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BackgroundThe pronociceptive neuromediator calcitonin gene-related peptide (CGRP) is associated with pain transmission and modulation. After spontaneous subarachnoid hemorrhage (sSAH), the vasodilatory CGRP is excessively released into cerebrospinal fluid (CSF) and serum and modulates psycho-behavioral function. In CSF, the hypersecretion of CGRP subacutely after good-grade sSAH was significantly correlated with an impaired health-related quality of life (hrQoL). Now, we prospectively analyzed the treatment-specific differences in the secretion of endogenous CGRP into serum after good-grade sSAH and its impact on hrQoL.MethodsTwenty-six consecutive patients (f:m = 13:8; mean age 50.6 years) with good-grade sSAH were enrolled (drop out n = 5): n = 9 underwent endovascular aneurysm occlusion, n = 6 microsurgery, and n = 6 patients with perimesencephalic SAH received standardized intensive medical care. Plasma was drawn daily from day 1 to 10, at 3 weeks, and at the 6-month follow-up (FU). CGRP levels were determined with competitive enzyme immunoassay in duplicate serum samples. All patients underwent neuropsychological self-report assessment after the onset of sSAH (t1: day 11–35) and at the FU (t2).ResultsDuring the first 10 days, the mean CGRP levels in serum (0.470 ± 0.10 ng/ml) were significantly lower than the previously analyzed mean CGRP values in CSF (0.662 ± 0.173; p = 0.0001). The mean serum CGRP levels within the first 10 days did not differ significantly from the values at 3 weeks (p = 0.304). At 6 months, the mean serum CGRP value (0.429 ± 0.121 ng/ml) was significantly lower compared to 3 weeks (p = 0.010) and compared to the first 10 days (p = 0.026). Higher mean serum CGRP levels at 3 weeks (p = 0.001) and at 6 months (p = 0.005) correlated with a significantly poorer performance in the item pain, and, at 3 weeks, with a higher symptom burden regarding somatoform syndrome (p = 0.001) at t2.ConclusionOur study reveals the first insight into the serum levels of endogenous CGRP in good-grade sSAH patients with regard to hrQoL. In serum, upregulated CGRP levels at 3 weeks and 6 months seem to be associated with a poorer mid-term hrQoL in terms of pain. In migraineurs, CGRP receptor antagonists have proven clinical efficacy. Our findings corroborate the potential capacity of CGRP in pain processing.

Objective: Glioblastoma multiforme (GBM) WHO°IV is the most frequent and at the same time prognostically most unfavorable brain tumor with a heterogeneous appearance in MRI. Recent publications have shown that GBMs grouped into three phenotypically different subtypes are associated with significant [for full text, please go to the a.m. URL]

Objective: Tumor cell invasion has been demonstrated to be enhanced by inflammatory cytokines such as IL-17A, IL-22, IL-23 and CCL20 in various tumor entities other than glioblastoma (GBM). We have tested the impact of these factors on GBM migration and invasion utilizing four different in vitro techniques. [for full text, please go to the a.m. URL]

Objective: Anosmia and dysgeusia are discussed as specific symptoms with respect to COVID-19. As preceding studies found alterations in the olfactory bulbus in MRI analyses in patients with anosmia, the aim of our study was to analyse cortical neuroplastic alterations in the olfactory system in patients [for full text, please go to the a.m. URL]

Objective: Planning is a crucial factor for successful treatment in neurosurgery. 3D visualization (3D) and virtual reality (VR) allows for superior image data presentation, condenses image information and accommodates our stereopsis habits. We developed a neurosurgical planning tool which allows 3D [for full text, please go to the a.m. URL]

Objective: The expression level of programmed cell death ligand 1 (PDL-1) might be an indicator for response to immunotherapy using checkpoint inhibitors in patients with non-small cell lung cancer (NSCLC). As intra-tumoral differences and discrepancies between the PDL-1 expression in the primary tumor [for full text, please go to the a.m. URL]

Objective: To specifically identify invasive glioblastoma (GBM) cells we used Laser Microdissection in GBM specimen acquired during 5-ALA supported resection. We addressed several obstacles to optimize the dissection protocol: a. stability of the Protoporphyin IX fluorescence after retrieval of the [for full text, please go to the a.m. URL]

Objective: SARS-CoV-2 was first reported in Wuhan, China, at the beginning of 2020 leading to a global pandemic in the following. Though COVID-19 is mainly discussed in the context of respiratory symptoms, neurological symptoms are present in many patients. The aim of our study was to investigate subcortical [for full text, please go to the a.m. URL]

Objective: Gliomagenesis is a highly relevant topic that has not yet been fully understood. Studies suggest that high-grade gliomas, such as GBMs, originally derive from neural precursor cells. There are two regions in the human brain containing large pools of neural stem cells, first the subventricular [for full text, please go to the a.m. URL]

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)

PurposeBrain metastases (BM) can present a displacing or infiltrating growth pattern, independent of the primary tumor type. Previous studies have shown that tumor cell infiltration at the macro-metastasis/brain parenchyma interface (MMPI) is correlated with poor outcome. Therefore, a pre-therapeutic, non-invasive detection tool for potential metastatic cell infiltration at the MMPI would be desirable to help identify patients who may benefit from a more aggressive local treatment strategy. The aim of this study was to identify specific magnetic resonance imaging (MRI) patterns at the MMPI in patients with BM and to correlate these patterns with patient outcome.Patients and MethodsIn this retrospective analysis of a prospective BM registry, we categorized preoperative MR images of 261 patients with BM according to a prespecified analysis system, which consisted of four MRI contrast enhancement (CE) patterns: two with apparently regularly shaped borders (termed “rim-enhancing” and “spherical”) and two with irregular delineation (termed “breakout” and “diffuse”). The primary outcome parameter was overall survival (OS). Additionally analyzed prognostic parameters were the Karnofsky Performance Index, tumor size, edema formation, extent of resection, and RPA class.ResultsOS of patients with a breakout pattern was significantly worse than OS of all other groups.ConclusionOur data show that BM with a breakout pattern have a highly aggressive clinical course. Patients with such a pattern potentially require a more aggressive local and systemic treatment strategy.

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

Simple Summary Functional magnetic resonance imaging (fMRI) in patients with brain tumors enables the visualization of eloquent cortical areas and can be used for planning surgical interventions and assessing the risk of postoperative functional deficits. While preoperative fMRI paradigms used to determine the localization of speech-critical or motor areas dominate the literature, there are hardly any studies that investigate the retinotopic organization of the visual field in patients with occipital lesions or tumors. The aim of this study was to evaluate the effect of a brain tumor or space-occupying brain lesions on the retinotopic organization of the occipital cortex, the activation of and the functional connectivity between cortical areas involved in visual processing. We found a high degree of similarity in the activation profiles of patients and healthy controls, indicating that the retinotopic organization of the visual cortex can reliably be described by fMRI retinotopic mapping as part of the preoperative examination of patients with tumors and space-occupying brain lesions. Abstract Functional magnetic resonance imaging (fMRI) is a valuable tool in the clinical routine of neurosurgery when planning surgical interventions and assessing the risk of postoperative functional deficits. Here, we examined how the presence of a brain tumor or lesion in the area of the occipital lobe affects the results of fMRI retinotopic mapping. fMRI data were evaluated on a retrospectively selected sample of 12 patients with occipital brain tumors, 7 patients with brain lesions and 19 control subjects. Analyses of the cortical activation, percent signal change, cluster size of the activated voxels and functional connectivity were carried out using Statistical Parametric Mapping (SPM12) and the CONN and Marsbar toolboxes. We found similar but reduced patterns of cortical activation and functional connectivity between the two patient groups compared to a healthy control group. Here, we found that retinotopic organization was well-preserved in the patients and was comparable to that of the age-matched controls. The results also showed that, compared to the tumor patients, the lesion patients showed higher percent signal changes but lower values in the cluster sizes of the activated voxels in the calcarine fissure region. Our results suggest that the lesion patients exhibited results that were more similar to those of the control subjects in terms of the BOLD signal, whereas the extent of the activation was comparable to that of the tumor patients.

Introduction: To evaluate the feasibility and efficacy of the innovative micro-inspection tool QEVO® (Carl Zeiss Meditec, Oberkochen, Germany) as an endoscopic adjunct to microscopes for better visualization of the surgical field in complex deep-seated intracranial tumors in infants and adults. Materials and Methods: We retrospectively assessed the surgical videos of 25 consecutive patients with 26 complex intracranial lesions (time frame 2018–2020). Lesions were classified according to their anatomical area: 1 = sellar region (n = 6), 2 = intra-ventricular (except IV.ventricle, n = 9), 3 = IV.ventricle and rhomboid fossa (n = 4), and 4 = cerebellopontine angle (CPA) and foramen magnum (n = 7). Indications to use the QEVO® tool were divided into five “QEVO® categories”: A = target localization, B = tailoring of the approach, C = looking beyond the lesion, D = resection control, and E = inspection of remote areas. Results: Overall, the most frequent indications for using the QEVO® tool were categories D (n = 19), C (n = 17), and E (n = 16). QEVO® categories B (n = 8) and A (n = 5) were mainly applied to intra-ventricular procedures (anatomical area 2). Discussion: The new micro-inspection tool QEVO® is a powerful endoscopic device to support the comprehensive visualization of complex intracranial lesions and thus instantly increases intraoperative morphological understanding. However, its use is restricted to the specific properties of the respective anatomical area.

The multidisciplinary management of patients with brain metastases (BM) consists of surgical resection, different radiation treatment modalities, cytotoxic chemotherapy, and targeted molecular treatment. This review presents the current state of neurosurgical technology applied to achieve maximal resection with minimal morbidity as a treatment paradigm in patients with BM. In addition, we discuss the contribution of neurosurgical resection on functional outcome, advanced systemic treatment strategies, and enhanced understanding of the tumor biology.

In patients with brain metastases (BM), advanced age is considered a negative prognostic factor. To address the potential reasons for that, we assessed 807 patients who had undergone BM resection, 315 patients aged at least 65 years (group A) were compared with 492 younger patients (group B). We analyzed the impact of the pre- and postoperative Karnofsky performance status (KPS), postoperative treatment structure and post-treatment survival. BM resection significantly improved KPS scores in both groups (p = 0.0001). Median survival after BM resection differed significantly between the groups (A: 5.81 vs. B: 8.12 months, p = 0.0015). In both groups, patients who received postoperative systemic treatment showed significantly longer overall survival (p = 0.00001). However, elderly patients less frequently received systemic treatment (p = 0.0001) and the subgroup of elderly patients receiving such therapies had a significantly higher postsurgical KPS score (p = 0.0007). In all patients receiving systemic treatment, age was no longer a negative prognostic factor. Resection of BM improves the functional status of elderly patients, thus enhancing the likeliness to receive systemic treatment, which, in turn, leads to longer overall survival. In the context of such a treatment structure, age alone is no longer a prognostic factor for survival.

Introduction: The application of neuro-endoscopes in cerebral aneurysm surgery may help to avoid unintended aneurysm remnants and the accidental clipping of perforating arteries and aid the detection of blood collecting in the subdural spaces. Here, we present our experience with the novel endoscopic micro-inspection tool QEVO (R) (Carl Zeiss Meditec, Germany) in aneurysm surgery. Materials and Equipment: In all patients the surgical microscope KINEVO (R) (Carl Zeiss Meditec, Germany) and the Microinspection tool QEVO (R) were applied. Methods: The case series comprises 22 unruptured cerebral aneurysms of the anterior circulation. All aneurysms were treated surgically. All patients routinely underwent computed tomography and digital subtraction angiography within 10 days after surgery. Results: No aneurysm remnants, cerebral ischemic deficits, or subdural hematomas were detected. Discussion: In this technical note, we discuss the benefits and limitations of the QEVO (R) tool and illustrate the major paradigms by means of intraoperative photographs.

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

Implantation of a cranioplasty after osteoclastic craniotomy or craniectomy is one of the most common neurosurgical procedures, and polymethylmethacrylate (PMMA) is one of the most frequently applied materials for cranioplasty. This report describes the unique case of a patient with recurrent transitional meningioma WHO I that infiltrated the PMMA cranioplasty 7 years after primary surgery. We propose to restrict the use of porous PMMA as cranioplasty after the removal of convexity meningioma.