The use of the sodium fluorescein and YELLOW 560 nm filter for the resection of pediatric posterior fossa lesions

Purpose This study aimed to verify the feasibility, safety, and benefit of using fluorescein sodium (FL) and a YELLOW 560 nm filter in posterior fossa tumors in children. Methods All cases of pediatric posterior fossa tumors that have undergone surgery using fluorescein (2018–2022) have been included and were examined retrospectively. In those cases where resection of the tumor was planned, a blinded neuroradiologist distinguished gross total resection and subtotal resection according to the postoperative MRI findings. The surgical report and medical files were reviewed regarding the intraoperative staining grade and adverse events. The grade of fluorescent staining of the targeted lesion was assessed as described in the surgical reports. The screening was conducted for any reference to the degree of fluorescent staining: “intense,” “medium,” “slight,” and “no staining.” Results 19 cases have been included. In 14 cases, a complete resection was initially intended. In 11 of these cases, a gross total resection could be achieved (78.6%). Staining was described as intense in most cases (58.8%). Except for yellow-colored urine, no side effects obviously related to FL were found throughout the observation period. Conclusion In combination with a specific filter, FL is a reliable, safe, and feasible tool in posterior fossa surgery in children

Preoperative Assessment of Language Dominance through Combined Resting-State and Task-Based Functional Magnetic Resonance Imaging

Brain lesions in language-related cortical areas remain a challenge in the clinical routine. In recent years, the resting-state fMRI (RS-fMRI) was shown to be a feasible method for preoperative language assessment. The aim of this study was to examine whether language-related resting-state components, which have been obtained using a data-driven independent-component-based identification algorithm, can be supportive in determining language dominance in the left or right hemisphere. Twenty patients suffering from brain lesions close to supposed language-relevant cortical areas were included. RS-fMRI and task-based (TB-fMRI) were performed for the purpose of preoperative language assessment. TB-fMRI included a verb generation task with an appropriate control condition (a syllable switching task) to decompose language-critical and language-supportive processes. Subsequently, the best fitting ICA component for the resting-state language network (RSLN) referential to general linear models (GLMs) of the TB-fMRI (including models with and without linguistic control conditions) was identified using an algorithm based on the Dice index. Thereby, the RSLNs associated with GLMs using a linguistic control condition led to significantly higher laterality indices than GLM baseline contrasts. LIs derived from GLM contrasts with and without control conditions alone did not differ significantly. In general, the results suggest that determining language dominance in the human brain is feasible both with TB-fMRI and RS-fMRI, and in particular, the combination of both approaches yields a higher specificity in preoperative language assessment. Moreover, we can conclude that the choice of the language mapping paradigm is crucial for the mentioned benefits

The role of "Suppressor of Cytokine Signaling" (SOCS) proteins in murine infection with Toxoplasma gondii

Die orale Infektion mit 100 Zysten T. gondii führt bei C57BL/6-Mäusen zu einer Immunpathologie, die durch Pan-Ileitis und Tod der Mäuse innerhalb von 7-14 Tagen gekennzeichnet ist. Die Immunpathogenese der Infektion wird durch Th1- (und/oder sog. Th17)-Zellen vermittelt und zeigt weitreichende Parallelen zur Pathogenese des M. Crohn beim Menschen. Balb/c- und CBA/ca-Mäuse hingegen sind resistent und erkranken nicht an einer Darmpathologie. Die kürzlich entdeckten "Suppressor of Cytokine Signaling" (SOCS)-Proteine gelten als immunmodulatorische Moleküle, die Zytokinwirkungen hemmen können. In der vorliegenden Arbeit sollte die Frage geklärt werden, inwieweit a) sich die Expression von SOCS-Proteinen und die Produktion proinflammatorischer Zytokine zwischen naiven und infizierten Tieren der oben genannten Mausstämme unterscheidet, b) wie sich die lokale von der systemischen Expression dieser Immunmarker unterscheidet, und c) ob es eine Korrelation der SOCS-Expression und der Produktion proinflammatorischer Zytokine mit der Morbidität, der Schwere der histologischen Veränderungen und der Parasitenzahl im Ileum sowie mit den Frequenzen bestimmter Leukozytenpopulationen gibt. Dazu wurden Tiere der oben genannten Mausstämme oral mit 100 Zysten T. gondii infiziert und im Verlauf der Infektion gewogen. An Tag 7 nach der Infektion wurden Milz, MLN und Ileum der Tiere entnommen und die histologischen Veränderungen im Ileum, die Anzahl der Parasiten sowie die Konzentrationen der wesentlich an der Pathologie beteiligten Zytokine IFN-γ, IL-6 und IL-23p19 bestimmt. Weiterhin wurden die Expressionen von SOCS-1 und SOCS-3 sowie die relativen Frequenzen bestimmter Leukozytenpopulationen bestimmt. Es konnte gezeigt werden, dass die orale Infektion mit 100 Zysten T. gondii zu einer Induktion des Th1-Zytokins IFN-γ und der "Th17"-Zytokine IL-6 und IL-23p19 führt, die genetisch reguliert ist. Die lokalen Konzentrationen der "Th17"-Zytokine, nicht aber die des Th1-Zytokins IFN-γ korrelierten hierbei mit Morbidität, histopathologischen Veränderungen und Parasitenlast im Ileum der Mäuse sowie mit einer erhöhten Frequenz von Makrophagen. Dies sollte auf eine wichtigere Rolle für die "Th17"- als für die Th1-Immunantwort bei der Entstehung der Pathologie hindeuten. Systemisch waren die Konzentrationen sowohl der Th1- als auch der "Th17"-Zytokine hingegen bei den resistenten Mausstämmen höher als bei den suszeptiblen Mäusen. Ebenso konnte in der vorliegenden Arbeit zum ersten Mal gezeigt werden, dass es in vivo unter der Infektion mit T. gondii zu einer Induktion von SOCS-1 und SOCS-3 kommt, die mit der Produktion der proinflammatorischen Th1- und "Th17"-Zytokine in lokalen und systemischen Kompartimenten korreliert und daher vermutlich als Reaktion auf erhöhte Zytokinkonzentrationen zu betrachten ist. Auffällig war insbesondere eine bei den suszeptiblen Mäusen signifikant erhöhte lokale Induktion von SOCS-3, für das eine spezielle regulatorische Rolle von IL-6 angenommen wird.In C57BL/6 mice, oral infection with 100 cysts of T. gondii leads to severe ileitis and death of the mice within 7-14 days. The immunopathology of this infection is mediated through Th1 (and/or Th17) cells and shows fundamental similarities to the pathogenesis of human Crohn's Disease. Balb/c und CBA/ca mice, however, are resistant to the infection and do not develop an intestinal pathology. The recently discovered "`Suppressor of Cytokine Signaling"' (SOCS) proteins are immunomodulatory molecules which have the ability to inhibit cytokine effects. The purpose of this paper was to identify how a) the expression of SOCS proteins and the production of proinflammatory cytokines differs between infected and wildtype mice of the above mentioned haplotypes, b) how local expression of these immune markers differs from systemic expression, and c) if there is a correlation between SOCS expression and the production of proinflammatory cytokines on one hand, and the morbidity, the severity of the histopathological changes, the number of parasites in the ileum, as well as the frequency of certain leukocyte populations on the other hand. Therefore, mice of the above mentioned haplotypes were infected orally with 100 cysts of T. gondii and weighed during the course of infection. On day 7 post infection, spleen, mesenterial lymph nodes, and ileum were harvested and histophathological changes in the ileum, as well as concentrations of IFN-γ, IL-6, and IL-23p19 were determined. Furthermore, SOCS-1 and SOCS-3 expressions and relative frequencies of certain leukocyte populations were determined. It could be demonstrated that oral infection with 100 cysts of T. gondii leads to induction of the Th1 cytokine IFN-γ and the "Th17" cytokines IL-6 and IL-23p19, which is genetically regulated. Local concentrations of the "Th17" cytokines, but not of the Th1 cytokine IFN-γ, correlated with the morbidity, the histopathological changes, the parasite load in the ileum, as well as an increased frequency of macrophages. These findings point towards a more important role of the "Th17" cytokines compared to the Th1 immune response in the pathogenesis of the infection. Systemically, concentrations of both the Th1 and the "Th17" cytokines were, however, increased in resistant as compared to susceptible mice. Furthermore, it could be demonstrated for the first time that infection with T. gondii leads to an induction of SOCS-1 and SOCS-3 in vivo which correlated with the production of proinflammatoriy Th1 and "Th17" cytokines in local and systemic compartments. The increased SOCS expression can be interpreted as reactive to increased cytokine concentrations. Remarkably, SOCS-3, which has been attributed a specific regulatory role for IL-6, was significantly increased in susceptible mice

A multicenter cohort study of early complications after cranioplasty: results of the German Cranial Reconstruction Registry

OBJECTIVE Cranioplasty (CP) is a crucial procedure after decompressive craniectomy and has a significant impact on neurological improvement. Although CP is considered a standard neurosurgical procedure, inconsistent data on surgery-related complications after CP are available. To address this topic, the authors analyzed 502 patients in a prospective multicenter database (German Cranial Reconstruction Registry) with regard to early surgery-related complications. METHODS Early complications within 30 days, medical history, mortality rates, and neurological outcome at discharge according to the modified Rankin Scale (mRS) were evaluated. The primary endpoint was death or surgical revision within the first 30 days after CP. Independent factors for the occurrence of complications with or without surgical revision were identified using a logistic regression model. RESULTS Traumatic brain injury (TBI) and ischemic stroke were the most common underlying diagnoses that required CP. In 230 patients (45.8%), an autologous bone flap was utilized for CP; the most common engineered materials were titanium (80 patients [15.9%]), polyetheretherketone (57[11.4%]), and polymethylmethacrylate (57[11.4%]). Surgical revision was necessary in 45 patients (9.0%), and the overall mortality rate was 0.8% (4 patients). The cause of death was related to ischemia in 2 patients, diffuse intraparenchymal hemorrhage in 1 patient, and cardiac complications in 1 patient. The most frequent causes of surgical revision were epidural hematoma (40.0% of all revisions), new hydrocephalus (22.0%), and subdural hematoma (13.3%). Preoperatively increased mRS score (OR 1.46, 95% CI 1.08-1.97, p = 0.014) and American Society of Anesthesiologists Physical Status Classification System score (OR 2.89, 95% CI 1.42-5.89, p = 0.003) were independent predictors of surgical revision. Ischemic stroke, as the underlying diagnosis, was associated with a minor rate of revisions compared with TBI (OR 0.18, 95% CI 0.06-0.57, p = 0.004). CONCLUSIONS The authors have presented class II evidence-based data on surgery-related complications after CP and have identified specific preexisting risk factors. These results may provide additional guidance for optimized treatment of these patients