@article{MrestaniPauliKollmannsbergeretal.2021, author = {Mrestani, Achmed and Pauli, Martin and Kollmannsberger, Philip and Repp, Felix and Kittel, Robert J. and Eilers, Jens and Doose, S{\"o}ren and Sauer, Markus and Sir{\´e}n, Anna-Leena and Heckmann, Manfred and Paul, Mila M.}, title = {Active zone compaction correlates with presynaptic homeostatic potentiation}, series = {Cell Reports}, volume = {37}, journal = {Cell Reports}, number = {1}, doi = {10.1016/j.celrep.2021.109770}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265497}, pages = {109770}, year = {2021}, abstract = {Neurotransmitter release is stabilized by homeostatic plasticity. Presynaptic homeostatic potentiation (PHP) operates on timescales ranging from minute- to life-long adaptations and likely involves reorganization of presynaptic active zones (AZs). At Drosophila melanogaster neuromuscular junctions, earlier work ascribed AZ enlargement by incorporating more Bruchpilot (Brp) scaffold protein a role in PHP. We use localization microscopy (direct stochastic optical reconstruction microscopy [dSTORM]) and hierarchical density-based spatial clustering of applications with noise (HDBSCAN) to study AZ plasticity during PHP at the synaptic mesoscale. We find compaction of individual AZs in acute philanthotoxin-induced and chronic genetically induced PHP but unchanged copy numbers of AZ proteins. Compaction even occurs at the level of Brp subclusters, which move toward AZ centers, and in Rab3 interacting molecule (RIM)-binding protein (RBP) subclusters. Furthermore, correlative confocal and dSTORM imaging reveals how AZ compaction in PHP translates into apparent increases in AZ area and Brp protein content, as implied earlier.}, language = {en} } @article{StetterLopezCaperuchipiHoppKraemeretal.2021, author = {Stetter, Christian and Lopez-Caperuchipi, Simon and Hopp-Kr{\"a}mer, Sarah and Bieber, Michael and Kleinschnitz, Christoph and Sir{\´e}n, Anna-Leena and Albert-Weißenberger, Christiane}, title = {Amelioration of cognitive and behavioral deficits after traumatic brain injury in coagulation factor XII deficient mice}, series = {International Journal of Molecular Sciences}, volume = {22}, journal = {International Journal of Molecular Sciences}, number = {9}, issn = {1422-0067}, doi = {10.3390/ijms22094855}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284959}, year = {2021}, abstract = {Based on recent findings that show that depletion of factor XII (FXII) leads to better posttraumatic neurological recovery, we studied the effect of FXII-deficiency on post-traumatic cognitive and behavioral outcomes in female and male mice. In agreement with our previous findings, neurological deficits on day 7 after weight-drop traumatic brain injury (TBI) were significantly reduced in FXII\(^{-/-}\) mice compared to wild type (WT) mice. Also, glycoprotein Ib (GPIb)-positive platelet aggregates were more frequent in brain microvasculature of WT than FXII\(^{-/-}\) mice 3 months after TBI. Six weeks after TBI, memory for novel object was significantly reduced in both female and male WT but not in FXII\(^{-/-}\) mice compared to sham-operated mice. In the setting of automated home-cage monitoring of socially housed mice in IntelliCages, female WT mice but not FXII\(^{-/-}\) mice showed decreased exploration and reacted negatively to reward extinction one month after TBI. Since neuroendocrine stress after TBI might contribute to trauma-induced cognitive dysfunction and negative emotional contrast reactions, we measured peripheral corticosterone levels and the ration of heart, lung, and spleen weight to bodyweight. Three months after TBI, plasma corticosterone levels were significantly suppressed in both female and male WT but not in FXII\(^{-/-}\) mice, while the relative heart weight increased in males but not in females of both phenotypes when compared to sham-operated mice. Our results indicate that FXII deficiency is associated with efficient post-traumatic behavioral and neuroendocrine recovery.}, language = {en} } @phdthesis{Feldheim2021, author = {Feldheim, Jonas Alexander}, title = {ATF5-Expression und MGMT-Promotormethylierungs{\"a}nderungen in glialen Tumoren}, doi = {10.25972/OPUS-24320}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-243208}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {Die WHO-Klassifikation der Hirntumoren von 2016 ebnete den Weg f{\"u}r molekulare Marker und Therapie-Angriffspunkte. Der Transkriptionsfaktor ATF5 k{\"o}nnte ein solcher sein. Er unterdr{\"u}ckt die Differenzierung von neuronalen Vorl{\"a}uferzellen und wird in Glioblastomen (GBM) {\"u}berexprimiert. Daten zur ATF5-Expression in WHO Grad II Gliomen (LGG) und GBM-Rezidiven sind nur sp{\"a}rlich vorhanden. Daher untersuchten wir 79 GBM, 40 LGG und 10 Normalhirnproben auf ihre ATF5-mRNA- und Proteinexpression mit quantitativer Echtzeit-PCR bzw. Immunhistochemie und verglichen sie mit multiplen, retrospektiv erhobenen klinischen Charakteristika der Patienten. ATF5 war in LGG und GBM verglichen zum Normalhirn sowohl auf mRNA-, als auch Proteinebene {\"u}berexprimiert. Obwohl die ATF5-mRNA-Expression im GBM eine erhebliche Fluktuationsrate zeigte, gab es keine signifikanten Expressionsunterschiede zwischen GBM-Gruppen unterschiedlicher biologischer Wachstumsmuster. ATF5-mRNA korrelierte mit dem Alter der Patienten und invers mit der Ki67-F{\"a}rbung. Kaplan Meier- und Cox-Regressionsanalysen zeigten eine signifikante Korrelation der ATF5-mRNA-Expression mit dem {\"U}berleben nach 12 Monaten sowie dem progressionsfreien {\"U}berleben. Die Methylierung des Promotors der O6-Methylguanin-DNA-Methyltransferase (MGMT) ist ein etablierter Marker in der Therapie des GBMs. Sie ist mit dem therapeutischen Ansprechen auf Temozolomid und dem {\"U}berleben assoziiert. Uns fielen inzidentell Ver{\"a}nderungen der MGMT-Promotormethylierung auf, woraufhin wir den aktuellen Wissensstand mittels einer ausf{\"u}hrlichen Literatur-Metaanalyse zusammenfassten. Dabei fanden wir Ver{\"a}nderungen der MGMT-Promotormethylierung bei 115 der 476 Patienten. Wir schlussfolgern, dass die ATF5-mRNA-Expression als prognostischer Faktor f{\"u}r das {\"U}berleben der Patienten dienen k{\"o}nnte. Da seine in vitro-Inhibition zu einem selektiven Zelltod von Gliomzellen f{\"u}hrte und wir eine {\"U}berexpression in glialen Tumoren nachweisen konnten, zeigt ATF5 Potential als ubiquit{\"a}res Therapieziel in Gliomen. Zum aktuellen Zeitpunkt ergibt sich keine klare Indikation, den klinischen Standard der MGMT-Teststrategie zu ver{\"a}ndern. Trotzdem k{\"o}nnte eine erneute Testung der MGMT-Promotormethylierung f{\"u}r zuk{\"u}nftige Therapieentscheidungen sinnvoll sein und wir regen an, dass dieses Thema in klinischen Studien weiter untersucht wird.}, subject = {Glioblastom}, language = {de} } @article{LillaKesslerWeilandetal.2021, author = {Lilla, Nadine and Kessler, Almuth F. and Weiland, Judith and Ernestus, Ralf-Ingo and Westermaier, Thomas}, title = {Case Report: A Case Series Using Natural Anatomical Gaps — Posterior Cervical Approach to Skull Base and Upper Craniocervical Meningiomas Without Bone Removal}, series = {Frontiers in Surgery}, volume = {8}, journal = {Frontiers in Surgery}, issn = {2296-875X}, doi = {10.3389/fsurg.2021.666699}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-244613}, year = {2021}, abstract = {Background: Removal of anteriorly located tumors of the upper cervical spine and craniovertebral junction (CVJ) is a particular surgical challenge. Extensive approaches are associated with pain, restricted mobility of neck and head and, in case of foramen magnum and clivus tumors, with retraction of brainstem and cerebellum. Methods: Four symptomatic patients underwent resection of anteriorly located upper cervical and lower clivus meningiomas without laminotomy or craniotomy using a minimally invasive posterior approach. Distances of natural gaps between C0/C1, C1/C2, and C2/C3 were measured using preoperative CT scans and intraoperative lateral x-rays. Results: In all patients, safe and complete resection was conducted by the opening of the dura between C0/C1, C1/C2, and C2/C3, respectively. There were no surgical complications. Local pain was reported as very moderate by all patients and postoperative recovery was extremely fast. All tumors had a rather soft consistency, allowing mass reduction prior to removal of the tumor capsule and were well separable from lower cranial nerves and vascular structures. Conclusion: If tumor consistency is appropriate for careful mass reduction before removal of the tumor capsule and if tumor margins are not firmly attached to crucial structures, then upper cervical, foramen magnum, and lower clivus meningiomas can be safely and completely removed through natural gaps in the CVJ region. Both prerequisites usually become clear early during surgery. Thus, this tumor entity may be planned using this minimally invasive approach and may be extended if tumor consistency turns out to be less unfavorable for resection or if crucial structures cannot be easily separated from the tumor.}, language = {en} } @article{LinsenmannCattaneoMaerzetal.2021, author = {Linsenmann, Thomas and Cattaneo, Andrea and M{\"a}rz, Alexander and Weiland, Judith and Stetter, Christian and Nickl, Robert and Westermaier, Thomas}, title = {Combined frameless stereotactical biopsy and intraoperative cerebral angiography by 3D-rotational fluoroscopy with intravenous contrast administration: a feasibility study}, series = {BMC Medical Imaging}, volume = {21}, journal = {BMC Medical Imaging}, doi = {10.1186/s12880-021-00622-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-270370}, year = {2021}, abstract = {Background Mobile 3-dimensional fluoroscopes are an integral part of modern neurosurgical operating theatres and can also be used in combination with free available image post processing to depict cerebral vessels. In preparation of stereotactic surgery, preoperative Computed Tomography (CT) may be required for image fusion. Contrast CT may be of further advantage for image fusion as it regards the vessel anatomy in trajectory planning. Time-consuming in-hospital transports are necessary for this purpose. Mobile 3D-fluoroscopes may be used to generate a CT equal preoperative data set without an in-hospital transport. This study was performed to determine the feasibility and image quality of intraoperative 3-dimensional fluoroscopy with intravenous contrast administration in combination with stereotactical procedures. Methods 6 patients were included in this feasibility study. After fixation in a radiolucent Mayfield clamp a rotational fluoroscopy scan was performed with 50 mL iodine contrast agent. The image data sets were merged with the existing MRI images at a planning station and visually evaluated by two observer. The operation times were compared between the frame-based and frameless systems ("skin-to-skin" and "OR entry to exit"). Results The procedure proves to be safe. The entire procedure from fluoroscope positioning to the transfer to the planning station took 5-6 min with an image acquisition time of 24 s. In 5 of 6 cases, the fused imaging was able to reproduce the vascular anatomy accurately and in good quality. Both time end-points were significantly shorter compared to frame-based interventions. Conclusion The images could easily be transferred to the planning and navigation system and were successfully merged with the MRI data set. The procedure can be completely integrated into the surgical workflow. Preoperative CT imaging or transport under anaesthesia may even be replaced by this technique in the future. Furthermore, hemorrhages can be successfully visualized intraoperatively and might prevent time delays in emergencies.}, language = {en} } @article{SchwinnMokhtariThuseketal.2021, author = {Schwinn, Stefanie and Mokhtari, Zeinab and Thusek, Sina and Schneider, Theresa and Sir{\´e}n, Anna-Leena and Tiemeyer, Nicola and Caruana, Ignazio and Miele, Evelina and Schlegel, Paul G. and Beilhack, Andreas and W{\"o}lfl, Matthias}, title = {Cytotoxic effects and tolerability of gemcitabine and axitinib in a xenograft model for c-myc amplified medulloblastoma}, series = {Scientific Reports}, volume = {11}, journal = {Scientific Reports}, number = {1}, doi = {10.1038/s41598-021-93586-x}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-261476}, year = {2021}, abstract = {Medulloblastoma is the most common high-grade brain tumor in childhood. Medulloblastomas with c-myc amplification, classified as group 3, are the most aggressive among the four disease subtypes resulting in a 5-year overall survival of just above 50\%. Despite current intensive therapy regimens, patients suffering from group 3 medulloblastoma urgently require new therapeutic options. Using a recently established c-myc amplified human medulloblastoma cell line, we performed an in-vitro-drug screen with single and combinatorial drugs that are either already clinically approved or agents in the advanced stage of clinical development. Candidate drugs were identified in vitro and then evaluated in vivo. Tumor growth was closely monitored by BLI. Vessel development was assessed by 3D light-sheet-fluorescence-microscopy. We identified the combination of gemcitabine and axitinib to be highly cytotoxic, requiring only low picomolar concentrations when used in combination. In the orthotopic model, gemcitabine and axitinib showed efficacy in terms of tumor control and survival. In both models, gemcitabine and axitinib were better tolerated than the standard regimen comprising of cisplatin and etoposide phosphate. 3D light-sheet-fluorescence-microscopy of intact tumors revealed thinning and rarefication of tumor vessels, providing one explanation for reduced tumor growth. Thus, the combination of the two drugs gemcitabine and axitinib has favorable effects on preventing tumor progression in an orthotopic group 3 medulloblastoma xenograft model while exhibiting a favorable toxicity profile. The combination merits further exploration as a new approach to treat high-risk group 3 medulloblastoma.}, language = {en} } @phdthesis{Schmitt2021, author = {Schmitt, Dominik}, title = {Genexpressionsanalysen der tumor-/metastasierungsassoziierten Proteine ATF5, KiSS1, RPS27, BRMS1 und TTK in neuroglialen Hirntumoren}, doi = {10.25972/OPUS-22287}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-222873}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {Hirntumoren werden nach histologischen und molekulargenetischen Gesichtspunkten unterteilt. Neben dem Krankheitsverlauf unterscheiden sich LGA auch genetisch von GBM. Wie die mRNA der Proteine ATF5, KiSS1, RPS27, BRMS1 und TTK in LGA exprimiert ist bzw. sich im Verlauf ver{\"a}ndert, war in dieser Form noch nicht in einem Patientenpanel untersucht worden. Ziel dieser Arbeit war es, die mRNA-Expressionsraten zu bestimmen sowie Korrelationen und Kointegrationen mit klinischen Daten zu analysieren. Außerdem wurden Besonderheiten der Verteilung innerhalb des Patientenpanels beschrieben. Quantitative-PCR-Analysen wurden durchgef{\"u}hrt. Die Expressionswerte wurden auf die Expression des Haushaltsgens GAPDH normalisiert. Die resultierenden ∆CTm - bzw. ∆∆CT-Werte sowie die klinischen Patientendaten waren Basis f{\"u}r Kointegrations-, Korrelations-, Expressions-, {\"A}hnlichkeits- und Verlaufsanalysen. KiSS1 schien generell kaum oder nicht in der Vielzahl der Tumoren exprimiert zu sein, Aussagen zur klinischen Korrelation erwiesen sich als schwierig. F{\"u}r RPS27 konnten tendenziell niedrigere Werte in den Verlaufstumoren im Vergleich zu den LGA gefunden werden. Auch f{\"u}r BRMS1 war in der Mehrzahl der F{\"a}lle die mRNA der Vorl{\"a}ufertumoren in Relation zu den Rezidiven st{\"a}rker exprimiert. ATF5 korrelierte nach Kendall RE und PFS (-0,324; p=0,077) in der Gruppe der IDH1-mutierten LGA, f{\"u}r TTK nach Kendall OS und RE (-0,444; p=0,097) im Gesamtpanel und nach Pearson auch RE und PFS (-0,43; p=0,096) in der Gruppe der IDH1-mutierten LGA.}, subject = {Genexpression}, language = {de} } @article{GrosseRueckriegelThomaleetal.2021, author = {Grosse, Frederik and Rueckriegel, Stefan Mark and Thomale, Ulrich-Wilhelm and Hern{\´a}iz Driever, Pablo}, title = {Mapping of long-term cognitive and motor deficits in pediatric cerebellar brain tumor survivors into a cerebellar white matter atlas}, series = {Child's Nervous System}, volume = {37}, journal = {Child's Nervous System}, number = {9}, issn = {0256-7040}, doi = {10.1007/s00381-021-05244-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-307416}, pages = {2787-2797}, year = {2021}, abstract = {Purpose Diaschisis of cerebrocerebellar loops contributes to cognitive and motor deficits in pediatric cerebellar brain tumor survivors. We used a cerebellar white matter atlas and hypothesized that lesion symptom mapping may reveal the critical lesions of cerebellar tracts. Methods We examined 31 long-term survivors of pediatric posterior fossa tumors (13 pilocytic astrocytoma, 18 medulloblastoma). Patients underwent neuronal imaging, examination for ataxia, fine motor and cognitive function, planning abilities, and executive function. Individual consolidated cerebellar lesions were drawn manually onto patients' individual MRI and normalized into Montreal Neurologic Institute (MNI) space for further analysis with voxel-based lesion symptom mapping. Results Lesion symptom mapping linked deficits of motor function to the superior cerebellar peduncle (SCP), deep cerebellar nuclei (interposed nucleus (IN), fastigial nucleus (FN), ventromedial dentate nucleus (DN)), and inferior vermis (VIIIa, VIIIb, IX, X). Statistical maps of deficits of intelligence and executive function mapped with minor variations to the same cerebellar structures. Conclusion We identified lesions to the SCP next to deep cerebellar nuclei as critical for limiting both motor and cognitive function in pediatric cerebellar tumor survivors. Future strategies safeguarding motor and cognitive function will have to identify patients preoperatively at risk for damage to these critical structures and adapt multimodal therapeutic options accordingly.}, language = {en} } @article{WeilandBeezWestermaieretal.2021, author = {Weiland, Judith and Beez, Alexandra and Westermaier, Thomas and Kunze, Ekkehard and Sir{\´e}n, Anna-Leena and Lilla, Nadine}, title = {Neuroprotective strategies in aneurysmal subarachnoid hemorrhage (aSAH)}, series = {International Journal of Molecular Sciences}, volume = {22}, journal = {International Journal of Molecular Sciences}, number = {11}, issn = {1422-0067}, doi = {10.3390/ijms22115442}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-260755}, year = {2021}, abstract = {Aneurysmal subarachnoid hemorrhage (aSAH) remains a disease with high mortality and morbidity. Since treating vasospasm has not inevitably led to an improvement in outcome, the actual emphasis is on finding neuroprotective therapies in the early phase following aSAH to prevent secondary brain injury in the later phase of disease. Within the early phase, neuroinflammation, thromboinflammation, disturbances in brain metabolism and early neuroprotective therapies directed against delayed cerebral ischemia (DCI) came into focus. Herein, the role of neuroinflammation, thromboinflammation and metabolism in aSAH is depicted. Potential neuroprotective strategies regarding neuroinflammation target microglia activation, metalloproteases, autophagy and the pathway via Toll-like receptor 4 (TLR4), high mobility group box 1 (HMGB1), NF-κB and finally the release of cytokines like TNFα or IL-1. Following the link to thromboinflammation, potential neuroprotective therapies try to target microthrombus formation, platelets and platelet receptors as well as clot clearance and immune cell infiltration. Potential neuroprotective strategies regarding metabolism try to re-balance the mismatch of energy need and supply following aSAH, for example, in restoring fuel to the TCA cycle or bypassing distinct energy pathways. Overall, this review addresses current neuroprotective strategies in aSAH, hopefully leading to future translational therapy options to prevent secondary brain injury.}, language = {en} } @article{LinsenmannMaerzDufneretal.2021, author = {Linsenmann, Thomas and M{\"a}rz, Alexander and Dufner, Vera and Stetter, Christian and Weiland, Judith and Westermaier, Thomas}, title = {Optimization of radiation settings for angiography using 3D fluoroscopy for imaging of intracranial aneurysms}, series = {Computer Assisted Surgery}, volume = {26}, journal = {Computer Assisted Surgery}, number = {1}, doi = {10.1080/24699322.2021.1894240}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-259251}, pages = {22-30}, year = {2021}, abstract = {Mobile 3D fluoroscopes have become increasingly available in neurosurgical operating rooms. We recently reported its use for imaging cerebral vascular malformations and aneurysms. This study was conducted to evaluate various radiation settings for the imaging of cerebral aneurysms before and after surgical occlusion. Eighteen patients with cerebral aneurysms with the indication for surgical clipping were included in this prospective analysis. Before surgery the patients were randomized into one of three different scan protocols according (default settings of the 3D fluoroscope): Group 1: 110 kV, 80 mA (enhanced cranial mode), group 2: 120 kV, 64 mA (lumbar spine mode), group 3: 120 kV, 25 mA (head/neck settings). Prior to surgery, a rotational fluoroscopy scan (duration 24 s) was performed without contrast agent followed by another scan with 50 ml of intravenous iodine contrast agent. The image files of both scans were transferred to an Apple PowerMac(R) workstation, subtracted and reconstructed using OsiriX(R) MD 10.0 software. The procedure was repeated after clip placement. The image quality regarding preoperative aneurysm configuration and postoperative assessment of aneurysm occlusion and vessel patency was analyzed by 2 independent reviewers using a 6-grade scale. This technique quickly supplies images of adequate quality to depict intracranial aneurysms and distal vessel patency after aneurysm clipping. Regarding these features, a further optimization to our previous protocol seems possible lowering the voltage and increasing tube current. For quick intraoperative assessment, image subtraction seems not necessary. Thus, a native scan without a contrast agent is not necessary. Further optimization may be possible using a different contrast injection protocol.}, language = {en} } @article{LangeSteigerwaldMalzacheretal.2021, author = {Lange, Florian and Steigerwald, Frank and Malzacher, Tobias and Brandt, Gregor Alexander and Odorfer, Thorsten Michael and Roothans, Jonas and Reich, Martin M. and Fricke, Patrick and Volkmann, Jens and Matthies, Cordula and Capetian, Philipp D.}, title = {Reduced Programming Time and Strong Symptom Control Even in Chronic Course Through Imaging-Based DBS Programming}, series = {Frontiers in Neurology}, volume = {12}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2021.785529}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-249634}, year = {2021}, abstract = {Objectives: Deep brain stimulation (DBS) programming is based on clinical response testing. Our clinical pilot trial assessed the feasibility of image-guided programing using software depicting the lead location in a patient-specific anatomical model. Methods: Parkinson's disease patients with subthalamic nucleus-DBS were randomly assigned to standard clinical-based programming (CBP) or anatomical-based (imaging-guided) programming (ABP) in an 8-week crossover trial. Programming characteristics and clinical outcomes were evaluated. Results: In 10 patients, both programs led to similar motor symptom control (MDS-UPDRS III) after 4 weeks (medicationOFF/stimulationON; CPB: 18.27 ± 9.23; ABP: 18.37 ± 6.66). Stimulation settings were not significantly different, apart from higher frequency in the baseline program than CBP (p = 0.01) or ABP (p = 0.003). Time spent in a program was not significantly different (CBP: 86.1 ± 29.82\%, ABP: 88.6 ± 29.0\%). Programing time was significantly shorter (p = 0.039) with ABP (19.78 ± 5.86 min) than CBP (45.22 ± 18.32). Conclusion: Image-guided DBS programming in PD patients drastically reduces programming time without compromising symptom control and patient satisfaction in this small feasibility trial.}, language = {en} } @article{GugelGrimmHartjenetal.2021, author = {Gugel, Isabel and Grimm, Florian and Hartjen, Philip and Breun, Maria and Zipfel, Julian and Liebsch, Marina and L{\"o}wenheim, Hubert and Ernemann, Ulrike and Kluwe, Lan and Mautner, Victor-Felix and Tatagiba, Marcos and Schuhmann, Martin Ulrich}, title = {Risk stratification for immediate postoperative hearing loss by preoperative BAER (brainstem auditory evoked response) and audiometry in NF2-associated vestibular schwannomas}, series = {Cancers}, volume = {13}, journal = {Cancers}, number = {6}, issn = {2072-6694}, doi = {10.3390/cancers13061384}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-234165}, year = {2021}, abstract = {Both brainstem auditory evoked potentials (BAEP) and audiometry play a crucial role in neuro-oncological treatment decisions in Neurofibromatosis Type 2 associated (NF2) vestibular schwannoma (VS) as hearing preservation is the major goal. In this study, we investigated the risk of immediate postoperative hearing deterioration (>15 dB and/or 15\% loss in pure-tone average [PTA]/ speech discrimination score [SDS] in a cohort of 100 operated VS (ears) in 72 NF2 patients by retrospective analysis of pre- and postoperative hearing data (PTA, SDS, American Association of Otolaryngology-Head and Neck Surgery [AAO-HNS], and brainstem auditory evoked potential [BAEP] class) taking into account relevant influencing factors, particularly preoperative audiometry and BAEP status and the extent of resection. Immediately after surgery, the hearing was preserved in 73\% of ears and approximately ~60\% of ears kept their hearing classes. Preoperative BAEP (p = 0.015) and resection amount (p = 0.048) significantly influenced postoperative hearing outcome. The prediction model for postoperative hearing deterioration/loss between preoperative BAEP and AAO-HNS class showed increased risk by increasing BAEP class. Twenty-one tumors/ears were identified with large BAEP and AAO-HNS class discrepancies (≥2 points) and were associated with a high (48-100\%) risk of deafness after surgery in ears with preoperative available hearing. Overall, the results were heterogeneous but the better both BAEP and audiometry class before surgery, the higher the chance of hearing maintenance afterwards. Large resection amounts (e.g., 100\% risk in near-total resections) exhibit a significant (p < 0.05) higher risk compared to smaller amounts (e.g., 10/20\% in laser-coagulated/partially resected tumors). Our results emphasized the indispensable role of both hearing monitoring in form of audiometry and neurophysiology (BAEP) in the pre-and perioperative monitoring of NF2-associated VS. Both BAEP and audiometry are good prognostic markers for the postoperative hearing outcome. The extent of resection should be strictly guided by and adjusted to the intraoperative neurophysiological monitoring.}, language = {en} } @article{SalvadorBurekLoehretal.2021, author = {Salvador, Ellaine and Burek, Malgorzata and L{\"o}hr, Mario and Nagai, Michiaki and Hagemann, Carsten and F{\"o}rster, Carola Y.}, title = {Senescence and associated blood-brain barrier alterations in vitro}, series = {Histochemistry and Cell Biology}, volume = {156}, journal = {Histochemistry and Cell Biology}, number = {3}, issn = {1432-119X}, doi = {10.1007/s00418-021-01992-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-267435}, pages = {283-292}, year = {2021}, abstract = {Progressive deterioration of the central nervous system (CNS) is commonly associated with aging. An important component of the neurovasculature is the blood-brain barrier (BBB), majorly made up of endothelial cells joined together by intercellular junctions. The relationship between senescence and changes in the BBB has not yet been thoroughly explored. Moreover, the lack of in vitro models for the study of the mechanisms involved in those changes impede further and more in-depth investigations in the field. For this reason, we herein present an in vitro model of the senescent BBB and an initial attempt to identify senescence-associated alterations within.}, language = {en} } @article{NotzLotzHerrmannetal.2021, author = {Notz, Quirin and Lotz, Christopher and Herrmann, Johannes and Vogt, Marius and Schlesinger, Tobias and Kredel, Markus and Muellges, Wolfgang and Weismann, Dirk and Westermaier, Thomas and Meybohm, Patrick and Kranke, Peter}, title = {Severe neurological complications in critically ill COVID‑19 patients}, series = {Journal of Neurology}, journal = {Journal of Neurology}, issn = {0340-5354}, doi = {10.1007/s00415-020-10152-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-232429}, pages = {1576-1579}, year = {2021}, abstract = {No abstract available.}, language = {en} } @phdthesis{Martellotta2021, author = {Martellotta, Donato Daniel}, title = {Stellenwert von CXCL12 und CXCR4 in der Pathogenese des Vestibularisschwannomes}, doi = {10.25972/OPUS-24145}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-241454}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {CXCR4 ist der spezifische Rezeptor f{\"u}r das Chemokin CXCL12 und ist {\"u}berexprimiert in Vestibularisschwannomzellen. Das Ziel dieser Arbeit war es den Effekt des spezifischen Inhibitors AMD3100 auf die CXCR4 vermittelte Proliferation und Migration der Vestibularisschwannomzellen in verschiedenen Zellkuturmodellen zu analysieren. Die nachgewiesene Inhibition von CXCR4 deutet auf einen m{\"o}glichen Einsatz von AMD3100 in der systemischen Therapie von NF-2 Patienten hin.}, subject = {CXCL12}, language = {de} } @article{KunzHirthSchweitzeretal.2021, author = {Kunz, Felix and Hirth, Matthias and Schweitzer, Tilmann and Linz, Christian and Goetz, Bernhard and Stellzig-Eisenhauer, Angelika and Borchert, Kathrin and B{\"o}hm, Hartmut}, title = {Subjective perception of craniofacial growth asymmetries in patients with deformational plagiocephaly}, series = {Clinical Oral Investigations}, volume = {25}, journal = {Clinical Oral Investigations}, issn = {1432-6981}, doi = {10.1007/s00784-020-03417-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-232803}, pages = {525-537}, year = {2021}, abstract = {Objectives The present investigation aimed to evaluate the subjective perception of deformational cranial asymmetries by different observer groups and to compare these subjective perceptions with objective parameters. Materials and methods The 3D datasets of ten infants with different severities of deformational plagiocephaly (DP) were presented to 203 observers, who had been subdivided into five different groups (specialists, pediatricians, medical doctors (not pediatricians), parents of infants with DP, and laypersons). The observers rated their subjective perception of the infants' cranial asymmetries using a 4-point Likert-type scale. The ratings from the observer groups were compared with one another using a multilevel modelling linear regression analysis and were correlated with four commonly used parameters to objectively quantify the cranial asymmetries. Results No significant differences were found between the ratings of the specialists and those of the parents of infants with DP, but both groups provided significantly more asymmetric ratings than did pediatricians, medical doctors, or laypersons. Moreover, the subjective perception of cranial asymmetries correlated significantly with commonly used parameters for objectively quantifying cranial asymmetries. Conclusions Our results demonstrate that different observer groups perceive the severity of cranial asymmetries differently. Pediatricians' more moderate perception of cranial asymmetries may reduce the likelihood of parents to seek therapeutic interventions for their infants. Moreover, we identified some objective symmetry-related parameters that correlated strongly with the observers' subjective perceptions. Clinical relevance Knowledge about these findings is important for clinicians when educating parents of infants with DP about the deformity.}, language = {en} } @article{PauliPaulProppertetal.2021, author = {Pauli, Martin and Paul, Mila M. and Proppert, Sven and Mrestani, Achmed and Sharifi, Marzieh and Repp, Felix and K{\"u}rzinger, Lydia and Kollmannsberger, Philip and Sauer, Markus and Heckmann, Manfred and Sir{\´e}n, Anna-Leena}, title = {Targeted volumetric single-molecule localization microscopy of defined presynaptic structures in brain sections}, series = {Communications Biology}, volume = {4}, journal = {Communications Biology}, doi = {10.1038/s42003-021-01939-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-259830}, pages = {407}, year = {2021}, abstract = {Revealing the molecular organization of anatomically precisely defined brain regions is necessary for refined understanding of synaptic plasticity. Although three-dimensional (3D) single-molecule localization microscopy can provide the required resolution, imaging more than a few micrometers deep into tissue remains challenging. To quantify presynaptic active zones (AZ) of entire, large, conditional detonator hippocampal mossy fiber (MF) boutons with diameters as large as 10 mu m, we developed a method for targeted volumetric direct stochastic optical reconstruction microscopy (dSTORM). An optimized protocol for fast repeated axial scanning and efficient sequential labeling of the AZ scaffold Bassoon and membrane bound GFP with Alexa Fluor 647 enabled 3D-dSTORM imaging of 25 mu m thick mouse brain sections and assignment of AZs to specific neuronal substructures. Quantitative data analysis revealed large differences in Bassoon cluster size and density for distinct hippocampal regions with largest clusters in MF boutons. Pauli et al. develop targeted volumetric dSTORM in order to image large hippocampal mossy fiber boutons (MFBs) in brain slices. They can identify synaptic targets of individual MFBs and measured size and density of Bassoon clusters within individual untruncated MFBs at nanoscopic resolution.}, language = {en} } @article{StetterWeidnerLillaetal.2021, author = {Stetter, Christian and Weidner, Franziska and Lilla, Nadine and Weiland, Judith and Kunze, Ekkehard and Ernestus, Ralf-Ingo and Muellenbach, Ralf Michael and Westermaier, Thomas}, title = {Therapeutic hypercapnia for prevention of secondary ischemia after severe subarachnoid hemorrhage: physiological responses to continuous hypercapnia}, series = {Scientific Reports}, volume = {11}, journal = {Scientific Reports}, number = {1}, doi = {10.1038/s41598-021-91007-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-260779}, pages = {11715}, year = {2021}, abstract = {Temporary hypercapnia has been shown to increase cerebral blood flow (CBF) and might be used as a therapeutical tool in patients with severe subarachnoid hemorrhage (SAH). It was the aim of this study was to investigate the optimum duration of hypercapnia. This point is assumed to be the time at which buffer systems become active, cause an adaptation to changes of the arterial partial pressure of carbon dioxide (PaCO2) and annihilate a possible therapeutic effect. In this prospective interventional study in a neurosurgical ICU the arterial partial pressure of carbon dioxide (PaCO\(_2\)) was increased to a target range of 55 mmHg for 120 min by modification of the respiratory minute volume (RMV) one time a day between day 4 and 14 in 12 mechanically ventilated poor-grade SAH-patients. Arterial blood gases were measured every 15 min. CBF and brain tissue oxygen saturation (StiO\(_2\)) were the primary and secondary end points. Intracranial pressure (ICP) was controlled by an external ventricular drainage. Under continuous hypercapnia (PaCO\(_2\) of 53.17 ± 5.07), CBF was significantly elevated between 15 and 120 min after the start of hypercapnia. During the course of the trial intervention, cardiac output also increased significantly. To assess the direct effect of hypercapnia on brain perfusion, the increase of CBF was corrected by the parallel increase of cardiac output. The maximum direct CBF enhancing effect of hypercapnia of 32\% was noted at 45 min after the start of hypercapnia. Thereafter, the CBF enhancing slowly declined. No relevant adverse effects were observed. CBF and StiO\(_2\) reproducibly increased by controlled hypercapnia in all patients. After 45 min, the curve of CBF enhancement showed an inflection point when corrected by cardiac output. It is concluded that 45 min might be the optimum duration for a therapeutic use and may provide an optimal balance between the benefits of hypercapnia and risks of a negative rebound effect after return to normal ventilation parameters.}, language = {en} } @phdthesis{Weidner2021, author = {Weidner, Franziska}, title = {Therapeutische Hyperkapnie bei aneurysmatischer Subarachnoidalblutung (SAB) : Evaluation der optimalen Hyperkapniedauer}, doi = {10.25972/OPUS-23869}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-238696}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {In einer vorangegangenen Phase-1-Studie wurde beobachtet, dass bei Patienten mit schwerer aneurysmatischer SAB, die CBF durch intermittierende kontrollierte Hyperkapnie erh{\"o}ht werden kann. Zudem zeigte sich in dieser vorherigen Studie nach dem Zur{\"u}cksetzen der mechanischen Beatmung auf die Ausgangsparameter eine langsame und asymptotische R{\"u}ckkehr der CBF zu den Ausgangsniveaus ohne einen negativen Rebound-Effekt. Diese Beobachtung legte nahe, dass eine l{\"a}ngere Dauer der Hyperkapnie den CBF-erh{\"o}henden Effekt verl{\"a}ngern kann. Die vorliegende Studie wurde als Dosisoptimierungsstudie geplant, um den Zeitpunkt zu bestimmen, zu dem der CBF ein Maximum erreicht, und unter der Annahme, dass nach diesem Maximum Puffermechanismen in Blut und Liquor zu Anpassungsmechanismen f{\"u}hren k{\"o}nnen, die nach dem Abbruch zu einem negativen Rebound-Effekt f{\"u}hren. Es ergab sich eine "Netto" - Optimaldauer der Hyperkapnieintervention von 45 Minuten.}, subject = {Hyperkapnie}, language = {de} } @article{AbboudAsendorfHeinrichetal.2021, author = {Abboud, Tammam and Asendorf, Thomas and Heinrich, Jutta and Faust, Katharina and Krieg, Sandro M. and Seidel, Kathleen and Mielke, Dorothee and Matthies, Cordola and Ringel, Florian and Rohde, Veit and Szel{\´e}nyi, Andrea}, title = {Transcranial versus direct cortical stimulation for motor-evoked potentials during resection of supratentorial tumors under general anesthesia (the TRANSEKT-trial): study protocol for a randomized controlled trial}, series = {Biomedicines}, volume = {9}, journal = {Biomedicines}, number = {10}, issn = {2227-9059}, doi = {10.3390/biomedicines9101490}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-248513}, year = {2021}, abstract = {Background: Monitoring of motor function during surgery for supratentorial tumors under general anesthesia applies either transcranial electrical stimulation (TES) or direct cortical stimulation (DCS) to elicit motor-evoked potentials. To date, there is no guideline that favor one method over the other. Therefore, we designed this randomized study to compare between both methods regarding the prediction of postoperative motor deficits and extent of tumor resection. Methods: This is a multicenter (six centers in Germany and one in Switzerland), double blind, parallel group, exploratory, randomized controlled clinical trial. Patients without or with mild paresis, who are scheduled for surgical resection of motor-eloquent brain tumors under general anesthesia will be randomized to surgical resection under TES or surgical resection under DCS. The primary endpoint is sensitivity and specificity in prognosis of motor function 7 days after surgery. The main secondary endpoint is the extent of tumor resection. The study is planned to include 120 patients within 2 years. Discussion: The present exploratory study should compare TES and DCS regarding sensitivity and specificity in predicting postoperative motor deficit and extent of tumor resection to calculate the required number of patients in a confirmatory trial to test the superiority of one method over the other.}, language = {en} } @phdthesis{Chatzidimitriou2021, author = {Chatzidimitriou, Nikolaos}, title = {Wird die Behandlung des kindlichen Hydrocephalus durch neue Ventilsysteme verbessert? Ein Vergleich zweier Shuntsysteme}, doi = {10.25972/OPUS-23472}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-234729}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {Der Unishunt der Firma Codman gilt als Niederdruck-System und f{\"u}hrt in aufrechter K{\"o}rperposition zur erheblichen {\"U}berdrainage. Das Delta-System der Firma Medtronic hingegen soll durch seinen Ventilmechanismus eine {\"U}berdrainage verhindern und den Liquordruck in einem physiologischen Rahmen halten. Die vorliegende Studie untersucht die Frage, ob das Delta-System gegen{\"u}ber dem Unishunt einen Vorteil hinsichtlich der {\"U}berdrainage aufweist, der sich an der revisionsfreien Funktionsdauer zeigt. Unter Ber{\"u}cksichtigung der Ventrikelweite pr{\"u}ften wir insbesondere, ob die {\"U}berdrainage und die damit verbundenen Komplikationen verringert werden k{\"o}nnen. In einer retrospektiven Fall-Sammel-Studie wurden die Patientendaten von 199 Kindern im Alter zwischen einem Tag und 10.4 Jahren ausgewertet, die im Zeitraum vom 01.01.1985 bis 01.03.2002 in der Abteilung f{\"u}r p{\"a}diatrische Neurochirurgie der Universit{\"a}tsklinik W{\"u}rzburg eine Erstimplantation eines ventrikuloperitonealen oder -atrialen Shunts mit Verwendung eines Unishunts (n= 138) oder eines Delta-Systems (n=61) erhielten. Gewertet wurden alle mechanischen oder infekti{\"o}sen Komplikationen, die zu einer operativen Shuntrevision f{\"u}hrten. Bei den mechanischen Komplikationen unterschieden wir zwischen proximaler Obstruktion, distaler Obstruktion, Migration, Diskonnektion oder Katheterriss, Ventilunterfunktion und {\"U}berdrainage. Als {\"U}berdrainage wurden operationspflichtige Subduralerg{\"u}sse, eindeutige Unterdruck-beschwerden und das Slit-Ventricle-Syndrom gewertet. Asymptomatische Subdural-erg{\"u}sse und andere nicht operationspflichtige Funktionsanomalien werteten wir nicht als Komplikation. Als Shuntinfektion bezeichneten wir klinische und laborchemische Zeichen einer bakteriellen Infektion, die nach Shuntexplantation abklangen. Die durchschnittliche Funktionsdauer der Shunts wurde in vorliegender Studie durch das Delta-System nicht verl{\"a}ngert. Die kumulative Revisionswahrscheinlichkeit nach einem Jahr betrug beim Unishunt 30.6 \%, beim Delta-System 24.9 \%, lag aber nach f{\"u}nf Jahren mit 58.0 \% beim Delta-System h{\"o}her als beim Unishunt (40.9 \%). Bei den mechanischen Komplikationen ergab sich als wesentlicher Unterschied zwischen beiden getesteten Systemen eine h{\"a}ufigere distale Blockade des Peritonealkatheters beim Unishunt, die aber durch h{\"a}ufigere Ventilfehlfunktion des Delta-Systems weitgehend ausgeglichen wurde. Die niedrigste Druckstufe f{\"u}hrte beim Delta-System signifikant h{\"a}ufiger zu einer proximalen Obstruktion als die h{\"o}chste. Die eigenen Untersuchungsergebnisse sprechen daf{\"u}r, dass Delta-Ventile tats{\"a}chlich der Neigung zur {\"U}berdrainage entgegenwirken, ohne dass sich dieser Vorteil in der Revisionsrate bemerkbar macht. Das Delta-System f{\"u}hrt zu einer niedrigeren {\"U}berdrainagerate und weniger {\"U}berdrainage-assoziierten Erscheinungen wie Subduralerg{\"u}ssen. Dieser Unterschied war am ehesten morphologisch zu erfassen, jedoch im Vergleich zum Unishunt nicht signifikant. Der Unishunt war mit einer h{\"o}heren Infektionsrate von 11.6 \% im Vergleich zum Delta-System (3.3 \%) belastet. Der Unterschied l{\"a}sst sich weder mit konstruktiven Ventilmerkmalen noch mit besonderen Maßnahmen der Infektionsprophylaxe erkl{\"a}ren. Der im Vergleich zum Unishunt h{\"o}here Preis des Delta-Systems findet keinen Niederschlag in einer niedrigeren Komplikationsrate des Systems.}, language = {de} }