Roland Roelz's research while affiliated with University of Freiburg and other places

Publications (58)

Article
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Skull base cerebrospinal fluid (CSF) leaks can lead to severe complications and require appropriate diagnosis and treatment. Cisternography is applied when exact localization via conventional imaging is not successful. The present study is aimed at identifying factors with potential impact on radiological results and surgical success. Cisternograph...
Article
Background: Favorable outcomes are seen in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) grade V aneurysmal subarachnoid hemorrhage. Therefore, the usefulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. We previously modif...
Article
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Background: To establish a practical risk chart for prediction of delayed cerebral infarction (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) by using information that is available until day 5 after ictus. Methods: We assessed all consecutive patients with aSAH admitted to our service between September 2008 and September 2015 (n = 417). Th...
Article
Background Delayed cerebral ischemia increases mortality and morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Various techniques are applied to detect cerebral vasospasm and hypoperfusion. Contrast-enhanced ultrasound perfusion imaging (UPI) is able to detect cerebral hypoperfusion in acute ischemic stroke. This prospective study aimed to...
Article
Object: The initial amount of subarachnoid and ventricular blood is an important prognostic factor for outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). In this comparative study of an unselected aSAH-population, we assess the modifiability of these factors by implementation of blood clearance by cisternal lavage. Methods: All...
Article
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Background All-posterior lumbar VCR may be less invasive compared to combined retroperitoneal plus dorsal approaches. Stable lumbar vertebral body replacement requires implants with a large footprint to prevent implant subsidence. The narrow corridor between the lumbar nerve roots and the dural tube, however, impedes insertion of such implants via...
Article
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Craniopharyngiomas are typically located in the sellar region and frequently contain space-occupying cysts. They usually cause visual impairment and endocrine disorders. Due to the high potential morbidity associated with radical resection, several less invasive surgical approaches have been developed. This study investigated stereotactic-guided im...
Article
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Background To compare the efficacy of two different concepts of cisternal therapy—PREVENTIVE fibrinolysis plus on-demand spasmolysis versus RESCUE spasmolysis—for the prevention of cerebral vasospasm (CVS) and delayed cerebral infarction (DCI) in patients with aneurysmal subarachnoid haemorrhage (aSAH). Methods Retrospective analysis of 84 aSAH pa...
Article
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Background Deep surgical site infections (dSSIs) after instrumented spinal surgery pose major therapeutic challenges. Standard treatment involves surgical debridement, wound drainage, and long-term antibiotic administration. Autologous platelet-rich fibrin (PRF) constitutes a biomaterial obtained from patients’ own blood that contains leukocytes, c...
Article
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Study Design Prospective cohort study. Objectives The purpose of this prospective study was to evaluate a protocol for radiation-sparing kyphoplasty by assessing dosemetrically recorded radiation exposures to both patient and surgeon. Methods This prospective clinical study examines the radiation exposure to patient and surgeon during single-leve...
Article
Objective: A major challenge of a minimally invasive spinal approach (MIS) is maintaining freedom of maneuverability through small operative corridors. Unfortunately, during tubular resection of intradural pathologies, the durotomy and its accompanying tenting sutures offer a smaller operating window than the maximum surface of the tube's base. Th...
Article
Intradural petrous bone drilling has become a widespread practice, providing extended exposure in the removal of cerebellopontine angle (CPA) or petroclival tumors. Adjacent neurovascular structures are at risk, however, when drilling is performed in this deep and narrow area. Hence, this study evaluates the use of Piezosurgery (PS) as a non-rotati...
Article
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BACKGROUND Percutaneous rhizotomy of the Gasserian ganglion for trigeminal neuralgia is an effective therapeutic procedure. Yet, landmark-guided cannulation of the foramen ovale is manually challenging and difficult to learn. OBJECTIVE To overcome these limitations, we assessed the feasibility and accuracy of an augmented reality (AR)-guided punct...
Article
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Purpose: The aim of this study was the development and external validation of a logistic regression model to differentiate gliosarcoma (GSC) and glioblastoma multiforme (GBM) on standard MR imaging. Methods: A univariate and multivariate analysis was carried out of a logistic regression model to discriminate patients histologically diagnosed wit...
Article
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Background Delayed cerebral infarction (DCI) is a major cause of death and poor neurological outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Direct intrathecal therapies with fibrinolytic and spasmolytic drugs have appeared promising in clinical trials. However, access to the subarachnoid space for intrathecal drug administratio...
Article
Objective(s) Intracerebral hemorrhage (ICH) contributes considerably to the high morbidity and mortality of aneurysmal subarachnoid hemorrhage (aSAH). Specific patterns of aSAH-associated ICH that are not compatible with favorable outcome remain unknown. The main objective of this study is to report patterns of aSAH-associated ICH that result in un...
Article
In this article, we reported a 9-year-old male child patient who suffered severe subarachnoid hemorrhage due to ruptured dissecting aneurysm of the left parieto-occipital artery. After endovascular occlusion of the aneurysm, increased intracranial pressure refractory to noninvasive therapy required secondary decompressive hemicraniectomy. Critical...
Article
Objective In patients with multilevel degenerative cervical myelopathy (DCM), laminectomy and fusion are widely accepted techniques for ameliorating the disorder. However, the idea of whether one should bridge the cervicothoracic junction to prevent instrument failure or adjacent segment disease is a subject of controversial discussion. The current...
Article
Study design: A randomized controlled trial. Objective: To compare the radiation exposure with the scrub nurse, assistant surgeon, and anesthetist during minimally invasive transforaminal lumbar interbody fusion using conventional 2-dimensional (2D) fluoroscopy or 3D fluoroscopy-based navigation. Summary of background data: Minimally invasive...
Article
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The prognosis of patients with aneurysmal subarachnoid haemorrhage requiring decompressive craniectomy is usually poor. Proper selection and early performing of decompressive craniectomy might improve the patients' outcome. We aimed at developing a risk score for prediction of decompressive craniectomy after aneurysmal subarachnoid haemorrhage. All...
Article
Background Technical advances in minimally invasive spine surgery have reduced blood loss, access trauma, and postoperative length of stay. However, operating on the susceptible group of octogenarians still poses a dilemma because of a plethora of age-related comorbidities. The aim of this study was to investigate the safety of minimally invasive s...
Article
Background and Purpose— Delayed cerebral infarction (DCI) is an important cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage is a new method for DCI prevention. Here, we assess the effects of implementing STX-VCS in...
Article
Objective: Cerebral amyloid angiopathy (CAA) is an important cause of intracerebral hemorrhage (ICH). However, data on surgical intervention in CAA-related ICH is very limited. In this retrospective study we assessed safety and efficacy of free-hand catheter aspiration followed by local thrombolysis in CAA-related large ICH. Patients and methods:...
Article
Objective: Delayed cerebral ischemia (DCI) is strongly associated with poor outcome after subarachnoid hemorrhage (SAH). Cerebral vasospasm is a major contributor to DCI and requires special attention. To evaluate the effect of vasospasm management on SAH outcome, we performed a pooled analysis of 2 observational SAH cohorts. Materials: Data fro...
Article
Delayed cerebral infarction (DCI) contributes to the burden of morbidity and mortality acquired by patients with aneurysmal subarachnoid hemorrhage (SAH). Cisternal lavage may prevent DCI. Delivery of lavage therapy to the basal cisterns, however, is challenging. Here, we report a novel method for the delivery of cisternal lavage using a cisterno-v...
Article
BACKGROUND Automatic segmentation is gaining relevancy in image-based targeting of neural structures. OBJECTIVE To evaluate its feasibility, we retrospectively analyzed the concordance of magnetic resonance imaging (MRI)-based automatic segmentation of the subthalamic nucleus (STN) and intraoperative microelectrode recordings (MERs). METHODS Elec...
Article
Delayed Cerebral Infarction (DCI) due to Cerebral Vasospasm (CVS) is an important contributor to poor outcome after aneurysmal subarachnoid haemorrhage (aSAH). Despite established risk factors CVS and DCI are unpredictable at the individual patient level. Efficient treatments are lacking. We report a novel rescue therapy for DCI: Access to the basa...
Article
BACKGROUND Chronic posthemorrhagic hydrocephalus necessitating shunt placement is a common complication of subarachnoid hemorrhage (SAH). OBJECTIVE To evaluate the role of external ventricular drainage (EVD) weaning on risk of shunt dependency after SAH. METHODS Two German university hospitals with different EVD management regimes (rapid weaning...
Article
Objective: Delayed cerebral infarction (DCI) confers considerable morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Available prevention strategies are insufficient. Cisternal blood clearance by stereotactic catheter ventriculocisternostomy (STX-VCS) and cisternal lavage therapy is a novel concept for DCI prevention. Here, w...
Article
Full-text available
Background and purpose: Delayed cerebral infarction (DCI) is a major source of morbidity and mortality after aneurysmal subarachnoid hemorrhage. We report a novel intervention-stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage therapy-for DCI prevention. Outcomes of 20 consecutive patients are compared with...
Article
BACKGROUND: Cerebral vasospasm leading to delayed cerebral infarction (DCI) is a central source of poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Current treatments of cerebral vasospasm are insufficient. Cisternal blood clearance is a promising treatment option. However, a generally applicable, safe, and effective method...
Article
Background and purpose: New deep brain stimulation leads with electrode contacts that are split along their circumference allow steering of the electrical field in a predefined direction. However, imaging-assisted directional stimulation requires detailed knowledge of the exact orientation of the electrode array. The purpose of this study was to e...
Article
OBJECTIVE An asymmetry of the A 1 segments (A1SA) of the anterior cerebral arteries (ACAs) is an assumed risk factor for the development of anterior communicating artery aneurysms (ACoAAs). It is unknown whether A1SA is also clinically relevant after aneurysm rupture. The authors of this study investigated the impact of A1SA on the clinical course...
Article
Object: We report on our experience with treating juxtafacet cysts focusing on clinical outcome, rate of recurrence and secondary surgery, especially fusion. Methods: This retrospective study evaluates patients who underwent surgical resection of juxtafacet cysts without concomitant fusion from 2002 to 2013 with a minimum follow-up of one year....
Article
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Diffuse low grade gliomas (DLGG) are continuously progressive primary brain neoplasms that lead to neurological deficits and death. Treatment strategies are controversial. Randomized trials establishing the prognostic value of surgery do not exist. Here, we report the results of a nine-year near-randomized patient distribution between resection and...
Article
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Purpose Safe treatment of giant central thoracic disc herniations (cTDHs) remains a surgical challenge due to frequent calcifications, intradural extension and, importantly, the rare exposure of spine surgeons to these lesions. We report our 10-year experience in the management of giant cTDH by mini-thoracotomy and offer a detailed description of t...
Article
Background: Cerebral vasospasm usually develops several days after subarachnoid hemorrhage (SAH) and is generally acknowledged as a strong outcome predictor. In contrast, much less is known about the nature and eventual consequences of early angiographic vasospasm (EAVS) seen on admission digital subtraction angiography (DSA). Therefore, we aimed...
Article
Background: Intraventricular hemorrhage is known to complicate the course and outcome of aneurysmal subarachnoid hemorrhage. Aims: To identify independent risk factors for intraventricular hemorrhage development and its severity during aneurysm rupture. Methods: Six hundred and twenty-five subarachnoid hemorrhage patients treated at our instit...
Article
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Leptomeningeal metastasis (LM) of high grade gliomas (HGG) can lead to devastating disease courses. Understanding of risk factors for LM is important to identify patients at risk. We reviewed patient records and magnetic resonance imaging (MRI) of all patients with a first diagnosis of HGG who underwent surgery in our institution between 2008 and 2...
Article
BACKGROUND Along with subarachnoid hemorrhage (SAH), a ruptured aneurysm may also cause an intracerebral hematoma (ICH), which negatively impacts the functional outcome of SAH. OBJECTIVE To identify independent risk factors of aneurysmal ICH. METHODS Six hundred thirty-two consecutive patients with aneurysmal SAH treated at our institution from J...
Article
A large spectrum of possible diagnoses must be taken into consideration when a contrast-enhancing lesion of the pontomedullary region is found on MRI. Among these diagnoses are neoplastic, inflammatory, and infectious, as well as vascular pathologies. The authors report a rare case of an intracranial dural arteriovenous fistula (DAVF) with perimedu...
Article
Contrary to aneurysmal bleeding, non-aneurysmal non-traumatic subarachnoid hemorrhage (NASAH) is rarely associated with unfavorable clinical outcome, cerebral infarction and vasospasm. We aimed to identify independent predictors for a poor clinical course and outcome after NASAH. All patients with NASAH treated at our institution between January 20...
Article
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Purpose: To assess the frequency, risk factors, and management of accidental durotomy in minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Methods: This single-center study retrospectively investigates 372 patients who underwent MIS TLIF and were mobilized within 24 hours after surgery. The frequency of accidental durotomies,...
Article
Cerebral infarction (CI) is a crucial complication of aneurysmal subarachnoid hemorrhage (SAH) associated with poor clinical outcome. We aimed at developing an early risk score for CI based on clinical characteristics available at the onset of SAH. Out of a database containing 632 consecutive patients with SAH admitted to our institution from Janua...
Article
Purpose: To demonstrate a case of isolated pauci-immune vasculitis of the pituitary gland in which the diagnosis was attained by stereotactic biopsy. Methods: We report a 36-year-old man who presented with diabetes insipidus and secondary hypogonadism. Cranial MRI revealed an enhancing lesion of the pituitary stalk. A histological sample was obtain...
Article
Cerebral infarction is a frequent and serious complication of aneurysmal subarachnoid hemorrhage (SAH). This study aimed to identify independent predictors of the timing of cerebral infarction and clarify its impact on disease course and patients' outcome. All consecutive patients with SAH admitted to our institution from January 2005 to December 2...
Article
We report a 55-year-old man affected by a slowly progressive hemiparesis. Imaging revealed giant dilations of brain perivascular spaces, or Virchow-Robin spaces of the thalamo-mesencephalic region and occlusive hydrocephalus. Stereotactic catheter cystoventriculostomy alone reverted hemiparesis. However, conversion of the catheter into a peritoneal...
Article
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Introduction Although there are many experimental studies describing the methodology of the middle cerebral artery occlusion (MCAO) in the literature, only limited data on these distinct anatomical structures and the details of the surgical procedure in a step by step manner. The aim of the present study simply is to examine the surgical anatomy of...
Conference Paper
Full-text available
A 90-year-old woman who had suffered a fall at home presented with mild confusion, retrograde amnesia and headaches to our emergency room. Clinical examination revealed soft biparietal tumescences without laceration of the overlying skin. A CT scan of the head was performed (Figure 1a+b) and showed a biparietal lenticular shaped hyperdense lesion e...

Citations

... This raises the potential for very precise minimally invasive procedures, which could perspectively be applied bedside with minor efforts [33,36]. AR-assisted puncture of the gasserian ganglion for precise radiofrequency ablation in trigeminal neuralgia provides another interesting approach in minimally invasive interventional pain management [26]. For cranial neurosurgery, besides the applications of AR in phantom studies or for preoperative simulations and training, the first descriptions of intraoperative use can also be found (AR-assisted navigation) [9,16,18,25]. ...
... Nonetheless, target therapy with B-RAF and MEK inhibitor agents has shown good results in the treatment of a number of human cancers (6,(16)(17)(18) and glial tumors (16,18,19) harboring the V600E BRAF mutation. These results have led to successful use of these agents for aggressive PCPs that present with a high frequency of BRAF V600E mutation (3,(16)(17)(18)(19)(20)(21). ...
... Once ICP increases, the chance of ICP elevation not sufficiently responsive to medical treatment alone is high, and we acknowledge the value of identifying patients at high risk of ICP decompensation adequately and early. Jabbarli et al. identified intracerebral hemorrhage, "rapid" vasospasm on angiography, early cerebral infarction, aneurysm diameter larger than 5 mm, clipping, age under 55, Hunt and Hess grade 4 or 5, reduced consciousness, and the presence of an external ventricular drain as risk factors associated with ICP decompensation and the need for decompressive hemicraniectomy [10]. ...
... 23 Although the literature supports increased age as a worse prognostic factor, this was not apparent in our population. 24,25 Overall, in this analysis, age as a single variable did not negatively influence these odds as long as the patient's ASA class was not IV-VI. The ability of the elderly patients to meet MCID parameters may justify a more aggressive approach in healthy elderly patients, including octogenarians, but needs further analysis. ...
... The aim of the present retrospective case-control study was therefore to generate novel data on the safety and efficacy of a minimally invasive catheter evacuation technique in patients with VKA-related deep and lobar ICH. In this approach, hematoma reduction is achieved by free-hand, bedside catheter placement with aspiration, followed by catheter irrigation with urokinase (19,20). ...
... This period was chosen because electronic documentation of daily TCD and level of consciousness were available from September 2008. The period ends when methods of intracranial blood clearance were implemented in our department (16). ...
... This is the first large multicenter study of more than hundred thousand patients that has shown significant improvement in discharge outcomes with EVT for DCI. Another recent study of 1,000 patients showed that early and more frequent EVT increased odds for favorable outcome compared to a more restrictive strategy (50) in DCI. ...
... Another important application is pre-operative planning and post-operative evaluation of Deep Brain Stimulation (DBS) surgery [7,8,9]. DBS is an established treatment for movement disorders and psychiatric diseases, in which the target, a specific deep brain structure, is stimulated via an implanted electrode [10,11,12,13]. ...
... In contrast, patients at low DCI risk who developed cerebral vasospasm (CVS) against expectations were selected for RESCUE intrathecal therapy: STX-VCS was performed for cisternal application of nimodipine. 6 Here, we compare the efficacy of these two different concepts of intrathecal therapy aiming at DCI prevention. ...