Surgical results of 158 petroclival meningiomas with special focus on standard craniotomies

Objective The goal of this retrospective study is the evaluation of risk factors for postoperative neurological deficits after petroclival meningioma (PCM) surgery with special focus on standard craniotomies. Materials and methods One-hundred-fifty-eight patients were included in the study, of which 133 patients suffered from primary and 25 from recurrent PCM. All patients were operated on and evaluated concerning age, tumor size, histology, pre- and postoperative cranial nerve (CN) deficits, morbidity, mortality, and surgical complications. Tumor-specific features—e.g., consistency, surface, arachnoid cleavage, and location—were set in a four-grade classification system that was used to evaluate the risk of CN deficits and tumor resectability. Results After primary tumor resection, new CN deficits occurred in 27.3% of patients. Preoperative ataxia improved in 25%, whereas 10% developed new ataxia. Gross total resection (GTR) was achieved in 59.4%. The morbidity rate, including hemiparesis, shunt-dependence, postop-hemorrhage, and tracheostomy was 22.6% and the mortality rate was 2.3%. In recurrent PCM surgery, CN deficits occurred in 16%. GTR could be achieved in three cases. Minor complications occurred in 20%. By applying the proposed new classification system to patients operated via standard craniotomies, the best outcome was observed in type I tumor patients (soft tumor consistency, smooth surface, plane arachnoid cleavage, and unilateral localization) with GTR in 78.7% (p < 0.001) and 11.9% new CN deficits (p = 0.006). Conclusion Standard craniotomies as the retrosigmoid or subtemporal/pterional approaches are often used for the resection of PCMs. Whether these approaches are sufficient for GTR—and avoidance of new neurological deficits—depends mainly on the localization and intrinsic tumor-specific features

Two predominant molecular subtypes of spinal meningioma: thoracic NF2‑mutant tumors strongly associated with female sex, and cervical AKT1‑mutant tumors originating ventral to the spinal cord

Spinal meningiomas (SM) comprise 5–10% of primary meningiomas and up to 30% of spinal intradural tumors. SMs are usually sporadic, but rarely, they can develop in association with genetic diseases like neurofibromatosis type 2 or schwannomatosis [2, 4, 6]. While the mutational landscape of intracranial meningiomas has been extensively studied [3, 5, 11, 14], our understanding of the molecular profile of SM remains incomplete. To date, genomic studies in SMs have been underpowered to make significant conclusions about the correlations between main genomic driver alterations and clinical features of these tumors. Here, we sought to assess the mutational profile of WHO grade 1 SM and to investigate the clinical characteristics that correlate with the genomic status

Improved visualization of intracranial vessels with intraoperative coregistration of rotational digital subtraction angiography and intraoperative 3D ultrasound.

Ultrasound can visualize and update the vessel status in real time during cerebral vascular surgery. We studied the depiction of parent vessels and aneurysms with a high-resolution 3D intraoperative ultrasound imaging system during aneurysm clipping using rotational digital subtraction angiography as a reference.We analyzed 3D intraoperative ultrasound in 39 patients with cerebral aneurysms to visualize the aneurysm intraoperatively and the nearby vascular tree before and after clipping. Simultaneous coregistration of preoperative subtraction angiography data with 3D intraoperative ultrasound was performed to verify the anatomical assignment.Intraoperative ultrasound detected 35 of 43 aneurysms (81%) in 39 patients. Thirty-nine intraoperative ultrasound measurements were matched with rotational digital subtraction angiography and were successfully reconstructed during the procedure. In 7 patients, the aneurysm was partially visualized by 3D-ioUS or was not in field of view. Post-clipping intraoperative ultrasound was obtained in 26 and successfully reconstructed in 18 patients (69%) despite clip related artefacts. The overlap between 3D-ioUS aneurysm volume and preoperative rDSA aneurysm volume resulted in a mean accuracy of 0.71 (Dice coefficient).Intraoperative coregistration of 3D intraoperative ultrasound data with preoperative rotational digital subtraction angiography is possible with high accuracy. It allows the immediate visualization of vessels beyond the microscopic field, as well as parallel assessment of blood velocity, aneurysm and vascular tree configuration. Although spatial resolution is lower than for standard angiography, the method provides an excellent vascular overview, advantageous interpretation of 3D-ioUS and immediate intraoperative feedback of the vascular status. A prerequisite for understanding vascular intraoperative ultrasound is image quality and a successful match with preoperative rotational digital subtraction angiography

The impact and prospect of traumatic brain injury on olfactory function: a cross-sectional and prospective study

Traumatic brain injury (TBI) can cause olfactory loss. The aim of this cross-sectional and prospective study was to determine the prevalence of olfactory loss among 110 patients with TBI within 3 months after the trauma. In 81 patients ("cross-sectional"-group), olfactory function could be measured using the validated "Sniffin' Sticks" test for odor threshold and odor identification. In addition, the prospective change of olfactory function was studied in 36 patients ("follow-up"-group) by means of a validated odor threshold, discrimination and identification test. Olfactory function was significantly better in patients with TBI I° compared to individuals with TBI II° and III°. Clinically significant improvement of olfactory function was found in 36 % of the patients, most frequently during the first 6 months after the injury, in a median follow-up interval of 21 months. TBI I° has in general no major effect on olfaction. In contrast, patients with TBI II° and III° exhibit smell loss in 57 %. Chances for olfactory recovery were highest within the first 6 months after the trauma

Olfactory bulb volume changes associated with trans-sphenoidal pituitary surgery.

ObjectiveThe trans-sphenoidal approach is most frequently used for pituitary adenoma (PA) enucleation. However, effects of this surgery on neighboring structures have received little attention so far. In particular, no investigations on olfactory bulb (OB) anatomy after trans-sphenoidal surgery have been reported. Because impairment of olfaction has been shown in small groups following trans-sphenoidal surgery we hypothesized that the transnasal approach is likely to alter OB volume which is associated with changes of olfactory function.MethodsThe study comprised 33 patients with pituitary adenoma (14 women and 19 men, mean age 50 years). Comprehensive assessment of olfactory function was conducted with the "Sniffin' Sticks" test kit. Based on magnetic resonance imaging scans OBs were measured before and approximately one year after trans-sphenoidal PA enucleation.ResultsOwing to postoperative non-compliance and MRI artifacts partly due to drill friction complete evaluation of "Sniffin' Sticks" in term of obtaining the TDI score was possible pre- and postoperatively in 21 patients whereas OB volumes were available in 32 patients. Approximately one year after surgery olfactory function was not significantly different from baseline. However, left- and right-sided OB volume in patients treated via trans-sphenoidal surgery decreased (p = 0.001). The side of the surgical approach did not affect OB volume in a side-specific manner. Changes in odor threshold were significantly correlated to changes in right-sided OB volume (r = 0.45, p = 0.024).ConclusionOverall olfactory performance one year after surgery was not significantly different from baseline. However, changes in OB volume are associated with changes in olfactory performance and OB volumes decreased in patients

Pattern of the evaluation of registration results by overlapping the rDSA and the 3D-ioUS (rDSA rotational digital subtraction angiography, 3D-ioUS: intraoperative 3D-ultrasound, TN: true negative, FN: false negative, TP: true positive, FP: false positive).

<p>Evaluation of registration; a.: preoperative rDSA; b.: preoperative 3D-ioUS; c.: intraoperative coregistration of a. and b.</p

Evaluation of 3D-ioUS.

<p>Aneurysm volumes were calculated from the maximum intensity projection (MIP) volumes of ioUS. As indicated, ioUS measurements were performed pre- and post-clipping. Two independent investigators evaluated the data which is depicted on a scale from – (not available or insufficient images) to +, ++, or +++. The overlap presents the volumetric ratio of the aneurysms.</p><p>Evaluation of 3D-ioUS.</p

Patient 17: The black arrow indicates M2 segment (temporal branch of MCA) of the medial cerebral artery, vasospasm of M2 segment visualized in post-clipping 3D-ioUS (E) which led to repositioning of the clip; (rDSA (red), 3D-ioUS (blue, orange); A: pre-clipping conventional DSA; B: pre-clipping rDSA; C: pre-clipping 3D-ioUS; D: post-clipping conventional DSA; E: post-clipping 3D-ioUS; F: coregistration of C+E.

<p>Patient 17: The black arrow indicates M2 segment (temporal branch of MCA) of the medial cerebral artery, vasospasm of M2 segment visualized in post-clipping 3D-ioUS (E) which led to repositioning of the clip; (rDSA (red), 3D-ioUS (blue, orange); A: pre-clipping conventional DSA; B: pre-clipping rDSA; C: pre-clipping 3D-ioUS; D: post-clipping conventional DSA; E: post-clipping 3D-ioUS; F: coregistration of C+E.</p

Patient 5: The yellow arrow indicates the aneurysm of the medial cerebral artery bifurcation; the black Arrow indicates the aneurysm origin/neck; improved visualization of the aneurysm neck in 3D-ioUS (B) with narrow M1 segment of the medial cerebral artery due to high blood flow velocity in bifurcation marked with a white arrow (D, E).; rDSA (red), 3D-ioUS (blue, glow-orange), A: pre-clipping rDSA; B: pre-clipping 3D-ioUS; C: coregistration of A+B; D: pre-clipping duplex; E: MIP 3D-ioUS; F: coregistration of A+E.

<p>Patient 5: The yellow arrow indicates the aneurysm of the medial cerebral artery bifurcation; the black Arrow indicates the aneurysm origin/neck; improved visualization of the aneurysm neck in 3D-ioUS (B) with narrow M1 segment of the medial cerebral artery due to high blood flow velocity in bifurcation marked with a white arrow (D, E).; rDSA (red), 3D-ioUS (blue, glow-orange), A: pre-clipping rDSA; B: pre-clipping 3D-ioUS; C: coregistration of A+B; D: pre-clipping duplex; E: MIP 3D-ioUS; F: coregistration of A+E.</p

Patient 30: The white arrows indicate the aneurysms of the medial cerebral artery bifurcation.

<p>Contrary to rDSA (G; 2 aneurysms detected), 3 aneurysms were displayed in 3D-ioUS (H, J, K; 2 on MCA bifurcation and the 3rd aneurysm on M2 branch) as confirmed by the intraoperative view; (rDSA (red), 3D-ioUS (blue, glow- orange)); G: pre-clipping rDSA; H: pre-clipping 3D-ioUS; I: coregistration of G+H; J: MIP 3D-ioUS; K: MIP of 3D-ioUS; L: coregistration of K+H.</p