Neurosurgical research is crucial to further improving the safety and precision of operations on the brain and spinal cord. Thanks to the latest technologies, we can now visualize vital structures in the brain during surgery, making even the most complex procedures safer. Our continuous research and development enables us to further refine surgical techniques and optimize treatment approaches in order to achieve the best therapy for our patients. Our neurosurgery projects and studies at the Inselspital Bern play a central role in this.
HORAO ‒ successful research thanks to crowdfunding
A major challenge in neuro-oncological surgery is the intraoperative identification of fiber tracts and the differentiation between tumorous and healthy tissue. In search of an innovative approach to overcome this challenge, neurosurgeons at Inselspital launched the HORAO project.
It started with a crowdfunding challenge to generate financial resources and a subsequent crowdsourcing challenge which resulted in a research collaboration with the winning research team from Ecole Polytechnique in Paris in 2019. In 2021, the HORAO research project won a 4-year Sinergia grant for groundbreaking projects from the Swiss National Science Foundation (SNSF).
After a promising initial series of near-in-vivo measurements at the Department of Neurosurgery of the University of Bern, the HORAO research team has grown and continues with enhanced expertise, now re-enforced with a machine-learning sub-group.
Project leader: Prof. Dr. Philippe Schucht, MD
Project manager: David Hasler
Peers for Peers
Information = relevance
The "Peers for Peers" platform was founded by medical professionals to help doctors and researchers find the really important articles from the plethora of current publications – new findings that could already flow into the treatment of patients, but are usually found only later in textbooks. Peers for Peers offers the easiest and fastest route to new therapies in neurosurgery. The platform starts as an initiative of the European Association of Neurosurgical Societies (EANS) initially in the vascular area.
Project leader: Prof. Dr. Andreas Raabe, MD
Project manager: Luisa Tonarelli
CCCV study
The effect of increasing transcranial electric stimulation current or pulse duration on intraoperative patient movement and motor evoked potential amplitude
In this study, a medical product, the IOM device (IOM = intraoperative neuromonitoring) is used, which is certified for this use and has been used successfully for several years. In the study, we compare the effects of different stimulation parameters. Specifically, different combinations of current strength and pulse duration are tested to find out which of them causes the patient to move minimally and thus affects the surgeon the least. During an operation on the brain, it is important to act with millimeter precision and thus any unnecessary movement of the patient should be avoided.
| Head of study: | Prof. Dr. Kathleen Seidel, MD |
| Study coordinator: | Dr. Jonathan Wermelinger |
| Study identifier: | NCT05375669 |
RESDEX study
Restrictive use of dexamethasone in glioblastoma
This study investigates whether neurosurgical treatment of brain tumors in certain patients can be performed without the additional administration of dexamethasone (cortisone), or only with a minimal dose of dexamethasone.
| Head of study: | Prof. Dr. Andreas Raabe, MD |
| Study coordinator: | Nicole Söll |
| Study identifier: | NCT04266977 |
ReSurge study
Randomized Controlled Comparative Phase II Trial on Surgery for Glioblastoma Recurrence
To date, there are two established strategies for treating a recurrent brain tumor:
- Re-surgery of the brain tumor followed by second-line therapy (chemotherapy or radiotherapy).
- Immediate second-line therapy (chemotherapy or radiotherapy) without prior surgery.
Which of the two treatment strategies has the greater success has not yet been clarified. The aim of this study is to investigate exactly this. It is to be clarified which of the two treatment strategies has the greater success.
| Head of study: | Prof. Dr. Philippe Schucht, MD |
| Study coordinator: | David Hasler |
| Study identifier: | NCT02394626 |
SONOBIRD study
A randomized, unblinded, multicenter, two-arm pivotal study of SonoCloud-9 combined with carboplatin versus standard lomustine or temozolomide in patients undergoing planned resection for first recurrence of glioblastoma
The standard treatment for a recurrent brain tumor usually consists of surgery and chemotherapy – for example with lomustine or temozolomide. The aim is to inhibit tumor growth. However, there is a natural barrier in the brain, the so-called blood-brain barrier (BBB): it prevents drugs that are transported via the bloodstream from reaching the brain tissue. If this barrier is made more permeable, chemotherapeutic drugs administered via a vein in the arm (as an intravenous infusion) can reach the brain tumor more easily.
This study uses an implantable medical device called SC9. When activated, this device emits ultrasound waves that increase the permeability of the blood-brain barrier when small bubbles (contrast agent) are simultaneously introduced into a vein. Several studies in animals and recent clinical trials with almost 70 patients in France and the USA have shown that the use of this device allows the opening of the blood-brain barrier and facilitates the introduction of chemotherapeutic drugs into the brain.
With the help of the study, we now want to find out what influence the SonoCloud 9 (SC9) therapy procedure in combination with carboplatin has on life expectancy and tumor growth in patients with recurrent glioblastoma.
| Head of study: | Prof. Dr. Philippe Schucht, MD |
| Study coordinator: | David Hasler |
| Study identifier: | NCT05902169 |
TRANSEKT study
Comparison between transcranial and direct cortical stimulation of motor evoked potentials during the resection of supratentorial brain tumors in terms of prognostic accuracy for postoperative motor deficits
During operations on tumors within the skull, which are located in an area of the brain which, among other things, controls the movement of certain parts of the body (hand, arm, leg or foot), it is necessary to monitor the movement functions during the operation in order to remove the tumor as much as possible without impairing the movement function.
The aim of this study is to compare two methods of motor function monitoring: transcranial stimulation and direct cortical stimulation. The transcranial stimulation is carried out by electrodes that are fixed at certain points on the scalp. The direct cortical stimulation is carried out by strip electrodes, which are pushed under the meninges after opening the skull and come to rest directly on the brain surface.
| Head of study: | Prof. Dr. Kathleen Seidel, MD |
| Study coordinator: Backup: | Dr. Jonathan Wermelinger Nicole Söll |
| Study identifier: | DRKS00023256 |
VANCO study
Suprafascial vancomycin powder for prevention of surgical site infections after instrumented posterior spinal fusion: A randomized controlled phase-II trial
We want to investigate whether the antibiotic vancomycin in its powder form, which is given into the superficial wound at the end of the operation, reduces the rate of surgical wound infections in open, instrumented (with a screw-rod system) surgery on the spine with posterior access. In addition, the safety and tolerability of this method should also be examined.
Vancomycin is an antibiotic that inhibits cell wall formation in susceptible bacteria. The drug has been used routinely worldwide for decades for the prophylaxis and therapy of certain bacterial infections. However, there is no official recommendation anywhere in the world, including Switzerland, for the use of the (undissolved) powder form for infection prophylaxis ("off-label" application).
| Head of study: | PD Dr. Ralph Schär, MD |
| Study coordinator: | Nicole Söll |
| Study identifier: | NCT04017468 |
EMINENT-ICH study
Early minimally invasive image guided endoscopic evacuation of intracerebral haemorrhage (EMINENT-ICH): a randomized controlled trial
Spontaneous cerebral hemorrhage is the second most common type of stroke, affecting approximately 2500 people in Switzerland every year. One year after a cerebral hemorrhage, around half of those affected have died, while many of the survivors are severely impaired.
Currently, there is no effective treatment for cerebral hemorrhage. The standard treatment consists of controlling blood pressure, intensive monitoring and early rehabilitation. Open brain surgery is also often performed to remove the bleeding. However, neither this nor the standard treatment shows any clear advantages for survival or quality of life for those affected.
However, minimally invasive endoscopic removal of the bleeding point could offer advantages, as smaller studies suggest. However, large, randomized studies are needed to confirm these results. The EMINENT-ICH study aims to show that minimally invasive endoscopic intervention together with standard treatment can offer better chances of survival and less permanent damage for patients.
| Head of study: | Prof. Dr. Andreas Raabe |
| Study coordinator | Dr. Sc. nat. Lisa Grönnert |
| Study identifier: | NCT04805177 |
Proteomics project
A proteomics discovery approach to identify candidate biomarkers of atherosclerotic plaque instability in endarterectomy specimens of patients with carotid disease
An important cause of stroke is carotid stenosis, a narrowing caused by deposits in the carotid artery. The narrowing is caused by arteriosclerosis, in which fats and cholesterol crystals are deposited in the arterial walls. When these plaques rupture, small particles can be released and travel through the bloodstream to the brain, causing a stroke. It has been hypothesized that certain plaque compositions are associated with a higher risk of rupture and subsequent stroke.
In our research project, we are investigating the exact composition of these deposits and comparing them between different patient groups. We hope that this will enable us to identify deposits at an early stage that are at increased risk of rupturing, so that targeted treatment measures can be taken to prevent strokes.
| Head of project: | Prof. Dr. Andreas Raabe |
| Project coordinator: | Dr. Sc. nat. Lisa Grönnert |
Study on aneurysms in smokers
Swiss pilot screening study for unruptured intracranial aneurysms to prevent subarachnoid hemorrhage in smokers
(Schweizer Pilot-Screening-Studie für unrupturierte intrakranielle Aneurysmen bei Rauchern zur Verhinderung von Subarachnoidalblutung)
The aim of the study is to find out whether smokers between 30 and 60 years of age who have smoked more than one pack of cigarettes per day on average for 10 years (10 pack-years) have an increased incidence of unruptured aneurysms of the cerebral vessels. Furthermore, we would like to investigate the consequences of such an examination on further treatment if an aneurysm is discovered (if necessary, elimination of the aneurysm, smoking cessation) and quality of life.
Approximately 3% of the population have a so-called aneurysm of the cerebral vessels. These aneurysms are bulges in the blood vessels that can burst and cause a life-threatening cerebral haemorrhage. As aneurysms of the cerebral vessels do not cause any symptoms, they are usually discovered by chance or as soon as a cerebral haemorrhage occurs.
Smoking is one of the most important risk factors for the development of a cerebral hemorrhage from an aneurysm. 40% of all patients with cerebral hemorrhages from aneurysms are smokers. If smokers are known to have an unruptured aneurysm, the risk of a cerebral hemorrhage later in life is increased.
Recent findings from smaller studies suggest that smokers are significantly more likely to have aneurysms of the brain vessels (> 10%) than the general population (3%). This raises the question of whether there is a benefit to screening heavier smokers, as is done for other diseases such as bowel cancer, in order to prevent future cerebral hemorrhages.
| Head of study: | PD Dr. Johannes Goldberg, MD |
| Study coordinator: | Nicole Söll |
VasoStim study
Stimulation of the cervical medulla in patients with vascular spasms of the cerebral arteries after bleeding from a ruptured vascular sac: VasoStim study
Subarachnoid hemorrhage (SAH) is a life-threatening brain hemorrhage. One third of those affected die before arriving at the hospital, another third survive with permanent disabilities, and only one third have no or only minor abnormalities. In addition, dangerous vasospasms can occur from the fourth day after the hemorrhage, which worsen the course of the disease. Patients with grade 3 hemorrhage according to the Fisher classification are at particularly high risk for these vasospasms. Current therapies are only partially effective.
In this study with 15 patients at the Inselspital, we are investigating the effect and mechanisms of neurostimulation in reducing vasospasms. The neurostimulator has not yet been tested and approved for vasospasms.
| Head of study: | Dr. med. Janine-Ai Schlaeppi |
| Study identifier: | NCT05150002 |
Burst-DBS study
Thalamic-Burst-DBS for Neuropathic Pain
About 1-10% of all stroke patients subsequently develop a chronic neuropathic pain syndrome, which can often only be inadequately treated with conventional therapies and medications. In these cases, there are alternative treatment methods such as deep brain stimulation (DBS). In this procedure, electrodes are implanted in specific anatomical structures of the brain to deliver therapeutic electrical pulses. Despite an initially good response to this therapy, many patients unfortunately experience a return of pain to baseline levels.
In our research project, we now want to find out whether a new form of stimulation, known as burst stimulation, works well or equally well or better in patients with deep brain stimulation in the area of the thalamus.
| Head of study: | Dr. Andreas Nowacki |
| Study coordinator: | Nicole Söll |
| Study identifier: | NCT05204472 |