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Tethered cord

W. Peter Vandertop

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Surgery in adults with tethered cord syndrome: outcome study with independent clinical review

Redmer van Leeuwen, Nicolette C. Notermans, and W. Peter Vandertop

Object. The authors conducted a study to evaluate the risks and short-term benefits of surgical treatment for tethered cord syndrome (TCS) in patients older than 18 years of age.

Methods. The authors studied a series of 57 consecutive adult patients with TCS of varying origins. Patients were examined by the same neurologist in a standardized fashion before and after surgery, and most were followed for at least 2 years postoperatively.

Patient age ranged from 19 to 75 years. The mean age at onset of symptoms and diagnosis was 30 years and 37 years, respectively. Muscle strength improved (15 cases) or showed no change postoperatively (38 cases) in a large majority of patients (93%). In four patients a minor decrease in muscle strength was demonstrated, and there was significant deterioration in two (3.5%). In the two latter patients, a rapid decline in motor function was present preoperatively. Subjective assessment of pain, gait, sensory function, and bladder/bowel function at 4 weeks, 6 months, and 2 years postsurgery revealed improvement in a substantial percentage of patients. No major surgery-related complications occurred.

Conclusions. This is the largest series to date in which adult patients with TCS comprise the report. Untethering procedures in these patients were safe and effective, at least in the short term. Patients with rapid loss of motor function, lipomyelomeningocele, or split cord malformation seem to be at a higher risk of postsurgery deterioration. A follow-up period of many more years will be necessary to determine whether aggressive surgery is beneficial in the long term.

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Third Ventriculostomy

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Neuronavigation in Solitary Intracerebral Tumors

W. Peter Vandertop

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Magnetic resonance imaging–based synthetic computed tomography of the lumbar spine for surgical planning: a clinical proof-of-concept

Victor E. Staartjes, Peter R. Seevinck, W. Peter Vandertop, Marijn van Stralen, and Marc L. Schröder


Computed tomography scanning of the lumbar spine incurs a radiation dose ranging from 3.5 mSv to 19.5 mSv as well as relevant costs and is commonly necessary for spinal neuronavigation. Mitigation of the need for treatment-planning CT scans in the presence of MRI facilitated by MRI-based synthetic CT (sCT) would revolutionize navigated lumbar spine surgery. The authors aim to demonstrate, as a proof of concept, the capability of deep learning–based generation of sCT scans from MRI of the lumbar spine in 3 cases and to evaluate the potential of sCT for surgical planning.


Synthetic CT reconstructions were made using a prototype version of the “BoneMRI” software. This deep learning–based image synthesis method relies on a convolutional neural network trained on paired MRI-CT data. A specific but generally available 4-minute 3D radiofrequency-spoiled T1-weighted multiple gradient echo MRI sequence was supplemented to a 1.5T lumbar spine MRI acquisition protocol.


In the 3 presented cases, the prototype sCT method allowed voxel-wise radiodensity estimation from MRI, resulting in qualitatively adequate CT images of the lumbar spine based on visual inspection. Normal as well as pathological structures were reliably visualized. In the first case, in which a spiral CT scan was available as a control, a volume CT dose index (CTDIvol) of 12.9 mGy could thus have been avoided. Pedicle screw trajectories and screw thickness were estimable based on sCT findings.


The evaluated prototype BoneMRI method enables generation of sCT scans from MRI images with only minor changes in the acquisition protocol, with a potential to reduce workflow complexity, radiation exposure, and costs. The quality of the generated CT scans was adequate based on visual inspection and could potentially be used for surgical planning, intraoperative neuronavigation, or for diagnostic purposes in an adjunctive manner.

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Open-wound treatment for gunshot to the brain

Case report

Pepijn van den Munckhof, Vincent G. Geukers, Fonnet E. Bleeker, Celia E. Allison, and W. Peter Vandertop

The authors report a case of a gunshot wound to the brain in a 2.5-year-old girl. To treat the uncontrollably elevated intracranial pressure, the patient underwent bilateral decompressive craniectomy and experimental open-wound treatment. She recovered to a good functional level.

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Letter to the Editor: Volume management after subarachnoid hemorrhage

René Post, Bert A. Coert, Dagmar Verbaan, and W. Peter Vandertop

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Letter to the Editor: Short-term ε-aminocaproic acid treatment and endovascular coil embolization

René Post, Bert A. Coert, W. Peter Vandertop, Dagmar Verbaan, and Menno R. Germans

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Letter to the Editor. Ultra-early aneurysm treatment

René Post, Jantien Hoogmoed, Dagmar Verbaan, and W. Peter Vandertop

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High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle

Philip C. de Witt Hamer, Marco J. T. Verstegen, Rob J. De Haan, W. Peter Vandertop, Ralph T. W. M. Thomeer, Jan J. A. Mooij, and Wouter R. van Furth

Object. Patients harboring colloid cysts of the third ventricle can present with acute neurological deterioration, or the first indication of the lesion may appear when the patient suddenly dies. The risk of such an occurrence in a patient already identified as harboring a colloid cyst is unknown. The goal of this study was to estimate the risk of acute deterioration in patients with colloid cysts.

Methods. A retrospective study was made of a cohort of patients with newly diagnosed colloid cysts who were recruited in The Netherlands between January 1, 1993, and December 31, 1997. Seventy-eight patients were identified, all of whom displayed symptoms. Twenty-five patients (32%) presented with symptoms of acute deterioration; four patients died suddenly and the cysts were discovered at autopsy. The overall mortality rate was 12%. Results of a multivariate logistic regression analysis demonstrated that no subgroup of patients presenting without acute deterioration could be identified on the basis of patient age, duration of symptoms, cyst size, or the presence of hydrocephalus. The national incidence of colloid cysts in The Netherlands is 1/106 person-years; the prevalence was estimated to be 1800 asymptomatic colloid cysts.

Conclusions. Acute deterioration was a frequent presentation among a national cohort of Dutch patients harboring symptomatic colloid cysts. The risk of acute deterioration in a symptomatic patient with a colloid cyst in The Netherlands is estimated to be 34%. The estimated risk for an asymptomatic patient with an incidental colloid cyst is significantly lower. These results strongly advocate the selection of surgical treatment for patients with symptomatic colloid cysts.