Clinical Results and Quality of Life After Transcortical Versus Transcallosal Resection of Adult Lateral and Third Ventricle Lesions: Long-Term Outcome.

BACKGROUND: Resection of intraventricular tumors can be achieved using 2 main operative approaches: transcallosal or transcortical. This study aims to describe preoperative and postoperative factors as well as quality of life (QoL) based on long-term results in these patients. METHODS: Patients underwent surgery of primary intraventricular lesions between 2007 and 2020 via a transcortical (group A) or transcallosal (group B) route. The main clinical parameters were completeness of resection, overall survival, surgical complications, postoperative neurologic deficits, and seizure rates. QoL was assessed using a modified questionnaire Short-Form 36 inventory. RESULTS: Forty patients (19 women and 21 men) met the inclusion criteria. Group A consisted of 26 patients (12 women and 14 men; median age 45.5 years ± 16.7 standard deviation) and had lower preoperative tumor volume (confounder) compared with group B (7 women and 7 men; age 50.0 ± 17.4 years). Gross total resection was achieved in 65% in group A and 71% in group B. Follow-up was 7.8 ± 3.9 years. New seizures/permanent neurologic deficits occurred in 27%/15% (group A) and 29%/29% (group B) and surgical complications in 23% of patients. Group B had a higher degree of memory impairment (21%) compared with group A (10%). QoL impairment was present in both groups mainly regarding physical role function and mental health index. CONCLUSIONS: Keeping in mind the limitations, transcallosal surgery was associated with a higher probability of neurologic deficits and memory impairment in our series. However, it had fewer surgical complications with similar gross total resection and seizure rates.

Long-Term Clinical and Radiologic Outcome Following Surgical Treatment of Lumbar Spondylodiscitis: A Retrospective Bicenter Study.

BACKGROUND AND STUDY AIMS: Spinal instrumentation for spondylodiskitis (SD) remains highly controversial. To date, surgical data are limited to relatively small case series with short-term follow-up data. In this study, we wanted to elucidate the biomechanical, surgical, and neurologic long-term outcomes in these patients. MATERIAL AND METHODS: A retrospective analysis from two German primary care hospitals over a 9-year period (2005-2014) was performed. The inclusion criteria were (1) pyogenic lumbar SD, (2) minimum follow-up of 1 year, and (3) surgical instrumentation. The clinical and radiologic outcome was assessed before surgery, at discharge, and at a minimum of 12 months of follow-up. Follow-up included physical examination, laboratory results, CT and MRI scans, as well as assessment of quality of life (QoL) using short-form health survey (SF-36) inventory, Oswestry Disability Questionnaire, and visual analog scale (VAS) spine score. RESULTS: Complete data were available in 70 patients (49 males and 21 females, with an age range of 67±12.3 years) with a median follow-up of 6.6 ± 4.2 years. Follow-up data were available in 70 patients after 1 year, in 58 patients after 2 years, and in 44 patients after 6 years. Thirty-five patients underwent posterior stabilization and decompression alone and 35 patients were operated on in a two-stage 360-degree interbody fusion with decompression. Pre- and postoperative angles of the affected motion segment were 17.6 ± 10.2 and 16.1 ± 10.7 degrees in patients with posterior instrumentation only and 21.0 ± 10.2 and 18.3 ± 10.5 degrees in patients with combined anterior/posterior fusion. Vertebral body subsidence was seen in 12 and 6 cases following posterior instrumentation and 360-degree instrumentation, respectively. Nonfusion was encountered in 22 and 11 cases following posterior instrumentation and 360-degree instrumentation, respectively. The length of hospital stay was 35.0 ± 24.5 days. Surgery-associated complication rate was 18% (12/70). New neurologic symptoms occurred in 7% (5/70). Revision surgery was performed in 3% (2/70) due to screw misplacement/hardware failure and in 3% (2/70) due to intraspinal hematoma. Although patients reported a highly impaired pain deception and vitality, physical mobility was unaffected and pain disability during daily activities was moderate. CONCLUSION: Surgical treatment of SD with a staged surgical approach (if needed) is safe and provides very good long-term clinical and radiologic outcome.

Extended salvage surgery after high-dose chemoradiation therapy for tumors in the cervico-thoracic junction with invasion of the chest wall and the spine: a case series.

The treatment of malignant tumors localized in the upper thoracic cavity and involving the spine at the cervico-thoracic junction (CTJ) is challenging. We report on three patients with malignant tumors invading the thoracic inlet and the spine at the CTJ. All three patients underwent radical tumor resection and 360° spine fusion following the posterior pedicle screw instrumentation and anterior vertebrectomy combined with implantation of an expandable titanium cage. Postoperatively, a mild paresis with hypesthesia of the ipsilateral arm occurred in one patient because of brachial plexus involvement. Two patients were still alive at last follow-up after 83 and 143 months, the third patient succumbed to tumor progression 13 months after extended salvage surgery. We display the possibilities of extended 'salvage' therapy in well-selected patients that were deemed hopeless regarding neurological function, biomechanical stability and tumor control after multiple courses of combined radio-chemotherapy.

Mechanical stability of a novel screw design after repeated insertion: can the double-thread screw serve as a back up?

BACKGROUND: We investigated mechanical pull-out behavior and tightening torque of a novel dual-core pedicle "6T screw" (6T). The aim of this study was to test if these changes in screw geometry are increasing the strength of the pedicle screw fixation after repeated insertion. METHODS: Three different types of pedicle screws were inserted in rigid foam blocks. Tightening torque and pull-out strength were measured during two repetitive insertions of a standard 6.5×45-mm conical screw. The third insertion into the pilot hole was performed using either standard 6.5×45-mm or 7.2×45-mm conical screws or the novel 6.5×45-mm (6T) screw. Additionally, we performed a surface analysis to investigate the bone/screw interface. RESULTS: The maximal tightening torque at the third insertion of the novel 6T screw was 194% higher compared to the standard 6.5×45-mm conical screw and 135% higher compared to the standard 7.2×45-mm conical screw. The pull-out strength of the 6T screw showed no significant changes, and surface analysis revealed a compression of the screw-foam interface due to the different internal diameters. CONCLUSIONS: The modified geometrical design of the 6T screw seems to have no statistically significant effect on the pull-out strength, although it achieved a higher tightening torque. This might be due to the different pitch angle cutting a new thread into the material and also to the enlarged inner diameter.

Combined Laser-Doppler Flowmetry and Spectrophotometry: Feasibility Study of a Novel Device for Monitoring Local Cortical Microcirculation during Aneurysm Surgery.

Background Monitoring of cortical cerebral perfusion is essential, especially in neurovascular surgery. Study Aims To test a novel noninvasive laser-Doppler flowmetry and spectrophotometry device for feasibility during elective cerebral aneurysm surgery. Material and Methods In this prospective single-institution nonrandomized trial, we studied local cerebral microcirculation using the noninvasive laser-Doppler spectrophotometer "Oxygen-to-see" (O2C) in 20 consecutive patients (15 female, 5 male; median age: 60.5 ± 11.7 years) who were operated on for incidental cerebral aneurysms. Capillary-venous oxygenation (oxygen saturation ["SO2"]), postcapillary venous filling pressures (relative hemoglobin content ["rHb"]), blood cell velocity ("velo"), and blood flow ("flow") were measured in 7-mm tissue depth using a subdural fiberoptic probe. Results Representative recordings were acquired immediately after dural opening over a median time span of 88 ± 21.8 seconds (range: 60-128 seconds) before surgical manipulation. Baseline values (median ± 2 standard deviations) of brain perfusion as measured with the O2C device were SO2, 39 ± 16.6%; rHb, 53 ± 18.6 arbitrary units (AU); velo, 60 ± 20.4 AU; and flow, 311 ± 72.8 AU. Placement of the self-retaining retractor led to a decrease in SO2 of 17% ± 29% (p < .05) and flow of 10% ± 11% (p < .01); rHb increased by 18% ± 20% (p < .01), and velo remained unchanged. Retractor removal caused the opposite with an increased flow of 10% ± 7% (p < 0.001) and velo (3% ± 6%, p = 0.11), but a decrease in SO2 of 24% ± 33% (p = 0.09) and rHb of 12% ± 20% (p =0.18). No neurologic or surgical complications occurred. Conclusion Using this novel noninvasive system, we were able to measure local cerebral microcirculation during aneurysm surgery. Our data indicate that this device is able to detect changes during routine neurosurgical maneuvers. Thus it may be useful for early detection of cerebral microcirculatory disturbances.

Migration measurement of the cemented Lubinus SP II hip stem - a 10-year follow-up using radiostereometric analysis.

In a previous radiostereometric analysis (RSA) of the Lubinus SP II (Link, Hamburg, Germany), which is one of the most often used cemented hip stems worldwide, our research group detected a very small but statistically significant distal migration of -0.03±0.17 mm 2 years after surgery compared to the postoperative radiograph. Maximum subsidence occurred between 6 and 12 months. The implant appeared to have stabilized after 2 years. The mean value of maximum total point motion (MTPM) was 0.99±0.69 mm, which was detected 2 years after surgery. The purpose of this study was to analyze the migration pattern and to verify the predictive value of short-term RSA of the Lubinus SP II stem after 10 years. After a follow-up of 5 and 10 years, 38 and 27 out of 100 patients remained available for further assessment, respectively. No statistically significant implant translation or rotation was found along or about the axes of the global coordinate system 5 and 10 years after surgery with respect to the postoperative radiograph. Furthermore, the MTPM was stable in both follow-up periods. The results suggest that the Lubinus SP II hip stem is still stable 10 years after surgery, supporting that determining prognosis by short-term RSA follow-up of 2 years could be an appropriate tool for appraisal of implant behavior 10 years after surgery.

Plasticity Related Gene 3 (PRG3) overcomes myelin-associated growth inhibition and promotes functional recovery after spinal cord injury.

The Plasticity Related Gene family covers five, brain-specific, transmembrane proteins (PRG1-5, also termed LPPR1-5) that operate in neuronal plasticity during development, aging and brain trauma. Here we investigated the role of the PRG family on axonal and filopodia outgrowth. Comparative analysis revealed the strongest outgrowth induced by PRG3 (LPPR1). During development, PRG3 is ubiquitously located at the tip of neuronal processes and at the plasma membrane and declines with age. In utero electroporation of PRG3 induced dendritic protrusions and accelerated spine formations in cortical pyramidal neurons. The neurite growth promoting activity of PRG3 requires RasGRF1 (RasGEF1/Cdc25) mediated downstream signaling. Moreover, in axon collapse assays, PRG3-induced neurites resisted growth inhibitors such as myelin, Nogo-A (Reticulon/RTN-4), thrombin and LPA and impeded the RhoA-Rock-PIP5K induced neurite repulsion. Transgenic adult mice with constitutive PRG3 expression displayed strong axonal sprouting distal to a spinal cord lesion. Moreover, fostered PRG3 expression promoted complex motor-behavioral recovery compared to wild type controls as revealed in the Schnell swim test (SST). Thus, PRG3 emerges as a developmental RasGRF1-dependent conductor of filopodia formation and axonal growth enhancer. PRG3-induced neurites resist brain injury-associated outgrowth inhibitors and contribute to functional recovery after spinal cord lesions. Here, we provide evidence that PRG3 operates as an essential neuronal growth promoter in the nervous system. Maintaining PRG3 expression in aging brain may turn back the developmental clock for neuronal regeneration and plasticity.

Temozolomide toxicity operates in a xCT/SLC7a11 dependent manner and is fostered by ferroptosis.

The glutamate exchanger xCT (SLC7a11) is causally linked with the malignancy grade of brain tumors and represents a key player in glutamate, cystine and glutathione metabolism. Although blocking xCT is not cytotoxic for brain tumors, xCT inhibition disrupts the neurodegenerative and microenvironment-toxifying activity of gliomas. Here, we report on the use of various xCT inhibitors as single modal drugs and in combination with the autophagy-inducing standard chemotherapeutic agent temozolomide (Temodal/Temcad®, TMZ). xCT overexpressing cells (xCTOE) are more resistant to the FDA and EMA approved drug sulfasalazine (Azulfidine/Salazopyrin/Sulazine®, SAS) and RNAi-mediated xCT knock down (xCTKD) in gliomas increases the susceptibility towards SAS in rodent gliomas. In human gliomas, challenged xCT expression had no impact on SAS-induced cytotoxicity. Noteworthy, other xCT inhibitors such as erastin and sorafenib showed enhanced efficacy on xCTKD gliomas. In contrast, cytotoxic action of TMZ operates independently from xCT expression levels on rodent gliomas. Human glioma cells with silenced xCT expression display higher vulnerability towards TMZ alone as well as towards combined TMZ and SAS. Hence, we tested the partial xCT blockers and ferroptosis inducing agents erastin and sorafenib (Nexavar®, FDA and EMA-approved drug for lung cancer). Noteworthy, xCTOE gliomas withstand erastin and sorafenib-induced cell death in a concentration-dependent manner, whereas siRNA-mediated xCT knock down increased susceptibility towards erastin and sorafenib. TMZ efficacy can be potentiated when combined with erastin, however not by sorafenib. Moreover, gliomas with high xCT expression are more vulnerable towards combinatorial treatment with erastin-temozolomide. These results disclose that ferroptosis inducers are valid compounds for potentiating the frontline therapeutic agent temozolomide in a multitoxic approach.

Differences in Intrusive Memory Experiences in Post-traumatic Stress Disorder after Single, Re- and Prolonged Traumatization.

Intrusive memory experiences (IMEs) are a common symptom of post-traumatic stress disorder (PTSD). Sensory perceptions of IMEs in the PTSD context vary substantially. The present research examined 20 patients with a single trauma, 20 re-traumatized patients and 80 Holocaust-traumatized patients who suffered from PTSD. Our results revealed significant differences in IME frequency based on the types of trauma experience. The findings suggest that patients with prolonged (Holocaust) traumata suffered from visual (65%) and combined visual/acoustic intrusive memories (29%), whereas visual memory experiences were most frequent (90%) among single-trauma patients. The trauma experience and the intrusive memory trigger stimulus were interdependent. The type of trauma critically affects the traumatic experience. Future studies should focus on these findings to improve PTSD therapeutic options.

Single- and multi-level anterior decompression and fusion for cervical spondylotic myelopathy--a long term follow-up with a minimum of 5 years.

OBJECTIVE: Cervical spondylotic myelopathy (CSM) is a common disease leading to significant neurological disability. We compared patients suffering from a single- and a multi-level pathology to analyze the influence of the natural course of the disease on the long-term outcome after surgery. METHODS: We analyzed the records of 52 patients with CSM after surgery. The neurological status of the patients was assessed by the modified Japanese Orthopaedic Association Scale (mJOAS). X-rays were conducted before and after surgery. RESULTS: 52 patients were treated by a single-level (n=27) or a multi-level approach (n=25) more than 5 years ago. A significant improvement of the neurological status could be seen even 5 years or more after surgery in both groups without differences. After one year no further improvement could be observed. In the single-level group a trend to a subsequent loss of lordotic correction could be seen. Anterior plates were only used in the multi-level group. CONCLUSION: The anterior approach is an effective procedure to improve the symptoms of a CSM for many years. The risk of a multi-level pathology does not appear to exceed the risks of a single-level pathology concerning clinical long-term outcome after surgery. The clinical success is not hindered by a loss of correction in this specific setting.