Endoscopic Visualization of an Iatrogenic Valve Mechanism: Elucidating the Pathogenesis of Postoperative Tumor Bed Cysts.

Space-occupying tumor bed cysts have been reported after resection of intracranial tumors, although the exact mechanism of their pathogenesis is unclear. Opening of the ventricular system during the tumor resection appears to be a risk factor. Occlusion of the surgical opening of the ventricle using fibrinogen-coated collagen fleece has been suggested to restore the integrity of the ventricular system. Here we present a clinical image depicting an iatrogenic valve mechanism caused by a fleece intended to seal a surgical opening of the lateral ventricle, leading to development of a space-occupying tumor bed cyst and cerebrospinal fluid fistula.

Outcome following surgical treatment of chronic subdural hematoma in the oldest-old population.

As a result of the demographic shift in western societies, the mean age at presentation of patients suffering from chronic subdural hematomas (cSDH) is increasing. Therapeutic strategies, surgical and non-surgical, need to be reevaluated and adapted accordingly. Age is considered to be a positive risk factor for a higher perioperative morbidity and mortality. The purpose of this study is to determine if old age (≥85 years) should be seen as a contraindication for surgical treatment. Two groups (56 patients each) with cSDH over and below 85 years of age from a single neurosurgical department with well-defined surgical treatment guidelines were retrospectively analyzed. Clinical characteristics of the patients, localization, treatment, prior medication, and complications were compared. Outcome was measured by clinical improvement postoperatively and by the Glasgow Outcome Scale (GOS) at 1 month after surgery. Age ≥85 years was associated with higher GOS 1 month after surgery (p = 0.038). 51.8% (58) of all patients had a complete neurological recovery postoperatively, and 74% (43) of these patients were ≥85 years. Elderly patients suffered from a significantly higher complication rate (p < 0.001) with odds of having a complication 18.3 times higher (p < 0.001) compared to patients <85 years. Both groups had a comparable mean hospitalization time (9.8 days for patients ≥85 years and 9.5 days for patients <85 years). Old age has no negative impact on overall outcome after surgical therapy of cSDH. Despite significantly higher complication rate in elderly patients, the outcome assessed by the GOS at 1 month after surgery was significantly better in comparison to patients younger than 85 years. Old age does therefore not seem to be a contraindication for surgical treatment of cSDH.

Association of early inflammatory parameters after subarachnoid hemorrhage with functional outcome: A prospective cohort study.

OBJECTIVE: Early brain injury after aneurysmal subarachnoid hemorrhage (aSAH) comprises a pronounced neuroinflammatory reaction. Nevertheless, its relevance for functional outcome and its role as outcome predictor remains uncertain. We evaluated the relationship of various early inflammatory parameters regarding functional outcome according to the modified Rankin Scale score (mRS) at discharge (primary objective) and six months after aSAH. PATIENTS: A total of 81 patients (63% female) with a mean age of 53.8 ± 13.2 years were included. METHODS: At admission clinical data and various inflammatory parameters in serum and - wherever applicable - cerebrospinal fluid (CSF) of patients after aSAH were assessed. Outcome was evaluated according to dichotomized mRS at discharge and six months after aSAH (unfavorable outcome: mRS 3-6). Univariate and thereafter multivariate logistic regression analyses were performed using SAS 9.2. RESULTS: Elevated levels of interleukin 6 (IL-6) and leukemia inhibitory factor (LIF) in serum and CSF were related to unfavorable outcome at discharge (p<0.05; univariate analyses). IL-6 remains the only parameter relevant for outcome applying a multivariate model including the relevant baseline characteristics. Six months after aSAH no significant correlation was found regarding the outcome, most likely due to the high drop-out rate (27%). A pronounced rise of LIF serum and CSF levels after aSAH was observed. CONCLUSION: Higher early IL-6 serum levels after aSAH are associated with poor outcome at discharge. In addition, involvement of LIF in the early inflammatory reaction after aSAH has been demonstrated.