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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.

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.

Objective: Novel systemic targeted treatment strategies for various cancers have led to both an improved overall survival and increased incidence of brain metastases. We analyzed structure and quality of the interdisciplinary treatment and outcome of patients undergoing resection of symptomatic brain[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

The vasodilatory calcitonin gene-related peptide (CGRP) is excessively released after spontaneous subarachnoid hemorrhage (sSAH) and modulates psycho-behavioral function. In this pilot study, we prospectively analyzed the treatment-specific differences in the secretion of endogenous CGRP into cerebrospinal fluid (CSF) during the acute stage after good-grade sSAH and its impact on self-reported health-related quality of life (hrQoL). Twenty-six consecutive patients (f:m = 13:8; mean age 50.6 years) with good-grade sSAH were enrolled (drop out 19% (n = 5)): 35% (n = 9) underwent endovascular aneurysm occlusion, 23% (n = 6) microsurgery, and 23% (n = 6) of the patients with perimesencephalic SAH received standardized intensive medical care. An external ventricular drain was inserted within 72 h after the onset of bleeding. CSF was drawn daily from day 1–10. CGRP levels were determined via competitive enzyme immunoassay and calculated as “area under the curve” (AUC). All patients underwent a hrQoL self-report assessment (36-Item Short Form Health Survey (SF-36), ICD-10-Symptom-Rating questionnaire (ISR)) after the onset of sSAH (t1: day 11–35) and at the 6-month follow-up (t2). AUC CGRP (total mean ± SD, 5.7 ± 1.8 ng/ml/24 h) was excessively released into CSF after sSAH. AUC CGRP levels did not differ significantly when dichotomizing the aSAH (5.63 ± 1.77) and pSAH group (5.68 ± 2.08). aSAH patients revealed a higher symptom burden in the ISR supplementary item score (p = 0.021). Multiple logistic regression analyses corroborated increased mean levels of AUC CGRP in CSF at t1 as an independent prognostic factor for a significantly higher symptom burden in most ISR scores (compulsive-obsessive syndrome (OR 5.741, p = 0.018), anxiety (OR 7.748, p = 0.021), depression (OR 2.740, p = 0.005), the supplementary items (OR 2.392, p = 0.004)) and for a poorer performance in the SF-36 physical component summary score (OR 0.177, p = 0.001). In contrast, at t2, CSF AUC CGRP concentrations no longer correlated with hrQoL. To the best of our knowledge, this study is the first to correlate the levels of endogenous CSF CGRP with hrQoL outcome in good-grade sSAH patients. Excessive CGRP release into CSF may have a negative short-term impact on hrQoL and emotional health like anxiety and depression. While subacutely after sSAH, higher CSF levels of the vasodilator CGRP are supposed to be protective against vasospasm-associated cerebral ischemia, from a psychopathological point of view, our results suggest an involvement of CSF CGRP in the dysregulation of higher integrated behavior.

Objective: Neuropsychological dysfunction after treatment of spontaneous subarachnoid hemorrhage (sSAH) is common but underreported. The vasodilatory calcitonin gene-related peptide (CGRP) is excessively released after sSAH and modulates psycho-behavioral function. We prospectively analyzed the treatment-specific[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: This study was designed to evaluate the relevance of immediate postoperative imaging in ventriculoperitoneal-shunting (VP-shunting) procedures. Methods: 461 consecutive patients (male 243, female 218; mean age 51.9 years) with VP-shunting procedures who presented during the ten years interval[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: Diagnosis of cerebrospinal fluid (CSF) infection in patients with external ventricular drainage is often done by clinical symptoms and/or laboratory values such as cell count or glucose values. But there seems to be a mismatch between the number of clinically diagnosed CSF infections[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: Until now, only few studies have addressed the effect of unruptured intracranial aneurysm (UIA) treatment on cognitive function. Neuropsychological assessment after UIA treatment is underreported and prospective trials have repeatedly been demanded. In 2014, we conducted a prospective and[for full text, please go to the a.m. URL], 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Objective: Despite all surgical care hydrocephalus shunting procedures are associated with several complications and risks. This study was designed to evaluate possible complications of hydrocephalus shunting procedures depending on patients’ weight. Method: Patient charts were reviewed retrospectively[for full text, please go to the a.m. URL], 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Objective: In an aging population the prevalence of demential syndroms increases dramatically. Chronic subdural hematomas (CSH) are a surgically treatable cause for dementia and cognitive decline. However, little is known about age-dependent predominant symptoms and age-adjusted rates of restoration[for full text, please go to the a.m. URL], 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Objective: The endogenous, vasodilatatory Calcitonin-Gene related Peptide (CGRP) is stored in perivascular nerve fibres around cerebral arteries and regulates cerebral blood flow under physiologic conditions. Increased levels of CGRP are consistently reported in migraine patients but the role of CGRP[for full text, please go to the a.m. URL], 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Objective: The abundantly expressed vasoconstrictive Neuropeptide Y (NPY) has been shown to have the potential to significantly influence the development of vasospasm-related cerebral ischemia and functional outcome, subsequently after spontaneous subarachnoid hemorrhage (SAH). Here, we present the [for full text, please go to the a.m. URL], 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Objective: In normal brain, the potent vasoconstrictive Neuropeptide Y (NPY) is abundantly expressed in the hypothalamus, forebrain, hippocampus and brainstem. NPY is stored in perivascular nerve fibres of the cerebral arteries, regulating cerebral vascular diameter and blood flow. Its role in the pathogenesis[for full text, please go to the a.m. URL], 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Brain metastases (BM) develop in about 30% of all cancer patients. Surgery plays an important role in confirming neuropathological diagnosis, relieving mass effects and improving the neurological status. To select patients with the highest benefit from surgical resection, prognostic indices (RPA, GPA) have been formulated which are solely focused on survival without considering neurological improvement. In this study we analyzed the impact of surgical resection on the neurological status in addition to overall survival in 206 BM patients. Surgical mortality and morbidity was 0.0% and 10.3% respectively. New neurologic deficits occurred in 6.3% of all patients. The median overall survival was 6.3 months. Poor RPA class and short time interval between diagnosis of cancer and the occurrence of BM were independent factors predictive for poor survival. Improvement of neurological performance was achieved in 56.8% of all patients, with the highest improvement rate seen in patients presenting with increased intracranial pressure and hemiparesis. Notably, the neurological benefits were independent from RPA class. In conclusion, surgical resection leads to significant neurological improvement despite poor RPA class and short overall survival. Considering the low mortality and morbidity rates, resection should be considered as a valid option to increase neurological function and quality of life for patients with BM.

Subarachnoid hemorrhages (SAH) due to true aneurysms of the Posterior Cerebral Artery (PCA) during puerperium in young and healthy females are extremely rare. We present the case of a 31-year old, healthy woman that experienced a spontaneous SAH due to a PCA aneurysm, arising from the P3 segment, 9 days post-delivery. The aneurysm was successfully treated via an endovascular approach and the patient recovered well. After 21 days she was discharged from hospital without neurological deficits. The clinical course is described in detail and illustrated with a computed tomography scan (CT) and digital subtraction angiography (DSA) pre – and post-embolization. The literature is reviewed and possible etiologies of the formation and rupture of the aneurysm are discussed.

Im Rahmen der tiefen Hirnstimulation wird über eine Bohrlochtrepanation eine Elektrode zum Teil in Kerngebiete eingebracht, die in der Bildgebung nicht zur Darstellung kommen. Um diese nur wenige Millimeter großen Strukturen zielsicher zu erreichen, wird auf Koordinaten stereotaktischer Atlanten zurückgegriffen. Das Ziel der vorliegenden Studie ist es, die Zuverlässigkeit der atlasbasierten Koordinaten zu untersuchen. Am Beispiel des Nucleus subthalamicus, der Zielstruktur beim Morbus Parkinson, wurde die Genauigkeit der Übertragung von allgemeinen Atlaskoordinaten auf individuelle stereotaktische Koordinaten überprüft. Verschiedene Planungsmodi wurden diesbezüglich verglichen., Deep brain stimulation is used as a treatment of Parkinson´s disease. The stereotactic target is very small, and therefore stereotactic atlases are used. Our intention was to analyse the reliability of atlas-based coordinates. Using the example of the subthalamic nucleus, the target in deep brain stimulation at Parkinson´s disease, we checked the accuracy of atlas-based coordinates compared to individually defined stereotactic coordinates.