Publications by authors named "Brawanski A"

Background: Accurate and repeatable measurement of high-grade glioma (HGG) enhancing (Enh.) and T2/FLAIR hyperintensity/edema (Ed.) is required for monitoring treatment response.

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Purpose: Brain metastases (BM) can present a displacing or infiltrating growth pattern, independent of the primary tumor type. Previous studies have shown that tumor cell infiltration at the macro-metastasis/brain parenchyma interface (MMPI) is correlated with poor outcome. Therefore, a pre-therapeutic, non-invasive detection tool for potential metastatic cell infiltration at the MMPI would be desirable to help identify patients who may benefit from a more aggressive local treatment strategy.

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  • The study investigates the relationship between the release of CGRP in the cerebrospinal fluid and health-related quality of life after spontaneous subarachnoid hemorrhage (sSAH).
  • Twenty-six patients with sSAH underwent various treatments, and daily CSF samples were analyzed for CGRP levels while patients reported their health status using standardized assessments.
  • Higher CGRP levels were found to correlate with an increased symptom burden, including anxiety and depression, indicating that CGRP may serve as a prognostic factor for psychological outcomes following sSAH.
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  • Postoperative spinal epidural hematoma (pSEH) is a rare but serious complication occurring in 0.69% of patients after spinal decompression surgery, often leading to neurologic impairment if not treated promptly.
  • A study of 6,024 patients identified anticoagulant use, abnormal preoperative coagulation tests, and smoking as significant risk factors for developing pSEH, with multiple-level surgeries also showing a trend toward increased risk.
  • Patients presenting only with pain tend to have better recovery outcomes, whereas those with paraplegia face a higher likelihood of poor neurologic recovery.
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Hydrocephalus with the need for shunt placement is a common sequela after aneurysmal subarachnoid hemorrhage (aSAH). In 2009 Chan et al. published a formula to predict shunt dependency in SAH patients, the failure risk index (FRI).

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  • The study investigates the occurrence of cerebrospinal fluid (CSF) fistula following incidental durotomy (ID) during spinal surgeries, finding a low incidence but highlighting that revision surgeries have the highest risk.
  • Among 6024 patients, 22 developed CSF fistulas, predominantly in the lumbar region, with no significant differences noted in intraoperative management techniques between the CSF fistula group and those with ID only.
  • Postoperative care strategies, particularly prolonged bed rest and laxative therapy, were found to significantly reduce the risk of developing CSF fistulas, with affected patients requiring longer hospital stays.
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  • The philosophy in oncologic neurosurgery has shifted focus from aggressive resection to preserving neurological function.
  • Recent advancements in visualization techniques, both before and during surgery, enhance the safety and effectiveness of neurosurgical procedures by allowing better observation of tumors and surrounding brain tissue.
  • Our institution's approach combines various neuroimaging methods to improve surgical outcomes for patients with high grade gliomas, as highlighted in a recent study on patient survival trends following the establishment of our Neuro-Oncology Center.
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Background: The use of endoscopes in neurosurgery is well established, but the integration of a full high definition signaling, 45° angled endoscopic tool into a digital surgical microscope, is new. We report our first experiences in a cadaveric study and a clinical case series using the new microinspection tool QEVO that serves as a plug-in feature for the recently launched KINEVO 900 digital visualization platform (CARL ZEISS MEDITEC, Oberkochen, Germany). For illustration purposes, we offer video footage.

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Goal: Cerebral amyloid angiopathy (CAA) is the second-most common cause of nontraumatic intracerebral hemorrhages (ICH), surpassed only by uncontrolled hypertension. We characterized the percentage, risk factors, and comorbidities of patients suffering from CAA-related ICH in relation to long-term outcomes.

Material And Methods: We performed retrospective analyses and clinical follow-ups of individuals suffering from ICH who were directly admitted to neurosurgery between 2002 and 2016.

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  • Epidermoid cysts are non-cancerous growths, and the surgery aims to remove them completely while protecting important nerves in the brain.
  • A case is presented of a 31-year-old man who experienced headaches and brief loss of consciousness, leading to the discovery of a mass at the cerebellopontine angle, identified as an epidermoid cyst during surgery.
  • The surgery was successful, with no complications, and the patient reported being symptom-free three months post-operation; a video detailing the surgery is available at the provided link.
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Background: Herein, we report our clinical experience with the novel polyethylene glycol-covered matrix dural onlay, Hemopatch® (Baxter Deutschland GmbH, Unterschleißheim, Germany) for the prevention of postoperative cerebrospinal fluid (CSF) fistulas.

Methods: Retrospectively, 22 consecutive patients (11 females, 11 males, mean age: 49.8 years, range: 15-77 years) with oncological and vascular intracranial lesions were included in this study.

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Objective: Subthalamic deep brain stimulation may alleviate bradykinesia in Parkinson patients. Research suggests that this stimulation effect may be mediated by brain networks like the corticocerebellar loop. This study investigated the connectivity between stimulation sites and cortical and subcortical structures to identify connections for effective stimulation.

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  • Glioblastoma multiforme (GBM) is a highly recurrent brain tumor, and maximizing tumor removal (extent of resection) during surgery is critical for treatment success.
  • In a study of 106 patients, fluorescein sodium (FL) was injected before surgery, and a specialized YELLOW 560 nm filter was used to enhance tumor visibility, leading to successful tumor identification in nearly all cases.
  • The results showed that 84% of patients achieved gross total resection with minimal complications, indicating that FL and the filter are effective and safe methods for improving outcomes in recurrent GBM surgeries.
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Spinal synovial cysts (SSC) are a rare but important differential diagnosis for degenerative or space-occupying spinal lesions. There is controversy about the most beneficial treatment, which can be conservative or surgical. We provide a review of our surgical data for purposes of quality assessment and improvement.

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Objectives: Neuropsychological dysfunction after treatment of spontaneous subarachnoid haemorrhage (sSAH) is common but underreported. The vasoconstrictor neuropeptide Y (NPY) is excessively released after sSAH and in psychiatric disorders. We prospectively analysed the treatment-specific differences in the secretion of endogenous cerebrospinal fluid (CSF) NPY during the acute stage after sSAH and its impact on cognitive processing.

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Purpose: Advanced morphology analysis and image-based hemodynamic simulations are increasingly used to assess the rupture risk of intracranial aneurysms (IAs). However, the accuracy of those results strongly depends on the quality of the vessel wall segmentation.

Methods: To evaluate state-of-the-art segmentation approaches, the Multiple Aneurysms AnaTomy CHallenge (MATCH) was announced.

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Recently, we introduced a mathematical toolkit called selected correlation analysis (sca) that reliably detects negative and positive correlations between arterial blood pressure (ABP) and intracranial pressure (ICP) data, recorded during multimodal monitoring, in a time-resolved way. As has been shown with the aid of a mathematical model of cerebral perfusion, such correlations reflect impaired autoregulation and reduced intracranial compliance in patients with critical neurological diseases. Sca calculates a Fourier transform-based index called selected correlation (sc) that reflects the strength of correlation between the input data and simultaneously an index called mean Hilbert phase difference (mhpd) that reflects the phasing between the data.

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  • Study involved five patients with non-enhancing gliomas as seen in MRI but positive in FET-PET scans, using fluorescein sodium and a special light filter for surgery.
  • Patients received fluorescein at the start of anesthesia, and surgeries showed clear correlation between FET-PET positive areas and fluorescence in lesions, corroborated by histopathology results.
  • Results highlighted that fluorescein successfully aided in identifying and resecting tumors, even with negative MRI findings, without any adverse effects reported.
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Aim: Recently, D,L-methadone has been put forward as adjuvant treatment in glioblastoma (GBM).

Methods: We analyzed the μ-opioid receptor expression in a set of GBM cell lines and investigated the efficacy of D,L-methadone alone and in combination with temozolomide (TMZ). Results & conclusion: Expression of the μ-opioid receptor was similar in the tested cell lines.

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Objective: Space-occupying spinal metastases (SM), commonly diagnosed because of acute neurological deterioration, consequently lead to immediate decompression with tumor removal or debulking. In this study, we analyzed a series of patients with surgically treated spinal metastases and explicitly sought to determine individual predictors of functional outcome.

Patients And Methods: 94 patients (26 women, 68 men; mean age 64.

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  • The treatment approach for glioblastoma (GBM) involves surgery followed by chemotherapy and radiotherapy, with the best outcomes linked to maximal tumor resection. A specialized neuro-oncology care center (NOC) employs advanced techniques to enhance patient outcomes through improved surgical methods.
  • In a study of 149 newly diagnosed GBM patients, those treated after the establishment of the NOC showed a significantly higher rate of complete tumor resection compared to those treated beforehand.
  • Patients achieving complete resection experienced better progression-free survival (PFS) and overall survival (OS), with no increase in neurological deficits post-surgery, indicating that the advanced surgical techniques used in the NOC are effective.
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Aim: Limited focus has been placed on neuropsychological patient profiles after spontaneous subarachnoid hemorrhage (sSAH). We conducted a prospective controlled study in good-grade sSAH patients to evaluate the time course of treatment-specific differences in cognitive processing after sSAH.

Material And Methods: Twenty-six consecutive sSAH patients were enrolled (drop out n=5).

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Deep brain stimulation for Parkinson's disease has become an established treatment option in recent years. The method and its application in clinical practice has proved to be safe and effective. Nevertheless, procedure-related and hardware-related complications occur.

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