BACKGROUND: Symptomatic chronic subdural hematoma (scSDH) is one of the most frequent diseases in neurosurgical practice, and its incidence is increasing. However, treatment modalities are still controversial. OBJECT: The aim of this retrospective single-center study is to compare for the first time two surgical methods in the treatment of subdural hematoma that have been proven to be efficient in previous studies in a direct comparison. METHODS: We analyzed the data of 143 scSDHs in 113 patients undergoing surgery for subdural hematoma with placement of subperiostal or subdural drainage after double burr-hole trepanation for hematoma evacuation. RESULTS: Overall, there were no statistically significant differences regarding general patient characteristics, preoperative and postoperative symptoms, postoperative hematoma remnant, rates of recurrences, mortality, complications, and outcome at discharge and at 3-month follow up between the groups. There was a close to significant tendency of lower mortality after placement of subperiostal drainage system and a tendency towards lower rate of recurrent hematoma after placement of subdural drainage system. CONCLUSIONS: Our study shows for the first time a direct comparison of two mainly used surgical techniques in the treatment of scSDH. Both methods proved to be highly effective, and general patient data, complications, outcome and mortality of both groups are equal or superior compared with previously published series. Because there is a clear tendency to less mortality and fewer serious complications, treatment with double burrhole trepanation, irrigation, and placement of subperiostal drainage is our treatment of choice in patients with predictable high risk of complications.

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Placement of external ventricular drainage (EVD) catheters is the gold standard for managing acute hydrocephalus, but the range of complications varies in different studies. The objective of this present single institute study is to analyze iatrogenic factors, which may influence the EVD device placement and the patient's outcome. A total of 137 EVD placements in 120 patients at the University Hospital Zurich were analyzed retrospectively. Discriminative findings between the pre-and postoperative imaging were obtained and evaluated in detail with regards to the postoperative course, ventriculostomyrelated infection, and acute neurological deterioration directly related to the EVD placement. These findings were correlated to iatrogenic factors including education level of the neurosurgeon and surgical setting. Overall EVD-related complication rate was 16.1%, including infection rate of 10.2%, catheter malplacement rate of 2.2%, and hemorrhage rate of 3.6%. Although not statistically significant, catheter-associated hemorrhages and malplacements were found mostly in primary EVD surgery, with a higher complication rate associated with junior residents as the performing surgeon. In contrast, ventriculostomy-related infection was most likely present in patients with more than one EVD placement and in patients treated by more experienced physicians. Complications related to EVD are common. The rate and character of the complication depends on the education level of the surgeon.

BACKGROUND Treatment options for patients with glioblastoma at progression have remained controversial and selection criteria for the appropriate type of intervention remain poorly defined. The objectives were to determine which factors favor the decision for second surgery and which factors are associated with overall survival (OS) and to evaluate the NIH recurrent glioblastoma scale. The scale includes tumor involvement of eloquent brain regions, functional status and tumor volume. METHODS A retrospective single center analysis of patients with newly diagnosed glioblastoma undergoing initial surgery between January 2007 and December 2011 was performed. Patients were separated into two groups: those with vs. those without second resection surgery at disease progression. OS was compared using the multiple logistic regression model, Cox proportional hazard regression, and Kaplan-Meier survival analysis. RESULTS The data of 98 patients was statistically analyzed. 58 patients had initial surgery only (age 61.27y; mOS 14.81 months), 40 patients underwent second surgery at disease progression (age 55y; mOS 18.86 months). Age was the only predictor for repeated surgery (P 0.012; odds ratio 0.94. At the time of tumor progression, administration of alkylating chemotherapy (P 0.004; HR 0.24) or bevacizumab (P 0.001; HR 0.23) was associated with longer OS. Reoperation was associated with a lower hazard ratio (P 0.134; HR 0.66). The NIH recurrent glioblastoma scale showed statistically significant improvement of prognosis prediction with the addition of age. CONCLUSIONS Surgery of progressive glioblastoma and postoperative treatment at the time of progression is associated with improved OS in some patients. The addition of age may improve survival prediction of the NIH recurrent glioblastoma scale. The authors have no personal or financial or institutional interest in any drugs, materials, or devices described in this article.Abbreviations: CCNU = lomustine; GTR = gross-total resection; HR = hazard ratio; KPS = Karnofsky performance status; MRI = magnet resonance imaging; NIH = national institute of health; OR = odds ratio; OS = overall survival; RT = radiotherapy; STR = subtotal resection; TMZ = temozolomide.[1]Abstract Background: Treatment options for patients with glioblastoma at progression have remained

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Biomarkers may help predict the efficacy of neoadjuvant chemoradiation in patients with rectal cancer. We hypothesized that the expression of topoisomerase I (Topo I) and thymidylate synthase (TS) may help predict the treatment response in patients undergoing irinotecan and capecitabine-based chemoradiation. Patients with rectal cancer (cT3/4Nx or Tx/N+) received neoadjuvant chemoradiotherapy within clinical studies with irinotecan and capecitabine. Samples of normal and tumour tissues were collected before the start of the treatment and during surgical resection. Topo I and TS were measured using real-time PCR. The results of gene expression levels were compared between responders (defined as ypT0-2 ypN0) and nonresponders (ypT3-4 or ypN1/2). A total of 38 patients were analysed, 18 of them were responders. The biopsies of the untreated tumour tissue of responding patients showed a significant higher expression of Topo I compared with nonresponding patients (P = 0.015). Normal tissue did not show this difference (P = 0.126). During chemoradiation, the Topo I expression in tumour tissue of responders decreased significantly. TS did not show any differences between responders and nonresponders before treatment, but a significant decrease in the tumour tissue of responders was noted at the end of the treatment. Our data suggest that Topo I expression in rectal tumour mucosa might serve as a predictor of response to the neoadjuvant irinotecan-based chemoradiation, and hence might be a factor contributing to the development of individualized treatment.