Islam Fayed

Georgetown Hospital System · Department of Neurosurgery

Objective Spinal cord stimulation (SCS) is an invasive treatment option for patients suffering from chronic low-back pain (cLBP). It is an effective treatment that has been shown to reduce pain and increase the quality of life in patients. However, the activation of pain processing regions of cLBP patients receiving SCS has not been assessed using...

BACKGROUND AND OBJECTIVES Long-term outcomes in deep brain stimulation (DBS) depend on accuracy of lead placement. Microelectrode recording (MER) is a long-used adjunct to leverage neurophysiological information to confirm satisfactory trajectory of implanted electrodes. The goal of this study was to evaluate the consistency in which electrodes are...

Introduction: Adoption of robotic techniques is increasing for neurosurgical applications. Common cranial applications include stereoelectroencephalography (sEEG) and deep brain stimulation (DBS). For surgeons to implement robotic techniques in these procedures, realistic learning curves must be anticipated for surgeons to overcome the challenges...

INTRODUCTION Thoracic spinal cord stimulation (SCS) may be an effective treatment option for patients with chronic low back pain (cLBP), and pain levels can be assessed using subjective clinical scores. The use of diffusion-derived imaging of brain regions involved in pain has yet to be studied. METHODS DTI and MAP data was gathered from five cLBP...

INTRODUCTION Thoracic spinal cord stimulation (tSCS) is an effective treatment of chronic low-back pain (cLBP). Although diffusion imaging has been conducted in this group of patients, the study of diffusion-derived structural imaging of regions involved in pain processing has not been conducted. METHODS Diffusion-weighted imaging scans were acqui...

INTRODUCTION Multi-delay, pseudo-continuous arterial spin labelling (PCASL) is a novel technique capable of perfusion imaging without contrast. It overcomes the limitation of a low signal-to-noise ratio of pulsed-ASL, and multiple post-label delays allow it to account for and measure arterial transit time (ATT). This makes it a suitable tool for th...

INTRODUCTION A treatment of chronic low-back pain is implantation of a thoracic spinal cord stimulator (tSCS), which has been shown to reduce pain. The functional changes in pain processing regions of the brain as assessed by resting-state fMRI and multi-delay pseudocontinuous arterial spin labeling (PCASL) have never been studied. METHODS PCASL d...

INTRODUCTION Thoracic spinal cord stimulation (tSCS) is an interventional option for patients with refractory chronic low back pain (cLBP). The use of functional imaging of brain regions involved in pain as a quantitative method to evaluate treatment effectiveness has not yet been studied. METHODS pCASL data using 5 post-label delays (0.5-2.5s) al...

As we enter 2024, companies will need to innovate and use AI smarter. Data storage and backup account for at least 30% of the IT budget. Our predictions below focus on optimizing the data management components of AI and cloud technologies, with long-term implications as GenAI unlocks a new era of end-user productivity and technical proficiency. If...

BACKGROUND AND OBJECTIVES Robotic assistance has garnered increased use in neurosurgery. Recently, this has expanded to include deep brain stimulation (DBS). Several studies have reported increased accuracy and improved efficiency with robotic assistance, but these are limited to individual robotic platforms with smaller sample sizes or are broader...

Purpose Subependymal giant cell astrocytoma (SEGA) is a WHO grade I pediatric glioma arising in 5–15% of patients with tuberous sclerosis (TSC). Rare cases of isolated SEGA without TSC have been described. The etiology, genetic mechanisms, natural history, and response to treatment of these lesions are currently unknown. We describe two such cases...

Background and objectives: Directional leads have garnered widespread use in deep brain stimulation (DBS) because of the ability to steer current and maximize the therapeutic window. Accurate identification of lead orientation is critical to effective programming. Although directional markers are visible on 2-dimensional imaging, precise orientati...

Diffusion-weighted magnetic resonance imaging (dwMRI) has increasingly demonstrated greater utility in analyzing neuronal microstructure. In patients with chronic low back pain (cLBP), using dwMRI to observe neuronal microstructure can lead to non-invasive biomarkers which could provide clinicians with an objective quantitative prognostic tool. In...

Background: Precise electrode position is vital for effective deep brain stimulation in treating motor symptoms in Parkinson's disease (PD). Enlarged perivascular spaces (PVSs) are associated with pathophysiology of neurodegenerative diseases including PD and may affect the microstructure of surrounding brain tissue. Objective: To quantify the c...

Purpose: Despite significant advances in epileptology, there are still many uncertainties about the role of the insula in epilepsy. Until recently, most insular onset seizures were wrongly attributed to the temporal lobe. Further, there are no standardised approaches to the diagnosis and treatment of insular onset seizures. This systematic review...

Recent studies suggest that changes in neuronal metabolism are associated with epilepsy. High rates of ATP depletion, lactate dehydrogenase A and lactate production have all been found in epilepsy patients, animal and tissue culture models. As such, it can be hypothesized that chronic seizures lead to continuing elevations in neuronal energy demand...

Background Lumbar synovial cysts (LSCs) can cause painful radiculopathy, sensory and/or motor deficits. Historically, first-line surgical treatment has been decompression with fusion. Recently, minimally invasive laminectomy without fusion has shown equal or superior results to traditional decompression and fusion methods. Objective This study inv...

INTRODUCTION The concept of accelerated degeneration at the level adjacent to a fused spinal segment is a well-known and studied phenomenon. Most current surgical paradigms address this with extension of fusion. However, decompression with laminectomy and/or discectomy, particularly with MIS approaches, are viable options. METHODS A single-center...

INTRODUCTION Lumbar synovial cysts (LSC), most often occurring at L4-5, can cause painful radiculopathy and/or sensory or motor deficits when symptomatic. The etiology of these lesions is thought to be related to degeneration of the facet joints. Historically, the first-line surgical treatment has been decompression with fusion. More recently, mini...

Background Intradural spinal cord pathologies have traditionally been managed with open surgical procedures and require the completion of a durotomy. Minimally invasive techniques are emerging as alternative procedures with the goal of reducing complications, but often require specialized equipment with additional training. Methods We conduct a si...

Objective: Single-position lateral lumbar interbody fusion (SP-LLIF) has recently gained significant popularity due to increased operative efficiency, but it remains technically challenging. Robot-assisted percutaneous pedicle screw (RA-PPS) placement can facilitate screw placement in the lateral position. The authors have reported their initial e...

Objective Recent evidence favors a network concept in tuberous sclerosis (TSC) with seizure generation and propagation related to changes in global and regional connectivity between multiple, anatomically distant tubers. Direct exploration of network dynamics in TSC has been made possible through intracranial sampling with stereoelectroencephalogra...

Purpose Unlike tandem stenosis of the cervical and lumbar spine, tandem cervical and thoracic stenosis (TCTS) of the spine is less common, and the approach and order of intervention are controversial. We aim to review the literature to evaluate the incidence and interventions for patients with cervical and thoracic stenosis. We provide illustrative...

Background Uncontrolled seizures in patients with gliomas have a significant impact on quality of life and morbidity, yet the mechanisms through which these tumors cause seizures remain unknown. Here, we hypothesize that the active metabolite D-2-hydroxyglutarate (D-2-HG) produced by the IDH-mutant enzyme leads to metabolic disruptions in surroundi...

Uncontrolled seizures in patients with low grade gliomas have a significant impact on quality of life and morbidity, yet the mechanisms through which these tumors cause seizures remain unknown. Albeit there are multiple features that contribute to tumor related epileptogenesis, IDH mutations are determined to be an independent factor, although the...

BACKGROUND Commercial magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) systems utilize a generalized Arrhenius model to estimate the area of tissue damage based on the power and time of ablation. However, the reliability of these estimates in Vivo remains unclear. OBJECTIVE To determine the accuracy and precision of the therm...

Epilepsy in the context of brain tumors provides a great burden in these patients, yet mechanisms underlying this process are poorly understood. It has been demonstrated that isocitrate dehydrogenase (IDH) mutations are an independent factor in epileptogenesis in patients with low grade gliomas. Here, using electrographically sorted human cortical...

BACKGROUND Sacroiliac joint (SIJ) dysfunction can lead to significant pain and disability, greatly impairing quality of life. Arthrodesis may take up to 1 year to occur, after which revision can be considered. There is a need for highly accurate and reproducible techniques for revision that allow for purchase through undisturbed bone to prevent pro...

Background: Anterior cervical discectomy and fusion (ACDF) has conventionally been performed using an allograft cage with a plate-and-screw construct. Recently, standalone cages have gained popularity due to theorized decreases in operative time and postoperative dysphagia. Few studies have compared these outcomes. Here, we directly compare the ou...

INTRODUCTION Epileptic seizures in patients with low-grade, isocitrate dehydrogenase (IDH) mutated gliomas reach 90%, a major source of morbidity for these patients. Albeit there are multiple features that contribute to tumor related epileptogenesis, IDH mutations are determined to be an independent factor, although the pathogenesis remains poorly...

Deep brain stimulation (DBS) has traditionally been used to target the subthalamic nucleus (STN) or globus pallidus internus (GPi) to treat Parkinson’s disease (PD) and the ventral intermediate thalamic nucleus (VIM) to treat essential tremor (ET). Recent case reports have described targeting both the STN and VIM with a single trajectory and electr...

Endovascular thrombectomy has revolutionized the management of acute ischemic stroke from emergent large vessel occlusion. Continued technological advancement in the field, as evidenced by successive introduction of large bore aspiration catheters with enhanced trackability and large inner diameter, has played a major role in achieving fast and rob...

Introduction: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new technology that provides a clinically efficacious and minimally invasive alternative to conventional microsurgical resection. However, little data exist on how costs compare to traditional open surgery. The goal of this paper is to investigate the cost-ef...

Introduction: The insula presents anatomic challenges to surgical exploration and intervention. Open neurosurgical intervention is associated with high rates of complications despite improved seizure control. Minimally invasive techniques using novel energy delivery methods have gained popularity due to their relative safety and ability to overcom...

Objective Percutaneous pedicle screws (PPS) are used to stabilize the spine after interbody fusion in minimally invasive approaches. Recently, robotic assistance has been developed to improve the accuracy of PPS. We report our initial experience with ExcelsiusGPS and compare its accuracy to our historical cohort of fluoroscopy-guided PPS. Methods...

Objective The true incidence of perioperative COVID-19 is not well elucidated in the neurosurgical literature. We aim to review the impact of the pandemic on neurosurgical case volume, to study the incidence of COVID-19 in patients undergoing these procedures during the perioperative period, and to compare characteristics and outcomes of this group...

In this study, we report three cases of spontaneous intracranial hemorrhage in patients who were initially hospitalized at our tertiary care center in Washington, DC with symptoms of COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all three patients, who were critically ill, requiring intubation and...

Ependymomas are the most common adult intramedullary spinal tumors.¹ Although uncommon in the brainstem, ependymomas make up a large proportion of tumors of this location.2–8 We present an operative video case report of an intrinsic ependymoma at the cervicomedullary junction. The purpose of this report is to present the clinical picture, operative...

Background: Posterior cervical fusion (PCF) is performed to treat cervical myelopathy, radiculopathy, and/or deformity. Constructs ending at the cervicothoracic junction (CTJ) may lead to higher rates of adjacent segment disease, and much debate exists regarding crossing the CTJ due to paucity of data in the literature. Objective: To determine w...

Background: Pancreatic neuroendocrine tumors (pNETs) are known to frequently metastasize to the liver and lymphatics; however, metastasis to the spine is exceedingly rare. We report the first case of an intradural, extramedullary pNET metastasis to the upper cervical spine. Case description: A 75-year-old Hispanic male patient with history of st...

First case series on Vertically stacked Single Segment Activation (V-SSA) for Directional DBS in GPi; Monopolar stimulation using (2A- and 3A-) or (2B- and 3B-) or (2C- and 3C-). Early experience Takeaways: * Programming using V-SSA could leverage the benefits of directionality over double-monopolar ring or complex bipolar montages. * While all 7...

Disc herniation is a fairly common condition with a frequency of 40 to 50 per 100,000 people. Conversely, symptomatic thoracic disc herniation (TDH) is significantly less common. It is most commonly seen in mid-to-late adult life, with the peak of 80% occurring between 40 and 50 years of age. There is no significant difference in gender. Surgical p...

Synovial cysts of the lumbar spine result from degeneration of the facet capsule, and their prevalence may be as high as 10% in symptomatic patients. Although conservative management is possible, the majority of patients will require resection. Traditional procedures for resection use an ipsilateral approach requiring partial or complete resection...

INTRODUCTION Despite the ketogenic diet's successful use since the 1920s, epilepsy as a disease of energy metabolism is a novel concept. We previously established that seizures deplete neuronal energy stores and reprogram neurons from aerobic to glycolytic metabolic phenotype, marked by upregulation of lactate dehydrogenase A (LDHA). LDHA has recen...

INTRODUCTION Recent evidence favors a network concept in tuberous sclerosis complex (TSC) with seizure generation and propagation related to changes in global and regional connectivity between multiple, anatomically distant tubers. Direct exploration of network dynamics in TSC has been made possible through intracranial sampling with stereoelectroe...

INTRODUCTION Deep brain stimulation (DBS) has traditionally been used to target the subthalamic nucleus (STN) or globus pallidus internus (GPi) to treat the bradykinesia and rigidity of Parkinson's disease (PD) and the ventral intermediate thalamic nucleus (VIM) to treat essential tremor (ET). Recent case reports have described targeting both the S...

BACKGROUND Stereoelectroencephalography (sEEG) using depth electrodes has become a mainstay of pediatric epilepsy surgery. This technique relies on rigid cranial fixation using skull pins, which forms the basis for accurate stereotactic navigation. The use of cranial fixation pins poses the threat of traumatic skull injuries in young children becau...

Background: Smartphone applications (apps) are being increasingly utilized in the health care arena to improve patient care and outcomes. Objective: To further demonstrate the ability of a smartphone app to improve patient compliance with preoperative instructions and to decrease the number of last-minute surgery cancellations. Methods: Patien...

Purpose To investigate the safety and efficacy of stereoelectroencephalography (sEEG) directed magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) in medically refractory insular epilepsy in pediatric patients, define the relationship between ablation volumes and seizure control, and analyze the relationship between thermal energ...

Background: Spondylolysis is a defect in the pars interarticularis that typically presents with axial back pain. Recently, minimally invasive spine techniques have increased in popularity and have been applied to the Buck technique of direct pars repair. Case description: In our series, 2 patients underwent minimally invasive direct pars repair...

Background Different diseases may occur within the same anatomic space and invade one another. Lesions of this nature are described as collision tumors. Collision tumors of the sella are rare, with pituitary adenoma-craniopharyngiomas having been described in only 15 cases. We discuss common and rare lesions of the sellar region, their neurodiagnos...

INTRODUCTION Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a safe and effective minimally invasive technique for several intracranial pathologies. However, the effects of variable thermal energy on tissue ablation dynamics are poorly understood, particularly in the pediatric population. This study aims to exa...

OBJECTIVE Stereoelectroencephalography (sEEG) and MR-guided laser interstitial thermal therapy (MRgLITT) have both emerged as minimally invasive alternatives to open surgery for the localization and treatment of medically refractory lesional epilepsy. Although some data are available about the use of these procedures individually, reports are almos...

Introduction: MR-guided laser interstitial thermal therapy (MRgLITT) has emerged as a safe and effective treatment option for the ablation of epileptic foci. Its minimally invasive nature makes it attractive due to decreased morbidity and hospital stay. Objective: To report the efficacy and safety of MRgLITT as a minimally invasive procedure for...

Objective: Tandem cervical and lumbar spinal stenosis (TSS) is classically described as intermittent claudication, gait disturbance, and clinical findings of mixed myelopathy and polyradiculopathy. Rarely, patients can present with TSS manifesting in isolated lumbar pain. Several reports have demonstrated improved lumbar back pain and radiculopathy...