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OBJECTIVE The development of persistent hydrocephalus in patients after spontaneous intracerebral hemorrhage (ICH) is still poorly understood and many variables predicting the need for a cerebrospinal fluid (CSF)-shunt have been described in the literature with varying results. The aim of this study is to find predictive factors for shunt dependency. METHODS We performed a retrospective, single-center study of 99 neurosurgically treated patients with spontaneous ICH. Variables, including age, Glasgow Coma Scale (GCS), intraventricular hemorrhage (IVH), location of hemorrhage, acute hydrocephalus and volumetric analysis of IVH, ICH and intraventricular CSF were compared between patients with and without CSF-shunt implantation. Furthermore, receiver operating characteristics (ROC) for ICH, IVH and intraventricular CSF volume parameters were calculated. RESULTS CSF-shunt implantation was performed significantly more often in patients after thalamic (p=0.03) and cerebellar ICH (p=0.04). Moreover, a lower ratio between the total hemorrhage volume and intraventricular CSF volume (p=0.007), a higher IVH distribution in the third ventricle and an acute hydrocephalus (p

Purpose: To compare percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFTC) for the treatment of trigeminal neuralgia (TGN). Methods: Retrospective single center analysis of data from 230 patients with TGN that underwent 202 PBC (46%) and 234 RFTC (54%) from 2002 to 2019. Comparison of demographic data and TGN characteristics between procedures as well as assessment of 1) initial pain relief (IPR) by an improved Barrow Neurological Institute (BNI) pain intensity scale of I-III; 2) recurrence free survival (RFS) of patients with a follow-up of at least six months by Kaplan-Meier analysis; 3) risk factors for failed IPR and RFS by regression analysis and 4) complications and adverse events. Results: IPR was achieved in 353 (84.2%) procedures and showed no significant difference between PBC (83.7%) and RFTC (84.9%). Patients who suffered from multiple sclerosis (Odds ratio 5.34) or had a higher preoperative BNI (Odds ratio 2.01) showed a higher risk of not becoming pain free. RFS in 283 procedures was longer for PBC (44%) with 481 days compared to RFTC (56%) with 421 days (p=0.036) but without statistical significance. The only factor that showed a significant influence on RFS rates was a postoperative BNI ≤ II (P=Conclusion: Both percutaneous interventions lead to a comparable IPR and RFS with a low and comparable probability of complications. An individualized approach, considering the advantages and disadvantages of each intervention should guide the decision-making process.

To investigate predictive value of preradiosurgery leukocyte-based prognostic ratios in a selected cohort of non-small cell lung cancer (NSCLC) patients with radiosurgery-treated brain metastases (BM) and concomitant immunotherapy (IT) or targeted therapy (TT).We performed a retrospective analysis of 166 patients with NSCLC BM treated with Gamma Knife radiosurgery. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio were assessed within 14 days before radiosurgery.In radiosurgically treated patients with NSCLC BM with concomitant IT or TT, estimated median survival after first Gamma Knife radiosurgery treatment was significantly longer in patients with NLR cutoff value5 (P = 0.038). Consequently, the Cox regression model for NLR cutoff value groups revealed a significant hazard ratio of 1.519 (95% confidence interval 1.020-2.265, P = 0.040). In addition, each increase in NLR of 1 equaled an increase of 5.4% in risk of death (hazard ratio 1.054, 95% confidence interval 1.024-1.085, P0.001). After adjusting for sex, age, Karnofsky performance scale, and presence of extracranial metastases, NLR remained a significant and independent predictor for survival (hazard ratio 1.047, 95% confidence interval 1.017-1.078, P = 0.002). In contrast, platelet-to-lymphocyte ratio and lymphocyte-to-monocyte ratio did not exhibit the same predictive value among patients with radiosurgery-treated BM with concomitant IT or TT.In patients with NSCLC BM treated with radiosurgery with concomitant IT or TT, preradiosurgery NLR represents a simple prognostic predictor for survival and is superior to other leukocyte-based ratios. NLR may be relevant for clinical decision making, therapeutic evaluation, patient counseling, and appropriate stratification of future clinical trials among patients with radiosurgery-treated BM.

Purpose To investigate the clinical value of the inflammation based prognostic scores for patients with radiosurgically treated brain metastases (BM) originating from non-pulmonary primary tumor (PT). Methods A retrospective analysis of 340 BM patients of different PT origin (melanoma, breast, gastrointestinal, or genitourinary cancer) was performed. Pre-radiosurgical laboratory prognostic scores, such as the Neutrophil-to-Lymphocyte Ratio (NLR), the Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR), and the modified Glasgow Prognostic Score (mGPS), were investigated within 14 days before the first Gamma Knife radiosurgical treatment (GKRS1). Results In our study cohort, the estimated survival was significantly longer in patients with NLR 4 (p = 0.001) and in patients with a mGPS score of 0 (p Conclusions Summarizing previously published and present data, pre-radiosurgical mGPS and NLR groups seem to be the most effective and simple independent prognostic factors to predict clinical outcome in radiosurgically treated BM patients.

Objective This systematic comparison between pre‐ and postnatal imaging findings and postnatal motor outcome assesses the reliability of MRI accuracy in the prognostication of the future long‐term (mean, 11.4 years) ambulatory status in a historic group of postnatally repaired myelomeningocele (MMC) cases. Methods A retrospective, single‐center study of 34 postnatally repaired MMC patients was performed. We used fetal and postnatal magnetic resonance imaging (MRI) to compare the fetal and postnatal radiological lesion level to each other and to the postnatal ambulatory level as a standard of reference and analyzed Chiari II malformation characteristics. Results In 13/15 (87%) and 29/31 (94%) cases, the functional level was equal to or better than the prenatal and postnatal radiological lesion level. A radiological lesion level agreement within two segments could be achieved in 13/15 (87%) patients. A worse than expected functional level occurred in cases with Myelocele (2/3 patients), coexistent crowding of the posterior fossa (2/3 patients) and/or abnormal white matter architecture, represented by callosal dysgenesis (1/3 patients). In all patients (2/2) with a radiological disagreement of more than two segments, segmentation disorders and scoliosis were observed. Conclusion Fetal and postnatal MRI are predictive of the long‐term ambulatory status in postnatally repaired MMC patients., Key points What's already known about this topic? Fetal and postnatal magnetic resonance imaging (MRI) show a good correlation in identifying the level of the myelomeningocele (MMC) lesion.Prenatal ultrasound (US) and fetal MRI show a comparable agreement, within two segments, in predicting the short‐term ambulatory status. What does this study add? Fetal and postnatal MRI have a good predictive value for the long‐term ambulatory status in patients with postnatal MMC closure.MMC patients with worse than expected ambulatory status showed signs of vermian displacement and corpus callosum dysgenesis.In MMC patients with spinal segmentation disorders and scoliosis, there was a major disagreement between fetal and postnatal MRI, specifically with regard to the MMC lesion level.

OBJECTIVES To assesses the postoperative outcome and the applicability of current Chiari 1 malformation (CM1) scores in a tailored surgical treatment approach in patients with CM1. METHODS This retrospective single center study analyzed 81 surgically treated patients between 2000 and 2020. Based on our institutional policy, four types of approaches were performed in that period based on a case by case decision: 1) Foramen magnum decompression (FMD) with dura splitting (FMDds), 2) FMD with duraplasty (FMDdp), 3) FMD with duraplasty and tonsillar manipulation (FMDao) and 4) tonsillar resection/reduction (TR). Patient characteristics, the Chicago Chiari Outcome Scale (CCOS), Chiari Severity Index (CSI), and the fourth ventricular roof angle (FVRA) were compared among the four groups to establish a treatment algorithm. RESULTS FMDds, FMDdp, FMDao and TR was performed in 11 (14%), 24 (30%), 21 (26%) and 25 (31%) patients, respectively. After a mean follow-up time of 6.6 years, 8/11 (73%), 19/24 (79%), 19/21 (90%) and 24/24 (100%) patients had a CCOS of 13–16 points after FMDds, FMDdp, FMDao and TR, respectively. Overall, 6/11 (55%), 4/17 (24%), 3/18 (17%) and 7/24 (29%) patients had a CSI grade 1 before FMDds, FMDdp, FMDao and TR. A weak negative and statistically not significant correlation between CCOS and CSI was observed (p = 0.07, n = 69). The preoperative FVRA was

Objectives: Multiple risk factors have been described to be related to external ventricular drain (EVD) associated infections, with results varying between studies. Former studies were limited by a non-uniform definition of EVD associated infection, thus complicating a comparison between studies. In this regard, we assessed risk factors promoting EVD associated infections and propose a modified practice-oriented definition of EVD associated infections.Methods: We performed a retrospective, single-center study on patients who were treated with an EVD, at the neurosurgical intensive care unit (ICU) at a tertiary center between 2008 and 2019. Based on microbiological findings and laboratory results, patients were assigned into an infection and a non-infection group. Patient characteristics and potential risk factors were compared between the two groups (p < 0.05). Receiver operating characteristics (ROC) for significant clinical, serum laboratory and cerebrospinal fluid (CSF) parameters were calculated.Results: In total, 396 patients treated with an EVD were included into the study with a mean age of 54.3 (range: 18–89) years. EVD associated infections were observed in 32 (8.1%) patients. EVD insertion at another hospital (OR 3.86), and an increased CSF sampling frequency of more than every third day (OR 12.91) were detected as major risk factors for an EVD associated infection. The indication for EVD insertion, surgeon's experience, the setting of EVD insertion (ICU vs. operating room) and the operating time did not show any significant differences between the two groups. Furthermore, ROC analysis showed that clinical, serum laboratory and CSF parameters did not provide specific prediction of EVD associated infections (specificity 44.4%). This explains the high overtreatment rate in our cohort with the majority of our patients who received intrathecal vancomycin (63.3%), having either negative microbiological results (n = 12) or were defined as contaminations (n = 7).Conclusions: Since clinical parameters and blood analyzes are not very predictive to detect EVD associated infections in neurosurgical patients, sequential but not too frequent microbiological and laboratory analysis of CSF are still necessary. Furthermore, we propose a uniform classification for EVD associated infections to allow comparability between studies and to sensitize the treating physician in determining the right treatment.

Background Vertical perithalamic hemispherotomy was introduced by Olivier Delalande in 1992 as an alternative concept of functional hemispherectomy. Objective To provide a step-by-step illustration of the surgical anatomy of this procedure. Methods The descriptions in this manuscript are based on an experience of 52 hemispherotomies performed with the same technique by a single surgeon. Results Our illustrations of the surgical anatomy and the descriptions of the surgical nuances facilitate a deep understanding for the surgical concept of Delalande's vertical hemispherotomy technique. They highlight the advantages (ie, reduced risk of inadvertent damage to the contralateral hemisphere and a clear orientation by defined anatomical landmarks) over the recently suggested modifications to this original technique. Conclusion Olivier Delalande's original technique remains the most appealing concept of vertical hemispherotomy to us.

BACKGROUND The superior thalamic vein (STV) was first described comprehensively by Ferner in 1958 as the most prominent thalamic vein; it originates from the central superior portion of the thalamus, coursing medially to the third ventricular thalamic surface, where it turns posteriorly to parallel the internal cerebral vein (ICV) before ending into its posterior portion. Since historical anatomic and angiographic studies in the pre-computed tomography (CT)/magnetic resonance imaging era, the STV has not been investigated. OBJECTIVE To describe the anatomic course of the STV with its variations, and to propose a classification system based on its draining pattern. METHODS We retrospectively screened our imaging database for 50 patients who had a CT-angiography with predefined parameters. The images were independently reviewed by 3 neurosurgeons and 1 neuroradiologist to classify the STV into 4 types: type 1A-drainage into the anterior portion of the ICV, type 1B-drainage into the posterior portion of the ICV, type 2-drainage into the vein of Rosenthal, type 3-drainage into a medial (3A) or lateral (3B) atrial vein, and type 4-drainage into the vein of Galen. RESULTS In 50 patients, we could identify 96 STVs. In 2 hemispheres, the STV was doubled. The 92 single STVs were classified as type 1A in 25 hemispheres (27.2%), type 1B in 45 (48.9%), type 2 in 12 (13.0%), type 3A in 8 (8.7%), type 3B in 1 (1.1%), and type 4 in 1 (1.1%). CONCLUSION The draining pattern of the STV varies widely from the initial description.