| 1. |
- Alonso, Fabiola, et al.
(författare)
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Influence of Virchow-Robin spaces on the electric field distribution in subthalamic nucleus deep brain stimulation
- 2021
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier. - 0303-8467 .- 1872-6968. ; 204
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Tidskriftsartikel (refereegranskat)abstract
- Patient MRI from DBS implantations in the subthalamic nucleus (STN) were reviewed and it was found that around 10% had Virchow-Robin spaces (VRS). Patient-specific models were developed to evaluate changes in the electric field (EF) around DBS leads. The patients (n = 7) were implanted bilaterally either with the standard voltage-controlled lead 3389 or with the directional current-controlled lead 6180. The EF distribution was evaluated by comparing simulations using patient-specific models with homogeneous models without VRS. The EF, depicted with an isocontour of 0.2 V/mm, showed a deformation in the presence of the VRS around the DBS lead. For patient-specific models, the radial extension of the EF isocontours was enlarged regardless of the operating mode or the DBS lead used. The location of the VRS in relation to the active contact and the stimulation amplitude, determined the changes in the shape and extension of the EF. It is concluded that it is important to take the patients? brain anatomy into account as the high conductivity in VRS will alter the electric field if close to the DBS lead. This can be a cause of unexpected side effects.
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| 2. |
- Alonso-Magdalena, Lucía, et al.
(författare)
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Prevalence and disease disability in immigrants with multiple sclerosis in Malmö, southern Sweden
- 2024
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier. - 0303-8467 .- 1872-6968. ; 240
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multiple sclerosis (MS) is the most common chronic demyelinating disease of the central nervous system and the major non-traumatic cause of permanent disability in young adults. Several migration studies have been performed over the years suggesting a pattern of higher disease disability in certain ethnic groups. To our knowledge, differences in disease progression in immigrants have not been studied in Sweden before. Thus, the aims of our study were to estimate the prevalence of multiple sclerosis among first-generation immigrants in the City of Malmö and to compare differences in disease severity with the native population.Methods: All persons with multiple sclerosis living in Malmö on prevalence day 31 Dec 2010 were included. Cases were classified according to the country of birth into Scandinavians, Western and non-Western.Results: The crude prevalence was 100/100,000 (95% CI, 80–124) among first-generation immigrants, 154/100,000 (95% CI, 137–173) among individuals with Scandinavian background, 123/100,000 (95% CI, 94–162) in the Western group and 76/100,000 (95% CI, 53–108) in the non-Western group. The mean Multiple Sclerosis Severity Score (MSSS) value among Scandinavians was 4.2 (SD 3.5), whereas the figures in the immigrant group were 4.6 (SD 3.3) and 5.2 (SD 3.7) among Westerns respectively non-Westerns, which differences were not statistically significant. When adjusting for gender, age at onset and initial disease course, the mean MSSS difference between the non-Western and the Scandinavian individuals was 1.7 (95% CI 0.18–3.3, p = 0.030). There were no differences on time to diagnosis or the time from diagnosis to treatment initiation between the three groups.Conclusions: We found a lower prevalence among Western and non-Western first-generation immigrants compared to the Scandinavian population and a more severe disease in non-Western immigrants than in Scandinavians.
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| 3. |
- 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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| 4. |
- El-Sherif, Ahmed M., et al.
(författare)
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Resource utilization in management of spontaneous intracerebral hemorrhage without systemic risk factors : Does early surgical decompression matter?
- 2023
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier. - 0303-8467 .- 1872-6968. ; 231
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Forskningsöversikt (refereegranskat)abstract
- Background: Even though different subtypes of spontaneous ICH are frequently linked to a poor prognosis, their causes, pathological features, and prognoses vary. Atypical intracerebral hemorrhage is the subtype of spontaneous ICH that usually occurs due to an underlying localized vascular lesion. It is unrelated to systemic vascular risk factors, mostly affects children and young adults and is associated with a relatively good outcome. This fact should be considered when planning the evaluation and treatment. Investigating the cause of this subtype is fundamental to providing optimal management. However, if resources do not allow completing the investigations, the cause will be more difficult to discover. Treatment decisions will be made under stress to save the patient's life, especially with rapidly deteriorating patients. Methods: We described three cases of spontaneous ICH without systemic risk factors where the bleeding source could not be determined before surgery due to a lack of resources, preventing preoperative vascular investigation. Knowing that the atypical ICH has a distinct identity, regarding etiology and prognosis, encouraged the surgeons to resort to early surgical decompression as an alternative plan. We reviewed the literature searching for supporting evidence. Results: The results of treatment of the presented cases were satisfactory. The lack of reported similar cases was brought to light by a literature analysis that sought to provide backing for the proposed management strategy. In the end, we supplied two graphic organizers to help readers remember the different types and treatment of hemorrhagic stroke. Conclusion: There isn't enough evidence to show that there are other ways to treat atypical intracerebral haemorrhage when resources are limited. The presented cases highlight the importance of decisionmaking in resource-constrained situations when patient outcomes can be improved.
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| 5. |
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| 6. |
- Necking, Erik, et al.
(författare)
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Complications of intrathecal drug delivery therapy (ITDD) : A retrospective study of 231 implantations between 1999 and 2014
- 2021
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Ingår i: Clinical neurology and neurosurgery. - : ELSEVIER. - 0303-8467 .- 1872-6968. ; 205
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Determination of types and frequencies of complications related to ITDD therapy, and assessment of possible risk factors for such complications. Methods: Retrospective study (1999-2014) including all ITDD-implantations at one regional center in Sweden. Descriptors comprised: sex; age; medical condition; body weight index; preoperative ASA-grade; presence of indwelling urinary catheters, feeding tubes, and/or daily urinary or anal incontinence; primary or reimplantation; type of pump and catheter; drug delivered; weekday of surgery; surgical procedure time; surgeon; experience of surgeon; surgical theater; and type of antibiotic prophylaxis. All deaths during the study period were assessed as regards possible relation to ITDD. Data were analyzed with SPSS 25, using Chi(2) test for correlations between descriptors and complications. Results: 231 ITDD pump implantations/re-implantations occurred in 159 patients. Seventy-eight (34%) instances of complications were found: 33 catheter-associated; 6 pump-associated; and 29 infection-associated, where 16 were surgical site infections. A higher infection rate occurred in pump re-implantations, as compared to primary implantations (p = 0.002), and in patients with traumatic spinal cord injury (TSCI) as compared to other diagnoses (p = 0.02). Cloxacillin as antibiotic prophylaxis correlated with a higher infection risk (p = 0.005) relative to other antibiotic prophylaxis. Prolonged surgical procedure time in re-implantations correlated positively with increased catheter-associated complications (p = 0.006). Conclusion: Complications in ITDD therapy were common, comprising catheter-, infection-, and pump-associated mishaps. A comprehensive system of care needs to be present for managing complications. Future studies may show less complications due to improved protocols and equipment.
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| 8. |
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| 9. |
- Samuelsson, Jennifer, et al.
(författare)
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Risk of de novo aneurysm formation in patients previously diagnosed with a ruptured or unruptured aneurysm: 18-year follow-up.
- 2023
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Ingår i: Clinical neurology and neurosurgery. - 0303-8467 .- 1872-6968. ; 233
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Tidskriftsartikel (refereegranskat)abstract
- Data on de novo aneurysm formation after treatment for intracranial aneurysms remains scarce. We studied the incidence of de novo aneurysm formation in patients who had undergone aneurysm treatment more than 18 years prior to follow-up. As it is a disease affecting a younger patient population more specific guidelines are needed when planning a follow-up regime.The rate of de novo aneurysm formation was assessed with Magnetic Resonance Angiography (MRA) follow-up >18 years after endovascular or microsurgical treatment for an intracranial aneurysm. Variables associated with de novo aneurysm formation were studied using logistic regression. Missing data were imputed using chained random forests. A data-driven model for the prediction of de novo aneurysm was created to calculate the relative variable importance of ten clinical features.De novo aneurysms were identified in 11/81 (13.6 %) patients, of whom 1 was male, over a median follow-up of 20 years. Sex was the most important variable associated with de novo aneurysm formation. Regarding the development of de novo aneurysm, men displayed an odds ratio (OR) of 0.16 (0.01-0.97), compared with women. OR for mRS score 2 or more was 0.20 (95 % CI 0.01-1.34), and OR for smokers was 3.70 (0.54-31.18). Six out of 11 patients (54.5 %) needed treatment; 1 underwent endovascular treatment (EVT) and 5 underwent microsurgical treatment (MST). The overall annual de novo aneurysm formation rate was 0.92 %.This study highlights the need for a longer follow-up imaging monitoring of patients that have previously undergone treatment for an intracranial aneurysm. These data are useful to take into consideration when planning a follow-up strategy.
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| 10. |
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| 11. |
- Svedung-Wettervik, Teodor, et al.
(författare)
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Patient-reported quality of life in grade 2 and 3 gliomas after surgery, can we do more?
- 2022
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier. - 0303-8467 .- 1872-6968. ; 214
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the effects of surgery and the explanatory variables for patient-reported health-related quality of life (HRQoL) after brain tumor surgery for astrocytomas and oligodendrogliomas grade 2 and 3.Methods: Patients operated for an astrocytoma or an oligodendrogliomas, grade 2 or 3, at the Department of Neurosurgery, Uppsala, Sweden, 2016-2021, were included. HRQoL was assessed with RAND-36 preoperatively and 4 months postoperatively. Demographic, tumor, and treatment data were prospectively collected.Results: Sixty-two patients were included, 34 with an astrocytoma and 28 with an oligodendroglioma. Physical function, role physical, general health, vitality, and social functioning decreased significantly (p-values < 0.01) 4 months after surgery, whereas bodily pain, role emotional, and mental health remained unchanged. In Spearman analyses, younger patients deteriorated more in role physical, females worsened less often in general health but more often in social functioning than males, a higher level of education correlated with a more pronounced drop in social functioning, and a greater extent of resection corresponded to a worsening in physical function postoperatively (p-values < 0.05).Conclusions: Several HRQoL domains deteriorated after glioma surgery in specific groups of patients, particularly general health, vitality, physical, and social functions. This was only weakly explained by surgical variables. Specific groups of patients may need closer follow-ups and tailored support/rehabilitation to detect and address these HRQoL deteriorations.
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| 12. |
- Vigren, Patrick, et al.
(författare)
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Experiences of awake surgery in non-tumoural epilepsy in eloquent localizations
- 2020
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Ingår i: Clinical neurology and neurosurgery. - : ELSEVIER. - 0303-8467 .- 1872-6968. ; 199
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Tidskriftsartikel (refereegranskat)abstract
- Background: Whilst modern awake intraoperative mapping has been widely accepted and implemented in the last decades in neuro-oncology, sparse reports have been published on the safety and efficiency of this approach in epilepsy surgery. Method: This article reports four cases with different locations of epileptogenic zones as examples of possible safe and efficient resections. Result: The results of the resections on seizure control were Engel 1 (no disabling seizures) in all cases and no patient experienced significant neurological deficits. Discussion: The discussion focuses on aspects of the future of epilepsy surgery in a hodotopical paradigm.
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| 13. |
- Wedin, Johan O, et al.
(författare)
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Heparin-binding protein as a marker of ventriculostomy related infection and central nervous system inflammation in neuro-intensive care
- 2023
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier BV. - 0303-8467 .- 1872-6968. ; 229
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Diagnosis of ventriculostomy related infections (VRI) in the neuro-intensive care unit remains chal-lenging and current biomarkers lack adequate precision. The aim of this study was to explore the potential of Heparin-binding protein (HBP) in cerebrospinal fluid (CSF) as a diagnostic biomarker of VRI.Methods: All patients treated with an external ventricular drain (EVD) between January 2009 and March 2010 at Skane university hospital in Lund, Sweden, were consecutively included. CSF samples obtained during routine care were analyzed for HBP. VRI was defined as a positive bacterial microbiology test result on a CSF sample with an erythrocyte-corrected leukocyte count of > 50 x 106/l. HBP levels at VRI diagnosis was compared to peak HBP levels in non-VRI controls.Results: In total, 394 CSF samples from 103 patients were analyzed for HBP. Seven patients (6.8%) fulfilled VRI criteria. Levels of HBP were significantly higher in VRI subjects (31.7 ng/mL [IQR 26.9-40.7 ng/mL]) compared to non-VRI controls (7.7 ng/mL [IQR 4.1-24.5 ng/mL]) (p = 0.024). The AUC of the receiver operating char-acteristic (ROC) curve was 0.76 (95% confidence interval [CI], 0.62-0.90). Among non-VRI patients, HBP was highest in patients with acute bacterial meningitis. Patients with subarachnoid hemorrhage displayed higher HBP levels than those with traumatic brain injury or shunt dysfunction.Conclusions: HBP levels were higher in VRI subjects and varied between patients and different diagnoses. To validate the clinical usefulness and added value of HBP as a biomarker for VRI, the results need to be confirmed in larger studies with head-to-head comparisons to current biomarkers.
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