acta neurochirurgica. - : Springer Science and Business Media LLC. - 0942-0940 .- 0001-6268. ; 161:2, s. 333-341
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Tidskriftsartikel (refereegranskat)abstract
- Surgery is the main treatment modality for intracranial meningiomas, but data on short-term surgical outcome are limited. The aim of this Swedish nationwide registry-based study was to benchmark the 30-day complication rate in a cohort of meningioma patients using data from the Swedish brain tumor registry (SBTR). Furthermore, we investigated outcomes for asymptomatic patients.Data were collected from the SBTR for all adults with histopathologically verified intracranial meningioma between 2009 and 2015. Patient symptoms, tumor characteristics, and complications within 30days postoperatively were analyzed.In total, 2324 patients, with a mean age of 58.7years (SD 13.5), underwent surgery for intracranial meningioma and 14.1% of the patients were asymptomatic before the intervention. The most common symptom prior to treatment was focal deficit, which occurred in 1450 patients (62.4%). Moreover, within 30days after surgery, 344 patients (14.8%) developed new neurological deficits and new-onset seizures occurred in 105 patients (4.5%), while 8.3% of asymptomatic patients developed neurological deficit and 3.7% new-onset seizures. Due to complications, reoperations were performed in 120 patients (5.2%). The postoperative 30-day mortality in the whole cohort was 1.5%.This study benchmarks the 30-day complication rate after meningioma surgery and provides outcome data in the highly relevant group of asymptomatic patients using data from the Swedish brain tumor registry. Since surgical decision-making is a careful consideration of short-term risk versus long-term benefit, this information may be useful for both caregivers and patients.
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| 8. |
- Corell, Alba, et al.
(författare)
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[Paroxysmal sympathetic hyperactivity]. : ABC om Paroxysmal sympatisk hyperaktivitet.
- 2021
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Ingår i: Lakartidningen. - 1652-7518. ; 118
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Tidskriftsartikel (refereegranskat)abstract
- Paroxysmal sympathetic hyperactivity (PSH) is a condition mainly described in patients after traumatic brain injury and it is also known under the terms "autonomic storm" and "dysautonomia". It affects between 8-10% of patients after traumatic brain injury and can also affect patients after other neurological diseases, such as anoxic brain injury, stroke, tumors or infections. PSH manifests with six main symptoms: tachycardia, tachypnea, hypertension, hyperthermia, hyperhidrosis and increased muscle tonus. It is of outmost importance to exclude other causes for the symptoms and there are diagnostic criteria established to identify and diagnose PSH. The treatment is pharmacological and non-pharmacological and often multimodal. PSH is probably underdiagnosed and increased awareness is needed.
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| 9. |
- Corell, Alba
(författare)
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Population-based studies of brain tumor surgery: surgical outcome and prognostic factors
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Neurosurgery is the cornerstone in the treatment of a majority of brain tumors. Surgery can sometimes cure or delay tumor progression. However, surgery is associated with risks, and adequate information about the anticipated peri- and postoperative course is important for informed consent. The identification of tumor markers in a preoperative setting is beneficial in lower-grade gliomas, a heterogeneous group in terms of biological behavior where molecular markers play an important role in diagnosis and treatment. We investigated the role of the non-invasive radiological marker T2-FLAIR mismatch by means of a population-based study. The mismatch sign is highly specific for IDH-mutated 1p/19q non-codeleted gliomas and thus useful in the preoperative setting. We examined how age affects lower-grade glioma treatment, in addition to short-term postoperative complications. Older patients (≥60 years) seem to tolerate neurosurgery compared with younger patients (<60 years), although a higher rate of neurological deficit occurred postoperatively. Meningioma is the most common intracranial tumor and surgery is the main treatment modality. The short-term postoperative risk for complications after meningioma surgery, both in symptomatic and asymptomatic, was studied. The complication rate in the short-term (30-day) postoperative period in Sweden lies in line with the relevant literature. Through a registry-based approach we studied the return to work long-term (up to two years) after meningioma surgery. The sick leave pattern after meningioma surgery revealed that surgery is associated with considerable risk of long-term sick leave two years after the operation as 57% in meningioma patients returned to work compared with 84% of matched controls. Risk factors for long-term sick leave were history of depression, surgical neurological deficit and higher tumor grade. The present work contributes with elucidating on a promising non-invasive radiological marker and the role of age in lower-grade gliomas, and in patients with meningioma data on the current postoperative risk after meningioma surgery and novel data with regard to return to work.
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| 10. |
- Corell, Alba, et al.
(författare)
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Shared decision-making in neurosurgery: a scoping review.
- 2021
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Ingår i: Acta neurochirurgica. - : Springer Science and Business Media LLC. - 0942-0940 .- 0001-6268. ; 163, s. 2371-2382
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Forskningsöversikt (refereegranskat)abstract
- In modern neurosurgery, there are often several treatment alternatives, with different risks and benefits. Shared decision-making (SDM) has gained interest during the last decade, although SDM in the neurosurgical field is not widely studied. Therefore, the aim of this scoping review was to present the current landscape of SDM in neurosurgery.A literature review was carried out in PubMed and Scopus. We used a search strategy based on keywords used in existing literature on SDM in neurosurgery. Full-text, peer-reviewed articles published from 2000 up to the search date February 16, 2021, with patients 18years and older were included if articles evaluated SDM in neurosurgery from the patient's perspective.We identified 22 articles whereof 7 covered vestibular schwannomas, 7 covered spinal surgery, and 4 covered gliomas. The other topics were brain metastases, benign brain lesions, Parkinson's disease and evaluation of neurosurgical care. Different methods were used, with majority using forms, questionnaires, or interviews. Effects of SDM interventions were studied in 6 articles; the remaining articles explored factors influencing patients' decisions or discussed SDM aids.SDM is a tool to involve patients in the decision-making process and considers patients' preferences and what the patients find important. This scoping review illustrates the relative lack of SDM in the neurosurgical literature. Even though results indicate potential benefit of SDM, the extent of influence on treatment, outcome, and patient's satisfaction is still unknown. Finally, the use of decision aids may be a meaningful contribution to the SDM process.
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| 11. |
- Corell, Alba, et al.
(författare)
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Spinal cord compression in relation to clinical symptoms in patients with spinal meningiomas.
- 2021
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier BV. - 1872-6968 .- 0303-8467. ; 211
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Tidskriftsartikel (refereegranskat)abstract
- Spinal meningiomas are common primary tumors of the spinal canal and the resulting spinal cord compression (SCC) is intrinsically related to symptoms and outcome, but literature concerning this association is limited. We aimed to present data on both degree of SCC and tumor occupancy percentage in relation to neurological symptoms and outcome.Patients ≥18 years with a histological diagnosis of spinal canal meningioma treated between 2000 and 2017 were retrospectively evaluated for symptoms and neurological outcome in relation to SCC (i.e. compression of spinal cord at maximal tumor compression compared to maximum area above/below compression) and tumor occupancy percentage (percentage of dural sac area occupied by tumor at maximal tumor compression). Area segmentation of spinal cord, tumor and dural sac (as marker of spinal canal) was performed manually on magnetic resonance imaging (MRI) scans. The neurological deficit was assessed pre- and postoperatively according to the McCormick score. A logistic regression was made with a training set to identify the cut-off level for motor deficit.The cohort included 111 patients with a mean age of 62.5 years and 77.5% were female. The dominating symptoms preoperatively were sensory disturbance (91.0%), motor deficit (80.2%) and gait disturbance (67.6%). Postoperatively 53.2% of patients, also in some of those with severe deficit and high tumor occupancy, improved their neurological deficit and 43.2% were unchanged. Patients with intradural meningioma and assessable MRI scans were included to evaluate SCC (n=83). The mean extent of SCC was 50.6%. Exploration of tumor occupancy percentage identified a cut-off at 65% tumor occupancy to best discriminate between patients with or without motor deficit.Patients with an intradural tumor occupancy percentage of >65% are more likely to have a preoperative symptom and deficit, validating previous findings. Therefore, we suggest that even in asymptomatic, otherwise fit, patients with tumor occupancy approaching 65% should be considered for surgery since there is a high risk of developing deficit with even minimal growth. Concerning recovery, patients with tumor both high tumor occupancy and significantly impaired function tended to improve their functional level postoperatively.
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| 12. |
- Corell, Alba, et al.
(författare)
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Stemness and clinical features in relation to the subventricular zone in diffuse lower-grade glioma : an exploratory study
- 2022
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Ingår i: Neuro-Oncology Advances. - : Oxford University Press. - 2632-2498. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The subventricular zone (SVZ) of the human brain is a site of adult stem cell proliferation and a microenvironment for neural stem cells (NSCs). It has been suggested that NSCs in the SVZ are potential cells of origin containing driver mutations of glioblastoma, but their role in the origin of diffuse lower-grade gliomas (dLGGs) is not much studied. Methods We included 188 patients >= 18 years with IDH-mutated dLGG (WHO grades 2-3) histologically diagnosed between 2007 and 2020. Tissue microarrays of tumor samples for patients between 2007 and 2016 were used for immunodetection of Nestin, SOX2, SOX9, KLF4, NANOG, CD133 cMYC, and Ki67. DNA methylation profile was used for stemness index (mDNAsi). Tumor contact with the SVZ was assessed and the distance was computed. Results Overall, 70.2% of the dLGG had SVZ contact. Tumors with SVZ contact were larger (102.4 vs 30.9 mL, P < .01), the patients were older (44.3 vs 40.4 years, P = .04) and more often had symptoms related to increased intracranial pressure (31.8% vs 7.1%, P < .01). The expression of SOX2, SOX9, Nestin, and Ki67 showed intersample variability, but no difference was found between tumors with or without SVZ contact, nor with the actual distance to the SVZ. mDNAsi was similar between groups (P = .42). Conclusions We found no statistical relationship between proximity with the SVZ and mDNAsi or expression of SOX2, SOX9, Nestin, and Ki67 in IDH-mutated dLGG. Our data suggest that the potential impact of SVZ on IDH-mutated dLGG is probably not associated with a more stemness-like tumor profile.
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| 13. |
- Corell, Alba, et al.
(författare)
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Successful adaptation of twinning concept for global neurosurgery collaborations-a validation study
- 2024
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Ingår i: ACTA NEUROCHIRURGICA. - : Springer. - 0001-6268 .- 0942-0940. ; 166:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Globally, many regions have an urgent, unmet need of neurosurgical care. A multi-step neurosurgical twinning technique, International Neurosurgical Twinning Modeled for Africa (INTIMA), was proved to be successful during a previous mission to Neurosurgical Unit, Enugu, Nigeria. The Swedish African Neurosurgical Collaboration (SANC) performed a developmental mission together with the local neurosurgical unit in The Gambia, adopting the INTIMA model.Methods A multidisciplinary team visited for a 2-week collaborative mission at the Neurosurgical Department of the Edward Francis Small Teaching Hospital in Banjul, The Gambia. The mission followed the data of neurosurgical operations during and after the mission as well as about the operations 3 months prior to and after the mission was collected.Results During the mission, a total of 22 operations was carried out, the most common being degenerative spinal conditions (n = 9). In the 3 months following the mission, 43 operations were performed compared to 24 during the 3 months leading up to the mission. The complexity of the performed procedures increased after the mission. An operating microscope (Moller-Wedel) was donated and installed and the neurosurgeons on site underwent training in microneurosurgery. The surgical nurses, nurses at the postoperative ward, and the physiotherapists underwent training. A biomedical engineer serviced multiple appliances and devices improving the patient care on site while training local technicians.Conclusion This study validated the use of the INTIMA model previously described in a mission by Swedish African Neurosurgical Collaboration (SANC). The model is sustainable and produces notable results. The core strength of the model is in the multidisciplinary team securing all the aspects and steps of the neurosurgical care. Installation of an operating microscope opened for further microsurgical possibilities, improving the neurosurgical care in The Gambia.
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| 14. |
- Corell, Alba, et al.
(författare)
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The clinical significance of the T2-FLAIR mismatch sign in grade II and III gliomas: a population-based study.
- 2020
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Ingår i: BMC cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- The T2-FLAIR mismatch sign is an imaging finding highly suggestive of isocitrate dehydrogenase mutated (IDH-mut) 1p19q non-codeleted (non-codel) gliomas (astrocytomas). In previous studies, it has shown excellent specificity but limited sensitivity for IDH-mut astrocytomas. Whether the mismatch sign is a marker of a clinically relevant subtype of IDH-mut astrocytomas is unknown.We included histopathologically verified supratentorial lower-grade gliomas (LGG) WHO grade II-III retrospectively during the period 2010-2016. In the period 2017-2018, patients with suspected LGG radiologically were prospectively included, and in this cohort other diagnoses than glioma could occur. Clinical, radiological and molecular data were collected. For clinical evaluation we included all patients with IDH-mut astrocytomas. In the 2010-2016 cohort DNA methylation analysis with Infinium MethylationEPIC BeadChip (Illumina) was performed for patients withan IDH-mut astrocytomawith available tissue. We aimed to examine the association of the T2-FLAIRmismatch sign with clinical factors and outcomes. Additionally, we evaluated the diagnostic reliability of the mismatch sign and its relation to methylation profiles.Out of 215 patients with LGG, 135 had known IDH-mutation and 1p19q codeletion status. Fifty patients hadan IDH-mut astrocytoma and 12 of these (24.0%) showed a mismatch sign. The sensitivity and specificity of the mismatch sign for IDH-mut detection were 26.4 and 97.6%, respectively. There were no differences between patients withan IDH-mut astrocytoma with or without mismatch sign when grouped according to T2-FLAIR mismatch sign with respect to baseline characteristics, clinical outcomes and methylation profiles. The overall interrater agreement between neuroradiologist and clinical neurosurgeons for the T2-FLAIR mismatch sign was significant when all 215 MRI examination assessed (κ=0.77, p<0.001, N=215).The T2-FLAIR mismatch sign in patients withan IDH-mut astrocytoma is not associated with clinical presentation or outcome. It seems unlikely that the IDH-mut astrocytomas with mismatch sign represent a specific subentity. Finally, we have validated that the T2-FLAIR mismatch sign is a reliable and specific marker of IDH-mut astrocytomas.
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| 15. |
- Corell, Alba, et al.
(författare)
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[The glymphatic system - an overview]. : Glymfatiska systemet – renar hjärnan från slaggprodukter.
- 2023
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Ingår i: Lakartidningen. - 1652-7518. ; 120:6-7
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Forskningsöversikt (refereegranskat)abstract
- The glymphatic system as a concept was introduced a decade ago and the knowledge regarding the circulation of the cerebrospinal fluid has since been revised. The research of the glymphatic system is extensive today, but there are many knowledge gaps. The glymphatic system was first investigated in animal experiments, but with the MR techniques available today the glymphatic system has also been shown to exist in humans. Studies suggest that the glymphatic system may be involved in the pathophysiological processes of neurological pathologies, such as degenerative brain disorders and normal pressure hydrocephalus (NPH), but also in the aftermath of ischemic stroke, subarachnoidal hemorrhage and traumatic brain injury. It is believed that the glymphatic system with its cleansing capabilities is upregulated during sleep, and interestingly studies show association between lack of sleep and neurodegenerative diseases. In this article, we present an overview of the glymphatic system and its possible role in intracranial pathologies.
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| 16. |
- Elmi Terander, Adrian, et al.
(författare)
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Spinal neurokirurgi på grund av radikulopati och myelopat : [Spinal neurosurgery radiculopathy and myelopathy]
- 2023
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Ingår i: Läkartidningen. - : Läkartidningen Förlag. - 0023-7205 .- 1652-7518. ; 120
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Tidskriftsartikel (refereegranskat)abstract
- The field of spinal neurosurgery covers degenerative conditions and trauma as well as tumors, malformations and vascular disorders of spine and spinal cord. This article focuses on the Swedish spinal neurosurgical care regarding radiculopathy and myelopathy. Disc herniation, foraminal stenosis, spinal stenosis and spinal cord compression due to degenerative disorders or tumors are discussed. Treatment options such as anterior cervical decompression and fusion, posterior forami-notomy, laminectomy and approaches to spinal intradural tumors are briefly presented. The aim is to present symptoms, diagnostics and treatment options of common conditions to facilitate early detection and referral to neurosurgical centers to avoid delayed dia-gnosis and neurological impairment.
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| 17. |
- Ferreyra Vega, Sandra, et al.
(författare)
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DNA methylation profiling for molecular classification of adult diffuse lower-grade gliomas.
- 2021
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Ingår i: Clinical Epigenetics. - : Springer Nature. - 1868-7083 .- 1868-7075. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: DNA methylation profiling has facilitated and improved the classification of a wide variety of tumors of the central nervous system. In this study, we investigated the potential utility of DNA methylation profiling to achieve molecular diagnosis in adult primary diffuse lower-grade glioma (dLGG) according to WHO 2016 classification system. We also evaluated whether methylation profiling could provide improved molecular characterization and identify prognostic differences beyond the classical histological WHO grade together with IDH mutation status and 1p/19q codeletion status. All patients diagnosed with dLGG in the period 2007-2016 from the Västra Götaland region in Sweden were assessed for inclusion in the study.RESULTS: A total of 166 dLGG cases were subjected for genome-wide DNA methylation analysis. Of these, 126 (76%) were assigned a defined diagnostic methylation class with a class prediction score ≥ 0.84 and subclass score ≥ 0.50. The assigned methylation classes were highly associated with their IDH mutation status and 1p/19q codeletion status. IDH-wildtype gliomas were further divided into subgroups with distinct molecular features.CONCLUSION: The stratification of the patients by methylation profiling was as effective as the integrated WHO 2016 molecular reclassification at predicting the clinical outcome of the patients. Our study shows that DNA methylation profiling is a reliable and robust approach for the classification of dLGG into molecular defined subgroups, providing accurate detection of molecular markers according to WHO 2016 classification.
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| 18. |
- Gómez Vecchio, Tomás, et al.
(författare)
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Classification of Adverse Events Following Surgery in Patients With Diffuse Lower-Grade Gliomas
- 2021
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Ingår i: Frontiers in Oncology. - : Frontiers Media S.A.. - 2234-943X. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recently, the Therapy-Disability-Neurology (TDN) was introduced as a multidimensional reporting system to detect adverse events in neurosurgery. The aim of this study was to compare the novel TDN score with the Landriel–Ibanez classification (LIC) grade in a large cohort of patients with diffuse lower-grade glioma (dLGG). Since the TDN score lacks validation against patient-reported outcomes, we described health-related quality of life (HRQoL) change in relation to TDN scores in a subset of patients.Methods: We screened adult patients with a surgically treated dLGG World Health Organization (WHO) grade 2 and 3 between 2010 and 2020. Up until 2017, it consists of a retrospective cohort (n = 158). From 2017 and onwards, HRQoL was registered using EuroQoL-5-dimension, three levels of response (EQ-5D 3L) questionnaire at baseline and 3 months follow-up, in a prospectively recruited cohort (n = 102). Both the LIC grade and TDN score were used to classify adverse events.Results: In total, 231 patients were included. In 110/231 (47.6%) of the surgical procedures, a postoperative complication was registered. When comparing the TDN score to LIC grades, only a minor shift towards complications of higher order could be observed. EQ-5D 3L was reported for 45 patients. Patients with complications related to surgery had pre- to postoperative changes in EQ-5D 3L index values (n = 27; mean 0.03, 95% CI −0.06 to 0.11) that were comparable to patients without complications (n = 18; mean −0.06, 95% CI −0.21 to 0.08). In contrast, patients with new-onset neurological deficit had a deterioration in HRQoL at follow-up, with a mean change in the EQ-5D 3L index value of 0.11 (n = 13, 95% CI 0.0 to 0.22) compared to −0.06 (n = 32, 95% CI −0.15 to 0.03) for all other patients.Conclusions: In patients with dLGG, TDN scores compared to the standard LIC tend to capture more adverse events of higher order. There was no clear relation between TDN severity and HRQoL. However, new-onset neurological deficit caused impairment in HRQoL. For the TDN score to better align with patient-reported outcomes, more emphasis on neurological deficit and function should be considered.
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| 19. |
- Khaki, D., et al.
(författare)
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Differences in Presentation, Radiological Features, and Outcomes in Traumatic Versus Spontaneous Acute Subdural Hematomas-A Single-Institution Population-Based Study
- 2022
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 164
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Spontaneous acute subdural hematoma (sASDH) is a rare neurosurgical condition, with the literature mainly consisting of case reports. In the present study, we compared sASDH with traumatic ASDH (tASDH) to determine the differences in presentation, radiological features, and outcomes in a population-based setting. METHODS: All adult patients (age >= 18 years) who had undergone surgery for ASDH (n = 266), either spontaneous or traumatic, from 2010 to 2020 were included retrospectively. The cohort was divided into 2 groups for comparative analysis: sASDH group (n = 24) versus tASDH group (n = 242). RESULTS: Of the 266 patients, 24 (9.0%) had presented with sASDH. The sASDH group had a mean age of 66.2 years, and sudden headache was the most common presenting symptom (83.3%). The sASDH group had a higher Glasgow coma scale score at presentation compared with the tASDH group (Glasgow coma scale scores, 10 and 8, respectively; P < 0.01). The outcomes, assessed using the Glasgow outcome scale (GOS), revealed a greater incidence of more favorable outcomes (GOS score 4-5) for the sASDH group (72.7%) than for the tASDH group (41.5%). CONCLUSIONS: In the present population-based study of surgically evacuated ASDH cases, 9% were spontaneous without previous trauma. The outcomes (GOS scores) were significantly more favorable for those with sASDH than for those with tASDH. In one half of the patients with sASDH, arterial bleeding was noted perioperatively, although the preoperative radiological examinations revealed no abnormalities for most patients. However, the lack of sufficient examinations such as computed tomography angiography made it difficult to establish the most common etiology of bleeding in those with sASDH. Further research is warranted to determine the reference standard method for the investigation of sASDH.
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| 20. |
- Khaki, Djino, et al.
(författare)
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Selection of CT variables and prognostic models for outcome prediction in patients with traumatic brain injury
- 2021
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Ingår i: Scandinavian Journal of Trauma Resuscitation & Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 29:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Traumatic brain injuries (TBI) are associated with high risk of morbidity and mortality. Early outcome prediction in patients with TBI require reliable data input and stable prognostic models. The aim of this investigation was to analyze different CT classification systems and prognostic calculators in a representative population of TBI-patients, with known outcomes, in a neurointensive care unit (NICU), to identify the most suitable CT scoring system for continued research. Materials and methods We retrospectively included 158 consecutive patients with TBI admitted to the NICU at a level 1 trauma center in Sweden from 2012 to 2016. Baseline data on admission was recorded, CT scans were reviewed, and patient outcome one year after trauma was assessed according to Glasgow Outcome Scale (GOS). The Marshall classification, Rotterdam scoring system, Helsinki CT score and Stockholm CT score were tested, in addition to the IMPACT and CRASH prognostic calculators. The results were then compared with the actual outcomes. Results Glasgow Coma Scale score on admission was 3-8 in 38%, 9-13 in 27.2%, and 14-15 in 34.8% of the patients. GOS after one year showed good recovery in 15.8%, moderate disability in 27.2%, severe disability in 24.7%, vegetative state in 1.3% and death in 29.7%. When adding the variables from the IMPACT base model to the CT scoring systems, the Stockholm CT score yielded the strongest relationship to actual outcome. The results from the prognostic calculators IMPACT and CRASH were divided into two subgroups of mortality (percentages); <= 50% (favorable outcome) and > 50% (unfavorable outcome). This yielded favorable IMPACT and CRASH scores in 54.4 and 38.0% respectively. Conclusion The Stockholm CT score and the Helsinki score yielded the closest relationship between the models and the actual outcomes in this consecutive patient series, representative of a NICU TBI-population. Furthermore, the Stockholm CT score yielded the strongest overall relationship when adding variables from the IMPACT base model and would be our method of choice for continued research when using any of the current available CT score models.
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| 21. |
- Ljungqvist, Johan, et al.
(författare)
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Clinical experiences and learning curves from robot-assisted neurosurgical biopsies with Stealth Autoguide™
- 2024
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Ingår i: NEURO-ONCOLOGY ADVANCES. - 2632-2498. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Biopsies of intracranial lesions are a cornerstone in the diagnosis of unresectable tumors to guide neurooncological treatment; however, the procedure is also associated with risks. The results from the cranial robot guidance system Stealth Autoguide (TM) were studied after introduction at a neurosurgical department. Primary aims include the presentation of clinical and radiological data, accuracy of radiological diagnosis, learning curves of the new technology, diagnostic yield, and precision. The secondary aim was to study complications.Methods Retrospective data inclusion was performed on patients >= 18 years undergoing biopsy with Stealth Autoguide (TM) due to suspected brain tumors in the first 3 years after the introduction of the technique. Data regarding clinical characteristics, intraoperative variables, pathological diagnosis, and complications were recorded. Analyses of learning curves were performed.Results A total of 79 procedures were performed on 78 patients with a mean age of 62 years (SD 12.7, range 23-82), 30.8% were female. Tumors were often multifocal (63.3%) and supratentorial (89.9%). The diagnostic yield was 87.3%. The first-hand radiological diagnosis was correct in 62.0%. A slight decrease in operation time was observed, although not significant. The surgeon contributed to 12% of the variability.Conclusions Robot-assisted biopsies with Stealth Autoguide (TM) seem to be comparable, with regards to complications, to frame-based and other frameless neurosurgical biopsies. Learning curves demonstrated no statistical differences in time of surgery and only 12% surgeon-related variation (ie, variation caused by the change of performing surgeon), suggesting a successful implementation of this technical adjunct. Neurosurgeons will sometimes biopsy a tumor to officially diagnose it if it is too risky to remove with surgery. Biopsies are typically performed by the surgeon without the use of robots. In this study, the authors wanted to describe their experience with robot-assisted brain tumor biopsies. To do this, they reviewed the medical records of patients who had brain tumor biopsies done with a commercial robot. Their results showed that 78 patients had a robot-assisted brain tumor biopsy at their hospital. A diagnosis was achievable for 87% of these patients. The time taken for surgery did not seem to change much over the study period, and the surgeon only accounted for a small portion of the differences in the length of surgery. Although 41% of patients had some bleeding at the site of biopsy, the bleedings were most often small and rarely caused problems for the patient.
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| 22. |
- Munkvold, Bodil Karoline Ravn, et al.
(författare)
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Variations in the management of diffuse low-grade gliomas : A Scandinavian multicenter study
- 2021
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Ingår i: Neuro-Oncology Practice. - : Oxford University Press. - 2054-2577 .- 2054-2585. ; 8:6, s. 706-717
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Tidskriftsartikel (refereegranskat)abstract
- Background. Early extensive surgery is a cornerstone in treatment of diffuse low-grade gliomas (DLGGs), and an additional survival benefit has been demonstrated from early radiochemotherapy in selected "high-risk" patients. Still, there are a number of controversies related to DLGG management. The objective of this multicenter population-based cohort study was to explore potential variations in diagnostic work-up and treatment between treating centers in 2 Scandinavian countries with similar public health care systems.Methods. Patients screened for inclusion underwent primary surgery of a histopathologically verified diffuse WHO grade II glioma in the time period 2012 through 2017. Clinical and radiological data were collected from medical records and locally conducted research projects, whereupon differences between countries and inter-hospital variations were explored.Results. A total of 642 patients were included (male:female ratio 1:4), and annual age-standardized incidence rates were 0.9 and 0.8 per 100 000 in Norway and Sweden, respectively. Considerable inter-hospital variations were observed in preoperative work-up, tumor diagnostics, surgical strategies, techniques for intraoperative guidance, as well as choice and timing of adjuvant therapy.Conclusions. Despite geographical population-based case selection, similar health care organizations, and existing guidelines, there were considerable variations in DLGG management. While some can be attributed to differences in clinical implementation of current scientific knowledge, some of the observed inter-hospital variations reflect controversies related to diagnostics and treatment. Quantification of these disparities renders possible identification of treatment patterns associated with better or worse outcomes and may thus represent a step toward more uniform evidence-based care.
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| 23. |
- Näslund, Olivia, et al.
(författare)
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Meningioma classification by immunohistochemistry : A replicability study
- 2023
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Ingår i: BRAIN AND SPINE. - : Elsevier BV. - 2772-5294. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Meningiomas account for nearly 40% of intracranial tumors. Recently, the immunohistochemistry (IHC) markers S100B, SCGN, ACADL and MCM2 have been shown to be associated with underlying biological subtypes of meningioma (MG1-MG4). We aimed to evaluate these IHC markers in a clinical setting.Research question: Are the new proposed IHC markers clinically useful?Methods: In total, 244 patients with meningiomas with tissue in TMAs were included and the IHC markers S100B, SCGN, ACADL and MCM2 were analyzed. Two sets of analyses were performed; the first included all samples with any staining considered positive, the second only samples with >10% immunopositivity. PFS and OS were analyzed in correlation to immunopositivity in the second analysis set.Results: In the first set of analyses only 26.2% of samples could be to allocate to one group. No further analyses were performed with this selection. In the second set of analyses 52.0% could be allocated to a group. There was an enrichment of WHO grade 2 and 3 tumors in MG3 and MG4 as compared to MG1 (24.1% and 25.7% vs. 12.1%). Both the molecular group (p 1/4 0.032) and WHO grade (p 1/4 0.005) had significant impact on PFS, but only WHO grade predicted OS (p 1/4 0.033).Conclusion: We studied the proposed new method of classifying meningiomas into groups MG1, MG2, MG3 and MG4 using IHC markers, but found difficulties applying the classification system in our material mainly due to lack of exclusivity of markers. Thus, in its present form the classification method lacks clinical applicability.
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| 24. |
- Sagberg, Lisa Millgård, et al.
(författare)
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Is intracranial volume a risk factor for IDH-mutant low-grade glioma? A case-control study.
- 2022
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Ingår i: Journal of neuro-oncology. - : Springer Science and Business Media LLC. - 1573-7373 .- 0167-594X. ; 160:101–106
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Tidskriftsartikel (refereegranskat)abstract
- Risk of cancer has been associated with body or organ size in several studies. We sought to investigate the relationship between intracranial volume (ICV) (as a proxy for lifetime maximum brain size) and risk of IDH-mutant low-grade glioma.In a multicenter case-control study based on population-based data, we included 154 patients with IDH-mutant WHO grade 2 glioma and 995 healthy controls. ICV in both groups was calculated from 3D MRI brain scans using an automated reverse brain mask method, and then compared using a binomial logistic regression model.We found a non-linear association between ICV and risk of glioma with increasing risk above and below a threshold of 1394ml (p<0.001). After adjusting for ICV, sex was not a risk factor for glioma.Intracranial volume may be a risk factor for IDH-mutant low-grade glioma, but the relationship seems to be non-linear with increased risk both above and below a threshold in intracranial volume.
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| 25. |
- Svenjeby, Caroline, et al.
(författare)
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Changes in clinical management of diffuse IDH-mutated lower-grade gliomas: patterns of care in a 15-year period
- 2022
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Ingår i: Journal of Neuro-Oncology. - : Springer Science and Business Media LLC. - 0167-594X .- 1573-7373. ; 160:3, s. 535-543
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Tidskriftsartikel (refereegranskat)abstract
- Background: Isocitrate dehydrogenase (IDH) mutated diffuse lower-grade gliomas (dLGG) are infiltrating brain tumors and increasing evidence is in favor of early multimodal treatment. In a Scandinavian population-based setting, we wanted to study treatment patterns over the last 15 years, focusing on the short-term postoperative course to better understand the potential negative consequences of treatment. Methods: Patients ≥ 18 years with primary IDH-mutated dLGG grade 2 and 3, operated between January 2007–June 2021 were identified. Patients were divided into subgroups (2007–2011, 2012–2016, and 2017–2021) and comparisons regarding tumor- and disease characteristics, treatment, and postoperative outcome were performed. Results: We identified 202 patients (n = 61, 2007–2011; n = 72, 2012–2016; n = 69, 2017–2021), where of 193 underwent resection without change in proportion of resections over time. More patients underwent complete resections in recent times (6.1%; 15.7%; 26.1%, respectively; p = 0.016). Forty-two patients had any neurological deficit postoperatively (14.8%; 23.6%; 23.2%; p = 0.379), mostly minor and transient. Differences in oncological therapy were seen between the investigated subgroups. Early radiotherapy alone (32.8%; 7%; 2.9%; p < 0.001), concomitant chemoradiotherapy (23%; 37.5%; 17.4%; p = 0.022), sequential chemoradiotherapy (0%; 18%; 49.3%; p < 0.001), and no adjuvant treatment (42.6%; 23.6%; 18.8%; p = 0.009) shifted during the studied period. Increasingly more patients received proton radiotherapy compared to photon radiotherapy during the later time periods (p < 0.001). Conclusion: Complete resections were performed more often in later time periods without an apparent increase in surgical morbidity. Early adjuvant oncological treatment shifted towards providing chemotherapy and combined chemoradiotherapy more often in later time periods. Protons replaced photons as the radiation modality of choice.
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