Neurology Commons^™

Automated Fiber Tract Reconstruction For Surgery Planning: Extensive Validation In Language-Related White Matter Tracts., Matteo Mancini, Sjoerd B. Vos, Vejay N. Vakharia, Aidan G. O'Keeffe, Karin Trimmel, Frederik Barkhof, Christian Dorfer, Salil Soman, Gavin P. Winston, Chengyuan Wu, John S. Duncan, Rachel Sparks, Sebastien Ourselin

Department of Neurosurgery Faculty Papers

Diffusion MRI and tractography hold great potential for surgery planning, especially to preserve eloquent white matter during resections. However, fiber tract reconstruction requires an expert with detailed understanding of neuroanatomy. Several automated approaches have been proposed, using different strategies to reconstruct the white matter tracts in a supervised fashion. However, validation is often limited to comparison with manual delineation by overlap-based measures, which is limited in characterizing morphological and topological differences. In this work, we set up a fully automated pipeline based on anatomical criteria that does not require manual intervention, taking advantage of atlas-based criteria and advanced acquisition protocols …

Cervical Posterior Longitudinal Ligament Ossification : Microscopy-Assisted Anterior Corpectomy And Fusion., Wanyi Wang, Tao Ding, James Harrop, Huilin Yang, Xiaofeng Gu, Dehong Feng, Yafeng Zhang, Hao Liu, Fenglin Tang, Yuntao Xue, Miao Lu, Chao Wu

Department of Neurosurgery Faculty Papers

OBJECTIVE: To explore the clinical efficacy and safety of microscopy-assisted anterior corpectomy and fusion for cervical ossification of the posterior longitudinal ligament (OPLL).

METHODS: A retrospective review of 32 cervical OPLL patients who underwent microscopy-assisted anterior corpectomy and fusion from June 2012 to March 2017 was carried out. Patients were evaluated with outcome metrics: Japanese Orthopaedic Association (JOA) scores (17 points method), visual analog scale (VAS), and radiographic parameters of the lordotic angle. The complications during treatment and follow-up were recorded.

RESULTS: This study included 32 patients (15 males and 17 females) with a mean age of 58.3 ± 2.9 …

Re-Code Dcm (Research Objectives And Common Data Elements For Degenerative Cervical Myelopathy): A Consensus Process To Improve Research Efficiency In Dcm, Through Establishment Of A Standardized Dataset For Clinical Research And The Definition Of The Research Priorities, Benjamin M. Davies, Danyal Z. Khan, Oliver D. Mowforth, Angus G.K. Mcnair, Toto Gronlund, Angelos G. Kolias, Lindsay Tetreault, Michelle L. Starkey, Iwan Sadler, Ellen Sarewitz, Delphine Houlton, Julia Carter, Sukhvinder Kalsi-Ryan, Bizhan Aarabi, Brian K. Kwon, Shekar N. Kurpad, James Harrop, Jefferson R. Wilson, Robert Grossman, Armin Curt, Michael G. Fehlings, Mark R.N. Kotter

Department of Neurosurgery Faculty Papers

Study Design: Mixed-method consensus process.

Objectives: Degenerative cervical myelopathy (DCM) is a common and disabling condition that arises when mechanical stress damages the spinal cord as a result of degenerative changes in the surrounding spinal structures. RECODE-DCM (REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy) aims to improve efficient use of health care resources within the field of DCM by using a multi-stakeholder partnership to define the DCM research priorities, to develop a minimum dataset for DCM clinical studies, and confirm a definition of DCM.

Methods: This requires a multi-stakeholder partnership and multiple parallel consensus development processes. It …

The Insula And Its Epilepsies, Barbara C. Jobst, Jorge Gonzalez-Martinez, Jean Isnard, Philippe Kahane, Nuria Lacuey, Samden D. Lahtoo, Dang K. Nguyen, Chengyuan Wu, Fred Lado

Department of Neurosurgery Faculty Papers

Insular seizures are great mimickers of seizures originating elsewhere in the brain. The insula is a highly connected brain structure. Seizures may only become clinically evident after ictal activity propagates out of the insula with semiology that reflects the propagation pattern. Insular seizures with perisylvian spread, for example, manifest first as throat constriction, followed next by perioral and hemisensory symptoms, and then by unilateral motor symptoms. On the other hand, insular seizures may spread instead to the temporal and frontal lobes and present like seizures originating from these regions. Due to the location of the insula deep in the brain, …

Hemispheric Regional Based Analysis Of Diffusion Tensor Imaging And Diffusion Tensor Tractography In Patients With Temporal Lobe Epilepsy And Correlation With Patient Outcomes., Mahdi Alizadeh, Lauren Kozlowski, Jennifer Muller, Neha Ashraf, Shiva Shahrampour, Feroze B. Mohamed, Chengyuan Wu, Ashwini Sharan

Department of Neurosurgery Faculty Papers

Imaging in the field of epilepsy surgery remains an essential tool in terms of its ability to identify regions where the seizure focus might present as a resectable area. However, in many instances, an obvious structural abnormality is not visualized. This has created the opportunity for new approaches and imaging innovation in the field of epilepsy, such as with Diffusion Tensor Imaging (DTI) and Diffusion Tensor Tractography (DTT). In this study, we aim to evaluate the use of DTI and DTT as a predictive model in the field of epilepsy, specifically Temporal Lobe Epilepsy (TLE), and correlate their clinical significance …

Spinal Infections: From Prevention To Cure, James Harrop

Department of Neurosurgery Faculty Papers

AOSpine North America (AOSNA) is honored to have the ability to present this focused issue on spinal infections. As we are all aware, spinal infections are a prevalent part of our daily treatment regimen as spine surgeons—whether these infections are in our elective practice or emergencies.

Plasma Soluble Human Elastin Fragments As An Intra-Aneurysmal Localized Biomarker For Ruptured Intracranial Aneurysm, Daichi Nakagawa, Mario Zanaty, Joseph Hudson, Nahom Teferi, Daizo Ishii, Lauren Allan, Pascal Jabbour, Santiago Ortega-Gutierrez, Edgar A. Samaniego, David M. Hasan

Department of Neurosurgery Faculty Papers

Background—Fragmentation of the tunica media is a hallmark of intracranial aneurysm formation, often leading to aneurysmal progression and subsequent rupture. The objective of this study is to determine the plasma level of elastin fragments in the lumen of ruptured versus unruptured human intracranial aneurysms. Methods and Results—One hundred consecutive patients with/without ruptured saccular intracranial aneurysms undergoing endovascular coiling or stent-assisted coiling were recruited. Blood samples were collected from the lumen of intracranial aneurysm using a microcatheter. The tip of the microcatheter was placed inside the aneurysm’s sac in close proximity to the inner wall of the dome. Plasma levels of …

Chronically Implanted Intracranial Electrodes: Tissue Reaction And Electrical Changes., Andrew Campbell, Chengyuan Wu

Department of Neurosurgery Faculty Papers

The brain-electrode interface is arguably one of the most important areas of study in neuroscience today. A stronger foundation in this topic will allow us to probe the architecture of the brain in unprecedented functional detail and augment our ability to intervene in disease states. Over many years, significant progress has been made in this field, but some obstacles have remained elusive-notably preventing glial encapsulation and electrode degradation. In this review, we discuss the tissue response to electrode implantation on acute and chronic timescales, the electrical changes that occur in electrode systems over time, and strategies that are being investigated …

Cigarette Smoke Initiates Oxidative Stress-Induced Cellular Phenotypic Modulation Leading To Cerebral Aneurysm Pathogenesis., Robert M. Starke, John W. Thompson, Muhammad S. Ali, Crissey L. Pascale, Alejandra Martinez Lege, Dale Ding, Nohra Chalouhi, David M. Hasan, Pascal Jabbour, Gary K Owens, Michal Toborek, Joshua M. Hare, Aaron S. Dumont

Department of Neurosurgery Faculty Papers

OBJECTIVE: Cigarette smoke exposure (CSE) is a risk factor for cerebral aneurysm (CA) formation, but the molecular mechanisms are unclear. Although CSE is known to contribute to excess reactive oxygen species generation, the role of oxidative stress on vascular smooth muscle cell (VSMC) phenotypic modulation and pathogenesis of CAs is unknown. The goal of this study was to investigate whether CSE activates a NOX (NADPH oxidase)-dependent pathway leading to VSMC phenotypic modulation and CA formation and rupture.

APPROACH AND RESULTS: In cultured cerebral VSMCs, CSE increased expression of NOX1 and reactive oxygen species which preceded upregulation of proinflammatory/matrix remodeling genes …

Migraine And Vascular Disease Biomarkers: A Population-Based Case-Control Study., Gretchen E. Tietjen, Jagdish Khubchandani, Nabeel Herial, Inge H. Palm-Meinders, Hille Koppen, Gisela M. Terwindt, Mark A. Van Buchem, Lenore J. Launer, Michel D. Ferrari, Mark C. Kruit

Department of Neurosurgery Faculty Papers

Background The underpinnings of the migraine-stroke association remain uncertain, but endothelial activation is a potential mechanism. We evaluated the association of migraine and vascular disease biomarkers in a community-based population. Methods Participants (300 women, 117 men) were recruited as a part of the Dutch CAMERA 1 (Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis) study. Participants were aged 30-60 (mean 48) years, 155 migraine had with aura (MA), 128 migraine without aura (MO), and 134 were controls with no severe headaches. Plasma concentrations of fibrinogen, Factor II, D-dimer, high sensitivity C-reactive protein (hs-CRP), and von Willebrand factor antigen were compared …

Ependymomas Overexpress Chemoresistance And Dna Repairrelated Proteins, Sherise D. Ferguson, Shouhao Zhou, Joanne Xiu, Yuuri Hashimoto, Nader Sanai, Lyndon Kim, Santosh Kesari, John De Groot, David Spetzler, Amy B. Heimberger

Department of Neurosurgery Faculty Papers

Background: After surgery and radiation, treatment options for ependymoma are few making recurrence a challenging issue. Specifically, the efficacy of chemotherapy at recurrence is limited. We performed molecular profiling on a cohort of ependymoma cases in order to uncover therapeutic targets and to elucidate the molecular mechanisms contributing to treatment resistance. Results: This ependymoma cohort showed minimal alterations in gene amplifications and mutations but had high expression rates of DNA synthesis and repair enzymes such as RRM1 (47%), ERCC1 (48%), TOPO1 (62%) and class III β-tublin (TUBB3) (57%), which are also all associated with chemoresistance. This cohort also had high …

The Technique Of S2-Alar-Iliac Screw Fixation: A Literature Review, Ai-Min Wu, Dong Chen, Chun-Hui Chen, Yu-Zhe Li, Li Tan Li Tang, Kevin Phan, Kern Singh, Brittany E. Haws, Daniele Vanni, Yusef I. Mosley, Srinivas K. Prasad, James Harrop, Zhong-Ke Lin, Yan Lin, Wen-Fei Ni, Xiang-Yang Wang

Department of Neurosurgery Faculty Papers

The distal fixation in thoracolumbar deformity surgery can be challenging for spine surgeons. When isolated S1-pedicle screws are utilized as the sole distal fixation in long thoracolumbar posterior constructs, there is a high rate of failure, due to loosening, breakage, and pseudarthrosis. Unfortunately, with iliac screw fixation the entry point at the posterior superior iliac spine requires considerable soft tissue dissection and may potentially increase the likelihood of wound complications. S2-alar-iliac (S2AI) screw fixation technique was developed recently to provide increased fixation with a lower profile screw and rod construct. These screws can be inserted with percutaneous or free hand …

Hidden Blood Loss Between Pccp And Pfna In Elderly Femoral Intertrochanteric Fracture, Tao Ding, Huilin Yang, James Harrop, Xiaofeng Gu, Dehong Feng, Yafeng Zhang, Fan Zhan Zhang, Yuntao Xue

Department of Neurosurgery Faculty Papers

To compare perioperative hidden blood loss in the treatment of femoral intertrochanteric fractures with percutaneous compression plate (PCCP) and proximal femoral nail anti-rotation (PFNA) in elderly patients, and analyse its influencing factors in order to provide the necessary data support for clinical perioperative treatment, and choice of appropriate internal fixation method. Retrospective analyses was carried out on data obtained from 158 patients with intertrochanteric fracture treated with PCCP or PFNA from January 2010 to May 2017. Data were obtained from variables such as age, gender, height, weight, operative bleeding and postoperative drainage, operation time, etc. Upon blood routine examination before …

Sex Differential In 15-Hydroxyprostaglandin Dehydrogenase Levels In The Lumen Of Human Intracranial Aneurysms., Nohra Chalouhi, Pascal Jabbour, Mario Zanaty, Robert M. Starke, James Torner, Daichi Nakagawa, David M. Hasan

Department of Neurosurgery Faculty Papers

BACKGROUND: Aspirin is a promising medical therapy for the prevention of intracranial aneurysm (IA) rupture. Recently, we found that men have a better response to aspirin than women. The purpose of this study was to determine whether a sex differential exists in the level of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) in the lumen of human IAs.

METHODS AND RESULTS: Consecutive patients undergoing coiling or stent-assisted coiling for a saccular IA at our institution were enrolled. Two samples (A and B) were collected from IA lumens, and the plasma level of 15-PGDH was measured using an ELISA-based method. The study included 38 patients, …

Efficacy, Safety, And Timing Of Anticoagulant Thromboprophylaxis For The Prevention Of Venous Thromboembolism In Patients With Acute Spinal Cord Injury: A Systematic Review, Paul M. Arnold, James S. Harrop, Geno J. Merli, Lindsay G. Tetreault, Brain K. Kwon, Steve Casha, Katherine Palmieri, Jefferson R. Wilson, Michael G. Fehlings, Haley K. Holmer, Daniel C. Norvell

Department of Neurosurgery Faculty Papers

Study Design: Systematic review. Objectives: The objective of this study was to answer 5 key questions: What is the comparative effectiveness and safety of (1a) anticoagulant thromboprophylaxis compared to no prophylaxis, placebo, or another anticoagulant strategy for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after acute spinal cord injury (SCI)? (1b) Mechanical prophylaxis strategies alone or in combination with other strategies for preventing DVT and PE after acute SCI? (1c) Prophylactic inferior vena cava filter insertion alone or in combination with other strategies for preventing DVT and PE after acute SCI? (2) What is the optimal timing to …

A Clinical Practice Guideline For The Management Of Patients With Degenerative Cervical Myelopathy: Recommendations For Patients With Mild, Moderate, And Severe Disease And Nonmyelopathic Patients With Evidence Of Cord Compression, Michael G. Fehlings, Lindsay A. Tetreault, K. Daniel Riew, James W. Middleton, Bizhan Aarabi, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Simon Carette, Robert Chen, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Ferlan, James S. Harrop, Langston T. Holly, Sukhvinder Kalsi-Ryan, Mark Kotter, Brian K. Kwon, Allan R. Martin, James Milligan, Hiroaki Nakashima, Narihito Nagoshi, John Rhee, Anoushka Singh, Andrea C. Skelly, Sumeet Sodhi, Jefferson R. Wilson, Albert Yee, Jeffrey C. Wang

Department of Neurosurgery Faculty Papers

Study Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline …

A Clinical Practice Guideline For The Management Of Acute Spinal Cord Injury: Introduction, Rationale, And Scope, Michael G. Fehlings, Lindsay A. Tetreault, Jefferson R. Wilson, Brian K. Kwon, Anthony S. Burns, Allan R. Martin, Gregory Hawryluk, James S. Harrop

Department of Neurosurgery Faculty Papers

Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient’s physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of …

Intracranial Eeg Fluctuates Over Months After Implanting Electrodes In Human Brain., Hoameng Ung, Steven N. Baldassano, Hank Bink, Abba M. Krieger, Shawniqua Williams, Flavia Vitale, Chengyuan Wu, Dean Freestone, Ewan Nurse, Kent Leyde, Kathryn A. Davis, Mark Cook, Brian Litt

Department of Neurosurgery Faculty Papers

OBJECTIVE: Implanting subdural and penetrating electrodes in the brain causes acute trauma and inflammation that affect intracranial electroencephalographic (iEEG) recordings. This behavior and its potential impact on clinical decision-making and algorithms for implanted devices have not been assessed in detail. In this study we aim to characterize the temporal and spatial variability of continuous, prolonged human iEEG recordings.

APPROACH: Intracranial electroencephalography from 15 patients with drug-refractory epilepsy, each implanted with 16 subdural electrodes and continuously monitored for an average of 18 months, was included in this study. Time and spectral domain features were computed each day for each channel for …

Timing Of Decompression In Patients With Acute Spinal Cord Injury: A Systematic Review, Jefferson R. Wilson, Lindsay A. Tetreault, Brian Kwon, Paul M. Arnold, Thomas E. Mroz, Christopher I. Shaffrey, James S. Harrop, Jens R. Chapman, Steven Casha, Andrea C. Skelly, Haley K. Holmer, Erika D. Brodt, Michael G. Fehlings

Department of Neurosurgery Faculty Papers

Study Design: Systematic review. Objective: To conduct a systematic review and synthesis of the literature to assess the comparative effectiveness, safety, and cost-effectiveness of early (≤24 hours) versus late decompression (>24 hours) in adults with acute spinal cord injury (SCI). Methods: A systematic search was conducted of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar to identify studies published through November 6, 2014. Studies published in any language, in humans, and with an abstract were considered for inclusion. Included studies were critically appraised and the overall strength of evidence was determined using methods proposed by the Grading of …

Efficacy And Safety Of Methylprednisolone Sodium Succinate In Acute Spinal Cord Injury: A Systematic Review, Michael G. Fehlings, Jefferson R. Wilson, James S. Harrop, Brian Kwon, Lindsay A. Tetreault, Paul M. Arnold, Jeffrey M. Singh, Gregory W.J. Hawryluk, Joseph R. Dettori

Department of Neurosurgery Faculty Papers

Study Design: Systematic review and meta-analysis. Objective: The objective of this study was to conduct a systematic review to assess the comparative effectiveness and safety of high-dose methylprednisolone sodium succinate (MPSS) versus no pharmacological treatment in patients with traumatic spinal cord injury (SCI). Methods: A systematic search was performed in PubMed and the Cochrane Collaboration Library for literature published between January 1956 and June 17, 2015. Included studies were critically appraised, and Grades of Recommendation Assessment, Development and Evaluation methods were used to determine the overall quality of evidence for primary outcomes. Previous systematic reviews on this topic were collated …

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 …

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 …

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 …

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. …

Duration Of Posttraumatic Amnesia Predicts Neuropsychological And Global Outcome In Complicated Mild Traumatic Brain Injury., Tessa Hart, Thomas A. Novack, Nancy Temkin, Jason Barber, Sureyya S. Dikmen, Ramon Diaz-Arrastia, Joseph Ricker, Dale C. Hesdorffer, Jack Jallo, Nancy H. Hsu, Ross Zafonte

Department of Neurosurgery Faculty Papers

OBJECTIVES: Examine the effects of posttraumatic amnesia (PTA) duration on neuropsychological and global recovery from 1 to 6 months after complicated mild traumatic brain injury (cmTBI).

PARTICIPANTS: A total of 330 persons with cmTBI defined as Glasgow Coma Scale score of 13 to 15 in emergency department, with well-defined abnormalities on neuroimaging.

METHODS: Enrollment within 24 hours of injury with follow-up at 1, 3, and 6 months.

MEASURES: Glasgow Outcome Scale-Extended, California Verbal Learning Test II, and Controlled Oral Word Association Test. Duration of PTA was retrospectively measured with structured interview at 30 days postinjury.

RESULTS: Despite all having a …

Intraoperative Neurophysiological Monitoring For Endoscopic Endonasal Approaches To The Skull Base: A Technical Guide., Harminder Singh, Richard W. Vogel, Robert M. Lober, Adam T. Doan, Craig I. Matsumoto, Tyler J. Kenning, James J. Evans

Department of Neurosurgery Faculty Papers

Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory …

Iv And Ip Administration Of Rhodamine In Visualization Of Wbc-Bbb Interactions In Cerebral Vessels., Zachary Wilmer Reichenbach, Hongbo Li, John P. Gaughan, Melanie B. Elliott, Ronald Tuma

Department of Neurosurgery Faculty Papers

Epi-illuminescence intravital fluorescence microscopy has been employed to study leukocyte-endothelial interactions in a number of brain pathologies. Historically, dyes such as Rhodamine 6G have been injected intravenously. However, intravenous injections can predispose experimental animals to a multitude of complications and requires a high degree of technical skill. Here, we study the efficacy of injecting Rhodamine 6G into the peritoneum (IP) for the purpose of analyzing leukocyte-endothelial interactions through a cranial window during real time intravital microscopy. After examining the number of rolling and adherent leukocytes through a cranial window, we found no advantage to the intravenous injection (IV). Additionally, we …

Endovascular Stroke Therapy Results Improve Over Time: The ‘Learning Curve’ At A New Comprehensive Stoke Center, Ethan A. Benardete, Anil K. Nair

Department of Neurosurgery Faculty Papers

Background: The requirements for a comprehensive stroke center (CSC) include the capability to perform endovascular stroke therapy (EST). EST is a complex process requiring early identification of appropriate patients and effective delivery of intervention. In order to provide prompt intervention for stroke, CSCs have been established away from large academic centers in community-based hospitals. We hypothesized that quantifiable improvements would occur during the first 2 years of a community-based CSC as the processes and personnel evolved. We report the results over time of EST at a new community-based CSC. Methods: We have retrospectively analyzed demographic data and outcome metrics of …

Management Of Head And Neck Pseudoaneurysms: A Review Of 33 Consecutive Cases., Eliza Anderson, Nohra Chalouhi, Md, Aaron Dumont, Stavropoula Tjoumakaris, Mario Zanaty, Robert H. Rosenwasswer Md, Robert M Starke, Pascal Jabbour Md

Department of Neurosurgery Faculty Papers

Background. Endosaccular coiling, vessel occlusion, stenting, stent-assisted coiling, and flow diversion are all endovascular treatment options for pseudoaneurysms (PAs) of the head and neck. We explore different clinical situations in which these were selected for PA management at a single institution. Methods. Over a period of ten years, 33 patients presented to our hospital with PAs of the head and neck. Their outcomes and procedural complications are discussed. Results. We observed a complication rate of 18.2% (6 of 33), consisting predominantly of infarcts following vessel occlusion. As measured by the modified Rankin Scale, 25 (75.8%) patients had achieved favorable outcomes …

Cerebral Arteriovenous Malformations: Evaluation And Management., Norman Ajiboye, Nohra Chalouhi, Md, Robert M Starke, Mario Zanaty, Rodney Bell, Md

Department of Neurosurgery Faculty Papers

There has been increased detection of incidental AVMs as result of the frequent use of advanced imaging techniques. The natural history of AVM is poorly understood and its management is controversial. This review provides an overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management of AVMs. The authors discussed the imaging techniques available for detecting AVMs with regard to the advantages and disadvantages of each imaging modality. Furthermore, this review paper discusses the factors that must be considered for the most appropriate management strategy (based on the current evidence in the literature) and the risks and benefits …