Scientific assessment of Neurosurgical Intervention in Neurosurgical Treatment Strategies

The research within our LUMC departments is conducted within departmental research programmes. The research programme below is embedded within the department of Neurosurgery.

Research in the Neurosurgical department of the Leiden University Medical centre is focussing on efficacy of care on 4 themes: Spine, Nerve, Trauma and Skull base surgery.

The common denominator in these themes is the research into efficacy of neurosurgical care. The principal investigator of the ‘spine’ theme is dr. Vleggeert-Lankamp, who is supervising 11 PhD candidates, that all have their own research line in neurosurgical efficacy of care. The principal investigator of the ‘nerve’ theme is Prof. dr. Malessy, supervising 2 PhD students, the principal investigator of the ‘trauma’ theme is Prof. dr. W. C. Peul, who is supervising 3 PhD students, and the principal investigator of the ‘skull base’ theme is dr. van Furth, who is supervising 4 PhD students.

Aim and focus

Degenerative, dysontogenic, traumatic and tumourous disorders of the spine may or may not benefit from surgical intervention. Decision making depends on a.o. natural course, surgical risks and costs versus health-related quality of life. The outcome of randomized controlled trials or otherwise case control studies will set standards and subsequently guidelines. The aim of the spine oriented studies mainly focuses on providing insight in the efficacy and efficiency of spine surgical interventions.

Although surgical nerve repair appears to be a straight forward procedure its functional results are poor, particularly in more complex cases. The LUMC is the national referral centre for major nerve lesions. The objective of our research is to clinically improve selection for surgery, surgical procedures, and basic-translationally study improve  the nerve regenerative process.

Traumatic brain injury is one of the major causes of death among people under the age of 45 and out of hospitalized traumatic brain injury survivors more than half experience long-term disability due to physical, cognitive or psychological deficits. The gravity of the condition stands in sharp contrast to the scientific evidence on the most optimal care strategies in TBI. The aim of our research group is to describe these care strategies, comparing these thereupon and subsequently enabling fast identification of the most effective interventions. 

Our reasearch of skull base surgery follows a paradigm shift: from surgery centred to patient centred. Our studies focus on patient outcome measurement and optimizing treatment strategies for a wider range of skull base patients; pituitary tumour, meningioma, vestibular schwannoma and chordoma. 

Position in international context

The position of the spine research at the Neurosurgical department of the LUMC is leading in Europe and a group to reckon with globally. Members of our group are frequently invited as speaker on international spine congresses or asked as faculty in international spine courses. Currently, two European observational cohort and database studies (INNOVATE and chordoma database) are performed that are carried out in cooperation with several well-known, high volume spine surgery centers in Europe. 

  • Dr Vleggeert-Lankamp is a board member of the Cervical Spine Research Society Europe (secretary), an active member of ISSLS, Eurospine and EANS, and participating in their annual meetings and program committees. She is a frequent moderator and guest tutor on international spine meetings.
  • Prof Malessy is globally an important player in nerve regeneration research. He is frequently asked as a moderator and faculty member for international congresses and courses. He is the president of the Americal Association of Hand Surgery.
  • Prof Peul initiated, as a management team member, the cohort study Center-TBI, funded by a FP7 grant from the European union. In this project, our group works in close collaboration with the major European neurotrauma units of the University of Cambridge, Karolinska and of the University of Antwerp. In 2016, the World Congress of the International Brain Injury Foundation took place in the Hague and was hosted by prof. Peul as congress president.
  • Dr van Furth is globally a key player in the field of endoscopic skull base surgery. He is course director of the yearly Skull Base Masterclass and Symposium in Leiden and is regularly asked as faculty for other endoscopic skull base courses. Currently, multiple international collaboration are established with centers in Europe and the USA to develop PROMs and assess outcomes of skull base pathologies and specifically outcomes of endoscopic surgery.

Content / highlights / achievements

  • It was shown that MRI disc anatomy does not correlate to clinical condition after herniated disc surgery.
  • Clinical and economic evaluation of interspinous spacers in lumbar spinal stenosis revealed that these devices should not be used anymore for neurogenic claudication.
  • Cauda equine syndrome outcome parameters do insufficiently contain sexuality related parameters, and both care givers and patients feel the need to improve communication on this topic.
  • Human nerve segments can be genetically modified with an AAV2 vector
  • Severe obstetric brachial plexus palsies can be identified at one month of age.
  • Wide practice variation exists in the neurosurgical management of TBI within an otherwise homogeneous setting.
  • An aggressive treatment strategy favoring early emergency evacuation of the hematoma in patients with traumatic acute subdural hematoma is associated with a favorable outcome in comparison with a conservative strategy.

Future themes

  • Future perspectives in spine research include publication of results of now closed inclusion periods for multicentre RCTs on comparison of cervical disectomy, interbody fusion and artificial disc, and on Gill’s procedure versus spondylodesis; the continuation of  national observational cohort studies assessing timing of cervical discectomy; the commencement of a study on the role of arthrosis in spine disease; continuation of European observational cohort studies on the conservative versus surgical treatment of odontoid fracture, the length of cervical posterior spondylodesis, and the gains of a European database on chordoma; and the assessment of functional gain versus costs of complex nerve surgeries.
  • In nerve studies, focus is currently on outcome measurements in obstetric brachial plexus lesions (OBPL)  in which patient reported outcome measures will be evaluated, and in which implementation of PROM evaluation will be executed. Besides that, sensibility in OBPL will be further investigated and research on adult brachial plexus will be continued.
  • In the nearby future our neurotrauma research group will focus on analysing the Center-TBI data on surgical questions, extending our national neurotrauma cohort study Net-QuRe to more Dutch centers, finalising our randomised trial on surgery for chronic subdural hematoma and starting a case control study on the role of haemostasis in hematoma progression. 
  • For pituitary tumours randomized controlled trials will be conducted to assess the (cost-) effectiveness of surgery and medical therapy with the focus on preserving quality of life. When RCTs are (ethically) not possible, cohort studies will be conducted to compare different treatment strategies for pituitary and meningioma tumours using new sophisticated epidemiological designs and models. Multiple Value Based Healthcare projects are currently ongoing, focusing on: development of a new meningioma-specific PROM, comprehensive measurement of surgical outcomes of pituitary, meningioma and chordoma surgery, and shortening hospitalization length after endoscopic pituitary surgery. Newly developed PET/CT techniques for visualization of functioning pituitary tumors will be evaluated.   

Cohesion within LUMC

Departments of Orthopedic Surgery, Pathology (Neuro-pathology), Neurology (Clinical Neurophysiology), Molecular Genetics, Urology, Department of Endocrinology (skull-base), Department of Surgery/Traumatology (trauma), Department of Ophthalmology, Department of Medical Decision Making, Statistics and Epidemiology.