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  1. Article ; Online: Intracerebral mucormycosis after COVID-19: illustrative cases.

    Nohman, Amin I / Ivren, Meltem / Klein, Sabrina / Khatamzas, Elham / Unterberg, Andreas / Giese, Henrik

    Journal of neurosurgery. Case lessons

    2022  Volume 3, Issue 25, Page(s) CASE21567

    Abstract: Background: In this case report the authors present two female patients with intracranial mucormycosis after coronavirus disease 2019 (COVID-19).: Observations: The first patient was a 30-year-old woman with no past medical history or allergies who ... ...

    Abstract Background: In this case report the authors present two female patients with intracranial mucormycosis after coronavirus disease 2019 (COVID-19).
    Observations: The first patient was a 30-year-old woman with no past medical history or allergies who presented with headaches and vomiting. Magnetic resonance imaging (MRI) and computed tomography of the skull showed an endonasal infection, which had already destroyed the frontal skull base and caused a large frontal intracranial abscess. The second patient was a 29-year-old woman with multiple pre-existing conditions, who was initially admitted to the hospital due to a COVID-19 infection and later developed a hemiparesis of the right side. Here, the MRI scan showed an abscess configuration in the left motor cortex. In both cases, rapid therapy was performed by surgical clearance and abscess evacuation followed by antifungal, antidiabetic, and further supportive treatment for several weeks.
    Lessons: Both cases are indicative of a possible correlation of mucormycosis in the setting of severe immunosuppression involved with COVID-19, both iatrogenic with the use of steroids and previous medical history. Furthermore, young and supposedly healthy patients can also be affected by this rare disease.
    Language English
    Publishing date 2022-06-20
    Publishing country United States
    Document type Case Reports
    ISSN 2694-1902
    ISSN (online) 2694-1902
    DOI 10.3171/CASE21567
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking.

    Belotti, Francesco / Tuncer, Mehmet Salih / Rosenstock, Tizian / Ivren, Meltem / Vajkoczy, Peter / Picht, Thomas

    Brain sciences

    2021  Volume 11, Issue 11

    Abstract: Background: Surgical planning with nTMS-based tractography is proven to increase safety during surgery. A preoperative risk stratification model has been published based on the M1 infiltration, RMT ratio, and tumor to corticospinal tract distance (TTD). ...

    Abstract Background: Surgical planning with nTMS-based tractography is proven to increase safety during surgery. A preoperative risk stratification model has been published based on the M1 infiltration, RMT ratio, and tumor to corticospinal tract distance (TTD). The correlation of TTD with corticospinal tract to resection cavity distance (TRD) and outcome is needed to further evaluate the validity of the model.
    Aim of the study: To use the postop MRI-derived resection cavity to measure how closely the resection cavity approximated the preoperatively calculated corticospinal tract (CST) and how this correlates with the risk model and the outcome.
    Methods: We included 183 patients who underwent nTMS-based DTI and surgical resection for presumed motor-eloquent gliomas. TTD, TRD, and motor outcome were recorded and tested for correlations. The intraoperative monitoring documentation was available for a subgroup of 48 patients, whose responses were correlated to TTD and TRD.
    Results: As expected, TTD and TRD showed a good correlation (Spearman's ρ = 0.67,
    Conclusions: The TTD approximates the TRD well, confirming the best predictive parameter and giving strength to the nTMS-based risk stratification model. Our analysis of TRD supports the use of the nTMS-based TTD measurement to estimate the resection preoperatively, also confirming the 8 mm cutoff. Nevertheless, the TRD proved to have a slightly stronger correlation with the outcome as the surgeon's experience, anatomofunctional knowledge, and MEP observations influence the expected EOR.
    Language English
    Publishing date 2021-11-16
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2651993-8
    ISSN 2076-3425
    ISSN 2076-3425
    DOI 10.3390/brainsci11111517
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  3. Conference proceedings: Intracranial angioleiomyoma – a rare pathology with distinctive histopathological features

    Ivren, Meltem / Cherkezov, Asan / Haux, Daniel / Reuss, David / Younsi, Alexander / Unterberg, Andreas W.

    2022  , Page(s) V276

    Title translation Intrakranielle Angioleiomyome: eine seltene Erkrankung mit speziellen histopathologischen Eigenschaften
    Event/congress 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie; Köln; Deutsche Gesellschaft für Neurochirurgie; 2022
    Keywords Medizin, Gesundheit
    Publishing date 2022-05-25
    Publisher German Medical Science GMS Publishing House; Düsseldorf
    Document type Conference proceedings
    DOI 10.3205/22dgnc268
    Database German Medical Science

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  4. Article ; Online: Comparison of anatomical-based vs. nTMS-based risk stratification model for predicting postoperative motor outcome and extent of resection in brain tumor surgery.

    Ivren, Meltem / Grittner, Ulrike / Khakhar, Rutvik / Belotti, Francesco / Schneider, Heike / Pöser, Paul / D'Agata, Federico / Spena, Giannantonio / Vajkoczy, Peter / Picht, Thomas / Rosenstock, Tizian

    NeuroImage. Clinical

    2023  Volume 38, Page(s) 103436

    Abstract: Background: Two statistical models have been established to evaluate characteristics associated with postoperative motor outcome in patients with glioma associated to the motor cortex (M1) or the corticospinal tract (CST). One model is based on a ... ...

    Abstract Background: Two statistical models have been established to evaluate characteristics associated with postoperative motor outcome in patients with glioma associated to the motor cortex (M1) or the corticospinal tract (CST). One model is based on a clinicoradiological prognostic sum score (PrS) while the other one relies on navigated transcranial magnetic stimulation (nTMS) and diffusion-tensor-imaging (DTI) tractography. The objective was to compare the models regarding their prognostic value for postoperative motor outcome and extent of resection (EOR) with the aim of developing a combined, improved model.
    Methods: We retrospectively analyzed a consecutive prospective cohort of patients who underwent resection for motor associated glioma between 2008 and 2020, and received a preoperative nTMS motor mapping with nTMS-based diffusion tensor imaging tractography. The primary outcomes were the EOR and the motor outcome (on the day of discharge and 3 months postoperatively according to the British Medical Research Council (BMRC) grading). For the nTMS model, the infiltration of M1, tumor-tract distance (TTD), resting motor threshold (RMT) and fractional anisotropy (FA) were assesed. For the PrS score (ranging from 1 to 8, lower scores indicating a higher risk), we assessed tumor margins, volume, presence of cysts, contrast agent enhancement, MRI index (grading white matter infiltration), preoperative seizures or sensorimotor deficits.
    Results: Two hundred and three patients with a median age of 50 years (range: 20-81 years) were analyzed of whom 145 patients (71.4%) received a GTR. The rate of transient new motor deficits was 24.1% and of permanent new motor deficits 18.8%. The nTMS model demonstrated a good discrimination ability for the short-term motor outcome at day 7 of discharge (AUC = 0.79, 95 %CI: 0.72-0.86) and the long-term motor outcome after 3 months (AUC = 0.79, 95 %CI: 0.71-0.87). The PrS score was not capable to predict the postoperative motor outcome in this cohort but was moderately associated with the EOR (AUC = 0.64; CI 0.55-0.72). An improved, combined model was calculated to predict the EOR more accurately (AUC = 0.74, 95 %CI: 0.65-0.83).
    Conclusion: The nTMS model was superior to the clinicoradiological PrS model for potentially predicting the motor outcome. A combined, improved model was calculated to estimate the EOR. Thus, patient counseling and surgical planning in patients with motor-associated tumors should be performed using functional nTMS data combined with tractography.
    MeSH term(s) Humans ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Transcranial Magnetic Stimulation/methods ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Brain Neoplasms/pathology ; Diffusion Tensor Imaging/methods ; Retrospective Studies ; Prospective Studies ; Brain Mapping/methods ; Glioma/diagnostic imaging ; Glioma/surgery ; Glioma/pathology ; Risk Assessment
    Language English
    Publishing date 2023-05-16
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2701571-3
    ISSN 2213-1582 ; 2213-1582
    ISSN (online) 2213-1582
    ISSN 2213-1582
    DOI 10.1016/j.nicl.2023.103436
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  5. Article ; Online: Bicentric validation of the navigated transcranial magnetic stimulation motor risk stratification model.

    Rosenstock, Tizian / Häni, Levin / Grittner, Ulrike / Schlinkmann, Nicolas / Ivren, Meltem / Schneider, Heike / Raabe, Andreas / Vajkoczy, Peter / Seidel, Kathleen / Picht, Thomas

    Journal of neurosurgery

    2021  Volume 136, Issue 4, Page(s) 1194–1206

    Abstract: Objective: The authors sought to validate the navigated transcranial magnetic stimulation (nTMS)-based risk stratification model. The postoperative motor outcome in glioma surgery may be preoperatively predicted based on data derived by nTMS. The tumor- ... ...

    Abstract Objective: The authors sought to validate the navigated transcranial magnetic stimulation (nTMS)-based risk stratification model. The postoperative motor outcome in glioma surgery may be preoperatively predicted based on data derived by nTMS. The tumor-to-tract distance (TTD) and the interhemispheric resting motor threshold (RMT) ratio (as a surrogate parameter for cortical excitability) emerged as major factors related to a new postoperative deficit.
    Methods: In this bicentric study, a consecutive prospectively collected cohort underwent nTMS mapping with diffusion tensor imaging (DTI) fiber tracking of the corticospinal tract prior to surgery of motor eloquent gliomas. The authors analyzed whether the following items were associated with the patient's outcome: patient characteristics, TTD, RMT value, and diffusivity parameters (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]). The authors assessed the validity of the published risk stratification model and derived a new model.
    Results: A new postoperative motor deficit occurred in 36 of 165 patients (22%), of whom 20 patients still had a deficit after 3 months (13%; n3 months = 152). nTMS-verified infiltration of the motor cortex as well as a TTD ≤ 8 mm were confirmed as risk factors. No new postoperative motor deficit occurred in patients with TTD > 8 mm. In contrast to the previous risk stratification, the RMT ratio was not substantially correlated with the motor outcome, but high RMT values of both the tumorous and healthy hemisphere were associated with worse motor outcome. The FA value was negatively associated with worsening of motor outcome. Accuracy analysis of the final model showed a high negative predictive value (NPV), so the preoperative application may accurately predict the preservation of motor function in particular (day of discharge: sensitivity 47.2%, specificity 90.7%, positive predictive value [PPV] 58.6%, NPV 86.0%; 3 months: sensitivity 85.0%, specificity 78.8%, PPV 37.8%, NPV 97.2%).
    Conclusions: This bicentric validation analysis further improved the model by adding the FA value of the corticospinal tract, demonstrating the relevance of nTMS/nTMS-based DTI fiber tracking for clinical decision making.
    MeSH term(s) Brain Mapping/methods ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Diffusion Tensor Imaging/methods ; Humans ; Neuronavigation/methods ; Risk Assessment ; Transcranial Magnetic Stimulation/methods
    Language English
    Publishing date 2021-09-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2021.3.JNS2138
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  6. Conference proceedings: Comparison of two different risk stratification models to predict the postoperative motor outcome in brain tumour surgery

    Ivren, Meltem / Khakhar, Rutvik / Schneider, Heike / Spena, Giannantonio / Vajkoczy, Peter / Picht, Thomas / Rosenstock, Tizian

    2021  , Page(s) P032

    Title translation Risikostratifizierung des motorischen Outcomes in der Hirntumorchirurgie – ein Vergleich zweier Modelle
    Event/congress 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie; sine loco [digital]; Deutsche Gesellschaft für Neurochirurgie; 2021
    Keywords Medizin, Gesundheit
    Publishing date 2021-06-04
    Publisher German Medical Science GMS Publishing House; Düsseldorf
    Document type Conference proceedings
    DOI 10.3205/21dgnc320
    Database German Medical Science

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