Luis Daniel Diaz-Aguilar

University of California, San Diego | UCSD · Division of Neurosurgery

Background : Dural closure is an important part of any pediatric spinal procedure with intradural pathology to prevent post-operative cerebrospinal fluid (CSF) egress and associated complications. Utilization of nonpenetrating titanium clips is one closure option that may have technical advantages such as ease of use and amenability to a narrow sur...

Purpose: To examine the role of demographics on surgical management and inpatient complications in patients with spinal deformity between 2010 and 2014 via retrospective analysis. Methods: Data were obtained from the National Inpatient Sample (NIS). International Classification of Diseases 9th revision codes were used to identify patients with a p...

Previous literature has repeatedly demonstrated the effective use of antifibrinolytic medication such as Tranexamic acid (TXA) to reduce blood loss during spine surgery. However, there is concern that high doses of TXA may increase the risk of complications, such as thromboembolism or seizure. The purpose of this retrospective case series was to de...

Objectives To examine the current scientific literature on deep-brain stimulation targeting the habenula for the treatment of neuropsychiatric disorders including schizophrenia, major depressive disorder, and obsessive-compulsive disorder. Materials and Methods Two authors performed independent database searches using the PubMed, Cochrane, PsycINFO...

Background/Aims: Although early therapeutic research on psychedelics dates back to the 1940's, this field of investigation was met with many cultural and legal challenges in the 1970's. Over the past two decades, clinical trials using psychedelics have resumed. Therefore, the goal of this study was to 1) better characterize the recent uptrend in ps...

Background Surgical treatment of scoliosis includes long and invasive multi-level instrumentation and correction which may result in high rates of postoperative complications, especially in elderly patients with osteopenia or multiple comorbidities. Minimally invasive surgical options may benefit these patients. Case Description A 73-year-old femal...

This was a national database study. To examine the role of comorbidities and demographics on inpatient complications in patients with lumbar degenerative conditions. Degenerative conditions of the lumbar spine account for the most common indication for spine surgery in the elderly population in the United States. Significant studies investigating d...

Background Degenerative scoliosis of the lumbar spine is a prominent cause of adult spinal deformity with an increasing prevalence as the population ages. This pathology is associated with debilitating symptoms, including radicular back pain and lower extremity claudication. Surgical realignment of the spine and restoration of sagittal imbalance ca...

Introduction Patients with prolonged cervical neck pathologies refractory to non-surgical treatments are candidates for anterior cervical discectomy and fusion (ACDF), which postoperatively reduces pain and disability. Oftentimes, additional posterior surgery is required to achieve optimal cervical alignment and lordosis. Here, we evaluate the effi...

Introduction: As the population continues to age, there is an increasing prevalence of adult spinal deformity (ASD) disorders, some of which require invasive reconstructive procedures. In order to help inform future practice regarding this common group of spinal pathologies, we examine the role of demographics on surgical management and inpatient c...

Background Accurate spinal screw placement in spinal instrumentation is of utmost importance to avoid injury to surrounding neurovascular structures. This study was performed to investigate differences in accuracy, operating room time, length of stay, and operative blood loss across studies involving all types of spinal fixation. Methods PubMed, E...

INTRODUCTION: Low Back Pain (LBP) is a global healthcare issue, and first line therapy for patients with LBP include physical therapy, oral pain relievers, and steroid injections. If unsuccessful, surgical procedures are indicated. Non-surgical second-line treatments for LBP are warranted, and one example is DiscSeal, a colloidal form of viscous...

Background: Dural closure is an important part of any pediatric spinal procedure with intradural pathology to prevent post-operative cerebrospinal fluid (CSF) egress and associated complications. Utilization of nonpenetrating titanium clips is one closure options that may have technical advantages such as ease of use and amenability to a narrow sur...

PurposeMultiple-rod constructs (MRCs) are often used in deformity correction for increased stability and rigidity. There are currently no reports showing minimally invasive placement of MRCs in adult deformity surgery and its technical feasibility through preoperative software planning.Methods Data were collected retrospectively from medical record...

Objective: To study the impact of demographic factors on management of traumatic injury to the lumbar spine and postoperative complication rates. Methods: Data was obtained from the National Inpatient Sample (NIS) between 2010-2014. International Classification of Diseases, 9th revision, Clinical Modification codes identified patients diagnosed...

Objective Chondrosarcomas of the skull base are rare tumors most commonly treated surgically with or without adjuvant radiation therapy. Using the National Cancer Database (NCDB), we analyzed overall survival (OS), treatment modalities, and prognosticators. Methods The NCDB was queried for all cases of histologically confirmed skull base chondrosa...

Demographic variables that influence lumbar spine trauma management and outcomes, including rates of decompression and fusion, are poorly understood. To study the impact of demographic factors on patient management of traumatic injury to the lumbar spine and postoperative complication rates. Data was obtained from the National Inpatient Sample (NIS...

Accurate screw placement in spinal instrumentation is of utmost importance to avoid injury to surrounding neurovascular structures. Freehand screw placement has demonstrated a wide range of accuracy. As a result, several means of improving screw accuracy have been developed. Most recently, robotic surgical techniques have been applied to spinal fix...

Low Back Pain (LBP) is a global healthcare issue, and first line therapy for patients with LBP include physical therapy, oral pain relievers, and steroid injections. If unsuccessful, surgical procedures are indicated. Non-surgical second-line treatments for LBP are warranted, and one example is DiscSeal, a colloidal form of viscous gel composed of...

Demographic variables that influence lumbar spine trauma management and outcomes, including rates of decompression and fusion, are poorly understood. To study the impact of demographic factors on patient management of traumatic injury to the lumbar spine and postoperative complication rates. Data was obtained from the National Inpatient Sample (NIS...

Degenerative conditions of the lumbar spine account for the most common indication for spine surgery in the elderly population in the US. Significant studies investigating demographic as predictors of surgical rates and health outcomes for degenerative lumbar conditions are lacking. To examine the role of comorbidities and demographics on inpatient...

Children with non-operative brain tumors, such as diffuse intrinsic pontine gliomas (DIPG), often have hydrocephalus causing potentially life-threatening increased intracranial pressures. Endoscopic third ventriculostomy (ETV) is a minimally invasive alternative to treat hydrocephalus without implanted hardware. We herein review our institutional o...

OBJECTIVE Children with nonoperative brain tumors, such as diffuse intrinsic pontine gliomas (DIPGs), often have life-threatening hydrocephalus. Palliative shunting is common in such cases but can be complicated by hardware infection and mechanical failure. Endoscopic third ventriculostomy (ETV) is a minimally invasive alternative to treat hydrocep...

INTRODUCTION Oblique lumbar interbody fusion (OLIF) at L5-S1, also known as a lateral decubitus anterior lumbar interbody fusion (ALIF) or anterior-to-psoas (ATP) approach, is a technique that provides a minimally invasive corridor to a key segment in the spine for degenerative conditions and deformity correction. However, the evaluation of complic...

Background: As an established antifibrinolytic agent, tranexamic acid (TXA) has garnered widespread use during surgery to limit intraoperative blood loss. Today, it is routinely administered in orthopedic, liver, dental, prostate, and cardiac surgeries. Within the field of neurosurgery, it is often introduced in cases of traumatic brain injury or e...

Single position lateral fusion reduces the need for a secondary surgery and robotic guidance allows for potentially higher accuracy of screw placement. We expand the role of robotics with a simultaneous workflow where 2 surgeons can work in single position surgery and discuss the technical feasibility of placement of S2-alar-iliac (S2AI) screws in...

Objective Osteosarcomas of the skull base are rare and aggressive tumors that are most commonly treated with primary surgical resection and adjuvant chemoradiation. Using the National Cancer Database (NCDB), we analyzed demographic and clinical prognosticators for overall survival (OS). Methods The NCDB was queried for cases of histologically conf...

Background The oblique lateral interbody fusion (OLIF) procedure is an important component of the surgeon’s armamentarium for the treatment of degenerative spinal conditions. OLIF with posterior spinal fixation (PSF) is frequently performed and requires additional time because the patient is flipped to prone position and re-draped. We report a seri...

Extreme lateral interbody fusion (XLIF) is a popular surgical technique to address a wide variety of spinal pathologies. The purpose of this chapter is to explore the XLIF procedure, including indications for its use, post-fusion operative outcomes, intraoperative considerations, and advantages and disadvantages over similar fusion techniques.

Syringomyelia is commonly associated with Chiari I malformation and varies widely in presenting symptoms. In the context of syringomyelia-Chiari complex, posterior fossa decompression via a suboccipital approach is the most common mode of operative management, and typically produces excellent reduction in syrinx size. However, no comprehensive revi...

Minimally invasive surgery (MIS) of the posterior cervical spine with robotic assistance has recently emerged to treat degenerative disc disease. Robotic arms and 3D neuronavigation with preoperatively planned placement are used to achieve real-time intraoperative guidance, reducing screw malposition through increased accuracy and stability. This r...

The use of robotic guidance for spinal instrumentation is promising for its ability to offer the advantages of precision, accuracy, and reproducibility. This has become even more important in the era of lateral interbody surgery because spinal robotics opens up the possibility of a straightforward workflow for single-position surgery in the lateral...

Cervical angina is an often-overlooked etiology of noncardiac chest pain that may mimic true angina pectoris but is due to cervical spine disease. Diagnosis can be difficult, and treatment ranges from conservative therapy to surgical management. However, of patient's refractory to conservative therapy, approximately ninety percent experience postop...

Objective The University of California at San Diego (UCSD) Health system’s institution-wide response to the COVID-19 pandemic was founded on rapid development of in-house testing capacity, optimization of PPE usage, expansion of ICU capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an OR tria...

Background Recently, there has been increased interest in patient satisfaction measures such as Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. This systematic review aims to analyze the available spine surgery literature to evaluate factors predictive of patient satisfaction as measured by these s...

Background: Pancreatic ductal adenocarcinoma (PDAC) is the most common pancreatic malignancy, which rarely metastasizes to the spine. Case description: Here, we present a lytic lumbar metastatic PDAC resulting in severe epidural spinal cord compression (ESCC) with instability. The lesion required preoperative particle embolization, surgical deco...

We follow the development of staged resection from its first description by Walter E. Dandy, one of the founding fathers of neurosurgery, in 1925 in which he removed a large vestibular schwannoma. This historical vignette cites neurosurgical case reports and literature to demonstrate the evolution of staged resection of intracranial lesions, from D...

The use of robotic guidance for spinal instrumentation has become promising for its ability to offer the advantages of precision, accuracy, and reproducibility. However, utilization and adoption of robotic platforms for spine surgery remain limited especially in comparison to other surgical fields. We present here a case of a 71-yr-old man with a p...

Objective: Despite recently heightened advocacy efforts relating to pregnancy and family leave policies in multiple surgical specialties, no studies to date have described female neurosurgeons' experiences with childbearing. The AANS/CNS Section of Women in Neurosurgery created the Women and Pregnancy Task Force to ascertain female neurosurgeons'...

Neuronuclear imaging has been utilized for several decades in the study of primary neurodegenerative conditions, such as dementia and parkinsonian syndromes, both for research and clinical purposes. There has been a relative paucity of application of neuronuclear imaging to evaluate non-neurodegenerative conditions that can also have long-term effe...

Purpose: Pathologic corneal neovascularization is a major cause of blindness worldwide, and treatment options are currently limited. VEGF is one of the critical mediators of corneal neovascularization but current anti-VEGF therapies have produced limited results in the cornea. Thus, additional therapeutic agents are needed to enhance the antiangio...

Purpose Primary spinal cord tumors are rare, and evidence-based management of these patients remains a source of controversy. This study used a large cohort of low-grade spinal cord astrocytomas to determine the effectiveness of prognostic factors and survival. Methods The Surveillance, Epidemiology, and End Results (SEER) cancer registry was used...

Background Ependymomas are relatively uncommon tumors that constitute about 7% of all primary intracranial neoplasms. Among these, high-grade ependymomas are locally aggressive and recur most commonly at the primary site following resection. Ependymomas are also known to be the one glial neoplasm that tends to frequently metastasize inside and outs...

Background Neurenteric cysts (NECs) are rare developmental malformations of the central nervous system (CNS) which originate as benign congenital lesions. They originate from developmental foregut precursors, and are presumed to be the result of abnormal partitioning of the embryonic notochord plate. Such NECs predominantly arise in the cervical re...

Background: Sacral chordomas are rare, slow growing, locally aggressive tumors. Unfortunately, aggressive surgical resection is often associated with increased neurological morbidity. Methods: This technical note focuses on the utilization of partial sacrectomy for the resection of complex spinal chordomas. Results: The case presented document...

Background Chordomas are uncommon malignant bone tumors that are often minimally symptomatic for several years. By the time they are diagnosed, these lesions are typically large, involve major neural, bony, and vascular structures, and are no longer readily resectable. This leads to a high recurrence rate. Case Description In this case report, we...

Background Saccrococcygeal teratomas (SCT) are derived from embryonic germ cell layers. They frequently present at the base of the coccyx within the pelvis. While these tumors are common in children, they are exceedingly rare in adults. In adults, a majority of these tumors are intrapelvic and associated with a low risk of malignant transformation....

Objective: Identify the effect of patient characteristics, disease traits, and treatment modality on patient outcomes in the rare disease process of intraosseous mucoepidermoid carcinoma. Study design: Retrospective review of institutional case records and literature. Methods: This study includes one case report, a literature review of the MED...

Purpose: To evaluate novel immunophenotypic profiles of patients with orbital lymphoproliferative tumors. Methods: From 2006 to 2014, surgical biopsies from consecutive patients with newly diagnosed orbital mucosa-associated lymphoid tissue (MALT) lymphoma and IgG4-related ophthalmic disease (IgG4-ROD) were collected from Tokyo Medical Universit...

Infectious agents have been identified as a major cause of specific types of human cancers worldwide. Several microorganisms have been identified as potential aggravators of ocular adnexal neoplasms; however, given the rarity of these neoplasms, large epidemiological studies are difficult to coordinate. This study aimed to conduct an exhaustive sea...

Purpose: Oxidative stress and metabolic dysregulation of the RPE have been implicated in AMD; however, the molecular regulation of RPE metabolism remains unclear. The transcriptional coactivator, peroxisome proliferator-activated receptor-gamma coactivator 1α (PGC-1α) is a powerful mediator of mitochondrial function. This study examines the abilit...

Proliferative retinopathic diseases often progress in 2 phases: initial regression of retinal vasculature (phase 1) followed by subsequent neovascularization (NV) (phase 2). The immune system has been shown to aid in vascular pruning in such retinopathies; however, little is known about the role of the alternative complement pathway in the initial...

Accumulating evidence demonstrates a functional role for the hippocampus in mediating relapse to cocaine-seeking behavior and extinction-induced inhibition of cocaine seeking, and dentate gyrus neurogenesis in the hippocampus may have a role. Here, we tested the hypothesis that disruption of normal hippocampal activity during extinction alters rela...