Neurology Commons^™

Insular And Amygdala Origin Seizures: Unmasked With Electrocorticography (Ecog), Younes Motii, Arichenaramanathan Manmatharayan, Parthasarathi Chamiraju, Mona Elsayed

Medical Student Research Symposium

Insular and Amygdala Origin Seizures: Unmasked with Electrocorticography (ECOG)

Introduction:

Insula and amygdala have a large network of connections to other cortical regions. Seizures originating from these structures may become evident only after propagation to other structures. High degree of attention must be paid to auras and seizure semiology in patients with medically intractable epilepsy.

Methodology:

We have described a series of three adult male patients with focal intractable epilepsy who did not have structural lesions on Magnetic Resonance Imaging (MRI). Patients underwent MRI, Positron Emission Tomography (PET) scan, scalp electroencephalography (EEG), and stereo EEG implantation.

Results:

All three patients …

Reduced Risk Of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From A United States Claims Database, Chengyuan Wu, Sean J Nagel, Rahul Agarwal, Monika Pötter-Nerger, Wolfgang Hamel, Ashwini Sharan, Allison T Connolly, Binith Cheeran, Paul S Larson

Department of Neurosurgery Faculty Papers

Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern and traditional DBS systems in patients with Parkinson's disease (PD) or essential tremor (ET) in the United States.

Design: Retrospective, contemporaneous cohort study.

Setting: Multicenter data from the United States Centers for Medicare and Medicaid Services administrative claims database between 2016 and 2018.

Participants: This population-based sample consisted of 5,998 patients implanted with a DBS system, …

Role Of Intra-Operative Ultrasound In Brain Tumour Surgeries, Mohammad Hamza Bajwa, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

The use of intra-operative ultrasound remains a largely underutilized option in brain tumour surgeries. The widespread availability of neuronavigation may be the reason why such a useful modality has become less popular even though recent advances in ultrasound technology have greatly improved its utility. The available literature also clearly shows that it offers additional advantages especially when used with neuronavigation. Herein the authors have briefly touched upon the available literature on the role of intraoperative ultrasound in brain tumour surgeries.

Tranexamic Acid To Reduce Head Injury Death In People With Traumatic Brain Injury: The Crash-3 International Rct, Ian Roberts, Haleema Shakur-Still, Amy Aeron-Thoma, Danielle Beaumont, Antonio Belli, Amy Brenner, Madeleine Cargill, Rizwana Chaudhri, Nicolas Douglas, Rashid Jooma

Section of Neurosurgery

Background: Tranexamic acid safely reduces mortality in traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury and can cause brain herniation and death. We assessed the effects of tranexamic acid in traumatic brain injury patients.
Objective: To assess the effects of tranexamic acid on death, disability and vascular occlusive events in traumatic brain injury patients. We also assessed cost-effectiveness.
Design: Randomised trial and economic evaluation. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers and those assessing outcomes were masked to allocation. …

A Feasibility Study Of Lavender Aromatherapy In An Awake Craniotomy Environment, Kailah Cathey, Nichole Gunyon, Nancy Chung, Nancy Conway, Diane Ames, Maharaj Singh, Amin B. Kassam, Richard A. Rovin

Journal of Patient-Centered Research and Reviews

Purpose: Integrative medicine interventions are needed for awake craniotomies, as many patients experience anxiety. Lavender aromatherapy significantly reduces anxiety or pain in a variety of surgical procedures. This feasibility study used lavender aromatherapy during awake craniotomies to determine the number of patients who would consent and complete the study, the technicality of lavender aromatherapy use, and acceptance by operating room (OR) staff.

Methods: We approached 40 consecutive patients (≥18 years old). Exclusion criteria were pulmonary issues or sensitivity to lavender. Outcome measures in consented patients were enrollment and completion rates, anxiety and pain as measured by the Visual Analog Scale …

Brief History Of Spinal Neurosurgical Societies In The United States: Part 1., Sasha Vaziri, Daniel K. Resnick, Christopher P. Ames, James S. Harrop, Christopher I. Shaffrey, Kern Singh, Justin S. Smith, Daniel J. Hoh

Department of Neurosurgery Faculty Papers

No abstract provided.

Commentary: The History Of Neurosurgery At Albany Medical College And Albany Medical Center Hospital, Albany, New York., Pouya Entezami, Michael R. Gooch, Adedamola Adepoju, Julie Pilitsis, Tyler J. Kenning, Alan Boulos, David L. Semenoff

Department of Neurosurgery Faculty Papers

The origins of the Department of Neurosurgery at Albany Medical College closely parallel the development of early America and the establishment of modern health care.The tales of Washington Irving, the works of the Hudson River School of painters, and summers in the Catskill Mountains or Adirondacks are the stories that color the history of Upstate New York (Figure1). As a social, industrial, and political hub of the American colonies, New England’s need for centers providing structured medicine led to the creation of Albany Medical College in1839, one of the earliest such institutions in the young nation.1 Rapid progress in nearly …

Endovascular Coiling Versus Neurosurgical Clipping For Aneurysmal Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis, Syed Ijlal Ahmed, Gohar Javed, Syeda Beenish Bareeqa, Syeda Sana Samar, Ali Shah, Arwa Giani, Zainab Azam, Abeer Tasleem, Syed Hasham Humayun

Section of Neurosurgery

Background: Aneurysmal subarachnoid hemorrhage is a frequently devastating condition with a reported incidence of between 10 and 15 people per 100,000 in the United States. Currently, according to the best of our knowledge, there are not enough meta-analyses available in the medical literature of the last five years which compare the risks and benefits of endovascular coiling with neurosurgical clipping.
Methods: Twenty-two studies were selected out of the short-listed studies. The studies were selected on the basis of relevance to the topic, sample size, sampling technique, and randomization. Data were analyzed on Revman software.
Results: Mortality was found to be …

Consensus Statement From The International Consensus Meeting On The Role Of Decompressive Craniectomy In The Management Of Traumatic Brain Injury: Consensus Statement, P. J. Hutchinson, A. G. Kolias, T. Tajsic, A. Adeleye, A. T. Aklilu, T. Apriawan, A. H. Bajamal, E. J. Barthelemy, J. S. Ullman, F. Servadei, +41 Additional Authors

Journal Articles

No abstract provided.

Delta-Aminolevulinic Acid-Mediated Photodiagnoses In Surgical Oncology: A Historical Review Of Clinical Trials., Joseph F Georges, Amber Valeri, Huan Wang, Aaron Brooking, Michael Kakareka, Steve S Cho, Zein Al-Atrache, Michael Bamimore, Hany Osman, Joseph Ifrach, Si Yu, Carrie Li, Denah Appelt, John Y K Lee, Peter Nakaji, Kristin Brill, Steven S. Yocom

PCOM Scholarly Papers

Fluorescence imaging is an emerging clinical technique for real-time intraoperative visualization of tumors and their boundaries. Though multiple fluorescent contrast agents are available in the basic sciences, few fluorescence agents are available for clinical use. Of the clinical fluorophores, delta aminolevulinic acid (5ALA) is unique for generating visible wavelength tumor-specific fluorescence. In 2017, 5ALA was FDA-approved for glioma surgery in the United States. Additionally, clinical studies suggest this agent may have utility in surgical subspecialties outside of neurosurgery. Data from dermatology, OB/GYN, urology, cardiothoracic surgery, and gastrointestinal surgery show 5ALA is helpful for intraoperative visualization of malignant tissues in multiple …

Lateralized Hippocampal Oscillations Underlie Distinct Aspects Of Human Spatial Memory And Navigation., Jonathan Miller, Andrew J. Watrous, Melina Tsitsiklis, Sang Ah Lee, Sameer A. Sheth, Catherine A. Schevon, Elliot H. Smith, Michael R. Sperling, Ashwini Sharan, Ali Akbar Asadi-Pooya, Gregory A. Worrell, Stephen Meisenhelter, Cory S. Inman, Kathryn A. Davis, Bradley Lega, Paul A. Wanda, Sandhitsu R. Das, Joel M. Stein, Richard Gorniak, Joshua Jacobs

Department of Neurology Faculty Papers

The hippocampus plays a vital role in various aspects of cognition including both memory and spatial navigation. To understand electrophysiologically how the hippocampus supports these processes, we recorded intracranial electroencephalographic activity from 46 neurosurgical patients as they performed a spatial memory task. We measure signals from multiple brain regions, including both left and right hippocampi, and we use spectral analysis to identify oscillatory patterns related to memory encoding and navigation. We show that in the left but not right hippocampus, the amplitude of oscillations in the 1-3-Hz "low theta" band increases when viewing subsequently remembered object-location pairs. In contrast, in …

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Primary goals:

1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

Rare Case Of Diffuse Spinal Arachnoiditis Following A Complicated Vertebral Artery Dissection, Elias Atallah, Md, Sophia Dang, Sage Rahm, Nohra Chalouhi, Md, Stavropoula Tjoumakaris Md, Robert H. Rosenwasswer Md, Pascal Jabbour Md

Department of Neurosurgery Posters

Spinal arachnoiditis (SA) is an extremely rare and delayed complication of intracranial subarachnoid hemorrhage (SAH). SA is an inflammatory process leading to chronic fibrosis of the spinal cord. Possible pathophysiology is a two-staged disease of initial inflammatory reaction secondary to SAH, followed by a “free interval phase” prior to delayed adhesive phase (i.e. SA). The clinical course can be complicated and is the cause of major morbidity.

Robotics In Neurosurgery: A Literature Review, Syed Ijlal Ahmed, Gohar Javed, Bakhtawar Mubeen, Syeda Beenish Bareeqa, Hiba Rasheed, Alizay Rehman, Masroor Mubeen Phulpoto, Syeda Sana Samar, Kashif Aziz

Section of Neurosurgery

Robotic surgery has been the forte of minimally invasive stereo-tactic procedures for some decades now. Ongoing advancements and evolutionary developments require substantial evidence to build the consensus about its efficacy in the field of neurosurgery. Main obstacle in obtaining successful results in neurosurgery is fine neural structures and other anatomical limitations. Currently, human rationalisation and robotic precision works in symbiosis to provide improved results. We reviewed the current data about recent interventions. Robots are capable of providing virtual data, superior spatial resolution and geometric accuracy, superior dexterity, faster manoeuvring and non-fatigability with steady motion. Robotic surgery also allows simulation of …

Delayed Spinal Cord Infarction Following Anterior Cervical Surgical Decompression, Muhammad Faheem Khan, Rashid Jooma, Fauzan Alam Hashmi, Muhammad Faraz Raghib

Section of Neurosurgery

Anterior cervical discectomy and fusion (ACDF) for cord compression is a safe and effective procedure with good outcomes. However, worsening of myelopathy is the most feared adverse event of the surgery. We report the case of a 36-year-old male patient who presented with an acute non-traumatic C5-6 cervical disc herniation causing incomplete quadriparesis. He underwent an uncomplicated ACDF at C5-6, and after an initial period of improvement, he developed a delayed onset of an anterior cord syndrome on day 3, without any discerning cause. We have reviewed similar cases reported in the literature and believe that our patient's postsurgical course …

Anterior Inferior Cerebellar Arteries Juxtaposed With The Internal Acoustic Meatus And Their Relationship To The Cranial Nerve Vii/Viii Complex., Fernando Alonso, Mohammad W Kassem, Joe Iwanaga, Rod J Oskouian, Marios Loukas, Amin Demerdash, R Shane Tubbs

Articles, Abstracts, and Reports

Vascular loops in the cerebellopontine angle (CPA) and their relationship to cranial nerves have been used to explain neurological symptoms. The anterior inferior cerebellar artery (AICA) has variable branches producing vascular loops that can compress the facial cranial nerve (CN) VII and vestibulocochlear (CN VIII) nerves. AICA compression of the facial-vestibulocochlear nerve complex can lead to various clinical presentations, including hemifacial spasm (HFS), tinnitus, and hemiataxia. The formation of arterial loops inside or outside of the internal auditory meatus (IAM) can cause abutment or compression of CN VII and CN VIII. Twenty-five (50 sides) fresh adult cadavers underwent dissection of …

Chiari I Malformation And Spinal Cord Ischemia In A Cadaver., Faizullah Mashriqi, Marios Loukas, Rod J Oskouian, Anthony V D'Antoni, R Shane Tubbs

Articles, Abstracts, and Reports

With advanced imaging, the Chiari I malformation (CIM) is more frequently diagnosed than in the past when this entity was identified most commonly at autopsy. Herein, we report the rare case of an adult cadaver found not only to have CIM but also adjacent spinal cord ischemia. This case is discussed in the context of chronic compression of the spinal cord by a CIM and the need for close monitoring of these patients.

Cost-Effective Practice Of Neurology: An Idea Whose Time Has Come, Rashid Jooma

Rashid Jooma

Pakistanis spent $ 7.2 billion on healthcare in 2013 (3.1% of our Gross Domestic Product), representing a per capita expenditure of $ 39.4. The government contribution to this was no more than 31.4% ($ 12.4 per capita). The public allocations to health thus represent a paltry 4.7% of total government expenditure and are just shy of 1% of our GDP.

Unmet Need For Surgery In South Asia, Sanjay Nagral, Maharra Hussain, Sarder A. Nayeem, Ranjan Dias, Ather Enam, Samiran Nundy

Section of Neurosurgery

No abstract provided.

Neurorobotics In Pakistan, Ather Enam, Muhammad Waqas

Section of Neurosurgery

No abstract provided.

Providing Care Beyond The Hospital: Perspective Of A Tertiary Care Hospital From A Developing Country, Saad Akhtar, Muhammad Waqas, Badar Uddin Ujjan, Adnan Salim, Gohar Javed, Syed Ijlal Ahmed, Malikah Surani, Marium Khan

Section of Neurosurgery

Background: Neurorehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing frequently is unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by a professional nurse.
Methods: This was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of 2 groups. Group 1 (consisting of patients cared for by a professional nurse) included 94 patients and …

Cost-Effective Practice Of Neurology: An Idea Whose Time Has Come, Rashid Jooma

Pakistan Journal of Neurological Sciences (PJNS)

Pakistanis spent $ 7.2 billion on healthcare in 2013 (3.1% of our Gross Domestic Product), representing a per capita expenditure of $ 39.4. The government contribution to this was no more than 31.4% ($ 12.4 per capita). The public allocations to health thus represent a paltry 4.7% of total government expenditure and are just shy of 1% of our GDP.

Neurosurgery Literature Highlights & Psychiatry Literature Highlights, Muhammad Waqas Shaiq, Muhammad Shahzad Shamim

Pakistan Journal of Neurological Sciences (PJNS)

Today, a great challenge of our profession is to envision how we will deliver exemplary neurosurgical care in the future. To accomplish this requires anticipating how economic, political, and societal influences will affect our ability to provide the highest quality of patient care in an arena that will look increasingly different from today's world of medicine. Already, our profession is battling a relentless assault as numerous sectors implement change that impacts us and our community every day. Surviving this requires an effective strategy that will involve significant cultural change.

Neurosurgical Applications Of Magnetic Resonance Diffusion Tensor Imaging, Daniel D. Hirsch, Bs, Benjamin M. Zussman, Bs, Adam E. Flanders, Md, Ashwini D. Sharan, Md

JHN Journal

Magnetic Resonance (MR) Diffusion Tensor Imaging (DTI) is a rapidly evolving technology that enables the visualization of neural fiber bundles, or white matter (WM) tracts. There are numerous neurosurgical applications for MR DTI including: (1) Tumor grading and staging; (2) Pre-surgical planning (determination of resectability, determination of surgical approach, identification of WM tracts at risk); (3) Intraoperative navigation (tumor resection that spares WM damage, epilepsy resection that spares WM damage, accurate location of deep brain stimulation structures); (4) Post-operative assessment and monitoring (identification of WM damage, identification of tumor recurrence). Limitations of MR DTI include difficulty tracking small and crossing …

A Critical Analysis Of The Current State Of Neurosurgery Training In Pakistan, Muhammad Shahzad Shamim, Muhammad Zubair Tahir, Saniya Siraj Godil, Rajesh Kumar, Arshad Ali Siddiqui

Section of Neurosurgery

Objective: To observe interdepartmental variation in the availability of resources and academic activities within the various neurosurgery programs of Pakistan.
Methods: This was a proforma-based survey of neurosurgery trainees and young neurosurgeons of Pakistan, looking at the academic infrastructure and output of their programs. The proforma was filled by 36 respondents from 11 neurosurgery centers of the country. All these centers were accredited for neurosurgery training in Pakistan.
Results: Out of the 36 respondents, 30 were completing a Fellowship training (FCPS) and six were enrolled for a Master in Surgery (MS) program. About 80% of the participants used the Youman's …

The Prevalence Of Cervico-Arterial Dissection In Sub-Arachnoid Hemorrhage In The United States, Ali Seifi, Md, Fred Rincon, Md, Msc, Mitchell Maltenfort, Phd, Pascal Jabbour, Md, Rodney Bell, Md, Michael Moussouttas, Md

Department of Neurology Faculty Papers

Objectives: In this study, we sought to determine the prevalence of cervico-arterial dissection in aubarachnoid hemorrhage (SAH) using a large administrative database.

Fuzzy Logic: A “Simple” Solution For Complexities In Neurosciences?, Saniya Siraj Godil, Muhammad Shahzad Shamim, Ather Enam, Uvais Qidwai

Medical College Documents

Background: Fuzzy logic is a multi-valued logic which is similar to human thinking and interpretation. It has the potential of combining human heuristics into computer-assisted decision making, which is applicable to individual patients as it takes into account all the factors and complexities of individuals. Fuzzy logic has been applied in all disciplines of medicine in some form and recently its applicability in neurosciences has also gained momentum.
Methods: This review focuses on the use of this concept in various branches of neurosciences including basic neuroscience, neurology, neurosurgery, psychiatry and psychology.
Results: The applicability of fuzzy logic is not limited …

Intradiploic Epidermoid Cyst Overlying The Torcula: A Surgical Challenge, Amad Naseer Khan, Salema Khalid, Ather Enam

Medical College Documents

Intradiploic tumours are rare, slow growing tumours that can present in many different ways, including a painless lump, tenderness, headache and rarely with focal neurological signs. The authors present the case of a gentleman in whom the tumour presented in an unusual location and presented a surgical challenge. The major take home message from this case report is that an epidermoid cyst overlying the torcula is to be approached with great caution and care and is without doubt a surgical challenge.

Is The Quality Of Neurosurgical Literature Improving?, James Harrop, Md, Mitchell Maltenfort, Phd

JHN Journal

Introduction:

The advent of evidence-based medicine has resulted in higher quality journal manuscripts in numerous medical disciplines. However, the impact in the neurosurgical literature has not been reported.

Objective:

To quantify the impact of evidence-based medicine on the quality of articles published in the Neurosurgery literature.

Methods:

Articles published in the journal Neurosurgery (founded in 1977) were reviewed for 1978, 1988, 1998, and 2008. Each decade’s sample was classified as therapeutic, diagnostic and prognostic based on a published system for determining level of evidence.

Results:

438 articles were reviewed. Articles not considered included any published under the heading “Case Report” …

Research-Retreat-Recovery: A Potential Model For Organization And Completion Of Research Projects. Experience From A Neurosurgery Department In A Developing Country, Saniya Siraj Godil, Syed Faraz Kazim, Muhammad Shahzad Shamim

Medical College Documents

Background: In the current era of biomedical research, it is imperative that every research study at an institution is properly organized, and frequently audited to streamline efforts and maintain standards. Recently, a research retreat was organized by the Section of Neurosurgery at Aga Khan University Hospital, Karachi, Pakistan, and following that a recovery team was made with the aim of recovering "lost in translation" research projects. In the realm of our experience, the current model is being proposed as a means for organization of departmental research.
Methods: The "research" component of the model comprised compilation of an abstract book of …