Pub Date : 2020-05-30DOI: 10.1097/01.CNE.0000694460.05099.b7
A. Larson, L. Rinaldo, G. Lanzino, F. Meyer, L. Savastano
After a patient has been selected for revascularization surgery, it is necessary to determine which specific revascularization technique is most suited to the particular patient. Revascularization procedures for moyamoya disease (MMD) can be broadly categorized into 2 main categories— direct and indirect—which are differentiated according to whether a direct anastomosis between a donor and a recipient vessel is made. Multiple variations in each of these techniques have been described and understanding which specific procedure is most appropriate in a particular case, when a combination is necessary, and how to preserve preexistent anastomosis is of utmost importance. The complex decision-making process and the required specialized periand intraoperative care explains the superior outcomes in MMD admissions and revascularization procedures in highvolume centers. The third installment of this series describes the various direct and indirect revascularization techniques, their indications, benefits, and drawbacks.
{"title":"Contemporary Management of Moyamoya Disease: Part III—Revascularization Techniques","authors":"A. Larson, L. Rinaldo, G. Lanzino, F. Meyer, L. Savastano","doi":"10.1097/01.CNE.0000694460.05099.b7","DOIUrl":"https://doi.org/10.1097/01.CNE.0000694460.05099.b7","url":null,"abstract":"After a patient has been selected for revascularization surgery, it is necessary to determine which specific revascularization technique is most suited to the particular patient. Revascularization procedures for moyamoya disease (MMD) can be broadly categorized into 2 main categories— direct and indirect—which are differentiated according to whether a direct anastomosis between a donor and a recipient vessel is made. Multiple variations in each of these techniques have been described and understanding which specific procedure is most appropriate in a particular case, when a combination is necessary, and how to preserve preexistent anastomosis is of utmost importance. The complex decision-making process and the required specialized periand intraoperative care explains the superior outcomes in MMD admissions and revascularization procedures in highvolume centers. The third installment of this series describes the various direct and indirect revascularization techniques, their indications, benefits, and drawbacks.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 6"},"PeriodicalIF":0.0,"publicationDate":"2020-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000694460.05099.b7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41507235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-15DOI: 10.1097/01.CNE.0000693984.67034.69
A. Larson, D. Johnson, V. Lehman, L. Rinaldo, J. Klaas, G. Lanzino, L. Savastano
Clinical presentations of moyamoya disease (MMD) are significantly variable and nonspecific. Radiographic characteristics seen on various imaging studies are therefore crucial in making an accurate diagnosis of MMD. Furthermore, certain imaging studies may provide information regarding disease severity and risk for stroke, thereby informing the surgeon as to a bypass procedure is indicated. The advent of various grading systems is also helpful in this regard. In the second volume of this series, imaging features and various grading systems of MMD are discussed.
{"title":"Contemporary Management of Moyamoya Disease: Part II—Imaging Features and Grading Systems","authors":"A. Larson, D. Johnson, V. Lehman, L. Rinaldo, J. Klaas, G. Lanzino, L. Savastano","doi":"10.1097/01.CNE.0000693984.67034.69","DOIUrl":"https://doi.org/10.1097/01.CNE.0000693984.67034.69","url":null,"abstract":"Clinical presentations of moyamoya disease (MMD) are significantly variable and nonspecific. Radiographic characteristics seen on various imaging studies are therefore crucial in making an accurate diagnosis of MMD. Furthermore, certain imaging studies may provide information regarding disease severity and risk for stroke, thereby informing the surgeon as to a bypass procedure is indicated. The advent of various grading systems is also helpful in this regard. In the second volume of this series, imaging features and various grading systems of MMD are discussed.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000693984.67034.69","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47419255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-30DOI: 10.1097/01.cne.0000689060.31972.cf
A. Larson, L. Rinaldo, J. Klaas, G. Lanzino, L. Savastano
{"title":"Contemporary Management of Moyamoya Disease: Part I—Background and Clinical Presentation","authors":"A. Larson, L. Rinaldo, J. Klaas, G. Lanzino, L. Savastano","doi":"10.1097/01.cne.0000689060.31972.cf","DOIUrl":"https://doi.org/10.1097/01.cne.0000689060.31972.cf","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"42 1","pages":"1 - 3"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.cne.0000689060.31972.cf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47085665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-30DOI: 10.1097/01.cne.0000668412.15974.19
J. Hatef, E. Sribnick, J. Leonard
acterized by herniation of the rhombencephalic structures (cerebellum and brainstem) from the posterior fossa. Originally characterized in postmortem examinations performed by Dr. Hans Chiari in the late 1800s, the term “Chiari malformation” has since expanded to encompass multiple different diagnoses. Chiari malformation types II, III, and IV refer to secondary herniation of the cerebellar vermis and brainstem due to myelomeningocele (type II), herniation of the hindbrain into encephalocele defects (type III), and cerebellar aplasia (type IV). Chiari malformation type I is the most common, and its presentation and management have been the focus of this review.
{"title":"Updated Evidence Regarding Chiari Malformation Type I and Management Options","authors":"J. Hatef, E. Sribnick, J. Leonard","doi":"10.1097/01.cne.0000668412.15974.19","DOIUrl":"https://doi.org/10.1097/01.cne.0000668412.15974.19","url":null,"abstract":"acterized by herniation of the rhombencephalic structures (cerebellum and brainstem) from the posterior fossa. Originally characterized in postmortem examinations performed by Dr. Hans Chiari in the late 1800s, the term “Chiari malformation” has since expanded to encompass multiple different diagnoses. Chiari malformation types II, III, and IV refer to secondary herniation of the cerebellar vermis and brainstem due to myelomeningocele (type II), herniation of the hindbrain into encephalocele defects (type III), and cerebellar aplasia (type IV). Chiari malformation type I is the most common, and its presentation and management have been the focus of this review.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.cne.0000668412.15974.19","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46736462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.1097/01.cne.0000666640.04173.bb
Jason I. Liounakos, Michael Y. Wang
become one of the hottest topics in spine surgery over recent years. It is widely understood that, to achieve the best functional outcome, sagittal alignment must be considered both when initially evaluating a patient and when deciding upon a surgical intervention. Of all the measurable spinal parameters available, restoration of sagittal alignment has most reproducibly been associated with improved patient-reported functional outcomes. The implications of this are significant for both patients and surgeons alike, as the specific impact of surgery on sagittal balance varies greatly among different procedures, and the end effect is not easily undone. According to an analysis of the national inpatient sample reviewing trends in lumbar fusion procedures from 2004 to 2015 by Martin et al., the volume of elective lumbar fusions has increased more than 62.3% over this time. The greatest increases were seen in patients being treated for lumbar spondylolisthesis and scoliosis, and degenerative lumbar spondylosis, posttraumatic kyphosis, and lumbar stenosis with instability. Although technological advances and access to care are responsible for some of these numbers, a main driving force behind increases in lumbar fusion for diagnoses other than scoliosis is likely the fact that the population of the developed world is progressively getting older. As the average life expectancy increases, so does the proportion of aged patients who are likely to seek surgical treatment for symptomatic degenerative disease of the spine. The responsibility falls on spine surgeons to select the most appropriate surgical or nonsurgical interventions for such patients on an individualized basis. This article serves primarily to address the importance of taking sagittal alignment into account when making these decisions and to provide strategies to maintain spinopelvic harmony.
{"title":"Maintaining Sagittal Balance When Performing Lumbar Fusion Surgery","authors":"Jason I. Liounakos, Michael Y. Wang","doi":"10.1097/01.cne.0000666640.04173.bb","DOIUrl":"https://doi.org/10.1097/01.cne.0000666640.04173.bb","url":null,"abstract":"become one of the hottest topics in spine surgery over recent years. It is widely understood that, to achieve the best functional outcome, sagittal alignment must be considered both when initially evaluating a patient and when deciding upon a surgical intervention. Of all the measurable spinal parameters available, restoration of sagittal alignment has most reproducibly been associated with improved patient-reported functional outcomes. The implications of this are significant for both patients and surgeons alike, as the specific impact of surgery on sagittal balance varies greatly among different procedures, and the end effect is not easily undone. According to an analysis of the national inpatient sample reviewing trends in lumbar fusion procedures from 2004 to 2015 by Martin et al., the volume of elective lumbar fusions has increased more than 62.3% over this time. The greatest increases were seen in patients being treated for lumbar spondylolisthesis and scoliosis, and degenerative lumbar spondylosis, posttraumatic kyphosis, and lumbar stenosis with instability. Although technological advances and access to care are responsible for some of these numbers, a main driving force behind increases in lumbar fusion for diagnoses other than scoliosis is likely the fact that the population of the developed world is progressively getting older. As the average life expectancy increases, so does the proportion of aged patients who are likely to seek surgical treatment for symptomatic degenerative disease of the spine. The responsibility falls on spine surgeons to select the most appropriate surgical or nonsurgical interventions for such patients on an individualized basis. This article serves primarily to address the importance of taking sagittal alignment into account when making these decisions and to provide strategies to maintain spinopelvic harmony.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.cne.0000666640.04173.bb","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43588610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1097/01.CNE.0000840100.01791.60
Yu-po Lee, S. Farhan, P. Kiester, N. Bhatia
or neurogenic spinal arthropathy, is a rare, slowly progressive degeneration of the spine. This phenomenon occurs in the setting of any prior condition leading to the loss of afferent innervation to the spine and central nervous system. The end result is that the normal protective sensation of the joints in the vertebral column is diminished. This then leads to the progressive degeneration of the spinal column. Jean-Martin Charcot first described a causal link between neurologic injury and progressive bone and joint damage in 1868. His theory was based on the destruction of certain peripheral joints that he observed in patients with tertiary syphilis. Charcot described this damage as “ataxic arthropathy.” The first case of Charcot spinal arthropathy was reported in 1884 by Kronig in a patient with tabes dorsalis secondary to tertiary syphilis. Historically, Charcot spinal arthropathy was most commonly reported in the setting of tertiary syphilis. Contemporary Charcot spine cases are more commonly seen in patients who have suffered traumatic spinal cord injuries. Charcot spinal arthropathy may also occur secondary to conditions that disrupt the sensory signaling pathways, such as syringomyelia, meningocele, myelomeningocele, diabetes mellitus, peripheral neuropathies, Parkinson disease, transverse myelitis, and other conditions. Repetitive external forces to the insensate vertebral column cause inflammation in the subchondral bone and articular cartilage. This inflammatory process stimulates facet destruction, intervertebral disc degeneration, and bone destruction. This ultimately leads to progressive deformity and gross spinal instability. Untreated, Charcot spinal arthropathy can result in significant morbidity due to continuous pain, loss of sitting tolerance, ascending neurologic dysfunction, infection, vascular injury, and even death. Early medical and surgical care is required once the diagnosis has been recognized.
{"title":"Charcot Disease of the Spine: Diagnosis and Treatment","authors":"Yu-po Lee, S. Farhan, P. Kiester, N. Bhatia","doi":"10.1097/01.CNE.0000840100.01791.60","DOIUrl":"https://doi.org/10.1097/01.CNE.0000840100.01791.60","url":null,"abstract":"or neurogenic spinal arthropathy, is a rare, slowly progressive degeneration of the spine. This phenomenon occurs in the setting of any prior condition leading to the loss of afferent innervation to the spine and central nervous system. The end result is that the normal protective sensation of the joints in the vertebral column is diminished. This then leads to the progressive degeneration of the spinal column. Jean-Martin Charcot first described a causal link between neurologic injury and progressive bone and joint damage in 1868. His theory was based on the destruction of certain peripheral joints that he observed in patients with tertiary syphilis. Charcot described this damage as “ataxic arthropathy.” The first case of Charcot spinal arthropathy was reported in 1884 by Kronig in a patient with tabes dorsalis secondary to tertiary syphilis. Historically, Charcot spinal arthropathy was most commonly reported in the setting of tertiary syphilis. Contemporary Charcot spine cases are more commonly seen in patients who have suffered traumatic spinal cord injuries. Charcot spinal arthropathy may also occur secondary to conditions that disrupt the sensory signaling pathways, such as syringomyelia, meningocele, myelomeningocele, diabetes mellitus, peripheral neuropathies, Parkinson disease, transverse myelitis, and other conditions. Repetitive external forces to the insensate vertebral column cause inflammation in the subchondral bone and articular cartilage. This inflammatory process stimulates facet destruction, intervertebral disc degeneration, and bone destruction. This ultimately leads to progressive deformity and gross spinal instability. Untreated, Charcot spinal arthropathy can result in significant morbidity due to continuous pain, loss of sitting tolerance, ascending neurologic dysfunction, infection, vascular injury, and even death. Early medical and surgical care is required once the diagnosis has been recognized.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"43 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48367404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/01.CNE.0000839696.16882.64
Anna M. Lin, H. Makanji, Srikanth N. Divi, Dhruv K. C. Goyal, Matthew S. Galetta, Gregory D. Schroeder, C. Kepler, A. Vaccaro
spinal cord injury (SCI) each year and 300,000 people currently living with an SCI in the United States. The economic burden of such injuries is daunting because the afflicted individual spends an average of 171 days in the hospital over the first 2 years after injury. It has been estimated that the initial hospital expenses average about $95,203 and lifetime medical expenses can range from $500,000 to more than $2 million, depending on the severity and morphology of the injury. In addition to the physical and economic burdens of the SCI, the psychological burden is compounded by uncertainty around the severity and prognosis of an acute SCI. Despite numerous advances in medical, surgical, and rehabilitative care for these patients, long-term outcomes cannot be accurately predicted, furthering the psychological toll such a trauma has on an individual. Additionally, a lack of full understanding about the downstream biochemical pathways that are activated when the spinal cord is injured makes the development of new drugs and therapeutic interventions for these injuries difficult—especially considering there are no easily reproducible objective measurements that can be used for comparison of these novel therapeutic solutions. The pathogenesis of spinal cord trauma can be divided into 2 main types: (1) transection injuries—in which a sharp force penetrates the spinal cord; and (2) contusion traumas—where the spinal cord is crushed or bruised on impact. The pathophysiological timeline of SCI includes 2 phases: primary and secondary injury. The primary injury is the immediate impact of the trauma, including loss of sensory, motor, and autonomic functions, which disrupts the gray matter and microvasculature of the spinal cord. The secondary injury pattern begins to take place immediately after the acute phase, and can continue for months
{"title":"A Review of CSF and Serum Biomarkers to Stratify Acute Spinal Cord Injury Based on Severity of Injury and Prognosis","authors":"Anna M. Lin, H. Makanji, Srikanth N. Divi, Dhruv K. C. Goyal, Matthew S. Galetta, Gregory D. Schroeder, C. Kepler, A. Vaccaro","doi":"10.1097/01.CNE.0000839696.16882.64","DOIUrl":"https://doi.org/10.1097/01.CNE.0000839696.16882.64","url":null,"abstract":"spinal cord injury (SCI) each year and 300,000 people currently living with an SCI in the United States. The economic burden of such injuries is daunting because the afflicted individual spends an average of 171 days in the hospital over the first 2 years after injury. It has been estimated that the initial hospital expenses average about $95,203 and lifetime medical expenses can range from $500,000 to more than $2 million, depending on the severity and morphology of the injury. In addition to the physical and economic burdens of the SCI, the psychological burden is compounded by uncertainty around the severity and prognosis of an acute SCI. Despite numerous advances in medical, surgical, and rehabilitative care for these patients, long-term outcomes cannot be accurately predicted, furthering the psychological toll such a trauma has on an individual. Additionally, a lack of full understanding about the downstream biochemical pathways that are activated when the spinal cord is injured makes the development of new drugs and therapeutic interventions for these injuries difficult—especially considering there are no easily reproducible objective measurements that can be used for comparison of these novel therapeutic solutions. The pathogenesis of spinal cord trauma can be divided into 2 main types: (1) transection injuries—in which a sharp force penetrates the spinal cord; and (2) contusion traumas—where the spinal cord is crushed or bruised on impact. The pathophysiological timeline of SCI includes 2 phases: primary and secondary injury. The primary injury is the immediate impact of the trauma, including loss of sensory, motor, and autonomic functions, which disrupts the gray matter and microvasculature of the spinal cord. The secondary injury pattern begins to take place immediately after the acute phase, and can continue for months","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"43 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43979090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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