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  • 1
    Online Resource
    Online Resource
    Ultra-early tranexamic acid after subarachnoid haemorrhage (ULTRA): a randomised controlled trial
    Elsevier BV ; 2021
    In:  The Lancet Vol. 397, No. 10269 ( 2021-01), p. 112-118
    Details
    In: The Lancet, Elsevier BV, Vol. 397, No. 10269 ( 2021-01), p. 112-118
    Type of Medium: Online Resource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(20)32518-6
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2067452-1
    detail.hit.zdb_id: 3306-6
    detail.hit.zdb_id: 1476593-7
    SSG: 5,21
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  • 2
    Online Resource
    Online Resource
    Image-guided vascular neurosurgery based on three-dimensional rotational angiography : Technical note
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2007
    In:  Journal of Neurosurgery Vol. 106, No. 3 ( 2007-03), p. 501-506
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 106, No. 3 ( 2007-03), p. 501-506
    Abstract: ✓Three-dimensional rotational angiography is capable of exquisite visualization of cerebral blood vessels and their pathophysiology. Unfortunately, images obtained using this modality typically show a small region of interest without exterior landmarks to allow patient-to-image registration, precluding their use for neuronavigation purposes. The aim of this study was to find an alternative technique to enable 3D rotational angiography–guided vascular neurosurgery. Three-dimensional rotational angiograms were obtained in an angiographic suite with direct navigation capabilities. After image acquisition, a navigated pointer was used to touch fiducial positions on the patient's head. These positions were located outside the image volume but could nevertheless be transformed into image coordinates and stored in the navigation system. Prior to surgery, the data set was transferred to the navigation system in the operating room, and the same fiducial positions were touched again to complete the patient-to-image registration. This technique was tested on a Perspex phantom representing the cerebral vascular tree and on two patients with an intracranial aneurysm. In both the phantom and patients, the neuronavigation system provided 3D images representing the vascular tree in its correct orientation, that is, the orientation seen by the neurosurgeon through the microscope. In one patient, tissue shift was clearly observed without significant changes in the orientation of the structures. Results in this study demonstrate the feasibility of using 3D rotational angiography data sets for neuronavigation purposes. Determining the benefit of this type of navigation should be the subject of future studies.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.2007.106.3.501
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2007
    detail.hit.zdb_id: 2026156-1
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  • 3
    Online Resource
    Online Resource
    Application accuracy in frameless image-guided neurosurgery: a comparison study of three patient-to-image registration methods
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2007
    In:  Journal of Neurosurgery Vol. 106, No. 6 ( 2007-06), p. 1012-1016
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 106, No. 6 ( 2007-06), p. 1012-1016
    Abstract: The aim of this study was to compare three patient-to-image registration methods in frameless stereotaxy in terms of their application accuracy (the accuracy with which the position of a target can be determined intraoperatively). In frameless stereotaxy, imaging information is transposed to the surgical field to show the spatial position of a localizer or surgical instrument. The mathematical relationship between the image volume and the surgical working space is calculated using a rigid body transformation algorithm, based on point-pair matching or surface matching. Methods Fifty patients who were scheduled to undergo a frameless image-guided neurosurgical procedure were included in the study. Prior to surgery, the patients underwent either computerized tomography (CT) scanning or magnetic resonance (MR) imaging with widely distributed adhesive fiducial markers on the scalp. An extra fiducial marker was placed on the head as a target, as near as possible to the intracranial lesion. Prior to each surgical procedure, an optical tracking system was used to perform three separate patient-to-image registration procedures, using anatomical landmarks, adhesive markers, or surface matching. Subsequent to each registration, the target registration error (TRE), defined as the Euclidean distance between the image space coordinates and world space coordinates of the target marker, was determined. Independent of target location or imaging modality, mean application accuracy (± standard deviation) was 2.49 ± 1.07 mm when using adhesive markers. Using the other two registration strategies, mean TREs were significantly larger (surface matching, 5.03 ± 2.30 mm; anatomical landmarks, 4.97 ± 2.29 mm; p 〈 0.001 for both). Conclusions The results of this study show that skin adhesive fiducial marker registration is the most accurate noninvasive registration method. When images from an earlier study are to be used and accuracy may be slightly compromised, anatomical landmarks and surface matching are equally accurate alternatives.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.2007.106.6.1012
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2007
    detail.hit.zdb_id: 2026156-1
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  • 4
    Online Resource
    Online Resource
    Auditory feedback during frameless image-guided surgery in a phantom model and initial clinical experience : Technical note
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2009
    In:  Journal of Neurosurgery Vol. 110, No. 2 ( 2009-02), p. 257-262
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 110, No. 2 ( 2009-02), p. 257-262
    Abstract: In this study the authors measured the effect of auditory feedback during image-guided surgery (IGS) in a phantom model and in a clinical setting. In the phantom setup, advanced IGS with complementary auditory feedback was compared with results obtained with 2 routine forms of IGS, either with an on-screen image display or with imageinjection via a microscope. The effect was measured by means of volumetric resection assessments. The authors also present their first clinical data concerning the effects of complementary auditory feedback on instrument handling during image-guided neurosurgery. When using image-injection through the microscope for navigation, however, resection quality was significantly worse. In the clinical portion of the study, the authors performed resections of cerebral mass lesions in 6 patients with the aid of auditory feedback. Instrument tip speeds were slightly (although significantly) influenced by this feedback during resection. Overall, the participating neurosurgeons reported that the auditory feedback helped in decision-making during resection without negatively influencing instrument use. Postoperative volumetric imaging studies revealed resection rates of ≥ 95% when IGS with auditory feedback was used. There was only a minor amount of brain shift, and postoperative resection volumes corresponded well with the preoperative intentions of the neurosurgeon. Although the results of phantom surgery with auditory feedback revealed no significant effect on resection quality or extent, auditory cues may help prevent damage to eloquent brain structures.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2008.3.17431
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2009
    detail.hit.zdb_id: 2026156-1
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  • 5
    Online Resource
    Online Resource
    High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction
    SAGE Publications ; 2020
    In:  Journal of Intensive Care Medicine Vol. 35, No. 2 ( 2020-02), p. 161-169
    Details
    In: Journal of Intensive Care Medicine, SAGE Publications, Vol. 35, No. 2 ( 2020-02), p. 161-169
    Abstract: Guidelines on the management of aneurysmal subarachnoid hemorrhage (aSAH) recommend euvolemia, whereas hypervolemia may cause harm. We investigated whether high early fluid input is associated with delayed cerebral ischemia (DCI), and if fluid input can be safely decreased using transpulmonary thermodilution (TPT). Methods: We retrospectively included aSAH patients treated at an academic intensive care unit (2007-2011; cohort 1) or managed with TPT (2011-2013; cohort 2). Local guidelines recommended fluid input of 3 L daily. More fluids were administered when daily fluid balance fell below +500 mL. In cohort 2, fluid input in high-risk patients was guided by cardiac output measured by TPT per a strict protocol. Associations of fluid input and balance with DCI were analyzed with multivariable logistic regression (cohort 1), and changes in hemodynamic indices after institution of TPT assessed with linear mixed models (cohort 2). Results: Cumulative fluid input 0 to 72 hours after admission was associated with DCI in cohort 1 (n=223; odds ratio [OR] 1.19/L; 95% confidence interval 1.07-1.32), whereas cumulative fluid balance was not. In cohort 2 (23 patients), using TPT fluid input could be decreased from 6.0 ± 1.0 L before to 3.4 ± 0.3 L; P = .012), while preload parameters and consciousness remained stable. Conclusion: High early fluid input was associated with DCI. Invasive hemodynamic monitoring was feasible to reduce fluid input while maintaining preload. These results indicate that fluid loading beyond a normal preload occurs, may increase DCI risk, and can be minimized with TPT.
    Type of Medium: Online Resource
    ISSN: 0885-0666 , 1525-1489
    URL: Article
    DOI: 10.1177/0885066617732747
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2001472-7
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  • 6
    Online Resource
    Online Resource
    The Incidence of Cranial Arteriovenous Shunts in Patients With Pulsatile Tinnitus: A Prospective Observational Study
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Otology & Neurotology Vol. 39, No. 5 ( 2018-06), p. 648-653
    Details
    In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 5 ( 2018-06), p. 648-653
    Abstract: Finding the underlying cause for pulsatile tinnitus can be challenging. We aimed to determine the incidence of arteriovenous shunts, i.e., arteriovenous malformations (AVMs) or dural arteriovenous fistulas (dAVFs), in patients referred for catheter angiography (digital subtraction angiography [DSA]). Furthermore, we assessed which clinical features were predictive for the presence of such a lesion. Study Design and Methods: Fifty-one patients with pulsatile tinnitus, who were referred to us for DSA to exclude an arteriovenous shunt, were enrolled, prospectively. Main Outcome Measures: DSA determined the presence of a dAVF or AVM. Clinical characteristics were recorded systematically and all patients underwent a physical examination. Results: Fifty patients were included in the final analyses. While no AVMs were found, a dAVF was found in 12 cases (24%). Three of these demonstrated cortical venous reflux, thus requiring treatment due to the risk of hemorrhage. In three cases (6%), DSA demonstrated a non-arteriovenous-shunt abnormality, likely causing the tinnitus. The odds of having a dAVF were significantly raised by unilaterality, objective bruit, and the ability to influence the tinnitus with compression. Unilaterality even had a negative predictive value of 1 and, if used as selection criterion, would have raised dAVF prevalence from 24 to 32%. Conclusion: In a tertiary care setting, the prevalence of dAVFs in patients with pulsatile tinnitus is not negligible. Thus, patients with unilateral pulsatile tinnitus should be offered dynamic vascular imaging to rule out a dAVF. Especially, since some of these patients are at risk of intracranial hemorrhage and treatment options exist.
    Type of Medium: Online Resource
    ISSN: 1531-7129 , 1537-4505
    URL: Article
    DOI: 10.1097/MAO.0000000000001767
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2058738-7
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  • 7
    Online Resource
    Online Resource
    An MKM-mounted instrument holder for frameless point-stereotactic procedures: a phantom-based accuracy evaluation : Technical note
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2001
    In:  Journal of Neurosurgery Vol. 95, No. 6 ( 2001-12), p. 1067-1074
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 95, No. 6 ( 2001-12), p. 1067-1074
    Abstract: ✓ To enable the use of the Mehrkoordinaten Manipulator (MKM) robotic navigation system for frameless point stereotactic procedures, a new instrument holder is presented. A phantom-based accuracy study was performed in which this new method was compared with frame-based procedures performed using the Brown-Roberts-Wells (BRW) stereotactic frame. The authors acquired computerized tomography scans of a test phantom, consisting of 19 acrylic plastic target rods on a circular base. These images were used in frame-based (BRW) and frameless (MKM) localization experiments. In both cases the authors calculated the distances between the actual target positions and the positions reached stereotactically. The mean application accuracy (target registration error) was 0.68 mm when the BRW frame was used and 0.96 mm when the MKM system was used after manual repositioning of the microscope (p 〈 0.001). Positioning accomplished using robotics only demonstrated a slightly larger inaccuracy: 1.47 mm (p 〈 0.005). Because the surgeon is concerned with the largest error in an individual case rather than the mean error in a large number of cases, the mean + three standard deviations was also compared. This value differed very little between the manually positioned MKM system and the BRW frame (2.04 mm and 1.84 mm, respectively). Although repeatability per target appeared to be slightly better when the BRW frame was used, accuracy was more homogeneous over the phantom volume when the MKM system was used (both differences were not significant). In conclusion, the accuracy of point stereotactic procedures performed using an instrument holder attached to the MKM system is comparable with the accuracy of procedures involving a stereotactic frame. Moreover, the frameless techniques and robotic features of the MKM enable a more surgeon- and patient-friendly stereotactic procedure.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.2001.95.6.1067
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2001
    detail.hit.zdb_id: 2026156-1
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  • 8
    Online Resource
    Online Resource
    High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts
    Springer Science and Business Media LLC ; 2019
    In:  European Radiology Vol. 29, No. 11 ( 2019-11), p. 5961-5970
    Details
    In: European Radiology, Springer Science and Business Media LLC, Vol. 29, No. 11 ( 2019-11), p. 5961-5970
    Type of Medium: Online Resource
    ISSN: 0938-7994 , 1432-1084
    URL: Article
    DOI: 10.1007/s00330-019-06234-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 1472718-3
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  • 9
    Online Resource
    Online Resource
    Total Bolus Extraction Method Improves Arterial Image Quality in Dynamic CTAs Derived from Whole-Brain CTP Data
    Hindawi Limited ; 2014
    In:  BioMed Research International Vol. 2014 ( 2014), p. 1-6
    Details
    In: BioMed Research International, Hindawi Limited, Vol. 2014 ( 2014), p. 1-6
    Abstract: Background and Purposes . The 320-detector row CT scanner enables visualization of whole-brain hemodynamic information (dynamic CT angiography (CTA) derived from CT perfusion scans). However, arterial image quality in dynamic CTA (dCTA) is inferior to arterial image quality in standard CTA. This study evaluates whether the arterial image quality can be improved by using a total bolus extraction (ToBE) method. Materials and Methods . DCTAs of 15 patients, who presented with signs of acute cerebral ischemia, were derived from 320-slice CT perfusion scans using both the standard subtraction method and the proposed ToBE method. Two neurointerventionalists blinded to the scan type scored the arterial image quality on a 5-point scale in the 4D dCTAs in consensus. Arteries were divided into four categories: (I) large extradural, (II) intradural (large, medium, and small), (III) communicating arteries, and (IV) cerebellar and ophthalmic arteries. Results . Quality of extradural and intradural arteries was significantly higher in the ToBE dCTAs than in the standard dCTAs (extradural P = 0.001 , large intradural P 〈 0.001 , medium intradural P 〈 0.001 , and small intradural P 〈 0.001 ). Conclusion . The 4D dCTAs derived with the total bolus extraction (ToBE) method provide hemodynamic information combined with improved arterial image quality as compared to standard 4D dCTAs.
    Type of Medium: Online Resource
    ISSN: 2314-6133 , 2314-6141
    URL: Article
    DOI: 10.1155/2014/603173
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2014
    detail.hit.zdb_id: 2698540-8
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  • 10
    Online Resource
    Online Resource
    Current accuracy of surface matching compared to adhesive markers in patient-to-image registration
    Springer Science and Business Media LLC ; 2019
    In:  Acta Neurochirurgica Vol. 161, No. 5 ( 2019-5), p. 865-870
    Details
    In: Acta Neurochirurgica, Springer Science and Business Media LLC, Vol. 161, No. 5 ( 2019-5), p. 865-870
    Type of Medium: Online Resource
    ISSN: 0001-6268 , 0942-0940
    URL: Article
    DOI: 10.1007/s00701-019-03867-8
    RVK:
    XA 10000
    RVK:
    XA 12300
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 1464215-3
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