Publications by authors named "Unterberg A"

Article Synopsis
  • Pediatric intracranial tumors at the skull base are rare, challenging to treat due to complex anatomy, and lack substantial clinical evidence, prompting a study on surgical approaches and outcomes.
  • The study involved 12 children under 18 who underwent skull base surgery from 2017 to 2023, analyzing demographics, tumor details, surgical methods, and survival rates.
  • Results indicated a predominance of female patients, varying tumor locations and types, with 58.3% achieving gross or near-total resection; however, 33.3% of patients died from tumor progression within an average of 15 months.
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Introduction: Neuroendoscopy has become a well-established procedure for treating various intracranial conditions.

Research Question: We evaluated the advantages of that technique, with focus on adverse events.

Material And Methods: Retrospective analysis included all patients who underwent neuroendoscopic procedures between January 2017 and December 2023.

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Article Synopsis
  • This study investigates the relationship between motor deficits (MD) in patients after glioma surgery and the proximity of the tumor to key motor pathways, specifically the corticospinal tract (CST).
  • It compares two imaging techniques—conventional Diffusion Tensor Imaging Fiber Tracking (DTI-FT) and q-ball Imaging Fiber Tracking (QBI-FT)—to determine which better predicts postoperative motor impairment.
  • Preliminary results indicate that patients with more severe MD have lesions significantly closer to the CST when analyzed using QBI-FT, suggesting this method could improve neurosurgical planning, although more extensive research is needed to validate these findings.
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Background: Accurate intraoperative tissue diagnostics could impact on decision making regarding the extent of resection (EOR) during brain tumor surgery. Stimulated Raman histology (SRH) is a label-free optical imaging method that uses different biochemical properties of tissue to generate a hematoxylin-eosin-like image and, in combination with an artificial intelligence-based image classifier, offers the opportunity to obtain rapid intraoperative tissue diagnoses.

Objective: The goal of this study was to report on our initial experience with SRH to evaluate its accuracy in comparison to final tissue diagnosis.

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Purpose: Mutations in the Isocitrate Dehydrogenase (IDH) genes, IDH1 or IDH2, define a group of adult diffuse gliomas associated with a younger age at diagnosis and better prognosis than IDH wild-type glioblastoma. Within IDH mutant gliomas, a small fraction of astrocytic tumors present with grade 4 histologic features and poor prognosis. In molecular studies, homozygous deletion of CDKN2A/B is independently predictive of poor prognosis and short survival.

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Routine postoperative ICU admission following brain tumor surgery may not benefit selected patients. The objective of this study was to develop a risk prediction instrument for early (within 24 h) postoperative adverse events using machine learning techniques. Retrospective cohort of 1000 consecutive adult patients undergoing elective brain tumor resection.

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Introduction: Spinal tumors (ST) often result in dire prognosis, carrying risks such as permanent paralysis, sensory loss, and sphincter dysfunction. Data on their incidence and etiology in pediatric populations are markedly scant. Our study investigates the etiology, clinical manifestation, treatment, and outcomes of pediatric ST.

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Background: Sonic Hedgehog (Shh), extensively researched for its role in early neurogenesis and brain development, has recently been recognized for its neuroprotective potential following neuronal injuries. This study examines the immediate impact of early administered Shh on the local inflammatory response post-acute spinal cord injury in rats.

Methods: Thirty-four female Wistar rats underwent either sham surgery (laminectomy; n = 10) or clip compression/contusion spinal cord injury (SCI) at the T9 level.

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Article Synopsis
  • The study investigates the management of primary spinal sarcomas, highlighting the significance of a multidisciplinary approach centered on surgical intervention due to the tumors' complexity and high recurrence rates.
  • A retrospective analysis of 14 patients revealed chondrosarcoma as the most common type, and surgical strategies included en-bloc resection, intra-lesional excision, and tumor debulking, showing significant post-surgery improvements in neurological conditions and functional status.
  • Overall, the findings underscore the effectiveness of surgical approaches, particularly en-bloc resection, in treating spinal sarcomas while noting the importance of careful management to mitigate risks of complications.
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  • Recent research indicates that removing dead tissue (necrotic tissue) during surgery for ischemic cerebellar stroke may improve recovery more than just removing pressure (decompressive surgery) alone, but optimal procedures and outcomes related to the amount of tissue removed haven't been well-studied.* -
  • This study analyzed data from 91 patients who had surgery for ischemic cerebellar stroke, measuring the volume of infarcted tissue before and after operations, and evaluating functionality at 3 months post-surgery using a standardized ranking scale.* -
  • Results showed that patients who had necrosectomy (removal of necrotic tissue) were significantly more likely to achieve favorable recovery outcomes, with a specific threshold of
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Purpose: Angioleiomyoma, predominantly arising from the extremities, is a benign soft tissue tumor. Reports on its intracranial location are rare. We assessed clinical, radiological, and pathological features of intracranial angioleiomyoma (iALM) treated at our neurosurgical institution.

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Microglia are present throughout the central nervous system and are vital in neural repair, nutrition, phagocytosis, immunological regulation, and maintaining neuronal function. In a healthy spinal cord, microglia are accountable for immune surveillance, however, when a spinal cord injury occurs, the microenvironment drastically changes, leading to glial scars and failed axonal regeneration. In this context, microglia vary their gene and protein expression during activation, and proliferation in reaction to the injury, influencing injury responses both favorably and unfavorably.

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Objective: Otitis media and sinusitis are common childhood infections, typically mild with good outcomes. Recent studies show a rise in intracranial abscess cases in children, raising concerns about a link to COVID-19. This study compares a decade of data on these cases before and after the pandemic.

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Study Design: Prospective case series.

Objectives: Drawing from prospective data, this study delves into the frequency and nature of adverse events (AEs) following spinal surgery specifically in octogenarians, shedding light on the challenges and implications of treating this specific cohort as well as on risk factors for their occurrence.

Methods: Octogenarians who received spinal surgery and were discharged between January 2019 and December 2022 were proactively included in our study.

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Objective: Characterize the neurophysiological effects of mild hypothermia on stroke and spreading depolarizations (SDs) in gyrencephalic brains.

Methods: Left middle cerebral arteries (MCAs) of six hypothermic and six normothermic pigs were permanently occluded (MCAo). Hypothermia began 1 h after MCAo and continued throughout the experiment.

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Introduction: In light of an aging global population, understanding adverse events (AEs) in surgeries for older adults is crucial for optimal outcomes and patient safety.

Research Question: Our study compares surgical outcomes and AEs in patients aged 65-79 with those aged ≥80, focusing on clinical outcomes, morbidity and mortality rates, and age-related risk factors for AEs.

Material And Methods: Our study, from January 2019 to December 2022, involved patients aged 65-79 and ≥ 80 undergoing spinal surgery.

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Background: H3 K27M-mutated gliomas were first described as a new grade 4 entity in the 2016 World Health Organization classification. Current studies have focused on its typical appearance in children and young adults, increasing the need to better understand the prognostic factors and impact of surgery on adults. Here, we report a multicentric study of this entity in adults.

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Introduction: Brain tumor surgery represents a critical and high-risk area within the field of neurosurgery. Our study aims to offer a comprehensive analysis of adverse events (AEs) from a prospectively maintained database at a leading neurosurgical tertiary center, with a specific focus on different types of tumor entities.

Methods: From January 2022 to September 2023, our study focused on adult patients, who underwent surgery for intracranial tumors.

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Background: We aimed to compare the clinical course of patients aged 18-65 years and ≥65years who underwent anterior cervical discectomy and fusion (ACDF) or corpectomy for ventrally located CSEA.

Methods: Clinical and imaging data were retrospectively collected from the institutional database between September 2005 and December 2021.

Results: A total of 35 and 26 patients aged 18-64 and ≥ 65 years, respectively who were diagnosed with ventrally located CSEA were included.

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Importance: According to the current American Heart Association/American Stroke Association guidelines, decompressive surgery is indicated in patients with cerebellar infarcts that demonstrate severe cerebellar swelling. However, there is no universal definition of swelling and/or infarct volume(s) available to support a decision for surgery.

Objective: To evaluate functional outcomes in surgically compared with conservatively managed patients with cerebellar infarcts.

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Purpose: Surgery for recurrent glioma provides cytoreduction and tissue for molecularly informed treatment. With mostly heavily pretreated patients involved, it is unclear whether the benefits of repeat surgery outweigh its potential risks.

Methods: Patients receiving surgery for recurrent glioma WHO grade 2-4 with the goal of tissue sampling for targeted therapies were analyzed retrospectively.

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Article Synopsis
  • Visual field deficits (VFDs) are often seen in patients with brain lesions, particularly in the temporal and occipital lobes; this study assesses how two imaging techniques—Diffusion Tensor Fiber Tractography (DTI-FT) and Q-ball High-Resolution Fiber Tractography (QBI-HRFT)—help in planning surgeries to minimize VFDs.
  • The research involved eight patients with gliomas near the optic radiation (OR), revealing that those with VFDs had a closer proximity of their lesions to the OR, indicating that smaller distances could correlate with a higher likelihood of vision loss.
  • The findings suggest that QBI-HRFT offers a more precise reconstruction of OR compared to DTI-
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Malignant tumors commonly exhibit a reversed pH gradient compared with normal tissue, with a more acidic extracellular pH and an alkaline intracellular pH (pH). In this prospective study, pH values in gliomas were quantified using high-resolution phosphorous 31 (P) spectroscopic MRI at 7.0 T and were used to correlate pH alterations with histopathologic findings.

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Objective: Tuberculum sellae meningiomas (TSMs) are typically in the proximity of the optic nerves and the optic chiasm, thus making the primary aim of surgery the enhancement or stabilization of the patients' visual acuity. The authors therefore undertook a retrospective review of their 17-year experience with the pterional approach to ascertain the resection rate, neurological outcome, and visual outcome.

Methods: Patients who underwent TSM surgery between September 2003 and December 2020 at the authors' institution were retrospectively evaluated.

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