January 2025
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1 Read
Operative Neurosurgery
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January 2025
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1 Read
Operative Neurosurgery
December 2024
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6 Reads
Journal of Neurosurgery Pediatrics
OBJECTIVE Corpus callosotomy is an effective treatment for atonic seizures in patients with medically refractory epilepsy. A large modern series of corpus callosotomies performed via open craniotomy highlights the importance of establishing contemporary complication rates for this operation as a benchmark for comparison with newer methodologies. The authors’ study, therefore, examined operative factors and complication rates for a sample of patients who underwent open microsurgical craniotomy for corpus callosotomy to determine current metrics regarding safety and effectiveness for this procedure. METHODS The authors retrospectively reviewed institutional data for patients who underwent first-time open callosotomy from 2005 to 2022. Demographic and clinical variables were collected and analyzed with a focus on operative factors and complication rates. RESULTS A total of 105 patients were included in the study (mean [range] age 9.39 [0.67–24.17] years); 58.1% (n = 61) were male. One surgeon performed a majority of the operations (n = 80 [76.20%]); 2 other surgeons performed the remaining surgical procedures (21.9% and 1.90%, respectively). In total, 66 complete, 38 subtotal (anterior 70%–99%), and 1 posterior (40%) callosotomies were performed. Blood loss was available for 102 (97.1%) patients (mean [range] 96.67 [10–500] ml). The mean [range] operative time was calculated as 226.76 (45–386) minutes in 76 (72.4%) patients by excluding those patients who underwent concurrent vagal nerve stimulator placement or revision. The operative complication rate was determined to be 6.7% and was comprised of 3 cases of transient pseudomeningocele, 3 wound infections, and 1 delayed intraparenchymal hemorrhage. No venous infarcts were observed on postoperative MRI. CONCLUSIONS This is the largest single-center series of open callosotomy patients thus far in the literature and describes important updated metrics to help evaluate new techniques being developed for the surgical treatment of atonic seizures in medically intractable epilepsy.
November 2024
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9 Reads
Journal of Neuro-Oncology
Purpose Length of stay (LOS) is a critical metric of healthcare delivery. Prolonged LOS is associated with a heightened risk of adverse complications. We aimed to provide a comprehensive evaluation of LOS, specifically identifying variables associated with extended LOS (eLOS), in children and young adults following elective craniotomy for tumor resection. Methods All elective craniotomies for tumor resection performed at our tertiary care children’s hospital from January 2010 to December 2022 were included for review, excluding patients > 21 years of age. Demographic, clinical, and procedural variables for each craniotomy were collected. LOS was defined as the interval in days from index surgery to discharge. eLOS was defined as greater than 7 days. Results 1,276 patients underwent a total of 1,497 elective craniotomies for tumor resection. The median age was 9.45 years old, with the most common age group being > 10 years (45.6%). Most patients had supratentorial tumors (63.4%) and underwent de novo surgery (60.7%). Patients with an eLOS experienced longer ICU admissions, longer surgical times, and were younger. Variables found to be significantly associated with eLOS were posterior fossa resection (OR = 2.45), de novo craniotomy (OR = 0.49), prior shunt or ETV (OR = 1.80), tumor type (craniopharyngioma (OR = 3.74) and medulloblastoma (OR = 0.51)), and the presence of at least one postoperative event (POE) (OR = 29.85). Conclusion This is the largest study evaluating factors (patient, tumor, surgical) associated with eLOS after elective craniotomy for tumor resection in children and young adults. The findings of this clinical study are important for preoperative counseling, neurosurgical team preparedness, and healthcare delivery optimization.
November 2024
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2 Reads
Operative Neurosurgery
September 2024
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15 Reads
Cureus
Introduction As part of the Milestones Initiative of the Accreditation Council for Graduate Medical Education (ACGME), residents in neurosurgery are expected to participate in either clinical research or basic science research. Therefore, each neurosurgical training program must offer the support and opportunity to achieve this goal. In 2012, a structured effort to promote a resident culture of research was introduced into the authors’ neurosurgery residency training curriculum. This study reviews this experience over the last decade. Methods Data were collected from the authors’ departmental neurosurgery website and Scopus to create a database of neurosurgical residents who graduated 10 years before and after 2012 and their publication output. Bibliometric measures were collected for all articles published by residents. Results were compared between residents who graduated before and after the introduction of the research initiative. Results A total of 127 publications were analyzed from 37 residents, constituting 174 authorships. There was a statistically significant increase in the number of publications per resident (P < 0.001), citation number per author (P = 0.002), and author h-index (P < 0.001) after implementing the initiative. There were no significant differences in the pre-residency and baseline demographic variables between the two groups. Conclusion This study relates the experience of initiating a research culture at the authors’ neurosurgery training program, which did not emphasize scholarly productivity historically. The effort focused on creating a culture of curiosity as opposed to formal requirements. The results provided evidence that this strategy yielded a significant increase in academic output and impact. These findings have important implications for neurosurgical training programs.
August 2024
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16 Reads
Journal of Neurointerventional Surgery
Background Previous data on the prevalence of unruptured intracranial aneurysms (UIAs) vary widely, and studies based on these data are plagued with unintentional bias. Accurate prevalence data are paramount for any physician who counsels patients with intracranial aneurysms on rupture risk and treatment. We therefore sought to determine a more accurate number for the true prevalence of UIAs. Methods A retrospective chart review was conducted at a level 1 trauma center and tertiary care hospital in an urban setting between 2019 and 2020. Inclusion criteria included patients admitted with blunt trauma. Exclusion criteria included not having a head and neck CTA performed and read by an attending radiologist. All head and neck CTA radiology reads were reviewed for incidentally discovered UIAs. Subgroup analysis was performed by age group, race, and gender. Results A total of 5978 out of 8999 patients met the inclusion criteria, and 54 patients with 58 total aneurysms were identified giving an overall prevalence of 0.9%. Subgroup analysis was performed for all age groups, genders, and racial groups. Conclusion The overall aneurysm prevalence was found to be 0.9% in this sample. This rate is lower than rates previously cited in the literature and those quoted in local practice. This finding has significant implications when attempting to understand average rupture risk. Further studies are needed to power more subgroup analyses to use a more personalized approach to understanding an individual’s risk of rupture.
August 2024
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18 Reads
Operative Neurosurgery
We present the case of an asymptomatic 34-year-old woman who was found to have an incidental left trigeminal schwannoma. 1,2 Owing to the rapid increase in size on imaging, an atypical finding for this type of lesion, ³ as well as the risk of cranial nerve involvement and need for tissue diagnosis, the patient underwent a microsurgical left transorbital approach with lateral orbitotomy to resect the lesion. 4,5 Piecemeal resection was performed, and the internal contents of the cavernous sinus were preserved. Ultimately, gross total resection was achieved with no residual disease identified on postoperative imaging. No new neurologic deficits were noted after surgery. The technical considerations for the transorbital approach and the literature review on the outcomes for middle fossa lesions accessed by a lateral orbitotomy are reviewed. ⁶⁻¹⁰ The patient consented to the procedure and to the publication of her images. Institutional Review Board approval was deemed unnecessary due to the retrospective, case-report nature of this work.
July 2024
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5 Reads
Journal of Neurointerventional Surgery
Introduction Ruptured distal anterior cerebral artery (DACA) aneurysms present specific technical challenges for both open surgical and endovascular management. We aimed to perform a systematic review and meta-analysis of those studies that compared microsurgical and endovascular treatment of ruptured DACA aneurysms. Methods Systematic searches of Pubmed, Medline, and Embase were undertaken in December 2023 for published studies reporting microsurgical clipping and endovascular coiling of ruptured DACA aneurysms. Outcomes included aneurysm occlusion rates, clinical outcomes, and mortality. Results Across 15 studies, 577 and 212 patients with ruptured DACA aneurysms were managed with open microsurgery and endovascular treatment, respectively. Endovascular coiling was associated with a lower rate of complete aneurysm occlusion (RR = 0.73, 95%CI:0.62- 0.87) when compared to microsurgical clipping. Due to limited data, no significant difference was found in functional outcomes between coiling and clipping both at discharge (RR = 1.21, 95%CI:1.0–1.46) and greater than 90 days postoperatively (RR = 1.21, 95%CI:1.0–1.46). Furthermore, no significant difference was observed between the two treatment methods in terms of mortality both during the hospitalization (RR = 1.86, 95%CI:0.45–7.66) and within the 90-day postoperative period (RR = 0.39, 95%CI:0.03–4.55) Conclusion Clipping is associated with a higher aneurysm occlusion rate when compared to coiling for ruptured DACA aneurysms. • Download figure • Open in new tab • Download powerpoint Abstract P-008 Figure 1 • Download figure • Open in new tab • Download powerpoint Abstract P-008 Figure 2 • Download figure • Open in new tab • Download powerpoint Abstract P-008 Figure 3 Disclosures M. Motiwala None. M. Elmarawany None. K. Lee None. E. Hayes None. K. Abhinav None. M. Teo None.
July 2024
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4 Reads
Journal of Neurointerventional Surgery
Objective Over the last decade, the Neurosurgery Research and Education Foundation (NREF) has offered an Endovascular and Vascular Techniques course for senior residents to familiarize themselves with the basics of endovascular and cerebrovascular surgery. In the current work, the impact of this course on the careers of previous attendees was evaluated. Methods A list of attendees over 10 years from the NREF Endovascular and Vascular Techniques course was obtained, and data regarding each attendee including demographic information, career progression, and academic output were determined. Outcomes included a career in cerebrovascular or endovascular neurosurgery, clinical practice setting, and research impact. Results From 2012 to 2022, 207 US neurosurgery residents attended the NREF Endovascular and Vascular Techniques course. Of all attendees, 184 have graduated from residency with 133 (72.3%) of these pursuing careers in vascular neurosurgery. Of the 172 who are currently in practice, 94 (54.7%) work in academic neurosurgery. The mean ± SD number of publications after the course and total H-index were 22 ± 36 and 9 ± 8, respectively. The mean ± SD number of citations after the course was 348 ± 730, and the mean ± SD number of cerebrovascular publications after the course was 30 ± 53. Almost half of all papers published by previous attendees after the course (47.8%) were determined to be cerebrovascular publications. Conclusions Young neurosurgeons who attended the NREF Endovascular and Vascular Techniques have found significant success pursuing vascular neurosurgery across the United States, both clinically and academically. The course has afforded these attendees unique insights and meaningful connections into the field that have proved invaluable as their careers progress.View this table: • View inline • View popup • Download powerpoint Abstract E-258 Table 1 Attendee demographic information View this table: • View inline • View popup • Download powerpoint Abstract E-258 Table 2 Details regarding fellowship View this table: • View inline • View popup • Download powerpoint Abstract E-258 Table 3 Details regarding career progression View this table: • View inline • View popup • Download powerpoint Abstract E-258 Table 4 Academic output Disclosures M. Motiwala None. A. Kashkoush None. T. Orr None. M. El-Abtah None. J. Petitt None. N. Khan None. M. Bain None. A. Arthur None.
July 2024
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8 Reads
Journal of Neurointerventional Surgery
Background and Objectives The management of blunt cerebrovascular injuries (BCVI) remains an important topic within trauma and neurosurgery today. There remains a lack of consensus within the literature and significant variation across institutions. The purpose of this study was to evaluate management of BCVI at a large, tertiary referral trauma center. Methods IRB approval was obtained to conduct a retrospective review of patients with BCVI at our Level 1 Trauma Center. Computed tomography angiography was used to identify BCVI for each patient. Patient information was collected, and statistical analysis was performed. With the inclusion risk factors for ischemic complications, a novel scoring system based on ischemic risk, the ‘Memphis Score,’ was developed and evaluated to grade BCVI. Results 217 patients with BCVI from July 2020 to August 2022 were identified. The most common mechanism of injury was motor vehicle collision (141, 65.0%). Vertebral arteries were the most common vessel injured (136, 51.1%) with most injuries occurring at a high cervical location (101, 38.0%). Denver Grade 1 injuries (89, 33.5%) and a Memphis Score of 1 were most frequent (172, 64.6%), and initial anticoagulation with heparin drip was initiated 56.7% of the time (123). Endovascular treatment (EVT) was required in 24 patients (11.1%) and was usually performed in the first 48 hours (15, 62.5%). While Denver Grade (p = 0.019) and Memphis Score (p < 0.00001) were significantly higher in those patients undergoing EVT, only the Memphis Score demonstrated a significant difference between those patients who had stroke or worsening on follow up imaging and those who did not (p = 0.0009). Conclusion Though BCVI management has improved since early investigative efforts, institutions must evaluate and share their data to help clarify outcomes. The novel ‘Memphis Score’ presents a standardized framework to communicate ischemic risk and guide management of BCVI.View this table: • View inline • View popup • Download powerpoint Abstract O-031 Table 1 Memphis score • Download figure • Open in new tab • Download powerpoint Abstract O-031 Figure 2 Disclosures M. Motiwala None. V. Nguyen None. T. Orr None. K. Parikh None. E. Miller None. M. Barats None. J. Roach None. S. Himel None. B. Mulpur None. N. Khattar None. A. Arthur None. V. Inoa-Acosta None. C. Nickele None. D. Hoit None. L. Elijovich None. N. Goyal None. N. Khan None.
... [23] For instance, the guide cited a meta-analysis examining complications after cerebrospinal fluid lumbar drainage in patients with aneurysmal subarachnoid hemorrhage. [24] This study reported outcomes using both relative risk and risk difference. Furthermore, the authors made a breakdown of the complications into three distinct categories: delayed cerebral ischemia, rebleeding, and infection. ...
January 2024
World Neurosurgery
... Although the cohort was small, only 1 patient (5%) had a post-operative stroke, similar to the medical management arms of COSS (2.0%, ipsilateral ischemic stroke) and SAMMPRIS (5.8%) as well as to other post-COSS evaluations of bypass (Table 6) [9,17]. Indeed, a recent systematic review of EC-IC bypass for VOD suggested a trend towards decreased perioperative (5.7%) and overall stroke (9.1%) rates over time [25]. The majority had received evidence-based medical therapy with aspirin (100%) or DAPT (70.0%) and had comorbidities commensurate with increased stroke risk. ...
February 2023
World Neurosurgery
... Surgery also linked with POCI in adult patients with MMD. A meta-analysis suggested that combined bypass and direct bypass offer significant benefits to the outcomes of advanced stroke and cerebral hemorrhage (27). Conversely, a retrospective multicenter study did not identify significant differences in the recurrence of stroke, perioperative stroke, and mortality between MMD patients treated with indirect and direct bypass (or combined bypass) (17). ...
September 2022
Stroke
... However, STA-ACA, STA-PCA, and occipital artery-PCA anastomosis may be performed to address the ACA and PCA territories discretely. Radial artery or saphenous vein grafts may be utilized for intermediate-or high-flow bypass, respectively, but entail potential risk of reperfusion hemorrhage due to hyperperfusion syndrome (6,35). Direct revascularization has a robust evidence base demonstrating efficacy in reducing hemorrhagic events in MMD patients (35). ...
August 2022
... In contrast, morphological changes in the large vessels of the head and neck associated with arteriovenous malformations are exceedingly rare. Notably, such changes have only been reported in cases where the malformations do not involve cerebral tissue [13]. Our case uniquely demonstrates a morphological alteration in the carotid artery (CA) and its primary branches associated with the presence of a CAVM, with normalization of vessel morphology following successful closure of the CAVM. ...
July 2022
Neurosurgical FOCUS
... Moreover, 2ME loaded TPGS micelles afforded higher degree of protection when compared with raw 2ME. The observed ant-fibrotic effects gain support by several reports highlighting its anti-fibrotic activities of 2ME in the liver [74], lung [75] and kidney [76]. Thus, it can suggest that 2ME anti-fibrotic activity contributes to its protection against CSA-induced kidney injury. ...
October 2021
Hypertension
... [8] Female, 23 C7-T2 2021 C4-T3 Replacement Laminoplasty and microsurgical resection of ependymoma: two-dimensional operative video. [7] Female, 47 C4-T3 ...
June 2021
Operative Neurosurgery
... [25][26][27] Even within the field of neurosurgery, investigators have examined physician payments, presenting descriptive analyses of the available data. [28][29][30] Our analysis comprehensively examines not only the descriptive changes observed but also the impact of geography and physician practice location on physician payments at a county level. Despite these strengths, however, our analysis has important limitations. ...
August 2020
Neurosurgery
... These areas of hypoxic-ischemic injury that are greater than can be explained by focal contusion or restriction of blood flow within a blood vessel territory and may even extend to an entire hemisphere or both hemispheres with sparing of the deep gray areas. [4,5,8,9,34] Few pre-clinical models study hypoxic-ischemic resulting from a combination of injuries, but instead, study the pathophysiology of one pathoanatomic lesion such as focal contusion or diffuse axonal injury. Clinically, rarely does any type of severe TBI present with a single pathoanatomic lesion. ...
April 2020
Neurosurgery
... Royalties and licensure comprised the majority of the funding exchanged in this study, and these payments provide a way for industry to reimburse surgeons for their input in product innovation. 21 As these payments usually correlate with sales revenue, the top 10% of surgeons have a financial incentive to promote the use of company products 22 . Recognizing these participants may help attendees better understand the potential biases present. ...
February 2020
World Neurosurgery