Die SFCNS eine vielfltige Fderation
In: Schweizerische Ärztezeitung: SÄZ ; offizielles Organ der FMH und der FMH Services = Bulletin des médecins suisses : BMS = Bollettino dei medici svizzeri
ISSN: 1424-4004
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In: Schweizerische Ärztezeitung: SÄZ ; offizielles Organ der FMH und der FMH Services = Bulletin des médecins suisses : BMS = Bollettino dei medici svizzeri
ISSN: 1424-4004
In: Journal of neurological surgery. Part A, Central European neurosurgery = Zentralblatt für Neurochirurgie, Band 73, Heft S 03
ISSN: 2193-6323
In: MTZ - Motortechnische Zeitschrift, Band 80, Heft 4, S. 34-41
ISSN: 2192-8843
In: MTZ worldwide, Band 80, Heft 4, S. 32-39
ISSN: 2192-9114
In: Swiss Medical Forum ‒ Schweizerisches Medizin-Forum, Band 16, Heft 1
ISSN: 1424-4020
In: Journal of neurological surgery. Part A, Central European neurosurgery = Zentralblatt für Neurochirurgie, Band 82, Heft 4, S. 317-324
ISSN: 2193-6323
Abstract
Objective The objective of this study was to determine the performance of the standard alarm criterion of motor evoked potentials (MEPs) of the facial nerve in surgeries performed for resections of vestibular schwannomas or of other lesions of the cerebellopontine angle.
Methods This retrospective study included 33 patients (16 with vestibular schwannomas and 17 with other lesions) who underwent the resection surgery with transcranial MEPs of the facial nerve. A reproducible 50% decrease in MEP amplitude, resistant to a 10% increase in stimulation intensity, was applied as the alarm criterion during surgery. Facial muscular function was clinically evaluated with the House–Brackmann score (HBS), pre- and postsurgery at 3 months.
Results In the patient group with vestibular schwannoma, postoperatively, the highest sensitivity and negative predictive values were found for a 30% decrease in MEP amplitude, that is, a criterion stricter than the 50% decrease in MEP amplitude criterion, prone to trigger more warnings, used intraoperatively. With this new criterion, the sensitivity would be 88.9% and the negative predictive value would be 85.7%. In the patient group with other lesions of the cerebellopontine angle, the highest sensitivity and negative predictive values were found equally for 50, 60, or 70% decrease in MEP amplitude. With these criteria, the sensitivities and the negative predictive values would be 100.0%.
Conclusion Different alarm criteria were found for surgeries for vestibular schwannomas and for other lesions of the cerebellopontine angle. The study consolidates the stricter alarm criterion, that is, a criterion prone to trigger early warnings, as found previously by others for vestibular schwannoma surgeries (30% decrease in MEP amplitude).
In: Journal of neurological surgery. Part A, Central European neurosurgery = Zentralblatt für Neurochirurgie, Band 81, Heft 2, S. 170-176
ISSN: 2193-6323
Abstract
Background The optimal management of posterior fossa arteriovenous malformations (pfAVMs) is a matter of debate. To advance this discussion, we present our clinical series and the results of a systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
Methods Fourteen consecutive patients with pfAVMs were admitted between 2007 and 2018. Preoperative status, radiologic parameters, and outcome were assessed. A systematic literature review was performed according to the PRISMA-P guidelines.
Results Ten patients presented with rupture (71%), of whom three had associated aneurysms (AAs). The treatments were microsurgery (n = 4), endovascular (n = 3), radiosurgery (n = 2), a combination of two or three treatment modalities (n = 3), or conservative (n = 2). At discharge, all four patients (100%) with unruptured pfAVMs had a good outcome (modified Rankin Scale [mRS]: 0–2). In contrast, in ruptured pfAVM cases, mRS was 0 to 2 in four patients (40%), mRS 3 to 4 in two (20%), mRS 5 in three (30%), and one patient (10%) died within 30 days after gamma knife treatment due to pancreatitis secondary to chronic alcohol abuse. At discharge, four patients (29%) had persistent preinterventional cranial nerve and/or focal neurologic deficits. The literature review identified 63 articles with 1,753 pfAVM patients. Overall, 66% of pfAVMs presented with rupture, and AAs were found in 20% of the cases, which is higher than in supratentorial AVMs (stAVMs).
Conclusions Because pfAVMs are associated with higher rates of hemorrhagic presentation, higher rates of morbidity and mortality when ruptured, and have a higher incidence of AAs compared with stAVMs, early curative treatment is recommended as soon as the diagnosis is established, regardless of rupture status.
In: Journal of neurological surgery. Part A, Central European neurosurgery = Zentralblatt für Neurochirurgie, Band 78, Heft 4, S. 337-343
ISSN: 2193-6323
Introduction Efficient neurosurgical training is of paramount importance to provide continuing high-quality medical care to patients. In this era of law-enforced working hour restrictions, however, maintaining high-quality training can be a challenge and requires some restructuring. We evaluated the current status of resident training in Germany.
Methods An electronic survey was sent to European neurosurgical trainees between June 2014 and March 2015. The responses of German trainees were compared with those of trainees from other European countries. Logistic regression analysis was performed to assess the effect size of the relationship between a trainee being from Germany and the outcome (e.g., satisfaction, working time).
Results Of 532 responses, 95 were from German trainees (17.8%). In a multivariate analysis corrected for baseline group differences, German trainees were 29% as likely as non-German trainees to be satisfied with clinical lectures given at their teaching facility (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18–0.49; p < 0.0001). The satisfaction rate with hands-on operating room exposure was 73.9% and equal to the rate in Europe (OR: 0.94; 95% CI, 0.56–1.59; p = 0.834). German trainees were 2.3 times as likely to perform a lumbar spine intervention as the primary surgeon within the first year of training (OR: 2.27; 95% CI, 1.42–3.64; p = 0.001). However, they were less likely to perform a cervical spine procedure within 24 months of training (OR: 0.38; 95% CI, 0.17–0.82; p = 0.014) and less likely to perform a craniotomy within 36 months of training (OR: 0.49; 95% CI, 0.31–0.79; p = 0.003). Only 25.6% of German trainees currently adhere to the weekly limit of 48 hours as requested from the European Working Time Directive 2003/88/EC, and in an international comparison, German trainees were twice as likely to work > 50 hours per week (OR: 2.13; 95% CI, 1.25–3.61; p = 0.005). This working time, however, is less spent in the operating suite (OR: 0.26; 95% CI, 0.11–0.59; p = 0.001) and more doing administrative work (OR: 1.83; 95% CI, 1.13–2.96; p = 0.015).
Conclusion Some theoretical and practical aspects of neurosurgical training are superior, but a considerable proportion of relevant aspects are inferior in Germany compared with other European countries. The present analyses provide the opportunity for a critical review of the local conditions in German training facilities.
In: Swiss Medical Forum ‒ Schweizerisches Medizin-Forum, Band 15, Heft 48
ISSN: 1424-4020
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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