Neurosurgery Commons^™

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 …

Assessment Of Dnase Activity By Ratiometric Fluorescence Resonance Energy Transfer, Candace L Minchew, Vladimir V Didenko

Faculty, Staff and Students Publications

The present protocol describes a simple and sensitive ratiometric Förster resonance energy transfer (FRET) assay for the detection and quantitative assessment of DNase activity. Ratiometric FRET measurements make use of the ratio of donor and acceptor emission signals. The assay detects single-stranded DNA breaks using a staple-shaped, dual-tagged 38-mer FRET oligoprobe, employed as a real-time DNA cleavage sensor. The main application of the described approach is the quantitative assessment of the effects of reaction conditions, such as pH, temperature, and buffer composition, on DNase activity. Due to its ability to detect even minor and slow DNA cleavage, the assay is …

Experience Matters: An Application Of The Operative Value Index For Lumbar Fusions, Danyal Quraishi, Advith Sarikonda, D. Mitchell Self, Steven R. Glener, Arbaz A. Momin, Emily L. Isch, Ashmal K. Sami, Matthews Lan, Nicholas Clark, Ashwini Sharan, Srinivas Prasad, Jack Jallo, Joshua Pelta-Heller, Alex R. Vaccaro, James Harrop, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: As healthcare systems transition to value-based care models, it is critical to understand factors influencing costs and outcomes in neurosurgery. This study utilizes Time-Driven Activity-Based Costing (TDABC) to assess the impact of surgeon experience and case volume on costs, clinical outcomes, and operative value in lumbar fusions. While TDABC has been applied in various surgical specialties, its use in neurosurgery, particularly in analyzing surgeon-specific factors, remains limited.

METHODS: A retrospective cohort study was conducted at a single center, analyzing lumbar instrumented arthrodesis procedures from 2017 to 2019. Primary variables included surgeon experience (years) and case volume (annual procedures). Confounding …

Secondary Malignancies In Patients With Meningioma: A Surveillance, Epidemiology, And End Results Data Analysis, Maxwell W. Pickles, Thomas Z. Rohan, Shreya Vinjamuri, Nikolaos Mouchtouris, Roger Murayi, David P. Bray, James J. Evans

Department of Neurosurgery Faculty Papers

BACKGROUND: The risk of secondary primary malignancies (SPMs) in meningioma patients is not well understood. In this unidirectional analysis, we evaluated the risk of SPMs occurring following a primary diagnosis of meningioma.

METHODS: The Surveillance, Epidemiology, and End Results (SEER-17) database (2000-2020) was used to identify 124,769 meningioma patients from a total of 9,208,295 cancer cases. Standardized incidence ratios (SIRs) were calculated using SEER's statistical analysis package to evaluate SPM risk. Basic demographic and treatment information was collected as well.

RESULTS: Of the 124,769 patients, 11,411 (9.2%) received diagnoses of an SPM, which correlates to a higher risk than the …

Risk Factors For In-Stent Stenosis After Flow-Diverter Implantation For Intracranial Aneurysm: A Single Center Analysis Of 161 Consecutive Patients, Rabab Alshahrani, Spyridon Karadimas, Mohammed Ali Alvi, Patrick Joseph Nicholson, Timo Krings

Department of Neurosurgery Faculty Papers

INTRODUCTION: Flow diverters (FD) are used for the treatment of intracranial aneurysms, by redirecting flow and serving as a scaffold for endothelial coverage of the aneurysm ostium. However, in-stent stenosis has been observed in some patients treated with these devices, the cause of which and the epidemiology remaining elusive. In the current study we aimed to elucidate potential factors leading to higher degree of in-stent stenosis including gender, location, and type of FD.

METHODS: The authors queried their institutional Electronic Health Record (EHR) for all patients undergoing FD for intracranial saccular aneurysms. We excluded cases where an FD was performed …

A Comparison Of Different Posterior Arthrodesis Techniques Versus Anterior Dens Screw For Odontoid Fractures: A Systematic Review And Meta-Analysis, Pavlos Texakalidis, Stavros Matsoukas, Michael Cloney, Mykhaylo Krushelnytskyy, Kevin Swong, Najib El Tecle, Tyler Koski, Nader Dahdaleh

Department of Neurosurgery Faculty Papers

BACKGROUND AND OBJECTIVES: Odontoid fractures are often managed surgically. The most common approaches are anterior dens screw (ADS) and posterior arthrodesis (PA), with the latter being associated with significantly higher fusion rates. PA techniques can include wiring, C1-C2 transarticular (TA) screws, and C1 lateral mass (LM)-C2 pars/pedicle screws. Most comparative studies group multiple PA techniques together when comparing PA versus ADS. Our objective was to systematically review the literature and identify studies that separately provide fusion rates of each different posterior C1-C2 arthrodesis (PA) technique utilized compared to ADS.

METHODS: A systematic literature review was conducted according to the Preferred …

Development And Diversity Of Astrocytes, Michael R Williamson, Sanjana Murali, Benjamin Deneen

Faculty, Staff and Students Publications

Proper development of the central nervous system (CNS) depends on astrocytes, which are the most abundant glial cells in the CNS. Here, we provide an overview of astrocyte ontogeny and morphogenesis, highlighting mechanisms that regulate astrocyte development. In addition, we describe the roles of astrocytes in regulating the development of other CNS cell types, with emphasis on neural circuits and vascular networks. We also discuss evidence for astrocyte diversity and its implications for CNS development. Finally, we pose open questions related to astrocyte development and its intersection with astrocyte diversity.

Idiopathic Transverse Myelitis: A Case Report, Danielle Whitacre

Lynchburg Journal of Medical Science

The objective of this paper is to review a case report for a patient with idiopathic transverse myelitis. This rare disease can easily be forgotten based on the vagueness of symptoms and as the presentation can vary drastically. In this case, a magnetic resonance imaging (MRI) test was ordered after a patient presented with a sensory deficit from the level of his chest to his toes that showed a 1.5 centimeter (cm) intramedullary spinal cord lesion at the level of T1. From the imaging, the differential diagnosis included transverse myelitis, a demyelinating lesion, and primary neoplasms such as ependymoma and …

Do Anterior-Posterior Lumbar Fusions Provide More Short-Term Value Than Posterior-Only? An Application Of The Operative Value Index, Steven R. Glener, Advith Sarikonda, D. Mitchell Self, Ashmal Sami, Danyal Quraishi, Emily Isch, Arbaz A. Momin, Cheritesh R. Amaravadi, Jack Jallo, Joshua Heller, Ashwini Sharan, Alex R. Vaccaro, Srinivas K. Prasad, James Harrop, Nicholas J. Clark, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

BACKGROUND: Lumbar fusion is a common treatment for degenerative spine changes. Although both anterior-posterior (AP) and posterior-only approaches are used, their cost-effectiveness remains uncertain. This study aims to compare the costs and short-term "value" (outcomes per dollar spent) of AP and posterior-only lumbar fusions using time-driven activity-based costing and patient-reported outcomes.

METHODS: A retrospective review of AP and posterior lumbar fusions from 2017 to 2022 was conducted. Time-driven activity-based costing was used to assign intraoperative costs based on resource utilization, and the Oswestry Disability Index (ODI) was collected preoperatively and 3 months postoperatively. The Operative Value Index (OVI) was defined …

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 …

Advancing Novel Contrast Agents For Applications In Fluorescence-Guided Neurosurgery Using Fluorescence Cryotomography, Augustino Vittorio Scorzo

Dartmouth College Ph.D Dissertations

Fluorescence guided surgery (FGS) is an emerging surgical technique that aims to help surgeons identify tissue types to assist in surgical decision making - ideally providing “cut-by-color” guidance. A primary application for this approach is the identification of tumor tissue to achieve more accurate and complete tumor removal while simultaneously minimizing damage to surrounding normal tissue. The cornerstone of tumor visualization for FGS is the administration of fluorescent contrast agents, or in some cases metabolic precursors, designed to accumulate specifically in tumor tissue, and a wide range of agents that use different targeting mechanisms are currently under investigation. Although these …

24-Month Patient-Reported Outcomes For A Novel Lumbar Total Joint Replacement, Ahilan Sivaganesan, Marissa Koscielski, Ashmal Sami, J. Alex Sielatycki, Jeffrey Goldstein, Brady Riesgraf, Craig Humphreys, Scott Hodges

Department of Neurosurgery Faculty Papers

BACKGROUND: Lumbar fusion remains a prevalent treatment for degenerative conditions; however, its limitations have sparked interest in alternative motion-sparing procedures. Our study evaluates 24-month postoperative patient-reported outcomes from an OUS pilot clinical study on a novel lumbar total joint replacement (TJR) for degenerative conditions.

METHODS: Data was collected from 63 patients, of which 56 patients fulfilled the inclusion criteria. Self-reported measures collected for this study are Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), Minimal Symptom State (MSS), Minimal Clinical Important Difference (MCID), Substantial Clinical Benefit (SCB). This retrospective analysis of prospective, IRB-approved collected data reports 24 month patient-reported outcomes …

A Forward Genetic Screen Identifies Potassium Channel Essentiality In Shh Medulloblastoma Maintenance, Jerry J Fan, Anders W Erickson, Julia Carrillo-Garcia, Xin Wang, Patryk Skowron, Xian Wang, Xin Chen, Guanqiao Shan, Wenkun Dou, Shahrzad Bahrampour, Yi Xiong, Weifan Dong, Namal Abeysundara, Michelle A Francisco, Ronwell J Pusong, Wei Wang, Miranda Li, Elliot Ying, Raúl A Suárez, Hamza Farooq, Borja L Holgado, Xiaochong Wu, Craig Daniels, Adam J Dupuy, Juan Cadiñanos, Allan Bradley, Anindya Bagchi, Branden S Moriarity, David A Largaespada, A Sorana Morrissy, Vijay Ramaswamy, Stephen C Mack, Livia Garzia, Peter B Dirks, Xuejun Li, Siyi Wanggou, Sean Egan, Yu Sun, Michael D Taylor, Xi Huang

Faculty, Staff and Students Publications

Distinguishing tumor maintenance genes from initiation, progression, and passenger genes is critical for developing effective therapies. We employed a functional genomic approach using the Lazy Piggy transposon to identify tumor maintenance genes in vivo, and applied this to SHH medulloblastoma (MB). Combining Lazy Piggy screening in mice and transcriptomic profiling of human MB, we identified the voltage-gated potassium channel KCNB2 as a candidate maintenance driver. KCNB2 governs cell volume of MB-propagating cells, with KCNB2 depletion causing osmotic swelling, decreased plasma membrane tension, and elevated endocytic internalization of EGFR, thereby mitigating proliferation of MB-propagating cells to ultimately impair MB growth. …

Time-Driven Activity-Based Costing For Cervical Myelopathy Surgery: A Step Towards Total Episode Costs, Kavantissa M. Keppetipola, Adam Leibold, Jay Trivedi, Ashmal Sami, Advith Sarikonda, D. Mitchell Self, Emily L. Isch, Steven R. Glener, Srinivas Prasad, Jack Jallo, Joshua E. Pelta-Heller, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: Time-driven activity-based costing (TDABC) is a highly accurate method for determining the true cost of delivering a healthcare service. However, TDABC is most often applied to a singular phase of care such as an outpatient visit or a surgical event. Here we broaden the scope by using TDABC to estimate the costs of surgically treating cervical myelopathy - from the moment of surgical scheduling until post-operative hospital discharge.

METHODS: In a single-center retrospective study at a large tertiary academic institution, TDABC was employed to measure pre-operative, intra-operative, and post-operative (inpatient) costs for 63 patients undergoing elective surgery for cervical …

Comparison Between Pipeline Embolization Device (Ped) Versus Flow Redirection Endoluminal Device (Fred) For Intracranial Aneurysms: A Comprehensive Systematic Review And Meta-Analysis, Seyed Maroufi, Mohammad Fallahi, Muhammad Waqas, Othman Bin-Alamer, Manisha Koneru, Joanna Roy, Jane Khalife, Hamza Shaikh, Daniel Tonetti

Department of Neurosurgery Faculty Papers

OBJECTIVES: The performance of the Pipeline Embolization Device (PED) and relatively newer double-layered Flow Re-Direction Endoluminal Device (FRED) have been studied for the treatment of intracranial aneurysms, but direct comparisons between PED and FRED are limited. The current systematic review aims at comparing the efficacy and safety of PED and FRED.

METHODS: A systematic review of the literature was conducted according to the PRISMA guideline. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched, and related records were identified. A meta-analysis of double-arm studies comparing PED and FRED was conducted on angiographic and clinical outcomes, retreatment rates, and …

The Evolvement Of The 100 Most Cited Articles In Spine Surgery In The Last Decade Compared To All-Time, Mark Miller, Matthew Meade, Ruchir Nanavati, William T Diciurcio, Maneesha Palakurthi, Adam Kohring, Justin Le, Christopher Giuditta, Christopher Kepler, Barrett Woods

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Decision-making in spine surgery is continuously shaped by advancements in the field through evidence-based medicine. This is demonstrated through the evolution of the quality and impact of scientific research within the field of spine surgery. To date, there is limited literature investigating interval changes in methodological rigor of scientific investigation within the field of spine surgery.

METHODS: The top 100 cited articles were recorded for manuscripts from January 1, 2013, to December 31, 2023, and the top 100 most cited manuscripts of all time for spine surgery, via the Scopus abstract and citation database. Data collected included year of …

Glutamatergic Regulation Of Mirna-Containing Intraluminal Vesicle Trafficking And Extracellular Vesicle Secretion From Cortical Neurons, Marcela Bertolio, Qiyi Li, Francesca E Mowry, Kathryn E Reynolds, Rashed Alananzeh, Haichao Wei, Kyoeun Keum, Rachel Jarvis, Jiaqian Wu, Yongjie Yang

Faculty, Staff and Student Publications

Neuronal extracellular vesicles (microvesicles and exosomes) are emerging secreted vesicular signals that play important roles in the CNS. Currently, little is known about how glutamatergic signalling affects the subcellular localisation of exosome precursor intraluminal vesicles (ILVs), microRNA (miR) packaging into ILVs and in vivo spreading of neuronal EVs. By selectively labelling ILVs and exosomes (but not plasma membrane-derived MVs) with GFP-tagged human CD63 (hCD63-GFP) in cortical neurons, we found that glutamate stimulation significantly redistributes subcellular localisation of hCD63-GFP+ ILVs, especially decreasing its co-localisation with multi-vesicular body (MVB) marker Rab7 while substantially promoting EV secretion. Interestingly, glutamate stimulation only modestly alters …

Decompression With Intradural Dissection For The Chiari Malformation Type I: Toward Eliminating Wound Complications, Anna Lin, Lindsey Asti, Marissa Carroll, Jeffrey Campbell, Jospeh Piatt

Department of Neuroscience Faculty Papers

BACKGROUND: There is continuing conversation about surgical technique in the management of the Chiari malformation. Popular options include osseous decompression alone, decompression with dural splitting, and decompression with intradural dissection (DID) and duraplasty. Wound complications after intradural dissection are a persistent problem. The current study of an institutional series examines wound complication rates after intradural dissection without dural closure.

METHODS: A retrospective single-institution chart review was performed for patients < 21 years with Chari malformation type I who underwent DID without dural closure and had at least 6 months of follow-up. Bone removal corresponded to the area of attachment of the rectus capitis posterior minor muscles together with laminectomy of the atlas. The trapezius and semispinalis capitis muscles were retracted but were not separated from the occiput.

RESULTS: A total of 76 patients were treated from May 2010 through May 2024. Thirty-eight (50.0%) patients had syringomyelia. The median age at surgery was 9 years (interquartile range [IQR] 4-13), …

Safe Paralytic Reversal For Neurologic Examinations, Keenan Piper, Md

Health Equity and Quality Improvement (HEQI) Summit

AIM Statement

Institute a protocol for safe administration of sugammadex to obtain neurologic exams with a goal of 90% adherence and three or less agitation-related complications over a 6-month period

Instituting A New Traumatic Ich Algorithm At Jefferson, Michael Baldassari, Md, Matthews Lan, Md, Caitlin Ritz, Md, Tyler Alexander, Bs, Richard Schmidt, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Traumatic brain injury (TBI) is a high-incidence condition causing substantial economic burden on trauma centers worldwide. Many institutions have begun using validated algorithms for safe management, such as the Modified Brain Injury Guidelines (BIG) Criteria. At Jefferson, tICH have not historically been treated algorithmically, and therefore, tICH patients are often subject to excessive imaging surveillance and admission lengths.

Aim Statement: To institute a new algorithm modeled off mBIG criteria for the management of tICH patient at Jefferson to streamline treatment and safely reduce the number of surveillance HCTs obtained, as well as length of stay in this …

Development And Validation Of A Clinical Risk Model For Postoperative Outcome In Newly Diagnosed Glioblastoma: A Report Of The Rano Resect Group, Philipp Karschnia, Jacob S Young, Gilbert C Youssef, Antonio Dono, Levin Häni, Tommaso Sciortino, Francesco Bruno, Stephanie T Juenger, Nico Teske, Jorg Dietrich, Michael Weller, Michael A Vogelbaum, Martin Van Den Bent, Juergen Beck, Niklas Thon, Jasper K W Gerritsen, Shawn Hervey-Jumper, Daniel P Cahill, Susan M Chang, Roberta Rudà, Lorenzo Bello, Oliver Schnell, Yoshua Esquenazi, Maximilian I Ruge, Stefan J Grau, Raymond Y Huang, Patrick Y Wen, Mitchel S Berger, Annette M Molinaro, Joerg-Christian Tonn

Faculty, Staff and Student Publications

Background: Following surgery, patients with newly diagnosed glioblastoma frequently enter clinical trials. Nuanced risk assessment is warranted to reduce imbalances between study arms. Here, we aimed (I) to analyze the interactive effects of residual tumor with clinical and molecular factors on outcome and (II) to define a postoperative risk assessment tool.

Methods: The response assessment in neuro-oncology (RANO) resect group retrospectively compiled an international, seven-center training cohort of patients with newly diagnosed glioblastoma. The combined associations of residual tumor with molecular or clinical factors and survival were analyzed, and recursive partitioning analysis was performed for risk modeling. The resulting model …

Impact Of The Covid-19 Pandemic On Pediatric Complicated Sinusitis: A Single Institutional Experience, Rohit Nallani, Mackenzie O'Donnell, Nathan Farrokhian, Meghan Tracy, David Garcia, Jill M. Arganbright

Research Days

Background: Institutions around the world have noted increasing trends in complicated sinogenic infections in children following the start of the COVID-19 pandemic. Treatment of these infections often requires combined medical and surgical management. Further study is needed to understand changing epidemiology, microbiology, and contributing demographic factors for these infections. We noted increasing trend of surgically managed complicated sinusitis during the COVID-19 pandemic at our institution and hypothesized there were higher rates of intracranial complications.

Methods: We performed a retrospective cohort study with chart review of all children under the age of 18 treated surgically for complicated sinusitis between January 1, …

Multicentre Analysis Of Seizure Outcome Predicted By Removal Of High-Frequency Oscillations, Vasileios Dimakopoulos, Jean Gotman, Petr Klimes, Nicolas Von Ellenrieder, Shi Bei Tan, Garnett Smith, Stephen V. Gliske, Margarita Maltseva, Minette Krisel Manalo, Martin Pail, Milan Brazdil, Dorien Van Blooijs, Maryse A. Van 'T Klooster, Sarah Johnson, Samantha Laboy, Debora Ledergerber, Lukas Imbach, Christos Papadelis, Michael R. Sperling, Maeike Zijlmans, Jan Cimbalnik, Julia Jacobs, William C. Stacey, Birgit Frauscher, Johannes Sarnthein

Department of Neurology Faculty Papers

In drug-resistant focal epilepsy, planning surgical resection can involve presurgical intracranial EEG (iEEG) recordings to detect seizures and other iEEG patterns to improve postsurgical seizure outcome. We hypothesized that resection of tissue generating interictal high-frequency oscillations (HFOs, 80-500 Hz) in the iEEG predicts surgical outcome. In eight international epilepsy centres, iEEG was recorded during the presurgical evaluation of patients. The patients were of all ages, had epilepsy of all types, and underwent surgical resection of a single focus aiming at seizure freedom. In a prospective analysis, we applied a fully automated definition of HFO that was independent of the dataset. …

Is Anterior Cervical Discectomy And Fusion More Expensive At Quaternary Care Centers? An Application Of Time-Driven Activity-Based Costing, Jay Trivedi, Advith Sarikonda, Adam Leibold, D. Mitchell Self, Nikolaos Mouchtouris, Steven R. Glener, Ashmal Sami, Kavantissa M. Keppetipola, Emily Isch, Joshua Pelta-Heller, Srinivas Prasad, Ashwini Sharan, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

OBJECTIVE: Hospital setting is postulated to be a key driver of cost variation for neurosurgical procedures. Limitations in contemporary costing methodologies have led to the development of time-driven activity-based costing (TDABC). This study applies TDABC to anterior cervical discectomy and fusion (ACDF) to compare intraoperative costs at quaternary care centers versus satellite hospitals affiliated with the same health network.

METHODS: Nine hundred and fifty-eight ACDF cases performed at two quaternary care hospitals (n = 806) and six satellite hospitals (n = 152) were reviewed. Process maps were created to map the intraoperative episode, and TDABC methodology was used to calculate …

Comparison Of Graft Patency Between Sta, Ra, And Sv Grafts Of Intracranial Aneurysms Of The Internal Carotid Artery, Nassos Tziviskos, Hallie Tiburzi, Susrut Dube

Rowan-Virtua Research Day

Abstract

Background: Patients with intracranial internal carotid artery (ICA) aneurysms that are not amenable to treatments like coiling, stenting, or clipping have limited treatment options. One option is vascular bypass of the aneurysm to introduce a stable route for cerebral perfusion, which can be performed using the superficial temporal artery (STA) or alternatively radial artery (RA) or saphenous vein (SV) grafts, among other vessels.

Methods: The major databases were searched to identify studies that explored graft patency and functional outcome for patients who underwent bypass for intracranial ICA aneurysms with STA, RA, or SV grafts and proportion meta-analysis was performed. …

Perioperative Goal-Directed Fluid Therapy In Neurosurgical Patients: A Scoping Review Of Current Evidence And Research Gaps, Daarsh Goradia, Riya Gandhi, Nisarg Shah, Eric Choi

Rowan-Virtua Research Day

Background: Neurosurgical patients are sensitive to fluid imbalances in postoperative settings. Traditional fluid management has been shown to have variable outcomes. Goal-directed fluid therapy (GDFT) is a tailored approach, but its benefits are not well established in neurosurgery.

Hypothesis: The aim of this study is to identify and map the existing literature on perioperative GDFT in neurosurgical patients, including study characteristics, reported outcomes, and knowledge gaps.

Methods: This scoping review follows the PRISMA-ScR reporting guidelines and the Arksey and O’Malley six-stage methodological framework. A literature search was performed across three databases from January 2000 to April 23, 2025. Studies evaluating …

Understanding The Effect Of Advanced Patient Age On Outcomes And Complications Of Spinal Surgery, Alexander R. Woznicki, Daniel K. Fahim

Posters

• In 2020, 6.7 million individuals in the United States were older than 85. This is projected to increase to 12.6 million in 20601

• The risk of developing many spinal conditions increases with age2,3,4

• Decreases in disk height changes the loadbearing properties of the spine

• Decreased bone density makes the vertebrae susceptible to fracture

• Weakening of spinal ligaments predispose to disc degeneration

• Hypertrophy of the ligamentum flavum and susceptibility to disk herniation can lead to spinal stenosis

• Damage of the cervical spinal cord can manifest as weakness and clumsiness in the upper extremities and …

Safety Profile Of Spinal Cord Stimulator Paddle Lead Revision And Replacement, Saini Kethireddy, Michael Staudt

Posters

• Spinal cord stimulation (SCS) is a neuromodulatory treatment for patients experiencing chronic pain resistant to conservative therapies. It is often used for postlaminectomy syndrome, complex regional pain syndrome, and neuropathic pain.
• SCS leads can be categorized into percutaneous leads and paddle leads, the latter requiring a laminectomy for implantation.
• The advantages of paddle leads include lower migration rates and more efficient energy delivery.
• Revision surgery may be required in instances of lead failure, migration or misplacement. Paddle lead replacement can be challenging due to extensive scar tissue formation, often requiring additional dissection.
• Reoperation for paddle leads has raised concerns about …

Multidisciplinary Care In Body Contouring: An Integrative Approach To Enhancing Outcomes, Jacob Dinis, Sofia C Perez Otero, Diego M Quirarte, Winston R Owens, Sebastian J Winocour

Faculty, Staff and Students Publications

Body contouring procedures have become increasingly common to meet the growing demand for aesthetic surgery, particularly in the context of bariatrics. Massive weight loss (MWL) patients are complex and often require extensive management of comorbidities, malnutrition status, physical debilitation, and psychological sequelae. Patient optimization prior to body contouring surgery in addition to strict postoperative maintenance are crucial to achieve favorable and sustainable outcomes. Surgical candidates should be screened thoroughly, and in the MWL patient population specifically, multidisciplinary care is needed for proper evaluation and support. Notable specialists that routinely contribute in MWL and body contouring patient care include plastic surgeons, …

Portable Head Computed Tomography Protocol For Trauma, Christian Quinones, Alexander Bolufer, Cory Hewitt, Sagun Tuli

HCA Healthcare Journal of Medicine

The use of portable computed tomography (CT) scanners has been shown to reduce risks associated with intrahospital transport and to expedite imaging in critically ill patients. While their use is established in intensive care units, their utility on intraoperative trauma patients remains underexplored. This paper reviews existing literature on portable CT use, defines appropriate clinical indications, outlines contraindications, and identifies quality metrics and implementation challenges. It also presents a proposed protocol for integrating portable head CT imaging into trauma workflows, focusing on early identification of intracranial or spinal injuries in the operating room. The development and analysis of standardized protocols …