Neurosurgery Commons^™

Improving Patient Safety Through A Postoperative Debriefing Initiative, Ellina Hattar, Md, Monica Young, Dnp, Mba, Rn, Cnor, Erin Leonetti, Rn, Omaditya Khanna, Md, Anthony Stefanelli, Md, James Harrop, Md, Ashwini Sharan Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Effective and clear communication in the operating room is a necessary aspect of any surgery. Every member of the operative team is integral in fostering an environment focused on patient safety. As such, the institution of a postoperative debrief session may allow for feedback from every member of the team that will ultimately aid in improving a patient’s experience.

Improving Serial Imaging Protocols In Spontaneous Intracerebral Hemorrhage, Kevin Hines, Md, Nikolaos Mouchtouris, Md, Fadi Al-Saiegh, Md, Karim Hafazalla, Jacob Mazza, Giuliana Labella, Muhammad K. Athar, Md, Adam Flanders, Md, M. Reid Gooch, Md, Stavropoula Tjoumakaris, Md, Robert H. Rosenwasswer, Md, Pascal Jabbour, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Aim to decrease unnecessary use of serial imaging in sICH patients.

• This project plans to decrease the number of scans in this patient population while increasing faculty/staff satisfaction and efficiency of resource utilization.
• The goal is to decrease HCT utilization by 20% without compromising patient care or decision making.
• After finalizing and approving the HCT protocol, implementation of a trial period for two

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 …

Covid-19: Launching Neurosurgery Into The Era Of Telehealth In The United States, Christina Huang Wright, James Wright, Berje Shammassian

Faculty Scholarship

The authors discuss the implications of the COVID-19 pandemic on the use of telehealth in the United States.

Primary Pediatric Cerebellar Gliosarcoma, Syed Sarmad Bukhari, Muhammad Junaid, Ali Afzal, Anisa Kulsoom

Section of Neurosurgery

Background: Primary gliosarcomas of the central nervous are rare and very few have been reported in the infratentorial compartment. Here, we describe such a lesion in a 12-year-old male.
Case description: A 12-year-old male presented with headache, ataxia, and vomiting. When Magnetic resonance studies documented a posterior fossa lesion, he underwent placement of a right ventriculoperitoneal shunt followed by a suboccipital craniectomy. The lesion proved to be a primary gliosarcoma. Unfortunately, it recurred 2 years later and required repeated resection.
Conclusion: Here, we reviewed the rare case of a 12-year-old male requiring shunt placement and suboccipital craniectomy for a primary …

Brain Injury And Dementia In Pakistan: Current Perspectives, Maheen M. Adamson, Sadia Shakil, Tajwar Sultana, Muhammad Abul Hasan, Fatima Mubarak, Ather Enam, Muhammad A. Parvaz, Adeel Razi

Department of Radiology

Alzheimer's disease (AD) is the most common form of dementia, accounting for 50-75% of all cases, with a greater proportion of individuals affected at older age range. A single moderate or severe traumatic brain injury (TBI) is associated with accelerated aging and increased risk for dementia. The fastest growth in the elderly population is taking place in China, Pakistan, and their south Asian neighbors. Current clinical assessments are based on data collected from Caucasian populations from wealthy backgrounds giving rise to a "diversity" crisis in brain research. Pakistan is a lower-middle income country (LMIC) with an estimated one million people …

The Utility Of Cervical Spine Bracing As A Postoperative Adjunct To Multilevel Anterior Cervical Spine Surgery, Ian F. Caplan, Saurabh Sinha, Benjamin Osiemo, Scott Mcclintock, James M. Schuster, Harvey Smith, Gregory Glauser, Nikhil Sharma, Ali K. Ozturk, Zarina S. Ali, Neil R. Malhotra

Mathematics Faculty Publications

Background: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. Here, we study the impact of bracing on short-term outcomes related to safety, quality of care, and direct costs in multilevel ACDF.

Methods: Retrospective cohort analyses of all consecutive patients undergoing multilevel ACDF with or without bracing from 2013 to 2017 was undertaken (n = 616). Patient demographics and comorbidities were analyzed. Tests of independence and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility [ARF], or …

Musculoskeletal Pain Outcomes Pre- And Post Intrathecal Baclofen Pump Implant In Children With Cerebral Palsy: A Prospective Cohort Study., Chantel C. Barney, Alyssa M. Merbler, Jean Stansbury, Linda E. Krach, Michael D. Partington, Patrick Graupman, Peter D. Kim, Debbie Song, Frank J. Symons

Manuscripts, Articles, Book Chapters and Other Papers

Objective: To characterize musculoskeletal pain intensity, duration, frequency, and interference with activities of daily living in children with cerebral palsy (CP) before and after intrathecal baclofen pump placement.

Design: Prospective cohort study.

Setting: Children's tertiary hospital.

Participants: Participants were children with CP (N=32; 53% male; mean age, 9.9y; age range, 4-17y). The majority of participants had a CP diagnosis of quadriplegia (76%) and relied on wheeled mobility (91%).

Interventions: Assessments were completed pre- and post intrathecal baclofen pump implant.

Main outcome measures: Because of considerable patient heterogeneity, both pain measures (Brief Pain Inventory, Dalhousie Pain Interview) were completed by proxy …

Primary Intracranial Malignant Melanoma, Ummey Hani, Dr Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Primary intracranial malignant melanoma (PIMM) are rare brain tumours; more infrequent than melanomas metastasizing to the brain or those extending to the brain from adjacent structures such as the orbit. Complete surgical excision with adjuvant chemotherapy and radiation remains the mainstay of treatment. Herein, we have reviewed the literature to find the treatment modalities for PIMMs that can lead to longer overall survivals and better patient outcomes.

Iatrogenic Trauma Following Percutaneous And Minimally Invasive Surgical Interventions, M Hammad Ather, Tashfeen Ahmad, Shabbir Akhtar, Tabish Chawla, Aneela Darbar, Wardah Rafaqat, Syed Shahabuddin, Noman Shahzad, Shahid Ahmed Sami

Section of Urology

Technological progress has changed the landscape of surgical practice. Minimally invasive surgery (MIS) and percutaneous interventions (PC) are constantly replacing open procedures. This reduces hospital stay and allows quicker recovery. The application of MIS should follow the good medical practice dictum by Hippocrates i.e. "First do no harm". To remain abreast with new procedures, the medical personnel are required to update and enhance their knowledge and skill. To ensure safety, the innovations are rigorously tested and tried. The learning curve of MIS is shortened by simulator training and proctorship. Credentialing processes are in place to enhance safe delivery of care. …

Trauma - Striving For Change, Ather Enam, Hasnain Zafar, Rehan Nasir Khan

Section of Neurosurgery

No abstract provided.

Psychological Distress And Its Associated Factors Among Informal Care Givers Of Disabled Young Adults With Traumatic Brain Injuries, Samera Punjwani, Yasmin Parpio, Rubina Barolia, Muhammad Shahzad Shamim, Nargis Asad

Department of Surgery Docs

Objective: To measure the psychological distress among the informal caregivers of disabled young adults with traumatic brain injuries (TBI) and to identify its associated factors.
Methods: An analytical cross sectional study was conducted with 76 informal caregivers of young adults (19 - 50 years) with TBI, using admission records of one of the tertiary care hospitals in Karachi, Pakistan from 2015 to 2016. Data were collected using a structured questionnaire comprising a general demographic questionnaire and the General Health Questionnaire- 28. The effect of the predictors on the psychological distress was determined by applying multiple linear regression analysis.
Results: The …

Expression Of Cytokines And Chemokines As Predictors Of Stroke Outcomes In Acute Ischemic Stroke, Sarah R. Martha, Qiang Cheng, Justin F. Fraser, Liyu Gong, Lisa A. Collier, Stephanie M. Davis, Doug Lukins, Abdulnasser Alhajeri, Stephen Grupke, Keith R. Pennypacker

Institute for Biomedical Informatics Faculty Publications

Introduction: Ischemic stroke remains one of the most debilitating diseases and is the fifth leading cause of death in the US. The ability to predict stroke outcomes within the acute period of stroke would be essential for care planning and rehabilitation. The Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC; clinicaltrials.gov NCT03153683) study collects arterial blood immediately distal and proximal to the intracranial thrombus at the time of mechanical thrombectomy. These blood samples are an innovative resource in evaluating acute gene expression changes at the time of ischemic stroke. The purpose of this study was to identify inflammatory genes and …

Cortical Encoding Of Melodic Expectations In Human Temporal Cortex, G. M. Di Liberto, C. Pelofi, R. Bianco, P. Patel, A. D. Mehta, J. L. Herrero, A. De Cheveigne, S. Shamma, N. Mesgarani

Journal Articles

No abstract provided.

Submaximal Angioplasty For Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis Of Peri-Procedural And Long-Term Risk, C. J. Stapleton, Y. F. Chen, H. Shallwani, K. Vakharia, T. N. Turan, H. H. Woo, C. P. Derdeyn, F. T. Charbel, A. H. Siddiqui, S. Amin-Hanjani

Journal Articles

© 2019 by the Congress of Neurological Surgeons. BACKGROUND: Symptomatic intracranial atherosclerotic disease (ICAD) is an important cause of stroke. Although the high periprocedural risk of intracranial stenting from recent randomized studies has dampened enthusiasm for such interventions, submaximal angioplasty without stenting may represent a safer endovascular treatment option. OBJECTIVE: To examine the periprocedural and long-term risks associated with submaximal angioplasty for ICAD based on the available literature. METHODS: All English language studies of intracranial angioplasty for ICAD were screened. Inclusion criteria were as follows: ≥ 5 patients, intervention with submaximal angioplasty alone, and identifiable periprocedural (30-d) outcomes. Analysis was …

Role Of Sulfonylurea Receptor 1 And Glibenclamide In Traumatic Brain Injury: A Review Of The Evidence, R. M. Jha, J. Bell, G. Citerio, J. C. Hemphill, W. T. Kimberly, R. K. Narayan, J. Sahuquillo, K. N. Sheth, J. M. Simard

Journal Articles

No abstract provided.

A Model For Focal Seizure Onset, Propagation, Evolution, And Progression, J. Liou, E. H. Smith, L. M. Bateman, S. L. Bruce, G. M. Mckhann, R. R. Goodman, R. G. Emerson, C. A. Schevon, L. F. Abbott

Journal Articles

No abstract provided.

Identification Of A Brainstem Locus That Inhibits Tumor Necrosis Factor., A. M. Kressel, T. Tsaava, Y. A. Levine, E. H. Chang, M. E. Addorisio, Q. Chang, B. J. Burbach, V. A. Pavlov, S. S. Chavan, K. J. Tracey, +4 Additional Authors

Journal Articles

In the brain, compact clusters of neuron cell bodies, termed nuclei, are essential for maintaining parameters of host physiology within a narrow range optimal for health. Neurons residing in the brainstem dorsal motor nucleus (DMN) project in the vagus nerve to communicate with the lungs, liver, gastrointestinal tract, and other organs. Vagus nerve-mediated reflexes also control immune system responses to infection and injury by inhibiting the production of tumor necrosis factor (TNF) and other cytokines in the spleen, although the function of DMN neurons in regulating TNF release is not known. Here, optogenetics and functional mapping reveal cholinergic neurons in …

The Hydrogel Endovascular Aneurysm Treatment Trial (Heat): A Randomized Controlled Trial Of The Second-Generation Hydrogel Coil, B. R. Bendok, K. R. Abi-Aad, J. D. Ward, J. F. Kniss, M. J. Kwasny, R. J. Rahme, S. G. Aoun, T. Y. El Ahmadieh, H. H. Woo, J. Hartman, +57 Additional Authors

Journal Articles

© 2020 Congress of Neurological Surgeons 2020. BACKGROUND: Aneurysm recurrence after coiling has been associated with aneurysm growth, (re)hemorrhage, and a greater need for follow-up. The second-generation HydroCoil Embolic System (HES; MicroVention, Inc) consists of a platinum core with integrated hydrogel and was developed to reduce recurrence through enhancing packing density and healing within the aneurysm. OBJECTIVE: To compare recurrence between the second-generation HES and bare platinum coil (BPC) in the new-generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT). METHODS: HEAT is a randomized, controlled trial that enrolled subjects with ruptured or unruptured 3- to 14-mm intracranial aneurysms amenable to coiling. …

A Management Algorithm For Adult Patients With Both Brain Oxygen And Intracranial Pressure Monitoring: The Seattle International Severe Traumatic Brain Injury Consensus Conference (Sibicc), R. Chesnut, S. Aguilera, A. Buki, E. Bulger, G. Citerio, D. J. Cooper, R. D. Arrastia, M. Diringer, J. S. Ullman, G. W. Hawryluk, +32 Additional Authors

Journal Articles

No abstract provided.

Letter: A Guide To The Prioritization Of Neurosurgical Cases After The Covid-19 Pandemic., Jg Thomas, S Gandhi, Tg White, C Jocelyn, Tm Soo, M Eisenberg, M Schulder, Rk Narayan

Journal Articles

No abstract provided.

Coronavirus Neurosurgical/Head And Neck Drape To Prevent Aerosolization Of Coronavirus Disease 2019 (Covid-19): The Lenox Hill Hospital/Northwell Health Solution, Rs D'Amico, D Khatri, K Kwan, G Baum, Y Serulle, D Silva, Ml Smith, Ja Ellis, M Levine, R Ortiz, Dj Langer, Ja Boockvar

Journal Articles

No abstract provided.

A Roadmap To Reopening A Neurosurgical Practice In The Age Of Covid-19, Rs D'Amico, G Baum, Y Serulle, D Silva, Ml Smith, Ra Wallack, Ja Ellis, M Levine, R Oritz, Ja Boockvar, Dj Langer

Journal Articles

No abstract provided.

Computer-Assisted Planning For Minimally Invasive Anterior Two-Thirds Laser Corpus Callosotomy: A Feasibility Study With Probabilistic Tractography Validation: Automated Laser Callosotomy Trajectory Planning, V. N. Vakharia, R. E. Sparks, S. B. Vos, Y. Bezchlibnyk, A. D. Mehta, J. T. Willie, C. Wu, A. Sharan, S. Ourselin, J. S. Duncan

Journal Articles

© 2020 The Authors Background: Anterior two-thirds corpus callosotomy is an effective palliative neurosurgical procedure for drug-refractory epilepsy that is most commonly used to treat drop-attacks. Laser interstitial thermal therapy is a novel stereotactic ablative technique that has been utilised as a minimally invasive alternative to resective and disconnective open neurosurgery. Case series have reported success in performing laser anterior two-thirds corpus callosotomy. Computer-assisted planning algorithms may help to automate and optimise multi-trajectory planning for this procedure. Objective: To undertake a simulation-based feasibility study of computer-assisted corpus callostomy planning in comparison with expert manual plans in the same patients. Methods: …

Carotid Revascularization And Its Effect On Cognitive Function: A Prospective Nonrandomized Multicenter Clinical Study, J. L. Whooley, B. C. David, H. H. Woo, B. L. Hoh, K. B. Raftery, A. Hussain Siddiqui, M. Westerveld, S. Amin-Hanjani, Z. Ghogawala

Journal Articles

© 2020 The Author(s) Background: There is conflicting data on the effect of carotid revascularization on cognitive function. Objective: To examine cerebral blood flow and cognitive function after carotid revascularization. Methods: Patients with unilateral, asymptomatic hemodynamically significant carotid artery stenosis (80% by computed tomography angiography or magnetic resonance angiography) were eligible. Cerebral blood flow was measured preoperatively and 1 month postoperatively using quantitative phase contrast magnetic resonance angiography. Preoperative flow impairment was defined as ipsilateral flow at least 20% less than contralateral flow (ie, an ipsilateral and/or contralateral flow ratio ≤0.8). Significant improvement in blood flow was defined as at …

The Α7 Nicotinic Acetylcholine Receptor Agonist, Gts-21, Attenuates Hyperoxia-Induced Acute Inflammatory Lung Injury By Alleviating The Accumulation Of Hmgb1 In The Airways And The Circulation, R. A. Sitapara, A. G. Gauthier, S. I. Valdés-Ferrer, M. Lin, V. Patel, M. Wang, A. T. Martino, K. J. Tracey, V. A. Pavlov, L. L. Mantell, +2 Additional Authors

Journal Articles

© 2020 The Author(s). Background: Oxygen therapy, using supraphysiological concentrations of oxygen (hyperoxia), is routinely administered to patients who require respiratory support including mechanical ventilation (MV). However, prolonged exposure to hyperoxia results in acute lung injury (ALI) and accumulation of high mobility group box 1 (HMGB1) in the airways. We previously showed that airway HMGB1 mediates hyperoxia-induced lung injury in a mouse model of ALI. Cholinergic signaling through the α7 nicotinic acetylcholine receptor (α7nAChR) attenuates several inflammatory conditions. The aim of this study was to determine whether 3-(2,4 dimethoxy-benzylidene)-anabaseine dihydrochloride, GTS-21, an α7nAChR partial agonist, inhibits hyperoxia-induced HMGB1 accumulation in …

Guidelines For The Management Of Severe Traumatic Brain Injury: 2020 Update Of The Decompressive Craniectomy Recommendations, G. W. Hawryluk, A. M. Rubiano, A. M. Totten, C. O'Reilly, J. S. Ullman, S. L. Bratton, R. Chesnut, O. A. Harris, N. Kissoon, J. Ghajar, +6 Additional Authors

Journal Articles

© Congress of Neurological Surgeons 2020. When the fourth edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury were finalized in late 2016, it was known that the results of the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) randomized controlled trial of decompressive craniectomy would be public after the guidelines were released. The guideline authors decided to proceed with publication but to update the decompressive craniectomy recommendations later in the spirit of "living guidelines," whereby topics are updated more frequently, and between new editions, when important new evidence is published. The update …

Brain-Informed Speech Separation (Biss) For Enhancement Of Target Speaker In Multitalker Speech Perception, E. Ceolini, J. Hjortkjær, D. D. Wong, J. O'Sullivan, V. S. Raghavan, J. Herrero, A. D. Mehta, S. C. Liu, N. Mesgarani

Journal Articles

© 2020 Hearing-impaired people often struggle to follow the speech stream of an individual talker in noisy environments. Recent studies show that the brain tracks attended speech and that the attended talker can be decoded from neural data on a single-trial level. This raises the possibility of “neuro-steered” hearing devices in which the brain-decoded intention of a hearing-impaired listener is used to enhance the voice of the attended speaker from a speech separation front-end. So far, methods that use this paradigm have focused on optimizing the brain decoding and the acoustic speech separation independently. In this work, we propose a …

Estimating And Interpreting Nonlinear Receptive Field Of Sensory Neural Responses With Deep Neural Network Models, M. Keshishian, H. Akbari, B. Khalighinejad, J. L. Herrero, A. D. Mehta, N. Mesgarani

Journal Articles

No abstract provided.

Does Increasing Packing Density Using Larger Caliber Coils Improve Angiographic Results Of Embolization Of Intracranial Aneurysms At 1 Year: A Randomized Trial, J. Raymond, J. Ghostine, B. A. Van Adel, J. J. Shankar, D. Iancu, A. P. Mitha, P. Kvamme, R. D. Turner, H. H. Woo, T. E. Darsaut, +13 Additional Authors

Journal Articles

© 2020 American Society of Neuroradiology. All rights reserved. BACKGROUND AND PURPOSE: The impact of increased aneurysm packing density on angiographic outcomes has not been studied in a randomized trial. We sought to determine the potential for larger caliber coils to achieve higher packing densities and to improve the angiographic results of embolization of intracranial aneurysms at 1 year. MATERIALS AND METHODS: Does Embolization with Larger Coils Lead to Better Treatment of Aneurysms (DELTA) was an investigator-initiated multicenter prospective, parallel, randomized, controlled clinical trial. Patients had 4- to 12-mm unruptured aneurysms. Treatment allocation to either 15- (experimental) or 10-caliber coils …