Christian Ewald

• Head of Department at Städtisches Klinikum Brandenburg

Meningiomas are the most frequent primary intracranial tumors. The considerable variety of histological subtypes has been expanded by the definition of molecular alterations, which can improve both diagnostic accuracy and determination of individual patient's outcome. According to the upcoming WHO classification of brain tumors, the in‐time analysi...

Background: Primary adherent glioblastoma cell lines are an important tool in investigating cellular and molecular tumor biology, as well as treatment options for patients. Aim: The phenotypical and immunocytochemical characterization of primary cell lines from glioblastoma specimens during establishment is of great importance, in order to relia...

Introduction Kyphoplasty is an established method of treating osteoporotic vertebral body compression fractures. In recent years, several techniques to enhance the efficiency and outcomes of this surgery have been developed and implemented in clinical practice. In the present study, we assess the impact of two new access instruments on overall oper...

The polyphenolic compounds present in green tea are preventative against cancer in several animal tumor models. However, direct cytotoxic effects on cancer cells have also been reported. In order to determine whether drinking of green tea has chemopreventive or cytotoxic effects on brain cancer cells, we investigated the effect of the major green t...

Background Cerebellar hemorrhage is a potentially life-threatening condition and an understanding of the factors influencing outcome is essential for sound clinical decision-making. Methods We retrospectively evaluated data from 50 consecutive patients who suffered a first spontaneous cerebellar hemorrhage (SCH) from 2005 to 2014, analysing their...

Objective: It is still a prevalent assumption that a postoperative infection may confer a survival advantage in patients with glioblastoma multiforme. The neurosurgical literature contains some anecdotal reports of patients with malignant gliomas who experienced prolonged overall survival after a bacterial infection. This association has been analy...

Objective: Pluripotent cells do not only play an essential role in developmental biology but also in carcinogenesis and malignancy of tumors. These cells represent a special subgroup or state of cancer stem cells. Pluripotent cells are able to form every other cell type and are characterized by specific expression profiles of the key transcription...

Objective: We showed increased fatty acid synthase (FASN) expression level in glioblastoma (GBM) compared to astrocytoma WHO grade I to III. We revealed a dose and time dependent decrease in viability and proliferation rate of primary human GBM cell cultures under treatment of Orlistat. With regard to possible clinical use we investigated the effec...

Objective: Stem cell associated cells with CD133 as the most popular marker are considered an important factor for the treatment failure in high grade gliomas. But during the last years, the relevance of the surface protein CD133 has become more and more an issue of discussion. In this study we define possible further marker genes describing stem c...

NANOG, as a key regulator of pluripotency and acting synergistically with other factors, has been described as a crucial transcription factor in various types of cancer. In meningiomas the expression of this marker has not yet been described. With our study, we aimed to identify and localize Nanog and other possible markers of pluripotency, stem ce...

Degenerative spine disease in patients older than 65 years becomes more and more an issue of interest in daily routine. The following chapter resumes pathogenesis and clinical and radiological aspects. We present possible therapeutic approaches including cervical and lumbar pathologies against the background of the actual scientific data. Diagnosis...

Background : Intracerebral hemorrhage (ICH) is a life threatening entity, and an early outcome assessment is mandatory for optimizing therapeutic efforts. Methods: We retrospectively analyzed data from 342 patients with spontaneous primary ICH to evaluate possible predictors of 30-day mortality considering clinical, radiological, and therapeutical...

Aneurysmal subarachnoid hemorrhage (SAH) is a serious condition associated with high mortality rates and long-term disability. We investigated the impact of fluid balance on neurologic outcome after adjustment for possible confounders related to intensive care therapy and extra-cerebral organ failure during the early phase after SAH. In this retros...

Objective: “Stem cell like” cells with CD133 as the most popular marker are considered an important factor for the treatment failure in high grade gliomas. But during the last years the relevance of the surface protein CD133 has become more and more an issue of discussion. In this study we wanted to define possible new marker genes describing stem...

The symptomatic, degenerative lumbar spinal stenosis becomes more and more an important problem in elderly patients. This survey describes typical symptoms, diagnostic tools and current treatment options considering the actual literature. Pathophysiological basis is the progressive degeneration of lumbar osseous and disco ligamentous structures lea...

A 52-year-old heart-lung transplant patient presented to the emergency department with acute onset of neurologic symptoms. MRI showed ballooning of the left ventricle, midline shift and contrast enhancement in the anterior horn of the left ventricle. Ventricle neuroendoscopy revealed whitish, floccose aerial structures within the left ventricle. Br...

The optimal management of chronic subdural hematomas remains a challenge. Twist drill craniotomy or burr hole trephination are considered optimal initial treatments, but the reoperation rate for hematoma recurrence and other complications is still high. Therefore, evaluation of possible risk factors for initial treatment failure is crucial. In this...

OBJECT The complication rate for cranioplasty after decompressive craniectomy is higher than that after other neurosurgical procedures; aseptic bone resorption is the major long-term problem. Patients frequently need additional operations to remove necrotic bone and replace it with an artificial bone substitute. Initial implantation of a bone subst...

In human glioma research, quantitative real-time reverse-transcription PCR is a frequently used tool. Considering the broad variation in the expression of candidate reference genes among tumor stages and normal brain, studies using quantitative RT-PCR require strict definition of adequate endogenous controls. This study aimed at testing a panel of...

External ventricular drainage (EVD) is frequently used in neurosurgery to drain cerebrospinal fluid in patients with raised intracranial pressure. We performed a retrospective single center study in order to evaluate the incidence of EVD-related infections and to identify underlying risk factors. 246 EVDs were placed in 218 patients over a 30-month...

Study design: A biomechanical human cadaveric study. Objective: The authors tested a cannulated and perforated lag screw and compared in situ polymethylmethacrylate (PMMA) augmentation against nonaugmentation for fixation of osteoporotic type II odontoid fractures. Summary of background data: Osteoporosis has been identified as a strong predic...

Background Five-aminolevulinic acid (Gliolan, medac, Wedel, Germany, 5-ALA) is approved for fluorescence-guided resections of adult malignant gliomas. Case reports indicate that 5-ALA can be used for children, yet no prospective study has been conducted as of yet. As a basis for a study, we conducted a survey among certified European Gliolan users...

Autologous bone flap reinsertion after craniectomy follows whenever the cerebral situation has consolidated. However, aseptic resorption of the bone flap still remains a matter of concern. We report on possible perioperative complications in patients undergoing autologous bone flap reinsertion and identify risk factors that may predispose to bone f...

Fatty acid synthase (FASN), catalyzing the de novo synthesis of fatty acids, is known to be deregulated in several cancers. Inhibition of this enzyme reduces tumor cell proliferation. Unfortunately, adverse effects and chemical instability prevent the in vivo use of the best-known inhibitors, Cerulenin and C75. Orlistat, a drug used for obesity tre...

Objective: Axitinib, a multi receptor tyrosine kinase (RTK) receptor inhibitor, specifically targets VEGFRs, PDGFRs and c-Kit. It`s the aim to investigate the effects of axitinib on glioma cell growth in a ex vivo organotypic brain slice cultures of gliomas, primary glioma cell cultures and glioma cell lines. Methods: Organotypic brain slice cultu...

Objective: The PI3K/Akt pathway and its effector mTOR play an im¬portant role in regulation of cell growth and have recently been evaluated as a target for the treatment of gliomas. But to date little is known about mTOR in more benign intracranial tumor like meningiomas. This study aims to elucidate the role of the pro-survival PI3K/Akt/mTOR pathw...

Objective Our study targets specific tumor signaling pathways in human glioblastoma, which might be of importance for cell proliferation and inducing apoptosis. For the quantitative analysis of the gene expressions by qPCR, we evaluated the best matching reference genes (housekeeping genes) among B2M, GAPDH, HMBS, HPRT, SDHA, TBP, UBC and YWHAZ....

Background: Different studies have shown that atrophy of paraspinal muscles arises after open dorsal lumbar fusion, and the reasons for this atrophy are still not yet fully clarified. This prospective study investigates the extent of atrophy of the lumbar paraspinal muscles after open lumbar interbody fusion, its possible causes, and their associa...

Gain of (proto-)oncogenes and loss or promoter hypermethylation of tumor suppressor genes (TSGs) play essential roles in tumorigenesis. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) allows simultaneous detection of both these alterations. MS-MLPA was performed on 20 medulloblastoma samples (n = 12 cryoconserved; n...

Background: Postoperative scar formation appears regularly after lumbar disc operation and is seen as one possible reason for prolonged complaints after surgery. Therefore several materials have been developed to decrease scarring in the spinal canal without having proven a significant clinical effect. Material and methods: This retrospective analy...

Degenerative lumbar spinal stenosis is increasingly being diagnosed in persons over age 65. In 2011, 55 793 older people with this condition were treated as inpatients in German hospitals. Among physicians, there is much uncertainty about the appropriate treatment strategy. Selective literature review. Lumbar spinal stenosis in older people is char...

Autologous bone flap reinsertion follows as a second surgical intervention after decompressive craniectomy in patients with malignant middle cerebral artery (MCA) infarction. In addition to surgery-related short-term complications, aseptic resorption of the reimplanted bone flap is a possible long-term problem which has not yet been sufficiently el...

Background Autologous bone flap reinsertion follows as a second surgical intervention after decompressive crani-ectomy in patients with malignant middle cerebral artery (MCA) infarction. In addition to surgery-related short-term complications, aseptic resorption of the reimplanted bone flap is a possible long-term problem which has not yet been suf...

Background: Expandable cervical cages have been utilised successfully to reconstruct the cervical spine for various conditions. However, to date there are only limited data on their influence on cervical sagittal profile. In this retrospective study, we present our experience with performing anterior cervical corpectomy in one or two levels using...

Object: In patients who have undergone decompressive craniectomy, autologous bone flap reinsertion becomes necessary whenever the cerebral situation has consolidated. However, aseptic necrosis of the bone flap remains a concern. The aim of this study was to report possible perioperative complications in patients undergoing autologous bone flap rei...

PURPOSE: Single center evaluation of the placement accuracy of thoracolumbar pedicle screws implanted either with fluoroscopy or under CT-navigation using 3D-reconstruction and intraoperative computed tomography control of the screw position. There is in fact a huge variation in the reported placement accuracy of pedicle screws, especially concerni...

Purpose: The aim of this study was to investigate the effects of age on outcome in a large cohort of surgical intensive care unit (ICU) patients. Methods: In this retrospective analysis of prospectively collected data, all 11537 adult patients admitted directly from the operating room to our 50-bed surgical ICU between January 1, 2004, and Janua...

OBJECTIVE: Dysnatremia may have an impact on outcomes in critically ill patients, but this has not been widely investigated in surgical ICU patients. We investigated the epidemiology of dysnatremia in a large cohort of surgical ICU patients and evaluated the possible influence of the time of acquisition of dysnatremia and fluctuations in serum sodi...

Objective: Dysnatremia may have an impact on outcomes in critically ill patients, but this has not been widely investigated in surgical ICU patients. We investigated the epidemiology of dysnatremia in a large cohort of surgical ICU patients and evaluated the possible influence of the time of acquisition of dysnatremia and fluctuations in serum sod...

Study design: Prospective observational clinical study. Objective: The aim of this study is to evaluate the technical feasibility and the safety of additional cement augmentation of anterior cervical implants in patients with poor bone quality because of osteoporosis or tumor infiltration. Summary of background data: With an increasing number...

Besides the treatment of osteoporotic vertebral compression fractures of AO type A1, balloon kyphoplasty (BKP) is seen as a therapeutic option even in the treatment of incomplete osteoporotic burst fractures (AO type A3.1). However, due to involvement of the posterior vertebral body wall, the risk of cement leakages is considered to be higher. This...

Die lumbale Spinalkanalstenose ist ein häufiges Problem in der täglichen Praxis. In der Regel bedingt durch degenerative Veränderungen der Lendenwirbelsäule ist das typische klinische Bild die sog. „Claudicatio spinalis“, also belastungsabhängige Rückenschmerzen mit zunehmender lumboischialgiformer Schmerzausstrahlung und dann auch im Verlauf mögli...

To evaluate the outcome of patients with spinal metastases, treated under palliative considerations by spinal decompression and sole posterior instrumentation, in respect to survival, neurological symptomatology, pain, ECOG grade, and Tomita's prognostic score (TPS). Fifty-seven consecutive patients with metastatic vertebral tumors were treated usi...

Lumbar spinal stenosis is a common problem in daily routine practice. In the vast majority of cases stenosis is caused by degenerative changes of the lumbar spine with neurogenic claudication being the typical symptom. This is defined as sciatic pain and discomfort which deteriorates during walking and standing, leading to progressive neurological...

Scalp defects often arise in multimorbid patients. This study aimed at establishing an algorithm of defect repair with particular focus on new regenerative options.All patients, who consulted to the Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Jena between April 2005 and March 2010 were reviewed. Different reconstructive...

Objective: Tuberculous meningitis (TBM) is a major and life-threatening extrapulmonary complication of tuberculosis. The incidence of cerebral infarction in childhood TBM ranges from 13% to 53%. Cerebral infarction in TBM is caused by a panarteritis, which consequently leads to an arteriopathy with ischemic events. In the present case, we report on...

The operative treatment of subcortical metastatic tumours within the paracentral area is still under discussion. Against the background of possible new postoperative neurological deficits and of evolving new radio oncological techniques, the indication for surgery is limited only to a subgroup of patients. In this retrospective study we present the...

High levels of fatty acid synthase (FAS) expression have been reported in hormone receptor-positive tumors, including prostate, breast, and ovarian cancers, and its inhibition reduces tumor growth in vitro and in vivo. Similar to other hormone receptor-positive tumor types, meningiomas are progesterone receptor- and estrogen receptor-immunoreactive...

The surgical management of cervical spondylodiscitis consists of the resection of the affected disc, the decompression of the cervical spinal cord, followed by the stabilization using an autologous bone graft or a titanium implant combined with a ventral plate fixation. Until now, there were no studies about the practicability and putative safety o...

Systemic amyloidosis manifests in several organs and causes different clinical scenarios. To date, an isolated affection of intracranial blood vessels is only known to occur in cerebral amyloid angiopathy (CAA) but not in occult systemic amyloidosis or in monoclonal gammopathy of undetermined significance (MGUS). This report describes a very rare d...

Hintergrund: Das spontane intraspinale Empyem bleibt ein seltenes Problem in der Wirbelsäulenchirurgie. Mit dieser Studie möchten wir die Ergebnisse nach Operation von 23 Patienten untersuchen. Methoden: Es handelt sich um eine retrospektive Studie über 23 Patienten mit spontanen intraspinalen Empyemen. Die Daten wurden anhand der vorliegenden Kran...

Intraspinal empyema is a rare entity in spinal surgery. This study analyses the results after operating in 23 patients. This is a retrospective study of 23 patients suffering from intraspinal empyema treated operatively in our department. The data were obtained by analysing the patient documents including the radiological and microbiological data....

Calcium ions are highly versatile spacial and temporal intracellular signals of non-excitable cells and have an important impact on nearly every aspect of cellular life controlling cell growth, metabolism, fluid secretion, information processing, transcription, apoptosis, and motility. Neurons and glia respond to stimuli, including neurotransmitter...

We report the case of a 41-year-old man suffering for nine years from a solitary fibrous tumour (SFT) of the tentorium cerebelli. The tumour recurred twice, being characterized by a stepwise loss of antigenic profile and an enhanced proliferative activity. Meningeal SFTs are seldom described in literature. Malignant variants occur at peripheral sit...

Bacterial spondylodiscitis is a rare entity in spinal surgery. This study analyses the postoperative results of 53 patients, focusing on the history, the treatment, and the course of the disease. This retrospective study is based on the patients' medical charts, including the laboratory and microbiological data. Twenty-nine patients suffered from d...

Generally, gliomas do not metastasize. Therefore, larger series are not available to investigate the pathways of tumour spread. Here, we present the case of a young man with a glioblastoma multiforme WHO grade IV and distant metastases in several tissues. The glioblastoma multiforme WHO grade IV of a young male patient recurred within a very short...

Genomic loss and promotor methylation contribute to inactivation of tumor suppressor genes (TSGs). Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) is a relatively new method for simultaneous detection of both these alterations. Here, we apply MS-MLPA to a series of 15 meningiomas of different WHO grades. The two MS-M...

Background: 15% of CNS tumors are intraspinal ones that comprise a group of intramedullary, extramedullary and extradural neoplasias. Our aim was to reevaluate patient data, because there still is disagreement over prevalence, prognosis, and optimal treatment. Material and methods: Patient data were reviewed in all patients (n=70) excluding those w...

The case of a 7-year-old boy suffering from a supratentorial primitive neuroectodermal tumour (sPNET) at the age of 5 is presented. The tumour has been characterized by astrocytic areas within the sPNET revealing malignant transformation up to a multiform glioblastoma during the course of the disease. The clonal origin of both tumour components was...

Durch die Nutzung molekularbiologischer Methoden stehen der modernen Mikrobiologie neue Untersuchungstechniken zur Verfügung. Gerade im Hinblick auf akute lebensbedrohliche Erkrankungen mit der Notwendigkeit einer raschen Antibiotikagabe und der damit verbundenen verminderten Nachweismöglichkeit mittels Bakterienkultur gewinnen diese Techniken stär...

Astrocytomas are intracranial malignancies for which invasive growth and high motility of tumour cells preclude total resection; the tumours usually recur in a more aggressive and, eventually, lethal form. Clinical outcome is highly variable and the accuracy of morphology-based prognostic statements is limited. In order to identify novel molecular...

Pyogenic infections of the central nervous system of dental origin are quite uncommon in industrialized countries. We report six cases with intracerebral (n = 4) and intraspinal (n = 2) infections treated in our hospital. The microbial pathogen was successfully isolated in all patients. Fusobacterium nucleatum as well as Streptococcus species were...

Durch die Nutzung molekularbiologischer Methoden stehen der modernen Mikrobiologie neue Untersuchungstechniken zur Verfügung. Gerade im Hinblick auf akute lebensbedrohliche Erkrankungen mit der Notwendigkeit einer raschen Antibiotikagabe und der damit verbundenen verminderten Nachweismöglichkeit mittels Bakterienkultur gewinnen diese Techniken stär...

Unlabelled: Synovial cysts originating from the facet joint of the lumbar spine are a rare cause of radiculopathy. Surgical resection is considered to be the treatment of choice, although very little is known about the natural history of spinal synovial cysts. Only six cases have been published up to now concerning the spontaneous regression of a...

Spontaneous herniation of the spinal cord through a ventral dural defect is a rare neurological entity. We report on 3 patients treated in our clinic within 6 months. In 2 cases, the lesions were located at the BWK6 level and, in one case, at BWK2. The clinical presentation of all patients was f progressive Brown-Séquard's Syndrome. Diagnosis was c...

Zusammenfassung Die spontane Herniation des thorakalen Rckenmarks durch einen ventrolateralen Duradefekt ist eine sehr seltene Erkrankung deren Genese letztendlich immer noch unklar ist. Wir beschreiben 3 Flle aus unserem Patientengut, welche von uns innerhalb eines halben Jahres operativ behandelt wurden. Die Lsion befand sich in 2 Fllen in Hhe B...

We report one case of spontaneous thoracic spinal cord herniation. To our knowledge, this is the first case involving radiological documentation of the development of herniation. Clinical features and surgical techniques are also presented. We describe the case of a 51-year-old female patient who experienced progressive Brown-Sequard syndrome for 2...

Operative clipping is the most effective method in the treatment of cerebral giant aneurysms. But about 50% of all giant aneurysms are treatable this way. We want to report about eight patients with giant cerebral aneurysms, which were in our opinion "unclippable" without causing ischaemia in depending brain areas. We describe eight cases of giant...

Giant aneurysms of the basilar artery are rare. With a diameter of 25 mm or more they are often partially thrombosed and show atheromatous plaques. There are some problems in the treatment especially when the aneurysm is broadbased with bulbous origin encorporating the origin of the posterior cerebral artery (PCA). In many of these cases neither op...

Giant aneurysms of the basilar artery are rare. With a diameter of 25 mm or more they are often partial-ly thrombosed and show atheromatous plaques. There are some problems in the treatment especially when the aneurysm is broadbased with bulbous origin encorporating the origin of the posterior cerebral artery (PCA). In many of these cases neither o...