Neurology Commons^™

Macrophage Type 2 Differentiation In A Patient With Laryngeal Squamous Cell Carcinoma And Metastatic Prostate Adenocarcinoma To The Cervical Lymph Nodes., Michael C. Topf, Madalina Tuluc, Larry A. Harshyne, Adam J. Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: The tumor microenvironment often polarizes infiltrating macrophages towards a type 2, or M2 phenotype, that is characterized by expression of various cysteine-rich, scavenger receptors, including CD163. The primary function of M2 macrophages is to facilitate wound healing. As such, they are capable of providing metabolic support to a growing tumor, neovascularization, as well as protection from cytotoxic T cells. The tumor microenvironment contains a milieu of secreted factors and vesicles, which in certain circumstances can gain access to lymphatic vessels that drain to local lymph nodes.

CASE PRESENTATION: We report a 59-year-old male with recurrent T4 squamous cell carcinoma …

Ruptured Mycotic Aneurysms: Report And Outcomes Of Two Surgically Managed Patients, Aleena Khan, Muhammad Waqas, Waseem Mehmood Nizamani, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Mycotic aneurysm is a rare potentially life-threatening complication of infective endocarditis (IE). Little data is available on the management and outcomes of ruptured mycotic aneurysms with large intracerebral hematoma. Few cases have been described on the management of mycotic aneurysm in the presence of life-threatening hematoma and mass effect.
Case description: We are presenting two cases of ruptured mycotic aneurysm with intracerebral hematoma and impending brain herniation. Both patients had signs of high intracranial pressure and required urgent surgical evacuation of clot. One patient survived while the other patient expired soon after surgery.
Conclusion: Mycotic aneurysm of middle cerebral …

Role Of Intra-Operative Mri (Imri) In Improving Extent Of Resection And Survival In Patients With Glioblastoma Multiforme, Inamullah Khan, Muhammad Waqas, Muhammad Shahzad Shamim

Section of Neurosurgery

Multiple intraoperative aids have been introduced to improve the extent of resection (EOR) in Glioblastoma Multiforme (GBM) patients, avoiding any new neurological deficits. Intraoperative MRI (iMRI) has been debated for its utility and cost for nearly two decades in neurosurgical literature. Review of literature suggests improved EOR in GBM patients who underwent iMRI assisted surgical resections leading to higher overall survival (OS) and progression free survival (PFS). iMRI provides real time intraoperative imaging with reasonable quality. Higher risk for new postoperative deficits with increased EOR is not reported in any study using iMRI. The level of evidence regarding prognostic benefits …

Degenerative Changes Of The Canine Cervical Spine After Discectomy Procedures, An In Vivo Study., Peter Grunert, Yu Moriguchi, Brian P Grossbard, Rodolfo J Ricart Arbona, Lawrence J Bonassar, Roger Härtl

Articles, Abstracts, and Reports

BACKGROUND: Discectomies are a common surgical treatment for disc herniations in the canine spine. However, the effect of these procedures on intervertebral disc tissue is not fully understood. The objective of this study was to assess degenerative changes of cervical spinal segments undergoing discectomy procedures, in vivo.

RESULTS: Discectomies led to a 60% drop in disc height and 24% drop in foraminal height. Segments did not fuse but showed osteophyte formation as well as endplate sclerosis. MR imaging revealed terminal degenerative changes with collapse of the disc space and loss of T2 signal intensity. The endplates showed degenerative type II …

Outcomes Of Post-Neurosurgical Ventriculostomy-Associated Infections, Muhammad Ehsan Bari, Ghani Haider, Komail Malik, Muhammad Waqas, Syed Faisal Mahmood, Mubbashira Siddiqui

Section of Neurosurgery

Background: Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes.
Methods: This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included. Patients with preexisting bacterial meningitis or ventriculitis were excluded from the study. Outcome assessment was based on Glasgow outcome scale (GOS) at 1 and 3 months …

Extent Of Resection And Timing Of Surgery In Adult Low Grade Glioma, Farhan A. Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Low grade glioma is a group of WHO grade II tumours including diffuse astrocytoma, oligodendroglioma, and oligoastrocytoma. Strong evidence exists in literature now to support early surgery and higher extent of safe resection in improving outcomes. In this review, we are highlighting some of the important studies done in the last few years specifically addressing timing of surgery and extent of resection.

Undetected Small Accessory Mental Foramina Using Cone-Beam Computed Tomography., Joe Iwanaga, Koichi Watanabe, Tsuyoshi Saga, Shogo Kikuta, Yoko Tabira, Sadaharu Kitashima, Christian Fisahn, Fernando Alonso, R Shane Tubbs, Jingo Kusukawa, Koh-Ichi Yamaki

Articles, Abstracts, and Reports

INTRODUCTION: The accessory foramina could not be identified on some imaging modalities such as surface-rendered images. The purpose of this study was to investigate the ability of surface-rendered images in detecting these foramina.

MATERIALS AND METHODS: We analyzed 20 accessory mental foramina (AMF) in nine mandibles removed from cadavers with cone-beam computed tomography (CBCT) and assessed in surface-rendered images. All AMF were divided into three groups depending on their visibility.

RESULTS: Group 1 included AMF that were clearly visible as foramina, Group 2 were not clearly visible but could be recognized with concave parts, and Group 3 were not visible …

Prognostic Significance Of Idh 1 Mutation In Patients With Glioblastoma Multiforme, Inamullah Khan, Muhammad Waqas, Muhammad Shahzad Shamim

Section of Neurosurgery

Focus of brain tumour research is shifting towards tumour genesis and genetics, and possible development of individualized treatment plans. Genetic analysis shows recurrent mutation in isocitrate dehydrogenase (IDH1) gene in most Glioblastoma multiforme (GBM) cells. In this review we evaluated the prognostic significance of IDH 1 mutation on the basis of published evidence. Multiple retrospective clinical analyses correlate the presence of IDH1 mutation in GBM with good prognostic outcomes compared to wild-type IDH1. A systematic review reported similar results. Based on the review of current literature IDH1 mutation is an independent factor for longer overall survival (OS) and progression free …

Quality Of Life In Individuals Surgically Treated For Congenital Hydrocephalus During Infancy: A Single-Institution Experience, Saad Akhtar Khan, Muhammad Faheem Khan, Saqib Kamran Bakhshi, Omar Irfan, Hamza Abdur Rahim Khan, Asad Abbas, Safia Awan, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country.
Methods: This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at QOL.
Results: Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, …

Association Of Magnet Status With Hospitalization Outcomes For Ischemic Stroke Patients., Kimon Bekelis, Symeon Missios, Todd A. Mackenzie

Department of Neurosurgery Faculty Papers

BACKGROUND: It is not clear whether Magnet recognition by the American Nurses Credentialing Center (nursing excellence program) is associated with improved patient outcomes. We investigated whether hospitalization in a Magnet hospital is associated with improved outcomes for patients with ischemic stroke.

METHODS AND RESULTS: We performed a cohort study of patients with ischemic stroke from 2009 to 2013, who were registered in the New York Statewide Planning and Research Cooperative System database. Propensity-score-adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was …

Comparison Of Stroke Cohorts Cared For By Two Different Specialties In A Practice-Based Tele-Stroke Population, Elias Atallah, Kimon Bekelis, Hassan Saad, Ayan Kumar, Justin Turpin, Randa Barsoom, Sophia Dang, Jonathan Li, Stavropoula Tjoumakaris, David Hasan, Maureen Deprince, Giuliana Labella, Robert H. Rosenwasswer, Pascal Jabbour

Department of Neurosurgery Posters

Conclusion

• Telemedicine is allowing for more patients suffering from AIS to receive care by dedicated stroke physicians including neurovascular surgeons.
• Our study does not find any difference in outcome between neurologists, who have traditionally managed stroke care, and neurosurgeons.
• Although ischemic stroke is a matter of multidisciplinary management, these surgeons are appropriately knowledgeable to prescribing IVrt-PA and concurrently performing MT in a highly-specialized stroke unit.

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

Section of Neurosurgery

No abstract provided.

Secondary Hematoma Expansion And Perihemorrhagic Edema After Intracerebral Hemorrhage: From Bench Work To Practical Aspects., Krista Lim-Hing, Fred Rincon

Department of Neurology Faculty Papers

Intracerebral hemorrhages (ICH) represent about 10-15% of all strokes per year in the United States alone. Key variables influencing the long-term outcome after ICH are hematoma size and growth. Although death may occur at the time of the hemorrhage, delayed neurologic deterioration frequently occurs with hematoma growth and neuronal injury of the surrounding tissue. Perihematoma edema has also been implicated as a contributing factor for delayed neurologic deterioration after ICH. Cerebral edema results from both blood-brain barrier disruption and local generation of osmotically active substances. Inflammatory cellular mediators, activation of the complement, by-products of coagulation and hemolysis such as thrombin …

Noninvasive Monitoring Intracranial Pressure - A Review Of Available Modalities, Marium Naveed Khan, Hussain Shallwani, Muhammad Ulusyar Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Intracranial pressure (ICP) monitoring is important in many neurosurgical and neurological patients. The gold standard for monitoring ICP, however, is via an invasive procedure resulting in the placement of an intraventricular catheter, which is associated with many risks. Several noninvasive ICP monitoring techniques have been examined with the hope to replace the invasive techniques. The goal of this paper is to provide an overview of all modalities that have been used for noninvasive ICP monitoring to date.
Methods: A thorough literature search was conducted on PubMed, selected articles were reviewed in completion, and pertinent data was included in the …

Perioperative Steroids For Lumbar Disc Surgery: A Meta-Analysis Of Randomized Controlled Trials, Muhammad Waqas, Hussain Shallwani, Muhammad Shahzad Shamim, Khabir Ahmed

Department of Surgery Docs

Background: Our review question was "Does perioperative steroids administration, in comparison with other treatments or placebo, improve either postoperative pain control, length of hospital stay, or return to work in patients undergoing lumbar disc surgery?"
Methods: We searched PubMed, CINAHL PLUS, and Cochrane databases for randomized control trials (RCTs) studying the role of steroids for lumbar disc surgery. Studies that compared perioperative steroids with other treatments or placebo were included. Study outcomes included postoperative back pain, leg pain, length of hospital stay, and return to work. Data was extracted through a proforma. Means and mean differences were calculated for continuous …

Perioperative Vision Loss In Cervical Spinal Surgery., Brandon C Gabel, Arthur Lam, Jens R Chapman, Rod J Oskouian, Ahmad Nassr, Bradford L Currier, Arjun S Sebastian, Paul M Arnold, Steven Hamilton, Michael G Fehlings, Thomas E Mroz, K Daniel Riew

Articles, Abstracts, and Reports

STUDY DESIGN: Retrospective multicenter case series.

OBJECTIVE: To assess the rate of perioperative vision loss following cervical spinal surgery.

METHODS: Medical records for 17 625 patients from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify occurrences of vision loss following surgery.

RESULTS: Of the 17 625 patients in the registry, there were 13 946 patients assessed for the complication of blindness. There were 9591 cases that involved only anterior surgical approaches; the remaining …

Anterior Cervical Infection: Presentation And Incidence Of An Uncommon Postoperative Complication., George M. Ghobrial, James S. Harrop, Rick C. Sasso, Chadi A. Tannoury, Tony Tannoury, Zachary A. Smith, Wellington K. Hsu, Paul M. Arnold, Michael G. Fehlings, Thomas E. Mroz, Anthony F. De Giacomo, Bruce C. Jobse, Ra'kerry K. Rahman, Sara E. Thompson, K Daniel Riew

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Retrospective multi-institutional case series.

OBJECTIVE: The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections.

METHODS: A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 …

Low Cost Quality Initiatives For Management Of Neurosurgical Patients In Developing Nations: Perspective From A Tertiary Care Centre In Pakistan, Hamid Hussain Rai, Muhammad Waqas, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Targeting resources on cost-effective care strategies is pertinent for developing nations, specifically for already burdened specialties such as neurosurgery, where without state support and insurance companies, expenses are borne by the patient themselves.
Methods: This was a descriptive review of literary work published by the section of neurosurgery at Aga Khan University Hospital, Pakistan. We searched PubMed and CiNAHL databases to identify articles, which were then critically analyzed and discussed from a perspective of low-cost quality care.
Results: We demonstrate the cost effectiveness of three initiatives, namely, blood ordering protocol for elective spine arthrodesis, nonoperative management being superior to …

Osborne's Ligament: A Review Of Its History, Anatomy, And Surgical Importance., Andre Granger, Juan P Sardi, Joe Iwanaga, Thomas J Wilson, Lynda Yang, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

When discussing the pathophysiology of ulnar neuropathy, Geoffrey Vaughan Osborne described a fibrous band that can be responsible for the symptoms seen in this disorder. In this paper, we take a glimpse at the life of Osborne and review the anatomy and surgical significance of Osborne's ligament. This band of tissue connects the two heads of the flexor carpi ulnaris and thus forms the roof of the cubital tunnel. To our knowledge, no prior publication has reviewed the history of this ligament, and very few authors have studied its anatomy in any detail. Therefore, the aim of the present paper …

Establishment Of Site Specific Multi-Disciplinary Tumour Boards In Pakistan: Sharing Experience Of Neuro Oncology Team Based At A Tertiary Care University Hospital, Muhammad Waqas, Ahmed Nadeem Abbasi

Section of Neurosurgery

No abstract provided.

Bone Morphogenic Proteins Are A Good Choice For Select Spinal Surgeries And Merit Further Research., Doniel Drazin, Eric Choi, Alfredo Garcia, Tarush Rustagi

Articles, Abstracts, and Reports

No abstract provided.

Open-Label Phase I Clinical Study To Assess The Safety And Efficacy Of Cilostazol In Patients Undergoing Internal Carotid Artery Stent Placement, A E. Hassan, H Zacharatos, M Grigoryan, Muhammed Suri, Adnan Qureshi

Articles

BACKGROUND:

One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel.

OBJECTIVE:

To evaluate the safety and clinical efficacy of cilostazol and aspirin therapy following internal carotid artery stent placement up to 1 month postprocedure.

METHODS:

A phase I open-label, nonrandomized two-center prospective study was conducted. All subjects received aspirin (325 mg/day) and cilostazol (200 mg/day) 3 days before extracranial stent placement. Two antiplatelet agents were continued for 1 …

Preventive Gabapentin Versus Pregabalin To Decrease Postoperative Pain After Lumbar Microdiscectomy: A Randomized Controlled Trial, Mohsin Qadeer, Muhammad Waqas, Muhammad Jawad Rashid, Ather Enam, Salman Sharif, Ghulam Murtaza

Section of Neurosurgery

Study design: Randomized controlled trial.
Purpose: The purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital.
Overview of literature: Pregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery.
Methods: This randomized controlled trial was carried out at our institute from February to October 2011 on 78 patients, with 39 participants in each study group. Patients undergoing …

Frequent Mild Head Injury Promotes Trigeminal Sensitivity Concomitant With Microglial Proliferation, Astrocytosis, And Increased Neuropeptide Levels In The Trigeminal Pain System., Ashley L. Tyburski, Lan Cheng, Soroush Assari, Kurosh Darvish, Melanie B Elliott

Department of Neurosurgery Faculty Papers

BACKGROUND: Frequent mild head injuries or concussion along with the presence of headache may contribute to the persistence of concussion symptoms.

METHODS: In this study, the acute effects of recovery between mild head injuries and the frequency of injuries on a headache behavior, trigeminal allodynia, was assessed using von Frey testing up to one week after injury, while histopathological changes in the trigeminal pain pathway were evaluated using western blot, ELISA and immunohistochemistry. RESULTS: A decreased recovery time combined with an increased mild closed head injury (CHI) frequency results in reduced trigeminal allodynia thresholds compared to controls. The repetitive CHI …

Neurosurgery Concepts: Key Perspectives On Imaging Characteristics Of Spinal Metastases, Surgery For Low Back Pain, Anesthesia For Disc Surgery, And Laminectomy Versus Laminectomy And Fusion For Lumbar Spondylolisthesis., Carlito Lagman, Lawrance K Chung, Luke Macyszyn, Winward Choy, Zachary A Smith, Nader S Dahdaleh, Angela M Bohnen, Jin M Cho, Chaim B Colen, Edward Duckworth, Anand V Germanwala, Peter Kan, Alexander A Khalessi, Chae-Yong Kim, Sandi Lam, Gordon Li, Michael Lim, Jonathan H Sherman, Vincent Y Wang, Gabriel Zada, Isaac Yang

Neurological Surgery Faculty Publications

No abstract provided.

Neurosurgery Concepts: Key Perspectives On Endoscopic Versus Microscopic Resection For Pituitary Adenomas, Surgical Decision-Making In Tuberculum Sellae Meningiomas, Optic Nerve Mobilization During Resection Of Craniopharyngiomas, And Evaluation Of Headache And Quality Of Life After Endoscopic Transphenoidal Surgery For Pituitary Adenomas, Anand Germanwala, Ryan Hofler, Carlito Lagman, Lawrence Chang, Alexander Khaleesi, Jonathan H. Sherman, +Several Additional Authors

Neurological Surgery Faculty Publications

No abstract provided.

Neurorobotics In Pakistan, Ather Enam, Muhammad Waqas

Section of Neurosurgery

No abstract provided.

Complications Of In-Patient Cerebral Angiography: Comparison Between Patients With And Without Sub Arachnoid Haemorrhage, Yaseen Rauf, Usman Tariq Siddiqui, Gohar Javed

Section of Neurosurgery

Objective: To compare complications of cerebral angiography among patients with and without subarachnoid haemorrhage.
Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients undergoing inpatient therapeutic and diagnostic cerebral angiographies from 2001 to 2010. The patients were divided into subarachnoid and non-subarachnoid haemorrhage groups. During the study period no modifications were made to the operational protocol and all patients were subjected to the same procedure and prophylactic care.
Results: Of the 93 patients, 42(45.2%) were women and 51(54.8%) were men. The overall mean age was 45.27±16.15 years (range: 4-80 years). The …

Astrocytes Promote Progression Of Breast Cancer Metastases To The Brain Via A Kiss1-Mediated Autophagy., Natalya Kaverina, Anton V Borovjagin, Zaira Kadagidze, Anatoly Baryshnikov, Maria Baryshnikova, Dmitry Malin, Dhimankrishhna Ghosh, Nameeta Shah, Danny R Welch, Patrik Gabikian, Apollon Karseladze, Charles Cobbs, Ilya V Ulasov

Articles, Abstracts, and Reports

Formation of metastases, also known as cancer dissemination, is an important stage of breast cancer (BrCa) development. KISS1 expression is associated with inhibition of metastases development. Recently we have demonstrated that BrCa metastases to the brain exhibit low levels of KISS1 expression at both mRNA and protein levels. By using multicolor immunofluorescence and coculture techniques here we show that normal adult astrocytes in the brain are capable of promoting metastatic transformation of circulating breast cancer cells localized to the brain through secretion of chemokine CXCL12. The latter was found in this study to downregulate KISS1 expression at the post-transcriptional level …

Return To Play After Cervical Spine Injuries: A Consensus Of Opinion., John C. France, Michael Karsy, James S. Harrop, Andrew T. Dailey

Department of Neurosurgery Faculty Papers

Study Design Survey. Objective Sports-related spinal cord injury (SCI) represents a growing proportion of total SCIs but lacks evidence or guidelines to guide clinical decision-making on return to play (RTP). Our objective is to offer the treating physician a consensus analysis of expert opinion regarding RTP that can be incorporated with the unique factors of a case for clinical decision-making. Methods Ten common clinical scenarios involving neurapraxia and stenosis, atlantoaxial injury, subaxial injury, and general cervical spine injury were presented to 25 spine surgeons from level 1 trauma centers for whom spine trauma is a significant component of their practice. …