Neurosurgery Commons^™

Clinical Applications Of Direct Cortical Stimulation During Awake Craniotomies. Commentary On Passive Functional Mapping Using Infrared Thermography In Epilepsy Awake Surgery., Ramiro Antonio Perez De La Torre, Ramanathan Siddarth, Pérez Ramírez Pedro, Santiago Noé

Archives of Neurosurgery

As clinicians, we rely on various imaging methods to identify abnormal brain lesions. We can distinguish this myriad of neurological disorders by using imaging alone or together with either or both electrophysiological monitoring and direct cortical stimulation. This last alternative is the most frequently used approach to diagnosing brain lesions requiring awake craniotomies for adequate management. Awake craniotomies have become the standard of care for focal lesions, including vascular malformations like cavernous angiomas, intrinsic brain tumors, gliomas, vasculitic brain lesions, postinfectious brain lesions, brain metastasis, and also for epilepsy surgery. Surgery for epileptic patients requires multidisciplinary team interactions and a ...

Utilization Of The Nurse Practitioner Skillset In Partnership With The Medical Device Industry, Daniel C. Rowland

Doctor of Nursing Practice (DNP) Projects

BACKGROUND: Millions of nurse practitioners (NP), physician assistants (PA), and registered nurses (RN) are optimistic that their current employers will help them reach their full potential. One area that can add value to the hospital and empower employees to work to the full scope of their practice, and utilize the skillsets like that of an NP, is to train these providers to support medical device equipment in the operating room instead of relying on medical device representatives (MDRs) of medical device companies.

METHODS: Training NPs, PAs, or RNs how to support neurological medical device equipment will better utilize the skillset ...

Innocuous Expectoration Of An Anterior C3 Loosened Screw—Case Report And Literature Review About A Benevolent Evolution With No Esophageal Injury, Gerson Reyes Rodriguez, José Alberto Israel Romero Rangel, Manuel Soto García, Manuel Rodriguez Garcia, Victor David Lopez Garcia, Iris Tatiana Montes González, José Antonio Soriano Sánchez

Archives of Neurosurgery

The anterior cervical discectomy and fusion (ACDF) technique is the gold-standard treatment for myeloradiculopathy. We present the case of a seventy-five years old female who came to revision because of worsening solids dysphagia, dry cough, and foreign body sensation in the past two weeks; we had practiced her an ACDF procedure four years ago. She denied presenting neurological deficit or neck pain. The physical examination was normal. Cephalic migration of the left C3 screw was evident on cervical plain and dynamic films and CT-Scan. She was admitted to the hospital for an upper gastrointestinal endoscopy that visualized retropharyngeal ulceration. Thirty ...

L5-S1 Collapsed Space Is Not A Contraindication For Elif. Technical Note And Preliminary Clinical Results, Iris Tatiana Montes González, Sergio Soriano Solis, Manuel Eduardo Soto García, Manuel Rodríguez García, Gerson Reyes Rodríguez., Víctor David López García, José Antonio Soriano Sánchez

Archives of Neurosurgery

INTRODUCTION: Extraforaminal lumbar interbody fusion (ELIF) avoids vascular, neural, and genitourinary risks of anterior and lateral techniques. However, many authors consider ELIF to be contraindicated in L5-S1, especially in the case of a collapsed space. Therefore, we aim to provide a technical note for ELIF in the context of an L5-S1 collapsed space and present our experience and the postoperative clinical results of our patients. MATERIALS AND METHODS: We collected data from the records of patients with ELIF L5-S1 level collapsed between March 2020 to June 2021, using for this study sex, age, clinical symptoms, diagnosis, L5-S1 height space, EVA ...

Prospective Study On Embolization Of Intracranial Aneurysms With The Pipeline Device (Premier Study): 3-Year Results With The Application Of A Flow Diverter Specific Occlusion Classification, Ricardo A. Hanel, Ajit S. Puri

Radiology Publications

BACKGROUND: The pipeline embolization device (PED; Medtronic) has presented as a safe and efficacious treatment for small- and medium-sized intracranial aneurysms. Independently adjudicated long-term results of the device in treating these lesions are still indeterminate. We present 3-year results, with additional application of a flow diverter specific occlusion scale.

METHODS: PREMIER (prospective study on embolization of intracranial aneurysms with pipeline embolization device) is a prospective, single-arm trial. Inclusion criteria were patients with unruptured wide-necked intracranial aneurysms < /=12 mm. Primary effectiveness (complete aneurysm occlusion) and safety (major neurologic event) endpoints were independently monitored and adjudicated.

RESULTS: As per the protocol, of 141 patients treated with a PED, 25 (17.7%) required angiographic follow-up after the first year due to ...

Role Of Surgery In Multifocal Glioblastoma, Syeda Kubra Kishwar Jafri, Syed Sarmad Bukhari, Muhammad Shahzad Shamim

Section of Neurosurgery

The management of multifocal glioblastomas is a point of constant discussion amongst neuro-oncologists. Best outcomes in glioblastoma management come from gross total resection (GTR) followed by concomitant radiation and chemotherapy (CCRT). Multifocal disease is resistant to GTR. Conventional management of these lesion is usually biopsy only followed by CCRT. Recent evidence has shown that there may be some benefit to attempting GTR of the largest lesion whenever safe to do so.

An Unusual Case Of A Giant Intradiploic Epidermoid Cyst Removed Using A Combined Supra-Infratentorial Retromastoid Approach., César Adán Almendárez-Sánchez, Saúl Solorio-Pineda, Abrahan Alfonso Tafur-Grandett, Miguel Ángel Ramírez-Sosa Dr., Gabriel Arturo Ramos Martínez, Leonardo Álvarez-Vázquez

Archives of Neurosurgery

Background: Epidermoid cysts (EC) are relatively rare congenital lesions. They arise from ectodermal debris during aberrant closure of the neural tube, are benign, and of slow growth. They are found predominantly in the cistern of the cerebellopontine angle, most are intradural, and very rarely, there is underlying compression of the venous sinuses, leading to benign intracranial hypertension.

Case description: We present the case of a patient diagnosed with a giant extradural, intradiploic EC with compression of the left transverse sinus and its successful management by using ultrasonic aspiration, performing a combined supra-infratentorial retromastoid approach with occipitotemporal craniotomy, without subsequent residual ...

Seizure Prediction In Epilepsy Patients, Gary Dean Cravens

NSU REACH and IPE Day

Purpose/Objective: Characterize rigorously the preictal period in epilepsy patients to improve the development of seizure prediction techniques. Background/Rationale: 30% of epilepsy patients are not well-controlled on medications and would benefit immensely from reliable seizure prediction. Methods/Methodology: Computational model consisting of in-silico Hodgkin-Huxley neurons arranged in a small-world topology using the Watts-Strogatz algorithm is used to generate synthetic electrocorticographic (ECoG) signals. ECoG data from 18 epilepsy patients is used to validate the model. Unsupervised machine learning is used with both patient and synthetic data to identify potential electrophysiologic biomarkers of the preictal period. Results/Findings: The model has ...

The Many Worlds Of Neurosurgery And The Labyrinth Of Borges, Juan F. Villalonga, Giulia Guizzardi, Domenico Solari

Archives of Neurosurgery

Nowadays, an apprentice of neurosurgery has to complete long and different pathways of education.The encounter between the schools of Napoli and Tucuman, make us identify a common strategy of neurosurgical education. In attempt of defining the philosophy behind it we attempt a comparison in between the life and training of a modern neurosurgeon and the character of a tale of Borges (i.e. Ts'ui Pên). As neurosurgeons of the 21st century we must be like the inextricable Ts'ui Pên.

Exploring The Effects Of Spinal Cord Stimulation For Freezing Of Gait In Parkinsonian Patients, Olivia Samotus

Electronic Thesis and Dissertation Repository

Dopaminergic replacement therapies (e.g. levodopa) provide limited to no response for axial motor symptoms including gait dysfunction and freezing of gait (FOG) in Parkinson’s disease (PD) and Richardson’s syndrome progressive supranuclear palsy (PSP-RS) patients. Dopaminergic-resistant FOG may be a sensorimotor processing issue that does not involve basal ganglia (nigrostriatal) impairment. Recent studies suggest that spinal cord stimulation (SCS) has positive yet variable effects for dopaminergic-resistant gait and FOG in parkinsonian patients. Further studies investigating the mechanism of SCS, optimal stimulation parameters, and longevity of effects for alleviating FOG are warranted. The hypothesis of the research described in ...

Passive Functional Mapping Using Infrared Thermography In Epilepsy Awake Surgery: Case Report, Enrique De Font-Réaulx, Javier Terrazo-Lluch, Paul Shkurovich-Bialik, Miguel Ángel Collado-Corona, Ernesto Ramírez-Navarrete, Luis Díaz-López Md, Alma Rosa Martínez-Rosas Msc, Adalberto González-Astiazarán

Archives of Neurosurgery

Background: Active Functional Mapping (AFM) is the gold standard method for localizing cortical and subcortical brain functional areas and tracts. By definition, it requires direct application of controlled electrical stimuli under established protocols. Nevertheless, it entails inherent risks, such as causing intraoperative seizures. On the other hand, Passive Functional Mapping (PFM) doesn´t require electrical stimulation of the nervous system. PFM is based on the knowledge that brain metabolism generates different electromagnetic radiation patterns depending on its metabolism, that are invisible to the human eye, but infrared thermographic cameras can show those changes related to brain activity without the use ...

The Scientific Divulgation In Neurosurgery., Rodrigo Ramos-Zuñiga, Sergio Manuel Ibarra-Navarro

Archives of Neurosurgery

The communication of scientific findings in a young discipline in the evolution of knowledge about the human nervous system, has had a consistent and significant advance. This interdisciplinary and multidisciplinary vision has been a fundamental educational axis in the development of neurosurgery in terms of innovation, scientific progress, technological development and quality of patient care. It is therefore essential that scientific writing and communication channels continue to preserve these quality standards, to validate without bias and with certainty, the value and strength of the advances of neurosurgery as a science.

Aneurysmal Subarachnoid Hemorrhage And Acute Subdural Hematoma, Neurosurgical And Endovascular Rescue. Case Report., José Omar Santellan Resident, José Ramón Aguilar Dr., Abraham Ibarra Dr., Ulises García Dr.

Archives of Neurosurgery

Introduction: Acute subdural hemorrhage (aSDH) in association with aneurismal subarachnoid hemorrhage (SAH) is a severe disease with an incidence of 0.5% to 7.9% of all SAH. Due to the rarity of aneurysmal aSDH, it remains difficult to define a comprehensive management protocol. In this case review, following the CARE guidelines, we show the hybrid management of this pathology to know the importance of using different types of neurosurgical treatments in case of two severe diseases in critical patients.

We present two patients who developed sudden onset cephalea and neurological impairment secondary to aneurysmal subarachnoid hemorrhage associated with acute ...

Microvascular Decompression For Hemifacial Spasm: Surgical Technical Nuances And Results After 300 Microvascular Decompression Surgeries, Rogelio Revuelta Gutiérrez, Miguel Vega-Arroyo, Olivia L. Vales-Hidalgo, Cynthia E. López-Rafael, Jesús Martínez-Manrique, Sergio Moreno Jiménez

Archives of Neurosurgery

Introduction: Hemifacial spasm (HFS) is characterized by the involuntary, paroxysmal, painless, and progressive spasmodic contractions of facial muscles innervated by the ipsilateral seventh cranial nerve. To date, neuroimaging studies (Computed Tomography scan [CT] and Magnetic Resonance Imaging [MRI]) are unable to establish the diagnosis. HFS medical treatment with antiepileptic drugs, and Botulinum toxin application are temporarily effective, however, both have shown side effects and lesser cost-effective results. Currently, surgical Micro Vascular Decompression (MVD) for HFS has the highest curative rates and lower operative morbidity. We analyze the demographics, clinical manifestations, outcomes, and complications that to our knowledge, is the largest ...

Issues To Publish In Latin America, Fiacro Jiménez Ponce, José Antonio Soriano Sánchez, José Alberto Israel Romero Rangel

Archives of Neurosurgery

Scientific knowledge is essential to the development of civilization, particularly in our case for anatomy and physiology of the central nervous system and neurosurgical practice. In this editorial, we are reviewing three critical aspects of scientific publications: The scientific training of physicians, the impact of publications, and the ethical aspects related to elaborating a paper.

Short Chain Fatty Acids Taken At Time Of Thrombectomy In Acute Ischemic Stroke Patients Are Independent Of Stroke Severity But Associated With Inflammatory Markers And Worse Symptoms At Discharge, Nicholas Henry, Jacqueline A. Frank, Christopher J. Mclouth, Amanda L. Trout, Andrew J. Morris, Jianzhong Chen, Ann M. Stowe, Justin F. Fraser, Keith R. Pennypacker

Behavioral Science Faculty Publications

Introduction: Short chain fatty acids (SCFA) are gut microbiota-derived metabolites that contribute to the gut-brain axis and may impact stroke outcomes following gut dysbiosis. We evaluated plasma SCFA concentrations against stroke severity parameters and identified SCFA-associated protein networks.

Methods: The Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC), a continuously enrolling tissue bank, was used to obtain stroke samples. Arterial blood distal and proximal to the thrombus was obtained from Acute Ischemic Stroke (AIS) Patients (n=53) during thrombectomy. Patient demographics, stroke presentation and outcome parameters were reported. The SCFAs were isolated from proximal plasma via chemical derivatization UHPLC coupled ...

Eagle Syndrome: Efficacies Of Medical And Surgical Treatments, Kirklin Mitchell

Capstone Showcase

Eagle Syndrome is a rare syndrome caused by elongation of the styloid process of the temporal bone or calcification of the stylohyoid ligament occurring in a very small percentage of the population that can cause a wide range of common symptoms, leading to it being often misdiagnosed. While there are no set standards for treating Eagle Syndrome, both pharmaceutical and surgical options exist. Pharmaceutical options are often ineffective in long term treatment so surgery is usually required for full symptom resolution. Transoral and Transcervical surgeries have similar efficacies but each come with important drawbacks when considering which type of surgery ...

Stereotactic Radiosurgery For Pituitary Adenomas: A Review Of Literature, Kaynat Siddiqui, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Stereotactic radiosurgery (SRS) is a choice of treatment for pituitary adenomas (PA), particularly for residual or recurrent disease, apart from surgery. It has a progression free survival and endocrine remission rate comparable to surgery, with fewer side effects, making it an ideal tool for dealing with PA. In this review, we have discussed the role of SRS for primary as well as post-operative residual/ recurrent PA, and have assessed its safety and outcomes.

Intensive Care Bundle With Blood Pressure Reduction In Acute Cerebral Hemorrhage Trial (Interact3): Study Protocol For A Pragmatic Stepped-Wedge Cluster-Randomized Controlled Trial, Lili Song, Xin Hu, Lu Ma, Xiaoying Chen, Menglu Ouyang, Laurent Billot, Qiang Li, Paula Muñoz-Venturelli, Carlos Abanto, Mohammad Wasay

Section of Neurology

Background: Early intensive blood pressure (BP) lowering remains the most promising treatment for acute intracerebral hemorrhage (ICH), despite discordant results between clinical trials and potential variation in the treatment effects by approach to control BP. As the third in a series of clinical trials on this topic, the INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3) aims to determine the effectiveness of a goal-directed care bundle protocol of early physiological control (intensive BP lowering, glycemic control, and pyrexia treatment) and reversal of anticoagulation, in acute ICH.
Methods: INTERACT3 is a pragmatic, international, multicenter, stepped-wedge (4 ...

Can Activated Titanium Interbody Cages Accelerate Or Enhance Spinal Fusion? A Review Of The Literature And A Design For Clinical Trials, Nathaniel Toop, Connor Gifford, Rouzbeh Motiei-Langroudi, Arghavan Farzadi, Daniel Boulter, Reza Forghani, H. Francis Farhadi

Neurosurgery Faculty Publications

While spinal interbody cage options have proliferated in the past decade, relatively little work has been done to explore the comparative potential of biomaterial technologies in promoting stable fusion. Innovations such as micro-etching and nano-architectural designs have shown purported benefits in in vitro studies, but lack clinical data describing their optimal implementation. Here, we critically assess the pre-clinical data supportive of various commercially available interbody cage biomaterial, topographical, and structural designs. We describe in detail the osteointegrative and osteoconductive benefits conferred by these modifications with a focus on polyetheretherketone (PEEK) and titanium (Ti) interbody implants. Further, we describe the rationale ...