Stefan Rohde

Difference in configuration of ruptured and unruptured intracranial aneurysms determined by biplanar digital subtraction angiography

Summary¶Summary There is an ongoing discussion about the risk of bleeding from unruptured intracranial aneurysms. Management guidelines were developed recently and some of the recommendations for decision making are based on the anatomical configuration of the aneurysm. The common assumption is that the presence of multiple lobes or a daughter sac indicates a higher risk of rupture. We have investigated the anatomical configuration of ruptured and unruptured intracranial aneurysms using biplanar digital subtraction angiography (DSA). The objective was to determine, whether there was a difference between ruptured and unruptured aneurysms regarding lobulation, the presence of a daughter sac or the shape as measured by the height/neck ratio.Biplanar DSA images of 124 patients were retrospectively analyzed. A total of 53 unruptured and 94 ruptured aneurysms were found (=147 aneurysms in total). Aneurysms of less than 10u2009mm diameter accounted for 82% of all aneurysms. Overall, 10% of unruptured aneurysm showed a multilobular appearance on DSA compared with 20% of ruptured aneurysms (Fisher’s exact test, p=0.10). In the 5–9u2009mm aneurysm group, multiple lobes were found significantly more frequent in ruptured aneurysms (26% vs. 4%, Fisher’s exact test, p<0.05). A height/neck ratio of less than 1.5 was not found in unruptured aneurysms (0/26) but in 21% (12/57) of ruptured aneurysms (p<0.05).Our data provide scientific support for using morphological features for the decision making process in the management of unruptured intracranial aneurysms. An irregular multilobar appearance was significantly more common in aneurysms of 5–9u2009mm size that ruptured.

Fourier analysis of intracranial aneurysms: towards an objective and quantitative evaluation of the shape of aneurysms

Shape irregularities of intracranial aneurysms may indicate an increased risk of rupture. To quantify morphological differences, Fourier analysis of the shape of intracranial aneurysms was introduced. We compared the morphology of 45 unruptured (UIA) and 46 ruptured intracranial aneurysms (RIA) in 70 consecutive patients on the basis of 3D-rotational angiography. Fourier analysis, coefficient of roundness and qualitative shape assessment were determined for each aneurysm. Morphometric analysis revealed significantly smaller coefficient of roundness (P<0.02) and higher values for Fourier amplitudes numbers 2, 3 and 7 (P<0.01) in the RIA group, indicating more complex and irregular morphology in RIA. Qualitative assessment from 3D-reconstructions showed surface irregularities in 78% of RIA and 42% of UIA (P<0.05). Our data have shown significant differences in shape between RIA and UIA, and further developments of Fourier analysis may provide an objective factor for the assessment of the risk of rupture.

Increased incidence of thrombophilic abnormalities in patients with cranial dural arteriovenous fistulae.

Abstract Cranial dural arteriovenous fistulae (DAVF) may occur post-traumatic or sporadic. The physiopathologic mechanisms of sporadic DAVF are still unclear. A dural sinus thrombosis followed by an increase in venous pressure and/or an increased procoagulatory activity of the coagulation system are associated at least with some DAVF. The objective of this study was to investigate the coagulation profile in patients with DAVF. Thus the association of thrombophilic abnormalities, sinus thrombosis and DAVF should be analyzed. A total of 15 patients with cranial DAVF were included in this study. Blood samples were analyzed for 20210A mutation of the prothrombin gene, resistance to activated protein C and factor V Leiden mutation. Fibrinogen (Fib), Textarin time (TT), antithrombin (AT), protein C and protein S activity, von Willebrand factor antigen (vWF:Ag), Ristocetin cofactor activity (vWF:RCo), D-Dimer (DD) and coagulation factor VIII-activity (F VIII) were determined in all patients. Blood was screened for the occurrence of lupus antiphospholipid antibodies and cardiolipin antibodies. Thrombophilic risk factors were found in 5 (33%) of the 15 patients with cranial DAVF. Four patients had a heterozygote 20210A mutation of the prothrombin gene and one patient had a heterozygote FV Leiden mutation. Sinus thrombosis was detected in two patients with grade 2b DAVF and was associated with a 20210A mutation of the prothrombin gene in both patients. Additionally, one patient had deficient protein C activity and screening for cardiolipin antibodies was positive in three patients. In the current series the frequency of prothrombin Gene 20210A mutation was higher in patients with DAVF compared to the general population, whereas the incidence of Factor V Leiden mutation was not. Therefore in patients with cranial DAVF thrombophilic abnormalities should be considered in the post-operative/post-interventional management.

Posterior alien hand syndrome: case report.

Abstract. The alien hand syndrome (AHS) is involuntary uncontrolled movement of an arm with a sense of estrangement from the limb itself. AHS was initially used to describe interhemispheric disconnection phenomena in patients with lesions in the anterior corpus callosum, but it has been found in patients with posterior cerebral lesions without involvement of the corpus callosum, for example parietal infarcts or corticobasal degeneration. The posterior alien hand syndrome is less frequent and presents with nonpurposive behaviour like lifting the arm or writhing fingers. We report an 80-year-old woman with a posterior AHS of the dominant right hand. MRI showed atrophy of the pre- and postcentral gyri without involvement of the corpus callosum. We discuss the aetiology of the posterior AHS and the differences from the anterior varieties.

CT-Based Evaluation of Tumor Volume After Intra-Arterial Chemotherapy of Locally Advanced Carcinoma of the Oral Cavity: Comparison with Clinical Remission Rates

PurposeTo assess the volume of locally advanced tumors of the oral cavity and the oropharynx before and after intra-arterial (i.a.) chemotherapy by means of computed tomography and to compare these data with clinically determined treatment response of the same patient population.MethodsEighty-eight patients with histologically proven, advanced carcinoma of the oral cavity and/or the oropharynx (local tumor stages T3/4) received neoadjuvant i.a. chemotherapy with cisplatin as part of a multimodal therapeutic regimen, comprising (1) local chemotherapy, (2) surgery, and (3) combined radio-chemotherapy. Three weeks after the intervention, residual disease was evaluated radiologically by measurement of the tumor volume and clinically by inspection and palpation of the primary tumor according to WHO criteria.ResultsComparison of treatment response according to radiological and clinical criteria respectively revealed complete remission in 5% vs. 8% (p < 0.05), partial remission in 30% vs. 31%, stable disease in 61% vs. 58%, and tumor progression in 5% vs. 2%.ConclusionRadiological volumetry and clinical evaluation found comparable response rates after local chemotherapy. However, in patients with good response after local treatment, volumetric measurement with CT may help to distinguish between partial and complete remission. Thus, radiological tumor volumetry provides precise and differentiated information about tumor response and should be used as an additional tool in treatment monitoring after local chemotherapy.

Reliability of CT-based tumor volumetry after intraarterial chemotherapy in patients with small carcinoma of the oral cavity and the oropharynx

IntroductionThe aim of the study was to evaluate the feasibility and consistency of CT-based tumor volumetry in patients with early carcinoma of the oral cavity and the oropharynx before and after intraarterial (IA) chemotherapy, comparing these data with clinical remission rates.MethodsIncluded in the study were 61 patients (mean age 59.3xa0years; 47 men) with histologically proven small carcinoma of the oral cavity or the oropharynx (local tumor stages T1/2). Patients received IA chemotherapy with high-dose cisplatin as part of a multimodal therapeutic regimen and underwent both clinical and radiological examination before and 4xa0weeks after local chemotherapy.ResultsClinical evaluation of tumor response was possible in all patients (61/61). Radiological assessment of tumor volume was feasible in 42 of 61 patients (69%), but failed in 19 (31%) due to the absence of deep tumoral spread, lack of contrast enhancement or severe dental artifacts. Patients in whom evaluation was possible according to volumetric and clinical criteria revealed comparable remission rates: overall response 54.8% versus 52.4%, stable disease 40.4% versus 47.6%, and tumor progression 4.8% versus 0.0%.ConclusionBecause volume calculation was not feasible in approximately one-third of the patients, it cannot be recommended as a reliable indicator for treatment response in patients with small carcinoma of the oral cavity.

Local chemotherapy for squamous cell cancer of the oral cavity and oropharynx

BACKGROUNDnModern treatment concepts for patients suffering from oral and oropharyngeal cancer include more and more adjuvant therapeutic options. Local chemotherapy offers the possibility to apply an extremely high drug concentration at the tumor site while minimizing possible side effects by systemic neutralization at the same time.nnnPATIENTS AND METHODSnA total of 289 patients with histologically proven carcinoma of the oral cavity and the oropharynx underwent neoadjuvant intra-arterial chemotherapy with high-dosage cisplatin within a multimodal therapeutic setting. Concerning the TNM classification, more than 70% of the patients were classified as stages III and IV. The mean age at the time of intervention was 60 years, and 71% of the patients were male.nnnRESULTSnAfter the first cycle 19.3% of the patients presented with complete remission (grade I); 35.4% and 41.5% showed partial remissions (grade II) or stable disease (grade III), respectively. The mean observation time after treatment was 28 months (median: 24.2 months). Of the 137 patients who completed the full multimodal therapeutic scheme, 11% developed local recurrence, and 12.4% developed lymph node or distant metastasis. At the time of evaluation, 72.5% of these patients were still alive.nnnCONCLUSIONnIntra-arterial chemotherapy is a safe and highly effective procedure that should be considered as an important option in multimodal therapeutic concepts for oral and oropharyngeal cancer.ZusammenfassungHintergrundDie moderne Behandlung von Patienten mit Plattenepithelkarzinomen des Mundes und des Oropharynx beinhaltet zunehmend adjuvante Therapieformen. Die lokale Chemotherapie ermöglicht neben der Applikation einer extrem hohen Medikamentenkonzentration in der Tumorregion eine gleichzeitige Minimierung der Nebenwirkung durch systemische Antagonisierung.Patienten und MethodenIm Rahmen eines multimodalen Therapiekonzepts erhielten 289xa0Patienten mit histologisch gesicherten Karzinomen der Mundhöhle und des Oropharynx eine neoadjuvante i.a. Chemotherapie mit hochdosiertem Cisplatin. Nach TNM-Kriterien waren über 70% der Patienten den Stadienxa0T3 und T4 zuzuordnen. Das Alter zum Zeitpunkt der Intervention lag bei 60xa0Jahren, 71% der Patienten waren Männer.ErgebnisseDer Anteil vollständiger Remissionen (Gradxa0I) nach dem 1. Behandlungszyklus betrug 19,3%, partielle Remissionen konnten bei 35,4% (Gradxa0II) und 41,5% (Gradxa0III) erzielt werden. Der durchschnittliche Beobachtungszeitraum nach Behandlungsende betrug etwa 28xa0Monate (Median 24,2xa0Monate). Von 137xa0Patienten, die einen multimodalen Behandlungszyklus absolvierten, lebten zum Zeitpunkt der Auswertung noch 72,5%; 11% entwickelten ein Lokalrezidiv und 12,4% Lymphknoten- oder Fernmetastasen.SchlussfolgerungDie i.a. Chemotherapie ist ein sicheres Verfahren mit hoher Effektivität und stellt im Rahmen multimodaler Therapiekonzepte zur Behandlung oraler und oropharyngealer Karzinome eine wichtige Option dar.AbstractBackgroundModern treatment concepts for patients suffering from oral and oropharyngeal cancer include more and more adjuvant therapeutic options. Local chemotherapy offers the possibility to apply an extremely high drug concentration at the tumor site while minimizing possible side effects by systemic neutralization at the same time.Patients and methodsA total of 289xa0patients with histologically proven carcinoma of the oral cavity and the oropharynx underwent neoadjuvant intra-arterial chemotherapy with high-dosage cisplatin within a multimodal therapeutic setting. Concerning the TNM classification, more than 70% of the patients were classified as stages III and IV. The mean age at the time of intervention was 60xa0years, and 71% of the patients were male.ResultsAfter the first cycle 19.3% of the patients presented with complete remission (gradexa0I); 35.4% and 41.5% showed partial remissions (gradexa0II) or stable disease (gradexa0III), respectively. The mean observation time after treatment was 28xa0months (median: 24.2xa0months). Of the 137xa0patients who completed the full multimodal therapeutic scheme, 11% developed local recurrence, and 12.4% developed lymph node or distant metastasis. At the time of evaluation, 72,5% of these patients were still alive.ConclusionIntra-arterial chemotherapy is a safe and highly effective procedure that should be considered as an important option in multimodal therapeutic concepts for oral and oropharyngeal cancer.

Lokale Chemotherapie oraler und oropharyngealer Plattenepithelkarzinome

BACKGROUNDnModern treatment concepts for patients suffering from oral and oropharyngeal cancer include more and more adjuvant therapeutic options. Local chemotherapy offers the possibility to apply an extremely high drug concentration at the tumor site while minimizing possible side effects by systemic neutralization at the same time.nnnPATIENTS AND METHODSnA total of 289 patients with histologically proven carcinoma of the oral cavity and the oropharynx underwent neoadjuvant intra-arterial chemotherapy with high-dosage cisplatin within a multimodal therapeutic setting. Concerning the TNM classification, more than 70% of the patients were classified as stages III and IV. The mean age at the time of intervention was 60 years, and 71% of the patients were male.nnnRESULTSnAfter the first cycle 19.3% of the patients presented with complete remission (grade I); 35.4% and 41.5% showed partial remissions (grade II) or stable disease (grade III), respectively. The mean observation time after treatment was 28 months (median: 24.2 months). Of the 137 patients who completed the full multimodal therapeutic scheme, 11% developed local recurrence, and 12.4% developed lymph node or distant metastasis. At the time of evaluation, 72.5% of these patients were still alive.nnnCONCLUSIONnIntra-arterial chemotherapy is a safe and highly effective procedure that should be considered as an important option in multimodal therapeutic concepts for oral and oropharyngeal cancer.ZusammenfassungHintergrundDie moderne Behandlung von Patienten mit Plattenepithelkarzinomen des Mundes und des Oropharynx beinhaltet zunehmend adjuvante Therapieformen. Die lokale Chemotherapie ermöglicht neben der Applikation einer extrem hohen Medikamentenkonzentration in der Tumorregion eine gleichzeitige Minimierung der Nebenwirkung durch systemische Antagonisierung.Patienten und MethodenIm Rahmen eines multimodalen Therapiekonzepts erhielten 289xa0Patienten mit histologisch gesicherten Karzinomen der Mundhöhle und des Oropharynx eine neoadjuvante i.a. Chemotherapie mit hochdosiertem Cisplatin. Nach TNM-Kriterien waren über 70% der Patienten den Stadienxa0T3 und T4 zuzuordnen. Das Alter zum Zeitpunkt der Intervention lag bei 60xa0Jahren, 71% der Patienten waren Männer.ErgebnisseDer Anteil vollständiger Remissionen (Gradxa0I) nach dem 1. Behandlungszyklus betrug 19,3%, partielle Remissionen konnten bei 35,4% (Gradxa0II) und 41,5% (Gradxa0III) erzielt werden. Der durchschnittliche Beobachtungszeitraum nach Behandlungsende betrug etwa 28xa0Monate (Median 24,2xa0Monate). Von 137xa0Patienten, die einen multimodalen Behandlungszyklus absolvierten, lebten zum Zeitpunkt der Auswertung noch 72,5%; 11% entwickelten ein Lokalrezidiv und 12,4% Lymphknoten- oder Fernmetastasen.SchlussfolgerungDie i.a. Chemotherapie ist ein sicheres Verfahren mit hoher Effektivität und stellt im Rahmen multimodaler Therapiekonzepte zur Behandlung oraler und oropharyngealer Karzinome eine wichtige Option dar.AbstractBackgroundModern treatment concepts for patients suffering from oral and oropharyngeal cancer include more and more adjuvant therapeutic options. Local chemotherapy offers the possibility to apply an extremely high drug concentration at the tumor site while minimizing possible side effects by systemic neutralization at the same time.Patients and methodsA total of 289xa0patients with histologically proven carcinoma of the oral cavity and the oropharynx underwent neoadjuvant intra-arterial chemotherapy with high-dosage cisplatin within a multimodal therapeutic setting. Concerning the TNM classification, more than 70% of the patients were classified as stages III and IV. The mean age at the time of intervention was 60xa0years, and 71% of the patients were male.ResultsAfter the first cycle 19.3% of the patients presented with complete remission (gradexa0I); 35.4% and 41.5% showed partial remissions (gradexa0II) or stable disease (gradexa0III), respectively. The mean observation time after treatment was 28xa0months (median: 24.2xa0months). Of the 137xa0patients who completed the full multimodal therapeutic scheme, 11% developed local recurrence, and 12.4% developed lymph node or distant metastasis. At the time of evaluation, 72,5% of these patients were still alive.ConclusionIntra-arterial chemotherapy is a safe and highly effective procedure that should be considered as an important option in multimodal therapeutic concepts for oral and oropharyngeal cancer.

Lokale Chemotherapie oraler und oropharyngealer Plattenepithelkarzinome@@@Local chemotherapy for squamous cell cancer of the oral cavity and oropharynx

BACKGROUNDnModern treatment concepts for patients suffering from oral and oropharyngeal cancer include more and more adjuvant therapeutic options. Local chemotherapy offers the possibility to apply an extremely high drug concentration at the tumor site while minimizing possible side effects by systemic neutralization at the same time.nnnPATIENTS AND METHODSnA total of 289 patients with histologically proven carcinoma of the oral cavity and the oropharynx underwent neoadjuvant intra-arterial chemotherapy with high-dosage cisplatin within a multimodal therapeutic setting. Concerning the TNM classification, more than 70% of the patients were classified as stages III and IV. The mean age at the time of intervention was 60 years, and 71% of the patients were male.nnnRESULTSnAfter the first cycle 19.3% of the patients presented with complete remission (grade I); 35.4% and 41.5% showed partial remissions (grade II) or stable disease (grade III), respectively. The mean observation time after treatment was 28 months (median: 24.2 months). Of the 137 patients who completed the full multimodal therapeutic scheme, 11% developed local recurrence, and 12.4% developed lymph node or distant metastasis. At the time of evaluation, 72.5% of these patients were still alive.nnnCONCLUSIONnIntra-arterial chemotherapy is a safe and highly effective procedure that should be considered as an important option in multimodal therapeutic concepts for oral and oropharyngeal cancer.ZusammenfassungHintergrundDie moderne Behandlung von Patienten mit Plattenepithelkarzinomen des Mundes und des Oropharynx beinhaltet zunehmend adjuvante Therapieformen. Die lokale Chemotherapie ermöglicht neben der Applikation einer extrem hohen Medikamentenkonzentration in der Tumorregion eine gleichzeitige Minimierung der Nebenwirkung durch systemische Antagonisierung.Patienten und MethodenIm Rahmen eines multimodalen Therapiekonzepts erhielten 289xa0Patienten mit histologisch gesicherten Karzinomen der Mundhöhle und des Oropharynx eine neoadjuvante i.a. Chemotherapie mit hochdosiertem Cisplatin. Nach TNM-Kriterien waren über 70% der Patienten den Stadienxa0T3 und T4 zuzuordnen. Das Alter zum Zeitpunkt der Intervention lag bei 60xa0Jahren, 71% der Patienten waren Männer.ErgebnisseDer Anteil vollständiger Remissionen (Gradxa0I) nach dem 1. Behandlungszyklus betrug 19,3%, partielle Remissionen konnten bei 35,4% (Gradxa0II) und 41,5% (Gradxa0III) erzielt werden. Der durchschnittliche Beobachtungszeitraum nach Behandlungsende betrug etwa 28xa0Monate (Median 24,2xa0Monate). Von 137xa0Patienten, die einen multimodalen Behandlungszyklus absolvierten, lebten zum Zeitpunkt der Auswertung noch 72,5%; 11% entwickelten ein Lokalrezidiv und 12,4% Lymphknoten- oder Fernmetastasen.SchlussfolgerungDie i.a. Chemotherapie ist ein sicheres Verfahren mit hoher Effektivität und stellt im Rahmen multimodaler Therapiekonzepte zur Behandlung oraler und oropharyngealer Karzinome eine wichtige Option dar.AbstractBackgroundModern treatment concepts for patients suffering from oral and oropharyngeal cancer include more and more adjuvant therapeutic options. Local chemotherapy offers the possibility to apply an extremely high drug concentration at the tumor site while minimizing possible side effects by systemic neutralization at the same time.Patients and methodsA total of 289xa0patients with histologically proven carcinoma of the oral cavity and the oropharynx underwent neoadjuvant intra-arterial chemotherapy with high-dosage cisplatin within a multimodal therapeutic setting. Concerning the TNM classification, more than 70% of the patients were classified as stages III and IV. The mean age at the time of intervention was 60xa0years, and 71% of the patients were male.ResultsAfter the first cycle 19.3% of the patients presented with complete remission (gradexa0I); 35.4% and 41.5% showed partial remissions (gradexa0II) or stable disease (gradexa0III), respectively. The mean observation time after treatment was 28xa0months (median: 24.2xa0months). Of the 137xa0patients who completed the full multimodal therapeutic scheme, 11% developed local recurrence, and 12.4% developed lymph node or distant metastasis. At the time of evaluation, 72,5% of these patients were still alive.ConclusionIntra-arterial chemotherapy is a safe and highly effective procedure that should be considered as an important option in multimodal therapeutic concepts for oral and oropharyngeal cancer.