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1.
Clin Neurol Neurosurg ; 195: 106020, 2020 08.
Article in English | MEDLINE | ID: mdl-32673990

ABSTRACT

BACKGROUND: Chronic subdural hematoma (CSDH) is a frequent disease in neurosurgical practice. However, a considerable recurrence rate keeps this condition challenging to treat. We aimed to provide a simple tool for risk assessment in these patients. METHODS: We conducted a retrospective analysis of surgically treated patients with chronic subdural hematomas. In addition to patients' demographics, radiological assessment included volume, thickness, midline shift and density of hematomas. Statistically significant variables in univariate analysis were further analyzed in a multivariate logistic regression model to create a risk score for recurrence of CSDH. RESULTS: A total of 148 patients were identified and included for analysis. 50.7 % (n = 75) were older than 76 years of age. The overall hematoma recurrence rate requiring surgery was 23.6 % (n = 35). Preoperative thrombocytopenia, postoperative midline shift >6 mm, hematoma volume >80 mL and overall hematoma density >45 Hounsfield Units (HU), were significantly more frequent in the recurrence group. Furthermore, after multivariate assessment, postoperative hematoma density and volume were independent risk factors and included in the risk assessment tool. Patients were divided into 3 risk groups corresponding to the total scores. CONCLUSION: We provide a risk-score assessment for predicting recurrence of subdural hematoma. The risk-score comprises postoperative hematoma volume and density. This tool could ease decision making in follow-up evaluation and indication for recurrence surgery. Yet, further prospective evaluation is required to assess the clinical value of this tool.


Subject(s)
Drainage , Hematoma, Subdural, Chronic/diagnosis , Neurosurgical Procedures , Adult , Aged , Aged, 80 and over , Disease Progression , Female , Hematoma, Subdural, Chronic/surgery , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Risk Assessment , Risk Factors
2.
Neurosurg Rev ; 42(2): 197-208, 2019 Jun.
Article in English | MEDLINE | ID: mdl-28921173

ABSTRACT

Malignant glioma surgery involves the challenge of preserving the neurological status of patients harboring these lesions while pursuing a maximal tumor resection, which is correlated with overall and progression-free survival. Presently, several tools exist for assisting neurosurgeons in visualizing malignant tissue. Fluorescence-guided surgery (FGS) with 5-aminolevulinic acid (5-ALA) has increasingly been used during the last decade for identifying malignant glioma. Intraoperative magnetic resonance imaging (iMRI), first introduced in the mid-1990s, is being evaluated as a further tool to maximize the extent of resection. We aimed to evaluate the literature and discuss synergies and differences between FGS with 5-ALA and iMRI. We conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. After excluding non-relevant articles, 16 articles were evaluated and included in the qualitative analysis, comprising 2 (n = 2) reviews of the literatures, 1 (n = 1) book chapter, and 13 (n = 13) clinical articles. ALA-induced fluorescence goes beyond the borders of gadolinium contrast enhancement. Several studies stress the synergy between both tools, enabling increase in extent of resection. We point out advantages of combining both methods. iMRI, however, is not widely available, is expensive, and is not recommended as sole resection control tool in high-grade glioma. For these centers, FGS together with mapping and monitoring techniques, neuronavigation and, when needed, intraoperative ultrasound provides an excellent setting for achieving state-of-the-art gross total resection of high-grade gliomas.


Subject(s)
Aminolevulinic Acid , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/surgery , Glioma/diagnostic imaging , Glioma/surgery , Photosensitizing Agents , Fluorescence , Humans , Magnetic Resonance Imaging , Neuronavigation
3.
Eur J Surg Oncol ; 41(1): 128-35, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25182221

ABSTRACT

AIMS: The frequency of lymph node metastasis (LNM) is higher in cutaneous squamous cell carcinoma (cSCC) of the ear than in other head and neck cSCCs. Nodal dissemination is associated with a significantly worse prognosis and disease-specific survival. The aim of this study was to establish a prediction model for LNM in patients with cSCC of the ear. MATERIALS AND METHODS: Tumour characteristics of 353 patients with ear cSCC were analysed to assess differences between those with and without LNM and to calculate a prediction score for LNM occurrence. RESULTS: Regional LNM occurred in 10.5% of patients. Five-year disease-specific survival was significantly lower in the LNM group than in the control group (59% vs. 99%; p < 0.001). Recurrence number, invasion of cartilage, tumour depth, and tumour grading were the most important predictors for LNM, with correct prediction of LNM in 94.0% of cases. Our prediction score stratified patients into high and low risk groups (p < 0.001) with a sensitivity of 89.2%, a specificity of 94.6%, and an overall accuracy of 94.1%. CONCLUSION: Our new prediction model was able to accurately identify patients at high risk of LNM who may benefit from elective lymph node surgery.


Subject(s)
Carcinoma, Squamous Cell/pathology , Ear Neoplasms/pathology , Ear, External/pathology , Head and Neck Neoplasms/pathology , Lymph Nodes/pathology , Neoplasm Recurrence, Local/pathology , Skin Neoplasms/pathology , Aged , Aged, 80 and over , Disease-Free Survival , Ear Cartilage/pathology , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Grading , Neoplasm Invasiveness , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Assessment , Squamous Cell Carcinoma of Head and Neck
4.
J Oral Pathol Med ; 42(8): 587-93, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23369166

ABSTRACT

BACKGROUND: Bone resorption inhibitor-related osteopathology of the jaw (BRIOJ) is a severe complication in patients treated with bisphosphonates or denosumab. However, the precise pathogenesis of BRIOJ is not yet fully understood. Recent studies discovered the presence of Actinomyces colonies in biopsy material from BRIOJ patients. The aim of this study was to analyze current knowledge concerning the impact of Actinomyces on the pathogenesis of this condition and to present data from our own patients. METHODS: Data from 51 patients with histopathological diagnoses of BRIOJ were retrospectively analyzed. In addition, a systematic literature search for studies describing the presence of Actinomyces was performed. RESULTS: Actinomyces was present in 86% of our cases and 63.3% of 371 cases presented in the literature. All of our patients and 85% of patients described in the literature had a clearly defined local focus in association with osteopathology. A clear picture of whether Actinomyces colonizes the previously necrotic bone or contributes to inflammation causing subsequent bone necrosis is lacking in the literature. CONCLUSION: The pathogenesis of BRIOJ remains unknown; however, there seems to be a role for Actinomyces, and possibly other pathogens, in the development of osteopathology of the jaws, which is not exclusive to bisphosphonate therapy. This study supports the hypothesis that an infectious component is of utmost importance for the pathogenesis of BRIOJ.


Subject(s)
Actinomyces/isolation & purification , Bisphosphonate-Associated Osteonecrosis of the Jaw/etiology , Bone Density Conservation Agents/adverse effects , Diphosphonates/adverse effects , Actinomycosis/diagnosis , Adult , Aged , Aged, 80 and over , Alendronate/adverse effects , Antibodies, Monoclonal, Humanized/adverse effects , Biopsy , Bisphosphonate-Associated Osteonecrosis of the Jaw/microbiology , Bisphosphonate-Associated Osteonecrosis of the Jaw/pathology , Denosumab , Female , Humans , Imidazoles/adverse effects , Male , Middle Aged , RANK Ligand/antagonists & inhibitors , Retrospective Studies , Tooth Extraction/adverse effects , Zoledronic Acid
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