nach oben

Neurosurgical Review

Erschienen in:

01.12.2023 | Research

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

verfasst von: Selcuk Peker, Yavuz Samanci, Inan Erdem Ozdemir, Henricus P. M. Kunst, Daniëlle B. P. Eekers, Yasin Temel

Erschienen in: Neurosurgical Review | Ausgabe 1/2023

Einloggen, um Zugang zu erhalten

Abstract

Anecdotally, cystic vestibular schwannomas (cVSs) are regarded to have unpredictable biologic activity with poorer clinical results, and most studies showed a less favorable prognosis following surgery. While stereotactic radiosurgery (SRS) is a well-established therapeutic option for small- to medium-sized VSs, cVSs are often larger, thus making upfront SRS more complicated. The purpose of this retrospective study was to assess the efficacy and safety of upfront SRS for large cVSs. The authors reviewed the data of 54 patients who received upfront, single-session Gamma Knife radiosurgery (GKRS) with a diagnosis of large cVS (> 4 cm3). Patients with neurofibromatosis type 2, multiple VSs, or recurrent VSs and < 24 months of clinical and neuroimaging follow-up were excluded. Hearing loss (48.1%) was the primary presenting symptom. The majority of cVSs were Koos grade IV (66.7%), and the most prevalent cyst pattern was “mixed pattern of small and big cysts” (46.3%). The median time between diagnosis and GKRS was 12 months (range, 1–147 months). At GKRS, the median cVS volume was 6.95 cm³ (range, 4.1–22 cm³). The median marginal dose was 12 Gy (range, 10–12 Gy). The mean radiological and clinical follow-up periods were 62.2 ± 34.04 months (range, 24–169 months) and 94.9 ± 45.41 months (range, 24–175 months), respectively. At 2, 6, and 12 years, the tumor control rates were 100%, 95.7%, and 85.0%, respectively. Tumor shrinkage occurred in 92.6% of patients (n = 50), tumor volume remained stable in 5.6% of patients (n = 3), and tumor growth occurred in 1.9% of patients (n = 1). At a median follow-up of 53.5 months, the pre-GKRS tumor volume significantly decreased to 2.35 cm³ (p < 0.001). While Koos grade 3 patients had a greater possibility of attaining higher volume reduction, “multiple small thick-walled cyst pattern” and smaller tumor volumes decreased the likelihood of achieving higher volume reduction. Serviceable hearing (Gardner-Robertson Scale I–II) was present in 16.7% of patients prior to GKRS and it was preserved in all of these patients following GKRS. After GKRS, 1.9% of patients (n = 1) had new-onset trigeminal neuralgia. There was no new-onset facial palsy, hemifacial spasm, or hydrocephalus. Contrary to what was believed, our findings suggest that upfront GKRS seems to be a safe and effective treatment option for large cVSs.

Piccirillo E, Wiet MR, Flanagan S et al (2009) Cystic vestibular schwannoma: classification, management, and facial nerve outcomes. Otol Neurotol 30(2009):826–834. https://doi.org/10.1097/MAO.0b013e3181b04e18CrossRefPubMed

de Ipolyi AR, Yang I, Buckley A et al (2008) Fluctuating response of a cystic vestibular schwannoma to radiosurgery: case report. Neurosurg 62(2008):E1164-5. https://doi.org/10.1227/01.neu.0000325880.13494.f2CrossRef

Mehrotra N, Behari S, Pal L et al (2008) Giant vestibular schwannomas: focusing on the differences between the solid and the cystic variants. Br J Neurosurg 22(2008):550–556. https://doi.org/10.1080/02688690802159031CrossRefPubMed

Selesnick SH, Johnson G (1998) Radiologic surveillance of acoustic neuromas. Am J Otol 19(1998):846–849PubMed

Thakur JD, Khan IS, Shorter CD et al (2012) Do cystic vestibular schwannomas have worse surgical outcomes? Syst Anal Lit Neurosurg Focus FOC 33(2012):E12. https://doi.org/10.3171/2012.6.Focus12200CrossRef

Wu X, Song G, Wang X et al (2021) Comparison of surgical outcomes in cystic and solid vestibular schwannomas: a systematic review and meta-analysis. Neurosurg Rev 44(2021):1889–1902. https://doi.org/10.1007/s10143-020-01400-5CrossRefPubMed

Xia L, Zhang H, Yu C et al (2014) Fluid-fluid level in cystic vestibular schwannoma: a predictor of peritumoral adhesion. J Neurosurg 120(2014):197–206. https://doi.org/10.3171/2013.6.JNS121630CrossRefPubMed

Xu J, Ma J, Shi Y et al (2020) Differential protein expression between cystic and solid vestibular schwannoma using tandem mass tag-based quantitative proteomic analysis. Proteomics Clin Appl 14(2020):e1900112. https://doi.org/10.1002/prca.201900112CrossRefPubMed

Yashar P, Zada G, Harris B et al (2012) Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature. Neurosurg Focus 33(2012):E13. https://doi.org/10.3171/2012.7.FOCUS12206CrossRefPubMed

10.

Almefty RO, Xu DS, Mooney MA et al (2021) Comparison of surgical outcomes and recurrence rates of cystic and solid vestibular schwannomas. J Neurol Surg B Skull Base 82(2021):333–337. https://doi.org/10.1055/s-0039-1697039CrossRefPubMed

11.

Mastronardi L, Gazzeri R, Barbieri FR et al (2020) Postoperative functional preservation of facial nerve in cystic vestibular schwannoma. World Neurosurg 143(2020):e36–e43. https://doi.org/10.1016/j.wneu.2020.04.018CrossRefPubMed

12.

Tang IP, Freeman SR, Rutherford SA et al (2014) Surgical outcomes in cystic vestibular schwannoma versus solid vestibular schwannoma. Otol Neurotol 35(2014):1266–1270. https://doi.org/10.1097/MAO.0000000000000435CrossRefPubMed

13.

Boari N, Bailo M, Gagliardi F et al (2014) Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. J Neurosurg 121(2014):123–142. https://doi.org/10.3171/2014.8.GKS141506CrossRefPubMed

14.

Guadix SW, Tao AJ, An A et al (2021) Assessing the long-term safety and efficacy of Gamma Knife and linear accelerator radiosurgery for vestibular schwannoma: a systematic review and meta-analysis. Neurooncol Pract 8(2021):639–651. https://doi.org/10.1093/nop/npab052CrossRefPubMedPubMedCentral

15.

Kawashima M, Hasegawa H, Shin M et al (2020) Long-term outcomes of Gamma Knife radiosurgery for treating vestibular schwannoma with a lower prescription dose of 12 Gy compared with higher dose treatment. Otol Neurotol 41(2020):e1314–e1320. https://doi.org/10.1097/MAO.0000000000002885CrossRefPubMed

16.

Lefranc M, Da Roz LM, Balossier A et al (2018) Place of Gamma Knife Stereotactic radiosurgery in grade 4 vestibular schwannoma based on case series of 86 patients with long-term follow-up. World Neurosurg 114(2018):e1192–e1198. https://doi.org/10.1016/j.wneu.2018.03.175CrossRefPubMed

17.

Ogino A, Long H, Johnson S et al (2021) Useful hearing preservation is improved in vestibular schwannoma patients who undergo stereotactic radiosurgery before further hearing deterioration ensues. J Neurooncol 152(2021):559–566. https://doi.org/10.1007/s11060-021-03726-6CrossRefPubMed

18.

Tsao MN, Sahgal A, Xu W et al (2017) Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) practice guideline. J Radiosurg SBRT 5(2017):5–24PubMedPubMedCentral

19.

Wage J, Mignano J, Wu J (2021) Tufts medical center experience with long-term follow-up of vestibular schwannoma treated with Gamma Knife stereotactic radiosurgery: Novel Finding of Delayed Pseudoprogression. Adv Radiat Oncol 6(2021):100687. https://doi.org/10.1016/j.adro.2021.100687CrossRefPubMedPubMedCentral

20.

Wangerid T, Bartek J Jr, Svensson M et al (2014) Long-term quality of life and tumour control following Gamma Knife radiosurgery for vestibular schwannoma. Acta Neurochir (Wien) 156(2014):389–396. https://doi.org/10.1007/s00701-013-1924-5CrossRefPubMed

21.

Pendl G, Ganz JC, Kitz K et al (1996) Acoustic neurinomas with macrocysts treated with Gamma Knife radiosurgery. Stereotact Funct Neurosurg 66(1996):103–111. https://doi.org/10.1159/000099775CrossRefPubMed

22.

Shuto T, Matsunaga S (2016) Two cases of cystic enlargement of vestibular schwannoma as a late complication following Gamma Knife surgery. J Clin Neurosci 33(2016):239–241. https://doi.org/10.1016/j.jocn.2016.05.022CrossRefPubMed

23.

Ding K, Ng E, Romiyo P et al (2020) Meta-analysis of tumor control rates in patients undergoing stereotactic radiosurgery for cystic vestibular schwannomas. Clin Neurol Neurosurg 188(2020):105571. https://doi.org/10.1016/j.clineuro.2019.105571CrossRefPubMed

24.

Massaad E, Hamidi N, Goetz J et al (2021) Equivalent efficacy and safety of radiosurgery for cystic and solid vestibular schwannomas: a systematic review. World Neurosurg 146(2021):322–331. https://doi.org/10.1016/j.wneu.2020.11.040CrossRefPubMed

25.

Stastna D, Urgosik D, Chytka T et al (2021) Large vestibular schwannomas: long-term outcomes after stereotactic radiosurgery. Neuro Endocrinol Lett 41(2021):329–338PubMed

26.

Metwali H, Samii M, Samii A et al (2014) The peculiar cystic vestibular schwannoma: a single-center experience. World Neurosurg 82(2014):1271–1275. https://doi.org/10.1016/j.wneu.2014.07.011CrossRefPubMed

27.

Koos WT, Day JD, Matula C et al (1998) Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88(1998):506–512. https://doi.org/10.3171/jns.1998.88.3.0506CrossRefPubMed

28.

Gardner G, Robertson JH (1988) Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97(1988):55–66. https://doi.org/10.1177/000348948809700110CrossRefPubMed

29.

House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93(1985):146–147. https://doi.org/10.1177/019459988509300202CrossRefPubMed

30.

Albano L, Deng H, Wei Z et al (2022) The longitudinal volumetric response of vestibular schwannomas after Gamma Knife radiosurgery. J Neurosurg (2022):1-8. https://doi.org/10.3171/2022.7.JNS22812

31.

Dhayalan D, Perry A, Graffeo CS et al (2022) Salvage radiosurgery following subtotal resection of vestibular schwannomas: does timing influence tumor control? J Neurosurg (2022):1-10. https://doi.org/10.3171/2022.5.JNS22249

32.

Nagano O, Higuchi Y, Serizawa T et al (2008) Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg 109(2008):811–816. https://doi.org/10.3171/JNS/2008/109/11/0811CrossRefPubMed

33.

Youden WJ (1950) Index for rating diagnostic tests. Cancer 3(1950):32–35. https://doi.org/10.1002/1097-0142(1950)3:1%3c32::aid-cncr2820030106%3e3.0.co;2-3CrossRefPubMed

34.

Charabi S, Mantoni M, Tos M et al (1994) Cystic vestibular schwannomas: neuroimaging and growth rate. J Laryngol Otol 108(1994):375–379. https://doi.org/10.1017/s0022215100126854CrossRefPubMed

35.

Kameyama S, Tanaka R, Honda Y et al (1994) The long-term growth rate of residual acoustic neurinomas. Acta Neurochir (Wien) 129(1994):127–130. https://doi.org/10.1007/BF01406491CrossRefPubMed

36.

Hentschel MA, Hannink G, Steens SCA et al (2021) Development of a model to predict vestibular schwannoma growth: an opportunity to introduce new wait and scan strategies. Clin Otolaryngol 49(2021):273–283. https://doi.org/10.1111/coa.13661CrossRef

37.

Shuto T, Inomori S, Matsunaga S et al (2008) Microsurgery for vestibular schwannoma after Gamma Knife radiosurgery. Acta Neurochir (Wien) 150(2008):229–234. https://doi.org/10.1007/s00701-007-1486-5CrossRefPubMed

38.

Lee CC, Wu HM, Chung WY et al (2014) Microsurgery for vestibular schwannoma after Gamma Knife surgery: challenges and treatment strategies. J Neurosurg 212(2014):150–159. https://doi.org/10.3171/2014.8.GKS141312CrossRef

39.

Troude L, Boucekine M, Balossier A et al (2022) Is salvage surgery for large vestibular schwannomas after failed Gamma Knife radiosurgery more challenging? Neurosurg Rev 45(2022):751–761. https://doi.org/10.1007/s10143-021-01604-3CrossRefPubMed

40.

Kondziolka D, Lunsford LD, McLaughlin MR et al (1998) Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339(1998):1426–1433. https://doi.org/10.1056/NEJM199811123392003CrossRefPubMed

41.

Tuleasca C, George M, Faouzi M et al (2016) Acute clinical adverse radiation effects after Gamma Knife surgery for vestibular schwannomas. J Neurosurg 125(2016):73–82. https://doi.org/10.3171/2016.7.GKS161496CrossRefPubMed

42.

Shirato H, Sakamoto T, Takeichi N et al (2000) Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): comparison between cystic-type and solid-type VS. Int J Radiat Oncol Biol Phys 48(2000):1395–1401. https://doi.org/10.1016/s0360-3016(00)00731-8CrossRefPubMed

43.

Frisch CD, Jacob JT, Carlson ML et al (2017) Stereotactic radiosurgery for cystic vestibular schwannomas. Neurosurgery 80(2017):112–118. https://doi.org/10.1227/NEU.0000000000001376CrossRefPubMed

44.

Bowden G, Cavaleri J, Monaco E III et al (2017) Cystic vestibular schwannomas respond best to radiosurgery. Neurosurgery 81(2017):490–497. https://doi.org/10.1093/neuros/nyx027CrossRefPubMed

45.

Benech F, Perez R, Fontanella MM et al (2005) Cystic versus solid vestibular schwannomas: a series of 80 grade III-IV patients. Neurosurg Rev 28(2005):209–213. https://doi.org/10.1007/s10143-005-0380-yCrossRefPubMed

46.

El-Shehaby AMN, Reda WA, Abdel Karim KM et al (2018) Hearing preservation after Gamma Knife radiosurgery for cerebellopontine angle meningiomas. J Neurosurg 129(2018):38–46. https://doi.org/10.3171/2018.7.GKS181308CrossRefPubMed

47.

Hasegawa T, Kida Y, Kato T et al (2011) Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 115(2011):1078–1086. https://doi.org/10.3171/2011.7.JNS11749CrossRefPubMed

48.

Kano H, Kondziolka D, Khan A et al (2009) Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. J Neurosurg 111(2009):863–873. https://doi.org/10.3171/2008.12.JNS08611CrossRefPubMed

49.

Paek SH, Chung HT, Jeong SS et al (2005) Hearing preservation after Gamma Knife stereotactic radiosurgery of vestibular schwannoma. Cancer 104(2005):580–590. https://doi.org/10.1002/cncr.21190CrossRefPubMed

50.

Villafuerte CJ, Shultz DB, Laperriere N et al (2021) Radiation dose rate, biologically effective dose, and tumor characteristics on local control and toxicity after radiosurgery for acoustic neuromas. World Neurosurg 152(2021):e512–e522. https://doi.org/10.1016/j.wneu.2021.05.122CrossRefPubMed

51.

Starnoni D, Giammattei L, Cossu G et al (2020) Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 162(2020):2595–2617. https://doi.org/10.1007/s00701-020-04491-7CrossRefPubMed

52.

Vakilian S, Souhami L, Melancon D et al (2012) Volumetric measurement of vestibular schwannoma tumour growth following partial resection: predictors for recurrence. J Neurol Surg B Skull Base 73(2012):117–120. https://doi.org/10.1055/s-0032-1301395CrossRefPubMedPubMedCentral

53.

Jacob JT, Carlson ML, Driscoll CL et al (2016) Volumetric analysis of tumor control following subtotal and near-total resection of vestibular schwannoma. Laryngoscope 126(2016):1877–1882. https://doi.org/10.1002/lary.25779CrossRefPubMed

54.

Monfared A, Corrales CE, Theodosopoulos PV et al (2016) Facial nerve outcome and tumor control rate as a function of degree of resection in treatment of large acoustic neuromas: preliminary report of the Acoustic Neuroma Subtotal Resection Study (ANSRS). Neurosurgery 79(2016):194–203. https://doi.org/10.1227/NEU.0000000000001162CrossRefPubMed

55.

Starnoni D, Daniel RT, Tuleasca C et al (2018) Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach. Neurosurg Focus 44(2018):E4. https://doi.org/10.3171/2017.12.FOCUS17669CrossRefPubMed

56.

Hong RS, Kartush JM (2012) Acoustic neuroma neurophysiologic correlates: facial and recurrent laryngeal nerves before, during, and after surgery. Otolaryngol Clin North Am 45(2012):291–306. https://doi.org/10.1016/j.otc.2011.12.003CrossRefPubMed

57.

Chung WY, Pan DH, Lee CC et al (2010) Large vestibular schwannomas treated by Gamma Knife surgery: long-term outcomes. J Neurosurg 2010(113 Suppl):112–121. https://doi.org/10.3171/2010.8.GKS10954CrossRef

58.

Tosi U, Lavieri MET, An A et al (2021) Outcomes of stereotactic radiosurgery for large vestibular schwannomas: a systematic review and meta-analysis. Neurooncol Pract 8(2021):405–416. https://doi.org/10.1093/nop/npab011CrossRefPubMedPubMedCentral

59.

Niranjan A, Lunsford LD, Flickinger JC et al (1999) Can hearing improve after acoustic tumor radiosurgery? Neurosurg Clin N Am 10(1999):305–315. https://doi.org/10.1016/S1042-3680(18)30196-7CrossRefPubMed

60.

Thakur JD, Khan IS, Shorter CD et al (2012) Do cystic vestibular schwannomas have worse surgical outcomes? Syst Analy Lit Neurosurg Focus 33(2012):E12. https://doi.org/10.3171/2012.6.FOCUS12200CrossRef

61.

Eser Ocak P, Dogan I, Ocak U et al (2018) Facial nerve outcome and extent of resection in cystic versus solid vestibular schwannomas in radiosurgery era. Neurosurg Focus 44(2018):E3. https://doi.org/10.3171/2017.12.FOCUS17667CrossRefPubMed

62.

Huang CY, Peng SJ, Wu HM et al (2021) Quantification of tumor response of cystic vestibular schwannoma to Gamma Knife radiosurgery by using artificial intelligence. J Neurosurg (2021):1-9. https://doi.org/10.3171/2021.4.JNS203700

63.

Yang HC, Kano H, Awan NR et al (2011) Gamma Knife radiosurgery for larger-volume vestibular schwannomas. Clin Article J Neurosurg 114(2011):801–807. https://doi.org/10.3171/2010.8.JNS10674CrossRef

64.

Delsanti C, Regis J (2004) Cystic vestibular schwannomas. Neurochirurgie 50(2004):401–406PubMed

65.

Samanci Y, Budak M, Karaköse F et al (2022) Hypofractionated stereotactic radiosurgery for Koos grade IV vestibular schwannomas. ISRS Congress. Milan: Old City Publishing, Inc, 8:6

66.

Hasegawa T, Kida Y, Kato T et al (2013) Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 118(2013):557–565. https://doi.org/10.3171/2012.10.JNS12523CrossRefPubMed

67.

Klijn S, Verheul JB, Beute GN et al (2016) Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands. J Neurosurg 124(2016):1619–1626. https://doi.org/10.3171/2015.4.JNS142415CrossRefPubMed

68.

Tuleasca C, George M, Maire R et al (2017) Letter: Cystic vestibular schwannomas respond best to radiosurgery. Neurosurg 81(2017):E80–E82. https://doi.org/10.1093/neuros/nyx462CrossRef

69.

Wu CC, Guo WY, Chung WY et al (2017) Magnetic resonance imaging characteristics and the prediction of outcome of vestibular schwannomas following Gamma Knife radiosurgery. J Neurosurg 127(2017):1384–1391. https://doi.org/10.3171/2016.9.JNS161510CrossRefPubMed

70.

Lim SH, Park CK, Park BJ et al (2019) Long-term outcomes of gamma knife radiosurgery for cystic vestibular schwannomas. World Neurosurg 132(2019):e34–e39. https://doi.org/10.1016/j.wneu.2019.09.009CrossRefPubMed

71.

Da C, Jinming S (2020) Letter to the Editor regarding “Long-term outcomes of Gamma Knife radiosurgery for cystic vestibular schwannomas.” World Neurosurg 137(2020):485–486. https://doi.org/10.1016/j.wneu.2020.01.107CrossRefPubMed

Titel: Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas
verfasst von: Selcuk Peker
Yavuz Samanci
Inan Erdem Ozdemir
Henricus P. M. Kunst
Daniëlle B. P. Eekers
Yasin Temel
Publikationsdatum: 01.12.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Neurosurgical Review / Ausgabe 1/2023
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-022-01911-3

Neu im Fachgebiet Chirurgie

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

Abstract

Neu im Fachgebiet Chirurgie

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Fehlerkultur in der Medizin – Offenheit zählt!

Mehr Frauen im OP – weniger postoperative Komplikationen

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

Update Chirurgie

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

S2e-Leitlinie „Distale Radiusfraktur“

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2023

Preoperative prognostic nutrition index can independently predict the 6-month prognosis of elderly patients undergoing neurosurgical clipping for aneurysmal subarachnoid hemorrhage

The role of an open artificial intelligence platform in modern neurosurgical education: a preliminary study

Letter to the editor: Effect of postoperative tranexamic acid on recurrence rate and complications in chronic subdural hematomas patients: preliminary results of a randomized controlled clinical trial

Management principles of cranial base tumor with aneurysm

A systematic review of the power of standardization in pediatric neurosurgery

Predictors of postoperative performance status after surgical management of infratemporal fossa malignancies

Update Chirurgie