Publications (661) View all
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Article: Oberlin transfer and partial radial to axillary nerve neurotization to repair an explosive traumatic injury to the Brachial Plexus in a child: Case report.
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ABSTRACT: PURPOSE: Explosive injuries to the pediatric brachial plexus are exceedingly rare and as such are poorly characterized in the medical literature. METHODS: Herein, we describe an 8-year-old who was struck in the neck by a piece of shrapnel and suffered multiple vascular injuries in addition to a suspected avulsion of the cervical 5 and 6 ventral rami. The patient had a complete upper brachial plexus palsy and failed to demonstrate any clinical improvement at 6-months follow-up. He was taken to the operating from for a partial ulnar to musculocutaneous nerve neurotization as well as a partial radial to axillary nerve neurotization. RESULTS: The patient's motor exam improved from a Medical Research Council scale 1 to 4+ for biceps brachii and 0 to 4 deltoid function with greater than 90° of shoulder abduction. CONCLUSIONS: This outcome supports complex neurotization techniques as viable treatment options for persistent motor deficits following an upper brachial plexus injury in older, non-infant age, children.Child s Nervous System 05/2013; · 1.54 Impact Factor -
Article: Tectal plate gliomas: a review.
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ABSTRACT: INTRODUCTION: Tectal plate gliomas are generally benign neoplastic lesions arising in the brainstem which can, with local extension, obstruct the aqueduct of Sylvius and lead to hydrocephalus. ANATOMY: Diagnosis is based on initial suspicion fostered by the presentation of an obstructive hydrocephalus followed by physical exam which may potentially reveal indications of pyramidal tract dysfunction or cranial nerve palsies. DISCUSSION: MRI studies reveal a characteristic well-circumscribed, isodense or hypodense mass on T1-weighted images, with hyperdensity on T2 imaging. Yet current radiological methods insufficiently distinguish tectal plate gliomas from brainstem tumors or gliomas in the neighboring structures, and a definitive diagnosis requires biopsy and histopathological analysis. Management is planned according to the degree of associated signs and symptoms, and may range from diligent observation and periodic screening for advancing tumor development, to cerebrospinal fluid shunting in an effort to resolve obstructive hydrocephalus, to radio- and chemotherapy. A wide range of minimally invasive approaches using endoscopy is available for the neurosurgeon, including endoscopic third ventriculostomy and endoscopic aqueductoplasty.Child s Nervous System 04/2013; · 1.54 Impact Factor -
Article: The Indusium Griseum: Anatomic Study with Potential Application to Callosotomy.
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ABSTRACT: BACKGROUND:: Although the indusium griseum (IG) is often seen by the neurosurgeon, almost nothing exists in the literature regarding its anatomic structure. Some have postulated that this structure is a remnant of the hippocampus, and some have found memory deficits in patients following callosotomy OBJECTIVE:: To further investigate the anatomy of the IG in humans through gross and histologic analysis. METHODS:: The IG from 10 adult cadaveric brains underwent microdissection and immunohistochemical analysis. RESULTS:: Grossly, the IG was on average 2 cm in width over the body and genu of the corpus callosum and traveled in intimate contact anteriorly over the lamina terminalis, and posteriorly it was adherent to the splenium of the corpus callosum. Histologically, the IG is a thin layer of hypocellular glial tissue interposed between the pia and the corpus callosum. Glial cells composed the cellular constituents of the IG, and compared to the underlying corpus callosum, the IG was hypomyelinated. The fibers/axons of the IG travel in a perpendicular plane compared to those of the corpus callosum and the IG varied in thickness from one area to the other and it was occasionally discontinuous. CONCLUSION:: The IG is a glial membrane with no neuronal content or obvious connections to the hippocampus. Based on this study, transection of this membrane with callosotomy should not be the reason for postoperative memory loss seen in some of these patients. Future studies aimed at elucidating the function of the IG in humans are now warranted.Neurosurgery 04/2013; · 2.79 Impact Factor -
Article: Hysterical paralysis and premature burial: A medieval Persian case, fear and fascination in the west, and modern practice.
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ABSTRACT: Premature burial (taphophobia) is an ancient fear, but it became especially common in 18th and 19th century Europe and may have a modern-day counterpart. Examination of a well-documented case from medieval Persia reveals the importance of funeral practices in the risk of actual premature burial and sheds light on the question of why taphophobia became so prevalent in Europe during the early industrial revolution period. The medieval Persian case was attributed to hysterical paralysis (conversion). We discuss the relationship between hysterical paralysis and premature burial more generally and show that although understanding of conversion syndrome remains incomplete, modern knowledge and practices have limited the risk of any similar tragedy today.Journal of forensic and legal medicine 04/2013; 20(3):133-5. -
Article: Guillaume rondelet (1507-1566): Cardinal physician and anatomist who dissected his own son.
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ABSTRACT: The 16th century French anatomist Guillaume Rondelet will be remembered as a great naturalist and a founder of ichthyology. Little known to most is that Rondelet was a proficient anatomist and contemporary to Vesalius and in fact, both studied anatomy under Johannes Guinter. Even less known is that he established the first dissecting theatre at Montpellier and it was here that he would dissect his infant son in an attempt to identify the cause of death. In this article, we review the life and contributions to anatomy of Rondelet. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.Clinical Anatomy 04/2013; · 1.29 Impact Factor
