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Publications (3)4.35 Total impact

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    ABSTRACT: We evaluated long-term outcomes of posterior fossa decompression (PFD) without duroplasty in consecutive patients with newly diagnosed Chiari-1 malformation. We searched the institutional database for all adult patients who underwent Chiari decompression between 1995 and 2007. PFD was offered to all consecutive patients with Chairi-1 malformation during this time period. We excluded patients who underwent re-exploration after initial Chiari-1 decompression elsewhere. Besides the demographic variables, presenting symptoms, neurological and radiographic findings the clinical records were studied for long-term outcomes specifically symptomatic improvement. We defined symptomatic improvement as resolution of all presenting symptoms including pain and/or neurological deficits at the last follow-up. The factors associated with symptom recurrence were also analyzed. We identified 47 patients who underwent PFD for Chiari-1 malformation. Syringomyelia was noted in 36.2% of patients and the mean tonsilar herniation was 12.6mm. At a mean follow-up of 9.3 years, the symptomatic improvement rate was 60.6%. There were no operative complications. Repeat posterior fossa decompression was required for 31.9% patients with symptomatic recurrence at an average of 2.6 years after initial decompression. Fibrotic thickening overlying the dura mater was observed in one-third of these patients. This case series reports low complication but high long-term symptomatic recurrence rates adults with symptomatic Chiari-1 malformation undergoing PFD.
    Clinical neurology and neurosurgery 03/2014; 118C:53-58. · 1.30 Impact Factor
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    ABSTRACT: Recently, the incidence of bronchopulmonary carcinoid has increased substantially, whereas survival associated with both subtypes has declined. We reviewed our experience with bronchopulmonary carcinoid to identify factors associated with long-term survival. We reviewed our cancer registry from 1985 to 2009 for all patients undergoing surgical resection for bronchopulmonary carcinoid. Cox regression analysis was used to evaluate prognostic factors. Fifty-two patients met criteria for inclusion. Forty-three patients (82%) presented with typical histology. The likelihood of lymph node metastasis was similar for patients with typical histology and patients with atypical histology. For patients with typical histology, the 5-year survival rates with and without lymph node metastases were 100 per cent and 97 per cent, respectively (P = 0.420). The overall survival rate for patients with typical histology (97% at 5 years; 72% at 10 years) was significantly better than for patients with atypical histology (35% at 5 years, 0% at 10 years) (P < 0.001). Univariate and multivariate analyses demonstrated that long-term survival was associated with histology but not lymph node involvement (hazards ratio = 14.6, 95% confidence interval: 1.7, 125.2). Our data suggests that long-term survival is associated with histology, not lymph node involvement. We found tumor histology to be the strongest predictor of long-term survival in patients with pulmonary carcinoid tumors.
    The American surgeon 12/2011; 77(12):1669-74. · 0.92 Impact Factor
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    ABSTRACT: Neurosurgical patients commonly require mechanical ventilation and monitoring in a neurocritical care unit. There are only few studies that specifically address the process of liberation from mechanical ventilation in this population. Patients who remain ventilator or artificial airway dependent receive a tracheostomy. The appropriate timing for the procedure is not well defined and may be different among an inhomogeneous population of critically ill patients. In this article, we review the general principles of liberation and the current literature as it pertains to neurosurgical patients with primary brain injury. The criteria for "readiness of extubation" include a combination of neurologic assessment, hemodynamic, and respiratory parameters. Future studies are required to better assess indicators for extubation readiness, evaluate the predictors of extubation failure in brain-injured patients, and define the most appropriate timing for a tracheostomy.
    Journal of critical care 10/2011; 27(4):417.e1-8. · 2.13 Impact Factor