Nicolas E Alcalá, Hengameh B. Pajer, Martin G. Piazza, W. Goodnight, E. Yap, D. Sasaki-Adams, G. Hobbs, C. Quinsey
Prior work has shown that the human placenta is an available and realistic model for microdissection simulation. We sought to find a measurable improvement in the technical skills of neurosurgical residents with deliberate practice of microdissection tasks using a placental model. Postgraduate year (PGY) 1 to 3 neurosurgery residents were consented. A 1-min video of each participant's baseline skills skeletonizing placental vessels was recorded. Participants underwent 10 practice sessions with intermittent informal feedback for 30-60 min over 18 mo. Another 1-min video was recorded following the 10th dissection. The videos were blinded and assessed by 3 board eligible or certified microsurgical neurosurgeons using a modified Objective Structured Assessment of Aneurysm Clipping Skills. Performance was compared via t-testing among four domains: instrument handling, time flow and forward planning, quality of dissection, and respect for tissue. Microdissection, instrument handling, and quality of dissection were significantly improved after deliberate practice with the placental simulator (P < .05). Improvement was seen in time flow and forward planning and respect for tissue; however, this failed to be significant. Subjectively, residents expressed enjoyment performing the exercise. They also expressed a desire for demonstrations or videos to watch before practice sessions. The placental simulation model provides microsurgical skill development with minimal deliberate practice sessions. Practice exercises are favorably regarded and interest in continuing them is strong by residents. Residents expressed a desire to make the dissection more deliberate with demonstration, breakdown of steps, and mimicry, which could improve the effectiveness and enjoyment of the skills session.
{"title":"Improving Neurosurgery Resident Microdissection Through Placental Simulation","authors":"Nicolas E Alcalá, Hengameh B. Pajer, Martin G. Piazza, W. Goodnight, E. Yap, D. Sasaki-Adams, G. Hobbs, C. Quinsey","doi":"10.1093/neuopn/okab026","DOIUrl":"https://doi.org/10.1093/neuopn/okab026","url":null,"abstract":"\u0000 Prior work has shown that the human placenta is an available and realistic model for microdissection simulation. We sought to find a measurable improvement in the technical skills of neurosurgical residents with deliberate practice of microdissection tasks using a placental model. Postgraduate year (PGY) 1 to 3 neurosurgery residents were consented. A 1-min video of each participant's baseline skills skeletonizing placental vessels was recorded. Participants underwent 10 practice sessions with intermittent informal feedback for 30-60 min over 18 mo. Another 1-min video was recorded following the 10th dissection. The videos were blinded and assessed by 3 board eligible or certified microsurgical neurosurgeons using a modified Objective Structured Assessment of Aneurysm Clipping Skills. Performance was compared via t-testing among four domains: instrument handling, time flow and forward planning, quality of dissection, and respect for tissue. Microdissection, instrument handling, and quality of dissection were significantly improved after deliberate practice with the placental simulator (P < .05). Improvement was seen in time flow and forward planning and respect for tissue; however, this failed to be significant. Subjectively, residents expressed enjoyment performing the exercise. They also expressed a desire for demonstrations or videos to watch before practice sessions. The placental simulation model provides microsurgical skill development with minimal deliberate practice sessions. Practice exercises are favorably regarded and interest in continuing them is strong by residents. Residents expressed a desire to make the dissection more deliberate with demonstration, breakdown of steps, and mimicry, which could improve the effectiveness and enjoyment of the skills session.","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45328519","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 : 2021-09-16eCollection Date: 2021-12-01DOI: 10.1093/neuopn/okab029
Jennifer M Connelly, Melissa A Prah, Fernando Santos-Pinheiro, Wade Mueller, Elizabeth Cochran, Kathleen M Schmainda
Background and importance: Distinction of brain tumor progression from treatment effect on postcontrast magnetic resonance imaging (MRI) is an ongoing challenge in the management of brain tumor patients. A newly emerging MRI biomarker called fractional tumor burden (FTB) has demonstrated the ability to spatially distinguish high-grade brain tumor from treatment effect with important implications for surgical management and pathological diagnosis.
Clinical presentation: A 58-yr-old male with glioblastoma was treated with standard concurrent chemoradiotherapy (CRT) after initial resection. Throughout follow-up imaging, the distinction of tumor progression from treatment effect was of concern. The surgical report from a redo resection indicated recurrent glioblastoma, while the tissue sent for pathological diagnosis revealed no tumor. Presurgical FTB maps confirmed the spatial variation of tumor and treatment effect within the contrast-agent enhancing lesion. Unresected lesion, shown to be an active tumor on FTB, was the site of substantial tumor growth postresection.
Conclusion: This case report introduces the idea that a newly developed MRI biomarker, FTB, can provide information of tremendous benefit for surgical management, pathological diagnosis as well as subsequent treatment management decisions in high-grade glioma.
{"title":"Magnetic Resonance Imaging Mapping of Brain Tumor Burden: Clinical Implications for Neurosurgical Management: Case Report.","authors":"Jennifer M Connelly, Melissa A Prah, Fernando Santos-Pinheiro, Wade Mueller, Elizabeth Cochran, Kathleen M Schmainda","doi":"10.1093/neuopn/okab029","DOIUrl":"https://doi.org/10.1093/neuopn/okab029","url":null,"abstract":"<p><strong>Background and importance: </strong>Distinction of brain tumor progression from treatment effect on postcontrast magnetic resonance imaging (MRI) is an ongoing challenge in the management of brain tumor patients. A newly emerging MRI biomarker called fractional tumor burden (FTB) has demonstrated the ability to spatially distinguish high-grade brain tumor from treatment effect with important implications for surgical management and pathological diagnosis.</p><p><strong>Clinical presentation: </strong>A 58-yr-old male with glioblastoma was treated with standard concurrent chemoradiotherapy (CRT) after initial resection. Throughout follow-up imaging, the distinction of tumor progression from treatment effect was of concern. The surgical report from a redo resection indicated recurrent glioblastoma, while the tissue sent for pathological diagnosis revealed no tumor. Presurgical FTB maps confirmed the spatial variation of tumor and treatment effect within the contrast-agent enhancing lesion. Unresected lesion, shown to be an active tumor on FTB, was the site of substantial tumor growth postresection.</p><p><strong>Conclusion: </strong>This case report introduces the idea that a newly developed MRI biomarker, FTB, can provide information of tremendous benefit for surgical management, pathological diagnosis as well as subsequent treatment management decisions in high-grade glioma.</p>","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":"2 4","pages":"okab029"},"PeriodicalIF":0.0,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e2/03/okab029.PMC8508085.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39527296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cranioplasty is a procedure commonly performed as the next step in management for patients with decompressive craniectomy. It is commonly associated with complications that might result in implant failure and reoperation. Tissue engineering and regenerative medicine (TERM) involve the development of biological substitutes that restore tissue function and regrow and replace damaged tissues. TERM is a potential solution that might allow for improved long-term outcomes in cranioplasty. To present a case series that describes the management and treatment outcomes of using TERM in cranioplasty, using polycaprolactone-tricalcium phosphate (PCL-TCP) implants in 2 patients. In 2 young adults, large bone defects of the skull following decompressive craniectomy were reconstructed using patient-specific implants manufactured from PCL-TCP. Bone marrow aspirate was used as autologous biologic that incorporates stem cell and growth factors into the implant. Both patients recovered without any complications following surgery. Physical examination shows favorable healing outcomes with the defect area having a hard texture upon palpation. Postoperative imaging performed at 8 and 20 months for each patient, respectively, demonstrated ossification over the defect area. Satisfactory bone growth is seen with TERM cranioplasty. The PCL-TCP implant is a novel and recommendable alternative to currently available patient-specific implants used in cranioplasty. TERM cranioplasty is the potential solution to the quest of finding the ideal cranioplasty implant.
{"title":"Tissue Engineering and Regenerative Medicine Cranioplasty Using Polycaprolactone-Tricalcium Phosphate: Management and Treatment Outcomes","authors":"K. Hwang, J. B. Villavicencio, A. P. Agdamag","doi":"10.1093/neuopn/okab027","DOIUrl":"https://doi.org/10.1093/neuopn/okab027","url":null,"abstract":"\u0000 \u0000 \u0000 Cranioplasty is a procedure commonly performed as the next step in management for patients with decompressive craniectomy. It is commonly associated with complications that might result in implant failure and reoperation. Tissue engineering and regenerative medicine (TERM) involve the development of biological substitutes that restore tissue function and regrow and replace damaged tissues. TERM is a potential solution that might allow for improved long-term outcomes in cranioplasty.\u0000 \u0000 \u0000 \u0000 To present a case series that describes the management and treatment outcomes of using TERM in cranioplasty, using polycaprolactone-tricalcium phosphate (PCL-TCP) implants in 2 patients.\u0000 \u0000 \u0000 \u0000 In 2 young adults, large bone defects of the skull following decompressive craniectomy were reconstructed using patient-specific implants manufactured from PCL-TCP. Bone marrow aspirate was used as autologous biologic that incorporates stem cell and growth factors into the implant.\u0000 \u0000 \u0000 \u0000 Both patients recovered without any complications following surgery. Physical examination shows favorable healing outcomes with the defect area having a hard texture upon palpation. Postoperative imaging performed at 8 and 20 months for each patient, respectively, demonstrated ossification over the defect area.\u0000 \u0000 \u0000 \u0000 Satisfactory bone growth is seen with TERM cranioplasty. The PCL-TCP implant is a novel and recommendable alternative to currently available patient-specific implants used in cranioplasty. TERM cranioplasty is the potential solution to the quest of finding the ideal cranioplasty implant.\u0000","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48244262","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}
Behnam Rezai Jahromi, P. Tanskanen, Anniina Koski-Palkén, C. Schwartz, P. Koroknay-Pál, Inka Romo, M. Niemelä, J. Siironen
Despite recent advances in antibiotic treatment, pyogenic ventricular brain infections are still associated with adverse clinical outcome in 80% of affected patients and mortality rates approaching 60%. The limitation of antibiotic penetration into the cerebrospinal fluid (CSF) challenges the treatment. Intrathecal treatment remains an option for adjunctive therapy to intravenous (iv) antibiotics when the iv therapy fails to sterilize the CFS. Current treatment options do not allow for changing the CSF composition without adversely affecting intracranial pressure (ICP) and power of hydrogen (pH). To investigate if CSF composition exchange has impact on ventriculitis patients. We report 2 cases with pyogenic ventriculitis treated with a new intracranial active fluid exchange system that consists of a dual-lumen catheter to facilitate irrigation and drainage coupled with an intelligent digital pump. This new technique allowed us to change the composition of CSF to an antibiotic-consisted fluid. This resulted in the ability to directly modify the concentration of the targeted antibiotics in the CSF, while simultaneously removing bacterial mass without harming brain tissue and controlling ICP and pH. Our reported experience shows that drainage of purulent fluid caused by healthcare-associated ventriculitis or meningitis is now possible without harming brain tissue and ICP while also changing the composition of CSF to an antibiotic-consisted fluid. Actively removing pus and altering CSF in this manner had an impact on infection treatment and antibiotic penetration. Further cases are needed to confirm that our treatment algorithm is correctly tailored to assist clinicians in reliably treating this catastrophic condition.
{"title":"Active Cerebrospinal Fluid Exchange System for Treatment of Pyogenic Ventriculitis","authors":"Behnam Rezai Jahromi, P. Tanskanen, Anniina Koski-Palkén, C. Schwartz, P. Koroknay-Pál, Inka Romo, M. Niemelä, J. Siironen","doi":"10.1093/neuopn/okab030","DOIUrl":"https://doi.org/10.1093/neuopn/okab030","url":null,"abstract":"\u0000 \u0000 \u0000 Despite recent advances in antibiotic treatment, pyogenic ventricular brain infections are still associated with adverse clinical outcome in 80% of affected patients and mortality rates approaching 60%. The limitation of antibiotic penetration into the cerebrospinal fluid (CSF) challenges the treatment. Intrathecal treatment remains an option for adjunctive therapy to intravenous (iv) antibiotics when the iv therapy fails to sterilize the CFS. Current treatment options do not allow for changing the CSF composition without adversely affecting intracranial pressure (ICP) and power of hydrogen (pH).\u0000 \u0000 \u0000 \u0000 To investigate if CSF composition exchange has impact on ventriculitis patients.\u0000 \u0000 \u0000 \u0000 We report 2 cases with pyogenic ventriculitis treated with a new intracranial active fluid exchange system that consists of a dual-lumen catheter to facilitate irrigation and drainage coupled with an intelligent digital pump.\u0000 \u0000 \u0000 \u0000 This new technique allowed us to change the composition of CSF to an antibiotic-consisted fluid. This resulted in the ability to directly modify the concentration of the targeted antibiotics in the CSF, while simultaneously removing bacterial mass without harming brain tissue and controlling ICP and pH.\u0000 \u0000 \u0000 \u0000 Our reported experience shows that drainage of purulent fluid caused by healthcare-associated ventriculitis or meningitis is now possible without harming brain tissue and ICP while also changing the composition of CSF to an antibiotic-consisted fluid. Actively removing pus and altering CSF in this manner had an impact on infection treatment and antibiotic penetration. Further cases are needed to confirm that our treatment algorithm is correctly tailored to assist clinicians in reliably treating this catastrophic condition.\u0000","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43686185","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}
T. Cole, Dakota T Graham, A. Wakim, Michael A. Bohl, Clinton D. Morgan, J. Catapano, Kris A Smith, N. Sanai, M. Lawton
Three-dimensional (3D)-printed objects have been incorporated into many surgical specialties for various purposes. These devices can be customized and used as implants or surgical instruments. This study describes the use of a 3D-printed device that eliminates the need for a surgical assistant to occlude and retain the intracranial catheter during ventriculoperitoneal shunt creation and revision. After we identified design considerations and solutions, we modeled the device dimensions using computer-aided design software. Prototypes were 3D printed using stereolithography. Iterative design improvements were tested on cadaveric cranial samples. A final design was established, prepared by the in-hospital sterile processing department, and deployed successfully for clinical use. The design process for 3D-printed surgical instruments can produce straightforward idea-to-prototype pipelines. Because 3D-printed devices are easily duplicated and modified, small adjustments and new models can be developed, printed, and tested in a short time span.
{"title":"Local 3-Dimensional Printing of a Calvarium-Anchored Ventricular Catheter Occlusion Device","authors":"T. Cole, Dakota T Graham, A. Wakim, Michael A. Bohl, Clinton D. Morgan, J. Catapano, Kris A Smith, N. Sanai, M. Lawton","doi":"10.1093/neuopn/okab024","DOIUrl":"https://doi.org/10.1093/neuopn/okab024","url":null,"abstract":"\u0000 Three-dimensional (3D)-printed objects have been incorporated into many surgical specialties for various purposes. These devices can be customized and used as implants or surgical instruments. This study describes the use of a 3D-printed device that eliminates the need for a surgical assistant to occlude and retain the intracranial catheter during ventriculoperitoneal shunt creation and revision. After we identified design considerations and solutions, we modeled the device dimensions using computer-aided design software. Prototypes were 3D printed using stereolithography. Iterative design improvements were tested on cadaveric cranial samples. A final design was established, prepared by the in-hospital sterile processing department, and deployed successfully for clinical use. The design process for 3D-printed surgical instruments can produce straightforward idea-to-prototype pipelines. Because 3D-printed devices are easily duplicated and modified, small adjustments and new models can be developed, printed, and tested in a short time span.","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43545670","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}
{"title":"Letter: Global Neurosurgery Scope and Practice","authors":"U. S. Kanmounye, I. Esene","doi":"10.1093/neuopn/okab025","DOIUrl":"https://doi.org/10.1093/neuopn/okab025","url":null,"abstract":"","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44495717","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}
Awinita Barpujari, Chidinma M Wilson, Donald K. E. Detchou, Vamsi P. Reddy
To the Editor: This year marks the 75th anniversary of the First Annual Meeting of the Association of Medical Illustrators (AMI). The meeting, originally held in Philadelphia, Pennsylvania, on September 23–26, 1946, comprised a total of 40 members and guests.1 Today, the AMI boasts of over 800 members, spread across 4 continents. In light of this momentous achievement, we are delighted to highlight the significant contributions of medical illustrations to neurosurgery and call to attention the work of one particular artist: Max Brödel. Here, we discuss Max Brödel’s profound contributions to medical illustration and the importance of artistic capability and creativity in the field of neurosurgery. For centuries, neuroanatomy and neurosurgical pathologies have been conveyed through medical illustrations. As we continue to make immense strides in neurosurgical technology, it is because of visual maestros such as Brödel that neurosurgeons are able to conceptualize perplexing concepts, and at times subcellular processes, through computer graphics and animations. What even the most advanced microscopes cannot accomplish, medical illustrators are able to portray. Prior to his journey overseas, Brödel was enrolled in the Leipzig School of the Fine Arts (1884), where, under the tutelage of Dr Carl Ludwig, he began his serendipitous foray into anatomic and histological drawings.2 Even without formal medical training, Brödel acquired a meticulous understanding of anatomy, pathology, physiology, and surgery. His early exposure to the medical sciences enabled Brödel to cultivate a unique skillset that would ultimately allow him to master the “practice of putting art into medicine,” and was rightly crowned the father of modern medical illustration.2,3 Throughout his career, Brödel advocated for medical illustration as both an art form and a precise science with myriad purposes. Prior to Brödel’s arrival at Johns Hopkins in the 1890s, much of the visual medical documentation was done through photography. It was Brödel who pointed out that medical illustrations comprise a combination of analysis and interpretation: an ideal medium for learning and teaching.2 Under the guidance of renowned gynecologist Dr Howard Kelly at The Johns Hopkins, Brödel fine-tuned the precise science of medical illustrations and made some of his most significant contributions to academic medicine.2 Notably, Brödel was known to study his tissue of interest by injection, dissection, frozen section, or reconstruction prior to embarking on any drawing.2,4 It was due to Brödel’s dissatisfaction with prevailing techniques and their inability to capture the essence of living tissue that he ultimately created the “halftone” method, now commonly referred to as the Brödel carbon dust technique.5 Through the scrupulous study of his objects and his methodical choice of technique, Brödel was able to skillfully blend tissue realism with cross-sectional anatomy, all whilst maintaining topographical ac
{"title":"Letter: Max Brödel and the Practice of Putting Art Into Medicine","authors":"Awinita Barpujari, Chidinma M Wilson, Donald K. E. Detchou, Vamsi P. Reddy","doi":"10.1093/neuopn/okab023","DOIUrl":"https://doi.org/10.1093/neuopn/okab023","url":null,"abstract":"To the Editor: This year marks the 75th anniversary of the First Annual Meeting of the Association of Medical Illustrators (AMI). The meeting, originally held in Philadelphia, Pennsylvania, on September 23–26, 1946, comprised a total of 40 members and guests.1 Today, the AMI boasts of over 800 members, spread across 4 continents. In light of this momentous achievement, we are delighted to highlight the significant contributions of medical illustrations to neurosurgery and call to attention the work of one particular artist: Max Brödel. Here, we discuss Max Brödel’s profound contributions to medical illustration and the importance of artistic capability and creativity in the field of neurosurgery. For centuries, neuroanatomy and neurosurgical pathologies have been conveyed through medical illustrations. As we continue to make immense strides in neurosurgical technology, it is because of visual maestros such as Brödel that neurosurgeons are able to conceptualize perplexing concepts, and at times subcellular processes, through computer graphics and animations. What even the most advanced microscopes cannot accomplish, medical illustrators are able to portray. Prior to his journey overseas, Brödel was enrolled in the Leipzig School of the Fine Arts (1884), where, under the tutelage of Dr Carl Ludwig, he began his serendipitous foray into anatomic and histological drawings.2 Even without formal medical training, Brödel acquired a meticulous understanding of anatomy, pathology, physiology, and surgery. His early exposure to the medical sciences enabled Brödel to cultivate a unique skillset that would ultimately allow him to master the “practice of putting art into medicine,” and was rightly crowned the father of modern medical illustration.2,3 Throughout his career, Brödel advocated for medical illustration as both an art form and a precise science with myriad purposes. Prior to Brödel’s arrival at Johns Hopkins in the 1890s, much of the visual medical documentation was done through photography. It was Brödel who pointed out that medical illustrations comprise a combination of analysis and interpretation: an ideal medium for learning and teaching.2 Under the guidance of renowned gynecologist Dr Howard Kelly at The Johns Hopkins, Brödel fine-tuned the precise science of medical illustrations and made some of his most significant contributions to academic medicine.2 Notably, Brödel was known to study his tissue of interest by injection, dissection, frozen section, or reconstruction prior to embarking on any drawing.2,4 It was due to Brödel’s dissatisfaction with prevailing techniques and their inability to capture the essence of living tissue that he ultimately created the “halftone” method, now commonly referred to as the Brödel carbon dust technique.5 Through the scrupulous study of his objects and his methodical choice of technique, Brödel was able to skillfully blend tissue realism with cross-sectional anatomy, all whilst maintaining topographical ac","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46663042","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}
C. Honey, M. Hart, Linda A. Rammage, M. Morrison, A. Hu, C. Honey
Spasmodic dysphonia (SD) is a dystonia of the vocal folds causing difficulty with speech. A recent randomized controlled trial showed that thalamic deep brain stimulation (DBS) was safe and could improve this condition in the most common subtype—adductor SD. We investigated if thalamic DBS could also improve the other subtypes of abductor SD and mixed SD. These prospective blinded trials of 1 were designed to assess the safety of thalamic DBS in mixed and abductor SD and to quantify the magnitude of any benefit from unilateral or bilateral thalamic stimulation. One patient with mixed SD and one patient with abductor SD received bilateral thalamic DBS. After optimizing their DBS settings for vocal improvement, they were blinded and prospectively randomized to receive 1 mo of left, right, both, or neither hemisphere stimulation. Outcome was assessed by a speech language pathologist, blinded to the settings, rating voice recordings with the Unified Spasmodic Dysphonia Rating Scale, and by patient self-reported quality-of-life questionnaires. Additional outcomes included scores of mood and cognition. There were no complications. Both patients reported a subjective improvement of their voice and quality of life with blinded left thalamic DBS. The quality of their voice was also objectively rated as improved with blinded left thalamic DBS. This small proof-of-concept study suggests that left thalamic DBS can improve the quality of voice and quality of life of patients with mixed SD and abductor SD.
{"title":"Thalamic Deep Brain Stimulation Ameliorates Mixed and Abductor Spasmodic Dysphonia: Case Reports and Proof of Concept","authors":"C. Honey, M. Hart, Linda A. Rammage, M. Morrison, A. Hu, C. Honey","doi":"10.1093/NEUOPN/OKAB022","DOIUrl":"https://doi.org/10.1093/NEUOPN/OKAB022","url":null,"abstract":"\u0000 \u0000 \u0000 Spasmodic dysphonia (SD) is a dystonia of the vocal folds causing difficulty with speech. A recent randomized controlled trial showed that thalamic deep brain stimulation (DBS) was safe and could improve this condition in the most common subtype—adductor SD. We investigated if thalamic DBS could also improve the other subtypes of abductor SD and mixed SD. These prospective blinded trials of 1 were designed to assess the safety of thalamic DBS in mixed and abductor SD and to quantify the magnitude of any benefit from unilateral or bilateral thalamic stimulation.\u0000 \u0000 \u0000 \u0000 One patient with mixed SD and one patient with abductor SD received bilateral thalamic DBS. After optimizing their DBS settings for vocal improvement, they were blinded and prospectively randomized to receive 1 mo of left, right, both, or neither hemisphere stimulation. Outcome was assessed by a speech language pathologist, blinded to the settings, rating voice recordings with the Unified Spasmodic Dysphonia Rating Scale, and by patient self-reported quality-of-life questionnaires. Additional outcomes included scores of mood and cognition. There were no complications. Both patients reported a subjective improvement of their voice and quality of life with blinded left thalamic DBS. The quality of their voice was also objectively rated as improved with blinded left thalamic DBS.\u0000 \u0000 \u0000 \u0000 This small proof-of-concept study suggests that left thalamic DBS can improve the quality of voice and quality of life of patients with mixed SD and abductor SD.\u0000","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48805816","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}
Lauren E. Stone, Vanessa S. Goodwill, A. Wali, B. Hirshman, D. Santiago-Dieppa, A. Khalessi
Pleomorphic xanthoastrocytoma (PXA) is a rare World Health Organization (WHO) grade II lesion considered to portend a good prognosis. However, the literature contains several references of serious intracranial hemorrhages associated with PXAs, although the etiology is poorly understood. We present the case of a young woman with a Hunt and Hess V, Fisher 4 subarachnoid hemorrhage associated with a right cavernous sinus PXA. The case provides rare baseline angiographic imaging prior to a presenting hemorrhagic event and reveals progressive loss of structural vascular integrity at proximal large vessels. This case provides insight into the natural history of this entity, tropism for catastrophic vascular injury, and informs surgical management with an emphasis on preoperative vascular imaging and preparation for proximal vascular control with cervical exposure.
多形性黄色星形细胞瘤(PXA)是一种罕见的世界卫生组织(WHO) II级病变，被认为预示着良好的预后。然而，文献中包含了一些与pxa相关的严重颅内出血的文献，尽管病因尚不清楚。我们报告一位年轻女性的病例，她患有Hunt and Hess V, Fisher 4蛛网膜下腔出血，并伴有右侧海绵窦PXA。该病例在出现出血事件前提供了罕见的基线血管造影图像，显示近端大血管结构完整性的进行性丧失。本病例提供了对这种疾病的自然病史的深入了解，以及对灾难性血管损伤的倾向，并告知手术处理，重点是术前血管成像和准备近端血管控制与颈椎暴露。
{"title":"Subarachnoid Hemorrhage as a Consequence of Pleomorphic Xanthoastrocytoma: A Case Report","authors":"Lauren E. Stone, Vanessa S. Goodwill, A. Wali, B. Hirshman, D. Santiago-Dieppa, A. Khalessi","doi":"10.1093/NEUOPN/OKAB020","DOIUrl":"https://doi.org/10.1093/NEUOPN/OKAB020","url":null,"abstract":"\u0000 \u0000 \u0000 Pleomorphic xanthoastrocytoma (PXA) is a rare World Health Organization (WHO) grade II lesion considered to portend a good prognosis. However, the literature contains several references of serious intracranial hemorrhages associated with PXAs, although the etiology is poorly understood.\u0000 \u0000 \u0000 \u0000 We present the case of a young woman with a Hunt and Hess V, Fisher 4 subarachnoid hemorrhage associated with a right cavernous sinus PXA. The case provides rare baseline angiographic imaging prior to a presenting hemorrhagic event and reveals progressive loss of structural vascular integrity at proximal large vessels.\u0000 \u0000 \u0000 \u0000 This case provides insight into the natural history of this entity, tropism for catastrophic vascular injury, and informs surgical management with an emphasis on preoperative vascular imaging and preparation for proximal vascular control with cervical exposure.\u0000","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47146562","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}
Martin H. Pham, O. Hassan, L. Diaz-Aguilar, R. Lehman
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 complications associated with this level has been difficult as prior reports include other levels that have different anatomic considerations. To present a systematic review of previously reported cases of OLIF, lateral ALIF, and an ATP approach at L5-S1 to discuss their associated complications. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a PubMed search was performed up to January 2021 to identify literature describing OLIF, lateral ALIF, and ATP approaches involving the L5-S1 levels. A quality assessment with risk of bias analysis was performed using the methodological index for non-randomized studies (MINORS) assessment tool for each study. Data we then extracted to identify all complications. The initial search yielded 532 publications. After screening, there were 18 studies with 553 total patients who underwent OLIF including L5-S1. Analysis of these studies demonstrated a vascular complication rate of 2.5%, bowel-associated complication rate of 0.5%, ureteral injury rate of 0%, neurological injury rate of 1.9%, pseudarthrosis rate of 7.3%, and reoperation rate of 2.2%. The L5-S1 level remains an important target for sagittal alignment in both degenerative and deformity surgery. The OLIF surgical corridor to this level presents special anatomic and clinical considerations and is a safe approach to minimize morbidity with minimally invasive access.
{"title":"Complications Associated With Oblique Lumbar Interbody Fusion at L5-S1: A Systematic Review of the Literature","authors":"Martin H. Pham, O. Hassan, L. Diaz-Aguilar, R. Lehman","doi":"10.1093/NEUOPN/OKAB018","DOIUrl":"https://doi.org/10.1093/NEUOPN/OKAB018","url":null,"abstract":"\u0000 \u0000 \u0000 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 complications associated with this level has been difficult as prior reports include other levels that have different anatomic considerations.\u0000 \u0000 \u0000 \u0000 To present a systematic review of previously reported cases of OLIF, lateral ALIF, and an ATP approach at L5-S1 to discuss their associated complications.\u0000 \u0000 \u0000 \u0000 Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a PubMed search was performed up to January 2021 to identify literature describing OLIF, lateral ALIF, and ATP approaches involving the L5-S1 levels. A quality assessment with risk of bias analysis was performed using the methodological index for non-randomized studies (MINORS) assessment tool for each study. Data we then extracted to identify all complications.\u0000 \u0000 \u0000 \u0000 The initial search yielded 532 publications. After screening, there were 18 studies with 553 total patients who underwent OLIF including L5-S1. Analysis of these studies demonstrated a vascular complication rate of 2.5%, bowel-associated complication rate of 0.5%, ureteral injury rate of 0%, neurological injury rate of 1.9%, pseudarthrosis rate of 7.3%, and reoperation rate of 2.2%.\u0000 \u0000 \u0000 \u0000 The L5-S1 level remains an important target for sagittal alignment in both degenerative and deformity surgery. The OLIF surgical corridor to this level presents special anatomic and clinical considerations and is a safe approach to minimize morbidity with minimally invasive access.\u0000","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43722904","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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