Spezifische stereotaktische Optionen zur Behandlung seltener Epilepsien, basierend auf hypothalamischen Hamartomen

Hypothalamic hamartomas (HH) are rare non-neoplastic developmental disorders, which typically manifest as gelastic seizures in early childhood and play a causal role in the sezures associated with them. As pharmaceutical treatment is ineffective in most cases, early surgical or interventional treatment should be considered. Open surgery poses a high risk for complications and is increasingly being omitted. In endoscopic procedures it could be shown that disconnection of the HH is an important component of the procedure and often sufficient to achieve seizure control. Less invasive procedures, such as radiosurgery or brachytherapy are treatment options with low complication rates. The best seizure outcomes could be shown with lesioning procedures using stereotactically guided laser or radiofrequency ablation. In order to minimize the complication rates of these procedures it seems advisable to aim at disconnection and not necessarily destruction of the lesion

Patient radiation exposure from intraoperative computed tomography in spinal surgery.

Intraoperative CT imaging is becoming increasingly used, but often little attention is paid to the underlying radiation exposure to the patient. This work showed that the dosimetrically assessed radiation exposure for cervical and lumbar 3D scans with an intraoperative CT is considerably higher than with a 3D C-arm. Therefore, proper selection of the intraoperative 3D imaging system is essential, and further technological developments and dose-saving protocols are warranted to further reduce patient radiation exposure

Impact of Stereotactic Ventriculocisternostomy on Delayed Cerebral Infarction and Outcome After Subarachnoid Hemorrhage

Background and Purpose- Delayed cerebral infarction (DCI) is an important cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage is a new method for DCI prevention. Here, we assess the effects of implementing STX-VCS in an unselected aSAH patient population of a tertiary referral center. Methods- Retrospective cohort study of all consecutive aSAH patients admitted to a neurosurgical referral center during a 7-year period (April 2012 to April 2019). Midterm STX-VCS was introduced and offered to patients at high risk for DCI. We compared the incidence and burden of DCI, neurological outcome, and the use of induced hypertension and endovascular rescue therapy in this consecutive aSAH population 3.5 years before versus 3.5 years after STX-VCS became available. Results- Four hundred thirty-six consecutive patients were included: 222 BEFORE and 214 AFTER. Fifty-seven of 214 (27%) patients received STX-VCS. Stereotactic procedures resulted in one (2%) subdural hematoma. Favorable neurological outcome at 6 months occurred in 118 (53%) patients BEFORE and 139 (65%) patients AFTER (relative risk, 0.79 [95% CI, 0.66–0.95]). DCI occurred in 40 (18.0%) patients BEFORE and 17 (7.9%) patients AFTER (relative risk, 0.68 [95% CI, 0.57–0.86]), and total DCI volumes were 8933 (100%) and 3329 mL (36%), respectively. Induced hypertension was used in 97 (44%) and 30 (15%) patients, respectively (relative risk, 0.55 [95% CI, 0.46–0.65]). Thirty (13.5%) patients BEFORE versus 5 (2.3%) patients AFTER underwent endovascular rescue therapies (relative risk, 0.17 [95% CI, 0.07–0.42]). Conclusions- Selecting high-risk patients for STX-VCS reduced the DCI incidence, burden, and related mortality in a consecutive aSAH patient population. This was associated with an improved neurological outcome