Investigative Techniques Commons^™

Intrawound Vancomycin For Prevention Of Surgical Site Infection: Meta-Analysis Of Randomized Clinical Trials, Shaan Patel, Shiva Nischal, Kush Kale, Angelette Mendonca, Nelson Sofoluke, Srinivas Prasad, James Harrop, Daniel Refai

Department of Neurosurgery Faculty Papers

BACKGROUND: Surgical site infection remains a major cause of postoperative morbidity. Intrawound vancomycin has been proposed as an adjunct to standard prophylaxis, but its effectiveness across surgical settings remains uncertain. This systematic review and meta-analysis of randomized clinical trials aimed to evaluate the association between intraoperative intrawound vancomycin and surgical site infection in adults undergoing surgery.

METHODS: MEDLINE, Embase, and CENTRAL were searched from database inception to March 2026 for randomized clinical trials comparing intrawound vancomycin with standard care in adults undergoing operative procedures. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment using the Cochrane Risk of Bias …

Safety Of Carotid Endarterectomy In The Elderly And Octogenarian Population: A Nationwide Study Including 80,000 Patients, Victor Gabriel El-Hajj, Joanna Roy, Basel Musmar, Wi Jin Kim, Michael Rizzuto, Nathaniel Ellens, Rabab Alshahrani, Victor Staartjes, Adrian Elmi-Terander, Ramachandra Tummala, Stavropoula Tjoumakaris, Michael Gooch, Robert Rosenwasswer, Ziad Khabbaz, Pascal Jabbour

Department of Neurosurgery Faculty Papers

INTRODUCTION: Carotid endarterectomy (CEA) is an established procedure for stroke prevention in patients with carotid artery stenosis. While CEA is considered safe in younger patients, perioperative risks in octogenarians remain debated, with current guidelines classifying the procedure as "high-risk" in this patient population. This study aimed to evaluate short-term outcomes of CEA across age groups and to assess whether comorbidity burden better predicts outcomes than chronological age.

METHODS: The ACS-NSQIP database (2013-2020), was used to identify patients eligible for inclusion. The cohort was stratified based on age <  60, 60-80, and > 80 years. Propensity score matching and multivariable logistic regression were used to compare …

P-15 Peptide Enhanced Bone Graft Improves Time To Fusion In Transforaminal Lumbar Interbody Fusion: A Randomized, Controlled, Investigational Device Exemption Study, James S. Harrop, Michael P. Steinmetz, John E. O'Toole, Christopher D Chaput, Rick C. Sasso, K. Brandon Strenge, Greg Maislin, Jeffrey P. Mullin, Thomas B. Freeman, Anthony Guanciale, Howard Lantner, Michael E. Janssen, David G. Schwartz, John M. Small, Wellington K. Hsu, Paul M. Arnold

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Prospective, multicenter, single-blind, randomized, and controlled pivotal study.

OBJECTIVE: Compare time-to-fusion in patients treated with P-15L (PearlMatrix TM P-15 peptide enhanced bone graft) versus local autograft over 24 months and evaluate changes in pain and quality of life at 24 months relative to baseline.

SUMMARY OF BACKGROUND DATA: P-15L, an FDA-designated breakthrough device, is a composite bone graft with P-15, a 15-amino acid polypeptide that promotes cellular adhesion, proliferation, and differentiation to support bone formation.

METHODS: Patients (22-80 y) with degenerative disc disease were randomized to the investigational (P-15L) or control (local autograft) group during single-level transforaminal lumbar …

Risk Factors For In-Stent Stenosis After Flow-Diverter Implantation For Intracranial Aneurysm: A Single Center Analysis Of 161 Consecutive Patients, Rabab Alshahrani, Spyridon Karadimas, Mohammed Ali Alvi, Patrick Joseph Nicholson, Timo Krings

Department of Neurosurgery Faculty Papers

INTRODUCTION: Flow diverters (FD) are used for the treatment of intracranial aneurysms, by redirecting flow and serving as a scaffold for endothelial coverage of the aneurysm ostium. However, in-stent stenosis has been observed in some patients treated with these devices, the cause of which and the epidemiology remaining elusive. In the current study we aimed to elucidate potential factors leading to higher degree of in-stent stenosis including gender, location, and type of FD.

METHODS: The authors queried their institutional Electronic Health Record (EHR) for all patients undergoing FD for intracranial saccular aneurysms. We excluded cases where an FD was performed …

24-Month Patient-Reported Outcomes For A Novel Lumbar Total Joint Replacement, Ahilan Sivaganesan, Marissa Koscielski, Ashmal Sami, J. Alex Sielatycki, Jeffrey Goldstein, Brady Riesgraf, Craig Humphreys, Scott Hodges

Department of Neurosurgery Faculty Papers

BACKGROUND: Lumbar fusion remains a prevalent treatment for degenerative conditions; however, its limitations have sparked interest in alternative motion-sparing procedures. Our study evaluates 24-month postoperative patient-reported outcomes from an OUS pilot clinical study on a novel lumbar total joint replacement (TJR) for degenerative conditions.

METHODS: Data was collected from 63 patients, of which 56 patients fulfilled the inclusion criteria. Self-reported measures collected for this study are Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), Minimal Symptom State (MSS), Minimal Clinical Important Difference (MCID), Substantial Clinical Benefit (SCB). This retrospective analysis of prospective, IRB-approved collected data reports 24 month patient-reported outcomes …

Predictors Of Perioperative Stroke In Patients With Ischemic-Type Moyamoya Disease Treated With Surgical Revascularization: A Retrospective Multicenter Study, Basel Musmar, Joanna M. Roy, Hammam Abdalrazeq, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A. Grossberg, Adam A. Dmytriw, Aman B. Patel, Mirhojjat Khorasanizadeh, Christopher S. Ogilvy, Ajith J. Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo M. Cortez, Ricardo A. Hanel, Guilherme Porto, Alejandro M. Spiotta, Anthony J. Piscopo, David M. Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M. Nimjee, Kimon Bekelis, Mohamed M. Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M. Howard, Rosalind Lai, Rose Du, Rawad Abbas, Georgios S Sioutas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour

Department of Neurosurgery Faculty Papers

INTRODUCTION: Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive stenosis or occlusion of the internal carotid arteries and the development of collateral moyamoya vessels. Surgical revascularization is commonly used to prevent future ischemic events in ischemic-type MMD, but there remains a high rate of stroke perioperatively. This study aims to analyze the predictive factors for perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization using a large multicenter database.

METHODS: We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study included patients with ischemic-type …

Oculomotor Nerve Palsy Recovery Following Microsurgery Vs. Endovascular Treatment Of Posterior Communicating Artery Aneurysms: A Comparative Meta-Analysis Of Short- And Long-Term Outcomes, Rahim Abo Kasem, Conor Cunningham, Sameh Samir Elawady, Mohammad Mahdi Sowlat, Sofia Babool, Saad Hulou, Zachary Hubbard, Atakan Orscelik, Basel Musmar, Alejandro Spiotta

Department of Neurosurgery Faculty Papers

Recent advancements in endovascular treatment (EVT) and different views on optimal management for posterior communicating artery (PComA) aneurysms with oculomotor nerve palsy (ONP) highlight a need to compare recovery timelines between microsurgery and EVT; heterogeneous outcomes and influencing factors may also affect results. A comprehensive systematic review and meta-analysis were conducted by searching PubMed, Embase, Scopus, and Web of Science databases. The extracted data encompassed patient demographics, details on treatment modalities and timing, and characteristics of PComA aneurysms ONP caused by either unruptured or ruptured aneurysms. The primary outcome was ONP favorable recovery, defined as the resolution of admission symptoms, …

Human Studies Of The Efficacy And Safety Of Stem Cells In The Treatment Of Diabetic Peripheral Neuropathy: A Systematic Review And Meta-Analysis, Seyed Danial Alizadeh, Shima Jahani, Mohammad Rezaei Zadeh Rukerd, Reza Tabrizi, Rasoul Masoomi, Seyedeh Zahra Banihashemian, Mahgol Sadat Hassan Zadeh Tabatabaei, Zahra Ghodsi, Ahmad Pour-Rashidi, James Harrop, Vafa Rahimi-Movaghar

Department of Neurosurgery Faculty Papers

OBJECTIVE: To assess the efficacy and safety of stem cell therapy in human studies for diabetic peripheral neuropathy (DPN).

METHODS: A comprehensive literature review was performed across multiple databases, including Ovid MEDLINE ALL, Embase via Ovid SP, Scopus, Web of Science Core Collection, and Cochrane CENTRAL, up to January 31, 2024. Keywords and controlled vocabularies related to diabetic neuropathy and stem cell therapy were used. Inclusion criteria encompassed all controlled trials examining stem cell therapy for DPN, excluding animal or in vitro studies, review papers, conference abstracts, and editor letters. Data extraction and risk of bias assessment were independently performed …