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Rostami, Elham
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Publications (10 of 21) Show all publications
Engquist, H., Lewén, A., Hillered, L., Ronne-Engström, E., Nilsson, P., Enblad, P. & Rostami, E. (2020). CBF changes and cerebral energy metabolism during hypervolemia, hemodilution, and hypertension therapy in patients with poor-grade subarachnoid hemorrhage. Journal of Neurosurgery
Open this publication in new window or tab >>CBF changes and cerebral energy metabolism during hypervolemia, hemodilution, and hypertension therapy in patients with poor-grade subarachnoid hemorrhage
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2020 (English)In: Journal of Neurosurgery, ISSN 0022-3085Article in journal (Refereed) Published
Keywords
subarachnoid hemorrhage, cerebral blood flow, delayed cerebral ischemia, xenon CT, XeCT
National Category
Clinical Medicine
Research subject
Neurosurgery
Identifiers
urn:nbn:se:uu:diva-400694 (URN)10.3171/2019.11.JNS192759 (DOI)
Note

The Journal of Neurosurgery, publ online Jan 10, 2020 (accepted for publ Nov 5, 2019)

Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2020-02-05Bibliographically approved
Elf, K., Ronne-Engström, E., Semnic, R., Rostami-Berglund, E., Sundblom, J. & Zetterling, M. (2019). Continuous EEG monitoring after brain tumor surgery. Acta Neurochirurgica, 161(9), 1835-1843
Open this publication in new window or tab >>Continuous EEG monitoring after brain tumor surgery
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2019 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 161, no 9, p. 1835-1843Article in journal (Refereed) Published
Abstract [en]

Background

Prolonged seizures generate cerebral hypoxia and increased intracranial pressure, resulting in an increased risk of neurological deterioration, increased long-term morbidity, and shorter survival. Seizures should be recognized early and treated promptly.

The aim of the study was to investigate the occurrence of postoperative seizures in patients undergoing craniotomy for primary brain tumors and to determine if non-convulsive seizures could explain some of the postoperative neurological deterioration that may occur after surgery.

Methods

A single-center prospective study of 100 patients with suspected glioma. Participants were studied with EEG and video recording for at least 24 h after surgery.

Results

Seven patients (7%) displayed seizure activity on EEG recording within 24 h after surgery and another two patients (2%) developed late seizures. One of the patients with early seizures also developed late seizures. In five patients (5%), there were non-convulsive seizures. Four of these patients had a combination of clinically overt and non-convulsive seizures and in one patient, all seizures were non-convulsive. The non-convulsive seizures accounted for the majority of total seizure time in those patients. Non-convulsive seizures could not explain six cases of unexpected postoperative neurological deterioration. Postoperative ischemic lesions were more common in patients with early postoperative seizures.

Conclusions

Early seizures, including non-convulsive, occurred in 7% of our patients. Within this group, non-convulsive seizure activity had longer durations than clinically overt seizures, but only 1% of patients had exclusively non-convulsive seizures. Seizures were not associated with unexpected neurological deterioration.

Keywords
Brain tumor surgery, Postoperative seizures, Non-convulsive seizures, EEG monitoring
National Category
Neurosciences Neurology Surgery
Identifiers
urn:nbn:se:uu:diva-394255 (URN)10.1007/s00701-019-03982-6 (DOI)000482453900014 ()31278599 (PubMedID)
Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-10-11Bibliographically approved
Svedung-Wettervik, T., Howells, T., Hillered, L., Nilsson, P., Engquist, H., Lewén, A., . . . Rostami, E. (2019). Mild hyperventilation in traumatic brain injury - relation to cerebral energy metabolism, pressure autoregulation and clinical outcome. World Neurosurgery, 133, e567-e575
Open this publication in new window or tab >>Mild hyperventilation in traumatic brain injury - relation to cerebral energy metabolism, pressure autoregulation and clinical outcome
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2019 (English)In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 133, p. e567-e575Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Hyperventilation is a controversial treatment in traumatic brain injury (TBI). Prophylactic severe hyperventilation below 3.3 kPa/25 mm Hg) is generally avoided, due to the risk of cerebral ischemia. Mild hyperventilation (arterial pCO2 within 4.0-4.5 kPa/30-34 mm Hg) in cases of intracranial hypertension is commonly used, but its safety and benefits are not fully elucidated. The aim of this study was to evaluate the use of mild hyperventilation and its relation to, cerebral energy metabolism, pressure autoregulation and clinical outcome in TBI.

METHOD: This retrospective study was based on 120 patients with severe TBI treated at the neurointensive care unit, Uppsala university hospital, Sweden, 2008-2018. Data from cerebral microdialysis (glucose, pyruvate and lactate), arterial pCO2 and pressure reactivity index (PRx55-15) were analyzed for the first three days post-injury.

RESULTS: Mild hyperventilation 4.0-4.5 kPa (30-34 mm Hg) was more frequently used early and the patients were gradually normoventilated. Low pCO2 was associated with slightly higher intracranial pressure and slightly lower cerebral perfusion pressure (p-value < 0.01). There was no univariate correlation between low pCO2 and worse cerebral energy metabolism. Multiple linear regression analysis showed that mild hyperventilation was associated with lower PRx55-15 day 2 (p-value = 0.03), suggesting better pressure autoregulation. Younger age and lower ICP were also associated with lower PRx55-15.

CONCLUSIONS: These findings support the notion that mild hyperventilation is safe and may improve cerebrovascular reactivity.

Keywords
Traumatic brain injury, cerebral energy metabolism, clinical outcome, hyperventilation, neurointensive-care, pressure reactivity
National Category
Surgery
Research subject
Neurosurgery
Identifiers
urn:nbn:se:uu:diva-395237 (URN)10.1016/j.wneu.2019.09.099 (DOI)000503993700118 ()31561041 (PubMedID)
Available from: 2019-10-15 Created: 2019-10-15 Last updated: 2020-01-22Bibliographically approved
Juratli, T. A., Jones, P. S., Wang, N., Subramanian, M., Aylwin, S. J. B., Odia, Y., . . . Brastianos, P. K. (2019). Targeted treatment of papillary craniopharyngiomas harboring BRAF V600E mutations. Cancer, 125(17), 2910-2914
Open this publication in new window or tab >>Targeted treatment of papillary craniopharyngiomas harboring BRAF V600E mutations
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2019 (English)In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 125, no 17, p. 2910-2914Article in journal, Editorial material (Other academic) Published
Abstract [en]

Papillary craniopharyngiomas (PCPs) are characterized by the presence of BRAF V600E mutations, which are emerging as a useful guide for diagnosis and treatment decision making. The ongoing multicenter phase 2 Alliance A071601 trial is evaluating the efficacy of BRAF and mitogen-activated protein kinase kinase (MEK) inhibitors for patients with PCPs. With continued successful responses, it is proposed that BRAF (and MEK) inhibitors be evaluated for the neoadjuvant treatment of patients with PCPs.

Place, publisher, year, edition, pages
WILEY, 2019
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-396181 (URN)10.1002/cncr.32197 (DOI)000476048400001 ()31314136 (PubMedID)
Available from: 2019-10-31 Created: 2019-10-31 Last updated: 2019-10-31Bibliographically approved
Engquist, H., Rostami, E. & Enblad, P. (2019). Temporal Dynamics of Cerebral Blood Flow During the Acute Course of Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT. Neurocritical Care, 30(2), 280-290
Open this publication in new window or tab >>Temporal Dynamics of Cerebral Blood Flow During the Acute Course of Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT
2019 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 30, no 2, p. 280-290Article in journal (Refereed) Published
Abstract [en]

Background: Compromised cerebral blood flow (CBF) is a crucial factor in delayed cerebral ischemia after subarachnoid hemorrhage (SAH). Repeated measurement of CBF may improve our understanding of the temporal dynamics following SAH. The aim of this study was to assess CBF at different phases of the acute course in poor-grade SAH patients, hypothesizing more pronounced disturbances at day 4-7, and that the initial level of CBF determines the following course of CBF.

Methods: Mechanically ventilated SAH patients were scheduled for bedside measurement of regional and global cortical CBF at day 0-3, 4-7, and 8-12, using xenon-enhanced computed tomography in a mobile setup. Patients were dichotomized depending on high or low initial global cortical CBF and cutoff level 30ml/100g/min.

Results: Eighty-one patients were included, and 51 had measurements at day 0-3 and 4-7. In patients with high initial CBF, the level was unchanged at day 4-7; 37.7 (IQR 32.6-46.7) ml/100g/min versus 36.8 (IQR 29.5-44.8). The low-CBF group showed a slight increase from 23.6 (IQR 21.0-28.1) ml/100g/min to 28.4 (IQR 22.7-38.3) (P=0.025), still markedly lower than the high-CBF group (P=0.016). In the low-CBF group, CBF increased in patients who received hypertension, hypervolemia, and hemodilution (HHH therapy) but remained low in standard treated patients. For the subset of 27 patients examined also at day 8-12, the differences depending on initial CBF level were no longer statistically significant. Among patients with still low CBF at day 4-7, the proportion who had poor short-term outcome was 55% compared to 35% (n.s.) for patients with high CBF.

Conclusions: CBF studied in poor-grade SAH patients at large did not show any statistically significant changes over time. Stratifying patients by high or low initial CBF and whether HHH therapy was given revealed an association between low initial CBF and persistent low CBF at day 4-7. These findings may be of clinical relevance in managing SAH patients with low early CBF.

Place, publisher, year, edition, pages
HUMANA PRESS INC, 2019
Keywords
Subarachnoid hemorrhage, Delayed cerebral ischemia, Cerebral blood flow, Xenon-CT, XeCT, Temporal, Sequential
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-380427 (URN)10.1007/s12028-019-00675-x (DOI)000461380900008 ()30790226 (PubMedID)
Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2020-01-10Bibliographically approved
Rostami, E., Engquist, H., Howells, T., Johnson, U., Ronne-Engström, E., Nilsson, P., . . . Enblad, P. (2018). Early low cerebral blood flow and high cerebral lactate: prediction of delayed cerebral ischemia in subarachnoid hemorrhage. Journal of Neurosurgery, 128(6), 1762-1770
Open this publication in new window or tab >>Early low cerebral blood flow and high cerebral lactate: prediction of delayed cerebral ischemia in subarachnoid hemorrhage
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2018 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 128, no 6, p. 1762-1770Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE Delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is one of the major contributors to poor outcome. It is crucial to be able to detect early signs of DCI to prevent its occurrence. The objective of this study was to determine if low cerebral blood flow (CBF) measurements and pathological microdialysis parameters measured at the bedside can be observed early in patients with SAH who later developed DCI. METHODS The authors included 30 patients with severe SAH. The CBF measurements were performed at Day 0-3 after disease onset, using bedside xenon-CT. Interstitial glucose, lactate, pyruvate, glycerol, and glutamate were measured using microdialysis. RESULTS Nine of 30 patients developed DCI. Patients with DCI showed significantly lower global and regional CBF, and lactate was significantly increased in these patients. A high lactate/pyruvate ratio was also detected in patients with DCI. CONCLUSIONS Early low CBF measurements and a high lactate and lactate/pyruvate ratio may be early warning signs of the risk of developing DCI. The clinical value of these findings needs to be confirmed in larger studies.

Keywords
CBF, CBF = cerebral blood flow, CPP = cerebral perfusion pressure, DCI, DCI = delayed cerebral ischemia, GCS, GCS-M = Glasgow Coma Scale, GCS-motor, GOSE = Glasgow Outcome Scale–Extended, ICP = intracranial pressure, L/P = lactate/pyruvate, MD = microdialysis, NIC = neurointensive care, ROI = region of interest, SAH, SAH = subarachnoid hemorrhage, Xe-CT = xenon-CT, cerebral blood flow, delayed cerebral ischemia, lactate, lactate/pyruvate ratio, subarachnoid hemorrhage, vascular disorders, vasospasm, xenon-CT
National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-330940 (URN)10.3171/2016.11.JNS161140 (DOI)000440653000023 ()28574309 (PubMedID)
Available from: 2017-10-07 Created: 2017-10-07 Last updated: 2018-10-12Bibliographically approved
Engquist, H., Rostami, E., Ronne-Engström, E., Nilsson, P., Lewén, A. & Enblad, P. (2018). Effect of HHH-Therapy on Regional CBF after Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT. Neurocritical Care, 28(2), 143-151
Open this publication in new window or tab >>Effect of HHH-Therapy on Regional CBF after Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT
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2018 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 28, no 2, p. 143-151Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Management of delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is difficult and still carries controversies. In this study, the effect of therapeutic hypervolemia, hemodilution, and hypertension (HHH-therapy) on cerebral blood flow (CBF) was assessed by xenon-enhanced computerized tomography (XeCT) hypothesizing an increase in CBF in poorly perfused regions.

METHODS:

Bedside XeCT measurements of regional CBF in mechanically ventilated SAH patients were routinely scheduled for day 0-3, 4-7, and 8-12. At clinical suspicion of DCI, patients received 5-day HHH-therapy. For inclusion, XeCT was required at 0-48 h before start of HHH (baseline) and during therapy. Data from corresponding time-windows were also collected for non-DCI patients.

RESULTS:

Twenty patients who later developed DCI were included, and twenty-eight patients without DCI were identified for comparison. During HHH, there was a slight nonsignificant increase in systolic blood pressure (SBP) and a significant reduction in hematocrit. Median global cortical CBF for the DCI group increased from 29.5 (IQR 24.6-33.9) to 38.4 (IQR 27.0-41.2) ml/100 g/min (P = 0.001). There was a concomitant increase in regional CBF of the worst vascular territories, and the proportion of area with blood flow below 20 ml/100 g/min was significantly reduced. Non-DCI patients showed higher CBF at baseline, and no significant change over time.

CONCLUSIONS:

HHH-therapy appeared to increase global and regional CBF in DCI patients. The increase in SBP was small, while the decrease in hematocrit was more pronounced, which may suggest that intravascular volume status and rheological effects are of importance. XeCT may be potentially helpful in managing poor-grade SAH patients.

Keywords
Cerebral blood flow (CBF), Delayed cerebral ischemia (DCI), HHH-therapy (Triple-H), Subarachnoid hemorrhage (SAH), Xenon CT (XeCT)
National Category
Anesthesiology and Intensive Care Neurosciences
Identifiers
urn:nbn:se:uu:diva-330938 (URN)10.1007/s12028-017-0439-y (DOI)000431994700001 ()28983856 (PubMedID)
Available from: 2017-10-07 Created: 2017-10-07 Last updated: 2020-01-10Bibliographically approved
Engquist, H., Lewén, A., Howells, T., Johnson, U., Ronne-Engström, E., Nilsson, P., . . . Rostami, E. (2018). Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT.. Journal of Neurosurgical Anesthesiology, 30(1), 49-58
Open this publication in new window or tab >>Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT.
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2018 (English)In: Journal of Neurosurgical Anesthesiology, ISSN 0898-4921, E-ISSN 1537-1921, Vol. 30, no 1, p. 49-58Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome.

MATERIALS AND METHODS: Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enrolled in the study. Bedside XeCT was performed within day 0 to 3.

RESULTS: Data from 64 patients were obtained. Median global CBF was 34.9 mL/100 g/min (interquartile range [IQR], 26.7 to 41.6). There was a difference in CBF related to age with higher global CBF in the younger patients (30 to 49 y). CBF was also related to the severity of SAH with lower CBF in Fisher grade 4 compared with grade 3. rCBF disturbances and hypoperfusion were common; in 43 of the 64 patients rCBF<20 mL/100 g/min was detected in more than 10% of the region-of-interest (ROI) area and in 17 patients such low-flow area exceeded 30%. rCBF was not related to the localization of the aneurysm; there was no difference in rCBF of ipsilateral compared with contralateral vascular territories. In patients who initially were in Hunt & Hess grade I to III, median global CBF day 0 to 3 was significantly lower for patients who were in poor neurological state at discharge compared with patients in good neurological state, 25.5 mL/100 g/min (IQR, 21.3 to 28.3) versus 37.8 mL/100 g/min (IQR, 30.5 to 47.6).

CONCLUSIONS: CBF disturbances are common in the early phase after SAH. In many patients, CBF was heterogenic and substantial areas with low rCBF were detected. Age and CT Fisher grade were factors influencing global cortical CBF. Bedside XeCT may be a tool to identify patients at risk of deteriorating so they can receive intensified management, but this needs further exploration.

National Category
Anesthesiology and Intensive Care Neurosciences
Identifiers
urn:nbn:se:uu:diva-312080 (URN)10.1097/ANA.0000000000000395 (DOI)000428161600009 ()27906765 (PubMedID)
Available from: 2017-01-04 Created: 2017-01-04 Last updated: 2020-01-10Bibliographically approved
Johnson, U., Engquist, H., Lewén, A., Howells, T., Nilsson, P., Ronne-Engström, E., . . . Enblad, P. (2017). Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP. Acta Neurochirurgica, 159(6), 1065-1071
Open this publication in new window or tab >>Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP
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2017 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 159, no 6, p. 1065-1071Article in journal (Refereed) Published
Abstract [en]

Background Cerebral pressure autoregulation can be quantified with the pressure reactivity index (PRx), based on the correlation between blood pressure and intracranial pressure. Using PRx optimal cerebral perfusion pressure (CPPopt) can be calculated, i.e., the level of CPP where autoregulation functions best. The relation between cerebral blood flow (CBF) and CPPopt has not been examined. The objective was to assess to which extent CPPopt can be calculated in SAH patients and to investigate CPPopt in relation to CBF.

Methods Retrospective study of prospectively collected data. CBF was measured bedside with Xenon-enhanced CT (Xe-CT). The difference between actual CPP and CPPopt was calculated (CPPa dagger). Correlations between CPPa dagger and CBF parameters were calculated with Spearman's rank order correlation coefficient (rho). Separate calculations were done using all patients (day 0-14 after onset) as well as in two subgroups (day 0-3 and day 4-14).

Results Eighty-two patients with 145 Xe-CT scans were studied. Automated calculation of CPPopt was possible in adjunct to 60% of the Xe-CT scans. Actual CPP < CPPopt was associated with higher numbers of low-flow regions (CBF < 10 ml/100 g/min) in both the early phase (day 0-3, n = 39, Spearman's rho = -0.38, p = 0.02) and late acute phase of the disease (day 4-14, n = 35, Spearman's rho = -0.39, p = 0.02). CPP level per se was not associated with CBF.

Conclusions Calculation of CPPopt is possible in a majority of patients with severe SAH. Actual CPP below CPPopt is associated with low CBF.

Keywords
cerebral blood flow, autoregulation, CPP, subarachnoid haemorrhage
National Category
Clinical Medicine
Research subject
Neurosurgery
Identifiers
urn:nbn:se:uu:diva-294191 (URN)10.1007/s00701-017-3139-7 (DOI)000401117700016 ()28361248 (PubMedID)
Available from: 2016-09-21 Created: 2016-05-18 Last updated: 2017-06-13Bibliographically approved
Rostami, E., Nyström, P. W., Libard, S., Wikström, J., Casar Borota, O. & Gudjonsson, O. (2017). Recurrent papillary craniopharyngioma with BRAFV600E mutation treated with neoadjuvant-targeted therapy.. Acta Neurochirurgica, 159(11), 2217-2221
Open this publication in new window or tab >>Recurrent papillary craniopharyngioma with BRAFV600E mutation treated with neoadjuvant-targeted therapy.
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2017 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 159, no 11, p. 2217-2221Article in journal (Refereed) Published
Abstract [en]

Craniopharyngiomas are histologically benign but locally aggressive tumors in the sellar region that may cause devastating neurological and endocrine deficits. They tend to recur following surgery with high morbidity; hence, postoperative radiotherapy is recommended following sub-total resection. BRAFV600E mutation is the principal oncogenic driver in the papillary variant of craniopharyngiomas. Recently, a dramatic tumor reduction has been reported in a patient with BRAFV600E mutated, multiply recurrent papillary craniopharyngioma using a combination therapy of BRAF inhibitor dabrafenib and MEK inhibitor trametinib. Here, we report on near-radical reduction of a growing residual BRAFV600E craniopharyngioma using the same neoadjuvant therapy.

Keywords
BRAFV600E, Craniopharyngioma, RAF-inhibitor
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333691 (URN)10.1007/s00701-017-3311-0 (DOI)000412754600027 ()28918496 (PubMedID)
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2018-01-08Bibliographically approved
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