Neurosurgery Commons^™

A Rare Case Of Extra-Ventricular Supra-Sellar Neurocytoma – A Diagnostic Conundrum, Rohan Karkra, Suchitha Satish, Peri Keerthi

Digital Journal of Clinical Medicine

The brain and its associated structures are often the primary source or site of metastases for many tumors. Neurocytoma is a relatively rare neuronal neoplasm, first described as an intra-ventricular tumor that is not known to be very aggressive. It constitutes less than 0.5% of CNS neoplasms. Extraventricular Neurocytoma (EVN) is an extremely rare variant, of which only 12 cases have ever been reported in the supra-sellar region. In all of these 12 cases, the patient was initially misdiagnosed; hence, this condition is a diagnostic conundrum. Grossly, the tumor is firm and smooth with extensive blood supply and fibrous tissue. …

Amplification Of The Plag-Family Genes-Plagl1 And Plagl2-Is A Key Feature Of The Novel Tumor Type Cns Embryonal Tumor With Plagl Amplification, Michaela-Kristina Keck, Martin Sill, Andrea Wittmann, Piyush Joshi, Damian Stichel, Pengbo Beck, Konstantin Okonechnikow, Philipp Sievers, Annika K. Wefers, Nasir Uddin

Department of Pathology and Laboratory Medicine

Pediatric central nervous system (CNS) tumors represent the most common cause of cancer-related death in children aged 0-14 years. They differ from their adult counterparts, showing extensive clinical and molecular heterogeneity as well as a challenging histopathological spectrum that often impairs accurate diagnosis. Here, we use DNA methylation-based CNS tumor classification in combination with copy number, RNA-seq, and ChIP-seq analysis to characterize a newly identified CNS tumor type. In addition, we report histology, patient characteristics, and survival data in this tumor type. We describe a biologically distinct pediatric CNS tumor type (n = 31 cases) that is characterized by focal …

Decompression Vs. Decompression And Fusion In Cauda Equina Syndrome Secondary To Massive Lumbar Disc Herniation, Ruheksh Raj

Electronic Thesis and Dissertation Repository

Posterior spinal surgery through either a decompression or additional fusion procedure is the widely accepted standard of care for patients presenting with cauda equina syndrome (CES) secondary to massive disc herniation. A plethora of literature has been published regarding post- surgical outcome, particularly in regards to improvement of lower sacral nerve symptoms in relation to timing of surgery. There is a paucity of data with regards to long term clinical outcomes in patients between the decompression and decompression and fusion groups. We initially hypothesized was that there would be no longer term clinical differences in outcome between the two groups, …

Human Amniotic Membrane As A Dural Substitute In Neurosurgery: A Systematic Review, Zara Shah, Saqib Kamran Bakhshi, Mohammad Hamza Bajwa, Mujtaba Khalil, Michael C. Dewan, Muhammad Shahzad Shamim

Medical College Documents

Background: Several studies have highlighted the use of human amniotic membrane (HAM) in neurosurgical procedures as an effective dural substitute. HAM has inherent antifibrotic and anti-inflammatory properties and exhibits immunomodulatory effect that makes it an ideal dural substitute. Other advantages including easy availability, low cost of procurement, and storage also render it a promising dural substitute especially in low- and middle-income countries.
Methods: A systematic literature search was performed using PubMed, Scopus, and Google Scholar databases, using the search terms "human amniotic membrane," "dural repair," and "neurosurgery." To be eligible for inclusion in our review, papers had to report primary …

What Do We Know So Far About Ofatumumab For Relapsing Multiple Sclerosis? A Meta-Analytical Study, Hafiza Munazza Taj, Maryam Talib, Sania Siddiqa, Azza Sarfraz, Zouina Sarfraz, Karla Robles-Velasco, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Ofatumumab is a monoclonal antibody that reduces the level of B cells that alter the progression of relapsing multiple sclerosis. Originally approved by the Food and Drug Administration (FDA) in August 2020, this meta-analysis determines the outcomes of four randomized controlled trials (RCTs) for endline outcomes of Gadolinium-enhancing T1 lesions on MRI scans reported as Cohen's d and relapse rate reported as risk ratio. All four RCTs reported favorable findings of gadolinium-enhancing T1 lesions (Cohen's d = -0.44, p < 0.00001). The relapse rate was reduced by 46% post ofatumumab administration (RR = 0.54, p < 0.00001). With 14 ongoing trials in this area, more data is required to consolidate our findings.

Neurodevelopment And Recovery From Wasting, Harriet M. Babikako, Celine Bourdon, Emmie Mbale, Peace Aber, Annet Birabwa, Josephine Chimoyo, Wieger Voskuijl, Zaubina Kazi, John Mukisa, Ali Faisal Saleem

Department of Paediatrics and Child Health

Background and objectives: Acute illness with malnutrition is a common indication for hospitalization among children in low- and middle-income countries. We investigated the association between wasting recovery trajectories and neurodevelopmental outcomes in young children 6 months after hospitalization for an acute illness.
Methods: Children aged 2 to 23 months were enrolled in a prospective observational cohort of the Childhood Acute Illness & Nutrition Network, in Uganda, Malawi, and Pakistan between January 2017 and January 2019. We grouped children on the basis of their wasting recovery trajectories using change in mid-upper arm circumference for age z-score. Neurodevelopment was assessed with the …

Intraoperative Changes In Somatosensory Evoked Potentials As A Predictor Of Perioperative Stroke In Carotid Endarterectomy, Justin W. Meinert Bphil, Parthatharasy D. Thirumala Md, Jeffrey R. Balzer Phd, Donald J. Crammond Phd, Eyad E. Saca Md

Tower Health Research Day

No abstract provided.

Outcomes Of Children With Low-Grade Gliomas In Low- And Middle-Income Countries: A Systematic Review, Richard Ward, Hannah M Jones, Davis Witt, Frederick Boop, Eric Bouffet, Carlos Rodriguez-Galindo, Ibrahim Qaddoumi, Daniel C Moreira

Department of Medical Oncology Faculty Papers

Purpose: Pediatric CNS tumors are increasingly a priority, particularly with the WHO designation of low-grade glioma (LGG) as one of six index childhood cancers. There are currently limited data on outcomes of pediatric patients with LGGs in low- and middle-income countries (LMICs).

Methods: To better understand the outcomes of LGGs in LMICs, this systematic review interrogated nine literature databases.

Results: The search identified 14,977 publications. Sixteen studies from 19 countries met the selection criteria and were included for data abstraction and analysis. Eleven studies (69%) were retrospective reviews from single institutions, and one (6%) captured institutional data prospectively. The studies …

Myeloarchitectonic Maps Of Cat Auditory Cortex, Austin Robertson

Electronic Thesis and Dissertation Repository

The cerebral cortex contains myriad cortical areas that differ in structure, function, and connectivity. Current methods of delineating cortical structures and their subregions are insufficient for in vivo applications, either being highly invasive or requiring a detailed knowledge of a region’s tuning properties. To address this, we seek to establish a structural biomarker capable of delineating the cortex that possesses a non-invasive correlate. We explore myelin as a potential candidate by evaluating its efficacy in parcellating the feline auditory cortex through the generation of depthwise myelin density profiles for each of the 13 auditory cortical subregions. Our analyses revealed significant …

Pineal Cyst Apoplexy And Memory Loss: A Novel Complication, Areez Shafqat, Hanin Jaber Algethami, Shameel Shafqat, Syed Shafqat Ul Islam

Medical College Documents

An 8-year-old boy presented to our hospital complaining of a bilateral headache associated with episodes of anterograde amnesia. He had a road traffic accident 3 years ago when a computed tomography (CT) scan revealed traumatic brain injury. In addition, a small pineal cyst (PC) was noted with minor intramural calcifications. A follow-up CT a day later demonstrated increased density in the pineal gland of 60 Hounsfield Units, suggestive of apoplectic changes in the PC. However, the patient was lost to follow-up and presented with memory loss a year and a half later, upon which CT and magnetic resonance imaging revealed …

Association Between Vitamin D Supplementation And Cancer Mortality: A Systematic Review And Meta-Analysis, Renjie Zhang, Yu Zhang, Zheran Liu, Yiyan Pei, Ping Xu, Weelic Chong, Yang Hai, Ling He, Yan He, Jiayi Yu, Jingjing Wang, Fang Fang, Xingchen Peng

Department of Medical Oncology Faculty Papers

Background: Vitamin D deficiency is related to increased cancer risk and deaths. However, whether vitamin D supplementation reduces cancer mortality remains unclear, and several randomized controlled trials yield inconsistent results.

Methods: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception until 28 June 2022, for randomized controlled trials investigating vitamin D supplementation. Pooled relative risks (RRs) and their 95% confidence intervals (CIs) were estimated. Trials with vitamin D supplementation combined with calcium supplementation versus placebo alone and recruiting participants with cancer at baseline were excluded in the present study.

Results: This study included 12 …

Evolution Of The Ao Spine Sacral And Pelvic Classification System: A Systematic Review, Barry Ting Sheen Kweh, Jin W. Tee, F. Cumhur Oner, Klaus J. Schnake, Emiliano N. Vialle, Frank Kanziora, Shanmuganathan Rajasekaran, Marcel Dvorak, Jens R. Chapman, Lorin M. Benneker, Gregory Schroeder, Alexander R. Vaccaro

Rothman Institute Faculty Papers

OBJECTIVE: The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems.

METHODS: A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems.

RESULTS: A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary …

Primary Middle Meningeal Artery Embolization For A Chronic Subdural Hematoma After Non-Accidental Trauma In A Child: A Case Report, Saisree Ravi, Sohum Desai, Ameer E. Hassan, Wondwossen G. Tekle

School of Medicine Publications and Presentations

Chronic subdural hematoma in children can be pathognomonic of abusive head trauma. Treatment options for these range from observation to surgical evacuation depending on clinical circumstance and presenting features, which can include mental status changes, headaches, focal neurologic deficits, or asymptomatic presentation. Standalone endovascular treatments represent an area of growing interest in the adult population as an effective treatment modality. However, embolization as a singular treatment approach has not been reported in the pediatric population. We report the first case of stand-alone middle meningeal artery (MMA) embolization of a chronic subdural hematoma as a sequela of abusive head trauma in …

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 …

The Impact Of Volume Of Tissue Activation On Cortical-Striatal Networks And Verbal Fluency Declines In Post-Deep Brain Stimulation Parkinson's Disease Patients., Alexander Luke Alley

Electronic Theses and Dissertations

This study investigated the cortical-striatal networks of verbal fluency declines in 6-month, post-operative, deep brain stimulation Parkinson’s Disease patients. Nine Parkinson’s disease participants with implanted STN or GPi DBS systems were recruited for this study. Verbal fluency data was obtained from each patient preoperatively and 6- months post implantation. The stimulation-based volume of tissue activated area (VTA) of each target site (STN or GPi) was analyzed using Lead-DBS and Lead-Group. The white matter tracks intersecting each patient’s VTA, terminating in the pre-SMA, SMA, caudate nucleus, and anterior cingulate were investigated and correlated with verbal fluency declines. We found statistically significant …

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, …

Ten-Year Safety Of Pluripotent Stem Cell Transplantation In Acute Thoracic Spinal Cord Injury., Stephen L Mckenna, Reza Ehsanian, Charles Y Liu, Gary K Steinberg, Linda Jones, Jane S Lebkowski, Edward Wirth, Richard G Fessler

Department of Medicine Faculty Papers

OBJECTIVE: The purpose of this study was to evaluate the safety of oligodendrocyte progenitor cells (LCTOPC1) derived from human pluripotent stem cells administered between 7 and 14 days postinjury to patients with T3 to T11 neurologically complete spinal cord injury (SCI). The rationale for this first-in-human trial was based on evidence that administration of LCTOPC1 supports survival and potential repair of key cellular components and architecture at the SCI site.

METHODS: This study was a multisite, open-label, single-arm interventional clinical trial. Participants (n = 5) received a single intraparenchymal injection of 2 × 106 LCTOPC1 caudal to the epicenter of …

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.