Impacting the Treatment of Highly Eloquent Supratentorial Cerebral Cavernous Malformations by Noninvasive Functional Mapping—An Observational Cohort Study

2021 ◽  
Author(s):  
Sebastian Ille ◽  
Axel Schroeder ◽  
Isabel C Hostettler ◽  
Maria Wostrack ◽  
Bernhard Meyer ◽  
...  
Keyword(s):  
Decision Making ◽  
Functional Mapping ◽  
Seizure Outcome ◽  
Cerebral Cavernous Malformations ◽  
Language Mapping ◽  
Cavernous Malformations ◽  
Motor Mapping ◽  
Observational Cohort ◽  
And Function ◽  
The Impact

Abstract BACKGROUND Cerebral cavernous malformations (CCM) may cause cavernoma-related epilepsy (CRE) and intracranial hemorrhage (ICH). Functional mapping has shown its usefulness during the resection of eloquent lesions including the treatment of brain arteriovenous malformations. OBJECTIVE To evaluate the impact of noninvasive functional mapping on decision-making and resection of eloquently located CCM. METHODS Of 126 patients with intracranial cavernomas, we prospectively included 40 consecutive patients (31.7%) with highly eloquent CCM between 2012 and 2020. We performed functional mapping via navigated transcranial magnetic stimulation (nTMS) motor mapping in 30 cases and nTMS language mapping in 20 cases. Twenty patients suffered from CRE. CCM caused ICH in 18 cases. RESULTS We used functional mapping data including function-based tractography in all cases. Indication toward (31 cases) or against (9 cases) CCM resection was influenced by noninvasive functional mapping in 36 cases (90%). We resected CCMs in 24 cases, and 7 patients refused the recommendation for surgery. In 19 and 4 cases, we used additional intraoperative neuromonitoring and awake craniotomy, respectively. Patients suffered from transient postoperative motor or language deficits in 2 and 2 cases, respectively. No patient suffered from permanent deficits. After 1 yr of follow-up, anti-epileptic drugs could be discontinued in all patients who underwent surgery but 1 patient. CONCLUSION Surgery-related deficit rates are low even for highly eloquent CCM and seizure outcome is excellent. The present results show that noninvasive functional mapping and function-based tractography is a useful tool for the decision-making process and during microsurgical resection of eloquently located CCM.

scholarly journals Platelet Function Disturbance During Veno-Venous ECMO in ARDS Patients Assessed by Multiple Electrode Aggregometry—A Prospective, Observational Cohort Study

2019 ◽  
Vol 8 (7) ◽  
pp. 1056 ◽  
Author(s):  
Saskia Wand ◽  
Jan Felix Huber-Petersen ◽  
Joern Schaeper ◽  
Claudia Binder ◽  
Onnen Moerer
Keyword(s):  
Platelet Aggregation ◽  
Platelet Function ◽  
Extracorporeal Circulation ◽  
Inverse Correlation ◽  
Negative Effects ◽  
Multiple Electrode Aggregometry ◽  
Observational Cohort ◽  
And Function ◽  
The Impact ◽  
Multiple Electrode

Extracorporeal (veno-venous) membrane oxygenation (vvECMO) has been shown to have negative effects on platelet number and function. This study aimed to gain more information about the impact of vvECMO on platelet function assessed by multiple electrode aggregometry (MEA). Twenty patients with the indication for vvECMO were included. Platelet function was analyzed using MEA (Multiplate®) before (T-1), 6 h (T0), one (T1), two (T2), three (T3), and seven (T4) days after the beginning of vvECMO. Median aggregational measurements were already below the normal reference range before vvECMO initiation. Platelet aggregation was significantly reduced 6 h after vvECMO initiation compared to T-1 and spontaneously recovered with a significant increase at T2. Platelet count dropped significantly between T-1 and T0 and continuously decreased between T0 and T4. At T4, ADP-induced platelet aggregation showed an inverse correlation with the paO2 in the oxygenator. Platelet function should be assessed by MEA before the initiation of extracorporeal circulation. Although ECMO therapy led to a further decrease in platelet aggregation after 6 h, all measurements had recovered to baseline on day two. This implies that MEA as a whole blood method might not adequately reflect the changes in platelet function in the later stages of extracorporeal circulation.

Surgical decision-making on cerebral cavernous malformations

2001 ◽  
Vol 8 (5) ◽  
pp. 416-420 ◽  
Author(s):  
Han Soo Chang ◽  
Kazuhiro Hongo ◽  
Hiroshi Nakagawa ◽  
Tadaharu Tsuge
Keyword(s):  
Decision Making ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Surgical Decision ◽  
Surgical Decision Making

scholarly journals A Brazilian Cohort of Patients With Immuno-Mediated Chronic Inflammatory Diseases Infected by SARS-CoV-2 (ReumaCoV-Brasil Registry): Protocol for a Prospective, Observational Study

10.2196/24357 ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. e24357
Author(s):  
Claudia Marques ◽  
Adriana Maria Kakehasi ◽  
Ana Paula Monteiro Gomides ◽  
Eduardo Dos Santos Paiva ◽  
Edgard Torres dos Reis Neto ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Inflammatory Diseases ◽  
Progression Rate ◽  
Immune Mediated ◽  
Increased Risk ◽  
Observational Cohort ◽  
And Function ◽  
The Impact ◽  
Brazilian Cohort

Background Patients with immune-mediated rheumatic diseases (IMRD) are at increased risk of infections, including significant morbidity and high mortality. Considering the potential for unfavorable outcomes of SARS-CoV-2 infection in patients with IMRD, several questions were raised regarding the impact of COVID-19 at the start of the pandemic. Objective This paper presents the protocol of a study that aims to prospectively evaluate patients with IMRD and a confirmed COVID-19 diagnosis (using criteria provided by the Brazilian Ministry of Health). Methods The study comprised a prospective, observational cohort (patients with IMRD and COVID-19) and a comparison group (patients with only IMRD), with a follow-up time of 6 months to evaluate differences in health outcomes. The primary outcomes will be changes in IMRD disease activity after SARS-CoV-2 infection at 4 time points: (1) at baseline, (2) within 4-6 weeks after infection, (3) at 3 months after the second assessment (±15 days), and (4) at 6 months (±15 days). The secondary outcomes will be the progression rate to moderate or severe forms of COVID-19, need for intensive care unit admission and mechanical ventilation, death, and therapeutic changes related to IMRD. Two outcomes—pulmonary and thromboembolic events in patients with both IMRD and SARS-CoV-2 infection—are of particular interest and will be monitored with close attention (clinical, laboratory, and function tests as well as imaging). Results Recruitment opened in May 2020, with 1300 participants recruited from 43 sites as of November 2020. Patient recruitment will conclude by the end of December 2020, with follow-up occurring until April 2021. Data analysis is scheduled to start after all inclusion data have been collected, with an aim to publish a peer-reviewed paper in December 2020. Conclusions We believe this study will provide clinically relevant data on the general impact of COVID-19 on patients with IMRD. Trial Registration Brazilian Registry of Clinical Trials RBR-33YTQC; http://www.ensaiosclinicos.gov.br/rg/RBR-33ytqc/ International Registered Report Identifier (IRRID) DERR1-10.2196/24357

scholarly journals Surgical management and long-term seizure outcome after epilepsy surgery for different types of epilepsy associated with cerebral cavernous malformations

Epilepsia ◽  
2013 ◽  
Vol 54 (9) ◽  
pp. 1699-1706 ◽  
Author(s):  
Christian von der Brelie ◽  
Michael P. Malter ◽  
Pitt Niehusmann ◽  
Christian E. Elger ◽  
Marec von Lehe ◽  
...  
Keyword(s):  
Surgical Management ◽  
Epilepsy Surgery ◽  
Seizure Outcome ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Different Types

Occipital epilepsy: spatial categorization and surgical management

2009 ◽  
Vol 110 (2) ◽  
pp. 306-318 ◽  
Author(s):  
Nitin Tandon ◽  
Andreas V. Alexopoulos ◽  
Ann Warbel ◽  
Imad M. Najm ◽  
William E. Bingaman
Keyword(s):  
Decision Making ◽  
Mr Imaging ◽  
Surgical Management ◽  
Visual Function ◽  
Cleveland Clinic ◽  
Occipital Lobe ◽  
Visual Field Defects ◽  
Seizure Outcome ◽  
Visual Deficits ◽  
The Impact

Object Occipital resections for epilepsy are rare. Reasons for this are the relative infrequency of occipital epilepsy, difficulty in localizing epilepsy originating in the occipital lobe, imprecisely defined seizure outcome in patients treated with focal occipital resections in the MR imaging era, and concerns about producing visual deficits. The impact of lesion location on vision and seizure biology, the management decision-making process, and the outcomes following resection need elaboration. Methods The authors studied 21 consecutive patients who underwent focal occipital resections for epilepsy at Cleveland Clinic Epilepsy Center over a 13-year period during which MR imaging was used. Demographics, imaging, and data relating to the epilepsy and its surgical management were collected. The collateral sulcus, the border between the medial surface and the lateral convexity, and the inferior temporal sulcus were used to subdivide the occipital lobe into medial, lateral, and basal zones. Lesions that did not involve most or all of the occipital lobe (sublobar) were spatially categorized into these zones. Visual function, semiology, and scalp electroencephalography were evaluated in relation to these spatial categories. Preresection and postresection visual function and seizure frequency were evaluated and compared. Lastly, an exhaustive review and discussion of the published literature on occipital resections for epilepsy was carried out. Results Five lesions were lobar and 16 were sublobar. Patients with medial or lobar lesions had a much greater likelihood of preoperative visual field defects. Those with basal or lateral lesions had a greater likelihood of having a visual aura preceding some or all of their seizures and a trend (not significant) toward having a concordant lateralized onset by scalp electroencephalography. Invasive recordings were used in 8 cases. All patients had lesions (malformations of cortical development, tumors, or gliosis) that were completely resected, as evaluated on postoperative MR imaging. At last follow-up, 17 patients (81%) were seizure free or had only occasional auras (Wieser Class 1 or 2). The remaining 4 patients (19%) had a worthwhile improvement in seizure control (Class 3 or 4). Of the patients for whom both pre- and postoperative visual testing data were available, 50% suffered no new visual deficits, and 17% each developed a new quadrantanopia or a hemianopia. Conclusions Lesional occipital lobe epilepsy can be successfully managed with resection to obtain excellent seizure-free rates. Individually tailored resections (in lateral occipital lesions, for example) may help preserve intact vision in a subset of cases (38% in this series). Invasive recordings may further guide surgical decision-making as delineated by an algorithm generated by the authors. The authors' results suggest that the spatial location of the lesion correlates both with the semiology of the seizure and with the presence of visual deficit.

Hemorrhage from cerebral cavernous malformations

Neurology ◽  
2020 ◽  
Vol 95 (1) ◽  
pp. e89-e96 ◽  
Author(s):  
Bixia Chen ◽  
Annika Herten ◽  
Dino Saban ◽  
Steffen Rauscher ◽  
Alexander Radbruch ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cox Regression ◽  
Binary Logistic Regression Analysis ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Cox Regression Analysis ◽  
Mode Of Presentation ◽  
The Impact

ObjectiveTo determine the role of associated developmental venous anomalies (DVAs) in intracranial hemorrhage (ICH) caused by cerebral cavernous malformations (CCMs).MethodsWe analyzed patient registry data of 1,219 patients with cavernous malformations treated in our institution between 2003 and 2018. Patients with spinal and familial CCM and patients without complete MRI data were excluded. The impact of various variables on ICH as a mode of presentation was assessed with multivariate binary logistic regression analysis. Kaplan Meier/Cox regression analysis was performed to analyze cumulative 5-year-risk for (re)hemorrhage and to identify baseline predictors of this outcome.ResultsSeven hundred thirty-one patients with CCM were included. Multivariate logistic regression confirmed a statistically significant negative correlation with DVA (odds ratio [OR] 0.635 [95% confidence interval (CI) 0.459–0.878]) and positive correlation with brainstem localization (OR 6.277 [95% CI 4.287–9.191]) with ICH as the mode of presentation. Among 731 patients, 76 experienced (re)hemorrhage during 2,338 person-years of follow-up. Overall cumulative 5-year risk was 24.1% (95% CI 21.1%–27.5%). Cox regression analysis revealed initial presentation with ICH (hazard ratio [HR] 8.0 [95% CI 3.549–18.122]) and brainstem localization (HR 2.9 [95% CI 1.756–4.765]) as independent baseline predictors of (re)hemorrhage. Presence of DVA added no independent prognostic information (HR 1.1 [95% CI 0.717–1.885]).ConclusionPatients with CCM with associated DVA are at lower risk to present with ICH. During untreated 5-year follow-up, they showed equal (re)hemorrhage risk compared to patients with CCM without DVA.

Systemic Conservatism in North American Organizations

1990 ◽  
Vol 11 (3) ◽  
pp. 413-433
Author(s):  
Barbara Wake Carroll
Keyword(s):  
Decision Making ◽  
Cultural Values ◽  
The United States ◽  
Decision Making Process ◽  
Organizational Decision Making ◽  
Rational Models ◽  
And Performance ◽  
Conservative Values ◽  
And Function ◽  
The Impact

Rational theories of organizational decision-making have shown that organiza tional outcomes and performance reflect a mixture of behavioural, structural and contextual factors, such as the goals of managers, the size and function of the organization, and the condition of the external environment. Critiques of this model suggest that non-rational factors such as national or systemic cultural values also affect the decision-making process. This article treats Canada and the United States as similar systems that differ in the degree to which their cultures embody conservative values. The author hypothesizes that the expenditure pat terns of organizations in the two countries will reflect this variation in systemic conservatism, and tests this expectation against data from a longitudinal sample of firms from three industries in each of the two countries. The analysis suggests that the impact and relative importance of the factors included in rational models of decision-making differ in Canada and the U.S. in ways that are consistent with the systemic conservatism hypothesis.

Surgical management and long-term outcome of pediatric patients with different subtypes of epilepsy associated with cerebral cavernous malformations

2014 ◽  
Vol 13 (6) ◽  
pp. 699-705 ◽  
Author(s):  
Christian von der Brelie ◽  
Stefan Kuczaty ◽  
Marec von Lehe
Keyword(s):  
Surgical Treatment ◽  
Pediatric Patients ◽  
Neurological Deficits ◽  
Seizure Outcome ◽  
Symptom Duration ◽  
Cerebral Cavernous Malformations ◽  
Term Outcome ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Class 1

Object Sufficient data on surgical treatment and seizure outcome of pediatric patients with different types of epilepsy, especially drug-resistant epilepsy and associated cerebral cavernous malformations, are scarce. The aim of this study was to carefully evaluate seizure outcome using the International League Against Epilepsy (ILAE) classification with regard to the presurgical symptom duration. Methods Fifty-one pediatric patients younger than 19 years with cerebral cavernous malformations of all CNS localizations have been surgically treated at the authors' institution. Twenty-two patients with seizures or epilepsy who harbored cortically located supratentorial cerebral cavernous malformations underwent surgical treatment and were retrospectively analyzed. Results More extensive resections were used in 82% of all patients with epilepsy symptoms for longer than 2 years. Eighty-two percent of patients with symptom duration shorter than 2 years underwent circumscribed lesionectomy including the surrounding hemosiderotic rim. The overall rate of mild permanent, unanticipated postoperative deficits was 4.5%; the rate of anticipated neurological deficits was 9%. The mean follow-up was longer than 117 months in all groups. Seizure outcome was excellent in the group with symptom duration shorter than 2 years (100% ILAE Class 1). Seizure outcome was significantly worse in the group with longer symptom duration (p = 0.02). Seven patients were seizure free after surgery. Seizure outcome was stable over the years. Conclusions Since seizure outcome is worse with longer seizure duration, early surgery and, if needed, interdisciplinary intervention, is recommended. Even in cases of multiple cerebral cavernous malformations and epilepsy, surgery should be considered.

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