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  • 1
    Online Resource
    Online Resource
    Disseminated Intravascular Coagulopathy in Cranial Surgery: Case Report and Review of the Literature
    S. Karger AG ; 2022
    In:  Case Reports in Oncology Vol. 15, No. 2 ( 2022-6-17), p. 624-629
    Details
    In: Case Reports in Oncology, S. Karger AG, Vol. 15, No. 2 ( 2022-6-17), p. 624-629
    Abstract: We present a rare case with multifocal osseous metastases of prostate cancer and disseminated intravascular coagulopathy (DIC). The patient received systemic tumor therapy, including antiandrogen agents as well as cerebral radiation. Due to rapid clinical deterioration, indication for surgery of the space-occupying calvarial metastasis was made as a salvage therapy procedure. Depleted clotting factors were substituted, and patient underwent tumor embolization prior to surgery. Although his neurological status improved postoperatively, the patient died suffering from multiple supra- and infratentorial infarctions. Our case report elucidates the laboratory results and difficulties of DIC in this case as well as possible treatment strategies.
    Type of Medium: Online Resource
    ISSN: 1662-6575
    URL: Article
    DOI: 10.1159/000523897
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 2458961-5
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  • 2
    Online Resource
    Online Resource
    Frameless Stereotactic Functional Neuronavigation Combined with Intraoperative Magnetic Resonance Imaging as a Strategy in Highly Eloquent Located Tumors Causing Epilepsy
    S. Karger AG ; 2014
    In:  Stereotactic and Functional Neurosurgery Vol. 92, No. 1 ( 2014), p. 59-67
    Details
    In: Stereotactic and Functional Neurosurgery, S. Karger AG, Vol. 92, No. 1 ( 2014), p. 59-67
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Intractable epilepsy due to tumors located in highly eloquent brain regions is often considered surgically inaccessible because of a high risk of postoperative neurological deterioration. Intraoperative MRI and functional navigation contribute to overcome this problem. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 To retrospectively investigate the long-term results and impact of functional neuronavigation and 1.5-tesla intraoperative MRI on patients who underwent surgery of tumors associated with epilepsy located close to or within eloquent brain areas. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Nineteen patients (9 female, 10 male, mean age 41.4 ± 13.4 years, 11 low-grade and 8 high-grade glial tumors) were evaluated preoperatively using BOLD imaging, diffusion-tensor imaging tractography and magnetoencephalography. Functional data were implemented into neuronavigation in this multimodal approach. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In 14 of 19 patients (74%), complete resection was achieved, and in 5 patients significant tumor volume reduction was accomplished. Eight of 14 (57%) complete resections were achieved only by performing an intraoperative image update. Neurological deterioration was found permanently in 2 patients. After a mean follow-up of 43.8 ± 23.8 months, 15 patients (79%) became seizure free (Engel class Ia). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Despite the highly eloquent location of tumors causing intractable epilepsy, our multimodal approach led to complete resection in more than two-thirds of patients with an acceptable neurological morbidity and excellent long-term seizure control.
    Type of Medium: Online Resource
    ISSN: 1011-6125 , 1423-0372
    URL: Article
    DOI: 10.1159/000355216
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 1483576-9
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  • 3
    Online Resource
    Online Resource
    Risk Reduction in Dominant Temporal Lobe Epilepsy Surgery Combining fMRI/DTI Maps, Neuronavigation and Intraoperative 1.5-Tesla MRI
    S. Karger AG ; 2015
    In:  Stereotactic and Functional Neurosurgery Vol. 93, No. 3 ( 2015), p. 168-177
    Details
    In: Stereotactic and Functional Neurosurgery, S. Karger AG, Vol. 93, No. 3 ( 2015), p. 168-177
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 In dominant temporal lobe epilepsy surgery, speech, memory and visual systems are at risk. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging combined with intraoperative neuronavigation and MRI were investigated retrospectively regarding risk reductions for favorable neurological and seizure outcome. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Functional imaging risk maps were generated for 14 patients suffering from dominant temporal lobe epilepsy [7 with hippocampal sclerosis (HS), 7 with various lesions] and used for neuronavigation-guided tailored resection. Postoperative neurological and seizure outcome and complications were evaluated. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 None of the patients had postoperative speech dysfunction despite 2.3/3.6-cm mean hippocampal/neocortical resection. Verbal memory decline was found in 2 of the 14 (14.3%) patients, correlating with surgical lesions in fMRI memory-activated functional areas in the dominant posterior parahippocampal gyrus. Verbal memory scores did not statistically differ between the HS and the lesional group, neither pre- nor postoperatively. A contralateral visual field defect occurred in 1 patient (7.1%). An Engel class I seizure outcome was found in 12 patients (85.7%), and 11 were completely seizure free (78.6%) at a mean follow-up of 19.5 months. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 This retrospectively investigated protocol led to an excellent neurological and seizure outcome and a low complication rate in dominant temporal lobe epilepsy surgery.
    Type of Medium: Online Resource
    ISSN: 1011-6125 , 1423-0372
    URL: Article
    DOI: 10.1159/000375173
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
    detail.hit.zdb_id: 1483576-9
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  • 4
    Online Resource
    Online Resource
    Seminoma Clinical Stage 1 - Patterns of Care in Germany
    S. Karger AG ; 2016
    In:  Urologia Internationalis Vol. 96, No. 4 ( 2016), p. 390-398
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 96, No. 4 ( 2016), p. 390-398
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 International guidelines are ambivalent regarding the recommendations for the management of clinical stage 1 (CS1) seminoma. 〈 b 〉 〈 i 〉 Patients and Methods: 〈 /i 〉 〈 /b 〉 During 2008-2013, 1,050 patients with seminoma CS1 were prospectively registered with regard to assessing management modality (radiotherapy, carboplatin, surveillance). Associations with tumor size, rete testis invasion, age, year of diagnosis, type of institution, and geographic location were assessed. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of the total number of patients, 49.3% received carboplatin 1 course, 8.5% carboplatin 2 courses, 35.9% surveillance, and 6.3% radiotherapy. In 2013, surveillance increased significantly to 57.9%. Treatment decisions were significantly associated with rete testis invasion and tumor size. Carboplatin was applied significantly more in office clinics than elsewhere. There is some regional variation regarding treatment preferences. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The rising acceptance of surveillance mirrors international trends. The associations with prognostic factors demonstrate care givers to be compliant with contemporary guidelines. The association with the type of institution suggests non-oncological factors to be also relevant in decision making.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000443214
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
    detail.hit.zdb_id: 1464417-4
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  • 5
    Online Resource
    Online Resource
    Economic Burden in a German Cohort of Patients with Multiple Sclerosis
    S. Karger AG ; 2011
    In:  European Neurology Vol. 66, No. 6 ( 2011), p. 311-321
    Details
    In: European Neurology, S. Karger AG, Vol. 66, No. 6 ( 2011), p. 311-321
    Abstract: 〈 i 〉 Aims: 〈 /i 〉 To estimate costs of multiple sclerosis (MS) in a German cohort according to severity of the disease and clinical symptoms. 〈 i 〉 Methods: 〈 /i 〉 144 patients were recruited from an MS outpatient clinic. Costs were calculated according to current German health-economic guidelines from the perspective of the social health insurance system. Patients were either interviewed or completed a questionnaire. Cost assessment covered a 3-month period. Health outcomes were: Expanded Disability Status Scale, MS Functional Composite, Functional Assessment of MS, fatigue, depression (Beck Depression Inventory II) and patients’ socioeconomic status. Multivariate linear regression identified independent cost predictors. 〈 i 〉 Results: 〈 /i 〉 Total quarterly costs per patient were EUR 10,329 (95% CI 9,357–11,390). Direct costs were EUR 5,344 for the social health insurance system and EUR 140 for the patient. Drugs represented the major share of direct costs (and 35% of total costs); indirect costs accounted for 47% of total costs. Univariate and multivariate analyses identified age, disability, fatigue and depression as independent predictors for total, indirect or drug costs. 〈 i 〉 Conclusion: 〈 /i 〉 MS represents a high economic burden, with direct costs exceeding indirect costs. To reduce costs, research should focus on prevention that slows down progression of MS. Rehabilitation and symptomatic treatment may have merits in decreasing indirect costs.
    Type of Medium: Online Resource
    ISSN: 0014-3022 , 1421-9913
    URL: Article
    DOI: 10.1159/000331043
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1482237-4
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