Johannes HertaMedical University of Vienna | MedUni Vienna · Department of Neurosurgery
Johannes Herta
Doctor of Medicine
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66
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Introduction
Skills and Expertise
Publications
Publications (66)
Objective: This study provides an adaptive threshold algorithm for burst detection in electroencephalograms (EEG) of preterm infantes and evaluates its performance using clinical real-world EEG data.
Approach: We developed an adaptive threshold algorithm for burst detection in EEG recordings from preterm infants. To assess its applicability in the...
OBJECTIVE To optimize surgical positioning for posterior fossa surgery (PFS) using the semisitting position (SSP) to
avoid venous air embolism (VAE) and its possible life-threatening consequences, the authors evaluated their experi-
ences with the SSP by analyzing a large cohort of PFS patients.
METHODS A retrospective analysis of the charts of 2...
Purpose
Various surgical nuances of the telovelar approach have been suggested. The necessity of removing the posterior arch of C1 to accomplish optimal tumor exposure is still debated. Therefore, we report on our experience and technical details of the fourth ventricular tumor resection in a modified prone position without systematic removal of th...
A R T I C L E I N F O Keywords: elderly patients intraventricular hemorrhage spontaneous intracerebral hemorrhage volumetry A B S T R A C T Background: Spontaneous intracerebral hemorrhage (SICH) of the elderly is a devastating form of stroke with a high morbidity and economic burden. There is still a limited understanding of the risk factors for a...
Aim of this article is to give an overview of the technical background and the advantages of modern devices for different applications of cryoablation in cranio-orbital neurosurgery.
The treatment of orbital lesions is complicated by the complex and potentially inapparent anatomy due to retro-orbital fat. With the help of cryoprobes different well-...
For microvascular decompression surgery, adequate visualization of the trigeminal nerve root is essential. Several visualization techniques with operating microscopes, endoscopes, a combination of both, and exoscopes have been described. In this video, the authors use a 4K 3D exoscope (ORBEYE) as it offers superb optical image quality with a high d...
Objectives
The development of persistent hydrocephalus in patients after spontaneous intracerebral hemorrhage (ICH) is still poorly understood, and many variables predicting the need for a cerebrospinal fluid (CSF)-shunt have been described in the literature with varying results. The aim of this study is to find predictive factors for shunt depende...
Background: High cerebrospinal fluid (CSF) sampling frequency is considered a risk factor for external ventricular drain (EVD)-associated infections. To reduce manipulation at the proximal port and potentially minimize the risk of an infection, we aimed to analyze whether CSF parameters sampled from the far distal collection bag could provide relia...
Trigeminal neuralgia and other neuralgias of cranial nerves have been conceptualized in diagnostic classification schemes of the International Headache Society (IHS) and the International Association for the Study of Pain (IASP) to guide clinicians and researchers in the diagnostic approach of these painful conditions. Trigeminal neuralgia is an ex...
Objective:
MR-thermography guided Laser interstitial thermal therapy (LITT) provides a minimally invasive treatment option in children with CNS tumors or medically intractable epilepsy. However, transporting anaesthetized children between operating room (OR) and radiological suite creates logistical challenges. Thus, we describe advantages of usin...
Introduction:
Nimodipine is routinely administered to aneurysmal subarachnoid hemorrhage patients to improve functional outcomes. Nimodipine can induce marked systemic hypotension, which might impair cerebral perfusion and brain metabolism.
Methods:
Twenty-seven aneurysmal subarachnoid hemorrhage patients having multimodality neuromonitoring and...
Purpose
To compare percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFTC) for the treatment of trigeminal neuralgia.
Methods
This was a retrospective single-center analysis of data from 230 patients with trigeminal neuralgia who underwent 202 PBC (46%) and 234 RFTC (54%) from 2002 to 2019. Comparison of demographic data...
OBJECTIVE The development of persistent hydrocephalus in patients after spontaneous intracerebral hemorrhage (ICH) is still poorly understood and many variables predicting the need for a cerebrospinal fluid (CSF)-shunt have been described in the literature with varying results. The aim of this study is to find predictive factors for shunt dependenc...
Purpose: To compare percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFTC) for the treatment of trigeminal neuralgia (TGN).
Methods: Retrospective single center analysis of data from 230 patients with TGN that underwent 202 PBC (46%) and 234 RFTC (54%) from 2002 to 2019. Comparison of demographic data and TGN characteris...
OBJECTIVE
The objective of this study was to assess and compare the potential of 5-aminolevulinic acid (5-ALA) and Raman spectroscopy (RS) in detecting tumor-infiltrated brain in patients with glioblastoma (GBM).
METHODS
Between July 2020 and October 2021, the authors conducted a prospective clinical trial with 15 patients who underwent neurosurgi...
Background:
Patient positioning is an integral part of surgical planning, and numerous variations have been suggested to optimize the prone position. So far, however, little attention has been given to address the restrictions and special needs in an intraoperative MRI suite.
Objective:
To share our experience of transforming the modified prone...
Background:
Detailed anatomic visualization of the root entry zone of the trigeminal nerve is crucial to successfully perform microvascular decompression surgery (MVD) in patients with trigeminal neuralgia.
Objective:
To determine advantages and disadvantages using a 3-dimensional (3D) exoscope for MVD surgery.
Methods:
A 4K 3D exoscope (ORBEY...
INTRODUCTION
Supramaximal resection of gliomas to anatomic-functional boundaries is currently widely employed. This leads to removal of potentially tumor-negative thus healthy brain tissue. Therefore, a device that detects glioma tissue infiltrating the white matter in vivo would be valuable.
METHODS
Patients and methods. An in vivo Raman spectros...
OBJECTIVE
The goal of this study was to evaluate the feasibility, benefit, and safety of awake brain surgery (ABS) and intraoperative language mapping in children and adolescents with structural epilepsies. Whereas ABS is an established method to monitor language function in adults intraoperatively, reports of ABS in children are scarce.
METHODS
A...
Zusammenfassung
Für die Implantation von Elektroden bei Verdacht auf insuläre Epilepsie stehen verschiedene Zugänge zur Verfügung: 1) offen über eine Kraniotomie, 2) stereotaktisch, wobei die Elektroden orthogonal oder schräg über den Frontallappen und Parietallappen implantiert werden. Die stereotaktische Implantation wird rahmenbasiert, navigatio...
Purpose
Feasibility, reliability, and safety assessment of transcranial motor evoked potentials (MEPs) in infants less than 12 months of age.
Methods
A total of 22 patients with a mean age of 33 (range 13–49) weeks that underwent neurosurgery for tethered cord were investigated. Data from intraoperative MEPs, anesthesia protocols, and clinical rec...
Objective
To analyze characteristics associated with long-term pain relief after microvascular decompression (MVD) for trigeminal neuralgia (TGN). Description of associated morbidity and complication avoidance.
Methods
One hundred sixty-five patients with TGN underwent 171 MVD surgeries at the authors’ institution. Patient characteristics and magn...
Objectives: Multiple risk factors have been described to be related to external ventricular drain (EVD) associated infections, with results varying between studies. Former studies were limited by a non-uniform definition of EVD associated infection, thus complicating a comparison between studies. In this regard, we assessed risk factors promoting E...
Background:
The purpose of this study was to identify independent risk factors for incidental durotomy (ID) during decompressive lumbar spine surgery and describe its treatment.
Methods:
This retrospective review includes 650 patients who underwent lumbar decompression at a tertiary institution between January 2015 and October 2019. Data collect...
Brain microdialysis samples of intensive care patients treated with the essential anesthetics ketamine, midazolam and propofol were investigated. Importantly, despite decades of clinical use, comprehensive human cerebral pharmacokinetic data of these drugs is still missing.
To encounter this apparent lack of knowledge, we combined cerebral microdia...
Objective:
Evoked potentials are widely used in comatose patients to evaluate neurological function; however, prognostic relevance in patients after SAH is barely investigated. Therefore, we aimed to investigate the prognostic value of the proposed Evoked Potential Score (EPS) for somatosensory (SSEP) and brainstem auditory evoked potentials (BAEP...
Background
New-onset seizures after cranioplasty (NOSAC) are reported to be a frequent complication of cranioplasty (CP) after decompressive hemicraniectomy (DHC). There are considerable differences in the incidence of NOSAC and contradictory data about presumed risk factors in the literature. We suggest NOSAC to be a consequence of patients’ initi...
Objective: In surgery for meningiomas tumor location and extension is currently the only MRI characteristic used to predict the feasibility and difficulty of the resection. Key surgical tumor characteristics such as consistency and vascularity remain obscured until the tumor is exposed. We therefore aimed to identify MRI sequences able to predict t...
Background:
Drugs that inhibit blood clot formation are a risk factor for the development and recurrence of chronic subdural hematoma (cSDH). The use of non-steroidal antiinflammatory drug (NSAID) was associated with higher bleeding rates in non-neurosurgical patients, but their influence on cranial hematomas is unclear. We sought to better descri...
Objective:
Cranioplasty (CP) is considered as a straightforward and technically unchallenging operation; however, complication rates are high reaching up to 56%. Presence of a ventriculoperitoneal shunt (VPS) and timing of CP are reported risk factors for complications. Pressure gradients and scarring at the site of the cranial defect seem to be c...
OBJECTIVE
Gross-total resection (GTR) is the treatment of choice in the majority of patients suffering from spinal ependymal tumors. In such tumors, the extent of resection (EOR) is considered the key factor for tumor recurrence and thus patient prognosis. However, incomplete resection is not uncommon and leads to increased risk of tumor recurrence...
Neuromonitoring mittels kontinuierlichem EEG (cEEG) kommt bei intensivpflichtigen Patienten immer häufiger zur Anwendung. Mithilfe standardisierter EEG-Kriterien können nichtkonvulsive Anfälle bzw. Status epileptici sowie rhythmische und periodische EEG-Muster unklarer Wertigkeit („ictal-interictal continuum“) verlässlich detektiert und unterschied...
Background:
Delayed posthemorrhagic vasospasm remains among the major complications after aneurysmal subarachnoid hemorrhage (SAH) and can result in devastating ischemic strokes. As rescue therapy, neurointerventional procedures are used for selective vasodilatation.
Objective:
To investigate the effects of intra-arterial papaverine-hydrochlorid...
Neuromonitoring mittels kontinuierlichem EEG (cEEG) kommt bei intensivpflichtigen Patienten immer häufiger zur Anwendung. Mithilfe standardisierter EEG-Kriterien können nicht-konvulsive Anfälle bzw. Status epileptici sowie rhythmische und periodische EEG-Muster unklarer Wertigkeit („ictal-interictal continuum“) verlässlich detektiert und unterschie...
Background:
Critical care continuous electroencephalography (CCEEG) represents the gold standard for detection of nonconvulsive status epilepticus (NCSE) in neurological critical care patients. It is unclear which findings on short-term routine EEG and which clinical parameters predict NCSE during subsequent CCEEG reliably. The aim of the present...
Background: Ongoing or recurrent seizure activity without prominent motor features is a common burden in neurological critical care patients and people with epilepsy during ICU stays. Continuous EEG (CEEG) is the gold standard for detecting ongoing ictal EEG patterns and monitoring functional brain activity. However CEEG review is very demanding an...
Introduction
To investigate the effect of systematic electrode reduction from a common 10–20 EEG system on pattern detection sensitivity (SEN).
Methods
Two reviewers rated 17,130 one-minute segments of 83 prospectively recorded cEEGs according to the ACNS standardized critical care EEG terminology (CCET), including burst suppression patterns (BS)...
The goal of any epilepsy surgery is to improve patient ́s quality of life by achieving seizure freedom or by reducing the frequency of severely debilitating seizures. To achieve this goal, non-invasive and invasive diagnostic methods must precisely delineate the epileptogenic zone (EZ), which is defined as the area that needs to be resected to obta...
Objective:
To test the diagnostic accuracy of a new automatic algorithm for ictal onset source localization (IOSL) during routine presurgical epilepsy evaluation following STARD (Standards for Reporting of Diagnostic Accuracy) criteria.
Methods:
We included 28 consecutive patients with refractory focal epilepsy (25 patients with temporal lobe ep...
Zusammenfassung
Unklare quantitative und qualitative Bewusstseinsstörungen, nicht-konvulsive Anfälle und Status epileptici sowie Sedierungs- und Therapiemanagement sind Indikationen für die Anwendung von kontinuierlichem EEG Monitoring auf der Intensivstation. Durch technologische und wissenschaftliche Fortschritte gewinnt das Neuromonitoring mitte...
ObjectThis study describes an experimental rabbit model that allows the reproduction of percutaneous operations that are used in patients with trigeminal neuralgia (TN). Attention was given to an exact anatomical description of the rabbit’s middle cranial fossa as well as the establishment of conditions for a successful procedure. Methods
Morphomet...
Objective:
To assess whether ICU caregivers can correctly read and interpret continuous EEG (cEEG) data displayed with the computer algorithm NeuroTrend (NT) with the main attention on seizure detection and determination of sedation depth.
Methods:
120 screenshots of NT (480h of cEEG) were rated by 18 briefly trained nurses and biomedical analys...
Objective:
To investigate the effect of systematic electrode reduction from a common 10-20 EEG system on pattern detection sensitivity (SEN).
Methods:
Two reviewers rated 17130 one-minute segments of 83 prospectively recorded cEEGs according to the ACNS standardized critical care EEG terminology (CCET), including burst suppression patterns (BS)...
NeuroTrend is a computational method that automatically analyses long-term scalp EEGs in the ICU according to ACNS standardized critical care EEG terminology (CCET). At present, it is a screening aid to facilitate the review process and optimize resources.
A prospective multi-center study was performed in two neuro-ICUs including 68 patients who we...
Objective:
To develop a computational method to detect and quantify burst suppression patterns (BSP) in the
EEGs of critical care patients. A multi-center validation study was performed to assess the detection
performance of the method.
Methods:
The fully automatic method scans the EEG for discontinuous patterns and shows detected BSP and
quantitat...
Objectives:
To study periodic and rhythmic EEG patterns classified according to Standardized Critical Care EEG Terminology (SCCET) of the American Clinical Neurophysiology Society and their relationship to electrographic seizures.
Methods:
We classified 655 routine EEGs in 371 consecutive critically ill neurological patients into (1) normal EEGs...
Aims of the study:
Continuous EEG from critical care patients needs to be evaluated time efficiently to maximize the treatment effect. A computational method will be presented that detects rhythmic and periodic patterns according to the critical care EEG terminology (CCET) of the American Clinical Neurophysiology Society (ACNS). The aim is to show...
NeuroTrend is a computational method that analyzes long-term scalp EEGs in the ICU according to ACNS standardized critical care EEG terminology (CCET) including electrographic seizures. At present, it attempts to become a screening aid for continuous EEG (cEEG) recordings in the ICU to facilitate the review process and optimize resources.
A prospec...
Background:
Continuous EEG (cEEG) is necessary to document nonconvulsive seizures (NCS), nonconvulsive status epilepticus (NCSE), as well as rhythmic and periodic EEG patterns of 'ictal-interictal uncertainty' (RPPIIU) including periodic discharges, rhythmic delta activity, and spike-and-wave complexes in neurological intensive care patients. Howe...
This case report describes the de novo aneurysm formation at the anastomosis site 2 years after single-barrel superficial temporal artery to middle cerebral artery bypass surgery. Correct bypass patency and morphology of the anastomosis site was documented intraoperatively and immediately postoperatively by indocyanine green videoangiography and di...
WCN 2013 No: 1167 Topic: 4 — Neuro-critical care Computational EEG analysis for critically ill patients based on the standardized terminology of the ACNS Continuous EEG monitoring is an important tool to recognize clinically invisible deteriorations in critically ill patients. However, manually reviewing continuous EEG recordings requires substanti...