Background
Even though mechanical recanalization techniques have dramatically improved acute stroke care since the pivotal trials of decompressive hemicraniectomy for malignant courses of ischemic ...stroke, decompressive hemicraniectomy remains a mainstay of malignant stroke treatment. However, it is still unclear whether prior thrombectomy, which in most cases is associated with application of antiplatelets and/or anticoagulants, affects the surgical complication rate of decompressive hemicraniectomy and whether conclusions derived from prior trials of decompressive hemicraniectomy are still valid in times of modern stroke care.
Methods
A total of 103 consecutive patients who received a decompressive hemicraniectomy for malignant middle cerebral artery infarction were evaluated in this retrospective cohort study. Surgical and functional outcomes of patients who had received mechanical recanalization before surgery (thrombectomy group,
n
= 49) and of patients who had not received mechanical recanalization (medical group,
n
= 54) were compared.
Results
The baseline characteristics of the two groups did significantly differ regarding preoperative systemic thrombolysis (63.3% in the thrombectomy group vs. 18.5% in the medical group,
p
< 0.001), the rate of hemorrhagic transformation (44.9% vs. 24.1%,
p
= 0.04) and the preoperative Glasgow Coma Score (median of 7 in the thrombectomy group vs. 12 in the medical group,
p
= 0.04) were similar to those of prior randomized controlled trials of decompressive hemicraniectomy. There was no significant difference in the rates of surgical complications (10.2% in the thrombectomy group vs. 11.1% in the medical group), revision surgery within the first 30 days after surgery (4.1% vs. 5.6%, respectively), and functional outcome (median modified Rankin Score of 4 at 5 and 14 months in both groups) between the two groups.
Conclusions
A prior mechanical recanalization with possibly associated systemic thrombolysis does not affect the early surgical complication rate and the functional outcome after decompressive hemicraniectomy for malignant ischemic stroke. Patient characteristics have not changed significantly since the introduction of mechanical recanalization; therefore, the results from former large randomized controlled trials are still valid in the modern era of stroke care.
Modern head and neck reconstructive surgery offers a multitude of different reconstructive options. In such cases, donor site morbidity is an important factor in the affected patient’s ...decision-making. The aim of this study was to perform an objective comparison of donor site morbidity for the five most frequent microvascular donor sites in head and neck reconstructive surgery (radial forearm, anterolateral thigh, fibula, iliac crest, and scapula) using a uniform testing system. In this cross-sectional study, 117 donor sites were analyzed (106 for malignant disease and 11 for non-malignant disease): 73 radial forearm, 14 scapula, 12 anterolateral thigh, 10 fibula, and eight iliac crest. Testing consisted of range of motion, muscle strength, and sensation. The non-affected side served as the control. Quality of life was assessed using the Washington Quality of Life Questionnaire version 4 in its German translation. Range of motion was restricted in 15 cases (12.8%). Muscle strength was decreased in 58 cases (49.6%). Sensation was reduced in 70 cases (60%). Concerning quality of life, 31.2% of patients were limited in their daily activities. The scapula flap showed the highest incidence of overall donor site morbidity. However, correlation between objective and subjective donor site impairment was weak and the majority of patients experienced only minor limitations.
Abstract
Background
For non-resectable, eloquent, multifocal and deep-seated intracranial lesions, stereotactic frame-based biopsies can deliver a finite amount of tissue for neuropathology studies. ...With the increasing role of molecular genetics in the diagnostics of intracranial tumors, sufficient tissue for sequencing studies is of paramount importance. This study explored the rate of successful diagnosis after stereotactic frame-based biopsies of intracranial lesions in a high-throughput neurooncology center
Material and Methods
145 consecutive patients undergoing frame-based stereotactic biopsies in 2020 and 2021 at our neurosurgical department were included in this retrospective analysis. Aspects of histological and molecular (methylomics, panel-sequencing) neuropathology analysis in addition to clinical and radiological variables were analyzed. Cases were classified as conclusive, likely-conclusive (sufficient diagnosis with non-satisfying sequencing information), and inconclusive neuropathological diagnosis.
Results
Of 145 cases analyzed, astrocytic tumors were suspected in n= 94 (67%) of patients. In n= 122 cases (84%), a conclusive diagnosis was possible. For 14 (11%) cases, a likely-conclusive diagnosis was established Diagnoses comprised mainly WHO 4 glioblastomas (56%), WHO 3 gliomas (2%) in addition to WHO 1 and 2 gliomas (n=7, 5%), CNS lymphomas (n=23, 16%), inflammatory diseases (n=10, 7%) and normal or reactive tissue (n=4, 3%). Methylomics were pivotal in providing an integrated diagnosis in 30% of the cases (panel sequencing in 14%). In n= 12 (8%) of the cases further testing was hindered by insufficient tissue sample DNA. Only in 3 out of 12 cases this resulted in a final inconclusive diagnosis.
Conclusion
Although stereotactic frame-based biopsies deliver a limited amount of tissue, they bear an excellent histopathological and molecular genetic diagnostic yield, with rare cases of missing molecular data or rarely insufficient diagnosis. Optimizing the number and representativeness of cell and DNA-rich stereotactic biopsy specimen might enhance the diagnostic and therapeutic potential of precision oncology even further.
Abstract
Background
Leptomeningeal metastasis (LM) represents a terminal condition in a subset of patients with primary extra-cranial malignancies. With improved survival rates under novel systemic ...therapies for extra-cranial primary tumors, the role of cerebrospinal fluid (CSF) diversion via ventriculo-peritoneal shunts (VP-shunt) for symptom control of hydrocephalic LM is becoming increasingly important. This study hence aimed to describe this patient cohort and weigh out benefits against adverse events of palliative VP-shunt placement.
Material and Methods
A single-center retrospective analysis of all consecutive adult patients with VP-shunt placement over a period of six years was performed and clinical data (primary disease, clinical presentation, CSF diagnostics, previous therapies) in addition to surgical data (shunt devices, surgeries, and complications) and survival data were collected. Results were compared to a ‘non-oncological’ shunt cohort and statistical analyses was performed.
Results
38 patients with a median age of 53 (18-78) years (13 males, 25 females) underwent VP-Shunt placement. The most common underlying oncological conditions were breast cancer (n=21, 55%) and non-small cell lung cancer (NSCLC, n=11, 29%). The median time between primary tumor and LM diagnosis was 23 months (0 to 180 months). 14 patients (37%) presented with end-stage disease at primary tumor diagnosis, 25 (66%) patients had cranial metastases. Most patients presented with classical symptoms of intracranial hypertension and 11 patients (38%) had already received intrathecal treatment or radiotherapy before shunting. After shunting, symptom relief was achieved in 30 patients (79%) and 24 patients (63%) were eventually discharged home after surgery. Subsequently, 63% of the shunted patients underwent systemic or radiotherapy and 55% received intrathecal therapy. Revision surgery was performed for valve malfunctions and infections (n=3, 8% for either) or distal catheter malposition (n=2, 5%) but comparison with a ‘non-oncological’ shunt cohort showed no differences in complication rates. Median survival from shunting was 2.1 months (95% CI 0.5 to 3 months).
Conclusion
VP-shunt placement could relieve symptoms of intracranial hypertension secondary to LM of primary solid tumors without a higher risk of shunt complications compared to non-oncological patients, with many LM patients persuing further oncologic therapy. However, decision-making regarding VP-shunt placement in LM patients still retains a palliative nature.
Coagulation factor XII (FXII) deficiency is associated with decreased neutrophil migration, but the mechanisms remain uncharacterized. Here, we examine how FXII contributes to the inflammatory ...response. In 2 models of sterile inflammation, FXII-deficient mice (F12-/-) had fewer neutrophils recruited than WT mice. We discovered that neutrophils produced a pool of FXII that is functionally distinct from hepatic-derived FXII and contributes to neutrophil trafficking at sites of inflammation. FXII signals in neutrophils through urokinase plasminogen activator receptor-mediated (uPAR-mediated) Akt2 phosphorylation at S474 (pAktS474). Downstream of pAkt2S474, FXII stimulation of neutrophils upregulated surface expression of αMβ2 integrin, increased intracellular calcium, and promoted extracellular DNA release. The sum of these activities contributed to neutrophil cell adhesion, migration, and release of neutrophil extracellular traps in a process called NETosis. Decreased neutrophil signaling in F12-/- mice resulted in less inflammation and faster wound healing. Targeting hepatic F12 with siRNA did not affect neutrophil migration, whereas WT BM transplanted into F12-/- hosts was sufficient to correct the neutrophil migration defect in F12-/- mice and restore wound inflammation. Importantly, these activities were a zymogen FXII function and independent of FXIIa and contact activation, highlighting that FXII has a sophisticated role in vivo that has not been previously appreciated.
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