Neurosurgery Commons^™

Comparison Of Longitudinal Changes In Resting State Functional Magnetic Resonance Imaging Between Alzheimer’S And Healthy Controls, Berk Can Yilmaz

Theses

Resting State Functional Magnetic Resonance Imaging (rs-fMRI) is a technique that is widely used for analyzing brain function using different approaches and methods. This study involves rs-fMRI analysis of Blood Oxygenation Level Dependent (BOLD) signals acquired from Alzheimer’s disease (AD) Patients and Healthy Controls (HC). Each subject in the study had both functional and anatomical images with at least one rs-fMRI scan with their Anatomical (T1) scans. Previous rs-fMRI studies have demonstrated that AD shows differences in Amplitude of Low Frequency (<0.1 Hz) Fluctuations (ALFF), and Regional Homogeneity (ReHo) measures according to HCs.

The aim of the study is to investigate individual and group level differences using ReHo and mALFF related …

Arteriovenous Malformation With Associated Multiple Flow-Related Distal Anterior Cerebral Artery Aneurysms: A Case Report With Poor Outcomes, Ummey Hani, Muhammad Ehsan Bari, Syed Sarmad Bukhari

Section of Neurosurgery

Background: Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder.
Case description: A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his …

The Need For Neurosurgical Intervention In Trauma Patients With A Positive Ct Scan And Glasgow Coma Scale Of 13-15, Justin Pasquale, James Cipolla, Mark Cipolle Md, Puja Patel Md, Jennifer Macfarlan

Research Scholars Poster Presentation

No abstract provided.

Value Of Achieving A Watertight Dural Closure, And The Use Of Dural Sealants After Supratentorial Cranial Surgery, Ummey Hani, Fatima Aziz, Muhammad Shahzad Shamim

Section of Neurosurgery

Dural closure at the end of cranial surgery is considered an extremely important step to maintain anatomical continuity, separate the intradural space with the extradural one, and to prevent possible complications related to cerebrospinal fluid leak. Wherein its usefulness in posterior fossa craniotomy is established, many surgeons do not perform it routinely in supratentorial craniotomies, citing unnecessary delay and lack of evidence supporting it. Herein, we have reviewed the data to find evidence in support of watertight suture based dural closures compared to other dural closure techniques, in supratentorial craniotomies.

Biomarker Application For Precision Medicine In Stroke, Alexis N. Simpkins, Miroslaw Janowski, Helieh S. Oz, Jill Roberts, Gregory Bix, Sylvain Doré, Ann M. Stowe

Neurosurgery Faculty Publications

Stroke remains one of the leading causes of long-term disability and mortality despite recent advances in acute thrombolytic therapies. In fact, the global lifetime risk of stroke in adults over the age of 25 is approximately 25%, with 24.9 million cases of ischemic stroke and 18.7 million cases of hemorrhagic stroke reported in 2015. One of the main challenges in developing effective new acute therapeutics and enhanced long-term interventions for stroke recovery is the heterogeneity of stroke, including etiology, comorbidities, and lifestyle factors that uniquely affect each individual stroke survivor. In this comprehensive review, we propose that future biomarker studies …

Significance Of Micro-Rna Expression In Patients With Meningioma, Rida Mitha, Muhammad Shahzad Shamim

Section of Neurosurgery

Recent brain tumour research has shown abnormalities in gene expression as key features for almost all common brain tumours investigated. However, there is increasing evidence that epigenetic abnormalities are also crucial for tumorigenesis. Epigenetic abnormalities are heritable alterations affecting gene expression without changing the primary DNA sequence. Epigenetic abnormalities in meningiomas include abnormal microRNA expression, altered DNA methylation and histone and chromatin modifications. In this review we identify the role of altered expression of microRNA in the development and recurrence of meningioma. Based on the review of current literature, extensive knowledge of micro-RNA expression cannot only determine tumour recurrence and …

Endovascular Treatment Of Cervical Myelopathy From Brachiocephalic Venous Stenosis., Craig Schreiber, Alex Anavim, Mark Kotapka, Paul Brady

Neurosurgery Resident Research

Central venous stenosis is a rare cause of neurologic pathology. Here we present a case of brachiocephalic vein stenosis causing cervical myelopathy through venous engorgement. Our patient was a 51-y/o male who presented with ambulatory dysfunction so he was evaluated for cervical myelopathy. Imaging revealed cord compression from venous engorgement and brachiocephalic vein stenosis. He was treated with angioplasty and vessel stenting which significantly improved flow on postintervention imaging. In conclusion, preoperative vascular imaging should be considered in myelopathic patients as it can detect this rare but dangerous etiology.

Outcome Of Cranial Firearm Injuries In Civilian Population Based On A Novel Classification System, Farrukh Javeed, Asad Abbas, Lal Rehman, Syed Raza Khairat Rizvi, Ali Afzal, Hafiza Fatima Aziz

Section of Neurosurgery

Background: Cranial firearm injuries (CFAIs) are expected to be frequent during warfare; however, it is becoming increasingly common among civilian population in our part of the world. These injuries are associated with significant morbidity and mortality in addition to financial loss. The objective of our study is to evaluate the pattern of gunshot injuries to cranium and their outcome.
Methods: The study was conducted on 114 patients presenting with CFAIs to Jinnah Postgraduate Medical Centre, Karachi, Pakistan, between June 2015 and January 2019. Patients were evaluated with respect to age, gender, pattern of injury, Glasgow coma scale on arrival, radiological …

Tension Pneumocephalus After Right Dacryocystorhinostomy: A Rare But Potential Serious Complication, Sher Sethi, Syed Ahsan Ali

Section of Internal Medicine

Tension pneumocephalus is a phenomenon in which air enters through dural injury in the brain and then expands and causes a mass effect. The injury can be due to any neurosurgical procedure, trauma, infection and/or neoplasm. A 63-year-old female known case of diabetes and hypertension had an elective procedure of right dacryocystorhinostomy present to the emergency department the very next day with a loss of consciousness. Urgent CT of the head showed air in the cranium (pneumocephalus). A radiological sign named "Mount Fuji" is classical for tension pneumocephalus. She was closely monitored and shows good clinical improvement allowing the neurosurgery …

Permanent Pre-Operative Cerebrospinal Fluid Diversion In Paediatric Patients With Posterior Fossa Tumours, Ummey Hani, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Management options for obstructive hydrocephalus in children with posterior fossa tumours have been debated upon throughout the course of neurosurgical practice. Permanent pre-operative CSF diversion via ventricular shunts or endoscopic third ventriculostomy have been employed to prevent the possible persistence of hydrocephalus after tumour removal, but is considered unnecessary and even dangerous amongst a large group of neurosurgeons. In this paper, we have reviewed the literature for the merits and demerits of pre-operative permanent CSF diversion in paediatric patients presenting with posterior fossa tumours.

Implementing A Surgical Pre-Operative Checklist: Improving Transparency & Communication, Ritam Ghosh, Md, James Harrop, Md, Jesse Edwards, Md

Health Equity and Quality Improvement (HEQI) Summit

Our goal was to first analyze what the current practice was and if there was a need for improvement. To our knowledge, each surgical service has its own preop protocol and this is not standardized across the hospital. Furthermore, very few services have EPIC based protocols that allow for documentation and information sharing. For example, the neurosurgery service uses paper checklists, a style that is effective yet outdated.

A survey was sent out to multiple departments in order to gauge the current landscape of pre-operative care. Questions were posed to analyze if there was a need for improved documentation by …

Standardizing Postoperative Handoffs Using The Evidence-Based Ipass Framework Improves Handoff Communication For Postoperative Neurosurgical Patients In The Neuro-Intensive Care Unit, Richard F. Schmidt, Md, Matthew D. Vibbert, Md, Coleen A. Vernick, Do, Andrew M. Mendelson, Do, Caitlin Harley, Msn, Giuliana Labella, Msn, Jessica Houser, Bsn, Patrick Becher, Bsn, Erin Simko, Bsn, Pascal M. Jabbour, Md, Stavropoula I. Tjoumakaris, Md, M. Reid Gooch, Md, Ashwini D. Sharan, Md, Christopher J. Farrell, Md, James S. Harrop, Md, Robert H. Rosenwasswer, Md, Rebecca C. Jaffe, Md, Jack Jallo, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Within one year of initiation of the process improvement plan, we wanted to improve:

• Direct communication of airway and hemodynamic concerns
• Direct communication of operative events, complications, and perioperative management goals.
• Attendance at postoperative handoffs
• Confirmation of information by receiving teams
• Staff perceptions of handoff efficacy and teamwork.

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 …