1
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Sadagopan NS, Poylin VY, Jun C, El Tecle NE, Wolinsky JP. Robotic Resection of a Sciatic Notch Lipoma Using the DaVinci Surgical System: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01081. [PMID: 38451092 DOI: 10.1227/ons.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/16/2024] [Indexed: 03/08/2024] Open
Abstract
Sciatic notch lipomas are rare benign fatty tumors that can cause significant morbidity due to compression of the sciatic nerve. Surgical excision is the gold standard treatment, but traditional open techniques are associated with significant risks and prolonged recovery times. Robotic surgery provides opportunity to improve on traditional laparoscopic techniques by allowing better visualization of and access to regions of complex anatomy, including the pelvis. The potential benefits of robotic resection include reduced blood loss, minimized tissue trauma, and shorter hospital stays. Building on robotic techniques previously described by our group, we present a video of a robotic resection of a sciatic notch lipoma using the DaVinci Surgical System.1,2 The patient consented to the procedure. The procedure begins with the patient in lithotomy position, followed by the establishment of the robotic trocar sites in the peritoneum, including the endoscope, Da Vinci, and assistant ports. The advanced visualization and precise maneuverability allow for careful dissection and identification of vital structures, including the L5 and S1 nerve roots, with minimal tissue manipulation. Subtotal resection of the lipoma was achieved resulting in decompression of the sciatic nerve with preservation of the surrounding structures. This video highlights the technical aspects of the procedure, emphasizing the advantages of robotic assistance, such as enhanced dexterity, precision, and visualization. This new technique offers a promising alternative to open surgery for the management of sciatic notch lipomas, potentially improving patient outcomes and overall surgical experience.
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Affiliation(s)
- Nishanth S Sadagopan
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vitaliy Y Poylin
- Department of Gastrointestinal Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Changhan Jun
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jean-Paul Wolinsky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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2
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Khan ASR, Currier BL, Erickson MM, Nassr A, El Tecle NE, Moussallem CD. C1-C2 Posterior Screw-Rod Fixation. Instr Course Lect 2024; 73:651-664. [PMID: 38090931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Multiple approaches for instrumentation of the upper cervical spine have evolved to treat atlantoaxial instability which, until the 20th century, was largely considered to be inoperable and managed nonsurgically with immobilization. Surgeons set out to provide safe and effective approaches in a clearly dangerous and technically complex anatomic region. It is important to provide a historical analysis of the evolution of techniques that have shaped C1-C2 instrumentation, and how the diligent efforts of surgeons to improve the biomechanical stability and fusion rates of their constructs eventually led to the prevailing Harms technique. This technique is explored by describing its surgical steps, alternative techniques, and associated outcomes. For successful instrumentation of the atlantoaxial joint, a comprehensive understanding of spinal biomechanics, surgical techniques, and anatomic variations is imperative for surgeons to develop a tailored plan for each patient's individual pathology and anatomy.
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3
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Khan ASR, Mattei TA, Mercier PJ, Cloney M, Dahdaleh NS, Koski TR, El Tecle NE. Outcome Reporting in Spine Surgery: A Review of Historical and Emerging Trends. World Neurosurg 2023; 179:88-98. [PMID: 37480984 DOI: 10.1016/j.wneu.2023.07.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
The general objectives of spine surgery are to alleviate pain, restore neurologic function, and prevent or treat spinal deformities or instability. The accumulating expanse of outcome measures has allowed us to more objectively quantify these variables and, therefore, gauge the success of treatments, ultimately improving the quality of the delivered health care. It has become increasingly evident that spinal conditions and their accompanying interventions affect all aspects of a patient's life, including their physical, mental, emotional, and social well-being. This underscores the challenge of creating clinically relevant and accurate outcome measures in spine care, and the reason why there is a growing recognition of the importance of subjective measures such as patient-reported outcome measures, that consider a patients' health-related quality of life. Subjective measures provide valuable insights into patient experiences and perceptions of treatment outcomes, whereas objective measures provide a reproducible glimpse into key radiographic and clinical parameters that are associated with a successful outcome. In this narrative review, we provide a detailed analysis of the most common subjective and objective outcome measures employed in spine surgery, with a special focus on their current role as well as the possible future of outcome reporting.
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Affiliation(s)
- Ali Saif R Khan
- Center School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Tobias A Mattei
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Phillipe J Mercier
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Michael Cloney
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Tyler R Koski
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA.
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4
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Petrosyan E, Fares J, Lesniak MS, Koski TR, El Tecle NE. Biological principles of adult degenerative scoliosis. Trends Mol Med 2023; 29:740-752. [PMID: 37349248 DOI: 10.1016/j.molmed.2023.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
The global aging population has led to an increase in geriatric diseases, including adult degenerative scoliosis (ADS). ADS is a spinal deformity affecting adults, particularly females. It is characterized by asymmetric intervertebral disc and facet joint degeneration, leading to spinal imbalance that can result in severe pain and neurological deficits, thus significantly reducing the quality of life. Despite improved management, molecular mechanisms driving ADS remain unclear. Current literature primarily comprises epidemiological and clinical studies. Here, we investigate the molecular mechanisms underlying ADS, with a focus on angiogenesis, inflammation, extracellular matrix remodeling, osteoporosis, sarcopenia, and biomechanical stress. We discuss current limitations and challenges in the field and highlight potential translational applications that may arise with a better understanding of these mechanisms.
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Affiliation(s)
- Edgar Petrosyan
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Maciej S Lesniak
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Tyler R Koski
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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5
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Sankhyan M, Anderson EM, Urquiaga JF, Hockman JT, Aggarwal R, El Tecle NE, Mercier PJ. Urothelial Carcinoma of the Bladder With Primary Metastasis to the Brain: A Case Report and Literature Review. Cureus 2022; 14:e27587. [PMID: 36059295 PMCID: PMC9433789 DOI: 10.7759/cureus.27587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/05/2022] Open
Abstract
Brain metastases are the most common type of brain tumor in adults, commonly arising from primary tumor sites of the lung, breast, skin (melanoma), colon, and kidney. Isolated central nervous system (CNS) metastasis arising from urothelial carcinoma (UC) is a rare presentation yielding a poor prognosis. A 71-year-old male patient with a history of urothelial carcinoma, treated one year prior with partial cystectomy and adjuvant gemcitabine and cisplatin (GC) therapy, presented with worsening neurological symptoms, including progressively worsening dizziness, shuffling gait, drifting, expressive aphasia, and confusion. MRI revealed a left frontal 4.0 x 3.6 cm brightly contrast-enhancing tumor with possible hemorrhage, extensive vasogenic edema, and moderate mass effect. An additional smaller right cerebellar lesion was also noted. Outpatient CT of his chest, abdomen, and pelvis revealed no evidence of other malignant sites. He ultimately underwent a left craniotomy with a total resection of his left frontal mass. Pathological examination revealed a urothelial primary. Post-operative MRI revealed complete resection of the left frontal mass and the patient was discharged with no neurologic deficits on exam. In many cases, brain metastases may present years later following initial therapy of UC as the CNS may act as a sanctuary site during systemic chemotherapy. Chemotherapeutics such as gemcitabine with better penetration of the blood-brain barrier may be beneficial in delaying the onset of these metastases.
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6
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El Tecle NE, Urquiaga JF, Griffin ST, Alexopoulos G, El Ahamadieh TY, Aoun SG, Mattei TA. Misinterpretations of Null Hypothesis Significance Testing Results Near the P-value Threshold: An Estimation of The Prevalence of Such a Statistical Error In The Neurosurgical Literature. World Neurosurg 2021; 159:e192-e198. [PMID: 34915206 DOI: 10.1016/j.wneu.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Although statistical errors have been shown to be prevalent in the medical literature there has been a paucity of studies focusing on the prevalence of such errors in neurosurgery. In this article, we audit the contemporary neurosurgical literature for a common statistical mistake, namely, misinterpretations of null hypothesis significance testing results near the p-value threshold by conveying the idea of a "trend". METHODS PubMed/Medline was used to identify all articles published in six major neurosurgical journals between 2000 and 2020. The abstracts of these articles were extracted and scrutinized to determine when the word "trend" was used to express "near-statistical significance". RESULTS A total of 45,244 articles were included. Of those 461 (1.02% [0.86-1.18]) employed the word "trend" to indicate near statistical significance, a total of 3.8 [2.93-4.75] errors per issue per year. The error under study occurred more frequently in JNS Spine and less frequently in Acta Neurochirurgica (p=0.007). On an annual basis, there was no linear correlation between the total number of papers published per journal and the number of errors in that journal (r=0.34, p = 0.01). CONCLUSION Misinterpretations of null hypothesis significance testing results near the p-value threshold is present in at least 1% of the neurosurgical literature. While we believe that most statistical errors in medicine in general and neurosurgery in particular may be unintentional in nature, additional measures should be enacted to prevent the subsequent adoption of such methodological practices amongst future researchers.
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Affiliation(s)
- Najib E El Tecle
- Northwestern Memorial Hospital, Department of Neurological Surgery, Chicago, IL.
| | - Jorge F Urquiaga
- St. Louis University, Department of Neurological Surgery, St. Louis, MO
| | - Samuel T Griffin
- St. Louis University, Department of Neurological Surgery, St. Louis, MO
| | | | - Tarek Y El Ahamadieh
- University of Texan Southwestern, Department of Neurological Surgery, Dallas, TX
| | - Salah G Aoun
- University of Texan Southwestern, Department of Neurological Surgery, Dallas, TX
| | - Tobias A Mattei
- St. Louis University, Department of Neurological Surgery, St. Louis, MO
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7
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Hockman JT, El Tecle NE, Urquiaga JF, Alexopoulos G, Guzman MA, Coppens J. Dissemination Patterns and Short-Term Management of Multifocal Rosette-Forming Glioneuronal Tumors. World Neurosurg 2021; 149:86-93. [PMID: 33610864 DOI: 10.1016/j.wneu.2021.02.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multifocal rosette-forming glioneuronal tumors (RGNTs) are challenging to manage. Gross total resection is often impossible, and data on adjunctive therapies are limited. We reviewed cases of multifocal RGNTs in the literature with special focus on dissemination patterns and management. METHODS A literature review was conducted using PubMed and the key words "(multifocal OR multicentric OR satellite OR dissemination) AND glioneuronal." RESULTS There were 21 cases of multifocal RGNTs identified. Follow-up was available in 18 cases at a median of 17 months. Progression-free survival and overall survival at 1 year were 84% and 94%, respectively. Of all cases, 43% had cerebrospinal fluid (CSF) dissemination, 48% had intraparenchymal spread, and 10% had both. The presence of CSF dissemination led to palliative care and/or death in 20% of cases (n = 2). None of the cases with intraparenchymal spread progressed. Radiotherapy was used in 50% of cases with CSF dissemination, chemotherapy was used in 20%, and CSF shunting was used in 36%. No tumors with intraparenchymal spread required adjunctive therapy or shunting. CONCLUSIONS RGNTs with CSF dissemination are more likely to behave aggressively, and early adjunctive therapies should be discussed with patients. Tumors with intraparenchymal spread grow slowly, and maximal safe resection followed by observation is likely sufficient in the short term. Long-term behavior of multifocal RGNTs is still unclear.
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Affiliation(s)
- Jakob T Hockman
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA; Department of Pathology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Najib E El Tecle
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
| | - Jorge F Urquiaga
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Georgios Alexopoulos
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Miguel A Guzman
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jeroen Coppens
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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8
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Pernik MN, Deme PR, Nguyen ML, Aoun SG, Adogwa O, Hall K, Stewart NA, Dosselman LJ, El Tecle NE, McDonald SR, Bagley CA, Wingfield SA. Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium. J Am Geriatr Soc 2020; 69:1240-1248. [PMID: 33382460 DOI: 10.1111/jgs.17006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delirium is a common postoperative complication in geriatric patients, especially in those with underlying risk factors. Multicomponent nonpharmacologic interventions are effective in preventing delirium, however, implementation of these measures is variable in perioperative care. The aim of our study was to assess the impact of our Perioperative Optimization of Senior Health Program (UTSW POSH) on postoperative delirium in patients undergoing elective spine surgery. STUDY DESIGN The UTSW POSH program is an interdisciplinary perioperative initiative involving geriatrics, surgery, and anesthesiology to improve care for high-risk geriatric patients undergoing elective spine surgery. Preoperatively, enrolled patients (n = 147) were referred for a geriatric assessment and optimization for surgery. Postoperatively, patients were co-managed by the primary surgical team and the geriatrics consult service. UTSW POSH patients were retrospectively compared to a matched historical control group (n = 177) treated with usual care. Main outcomes included postoperative delirium and provider recognition of delirium. RESULTS UTSW POSH patients were significantly older (75.5 vs 71.5 years; P < .001), had more comorbidities (8.02 vs 6.58; P < .001), and were more likely to undergo pelvic fixation (36.1% vs 17.5%; P < .001). The incidence of postoperative delirium was lower in the UTSW POSH group compared to historical controls, although not statistically significant (11.6% vs 19.2%; P = .065). Delirium was significantly lower in patients who underwent complex spine surgery (≥4 levels of vertebral fusion; N = 106) in the UTSW POSH group (11.7% vs 28.9%, P = .03). There was a threefold increase in the recognition of postoperative delirium by providers after program implementation, (76.5% vs 23.5%; P = .001). CONCLUSIONS This study suggests that interdisciplinary care for high-risk geriatric patients undergoing elective spine surgery may reduce the incidence of postoperative delirium and increase provider recognition of delirium. The benefit may be greater for those undergoing larger procedures.
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Affiliation(s)
- Mark N Pernik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Palvasha R Deme
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Madelina L Nguyen
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Salah G Aoun
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Owoicho Adogwa
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Kristen Hall
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Nick A Stewart
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Luke J Dosselman
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, St Louis University Hospital, St. Louis, Missouri, USA
| | - Shelley R McDonald
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.,Department of Orthopedic Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Sarah A Wingfield
- Department of Internal Medicine, Geriatrics Division, UT Southwestern Medical School, Dallas, Texas, USA
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9
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Bendok BR, Abi-Aad KR, Ward JD, Kniss JF, Kwasny MJ, Rahme RJ, Aoun SG, El Ahmadieh TY, El Tecle NE, Zammar SG, Aoun RJN, Patra DP, Ansari SA, Raymond J, Woo HH, Fiorella D, Dabus G, Milot G, Delgado Almandoz JE, Scott JA, DeNardo AJ, Dashti SR. The Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): A Randomized Controlled Trial of the Second-Generation Hydrogel Coil. Neurosurgery 2020; 86:615-624. [PMID: 32078692 PMCID: PMC7534546 DOI: 10.1093/neuros/nyaa006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aneurysm recurrence after coiling has been associated with aneurysm growth, (re)hemorrhage, and a greater need for follow-up. The second-generation HydroCoil Embolic System (HES; MicroVention, Inc) consists of a platinum core with integrated hydrogel and was developed to reduce recurrence through enhancing packing density and healing within the aneurysm. OBJECTIVE To compare recurrence between the second-generation HES and bare platinum coil (BPC) in the new-generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT). METHODS HEAT is a randomized, controlled trial that enrolled subjects with ruptured or unruptured 3- to 14-mm intracranial aneurysms amenable to coiling. The primary endpoint was aneurysm recurrence using the Raymond-Roy scale. Secondary endpoints included minor and major recurrence, packing density, adverse events related to the procedure and/or device, mortality, initial complete occlusion, aneurysm retreatment, hemorrhage from target aneurysm during follow-up, aneurysm occlusion stability, and clinical outcome at final follow-up. RESULTS A total of 600 patients were randomized (HES, n = 297 and BPC, n = 303), including 28% with ruptured aneurysms. Recurrence occurred in 11 (4.4%) subjects in the HES arm and 44 (15.4%) subjects in the BPC arm (P = .002). While the initial occlusion rate was higher with BPC, the packing density and both major and minor recurrence rates were in favor of HES. Secondary endpoints including adverse events, retreatment, hemorrhage, mortality, and clinical outcome did not differ between arms. CONCLUSION Coiling of small-to-medium aneurysms with second-generation HES resulted in less recurrence when compared to BPC, without increased harm. These data further support the use of the second-generation HES for the embolization of intracranial aneurysms. VIDEO ABSTRACT
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Affiliation(s)
- Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona.,Department of Radiology, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Jennifer D Ward
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Jason F Kniss
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Mary J Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Chicago, Illinois
| | - Rudy J Rahme
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Najib E El Tecle
- Department of Neurological Surgery, Saint Louis University Hospital, St. Louis, Missouri
| | - Samer G Zammar
- Department of Neurological Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Rami James N Aoun
- Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Jean Raymond
- Laboratoire de Neuroradiologie Interventionnelle, Université de Montréal, Montreal, Canada
| | - Henry H Woo
- Department of Neurological Surgery, North Shore University Hospital, Manhasset, New York
| | - David Fiorella
- Department of Radiology, Stony Brook University Hospital, Stony Brook, New York
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Miami, Florida
| | - Genevieve Milot
- Département de Chirurgie, CHU de Quebec, Quebec City, Canada
| | | | - John A Scott
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Andrew J DeNardo
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Shervin R Dashti
- Department of Neurological Surgery Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky
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10
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Almekkawi AK, El Ahmadieh TY, Wu EM, Abunimer AM, Abi-Aad KR, Aoun SG, Plitt AR, El Tecle NE, Patel T, Stummer W, Bendok BR. The Use of 5-Aminolevulinic Acid in Low-Grade Glioma Resection: A Systematic Review. Oper Neurosurg (Hagerstown) 2019; 19:1-8. [DOI: 10.1093/ons/opz336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/24/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
For optimizing high-grade glioma resection, 5-aminolevulinic acid is a reliable tool. However, its efficacy in low-grade glioma resection remains unclear.
OBJECTIVE
To study the role of 5-aminolevulinic acid in low-grade glioma resection and assess positive fluorescence rates and the effect on the extent of resection.
METHODS
A systematic review of PubMed, Google Scholar, and Cochrane was performed from the date of inception to February 1, 2019. Studies that correlated 5-aminolevulinic acid fluorescence with low-grade glioma in the setting of operative resection were selected. Studies with biopsy only were excluded. Positive fluorescence rates were calculated. The quality index of the selected papers was provided. No patient information was used, so Institutional Review Board approval and patient consent were not required.
RESULTS
A total of 12 articles met the selection criteria with 244 histologically confirmed low-grade glioma patients who underwent microsurgical resection. All patients received 20 mg/kg body weight of 5-aminolevulinic acid. Only 60 patients (n = 60/244; 24.5%) demonstrated visual intraoperative 5-aminolevulinic acid fluorescence. The extent of resection was reported in 4 studies; however, the data combined low- and high-grade tumors. Only 2 studies reported on tumor location. Only 3 studies reported on clinical outcomes. The Zeiss OPMI Pentero microscope was most commonly used across all studies. The average quality index was 14.58 (range: 10-17), which correlated with an overall good quality.
CONCLUSION
There is an overall low correlation between 5-aminolevulinic acid fluorescence and low-grade glioma. Advances in visualization technology and using standardized fluorescence quantification methods may further improve the visualization and reliability of 5-aminolevulinic acid fluorescence in low-grade glioma resection.
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Affiliation(s)
- Ahmad Kareem Almekkawi
- Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, University of Harvard, Boston, Massachusetts
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, Zale Lipshy Hospital, The University of Texas Southwestern, Dallas, Texas
| | - Eva M Wu
- Department of Neurological Surgery, Zale Lipshy Hospital, The University of Texas Southwestern, Dallas, Texas
| | - Abdullah M Abunimer
- Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, University of Harvard, Boston, Massachusetts
| | - Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Salah G Aoun
- Department of Neurological Surgery, Zale Lipshy Hospital, The University of Texas Southwestern, Dallas, Texas
| | - Aaron R Plitt
- Department of Neurological Surgery, Zale Lipshy Hospital, The University of Texas Southwestern, Dallas, Texas
| | - Najib E El Tecle
- Department of Neurological Surgery, Saint Louis University Hospital, Saint Louis, Missouri
| | - Toral Patel
- Department of Neurological Surgery, Zale Lipshy Hospital, The University of Texas Southwestern, Dallas, Texas
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
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11
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Aoun SG, Peinado Reyes V, El Ahmadieh TY, Davies M, Patel AR, Ban VS, Plitt A, El Tecle NE, Moreno JR, Raisanen J, Bagley CA. Stem cell injections for axial back pain: a systematic review of associated risks and complications with a case illustration of diffuse hyperplastic gliosis resulting in cauda equina syndrome. J Neurosurg Spine 2019; 31:906-913. [PMID: 31491761 DOI: 10.3171/2019.6.spine19594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/17/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Axial low-back pain is a disease of epidemic proportions that exerts a heavy global toll on the active workforce and results in more than half a trillion dollars in annual costs. Stem cell injections are being increasingly advertised as a restorative solution for various degenerative diseases and are becoming more affordable and attainable by the public. There have been multiple reports in the media of these injections being easily available abroad outside of clinical trials, but scientific evidence supporting them remains scarce. The authors present a case of a serious complication after a stem cell injection for back pain and provide a systematic review of the literature of the efficacy of this treatment as well as the associated risks and complications. METHODS A systematic review of the literature was performed using the PubMed, Google Scholar, and Scopus online electronic databases to identify articles reporting stem cell injections for axial back pain in accordance with the PRISMA guidelines. The primary focus was on outcomes and complications. A case of glial hyperplasia of the roots of the cauda equina directly related to stem cell injections performed abroad is also reported. RESULTS The authors identified 14 publications (including a total of 147 patients) that met the search criteria. Three of the articles presented data for the same patient population with different durations of follow-up and were thus analyzed as a single study, reducing the total number of studies to 12. In these 12 studies, follow-up periods ranged from 6 months to 6 years, with 50% having a follow-up period of 1 year or less. Most studies reported favorable outcomes, although 36% used subjective measures. There was a tendency for pain relief to wane after 6 months to 2 years, with patients seeking a surgical solution. Only 1 study was a randomized controlled trial (RCT). CONCLUSIONS There are still insufficient data to support stem cell injections for back pain. Additional RCTs with long-term follow-up are necessary before statements can be made regarding the efficacy and safety.
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Affiliation(s)
| | | | | | | | | | | | | | - Najib E El Tecle
- 2Department of Neurological Surgery, Saint Louis University Hospital, St. Louis, Missouri
| | | | - Jack Raisanen
- 3Pathology, University of Texas Southwestern Medical Center, Dallas, Texas; and
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12
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Pines AR, Alghoul MS, Hamade YJ, Sattur MG, Aoun RJN, Halasa TK, Krishna C, Zammar SG, El Tecle NE, El Ahmadieh TY, Aoun SG, Byrne RW, Harrop JS, Ragel BT, Resnick DK, Lonser RR, Selden NR, Bendok BR. Assessment of the Interrater Reliability of the Congress of Neurological Surgeons Microanastomosis Assessment Scale. Oper Neurosurg (Hagerstown) 2019; 13:108-112. [PMID: 28931262 DOI: 10.1227/neu.0000000000001403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The potential for simulation-based learning in neurosurgical training has led the Congress of Neurosurgical Surgeons to develop a series of simulation modules. The Northwestern Objective Microanastomosis Assessment Tool (NOMAT) was created as the corresponding assessment tool for the Congress of Neurosurgical Surgeons Microanastomosis Module. The face and construct validity of the NOMAT have been previously established. OBJECTIVE To further validate the NOMAT by determining its interrater reliability (IRR) between raters of varying levels of microsurgical expertise. METHODS The NOMAT was used to assess residents' performance in a microanastomosis simulation module in 2 settings: Northwestern University and the Society of Neurological Surgeons 2014 Boot Camp at the University of Indiana. At Northwestern University, participants were scored by 2 experienced microsurgeons. At the University of Indiana, participants were scored by 2 postdoctoral fellows and an experienced microsurgeon. The IRR of NOMAT was estimated by computing the intraclass correlation coefficient using SPSS v22.0 (IBM, Armonk, New York). RESULTS A total of 75 residents were assessed. At Northwestern University, 21 residents each performed microanastomosis on 2 model vessels of different sizes, one 3 mm and one 1 mm. At the University of Indiana, 54 residents performed a single microanastomosis procedure on 3-mm vessels. The intraclass correlation coefficient of the total NOMAT scores was 0.88 at Northwestern University and 0.78 at the University of Indiana. CONCLUSION This study indicates high IRR for the NOMAT. These results suggest that the use of raters with varying levels of expertise does not compromise the precision or validity of the scale. This allows for a wider adoption of the scale and, hence, a greater potential educational impact.
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Affiliation(s)
- Andrew R Pines
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Mohammed S Alghoul
- Departm-ent of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Youssef J Hamade
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Mithun G Sattur
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | | | - Tariq K Halasa
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | | | - Najib E El Tecle
- Department of Neurological Surgery, St. Louis University Hospital, St. Louis, Missouri
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | - Richard W Byrne
- Departm-ent of Neurological Surgery, Rush Univ-ersity Medical Center, Chicago, Illinois
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Brian T Ragel
- Departm-ent of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Daniel K Resnick
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Russell R Lonser
- Department of Neurological Surgery, Ohio State University, Columbus, Ohio
| | - Nathan R Selden
- Departm-ent of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
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13
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Bindal S, El Ahmadieh TY, Plitt A, Aoun SG, Neeley OJ, El Tecle NE, Barnett S, Gluf W. Hypoglossal schwannomas: A systematic review of the literature. J Clin Neurosci 2018; 62:162-173. [PMID: 30472335 DOI: 10.1016/j.jocn.2018.11.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/12/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Schwannomas of the hypoglossal nerve are rare and account for a very small percentage of non-vestibular schwannomas. OBJECTIVES In this systematic review of the literature, we examined the epidemiology, symptomatology, management, and outcomes of patients with hypoglossal schwannomas. METHODS The electronic database Pubmed was searched for all reports of hypoglossal schwannomas with descriptions of symptoms, management, and outcome characteristics. Data was extracted from each study and compiled in a spreadsheet. Continuous variables were reported as means and medians. Categorical variables were reported as proportions. Additional analysis was not done due to inconsistent reporting of outcomes and small sample sizes. RESULTS A total of 59 studies (94 total individual cases) were included. 64% of patients were female with mean age of 44.6 years. The majority were intracranial/extracranial (50%). The most common symptoms were tongue deviation or speech disturbance (38%) and headaches (33%). Hypoglossal nerve dysfunction was present in 80% of patients. Surgical excision was performed in 93%, with a 15% complication rate. Evidence of residual mass after surgery was noted in 29%. Permanent hypoglossal nerve deficits occurred in 67%. Recurrence of tumor burden was reported in 6 studies, with median time to recurrence of 16.5 months. CONCLUSION Current evidence suggests overall favorable outcomes with surgical resection of hypoglossal schwannomas, with a large percentage of patients experiencing mild and usually well-tolerated neurologic deficit. Limitations of this study include the use of retrospective data taken from case reports/series with highly selected patients, selective reporting, and absence of control groups.
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Affiliation(s)
- Shivani Bindal
- Department of Neurological Surgery, The University of Texas Southwestern, Dallas, TX, United States
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, The University of Texas Southwestern, Dallas, TX, United States.
| | - Aaron Plitt
- Department of Neurological Surgery, The University of Texas Southwestern, Dallas, TX, United States
| | - Salah G Aoun
- Department of Neurological Surgery, The University of Texas Southwestern, Dallas, TX, United States
| | - Om James Neeley
- Department of Neurological Surgery, The University of Texas Southwestern, Dallas, TX, United States
| | - Najib E El Tecle
- Department of Neurological Surgery, Saint Louis University Hospital, Saint Louis, MO, United States
| | - Samuel Barnett
- Department of Neurological Surgery, The University of Texas Southwestern, Dallas, TX, United States
| | - Wayne Gluf
- Department of Neurological Surgery, The University of Texas Southwestern, Dallas, TX, United States
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14
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El Tecle NE, Dahdaleh NS, Bydon M, Ray WZ, Torner JC, Hitchon PW. The natural history of complete spinal cord injury: a pooled analysis of 1162 patients and a meta-analysis of modern data. J Neurosurg Spine 2018; 28:436-443. [DOI: 10.3171/2017.7.spine17107] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVEThe natural history of complete spinal cord injury (SCI) is poorly studied. The classically quoted rate of improvement or conversion for patients with American Spinal Injury Association (ASIA) grade A (ASIA A) injuries is 15%–20%; however, data supporting this rate are very limited. In this paper, the authors conducted a meta-analysis of modern data reporting on ASIA A patients and evaluated factors affecting the natural history of the disease.METHODSThe authors conducted a systematic literature review of all randomized clinical trials (RCTs) and observational studies of patients with traumatic SCI. The Embase, MEDLINE, PubMed, Scopus, CINAHL, and Cochrane databases were reviewed for all studies reporting on SCI and published after 1992. A meta-analysis was conducted using the DerSimonian and Laird (random-effects) model with a summary odds ratio analysis.RESULTSEleven RCTs and 9 observational studies were included in the final analysis. Overall, the 20 included studies reported on 1162 patients with ASIA A injuries. The overall conversion rate was 28.1%, with 327 of 1162 patients improving to at least ASIA B. The overall rate of conversion noted in cervical spine injuries was 33.3%, whereas that in thoracic injuries was 30.6%. Patients undergoing early surgery had a higher rate of conversion (46.1%) than patients undergoing late surgery (25%) (OR 2.31, 95% CI 1.08–4.96, p = 0.03).CONCLUSIONSThe overall rate of conversion of ASIA A SCIs from pooled data of prospective trials and observational series is 28.1%. This rate of conversion is higher than what is reported in the literature. Early surgery is predictive of a higher conversion rate. However, there are not enough data to provide conclusions pertaining to the efficacy of biological and medical therapies.
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Affiliation(s)
| | - Nader S. Dahdaleh
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mohamad Bydon
- 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Wilson Z. Ray
- 4Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Patrick W. Hitchon
- 6Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Abstract
OBJECTIVE Patients with ventriculoperitoneal (VP) shunts with programmable valves who would benefit from osseointegrated hearing devices (OIHDs) represent a unique population. The aim of this study was to evaluate the magnetic field strengths of 4 OIHDs and their interactions with 5 programmable VP shunt valves. METHODS Magnetic field strength was measured as a function of distance for each hearing device (Cochlear Baha 5, Cochlear Baha BP110, Oticon Ponto Plus Power, and Medtronic Sophono) in the following modes: inactive, active in quiet, and active in 60 decibels of background noise in the sound booth. The hearing devices were introduced to each shunt valve (Aesculap proGAV, Aesculap proGAV 2.0, Codman Hakim, Codman Certas, and Medtronic Strata II) also as a function of distance in these identical 3 settings. Each trial was repeated 5 times. Between each trial, the valves were assessed for a change in setting. Finally, using a skull model, the devices were introduced to each other in standard anatomical locations and the valves were assessed for a change in settings. RESULTS The maximum magnetic field strengths generated by the Cochlear Baha 5, BP110, and Oticon OIHDs were 1.1, 36.2, and 48.7 gauss (G), respectively. The maximum strength generated by the Sophono device was > 800 G. The magnetic field strength of the hearing devices decreased markedly with increasing distance from the device. The strength of the Sophono's magnetic attachment decreased to 34.8 G at 5 mm. The Codman Hakim, Codman Certas, and Medtronic Strata II valve settings changed when rotating the valves next to the Sophono abutment. No other changes in valve settings occurred in the distance or anatomical models for any other trials. CONCLUSIONS This is the first study evaluating the interaction between OIHDs and programmable VP shunt valves. The findings suggest that it is safe to use these devices together without having to switch to a nonprogrammable valve or move the shunt valve to a more distant location. Still, care should be taken if the Sophono device is used to ensure that the valve is ≥ 5 mm away from the magnetic attachment.
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Affiliation(s)
- Matthew J. Pierson
- Division of Pediatric Neurosurgery, Department of Neurological Surgery; and
| | - Daniel Wehrmann
- Division of Pediatric Otolaryngology/ENT, Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - J. Andrew Albers
- Division of Pediatric Neurosurgery, Department of Neurological Surgery; and
| | - Najib E. El Tecle
- Division of Pediatric Neurosurgery, Department of Neurological Surgery; and
| | - Dary Costa
- Division of Pediatric Otolaryngology/ENT, Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Samer K. Elbabaa
- Division of Pediatric Neurosurgery, Department of Neurological Surgery; and
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16
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Hitchon PW, Abode-Iyamah K, Dahdaleh NS, Grossbach AJ, El Tecle NE, Noeller J, He W. Risk factors and outcomes in thoracic stenosis with myelopathy: A single center experience. Clin Neurol Neurosurg 2016; 147:84-9. [PMID: 27310291 DOI: 10.1016/j.clineuro.2016.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Identify risk factors predisposing to thoracic spinal stenosis and myelopathy (TS) and address treatment options and outcomes. METHODS A retrospective review of our center's experience with TS over 10 years. Clinical and magnetic resonance imaging (MRI) data, surgical intervention and outcomes using Frankel and Japanese Orthopedic Association (JOA) scales were collected. RESULTS A total of 44 patients with TS were identified. There were 30 men and 14 women with a mean age±SD of 66±15years. Neurological performance was evaluated using the Frankel scale (A-E or 1-5), and JOA scale for myelopathy (0-11). Frankel scores (1-5) and JOA scores (0-11) on admission were 3.5±0.9 and 6.8±2.6 respectively. At follow-up, Frankel scores had improved to 4.1±0.8 (p=0.041) and JOA scores had improved to 8.3±2.4 (p=0.021). The presence on admission of increased signal from the cord on T2-weighted MRI was associated with lower Frankel and JOA scores (3.3±0.9, and 6.2±2.5 respectively) than in those with absent increased signal (4.0±0.4 and 8.6±2.1, p=0.02 and p=0.008 respectively). There were 4 complications, requiring exploration and debridement for dehiscence in 3 and an epidural hematoma in the fourth that necessitated evacuation, with a good outcome. A fifth patient underwent reoperation at the same level 18 months later for persistent stenosis. CONCLUSION Thoracic stenosis with myelopathy should be entertained in patients with myelopathy. Over half of our patients with TS were over the age of 70, and men outnumbered women by a ratio of 2:1. Nearly half the patients with TS had concomitant cervical and/or lumbar degenerative disease warranting surgery also. Increased signal intensity on T2-weighted MRI images correlated with lower Frankel and JOA scores compared to those without. Decompression for thoracic stenosis is associated with neurological improvement.
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Affiliation(s)
- Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Kingsley Abode-Iyamah
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew J Grossbach
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, St. Louis University School of Medicine, St Louis, MO, USA
| | - Jennifer Noeller
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Wenzhuan He
- Department of Neurology & Neurosciences, Rutgers-New Jersey Medical School, Newark, NJ, USA
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Tecle NEE, Zammar SG, Hamade YJ, El Ahmadieh TY, Aoun RJN, Nanney AD, Batjer HH, Dumanian GA, Bendok BR. Use of a harvested radial artery graft with preservation of the vena comitantes to reduce spasm risk and improve graft patency for extracranial to intracranial bypass: Technical note. Clin Neurol Neurosurg 2016; 142:65-71. [DOI: 10.1016/j.clineuro.2015.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 12/16/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022]
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18
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El Tecle NE, Abode-Iyamah KO, Hitchon PW, Dahdaleh NS. Management of spinal fractures in patients with ankylosing spondylitis. Clin Neurol Neurosurg 2015; 139:177-82. [DOI: 10.1016/j.clineuro.2015.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/02/2015] [Accepted: 10/11/2015] [Indexed: 11/16/2022]
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19
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Zammar SG, El Tecle NE, El Ahmadieh TY, Adelson PD, Veznedaroglu E, Surdell DL, Harrop JS, Benes V, Rezai AR, Resnick DK, Bendok BR. Impact of a Vascular Neurosurgery Simulation-Based Course on Cognitive Knowledge and Technical Skills in European Neurosurgical Trainees. World Neurosurg 2015; 84:197-201. [DOI: 10.1016/j.wneu.2014.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/31/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
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20
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Smith TR, Cote DJ, Dasenbrock HH, Hamade YJ, Zammar SG, El Tecle NE, Batjer HH, Bendok BR. Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2015; 84:942-53. [PMID: 26093360 DOI: 10.1016/j.wneu.2015.05.073] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/15/2015] [Accepted: 05/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Middle cerebral artery aneurysms (MCAAs) are regularly treated by both microsurgical clipping and endovascular coiling. We performed a systematic meta-analysis to compare the safety and efficacy of these 2 methods. METHODS Literature was reviewed for all studies reporting angiographic occlusion and/or functional outcomes in adults with unruptured MCAA treated by endovascular coiling or microsurgical clipping. All studies in English that reported results for adults (≥18 years) with unruptured MCAAs, from 1990 to 2011 were considered for inclusion. RESULTS Twenty-six studies involving 2295 aneurysms treated with clipping or coiling for unruptured MCAAs were included for analysis. There were 1530 aneurysms that were treated with clipping and 765 aneurysms treated with coiling. Pooled analysis revealed failure of aneurysmal occlusion in 3.0% (95% confidence interval [CI] 1.2%-7.4%) of clipped cases. Pooled analysis of 15 studies (606 aneurysms) involving coiling and occlusion revealed lack of occlusion rates of 47.7% (95% CI 43.6%-51.8%) with the fixed-effects model and 48.2% (95% CI 39.0%-57.4%) with the random-effects model. Thirteen studies examined neurological outcomes after clipping and were pooled for analysis. Both fixed-effect and random-effect models revealed unfavorable outcomes in 2.1% (95% CI 1.3%-3.3%) of patients. There were 17 studies evaluating potential unfavorable neurological outcomes after coiling that were pooled for analysis. Fixed-effect and random-effect models revealed unfavorable outcomes in 6.5% (95% CI 4.5%-9.3%) and 4.9% (95% CI 3.0%-8.1%) of patients, respectively. CONCLUSIONS Based on this systematic review and meta-analysis of unruptured MCAAs, after careful consideration of patient, aneurysmal, and treatment center factors, we recommend surgical clipping for unruptured MCAA.
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Affiliation(s)
- Timothy R Smith
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - David J Cote
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hormuzdiyar H Dasenbrock
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Youssef J Hamade
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samer G Zammar
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - H Hunt Batjer
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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El Tecle NE, Patel BM, El Ahmadieh TY, Daou MR, Hamade YJ, Zammar SG, Shaibani A, Bendok BR. Novel use of a double lumen balloon catheter for venous sinus thrombolysis and venoplasty. J Clin Neurosci 2015; 22:1018-20. [DOI: 10.1016/j.jocn.2014.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/24/2014] [Accepted: 12/26/2014] [Indexed: 10/23/2022]
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22
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Arnaout OM, El Ahmadieh TY, Zammar SG, El Tecle NE, Hamade YJ, Aoun RJN, Aoun SG, Rahme RJ, Eddleman CS, Barrow DL, Batjer HH, Bendok BR. Microsurgical Treatment of Previously Coiled Intracranial Aneurysms: Systematic Review of the Literature. World Neurosurg 2015; 84:246-53. [PMID: 25731797 DOI: 10.1016/j.wneu.2015.02.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess indications, complications, clinical outcomes, and technical nuances of microsurgical treatment of previously coiled intracranial aneurysms. METHODS A systematic review of the literature was performed using PubMed/MEDLINE and EMBASE databases from January 1990 to December 2013. English-language articles reporting on microsurgical treatment of previously coiled intracranial aneurysms were included. Articles that involved embolization materials other than coils were excluded. Data on aneurysm characteristics, indications for surgery, techniques, complications, angiographic obliteration rates, and clinical outcomes were collected. RESULTS The literature review identified 29 articles reporting on microsurgical clipping of 375 previously coiled aneurysms. Of the aneurysms, 68% were small (<10 mm). Indications for clipping included the presence of a neck remnant (48%) and new aneurysmal growth (45%). Rebleeding before clipping was reported in 6% of cases. Coil extraction was performed in 13% of cases. The median time from initial coiling to clipping was 7 months. The angiographic cure rate was 93%, with morbidity and mortality of 9.8% and 3.6%, respectively. CONCLUSIONS Microsurgical clipping of previously coiled aneurysms can result in high obliteration rates with relatively low morbidity and mortality in select cases. Considerations for microsurgical strategies include the presence of sufficient aneurysmal tissue for clip placement and the potential need for temporary occlusion or flow arrest. Coil extraction is not needed in most cases.
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Affiliation(s)
- Omar M Arnaout
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samer G Zammar
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Youssef J Hamade
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Rami James N Aoun
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rudy J Rahme
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Christopher S Eddleman
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel L Barrow
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - H Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
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Aoun SG, El Ahmadieh TY, El Tecle NE, Daou MR, Adel JG, Park CS, Batjer HH, Bendok BR. A pilot study to assess the construct and face validity of the Northwestern Objective Microanastomosis Assessment Tool. J Neurosurg 2015; 123:103-9. [PMID: 25658787 DOI: 10.3171/2014.12.jns131814] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Microsurgical skills remain an integral component of neurosurgical education. There is a need for an objective scale to assess microsurgical skills. The objective of this study was to assess the face and construct validity of a bench training microanastomosis module and an objective assessment scale, i.e., the Northwestern Objective Microanastomosis Assessment Tool (NOMAT). METHODS Medical students, neurosurgical residents, and postdoctoral research fellows at Northwestern University were enrolled in the study. Trainees were divided into 3 groups based on microsurgical experience: 1) experienced, 2) exposed, and 3) novices. Each trainee completed two end-to-end microanastomoses using a 1-mm and a 3-mm synthetic vessel. Two cameras were installed to capture procedural footage. One neurosurgeon blindly graded the performance of trainees using both objective and subjective methods to assess construct validity. Two neurosurgeons reviewed the contents of the simulation module to assess face validity. RESULTS Twenty-one trainees participated in the study, including 6 experienced, 6 exposed, and 9 novices. The mean NOMAT score for experienced trainees on the 1-mm module was 47.3/70 compared with 26.0/70 and 25.8/70 for exposed and novice trainees, respectively (p = 0.02). Using subjective grading, experienced trainees performed significantly better on the 1-mm module (64.2/100) compared with exposed or novice trainees (23.3/100 and 25.0/100, respectively; p = 0.02). No statistical difference between groups was noted for the 3-mm module with both NOMAT and subjective grading. Experienced trainees took less time to perform both tasks compared with the others. CONCLUSIONS Face and construct validities of the microanastomosis module were established. The scale and the microanastomosis module could help assess the microsurgical skills of neurosurgical trainees and serve as a basis for the creation of a microsurgical curriculum.
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Affiliation(s)
- Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas; and
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas; and
| | | | | | | | | | - H Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas; and
| | - Bernard R Bendok
- Departments of 2 Neurological Surgery.,Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Zammar SG, El Tecle NE, El Ahmadieh TY, McClendon J, Comair YG, Bendok BR. A biological approach to treating brain arteriovenous malformations. Neurosurgery 2014; 74:N15-7. [PMID: 24642990 DOI: 10.1227/01.neu.0000445336.35080.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zammar SG, Hamade YJ, El Tecle NE, El Ahmadieh TY, Caughel KCM, Carroll TJ, Bendok BR. Optical coherence tomography as a potential tool for extravascular imaging in vascular neurosurgery. Neurosurgery 2014; 75:N17-8. [PMID: 25033360 DOI: 10.1227/01.neu.0000452315.99484.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hamade YJ, Zammar SG, El Tecle NE, El Ahmadieh TY, Yip BK, Smith TR, Bendok BR. Hemicraniectomy for Acute Stroke in Patients Older than Age 60: Neurosurgeons on the Frontlines of Multidisciplinary Stroke Therapy. World Neurosurg 2014; 82:931-2. [DOI: 10.1016/j.wneu.2014.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zammar SG, Hamade YJ, Aoun RJ, El Tecle NE, El Ahmadieh TY, Lall RR, Taub ZD, Swanson KR, Chandler JP, Bendok BR. Precision medicine in brain arteriovenous malformation management: arteries steal the show but veins may hold the crystal ball. Neurosurgery 2014; 75:N13-4. [PMID: 25406620 DOI: 10.1227/01.neu.0000457193.02158.c9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Samer G Zammar
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Bendok BR, El Tecle NE, El Ahmadieh TY, Koht A, Gallagher TA, Carroll TJ, Markl M, Sabbagha R, Sabbagha A, Cella D, Nowinski C, Dewald JPA, Meade TJ, Samson D, Batjer HH. Advances and innovations in brain arteriovenous malformation surgery. Neurosurgery 2014; 74 Suppl 1:S60-73. [PMID: 24402494 DOI: 10.1227/neu.0000000000000230] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Arteriovenous malformations (AVMs) of the brain are very complex and intriguing pathologies. Since their initial description by Luschka and Virchow in the middle of the 19th century, multiple advances and innovations have revolutionized their management and surgical treatment. Here, we review the historical landmarks in the surgical treatment of AVMs and then illustrate the most recent and futuristic technologies aiming to improve outcomes in AVM surgeries. In particular, we examine potential advances in patient selection, imaging, surgical technique, neuroanesthesia, and postoperative neuro-rehabilitation and quantitative assessments. Finally, we illustrate how concurrent advances in radiosurgery and endovascular techniques might present new opportunities to treat AVMs more safely from a surgical perspective.
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Affiliation(s)
- Bernard R Bendok
- Northwestern Memorial Hospital, Departments of *Neurological Surgery, ‡Radiology, §Otolaryngology, and ¶Anesthesiology, Chicago, Illinois; ‖Northwestern University, McCormick School of Engineering, Department of Biomedical Engineering, Evanston, Illinois; Northwestern University, #Neuropsychology Institute, **Department of Medical Social Sciences, ‡‡Department of Physical Therapy and Human Movement Sciences, and §§Department of Chemistry, Chicago, Illinois; ¶¶University of Texas Southwestern, Department of Neurological Surgery, Dallas, Texas
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Lamano JB, Bushnell GG, Chen H, Badrinathan A, El Tecle NE, Bendok BR, Glucksberg MR. Force characterization of intracranial endovascular embolization: coil type, microcatheter placement, and insertion rate. Neurosurgery 2014; 75:707-15; discussion 715-6. [PMID: 25181432 DOI: 10.1227/neu.0000000000000525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intraoperative rupture (IOR) is a rare, but potentially morbid complication of endovascular aneurysm coil embolization. Yet, IOR predictors have remained relatively uninvestigated in relation to coil design. OBJECTIVE To develop a novel in vitro aneurysm model to characterize forces exerted by coils of different design on the aneurysm during endovascular embolization that are hypothesized to contribute to IOR. METHODS A 3-mm saccular aneurysm model was developed with flat latex membrane at the dome apex. Membrane deflection was observed throughout simulated embolization and converted to force measurement. Simultaneous coil insertion and force measurement were accomplished with a compression strength-testing machine. Membrane and insertion forces across coil type, microcatheter tip placement, and insertion rate were evaluated. RESULTS Insertion force and force directly on the aneurysm wall exhibited a difference, with framing coils exerting greatest force, followed by filling and finishing coils. Regarding microcatheter placement, a similar graded response in membrane and insertion forces was observed with positioning in the top-third of the aneurysm generating the greatest force compared with central and bottom-third placement. Insertion rate was also a factor with the slowest rate (10 mm/min) exhibiting the greatest membrane force, followed by lower forces at 30 and 50 mm/min. A multiple linear regression model was created to assess the contributions of each factor toward aneurysm forces. CONCLUSION Increased force on the aneurysm is associated with framing coil use, microcatheter placement proximal to aneurysm dome, and slow insertion rate. Further characterization remains necessary to reduce IOR risk, especially concerning the contributions of insertion rate.
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Affiliation(s)
- Jonathan B Lamano
- *Department of Biomedical Engineering, Northwestern University, Evanston, Illinois; Department of ‡Neurological Surgery, §Otolaryngology, and ¶Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Hamade YJ, El Tecle NE, Zammar SG, El Ahmadieh TY, Yip BK, Bendok BR. Endovascular treatment of a complex bilobed left superior hypophyseal internal carotid artery aneurysm: a case illustration. Neurosurg Focus 2014; 37:1. [PMID: 24983719 DOI: 10.3171/2014.v2.focus14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report the case of a 62-year-old female who presented for stent-assistant coiling of an incidental 11-mm complex bilobed left superior hypophyseal internal carotid artery aneurysm. A microcatheter was navigated into the aneurysm and trapped by a 37-mm stent. Using three-dimensional and two-dimensional coils, the elongated aneurysm was coiled. The bigger lobe was coiled first followed by the smaller lobe. Minimal residual filling of the smaller lobe will be re-evaluated at 6-month follow up. The patient tolerated the procedure well and no complications were encountered. The video can be found here: http://youtu.be/TrXfsaICQVo .
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Zammar SG, Pines AR, El Tecle NE, El Ahmadieh TY, McClendon J, Riachi NJ, Bendok BR. Aneurysm wall composition may determine rupture risk and endovascular treatment failure. World Neurosurg 2014; 82:8-9. [PMID: 24780772 DOI: 10.1016/j.wneu.2014.04.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Samer G Zammar
- Departments of Neurological Surgery and Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew R Pines
- Departments of Neurological Surgery and Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Najib E El Tecle
- Departments of Neurological Surgery and Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tarek Y El Ahmadieh
- Departments of Neurological Surgery and Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jamal McClendon
- Departments of Neurological Surgery and Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Naji J Riachi
- Departments of Neurological Surgery and Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bernard R Bendok
- Departments of Neurological Surgery and Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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El Tecle NE, El Ahmadieh TY, Zammar SG, Hamade YJ, Stadler JA, Bendok BR. Migraine and hemorrhagic stroke: association or causation? World Neurosurg 2014; 81:e28-30. [PMID: 24487093 DOI: 10.1016/j.wneu.2014.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Najib E El Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samer G Zammar
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Youssef J Hamade
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James A Stadler
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Bendok BR, Rahme RJ, Aoun SG, El Ahmadieh TY, El Tecle NE, Batjer HH, Fishman AJ. Enhancement of the subtemporal approach by partial posterosuperior petrosectomy with hearing preservation. Neurosurgery 2014; 10 Suppl 2:191-9; discussion 199. [PMID: 24476903 DOI: 10.1227/neu.0000000000000300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The microsurgical management of aneurysms in the interpeduncular and ambient cisterns remains challenging. The classic subtemporal approach has several limitations. OBJECTIVE To present a modification of this approach that allows for broader exposure with hearing preservation. METHODS We retrospectively reviewed our clinical database between August 2007 and February 2012 for all patients who underwent a modified subtemporal partial posterosuperior petrosectomy. Clinical data, complications, and postoperative head computed tomography (CT) scans were analyzed. Improvement in the angle of view acquired by the new approach was measured using the OsiriX 3-D rendering software and was compared with that obtained from the subtemporal approach. Similar methods were used to study improvement in the angle of view in head CT scans of randomly selected control patients. RESULTS Five patients underwent a modified subtemporal approach for posterior circulation aneurysm clipping. All patients were women with a mean age of 49.8 years. Mean aneurysm size was 5.75 mm. Mean improvement in the angle of view was 17.52° in the study group (n = 5) and 11.7° in the control group (n = 10). Hearing was completely preserved in 3 patients. One patient had a subclinical conductive hearing loss, and 1 patient was not assessed formally at follow-up, but had no hearing concerns. No neurological sequelae were recorded. CONCLUSION Our modified subtemporal approach appears to be safe and provides an increased angle of view with minimal additional operative time and with low risk to hearing. This approach may expand this surgical corridor and reduce the need for temporal lobe retraction.
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Affiliation(s)
- Bernard R Bendok
- *Department of Neurological Surgery, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois; ‡Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; §Department of Otology-Neurotology and Cranial Base Surgery, Cadence Neuroscience Institute at Central DuPage Hospital, Winfield, Illinois
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Zammar SG, El Ahmadieh TY, El Tecle NE, Nanney AD, Bendok BR. Thoughtful selection of low risk aneurysms for observation does not eliminate rupture risk. Neurosurgery 2013; 73:N18-9. [PMID: 24257341 DOI: 10.1227/01.neu.0000438336.51481.c8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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El Ahmadieh TY, Aoun SG, Daou MR, El Tecle NE, Rahme RJ, Graham RB, Adel JG, Hunt Batjer H, Bendok BR. New-generation oral anticoagulants for the prevention of stroke: Implications for neurosurgery. J Clin Neurosci 2013; 20:1350-6. [DOI: 10.1016/j.jocn.2013.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/05/2013] [Accepted: 05/26/2013] [Indexed: 11/16/2022]
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El Ahmadieh TY, Aoun SG, El Tecle NE, Nanney AD, Daou MR, Harrop J, Batjer HH, Bendok BR. A Didactic and Hands-on Module Enhances Resident Microsurgical Knowledge and Technical Skill. Neurosurgery 2013; 73 Suppl 1:51-6. [DOI: 10.1227/neu.0000000000000104] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Dahdaleh NS, Lawton CD, El Ahmadieh TY, Nixon AT, El Tecle NE, Oh S, Fessler RG, Smith ZA. Evidence-based management of central cord syndrome. Neurosurg Focus 2013; 35:E6. [DOI: 10.3171/2013.3.focus13101] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Evidence-based medicine is used to examine the current treatment options, timing of surgical intervention, and prognostic factors in the management of patients with traumatic central cord syndrome (TCCS).
Methods
A computerized literature search of the National Library of Medicine database, Cochrane database, and Google Scholar was performed for published material between January 1966 and February 2013 using key words and Medical Subject Headings. Abstracts were reviewed and selected, with the articles segregated into 3 main categories: surgical versus conservative management, timing of surgery, and prognostic factors. Evidentiary tables were then assembled, summarizing data and quality of evidence (Classes I–III) for papers included in this review.
Results
The authors compiled 3 evidentiary tables summarizing 16 studies, all of which were retrospective in design. Regarding surgical intervention versus conservative management, there was Class III evidence to support the superiority of surgery for patients presenting with TCCS. In regards to timing of surgery, most Class III evidence demonstrated no difference in early versus late surgical management. Most Class III studies agreed that older age, especially age greater than 60–70 years, correlated with worse outcomes.
Conclusions
No Class I or Class II evidence was available to determine the efficacy of surgery, timing of surgical intervention, or prognostic factors in patients managed for TCCS. Hence, there is a need to perform well-controlled prospective studies and randomized controlled clinical trials to further investigate the optimal management (surgical vs conservative) and timing of surgical intervention in patients suffering from TCCS.
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El Ahmadieh TY, El Tecle NE, Lall RR, Park AE, Bendok BR. Blood Pressure Control for Spontaneous Intracerebral Hemorrhage. Neurosurgery 2013; 72:N14-6. [DOI: 10.1227/01.neu.0000430734.71114.bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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El Tecle NE, El Ahmadieh TY, Nanney AD, McClendon J, Bendok BR. Stroke: a global killer on the rise. World Neurosurg 2013; 80:2-4. [PMID: 23684853 DOI: 10.1016/j.wneu.2013.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/09/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Najib E El Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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El Ahmadieh TY, Adel JG, El Tecle NE, Daou MR, Aoun SG, Nanney AD, Bendok BR. Surgical treatment of elevated intracranial pressure: decompressive craniectomy and intracranial pressure monitoring. Neurosurg Clin N Am 2013; 24:375-91. [PMID: 23809032 DOI: 10.1016/j.nec.2013.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Surgical techniques that address elevated intracranial pressure include (1) intraventricular catheter insertion and cerebrospinal fluid drainage, (2) removal of an intracranial space-occupying lesion, and (3) decompressive craniectomy. This review discusses the role of surgery in the management of elevated intracranial pressure, with special focus on intraventricular catheter placement and decompressive craniectomy. The techniques and potential complications of each procedure are described, and the existing evidence regarding the impact of these procedures on patient outcome is reviewed. Surgical management of mass lesions and ischemic or hemorrhagic stroke occurring in the posterior fossa is not discussed herein.
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Affiliation(s)
- Tarek Y El Ahmadieh
- Department of Neurological Surgery, McGaw Medical Center, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 2210, Chicago, IL 60611, USA
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Bendok BR, El Tecle NE, El Ahmadieh TY, Bohnen AM. Reopening closed highways for stroke prevention. World Neurosurg 2013; 80:e201-2. [PMID: 23541747 DOI: 10.1016/j.wneu.2013.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 03/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Bernard R Bendok
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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El Tecle NE, El Ahmadieh TY, Daou MR, Bendok BR. Higher prehospital priority level for stroke makes sense: the Hyper Acute STroke Alarm (HASTA) study. World Neurosurg 2013; 82:e171-2. [PMID: 23542391 DOI: 10.1016/j.wneu.2013.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/09/2013] [Accepted: 03/21/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Najib E El Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marc R Daou
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Bendok BR, El Tecle NE, El Ahmadieh TY, Park AE. Cranial fistulae: venous occlusion, the road to cure and misery. World Neurosurg 2013; 80:e213. [PMID: 23541746 DOI: 10.1016/j.wneu.2013.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 03/21/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Bernard R Bendok
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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El Ahmadieh TY, El Tecle NE, Stadler JA, Bendok BR. Taming the beast: treating associated aneurysms to reduce risk of hemorrhage after radiosurgery for arteriovenous malformations. Neurosurgery 2013; 72:N15-7. [PMID: 23511829 DOI: 10.1227/01.neu.0000428421.82081.b9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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El Ahmadieh TY, El Tecle NE, Aoun SG, Yip BK, Ganju A, Bendok BR. How Can Simulation Thrive as an Educational Tool? Just Ask the Residents. Neurosurgery 2012; 71:N18-9. [DOI: 10.1227/01.neu.0000423044.97311.be] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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