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Surgical Management Of Fungal Vertebral Osteomyelitis, Benjamin M. Zussman, Bs, David L. Penn, Ms, James S. Harrop, Md
Surgical Management Of Fungal Vertebral Osteomyelitis, Benjamin M. Zussman, Bs, David L. Penn, Ms, James S. Harrop, Md
JHN Journal
Fungal vertebral osteomyelitis (FVO) is an uncommon but aggressive disease that may cause spinal instability, neurological insult, and possible death. Little data about treatment strategies and patient outcomes exist. A retrospective review of medical and surgical management with follow-up of this disease was performed.
Mis Posterior Cervical Spine Surgery: Five-Level Fusion Through A Novel Cervical Tube, Ashwini Sharan Md, Mitchell A. Hardenbrook, Md, John K. Ratliff Md, James Harrop, Md
Mis Posterior Cervical Spine Surgery: Five-Level Fusion Through A Novel Cervical Tube, Ashwini Sharan Md, Mitchell A. Hardenbrook, Md, John K. Ratliff Md, James Harrop, Md
JHN Journal
Minimally invasive surgical (MIS) techniques to the spine have focused mainly on the lumbar region. Many reports exist on the ability to decompress the neural structures in the lumbar and thoracic spine both via an anterior and posterior approach. Familiarity with these techniques now allows one or two level interbody and pedicle fusions, and treatment of trauma through MIS approaches. Controversy exists as to the efficacy of these techniques because direct studies comparing MIS approaches with open techniques are lacking. However, proponents of these techniques site smaller incision, less muscle retraction, less blood loss, shorter length of stay and better …
Case Report On Intracranial Hemorrhage Related To Type I Cryoglobulinemia, Richard Dalyai, Md, L. Fernando Gonzalez, Md
Case Report On Intracranial Hemorrhage Related To Type I Cryoglobulinemia, Richard Dalyai, Md, L. Fernando Gonzalez, Md
JHN Journal
A traumatic intracranial hemorrhage (ICH) is a common neurosurgical pathology that affects about 20 of 100,000 people every year with a mortality of at least 40%. However, a specific etiology, cannot be identified in about 30% of spontaneous ICH. Here, we present a rare case of ICH related to a patient's previously undiagnosed cryoglobinemia.
On The Incidence Of Pulmonary Embolism In Spinal Arthrodesis And The Need For Better Evidence And Prevention Guidelines, Zachary J. Senders, Bs, Benjamin Zussman, Bs, James S. Harrop, Md
On The Incidence Of Pulmonary Embolism In Spinal Arthrodesis And The Need For Better Evidence And Prevention Guidelines, Zachary J. Senders, Bs, Benjamin Zussman, Bs, James S. Harrop, Md
JHN Journal
Pulmonary Embolism (PE) is a rare but serious event that may occur after spinal surgery. Vascular endothelial damage during surgery and immobilization of the patient after surgery contribute to a higher risk of thrombosis and subsequent PE. Prophylaxis including intermittent pneumatic compression stockings, heparin, and other interventions is often employed by the treatment team to lower the risk of thromboembolic complications. In orthopedic, trauma, burn and other high-risk surgical patients, the incidence of PE has been thoroughly studied, and this knowledge has been used to establish prophylaxis guidelines specifically for these patients. The incidence of PE in spinal fusion patients, …
Bevacizumab: A Controversial Agent Against High-Grade Gliomas, Sussan Salas, Md, Miguel Guzman, Md, Kevin Judy, Md
Bevacizumab: A Controversial Agent Against High-Grade Gliomas, Sussan Salas, Md, Miguel Guzman, Md, Kevin Judy, Md
JHN Journal
Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults. Despite the current regimen of surgical resection with subsequent external beam radiotherapy and temozolomide, mean survival is 14.6 months and 2-year survival is 26%. GBM is a highly vascular tumor, a result of its increased expression of vascular endothelial growth factor (VEGF) compared to other brain tumors. VEGF promotes endothelial cell proliferation, and is thought to have a pivotal role during tumor progression. Multiple treatment modalities have targeted VEGF and VEGF receptors (VEGFTs) due to their essential roles in the regulation of angiogenic processes. Bevacizumab is a …
Emerging Clinical Imaging Techniques For Spinal Arteriovenous Malformations, Peter Campbell, Lisa Tartaglino, Hayan Dayoub, Pascal Jabbour Md, Aaron Dumont, L. Fernando Gonzalez, Robert H. Rosenwasser Md, Stavropoula Tjoumakaris
Emerging Clinical Imaging Techniques For Spinal Arteriovenous Malformations, Peter Campbell, Lisa Tartaglino, Hayan Dayoub, Pascal Jabbour Md, Aaron Dumont, L. Fernando Gonzalez, Robert H. Rosenwasser Md, Stavropoula Tjoumakaris
JHN Journal
Spinal arteriovenous malformations (SAVMs) are rare and under-diagnosed entities. If untreated, SAVMs can lead to progressive spinal cord myelopathy. The diversion of arterial blood through dorsal and/or medullary veins can lead to a vascular steal phenomena often accompanying highflow lesions, or venous hypertension and congestion which ultimately reduces intramedullary blood flow in lower flow malformations1. Therefore, timely diagnosis and a precise understanding of these lesions can determine surgical strategies and prevent delays in treatment.
Endovascular Management Of Acute Proximal Internal Carotid Artery Occlusion: The Jhn Experience, Richard Dalyai, Vismay Thakkar, Thana Theofanis, Pascal Jabbour Md, L. Fernando Gonzalez, Robert H. Rosenwasser Md, Stavropoula Tjoumakaris
Endovascular Management Of Acute Proximal Internal Carotid Artery Occlusion: The Jhn Experience, Richard Dalyai, Vismay Thakkar, Thana Theofanis, Pascal Jabbour Md, L. Fernando Gonzalez, Robert H. Rosenwasser Md, Stavropoula Tjoumakaris
JHN Journal
Stroke is a major cause of serious, long-term disability and the third leading cause of death, accounting for one in every 18 deaths in the United States. Approximately 800,000 strokes occur in the United States each year, leading to an estimated cost of 74 billion dollars in 2010. The severity and prognosis of patients with an acute internal carotid artery (ICA) occlusion is extremely poor. Studies have shown that 16-55% of patients will die from complications related to the infarction, 40-69% will be left with a profound deficit, and only 2-12% will make a reasonable recovery2. In young patients, internal …
Intracranial Neuroenteric Cysts: Two Atypical Cases And Review Of The Literature, Sonia Teufack, Peter Campbell, Yaron A. Moshel
Intracranial Neuroenteric Cysts: Two Atypical Cases And Review Of The Literature, Sonia Teufack, Peter Campbell, Yaron A. Moshel
JHN Journal
Introduction Neurenteric cysts (NCs) are rare intracranial lesions of endodermal origin. They typically arise as ventral intradural extramedullary spine developmental malformations. We present two atypical cases of intracranial NCs. Clinical Presentation The first patient presented with a headache and was found to have an enlarging 6.6cm left frontal lobe cystic mass. The second presented with diplopia secondary to left third nerve palsy and was found a have 1.7cm left superior prepontine lesion.
Cranial Nerve Palsy After Embolization Of Giant Cavernosu Carotid Aneurysms With Onyx Hd-500: Case Series And Review Of The Literature, Sonia Teufack, Stavropoula Tjoumakaris, L. Fernando Gonzalez, Aaron Dumont, Robert H. Rosenwasser Md, Pascal Jabbour Md
Cranial Nerve Palsy After Embolization Of Giant Cavernosu Carotid Aneurysms With Onyx Hd-500: Case Series And Review Of The Literature, Sonia Teufack, Stavropoula Tjoumakaris, L. Fernando Gonzalez, Aaron Dumont, Robert H. Rosenwasser Md, Pascal Jabbour Md
JHN Journal
Background Onyx liquid embolic system has been used in the treatment of intracranial aneurysm and arteriovenous malformation since 1999. Recently, Onyx HD-500 has been especially advocated for the treatment of large and giant intracranial aneurysms. Methods Two cases of cranial nerve palsy following embolization of unruptured symptomatic giant cavernous internal carotid artery aneurysms are presented. The first patient had a right 2.0cm x 1.5cm cavernous aneurysm, and the second a 2.7cm x 1.8cm left cavernous aneurysm. Both patients developed persistent diplopia after embolization with Onyx HD-500. Results Ophthalmological evaluation revealed that both patients had abductor nerve palsy on the same …
Developing A Clinical Guideline For Ct Scans In Closed Head Injury, Chengyuan Wu, Jack Jallo
Developing A Clinical Guideline For Ct Scans In Closed Head Injury, Chengyuan Wu, Jack Jallo
JHN Journal
Several years ago, every patient that was brought to Thomas Jefferson University Hospital with a closed head injury would receive a CT scan — regardless of whether or not that patient already had a scan performed at an outside institution. If the scan demonstrated any intracranial pathology, then a repeat CT scan was performed 12 hours after the initial scan as long as the patient remained neurologically stable. Ultimately, every patient received two CT scans at our institution separated by 12 hours. Now, each patient is followed by a total of three CT scans. If a patient had undergone a …
Multi-Modality Management Of An Intradural-Extramedullary Hemangioblastoma: A Case Report, Benjamin Zussman, David Penn, Shiveindra Jeyamohan, Maria Werner-Wasik, David W. Andrews Md, James Harrop
Multi-Modality Management Of An Intradural-Extramedullary Hemangioblastoma: A Case Report, Benjamin Zussman, David Penn, Shiveindra Jeyamohan, Maria Werner-Wasik, David W. Andrews Md, James Harrop
JHN Journal
Objective Stereotactic spinal radiosurgery may offer a complementary adjunct to microsurgery for patients with limited surgical candidacy due to significant medical comorbidities, aggressive or recurring tumors, or surgically inaccessible lesions. Our objective was to illustrate Intensity-Modulated Radiation Therapy (IMRT) treatment schemes in conjunction with surgical therapy for aggressive spinal neoplasms. Methods Case Report A 79-year-old man with severe progressive tetraparesis had an intradural-extramedullary mass at the C4-C5 level with severe spinal cord compression that extended out the foramen and anterior to the vertebral artery. Subtotal microsurgical resection was performed, completely decompressing the spinal cord and sparing the structures exiting the …
Giant Cavernous Malformation Presenting As A Large Cystic Intracranial Mass With An Enhancing Mural Nodule: A Case Report And Review Of The Literature, Peter Amenta Md, James J. Evans
Giant Cavernous Malformation Presenting As A Large Cystic Intracranial Mass With An Enhancing Mural Nodule: A Case Report And Review Of The Literature, Peter Amenta Md, James J. Evans
JHN Journal
Background Cavernous malformations are relatively rare vascular anomalies which typically follow a benign clinical course. The vast majority of these lesions are small and only become clinically significant when they induce seizures or hemorrhage. Rarely, cavernous malformations may grow to large sizes without a clinically significant acute hemorrhage, thus resulting in a presentation consistent with a large intracranial mass lesion. These giant cavernous malformations present a diagnostic challenge, as CT and MRI are frequently unable to distinguish them from neoplastic pathology.