TY - THES A1 - Köhler, Stefan T1 - Ophthalmologische und radiologische Hirndruckzeichen bei der isolierten Sagittalnahtsynostose T1 - Ophthalmological and radiological signs of elevated intracranial pressure in isolated sagittal synostosis N2 - Bei der häufigsten Form prämaturer Kraniosynostosen, der isolierten Sagittalnahtsynostose, wird das Gesundheitsrisiko durch intrakranielle Drucksteigerung als sehr gering eingeschätzt. Ziel der vorliegenden Studie war es, an einem größeren Kollektiv das individuelle Risiko einer Hirndrucksteigerung durch mangelhaftes Schädelwachstum (=Kraniostenose) zu bestimmen. Der erhöhte Druck wurde dabei identifiziert durch Stauungspapillen oder durch direkte Messung. In einer Längsschnittstudie wurden Augenhintergrundsbefunde von 200 Patienten ausgewertet, die der Würzburger kraniofazialen Arbeitsgruppe mit der klinischen Diagnose „isolierte Sagittalnahtsynostose“ vorgestellt worden waren. Die bei acht Patienten durchgeführten direkten Druckmessungen wurden ebenfalls ausgewertet. Alle in die Studie aufgenommenen Patienten wurden mindestens einmal in zwei Jahren, in 76% der Fälle entsprechend einer vorgegebenen Empfehlung zweimal jährlich ophthalmoskopisch untersucht. Zum Zeitpunkt der ersten Untersuchung waren die Kinder durchschnittlich 14 Monate, bei der letzten Untersuchung durchschnittlich sieben Jahre alt. Die Beobachtungsdauer lag zwischen 19 Monaten und 18 Jahren. Während der Beobachtungszeit entwickelten zehn Patienten eine sichere Hirndrucksteigerung nach der genannten Definition, drei von 71 nicht operierten Patienten und sieben von 129 operativ behandelten Kindern. Daraus errechnete sich ein kumulatives individuelles Risiko von knapp sechs Prozent im Spontanverlauf und knapp sieben Prozent nach vorangegangener Operation. Diese Zahlen waren aber durch diagnostische Irrtümer beeinflusst. Denn bei sechs der 200 Patienten musste die Diagnose im Verlauf zugunsten verschiedener Syndrome und Stoffwechselstörungen korrigiert werden. Drei dieser Patienten hatten Stauungspapillen entwickelt. Nach entsprechender Bereinigung des Studienkolletivs lag das individuelle Risiko einer Hirndrucksteigerung für nicht operierte Patienten mit isolierter Sagittalnahtsynostose bei drei Prozent, für operierte Patienten bei sechs Prozent. Bei zwei Patienten wurde die Hirndrucksteigerung durch direkte Messung nachgewiesen, während der Augenhintergrund unauffällig erschien – ein Hinweis auf die relativ geringe Sensitivität des ophthalmoskopischen Befundes. Aus den vorliegenden Daten ergibt sich die Empfehlung regelmäßiger Funduskontrollen bei der isolierten Sagittalnahtsynostose, die unbedingt auch nach einer Operation der Synostose bis mindestens zum achten, besser bis zum 10. bis 12. Lebensjahr fortgesetzt werden sollten. Untersuchungsintervalle von sechs Monaten stellen dabei einen vertretbaren Kompromiss zwischen Untersuchungsaufwand und diagnostischer Sicherheit dar. Denn alle Patienten mit Stauungspapillen wurden rechtzeitig therapiert, keiner von ihnen erlitt bleibende Funktionseinbußen der Sehnerven. Wegen der geringen Sensitivität der Ophthalmoskopie wurden in einem zweiten Teil der Arbeit Röntgenaufnahmen der Patienten auf radiologische Hirndruckzeichen ausgewertet. Das Schädelinnenrelief wurde beurteilt und in Anlehnung an die Literatur in drei Intensitätsgrade eingeteilt. Deutlich und generalisiert verstärkte Impressiones digitatae im Sinne eines Wolkenschädels wurden als mögliche Zeichen eines erhöhten intrakraniellen Drucks registriert. Am Ende des Beobachtungszeitraums wurde sowohl bei operierten als auch bei nicht operierten Patienten eine kumulative Wahrscheinlichkeit für das Auftreten eines Wolkenschädels von etwa 35% ermittelt, bei allerdings hoher statistischer Un¬genauigkeit. Insgesamt wurde bei 20% der nicht operierten und bei 15% der operierten Patienten ein Wolkenschädel registriert. In Zusammenschau mit den Ergebnissen des ersten Teils der Arbeit stützen diese Zahlen die Annahme, dass eine intrakranielle Drucksteigerung häufiger auftritt als funduskopisch nachgewiesen. Bei deutlich verstärktem Schädelinnenrelief im Röntgenbild sollte daher die Indikation zur invasiven Druckmessung großzügiger gestellt werden. Als überraschendes und bisher nicht beschriebenes Ergebnis ließ sich ein Übergreifen der Synostose auf weitere Nähte kumulativ bei 20% der operierten, nicht aber bei unoperierten Patienten nachweisen. Diese Beobachtung steht im Einklang mit der größeren Häufigkeit von Stauungspapillen im postoperativen Verlauf. Denkbar ist also eine negative Beeinflussung der Nahtphysiologie durch die Operation. N2 - For the most common form of craniosynostosis, the isolated sagittal synostosis, health risk due to elevated intracranial pressure (ICP) is assessed to be very low. Aim of the present study was to identify the individual risk of elevated intracranial pressure due to deficient growth of the skull (craniostenosis) by means of a larger collective. Elevated pressure was identified by papilledema or direct measurement. In a longitudinal study, fundus examinations of 200 patients, presented to the craniofacial workgroup of Wuerzburg with the clinical diagnosis of isolated sagittal synostosis, were evaluated retrospectively. The direct pressure measurements of 8 patients were also evaluated. Every patient included into the study had ophthalmological examinations at least every two years, in 76% of the cases twice a year according to our recommendation. The first examination was done at age of 14 months, the last one at 7 years in average. The observation period was between 19 months and 18 years. During the observation 10 patients developed an assured elevation of ICP according to the named definition, 3 of 71 not operated children and 7 of 129 operated children. Thus the calculated individual cumulative risk was just under 6% in the spontaneous course and just under 7% after operation. These numbers were influenced by diagnostic errors, as in 6 of the 200 cases the diagnosis of isolated synostosis had to be corrected to different syndromes or metabolism disorders. 3 of these patients developed papilledema. After correction of the collective the individual cumulative risk of elevated ICP was 3% in unoperated and 6% in operated children. In 2 of the patients the elevation of ICP was proved by direct measurement, while the fundus examinations were normal, an indication for the relatively low sensitivity of ophthalmoscopic findings. The present data recommend continuous examinations of the fundus in isolated sagittal synostosis, which should be continued at least until the 8th, better until the 10th to 12th year of life. Time interval of examination of 6 months is a compromise between effort an safeness. All patients with papilledema had been treated in time and none of the children suffered from persistent impairment of visual function. Because of the low sensitivity of the ophtalmoscopy, skull x-rays of the patients have been evaluated on radiological signs of elevated ICP in a second part of the study. Clear alterations of the cranial radiographs in form of beaten copper markings have been registrated as a sign of elevated ICP. At the end of the observation time the cumulative probability of the appearance of beaten copper markings was about 35% for operated as well as for unoperated children, with a high statistical uncertainty. All in all 20% of unoperated and 15% of operated patients had beaten copper markings. In synopsis with the findings of the first part of the study these numbers support the assumption that elevated ICP occurs more often than proved by fundus examinations. Therefore invasive measurement of ICP should be indicated easier when clear alteration of skull radiograph occurs. As a surprising and not yet published result, we proved an overlap of the synostosis on further sutures in cumulative 20% of the operated, but in none of the unoperated children. This observance is consistent with the higher number of papilledema in operated children. There might be a negative influence of suture physiology through the operation. KW - Hirndruck KW - Schädelnaht KW - Augenhintergrund KW - Neurochirurgie KW - Stauungspapille KW - Kraniosynostose KW - Sagittalnahtsynostose KW - Wolkenschädel KW - Impressiones digitatae KW - papilledema KW - intracranial pressure KW - sagittal synostosis KW - scaphocephaly KW - beaten copper markings Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-34666 ER - TY - JOUR A1 - Kessler, Michael A1 - Hertel, Dietrich A1 - Jungkunst, Hermann F. A1 - Kluge, Jürgen A1 - Abrahamczyk, Stefan A1 - Bos, Merijn A1 - Buchori, Damayanti A1 - Gerold, Gerhard A1 - Gradstein, S. Robbert A1 - Köhler, Stefan A1 - Leuschner, Christoph A1 - Moser, Gerald A1 - Pitopang, Ramadhanil A1 - Saleh, Shahabuddin A1 - Schulze, Christian H. A1 - Sporn, Simone G. A1 - Steffan-Dewenter, Ingolf A1 - Tjitrosoedirdjo, Sri S. A1 - Tscharntke, Teja T1 - Can Joint Carbon and Biodiversity Management in Tropical Agroforestry Landscapes Be Optimized? JF - PLoS One N2 - Managing ecosystems for carbon storage may also benefit biodiversity conservation, but such a potential 'win-win' scenario has not yet been assessed for tropical agroforestry landscapes. We measured above-and below-ground carbon stocks as well as the species richness of four groups of plants and eight of animals on 14 representative plots in Sulawesi, Indonesia, ranging from natural rainforest to cacao agroforests that have replaced former natural forest. The conversion of natural forests with carbon stocks of 227-362 Mg C ha\(^{-1}\) to agroforests with 82-211 Mg C ha\(^{-1}\) showed no relationships to overall biodiversity but led to a significant loss of forest-related species richness. We conclude that the conservation of the forest-related biodiversity, and to a lesser degree of carbon stocks, mainly depends on the preservation of natural forest habitats. In the three most carbon-rich agroforestry systems, carbon stocks were about 60% of those of natural forest, suggesting that 1.6 ha of optimally managed agroforest can contribute to the conservation of carbon stocks as much as 1 ha of natural forest. However, agroforestry systems had comparatively low biodiversity, and we found no evidence for a tight link between carbon storage and biodiversity. Yet, potential win-win agroforestry management solutions include combining high shade-tree quality which favours biodiversity with cacao-yield adapted shade levels. KW - forest soils KW - stocks KW - diversity KW - sequestration KW - conversion KW - balance KW - root Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-132016 VL - 7 IS - 10 ER - TY - JOUR A1 - Lilla, Nadine A1 - Füllgraf, Hannah A1 - Stetter, Christian A1 - Köhler, Stefan A1 - Ernestus, Ralf-Ingo A1 - Westermaier, Thomas T1 - First Description of Reduced Pyruvate Dehydrogenase Enzyme Activity Following Subarachnoid Hemorrhage (SAH) JF - Frontiers in Neuroscience N2 - Object: Several previous studies reported metabolic derangements and an accumulation of metabolic products in the early phase of experimental subarachnoid hemorrhage (SAH), which may contribute to secondary brain damage. This may be a result of deranged oxygen utilization due to enzymatic dysfunction in aerobic glucose metabolism. This study was performed to investigate, if pyruvate dehydrogenase enzyme (PDH) is affected in its activity giving further hints for a derangement of oxidative metabolism. Methods: Eighteen male Sprague-Dawley rats were randomly assigned to one of two experimental groups (n = 9): (1) SAH induced by the endovascular filament model and (2) sham-operated controls. Mean arterial blood pressure (MABP), intracranial pressure (ICP), and local cerebral blood flow (LCBF; laser-Doppler flowmetry) were continuously monitored from 30 min before until 3 h after SAH. Thereafter, the animals were sacrificed and PDH activity was measured by ELISA. Results: PDH activity was significantly reduced in animals subjected to SAH compared to controls. Conclusion: The results of this study demonstrate for the first time a reduction of PDH activity following SAH, independent of supply of substrates and may be an independent factor contributing to a derangement of oxidative metabolism, failure of oxygen utilization, and secondary brain damage. KW - secondary brain damage KW - aerobic glycolysis KW - CBF KW - metabolism KW - PDH KW - SAH Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157636 VL - 11 IS - 37 ER - TY - JOUR A1 - Conrads, Nora A1 - Grunz, Jan-Peter A1 - Huflage, Henner A1 - Luetkens, Karsten Sebastian A1 - Feldle, Philipp A1 - Grunz, Katharina A1 - Köhler, Stefan A1 - Westermaier, Thomas T1 - Accuracy of pedicle screw placement using neuronavigation based on intraoperative 3D rotational fluoroscopy in the thoracic and lumbar spine JF - Archives of Orthopaedic and Trauma Surgery N2 - Introduction In spinal surgery, precise instrumentation is essential. This study aims to evaluate the accuracy of navigated, O-arm-controlled screw positioning in thoracic and lumbar spine instabilities. Materials and methods Posterior instrumentation procedures between 2010 and 2015 were retrospectively analyzed. Pedicle screws were placed using 3D rotational fluoroscopy and neuronavigation. Accuracy of screw placement was assessed using a 6-grade scoring system. In addition, screw length was analyzed in relation to the vertebral body diameter. Intra- and postoperative revision rates were recorded. Results Thoracic and lumbar spine surgery was performed in 285 patients. Of 1704 pedicle screws, 1621 (95.1%) showed excellent positioning in 3D rotational fluoroscopy imaging. The lateral rim of either pedicle or vertebral body was protruded in 25 (1.5%) and 28 screws (1.6%), while the midline of the vertebral body was crossed in 8 screws (0.5%). Furthermore, 11 screws each (0.6%) fulfilled the criteria of full lateral and medial displacement. The median relative screw length was 92.6%. Intraoperative revision resulted in excellent positioning in 58 of 71 screws. Follow-up surgery due to missed primary malposition had to be performed for two screws in the same patient. Postsurgical symptom relief was reported in 82.1% of patients, whereas neurological deterioration occurred in 8.9% of cases with neurological follow-up. Conclusions Combination of neuronavigation and 3D rotational fluoroscopy control ensures excellent accuracy in pedicle screw positioning. As misplaced screws can be detected reliably and revised intraoperatively, repeated surgery for screw malposition is rarely required. KW - pedicle screws KW - vertebral pedicles KW - fluoroscopy KW - neuronavigation KW - spine Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324966 VL - 143 IS - 6 ER -