Publications by authors named "Mikael Von Und Zu Fraunberg"
Introduction: Decompressive craniectomy (DC) is a last-tier procedure to lower intracranial pressure in otherwise fatal brain injuries. DC significantly reduces mortality following traumatic brain injury (TBI) and ischemic stroke, but benefits in subarachnoid hemorrhage (SAH) are less clear.
Research Question: We compared the mortality and functional outcomes in patients who underwent DC after SAH with those who underwent DC following TBI or ischemic stroke.
Background: Heterozygous CWH43 loss-of-function (LOF) variants have been identified as iNPH risk factors, with 10-15% of iNPH patients carrying these variants in cohorts from the US. Mouse model harboring CWH43 LOF variants display a hydrocephalic phenotype with ventricular cilia alterations. Our aim was to study the effect of CWH43 variants on disease risk and clinical phenotype in Finnish and Norwegian iNPH cohorts.
View Article and Find Full Text PDFMicrowave (MW) sensing is regarded as a promising technique for various medical monitoring and diagnostic applications due to its numerous advantages and the potential to be developed into a portable device for use outside hospital settings. The detection of skull fractures and the monitoring of their healing process would greatly benefit from a rapidly and frequently usable application that can be employed outside the hospital. This paper presents a simulation- and experiment-based study on skull fracture detection with the MW technique using realistic models for the first time.
View Article and Find Full Text PDFBackground And Objectives: Large-scale genome-wide studies of chronic hydrocephalus have been lacking. We conducted a genome-wide association study (GWAS) in normal pressure hydrocephalus (NPH).
Methods: We used a case-control study design implementing FinnGen data containing 473,691 Finns with genotypes and nationwide health records.
Background: Treatment of persistent spinal pain syndrome (PSPS) is challenging. Chronic pain associated with PSPS can lead to an impaired ability to work.
Objective: To obtain information on whether receiving a disability pension (DP) affects pain and pain treatments in retiring working-age PSPS patients.
Acute evacuation of 54 intracerebral hematomas (aICH) during the microsurgical clipping of a ruptured middle cerebral artery bifurcation aneurysm-illustration of the individual clinical courses and outcomes with a serial brain CT/MRI panel until 12 months.
Acta Neurochir (Wien)
January 2024
Article Synopsis
- The study focused on aneurysmal intracerebral hemorrhage (aICH), highlighting the absence of personalized patient timelines and detailed brain imaging throughout treatment and recovery.
- Researchers analyzed 54 patients who underwent surgical clipping for a specific type of aneurysm, compiling data from emergency calls to clinical outcomes using timeline and imaging panels.
- Findings indicate that larger aICH volumes at the time of admission were linked to higher rates of rebleeds and mortality, emphasizing the need for timely intervention and enhanced imaging during surgery to monitor recovery.
Article Synopsis
- The study explores the relationship between pre-eclampsia and saccular intracranial aneurysms (sIAs), focusing on female patients, their relatives, and matched controls, to assess the prevalence of pre-eclampsia in these groups.
- It analyzed data from 265 female sIA patients, their female relatives, and a control group, revealing a higher prevalence of pre-eclampsia in sIA patients (11%) compared to matched controls (6%).
- The findings indicate that pre-eclampsia is more common among sIA patients, with familial occurrences observed in seven families, suggesting a need for further research into how pre-eclampsia may increase the risk of sIA rupture.
Article Synopsis
- - The study investigates the connection between having a family history of epilepsy in first-degree relatives and the likelihood of developing epilepsy after experiencing an aneurysmal subarachnoid hemorrhage (aSAH), which is a severe type of stroke often leading to significant complications.
- - Researchers analyzed data from 760 aSAH survivors and compared it with a control group of 2,240 individuals, finding that 15% of aSAH patients developed epilepsy within about 7 months post-stroke, significantly higher than the rates in the general population and their relatives.
- - The findings indicate that having at least one first-degree relative with epilepsy increases the risk of developing epilepsy after aSAH, with nearly 28% of patients
Background: Hyperspectral imaging (HSI) has the potential to enhance surgical tissue detection and diagnostics. Definite utilization of intraoperative HSI guidance demands validated machine learning and public datasets that currently do not exist. Moreover, current imaging conventions are dispersed, and evidence-based paradigms for neurosurgical HSI have not been declared.
View Article and Find Full Text PDFShould individual timeline and serial CT/MRI panels of all patients be presented in acute brain insult cohorts? A pilot study of 45 patients with decompressive craniectomy after aneurysmal subarachnoid hemorrhage.
Acta Neurochir (Wien)
November 2023
Purpose: Our review of acute brain insult articles indicated that the patients' individual (i) timeline panels with the defined time points since the emergency call and (ii) serial brain CT/MRI slice panels through the neurointensive care until death or final brain tissue outcome at 12 months or later are not presented.
Methods: We retrospectively constructed such panels for the 45 aneurysmal subarachnoid hemorrhage (aSAH) patients with a secondary decompressive craniectomy (DC) after the acute admission to neurointensive care at Kuopio University Hospital (KUH) from a defined population from 2005 to 2018. The patients were indicated by numbers (1.
Article Synopsis
- Intracranial aneurysms (IAs) are often asymptomatic, but those that rupture can lead to severe complications, making it crucial to identify which IAs are at risk of rupture.
- A study involving 7992 patients across 21 centers found that the location of an IA is the strongest predictor of whether it will rupture or be diagnosed incidentally, and that awareness of risk factors like hypertension and smoking influences diagnosis outcomes.
- Additionally, the findings suggest that age, IA size, and smoking status vary in their association with ruptured IAs, providing insights for better clinical decision-making and tailored patient care.
Article Synopsis
- Spinal cord stimulation (SCS) is a treatment for people who have had back surgery that didn't work, and many of these patients also use strong painkillers called opioids.* -
- The study looked at how retiring from work affected the use of opioids in patients with ongoing pain after failed back surgery, finding that most still used them even after retiring.* -
- Retirement didn't really help reduce the number of patients needing opioids, but those with long-term SCS treatment had lower doses and less increase in their painkiller use.*
Purpose: This study aims to elucidate the incidence of and independent risk factors for spinal cord stimulator implantations for patients who underwent lumbar spine surgery.
Methods: The PERFormance, Effectiveness, and Cost of Treatment (PERFECT) episodes database, which was established for selected diseases and procedures in Finland, includes all patients who underwent lumbar spine surgery for degenerative spine conditions or spinal cord stimulation (SCS) in Finland from 1986 to 2018. The data on age, sex, hospital diagnoses, surgical procedures, and causes of death were imported from the Finnish national registers into the PERFECT database.
Background And Purpose: Pathophysiological studies of saccular intracranial aneurysm (sIA) disease have shown that inflammation plays a crucial role in sIA development. Pharmaceutical inhibition of COX-2-PGE2-NF-κB signaling (COX-2, cyclooxygenase-2; PGE2, prostaglandin E2; NF-κB, nuclear factor κB) has been shown in animal models to inhibit sIA formation and progression suggesting that use of medication inhibiting COX-2 could reduce intracranial aneurysm formation also in patients.
Methods: The impact of COX-2 inhibition on de novo sIA formation was studied in two cohorts: in a previously described angiographically followed cohort of 1419 sIA patients and in a cohort of 117 sIA patients treated with stenting or stent-assisted embolization.
Background And Purpose: Hypertension is a risk factor for subarachnoid hemorrhage and is also considered a risk factor for saccular intracranial aneurysm (sIA) formation. However, there is little direct evidence that antihypertensive medication will reduce sIA formation.
Methods: The impact of antihypertensive medication on de novo sIA formation was studied in an angiographically followed cohort of 1419 patients.
Efficacy and tolerability in patients with chronic facial pain of two consecutive treatment periods of rTMS applied over the facial motor cortex, using protocols differing in stimulation frequency, duration, and train pattern.
Neurophysiol Clin
April 2022
Objective: We conducted an open-label cross-over study assessing the global effect of two high-frequency protocols of electric-field navigated repetitive transcranial magnetic stimulation (rTMS) targeted to functional facial motor cortex and comparing their efficacy and tolerability in patients with chronic facial pain. Outcome predictors were also assessed.
Methods: We randomized twenty consecutive patients with chronic facial pain (post-traumatic trigeminal neuropathic pain, n=14; persistent idiopathic facial pain, n=4; secondary trigeminal neuralgia, n=2) to receive two distinct 5-day rTMS interventions (10Hz, 2400 pulses and 20Hz, 3600 pulses) separated by six weeks.
Article Synopsis
- - The study aimed to investigate the occurrence of pre-eclampsia, gestational hypertension, chronic hypertension, and gestational diabetes in pregnant women with saccular intracranial aneurysms (sIAs).
- - Researchers analyzed medical records of 169 patients with sIA from 1990 to 2015, finding that 13% had pre-eclampsia and 19% experienced other hypertensive issues, compared to 5% and 10% in matched controls, respectively.
- - The findings suggest pre-eclampsia is more common in women with sIA, and those with pre-eclampsia tended to have irregularly shaped aneurysms, indicating a need for further research on
Background: Spinal cord stimulation (SCS) is an effective treatment in failed back surgery syndrome (FBSS). The effect of neuropathic pain medication use on SCS outcome is poorly understood.
Objective: To study the effect of gabapentinoid use on SCS outcome measured by trial success, explantation rate and opioid dose reduction during a 2-yr follow-up.
Background: Spinal cord stimulation (SCS) is an effective treatment in chronic neuropathic pain, but its efficacy in complex regional pain syndrome (CRPS) needs to be proven.
Objective: To study the outcome of SCS in CRPS as measured by trial success, explantation rate, complications, and changes in opioid and neuropathic pain medication use over a 4-yr follow-up.
Methods: We retrospectively reviewed all medical records of 35 consecutive CRPS patients who underwent SCS trials at 2 hospitals during January 1998 to December 2016.
Background: Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequelae leading to poorer neurological outcomes and predisposing to various complications.
Methods: A total of 2191 consecutive patients with aSAH were acutely admitted to the Neurointensive Care at the Kuopio University Hospital between 1990 and 2018 from a defined population. A total of 349 (16%) aSAH patients received a ventriculoperitoneal shunt, 101 with an adjustable valve (2012-2018), 232 with a fixed pressure valve (1990-2011), and 16 a valveless shunt (2010-2013).
Background: To study the clinical condition of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients alive at 3 years after neurointensive care.
Methods: Of the 769 consecutive aSAH patients from a defined population (2005-2015), 269 (35%) were in poor condition on admission: 145 (54%) with H&H 4 and 124 (46%) with H&H 5. Their clinical lifelines were re-constructed from the Kuopio Intracranial Aneurysm Database and Finnish nationwide registries.
Rupture of an intracranial aneurysm leads to subarachnoid hemorrhage, a severe type of stroke. To discover new risk loci and the genetic architecture of intracranial aneurysms, we performed a cross-ancestry, genome-wide association study in 10,754 cases and 306,882 controls of European and East Asian ancestry. We discovered 17 risk loci, 11 of which are new.
View Article and Find Full Text PDFObjective: Spinal cord stimulation (SCS) is an effective treatment in failed back surgery syndrome (FBSS). We studied the effect of preimplantation opioid use on SCS outcome and the effect of SCS on opioid use during a two-year follow-up period.
Materials And Methods: The study cohort included 211 consecutive FBSS patients who underwent an SCS trial from January 1997 to March 2014.
Article Synopsis
- Distinct tissue types can be identified using narrow-band imaging (NBI) during surgery, but previous studies often overlooked the impact of various factors like lighting and microstructural changes on image analysis.
- The study involved capturing images of facial nerves and internal carotid arteries from temporal bones and analyzing them with a custom spectral imaging system, which highlighted differences in reflectance among different tissue types.
- The results showed that the U-Net algorithm accurately classified over 90% of pixels, suggesting that NBI could be a valuable tool for improving tissue identification in surgical settings, although more research is needed for effective clinical use.