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11. Quantitative Anatomical Comparison of Surgical Approaches to Meckel’s Cave

Author

Zanin, L., Agosti, E., Ebner, F., de Maria, L., Belotti, F., Buffoli, B., Rezzani, R., Hirt, B., Ravanelli, M., Ius, T., Zeppieri, M., Tatagiba, M. S., Fontanella, Marco Maria, Doglietto, Francesco, Fontanella M. M., Doglietto F. (ORCID:0000-0002-7438-0734), Zanin, L., Agosti, E., Ebner, F., de Maria, L., Belotti, F., Buffoli, B., Rezzani, R., Hirt, B., Ravanelli, M., Ius, T., Zeppieri, M., Tatagiba, M. S., Fontanella, Marco Maria, Doglietto, Francesco, Fontanella M. M., and Doglietto F. (ORCID:0000-0002-7438-0734)

Abstract

Background: Meckel’s cave is a challenging surgical target due to its deep location and proximity to vital neurovascular structures. Surgeons have developed various microsurgical transcranial approaches (MTAs) to access it, but there is no consensus on the best method. Newer endoscopic approaches have also emerged. This study seeks to quantitatively compare these surgical approaches to Meckel’s cave, offering insights into surgical volumes and exposure areas. Methods: Fifteen surgical approaches were performed bilaterally in six specimens, including the pterional approach (PTA), fronto-temporal-orbito-zygomatic approach (FTOZA), subtemporal approach (STA), Kawase approach (KWA), retrosigmoid approach (RSA), retrosigmoid approach with suprameatal extension (RSAS), endoscopic endonasal transpterygoid approach (EETPA), inferolateral transorbital approach (ILTEA) and superior eyelid approach (SEYA). All the MTAs were performed both with 10 mm and 15 mm of brain retraction, to consider different percentages of surface exposure. A dedicated navigation system was used to quantify the surgical working volumes and exposure of different areas of Meckel’s cave (ApproachViewer, part of GTx-Eyes II, University Health Network, Toronto, Canada). Microsurgical transcranial approaches were quantified with two different degrees of brain retraction (10 mm and 15 mm). Statistical analysis was performed using a mixed linear model with bootstrap resampling. Results: The RSAS with 15 mm of retraction offered the maximum exposure of the trigeminal stem (TS). If compared to the KWA, the RSA exposed more of the TS (69% vs. 46%; p = 0.01). The EETPA and ILTEA exposed the Gasserian ganglion (GG) mainly in the anteromedial portion, but with a significant 20% gain in exposure provided by the EETPA compared to ILTEA (42% vs. 22%; p = 0.06). The STA with 15 mm of retraction offered the maximum exposure of the GG, with a significant gain in exposure compared to the STA with 10 mm of retraction (50%

Published
2023

12. Management und chirurgische Therapie der Neurofibromatose Typ 2

Author

Gugel, I., Mautner, V.-F., Schuhmann, M. U., and Ebner, F. H.

Abstract

Die Neurofibromatose Typ 2 (NF2) ist ein seltenes, autosomal-dominant vererbtes Tumordispositionssyndrom, das typischerweise mit bilateralen Vestibularisschwannomen (VS) assoziiert ist und somit ein hohes Risiko der Schallempfindungsschwerhörigkeit bis hin zur Ertaubung mit sich bringt. Die richtige Zuordnung der oft unspezifischen, nicht-VS-assoziierten Erstsymptome ist zur frühzeitigen Diagnosesicherung im Kindes- und Jugendalter entscheidend. Zur Diagnostik und im Verlauf werden Magnetresonanztomographien (MRT) der kompletten Neuroachse zum Nachweis ggf. multipler benigner Tumorläsionen (z. B. intrakraniale und spinale Schwannome und/oder intramedulläre Ependymome) und Hörprüfungen durchgeführt. In unklaren Fällen bringen dieNF2-Gen-Mutationsanalyse, aber auch die MR-Neurographie diagnostische Klarheit. Je nach Symptomatik, Tumorentität, Lokalisation und Ausdehnung stehen therapeutisch neben der Mikrochirurgie der Off-Label-Einsatz von Bevacizumab und in ausgewählten Indikationen eine Bestrahlung zur Verfügung.

Published
2024
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23. Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial.

Author

Robba, C, Badenes, R, Battaglini, D, Ball, L, Sanfilippo, F, Brunetti, I, Jakobsen, JC, Lilja, G, Friberg, H, Wendel-Garcia, PD, Young, PJ, Eastwood, G, Chew, MS, Unden, J, Thomas, M, Joannidis, M, Nichol, A, Lundin, A, Hollenberg, J, Hammond, N, Saxena, M, Martin, A, Solar, M, Taccone, FS, Dankiewicz, J, Nielsen, N, Grejs, AM, Ebner, F, Pelosi, P, TTM2 Trial collaborators, Robba, C, Badenes, R, Battaglini, D, Ball, L, Sanfilippo, F, Brunetti, I, Jakobsen, JC, Lilja, G, Friberg, H, Wendel-Garcia, PD, Young, PJ, Eastwood, G, Chew, MS, Unden, J, Thomas, M, Joannidis, M, Nichol, A, Lundin, A, Hollenberg, J, Hammond, N, Saxena, M, Martin, A, Solar, M, Taccone, FS, Dankiewicz, J, Nielsen, N, Grejs, AM, Ebner, F, Pelosi, P, and TTM2 Trial collaborators

Abstract

BACKGROUND: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients' outcome. METHODS: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. RESULTS: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). CONCLUSIONS: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. TRIAL REGISTRATION: clinicaltrials.gov NCT02908308 , Registered September 20, 2016.

Published
2022

40. The Worm-Specific Immune Response in Multiple Sclerosis Patients Receiving Controlled Trichuris suis Ova Immunotherapy

Author

Yordanova, I.A., Ebner, F., Schulz, A.R., Steinfelder, S., Rosche, B., Bolze, A., Paul, F., Mei, H.E., and Hartmann, S.

Subjects
mass cytometry, TSO, Trichuris suis, helminth therapy, clinical trial, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::616 Krankheiten, multiple sclerosis, Article, lcsh:Q, Function and Dysfunction of the Nervous System, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::615 Pharmakologie, Therapeutik, lcsh:Science, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Abstract

Considering their potent immunomodulatory properties, therapeutic applications of Trichuris suis ova (TSO) are studied as potential alternative treatment of autoimmune disorders like multiple sclerosis (MS), rheumatoid arthritis (RA), or inflammatory bowel disease (IBD). Clinical phase 1 and 2 studies have demonstrated TSO treatment to be safe and well tolerated in MS patients, however, they reported only modest clinical efficacy. We therefore addressed the cellular and humoral immune responses directed against parasite antigens in individual MS patients receiving controlled TSO treatment (2500 TSO p.o. every 2 weeks for 12 month). Peripheral blood mononuclear cells (PBMC) of MS patients treated with TSO (n = 5) or placebo (n = 6) were analyzed. A continuous increase of serum IgG and IgE antibodies specific for T. suis excretory/secretory antigens was observed up to 12 months post-treatment. This was consistent with mass cytometry analysis identifying an increase of activated HLA-DRhigh plasmablast frequencies in TSO-treated patients. While stable and comparable frequencies of total CD4+ and CD8+ T cells were detected in placebo and TSO-treated patients over time, we observed an increase of activated HLA-DR+CD4+ T cells in TSO-treated patients only. Frequencies of Gata3+ Th2 cells and Th1/Th2 ratios remained stable during TSO treatment, while Foxp3+ Treg frequencies varied greatly between individuals. Using a T. suis antigen-specific T cell expansion assay, we also detected patient-to-patient variation of antigen-specific T cell recall responses and cytokine production. In summary, MS patients receiving TSO treatment established a T. suis-specific T- and B-cell response, however, with varying degrees of T cell responses and cellular functionality across individuals, which might account for the overall miscellaneous clinical efficacy in the studied patients.

Published
2021

41. Skepticism towards advancing VR technology - student acceptance of VR as a teaching and assessment tool in medicine

Author

Walter, S, Speidel, R, Hann, A, Leitner, J, Jerg-Bretzke, L, Kropp, P, Garbe, J, Ebner, F, Walter, S, Speidel, R, Hann, A, Leitner, J, Jerg-Bretzke, L, Kropp, P, Garbe, J, and Ebner, F

Abstract

Objective: The high didactic potential of Virtual Reality (VR) contrasts with the point of view of students that the technology only has a relatively low significance for current and future teaching. This discrepancy was studied in a differentiated manner in order to gear the further development and implementation of VR towards the target group.Methods: From January 2020 to July 2020, medical students (N=318 ) were asked to watch ten videos online and rate them on the basis of acceptance indicators (e.g., fun and fairness). Using obstetrics as an example, the videos demonstrated five levels of VR technology functionality (e.g., haptic and adaptive feedback), some of which were visionary, in two use scenarios (teaching and the OSCE). The individual and aggregate indicators were compared with non-parametric testing procedures across application scenarios, functional levels and genders. In addition, correlations between the acceptance and the factors of semester, age, computer affinity, and previous VR experience were analyzed.Results: Across all functional levels, VR was more likely to be accepted in the classroom than in the OSCE. Comparisons across functional levels also revealed that the VR ready to be marketed was significantly more accepted than the visionary functions. This skepticism toward advancing VR technology was most pronounced with regard to the vision of autonomous VR examinations and among female students with a low computer affinity.Conclusion: The results suggest that the students' reservations are due to a lack of experience with the VR technology. In order for young physicians to become familiar with the technology and to be able to use it competently in the everyday clinical practice in the future, VR should not only be used as a teaching tool but also be part of the curriculum. Practical examinations using VR, on the other hand, are only recommended once the technology has become established in teaching and has been proven to be reliable., Zielsetzung: Das hohe didaktische Potenzial von VR steht im Kontrast zur studentischen Einschätzung, dass die Technologie nur eine relativ geringe Bedeutung für die gegenwärtige und zukünftige Lehre hat. Diese Diskrepanz wurde differenziert untersucht, um die Weiterentwicklung und Implementierung von VR zielgruppenorientiert auszurichten.Methodik: Von Januar bis Juli 2020 wurden Medizinstudierende (N=318) gebeten, zehn Videos online anzusehen und anhand von Akzeptanzindikatoren (z.B. Spaß und Fairness) zu bewerten. Am Beispiel der Geburtshilfe demonstrierten die Videos fünf teils visionäre Funktionsgrade der VR-Technologie (z.B. haptisches und adaptives Feedback) in zwei Einsatzszenarien (Lehre und OSCE-Prüfung). Die einzelnen und aggregierten Indikatoren wurden mit nicht-parametrischen Testverfahren zwischen den Einsatzszenarien, Funktionsgraden und Geschlechtern verglichen. Darüber hinaus wurden Zusammenhänge zwischen der Akzeptanz und den Faktoren Fachsemester, Alter, Computeraffinität und VR-Vorerfahrung analysiert.Ergebnisse: Über alle Funktionsgrade hinweg wurde VR in der Lehre eher akzeptiert als in der OSCE-Prüfung. Die Vergleiche zwischen den Funktionsgraden offenbarten außerdem, dass der marktreife Status Quo von VR signifikant besser angenommen wurde als die visionären Funktionen. Diese Skepsis gegenüber der fortschreitenden VR-Technologie war bei der Vision autonomer VR-Prüfungen und unter weiblichen Studierenden mit geringer Computeraffinität am stärksten ausgeprägt.Schlussfolgerung: Die Ergebnisse legen nahe, dass die Vorbehalte der Studierenden auf mangelnde Erfahrungswerte mit der VR-Technologie zurückzuführen sind. Damit die angehenden Ärzte die Technologie kennenlernen und zukünftig kompetent im Klinikalltag anwenden können, sollte VR nicht nur als Lehrmedium sondern auch als Lerngegenstand curricular eingeführt werden. Praktische Prüfungen in VR empfehlen sich dagegen erst, wenn sich die Technologie in der Lehre etabliert und als verlässlich erwie

Published
2021

48. Effect of Intraoperative High Positive End-Expiratory Pressure (PEEP) with Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients: A Randomized Clinical Trial

Author

Bluth, T, Neto, As, Schultz, Mj, Pelosi, P, de Abreu MG, Bobek, I, Canet, Jc, de Baerdemaeker, L, Gregoretti, C, Hedenstierna, G, Hemmes, Snt, Hiesmayr, M, Hollmann, M, Jaber, S, Laffey, J, Licker, Mj, Markstaller, K, Matot, I, Mills, G, Mulier, Jp, Putensen, C, Rossaint, R, Schmitt, J, Senturk, M, Severgnini, P, Sprung, J, Melo, Mfv, Wrigge, H, Abelha, F, Abitagaoglu, S, Achilles, M, Adebesin, A, Adriaensens, I, Ahene, C, Akbar, F, Al Harbi, M, al Kallab RA, Albanel, X, Aldenkortt, F, Alfouzan, Ras, Alruqaie, R, Altermatt, F, Araujo, Bld, Arbesu, G, Artsi, H, Aurilio, C, Ayanoglu, Oh, Bacuzzi, A, Baig, H, Baird, Y, Balonov, K, Balust, J, Banks, S, Bao, Xd, Baumgartner, M, Tortosa, Ib, Bergamaschi, A, Bergmann, L, Bigatello, L, Perez, Eb, Birr, K, Bojaxhi, E, Bonenti, C, Bonney, I, Bos, Ee, Bowman, S, Braz, Lg, Brugnoni, E, Brunetti, I, Bruni, A, Buenvenida, Sl, Camerini, Cj, Canet, J, Capatti, B, Carmona, J, Carungcong, J, Carvalho, M, Cattan, A, Cavaleiro, C, Chiumello, D, Ciardo, S, Coburn, M, Colella, U, Contreras, V, Dincer, Pc, Cotter, E, Crovetto, M, Crovetto, W, Darrah, W, Davies, S, De Hert, S, Peces, Ed, Delphin, E, Diaper, J, do Nascimento, P, Donatiello, V, Dong, J, Dourado, Md, Dullenkopf, A, Ebner, F, Elgendy, H, Ellenberger, C, Ari, De, Ermert, T, Farah, F, Fernandez-Bustamante, A, Ferreira, C, Fiore, M, Fonte, A, Palahi, Cf, Galimberti, A, Garofano, N, Giaccari, Lg, Gilsanz, F, Girrbach, F, Gobbi, L, Godfried, Mb, Goettel, N, Goldstein, Pa, Goren, O, Gorlin, A, Gil, Mg, Gratarola, A, Graterol, J, Guyon, P, Haire, K, Harou, P, Helf, A, Hempel, G, Cadiz, Mjh, Heyse, B, Hollmann, Mw, Huercio, I, Ilievska, J, Jakus, L, Jeganath, V, Jelting, Y, Jung, M, Kabon, B, Kacha, A, Ilic, Mk, Karuppiah, A, Kavas, Ad, Barcelos, Gk, Kellogg, Ta, Kemper, J, Kerbrat, R, Khodr, S, Kienbaum, P, Kir, B, Kiss, T, Kivrak, S, Klaric, V, Koch, T, Koksal, C, Kowark, A, Kranke, P, Kuvaki, B, Kuzmanovska, B, Lange, M, de Lemos MF, Lopez-Baamonde, M, Lopez-Hernandez, A, Lopez-Martinez, M, Luise, S, Macgregor, M, Magalhaes, D, Maillard, J, Malerbi, P, Manimekalai, N, Margarson, M, Martin, Dp, Martin, Yn, Martinez-Ocon, J, Martin-Loeches, I, Maseda, E, Mcauliffe, N, Mckenzie, Tj, Medina, P, Meersch, M, Menzen, A, Mertens, E, Meurer, B, Meyer-Treschan, T, Miao, Ch, Micalizzi, C, Milic, M, Modolo, Nsp, Moine, P, Molders, P, Montero-Feijoo, A, Moret, E, Muller, Mk, Murphy, Z, Nalwaya, P, Naumovski, F, Navalesi, P, Lima, Lhne, Adam, Vn, Neumann, C, Newell, C, Nisnevitch, Z, Nizamuddin, J, Novazzi, C, O'Connor, M, Oprea, G, Sungur, Mo, Ozbilgin, S, Pace, Mc, Pacheco, M, Packianathaswamy, B, Gonzalez, Ep, Papaspyros, F, Paredes, S, Passavanti, Mb, Pedemonte, Jc, Peremin, S, Philipsenburg, C, Pinho, D, Pinho, S, Posthuma, Lm, Pota, V, Preckel, B, Priani, P, Rached, Ma, Radoeshki, A, Ragazzi, R, Rajamanickam, T, Rajamohan, A, Ramakrishna, H, Rangarajan, D, Reiterer, C, Renew, Jr, Reynaud, T, Rhys, R, Rivas, E, Robitzky, L, Rubulotta, F, Machado, Hs, Nunes, Cs, Sabbatini, G, Sanahuja, Jm, Sansone, P, Santos, A, Sayedalahl, M, Schaefer, Ms, Scharffenberg, E, Scharffenberg, M, Schiffer, E, Schliewe, N, Schorer, R, Schumann, R, Selmo, G, Sendra, M, Shaw, K, Shosholcheva, M, Sibai, A, Simon, P, Simonassi, F, Sinno, C, Sivrikoz, N, Skandalou, V, Smith, N, Soares, M, Artiles, Ts, Castro, Ds, Sousa, M, Spadaro, S, Stamatakis, E, Steiner, La, Stevenazzi, A, Suarez-de-la-Rica, A, Suppan, M, Teichmann, R, Guerrero, Jmt, Thiel, B, Tolos, R, Altun, Gt, Tucci, M, Turnbull, Za, Turudic, Z, Unterberg, M, Van Limmen, J, Van Nieuwenhove, Y, Van Waesberghe, J, Francisco, M, Melo, V, Vitkovic, B, Vivona, L, Vizcaychipi, M, Volta, Ca, Weber, A, Weingarten, Tn, Wittenstein, J, Wyffels, P, Yague, J, Yates, D, Yavru, A, Zac, L, Zhong, J, Intensive Care Medicine, ACS - Heart failure & arrhythmias, Anesthesiology, ACS - Diabetes & metabolism, APH - Quality of Care, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, Bluth T., Serpa Neto A., Schultz M.J., Pelosi P., Gama de Abreu M., Bobek I., Canet J.C., Cinella G., de Baerdemaeker L., Gregoretti C., Hedenstierna G., Hemmes S.N.T., Hiesmayr M., Hollmann M.W., Jaber S., Laffey J., Licker M.-J., Markstaller K., Matot I., Mills G.H., Mulier J.P., Putensen C., Rossaint R., Schmitt J., Senturk M., Severgnini P., Sprung J., Vidal Melo M.F., Wrigge H., Abelha F., Abitagaoglu S., Achilles M., Adebesin A., Adriaensens I., Ahene C., Akbar F., Harbi M.A., Al Kallab R.A.K., Albanel X., Aldenkortt F., Alfouzan R.A.S., Alruqaie R., Altermatt F., de Castro Araujo B.L., Arbesu G., Artsi H., Aurilio C., Ayanoglu O.H., Bacuzzi A., Baig H., Baird Y., Balonov K., Balust J., Banks S., Bao X., Baumgartner M., Tortosa I.B., Bergamaschi A., Bergmann L., Bigatello L., Perez E.B., Birr K., Bojaxhi E., Bonenti C., Bonney I., Bos E.M.E., Bowman S., Braz L.G., Brugnoni E., Brull S.J., Brunetti I., Bruni A., Buenvenida S.L., Busch C.J., Camerini G., Capatti B., Carmona J., Carungcong J., Carvalho M., Cattan A., Cavaleiro C., Chiumello D., Ciardo S., Coburn M., Colella U., Contreras V., Dincer P.C., Cotter E., Crovetto M., Darrah W., Davies S., De Hert S., Peces E.D.C., Delphin E., Diaper J., Do Nascimento Junior P., Donatiello V., Dong J., Dourado M.D.S., Dullenkopf A., Ebner F., Elgendy H., Ellenberger C., Erdogan Ari D., Ermert T., Farah F., Fernandez-Bustamante A., Ferreira C., Fiore M., Fonte A., Palahi C.F., Galimberti A., Garofano N., Giaccari L.G., Gilsanz F., Girrbach F., Gobbi L., Godfried M.B., Goettel N., Goldstein P.A., Goren O., Gorlin A., Gil M.G., Gratarola A., Graterol J., Guyon P., Haire K., Harou P., Helf A., Hempel G., Cadiz M.J.H., Heyse B., Huercio I., Ilievska J., Jakus L., Jeganath V., Jelting Y., Jung M., Kabon B., Kacha A., Ilic M.K., Karuppiah A., Kavas A.D., Barcelos G.K., Kellogg T.A., Kemper J., Kerbrat R., Khodr S., Kienbaum P., Kir B., Kiss T., Kivrak S., Klaric V., Koch T., Koksal C., Kowark A., Kranke P., Kuvaki B., Kuzmanovska B., Lange M., de Lemos M.F., Lopez-Baamonde M., Lopez-Hernandez A., Lopez-Martinez M., Luise S., Macgregor M., Magalhaes D., Maillard J., Malerbi P., Manimekalai N., Margarson M., Martin A.K., Martin D.P., Martin Y.N., Martinez-Ocon J., Martin-Loeches I., Maseda E., McAuliffe N., McKenzie T.J., Medina P., Meersch M., Menzen A., Mertens E., Meurer B., Meyer-Treschan T., Miao C., Micalizzi C., Milic M., Modolo N.S.P., Moine P., Molders P., Montero-Feijoo A., Moret E., Muller M.K., Murphy Z., Nalwaya P., Naumovski F., Navalesi P., Navarro E Lima L.H., Adam V.N., Neumann C., Newell C., Nisnevitch Z., Nizamuddin J., Novazzi C., O'connor M., Oprea G., Sungur M.O., Ozbilgin S., Pace M.C., Pacheco M., Packianathaswamy B., Gonzalez E.P., Papaspyros F., Paredes S., Passavanti M.B., Pedemonte J.C., Peremin S., Philipsenburg C., Pinho D., Pinho S., Posthuma L.M., Pota V., Preckel B., Priani P., Rached M.A., Radoeshki A., Ragazzi R., Rajamanickam T., Rajamohan A., Ramakrishna H., Rangarajan D., Reiterer C., Ross Renew J., Reynaud T., Rhys R., Rivas E., Robitzky L., Rubulotta F., Machado H.S., Nunes C.S., Sabbatini G., Samuels J.D., Sanahuja J.M., Sansone P., Santos A., Sayedalahl M., Schaefer M.S., Scharffenberg M., Schiffer E., Schliewe N., Schorer R., Schumann R., Selmo G., Sendra M., Shaw K., Shosholcheva M., Sibai A., Simon P., Simonassi F., Sinno C., Sivrikoz N., Skandalou V., Smith N., Soares M., Artiles T.S., Castro D.S., Sousa M., Spadaro S., Stamatakis E., Steiner L.A., Stevenazzi A., Suarez-De-la-rica A., Suppan M., Teichmann R., Guerrero J.M.T., Thiel B., Tolos R., Altun G.T., Tucci M., Turnbull Z.A., Turudic Z., Unterberg M., Van Limmen J., Van Nieuwenhove Y., Van Waesberghe J., Vitkovic B., Vivona L., Vizcaychipi M., Volta C.A., Weber A., Weingarten T.N., Wittenstein J., Wyffels P., Yague J., Yates D., Yavru A., Zac L., Zhong J., Bluth, T., Serpa Neto, A., Schultz, M. J., Pelosi, P., Gama De Abreu, M., Aurilio, C., Pace, M. C., Passavanti, M. B., Pota, V., and Sansone, P.

Subjects
Lung Diseases, Male, medicine.medical_treatment, Atelectasis, Lung Disease, 01 natural sciences, Body Mass Index, Hypoxemia, Positive-Pressure Respiration, Postoperative Complications, 0302 clinical medicine, PEEP, postoperative complications, obese patients, Anesthesia, Respiratory function, 030212 general & internal medicine, Tidal volume, General Medicine, Middle Aged, Pleural Diseases, respiratory system, Adult, Anesthesia, General, Female, Humans, Obesity, Pulmonary Atelectasis, Respiratory Insufficiency, Surgical Procedures, Operative, Tidal Volume, Treatment Outcome, Intraoperative Care, Operative, 3. Good health, Pneumothorax, medicine.symptom, psychological phenomena and processes, Human, circulatory and respiratory physiology, NO, 03 medical and health sciences, mental disorders, medicine, Pleural Disease, 0101 mathematics, General, Positive end-expiratory pressure, Mechanical ventilation, Surgical Procedures, Pulmonary Atelectasi, business.industry, 010102 general mathematics, medicine.disease, respiratory tract diseases, Respiratory failure, Postoperative Complication, business
Abstract

Importance: An intraoperative higher level of positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers improves respiratory function in obese patients undergoing surgery, but the effect on clinical outcomes is uncertain. Objective: To determine whether a higher level of PEEP with alveolar recruitment maneuvers decreases postoperative pulmonary complications in obese patients undergoing surgery compared with a lower level of PEEP. Design, Setting, and Participants: Randomized clinical trial of 2013 adults with body mass indices of 35 or greater and substantial risk for postoperative pulmonary complications who were undergoing noncardiac, nonneurological surgery under general anesthesia. The trial was conducted at 77 sites in 23 countries from July 2014-February 2018; final follow-up: May 2018. Interventions: Patients were randomized to the high level of PEEP group (n = 989), consisting of a PEEP level of 12 cm H2O with alveolar recruitment maneuvers (a stepwise increase of tidal volume and eventually PEEP) or to the low level of PEEP group (n = 987), consisting of a PEEP level of 4 cm H2O. All patients received volume-controlled ventilation with a tidal volume of 7 mL/kg of predicted body weight. Main Outcomes and Measures: The primary outcome was a composite of pulmonary complications within the first 5 postoperative days, including respiratory failure, acute respiratory distress syndrome, bronchospasm, new pulmonary infiltrates, pulmonary infection, aspiration pneumonitis, pleural effusion, atelectasis, cardiopulmonary edema, and pneumothorax. Among the 9 prespecified secondary outcomes, 3 were intraoperative complications, including hypoxemia (oxygen desaturation with Spo2 ≤92% for >1 minute). Results: Among 2013 adults who were randomized, 1976 (98.2%) completed the trial (mean age, 48.8 years; 1381 [69.9%] women; 1778 [90.1%] underwent abdominal operations). In the intention-to-treat analysis, the primary outcome occurred in 211 of 989 patients (21.3%) in the high level of PEEP group compared with 233 of 987 patients (23.6%) in the low level of PEEP group (difference, -2.3% [95% CI, -5.9% to 1.4%]; risk ratio, 0.93 [95% CI, 0.83 to 1.04]; P =.23). Among the 9 prespecified secondary outcomes, 6 were not significantly different between the high and low level of PEEP groups, and 3 were significantly different, including fewer patients with hypoxemia (5.0% in the high level of PEEP group vs 13.6% in the low level of PEEP group; difference, -8.6% [95% CI, -11.1% to 6.1%]; P

Published
2019

50. First surgical experience with a high-definition 3-dimensional exoscope for cerebral bypass surgery in moyamoya patients

Author

Diesner, F, Steinhilber, B, and Ebner, F

Subjects
ddc: 610, 610 Medical sciences, Medicine
Abstract

Objective: Cerebral bypass surgery is the treatment of choice for Moyamoya patients with diminished cerebral perfusion. The standard superficial temporal artery to middle cerebral artery bypass (STA-MCA) is a technically demanding procedure which requires excellent optical visualisation and magnification.[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

Published
2020
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