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W P Vandertop

Publications and source records attributed to W P Vandertop.

At least 19 recordsLinked to original sources
PubMed2006

Air in the carotid canal as a predictor of distal internal carotid artery laceration.

The authors describe a 25-year old patient with blunt trauma-induced bilateral, distal segment internal carotid artery (ICA) lacerations, resulting in a left-sided direct carotid-cavernous sinus fistula (CCF) and presenting with massive oronasal bleeding. The combination of severe oronasal bleeding, with air in the carotid canal should alarm the treating physician to the presence of a distal internal carotid artery laceration.

Accidents, Traffic↗
PubMed2006

Basilar impression in osteogenesis imperfecta: can it be treated with halo traction and posterior fusion?

Basilar impression (BI) and hydrocephalus complicating osteogenesis imperfecta (OI) is usually treated by anterior transoral decompression and posterior fixation. Nevertheless, it may be questioned if posterior fusion following axial halo traction is adequate in patients with symptomatic BI complicating OI. We report on a case with progressive symptomatic hydrocephalus and BI complicating OI that was successfully treated by halo traction followed by posterior occipitocervical fusion. However, after a symptom free interval of 2 years the patient suffered from recurrence of symptomatic hydrocephalus needing additional ventriculoperitoneal (VP) shunt placement. In conclusion, posterior fusion without additional VP shunt placement may not be effective in the long term for ameliorating symptoms and signs and halting progressive hydrocephalus in BI complicating OI.

Adult↗
PubMed2006

Intracranial aneurysms in children under 1 year of age: a systematic review of the literature.

OBJECTIVE: Intracranial aneurysms are very rare in early childhood. Because the location, morphology as well as the clinical and radiological presentation of these aneurysms seem to be different from those in adults, we performed a systematic review of the literature to discuss the clinical, morphological, and radiological features of intracranial aneurysms in the first year of life. MATERIALS AND METHODS: A computerized search of both Pubmed and EMBASE from before 1966 to 2005 was performed. Included were all articles that dealt with cases in which an intracranial aneurysm was demonstrated in children under 1 year of age. RESULTS: We found 110 articles in which 131 cases of an intracranial aneurysm in children under 1 year were presented. The mean age at diagnosis of the aneurysm was 4.9+/-3.5 months with a male to female ratio of 1.1. There was a hemorrhagic presentation in 73% (n=96). The patients presenting with a hemorrhage were younger (mean 4.3 vs 6.7 months, P<0.001) and tended to have smaller-sized (i.e.<2.5 cm) aneurysms (P=0.07). The aneurysm was defined as traumatic or infectious in 15 and 13 cases, respectively. In 21% (n=27), there was various vascular or congenital co-morbidity. In 76%, the aneurysm was located in the anterior circulation. The prevalence of aneurysms on the middle cerebral artery (MCA) was nearly three times higher than on any other vessel. The mean aneurysm size was 1.8+/-1.4 cm, with 30 giant aneurysms (>2.5 cm). The giant aneurysms were significantly more often located in the posterior circulation (43 vs 16%, P=0.01). The mean period of follow-up was 13.6+/-24.8 months. The Glasgow Outcome Scale (GOS) could be derived in 106 cases: 50% had an excellent outcome (GOS of 5). CONCLUSIONS: The presentation of arterial aneurysms in children under the age of 1 year differs from that in adults with a significantly higher prevalence of giant aneurysms in the posterior circulation. The prevalence of aneurysms on the MCA is nearly three times higher than on any other vessel. The patients presenting with a hemorrhage were younger and tended to have smaller-sized aneurysms. Our study did not confirm the male predominance that has thus far been associated with pediatric aneurysms. The outcome is comparable or slightly better than in adults.

Databases, Factual↗
PubMed2005

The risk of rebleeding after external lumbar drainage in patients with untreated ruptured cerebral aneurysms.

BACKGROUND: Does continuous external lumbar CSF drainage before aneurysm repair in patients with aneurysmal subarachnoid hemorrhage increase the risk of rebleeding? METHOD: The study population, consisting of 18 patients treated by External Lumbar Drainage (ELD) after SAH before aneurysm repair, was compared with an independent control group of 324 SAH patients treated in another clinic. Control patients were selected for not being treated for the ruptured aneurysm yet and not having undergone any form of CSF drainage during the exposure time in the case patients. We calculated hazard ratios with the Cox regression model, adjusted for age and clinical condition on admission and hydrocephalus. FINDINGS: The cox regression analysis shows a non-adjusted hazard ratio of 2.1 (95% CI 0.8 to 5.3) in the model with 5 rebleedings in 18 patients. Adjustment for age, clinical condition on admission and hydrocephalus did not alter the hazard ratio estimate importantly in either analyses. CONCLUSIONS: An increased risk of rebleeding by external lumbar drainage in the acute phase after aneurysmal SAH could not be confirmed, but the data are too imprecise to rule out an increased risk. The potential benefits of early drainage should be weighed against the risks if the aneurysm is not occluded before or early after the start of drainage.

Adult↗
PubMed2005

Timing of aneurysm surgery in subarachnoid haemorrhage--an observational study in The Netherlands.

BACKGROUND: There is still lack of evidence on the optimal timing of surgery in patients with aneurysmal subarachnoid haemorrhage. Only one randomised clinical trial has been done, which showed no difference between early and late surgery. Other studies were observational in nature and most had methodological drawbacks that preclude clinically meaningful conclusions. We performed a retrospective observational study on the timing of aneurysm surgery in The Netherlands over a two-year period. METHOD: In eight hospitals we identified 1,500 patients with an aneurysmal subarachnoid haemorrhage. They were subjected to predefined inclusion criteria. We included all patients who were admitted and were conscious at any one time between admission and the end of the third day after the haemorrhage. We categorised the clinical condition on admission according the World Federation of Neurological Surgeons (WFNS) grading scale. Early aneurysm surgery was defined as operation performed within three days after onset of subarachnoid haemorrhage; intermediate surgery as performed on days four to seven, and late surgery as performed after day seven. Outcome was classified as the proportion of patients with poor outcome (death or dependent) two to four months after onset of subarachnoid haemorrhage. We calculated crude odds ratios with late surgery as reference. We distinguished between management results (reconstructed intention to treat analysis) and surgical results (on treatment analysis). The results were adjusted for the major prognosticators for outcome after subarachnoid haemorrhage. FINDINGS: We included 411 patients. There were 276 patients in the early surgery group, 36 in the intermediate surgery group and 99 in the late surgery group. On admission 78% were in good neurological condition (WFNS I-III). MANAGEMENT RESULTS: Overall, 93 patients (34%) operated on early had a poor outcome, 13 (36%) of those with intermediate surgery and 37 (37%) in the late surgery group had a poor outcome. For patients in good clinical condition on admission and planned for early surgery the adjusted odds ratio (OR) was 1.3 (95% CI 0.5 to 3.0). The adjusted OR for patients admitted in poor neurologicalcondition (WFNS IV-V) and planned for early surgery was 0.1 (95% CI 0.0 to 0.6). SURGICAL RESULTS: For patients in good clinical condition on admission who underwent early operation the adjusted OR was 1.1 (95% CI 0.4 to 3.2); it was 0.2 (95% CI 0.0 to 0.9) for patients admitted in poor clinical condition. CONCLUSIONS: In this observational study we found no significant difference in outcome between early and late operation for patients in good clinical condition on admission. For patients in poor clinical condition on admission outcome was significantly better after early surgery. The optimal timing of surgery is not yet settled. Ideally, evidence on this issue should come from a randomised clinical trial. However, such a trial or even a prospective study are unlikely to be ever performed because of the rapid development of endovascular coiling.

Adolescent↗
PubMed2005

Cerebral microdialysis and positron emission tomography after surgery for aneurysmal subarachnoid hemorrhage in grade I patients.

BACKGROUND: Using cerebral microdialysis, baseline values for energy-related chemical markers have been reported in awake patients. Radionuclide studies have demonstrated a locally decreased metabolism, thought to be the result of brain retraction. These baseline values, however, may not be applicable to patients after surgical aneurysm repair following a subarachnoid hemorrhage (SAH). We assessed metabolic chemical marker levels in World Federation of Neurological Surgeons Committee (WFNS) grade I SAH patients after aneurysm surgery and compared them with previously reported baseline values. METHODS: In 5 WFNS grade I SAH patients, energy-related chemical marker levels were obtained using microdialysis in the area of brain retraction after aneurysm surgery. In addition, an [(18)F]2-deoxy-d-glucose positron emission tomography (FDG-PET) was performed. RESULTS: The FDG-PET showed a decrease of glucose metabolism in the frontotemporal area. Comparing the mean values for chemical markers of this study with reported baseline values, the most striking difference was a mild decrease of pyruvate and an increase of the lactate/pyruvate ratio. In individual patients, some markers indicated possible ischemia. A consistent pattern or ischemic profile for all markers, however, was not found. CONCLUSION: FDG-PET scanning confirmed postoperative metabolic changes found in previous studies. Mean interstitial chemical marker levels ranged from normal to mildly deviant compared with reference chemical marker levels for awake patients and are likely to be applicable in SAH patients after aneurysm repair.

Adult↗
PubMed2004

Metastatic adenocarcinoma in the cerebellopontine angle, presenting as a meningioma: a case report of rare occurrence.

We present the case of a 36-year old woman who was referred to our hospital with an 8 weeks history of walking difficulties, nausea and vomiting, diminished hearing on the right side and diplopia. On Magnetic Resonance-Imaging (MRI) a tumour in the right cerebellopontine angle (CPA) was diagnosed. The tumour was resected and histopathological examination revealed an adenocarcinoma, suspicious for a metastasis from carcinoma of the breast considering the aspect of the cells, immunochemical profile, age and gender of the patient. No primary tumour was found. In cases without histopathological diagnosis, radiosurgery should be withheld when there is doubt about the clinical or radiological diagnosis.

Adenocarcinoma↗
PubMed2004

Craniopagus: the Suriname-Amsterdam conjunction.

OBJECTS: A case of a Suriname female occipito-parietal to occipito-parieto-temporal craniopagus twins is described. The girls were transferred to the VU University Medical Center (VUmc) in Amsterdam, the Netherlands, for further diagnostics and to analyze whether surgical separation was feasible and ethically justifiable. The multifactorial aspects of different treatment options are discussed. METHODS: The twins underwent multiple investigations by a multidisciplinary team. Advanced imaging techniques with 3D-CT scan, MRI and MRA scans, image fusion techniques and, most importantly, cerebral angiography with balloon occlusion tests were performed. CONCLUSIONS: Because of a shared venous ring, with preferential drainage to the left child, and which endovascular balloon occlusion showed could not be separated, surgical separation of the twins with a fair chance of survival without additional neurological damage and with prospects of a good quality of life was regarded as impossible. In accordance with the parents' wishes, the twins were not separated and offered optimal integral conservative treatment.

Cerebral Cortex↗
PubMed2003

The prognostic value of cognitive functioning in the survival of patients with high-grade glioma.

The authors studied cognitive functioning as a potential predictor of survival in 68 newly diagnosed patients with high-grade glioma. In a combined Cox proportional hazards model, the influence of tumor, treatment, and patient characteristics, including cognitive functioning, was studied. Older age and higher tumor grade were associated with poorer survival. Although cognitive impairment was not found to be an independent prognostic factor for the entire sample, it was associated with significantly poorer survival among older patients with World Health Organization grade IV gliomas. Assessment of cognitive functioning in these patients may improve clinical decision making and thus quality of treatment.

Age Factors↗
PubMed2003

Single-fraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study.

PURPOSE: In this single-institution trial, we investigated whether fractionated stereotactic radiation therapy is superior to single-fraction linac-based radiosurgery with respect to treatment-related toxicity and local control in patients with vestibular schwannoma. METHODS AND MATERIALS: All 129 vestibular schwannoma patients treated between 1992 and June 2000 at our linac-based radiosurgery facility were analyzed with respect to treatment schedule. Dentate patients were prospectively selected for a fractionated schedule of 5 x 4 Gy and later on 5 x 5 Gy at the 80% isodose in 1 week with a relocatable stereotactic frame. Edentate patients were prospectively selected for a nonfractionated treatment of 1 x 10 Gy and later on 1 x 12.5 Gy at 80% isodose with an invasive stereotactic frame. Both MRI and CT scans were made in all 129 patients within 1 week before treatment. All patients were followed yearly with MRI and physical examination. RESULTS: A fractionated schedule was given to 80 patients and a single fraction to 49 patients. Mean follow-up time was 33 months (range: 12-107 months). There was no statistically significant difference between the single-fraction group and the fractionated group with respect to mean tumor diameter (2.6 vs. 2.5 cm) or mean follow-up time (both 33 months). Only mean age (63 years vs. 49 years) was statistically significantly different (p = 0.001). Outcome differences between the single-fraction treatment group and the fractionated treatment group with respect to 5-year local control probability (100% vs. 94%), 5-year facial nerve preservation probability (93% vs. 97%), and 5-year hearing preservation probability (75% vs. 61%) were not statistically significant. The difference in 5-year trigeminal nerve preservation (92% vs. 98%) reached statistical significance (p = 0.048). CONCLUSION: Linac-based single-fraction radiosurgery seems to be as good as linac-based fractionated stereotactic radiation therapy in vestibular schwannoma patients, except for a small difference in trigeminal nerve preservation rate in favor of a fractionated schedule.

Adult↗
PubMed2003

[Neuromonitoring of patients following severe brain trauma].

To a considerable extent, the neurological outcome of patients with severe brain trauma is determined by the primary injury caused by the accident. Substantial progress has been made in our understanding of the pathophysiological processes resulting in secondary brain damage after brain trauma, partly as a result of the introduction of advanced techniques of neuromonitoring. Early recognition and treatment of the symptoms leading to this type of brain damage seems crucial to the effort to improve the neurological outcome in these patients. Useful modern neuromonitoring techniques include: measurement of the intracranial and cerebral perfusion pressure and continuous electroencephalography. Methods that are also reliable and readily applicable, but less relevant clinically, include cerebral microdialysis of fluid from the extracellular space, determination of the parenchymal oxygen tension, and determination of the venous oxygen saturation. Other techniques that are not clinically applicable include: determination of the cerebral blood flow, the cortical tissue perfusion or the regional cerebral oxygenation.

Brain Damage, Chronic↗
PubMed2003

[Brain abscess: a difficult diagnosis].

A 40-year-old man had experienced headaches for 6 days and a 51-year-old man (2 weeks after an operation for perianal abscess) had experienced tingling sensations in the left hand for 10 days. After an epileptic seizure both underwent a CT scan of the brain. On these an abnormality was visible, probably a malignant astrocytoma. After several days of complaint reduction with dexamethasone, drowsiness and leftsided hemiparesis occurred. Emergency operations revealed a brain abscess. In the younger patient drainage and the administration of antibiotics were followed by fatal brain oedema. In the eldest drainage and the administration of antibiotics were followed by the extraction of infected teeth; he recovered with a slight loss of strength in the left hand. Brain abscesses are rare in the Netherlands. The diagnosis can be difficult because clinical signs and symptoms are not specific and because an underlying systemic infection is often not apparent. Diffusion-weighted magnetic resonance imaging can nowadays differentiate purulent brain processes from cystic brain tumors. Early treatment (burr hole aspiration and antibiotics) is usually curative. Nevertheless, mortality continues to be almost 10% and (permanent) morbidity 45%.

Adult↗
PubMed2003

[Pain in the legs and progressive neurological deterioration: tethered cord syndrome in adults].

In four patients, women aged 58, 63 and 42 years, and a man aged 25 years, tethered cord syndrome was diagnosed. These patients suffered from progressive neurological symptoms, notably radiating pain in the legs in the first three patients, and muscle weakness and atrophy in the lower legs in the fourth patient. All four were treated surgically. Nowadays, the phrase tethered (spinal) cord is used for both occult and open closure defects of the neural tube. New neurological symptoms and signs can develop not only in childhood, but also in adults. Neurosurgical release of the tethered cord prevents further deterioration and often leads to significant subjective improvement of symptoms.

Adult↗
PubMed2003

The influence of brain tumor treatment on pathological delta activity in MEG.

The goal of the MEG study was to investigate the influence of tumor treatment on pathological delta activity (1-4 Hz). The treatment consisted of neurosurgery, and in some of the patients, additional radiotherapy. MEG and MR recordings were made both before and after the treatment in 17 patients. The signal power in the delta frequency band was determined for each recording. The malignant tumors were associated with large tumor volumes. Furthermore, both malignant tumors and tumor volume were associated with high signal powers in the delta band, indicating a correlation of delta power with the severity of the lesions. In all patients with high grade tumors, the delta power was lower after the treatment. The sources underlying the delta signals were estimated with an automatic single dipole analysis method. Estimated sources were projected onto MR scans. Preoperatively 14 clusters of equivalent sources describing focal activity were found in 12 out of 17 patients. Thirteen of these clusters were located near the tumor, and one cluster near an edema border. The locations near tumors are plausible and suggest that in general the source estimation was reliable. After the operation, 13 such clusters were found in 12 patients. Eleven clusters were located near the lesion border and one cluster near the edema border. Furthermore a cluster contralateral to the lesion in the other hemisphere indicated that brain lesions can affect the functioning of more distant brain areas than just the peritumoral brain tissue. Of the 12 patients who had preoperatively peritumoral clusters, 11 patients had postoperatively perilesional sources. In these cases the shift in source locations was in general considerably smaller than the dimension of the preoperative tumors. This finding indicates that similar areas generate the pre- and postoperative delta activity. Furthermore, focal delta sources were found in a case without tumor recurrence, and also in cases that most tumor tissue was removed. These findings suggest that the pathology underlying the slow waves is not the presence of the tumor bulk but the structural damage done by the tumors on the surrounding white/gray matter.

Adult↗