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Article ; Online: Treatment of a symptomatic cervical cerebrospinal fluid fistula after full endoscopic cervical foraminotomy with CT-guided epidural fibrin patch.

Motov, Stefan / Stemmer, B / Krauss, P / Maurer, C / Shiban, E

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

2023

Abstract: Background: There is only limited data on the management of cerebrospinal fluid (CSF) fistulas after cervical endoscopic spine surgery. We investigated the current literature for treatment options and present a case of a patient who was treated with CT- ... ...

Abstract	Background: There is only limited data on the management of cerebrospinal fluid (CSF) fistulas after cervical endoscopic spine surgery. We investigated the current literature for treatment options and present a case of a patient who was treated with CT-guided epidural fibrin patch. Methods: We present the case of a 47-year-old female patient with a suspected CSF fistula after endoscopic decompression for C7 foraminal stenosis. She was readmitted 8 days after surgery with dysesthesia in both upper extremities, orthostatic headache and neck pain, which worsened during mobilization. A CSF leak was suspected on spinal magnetic resonance imaging. A computer tomography (CT)-guided epidural blood patch was performed with short-term relief. A second CT-guided epidural fibrin patch was executed and the patient improved thereafter and was discharged at home without sensorimotor deficits or sequelae. We investigated the current literature for complications after endoscopic spine surgery and for treatment of postoperative CSF fistulas. Results: Although endoscopic and open revision surgery with dura repair were described in previous studies, dural tears in endoscopic surgery are frequently treated conservatively. In our case, the patient was severely impaired by a persistent CSF fistula. We opted for a less invasive treatment and performed a CT-guided fibrin patch which resulted in a complete resolution of patient's symptoms. Discussion and conclusion: CSF fistulas after cervical endoscopic spine procedures are rare complications. Conservative treatment or revision surgery are the standard of care. CT-guided epidural fibrin patch was an efficient and less invasive option in our case.
Language	English
Publishing date	2023-10-07
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1115375-1
ISSN	1432-0932 ; 0940-6719
ISSN (online)	1432-0932
ISSN	0940-6719
DOI	10.1007/s00586-023-07973-1
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Article ; Online: Can AI pass the written European Board Examination in Neurological Surgery? - Ethical and practical issues.

Stengel, Felix C / Stienen, Martin N / Ivanov, Marcel / Gandía-González, María L / Raffa, Giovanni / Ganau, Mario / Whitfield, Peter / Motov, Stefan

Brain & spine

2024 Volume 4, Page(s) 102765

Abstract: Introduction: Artificial intelligence (AI) based large language models (LLM) contain enormous potential in education and training. Recent publications demonstrated that they are able to outperform participants in written medical exams.: Research ... ...

Abstract	Introduction: Artificial intelligence (AI) based large language models (LLM) contain enormous potential in education and training. Recent publications demonstrated that they are able to outperform participants in written medical exams. Research question: We aimed to explore the accuracy of AI in the written part of the EANS board exam. Material and methods: Eighty-six representative single best answer (SBA) questions, included at least ten times in prior EANS board exams, were selected by the current EANS board exam committee. The questions' content was classified as 75 text-based (TB) and 11 image-based (IB) and their structure as 50 interpretation-weighted, 30 theory-based and 6 true-or-false. Questions were tested with Chat GPT 3.5, Bing and Bard. The AI and participant results were statistically analyzed through ANOVA tests with Stata SE 15 (StataCorp, College Station, TX). P-values of <0.05 were considered as statistically significant. Results: The Bard LLM achieved the highest accuracy with 62% correct questions overall and 69% excluding IB, outperforming human exam participants 59% (p = 0.67) and 59% (p = 0.42), respectively. All LLMs scored highest in theory-based questions, excluding IB questions (Chat-GPT: 79%; Bing: 83%; Bard: 86%) and significantly better than the human exam participants (60%; p = 0.03). AI could not answer any IB question correctly. Discussion and conclusion: AI passed the written EANS board exam based on representative SBA questions and achieved results close to or even better than the human exam participants. Our results raise several ethical and practical implications, which may impact the current concept for the written EANS board exam.
Language	English
Publishing date	2024-02-13
Publishing country	Netherlands
Document type	Journal Article
ISSN	2772-5294
ISSN (online)	2772-5294
DOI	10.1016/j.bas.2024.102765
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Article ; Online: Current state of preoperative embolization for spinal metastasis - A survey by the EANS spine section.

Motov, Stefan / Stengel, Felix / Ringel, Florian / Bozinov, Oliver / Stienen, Martin N

Brain & spine

2023 Volume 3, Page(s) 102712

Abstract: Introduction: Preoperative embolization (PE) for spinal metastasis can be used to reduce tumor blood supply in selected patients. The decision whether and when to perform PE varies largely among spine surgeons and centers.: Research question: The aim ...

Abstract	Introduction: Preoperative embolization (PE) for spinal metastasis can be used to reduce tumor blood supply in selected patients. The decision whether and when to perform PE varies largely among spine surgeons and centers. Research question: The aim was to understand the current decision-making process in European spine centers. Material and methods: The European Association of Neurosurgical Societies (EANS) spine section designed a 13-item online survey. It was distributed to neurosurgical residents and board-certified neurosurgeons between 7th of February and May 5, 2023. Results: We analyzed 120 survey responses. Most participants were board-certified neurosurgeons (71%) or residents (26%) in university hospitals (76%). Routinely performed PE was stated not a common practice in 62%. Of those using PE, 25% indicated to perform it in selected cases requiring vertebral body replacement. Reasons for not performing PE included lack of time (44%), unclear benefits (25%), no significant bleeding without PE (19%), and significant bleeding despite PE (8%). Most participants opted for PE < 24h before surgery, but in a separate anesthesia (54%). More experienced participants were more likely to observe reduced blood loss (BL) after PE (p = 0.014). The most common reported complications were neurological deterioration due to spinal cord infarction (n = 15) and swelling due to tumor necrosis (n = 13). Discussion and conclusions: PE is still not a routine among European spine surgeons and is considered mostly for elective cases with hypervascularized tumors scheduled in a separate anesthesia <24h before tumor resection. Most participants noted reduced intraoperative BL, but also a risk of procedure-related complications.
Language	English
Publishing date	2023-11-10
Publishing country	Netherlands
Document type	Journal Article
ISSN	2772-5294
ISSN (online)	2772-5294
DOI	10.1016/j.bas.2023.102712
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Article ; Online: Management of perimesencephalic nonaneurysmal subarachnoid hemorrhage: a national survey.

Wolfert, Christina / Maurer, Christoph J / Sommer, Björn / Steininger, Kathrin / Motov, Stefan / Bonk, Maximilian-Niklas / Krauss, Philipp / Berlis, Ansgar / Shiban, Ehab

Scientific reports

2023 Volume 13, Issue 1, Page(s) 12805

Abstract: Perimesencephalic nonaneurysmal subarachnoid hemorrhage (NASAH) is a rare type of subarachnoid hemorrhage (SAH), usually associated with minor complications compared to aneurysmal SAH. Up to date, data is scarce and consensus on therapeutic management ... ...

Abstract	Perimesencephalic nonaneurysmal subarachnoid hemorrhage (NASAH) is a rare type of subarachnoid hemorrhage (SAH), usually associated with minor complications compared to aneurysmal SAH. Up to date, data is scarce and consensus on therapeutic management and follow-up diagnostics of NASAH is often missing. This survey aims to evaluate the clinical management among neurosurgical departments in Germany. 135 neurosurgical departments in Germany received a hardcopy questionnaire. Encompassing three case vignettes with minor, moderate and severe NASAH on CT-scans and questions including the in-hospital treatment with initial observation, blood pressure (BP) management, cerebral vasospasm (CV) prophylaxis and the need for digital subtraction angiography (DSA). 80 departments (59.2%) answered the questionnaire. Whereof, centers with a higher caseload state an elevated complication rate (Chi
MeSH term(s)	Humans ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/therapy ; Subarachnoid Hemorrhage/complications ; Subarachnoid Space ; Tomography, X-Ray Computed/adverse effects ; Vasospasm, Intracranial/diagnostic imaging ; Vasospasm, Intracranial/therapy ; Vasospasm, Intracranial/complications ; Angiography, Digital Subtraction ; Cerebral Angiography
Language	English
Publishing date	2023-08-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-39195-2
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Article ; Online: High-frequency spinal cord stimulation in failed back surgery syndrome patients with predominant low back pain-single-center experience.

Motov, Stefan / Aftahy, Kaywan / Jörger, Ann-Kathrin / Wagner, Arthur / Meyer, Bernhard / Shiban, Ehab

Neurosurgical review

2021 Volume 44, Issue 5, Page(s) 2809–2818

Abstract: Treatment of patients with failed back surgery syndrome (FBSS) with predominant low back pain (LBP) remains challenging. High-frequency spinal cord stimulation (HF10 SCS) is believed to achieve significant pain reduction. We aimed to evaluate the real- ... ...

Abstract	Treatment of patients with failed back surgery syndrome (FBSS) with predominant low back pain (LBP) remains challenging. High-frequency spinal cord stimulation (HF10 SCS) is believed to achieve significant pain reduction. We aimed to evaluate the real-life efficacy of HF-10 SCS in a tertiary spine center. A prospective observational study of all patients with FBSS and predominant LBP who underwent HF-10 SCS surgery was performed between 2016 and 2018. Patients > 18 years with Visual Analogue Scale (VAS) scores of ≥ 5 for LBP and pain duration > 6 months under stable medication were implanted percutaneous under general anesthesia and a trial phase of 7-14 days was accomplished. Primary end point was a successful trial defined as ≥ 50% VAS score reduction for LBP. Thirty-four of 39 (85%) subjects had a successful trial. Fifty-three percent were female and the mean age was 69 years. Median follow-up lasted for 10 months. Devices were removed after a median of 10 months in 5 cases. Remaining 29 patients stated significant VAS score reduction for LBP from 8.1 to 2.9 and VAS for leg pain from 4.9 to 2.2. Twenty-four percent of all patients were able to discontinue their opioids. Eight of 9 patients (89%) with signs of adjacent disc disease and 7 of 10 (70%) patients with hardware failure were successfully implanted with significant VAS reduction for LBP. HF-10 SCS achieves significant pain reduction in most patients with FBSS and predominant LBP. It might be an efficient alternative to revision surgery.
MeSH term(s)	Aged ; Failed Back Surgery Syndrome/therapy ; Female ; Humans ; Low Back Pain/surgery ; Male ; Prospective Studies ; Spinal Cord ; Spinal Cord Stimulation ; Treatment Outcome
Language	English
Publishing date	2021-01-17
Publishing country	Germany
Document type	Journal Article ; Observational Study
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-020-01462-5
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Article ; Online: Dorsal instrumentation with and without vertebral body replacement in patients with thoracolumbar osteoporotic fractures shows comparable outcome measures.

Schwendner, Maximilian / Motov, Stefan / Ryang, Yu-Mi / Meyer, Bernhard / Krieg, Sandro M

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

2021 Volume 31, Issue 5, Page(s) 1138–1146

Abstract: Purpose: In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was ...

Abstract	Purpose: In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality. Methods: A total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed. Results: Medical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentation plus VBR resulted in a sagittal correction of 9.3 ± 7.4° (0.1-31.6°) compared to 6.0 ± 5.6° (0.2-22.8°) after dorsal instrumentation only, respectively (p = 0.0065). EQ-5D was completed by 79 patients after 4.00 ± 2.88 years (0.1-11.8 years) and was 0.56 ± 0.32 (- 0.21-1.00) for VBR compared to 0.56 ± 0.34 (- 0.08-1.00) without VBR after dorsal instrumentation (p = 0.994). Conclusion: 360° instrumentation represents a legitimate surgical technique with no additional morbidity even for the elderly and multimorbid osteoporotic population. Particularly, if sufficient long-term construct stability is in doubt or ventral stenosis is present, there is no need to abstain from additional ventral reinforcement and decompression.
MeSH term(s)	Aged ; Humans ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/injuries ; Lumbar Vertebrae/surgery ; Osteoporotic Fractures/complications ; Osteoporotic Fractures/diagnostic imaging ; Osteoporotic Fractures/surgery ; Outcome Assessment, Health Care ; Spinal Fractures/diagnostic imaging ; Spinal Fractures/etiology ; Spinal Fractures/surgery ; Thoracic Vertebrae/diagnostic imaging ; Thoracic Vertebrae/injuries ; Thoracic Vertebrae/surgery ; Treatment Outcome ; Vertebral Body
Language	English
Publishing date	2021-11-05
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1115375-1
ISSN	1432-0932 ; 0940-6719
ISSN (online)	1432-0932
ISSN	0940-6719
DOI	10.1007/s00586-021-07044-3
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Article: Neuromodulation bei chronischen Schmerzen

Motov, Stefan / Bonk, Maximilian Niklas / Sommer, Björn / Shiban, Ehab

Der Schmerzpatient

(Schmerz und Medikamente)

2021 Volume 4, Issue 03, Page(s) 114–119

Series title	Schmerz und Medikamente
Language	German
Publishing date	2021-07-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2512-6229 ; 2512-6210
ISSN (online)	2512-6229
ISSN	2512-6210
DOI	10.1055/a-1463-5194
Database	Thieme publisher's database

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Article ; Online: Implementation of a three-dimensional (3D) robotic digital microscope (AEOS) in spinal procedures.

Motov, Stefan / Bonk, Maximilian Niklas / Krauss, Philipp / Wolfert, Christina / Steininger, Kathrin / Picht, Thomas / Onken, Julia / Shiban, Ehab

Scientific reports

2022 Volume 12, Issue 1, Page(s) 22553

Abstract: Three-dimensional exoscopes have been designed to overcome certain insufficiencies of operative microscopes. We aimed to explore the clinical use in various spinal surgeries. We performed surgery on patients with different spine entities in a ... ...

Abstract	Three-dimensional exoscopes have been designed to overcome certain insufficiencies of operative microscopes. We aimed to explore the clinical use in various spinal surgeries. We performed surgery on patients with different spine entities in a neurosurgical department according to the current standard operating procedures over a 4-week period of time. The microsurgical part has been performed with Aesculap AEOS 3D microscope. Three neurosurgeons with different degree of surgical expertise completed a questionnaire with 43 items based on intraoperative handling and feasibility after the procedures. We collected and analyzed data from seventeen patients (35% male/65% female) with a median age of 70 years [CI 47-86] and median BMI of 25.8 kg/m
MeSH term(s)	Aged ; Female ; Humans ; Male ; Imaging, Three-Dimensional/methods ; Microscopy ; Microsurgery/methods ; Neurosurgical Procedures/methods ; Robotic Surgical Procedures ; Spine/surgery
Language	English
Publishing date	2022-12-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-27082-1
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Article ; Online: Hydrocephalus, cerebral vasospasm, and delayed cerebral ischemia following non-aneurysmatic spontaneous subarachnoid hemorrhages: an underestimated problem.

Wolfert, Christina / Maurer, Christoph J / Berlis, Ansgar / Schneider, Hauke / Steininger, Kathrin / Motov, Stefan / Krauss, Philipp / Sommer, Björn / Shiban, Ehab

Neurosurgical review

2022 Volume 46, Issue 1, Page(s) 23

Abstract: Non-aneurysmal subarachnoid hemorrhage (NASAH) is rare and mostly benign. However, complications such as cerebral vasospasm (CV), delayed cerebral ischemia (DCI), or post-hemorrhagic hydrocephalus (HC) may worsen the prognosis. The aim of this study was ... ...

Abstract	Non-aneurysmal subarachnoid hemorrhage (NASAH) is rare and mostly benign. However, complications such as cerebral vasospasm (CV), delayed cerebral ischemia (DCI), or post-hemorrhagic hydrocephalus (HC) may worsen the prognosis. The aim of this study was to evaluate the rate of these complications comparing perimesencephalic (PM) and non-perimesencephalic (NPM) SAH. Monocentric, retrospective analysis of patients diagnosed with NASAH from 01/2010 to 01/2021. Diagnosis was set only if vascular pathologies were excluded in at least one digital subtraction angiography, and NASAH was confirmed by cranial computed tomography (cCT) or lumbar puncture (LP). One hundred patients (62 female) with a mean age of 54.9 years (27-84) were identified. Seventy-three percent had a World Federation of Neurological Surgeons (WFNS) grading scale score I, while 9% were WFNS score IV or V at the time of admission. SAH was diagnosed by cCT in 86%, in 14% by lumbar puncture. Twenty-five percent necessitated short-term CSF diversion by extraventricular drainage or lumbar drainage, whereof 7 suffered from long-term HC treated with ventriculoperitoneal shunting (VPS). One patient without a short-term CSF drainage developed long-term HC. Ten percent developed CV, four of whom received intraarterial spasmolysis. Radiological DCI was diagnosed in 2%; none of these correlated with CV. Despite a mortality of 3% occurring solely in NPM SAH, the analyzed complication rate was comparable in both groups. We observed post-hemorrhagic complications in 35% of cases during the first 3 weeks after bleeding, predominantly in patients with NPM SAH. For this reason, close observation and cranial imaging within this time may be indicated not to overlook these complications.
MeSH term(s)	Humans ; Female ; Middle Aged ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/surgery ; Subarachnoid Hemorrhage/diagnosis ; Retrospective Studies ; Vasospasm, Intracranial/etiology ; Vasospasm, Intracranial/complications ; Brain Ischemia/complications ; Cerebral Infarction/complications ; Hydrocephalus/surgery ; Hydrocephalus/complications
Language	English
Publishing date	2022-12-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-022-01919-9
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Article ; Online: sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE): a prospective multicentre RCT.

Krauss, Philipp / Motov, Stefan / Bonk, Maximilian Niklas / Prescher, Andrea / Scorzin, Jasmin / Hajiabadi, Mohammad Mehdi / Schulte, Dirk Michael / Sommer, Bjoern / Seiz-Rosenhagen, Marcel / Ahmadi, Rezvan / Maciaczyk, Jaroslaw / Lehmberg, Jens / Shiban, Ehab

BMJ open

2023 Volume 13, Issue 4, Page(s) e067784

Abstract: Introduction: Persistent spine pain syndrome type 2 (PSPS2) represents a significant burden to the individual and society. Treatment options include revision surgery, stabilisation surgery of the spine, neuromodulation, analgesics and cognitive ... ...

Abstract	Introduction: Persistent spine pain syndrome type 2 (PSPS2) represents a significant burden to the individual and society. Treatment options include revision surgery, stabilisation surgery of the spine, neuromodulation, analgesics and cognitive behavioural therapy. Nevertheless, structured treatment algorithms are missing as high-level evidence on the various treatments is sparse. The aim of this study is to compare higher frequency neuromodulation with instrumentation surgery in patients suffering from PSPS2. Methods and analysis: The sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE) trial is a prospective randomised rater blinded multicentre study. Patients suffering from PSPS2 with a functional burden of Oswestry Disability Index (ODI) >20 points are randomised to treatment via spinal cord stimulation or spinal instrumentation. Primary outcome is back-related functional outcome according to the ODI 12 months after treatment. Secondary outcomes include pain perception (visual analogue scale), Short Form-36, EuroQOL5D, the amount of analgesics, the length of periprocedural hospitalisation and adverse events. Follow-up visits are planned at 3 and 12 months after treatment. Patients with previous lumbar instrumentation, symptomatic spinal stenosis, radiographical apparent spinal instability or severe psychiatric or systemic comorbidities are excluded from the study. In order to detect a significant difference of ≥10 points (ODI) with a power of 80%, n=72 patients need to be included. The recruitment period will be 24 months with a subsequent 12 months follow-up. The beginning of enrolment is planned for October 2022. Ethics and dissemination: The PROMISE trial is the first randomised rater blinded multicentre study comparing the functional effectiveness of spinal instrumentation versus neuromodulation in patients with PSPS2 in order to achieve high-level evidence for these commonly used treatment options in this severely disabling condition. Patient recruitment will be performed at regular outpatient clinic visits. No further (print, social media) publicity is planned. The study is approved by the local ethics committee (LMU Munich, Germany) and will be conducted according to the Declaration of Helsinki. Trial registration number: NCT05466110.
MeSH term(s)	Humans ; Low Back Pain ; Treatment Outcome ; Spinal Cord Stimulation ; Prospective Studies ; Lumbar Vertebrae/surgery ; Spinal Stenosis/surgery ; Decompression, Surgical/methods
Language	English
Publishing date	2023-04-03
Publishing country	England
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-067784
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