Ethical Considerations in Complications of Surgical Procedures.

Surgical procedures carry certain risks of complications, which need to be considered and discussed when any procedure is suggested to a patient. In this article, some ethical problems will be discussed concerning the communication of problems after they have occurred. Some clinical case studies will serve to clarify the need for having standards of ethical behavior, even in difficult situations.

Vascular Injury During Lumbar Disc Surgery: Case Report.

A retroperitoneal organ injury-vascular injury or solid organ injury-that occurs during lumbar disc surgery needs to be dealt with adequately, because otherwise it could result in a poor (or, even, fatal) outcome of a "simple" procedure. Vascular injuries require special attention from the neurosurgical side (think of the possibility!) and cooperation between neurosurgeons and abdominal/vascular surgeons. In the presented case of a very obese female patient, a bite injury of the aorta during L3/4 disc surgery led to delayed intra-abdominal hemorrhage, which then required an emergency abdominal operation followed by major thromboembolic complication, and ultimately resulted in amputation of the patient's healthy leg.

Occipital Nerve Stimulation in Chronic Migraine: The Relationship Between Perceived Sensory Quality, Perceived Sensory Location, and Clinical Efficacy-A Prospective, Observational, Non-Interventional Study.

Introduction: Occipital nerve stimulation (ONS) is used to treat therapy-resistant chronic migraine. Clinical use has resulted in a wide intraindividual and interindividual variation of clinical efficacy. The aim of this study was to analyze a potential relationship between sociodemographic variables, headache parameters, perceived sensory quality, perceived sensory location, as well as clinical efficacy.

Screening for Platelet Dysfunction and Use of Prophylactic Tranexamic Acid in Patients Undergoing Deep Brain Stimulation: A Retrospective Analysis of Incidence and Outcome of Intracranial Hemorrhage.

Introduction: The rate of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) is between 1.5 and 6.1%, with prolonged deficits occurring in 0.

Do Adaptors Shorten the Battery Life of Nonrechargeable Generators for Deep Brain Stimulation?

Objective: Generators implanted for deep brain stimulation must be replaced after several years. If a Kinetra generator is replaced by the Activa-PC, an adaptor will be required to attach it to the original extension cables. On the basis of our clinical impression that the battery life of the Active-PC generator was shorter when an adaptor was used, we performed this retrospective study.

Linking pre-existing biorepositories for medical research: the PopGen 2.0 Network.

The significance of human biorepositories for modern medical research, particularly for comprehensive population-based genetic analyses, is constantly growing. While large and centralized institutions are usually considered best suited to meet the increasing demand for high-quality "biobanks," most medical research institutions still host rather heterogeneous and fragmented biobanking activities, undertaken by clinical departments with oftentimes rather different scientific scope. Undoubtedly, most clinicians and medical researchers would appreciate infrastructural support in terms of the storage and handling of their biosamples, but they are also likely to expect access to their samples avoiding extensive formal requirements.

Fear of disease progression in adult ambulatory patients with brain cancer: prevalence and clinical correlates.

Background: Fear of progression (FoP) is frequent in patients with cancer and of high clinical relevance. Despite the often devastating prognosis of brain cancer, FoP has not yet been assessed in neurooncological patients.

Objective: The aim of this study was thus the assessment of FoP and its clinical correlates.

Social cognition in patients with intracranial tumors: do we forget something in the routine neuropsychological examination?

Purpose: Social cognitive functions are of high clinical relevance. To date, little is known about social cognition in neurooncological patients and this domain is usually not included in standardized neurocognitive test batteries. Aim of this study was thus to assess whether social cognition could pose a useful contribution to the neurocognitive assessment in patients with intracranial tumors.

The programmable shunt-system Codman Medos Hakim: A clinical observation study and review of literature.

Objectives: Hydrocephalus can be defined as clinically symptomatic dilatation of the internal ventricular system at the expense of brain and blood volume. Shunt insertion is the mainstay of therapy for communicating hydrocephalus. One of the most frequently used valves is the programmable Codman Medos Hakim valve which enables the pressure level to be adjusted from 30 to 200 mmH2O.

Assessment of preoperative anxiety in neurosurgical patients: Comparison of widely used measures and recommendations for clinic and research.

Objective: Preoperative anxiety is frequent in neurosurgical patients and of high clinical relevance (e. g., associated with anestesiological requirements and surgery outcome).

A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle.

Purpose: To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group.

Breaking Bad News to Patients with Intracranial Tumors: The Patients' Perspective.

Objective: Bad news refers to information that subjectively impedes a patient's future prospects. Patients with intracranial tumors potentially face numerous pieces of bad news. This study assessed the patients' perspective regarding the content of bad news, patients' preferences for the communication of bad news, and clinical consequences of mismatch of patients' communication preferences.

Surgery-Related Coping in Surgery Patients with Intracranial Tumors.

Background: Neurosurgical brain tumor removal poses a unique threat for patients while also minimizing instrumental control. Thus, psychological processes used by patients to cope with surgery-related anxiety are of utmost importance. This is the first study to assess both nature and effectiveness of surgery-related coping efforts in neuro-oncological patients.

Cross-cultural adaptation and psychometric properties of the SCOPA-Sleep-German version.

Aim of the study was the cross-cultural adaptation and validation of the German version of the Scale for Outcomes in Parkinson's disease-Sleep Scale (SCOPA-Sleep) for assessment of night-time sleep problems (NS) and daytime sleepiness (DS). Eighty-three patients with Parkinson's disease completed the SCOPA-Sleep and a multitude of measures for assessment of validity (e.g.

Complications of Impulse Generator Exchange Surgery for Deep Brain Stimulation: A Single-Center, Retrospective Study.

Background: Nonrechargeable deep brain stimulation impulse generators (IGs) with low or empty battery status require surgical IG exchange several years after initial implantation. The aim of this study was to investigate complication rates after IG exchange surgery and identify risk factors.

Methods: We retrospectively analyzed complications following IG exchange surgery from 2008 to 2015 in our department.

Comparison of the Battery Life of Nonrechargeable Generators for Deep Brain Stimulation.

Objective: Nonrechargeable deep brain stimulation (DBS) generators must be replaced when the battery capacity is exhausted. Battery life depends on many factors and differs between generator models. A new nonrechargeable generator model replaced the previous model in 2008.

Spatial and Cellular Expression Patterns of Erythropoietin-Receptor and Erythropoietin during a 42-Day Post-Lesional Time Course after Graded Thoracic Spinal Cord Impact Lesions in the Rat.

Erythropoietin (Epo) exhibits promising neuroregenerative potential for spinal cord injury (SCI), and might be involved in other long-term sequelae, such as neuropathic pain development. The current studies investigated the time courses and spatial and cellular patterns of Epo and erythropoietin receptor (EpoR) expression along the spinal axis after graded SCI. Male Long Evans rats received 100 kdyn, 150 kdyn, and 200 kdyn thoracic (T9) contusions from an Infinite Horizon impactor.

Intended cost reduction in laparoscopic appendectomy by introducing the endoloop: a single center experience.

Background: Cost reduction measures in medicine are gaining greater importance nowadays, especially in high-volume procedures such as laparoscopic appendectomy (LAE). Currently there are two common methods of dissecting the appendix from the caecal pole: linear stapler and endoloops. The endoloop is the cheaper device but can only be used in uncomplicated cases of appendicitis.

Intraoperative Thresholds for Capsular Stimulation Are Reliable for Chronic Pallidal Deep Brain Stimulation in Dystonia.

Background: The threshold current for inducing muscle contractions by stimulation of pyramidal tract fibres adjacent to the globus pallidus internus (GPi) is, besides microelectrode recordings for the determination of nuclear boundaries, currently the only neurophysiological marker for intraoperative refinement of the anatomically planned target point for pallidal deep brain stimulation (GPi-DBS) in dystonia.

Objectives: To determine the relationship between intraoperative thresholds for muscle contractions under general anaesthesia and postoperative thresholds in GPi-DBS.

Methods: Intraoperatively, current amplitude thresholds (120 µs, 130 Hz) were determined in 6 dystonic patients under general anaesthesia (through the uninsulated tip of the microelectrode guide tube).

Awake Craniotomy for Tumor Resection: Further Optimizing Therapy of Brain Tumors.

In recent years more and more data have emerged linking the most radical resection to prolonged survival in patients harboring brain tumors. Since total tumor resection could increase postoperative morbidity, many methods have been suggested to reduce the risk of postoperative neurological deficits: awake craniotomy with the possibility of continuous patient-surgeon communication is one of the possibilities of finding out how radical a tumor resection can possibly be without causing permanent harm to the patient.In 1994 we started to perform awake craniotomy for glioma resection.

Targeting of the Subthalamic Nucleus for Deep Brain Stimulation: A Survey Among Parkinson Disease Specialists.

Background: Deep brain stimulation within or adjacent to the subthalamic nucleus (STN) represents the most common stereotactic procedure performed for Parkinson disease. Better STN imaging is often regarded as a requirement for improving stereotactic targeting. However, it is unclear whether there is consensus about the optimal target.