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Article ; Online: Involuntary ambulatory triage during the COVID-19 pandemic - A neurosurgical perspective.

Harald Krenzlin / Christoph Bettag / Veit Rohde / Florian Ringel / Naureen Keric

PLoS ONE, Vol 15, Iss 6, p e

2020 Volume 0234956

Abstract: Background The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to health-care systems around the world. As approximately one-third of the world´s population is living under "lockdown" conditions, medical resources are being ... ...

Abstract	Background The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to health-care systems around the world. As approximately one-third of the world´s population is living under "lockdown" conditions, medical resources are being reallocated and hospital admissions are limited to emergencies. We examined the decision-making impact of these actions and their effects on access to hospital treatment in patients with neurosurgical conditions. Methods This retrospective cohort study analyzes hospital admissions of two major neurosurgical services in Germany during the nationwide lockdown period (March 16th to April 16th, 2020). Spinal or cranial conditions requiring immediate hospital admission and treatment constituted emergencies. Results A total of 243 in-patients were treated between March 16th and April 16th 2020 (122 patients at the University Medical Center Mainz, 121 patients at the University Medical Center Göttingen). Of these, 38.0±16% qualified as emergency admission. Another 1,688 admissions were reviewed during the same periods in 2018 and 2019, providing a frame of reference. Overall, emergency admissions declined by 44.7±0.7% during lockdown. Admissions for cranial emergencies fell by 48.1±4.44%, spinal emergencies by 30.9±14.6%. Conclusion Above findings indicate that in addition to postponing elective procedures, emergency admissions were dramatically curtailed during the COVID-19 lockdown. As this surely is unexpected and unintended, reasons are undoubtedly complex. As consequences in morbidity and mortality are still unpredictable, efforts should be made to accommodate all patients in need of hospital access going forward.
Keywords	Medicine ; R ; Science ; Q ; covid19
Subject code	360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The ESAS-score

Dorothee Mielke / Kim Bleuel / Christine Stadelmann / Veit Rohde / Vesna Malinova

PLoS ONE, Vol 15, Iss 2, p e

A histological severity grading system of subarachnoid hemorrhage using the modified double hemorrhage model in rats.

2020 Volume 0227349

Abstract: OBJECTIVE:The amount of extravasated blood is an established surrogate marker for subarachnoid hemorrhage (SAH) severity, which varies in different experimental SAH (eSAH) models. A comprehensive eSAH grading system would allow a more reliable ... ...

Abstract	OBJECTIVE:The amount of extravasated blood is an established surrogate marker for subarachnoid hemorrhage (SAH) severity, which varies in different experimental SAH (eSAH) models. A comprehensive eSAH grading system would allow a more reliable correlation of outcome parameters with SAH severity. The aim of this study was to define a severity score for eSAH related to the Fisher-Score in humans. MATERIAL AND METHODS:SAH was induced in 135 male rats using the modified double hemorrhage model. A sham group included 8 rats, in which saline solution instead of blood was injected. Histological analysis with HE(hematoxylin-eosin)-staining for the visualization of blood was performed in all rats on day 5. The amount and distribution of blood within the subarachnoid space and ventricles (IVH) was analyzed. RESULTS:The mortality rate was 49.6% (71/143). In all except five SAH rats, blood was visible within the subarachnoid space. As expected, no blood was detected in the sham group. The following eSAH severity score was established (ESAS-score): grade I: no SAH visible; grade II: local or diffuse thin SAH, no IVH; grade III: diffuse / thick layers of blood, no IVH; grade IV: additional IVH. Grade I was seen in five rats (7.9%), grade II in 28.6% (18/63), grade III in 41.3% (26/63) and grade IV in 22.2% (14/63) of the rats with eSAH. CONCLUSION:The double hemorrhage model allows the induction of a high grade SAH in more than 60% of the rats, making it suitable for the evaluation of outcome parameters in severe SAH.
Keywords	Medicine ; R ; Science ; Q
Subject code	630
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Therapeutic nihilism is inadequate in geriatric medicine

Roland Nau / Marius Großmann / Veit Rohde / Elmar Knopf / Joachim Dörges / Jörg Larsen

Clinical Case Reports, Vol 9, Iss 8, Pp n/a-n/a (2021)

2021

Abstract: Abstract Patients' wishes should guide therapeutic considerations in the face of options and necessities, particularly when an intervention carries the risk of death. Therefore, in the medical management of the young and the old, everything should be ... ...

Abstract	Abstract Patients' wishes should guide therapeutic considerations in the face of options and necessities, particularly when an intervention carries the risk of death. Therefore, in the medical management of the young and the old, everything should be attempted as long as the patient has a strong will to live.
Keywords	geriatric medicine ; health maintenance ; Medicine ; R ; Medicine (General) ; R5-920
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
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Article ; Online: Prognostic differences and implications on treatment strategies between butterfly glioblastoma and glioblastoma with unilateral corpus callosum infiltration

Mohammad Hazaymeh / Ronja Löber-Handwerker / Katja Döring / Tammam Abboud / Dorothee Mielke / Veit Rohde / Vesna Malinova

Scientific Reports, Vol 12, Iss 1, Pp 1-

2022 Volume 9

Abstract: Abstract Approximately 25% of glioblastomas show at diagnosis a corpus callosum infiltration, which is associated with poor prognosis. The extent of corpus callosum involvement, however, ranges from partial unilateral to complete bilateral infiltration. ... ...

Abstract	Abstract Approximately 25% of glioblastomas show at diagnosis a corpus callosum infiltration, which is associated with poor prognosis. The extent of corpus callosum involvement, however, ranges from partial unilateral to complete bilateral infiltration. The role of surgery in glioblastoma with corpus callosum involvement is controversial. In this study, we aimed to examine prognostic differences between glioblastoma with unilateral and glioblastoma with bilateral corpus callosum infiltration, and to evaluate possible treatment strategy implications. Patients with newly diagnosed glioblastoma from 2010 to 2019 were included. Corpus callosum infiltration was assessed in contrast-enhanced T1-weighted preoperative magnetic resonance imaging. Extent of resection, adjuvant treatments and overall survival were evaluated. Corpus callosum involvement was found in 96 (26.4%) out of 363 patients with newly diagnosed glioblastoma. Bilateral corpus callosum infiltration was found in 27 out of 96 patients (28%), and 69 patients had unilateral corpus callosum infiltration. Glioblastoma with corpus callosum affection had significantly lower median overall survival compared to glioblastoma without corpus callosum involvement (9 vs. 11 months, p = 0.02). A subgroup analysis of glioblastoma with unilateral corpus callosum infiltration revealed a significant difference in median overall survival dependent on extent of resection (6.5 without gross total resection vs. 11 months with gross total resection, Log-rank test p = 0.02). Our data confirms a shorter overall survival in glioblastoma subpopulation with corpus callosum involvement, especially for glioblastoma with bilateral corpus callosum infiltration. However, patients with partial corpus callosum infiltration undergoing gross total resection exhibited a significant survival benefit compared to their counterparts without gross total resection. Whenever reasonably achievable gross total resection should be considered as an integral part of the treatment strategy in glioblastoma ...
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: T1 mapping in patients with cervical spinal canal stenosis with and without decompressive surgery: A longitudinal study.

Stefanie, Meyer / Antonia, Geiger / Leah Shyela, Volnhals / Sabine, Hofer / Peter, Dechent / Jens, Frahm / Daniel, Behme / Christian, Brelie / Veit, Rohde / Mathias, Bähr / Jan, Liman / Ilko L, Maier

Journal of neuroimaging : official journal of the American Society of Neuroimaging

2024 Volume 34, Issue 3, Page(s) 329–338

Abstract: Background and purpose: Cervical spinal canal stenosis (cSCS) is a common cause of spinal impairment in the elderly. With conventional magnetic resonance imaging (MRI) suffering from various limitations, high-resolution single-shot T1 mapping has been ... ...

Abstract	Background and purpose: Cervical spinal canal stenosis (cSCS) is a common cause of spinal impairment in the elderly. With conventional magnetic resonance imaging (MRI) suffering from various limitations, high-resolution single-shot T1 mapping has been proposed as a novel MRI technique in cSCS diagnosis. In this study, we investigated the effect of conservative and surgical treatment on spinal cord T1 relaxation times in cSCS. Methods: T1-mapping was performed in 54 patients with cSCS at 3 Tesla MRI at the maximum-, above and below the stenosis. Subsequently, intraindividual T1-differences (ΔT1) intrastenosis were calculated. Twenty-four patients received follow-up scans after 6 months. Results: Surgically treated patients showed higher ΔT1 at baseline (154.9 ± 81.6 vs. 95.3 ± 60.7), while absolute T1-values within the stenosis were comparable between groups (863.7 ± 89.3 milliseconds vs. 855.1 ± 62.2 milliseconds). In surgically treated patients, ΔT1 decreased inverse to stenosis severity. After 6 months, ΔT1 significantly decreased in the surgical group (154.9 ± 81.6 milliseconds to 85.7 ± 108.9 milliseconds, p = .021) and remained unchanged in conservatively treated patients. Both groups showed clinical improvement at the 6-month follow-up. Conclusions: Baseline difference of T1 relaxation time (ΔT1) might serve as a supporting marker for treatment decision and change of T1 relaxation time might reflect relief of spinal cord narrowing indicating regenerative processes. Quantitative T1-mapping represents a promising additional imaging method to indicate a surgical treatment plan and to validate treatment success.
MeSH term(s)	Humans ; Spinal Stenosis/surgery ; Spinal Stenosis/diagnostic imaging ; Male ; Female ; Decompression, Surgical/methods ; Aged ; Longitudinal Studies ; Magnetic Resonance Imaging/methods ; Cervical Vertebrae/diagnostic imaging ; Cervical Vertebrae/surgery ; Middle Aged ; Treatment Outcome ; Reproducibility of Results ; Aged, 80 and over
Language	English
Publishing date	2024-02-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1071724-9
ISSN	1552-6569 ; 1051-2284
ISSN (online)	1552-6569
ISSN	1051-2284
DOI	10.1111/jon.13195
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Article ; Online: Study of Radial Nerve Injury Caused By Gunshot Wounds and Explosive Injuries among Iraqi Soldiers

Reza Akhavan-Sigari / Dorothee Mielke / Afshin Farhadi / Veit Rohde

Open Access Macedonian Journal of Medical Sciences, Vol 6, Iss

2018 Volume 9

Abstract: BACKGROUND: Gunshot wounds and blast injuries to the upper limbs produce complex wounds requiring management by multiple surgical specialities. AIM: We sought to determine the pattern of peripheral nerve injuries among Iraqi soldiers in the war. METHODS: ...

Abstract	BACKGROUND: Gunshot wounds and blast injuries to the upper limbs produce complex wounds requiring management by multiple surgical specialities. AIM: We sought to determine the pattern of peripheral nerve injuries among Iraqi soldiers in the war. METHODS: We performed a 3 year retrospective cohort analysis based on medical records of patients with sustaining gunshot wounds and blast injuries to the upper limbs. Ethical approval was obtained from the institutional review board. The patients included were male, serving military personnel of all age groups and ranks presenting with weakness or sensory loss of radial nerve. Three hundred eighteen patients aged 24 years or older with a high-energy, diaphyseal fracture of the humerus and complete motor and sensory radial nerve palsy were reviewed retrospectively. In these patients, the physical examination and electrodiagnostic study were carried out by experienced neurologists. Seddon's classification system was used to assess the severity of the injury. The data related to the types of fracture, the type of damage, the factors causing damage and the failure of treatment were entered into the IBM SPSS 23 software after extraction of files. Based on mid-range indicators and data distribution, traumatic injuries among Iraqi soldiers in the war against ISIL were then investigated. RESULTS: A group of 318 patients with mean age of 25.41 ± 6 years were enrolled in the study, of which 127 patients were included with an open fracture and 191 patients with closed lesions. All 127 patients with a transected radial nerve had an open humerus fracture and were part of a complex upper-extremity injury. 113 of 127 subjects had primary repair of the radial nerve and recovered well. 14 of 127 subjects were not recovered. 3 of them had iatrogenic radial nerve injury due to the internal fixation device. Furthermore, all 191 patients with closed injuries recovered well. The average time to initial signs of recovery was 8 weeks (range, 1–27 weeks). Axonotmesis and Neurotmesis were found in 283 (89%) subjects. The average time to full recovery was determined to be 6 months (range, 1–22 months). The blast was found to be the main cause of nerve injury in 236 (74.2%) cases, followed by gunshot damage (21.4%, 68 subjects), falling from height and motor vehicle accidents (4.4%, 14 subjects) and multiple injuries (17%, 54 cases). CONCLUSIONS: Trauma caused by factors such as explosions and gunshot worsens the condition of the injuries and presents the treatment conditions with many challenges. However, the success rate in post-surgical recovery of humerus fracture and injured radial nerve can be remarkably higher in young people as compared to other age groups.
Keywords	Gunshot wounds ; Radial nerve ; Humerus fracture ; Upper limbs ; Seddon's classification ; Medicine ; R
Subject code	150
Language	English
Publishing date	2018-09-01T00:00:00Z
Publisher	ID Design 2012/DOOEL Skopje
Document type	Article ; Online
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Article ; Online: The Importance of the Hedgehog Signaling Pathway in Tumorigenesis of Spinal and Cranial Chordoma

Reza Akhavan-Sigari / Walter Schulz-Schaeffer / Amanda Angelika Harcej / Veit Rohde

Journal of Clinical Medicine, Vol 8, Iss 2, p

2019 Volume 248

Abstract: Chordomas is rare malignant bone tumors thought to arise from remnants of embryonic notochord along the spine, frequently at the skull base and sacrum. Although chordoma is slow growing tumors, while are extremely recurrent, and aggressive, as well as ... ...

Abstract	Chordomas is rare malignant bone tumors thought to arise from remnants of embryonic notochord along the spine, frequently at the skull base and sacrum. Although chordoma is slow growing tumors, while are extremely recurrent, and aggressive, as well as the rate of prognosis remains poorly. Radical surgery and high-dose radiation are the most used treatments. Currently, there is no effective chemotherapeutic standard for chordomas. The Hedgehog (HH) pathway adjusts various processes included in expansion and differentiation of tissues and organs throughout the fetus’s life, furthermore cell growth and differentiation in the adult organism, of the cell in an adult organism, in which acute anesthesia is involved in multiple cancers. To study the role of signaling the hedgehog in the base of the skull and sacrum chordomas, the expression of SHH and GLI-1 levels were detected immuno histochemically, Additionally, PTCH-1 and GLI-1 expressions were distinguished by in- Situ- hybridization. Based on the findings presented herein, it is likely that the HH signal cascade was revealed even in cranial, where consecoently spinal chordoma and their recurrences play an important role. Our staining exhibited a canonical, ligand- dependent and autocrine Hedgehog signaling in skull base and sacrum chordomas including relapse. Due to the high levels of SHH and GLI-1 expression in all investigated chordoma samples, the study suggests a possible autocrine ligand-dependent activation of the canonical HH signaling cascade. A paracrine or non-canonical pathway cannot be excluded. Our results suggest that Hedgehog-inhibitors, like SHH-, GLI- and SMO- inhibitors, might serve as a potential and effective target for the treatment of chordomas.
Keywords	hedgehog signaling cascade ; tumorigenesis ; spinal and cranial chordomas ; Medicine ; R
Language	English
Publishing date	2019-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: SMART coils for intracranial aneurysm repair - a single center experience.

Daniel, Behme / Henrik, Sack / Ioannis, Tsogkas / Veit, Rohde / Marios-Nikos, Psychogios

BMC neurology

2020 Volume 20, Issue 1, Page(s) 38

Abstract: Background: Due to uniform stiffness of standard platinum coils, dense packing of intracranial aneurysms can be difficult to achieve, since stiffer coils can cause microcatheter prolapse or coil migration. SMART coils have a varying softness along the ... ...

Abstract	Background: Due to uniform stiffness of standard platinum coils, dense packing of intracranial aneurysms can be difficult to achieve, since stiffer coils can cause microcatheter prolapse or coil migration. SMART coils have a varying softness along the length of the coils to improve deliverability. We report our initial 2 year experience with the SMART coil system, including direct and follow-up results. Methods: We performed a retrospective study of all patients who underwent coil embolization of an intracranial aneurysm with SMART coils between July 2016 and August 2018 at our institution. We analyzed clinical and angiographic data before and directly after treatment as well as at 6 months follow-up. Results: A total of 49 patients harboring 49 aneurysms were treated; 23 (47%) were ruptured aneurysms. Most aneurysms (57%) were located in the anterior circulation. Median patient age was 55 (31-88), 63% were female. Mean aneurysm size was: neck 3.4 (±1.5), height 6.3 (±2.9) and width 5.2 (±2.3) mm. SMART coils were solely used in 96% of cases. Initial favorable angiographic results were achieved in 45 (92%) of 49 cases, which were stable at 6 months in 26/29 (90%). Thromboembolic complications occurred in 4 (8%) cases without clinical sequelae; microcatheter prolapse occurred in 1 case. No aneurysm rupture or device malfunction was observed. Conclusion: The treatment of ruptured and unruptured intracranial aneurysms with SMART Coils was safe and efficacious in our cohort.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Aneurysm, Ruptured/complications ; Blood Vessel Prosthesis ; Cohort Studies ; Embolization, Therapeutic/instrumentation ; Female ; Humans ; Intracranial Aneurysm/therapy ; Male ; Middle Aged ; Platinum ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Platinum (49DFR088MY)
Language	English
Publishing date	2020-01-29
Publishing country	England
Document type	Journal Article
ISSN	1471-2377
ISSN (online)	1471-2377
DOI	10.1186/s12883-020-1623-9
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Article ; Online: The role of intraoperative microelectrode recording and stimulation in subthalamic lead placement for Parkinson's disease.

Vesna Malinova / Anabel Pinter / Cristina Dragaescu / Veit Rohde / Claudia Trenkwalder / Friederike Sixel-Döring / Kajetan L von Eckardstein

PLoS ONE, Vol 15, Iss 11, p e

2020 Volume 0241752

Abstract: Objective Intraoperative microelectrode recording (MER) and test-stimulation are regarded as the gold standard for proper placement of subthalamic (STN) deep brain stimulation (DBS) electrodes in Parkinson's disease (PD), requiring the patient to be ... ...

Abstract	Objective Intraoperative microelectrode recording (MER) and test-stimulation are regarded as the gold standard for proper placement of subthalamic (STN) deep brain stimulation (DBS) electrodes in Parkinson's disease (PD), requiring the patient to be awake during the procedure. In accordance with good clinical practice, most attending neurologists will request the clinically most efficacious trajectory for definite lead placement. However, the necessity of microelectrode-test-stimulation is disputed, as it may limit the access to DBS therapy, excluding those not willing or incapable of undergoing awake surgery. Methods We retrospectively analyzed the MERs and microelectrode-test-stimulation results with regard to the decision on definite lead placement and clinical outcome in a cohort of 67 PD-patients with STN-DBS. All patients received bilateral quadripolar ring electrodes. To ascertain overall procedural efficacy, we calculated the surgical index (SI) by comparing preoperative motor improvement induced by levodopa to that induced by stimulation 7 to 18 months after surgery, measured as the relative difference between ON and OFF-states on the Unified Parkinson's Disease Rating Scale motor part (UPDRS-3). Additionally, a side-specific surgical index (SSSI) was calculated using the unilateral assessable items of the UPDRS-3. The SSSI where microelectrode-test-stimulation overruled MER were compared to those where the result of microelectrode-test-stimulation was congruent to MER results. Results A total of 134 electrodes were analyzed. For final lead placement, the central trajectory was chosen in 54% of patient hemispheres. The mean SI was 0.99 (± 0.24). SSSI averaged 1.04 (± 0.45). In 37 lead placements, microelectrode-test-stimulation overruled MER in the final trajectory selection, in 27 of these lead placements adverse effects during microelectrode-test-stimulation were decisive. Neither the number of test electrodes used nor the STN-signal length had an impact on the SSSI. The SSSI did not differ between ...
Keywords	Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
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Audio / Video ; Online: Emergency admissions to the Department of Neurosurgery at the University Medical Center Mainz 2 weeks before and during the nationwide lockdown.

Harald Krenzlin (264449) / Christoph Bettag (8992046) / Veit Rohde (246525) / Florian Ringel (459928) / Naureen Keric (4598035)

2020

Abstract: A) Admissions for spinal and cranial emergencies. B) Distribution of cranial emergencies. C) Patient routes leading to hospital admission during the COVID-19 pandemic. ...

Abstract	A) Admissions for spinal and cranial emergencies. B) Distribution of cranial emergencies. C) Patient routes leading to hospital admission during the COVID-19 pandemic.
Keywords	Medicine ; Neuroscience ; Biotechnology ; Marine Biology ; Cancer ; Mental Health ; Infectious Diseases ; emergency admissions ; neurosurgical perspective Background ; COVID -19 lockdown ; retrospective cohort study ; coronavirus disease 2019 ; University Medical Center Mainz ; hospital admissions ; March 16 ; April 16 ; University Medical Center G öttingen ; covid19
Publishing date	2020-06-18T19:28:21Z
Publishing country	us
Document type	Audio / Video ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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