Neurophysiological identification and differentiation between the motor and sensory roots in pediatric spinal cord lipoma surgery.

Background: Radical resection of spinal cord lipomas reduces the rate of re-tethering. Current conventional neurophysiological mapping techniques are not able to differentiate between crucial motor nerve roots and sensory roots. Enhanced differentiation could contribute to complete resection.

Velocity and pattern of growth of intracranial meningiomas.

Objective: The authors' aim was to assess the velocity and pattern of growth of meningiomas and to correlate the kinetics of tumor growth with their previously reported two-item radiological risk stratification and CNS WHO grade (5th edition, 2021).

Methods: The authors performed a serial volumetric analysis of meningiomas diagnosed radiologically at their institution between 2003 and 2015. The primary endpoint was velocity of diametric expansion (VDE), which represents the slope of the linear regression of the mean tumor diameter against time.

Natural history of meningiomas: a serial volumetric analysis of 240 tumors.

Objective: The management of asymptomatic intracranial meningiomas is controversial. Through the assessment of growth predictors, the authors aimed to create the basis for practicable clinical pathways for the management of these tumors.

Methods: The authors volumetrically analyzed meningiomas radiologically diagnosed at their institution between 2003 and 2015.

Trial of Spesolimab for Generalized Pustular Psoriasis.

Background: Generalized pustular psoriasis (GPP) is a rare, life-threatening, inflammatory skin disease characterized by widespread eruption of sterile pustules. Interleukin-36 signaling is involved in the pathogenesis of this disorder. Spesolimab, a humanized anti-interleukin-36 receptor monoclonal antibody, is being studied for the treatment of GPP flares.

Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms.

Delayed cerebral ischemia and cerebral vasospasm remain the leading causes of poor outcome in survivors of aneurysmal subarachnoid hemorrhage. Refractory cerebral vasospasms can be treated with endovascular vasodilator therapy, which can either be performed in conscious sedation or general anesthesia. The aim of this study is to compare the effect of the anesthesia modality on long-term clinical outcomes in patients undergoing endovascular vasodilator therapy due to cerebral vasospasm and hypoperfusion.

Efficiency of Iterative Metal Artifact Reduction Algorithm (iMAR) Applied to Brain Volume Perfusion CT in the Follow-up of Patients after Coiling or Clipping of Ruptured Brain Aneurysms.

Metal artifacts resulting from coiling or clipping of a brain aneurysm degrade image quality and reduce diagnostic usefulness of computed tomography perfusion CTP. Our aim was to assess the diagnostic value of the iterative metal artifact reduction algorithm (iMAR) in CTP studies after coiling or clipping of ruptured intracranial aneurysms. Fifty-eight CTP exams performed in 32 patients were analysed.

Nimodipine-Induced Blood Pressure Changes Can Predict Delayed Cerebral Ischemia.

Early diagnosis of delayed cerebral ischemia (DCI) in patients after aneurysmal subarachnoid hemorrhage (aSAH) still poses a leading problem in neurointensive care. The aim of this study was to analyze the effect of oral Nimodipine administration on systemic blood pressure in patients with evolving DCI compared to patients without DCI. Systolic (SBP), mean (MAP), and diastolic (DBP) blood pressures were analyzed at the time of Nimodipine administration and additionally 30, 60, and 120 min thereafter on days 1, 3, and 5 after aSAH.

Subdural versus subgaleal drainage for chronic subdural hematomas: a post hoc analysis of the TOSCAN trial.

Objective: The use of subdural drains after surgical evacuation of chronic subdural hematoma (CSH) decreases the risk of recurrence and has become the standard of care. Halfway through the controlled, randomized TOSCAN (Randomized Trial of Follow-up CT after Evacuation of Chronic Subdural Hematoma) trial, the authors' institutional guidelines changed to recommend subgaleal instead of subdural drainage. The authors report a post hoc analysis on the influence of drain location in patients participating in the TOSCAN trial.

Tiotropium add-on therapy is safe and reduces seasonal worsening in paediatric asthma patients.

There remains an unmet need for effective, well-tolerated therapeutic options in paediatric patients with not fully controlled asthma, for whom safety is of paramount importance.Data were pooled from five randomised, double-blind, placebo-controlled studies evaluating tiotropium 5 or 2.5 µg placebo add-on therapy in patients with symptomatic asthma aged 1-17 years.

Impact of regular magnetic resonance imaging follow-up after stereotactic radiotherapy to the surgical cavity in patients with one to three brain metastases.

Background: Administering stereotactic radiotherapy to the surgical cavity and thus omitting postoperative whole brain radiotherapy (WBRT) is a favored strategy in limited metastatic brain disease. Little is known about the impact of regular magnetic resonance imaging follow-up (MRI FU) in such patient cohorts. The aim of this study is to examine the impact of regular MRI FU and to report the oncological outcomes of patients with one to three brain metastases (BMs) treated with stereotactic radiosurgery (SRS) or hypo-fractionated stereotactic radiotherapy (HFSRT) to the surgical cavity.

ACE-inhibitors: a preventive measure for bone flap resorption after autologous cranioplasty?

Objective: Decompressive craniectomy (DC) is an established treatment for refractory intracranial hypertension. It is usually followed by autologous cranioplasty (AC), the reinsertion of a patient's explanted bone flap. A frequent long-term complication of AC is bone flap resorption (BFR), which results in disfigurement as well as loss of the protective covering of the brain.

Frequent Diagnostic Under-Grading in Isocitrate Dehydrogenase Wild-Type Gliomas due to Small Pathological Tissue Samples.

Background: In contrast to isocitrate dehydrogenase (IDH) mutation analysis, which is homogenous within a given tumor, diagnostic errors in histological analysis following the 2016 World Health Organization (WHO) classification could be due to small samples because of histological heterogeneity.

Objective: To assess whether the sample size sent to histopathology influences the tumor grading in IDH wild-type gliomas.

Methods: Histologically diagnosed WHO grade, sample volume, and preoperative tumor volume data of 111 patients aged who received resection of IDHwt gliomas between January 2007 and December 2015 at our hospital were evaluated.

Repetitive Computed Tomography Perfusion for Detection of Cerebral Vasospasm-Related Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage.

Background: Delayed cerebral infarction after aneurysmal subarachnoid hemorrhage (aSAH) still remains the leading cause of disability in patients that survive the initial ictus. It has been shown that computed tomography perfusion (CTP) imaging can detect hypoperfused brain areas. The aim of this study was to evaluate if a single acute CTP examination at time of neurologic deterioration is sufficient or if an additional baseline CTP increases diagnostic accuracy.

Using an orbit shield during volume perfusion CT: is it useful protection or an obstacle?

Aim: To evaluate the image quality and artefacts resulting from in-plane orbit shielding during computed tomography (CT) perfusion and to assess the possibility of artefact reduction using the iterative metal artefact reduction (iMAR) algorithm.

Materials And Methods: Twenty-eight perfusion CT examinations obtained from 20 patients using orbit shields were included in this study. Source images and perfusion maps were analysed retrospectively to detect the type and extent of artefacts.

Safety and efficacy of tiotropium in children aged 1-5 years with persistent asthmatic symptoms: a randomised, double-blind, placebo-controlled trial.

Background: Few studies have assessed the safety and efficacy of potential asthma medications in children younger than 5 years. We descriptively assessed the safety and efficacy of tiotropium, a long-acting anticholinergic drug, in children aged 1-5 years with persistent asthmatic symptoms.

Methods: This exploratory 12-week, randomised, double-blind, placebo-controlled, parallel-group, phase 2/3, regulatory multicentre trial was done at 32 hospitals, clinics, and clinical research units in 11 countries in Asia, Europe, and North America.

Long-Term Follow-Up of Repeat Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus.

Objective: Endoscopic third ventriculostomy (ETV) is a safe and less-invasive treatment strategy for patients with obstructive hydrocephalus and provides excellent outcome. Nevertheless, repeat ETV in cases of ETV failure is a controversial issue.

Methods: Between 1993 and 1999, 113 patients underwent a total of 126 ETVs at the Department of Neurosurgery, Mainz University Hospital.

Long-term results of endoscopic third ventriculostomy: an outcome analysis.

Object: Endoscopic third ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series.

Overcoming CSF overdrainage with the adjustable gravitational valve proSA.

Background: Despite progress in shunt valve technology, CSF overdrainage is still one of the most frequent complications in shunt-treated hydrocephalus. Particularly with regard to young and adolescent patients, treatment of manifest overdrainage is complicated by several hardly influenceable factors such as increasing height and mobility. Therefore, the aim of this study was to evaluate the therapeutic efficiency of the new adjustable gravitational valve, proSA.

Transventricular fenestration of the lamina terminalis: the value of a flexible endoscope: technical note.

Background: Recently, the authors demonstrated the technical feasibility of a transventricular translaminar terminalis ventriculostomy with a rigid endoscope. A major problem with this technique remains the contusion of the fornix at the foramen of Monro. Here, the authors evaluated alternative approaches and techniques, including the use of a flexible endoscope.

First clinical results with a new telemetric intracranial pressure-monitoring system.

Background: The knowledge of intracranial pressure (ICP) is the basis of an appropriate neurosurgical treatment. Because clinical, fundoscopic, or radiological data alone are often elusive, a pre- or postoperative long-term monitoring of the ICP itself is desirable.

Objective: We describe the first clinical experiences with a new telemetric ICP-monitoring device.

Endoscopic transventricular third ventriculostomy through the lamina terminalis.

Object: Endoscopic third ventriculostomy (ETV) has become a well-accepted option for obstructive hydrocephalus. However, standard ventriculostomy at the floor of the third ventricle might not be feasible under certain conditions. Here, the authors report in detail on their initial experience with an alternative option of endoscopic ventriculostomy through the lamina terminalis via a transventricular route.

Posterior calvarial augmentation in premature craniosynostosis: a technique avoiding foreign implants or free bone flaps.

Background: A surgical technique of posterior calvarial augmentation without the use of plates or screws and avoiding the formation of free bone flaps is described.

Discussion: Three infants with strong occipital flattening successfully underwent the procedure in their first year of life. There were no intra- or postoperative complications; the amelioration of the head shape and the cosmetic results in all three cases were convincing also in the long term.

Monovalent cation conductance in Xenopus laevis oocytes expressing hCAT-3.

hCAT-3 (human cationic amino acid transporter type three) was investigated with both the two-electrode voltage clamp method and tracer experiments. Oocytes expressing hCAT-3 displayed less negative membrane potentials and larger voltage-dependent currents than native or water-injected oocytes did. Ion substitution experiments in hCAT-3-expressing oocytes revealed a large conductance for Na+ and K+.