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Background: Gliomas are the most common primary tumours of the central nervous system and exhibit rapid growth that is associated with neovascularisation. Adrenomedullin is an important tumour survival factor in [...]

Background: Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus. In some cases a reclosure of the ventriculostoma occurs. This could be caused by different reasons, such as operative technique, size of the stoma, scarring, or a persisting Liliequist membrane., Methods: The databases of the Neurosurgical Department of the Philipps University Marburg and the International Neuroscience Institute Hannover have been explored. The medical reports of patients who suffered from hydrocephalus and were treated with ETV between 1990 and 2010 were reviewed, with special consideration of a nonpatent ventriculostoma and a repeated ETV., Results: Of 148 patients with ETV, we had 14 patients in whom the stoma was not patent. In 8 of those, we performed a successful second ventriculostomy. Five patients were treated with application of a ventriculoperitoneal shunt. One patient died of an acute obstructive hydrocephalus due to the closure of the ventriculostoma. The success rate of repeat ETV has been 87.5%., Conclusions: In cases of secondary closure of the stoma after ETV, an endoscopic reventriculostomy is recommended using the same operative approach and should be taken into consideration before the application of a cerebrospinal fluid diversion system., (Copyright © 2013 Elsevier Inc. All rights reserved.)

In this contribution, a medical software system for volumetric analysis of different cerebral pathologies in magnetic resonance imaging (MRI) data is presented. The software system is based on a semi-automatic segmentation algorithm and helps to overcome the time-consuming process of volume determination during monitoring of a patient. After imaging, the parameter settings-including a seed point-are set up in the system and an automatic segmentation is performed by a novel graph-based approach. Manually reviewing the result leads to reseeding, adding seed points or an automatic surface mesh generation. The mesh is saved for monitoring the patient and for comparisons with follow-up scans. Based on the mesh, the system performs a voxelization and volume calculation, which leads to diagnosis and therefore further treatment decisions. The overall system has been tested with different cerebral pathologies-glioblastoma multiforme, pituitary adenomas and cerebral aneurysms- and evaluated against manual expert segmentations using the Dice Similarity Coefficient (DSC). Additionally, intra-physician segmentations have been performed to provide a quality measure for the presented system.

Purpose: Deep brain stimulation (DBS) has been recognized as an efficacious treatment for movement disorders. Its beneficial effects however may be lost due to skin complications such as erosions or infections over the implanted foreign material. We sought to document skin complications in the entire Parkinson's disease patient population who received a DBS system at the Marburg/Kassel implantation centre since the start of our DBS program in January 2002 to analyze frequency, time course, and possible risk factors., Methods: We investigated 85 consecutive patients with Parkinson's disease (PD) from a single center/single surgeon DBS series for the occurrence of skin complications and analyzed localization, time course, and possible risk factors. Mean follow-up was 3 years (range 1-7 years)., Results: In total, 21/85 patients (24.7%) suffered a total of 30 single skin complications. Sixty percent of all incidents occurred within the first post-operative year. Forty percent of all incidents occurred later than the first year following primary implantation. Complications involved the burr hole cap in 37%, the course of the cables in 33%, and the impulse generator (IPG) site in 30%. Six of 21 patients suffered recurring skin complications. Eight patients permanently lost their DBS system. Factor analysis for age, gender, disease duration, disease severity, the incidence of hypertension or diabetes as well as a 2-day period with externalized electrodes for continuous test stimulation did not have any statistically significant impact on skin complications., Conclusions: We conclude that (1) PD patients have a risk for skin complications after DBS as long as the system remains in situ and (2) there are at present no identifiable risk factors for skin complications after DBS, other than PD itself.

Objectives: Recently, neurosurgeons have increasingly faced small intracerebral lesions in asymptomatic or minimally symptomatic patients. Here, we evaluated a series of four patients with nearly asymptomatic intraventricular tumors close to the corpus callosum that had been treated with the aid of an image-guided transcallosal approach., Patients and Methods: Four consecutive patients suffering from left intra- and paraventricular tumors were operated on via a contralateral interhemispheric transcallosal approach with the aid of neuronavigation. Our image-guided system directed: (1) the skin incision, (2) the interhemispheric dissection, and (3) the incision of the corpus callosum., Results: Using the image-guided contralateral interhemispheric transcallosal approach to the left ventricle all lesions have been completely resected without the risk of damage to the dominant hemisphere. The callosal incision was kept as limited as possible (1.2-2.1cm) depending on the size of the tumor. No postoperative neurological or neuropsychological deficit was observed in our series., Conclusion: Neuronavigation facilitates a safe and targeted contralateral interhemispheric transcallosal approach to the dominant hemisphere's lateral ventricle. Our technique minimizes the risk of damage to the dominant hemisphere and requires only a limited opening of the corpus callosum, which might decrease the risk of neuropsychological morbidity.

Objective: The increasing use of minimally invasive surgery, which has a longer learning curve compared to open surgery lets the necessity to develop training programs to improve endoscopic skills of trainees become ever clearer. The aim of this study was to compare the endoscopic skills of neurosurgeons versus general surgeons at first exposure to a virtual reality simulator., Methods: 72 general surgeons who visited the 122nd Conference of the German Surgeons Society (DGCH in Munich 2005) and 35 neuroendoscopic surgeons, who visited the Third World Conference of the International Study Group of Neuroendoscopy (ISGNE in Marburg 2005) participated in this study. Each participant performed the basic module "clip application" on the virtual reality simulator (LapSim). All participants were given the same pretest instructions. Time to complete the task, error score and economy of motion were recorded., Results: The general surgeons performed the clip application faster, but with more errors than neuroendoscopic surgeons. However, the difference of both parameters was not significant. Both surgeon groups have a similar score for economy of motion., Conclusion: Although neuroendoscopic surgeons were exposed to a foreign procedure and unfamiliar equipment, they were able to perform virtual endoscopy with similar accuracy as general surgeons, who are adapted to these endoscopic instruments and procedures and do these daily.

Objective: The purpose of this article is to focus for the first time on the operative management of a direct vertebral artery (VA)-posterior inferior cerebellar artery (PICA) end-to-end anastomosis in a partially thrombosed giant VA-PICA-complex aneurysm and to underline its usefulness as an additional treatment option., Methods: The operative technique of a direct VA-PICA end-to-end anatomosis is described in detail. The VA was entering the large aneurysm sack. Distally, the PICA originated from the aneurysm sack-VA-complex. The donor and recipient vessel were cut close to the aneurysm. Whereas the VA was cut in a straight manner, the PICA was cut at an oblique 45-degree angle to enlarge the vascular end diameter. Vessel ends were flushed with heparinized saline and sutured. The thrombotic material inside the aneurysm sack was removed and the distal VA clipped, leaving the anterior spinal artery and brainstem perforators free., Results: The patient regained consciousness without additional morbidity. Magnetic resonance imaging scans revealed a completely decompressed brainstem without infarction. The postoperative angiograms demonstrated a good filling of the anastomosed PICA., Conclusion: Despite the caliber mistmatch of these two vessels the direct VA-PICA end-to-end anastomosis provides an accurate alternative in addition to other anastomoses and bypass techniques, when donor and recipient vessels are suitable and medullary perforators do not have to be disrupted.

The relationship of exercise and diet on high-density lipoprotein (HDL) cholesterol was investigated in 45 long-distance runners (LD), 49 joggers (J), and 47 inactive (I) women. Fasting plasma triglycerides (TG), HDL cholesterol, total cholesterol (TC), and percent body fat (%BF) were measured in women ages 24-58 yr. TG levels were significantly lower in LD compared to I (p less than 0.02). Although TC was not significantly different among groups, HDL-cholesterol was higher in LD (78 mg/dl) compared to J (70 mg/dl) or I (62 mg/dl) (p less than 0.001). Multiple regression analyses indicated that alterations of plasma lipids and lipoprotein levels could not be attributed to intake differences of nutrients. Distance run and %BF were the strongest predictors of HDL-cholesterol in women. LD (23 %BF) were leaner than J (26 %BF) or I (30 %BF); however, when results were adjusted for %BF, significant differences between exercise groups remained for HDL cholesterol.

The relationship between exercise habits, menopausal status and HDL cholesterol (HDL-C) was studied in 44 long-distance runners, 47 joggers, and 45 relatively inactive females. In each group, some women were post-menopausal (Post-M) and some pre-menopausal (Pre-M). HDL-C level was higher in runners (77.6 mg/dl) and joggers (70.4 mg/dl) than in the inactive group (62.1 mg/dl), but was not different Pre-M vs Post-M. Total cholesterol (TC) and LDL-C were higher in Post-M than in Pre-M subjects, but did not differ among exercise groups. Body weight and % fat were lower in Pre-M vs Post-M groups and were lower in the runners vs inactive subjects. The HDL-C/TC ratio was higher in the runners vs inactive subjects and there was a significant exercise-menopausal interaction indicating a beneficial exercise effect. Adjustment of lipoprotein values for possible confounding variables did not alter these results. Endurance exercise by Post-M females may help prevent adverse lipid and lipoprotein changes which might predispose them to coronary heart disease.