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Ramirez MDJE, Montemurro N, Musa G, Chmutin GE, Nurmukhametov R, Rosario AR, Barza JL, Kaprovoy S, Konovalov N, Kudriavtsev D, Mukengeshay JN, Kalangu KK, Kachinga S, Sufianov A, Simfukwe K, Baeza-Antón L, Kutty RK, El-Ghandour NMF, Garozzo D. On the balance beam: facing the challenges of neurosurgical education in the third millennium. Surg Neurol Int 2024; 15:102. [PMID: 38628530 PMCID: PMC11021083 DOI: 10.25259/sni_1014_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
Background Neurosurgery is one of the most complex and challenging areas of medicine, and it requires an ongoing commitment to education and expertise. Preparing young neurosurgeons with comprehensive education that can allow them to achieve high professional standards is a pivotal aspect of our profession. Methods This paper aims to analyze the current scenario in neurosurgical training identifying innovative methods that can guarantee the highest level of proficiency in our specialty. Results Given the inherent high-stakes nature of neurosurgical procedures, there is a significant burden of responsibility in ensuring that neurosurgical training is of the highest caliber, capable of producing practitioners who possess not just theoretical knowledge but also practical skills and well-tuned judgment. Conclusion Providing high-quality training is one of the major challenges that the neurosurgical community has to face nowadays, especially in low- and middle-income countries; one of the main issues to implementing neurosurgery worldwide is that the majority of African countries and many areas in Southeast Asia still have few neurosurgeons who encounter enormous daily difficulties to guarantee the appropriate neurosurgical care to their population.
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Affiliation(s)
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gerald Musa
- Department of Neurological Diseases and Neurosurgery, Peoples Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Gennady E. Chmutin
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
| | - Renat Nurmukhametov
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
| | - Andreina Rosario Rosario
- Department of Neurosurgery, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
| | - Jesus Lafuente Barza
- Department of Neurosurgery, Spine Center Hospital del Mar, Sagrat Cor University Hospital, Barcelona, Spain
| | - Stanislav Kaprovoy
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Nikolay Konovalov
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Dmitry Kudriavtsev
- Department of Neurosurgery, Podolsk Regional Hospital, Moscow, Russian Federation
| | | | - Kazadi Kelvin Kalangu
- Department of Neurosurgery, University of Zimbabwe, College of Health Sciences, Zimbabwe
| | - Sichizya Kachinga
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Albert Sufianov
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
- Federal Centre of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, State Medical University (Sechenov University), Moscow, Russia
| | - Keith Simfukwe
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
| | - Laura Baeza-Antón
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork Presbyterian Hospital, New York, United States
| | - Raja K. Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | - Debora Garozzo
- Department of Neurosurgery, Mediclinic Parkview Hospital, Dubai, United Arab Emirates
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Reyes-Soto G, Pérez-Cruz JC, Delgado-Reyes L, Castillo-Rangel C, Cacho Diaz B, Chmutin G, Nurmukhametov R, Sufianova G, Sufianov A, Nikolenko V, Sufianov R, Goncharov E, Montemurro N, Encarnacion Ramirez MDJ. The Vertebrobasilar Trunk and Its Anatomical Variants: A Microsurgical Anatomical Study. Diagnostics (Basel) 2024; 14:534. [PMID: 38473006 DOI: 10.3390/diagnostics14050534] [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: 01/02/2024] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The trunk of the basilar artery has not been included in microanatomy studies. Anatomical variants of the perforant branches of the vertebrobasilar trunk and their relationship with neural structures are very important in surgical approaches. Surgical dissection for the treatment of vascular lesions requires a perfect knowledge of the microsurgical anatomy. METHODS We conducted a descriptive analysis of 50 brains, which were fixed with formalin at 10% for 2 weeks, and the arterial system was injected with colored latex. After microsurgical dissection, it was divided into three segments: the lower portion went from the anterior spinal artery to the anteroinferior cerebellar artery, the middle segment was raised from the upper limit of the lower portion to the origin of the superior cerebellar artery, and the upper segment ranged from the previous portion until the origin of the posterior cerebral artery. RESULTS The basilar artery had an average length of 30 mm. The average diameter at its junction with the vertebral arteries was 4.05 mm. The average middle segment was 3.4 mm in diameter and 15.2 mm in length. The diameter of the upper segment was 4.2 mm, and its average length was 3.6 mm. The average number of bulbar arteries was three, and their average diameter was 0. 66 mm. The number of caudal perforator arteries were five on average, with a diameter of 0.32 mm. We found three rare cases of anatomical variants in the vertebra-basilar junction. CONCLUSIONS The basilar artery emits penetrating branches in its lower, middle, and upper portions. The origin of penetrating branches was single or divided after forming a trunk. However, we observed long branches from perforant arteries.
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Affiliation(s)
- Gervith Reyes-Soto
- Unidad de Neurociencias, Department of Head and Neck, Instituto Nacional de Cancerología, Mexico City 04260, Mexico
| | - Julio C Pérez-Cruz
- Laboratorio de Técnicas Anatómicas y Material Didactico, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 01070, Mexico
- Departamento de Anatomía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Luis Delgado-Reyes
- Departamento de Anatomía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Carlos Castillo-Rangel
- Department of Neurosurgery, Servicio of the 1ro de Octubre Hospital of the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City 07760, Mexico
| | - Bernardo Cacho Diaz
- Functional Neurosciences Unit, Mexico National Cancer Institute, Mexico City 07760, Mexico
| | - Gennady Chmutin
- Department of Neurological Surgery, Peoples Friendship University of Russia, 103274 Moscow, Russia
| | - Renat Nurmukhametov
- Department of Neurological Surgery, Peoples Friendship University of Russia, 103274 Moscow, Russia
| | - Galina Sufianova
- Department of Pharmacology, Tyumen State Medical University, 625000 Tyumen, Russia
| | - Albert Sufianov
- Department of Pediatric Neurosurgery of Federal Center of Neurosurgery, Federal Center of Neurosurgery of Ministry of Health of the Russian Federation, 625000 Tyumen, Russia
| | - Vladimir Nikolenko
- Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Rinat Sufianov
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Evgeniy Goncharov
- Department of Petrovsky Russian Scientific Center of Surgery, 121359 Moscow, Russia
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), 56100 Pisa, Italy
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Santos DE, Bozkurt I, Nurmukhametov R, Dosanov M, Volovish A, Chmutin G, Sierra AT, Eneliz B, Bernard E, Nakry P, Scalia G, Chaurasia B. The future of minimally invasive spine surgery in low-income Latin American countries. Egypt J Neurol Psychiatry Neurosurg 2024; 60:35. [DOI: https:/doi.org/10.1186/s41983-024-00814-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/15/2024] [Indexed: 04/10/2024] Open
Abstract
AbstractTreatment of spinal disorders can be managed conservatively or surgically. With the trend toward minimalistic approaches, minimally invasive spinal surgery (MISS) has gained much more importance over the last decade. Its use along with the required training has tremendously increased in developed countries. However, the availability of MISS today is uneven in different regions due to the development and availability of technology, as well as the level of training and qualifications of surgeons who are able to perform such operations on the spine. The purpose of this article is to analyze the prospects for minimally invasive spine surgery in Latin America in comparison with higher income countries.
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Pérez-Cruz JC, Macías-Duvignau MA, Reyes-Soto G, Gasca-González OO, Baldoncini M, Miranda-Solís F, Delgado-Reyes L, Ovalles C, Catillo-Rangel C, Goncharov E, Nurmukhametov R, Lawton MT, Montemurro N, Encarnacion Ramirez MDJ. Latex vascular injection as method for enhanced neurosurgical training and skills. Front Surg 2024; 11:1366190. [PMID: 38464665 PMCID: PMC10920354 DOI: 10.3389/fsurg.2024.1366190] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Background Tridimensional medical knowledge of human anatomy is a key step in the undergraduate and postgraduate medical education, especially in surgical fields. Training simulation before real surgical procedures is necessary to develop clinical competences and to minimize surgical complications. Methods Latex injection of vascular system in brain and in head-neck segment is made after washing out of the vascular system and fixation of the specimen before and after latex injection. Results Using this latex injection technique, the vascular system of 90% of brains and 80% of head-neck segments are well-perfused. Latex-injected vessels maintain real appearance compared to silicone, and more flexible vessels compared to resins. Besides, latex makes possible a better perfusion of small vessels. Conclusions Latex vascular injection technique of the brain and head-neck segment is a simulation model for neurosurgical training based on real experiencing to improve surgical skills and surgical results.
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Affiliation(s)
- Julio C. Pérez-Cruz
- Laboratorio de Técnicas Anatómicas y Material Didactico, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
- Departamento de Anatomía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Mario A. Macías-Duvignau
- Laboratorio de Técnicas Anatómicas y Material Didactico, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Gervith Reyes-Soto
- Department of Head and Neck, Unidad de Neurociencias, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Oscar O. Gasca-González
- Departamento de Anatomía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Anatomía, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Franklin Miranda-Solís
- Laboratorio de Neuroanatomía, Centro de Investigación de Anatomía y Fisiología Alto Andina, Universidad Andina del Cusco, Cusco, Peru
| | - Luis Delgado-Reyes
- Departamento de Anatomía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos Ovalles
- Department of Neurosurgery, General Hospital, Durango, Mexico
| | - Carlos Catillo-Rangel
- Department of Neurosurgery, Servicio of the 1ro de Octubre Hospital of the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Evgeniy Goncharov
- Traumatology and Orthopedics Center, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Renat Nurmukhametov
- Neurological Surgery, Peoples Friendship University of Russia, Moscow, Russia
| | - Michael T. Lawton
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
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Goncharov EN, Koval OA, Igorevich EI, Encarnacion Ramirez MDJ, Nurmukhametov R, Valentinovich KK, Montemurro N. Analyzing the Clinical Potential of Stromal Vascular Fraction: A Comprehensive Literature Review. Medicina (Kaunas) 2024; 60:221. [PMID: 38399509 PMCID: PMC10890435 DOI: 10.3390/medicina60020221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Background: Regenerative medicine is evolving with discoveries like the stromal vascular fraction (SVF), a diverse cell group from adipose tissue with therapeutic promise. Originating from fat cell metabolism studies in the 1960s, SVF's versatility was recognized after demonstrating multipotency. Comprising of cells like pericytes, smooth muscle cells, and, notably, adipose-derived stem cells (ADSCs), SVF offers tissue regeneration and repair through the differentiation and secretion of growth factors. Its therapeutic efficacy is due to these cells' synergistic action, prompting extensive research. Methods: This review analyzed the relevant literature on SVF, covering its composition, action mechanisms, clinical applications, and future directions. An extensive literature search from January 2018 to June 2023 was conducted across databases like PubMed, Embase, etc., using specific keywords. Results: The systematic literature search yielded a total of 473 articles. Sixteen articles met the inclusion criteria and were included in the review. This rigorous methodology provides a framework for a thorough and systematic analysis of the existing literature on SVF, offering robust insights into the potential of this important cell population in regenerative medicine. Conclusions: Our review reveals the potential of SVF, a heterogeneous cell mixture, as a powerful tool in regenerative medicine. SVF has demonstrated therapeutic efficacy and safety across disciplines, improving pain, tissue regeneration, graft survival, and wound healing while exhibiting immunomodulatory and anti-inflammatory properties.
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Affiliation(s)
| | | | | | | | - Renat Nurmukhametov
- Neurological Surgery, Peoples Friendship University of Russia, 103274 Moscow, Russia
| | | | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), 56100 Pisa, Italy
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Encarnacion-Santos D, Nurmukhametov R, Donasov M, Volovich A, Bozkurt I, Wellington J, Espinal-Lendof M, Peralta I, Chaurasia B. Management of lumbar spondylolisthesis: A retrospective analysis of posterior lumbar interbody fusion versus transforaminal lumbar interbody fusion. J Craniovertebr Junction Spine 2024; 15:99-104. [PMID: 38644921 PMCID: PMC11029118 DOI: 10.4103/jcvjs.jcvjs_74_23] [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: 07/13/2023] [Accepted: 02/05/2024] [Indexed: 04/10/2024] Open
Abstract
Background One of the most frequent etiologies for spinal surgery is unstable lumbar spondylolisthesis (ULS). To decompress affected structures while maintaining or restoring stability through fusion, surgeons utilize a variety of procedures. When paired with interbody fusion, posterior fusion is most applied, resulting in greater fusion rates. The two most popular techniques for implementing spinal fusion are posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). As a result, these two procedures have been assessed formally. Methodology A retrospective analysis of patients who underwent interbody fusion for lumbar stenosis through PLIF and minimally invasive (MI)-TLIF was performed. The patients were followed up for 24 months and fusion rates, Visual Analog Score (VAS), and Oswestry Disability Index (ODI) alongside the MacNab clinical outcome score, were assessed. The Bridwell interbody fusion grading system was used to evaluate fusion rates in computed tomography (CT). Results Operations were performed in 60 cases where patients suffered from ULS. PLIF was performed on 33 patients (55%) (14 males and 19 females) and 27 patients (45%) (11 males and 16 females) who underwent MI-TLIF. In 87% of our respective cohort, either the L4-5 or the L5-S1 level was operated on. Overall fusion rates were comparable between the two groups; however, the TLIF group improved more in terms of VAS, ODI, and MacNab scores. On average, MI-TLIF surgery was longer and resulted in reduced blood loss. MI-TLIF patients were more mobile than PLIF patients postoperatively. Conclusion With well-established adequate results in the literature, TLIF offers benefits over other methods used for interbody lumbar fusion in ULS or other diseases of the spine. However, MI-TLIF may procure more advantageous for patients if MI methods are implemented. In this instance, TLIF outperformed PLIF due to shorter operating times, less blood loss, faster ODI recovery, better MacNab scores, and a greater decline in VAS pain ratings.
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Affiliation(s)
| | | | - Medet Donasov
- Deparment of People of Frienship University of Russia, Moscow, Russia
| | | | - Ismail Bozkurt
- Division of Vertebrology of the NCC No. 2 (CCB RAS) FGBNU “RNTSKH in B.V. Petrovskovo Academy”, Moscow, Russia/Branford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jack Wellington
- Deparment of People of Frienship University of Russia, Moscow, Russia
| | - Miguel Espinal-Lendof
- Department of Neurosurgery, CECANOT Medical Specialties, Santo Domingo, Dominican Republic
| | - Ismael Peralta
- Department of Neurosurgery, Hospital Dr. Alejandro Cabral, San Juan de la Maguana, Dominican Repúblic
| | - Bipin Chaurasia
- Division of Vertebrology of the NCC No. 2 (CCB RAS) FGBNU “RNTSKH in B.V. Petrovskovo Academy”, Moscow, Russia/Branford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Torres CSO, Mora AE, Campero A, Cherian I, Sufianov A, Sanchez EF, Ramirez ME, Pena IR, Nurmukhametov R, Beltrán MA, Juarez ED, Cobos AM, Lafuente-Baraza J, Baldoncini M, Luzzi S, Montemurro N. Enhancing microsurgical skills in neurosurgery residents of low-income countries: A comprehensive guide. Surg Neurol Int 2023; 14:437. [PMID: 38213434 PMCID: PMC10783688 DOI: 10.25259/sni_791_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 01/13/2024] Open
Abstract
Background The main objectives of this paper are to outline the essential tools, instruments, and equipment needed to set up a functional microsurgery laboratory that is affordable for low-income hospitals and to identify cost-effective alternatives for acquiring microsurgical equipment, such as refurbished or donated instruments, collaborating with medical device manufacturers for discounted rates, or exploring local suppliers. Methods Step-by-step instructions were provided on setting up the microsurgery laboratory, including recommendations for the layout, ergonomic considerations, lighting, and sterilization processes while ensuring cost-effectiveness, as well as comprehensive training protocols and a curriculum specifically tailored to enhance microsurgical skills in neurosurgery residents. Results We explored cost-effective options for obtaining microsurgery simulators and utilizing open-source or low-cost virtual training platforms. We also included guidelines for regular equipment maintenance, instrument sterilization, and establishing protocols for infection control to ensure a safe and hygienic learning environment. To foster collaboration between low-income hospitals and external organizations or institutions that can provide support, resources, or mentorship, this paper shows strategies for networking, knowledge exchange, and establishing partnerships to enhance microsurgical training opportunities further. We evaluated the impact and effectiveness of the low-cost microsurgery laboratory by assessing the impact and effectiveness of the established microsurgery laboratory in improving the microsurgical skills of neurosurgery residents. About microsutures and microanastomosis, after three weeks of training, residents showed improvement in "surgical time" for ten separate simple stitches (30.06 vs. 8.65 min) and ten continuous single stitches (19.84 vs. 6.51 min). Similarly, there was an increase in the "good quality" of the stitches and the suture pattern from 36.36% to 63.63%. Conclusion By achieving these objectives, this guide aims to empower low-income hospitals and neurosurgery residents with the necessary resources and knowledge to establish and operate an affordable microsurgery laboratory, ultimately enhancing the quality of microsurgical training and patient care in low-income countries.
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Affiliation(s)
| | | | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, San Miguel de Tucuman, Argentina
| | - Iype Cherian
- Institute of Neurosciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India
| | - Albert Sufianov
- Department of Neurosurgery, Federal Center of Neurosurgery, Tyumen
| | | | | | - Issael Ramirez Pena
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Eduardo Diaz Juarez
- Department of Neurosurgery, National University of Mexico Hospital General, Durango
| | | | | | - Matias Baldoncini
- Department of Neurosurgery, San Fernando Hospital, Belgrano, San Fernando, Argentina
| | - Sabino Luzzi
- Department of Neurosurgery, University of Pavia, Pavia
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Demichelis MDRE, Barrera A, Campero A, Sufianov A, Ramírez MDJE, Nurmukhametov R, Montemurro N, Castillo-Rangel C, Rosario AR, Baldoncini M. Lipotranferences in post neurosurgical esthetic defects. Surg Neurol Int 2023; 14:443. [PMID: 38213453 PMCID: PMC10783699 DOI: 10.25259/sni_783_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024] Open
Abstract
Background There are numerous procedures in which, beyond adequate manipulation of the temporalis muscle and cranial closure, patients may present bone and muscle defects due to atrophy and consequent facial asymmetry, causing psychological discomfort and functional deterioration. The objective of our work is to combine the knowledge of plastic surgery and apply it to cranial reconstructions with fat transfers in post-neurosurgical patients, analyzing its results. Methods During the year 2022, 45 fat transfer procedures were performed for the correction of craniofacial defects, of which 29 were female and 16 were male. All had a surgical history of pterional craniotomies and their variants, orbitozygomatic and transzygomatic approaches, with the consequent volume deficit. Results The procedure was performed on an outpatient basis, with local anesthesia, and in an average time of 30-40 min. The lower hemiabdominal region was used as the donor area, processing the fat using the decantation technique and injecting it into the receptor area at the craniofacial level. The patients tolerated the procedure adequately without intraoperative complications or superadded events. Conclusion Fat transfer is a minimally invasive, effective, and cost-effective technique that plastic surgery offers us to implement in post-neurosurgical patients, as it achieves natural results that stand the test of time.
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Affiliation(s)
| | - Augusto Barrera
- Plastic Surgery Service, Churruca-Visca Medical Complex, Buenos Aires, Argentina
| | - Alvaro Campero
- Neurosurgery Service, Padilla Hospital, Faculty of Medicine, National University of Tucumán, Tucuman, Argentina
| | - Albert Sufianov
- Department of Educational and Scientific Institute of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - Renat Nurmukhametov
- Department of Neurosurgery, Russian People’s Friendship University, Ulitsa Miklukho-Maklaya, Moscow, Russian Federation
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Carlos Castillo-Rangel
- Neurosurgery Service, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Regional Hospital October 1, Mexico City, Mexico
| | | | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, San Fernando, Argentina
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Gareev I, Encarnacion Ramirez MDJ, Nurmukhametov R, Ivliev D, Shumadalova A, Ilyasova T, Beilerli A, Wang C. The role and clinical relevance of long non-coding RNAs in glioma. Noncoding RNA Res 2023; 8:562-570. [PMID: 37602320 PMCID: PMC10432901 DOI: 10.1016/j.ncrna.2023.08.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/05/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023] Open
Abstract
Glioma represents a complex and heterogeneous disease, posing significant challenges to both clinicians and researchers. Despite notable advancements in glioma treatment, the overall survival rate for most glioma patients remains dishearteningly low. Hence, there is an urgent necessity to discover novel biomarkers and therapeutic targets specifically tailored for glioma. In recent years, long non-coding RNAs (lncRNAs) have emerged as pivotal regulators of gene expression and have garnered attention for their involvement in the development and progression of various cancers, including glioma. The dysregulation of lncRNAs plays a critical role in glioma pathogenesis and influences clinical outcomes. Consequently, there is growing interest in exploring the potential of lncRNAs as diagnostic and prognostic biomarkers, as well as therapeutic targets. By understanding the functions and dysregulation of lncRNAs in glioma, researchers aim to unlock new avenues for the development of innovative treatment strategies catered to glioma patients. The identification and thorough characterization of lncRNAs hold the promise of novel therapeutic approaches that could potentially improve patient outcomes and enhance the management of glioma, ultimately striving for better prospects and enhanced quality of life for those affected by this challenging disease. The primary objective of this paper is to comprehensively review the current state of knowledge regarding lncRNA biology and their intricate roles in glioma. It also delves into the potential of lncRNAs as valuable diagnostic and prognostic indicators and explores their feasibility as promising targets for therapeutic interventions.
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Affiliation(s)
- Ilgiz Gareev
- Bashkir State Medical University, Ufa, Republic of Bashkortostan, 450008, Russia
| | - Manuel de Jesus Encarnacion Ramirez
- Department of Neurosurgery, Рeoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow, 117198, Russian Federation
| | - Renat Nurmukhametov
- Division of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Denis Ivliev
- Department of Neurosurgery, Smolensk State Medical University of the Ministry of Health of the Russian Federation, Smolensk, Russia
| | - Alina Shumadalova
- Bashkir State Medical University, Ufa, Republic of Bashkortostan, 450008, Russia
| | - Tatiana Ilyasova
- Bashkir State Medical University, Ufa, Republic of Bashkortostan, 450008, Russia
| | - Aferin Beilerli
- Department of Obstetrics and Gynecology, Tyumen State Medical University, Tyumen, Russia
| | - Chunlei Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
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Nurmukhametov R, Medetbek A, Ramirez ME, Afsar A, Sharif S, Montemurro N. Factors affecting return to work following endoscopic lumbar foraminal stenosis surgery: A single-center series. Surg Neurol Int 2023; 14:408. [PMID: 38053695 PMCID: PMC10695345 DOI: 10.25259/sni_659_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Background This study evaluates the factors affecting the return to work of endoscopic surgery for lumbar foraminal stenosis (LFS), including symptoms, functional status, complications, and reoperation rates. Methods The authors' retrospective cohort study included 100 consecutive patients (50 males and 50 females) diagnosed with LFS who underwent endoscopic surgery at Trotsky National Research Center of Surgery between January 2018 and December 2021. Results There were no significant differences in age and preoperative visual analog scale and Oswestry disability index scores between the male and female groups, time to return to work for different patient groups after undergoing endoscopic lumbar foraminotomy (ELF). However, patients with more severe stenosis and comorbidities may take longer to recover. Confounding factors were patient age, preoperative physical function, and job requirements. Conclusion This study confirms that study ELF can effectively improve symptoms associated with lumbar radiculopathy, as well as back pain, and improve patients' quality of life. Comorbidity, smoking status, and complications prolong the time to return to work following ELF surgery compared to healthy subjects.
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Affiliation(s)
- Renat Nurmukhametov
- Department of Spinal Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Abakirov Medetbek
- Department of Spinal Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Manuel Encarnacion Ramirez
- Department of Neurosurgery, Russian People’s Friendship University, United Nations Educational, Scientific and Cultural Organization (UNESCO), Digital Anatomy, Moscow, Russian Federation
| | - Afifa Afsar
- Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
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Encarnacion-Santos D, Nurmukhametov R, Bozkurt I, Dosanov M, Volovish A, Chaurasia B. Restoring vertebral height in the treatment of multilevel vertebral compression fractures with vertebroplasty. Egypt J Neurol Psychiatry Neurosurg 2023; 59:135. [DOI: 10.1186/s41983-023-00737-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 10/11/2023] [Indexed: 04/10/2024] Open
Abstract
Abstract
Background
Osteoporosis (OP) is the fourth leading cause of disability in the elderly. The challenges presented by OP fractures are complex. Vertebral body fractures (VCF) are frequently encountered in osteoporotic patients. Due to the predominant age group of osteoporotic VCF along with co-morbidities, restoring the vertebral body height and the correction of kyphosis via minimally invasive methods are preferred. Vertebroplasty continues to be the most commonly employed method in this selection. The purpose of this study is to provide evidence for the combined employment of vertebroplasty with other minimally invasive techniques in the treatment of osteoporotic VCF. A retrospective analysis of patients treated for multilevel thoracolumbar osteoporotic VCF was performed. The patients were treated with percutaneous vertebroplasty (PVP), transforaminal lumbar interbody fusion supplemented by vertebroplasty (TLIF-VP) and minimally invasive transpedicular screw fixation supplemented by vertebroplasty (TP-VP). They were followed up for at least a year and VAS and ODI scores along with the degree of kyphotic correction and restoration of vertebral body height have been evaluated.
Results
Sixty patients with 132 levels of VCF treated were evaluated. PVP was superior in terms of shortened operative period, decreased blood loss, earlier ambulation and not requiring general anesthesia. Both TLIF-VP and TP-VP required general anesthesia, with longer operative period and increased blood loss, however it provided greater kyphotic correction. Restoration of vertebral body height was the highest in the PVP and TP-VP group. All patients benefited clinically from the interventions in regard to VAS pain and ODI scores.
Conclusions
VP continues to be the choice for minimally invasive correction of osteoporotic VCF. VP can be employed with other techniques as seen in this study in selected patients with sufficient symptomology. TLIF implantation allowed for discectomy and sufficient root decompression while transpedicular screw fixation allowed for greater correction especially in the chronic fractures.
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Ovalle Torres CS, Efe IE, Ramirez MDJE, Diaz Juarez E, Ruano Calderon A, Nurmukhametov R, Campero A, Ramirez Pena IJ, Montemurro N. Surgical Management of Temporal Lobe Epilepsy Secondary to Epidermoid Cysts: A Case Report With Review of the Literature. Cureus 2023; 15:e45360. [PMID: 37849566 PMCID: PMC10577610 DOI: 10.7759/cureus.45360] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Epidermoid cysts represent roughly 1% of all intracranial tumors. They are frequently located in the cerebellopontine angle but rarely extend to the supratentorial brain. Epilepsy is an extremely uncommon manifestation of this neoplasm. We suggest the surgical management of a 35-year-old male who presented with a six-month history of intractable temporal lobe epilepsy. His seizures were characterized by a focal onset in the form of déjà vu experiences, followed by a secondarily generalized tonic-clonic seizure. Imaging revealed a heterogeneous cystic mass in the right cerebellopontine angle, extending supratentorially causing a mass effect on the mesial temporal region. Gross total resection was achieved through a combined subtemporal-retrosigmoid approach. Histopathology revealed an epidermoid cyst. The patient was entirely seizure-free at the three-month follow-up. Epidermoid cysts may present with epileptic seizures. Seizure freedom can be achieved with surgical management in most cases. The patient's symptoms, imaging findings, and epileptogenic focus must be considered to select the appropriate surgical strategy.
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Affiliation(s)
| | - Ibrahim E Efe
- Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, DEU
| | | | | | | | | | - Alvaro Campero
- Neurosurgery, Hospital Ángel C. Padilla, San Miguel de Tucumán, ARG
| | | | - Nicola Montemurro
- Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, ITA
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13
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Ramirez ME, Türe U, Güngör A, Nurmukhametov R, Campero A, Baldoncini M, Kaprovoy S, Konovalov N, Mura J, Lawton MT, Montemurro N, Morcos JJ. "Surgery is Art. You Should be One of the Artists" Juha Hernesniemi (1947-2023). World Neurosurg 2023; 178:50-51. [PMID: 37531703 DOI: 10.1016/j.wneu.2023.07.011] [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: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Manuel Encarnacion Ramirez
- Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia, Moscow, Russian Federation
| | - Uğur Türe
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Abuzer Güngör
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; Department of Neurosurgery, Bakirkoy Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
| | - Renat Nurmukhametov
- Department of Spinal Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, Argentina
| | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Stanislav Kaprovoy
- Department of Spinal and Peripheral Nerve Surgery Burdenko Neurosurgical Center Moscow, Russia
| | - Nikolay Konovalov
- Department of Spinal and Peripheral Nerve Surgery Burdenko Neurosurgical Center Moscow, Russia
| | - Jorge Mura
- Department of Cerebrovascular and Skull Base Surgery, Instituto de Neurocirurgia Dr. Alfonso Asenjo, Providencia, Chile
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy.
| | - Jacques J Morcos
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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14
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Peralta I, Ramírez MDJE, Baldoncini M, Vicente D, Willingham AL, Nurmukhametov R, Valdez S, Castillo Y, Encarnación DA, Soler IJR, Rosario AR. Surgical nuances of giant neurocysticercosis according to intracranial location in the Southwest region of the Dominican Republic, presentation of cases, and literature review. Surg Neurol Int 2023; 14:242. [PMID: 37560572 PMCID: PMC10408627 DOI: 10.25259/sni_385_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Neurocysticercosis (NCC) is the most common infestation of the central nervous system, caused by the larval stage of the pig tapeworm Taenia solium. It is prevalent in regions with poor sanitation and underdevelopment, such as Latin America. CASE DESCRIPTION We present four cases in which they harbored an intraventricular/intraparenchymal, frontal convexity, cerebellomedullary, and intraparenchymal NCC cyst of medium size, respectively. Three of them underwent complete removal of the cyst by craniotomy; the fourth had a shunt for obstructive hydrocephalus first, followed by excision of a suboccipital cyst 8 months later. CONCLUSION The intraventricular/intraparenchymal lesion was more complex to treat than its subarachnoid counterparts because the average brain should be transected and dissected away to achieve total removal. Waterjet dissection, arachnoid microdissection, and cyst drainage allowed minor brain damage than capsule coagulation and traction. Populated prospective studies are needed better to understand the surgical nuances of these rare entities.
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Affiliation(s)
- Ismael Peralta
- Department of Neurosurgery, Dr. Alejandro Cabral Hospital, San Juan de la Maguana, Dominican Republic
| | | | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Argentina
| | - Dauly Vicente
- Department of Anesthesiology, Dr. Alejandro Cabral Hospital, Diego De Velasquez, San Juan de la Maguana, Dominican Republic
| | - Arve Lee Willingham
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Renat Nurmukhametov
- Department of Spinal Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Sandy Valdez
- Department of Neurosurgery, Dr. Alejandro Cabral Hospital, San Juan de la Maguana, Dominican Republic
| | - Yussaira Castillo
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
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15
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Peralta I, Ramírez MDJE, Baldoncini M, Vicente D, Willingham AL, Nurmukhametov R, Valdez S, Castillo Y, Encarnación DA, Soler IJR, Rosario AR. Surgical nuances of giant neurocysticercosis according to intracranial location in the Southwest region of the Dominican Republic, presentation of cases, and literature review. Surg Neurol Int 2023; 14:242. [DOI: : 10.25259/sni_385_2023] [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] [Indexed: 04/10/2024] Open
Abstract
Background:
Neurocysticercosis (NCC) is the most common infestation of the central nervous system, caused by the larval stage of the pig tapeworm Taenia solium. It is prevalent in regions with poor sanitation and underdevelopment, such as Latin America.
Case Description:
We present four cases in which they harbored an intraventricular/intraparenchymal, frontal convexity, cerebellomedullary, and intraparenchymal NCC cyst of medium size, respectively. Three of them underwent complete removal of the cyst by craniotomy; the fourth had a shunt for obstructive hydrocephalus first, followed by excision of a suboccipital cyst 8 months later.
Conclusion:
The intraventricular/intraparenchymal lesion was more complex to treat than its subarachnoid counterparts because the average brain should be transected and dissected away to achieve total removal. Waterjet dissection, arachnoid microdissection, and cyst drainage allowed minor brain damage than capsule coagulation and traction. Populated prospective studies are needed better to understand the surgical nuances of these rare entities.
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Affiliation(s)
- Ismael Peralta
- Department of Neurosurgery, Dr. Alejandro Cabral Hospital, San Juan de la Maguana, Dominican Republic,
| | | | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Argentina,
| | - Dauly Vicente
- Department of Anesthesiology, Dr. Alejandro Cabral Hospital, Diego De Velasquez, San Juan de la Maguana, Dominican Republic,
| | - Arve Lee Willingham
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain, United Arab Emirates,
| | - Renat Nurmukhametov
- Department of Spinal Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation,
| | - Sandy Valdez
- Department of Neurosurgery, Dr. Alejandro Cabral Hospital, San Juan de la Maguana, Dominican Republic,
| | - Yussaira Castillo
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis,
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16
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Vanegas Cerna G, Barrientos Castillo RE, Nurmukhametov R, Baldoncini M, López Lara CE, Rosario A, Ogando YE, Ramirez KM, Lafuente J, Chmutin GE, Montemurro N, Ramirez MDJE. Giant Invasive Intradural Extramedullary Lumbar Schwannoma: A Case Report and Literature Review. Cureus 2023; 15:e40708. [PMID: 37485228 PMCID: PMC10359865 DOI: 10.7759/cureus.40708] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Schwannomas are benign nerve sheath tumors that arise from Schwann cells, which are responsible for producing the myelin sheath that surrounds nerves. They are typically slow-growing and can occur in various locations in the body, including the lumbar region of the spine. We present a case of giant invasive intradural extramedullary schwannoma managed with posterior lumbar interbody fusion (PLIF) and laminectomy with excellent results. A 58-year-old man presented with lower back pain radiating to the right leg for six months. He had no history of trauma or systemic disease. Lumbosacral magnetic resonance imaging (MRI) showed a well-defined mass at the L3-L4 level compressing the right nerve root. The patient was managed with L3-L4-L5 transpedicular fixation and right-side laminectomy L3-L4 for resection of the tumor. Histopathological examination confirmed the diagnosis of schwannoma. The patient had a favorable postoperative recovery and experienced a resolution of symptoms. Lumbar schwannomas are rare they can cause significant symptoms and require appropriate diagnosis and management. Microsurgery is the preferred treatment, and endoscopic microsurgery is the most promising technique.
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Affiliation(s)
| | | | - Renat Nurmukhametov
- Department of Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, School of Medicine, University of Buenos Aires, Buenos Aires, ARG
| | | | - Andreina Rosario
- Department of Anatomy, Autonomous University of Santo Domingo (UASD), Santo Domingo, DOM
| | - Yamaurys E Ogando
- Department of Neurological Surgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | - Karina M Ramirez
- Department of Neurological Surgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | - Jesus Lafuente
- Department of Neurological Surgery, Hospital Universitario del Mar, Barcelona, ESP
| | - Gennady E Chmutin
- Department of Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, ITA
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Uhl JF, Sufianov A, Ruiz C, Iakimov Y, Mogorron HJ, Encarnacion Ramirez M, Prat G, Lorea B, Baldoncini M, Goncharov E, Ramirez I, Céspedes JRC, Nurmukhametov R, Montemurro N. The Use of 3D Printed Models for Surgical Simulation of Cranioplasty in Craniosynostosis as Training and Education. Brain Sci 2023; 13:894. [PMID: 37371373 DOI: 10.3390/brainsci13060894] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/03/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The advance in imaging techniques is useful for 3D models and printing leading to a real revolution in many surgical specialties, in particular, neurosurgery. METHODS We report on a clinical study on the use of 3D printed models to perform cranioplasty in patients with craniosynostosis. The participants were recruited from various medical institutions and were divided into two groups: Group A (n = 5) received traditional surgical education (including cadaveric specimens) but without using 3D printed models, while Group B (n = 5) received training using 3D printed models. RESULTS Group B surgeons had the opportunity to plan different techniques and to simulate the cranioplasty. Group B surgeons reported that models provided a realistic and controlled environment for practicing surgical techniques, allowed for repetitive practice, and helped in visualizing the anatomy and pathology of craniosynostosis. CONCLUSION 3D printed models can provide a realistic and controlled environment for neurosurgeons to develop their surgical skills in a safe and efficient manner. The ability to practice on 3D printed models before performing the actual surgery on patients may potentially improve the surgeons' confidence and competence in performing complex craniosynostosis surgeries.
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Affiliation(s)
- Jean Francois Uhl
- Anatomy Department, Paris University and UNESCO Chair of Digital Anatomy, 75100 Paris, France
| | - Albert Sufianov
- Federal Center of Neurosurgery, Sechenov University, 119435 Moscow, Russia
| | - Camillo Ruiz
- Laboratorio de Investigaciones Morfológicas Aplicadas, Universidad Nacional de La Plata, La Plata B1900, Argentina
| | - Yuri Iakimov
- Federal Center of Neurosurgery, Sechenov University, 119435 Moscow, Russia
| | - Huerta Jose Mogorron
- Anatomy Department, Paris University and UNESCO Chair of Digital Anatomy, 75100 Paris, France
| | | | - Guillermo Prat
- Laboratorio de Investigaciones Morfológicas Aplicadas, Universidad Nacional de La Plata, La Plata B1900, Argentina
| | - Barbara Lorea
- Laboratorio de Investigaciones Morfológicas Aplicadas, Universidad Nacional de La Plata, La Plata B1900, Argentina
| | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires B1406, Argentina
| | - Evgeniy Goncharov
- Traumatology and Orthopedics Center, Central Clinical Hospital of the Russian Academy of Sciences, 103272 Moscow, Russia
| | - Issael Ramirez
- Neurosurgery Department, The Royal Melbourne Hospital, Melbourne 3000, Australia
| | | | - Renat Nurmukhametov
- Neurological Surgery, Peoples Friendship University of Russia, 103274 Moscow, Russia
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
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Montemurro N, Pahwa B, Tayal A, Shukla A, De Jesus Encarnacion M, Ramirez I, Nurmukhametov R, Chavda V, De Carlo A. Macrophages in Recurrent Glioblastoma as a Prognostic Factor in the Synergistic System of the Tumor Microenvironment. Neurol Int 2023; 15:595-608. [PMID: 37218976 DOI: 10.3390/neurolint15020037] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 03/12/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Glioblastoma (GBM) is a common and highly malignant primary tumor of the central nervous system in adults. Ever more recent papers are focusing on understanding the role of the tumor microenvironment (TME) in affecting tumorigenesis and the subsequent prognosis. We assessed the impact of macrophages in the TME on the prognosis in patients with recurrent GBM. A PubMed, MEDLINE and Scopus review was conducted to identify all studies dealing with macrophages in the GBM microenvironment from January 2016 to December 2022. Glioma-associated macrophages (GAMs) act critically in enhancing tumor progression and can alter drug resistance, promoting resistance to radiotherapy and establishing an immunosuppressive environment. M1 macrophages are characterized by increased secretion of proinflammatory cytokines, such as IL-1ß, tumor necrosis factor (TNF), IL-27, matrix metalloproteinase (MMPs), CCL2, and VEGF (vascular endothelial growth factor), IGF1, that can lead to the destruction of the tissue. In contrast, M2 is supposed to participate in immunosuppression and tumor progression, which is formed after being exposed to the macrophage M-CSF, IL-10, IL-35 and the transforming growth factor-ß (TGF-β). Because there is currently no standard of care in recurrent GBM, novel identified targeted therapies based on the complex signaling and interactions between the glioma stem cells (GSCs) and the TME, especially resident microglia and bone-marrow-derived macrophages, may be helpful in improving the overall survival of these patients in the near future.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | - Anish Tayal
- University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | - Anushruti Shukla
- University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | | | - Issael Ramirez
- Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Renat Nurmukhametov
- Department of Spinal Surgery, Central Clinical Hospital of the Russian Academy of Sciences, 121359 Moscow, Russia
| | - Vishal Chavda
- Department of Pathology, Stanford of School of Medicine, Stanford University Medical Centre, Palo Alto, CA 94305, USA
| | - Antonella De Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
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Encarnacion Ramirez M, Ramirez Pena I, Barrientos Castillo RE, Sufianov A, Goncharov E, Soriano Sanchez JA, Colome-Hidalgo M, Nurmukhametov R, Cerda Céspedes JR, Montemurro N. Development of a 3D Printed Brain Model with Vasculature for Neurosurgical Procedure Visualisation and Training. Biomedicines 2023; 11:biomedicines11020330. [PMID: 36830866 PMCID: PMC9953411 DOI: 10.3390/biomedicines11020330] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Simulation-based techniques using three-dimensional models are gaining popularity in neurosurgical training. Most pre-existing models are expensive, so we felt a need to develop a real-life model using 3D printing technology to train in endoscopic third ventriculostomy. METHODS The brain model was made using a 3D-printed resin mold from patient-specific MRI data. The mold was filled with silicone Ecoflex™ 00-10 and mixed with Silc Pig® pigment additives to replicate the color and consistency of brain tissue. The dura mater was made from quick-drying silicone paste admixed with gray dye. The blood vessels were made from a silicone 3D-printed mold based on magnetic resonance imaging. Liquid containing paprika oleoresin dye was used to simulate blood and was pumped through the vessels to simulate pulsatile motion. RESULTS Seven residents and eight senior neurosurgeons were recruited to test our model. The participants reported that the size and anatomy of the elements were very similar to real structures. The model was helpful for training neuroendoscopic 3D perception and navigation. CONCLUSIONS We developed an endoscopic third ventriculostomy training model using 3D printing technology that provides anatomical precision and a realistic simulation. We hope our model can provide an indispensable tool for young neurosurgeons to gain operative experience without exposing patients to risk.
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Affiliation(s)
| | | | | | - Albert Sufianov
- Department of Neurosurgery, First Moscow State Medical University (Sechenov University), 121359 Moscow, Russia
| | - Evgeniy Goncharov
- Traumatology and Orthopedics Center, Central Clinical Hospital of the Russian Academy of Sciences, 121359 Moscow, Russia
| | - Jose A. Soriano Sanchez
- Instituto Soriano de Cirugía de Columna Mínimamente Invasiva at ABC Hospital, Neurological Center, Santa Fe Campus, Mexico City 05100, Mexico
| | - Manuel Colome-Hidalgo
- Instituto de Investigación en Salud, Universidad Autònoma de Santo Domingo, Santo Domingo 10014, Dominican Republic
| | | | | | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
- Correspondence:
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Encarnacion Ramirez M, Peralta Baez I, Nurmukhametov R, Goncharov E, Efe IE, Sufianov A, Ramirez Pena I. Comparative survey study of the use of a low cost exoscope vs. microscope for anterior cervical discectomy and fusion (ACDF). Front Med Technol 2023; 4:1055189. [PMID: 36688142 PMCID: PMC9846206 DOI: 10.3389/fmedt.2022.1055189] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is an often performed procedure in spine neurosurgery. These are often performed using an operating microscope (OM) for better illumination and visualization. But its use is limited to the surgeon and the assistant. There is difficulty in maneuvering long surgical instruments due to the limited space available. Exoscope (EX) has been used as an alternative to microscopes and endoscopes. We used an EX in patients undergoing ACDF for cervical spondylotic myelopathy. Methods A prospective comparative trial was conducted to test the safety and usability of a low-cost EX compared to a conventional surgical binocular OM in ACDF. Twenty-six patients with degenerative cervical myelopathy symptoms were operated by ACDF assisted by the EX and OM between December 2021 and June 2022. The authors collected and compared data on operative time, intraoperative hemorrhage, hospital admission, and complications in the two groups. Results There were no statistically significant differences between the two groups in mean operative time, hospital stay, or postoperative complications. The average intraoperative blood loss was significantly more in the OM group. There were no surgical complications related to the use of the EX or OM. The comfort level, preoperative setup and intraoperative adjustment of position and angle of the EX were rated higher than the OM group. The image quality, depth perception, and illumination were rated as inferior to that of the OM. The low-cost EX was rated to be superior to that of the OM with regard to education and training purposes. Conclusion Our study showed that the low-cost EX appears to be a safe and effective alternative for OM-assisted ACDF with great comfort and ergonomics and serves as an essential tool for education and training purposes. However, some limitations of our EX included slightly inferior image quality and illumination when compared with the OM.
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Affiliation(s)
- Manuel Encarnacion Ramirez
- Department of Neurosurgery, RUDN University, Moscow, Russia,Correspondence: Manuel Encarnacion Ramirez Issael Ramirez Pena
| | - Ismael Peralta Baez
- Department of Neurosurgery, Hospital Regional Alejandro Cabral, San Juan de la Maguana, Dominican Republic
| | | | - Efgeni Goncharov
- Traumatology and Orthopedics Center, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Ibrahim E. Efe
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Albert Sufianov
- Department of Neurosurgery, First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Issael Ramirez Pena
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia,Correspondence: Manuel Encarnacion Ramirez Issael Ramirez Pena
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Ramirez ME, Peralta I, Nurmukhametov R, Castillo REB, Castro JS, Volovich A, Dosanov M, Efe IE. Expanding access to microneurosurgery in low-resource settings: Feasibility of a low-cost exoscope in transforaminal lumbar interbody fusion. J Neurosci Rural Pract 2023; 14:156-160. [PMID: 36891107 PMCID: PMC9945030 DOI: 10.25259/jnrp-2022-3-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Less than a quarter of the world population has access to microneurosurgical care within a range of 2 h. We introduce a simplified exoscopic visualization system for low-resource settings. Materials and Methods We purchased a 48 megapixels microscope camera with a c-mount lens and a ring light at a total cost of US$ 125. Sixteen patients with lumbar degenerative disk disease were divided into an exoscope group and a microscope group. In each group, we performed four open and four minimally invasive transforaminal lumbar interbody fusions (TLIF). We conducted a questionnaire-based assessment of the user experience. Results The exoscope achieved similar outcomes with comparable blood loss and operating time as the microscope. It provided similar image quality and magnification. Yet, it lacked stereoscopic perception and the adjustability of the camera position was cumbersome. Most users strongly agreed the exoscope would significantly improve surgical teaching. Over 75% reported that they would recommend the exoscope to colleagues and all users saw its great potential for low-resource environments. Conclusion Our low-budget exoscope is safe and feasible for TLIF and purchasable at a fraction of the cost of conventional microscopes. It may thus help expand access to neurosurgical care and training worldwide.
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Affiliation(s)
| | - Ismael Peralta
- Department of Neurosurgery, Dr. Alejandro Cabral Hospital, San Juan de la Maguana, Dominican Republic
| | - Renat Nurmukhametov
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
| | | | - Juan Sebastian Castro
- Department of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Alexander Volovich
- Department of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Medet Dosanov
- Department of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Ibrahim E. Efe
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
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22
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Agaverdiev M, Shamsov B, Mirzoev S, Vardikyan A, Ramirez ME, Nurmukhametov R, Beilerli A, Zhang B, Gareev I, Pavlov V. MiRNA regulated therapeutic potential of the stromal vascular fraction: Current clinical applications - A systematic review. Noncoding RNA Res 2022; 8:146-154. [PMID: 36632616 PMCID: PMC9817091 DOI: 10.1016/j.ncrna.2022.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/29/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction The stromal vascular fraction (SVF) is a heterogeneous population of cells that, interacting with each other, can affect the processes of regeneration, angiogenesis, and immunomodulation. Over the past 20 years, there has been a trend towards an increase in the number of clinical studies on the therapeutic use of SVF. MicroRNAs (miRNAs) are also important regulators of cellular function and they have been shown to be involved in SVF cellular component function. The purpose of this study was to analyze existing clinical studies on the therapeutic use of SVF including the role of miRNAs in the regulation of the function of the cellular component of SVF as an anti-inflammatory, pro-angiogenic and cell differentiation activity. Methods The search strategy was to use material from the clinicaltrials.gov website, which focused on the key term "Stromal vascular fraction", and the inclusion and exclusion criteria were divided into two stages. Results By August 2022, there were 149 registered clinical trials. Most studies belong to either Phase 1-2 (49.37%), Phase 1 (25.32%) or Phase 2 (22.78%). Most of them focused in the fields of traumatology, neurology/neurosurgery, endocrinology, vascular surgery, and immunology. However, only 8 clinical trials had published results. All of clinical trials have similar preparation methods and 8 clinical trials have positive results with no serious adverse effects. Conclusions There appears to be a wide potential for the clinical use of SVF without reports of serious side effects. Many preclinical and clinical studies are currently underway on the use of SVF, and their future results will help to further explore their therapeutic potential. Nevertheless, there are not many studies on the role of miRNAs in the SVF microenvironment; however, this topic is very important for further study of the clinical application of SVF, including safety, in various human diseases.
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Affiliation(s)
- Murad Agaverdiev
- Department of Urology, Bashkir State Medical University, 450008, Ufa, Russian Federation
| | - Bedil Shamsov
- Department of Urology, Bashkir State Medical University, 450008, Ufa, Russian Federation
| | - Sorbon Mirzoev
- Department of Urology, City Clinical Hospital, №21, 450071, Ufa, Russian Federation
| | - Andranik Vardikyan
- Department of Urology, Bashkir State Medical University, 450008, Ufa, Russian Federation
| | - Manuel Encarnacion Ramirez
- Department of Neurosurgery, Рeoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow, 117198, Russian Federation
| | - Renat Nurmukhametov
- Division of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Aferin Beilerli
- Department of Obstetrics and Gynecology, Tyumen State Medical University, 54 Odesskaya Street, 625023, Tyumen, Russia
| | - Bohan Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Harbin, 150001, China
| | - Ilgiz Gareev
- Central Research Laboratory, Bashkir State Medical University, 450008, Ufa, Russian Federation,Corresponding author.
| | - Valentin Pavlov
- Department of Urology, Bashkir State Medical University, 450008, Ufa, Russian Federation
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Muacevic A, Adler JR, Nurmukhametov R, Goncharov E, Ramirez MDJE, Bozkurt I, Ramirez Pena IJ. A Case Report of a Sacral Giant Cell Tumor Treated With Block Resection and Lumbo-Pelvic Fixation. Cureus 2022; 14:e31224. [PMID: 36505101 PMCID: PMC9729751 DOI: 10.7759/cureus.31224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
Giant cell tumors (GCT) are benign but locally aggressive neoplasms composed of osteoclast-like giant cells and fusiform to ovoid mononuclear stromal cells. GCT generally comprise 5-10% of all benign bone tumors; they appear most frequently between the second and third decades of life. These tumors are also distributed throughout the vertebral column. Approximately half of all spinal GTCs develop in the sacrum. Many cases remain clinically silent and are discovered incidentally during the study of minor trauma. Symptomatic tumors often mimic other common spinal pathologies. Imaging studies ideal for diagnosis are CT and MRI. The techniques used in the treatment of giant cell tumors are curettage or intralesional surgery, block resection, radiotherapy, and chemotherapy. Herein, we report on a 23-year-old female patient diagnosed with a tumoral mass in the anterior part of the sacrum, suggestive of GCT. The lesion was completely excised in two consecutive surgeries, and lumbopelvic fixation was performed with favorable immediate postoperative results. Careful surgical planning with a multi-disciplinary approach leading to block resection still remains the most viable option for the treatment of vertebral GCT.
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Musa G, Barrientos Castillo RE, Slabov MV, Chirwa K, Chmutin GE, Ramirez MDJE, Nurmukhametov R. Degenerative Grade 3 Spondylolisthesis Management: A Case Report and Literature Review. Cureus 2022; 14:e29374. [PMID: 36284806 PMCID: PMC9584580 DOI: 10.7759/cureus.29374] [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: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Degenerative spine disorders are very common in the aging population. Degenerative spondylolisthesis is a relatively uncommon cause of chronic back pain in these patients. We present a case of high-grade spondylolisthesis managed with posterior lumbar interbody fusion (PLIF) and reduction of the listhesis with excellent results. A 56-year-old woman presented with chronic lower back pain managed as an outpatient for over 5 months with no relief. She had no history of trauma or risk factors for malignancy. Lumbosacral CT showed Meyerding grade 3 anterolisthesis of the fifth lumbar vertebra with complete L5-S1 disc collapse and bilateral spondylolysis. An MRI confirmed the findings. There was no spinal canal stenosis. The patient was managed with L4-L5-S1 transpedicular fixation and L5-S1 interbody cage with reduction of the listhesis. The patient had an incidental intraoperative dural tear which was repaired primarily and a wound drain was kept for 5 days without complications. The patient was ambulating by day 5 and was discharged without complications on day 10. Degenerative spondylolisthesis can cause chronic back pain with or without a history of trauma. Although no specific clinical features exist for this condition, it should be suspected in elderly patients even in the absence of a history of trauma. Surgical management in high-grade spondylolisthesis is indicated with interbody fixation and reduction.
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Ramirez MDJE, Nurmukhametov R, Musa G, Barrientos Castillo RE, Encarnacion VLA, Soriano Sanchez JA, Vazquez CA, Efe IE. Three-Dimensional Plastic Modeling on Bone Frames for Cost-Effective Neuroanatomy Teaching. Cureus 2022; 14:e27472. [PMID: 36060355 PMCID: PMC9421102 DOI: 10.7759/cureus.27472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
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Bernard E, Enelis B, Nurmukhametov R, Ramirez MDJE, Dosanov M, Shirshov I, Efe IE, Ramirez Pena IJ, Barrientos Castillo RE. Surgical Management of Lumbar Hardware Failure Due to Recurrent Postoperative Spondylodiscitis: Case Report. Cureus 2022; 14:e27457. [PMID: 36060329 PMCID: PMC9420540 DOI: 10.7759/cureus.27457] [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: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
Spondylodiscitis is a rare bacterial infection of the vertebrae and intervertebral discs that causes inflammation and follows a destructive course. When conservative management fails, surgical management requires immediate debridement of the infective focus, with decompression and stabilization through a ventral approach. The most frequently involved locations are the lumbar spine (58%), thoracic (30%), and cervical (11%) regions. Gram-positive organisms such as Staphylococcus aureus and Streptococcus species are the most commonly isolated organisms (67% and 24%, respectively). Pathophysiologically, infectious spondylodiscitis begins in the anterior portion of the vertebral body, due to its rich vascular supply, and then spreads to the rest of the vertebral body and along the medullary spaces. In this study, we report the management of recurrent lumbar postoperative spondylodiscitis with transforaminal lumbar interbody fusion (TLIF) hardware failure in a 62-year-old female.
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Ramirez MDJE, Peralta I, Nurmukhametov R, Castillo REB, Castro JS, Volovich A, Dosanov M, Efe IE. Expanding Access to Microneurosurgery in Low-Resource Settings: Feasibility of a Low-Cost Exoscope in Transforaminal Lumbar Interbody Fusion. J Neurosci Rural Pract 2022. [DOI: 10.1055/s-0042-1750103] [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] [Indexed: 10/17/2022] Open
Abstract
Abstract
Objectives Less than a quarter of the world population has access to microneurosurgical care within a range of 2 hours. We introduce a simplified exoscopic visualization system to achieve optical magnification, illumination, and video recording in low-resource settings.
Materials and Methods We purchased a 48 megapixels industrial microscope camera with a heavy-duty support arm, a wide field c-mount lens, and an LED ring light at a total cost of US$ 125. Sixteen patients with lumbar degenerative disk disease were divided into an exoscope group and a conventional microscope group. In each group we performed four open and four minimally invasive transforaminal lumbar interbody fusion procedures. We further conducted a questionnaire-based assessment of the user experience.
Results The overall user experience was positive. The exoscope achieved similar postoperative improvement with comparable blood loss and operating time as the conventional microscope. It provided a similar image quality, magnification and illumination. Yet, the lack of stereoscopic perception and the cumbersome adjustability of the camera position and angle resulted in a shallow learning curve. Most users strongly agreed that the exoscope would significantly improve surgical teaching. Over 75% reported they would recommend the exoscope to colleagues and all users saw its great potential for low-resource environments.
Conclusion Our low-budget exoscope is technically non-inferior to the conventional binocular microscope and purchasable at a significantly lower price. It may thus help expand access to neurosurgical care and training worldwide.
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Affiliation(s)
| | - Ismael Peralta
- Department of Neurosurgery, Dr. Alejandro Cabral Hospital, San Juan de la Maguana, Dominican Republic
| | - Renat Nurmukhametov
- Department of Neurosurgery, Peoples' Friendship University of Russia, Moscow, Russia
| | | | - Juan Sebastian Castro
- Department of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Alexander Volovich
- Department of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Medet Dosanov
- Department of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Ibrahim E. Efe
- Department of Neurosurgery, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Centre for Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
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Encarnacion Ramirez MDJ, Barrientos Castillo RE, Nurmukhametov R, Dosanov M, Tolokonnikov N, Bernard E, Efe IE. Microsurgical Wiltse Paraspinal Approach Using a Low-Budget Exoscope. Cureus 2022; 14:e25858. [PMID: 35836461 PMCID: PMC9275447 DOI: 10.7759/cureus.25858] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/29/2022] Open
Abstract
Access to microneurosurgical care in low- and middle-income countries remains limited mainly due to a lack of equipment. High purchasing and maintenance costs hinder the use of operating microscopes in low-resource facilities. The authors present an improved version of their previously introduced low-cost exoscope to achieve high magnification and illumination in low-resource environments. The setup included a 48-megapixel two-dimensional digital microscope camera, a wide field C-mount lens, ring light, and a two-link cantilever with a screw terminal. The surgical field was projected to a portable 17.3-inch 2K resolution monitor. Ten patients underwent exoscope-assisted transforaminal lumbar interbody fusion via the Wiltse paraspinal approach. The simple construction allowed a fast and intuitive preoperative setup. The in-plane switching type display provided a clear and bright image regardless of the viewing angle. The two-link arm of the cantilever allowed smooth positioning of the camera, overcoming the cumbersome up and down movements needed to zoom in and out with the previous prototype. Industrial microscope cameras are effective low-budget alternatives to conventional operating microscopes in lumbar microdiscectomy. The improved system is superior compared to the authors' previous prototype with regard to affordability, image quality, and adjustability of position and angle.
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Oleinikov B, Musa G, Livshitz MI, Kolcheva M, Ramirez MDJE, Nurmukhametov R, Efe IE. Surgical Management of a Pediatric Infratentorial Subdural Empyema as a Complication of Parapharyngeal Abscess. Cureus 2022; 14:e25270. [PMID: 35755555 PMCID: PMC9224697 DOI: 10.7759/cureus.25270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
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Ramirez MDJE, Nurmukhametov R, Bernard E, Peralta I, Efe IE. A Low-Cost Three-Dimensional Printed Retractor for Transforaminal Lumbar Interbody Fusion. Cureus 2022; 14:e24185. [PMID: 35592187 PMCID: PMC9110095 DOI: 10.7759/cureus.24185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/17/2022] Open
Abstract
The authors developed a low-cost surgical retractor to improve surgeon’s comfort and facilitate pedicle screw insertion in transforaminal lumbar interbody fusion surgery. The retractor was designed using three-dimensional (3D) modeling software and produced with the help of a 3D printer. It was attached to a mechanic retractor arm. The retractor was anchored to the transverse process through a concave notch at its tip, visualizing the junction between the transverse process and the superior articular process. The gutter-shaped body of the retractor helped stay within the ideal trajectory during screw insertion. The retractor was tested in 20 patients undergoing transforaminal lumbar interbody fusion with satisfactory results. Future models will be generated suitable for surgery of the cervical and thoracic spine.
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Encarnacion MDJ, Castillo REB, Matos Y, Bernard E, Elenis B, Oleinikov B, Nurmukhametov R, Castro JS, Volovich A, Dosanov M, Efe IE. EasyGO!-assisted microsurgical anterior cervical decompression: technical report and literature review. Neurol Neurochir Pol 2022; 56:281-284. [PMID: 35389505 DOI: 10.5603/pjnns.a2022.0027] [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: 12/26/2021] [Revised: 02/11/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Yasser Matos
- Department of Neurosurgery, Russian People's Friendship University, Moscow, Russia
| | - Edwin Bernard
- Department of Neurosurgery, Russian People's Friendship University, Moscow, Russia
| | - Brenda Elenis
- Department of Neurosurgery, Russian People's Friendship University, Moscow, Russia
| | - Boris Oleinikov
- Department of Neurosurgery, Russian People's Friendship University, Moscow, Russia
| | - Renat Nurmukhametov
- Department of Neurosurgery, Russian People's Friendship University, Moscow, Russia
| | - Juan Sebastian Castro
- Division of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Alexander Volovich
- Division of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Medet Dosanov
- Division of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Ibrahim E Efe
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. .,Centre for Surgery, Klinik Hirslanden, Zurich, Switzerland.
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Encarnacion Ramirez MDJ, Peralta I, Ramirez I, Dauly V, Mainer G, Nurmukhametov R, Efe IE. Development of a novel low-cost exoscope to expand access to microneurosurgical care in low- and middle-income countries. World Neurosurg 2022; 163:5-10. [DOI: 10.1016/j.wneu.2022.03.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022]
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Encarnacion-Ramirez MDJ, Aquino AA, Castillo REB, Melo-Guzmán G, López-Vujnovic D, Blas A, Acosta-Garcés R, Bernés-Rodríguez M, Guerra RM, Ayala-Arcipreste A, Nurmukhametov R, Efe IE. Surgical management of a penetrating drill bit injury to the skull base. Surg Neurol Int 2022; 13:49. [PMID: 35242415 PMCID: PMC8888304 DOI: 10.25259/sni_1229_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Low-energy penetrating brain injuries are rarely encountered in neurosurgical practice. Immediate surgical management remains the primary treatment strategy to control potential bleeding and prevents infectious complications. Case Description: A 28-year-old man presented with an orbital injury with left-sided chemosis, amaurosis, and ophthalmoplegia following an assault. Cranial CT revealed an industrial drill bit causing a penetrating injury to the skull base. The tip of the object reached the petrous apex. CT angiography showed no signs of cerebrovascular damage. The drill bit was visualized through a frontotemporal craniotomy. It was then carefully removed under direct microscopic vision. Postoperative ceftriaxone was administered. The patient was discharged in good condition on postoperative day 6. His vision impairment remained. Conclusion: Timely access to neuroimaging diagnostics and microneurosurgical facilities allows for good outcomes in the surgical treatment of low-velocity penetrating brain injuries.
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Affiliation(s)
| | - Amaya Alvarez Aquino
- Department of Neurosurgery, International Center for Neurological Restoration, Havanna, Cuba, Mexico,
| | | | | | | | - Agustin Blas
- Department of Neurosurgery, Hospital Juárez de México, Mexico-City, Mexico,
| | | | | | | | | | - Renat Nurmukhametov
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation,
| | - Ibrahim E. Efe
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
- Centre for Surgery Zurich, Klinik Hirslanden, Zurich, Switzerland
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Lebedev V, Epifanov D, Kostenko G, Ghodivala T, Nurmukhametov R, Pedyash N, Zuev A. MINIMALLY INVASIVE SPINAL CANAL RECONSTRUCTION FOR DEGENERATIVE LUMBAR SPINAL STENOSIS. Hir pozvonoč 2017. [DOI: 10.14531/ss2017.3.67-73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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