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Objective: Spontaneous intracerebral haemorrhage (ICH) might lead to neurological disability and mortality. Nonetheless, subjective interpretation of life circumstances might vary and depend on e.g. age or neurological function. Recent data from ischemic stroke patients show that there might be a paradox [for full text, please go to the a.m. URL]

Objective: Lower grade gliomas (LGG) often infiltrate eloquent regions, so that neurological impairment and oncological benefit by surgery have to be balanced. Aim of our study was to assess rate of permanent deficits and its risk factors in eloquently located LGGs. Methods: We retrieved all patients [for full text, please go to the a.m. URL]

Background In a previous article (10.1007/s00701-019-03888-3), preliminary results of a survey, aiming to shed light on the number of surgical procedures performed and assisted during neurosurgery residency in Europe were reported. We here present the final results and extend the analyses. Methods Board-certified neurosurgeons of European Association of Neurosurgical Societies (EANS) member countries were asked to review their residency case logs and participate in a 31-question electronic survey (SurveyMonkey Inc., San Mateo, CA). The responses received between April 25, 2018, and April 25, 2020, were considered. We excluded responses that were incomplete, from non-EANS member countries, or from respondents that have not yet completed their residency. Results Of 430 responses, 168 were considered for analysis after checking in- and exclusion criteria. Survey responders had a mean age of 42.7 ± 8.8 years, and 88.8% were male. Responses mainly came from surgeons employed at university/teaching hospitals (85.1%) in Germany (22.0%), France (12.5%), the United Kingdom (UK; 8.3%), Switzerland (7.7%), and Greece (7.1%). Most responders graduated in the years between 2011 and 2019 (57.7%). Thirty-eight responders (22.6%) graduated before and 130 responders (77.4%) after the European WTD 2003/88/EC came into effect. The mean number of surgical procedures performed independently, supervised or assisted throughout residency was 540 (95% CI 424–657), 482 (95% CI 398–568), and 579 (95% CI 441–717), respectively. Detailed numbers for cranial, spinal, adult, and pediatric subgroups are presented in the article. There was an annual decrease of about 33 cases in total caseload between 1976 and 2019 (coeff. − 33, 95% CI − 62 to − 4, p = 0.025). Variables associated with lesser total caseload during residency were training abroad (1210 vs. 1747, p = 0.083) and female sex by trend (947 vs. 1671, p = 0.111), whereas case numbers were comparable across the EANS countries (p = 0.443). Conclusion The final results of this survey largely confirm the previously reported numbers. They provide an opportunity for current trainees to compare their own case logs with. Again, we confirm a significant decline in surgical exposure during training between 1976 and 2019. In addition, the current analysis reveals that female sex and training abroad may be variables associated with lesser case numbers during residency.

Objective: The assessment criteria for successful fusion after spine surgery vary widely. While some authors content themselves with a lack of implant loosening, others request imaging evidence of bone bridge formation, e.g. on radiographs or even on computed tomography. The aim of this study was[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: DH1/2-wildtype (wt) astrocytomas have a high recurrence rate. Since the cIMPACT-NOW update 3, the subgroup of diffuse tumors with certain molecular markers are categorized as WHO IV tumors. Treatment recommendation has shifted to a more aggressive strategy. In this study, we aimed to[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: Spinal metastases are present in a sizeable proportion of patients with malignant neoplasia. Once neurologic deficits are present, life quality and prognosis decrease. This work is based on the assumption that patients with known malignant disease more frequently obtain medical care and screening.[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: The methylation of O6-methylguanine-DNA-methyltransferase (MGMT) is an established biomarker in IDH-wildtype glioblastoma (GBM) patients. It enhances the effectiveness of alkylating chemotherapy and by such affects the progression free survival (PFS) and overall survival (OS). Standardized[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: Implantation of a vp-shunt represents the current standard of care in hydrocephalus patients. Both combination valves implanted in this study contain a proprietary differential pressure valve, which is combined with a gravity-regulated anti-siphon device (ASD) in the proGAV (PG) valve and[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

Objective: Current evidence-based guidelines for the management of aneurysmal subarachnoid hemorrhage (SAH) focus primarily on the timing, modality and technique of aneurysm occlusion, and the prevention and treatment of delayed cerebral ischemia. Significant aspects of management in the intensive care[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

Objective: In recent years, some level of consensus for management of diffuse astrocytoma and oligodendroglioma was reached. Aim of the present study was to assess the current management of these lesions based on data from the LoG-Glio registry. Methods: Prospective data sets of primary diagnosis[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

Objective: End-of-life (EoL) decisions are, unfortunately, a routine part in neurosurgical care due to frequent devastating diagnoses resulting in a severely impaired prognosis. Patients’ provision, discussions with patients´ representatives and evaluation of the alleged will play an increasing[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

Objective: Level of evidence for surgical management in low grade glioma (LGG) is low and mainly relies on retrospective series. Hence prospective contemporary assessment of surgical outcome is important to assure surgical quality control and to evaluate surgical strategies. Methods: Prospective[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

Objective: Chronic subdural haematoma (cSDH) often causes mass effect and results in focal neurological deficits and / or reduced level of consciousness. Several techniques for cSDH evacuation have been described so far whereas twist-drill craniostomy (TDC) under local anesthesia represents the[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

Objective: Secondary sclerosing cholangitis (SC-CIP) might develop after longer periods of intensive care treatment. The development of casts in the intrahepatic bile ducts and pronounced cholestasis are pathognomonic for SC-CIP. In the further course liver cirrhosis with indication for liver transplantation[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: Degenerative changes of the cervical spinal column are the most common cause of spinal cord lesions in the elderly. Conventional clinical, electrophysiological and radiological diagnostics of spinal cord compression are often inconsistent. Methods: The feasibility and diagnostic potential[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: Diffuse low grade glioma (LGG) are often challenging to treat surgically due to their infiltrative growth. Based on the low incidence, prospective data on patients’ outcome and surgical treatment options are lacking. Aim of the study was to assess contemporary surgical outcome in a[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

Background Degenerative changes of the cervical spinal column are the most common cause of spinal cord lesions in the elderly. Conventional clinical, electrophysiological and radiological diagnostics of spinal cord compression are often inconsistent. Materials and methods The feasibility and diagnostic potential of a novel T1 mapping method at 0.5 mm resolution and 4 s acquisition time was evaluated in 14 patients with degenerative cervical spinal canal stenosis (SCS) and 6 healthy controls. T1 mapping was performed in axial sections of the stenosis as well as above and below. All subjects received standard T2-weighted MRI of the cervical spine (including SCS-grading 0-III), electrophysiological and clinical examinations. Results Patients revealed significantly decreased T1 relaxation times of the compressed spinal cord within the SCS (912 ± 53 ms, mean ± standard deviation) in comparison to unaffected segments above (1027 ± 39 ms, p, Highlights • Rapid T1 mapping at 0.5 mm resolution was tested in cervical spinal canal stenosis (SCS). • T1 relaxation times significantly decreased within the SCS. • T1 relaxation times were significantly lower in grade II vs grade I SCS. • Central conduction deficits were inversely correlated with T1 relaxation time. • Rapid T1 mapping robustly and accurately quantifies spinal cord compression.

Objective: Decision making in hydrocephalus patients might be challenging if solely based on clinical assessment. Hence, repeated imaging during life time follow-up is not uncommon. Accumulation of ionizing radiation may result in certain conditions like cataract and might even induce malignancies. [for full text, please go to the a.m. URL], 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Objective: D,L-Methadone has played a role in palliative care and is used for pain treatment in patients with cancer. Recently an increasing number of articles and TV programmes in (social) media suggested that D,L-Methadone would positively influence the clinical course of patients with high grad glioma[for full text, please go to the a.m. URL], 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Objective: Whether intracerebral hemorrhage (ICH) associated with non–vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. Methods: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. Results: We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs 26.5%; hazard ratio = 0.94, 95% confidence interval [CI] = 0.67–1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = −2.83, 95% CI = −5.28 to −0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30–0.84), and smaller baseline hematoma volume (linear regression coefficient = −0.24, 95% CI = −0.47 to −0.16). The two groups did not differ in the likelihood of baseline hematoma volume < 30cm3 (OR = 1.14, 95% CI = 0.81–1.62), hematoma expansion (OR = 0.97, 95% CI = 0.63–1.48), in-hospital mortality (OR = 0.73, 95% CI = 0.49–1.11), functional status at discharge (common OR = 0.78, 95% CI = 0.57–1.07), or functional status at 3 months (common OR = 1.03, 95% CI = 0.75–1.43). Interpretation: Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702–712. © 2018 American Neurological Association