Neurosurgery Commons^™

Transient Neuromonitoring Changes And Delayed Vertebrobasilar Infarction Following Anterior Cervical Discectomy And Fusion: Illustrative Case, Jacob M. Chaisson, Jack A. Leoni, Ellery A. Hayden, Gabriel C. Tender, Amit K. Bhandutia

School of Medicine Faculty Publications

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with a well-established safety profile. While direct vertebral artery injury is rare and typically recognized intraoperatively, delayed posterior circulation stroke is an even less common but major complication. In patients with risk factors for vascular disease, vascular stress from surgical manipulation may predispose them to thromboembolic events that are not immediately apparent. Transient intraoperative neuromonitoring (IONM) changes may represent early, underrecognized indicators of such vascular compromise. OBSERVATIONS: The authors present the case of a 61-year-old male who underwent elective three-level ACDF for degenerative cervical myelopathy. During cage placement, …

Geographic And Socioeconomic Predictors Of Early Follow-Up Loss In Patients Undergoing Pituitary Neuroendocrine Tumors (Pitnets) Resection: A Retrospective Review Of 1143 Cases, Daniel Quintana, Rithvik Ramesh, Robert C. Osorio, Wesley Shoap, Paul Mcmillan Villalobos, Philip V. Theodosopoulos, Sandeep Kunwar, Jose Gurrola, Ivan H. El Sayed, Manish K. Aghi, Ezequiel Goldschmidt

School of Medicine Faculty Publications

OBJECTIVE: Postoperative follow-up after PitNET resection is essential for monitoring tumor recurrence and endocrinological deficits. Despite advances in telehealth, loss to follow-up remains a persistent challenge across neurosurgical patients. This study aims to identify factors to identify patients are at higher risk of being lost to follow-up after surgery. METHODS: A retrospective analysis was conducted on 1,143 adult patients who underwent PitNET resection between 2012 and 2019 at a single institution. Clinical and radiological data were analyzed to assess loss to follow-up in the cohort. Multivariable logistic and negative binomial regression models were used to identify factors independently associated with …

Superficial Cervical Plexus Block For Postoperative Pain Management In Occipital Craniotomies: A Narrative Review, Shahab Ahmadzadeh, Bennett M. Ford, Alex V. Hollander, Mary Kathleen Luetkemeier, Tomasina Q. Parker-Actlis, Sahar Shekoohi

School of Medicine Faculty Publications

Post-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2-C4 nerves to anesthetize the occipital scalp region, covering the lesser occipital nerve territory that lies within typical posterior scalp incisions. Clinical evidence shows the block is effective in reducing acute postoperative pain after occipital craniotomy and diminishes opioid requirements. Studies have demonstrated successful and long-lasting analgesia, reductions in 24-h opioid consumption, and a lower incidence of severe pain. Moreover, the technique …

Surgical Management Of A Pulmonary Neuroendocrine Tumor Causing Epidural Spinal Cord Compression And Transdural Intramedullary Invasion: Illustrative Case, Wesley Shoap, Kion Gregory, Jack A. Leoni, Gabriel C. Tender

School of Medicine Faculty Publications

BACKGROUND Intramedullary spinal cord metastasis from local transdural invasion is an exceedingly rare event. Therefore, specific guidance on the timing, type, and extent of surgical intervention is lacking. OBSERVATIONS A 60-year-old male with a known pulmonary neuroendocrine tumor presented with 2 days of progressive lower extremity paraplegia rendering him nonambulatory. MRI demonstrated transpleural and paravertebral invasion by the mass with extension through the left T1–2 and T2–3 neural foramina causing significant epidural compression. There was also transdural invasion at T2 extending intramedullary to the C4 spinal level, with associated cord edema. He underwent posterior cervicothoracic laminectomy and fusion with transpedicular …

Surgical Versus Nonsurgical Management Of Civilian Craniocerebral Gunshot Injuries, Wesley Shoap, George Austin Crabill, Roboan Guillen, Kaleb Derouen, Jack Leoni, Zhide Fang, Berje Shammassian

School of Medicine Faculty Publications

Introduction: Craniocerebral gunshot wounds in the civilian population constitute a devastating subset of traumatic brain injuries (TBI). The aim of this study was to determine the association of mortality, intensive care unit length of stay (ICU LOS), and the Glasgow Outcome Scale Extended (GOS-E) among craniocerebral gunshot patients based on timing and type of intervention. Methods: The trauma database was queried for GSWH patients ages 15 and older who received neurosurgical intervention from January 1st 2016 to June 1st 2023. Operative notes were reviewed and patients were then divided into three groups; intracranial pressure monitor only with medical treatment (ICP), …

Unilateral Hemicraniectomy With Titanium Cranioplasty For The Treatment Of High Intracranial Pressure In A Pediatric Patient With Camurati-Engelmann Disease: Illustrative Case, Roboan Guillen-Arguello, Nicholas Sader, J. Gordon Mccomb

School of Medicine Faculty Publications

BACKGROUND Camurati-Engelmann disease (CED) is an extremely rare autosomal dominant genetic disorder that can cause increased intracranial pressure (ICP) secondary to cranial hyperostosis, which decreases intracranial volume. Surgical procedures to reduce ICP in medically refractory cases include intracranial volume expansion and ventriculoperitoneal shunting. OBSERVATIONS The authors present the case of a pediatric patient with CED and medically refractory increased ICP who underwent unilateral hemicraniectomy with titanium cranioplasty, resulting in a complete long-term resolution of symptoms. LESSONS Unilateral hemicraniectomy with titanium cranioplasty is a feasible surgical treatment for CED in pediatric patients with medically refractory increased ICP and papilledema.

Editorial To Advances In Minimally Invasive Spine Surgery, Gabriel C. Tender, George A. Crabill

School of Medicine Faculty Publications

No abstract provided.

Cervical Osteomyelitis In The Setting Of Multiple Comorbidities: A Complex Anatomical Approach. Illustrative Case, Jack A. Leoni, Michelle E. Veillon-Bradshaw, Kaleb J. Derouen, John M. Wilson, Wesley M. Shoap

School of Medicine Faculty Publications

BACKGROUND Vertebral osteomyelitis (VO), also known as spinal osteomyelitis or spondylodiscitis, is a rather rare yet serious disease comprising 3%–5% of all osteomyelitis cases, with only 3%–6% of this subset affecting the cervical spine. Risk factors include an advanced age, diabetes, immunosuppression, and intravenous (IV) drug use. The incidence of VO has increased over recent decades, with high-risk patients experiencing higher mortality rates. Treatment guidelines for VO are not standardized and rely on physician preference, often starting with IV antibiotics and progressing to surgery, if necessary. OBSERVATIONS A 54-year-old female with tracheostomy-dependent obesity hypoventilation syndrome, hypertension, and morbid obesity presented …

Prospective Trial Of Sacroiliac Joint Fusion Using 3d-Printed Triangular Titanium Implants: 5-Year Follow-Up, Vikas Patel, S. Craig Meyer, Don Kovalsky, Harry Lockstadt, Jim Farris, Robert Limoni, Abhineet Chowdhary, Philip Yuan, Casey Langel, Andy Kranenburg, Gabriel Tender

School of Medicine Faculty Publications

Study Design. Prospective, multicenter, single arm study with 5-year follow up Objective. To report long-term (5-year) safety, effectiveness, and radiographic outcomes after sacroiliac (SI) joint fusion (SIJF) with 3D-printed triangular titanium implants (TTI) and compare them with solid titanium plasma spray coated implants Summary of Background Data. A large literature base supports minimally invasive SIJF with TTI for chronic SIJ dysfunction. Methods. SIJF with TTI was performed in 51 subjects and scheduled follow-up occurred at 3, 6, 12, 24 and 60 months. Postoperative visits included quality of life questionnaires and functional tests. A high-resolution CT scan was performed at either …

Safety And Efficacy Of Minimally Invasive Posterior Cervical Fusion: A Single Center, Single Surgeon Retrospective Review, George A. Crabill, Kaleb Derouen, Kierany B. Shelvin, John M. Wilson, Gabriel C. Tender

School of Medicine Faculty Publications

Standard posterior cervical fusion is a common surgical technique that utilizes lateral mass screws and rods for fixation. A relatively new, minimally invasive technique involving interfacet decortication and placement of spacers has shown promise in terms of outcomes. We sought to determine fusion rates and complications of this new technique at our institution to bolster current literature. We retrospectively reviewed all patients that underwent a 3-level or less minimally invasive posterior cervical fusions by a single surgeon. Patients were evaluated to determine fusion rates and postoperative complications. Twenty-eight patients underwent minimally invasive posterior cervical fusion. Twenty-seven demonstrated fusion (96%). One …

Do Apoe4, Malnutrition, And Long Covid-19 Compound The Risk Factors For Stroke In Adverse Environments?, Alexander Vasconcelos Buzaglo, Carlos Meton De Alencar Gadelha Vieira, Gabriella Cunha Vieira Ciurleo, Ludmila Belayev, Reinaldo B. Oriá

School of Medicine Faculty Publications

No abstract provided.

Roadside Head Trauma In A Middle-Aged Man, Ian Michael Crimmins, David Isaac Beran

School of Medicine Faculty Publications

No abstract provided.

Speech, Voice, And Language Outcomes Following Deep Brain Stimulation: A Systematic Review, Fatemeh Tabari, Joel I. Berger, Oliver Flouty, Brian Copeland, Jeremy D. Greenlee, Karim Johari

School of Medicine Faculty Publications

Background Deep brain stimulation (DBS) reliably ameliorates cardinal motor symptoms in Parkinson’s disease (PD) and essential tremor (ET). However, the effects of DBS on speech, voice and language have been inconsistent and have not been examined comprehensively in a single study. Objective We conducted a systematic analysis of literature by reviewing studies that examined the effects of DBS on speech, voice and language in PD and ET. Methods A total of 675 publications were retrieved from PubMed, Embase, CINHAL, Web of Science, Cochrane Library and Scopus databases. Based on our selection criteria, 90 papers were included in our analysis. The …

Safety And Timing Of Early Therapeutic Anticoagulation Therapy After Craniotomy, John M. Wilson, Kierany B. Shelvin, Sarah E. Lawhon, George A. Crabill, Ellery A. Hayden, Alan J. Velander

School of Medicine Faculty Publications

Background: To date, there are few guidelines and studies to guide the timing of initiation of therapeutic anticoagulation (AC) after craniotomy. The goal of this study was to assess the timing, safety, and outcomes of patients following the administration of therapeutic AC after craniotomy. Methods: A retrospective case–control study was performed evaluating all craniotomy patients from August 2017 to July 2021. Cases were selected if they received therapeutic AC within ten days of craniotomy. Nineteen out of 1013 craniotomy patients met the inclusion criteria. Indications for therapeutic AC were diverse, including deep venous thrombosis, pulmonary embolism, dural venous sinus thrombosis, …

Potential Causal Association Between Gut Microbiome And Posttraumatic Stress Disorder, Qiang He, Wenjing Wang, Dingkang Xu, Yang Xiong, Chuanyuan Tao, Chao You, Lu Ma, Junpeng Ma, Caroline M. Nievergelt, Adam X. Maihofer, Torsten Klengel, Elizabeth G. Atkinson, Chia Yen Chen, Karmel W. Choi, Jonathan R.I. Coleman, Shareefa Dalvie, Laramie E. Duncan, Mark W. Logue, Allison C. Provost, Andrew Ratanatharathorn, Murray B. Stein, Katy Torres, Allison E. Aiello, Lynn M. Almli, Ananda B. Amstadter, Søren B. Andersen, Ole A. Andreassen, Paul A. Arbisi, Ariane Rung, Et Al

School of Public Health Faculty Publications

Background: The causal effects of gut microbiome and the development of posttraumatic stress disorder (PTSD) are still unknown. This study aimed to clarify their potential causal association using mendelian randomization (MR). Methods: The summary-level statistics for gut microbiome were retrieved from a genome-wide association study (GWAS) of the MiBioGen consortium. As to PTSD, the Freeze 2 datasets were originated from the Psychiatric Genomics Consortium Posttraumatic Stress Disorder Working Group (PGC-PTSD), and the replicated datasets were obtained from FinnGen consortium. Single nucleotide polymorphisms meeting MR assumptions were selected as instrumental variables. The inverse variance weighting (IVW) method was employed as the …

Clinical Rarity: Simultaneous Choroid Plexus Papilloma And Extraventricular Neurocytoma Presenting As Intraventricular Hemorrhage In An Adolescent, Kaleb Derouen, Kierany Shelvin, Wesley Shoap, Randall Craver, Jerome Volk, Oritsejolomi A. Roberts

School of Medicine Faculty Publications

We present a patient with an intraventricular hemorrhage. Imaging identified a left atrial intraventricular mass and a vague adjacent second periventricular cystic lesion. A guided trans-sulcal approach via a left parietal craniotomy resulted in a gross total resection of both lesions. These represented two distinct lesions, the periventricular cystic lesion was an extraventricular neurocytoma (EVN) and a World Health Organization grade 1 choroid plexus papilloma (CPP). The neurocytoma required methylation studies for confirmatory diagnosis. The patient had an uneventful recovery with a normal neurological exam at 12-weeks. This documents the occurrence of two distinct central nervous system tumors, a CPP …

The Effects Of Physical Activity On Experimental Models Of Vascular Dementia; A Systematic Review And Meta-Analysis, Ifechukwude J. Biose, Wesley H. Chastain, Rebecca J. Solch-Ottaiano, Viktoriya S. Grayson, Hanyun Wang, Somdeb Banerjee, Gregory J. Bix

School of Medicine Faculty Publications

Background; Physical activity is associated with improved brain health and cognition in humans. However, the validity, range, and quality of evidence for the beneficial outcomes linked to exercise in experimental models of vascular dementia (VaD) have not been evaluated. We performed a systematic review and meta-analysis of studies that assessed the effect of exercise intervention on models of VaD to provide an unbiased and comprehensive determination of the cognitive function and brain morphology benefits of exercise. Summary; A systematic search in three databases as well as study design characteristics and experimental data extraction were completed in December 2021. We investigated …

International Consensus Statement On Allergy And Rhinology: Sinonasal Tumors, Edward C. Kuan, Eric W. Wang, Nithin D. Adappa, Daniel M. Beswick, Nyall R. London, Shirley Y. Su, Marilene B. Wang, Waleed M. Abuzeid, Borislav Alexiev, Jeremiah A. Alt, Paolo Antognoni, Michelle Alonso-Basanta, Pete S. Batra, Mihir Bhayani, Diana Bell, Manuel Bernal-Sprekelsen, Christian S. Betz, Jean Yves Blay, Benjamin S. Bleier, Juliana Bonilla-Velez, Claudio Callejas, Ricardo L. Carrau, Roy R. Casiano, Paolo Castelnuovo, Rakesh K. Chandra, Vasileios Chatzinakis, Simon B. Chen, Alexander G. Chiu, Stephen C. Hernandez, Et Al

School of Medicine Faculty Publications

Background; Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology; Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. Methods; In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the …

Aneurysmal Subarachnoid Hemorrhage In Pregnancy: National Trends Of Treatment, Predictors, And Outcomes, Kasra Khatibi, Hamidreza Saber, Smit Patel, Lucido Luciano Ponce Mejia, Naoki Kaneko, Viktor Szeder, May Nour, Reza Jahan, Satoshi Tateshima, Geoffrey Colby, Gary Duckwiler, Yalda Afshar

School of Medicine Faculty Publications

Introduction Aneurysmal subarachnoid hemorrhage (aSAH) is a rare event associated with significant pregnancy-associated maternal and neonatal morbidity and mortality. The optimal treatment strategy and clinical outcome of aSAH in pregnancy remains unclear. We aimed to investigate the treatment utilizations and outcomes of aSAH in pregnant people. Methods Using the 2010-2018 National Inpatient Sample, we identified all birth hospitalizations of women between ages of 18 to 45 associated with subarachnoid hemorrhage and aneurysm treatment were included. Multivariate analyses were used to evaluate the effect of pregnancy state, mode of treatment of aneurysms, severity of subarachnoid hemorrhage on mortality and discharge destination …

Metastatic Primary Brain Rhabdomyosarcoma In A Pediatric Patient: Illustrative Case, Michel Gustavo Mondragón-Soto, Luis Del Valle, José Alfredo González-Soto, Roberto Alfonso De Leo-Vargas

School of Medicine Faculty Publications

BACKGROUND: Primary intracranial rhabdomyosarcoma is an extraordinarily rare malignant tumor, with even fewer presenting with distant metastasis. To date, only five cases, including the one presented here, have been reported to present metastatic activity. OBSERVATIONS: A 12-year-old boy presented with a few days of headache, nausea, vomiting, but no neurological deficit. Brain computed tomography and magnetic resonance imaging demonstrated hydrocephalus and a cystic lesion with left parieto-occipital extension. After resection, pathology reported primary rhabdomyosarcoma, with positive desmin and myogenin on immunohistochemistry. The patient presented with pulmonary metastasis. The patient had an overall survival of 21 months after diagnosis with optimal …

Laser Interstitial Thermal Therapy For Posterior Fossa Lesions: A Systematic Review And Analysis Of Multi-Institutional Outcomes, Mohammadmahdi Sabahi, Stephen J. Bordes, Edinson Najera, Alireza M. Mohammadi, Gene H. Barnett, Badih Adada, Hamid Borghei-Razavi

School of Medicine Faculty Publications

Background: Laser interstitial thermal therapy (LITT) has emerged as a treatment option for deep-seated primary and metastatic brain lesions; however, hardly any data exist regarding LITT for lesions of the posterior fossa. Methods: A quantitative systematic review was performed. Article selection was performed by searching MEDLINE (using PubMed), Scopus, and Cochrane electronic bibliographic databases. Inclusion criteria were studies assessing LITT on posterior fossa tumors. Results: 16 studies comprising 150 patients (76.1% female) with a mean age of 56.47 years between 2014 and 2021 were systematically reviewed for treatment outcomes and efficacy. Morbidity and mortality data could be extracted for 131 …

Persistent Brainstem Abscess Requiring Repeat Microsurgical Drainage: Case Report, Wesley M. Shoap, Ellery A. Hayden, George A. Crabill

School of Medicine Faculty Publications

n this paper, we present a patient who was treated for a pontine abscess at our institution. This patient underwent sub-occipital craniotomy for microscopic abscess drainage after which cultures grew Streptococcus intermedius. She was treated with antibiotics but failed to show clinical improvement and was taken back to the operating room for repeat abscess drainage. Clinical improvement was seen after the second operation. This case report describes open surgical technique as a safe and effective way of treating brainstem abscess.

Prospective Trial Of Sacroiliac Joint Fusion Using 3d-Printed Triangular Titanium Implants, Vikas Patel, Don Kovalsky, S Craig Meyer, Abhineet Chowdhary, Harry Lockstadt, Fernando Techy, Casey Langel, Robert Limoni, Philip S. Yuan, Andy Kranenburg, Daniel Cher, Gabriel Tender, Travis J. Hillen

School of Medicine Faculty Publications

Background: Prior trials provide strong evidence supporting minimally invasive sacroiliac joint (SIJ) fusion using triangular titanium implants (TTI) for chronic SIJ dysfunction.

Objective: To assess the safety and effectiveness of SIJF using a 3D-printed TTI.

Methods: Fifty-one subjects with carefully diagnosed SIJ dysfunction underwent SIJF with 3D TTI. Subjects completed pain, disability and quality of life questionnaires at baseline and 3, 6 and 12 months postoperatively. Functional tests were performed in the clinic at each visit. Pelvic CT scans were independently evaluated for radiolucency, bridging bone and other endpoints.

Results: Ninety percent had 12-month follow-up. Dysfunction due to pain (Oswestry …