Medicine and Health Sciences Commons^™

Review Of Cerebral Aneurysm Formation, Growth, And Rupture., Nohra Chalouhi, Md, Brian L Hoh, David Hasan

Department of Neurosurgery Faculty Papers

No abstract provided.

Preoperative Spinal Tumor Embolization: An Institutional Experience With Onyx., George M. Ghobrial, Md, Nohra El-Chalouhi, Md, James Harrop, Md, Richard Dalyai, Md, Stavropoula Tjoumakaris, Md, L Fernando Gonzalez, Md, David Hasan, Md, Robert Rosenwasser, Md, Pascal Jabbour, Md

Department of Neurosurgery Faculty Papers

BACKGROUND: Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection.

OBJECTIVE: We report our institutional experience with the embolization of hypervascular extradural spinal tumors with Onyx as well as earlier embolic agents in a series of 28 patients.

METHODS: A retrospective case review was conducted on patients undergoing preoperative transarterial embolization of a spinal tumor between 1995 and 2012 at our institution.

RESULTS: Twenty-eight patients met the inclusion criteria, with a mean age of 60.6 years. Twenty-eight patients had metastatic tumors. In 14 (50%) patients the metastases were from renal cell …

Journal Club: Role Of Endoscopic Third Ventriculostomy And Ventriculoperitoneal Shunt In Idiopathic Normal Pressure Hydrocephalus: Preliminary Results Of A Randomized Clinical Trial., George M. Ghobrial, Md, Michael J. Lang, Md

Department of Neurosurgery Faculty Papers

1. Significance/Context and Importance of the Study:

Idiopathic normal pressure hydrocephalus (INPH) was first defined by Hakim and colleagues in 1965¹, and its symptoms later classified by the clinical triad of gait dysfunction, urinary incontinence, and dementia. The exact pathophysiology of this disease is not well understood.² Surgical options for the treatment of INPH are ventriculoperitoneal shunt (VPS) placement (most commonly with a programmable valve), and endoscopic third ventriculostomy (ETV). VPS is by far the most common method used to treat INPH worldwide. Debate exists as to the superiority between the two management options. Historically, VPS placement …

Simulated Spinal Cerebrospinal Fluid Leak Repair: An Educational Model With Didactic And Technical Components., George M. Ghobrial, Md, Paul A Anderson, Rohan Chitale, Md, Peter Campbell, Md, Darlene A Lobel, Md, James Harrop, Md

Department of Neurosurgery Faculty Papers

BACKGROUND: In the era of surgical resident work hour restrictions, the traditional apprenticeship model may provide fewer hours for neurosurgical residents to hone technical skills. Spinal dura mater closure or repair is 1 skill that is infrequently encountered, and persistent cerebrospinal fluid leaks are a potential morbidity.

OBJECTIVE: To establish an educational curriculum to train residents in spinal dura mater closure with a novel durotomy repair model.

METHODS: The Congress of Neurological Surgeons has developed a simulation-based model for durotomy closure with the ongoing efforts of their simulation educational committee. The core curriculum consists of didactic training materials and a …

Thoracolumbar Spine Trauma: Review Of The Evidence., George M. Ghobrial Md, Jack Jallo, Md, Phd

Department of Neurosurgery Faculty Papers

AIM: The aim of this paper was to provide a comprehensive review of literature regarding the classification systems and surgical management of thoracolumbar spine trauma.

METHODS: A Pubmed search of "thoracolumbar", "spine", "fracture" was used on January 05, 2013. Exclusionary criteria included non-Human studies, case reports, and non-clinical papers. RESULTS. One thousand five hundred twenty manuscripts were initially returned for the combined search string; 150 were carefully reviewed, and 48 manuscripts were included in the review.

DISCUSSION: Traumatic spinal cord injury (SCI) has a high prevalence in North America. The thoracolumbar junction is a point of high kinetic energy transfer …

Multimodal Endovascular Management Of Acute Ischemic Stroke In Patients Over 75 Years Old Is Safe And Effective., George M Ghobrial, Nohra Chalouhi, Lana Rivers, Samantha Witte, Justin Davanzo, Richard Dalyai, Michelle L Gardecki, Pascal Jabbour, Fernando Gonzalez, Aaron S Dumont, Robert H Rosenwasser, Stavropoula Tjoumakaris

Department of Neurosurgery Faculty Papers

INTRODUCTION: Greater attention has been directed to endovascular recanalization of acute ischemic stroke in septuagenarians and above.

TECHNIQUE: A retrospective chart review was conducted to include patients treated for acute ischemic stroke from 2006 to 2012. All patients underwent initial neurological assessment and non-contrast head CT. Patients treated from 2009 to 2012 additionally received emergent CT angiogram and CT perfusion. 51 patients met the clinical and radiographic criteria and underwent multimodal endovascular revascularization for acute ischemic events.

RESULTS: All patients underwent cerebral angiography and met angiographic criteria for endovascular thrombolysis. 34 patients (67%) were older than 80 years of age. …

Cerebral Blood Flow Dynamics And Head-Of-Bed Changes In The Setting Of Subarachnoid Hemorrhage., David K Kung, Nohra El-Chalouhi, Md, Pascal Jabbour, Md, Robert M Starke, Aaron Dumont, Md, H Richard Winn, Matthew A Howard, David M Hasan

Department of Neurosurgery Faculty Papers

Head-of-bed (HOB) elevation is usually restricted in patients with aneurysmal subarachnoid hemorrhage (SAH). The goal of this study is to correlate HOB changes (0° and 90°) with cerebral blood flow using transcranial Doppler (TCD) and thermal diffusion probe in SAH patients. Thirteen patients with SAH were prospectively enrolled in the study. Eight patients underwent placement of a thermal diffusion probe for regional CBF measurement. CBF values were measured with the patients in flat (0°) and upright sitting positions (90°) at days 3, 7, and 10. The average increase in blood flow velocity when changing HOB from 0° to 90° was …

Endovascular Treatment Of Cerebral Mycotic Aneurysm: A Review Of The Literature And Single Center Experience., Mario Zanaty, Md, Nohra El-Chalouhi, Md, Robert M Starke, Stavropoula Tjoumakaris Md, L Fernando Gonzalez, Md, David Hasan, Md, Robert Rosenwasser, Md, Pascal Jabbour, Md

Department of Neurosurgery Faculty Papers

The management of mycotic aneurysm has always been subject to controversy. The aim of this paper is to review the literature on the intracranial infected aneurysm from pathogenesis till management while focusing mainly on the endovascular interventions. This novel solution seems to provide additional benefits and long-term favorable outcomes.

Key Neurological And Neurochemical Features In A Model Of Repetitive Concussions: Implications For Post-Concussion Headache, C. Macolino, B. Daiutolo, A. Tyburski, Melanie B. Elliott

Department of Neurosurgery Faculty Papers

Introduction

Incidence rates for concussion will continue to grow along with the increasing awareness and improvements in diagnosis. Headache is a hallmark feature of post-concussion syndrome. Post-concussion headache (PCH) is highly prevalent in the military with as high as 97.8% reporting having headaches¹. occurring in up to 85% of athletes following ^2-4. In the Military and sports, return to duty or play guidelines state that a soldier/player should be asymptomatic before returning to physical activity. However, headache following concussion is commonly dismissed. PCH can be a new headache resulting from head trauma or worsening of pre-existing headache …