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Objective: Aneurysmal subarachnoid hemorrhage (SAH) is a severe type of stroke accompanied with a number of early and late complications resulting in considerable morbidity and mortality. Several studies have already pointed to a delayed risk of post-SAH epilepsy, which is associated with poor outcome.[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: Several parameters are known to predict the survival of glioblastoma (GBM) comprising extend of resection and MGMT promotor methylation. Staining for glial fibrillary acidic protein (GFAP) is being frequently assessed during histological work-ups, however its clinical utility for GBM remains[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: To assess gadolinium contrast wall enhancement patterns of thrombosed intracranial aneurysms using in-vivo 7 Tesla MRI in correlation with histopathological findings. Methods: The study group comprised 13 patients (14 aneurysms) who were recruited between January 2011 and October 2018.[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: Risk for recurrent symptomatic hemorrhage in CCM is an important factor in decision making/consultation of patients. In this report, we analyze the risk and time pattern of re-hemorrhage events after a first initial bleeding. Methods: We performed a cross-sectional study based on[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

Knowledge of the exact tumor location and structures at risk in its vicinity are crucial for neurosurgical interventions. Neuronavigation systems support navigation within the patient's brain, based on preoperative MRI (preMRI). However, increasing tissue deformation during the course of tumor resection reduces navigation accuracy based on preMRI. Intraoperative ultrasound (iUS) is therefore used as real-time intraoperative imaging. Registration of preMRI and iUS remains a challenge due to different or varying contrasts in iUS and preMRI. Here, we present an automatic and efficient segmentation of B-mode US images to support the registration process. The falx cerebri and the tentorium cerebelli were identified as examples for central cerebral structures and their segmentations can serve as guiding frame for multi-modal image registration. Segmentations of the falx and tentorium were performed with an average Dice coefficient of 0.74 and an average Hausdorff distance of 12.2 mm. The subsequent registration incorporates these segmentations and increases accuracy, robustness and speed of the overall registration process compared to purely intensity-based registration. For validation an expert manually located corresponding landmarks. Our approach reduces the initial mean Target Registration Error from 16.9 mm to 3.8 mm using our intensity-based registration and to 2.2 mm with our combined segmentation and registration approach. The intensity-based registration reduced the maximum initial TRE from 19.4 mm to 5.6 mm, with the approach incorporating segmentations this is reduced to 3.0 mm. Mean volumetric intensity-based registration of preMRI and iUS took 40.5 s, including segmentations 12.0 s. Keywords: IGNS, Image-guided neurosurgery, Intra-operative ultrasound, MRI, Registration, Segmentation

Objective: Diffuse intrinsic pontine glioma (DIPG) is the most common brainstem tumor of childhood. As the opportunity of molecular diagnostics revealed intense histopathological heterogeneity of DIPGs and their different response to adjuvant therapy, biopsy is of rising interest. Biopsy is often performed[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)

Background: Designing treatment strategies for unruptured giant intracranial aneurysms (GIA) is difficult as evidence of large clinical trials is lacking. We examined the outcome following surgical or endovascular GIA treatment focusing on patient age, GIA location and unruptured GIA. Methods: Medline and Embase were searched for studies reporting on GIA treatment outcome published after January 2000. We calculated the proportion of good outcome (PGO) for all included GIA and for unruptured GIA by meta-analysis using a random effects model. Results: We included 54 studies containing 64 study populations with 1,269 GIA at a median follow-up time (FU-T) of 26.4 months (95% CI 10.8-42.0). PGO was 80.9% (77.4-84.4) in the analysis of all GIA compared to 81.2% (75.3-86.1) in the separate analysis of unruptured GIA. For each year added to patient age, PGO decreased by 0.8%, both for all GIA and unruptured GIA. For all GIA, surgical treatment resulted in a PGO of 80.3% (95% CI 76.0-84.6) compared to 84.2% (78.5-89.8, p = 0.27) after endovascular treatment. In unruptured GIA, PGO was 79.7% (95% CI 71.5-87.8) after surgical treatment and 84.9% (79.1-90.7, p = 0.54) after endovascular treatment. PGO was lower in high quality studies and in studies presenting aggregate instead of individual patient data. In unruptured GIA, the OR for good treatment outcome was 5.2 (95% CI 2.0-13.0) at the internal carotid artery compared to 0.1 (0.1-0.3, p < 0.1) in the posterior circulation. Patient sex, FU-T and prevalence of ruptured GIA were not associated with PGO. Conclusions: We found that the chances of good outcome after surgical or endovascular GIA treatment mainly depend on patient age and aneurysm location rather than on the type of treatment conducted. Our analysis may inform future research on GIA.

Objective: Precise image registration of intraoperative ultrasound (iUS) and preoperative MRI (preMRI) as well as the image fusion based on these is still an unsolved problem in image-guided surgery. Artifacts within 3D US reconstructions hinder direct fusion of preMRI and 3D iUS. A 2D-based segmentation[for full text, please go to the a.m. URL], 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Objective: The number of clinically oriented 7 Tesla MRI studies is increasing in the last years. Most 7 T research sites still conservatively exclude all subjects with metallic implants, regardless of type or location. The purpose of this study was to investigate potential RF-induced heating of titanium[for full text, please go to the a.m. URL], 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Objective: High-quality pre-operative images are essential for the treatment of intracerebral vascular pathologies. Digital subtraction angiography (DSA) is still the gold standard of the available imaging modalities, but with new ultra-high field MRI scanners, MR angiography (MRA) has the opportunity[for full text, please go to the a.m. URL], 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)