Hubertus Maximilian Mehdorn

• M.D. Ph.D.
• Professor at Universitätsklinikum Schleswig - Holstein

Surgical procedures carry certain risks of complications, which need to be considered and discussed when any procedure is suggested to a patient. In this article, some ethical problems will be discussed concerning the communication of problems after they have occurred. Some clinical case studies will serve to clarify the need for having standards o...

OBJECTIVE Little is known about the emotional health of parents caring for children with shunted hydrocephalus. The aim of this pilot study was to find out whether parents caring for shunt-treated hydrocephalic children experience serious psychological problems and psychosocial distress and whether these problems are related to the sociodemographic...

Purpose The introduction of molecular markers in to the diagnosis of gliomas has changed the therapeutic approach to this tumors. The aim of this study was to examine the impact of surgery on anaplastic astrocytomas (AA), which has not previously been fully elucidated. Methods This was a retrospective study involving a total of 143 patients who un...

Spatial learning and navigation are supported by distinct memory systems in the human brain such as the hippocampus based navigational system and the striatum-cortex based system involved in motor sequence, habit and reversal learning. Here, we studied the role of subthalamic circuits in hippocampus-associated spatial memory and striatal-associated...

A retroperitoneal organ injury-vascular injury or solid organ injury-that occurs during lumbar disc surgery needs to be dealt with adequately, because otherwise it could result in a poor (or, even, fatal) outcome of a "simple" procedure. Vascular injuries require special attention from the neurosurgical side (think of the possibility!) and cooperat...

Background: Convexity meningiomas (CM) can be successfully treated with neurosurgery. However, clinical complications due to CM have been reported. Moreover, systematic investigations of CM with respect to all relevant clinical factors are currently lacking. Methods: We performed a systematic investigation in 210 patients with supratentorial CM...

Background: Peritumoral brain edema (PTBE) is a common complication related to intracranial meningiomas. In several studies, researchers have investigated the pathogenesis of PTBE, and the factors involved in its development in patients with intracranial meningiomas have been reported. However, very little is known about the clinical effect of PTB...

Introduction While surgery is the primary treatment choice for intracranial meningiomas in young patients, surgery in elderly patients, especially those with pre-existing comorbidities, has been the subject of repeated discussion. This study investigated the postoperative risks and neurological benefits of meningioma surgery in elderly patients com...

Zusammenfassung. Für das angemessene Fällen klinischer Urteile anhand neuropsychologischer Testverfahren ist die Güte der Testnormierung von zentraler Relevanz. Ziel der aktuellen Untersuchung ist es, unterschiedliche Klassifikationsmethoden für neuropsychologische Testleistungen zu vergleichen, um so die Güte der Normierung verbreiteter neuropsych...

Objective: Generic psychosocial screening tools may not reflect the unique symptom profile of brain tumor patients (BTPs). The aim was to adapt the problem list of the Distress Thermometer (DT) for BTPs. Methods: First, items of low relevance for BTPs were identified on basis of retrospective analyses. Second, relevant yet missing problems were...

Introduction: Occipital nerve stimulation (ONS) is used to treat therapy-resistant chronic migraine. Clinical use has resulted in a wide intraindividual and interindividual variation of clinical efficacy. The aim of this study was to analyze a potential relationship between sociodemographic variables, headache parameters, perceived sensory quality...

Purpose: The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shuntin...

Intracranial space-occupying lesions, particularly glial tumors in eloquent areas, may challenge the neurosurgeon who aims at preserving most relevant neuropsychological functions while removing as much of the lesion as possible. It has been repeatedly questioned whether radical resection of gliomas is the method of choice because of their invasive...

Introduction: The rate of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) is between 1.5 and 6.1%, with prolonged deficits occurring in 0.4-2.5% of the patients. This retrospective study investigates whether the prophylactic administration of tranexamic acid (TA) to patients with abnormal platelet function detected preoperatively...

Summary: Despite its extensive use, the construct validity of the Rey-Osterrieth Complex Figure Test (ROCFT) is still disputed. One of the main questions is whether executive functions contribute to the copy condition. In this study, healthy participants (n = 198) as well as patients with acquired brain damage (n = 161) were examined to determine w...

The importance of international cooperation in neurosurgery incl. site visits to foreign hospitals is highlighted. The development of knowledge about function localization in brain surgery serves as an example. International cooperation led to modern day neurosurgery as shown e.g. in awake craniotomy.

The significance of human biorepositories for modern medical research, particularly for comprehensive population-based genetic analyses, is constantly growing. While large and centralized institutions are usually considered best suited to meet the increasing demand for high-quality “biobanks,” most medical research institutions still host rather he...

BACKGROUND Patient-centered assessments and disease-adjusted patient-reported outcome measures (PROMs) are crucial in neuro-oncology. The Distress Thermometer (DT) is a well-accepted screening tool for cancer patients including a numerical rating scale (1–10, cut-offs indicating relevant distress ≥4–6) and 40 items describing possible problem categ...

Background Fear of progression (FoP) is frequent in patients with cancer and of high clinical relevance. Despite the often devastating prognosis of brain cancer, FoP has not yet been assessed in neurooncological patients. Objective The aim of this study was thus the assessment of FoP and its clinical correlates. Methods In an ambulatory setting,...

Purpose: Interpersonal factors are of major importance for cancer patients’ physical and mental health. Brain tumor patients rank amongst those cancer patients with the highest psychosocial burden. Changes in language, cognition, and personality pose specific risk factors for impeding interpersonal functioning in this patient group. Despite this, r...

Background: Programming algorithms have never been tested for outcome. The EARLYSTIM study showed superior outcomes of deep brain stimulation of the subthalamic nucleus (STN-DBS) over best medical treatment in early Parkinson's disease (PD). Patients were programmed according to common guidelines but customized for each patient. Methods: Stimula...

Objective: Generators implanted for deep brain stimulation must be replaced after several years. If a Kinetra generator is replaced by the Activa-PC, an adaptor will be required to attach it to the original extension cables. On the basis of our clinical impression that the battery life of the Active-PC generator was shorter when an adaptor was use...

Objective: Patients suffering from aneurysmatic Subarachnoid Hemorrhage (SAH) may present with a variety of symptoms. The aim of this study is to evaluate the spectrum of misdiagnoses and to analyze the significance of delay of correct diagnosis on the clinical outcome. Methods: The data was collected prospectively from 2003 to 2013. Patients di...

Historical development of Navy Hospital in Kiel/Germany from 19th Century to Civil use - becoming Dept. of Neurosurgery of Kiel University Medical Center

Purpose: Social cognitive functions are of high clinical relevance. To date, little is known about social cognition in neurooncological patients and this domain is usually not included in standardized neurocognitive test batteries. Aim of this study was thus to assess whether social cognition could pose a useful contribution to the neurocognitive a...

Purpose: To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group. Methods: Forty-five patients...

Objective Whether intracerebral haemorrhage (ICH) associated with non‐vitamin K antagonist oral anticoagulants (NOAC‐ICH) has a better outcome compared to ICH associated with vitamin‐K antagonists (VKA‐ICH) is uncertain. Methods We performed a systematic review and individual patient data meta‐analysis of cohort studies comparing clinical and radi...

OBJECTIVE: Whether intracerebral haemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin-K antagonists (VKA-ICH) is uncertain. METHODS: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and rad...

Objectives: Hydrocephalus can be defined as clinically symptomatic dilatation of the internal ventricular system at the expense of brain and blood volume. Shunt insertion is the mainstay of therapy for communicating hydrocephalus. One of the most frequently used valves is the programmable Codman Medos Hakim valve which enables the pressure level t...

Objective Preoperative anxiety is frequent in neurosurgical patients and of high clinical relevance (e. g., associated with anestesiological requirements and surgery outcome). Little however is known about the quality of instruments for assessment of preoperative anxiety in this specific patient group and setting. This paper therefore focused on th...

Objective Bad news refer to information which subjectively impedes a patient’s future prospects. Patients with intracranial tumours potentially face numerous bad news. This study assessed the patients’ perspective regarding the content of bad news, patients’ preferences for the communication of bad news, and clinical consequences of mismatch of pat...

Background: Neurosurgical brain tumour removal poses a unique threat for patients while also minimizing instrumental control. Thus, psychological processes utilized by patients in order to cope with surgery-related anxiety are of utmost importance. This is the first study to assess both nature and effectiveness of surgery-related coping efforts in...

Die deutsche Version des SCOPA-Sleep Fragebogens zum Download

Aim of the study was the cross-cultural adaptation and validation of the German version of the Scale for Outcomes in Parkinson’s disease-Sleep Scale (SCOPA-Sleep) for assessment of night-time sleep problems (NS) and daytime sleepiness (DS). Eighty-three patients with Parkinson’s disease completed the SCOPA-Sleep and a multitude of measures for asse...

Background: Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving...

Background: Nonrechargeable deep brain stimulation impulse generators (IGs) with low or empty battery status require surgical IG exchange several years after initial implantation. The aim of this study was to investigate complication rates after IG exchange surgery and identify risk factors. Methods: We retrospectively analyzed complications fol...

Etwa 90% der Gliompatienten leiden unter neuropsychologischen Störungen, das heißt unter Veränderungen kognitiver Funktionen und/oder des affektiven Befindens infolge der Tumorerkrankung selbst bzw. ihrer Behandlung. Neuropsychologische Störungen haben eine ausgesprochen hohe Relevanz für Lebensqualität und Partizipation der Betroffenen. Der Beitra...

We characterized health-related quality of life (HRQoL), cognitive, and functional status in newly diagnosed glioblastoma (GBM) patients receiving Tumor treating fields (TTFields) with temozolomide (TMZ) versus TMZ alone in a planned interim analysis of a randomized phase III trial [NCT00916409], which showed significant improvement in progression-...

Objective: Nonrechargeable deep brain stimulation (DBS) generators must be replaced when the battery capacity is exhausted. Battery life depends on many factors and differs between generator models. A new nonrechargeable generator model replaced the previous model in 2008. Our clinical impression is that the earlier model had a longer battery life...

Erythropoietin (Epo) exhibits promising neuroregenerative potential for spinal cord injury (SCI) and might be involved in other long-term sequelae, such as neuropathic pain development. The current studies investigated the time courses and spatial and cellular patterns of Epo and EpoR expression along the spinal axis after graded SCI. Male Long Eva...

The aim of the study was to record movement-related single unit activity (SUA) in the human subthalamic nucleus (STN) during a standardized motor task of the upper limb. We performed microrecordings from the motor region of the human STN and registered kinematic data in 12 patients with Parkinson’s disease (PD) undergoing deep brain stimulation sur...

Abstract Background Cost reduction measures in medicine are gaining greater importance nowadays, especially in high-volume procedures such as laparoscopic appendectomy (LAE). Currently there are two common methods of dissecting the appendix from the caecal pole: linear stapler and endoloops. The endoloop is the cheaper device but can only be used i...

Background: The threshold current for inducing muscle contractions by stimulation of pyramidal tract fibres adjacent to the globus pallidus internus (GPi) is, besides microelectrode recordings for the determination of nuclear boundaries, currently the only neurophysiological marker for intraoperative refinement of the anatomically planned target p...

Background: In aneurysmal subarachnoid haemorrhage cerebral vasospasm leads to clinical worsening and poor outcome. Interventional treatment with nimodipine might be a therapeutic option. Objective: To evaluate the clinical course of patients with different interventional treatment types. Methods: A retrospective, observational analysis was pe...

Background Clinical outcome and mortality in intracerebral haemorrhage (ICH) associated with anticoagulant treatment is poor. Novel direct oral anticoagulant drugs (NOACs) are increasingly prescribed. Management of NOAC-associated ICH might be more challenging. The aim of this study was to compare the clinical and radiological course of ICH patient...

In recent years more and more data have emerged linking the most radical resection to prolonged survival in patients harboring brain tumors. Since total tumor resection could increase postoperative morbidity, many methods have been suggested to reduce the risk of postoperative neurological deficits: awake craniotomy with the possibility of continuo...

These proceeding cover new trends presented at the IV Congress of the International Society of Reconstructive Neurosurgery (ISRN), 2015. ISRN is an “open” multidisciplinary society that deals with advances in spine and peripheral-nerve reconstructive surgery, central nervous system revascularization (surgical, radio interventional), neuromodulation...

Background: Deep brain stimulation (DBS) within or adjacent to the subthalamic nucleus (STN) currently represents the most common stereotactic procedure performed for Parkinson's disease. Better STN imaging is often regarded as a requirement for improving stereotactic targeting. But, remarkably enough, it is unclear whether there is a consensus ab...

Background Chemokines and their receptors play a decisive role in tumor progression and metastasis. We recently found a new signaling mechanism in malignant glioma cells mediated by transmembrane chemokines that we termed “inverse signaling”. According to this hypothesis, soluble (s)-CXCL16 binds to the surface-expressed transmembrane (tm) -CXCL16,...

Interview about how our mind is influenced by increasing media coverage and communication needs

Introduction The treatment of glioblastoma multiforme (GBM) is a major challenge of neuro-oncology. Despite aggressive therapeutic strategies including surgery and radio-chemotherapy, median survival remains extremely low. This points to the urgent need for alternative treatment strategies such as immunotherapy. Immunological escape mechanisms, inv...

Aggressive cancer cells show histological similarities to embryonic stem cells. As differentiated cells can re-acquire pluripotency and self-renewal by transfection with the transcription factors OCT4, SOX2, KLF4 and MYC, with Nanog as readout for success, we comprehensively investigated their occurrence and frequency in human astrocytomas of diffe...

Question Low or empty battery status of non-rechargeable deep brain stimulation impuls generators (IG) requires a surgical IG exchange several years after initial implantation. Complications in patients undergoing DBS-Surgery are reported in the range between 7.6% and 25.3%. The aim of this study was to investigate the rate of complications after I...

Myelomeningoceles (mmc) are clinically challenging CNS malformations. Although improvement in their management has been achieved with respect to antenatal diagnosis, prevention, and fetal surgery, the cellular mechanisms of damage in the neural placode are poorly understood. We aimed to identify cellular and molecular factors in lesion amplifying c...

Objectives: Awake craniotomy is a well-established procedure in surgery of intracranial tumors in eloquent areas. However, sufficiently standardized instruments for the assessment of sensory-motor function before, during and after the operation are currently lacking, despite their importance for evaluation of operative outcome. Patients and metho...

This study presents the first validation of the Brief Cognitive Status Exam (BCSE) against two other screening tools for cognitive impairment in patients with intracranial tumors. 58 patients and 22 matched healthy controls completed the BCSE, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Patients were addit...

Deep brain stimulation (DBS) has become one of the major therapy options for movement disorders including dystonia. This article should give a review of the current literature from a neurosurgical perspective. Since dystonia is a rare disease, only few studies on larger cohorts have been published, and very few randomized controlled studies are ava...

Purpose: In patients with newly diagnosed glioblastoma that harbors a nonmethylated O(6)-methylguanine-DNA methyltransferase promotor, standard temozolomide (TMZ) has, at best, limited efficacy. The GLARIUS trial thus explored bevacizumab plus irinotecan (BEV+IRI) as an alternative to TMZ. Patients and methods: In this phase II, unblinded trial...

Intracranial meningiomas are tumors arising from the covering cells of the arachnoid layer of the dura mater or from the intraventricular choroid plexus. While mostly benign tumors, they still represent a major challenge to neurosurgeons and other medical disciplines involved in their diagnostic and therapeutic management. Although this review inte...

The chemokine CXCL12 (also termed SDF-1, stromal cell-derived factor-1) and its receptors CXCR4 and CXCR7 are known to play a pivotal role in tumor progression including glioblastomas (GBM). Previous investigations focused on the expression and functional roles of CXCR4 and CXCR7 in different GBM cell subpopulations, but comparative analysis in mat...

After performing a decompressive craniectomy, a cranioplastic surgery is usually warranted. The complications of this reconstructive procedure may differ from the initial operation. The authors of this study report on their experience to define patient-specific and procedural risk factors for possible complications following cranioplasty influencin...

Intracranial meningiomas are tumors arising from the covering cells of the arachnoid layer of the dura mater or from the intraventricular choroid plexus. While mostly benign tumors, they still represent a major challenge to neurosurgeons and other medical disciplines involved in their diagnostic and therapeutic management. Although this review inte...

Background: The incidence of intracerebellar hemorrhages approaches 5-10% of all intracerebral hematomas. The clinical presentation varies from headaches and dizziness to rapid deterioration of consciousness to the point of coma in severe cases. In order to find some concrete criteria that could influence the prognosis of these patients, we perfor...

BACKGROUND: Tumor Treating Fields (TTFields) are an anti-mitotic, electric-physical treatment modality. An interim analysis of the phase 3 trial comparing TTFields with maintenance temozolomide (TTFields/TMZ) showed superior progression free and overall survival compared to temozolomide alone (TMZ alone) in patients with newly diagnosed GBM. METHOD...

Background: The ideal treatment strategy for low-grade gliomas (LGGs) is a controversial topic. Additionally, only smaller single-center series dealing with the concept of intraoperative magnetic resonance imaging (iMRI) have been published. Objective: To investigate determinants for patient outcome and progression-free-survival (PFS) after iMRI...

Deep brain stimulation (DBS) in therapy for advanced Parkinson's disease (PD) is an accepted treatment. Infections of the system and other complications occasionally result in hardware removal and subsequent medical treatment alone for months. We have analyzed the clinical course of 15 patients requiring removal of at least parts of the DBS system,...

The cytokine hormone erythropoietin (EPO) and the chemokine CCL3 are known to be produced in the brain under various pathological conditions. In this study, we investigated whether EPO and CCL3 influence on each other during neuroinflammation. We showed that EPO could reduce lipopolysaccharide (LPS)-induced CCL3 mRNA expression in rat cerebellar ne...

Background: Occipital Nerve stimulation (ONS) is a treatment option for therapy-resistant chronic migraine. The precise effect of ONS onto the pathophysiology of migraine and the trigeminocervicale antinociceptive system remains unknown. In this study, the effect of ONS onto experimentally induced pain and antinociceptive reflexes in patients with...

Background: Occipital Nerve stimulation (ONS) induces sensory experiences in the distribution area of occipital nerves and can be used for treating chronic migraine. The aim of this therapy is to activate antinociceptive mechanisms for preventing migraine. The relationship between cognitive and affective properties of the induced sensations and the...

Aim: Occipital Nerve stimulation (ONS) is used for treating therapy-resistant chronic migraine. The relationship between stimulation parameters, induced sensations and the clinical efficacy of treating migraine is widely unknown to date. Therefore, the aim of this study is to evaluate the relationship beween stimulation parameters, sensations induc...

A rare case of idiopathic temporomesial encephalocele in a 64 years old female is presented. The clinical symptoms of this adult patient were spontaneous rhinorrhea and headaches. A temporomesial encephalocele could be diagnosed and the cele was removed surgically in two operative procedures. In case of clinical symptoms like rhinorrhea a surgical...

The Twist-1 transcription factor and its interacting protein Akirin-2 regulate apoptosis. We found that in glioblastomas, highly malignant brain tumors, Akirin-2 and Twist-1 were expressed in glial fi brillary acidic protein positive tumor regions as well as in tumor endothelial cells and infi ltrating macrophages / microglia. Temozolomide (TMZ) in...

The existence of endogenous neural progenitor cells (NPCs) in the adult spinal cord (sc) provides the potential for tailored repair therapies after spinal cord injury (SCI). This study investigates the impact of inflammatory mediators on properties of NPC cultures derived from adult rats after SCI. The Infinite Horizon impactor was used to apply 20...

Patients with highly malignant glioblastomas have a short median survival time mainly due to aggressive relapses after therapeutic treatment. Beside others, they achieve their progressive character via epithelial-to-mesenchymal transition (EMT). However, comprehensive investigations on EMT in paired primary-recurrent glioblastoma pairs are presentl...

Deep brain stimulation of subthalamic nucleus (STN-DBS) for Parkinson's disease allows for a reduction in medication dosage. Changes in total levodopa equivalent daily dose (LEDD) have been frequently reported, there is little information about changes within the drug classes. We retrospectively assessed the changes in antiparkinsonian drugs dosage...

Purpose: A randomised, open label phase III trial was conducted to evaluate efficacy of nimotuzumab, a monoclonal antibody against epidermal growth factor receptor (EGF-R) added to standard therapy for newly diagnosed glioblastoma. Patients and methods: 149 glioblastoma patients stratified as with or without residual tumour were randomly assigne...

Medulloblastoma, astrocytoma, and ependymoma represent the most common infratentorial tumors in childhood, while Ewing sarcomas in that localization are extremely rare. A large left infratentorial space-occupying lesion was diagnosed in a 12-year-old girl with signs of increased intracranial pressure. Following total tumor resection, histological a...

Postoperative MRI findings in sagittal and axial views obtained at day 1 following tumor resection and 2 years later during follow-up showing no residual tumor manifestation are provided as Supplementary Material in the online version of the Journal.

Background: Within the last years, occipital nerve stimulation (ONS) has proven to be an important method in the treatment of severe therapy-resistant neurological pain disorders. The correspondence between lead placement as well as possible stimulation parameters and the resulting stimulation effects remains unclear. Objective: The method aims...

Cavernous haemangiomas of the optic nerve, optic chiasm or optic tract are rare. Usually they present with acute onset of symptoms such as acute decline of visual acuity, headaches, nausea or even decline of the level of consciousness which suggests haemorrhage in or even out of the lesion. Otherwise, they have an insidious clinical pattern with su...

Intracerebral hemorrhage (ICH) is the most significant complication of Deep Brain Stimulation (DBS). To prevent ICH, stereotactic contrast enhanced T1-weighted images are used to visualize vessels as source of hemorrhage. Susceptibility-Weighted Imaging (SWI) is an MRI sequence with improved visualization of susceptibility differences between tissu...

Background. Obtaining intra-operative watertight closure of the dura is considered important in reducing post-operative cerebrospinal fluid (CSF) leak. The purpose of this study was to evaluate a fibrin sealant as an adjunct to sutured dural repair to obtain intra-operative watertight closure in cranial neurosurgery. Methods. This randomized, contr...

Objective Functional magnetic resonance imaging (fMRI) for motor and language mapping is used for presurgical planning. This study aimed to evaluate the value of fMRI in clinical routine for preoperative planning of brain surgery adjacent to functional brain areas. Methods Thirty-seven consecutive patients with brain lesions adjacent to sensomotor...