Journal of neurological surgery. Part A, Central European neurosurgery最新文献

Wilhelm Tönnis is considered the founder of postwar neurosurgery in West Germany. He was able to draw on a network of prewar and wartime colleagues and trained young colleagues who took up most of the leading neurosurgical positions in the first postwar decades. Interdisciplinary collaboration was important to him, especially with pathologists, radiologists, and neurologists. He was unable to reconnect with the broad international network of the prewar period. However, he maintained contact with his teacher Olivecrona in Sweden, other Scandinavian colleagues, and students from Italy, southeastern Europe, and South America. The network is illustrated by the description of his clinical and research staff and his colloquia, the authors of the Handbuch der Neurochirurgie (Handbook of Neurosurgery), which he co-founded, and the editors of the neurosurgical journals Zentralblatt für Neurochirurgie and Acta Neurochirurgica. Tönnis' significant influence on the emancipation of neurosurgery in the postwar decades becomes evident.

Background:  There is high risk of injury to the olfactory tract and olfactory bulb during surgery of the anterior cranial fossa. The goal of this study was to describe the outer arachnoid envelope around the olfactory bulb, which plays a significant role in approach-related injury of the nerve.

Methods:  A total of 20 fresh human cadaveric heads were examined. Five cadaveric heads were used to describe a gross overview of the topographic anatomy of the outer arachnoid cover of the olfactory bulb. In 15 cadaveric heads, endoscopic surgical approaches were performed to examine the in situ undisrupted anatomy of the outer arachnoid around the olfactory bulb. Four cadaveric heads were used for the lateral subfrontal approach, 5 heads for the medial subfrontal approach, 3 heads for the median subfrontal approach, and 3 heads for the anterior interhemispheric approach.

Results:  The outer arachnoid membrane of the frontal lobe attaches the olfactory bulb strongly to the above lying olfactory sulcus. Only the most rostral portion of the olfactory bulb became slightly detached from the frontal lobe. The outer arachnoid forms a decent protrusion around the tip of the olfactory bulbs. The fila olfactoria have their own outer arachnoid cover as a continuation of the same layer of the olfactory bulb. The effect of brain retraction and manipulation forces on the olfactory bulb and the role of the arachnoid membranes located here were visually analyzed and described in detail through the four different neurosurgical approaches we performed.

Conclusion:  The results of our observations provide important anatomical details for preserving the sense of smell during neurosurgical procedures.

Background:  Intracranial hypertension is a life-threatening condition that can be treated by decompressive craniectomy (DC), which involves removing a part of the skull and intracranial lesions. However, DC has many complications and requires a second surgery to repair the skull. Decompressive bone flap replacement (DBFR) or decompressive cranioplasty is a novel technique that replaces the bone flap with a titanium mesh, providing both decompression and skull integrity.

Methods:  The materials and methods of DBFR are described in detail. A three-dimensional titanium mesh is fabricated based on the computed tomography (CT) data of previous DC patients. An appropriate titanium mesh is selected based on the preoperative and intraoperative assessments. After removing the intracranial lesions, the titanium mesh is fixed over the bone window.

Results:  We successfully performed DBFR in three emergent cases. The postoperative CT scan showed adequate decompression in all cases. No reoperation for skull repair was needed, and there were no surgical complications. The cosmetic outcome was excellent. There were no relevant complications in the operative area.

Conclusions:  DBFR may be a safe and effective alternative to DC in a specific subgroup of patients, in whom complete removal of the bone flap is feasible. DBFR can reduce intracranial pressure while maintaining the integrity of the skull cavity, eliminating the need for additional surgery for skull repair. Possible improvements for DBFR in the future are suggested, such as using a greater curvature of the titanium mesh or a modified DBFR with a hinged titanium mesh.

Background:  Pituitary adenoma (PA) is a common intracranial endocrine tumor, but no precise target has been found for effective prediction and treatment of PA.

Methods:  Quantitative reverse transcription polymerase chain reaction (qRT‒PCR) analysis showed that circMFN2 could affect the expression of miR-146a-3p in PA samples. Moreover, we used Western blotting to evaluate the expression levels of TRAF6 and NF-κB markers. The EdU assay, scratch wound healing assay, and Matrigel invasion assay were performed to assess the potential function of this pathway in PA cells. Based on the bioinformatic analysis including KEGG, gene ontology (GO) analysis, and microarray analysis, we evaluated the efficacy of circMFN2 as a potential biomarker for diagnosing PA, and we aimed to determine the mechanism of action in PA cells.

Results:  Our findings indicate that there is a significant increase in the expression of circMFN2 in tissues, serum, and exosomes in the invasive group compared with the noninvasive and normal groups. Furthermore, this difference was statistically significant both preoperatively and postoperatively. To clarify its function, we downregulated this gene, and the experimental results suggested that the motility and proliferative capacity were reduced in vitro. In addition, rescue assays showed that miR-146a-3p could successfully reverse the inhibitory effect of circMFN2 knockdown on motility and proliferation in PA cells. Moreover, downregulation of circMFN2 and miR-146a-3p significantly changed the expression of TRAF6 and NF-κB.

Conclusion:  This study identified that circMFN2 regulates miR-146a-3p to promote adenoma development partially via the TRAF6/NF-κB pathway and may be a potential therapeutic target for PA.

In Germany, the idea of neurosurgery as a separate medical specialty emerged in the 1920s in response to Cushing's role model, but can in part also be attributed to the preceding decades of German brain research. First attempts of professional emancipation failed due to political conditions. During National Socialism, the military significance of neurosurgical expertise was recognized. Only after World War II, the advancement of the new specialty gathered pace by the spread of multiple new specialized units. It is worth mentioning that apart from a nationwide coverage with neurosurgical health care the academic recognition of the specialty has also been fully achieved with regard to medical care, research, and teaching.

Background:  Rapid spread of the SARS-CoV-2 pandemic in 2020 led to an indirect effect on non-COVID patients. Since neuro-oncology cases are unique and brain tumors need a specific therapeutic protocol at proper doses and at the right times, the effects of the pandemic on health care services for patients with glioblastomas (GBs) and their impact on overall survival (OS) and quality of life are not yet known.

Methods:  We conducted a retrospective study of 142 GB patients who underwent surgery, radiation, and chemotherapy before and after the lockdown period, aiming to determine the differences in access to care, treatment modality, and adjuvant therapies, and how the lockdown changed the prognosis.

Results:  The number of procedures performed for GB during the pandemic was comparable to that of the prepandemic period, and patients received standard care. There was a significant difference in the volume of lesions measured at diagnosis with a decreased number of "accidental" diagnoses and expression of a reduced use by the patient for a checkup or follow-up examinations. Patients expressed a significantly lower performance index in the lockdown period with longer progression-free survival (PFS) in the face of a comparable mean time to OS.

Conclusion:  Patients treated surgically for GB during the pandemic period had a more pronounced and earlier reduction in performance status than patients treated during the same period the year before. This appears to be primarily due to lower levels of care in the rehabilitation centers and more frequent discontinuation of adjuvant care.

The aim of this study is to compare the publication performance of two leading neurosurgical journals, "Acta Neurochirurgica" and "Zentralblatt für Neurochirurgie," over a period of over 70 years. Trends in the number of publications as well as the thematic development of neurosurgical research will be analyzed. For this study, the abstracts of publications from the years 1951 and 2023 in the two leading neurosurgical journals "Acta Neurochirurgica" and "Zentralblatt für Neurochirurgie" were analyzed by the authors. For the sake of clarity, a thematic categorization into thematic blocks has been made. The publication performance in the analyzed journals has significantly increased from one volume with 21 articles for Acta Neurochirurgica in 1951 to 12 volumes in with 506 articles in 2023. A total of one volume with 32 articles was recorded for Zentralblatt für Neurochirurgie in 1951 versus a total of 6 volumes with 90 articles in 2023. Furthermore, new research areas represented include epilepsy surgery, technological innovations such as robotic surgery and virtual reality, hydrocephalus, advancements in neurosurgical education, deep brain stimulation as well as historical and biographical topics. Overall, the results illustrate a significant enhancement in the publication output and thematic richness of neurosurgical research in over more than 70 years. This development underscores the dynamic and evolving nature of the field, driven by continuous scientific and technological advancements. Our comparison highlights the significant role of the journals "Acta Neurochirurgica" and "Zentralblatt für Neurochirurgie" in disseminating knowledge and promoting scientific progress in neurosurgery in Germany.

Comparing experiences with brain tumor surgery in the early decades of the 20th century, dominated after the World War I mostly by US/American neurosurgeons, the influences at that time in Europe with establishing an autonomic neurosurgery and the disruptions during World War II, killing and forced displacement of Jews, left-wing policies of neurosurgeons, and the absurd enforcement of fascistic medicine led to a stagnation in the development of this cut-off German country. Therefore, it is not surprising that the background, techniques, and ideas of neurosurgery in Germany at the time of the founding of the German Society of Neurosurgery did not differ significantly from those of the pre-war period.

The technical state of neurosurgery in Germany around 1950 was characterized by the limitations imposed by the postwar period in a war-damaged, challenging environment. Neurosurgeons from that era had to rely on their skills, knowledge, and improvisational skills when performing complex procedures with limited resources. The development of neurosurgery was also shaped by the division of the country with the establishment of different neurosurgical schools in East and West Germany. Despite these great challenges, German neurosurgery made significant contributions to the development of the field during this time. Significant and important advances were made in hemostatic techniques, anesthesiology, and the development of new surgical instruments. Limitations in resources and technology posed enormous challenges. Craniotomy, which is presented as an example, represents the long and complex path of development of our specialty.

Background:  In general, sufficient anchoring of screws in the bone material ensures the intended primary stability.

Methods:  Shape memory materials offer the option of using temperature-associated deformation energy in a targeted manner to compensate the special situation of osteoporotic bones or the potential lack of anchoring. An expansion screw was developed for these purposes. Using finite element analysis (FEA), the variability of screw configuration and actuator was assessed from shape memory. In particular, the dimensioning of the screw slot, the actuator length, and the actuator diameter as well as the angle of attack in relation to the intended force development were considered.

Results:  As a result of the FEA, a special configuration of expansion screw and shape memory element could be found. Accordingly, with an optimal screw diameter of 4 mm, an actuator diameter of 0.8 mm, a screw slot of 7.8 mm in length, and an angle of attack of 25 degrees, the best compromise between individual components and high efficiency in favor of maximum strength can be predicted.

Conclusion:  Shape memory material offers the possibility of using completely new forms of power development. By skillfully modifying the mechanical and shape memory elements, their interaction results in a calculated development of force in favor of a high primary stability of the screw material used. Activation by means of body temperature is a very elegant way of initializing the intended locking and screw strength.