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| 6. |
- Bartek, J, et al.
(författare)
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Predictors of recurrence and complications after chronic subdural hematoma surgery: a population-based study.
- 2017
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 106, s. 609-614
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Tidskriftsartikel (refereegranskat)abstract
- To investigate predictors of recurrence and moderate to severe complications after burr-hole surgery for chronic subdural hematoma (cSDH).A retrospective review was conducted in a Scandinavian single center population-based cohort of 759 adult cSDH patients operated with burr-hole surgery between January 1, 2005 and December 31, 2010. Possible predictors of recurrence and complications, assessed using a standardized reporting system of adverse events, were identified and analyzed in univariable analyses. Variables with a P value < 0.10 were included in a multivariable regression model.Recurrence was observed in 85 patients (11.2%), while moderate to severe complications were observed in 35 (4.6%) patients. Bilateral hematoma (OR 2.05, 95 % CI 1.25-3.35, P<0.01) and largest hematoma diameter in millimeters, (OR 1.05, 95 % CI 1.01-1.09, P<0.01) were independent predictors of recurrence in the multivariable model analysis. Glasgow Coma Score (GCS) of <13 (OR 6.06, 95 % CI 2.72-13.51, P<0.01) and Charlson Comorbidity Index (CCI) >1 (OR 2.28, 95 % CI 1.10-4.75, P=0.03) were independent predictors of moderate to severe complications.Recurrence after cSDH surgery is more often encountered in patients with radiological more extensive disease reflected by bilateral hematoma and large hematoma diameter. In contrary, moderate to severe complications are more often seen in patients in worse clinical condition, reflected by decreased level of consciousness and more comorbidities.
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| 8. |
- Bartek, Jiri, et al.
(författare)
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The role of angiotensin converting enzyme inhibitor in patients with chronic subdural hematoma: a Scandinavian population-based multicenter study.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 113
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the role of angiotensin converting enzyme (ACE) inhibitors in recurrence of chronic subdural hematoma (cSDH) after burr-hole surgery.A retrospective review was conducted in a Scandinavian multicenter population-based cohort of 1252 adult cSDH patients operated with burr-hole surgery between January 1, 2005 and December 31, 2010. The risk of cSDH recurrence was assessed in users of ACE inhibitors, users of angiotensin II receptor blockers (ARB) and those without ACE inhibitor treatment (no ACE inhibitor group) using univariable and multivariable regression analyses.There were 98 users (7.8%) of ACE inhibitors, and 63 users (5%) of ARBs only. The recurrence rate in the ACE inhibitor group was 16.3% (n=16), compared to 13.3% (n=153) in the no ACE inhibitor group (p=0.39) and 14.3% (n=9) in the ARB group (p=0.73). When comparing groups, age (p=0.01), Charlson comorbidity Index (p=0.01), the use of platelet inhibitors (p=0.001) and use of anticoagulants (p=0.01) differed between the ACE inhibitor and the no ACE inhibitor group. Only age differed (p=0.03) between the ACE inhibitor and ARB groups. In the analyses adjusted for differences in baseline characteristics, ACE inhibitor treatment did not influence risk for recurrence (OR 1.2, 95 % CI 0.7-2.2 p=0.46).Use of ACE inhibitors was not associated with risk of recurrence following burrhole surgery for cSDH in this population based study..
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| 9. |
- Basma, Jaafar, et al.
(författare)
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Minimizing Collateral Brain Injury Using a Protective Layer of Fibrin Glue : Technical Note
- 2015
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 84:6, s. 2030-2036
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Neurosurgical procedures expose the brain surface to a constant risk of collateral injury. We describe a technique where the brain surface is covered with a protective layer of fibrin glue and discuss its advantages. METHODS: A thin layer of fibrin glue was applied on the brain surface after its exposure in 34 patients who underwent different craniotomies for tumoral and vascular lesions. Data of 35 more patients who underwent standard microsurgical technique were collected as a control group. Cortical and pial injuries were evaluated using an intra-operative visual scale. Eventual abnormal signals at the early postoperative T2-weighted fluid-attenuated inversion recovery (T2FLAIR) magnetic resonance imaging (MRI) sequences were evaluated in oncological patients. RESULTS: Total pial injury was noted in 63% of cases where fibrin glue was not used. In cases where fibrin glue was applied, a significantly lower percentage of 26% (P < 0.01) had pial injuries. Only 9% had injuries in areas covered with fibrin glue (P < 0.0001). Early postoperative T2FLAIR MRI confirmed the differences of altered signal around the surgical field in the two populations. CONCLUSION: We propose beside an appropriate and careful microsurgical technique the possible use of fibrin glue as alternative, safe, and helpful protection during complex microsurgical dissections. Its intrinsic features allow the neurosurgeon to minimize the cortical manipulation preventing minor collateral brain injury.
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| 11. |
- Campanella, Fabio, et al.
(författare)
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Localizing Memory Functions in Brain Tumor Patients : Anatomical Hotspots over 260 Patients
- 2018
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 120, s. e690-e709
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Memory complaints are common in patients after brain tumor, but is difficult to map memory functions during awake surgery, to preserve them. Thus we analyzed one of the largest data sets on clinical, surgical, and anatomical correlates of memory in patients with brain tumor to date, providing anatomical hotspots for short and long-term memory functions. METHODS: A total of 260 patients with brain tumor (130 high-grade gliomas; 76 low-grade gliomas [LGG]; 54 meningiomas) were tested on 2 commonly used short-term memory (Digit Span Forward and Corsi Spatial Span) and 2 long-term memory tasks (Narrative Memory and Delayed Recall of Rey Figure). Patients were evaluated before and immediately after surgery and (for LGG) after 4 months and data analyzed by means of analysis of covariance and the voxel-based lesion-symptom mapping technique. RESULTS: As expected, patients with high-grade gliomas were already impaired before surgery, whereas patients with meningioma were largely unimpaired. Patients with LGG were unimpaired before surgery, but showed significant performance drop immediately after, with good recovery within few months. Voxel-based lesion-symptom mapping analyses identified specific anatomical correlates for verbal memory tasks, whereas visuospatial tasks provided good sensitivity to cognitive damage but failed to show anatomical specificity. Anatomical hotspots identified were in line with both previous functional magnetic resonance imaging and clinical studies on other neurological populations. CONCLUSIONS: Verbal memory tasks revealed a set of specific anatomical hotspots that might be considered eloquent for verbal memory functions, unlike visuospatial tasks, suggesting that commonly used spatial memory tasks might not be optimal to localize the damage, despite an otherwise good sensitivity to cognitive damage.
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| 12. |
- Campanella, Fabio, et al.
(författare)
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Long-Term Cognitive Functioning and Psychological Well-Being in Surgically Treated Patients with Low-Grade Glioma
- 2017
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 103, s. 799-808.e9
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this work is to provide an in-depth investigation of the impact of low-grade gliomas (LGG) and their surgery on patients' cognitive and emotional functioning and well-being, carried out via a comprehensive and multiple-measure psychological and neuropsychological assessment.Patients and Methods: Fifty surgically treated patients with LGG were evaluated 40 months after surgery on their functioning over 6 different cognitive domains, 3 core affective/emotional aspects, and 3 different psychological well-being measures to obtain a clearer picture of the long-term impact of illness and surgery on their psychological and relational world. Close relatives were also involved to obtain an independent measure of the psychological dimensions investigated.Results: Cognitive status was satisfactory, with only mild short-term memory difficulties. The affective and well-being profile was characterized by mild signs of depression, good satisfaction with life and psychological well-being, and good personality development, with patients perceiving themselves as stronger and better persons after illness. However, patients showed higher emotional reactivity, and psychological well-being measures were negatively affected by epileptic burden. Well-being was related to positive affective/emotional functioning and unrelated to cognitive functioning. Good agreement between patients and relatives was found.Conclusions: In the long-term, patients operated on for LGG showed good cognitive functioning, with no significant long-term cognitive sequelae for the extensive surgical approach. Psychologically, patients appear to experience a deep psychological change and maturation, closely resembling that of so-called posttraumatic growth, which, to our knowledge, is for the first time described and quantified in patients with LGG.
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| 15. |
- Drewes, Christina, et al.
(författare)
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Perioperative and postoperative quality of life in glioma patients - A longitudinal cohort study.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- Few studies assess patient-reported quality of life (QoL) in glioma patients undergoing surgery, and even fewer provide longitudinal data. Accordingly, there is little knowledge about the changes of QoL over time in glioma patients. We sought to explore peri- and postoperative development of generic QoL during the first six months after primary glioma surgery.136 adult patients undergoing primary surgery for high-grade (HGG) or low-grade (LGG) glioma were prospectively included in this explorative, longitudinal study. Patient-reported QoL was measured with the generic tool EQ-5D 3L preoperatively and at 1 and 6 months after surgery.At group level, there was no difference in EQ-5D index values in patients with HGG compared to patients with LGG at baseline or at 1 month. At 6 months, EQ-5D index values in HGG patients had deteriorated significantly (p<0.001), but remained stable in LGG patients. Individual level QoL development was more diverse. American Society of Anesthesiology class ≥3, resection grades other than gross total resection (GTR) and HGG were identified as independent predictors for negative development of QoLbetween 1 and 6 months after surgery.At group level, development of generic QoL between baseline and 1 and 6 months postoperatively seems to follow the natural disease trajectories of LGG and HGG, with deterioration in HGG patients at 6 months. Individual development of QoL is heterogeneous. HGG, resection grades other than GTR and preoperative comorbidity are predictors of postoperative QoL-impairment.
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| 19. |
- Jakobsson, Max, et al.
(författare)
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Prediction of Objectively Measured Physical Activity and Self-Reported Disability Following Lumbar Fusion Surgery.
- 2019
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 121
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the predictive value of preoperative fear-avoidance factors (self-efficacy for exercise, pain catastrophizing, kinesiophobia, and depression), walking capacity, and traditional predictor variables for predicting postoperative changes in physical activity level and disability 6 months after lumbar fusion surgery in patients with chronic low back pain (LBP). METHODS: We prospectively enrolled 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes in 1-3 segments of the lumbar spine. Associations between the predictors and the dependent variables were investigated with multiple linear regression analysis. Dependent variables were physical activity level as objectively measured with a triaxial accelerometer and disability as measured with the Oswestry Disability Index. RESULTS: Preoperative physical activity level (β=-0.349; P < 0.001) and self-efficacy for exercise (β= 0.176; P= 0.021) were significant predictors of the postoperative change in physical activity. Preoperative disability (β=-0.790; P < 0.001), self-efficacy for exercise (β= 0.152; P= 0.024), and pain catastrophizing (β= 0.383; P= 0.033) were significant predictors for the change in the Oswestry Disability Index. CONCLUSIONS: Patients with low levels of preoperative physical activity were more likely to increase their level of physical activity after lumbar fusion surgery, especially when their self-efficacy for exercise was high. However, most of these patients still had low levels of physical activity after surgery, and they may therefore need extra support in increasing their postoperative physical activity levels.
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| 20. |
- Jervaeus, Anna, et al.
(författare)
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Does the Time Trade-off Method Reflect Health-Related Quality of Life? : A Mixed Methods Analysis of Preference Measures 10 Years After Aneurysmal Subarachnoid Hemorrhage
- 2019
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 126, s. 11-20
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate if the time trade-off (TTO) method reflects health-related quality of life (HRQoL) 10 years after an aneurysmal subarachnoid hemorrhage (aSAH).Methods: A cross-sectional study with a mixed-methods approach was used to follow up 208 patients treated for aSAH. Data were collected with intramethod mixing; the quantitative data consisted of the EQ-5D-3L instrument and a TTO question, and the qualitative data comprised motivations to the TTO answer. The quantitative data were analyzed statistically and comparisons were made between participants willing to trade off years and those not willing to trade off years. The qualitative data were merged in a matrix and analyzed with manifest content analysis.Results: Participants willing to trade off years scored significantly lower HRQoL, and the correlation between EQ-5Dindex and EQ VAS to TTO values were rs = 0.369 (P < 0.001) and rs = 0.345 (P < 0.001), respectively. In the content analysis, 4 categories emerged: perceived full health or satisfactory life; adaptability and managing strategies; the importance of hope and meaning in life; and unacceptable changes do not make life worth living. The results showed that several reasons other than health status were evident when expressing the willingness to trade off or not trade off life-years.Conclusions: Individuals willing to trade off years showed significantly poorer HRQoL; however the TTO method did not seem to fully reflect HRQoL. Most participants did not want to trade off years, despite their living with severe disability, making it difficult to fully rely on the TTO method in evaluation of medical outcome.
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| 22. |
- Kihlström Burenstam Linder, Lars, et al.
(författare)
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Patient-Specific Titanium-Reinforced Calcium Phosphate Implant for the Repair and Healing of Complex Cranial Defects
- 2019
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Ingår i: World Neurosurgery. - : ELSEVIER SCIENCE INC. - 1878-8750 .- 1878-8769. ; 122, s. E399-E407
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The reconstruction of complex cranial defects is challenging and is associated with a high complication rate. The development of a patient-specific, titanium-reinforced, calcium phosphate-based (CaP-Ti) implant with bone regenerative properties has previously been described in 2 case studies with the hypothesis that the implant may improve clinical outcome. OBJECTIVE: To identify whether the introduction of CaP-Ti implant has the potential to improve clinical outcome. METHODS: A retrospective review of all patients having undergone CaP-Ti cranioplasty was conducted. Comprehensive clinical data were collected from the hospital computer database and patient records. Bone formation and osseointegration were analyzed in a single retrieval specimen. RESULTS: Fifty patients, with 52 cranial defects, met the inclusion criteria. The patient cohort displayed a previous failure rate of 64% (32/50) with autologous bone, alloplastic materials, or both. At a median follow-up time of 25 months, the explantation rate due to either early postoperative infection or persistent wound dehiscence was 1.9% (1/53) or 3.8% (2/53), respectively. Surgical intervention with local wound revision was required in 2 patients without the need of implant removal. One patient had a brain tumor recurrence, and the implant was explanted 31 months after implantation. Histologic examination showed that the entire implant was partly yet evenly transformed into vascularized compact bone. CONCLUSION: In the present study the CaP-Ti implant appears to have improved the clinical outcomes in a cohort of patients with a high rate of previous cranioplasty failures. The bone regenerative effect may in particular have an impact on the long-term success rate of the implant.
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| 23. |
- Maduri, Rodolfo, et al.
(författare)
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Image Merge Tailored Access Resection (IMTAR) of Spinal Intradural Tumors. Technical Report of 13 Cases.
- 2017
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 98, s. 594-602
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Standard translaminar approaches for intradural extramedullary (IDEM) tumors require extensive soft tissue dissection and partial facet removal. Ventral lesions may necessitate wider bone resection with subsequent possible spinal instability. Any manipulation of an already compromised spinal cord may lead to neurological injury. We describe an image-guided minimal access technique for IDEM tumor resection.METHODS: Retrospective chart review of 13 consecutive patients after institutional ethics committee approval. We superimpose preoperative magnetic resonance imaging data with intraoperative 3-dimensional fluoroscopic images, allowing to simultaneously visualize osseous anatomy and the soft tissue lesion using appropriate windowing. We then plan optimal angle of trajectory to the tumor, which defines the skin incision and the transmuscular trajectory. A tubular retractor is placed to span the tumor. Microsurgical tumor resection is then carried out using this angle of approach.RESULTS: Thirteen patients (mean age. 57 years; male-to-female ratio, 10:3) were operated on during 28 months. Gross total resection was achieved in all patients. Neurological improvement occurred in 12 of the 13 patients. There was no neurological deficit outside of the expected sensory loss due to intentional nerve root sacrifice. No mechanical pain nor tumor recurrence were noted during the follow-up (mean, 16 months; range, 2-30 months).CONCLUSIONS: Image merge tailored access resection appears to be at least equivalent in terms of tumor resection, blood loss, and complications to other tubular techniques. It may reduce risks of neurological deficit and spine instability. Image merge tailored access resection is a novel application of merging intraoperative fluoroscopic images with preoperative magnetic resonance images for tailored IDEM resection.
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| 24. |
- Pyykko, Okko T., et al.
(författare)
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Incidence, Comorbidities, and Mortality in Idiopathic Normal Pressure Hydrocephalus
- 2018
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Ingår i: World Neurosurgery. - : ELSEVIER SCIENCE INC. - 1878-8750 .- 1878-8769. ; 112, s. E624-E631
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Tidskriftsartikel (refereegranskat)abstract
- OBJECT: To investigate the incidence, comorbidities, mortality, and causes of death in idiopathic normal pressure hydrocephalus (iNPH). METHODS: A cohort of 536 patients with possible NPH from a defined population with a median follow-up time of 5.1 years, (range 0.04-19.9 years) was included in the study. Patients were evaluated by brain imaging and intraventricular pressure monitoring, with a brain biopsy specimen immunostained against amyloid-beta and hyper-phosphorylated tau. Hospital records were reviewed for vascular diseases and type 2 diabetes mellitus (T2DM). Death certificates and yearly population of the catchment area were obtained from national registries. RESULTS: A total of 283 patients had a clinical diagnosis of iNPH, leading to a median annual incidence of 1.58 iNPH patients per 100,000 inhabitants (range, 0.8-4.5). Alzeimer disease-related brain biopsy findings were less frequent in iNPH patients than in non-iNPH patients (P < 0.05). An overrepresentation of hypertension (52% vs. 33%, P < 0.001) and T2DM (23% vs. 13%, P = 0.002) was noted in iNPH patients. Age (hazard ratio [HR] 1.04/year, 95% confidence interval [CI] 1.03-1.06, P< 0.001) and T2DM (HR 1.63, 95% CI 1.23-2.16, P < 0.001) increased the risk of death in the iNPH patients and in the total population. iNPH was associated with decreased risk of death (HR 0.63, 95% CI 0.50-0.78, P < 0.001). The most frequent causes of death were cardiovascular and cerebrovascular disease. Dementia as a cause of death was more common in non-iNPH patients (27% vs. 10%, P < 0.001). CONCLUSIONS: Hypertension and T2DM are common in iNPH and the latter causes excess mortality in the affected patients.
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| 25. |
- Ravn Munkvold, Bodil Karoline, et al.
(författare)
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Pre- and postoperative headache in patients with intracranial tumors.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- We sought to examine prevalence of headache in patients with histopathologically verified intracranial tumors scheduled for surgery, and assess change in headache 1 and 6 months after surgical resection. Possible tumor and patient related predictors for preoperative headache and early postoperative symptom relief were also explored.The European Organization for Research and Treatment of Cancer (EORTC) has developed a quality of life questionnaire (EORTC QLQ-C30) with a brain cancer specific module, QLQ-BN20, containing 20 questions rating symptoms the past week on an ordinal scale ranging from 1-4. Analyses are based on question 4 in this questionnaire.In this prospective population based cohort study of 507 patients we found that headache is a frequent symptom in patients with intracranial neoplasms. 52% reported some degree of preoperative headache, and the prevalence dropped to 43% and 30% 1 and 6 months postoperatively. 19% and 9% reported postoperative worsening or new headache 1 and 6 months after surgery. Younger age, female gender and occipital tumor location were significant predictors for both preoperative headache and early postoperative relief. Additionally, Karnofsky Performance Status (KPS) below 70 was a predictor for headache relief 1 month after surgery. No independent risk factors for worsening or new headache after surgery were identified.Headache is a common symptom in patients with intracranial tumors, especially in younger and female patients. Many patients experience improvement after surgery, and younger age, female gender, occipital tumor location and functional dependence were identified as factors associated with early postoperative headache relief.
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| 26. |
- Ravn Munkvold, Bodil Karoline, et al.
(författare)
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The diagnostic properties of intraoperative ultrasound in glioma surgery and factors associated with gross total tumor resection.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- In glioma operations, we sought to analyze sensitivity, specificity and predictive values of intraoperative 3D ultrasound (US) for detecting residual tumor compared to early postoperative MR imaging. Factors possibly associated with radiological complete resection were also explored.144 operations for diffuse supratentorial gliomas were included prospectively in an unselected, population-based single institution series. Operating surgeons filled out a questionnaire immediately after surgery, stating if residual tumor was seen with US at the end of resection and rated US image quality (good, medium, poor). Extent of surgical resection was estimated from pre- and postoperative MRI images.Overall specificity was 85% for "no tumor remnant" seen in US images at the end of resection as compared to postoperative MRI findings. Sensitivity was 46%, but tumor remnants seen on MRI were usually small (median 1.05 ml) in operations with false negative US findings. Specificity was highest in low-grade glioma operations (94%), and lowest in patients who had previously undergone radiotherapy (50%). Smaller tumor volume and superficial location were factors significantly associated with gross total resection in a multivariable logistic regression analysis, while good ultrasound image quality did not reach statistical significance (p = 0.061).The specificity of intraoperative US is rather good, but sensitivity for detecting the last milliliter is low compared to postoperative MRI. Tumor volume and tumor depth are the predictors of achieving gross total resection, while ultrasound image quality was not.
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| 27. |
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| 28. |
- Sjåvik, Kristin, et al.
(författare)
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Venous thromboembolism prophylaxis in meningioma surgery - a population based comparative effectiveness study of routine mechanical prophylaxis with or without preoperative low molecular weight heparin
- 2016
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 88, s. 320-326
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Tidskriftsartikel (refereegranskat)abstract
- Object: Venous thromboembolism (VTE) is a serious complication after intracranial meningioma surgery. To what extent systemic prophylaxis with pharmacotherapy is beneficial with respect to VTE risk, or associated with increased risk of bleeding and postoperative hemorrhage, remains debated. The current study aimed to clarify the risk-benefit of prophylactic pharmacotherapy initiated the evening before craniotomy for meningioma. METHODS: In a Scandinavian population-based cohort we conducted a retrospective review of 979 operations for intracranial meningioma between 2007 and 2013 at three neurosurgical centers with population-based referral. We compared two different treatment strategies analyzing frequencies of VTE and proportions of postoperative intracranial hematomas requiring surgery or intensified subsequent observation or care (ICU or other intensified observation and/or treatment). One neurosurgical center favored preoperative prophylaxis with low-molecular weight heparin (LMWH) ("LMWH routine group") in addition to mechanical prophylaxis, while two centers favored mechanical prophylaxis with LMWH only given as needed in cases of delayed mobilization ("LMWH as needed group"). RESULTS: In the LMWH routine group, VTE was diagnosed after 24/626 operations (3.9%), while VTE was diagnosed after 11/353 (3.1%) operations in the LMWH as needed group (p=0.56). Clinically relevant postoperative hematomas occurred after 57/626 operations (9.1%) in the LMWH routine group compared to 23/353 (6.5%) in the LMWH as needed group (p=0.16). Surgically evacuated postoperative hematomas occurred after 19/626 operations (3.0%) in the LMWH routine group compared to 8/353 operations (2.3%) in the LMWH as needed group (p=0.26). CONCLUSION: There is no benefit of routine preoperative LMWH starting before intracranial meningioma surgery. Neither could we for primary outcomes detect a significant increase in clinically relevant postoperative hematomas secondary to this regimen. We suggest that "as-needed" perioperative administration of LMWH, reserved for patients with excess risk due to delayed mobilization, is effective and also appears to be the safest strategy.
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| 29. |
- Stensjøen, Anne Line, et al.
(författare)
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Does Pretreatment Tumor Growth Hold Prognostic Information for Patients with Glioblastoma?
- 2017
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 101
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Tidskriftsartikel (refereegranskat)abstract
- Glioblastomas are highly aggressive and heterogeneous tumors, both in terms of patient outcome and molecular profile. Magnetic resonance imaging of tumor growth could potentially reveal new insights about tumor biology noninvasively. The aim of this exploratory retrospective study was to investigate the prognostic potential of pretreatment growth rate of glioblastomas, after controlling for known prognostic factors.A growth model derived from clinical pretreatment postcontrast T1-weighted magnetic resonance imaging images was used to divide 106 glioblastoma patients into 2 groups. The "faster growth" group had tumors growing faster than expected based on their volume at diagnosis, whereas the "slower growth" group had tumors growing slower than expected. Associations between tumor growth and survival were examined by the use of multivariable Cox regression and logistic regression.None of the known prognostic factors were significantly associated with tumor growth. An extended multivariable Cox model showed that during the first 12 months of follow-up, there was no significant difference in survival between faster and slower growing tumors. Beyond 12 months' follow-up, however, there was a significant, independent survival benefit in having a tumor with slower pretreatment growth. In a multiple logistic regression model including patients receiving both radiotherapy and chemotherapy (n= 82), slower pre-treatment growth of the tumor was shown to be a significant predictor of 2-year survival (odds ratio 4.4).Pretreatment glioblastoma growth harbors prognostic information. Patients with slower growing tumors have higher odds of survival beyond 2 years, adjusted for other prognostic factors.
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| 30. |
- Viken, Heidi Heitmann, et al.
(författare)
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When are complications following brain tumor surgery detected?
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750.
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Tidskriftsartikel (refereegranskat)abstract
- To optimize follow-up and surveillance routines after intracranial surgery, knowledge about when complications occur is needed. We sought to explore when postoperative complications are detected after brain tumor surgery, and assess the severity of these.We did a retrospective review of hospital records in 1291 adult patients undergoing elective craniotomy for intracranial tumors between 2008-2016 at our institution. Medical history, comorbidity, registered outcomes within 30 days and time of detection of complications were registered. The severity and nature of complications were graded using the Landriel classification system.708 complications were registered in 465 (36.0%) operations within the first 30 days. 30.6% experienced mild or moderate complications (grade I-II), 5.4% experienced severe or fatal complications (grade III-IV). 5.7% (n=74) developed complications within 24 h. 45.7% of severe and fatal complications and 8.6% of mild and moderate complications were detected within 24 h, while 77.1% and 57.5%, respectively, were detected within one week. Multivariate analysis revealed that Karnofsky Performance Status < 70 and longer duration of surgery were factors associated with developing severe or fatal complications.Mild and moderate complications, dominated by extracranial infections such as urinary tract infections and pneumonias are very common after intracranial tumor surgery. Detection rates for mild and moderate complications are probably much affected by local routines for surveillance, screening, discharge, documentation, and follow up, perhaps limiting usefulness as a quality measure. Severe and fatal complications are mainly detected in the early postoperative course.
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| 31. |
- Vlachogiannis, Pavlos, et al.
(författare)
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Interleukin-6 Levels in Cerebrospinal Fluid and Plasma in Patients with Severe Spontaneous Subarachnoid Hemorrhage
- 2019
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Ingår i: World Neurosurgery. - : ELSEVIER SCIENCE INC. - 1878-8750 .- 1878-8769. ; 122, s. E612-E618
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Inflammatory processes play a key role in the pathophysiology of subarachnoid hemorrhage (SAH). This study evaluated whether different temporal patterns of intrathecal and systemic inflammation could be identified in the acute phase after SAH. The intensity of the inflammation was also assessed in clinical subgroups. METHODS: Cerebrospinal fluid (CSF) and blood samples were collected at days 1, 4, and 10 after ictus in 44 patients with severe SAH. Interleukin-6 (IL-6) was analyzed by a routine monoclonal antibody-based method. Median IL-6 values for each day were calculated. Day 4 IL-6 values were compared in dichotomized groups (age, sex, World Federation of Neurosurgical Societies [WFNS] grade, Fisher scale grade, outcome, vasospasm, central nervous system infection and systemic infections). RESULTS: CSF IL-6 levels were significantly elevated from day 1 to days 4 and 10, whereas plasma IL-6 showed a different trend at lower levels. Median CSF IL-6 concentrations for days 1, 4, and 10 were 876.5, 3361, and 1567 ng/L, whereas plasma was 26, 27.5, and 15.9 ng/L, respectively. No significant differences in CSF concentrations were observed between the subgroups, with the most prominent one being in day 4 IL-6 in the WFNS subgroups (grades 1-3 vs. 4-5, 1158.5 vs. 5538 ng/L; P = 0.056). Patients with systemic infection had significantly higher plasma IL-6 concentrations than patients without infection (31 vs. 16.05 ng/L, respectively; P = 0.028). CONCLUSIONS: Distinctly different inflammatory patterns could be seen intrathecally compared with the systemic circulation. In plasma, a significant difference in the intensity of the inflammation was seen in cases with systemic infection. No other subgroup showed statistically significant differences.
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| 32. |
- Volovici, Victor, et al.
(författare)
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Variation in Guideline Implementation and Adherence Regarding Severe Traumatic Brain Injury Treatment : A CENTER-TBI Survey Study in Europe
- 2019
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 125, s. e515-e520
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Guidelines may reduce practice variation and optimize patient care. We aimed to study differences in guideline use in the management of traumatic brain injury (TBI) patients and analyze reasons for guideline non-adherence.METHODS: As part of a prospective, observational, multicenter European cohort study, participants from 68 centers in 20 countries were asked to complete 72-item questionnaires regarding their management of severe TBI. Six questions with multiple sub-questions focused on guideline use and implementation.RESULTS: Questionnaires were completed by 65 centers. Of these, 49 (75%) reported use of the Brain Trauma Foundation guidelines for the medical management of TBI or related institutional protocols, 11 (17%) used no guidelines, and 5 used other guidelines (8%). Of 54 centers reporting use of any guidelines, 41 (75%) relied on written guidelines. Four centers of the 54 (7%) reported no formal implementation efforts. Structural attention to the guidelines during daily clinical rounds was reported by 21 centers (38%). The most often reported reasons for non-adherence were "every patient is unique" and the presence of extracranial injuries, both for centers that did and did not report the use of guidelines.CONCLUSIONS: There is substantial variability in the use and implementation of guidelines in neurotrauma centers in Europe. Further research is needed to strengthen the evidence underlying guidelines and to overcome implementation barriers.
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| 33. |
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| 34. |
- Al-Shudifat, Abdul Rahman Mohummad, et al.
(författare)
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A Patient-Assessed Morbidity to Evaluate Outcome in Surgically Treated Vestibular Schwannomas
- 2016
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750. ; 94, s. 2-550
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Outcome after treatment of vestibular schwannomas can be evaluated by health providers as mortality, recurrence, performance, and morbidity. Because mortality and recurrence are rare events, evaluation has to focus on performance and morbidity. The latter has mostly been reported by health providers. In the present study, we validate 2 new scales for patient-assessed performance and morbidity in comparison with different outcome tools, such as quality of life (QOL) (European Quality of Life-5 dimensions [EQ-5D]), facial nerve score, and work capacity.METHODS: There were 167 total patients in a retrospective (n = 90) and prospective (n = 50) cohort of surgically treated vestibular schwannomas. A new patient-assessed morbidity score (paMS), a patient-assessed Karnofsky score (paKPS), the patient-assessed QOL (EQ-5D) score, work capacity, and the House-Brackmann facial nerve score were used as outcome measures. Analysis of paMS components and their relation to other outcomes was done as uni- and multivariate analysis.RESULTS: All outcome instruments, except EQ-5D and paKPS, showed a significant decrease postoperatively. Only the facial nerve score (House-Brackmann facial nerve score) differed significantly between the retrospective and prospective cohorts. Out of the 16 components of the paMS, hearing dysfunction, tear dysfunction, balance dysfunction, and eye irritation were most often reported. Both paMS and EQ-5D correlated significantly with work capacity.CONCLUSIONS: Standard QOL and performance instruments may not be sufficiently sensitive or specific to measure outcome at the cohort level after surgical treatment of vestibular schwannomas. A morbidity score may yield more detailed information on symptoms that can be relevant for rehabilitation and occupational training after surgery.
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| 35. |
- Herou, Erik, et al.
(författare)
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Acute Traumatic Brain Injury Mortality in the elderly.
- 2015
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Ingår i: Surgical Neurology. - : Elsevier BV. - 0090-3019. ; 83:6, s. 996-1001
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Tidskriftsartikel (refereegranskat)abstract
- Despite recent progress, prognosis for the elderly (defined as aged 70 or more) afflicted by Traumatic Brain Injury (TBI) is unfavorable and surgical intervention remains controversial. Research during the last decade on the mortality rates or prognostic factors for survival in the elderly is limited.
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| 36. |
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| 37. |
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| 38. |
- Nilsson, Anna, et al.
(författare)
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Silver-Coated Ventriculostomy Catheters Do Not Reduce Rates of Clinically Diagnosed Ventriculitis
- 2018
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750. ; 117, s. 411-416
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of ventriculitis. Methods: During 1 year, clinical routine was changed from inserting noncoated catheters to silver-coated catheters. Rate of ventriculitis was compared between patient groups based on catheter type. To examine the clinical impact of silver coating, ventriculitis was defined as cases where antibiotic treatment was initiated on clinical suspicion. Results: Among 296 patients (186 noncoated and 110 silver-coated catheters), 18.9% were treated for ventriculitis, with 21.0% in the noncoated group and 15.5% in the silver-coated group (P = 0.242). Silver coating did not reduce the rate of positive cultures. Duration of EVD treatment was the single significant risk factor for ventriculitis. Silver-coated catheters did not reduce the need for cerebrospinal fluid shunt placement, days with antibiotics, days with EVD, or days in the intensive care unit. Conclusions: The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay.
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| 39. |
- Nittby, Henrietta Redebrandt, et al.
(författare)
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A Subgaleal Hematoma That Turned Out to Be a B-Cell Lymphoma
- 2016
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750. ; 93, s. 489-489
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Tidskriftsartikel (refereegranskat)abstract
- Background Subgaleal masses are relatively common in the clinical praxis, and after a trauma to the head, a subgaleal hematoma is usually suspected. However, other differential diagnoses, such as malignant tumors, should be kept in mind despite a history of a previous trauma. Case description and Conclusions We report a case of a subgaleal mass that was clinically and radiologically diagnosed as a subgaleal hematoma in a patient on antiplatelet therapy. The patient had a history of trauma to her head, but pathologic examination after surgery unexpectedly showed a malignant B-cell lymphoma. A review of the literature is also presented.
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| 40. |
- Troberg, Ebba, et al.
(författare)
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Prediction of Long-Term Outcome After Intracerebral Hemorrhage Surgery
- 2019
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750. ; 124, s. 96-105
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Tidskriftsartikel (refereegranskat)abstract
- Background: Surgery for spontaneous primary intracerebral hemorrhage (ICH) remains controversial. Previous surgical trials have primarily focused on short-term mortality while studies on long-term functional outcome are rare. We therefore conducted this retrospective study of long-term outcome on all ICH patients who underwent craniotomy at a single neurosurgical center during a 10-year period. Methods: We included all patients >15 years of age who underwent evacuation of spontaneous ICH at Skåne University Hospital between 2003 and 2012. Case fatality at 30 days, 1 year, and long-term follow-up (up to 10 years) were analyzed in relation to potential predictors of outcome. Long-term functional outcome was assessed in 2013 by telephone interview using the modified Rankin Scale (mRS). Results: Of 229 operated patients, overall case fatality was 20% at 30 days and 31% at 1 year. For patients with supratentorial ICH, the case fatality was 16% at 30 days and 27% at 1 year, and 29% at 30 days and 41% at 1 year for patients with cerebellar ICH. The most consistent independent predictors of mortality were preictal heart disease and level of consciousness on admission. Of 185 patients with long-term functional outcome available (median follow-up 6.14 years), 44 of them (24%) had a good outcome (mRS score 0–3) and 141 (76%) were severely disabled or dead (mRS score 4–6). Conclusions: The case fatality in our study was comparatively low, but most survivors lived dependently several years after surgery. Heart disease and level of consciousness were the most consistent predictors of mortality.
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| 41. |
- Uvelius, Erik, et al.
(författare)
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Quality of Life and Work Capacity Are Unrelated to Approach or Complications After Pituitary Surgery
- 2017
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750. ; 108, s. 24-32
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Tidskriftsartikel (refereegranskat)abstract
- Objective Endoscopic pituitary surgery has shown favorable clinical outcomes. Less is known about the impact of surgical approaches on health-related quality of life (HRQoL) and work capacity. The present study was undertaken to compare transsphenoidal microscope-assisted surgery with endoscopic transsphenoidal surgery regarding preoperative and surgical factors for the final outcome of HRQoL and work capacity. Methods In a retrospective study of patients operated on for pituitary adenoma, outcome was compared between those operated on before and after transition with endoscopic surgery at our department. Data were gathered via patient questionnaires and patients' files. Results After exclusions, 235 patients were included (99 microsurgical and 136 endoscopic). Frequency of complications was similar but tumor size was significantly larger in the endoscopic group. Complications did not affect HRQoL or work capacity. HRQoL was not affected by surgical technique but showed an overall trend toward lower values compared with the general population. Sick leave, return to work frequency, and permanent sick leave were not affected by surgical technique. Female gender was a factor for lower ratings in all outcome variables. Conclusions Surgical technique does not influence HRQoL or work capacity in this long-term follow-up although both are decreased compared with the general population. We conclude that fully endoscopic pituitary surgery, despite including larger tumors, bears the same risk for complications as microsurgery. In addition, females have a greater risk for decrease in HRQoL and work ability. This factor should be taken into account when informing patients and appreciating expectations of treatment.
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