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Article ; Online: Degenerative Cervical Myelopathy

Aria Nouri / Joseph S. Cheng / Benjamin Davies / Mark Kotter / Karl Schaller / Enrico Tessitore

Journal of Clinical Medicine, Vol 9, Iss 2, p

A Brief Review of Past Perspectives, Present Developments, and Future Directions

2020 Volume 535

Abstract: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord injury in developed countries; its prevalence is increasing due to the ageing of the population. DCM causes neurological dysfunction and is a significant cause of disability ... ...

Abstract	Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord injury in developed countries; its prevalence is increasing due to the ageing of the population. DCM causes neurological dysfunction and is a significant cause of disability in the elderly. It has important negative impacts on the quality of life of those affected, as well as on their caregivers. DCM is triggered by a variety of degenerative changes in the neck, which affect one or more anatomical structures, including intervertebral discs, vertebrae, and spinal canal ligaments. These changes can also lead to structural abnormalities, leading to alterations in alignment, mobility, and stability. The principle unifying problem in this disease, regardless of the types of changes present, is injury to the spinal cord due to compression by static and/or dynamic forces. This review is partitioned into three segments that focus on key elements of the past, the present, and the future in the field, which serve to introduce the focus issue on “Degenerative Cervical Myelopathy and the Aging Spine”. Emerging from this review is that tremendous progress has been made in the field, particularly in recent years, and that there are exciting possibilities for further advancements of patient care.
Keywords	focus issue ; update ; cervical spondylotic myelopathy ; compressive myelopathy ; Medicine ; R
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Breathing is coupled with voluntary action and the cortical readiness potential

Hyeong-Dong Park / Coline Barnoud / Henri Trang / Oliver A. Kannape / Karl Schaller / Olaf Blanke

Nature Communications, Vol 11, Iss 1, Pp 1-

2020 Volume 8

Abstract: Voluntary action and free will have been associated with cortical activity, referred to as “the readiness potential” that precedes self-initiated actions by about 1 s. Here, the authors show that the involuntary and cyclic motor act of breathing is ... ...

Abstract	Voluntary action and free will have been associated with cortical activity, referred to as “the readiness potential” that precedes self-initiated actions by about 1 s. Here, the authors show that the involuntary and cyclic motor act of breathing is coupled with voluntary action and the readiness potential.
Keywords	Science ; Q
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: ChatGPT in glioma adjuvant therapy decision making

Karl Schaller / Philippe Bijlenga / Aria Nouri / Kristof Egervari / Shahan Momjian / Julien Haemmerli / Lukas Sveikata / Adrien May / Christian Freyschlag / Johannes A Lobrinus / Denis Migliorini / Nicolae Sanda / Sebastien Tran / Jacky Yeung

BMJ Health & Care Informatics, Vol 30, Iss

ready to assume the role of a doctor in the tumour board?

2023 Volume 1

Abstract: Objective To evaluate ChatGPT‘s performance in brain glioma adjuvant therapy decision-making.Methods We randomly selected 10 patients with brain gliomas discussed at our institution’s central nervous system tumour board (CNS TB). Patients’ clinical ... ...

Abstract	Objective To evaluate ChatGPT‘s performance in brain glioma adjuvant therapy decision-making.Methods We randomly selected 10 patients with brain gliomas discussed at our institution’s central nervous system tumour board (CNS TB). Patients’ clinical status, surgical outcome, textual imaging information and immuno-pathology results were provided to ChatGPT V.3.5 and seven CNS tumour experts. The chatbot was asked to give the adjuvant treatment choice, and the regimen while considering the patient’s functional status. The experts rated the artificial intelligence-based recommendations from 0 (complete disagreement) to 10 (complete agreement). An intraclass correlation coefficient agreement (ICC) was used to measure the inter-rater agreement.Results Eight patients (80%) met the criteria for glioblastoma and two (20%) were low-grade gliomas. The experts rated the quality of ChatGPT recommendations as poor for diagnosis (median 3, IQR 1–7.8, ICC 0.9, 95% CI 0.7 to 1.0), good for treatment recommendation (7, IQR 6–8, ICC 0.8, 95% CI 0.4 to 0.9), good for therapy regimen (7, IQR 4–8, ICC 0.8, 95% CI 0.5 to 0.9), moderate for functional status consideration (6, IQR 1–7, ICC 0.7, 95% CI 0.3 to 0.9) and moderate for overall agreement with the recommendations (5, IQR 3–7, ICC 0.7, 95% CI 0.3 to 0.9). No differences were observed between the glioblastomas and low-grade glioma ratings.Conclusions ChatGPT performed poorly in classifying glioma types but was good for adjuvant treatment recommendations as evaluated by CNS TB experts. Even though the ChatGPT lacks the precision to replace expert opinion, it may serve as a promising supplemental tool within a human-in-the-loop approach.
Keywords	Computer applications to medicine. Medical informatics ; R858-859.7
Subject code	610 ; 616
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Use of Virtual Reality to Improve the Quality of the Hospital Stay for Patients in Neurosurgery

Pia Vayssiere / Paul E. Constanthin / Nalla Silva Baticam / Bruno Herbelin / Christine Degremont / Olaf Blanke / Karl Schaller / Philippe Bijlenga

Frontiers in Virtual Reality, Vol

2021 Volume 2

Abstract: Background: Virtual Reality (VR) technologies have numerous beneficial applications for patients during hospitalization (through complete immersion in a virtual, distant place allowing to “escape” from the context of hospitalization). Their positive ... ...

Abstract	Background: Virtual Reality (VR) technologies have numerous beneficial applications for patients during hospitalization (through complete immersion in a virtual, distant place allowing to “escape” from the context of hospitalization). Their positive effects in pain and anxiety management, neurorehabilitation and psychotherapy have been demonstrated. Here, we evaluated the effects of VR on the quality of hospitalization and postoperative pain after neurosurgery.Methods: Patients hospitalized in our department between 2019 and 2020 were prospectively enrolled and divided into a group that received a personal, 30-minutes-long, VR session using an Oculus Go ™ VR headset (VR group) or not (non-VR group). Surgeries were classified in simple or complex spinal and simple or complex cranial. Patient‘s overall satisfaction was considered as primary outcome, with secondary outcomes encompassing duration of hospitalization, pain reduction and patients’ opinion regarding VR.Results: 161 patients were enrolled (77 in the VR group and 84 in the non-VR group). There was no statistical difference between the two groups regarding satisfaction. The VR group presented with a significantly longer duration of hospitalization and higher maximal pain. Interestingly, pain reduction during hospitalization was significantly higher in the VR group, particularly in simple surgeries and spine surgeries. A vast majority of the VR group patients appreciated their VR experience (89.2%) and advocated for its systematic use (83.8%).Conclusion: VR can improve pain reduction during hospitalization after neurosurgery, particularly for simple spine surgeries. Furthermore, patients experiencing VR appear to appreciate it and advocate for its systematic use in neurosurgery. Further research is warranted to identify patients for whom addition of VR during hospitalization might bring the most benefit.
Keywords	virtual reality ; satisfaction ; pain improvement ; patients’ selection ; neurosurgery ; Electronic computers. Computer science ; QA75.5-76.95
Subject code	616
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Occult Disco-Ligamentous Lesions of the Subaxial c-Spine—A Comparison of Preoperative Imaging Findings and Intraoperative Site Inspection

Insa Janssen / Nico Sollmann / Melanie Barz / Thomas Baum / Karl Schaller / Claus Zimmer / Yu-Mi Ryang / Jan S. Kirschke / Bernhard Meyer

Diagnostics, Vol 11, Iss 3, p

2021 Volume 447

Abstract: Despite the general acceptance of magnetic resonance imaging (MRI) as the gold standard for diagnostics of traumatic disco-ligamentous injuries in the subaxial cervical spine, clinical experience shows cases where no lesion is detected in MRI exams but ... ...

Abstract	Despite the general acceptance of magnetic resonance imaging (MRI) as the gold standard for diagnostics of traumatic disco-ligamentous injuries in the subaxial cervical spine, clinical experience shows cases where no lesion is detected in MRI exams but obtained during surgery. The aim of this study was to compare intraoperative site inspection to preoperative imaging findings and to identify radiological features of patients having a risk for under- or over-estimating disco-ligamentous lesions. We performed a retrospective analysis of our clinical database, considering all patients who underwent surgical treatment of the cervical spine via an anterior approach after trauma between June 2008 and April 2018. Only patients with availability of immediate preoperative computed tomography (CT), 3-Tesla MRI scans, and information about intraoperative findings were considered. Results of preoperative imaging were set in context to intraoperative findings, and receiver operator characteristics (ROC) were calculated. Out of 144 patients receiving anterior cervical surgery after trauma, 83 patients (mean age: 59.4 ± 20.5 years, age range: 12–94 years, 63.9% males) were included in this study. Included patients underwent surgical treatment via anterior cervical discectomy and fusion (ACDF; 79 patients) or anterior cervical corpectomy and fusion (4 patients) with ventral plating. Comparing preoperative imaging findings to intraoperative site inspection, a discrepancy between imaging and surgical findings was revealed in 14 patients, leading to an overall specificity/sensitivity of preoperative imaging to identify disco-ligamentous lesions of the cervical spine of 100%/77.4%. Yet, adding the existence of prevertebral hematoma and/or vertebral fractures according to preoperative imaging improved the sensitivity to 95.2%. Lack of sensitivity was most likely related to severe cervical spondylosis, rendering correct radiological reporting difficult. Thus, the risk of missing a traumatic disco-ligamentous injury of the cervical ...
Keywords	cervical spine trauma ; computed tomography ; degenerative cervical spondylosis ; disco-ligamentous injuries ; intervertebral disc ; magnetic resonance imaging ; Medicine (General) ; R5-920
Subject code	610 ; 616
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Extent of Resection in Meningioma

Jean-Michel Lemée / Marco V. Corniola / Michele Da Broi / Holger Joswig / David Scheie / Karl Schaller / Eirik Helseth / Torstein R. Meling

Scientific Reports, Vol 9, Iss 1, Pp 1-

Predictive Factors and Clinical Implications

2019 Volume 6

Abstract: Abstract Meningiomas present as intracranial extra-axial lesions with dural attachment, which are primarily managed surgically. The extent of resection (EOR) may vary depending on patient- and tumor-related factors. The aim of this study is to identify ... ...

Abstract	Abstract Meningiomas present as intracranial extra-axial lesions with dural attachment, which are primarily managed surgically. The extent of resection (EOR) may vary depending on patient- and tumor-related factors. The aim of this study is to identify preoperative predictive factors of EOR and to propose an estimation of the predicted gross total resection (GTR) based of patient- and tumor-characteristics. 1469 patients from a retrospectively (1990 to 2002) and prospectively managed (2003 to 2010) databank of Oslo University Hospital, Norway, totalling 11,414 patient-years of follow-up were included. Patients had a mean age at surgery of 64 ± 20.1 years with a female-to-male ratio was 2.4:1 and a mean KPS of 81.2 ± 12.1. Skull-base meningiomas represented 47% of all cases. WHO grades were I in 92.3%, II in 5.2%, and III in 2.2%. Bone infiltration was described in 18.7% of cases. 39.3% of patients had Simpson I resection, 34.3% had Simpson II, 5.4% had Simpson III, 20.6% had Simpson IV, and 0.5% had Simpson V. The risk factors for incomplete resection were: symptomatic presentation (OR 0.56 [0.43–0.72]), skull-base location (OR 0.79 [0.70–0.88]), and bone invasion (OR 0.85 [0.73–0.99]). Using a recursive partitioning analysis, we propose a classification-tree for the prediction of GTR rate based on preoperatively determinable patient- and tumor characteristics. The identification of preoperative predictors of poor GTR rate may aid clinicians managing meningioma patients. In selected cases were the predicted GTR rate is low, staged treatment with surgical debulking followed by adjuvant therapy may be favored in order to minimize postoperative morbidity and mortality.
Keywords	Medicine ; R ; Science ; Q
Subject code	610 ; 616
Language	English
Publishing date	2019-04-01T00:00:00Z
Publisher	Nature Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Clinical Outcomes between Stand-Alone Zero-Profile Spacers and Cervical Plate with Cage Fixation for Anterior Cervical Discectomy and Fusion

Samuel Sommaruga / Joaquin Camara-Quintana / Kishan Patel / Aria Nouri / Enrico Tessitore / Granit Molliqaj / Shreyas Panchagnula / Michael Robinson / Justin Virojanapa / Xin Sun / Fjodor Melnikov / Luis Kolb / Karl Schaller / Khalid Abbed / Joseph Cheng

Journal of Clinical Medicine, Vol 10, Iss 3076, p

A Retrospective Analysis of 166 Patients

2021 Volume 3076

Abstract: Stand-alone (SA) zero-profile implants are an alternative to cervical plating (CP) in anterior cervical discectomy and fusion (ACDF). In this study, we investigate differences in surgical outcomes between SA and CP in ACDF. We conducted a retrospective ... ...

Abstract	Stand-alone (SA) zero-profile implants are an alternative to cervical plating (CP) in anterior cervical discectomy and fusion (ACDF). In this study, we investigate differences in surgical outcomes between SA and CP in ACDF. We conducted a retrospective analysis of 166 patients with myelopathy and/or radiculopathy who had ACDF with SA or CP from Jan 2013–Dec 2016. We measured surgical outcomes including Bazaz dysphagia score at 3 months, Nurick grade at last follow-up, and length of hospital stay. 166 patients (92F/74M) were reviewed. 92 presented with radiculopathy (55%), 37 with myelopathy (22%), and 37 with myeloradiculopathy (22%). The average operative time with CP was longer than SA (194 ± 69 vs. 126 ± 46 min) ( p < 0.001), as was the average length of hospital stay (2.1 ± 2 vs. 1.5 ± 1 days) ( p = 0.006). At 3 months, 82 patients (49.4%) had a follow-up for dysphagia, with 3 patients reporting mild dysphagia and none reporting moderate or severe dysphagia. Nurick grade at last follow-up for the myelopathy and myeloradiculopathy cohorts improved in 63 patients (85%). Prolonged length of stay was associated with reduced odds of having an optimal outcome by 0.50 (CI = 0.35–0.85, p = 0.003). Overall, we demonstrate that there is no significant difference in neurological outcome or rates of dysphagia between SA and CP, and that both lead to overall improvement of symptoms based on Nurick grading. However, we also show that the SA group has shorter length of hospital stay and operative time compared to CP.
Keywords	degenerative cervical myelopathy ; radiculopathy ; ACDF ; dysphagia ; cervical plating ; stand-alone implant ; Medicine ; R
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The Relationship Between Gastrointestinal Comorbidities, Clinical Presentation and Surgical Outcome in Patients with DCM

Aria Nouri / Jetan H. Badhiwala / So Kato / Hamed Reihani-Kermani / Kishan Patel / Jefferson R. Wilson / Insa Janssen / Joseph S. Cheng / Karl Schaller / Enrico Tessitore / Michael G. Fehlings

Journal of Clinical Medicine, Vol 9, Iss 3, p

Analysis of a Global Cohort

2020 Volume 624

Abstract: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults, presenting most frequently in patients 50 years or older. Gastrointestinal comorbidities (GICs) commonly occur in this group; however, their relationship ...

Abstract	Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults, presenting most frequently in patients 50 years or older. Gastrointestinal comorbidities (GICs) commonly occur in this group; however, their relationship with DCM has not been thoroughly investigated. It is the objective of the present study to investigate the difference between patients with or without GICs who are surgically treated for DCM. A cohort of 757 patients with clinical data and 458 with magnetic resonance imaging (MRI) data from the AOSpine North America and AOSpine International studies on DCM was evaluated. GICs were obtained at presentation and included gastric, intestinal, hepatic, and pancreatic conditions. Patients were dichotomized into 2 groups: those with GICs and those without GICs. Both clinical and MRI presentation, as well as baseline neurological and functional status, were compared. Neurological and functional outcomes at 2-year follow-up were also compared. GICs were present in 121 patients (16%). These patients were less commonly male (48.76% vs. 65.4%, p = 0.001) and were slightly less neurologically impaired based on the Nurick grade (3.05 ± 1.10 vs. 3.28 ± 1.16, p = 0.044) but not based on mJOA (12.74 ± 2.62 vs. 12.48 ± 2.76, p = 0.33). They also had a worse physical health score (32.80 ± 8.79 vs. 34.65 ± 9.38 p = 0.049), worse neck disability (46.31 ± 20.04 vs. 38.23 ± 20.44, p < 0.001), a lower prevalence of upper motor neuron signs (hyperreflexia, 70.2% vs. 78.9%, p = 0.037; Babinski’s sign 24.8% vs. 37.3%, p = 0.008), and a higher rate of psychiatric comorbidities (31.4% vs. 10.4%, p < 0.0001). On MRI, GIC patients less commonly exhibited signal intensity changes (T2 hyperintensity, 49.2% vs. 75.6%, p < 0.001; T1 hypointensity, 9.7% vs. 21.1%, p = 0.036), and had a lower number of T2 hyperintensity levels (0.82 ± 0.98 vs. 1.3 ± 1.11, p = 0.001). There was no difference in surgical outcome between the groups. DCM patients with GICs are more likely to be female and have ...
Keywords	cervical spondylotic myelopathy (csm) ; prospective ; multicenter ; anterior ; posterior ; Medicine ; R
Subject code	610
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Abnormal directed connectivity of resting state networks in focal epilepsy

Margherita Carboni / Pia De Stefano / Bernd J. Vorderwülbecke / Sebastien Tourbier / Emeline Mullier / Maria Rubega / Shahan Momjian / Karl Schaller / Patric Hagmann / Margitta Seeck / Christoph M. Michel / Pieter van Mierlo / Serge Vulliemoz

NeuroImage: Clinical, Vol 27, Iss , Pp 102336- (2020)

2020

Abstract: Objective: Epilepsy diagnosis can be difficult in the absence of interictal epileptic discharges (IED) on scalp EEG. We used high-density EEG to measure connectivity in large‐scale functional networks of patients with focal epilepsy (Temporal and ... ...

Abstract	Objective: Epilepsy diagnosis can be difficult in the absence of interictal epileptic discharges (IED) on scalp EEG. We used high-density EEG to measure connectivity in large‐scale functional networks of patients with focal epilepsy (Temporal and Extratemporal Lobe Epilepsy, TLE and ETLE) and tested for network alterations during resting wakefulness without IEDs, compared to healthy controls. We measured global efficiency as a marker of integration within networks. Methods: We analysed 49 adult patients with focal epilepsy and 16 healthy subjects who underwent high-density-EEG and structural MRI. We estimated cortical activity using electric source analysis in 82 atlas-based cortical regions based on the individual MRI. We applied directed connectivity analysis (Partial Directed Coherence) on these sources and performed graph analysis: we computed the Global Efficiency on the whole brain and on each resting state network. We tested these features in different group of patients. Results: Compared to controls, efficiency was increased in both TLE and ETLE (p < 0.05). The somato-motor-network, the ventral-attention-network and the default-mode-network had a significantly increased efficiency (p < 0.05) in both TLE and ETLE as well as TLE with hippocampal sclerosis. Significance: During interictal scalp EEG epochs without IED, patients with focal epilepsy show brain functional connectivity alterations in the whole brain and in specific resting-state-networks. This higher integration reflects a chronic effect of pathological activity within these structures and complement previous work on altered information outflow. These findings could increase the diagnostic sensitivity of scalp EEG to identify epileptic activity in the absence of IED.
Keywords	Epilepsy ; Resting State ; Connectivity ; Network integration ; Global Efficiency ; Computer applications to medicine. Medical informatics ; R858-859.7 ; Neurology. Diseases of the nervous system ; RC346-429
Subject code	616
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: MRI‐Compatible and Conformal Electrocorticography Grids for Translational Research

Florian Fallegger / Giuseppe Schiavone / Elvira Pirondini / Fabien B. Wagner / Nicolas Vachicouras / Ludovic Serex / Gregory Zegarek / Adrien May / Paul Constanthin / Marie Palma / Mehrdad Khoshnevis / Dirk Van Roost / Blaise Yvert / Grégoire Courtine / Karl Schaller / Jocelyne Bloch / Stéphanie P. Lacour

Advanced Science, Vol 8, Iss 9, Pp n/a-n/a (2021)

2021

Abstract: Abstract Intraoperative electrocorticography (ECoG) captures neural information from the surface of the cerebral cortex during surgeries such as resections for intractable epilepsy and tumors. Current clinical ECoG grids come in evenly spaced, millimeter‐ ...

Abstract	Abstract Intraoperative electrocorticography (ECoG) captures neural information from the surface of the cerebral cortex during surgeries such as resections for intractable epilepsy and tumors. Current clinical ECoG grids come in evenly spaced, millimeter‐sized electrodes embedded in silicone rubber. Their mechanical rigidity and fixed electrode spatial resolution are common shortcomings reported by the surgical teams. Here, advances in soft neurotechnology are leveraged to manufacture conformable subdural, thin‐film ECoG grids, and evaluate their suitability for translational research. Soft grids with 0.2 to 10 mm electrode pitch and diameter are embedded in 150 µm silicone membranes. The soft grids are compatible with surgical handling and can be folded to safely interface hidden cerebral surface such as the Sylvian fold in human cadaveric models. It is found that the thin‐film conductor grids do not generate diagnostic‐impeding imaging artefacts (<1 mm) nor adverse local heating within a standard 3T clinical magnetic resonance imaging scanner. Next, the ability of the soft grids to record subdural neural activity in minipigs acutely and two weeks postimplantation is validated. Taken together, these results suggest a promising future alternative to current stiff electrodes and may enable the future adoption of soft ECoG grids in translational research and ultimately in clinical settings.
Keywords	electrocorticography ; MRI compatibility ; neural implants ; soft electrodes ; translational research ; Science ; Q
Subject code	670
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
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