Marcos Tatagiba

University of Tuebingen, Tübingen, Baden-Württemberg, Germany

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Publications (334)735.72 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Tumour resection in the Rolandic region is a challenge. Aim of this study is to review a series of patients malignant glioma surgery in the Rolandic region which was performed by combinations of neuronavigation, sonography, 5-aminolevulinic acid fluorescence guided (5-ALA) surgery and intraoperative electrophysiological monitoring (IOM). 29 patients suffering malignant gliomas in the motor cortex (17) and sensory cortex (12) were analyzed with respect to functional outcome and grade of resections. Improvement of motor function was seen in 41.5% one week after surgery, 41.5% were stable, only 17% deteriorated. After three months patients had an improvement of motor function in 56%, of Karnofsky Score (KPS) 27% and sensory function was improved in 8%. Deterioration of motor function was seen in 16%, in sensory function 4% and in KPS 28% after three months. 25% showed no residual tumour in early post surgical contrast enhanced MRI. 10% had less than 2% residual tumour and 15% had 2-5% residual tumour. Preoperative functional neuroimaging, neuronavigation for planning the surgical approach and resection margins, intraoperative sonography and 5-ALA guided surgery in combination with the application of IOM shows that functional outcome and total to subtotal resection of malignant glioma in the Rolandic region is feasible. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 09/2015; 136. DOI:10.1016/j.clineuro.2015.05.021 · 1.13 Impact Factor
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    ABSTRACT: To apply our previously published residual ex vivo γH2AX foci method to patient-derived tumour specimens covering a spectrum of tumour-types with known differences in radiation response. In addition, the data were used to simulate different experimental scenarios to simplify the method. Evaluation of residual γH2AX foci in well-oxygenated tumour areas of ex vivo irradiated patient-derived tumour specimens with graded single doses was performed. Immediately after surgical resection, the samples were cultivated for 24h in culture medium prior to irradiation and fixed 24h post-irradiation for γH2AX foci evaluation. Specimens from a total of 25 patients (including 7 previously published) with 10 different tumour types were included. Linear dose response of residual γH2AX foci was observed in all specimens with highly variable slopes among different tumour types ranging from 0.69 (95% CI: 1.14-0.24) to 3.26 (95% CI: 4.13-2.62) for chondrosarcomas (radioresistant) and classical seminomas (radiosensitive) respectively. Simulations suggest that omitting dose levels might simplify the assay without compromising robustness. Here we confirm clinical feasibility of the assay. The slopes of the residual foci number are well in line with the expected differences in radio-responsiveness of different tumour types implying that intrinsic radiation sensitivity contributes to tumour radiation response. Thus, this assay has a promising potential for individualized radiation therapy and prospective validation is warranted. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Radiotherapy and Oncology 08/2015; DOI:10.1016/j.radonc.2015.08.006 · 4.36 Impact Factor
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    ABSTRACT: OBJECT A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results. METHODS An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis. The surgery was performed after the patients were randomly assigned to one of 2 groups using online randomization. The treatment group (n = 56) received parenteral nimodipine (1-2 mg/hr) and hydroxyethyl starch (hematocrit 30%-35%) from the day before surgery until the 7th postoperative day. The control group (n = 56) was not treated prophylactically. RESULTS Intent-to-treat analysis showed no statistically significant effects of the treatment on either preservation of facial nerve function (35 [67.3%] of 52 [treatment group] compared with 34 [72.3%] of 47 [control group]) (p = 0.745) or hearing preservation (11 [23.4%] of 47 [treatment group] compared with 15 [31.2%] of 48 [control group]) (p = 0.530) 12 months after surgery. Since tumor sizes were significantly larger in the treatment group than in the control group, logistic regression analysis was required. The risk for deterioration of facial nerve function was adjusted nearly the same in both groups (OR 1.07 [95% CI 0.34-3.43], p = 0.91). In contrast, the risk for postoperative hearing loss was adjusted 2 times lower in the treatment group compared with the control group (OR 0.49 [95% CI 0.18-1.30], p = 0.15). Apart from dose-dependent hypotension (p < 0.001), no clinically relevant adverse reactions were observed. CONCLUSIONS There were no statistically significant effects of the treatment. Despite the width of the confidence intervals, the odds ratios may suggest but do not prove a clinically relevant effect of the safe study medication on the preservation of cochlear nerve function after VS surgery. Further study is needed before prophylactic nimodipine can be recommended in VS surgery.
    Journal of Neurosurgery 08/2015; DOI:10.3171/2015.1.JNS142001 · 3.74 Impact Factor
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    ABSTRACT: To describe the clinical feasibility and outcome of the endoscopic-assisted posterior intradural petrous apecectomy approach (PIPA) for petroclival meningiomas extending into the supratentorial space. From 2005-2013, 29 patients with a petroclival meningioma underwent tumor removal through a PIPA approach. The approach consists of a retrosigmoid approach, intradural anterior resection of the petrous apex and microsurgical removal of the tumor, followed by endoscopic-assisted visualization and removal of tumor parts in the middle fossa or anterior to the brainstem. There were 7 male patients and 22 female patients; the mean age of the patients was 52.7 years. In total, 24 patients underwent surgery in a semi-sitting position, whereas five patients were in a supine position. A total resection was achieved in 19 patients (66%). A Karnofsky score > 60% was recorded in 27 patients (93%), with surgical complications that involved a CSF leak in three patients, bleeding in the surgical cavity in two patients and pneumocephalus in one patient. The most frequent postoperative neurological deficit was facial palsy (34%), which disappeared or improved consistently in nearly all the patients, except in one patient, who required a CNVII-CNXII anastomosis. For petroclival meningiomas extending into the middle fossa, the endoscopic-assisted PIPA approach is safe and straightforward. Familiarity with the retrosigmoid route, the absence of temporal lobe retraction, and early control of the cranial nerves, vessels and brainstem are the principal advantages of the PIPA approach; however, careful patient selection regarding the tumor extension is fundamental to obtaining optimal outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.
    World Neurosurgery 07/2015; DOI:10.1016/j.wneu.2015.07.033 · 2.88 Impact Factor
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    ABSTRACT: Tumor resection in the rolandic region, also known as sensorimotor cortex, is a challenge. This study aims at reviewing a series of patients undergoing resection of metastases in the sensorimotor cortex using a multimodal concept including neuronavigation, sonography, and intraoperative electrophysiological monitoring. Eleven patients suffering from metastases located in precentral (8) and postcentral gyrus (3) were analyzed concerning their functional motor outcome. Improvement of motor function could be seen in 5 patients 1 week after surgery, 5 patients remained unchanged, and only 1 deteriorated. Median survival time averaged 15 months. A multimodal approach, including preoperative and intraoperative neuronavigation, intraoperative sonography, and intraoperative electrophysiological monitoring can lead on to excellent functional outcome in surgery of metastases in the sensorimotor cortex. Copyright
    Neurosurgery Quarterly 06/2015; DOI:10.1097/WNQ.0000000000000188 · 0.09 Impact Factor
  • Florian Roser · Georgios Naros · Florian Ebner · Marcos Tatagiba
    Journal of Neurological Surgery, Part B: Skull Base 02/2015; 76(S 01). DOI:10.1055/s-0035-1546617 · 0.72 Impact Factor
  • Florian Roser · Marcos Tatagiba
    Journal of Neurological Surgery, Part B: Skull Base 02/2015; 76(S 01). DOI:10.1055/s-0035-1546487 · 0.72 Impact Factor
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    ABSTRACT: Background/Study Aims Percutaneous radiofrequency trigeminal rhizotomy (RTR) is a standardized treatment for trigeminal neuralgia, yet it has been associated with serious complications related to the cannulation of the foramen ovale. Some of these complications, such as carotid injury, are potentially lethal. Neuronavigation was recently proposed as a method to increase the procedure's safety. All of the techniques described so far rely on pre- or intraoperative computed tomography scanning. Here we present a simple method based on magnetic resonance imaging (MRI) (radiation free) used to target the foramen ovale under navigation guidance. Patients/Material and Methods We retrospectively analyzed nine patients who had undergone navigated percutaneous RTR based solely on preoperative MRI and compared them with 35 patients who underwent conventional RTR guided by fluoroscopy. We analyzed immediate and late outcome and categorized the results into pain free, > 70% pain reduction, and persistent pain. We also compared groups in terms of the duration of the procedure and the complication rates. Here we describe the navigation method in detail and review the anatomical landmarks for target definition. Results The duration of the surgical procedure was similar in both groups (32.1 in the standard technique versus 34.5 minutes with navigation; p = 0.5157). There was no significant difference between groups regarding pain reduction at the immediate (p = 1.0) or late follow-up (p = 0.6284) time points. Furthermore, no serious complications were observed in the navigated group. Conclusions We present a simple radiation-free method for neuronavigation-assisted percutaneous RTR. This method proved to be safe and effective, and it is especially recommended for young, inexperienced neurosurgeons. Georg Thieme Verlag KG Stuttgart · New York.
    Journal of Neurological Surgery. Part A: Central European Neurosurgery 01/2015; 76(02). DOI:10.1055/s-0034-1394190 · 0.61 Impact Factor
  • Article: Response.
  • M H Morgalla · M Tatagiba
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    ABSTRACT: The prediction of the long-term outcome of comatose patients after severe traumatic brain injury (TBI) using early somatosensory and acoustic evoked potentials is controversial. It was our aim to examine the different single components of the evoked potentials regarding their predictive capacity in comatose patients. We examined the amplitude and latency of the wave N20, the amplitude differences between right and left hemisphere, the central conduction time (CCT), the amplitude ratio N20 left/N20 right, the amplitude and latency of peak V, the inter-peak latency I-V and the amplitude ratio V/I. The long-term clinical outcome of the patients was re-evaluated 3 years after their discharge and correlated with the different components. Only the central conduction time (CCT) and the latency of the wave N20 indicated a statistical correlation with the later outcome (p = 0.0366). The amplitude ratio of wave V/I of the EAEP did not reveal a significant statistical difference between the various outcome groups. In this study, the use of single components of the SSEP and EAEP per se could not predict the long-term clinical outcome after TBI. Combined systems such as the Riffel Score are necessary in order to achieve this goal.
    The Neurodiagnostic journal 12/2014; 54(4):338-52. DOI:10.1080/21646821.2014.11106818
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    ABSTRACT: Object: Vestibular schwannomas (VS) are common benign tumors of the vestibular nerve that cause significant morbidity. The current treatment strategies for VS include surgery or radiation, with each treatment option having associated complications and side effects. The transcriptional landscape of schwannoma remains largely unknown. Methods: In this study the authors performed gene-expression profiling of 49 schwannomas and 7 normal control vestibular nerves to identify tumor-specific gene-expression patterns. They also interrogated whether schwannomas comprise several molecular subtypes using several transcription-based clustering strategies. The authors also performed in vitro experiments testing therapeutic inhibitors of over-activated pathways in a schwannoma cell line, namely the PI3K/AKT/mTOR pathway. Results: The authors identified over 4000 differentially expressed genes between controls and schwannomas with network analysis, uncovering proliferation and anti-apoptotic pathways previously not implicated in VS. Furthermore, using several distinct clustering technologies, they could not reproducibly identify distinct VS subtypes or significant differences between sporadic and germline NF2-associated schwannomas, suggesting that they are highly similar entities. The authors identified overexpression of PI3K/AKT/mTOR signaling networks in their gene-expression study and evaluated this pathway for therapeutic targeting. Testing the compounds BEZ235 and PKI-587, both novel dual inhibitors of PI3K and mTOR, attenuated tumor growth in a preclinical cell line model of schwannoma (HEI-293). In vitro findings demonstrated that pharmacological inhibition of the PI3K/AKT/mTOR pathway with next-generation compounds led to decreased cell viability and increased cell death. Conclusions: These findings implicate aberrant activation of the PI3K/AKT/mTOR pathway as a molecular mechanism of pathogenesis in VS and suggest inhibition of this pathway as a potential treatment strategy.
    Journal of Neurosurgery 09/2014; 121(6):1-100. DOI:10.3171/2014.6.JNS131433 · 3.74 Impact Factor
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    A. Sokolov · M. Erb · M. Tatagiba · W. Grodd · R. Frackowiak · M. Pavlova
    Klinische Neurophysiologie 09/2014; 45(03):144-150. DOI:10.1055/s-0034-1382071 · 0.12 Impact Factor
  • Constantin Roder · Sotirios Bisdas · Marcos Tatagiba
    European Journal of Surgical Oncology 08/2014; 40(8). DOI:10.1016/j.ejso.2014.04.014 · 3.01 Impact Factor
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    ABSTRACT: Objective: Lesions of the cerebellomedullary cistern lateral to the lower brainstem in an area extending from the foraminae of Luschka to the foramen magnum are rare and can be caused by various sources. There is no consensus on an ideal surgical approach. We describe the anatomical features and the surgical technique of the midline suboccipital subtonsillar (STA) approach to the cerebellomedullary cistern and its pathologies. Methods: The study was performed on three alcohol (ETOH)-fixed specimens (6 sides), and the technique of the approach was highlighted. The tonsillar retraction needed to view the important structures was measured. Additionally, the records of 31 patients who underwent the STA procedure were evaluated. We provide three clinical cases as examples. Results: Tonsillar retraction of 0.3cm (SD±0.1cm) exposed the PICA with its telo-velo-tonsillar and cortical branches. Retraction of 0.4cm (SD±0.2cm) exposed the spinal root of CN XI. Retraction of 0.9cm (SD±0.01cm) exposed the hypoglossal canal. Retraction of 1.3cm (SD±0.2cm) exposed the root exit zone of the glossopharyngeal nerve. Retraction of 1.6cm (SD±0.3cm) exposed the jugular foramen (JF), and retraction of 2.4cm (SD±0.2cm) exposed the inner auditory canal (IAC). In all of the selected cases, the pathology could be reached and exposed using the STA. Conclusions: We recommend STA as a straightforward, easy-to-learn and therefore time-saving and safe procedure compared with other standard approaches to the cerebellomedullary cistern and its pathologies.
    Clinical Neurology and Neurosurgery 07/2014; 125C:98-105. DOI:10.1016/j.clineuro.2014.07.029 · 1.13 Impact Factor
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    ABSTRACT: Introduction. The endoscope became a highly valued visualization tool in neurosurgery. However, technical limitations caused by the rigidity of current standard endoscopes significantly decrease ergonomy in transcranial neurosurgery. Further technological developments will aid enlarging the surgical applicability. Objective. To evaluate the intraoperative features of a rigid variable-view endoscope in neurosurgery. Methods. We assessed a 4 mm rigid rod lens endoscope (EndoCAMeleon, Karl Storz, Tuttlingen, Germany) in the intraoperative setting. The device offers a variable angle of view from 15° to 90° in one plane. The endoscope was used in 3 cases (aneurysm clipping, vestibular schwannoma surgery, endoscopic third ventriculostomy) for inspection. Results. Direct insertion of the device through the craniotomy/burr hole with the lowest angled view (15°) was always possible. Neurovascular structures crossing the access route could be visualized and avoided. This allowed a targeted positioning of the endoscope's tip in the operating field. Once the target point was reached, viewing direction was changed in one plane from 15° to 90° according to anatomic demands. As the endoscope's tip does not move while the lens is rotated, surrounding neurovascular structures are not at risk to be injured. However, turning of the lens-controlling wheel in proximity to delicate structures may be inconvenient. Conclusion. The rigid, variable-view endoscope has the potential to become an appreciated visualization tool in neuroendoscopy. The steerable lens enables a tremendous expansion of the visual field, resulting in higher efficiency for surgeons and increased safety for patients.
    Surgical Innovation 07/2014; 22(4). DOI:10.1177/1553350614543382 · 1.46 Impact Factor
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    ABSTRACT: Unlabelled: Spinal cord injury (SCI) and amyotrophic laterals sclerosis (ALS) are devastating neurological conditions that affect individuals worldwide, significantly reducing quality of life, both for patients and their relatives. Objective: The present review aims to summarize the multiple restorative approaches being developed for spinal cord repair, the use of different stem cell types and the current knowledge regarding stem cell therapy. Method: Review of the literature from the past 10 years of human studies using stem cell transplantation as the main therapy, with or without adjuvant therapies. Conclusion: The current review offers an overview of the state of the art regarding spinal cord restoration, and serves as a starting point for future studies.
    Arquivos de Neuro-Psiquiatria 06/2014; 72(6):451-456. DOI:10.1590/0004-282X20140051 · 0.84 Impact Factor
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    ABSTRACT: Unlabelled: Central nervous system (CNS) restoration is an important clinical challenge and stem cell transplantation has been considered a promising therapeutic option for many neurological diseases. Objective: The present review aims to briefly describe stem cell biology, as well as to outline the clinical application of stem cells in the treatment of diseases of the CNS. Method: Literature review of animal and human clinical experimental trials, using the following key words: "stem cell", "neurogenesis", "Parkinson", "Huntington", "amyotrophic lateral sclerosis", "traumatic brain injury", "spinal cord injury", "ischemic stroke", and "demyelinating diseases". Conclusion: Major recent advances in stem cell research have brought us several steps closer to their effective clinical application, which aims to develop efficient ways of regenerating the damaged CNS.
    Arquivos de Neuro-Psiquiatria 06/2014; 72(6):457-465. DOI:10.1590/0004-282X20140045 · 0.84 Impact Factor
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    ABSTRACT: BACKGROUND: The maneuver of transmeatal drilling carries the risk of injuring inner ear structures, which may cause immediate or delayed hearing loss. OBJECTIVE: To describe the changes in petrous bone anatomy caused by the tumor and to analyze both the incidence and the risk pattern for violation of the endolymphatic system in a surgical series. METHODS: One hundred patients operated on for vestibular schwannoma were included in this prospective study. Thin-slice computed tomography was performed before and after surgery. We assessed topographic measurements on both the pathological and healthy sides. Postoperatively, we evaluated anatomic and functional values. RESULTS: The diameter of the internal auditory canal was significantly larger (P < .001) in the petrous bones of the affected sides than in the contralateral healthy sides. An average of 5.6 ± 1.8 mm of the internal auditory canal was drilled, and the distance from the medial border of the sigmoid sinus to the drilling line (tangential to the drilled surface of the posterior lip of the internal auditory canal) was 9.8 ± 2.9 mm. A postoperative violation of the vestibular aqueduct (VA) was detected in 41 cases; the VA was intact in 55 cases; and the VA could not be clearly defined in 4 cases. The incidence of VA injury increased with increasing tumor size. In the patient group with good preoperative and postoperative hearing function, a VA injury occurred in 26% of cases, whereas the incidence increased to 67% in preoperatively deaf patients. CONCLUSION: Vestibular schwannomas cause significant distortion of the petrous bone anatomy. Detailed preoperative knowledge of the topography is necessary for the preservation of function. ABBREVIATIONS: IAC, internal auditory canal VA, vestibular aqueduct VS, vestibular schwannoma
    Neurosurgery 05/2014; 10. DOI:10.1227/NEU.0000000000000454 · 3.62 Impact Factor
  • G Naros · C Rossi · A Boss · F Schick · M Tatagiba · F Ebner · U Klose
    Klinische Neurophysiologie 03/2014; 45(01). DOI:10.1055/s-0034-1371272 · 0.12 Impact Factor
  • Monika Milian · Marcos Tatagiba · Guenther C Feigl
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    ABSTRACT: Awake craniotomy is a valuable procedure since it allows brain mapping and live monitoring of eloquent brain functions. The advantage of minimizing resource utilization is also emphasized by some physicians in North America. Data on how well an awake craniotomy is tolerated by patients and how much stress it creates is available from different studies, but this topic has not consequently been summarized in a review of the available literature. Therefore, it is the purpose of this review to shed more light on the still controversially discussed aspect of an awake craniotomy. We reviewed the available English literature published until December 2013 searching for studies that investigated patients' responses to awake craniotomies. Twelve studies, published between 1998 and 2013, including 396 patients with awake surgery were identified. Eleven of these 12 studies set the focus on the perioperative time, one study focused on the later postoperative time. The vast majority of patients felt well prepared and overall satisfaction with the procedure was high. In the majority of studies up to 30 % of the patients recalled considerable pain and 10-14 % experienced strong anxiety during the procedure. The majority of patients reported that they would undergo an awake craniotomy again. A post traumatic stress disorder was present neither shortly nor years after surgery. However, a normal human response to such an exceptional situation can for instance be the delayed appearance of unintentional distressing recollections of the event despite the patients' satisfaction concerning the procedure. For selected patients, an awake craniotomy presents the best possible way to reduce the risk of surgery related neurological deficits. However, benefits and burdens of this type of procedure should be carefully considered when planning an awake craniotomy and the decision should serve the interests of the patient.
    Acta Neurochirurgica 03/2014; 156(6). DOI:10.1007/s00701-014-2038-4 · 1.77 Impact Factor

Publication Stats

4k Citations
735.72 Total Impact Points


  • 2005–2015
    • University of Tuebingen
      • Department of Neurosurgery
      Tübingen, Baden-Württemberg, Germany
    • International Neuroscience Institute
      Hanover, Lower Saxony, Germany
  • 2005–2014
    • Universitätsklinikum Tübingen
      • Department of Neurosurgery
      Tübingen, Baden-Württemberg, Germany
  • 2011
    • Technische Universität München
      München, Bavaria, Germany
  • 2010
    • Werner Reichardt Centre for Integrative Neuroscience
      Tübingen, Baden-Württemberg, Germany
  • 1995–2005
    • Hannover Medical School
      • Institute for Pathology
      Hanover, Lower Saxony, Germany
  • 2003
    • University of Antwerp
      Antwerpen, Flanders, Belgium
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany
  • 2002
    • International Neuroscience Institute Hannover
      Hanover, Lower Saxony, Germany
    • University of Zurich
      • The KEY Institute for Brain-Mind Research
      Zürich, Zurich, Switzerland
  • 1998
    • University Medical Center Hamburg - Eppendorf
      • Department of Ophthalmology
      Hamburg, Hamburg, Germany
  • 1993
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Ángeles, California, United States