Abstract:
BACKGROUND:Chronic subdural haematomas (cSDHs) have shown an increasing incidence in an ageing population over the last 20 years, while unacceptable recurrence rates of up to 30 % persist. The recurrence rate of cSDH seems to be related to the excessive neoangiogenesis in the parietal membrane, which is mediated via vascular endothelial growth factor (VEGF). This is found to be elevated in the haematoma fluid and is dependent on eicosanoid/prostaglandin and thromboxane synthesis via cyclo-oxygenase-2 (COX-2). With this investigator-initiated trial (IIT) it was thought to diminish the recurrence rate of operated-on cSDHs by administering a selective COX-2 inhibitor (Celecoxib) over 4 weeks' time postoperatively in comparison to a control group. METHOD:The thesis of risk reduction of cSDH recurrence in COX-2-inhibited patients was to be determined in a prospective, randomised, two-armed, open phase-II/III study with inclusion of 180 patients over a 2-year time period in four German university hospitals. The treated- and untreated-patient data were to be analysed by Fisher's exact test (significance level of alpha, 0.05 [two-sided]). RESULTS:After screening of 246 patients from January 2009 to April 2010, the study had to be terminated prematurely as only 23 patients (9.3 %) could be enrolled because of on-going non-steroid anti-rheumatic (NSAR) drug treatment or contraindication to Celecoxib medication. In the study population, 13 patients were treated in the control group (six women, seven men; average age 66.8 years; one adverse event (AE)/serious adverse event (SAE) needing one re-operation because of progressive cSDH (7.7 %); ten patients were treated in the treatment group (one woman, nine men; average age 64.7 years; five AEs/SAEs needing two re-operations because of one progressive cSDH and one wound infection [20 %]). Significance levels are obsolete because of insufficient patient numbers. CONCLUSIONS:The theoretical advantage of COX-2 inhibition in the recurrent cSDH could not be transferred into the treatment of German cSDH patients as 66.6 % of the patients showed strict contraindications for Celecoxib. Furthermore, 55 % of the patients were already treated with some kind of COX-2 inhibition and, nevertheless, developed cSDH. Thus, although conceptually appealing, an anti-angiogenic therapy with COX-2 inhibitors for cSDH could not be realised in this patient population due to the high prevalence of comorbidities excluding the administration of COX2 inhibitors.
journal_name
Acta Neurochir (Wien)journal_title
Acta neurochirurgicaauthors
Schaumann A,Klene W,Rosenstengel C,Ringel F,Tüttenberg J,Vajkoczy Pdoi
10.1007/s00701-016-2949-3subject
Has Abstractpub_date
2016-11-01 00:00:00pages
2039-2044issue
11eissn
0001-6268issn
0942-0940pii
10.1007/s00701-016-2949-3journal_volume
158pub_type
杂志文章,随机对照试验abstract:BACKGROUND:Side-to-side neurorrhaphy may protect the denervated end organ and preserve the initial connection with proximal stump. We examined the effect of protective side-to-side anastomosis on nerve and end organ regeneration in proximal nerve injury model. METHODS:The left common peroneal nerve of 24 Sprague Dawle...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-019-03835-2
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abstract::Intra-operative neurophysiological techniques allow reliable identification of the sensorimotor region and make their anatomical and functional preservation feasible. Monopolar cortical stimulation has recently been described as a new mapping technique. In the present study this method was compared to the "traditional...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s007010050433
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abstract::A new case of hypothalamic hamartoma associated with precocious puberty is presented. After reviewing the literature, 23 other cases appeared. The ultrastructural study of the present case revealed common features with other hamartomatous lesions of the central nervous system and with the gangliogliomas. The data sugg...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01418802
更新日期:1985-01-01 00:00:00
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journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01401447
更新日期:1994-01-01 00:00:00
abstract::The patient is a 44-year-old man who underwent resection of a posterior nasopharynx tumor 12 years earlier via left lateral rhinotomy approach. The final pathological analysis indicated the tumor was a craniopharyngioma, and the patient subsequently underwent focal radiation. The patient returned to medical attention ...
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doi:10.1007/s00701-007-1168-3
更新日期:2007-01-01 00:00:00
abstract:PURPOSE:This article provides a review of the transcriptomic expression profiling studies that have been performed on meningiomas so far. We discuss some future prospects and challenges ahead in the field of gene expression profiling. METHODS:We performed a systematic search in the PubMed and EMBASE databases in May 2...
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abstract:BACKGROUND:Z-L response (ZLR) has been suggested to a new electromyographic (EMG) potential recorded from the facial muscle of patient with hemifacial spasm (HFS) during microvascular decompression (MVD). Although ZLR has been suggested to be useful, experience of ZLR monitoring is limited and its significance during M...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-017-3462-z
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journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01400876
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pub_type: 杂志文章,评审
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abstract::Traditional clinical outcome measures for the treatment of Parkinson's disease (PD) have focused on motor function and activities of daily living. However, in the past decade there has been a new emphasis on the use of health related quality of life (HRQOL) measures for translating how a patient's response to treatmen...
journal_title:Acta neurochirurgica
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abstract:BACKGROUND:The endoscopic endonasal approach for optic nerve decompression is suited for the management of non-traumatic optic neuropathy but remains underreported, presumably due to transcranial approaches still being favoured at individual centres. METHOD:The optic canal is approached endoscopically and transsphenoi...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-020-04476-6
更新日期:2020-09-01 00:00:00
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pub_type: 临床试验,杂志文章
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abstract:BACKGROUND:Nonfunctioning pituitary macroadenoma (NFMA) is a benign neoplasm that causes visual function disturbances and headaches and can be treated by transsphenoidal surgery (TSS). It is unclear how quality of life (QOL) changes with surgery and which QOL factors are affected by treatment. METHODS:The aim is to as...
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journal_title:Acta neurochirurgica
pub_type: 杂志文章
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journal_title:Acta neurochirurgica
pub_type: 杂志文章
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abstract::Ventriculo-subgaleal shunting was used for temporary decompression of hypertensive hydrocephalus. Pre- and post-shunt computed tomography was utilized in five cases as a method for detecting complications and determining shunt function. A clear-cut clinical improvement and stabilization followed the subgaleal diversio...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
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journal_title:Acta neurochirurgica
pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究
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更新日期:2010-11-01 00:00:00
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journal_title:Acta neurochirurgica
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更新日期:2021-01-20 00:00:00
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