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OBJECTIVEClinical evidence on giant intracranial aneurysms (GIAs), intracranial aneurysms with a diameter of at least 25 mm, is limited. The authors aimed to investigate the natural history, case fatality, and treatment outcomes of ruptured and unruptured GIAs.METHODSIn this international observational registry study, patients with a ruptured or unruptured GIA received conservative management (CM), surgical management (SM), or endovascular management (EM). The authors investigated rupture rates and case fatality.RESULTSThe retrospective cohort comprised 219 patients with GIAs (21.9% ruptured GIAs and 78.1% unruptured GIAs) whose index hospitalization occurred between January 2006 and November 2016. The index hospitalization in the prospective cohort (362 patients with GIAs [17.1% ruptured and 82.9% unruptured]) occurred between December 2008 and February 2017. In the retrospective cohort, the risk ratio for death at a mean follow-up of 4.8 years (SD 2.2 years) after CM, compared with EM and SM, was 1.63 (95% CI 1.23–2.16) in ruptured GIAs and 3.96 (95% CI 2.57–6.11) in unruptured GIAs. In the prospective cohort, the 1-year case fatality in ruptured GIAs/unruptured GIAs was 100%/22.0% during CM, 36.0%/3.0% after SM, and 39.0%/12.0% after EM. Corresponding 1-year rupture rates in unruptured GIAs were 25.0% during CM, 1.2% after SM, and 2.5% after EM. In unruptured GIAs, the HR for death within the 1st year in patients with posterior circulation GIAs was 6.7 (95% CI 1.5–30.4, p < 0.01), with patients with a GIA at the supraclinoid internal carotid artery as reference. Different sizes of unruptured GIAs were not associated with 1-year case fatality.CONCLUSIONSRupture rates for unruptured GIAs were high, and the natural history and treatment outcomes for ruptured GIAs were poor. Patients undergoing SM or EM showed lower case fatality and rupture rates than those undergoing CM. This difference in outcome may in part be influenced by patients in the CM group having been found poor candidates for SM or EM.Clinical trial registration no.: NCT02066493 (clinicaltrials.gov)

Objective: Few cerebral aneurysms are not completely clippable or even unclippable due to small size and/or difficult morphology. In some cases, the aneurysm can be clipped partially and the remnant is wrapped with muscle, cotton and glue (clip-wrapping), or, the aneurysm is wrapped solely. In [for full text, please go to the a.m. URL], 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Objective: Computation Fluid Dynamics (CFD) is a well established tool to investigate hemodynamics in vascular geometries. Various authors found correlations between specific CFD-parameters and intraoperatively thin-appearing aneurysm wall regions. Optical Coherence Tomography (OCT), providing tissue[for full text, please go to the a.m. URL], 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Objective: Mapping language capacity with its subfunctions during direct cortical stimulation (DCS) in the stetting of awake craniotomy might be challenging without using more than one language paradigm. Applying several language tasks leads to increasing surgery times and to patient’s exhaustion.[for full text, please go to the a.m. URL], 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Objective: Preceding studies found a main influence of the dentato-rubro-thalamic tract (DRTT) in the mechanisms of Essential Tremor. However, the influence of different parts of the DRTT, consisting of a ipsilateral and a decussating part, has not been investigated yet with respect to tremor reduction.[for full text, please go to the a.m. URL], 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Objective: The aim of our study was to investigate which subcorticalfiber tracts and cortical areas are involved in the occurrence of side-effects in deep brain stimulation for Parkinson’s disease. Methods: 21 patients with Parkinson’s disease and bilaterally implanted electrodes [for full text, please go to the a.m. URL], 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Objective: Hemodynamic parameters and the flow situation inside intracranial aneurysms have great influence on the risk of rupture. Therefore, computational fluid dynamics (CFD) is a frequently used tool for rupture risk assessment [ref:1]. However, there are great differences between different[for full text, please go to the a.m. URL], 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Objective: A score combining Glasgow Coma Scale (GCS) and pupil response (GCS-P) as well as the Eppendorf-Köln Scale (ECS) have been introduced as novel trauma scores recently. This study aims to evaluate the prognostic value of these scores in aneurysmal subarachnoid hemorrhage (SAH). Methods:[for full text, please go to the a.m. URL], 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Objective: Intraventricular tumors represent a rare and challenging neurosurgical entity. Complete surgical resection is the treatment of choice, if feasible, for any tumor identity. Here, we report 97 patients with classical primary intraventricular tumors that underwent surgery at our institution.[for full text, please go to the a.m. URL], 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Objective: Molecular markers in glioma are essential for diagnosis, treatment and prognosis. Isocitrate-dehydrogenase 1/2 (IDH1/2) is one of the major diagnostic classifiers which plays a significant role in tumor metabolism. So far it is a postoperative immuno-histological or molecular diagnosis.[for full text, please go to the a.m. URL], 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Objective: The pathophysiology of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) is still incompletely understood. Intrathecal inflammatory immune activation is suspected to play a major role for the induction of vasospasm and DCI. The aim of this study is to identify[for full text, please go to the a.m. URL], 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Objective: Aneurysmal subarachnoid haemorrhage (aSAH) remains a serious, life-threatening disease associated with high morbidity and mortality despite recent advances in neurocritical care as well as neurosurgical and endovascular treatment options. A multitude of pathological processes, such as inflammatory[for full text, please go to the a.m. URL], 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

OBJECTIVE Malignant gliomas metabolize glucose preferably by glycolysis which is in accordance with the Warburg effect. This induces a high demand of glucose combined with a significant lactic acid load. The hypoxia-inducible carbonic anhydrase (CA) IX has been shown to moderate the extrusion of hydrogen ions into the extracellular space. Since the acidification of the extracellular environment contributes to host tissue invasion due to activation of proteolytic enzymes, we hypothesized that CA IX plays an important role in malignant glioma Recently, specific small molecule inhibitors of this enzyme have been developed and may provide an innovative strategy for anti – invasive treatment. METHODS Two established and 4 primary GBM cell lines (2 with mesenchymal and 2 with proneural transcriptional profile) were exposed to the CAIX inhibitor U104 under normoxic and hypoxic conditions. Cell toxicity was measured by ATP and crystal violet assay. For invasion assessment, a matrigel invasion chamber system with 8 µm pore size polycarbonate filter was used. CAIX expression was analyzed by quantitative RTPCR and Western Blot. RESULTS Hypoxia significantly induced CAIX expression in all cell lines. Invasiveness increased significantly under hypoxic conditions in the mesenchymal cells (p < 0.01). Regardless of oxygenation status, the mesenchymal group displayed significantly higher invasiveness compared to the proneural group (p = 0.006). Looking at all cell lines, invasion is significantly inhibited by U104, both under normoxic and hypoxic conditions (p < 0.01). However, while the mesenchymal group showed the highest susceptibility to CAIX inhibition followed by the proneurally differentiated group, the established cell lines were entirely refractory to CAIX inhibition. CONCLUSION Our data demonstrate that CAIX inhibition can effectively inhibit invasion in malignant glioma cells independent from oxygenation status, however the effects are significantly influenced by cell type specific biological features.

Objective: Brain lesions in language-related cortical areas remain a challenge in clinical routine. In recent years, resting-state functional magnetic resonance imaging (rs-fMRI) has been shown to be a feasible method for preoperative language assessment. This study examined whether language-related[for full text, please go to the a.m. URL], 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Objective: Thyroid dysfunction has been associated with aortic aneurysms and vascular dysfunction, however, there is limited data available on the prevalence of hypothyroidism in patients with aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that the prevalence of hypothyroidism at admission[for full text, please go to the a.m. URL], 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Objective: Mesenchymal stem cells (MSC) show an inherent brain tumor cell tropism that can be exploited for targeted delivery of therapeutic genes to invasive glioma. We assessed whether a motile stem cell-based local immunmodulation is able to overcome the immunosuppressive GBM microenvironment and[for full text, please go to the a.m. URL], 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Objective: Intraventricular ependymal tumors in adults represent a rare and challenging neurosurgical entity. The role of radiotherapy is subject to controversial discussion and chemotherapy has shown to be ineffective, therefore complete surgical resection remains the treatment of choice, but scientific[for full text, please go to the a.m. URL], 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS)

Objective: The risk for intracranial aneurysms (IA) and aneurysmatic subarachnoid hemorrhage (SAH) is increased among patient’s family members, however, the genetic background of the disease is still poorly understood. Although large genome wide association studies identified several single nucleotide[for full text, please go to the a.m. URL], 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS)

Intracranial aneurysms (IA) are usually quantified according to their largest diameter. However, volumetry has recently been increasingly conducted as well, especially in giant intracranial aneurysms (GIAs). Since so far the true value of GIA volumetry is unknown, we designed a trial to examine correlations between GIA diameter and volume with special focus on clinical implications. Magnetic resonance imaging of 69 unruptured GIAs in 66 patients was retrospectively evaluated. The largest diameter and volume were measured. Also, potential associations to the patients’ clinical conditions were examined. Comparing GIA sizes of our patient cohort produced different results depending on whether GIA diameter or volume was measured. Measuring the diameter identified posterior circulation GIAs as the largest ones (39.2 mm, IQR 37.3–48.3), while measuring the volume found GIAs of the MCA to be the largest ones (12.3 cm3, IQR 7.2–27.8). A correlation of GIA diameter and volume was only found in anterior circulation GIAs, which were predominantly saccular in shape, but not in those of the posterior circulation, of which most were fusiform. Neither GIA diameter nor GIA volume but only GIA location was associated with neurological deficits. Diameter and volume measurements are not interchangeable modes of GIA quantification. Our data suggest that the idea of distinguishing different sizes of GIA may be clinically less relevant than examining their location, shape or mass effect.

Objective: According to ISUIA, cerebral aneurysms smaller than 7mm are believed to be associated with a low bleeding risk. However, other studies reported that a significant portion of ruptured aneurysms was smaller than 7 mm, which is in line with our clinical practice. The purpose of this study was[for full text, please go to the a.m. URL], 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Objective: The surgical management of lesions ventrally to the neuroaxis at the level of the craniovertebral junction (CVJ) and upper cervical spine is challenging. Here, we describe a minimal invasive dorsal approach for small ventrally located intradural lesions at the CVJ as an alternative for the[for full text, please go to the a.m. URL], 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Objective: Warning criteria for monitoring of motor evoked potentials (MEP) after direct cortical stimulation during surgery of supratentorial tumors have been well described. However, little is known about the value of MEP after transcranial electrical stimulation (TES) in predicting postoperative [for full text, please go to the a.m. URL], 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

OBJECT The underlying mechanisms causing intracranial perianeurysmal edema (PAE) are still poorly understood. Since PAE is most frequently observed in giant intracranial aneurysms (GIAs), the authors designed a study to examine the occurrence of PAE in relation to the location, size, and partial thrombosis (PT) of GIAs along with the clinical impact of PAE. METHODS Magnetic resonance imaging data for patients with a diagnosis of unruptured GIA from the international multicenter Giant Intracranial Aneurysm Registry were retrospectively analyzed with regard to location and size of the GIA, PAE volume, and the presence of PT. The occurrence of PAE was correlated to clinical findings. RESULTS Imaging data for 69 GIAs were eligible for inclusion in this study. Perianeurysmal edema was observed in 33.3% of all cases, with the highest frequency in GIAs of the middle cerebral artery (MCA; 68.8%) and the lowest frequency in GIAs of the cavernous internal carotid artery (ICA; 0.0%). Independent predictors of PAE formation were GIA volume (OR 1.13, p = 0.02) and the occurrence of PT (OR 9.84, p = 0.04). Giant intracranial aneurysm location did not predict PAE occurrence. Giant aneurysms with PAE were larger than GIAs without PAE (p < 0.01), and GIA volume correlated with PAE volume (rs = 0.51, p = 0.01). Perianeurysmal edema had no influence on the modified Rankin Scale score (p = 0.30 or the occurrence of aphasia (p = 0.61) or hemiparesis (p = 0.82). CONCLUSIONS Perianeurysmal edema was associated with GIA size and the presence of PT. As no PAE was observed in cavernous ICA aneurysms, even though they exerted mass effect on the brain and also displayed PT, the dura mater may serve as a barrier protecting the brain from PAE formation.

Objective: Pediatric patients constitute an unqiue subgroup of all cerebral AVM cases. Management of pediatric AVMs requires profound knowledge regarding the natural history of the lesion as well as associated treatment risks. Identification of children with AVMs that are more prone to bleed provides[for full text, please go to the a.m. URL], 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Objective: Subarachnoid hemorrhage (SAH) is still associated with high morbidity and mortality. Therefore, specialized neurointensive care is desirable in the acute stage in order to prevent major clinical impairment in the critical first hours post-injury. Our objective was to evaluate the clinical[for full text, please go to the a.m. URL], 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Objective: This study evaluates the clinical results and quality of life (QoL) after surgical treatment for trigeminal neuralgia (TN) in patients over 70 years. Methods: A total of 96 TN-patients were treated between 1998–2009 in which microvascular decompression (MVD) or percutaneous electrocoagulation[for full text, please go to the a.m. URL], 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010