Christoph Koch

University Medical Center Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany

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Publications (8)17.68 Total impact

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    ABSTRACT: Ultrasound harmonic imaging of perfusion after ultrasound contrast agent (UCA) bolus injection (BHI) can detect cerebral perfusion deficits. In a pilot study, we evaluated the ability of time-intensity curve (TIC) measurements to differentiate between normal and hypoperfused brain areas in acute ischemic stroke. Ten patients with symptoms of acute middle cerebral artery infarction were investigated (SONOS 5500, Harmonic Imaging 1.6/3.8 MHz, diencephalic plane, 10 cm investigation depth, SonoVue 2.4 mL bolus). Peak signal increase (PSI), time-to-peak intensity (TPI) and area under the curve (AUC) were calculated for 60 regions-of-interest (ROIs) in each patient. Reference methods: Perfusion- and diffusion-weighted MRI (PWI/DWI) within 4 h before/after BHI (PWI threshold: 4 s). Receiver operating characteristics (ROC) analysis defined cut-off values for each TIC variable to distinguish between normal and affected brain areas as defined by PWI/DWI. In five patients, PWI showed a perfusion delay >4 s; seven patients had a DWI lesion. In three patients, both PWI and DWI findings showed pathology; one patient had a normal MRI of the insonation plane. Cut-off values for PWI delay: PSI: 5.53% (sensitivity .98, specificity .89); TPI: 4.04 s (sensitivity .74, specificity .69) and AUC: .63 (sensitivity .94, specificity .58). Referred to the mean value in unaffected brain areas the relative thresholds were 17.6%, 109.5% and 16.1%, respectively. Regarding DWI, only for PSI, a significant cut-off value was defined: 10.86%, sensitivity .84, specificity .60 (34.6% of mean). In conclusion, these thresholds distinguish between normal and affected brain areas in acute ischemic stroke. (E-mail: [email protected] /* */).
    Ultrasound in Medicine & Biology 06/2007; 33(6):851-6. DOI:10.1016/j.ultrasmedbio.2006.12.006 · 2.21 Impact Factor
  • Christoph Koch ·
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    ABSTRACT: To summarize clinical key points, diagnostic features, and results of imaging and therapy of spinal dural arteriovenous fistula (SDAVF). SDAVF accounts for 70% of spinal arteriovenous malformation with an annual incidence of 5-10 cases per million. At least 80% of patients are male, and more than 66% of patients are in the sixth and seventh decade of life indicating preponderance of gender and age. Thrombophilia is not a predisposing factor of disease. Clinical course is predominated by symptoms of congestive myelopathy, but subarachnoid hemorrhage may occur. Double SDAVF is a rare problem in the management of disease. Magnetic resonance imaging has replaced myelography as screening procedure. Contrast-enhanced magnetic resonance angiography and multislice computerized tomographic angiography may facilitate diagnostic procedure, however, spinal angiography is still required to confirm diagnosis. Treatment by permanent occlusion of fistula results in clinical improvement in 70% of cases. Microsurgical shunt interruption has proven secure and reliable. Endovascular shunt embolization has been established as a standardized procedure, but occlusion rates are still lower than in surgical treatment. Advances have been made in diagnosis and treatment of SDAVF, but the disease is still not completely understood.
    Current Opinion in Neurology 03/2006; 19(1):69-75. DOI:10.1097/01.wco.0000200547.22292.11 · 5.31 Impact Factor

  • Aktuelle Neurologie 01/2006; 33(S 1). DOI:10.1055/s-2006-953362 · 0.32 Impact Factor

  • Aktuelle Neurologie 10/2005; 32(S 4). DOI:10.1055/s-2005-919675 · 0.32 Impact Factor
  • Source
    A Finis · H Ssenyonjo · U Knopp · C Koch · G Seidel · H Arnold · A Giese ·
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    ABSTRACT: Hemicraniectomy as a surgical treatment for intracranial pressure following large ischemic lesions is widely practiced in selected patients. The antiphospholipid antibody syndrome (APS), a disorder characterized by recurrent arterial and venous thrombosis, is a very rare cause of space occupying ischemic lesions. We present a case of a 35 year old female diagnosed with APS who initially presented with small ischemic lesions and within days developed a massive near-total infarction of the right hemisphere. Because of central nervous system, skin and systemic manifestations Sneddon's syndrome and catastrophic antiphospholipid antibody syndrome (CAPS) remained a possible diagnoses. Sneddon's syndrome is a non-inflammatory occlusive arteriopathy of small and medium size arteries predominantly of the skin and brain, whereas the catastrophic antiphospholipid antibody syndrome is characterized by acute multi-organ system thrombosis of small and large vessels. In addition to the diagnostic criteria for APS a heterozygous factor V Leiden mutation was found in this patient, which may be a contributing risk factor for cerebral ischemia. When considering invasive decompressive procedures the neurosurgeon has to be aware of the poor prognosis of some forms of APS with systemic manifestations.
    Acta Neurochirurgica 10/2005; 147(9):997-1002; discussion 1002. DOI:10.1007/s00701-005-0574-7 · 1.77 Impact Factor
  • Source
    M Ladehoff · D Zachow · C Koch · G Nowak · A Echelmeyer · H Arnold · A Giese ·
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    ABSTRACT: We present an unusual case of cerebellar haemorrhage followed by tension pneumocephalus several days after thoracotomy for resection of a Pancoast tumour. The postoperative course of the 32-year-old patient was complicated by a cerebellar haemorrhage and hydrocephalus caused by compression of the fourth ventricle. Immediate surgical evacuation of the haemorrhage and placement of an external ventricular drain was performed. Respirator ventilation maintaining a continuous positive airway pressure was required. Following weaning and extubation the patient rapidly deteriorated and became comatose. A cranial CT scan revealed a dilated ventricular system filled with air, and air in the subarachnoid space. Recovery of consciousness was observed after aspiration of intracranial air through the ventricular drainage. Recurrent deterioration of consciousness after repeated air aspiration indicated rapid refilling of the ventricles with air. The patient underwent emergency surgical re-exploration of the thoracic resection cavity: dural lacerations of the cervico-thoracic nerve roots C8 and Th1 were identified. Subarachnoid-pleural fistula, cerebellar haemorrhage and tension pneumocephalus after discontinuation of continuous positive airway pressure respiration are unusual complications of thoracic surgery. We discuss the putative pathomechanisms and present a brief review of the literature.
    Acta Neurochirurgica 06/2005; 147(5):561-4;discussion 564. DOI:10.1007/s00701-004-0402-5 · 1.77 Impact Factor
  • Source
    Christoph Koch · Stefan Gottschalk · Alf Giese ·
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    ABSTRACT: The authors report on a patient presenting with subarachnoid hemorrhage (SAH) that was initially attributed to an aneurysm of the right internal carotid artery. During surgical exploration and placement of a clip, however, it was observed that the aneurysm had not ruptured. Diagnostic workup including spinal magnetic resonance imaging revealed a vascular malformation of the lumbar spinal canal within a subarachnoid hematoma. Spinal angiography demonstrated a spinal dural arteriovenous fistula (DAVF) (Type I spinal arteriovenous malformation) with a feeding vessel arising from the L-4 radicular artery. In the literature, SAH due to spinal DAVFs is rare; only cases of dural fistulas of the craniocervical junction and the cervical spine have been reported. This is the first case of SAH that can be attributed to a lumbar DAVF. Although unusual even in cases of cervical DAVF, SAH as a presenting symptom may occur in spinal DAVF of any location. Nontraumatic SAH should not be prematurely attributed to the rupture of an intracranial aneurysm if the clinical findings and imaging results are inconclusive.
    Journal of Neurosurgery 05/2004; 100(4 Suppl Spine):385-91. DOI:10.3171/spi.2004.100.4.0385 · 3.74 Impact Factor
  • Christoph Koch ·
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    ABSTRACT: Es wird die Entwicklung der Behandlungstechnik und der medikamentsen Begleitbehandlung zur endovaskulren Behandlung von Karotisstenosen beschrieben. Seit 1987 wurde bei 361 Patienten eine endovaskulre Behandlung einer hochgradigen Karotisstenose durchgefhrt. 101 der insgesamt 372 behandelten Stenosen wurden durch perkutane transluminale Angioplastie ohne oder mit nachfolgender Stentimplantation behandelt, 271 Stenosen wurden durch direkte Stentangioplastie therapiert. Alle endovaskulren Behandlungen wurden ohne zerebrale Protektion durchgefhrt. Mit Einfhrung der direkten Stentangioplastie wurde die periinterventionelle Blutgerinnungshemmung von einer Zweifachkombination mit Acetylsalicylsure (ASS) und unfraktioniertem Heparin (UFH) auf eine Dreifachkombination mit ASS, Clopidogrel und niedermolekularem Heparin (NMH) umgestellt. Durch die technischen und medikamentsen Vernderungen wurde die Hufigkeit von periinterventionellen Komplikationen um mehr als 50% auf 1,5% reduziert. Durch die genderte Behandlungstechnik mit direkter Stentangioplastie und verbesserter Blutgerinnungshemmung wurden die Voraussetzungen fr einen direkten Vergleich der endovaskulren Behandlung von Karotisstenosen mit der chirurgischen Therapie im Rahmen der SPACE-Studie geschaffen, deren erste Ergebnisse in Krze erwartet werden. Weitere Verbesserungen der Behandlungstechnik und der medikamentsen Begleitbehandlung sind abzusehen.The technical and medical developments of endovascular treatment of carotid stenosis are described. Since 1987, endovascular treatment of high-grade carotid stenosis has been performed in 361 patients. 101 of 372 stenoses were treated by percutaneous transluminal angioplasty without and with stenting, respectively, while 271 stenoses were treated by direct stenting. All procedures were performed without cerebral protection. With implementation of direct stenting, the periprocedural anticoagulation was changed from acetylsalcylic acid (ASA) and unfractionated heparin (UFH) to a combination of ASA, clopidogrel and low molecular weight heparin (LMWH). By changing the technical and medical procedure, the relative risk reduction for morbidity and mortality was more than 50% to an absolute 1.5%.The combination of direct stenting and improved medical treatment enabled a direct comparison of endovascular treatment with surgical therapy within the SPACE trial with first results to be expected shortly. Further improvements of technical and medical treatment are conceivable.
    Clinical Neuroradiology 02/2004; 14(1):31-40. DOI:10.1007/s00062-004-5374-6 · 2.25 Impact Factor

Publication Stats

121 Citations
17.68 Total Impact Points


  • 2004-2007
    • University Medical Center Schleswig-Holstein
      Kiel, Schleswig-Holstein, Germany
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany
  • 2005
    • Universität zu Lübeck
      • Department of Neurosurgery
      Lübeck Hansestadt, Schleswig-Holstein, Germany