Serum biomarkers for experimental acute spinal cord injury: rapid elevation of neuron-specific enolase and S-100 beta.
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Animals↗
Biomedical subjects
Gerhard Marquardt
Publications and source records attributed to Gerhard Marquardt.
Brain surface reformatted images for fast and easy localization of perirolandic lesions.
OBJECT: The goal of this study was to evaluate a novel form of brain surface representation that allows simple, reliable mapping of the surface neuroanatomy for the preoperative evaluation of the spatial relationship between a focal lesion and the precentral gyrus. METHODS: High-resolution three-dimensional (3D) magnetic resonance (MR) imaging data sets were postprocessed using a curved multiplanar reformatting technique to create brain surface reformatted (BSR) images. These BSR images were reconstructed in less than 5 minutes and demonstrated the entire central sulcus with adjacent surface structures in one view. Two experienced neuroradiologists determined the localization of lesions near the central sulcus in 27 patients on standard MR images in three orthogonal planes and on BSR images. In addition, these observers judged whether the lesions were easy or difficult to localize on standard MR and BSR images, and whether diagnoses based on these methods were certain or doubtful. Anatomical localization based on BSR images was compared with that based on functional MR (fMR) images or intraoperative mapping of motor function. The BSR images yielded a perfect concordance with the fMR images and intraoperative mapping (Cohen kappa 1.0) and optimal diagnostic accuracy in localizing perirolandic lesions (both sensitivity and specificity were 100%). Localization was judged to be easy for 48 of 54 diagnoses based on BSR images compared with 26 of 54 based on standard MR images. Diagnoses were assessed as certain for 52 cases based on BSR images and 34 cases based on standard MR images. CONCLUSIONS: Brain surface reformatted imaging improves the diagnostic accuracy of standard anatomical MR imaging for localizing superficial brain lesions in relation to the precentral gyrus. The complementary use of this technique with standard two-dimensional imaging is supported by the fast and simple postprocessing technique and may provide useful information for preoperative surgical planning.
Adult↗
A novel dynamic model for experimental spinal cord compression.
OBJECT: The goal of this study was to develop a novel dynamic model for experimental spinal cord compression that closely approximates neoplastic epidural compression of the spinal cord in humans. METHODS: In 30 New Zealand white rabbits, the thoracic spine was exposed via a posterior approach. On each side of one vertebral lamina a small hole was drilled caudal to the articular process. A silicone band was passed through these holes, forming a loop. The spinal dura mater was exposed via an interlaminar approach. The loop was brought into contact with the dura mater and fixed in its position encircling 270 degrees of the circumference of the spinal cord. Thereafter, the loop was gradually tightened at set times by pulling at the ends of the band and fixing them again in their new position. The spinal cord was thus increasingly compressed in a circular and dynamic manner. Neurological deficits of various degrees were created in all animals in the compression group, and the compressive effect of the loop was reliably demonstrated on MR imaging. After decompression of the spinal cord, the neurological deficits were reversible in the majority of animals, and MR imaging revealed either no signal changes or only circumscribed ones within the cord. In contrast, MR images obtained in animals that did not recover revealed the occurrence of extensive chronic myelopathy. CONCLUSIONS: This novel model features reproducibility of paresis and neurological recovery. It is a dynamic model simulating circular tumor growth and is characterized by its easy, straightforward, and cost-saving applicability.
Animals↗
Basal ganglia haematomas in non-comatose patients: subacute stereotactic aspiration improves long-term outcome in comparison to purely medical treatment.
This study examined whether subacute stereotactic evacuation of basal ganglia haematomas in primarily non-comatose patients is suitable to improve the ultimate outcome of this subgroup of stroke patients. Applying rigorous selection criteria, 56 consecutive non-comatose patients with ganglionic haematomas were treated stereotactically, and 1-year outcomes employing four outcome parameters commonly used to assess outcome were compared with those of 39 similar patients who were treated purely medically. No survival benefit was found in long-term follow-up for either surgical or conservative treatment (total mortality 16.1% vs 28.2%; P=0.121). Among survivors, however, outcome was significantly better in surgical patients. Compared with medical patients, the median Glasgow Outcome Scale score was 1 point higher (P<0.0001) in surgical patients, and the median European Stroke Scale score improvement from baseline to 1-year score was significantly better (P<0.0001). Accordingly, the median Barthel Index score was significantly higher (P=0.002), and the median Modified Rankin Scale score was 1 point lower (P<0.0001). We conclude that primarily non-comatose patients with basal ganglia haematomas can ultimately profit from this form of minimally invasive treatment.
Activities of Daily Living↗
Protein S-100b for individual prediction of functional outcome in spinal epidural empyema.
STUDY DESIGN: A study correlating protein S-100b serum levels with postoperative functional outcome in patients with spinal cord compression resulting from epidural empyema. OBJECTIVES: To evaluate the potential value of protein S-100b for prediction of individual functional outcome in medullary lesions resulting from spinal epidural empyema. SUMMARY OF BACKGROUND DATA: Despite modern medical advances, a reliable individual prediction of functional outcome in case of spinal epidural empyema is still not possible. METHODS: Forming two outcome groups, clinical outcome following surgery was considered to be favorable in case of neurologic improvement with preservation or retrieval of walking ability, whereas nonimprovement without restoration of gait function was regarded to be unfavorable. Venous blood samples for protein S-100b were taken from all patients immediately after admission and regularly after operative decompression. Initial levels of S-100b were correlated with preoperative degree and duration of paresis, and the individual time course of S-100b measurements was correlated with clinical outcome. RESULTS: The initial level of protein S-100b is not correlated with preoperative degree and duration of paresis or with functional outcome. The individual time course of S-100b measurements, however, is different in both outcome groups. Levels of protein S-100b that were either always normal or that were initially increased but normalized rapidly within 3 days were invariably associated with retrieval of gait function, whereas none of those patients recovered in whom increased levels of S-100b persisted beyond the third postoperative day (P < 0.003). CONCLUSIONS: Protein S-100b might be a promising serum marker with prognostic significance in the event of spinal cord compression resulting from epidural empyema.
Adult↗
Morphology of proliferating and non-proliferating tumor cell nuclei in glioblastomas correlates with preoperative data from proton-MR-spectroscopy.
In contrast to the growing interest in proton-MR-spectroscopy (1HMRS) for preoperative examination of patients with brain tumors, there is nearly no knowledge about a correlation between data from 1HMRS and histomorphology as confirmed by quantitative morphological methods. Whether a correlation can be confirmed between data from 1HMRS and quantitative histomorphology of glioblastomas representing the most frequent type of brain tumors was investigated in the present study. Furthermore, it was of interest, whether correlations between spectroscopic data and histomorphology can be confirmed for proliferating and non-proliferating tumor cell nuclei independently. Using stringent inclusion criteria for this study, 24 patients were investigated by means of preoperative 1HMRS and by means of digital image analysis of paraffin sections from the surgical specimen. Proliferating and non-proliferating tumor cell nuclei were investigated separately in the region with the highest proliferative activity in each tumor using immunohistological staining for the proliferation marker Ki67. Main results showed highly significant correlations between total creatine and variables of nuclear size, as well as correlations between choline and variables of nuclear shape. These results were confirmed for both proliferating and non-proliferating tumor cell nuclei. A significant correlation between N-acetyl-aspartate level and topometric variables (number of neighbors per nucleus, variables describing distances between tumor cell nuclei) was confirmed for proliferating tumor cell nuclei. Discriminant analysis provided a good separation of cases with high and with low values for these spectroscopic variables based on histomorphometric data. In conclusion, the results confirm a direct correlation between data from preoperative 1HMRS and histomorphological characteristics of glioblastomas supporting the biological relevance of spectroscopic data for the examination of brain tumor patients.
Cell Nucleus↗
Direct transnasal approach for pituitary surgery.
One hundred four patients with pituitary tumours were treated using the direct transnasal approach. The data of these patients were analysed prospectively with regard to duration of surgery and occurrence of complications and compared with retrospective data from 52 patients in whom the traditional sublabial trans-sphenoidal approach was performed. Using the direct transnasal approach, mean operative time was significantly lower than with the sublabial technique. In addition, even though major complications were observed in neither treatment group, minor complications were significantly less frequent after the direct transnasal approach. Due to minimised dissection of normal tissue, this approach is less time-consuming and less traumatic, and the rate of minor complications is significantly lower than with the sublabial procedure.
Humans↗
Multiple target aspiration technique for subacute stereotactic aspiration of hematomas within the basal ganglia.
BACKGROUND: Stereotactic surgery for deep-seated intracerebral hematomas as a minimally invasive procedure has gained wide acceptance, but debate continues to be controversial concerning the issue of how to aspirate a sufficient proportion of the hematoma with minimized risk for the patient. The objective of this paper is to present a modified stereotactic aspiration technique which complies saliently with both demands. METHODS: The multiple target aspiration technique was used in a series of 64 consecutive patients with spontaneous hematomas within the basal ganglia. The results obtained with this technique were evaluated with particular regard to degree of aspiration and rate of recurrent hemorrhage and were compared with results achieved with stereotactic techniques utilizing physical fragmentation or chemical lysis of the clots. RESULTS: Using this technique, it was feasible in one single surgical procedure to aspirate more than 80% of the hematoma volume in 73.4% of the patients. Mean degree of aspiration was 88.8%, and rebleeding occurred only once (1.6%). These results compare favorably with those achieved with application of intricate stereotactic techniques. CONCLUSION: The multiple target aspiration technique performed in the subacute stage is a rapid and simple method for stereotactic removal of deep-seated hematomas and combines a high success rate with very low risk of recurrent hemorrhage.
Adult↗
Subacute stereotactic aspiration of haematomas within the basal ganglia reduces occurrence of complications in the course of haemorrhagic stroke in non-comatose patients.
BACKGROUND AND PURPOSE: Medical complications occurring after stroke of both ischaemic and haemorrhagic origin are frequent and constitute an important problem. The strongest factor predicting the occurrence of complications is known to be the initial neurological impairment level. The aim of this study was to examine whether subacute stereotactic aspiration of haematomas within the basal ganglia is suitable to reduce the occurrence of complications in the course of haemorrhagic stroke in non-comatose patients. METHODS: Following rigorous selection criteria, 56 consecutive non-comatose patients were treated by subacute stereotactic evacuation of the haematomas. Glasgow Coma Scale (GCS) scores after initiation of treatment, medical complications, mortality and length of in-patient stay before discharge for further rehabilitative treatment were recorded for each patient and were compared with the results obtained in a comparable group of 39 patients treated purely medically in another hospital. RESULTS: The level of consciousness improved markedly after stereotactic surgery, and GCS scores were significantly higher than those after pure medical treatment (p < 0.0001). In comparison with medical patients, complications were considerably fewer in the surgical group, and thus peri-ictal morbidity and mortality were significantly lower. Length of necessary treatment in the intensive care unit as well as total in-patient stay in the acute care facility were significantly reduced. CONCLUSIONS: Improving alertness, subacute stereotactic aspiration of deep-seated haematomas decreases occurrence of medical complications in the course of haemorrhagic stroke. Recovery can be accelerated, and patients are earlier suitable for further rehabilitative treatment.
Adult↗
Determination of histopathological tumor grade in neuroepithelial brain tumors by using spectral pattern analysis of in vivo spectroscopic data.
OBJECT: In this study, 1H magnetic resonance (MR) spectroscopy was prospectively tested as a reliable method for presurgical grading of neuroepithelial brain tumors. METHODS: Using a database of tumor spectra obtained in patients with histologically confirmed diagnoses, 94 consecutive untreated patients were studied using single-voxel 1H spectroscopy (point-resolved spectroscopy; TE 135 msec, TE 135 msec, TR 1500 msec). A total of 90 tumor spectra obtained in patients with diagnostic 1H MR spectroscopy examinations were analyzed using commercially available software (MRUI/VARPRO) and classified using linear discriminant analysis as World Health Organization (WHO) Grade I/II, WHO Grade III, or WHO Grade IV lesions. In all cases, the classification results were matched with histopathological diagnoses that were made according to the WHO classification criteria after serial stereotactic biopsy procedures or open surgery. Histopathological studies revealed 30 Grade I/II tumors, 29 Grade III tumors, and 31 Grade IV tumors. The reliability of the histological diagnoses was validated considering a minimum postsurgical follow-up period of 12 months (range 12-37 months). Classifications based on spectroscopic data yielded 31 tumors in Grade I/II, 32 in Grade III, and 27 in Grade IV. Incorrect classifications included two Grade II tumors, one of which was identified as Grade III and one as Grade IV; two Grade III tumors identified as Grade II; two Grade III lesions identified as Grade IV; and six Grade IV tumors identified as Grade III. Furthermore, one glioblastoma (WHO Grade IV) was classified as WHO Grade I/II. This represents an overall success rate of 86%, and a 95% success rate in differentiating low-grade from high-grade tumors. CONCLUSIONS: The authors conclude that in vivo 1H MR spectroscopy is a reliable technique for grading neuroepithelial brain tumors.
Brain Neoplasms↗
Glioblastoma multiforme of the brain stem in a patient with acquired immunodeficiency syndrome.
Glioblastoma of the brain stem is rare and there is no description of such a lesion in patients suffering from acquired immunodeficiency syndrome. The majority of intracerebral mass lesions are due either to toxoplasmosis or primary central nervous system lymphomas so that it is usually not included in the differential diagnosis of enhancing lesions of the central nervous system in these patients. A 31-year-old human immunodeficiency virus (HIV) infected man presented with a four months history of slowly progressive deterioration of brainstem associated symptoms despite antitoxoplasmic therapy. Magnetic resonance imaging revealed a large ring enhancing lesion in the brainstem. Clinical and neuroradiological data could not establish a proper diagnosis and a stereotactic serial biopsy was undertaken. Histological examination of the specimen showed a glioblastoma multiforme (GBM) as the first reported case of GBM located in the brainstem in an acquired immunodeficiency syndrome (AIDS) patient. Patient management and effectiveness of stereotactic serial biopsy are discussed.
AIDS Dementia Complex↗
Cerebellar hemorrhage after supratentorial craniotomy.
BACKGROUND: Cerebellar hemorrhage following supratentorial craniotomy is a very seldom described but serious complication. The present study evaluates the significance of presurgical and surgical factors that may predispose patients to these bleeding episodes. METHODS: The data of 52 cases of cerebellar hemorrhage following supratentorial craniotomy, 9 from our records and 43 from the literature, were analyzed with regard to various variables. RESULTS: The findings suggest that this clinical picture is unrelated to age, previous arterial hypertension, inherent or induced coagulopathies, type of primary underlying lesion, intraoperative positioning of the patient, type of anesthesia, or intracranial hypotension and its sequels. It entails significant morbidity, with one third of the patients left with cerebellar dysfunction or in a dependent state, and carries a mortality of about 25%. CONCLUSION: Not one single presurgical or surgical factor can reliably predict the occurrence of cerebellar hemorrhage after supratentorial craniotomy, and the etiology of this entity still remains unclear. The most important keys to minimize the hazardous sequelae are to be aware of this potential complication and to diagnose it early.
Adolescent↗
Application of recombinant activated factor VII during surgery for a giant skull base hemangiopericytoma to achieve safe hemostasis. Case report.
The authors report on a 64-year-old woman with a huge recurrent skull base hemangiopericytoma, in whom they encountered severe difficulty in attaining intraoperative hemostasis. Standard surgical hemostatic methods and the administration of fresh-frozen plasma and prothrombin complex concentrates failed to stop diffuse bleeding from an inoperable tumor remnant. At a critical point during the operation, the intravenous administration of recombinant activated factor VII, combined with mechanical compression, finally led to satisfactory hemostasis. The rationale for using recombinant activated factor VII in situations of uncontrolled bleeding during neurosurgical procedures is discussed, along with the literature in which the use of recombinant activated factor VII as a maneuver of last resort is reported for hemostasis in other surgical fields.
Cerebral Angiography↗
Primary meningeal osteosarcoma: case report and review of the literature.
OBJECTIVE AND IMPORTANCE: Primary meningeal osteosarcomas are extremely rare lesions; before this case report, only five cases had been reported in the literature. We encountered a patient with a meningeal osteosarcoma but no evidence of additional tumor at another remote site. CLINICAL PRESENTATION: A 56-year-old man presented with progressive weakness of the right leg and the right arm. Computed tomography and magnetic resonance imaging revealed an extracerebral frontoparietal tumor on the left side. INTERVENTION: The patient underwent complete resection of the tumor and subsequent radiotherapy of the tumor region. The histological examination showed evidence of the osteosarcoma, which was confined to the meninges. Postoperative adjuvant radiotherapy was administered. There was no tumor recurrence during 3 years of postoperative follow-up. Because the patient had no risk factors or further osteosarcomas, primary meningeal development was assumed. CONCLUSION: Despite their rarity, osteosarcomas must be considered in the differential diagnosis of meningeal tumors.
Cerebral Angiography↗