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Alsalkini M, Cibulková V, Breun M, Kessler AF, Schulz T, Cattaneo A, Wipplinger C, Hübner J, Ernestus RI, Nerreter T, Monoranu CM, Hagemann C, Löhr M, Nickl V. Cultivating Ex Vivo Patient-Derived Glioma Organoids Using a Tissue Chopper. J Vis Exp 2024. [PMID: 38314829 DOI: 10.3791/65952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Glioblastoma, IDH-wild type, CNS WHO grade 4 (GBM) is a primary brain tumor associated with poor patient survival despite aggressive treatment. Developing realistic ex vivo models remain challenging. Patient-derived 3-dimensional organoid (PDO) models offer innovative platforms that capture the phenotypic and molecular heterogeneity of GBM, while preserving key characteristics of the original tumors. However, manual dissection for PDO generation is time-consuming, expensive and can result in a number of irregular and unevenly sized PDOs. This study presents an innovative method for PDO production using an automated tissue chopper. Tumor samples from four GBM and one astrocytoma, IDH-mutant, CNS WHO grade 2 patients were processed manually as well as using the tissue chopper. In the manual approach, the tumor material was dissected using scalpels under microscopic control, while the tissue chopper was employed at three different angles. Following culture on an orbital shaker at 37 °C, morphological changes were evaluated using bright field microscopy, while proliferation (Ki67) and apoptosis (CC3) were assessed by immunofluorescence after 6 weeks. The tissue chopper method reduced almost 70% of the manufacturing time and resulted in a significantly higher PDOs mean count compared to the manually processed tissue from the second week onwards (week 2: 801 vs. 601, P = 0.018; week 3: 1105 vs. 771, P = 0.032; and week 4:1195 vs. 784, P < 0.01). Quality assessment revealed similar rates of tumor-cell apoptosis and proliferation for both manufacturing methods. Therefore, the automated tissue chopper method offers a more efficient approach in terms of time and PDO yield. This method holds promise for drug- or immunotherapy-screening of GBM patients.
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Affiliation(s)
- Marah Alsalkini
- Section Experimental Neurosurgery, Department of Neurosurgery, University Hospital Würzburg
| | - Veronika Cibulková
- Section Experimental Neurosurgery, Department of Neurosurgery, University Hospital Würzburg
| | - Maria Breun
- Department of Neurosurgery, University Hospital Würzburg
| | | | - Tim Schulz
- Department of Neurosurgery, University Hospital Würzburg
| | | | | | - Julian Hübner
- Department of Hematology, University Hospital Würzburg
| | | | | | - Camelia M Monoranu
- Department of Neuropathology, Institute of Pathology, University Hospital Würzburg
| | - Carsten Hagemann
- Section Experimental Neurosurgery, Department of Neurosurgery, University Hospital Würzburg
| | - Mario Löhr
- Department of Neurosurgery, University Hospital Würzburg
| | - Vera Nickl
- Department of Neurosurgery, University Hospital Würzburg;
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2
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Wipplinger C, Cattaneo A, Wipplinger TM, Lamllari K, Semmler F, Geske C, Messinger J, Nickl V, Beez A, Ernestus RI, Pham M, Westermaier T, Weiland J, Stetter C, Kunze E. Serum concentration-guided intravenous magnesium sulfate administration for neuroprotection in patients with aneurysmal subarachnoid hemorrhage: a retrospective evaluation of a 12-year single-center experience. Neurosurg Rev 2023; 46:256. [PMID: 37751032 PMCID: PMC10522732 DOI: 10.1007/s10143-023-02159-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
Delayed cerebral infarction (DCI) is a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). The benefits of magnesium sulfate as an alternative treatment are controversial, and most previous studies examined its benefits only as adjunctive treatment to traditional nimodipine. We retrospectively analyzed aSAH patients records with magnesium sulfate between 2010 and 2021. We aimed for a serum magnesium concentration of 2-2.5 mmol/l between post-hemorrhage days 3 and 12. The patients were separated in three groups based on average serum magnesium concentration (magnesium >2 mmol/l, reduced magnesium 1.1-1.9 mmol/l, and no magnesium). Additionally, we assessed delayed cerebral infarction (DCI) and clinical outcome at follow-up, using the modified Rankin Scale (mRS), categorized in favorable (0-3) and unfavorable outcome (4-5). In this analysis, 548 patients were included. Hereof, radiological evidence of DCI could be found in 23.0% (n = 126) of patients. DCI rates were lower if patients' average serum magnesium was higher than 2 mmol/l (magnesium 18.8%, n = 85; reduced magnesium 38.3%, n = 23; no magnesium 51.4%, n = 18; p < 0.001). Also, at the last follow-up, patients in the group with a higher serum magnesium concentration had better outcome (favorable outcome: magnesium 64.7%, n = 293; reduced magnesium 50.0%, n = 30; no magnesium 34.3%, n = 12; p < 0.001). This 12-year study reveals the value of serum concentration-guided magnesium administration in aSAH patients. Our findings demonstrate the safety and efficacy when titrated to a serum concentration of 2-2.5 mmol/l. We observed higher rates of delayed cerebral infarction and unfavorable outcomes in patients with serum concentrations below 2 mmol/l.
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Affiliation(s)
- C Wipplinger
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany.
| | - A Cattaneo
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - T M Wipplinger
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - K Lamllari
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - F Semmler
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - C Geske
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - J Messinger
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - V Nickl
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - A Beez
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - R-I Ernestus
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - M Pham
- Department of Neuroradiology, University Hospital of Würzburg, Würzburg, Germany
| | - T Westermaier
- Department of Neurosurgery, Helios Amper-Klinikum Dachau, Dachau, Germany
| | - J Weiland
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - C Stetter
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - E Kunze
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
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Hanafi I, Munder E, Ahmad S, Arabhamo I, Alziab S, Badin N, Omarain A, Jawish MK, Saleh M, Nickl V, Wipplinger T, Wipplinger C, Nickl R. War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014-2017: a cohort study and a literature review. BMC Emerg Med 2023; 23:35. [PMID: 36977988 PMCID: PMC10053936 DOI: 10.1186/s12873-023-00799-6] [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: 06/08/2022] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital. METHODS We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales. RESULTS Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores. CONCLUSIONS This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources.
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Affiliation(s)
- Ibrahem Hanafi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria.
| | - Eskander Munder
- Faculty of Medicine, Syrian Private University, Mazzah, Damascus, Syria
| | - Sulafa Ahmad
- Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria
| | - Iman Arabhamo
- Faculty of Medicine, Syrian Private University, Mazzah, Damascus, Syria
| | - Suzan Alziab
- Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria
| | - Noor Badin
- Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria
| | - Ahmad Omarain
- Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria
| | | | - Muhannad Saleh
- Division of Neurosurgery, Department of Surgery, Damascus Hospital, Damascus, Syria
| | - Vera Nickl
- Department of Neurosurgery, Würzburg University, Würzburg, Germany
| | - Tamara Wipplinger
- Department of Neurosurgery, Würzburg University, Würzburg, Germany
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA
| | | | - Robert Nickl
- Department of Neurosurgery, Würzburg University, Würzburg, Germany
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Wipplinger C, Wipplinger T, Griessenauer CJ. In Reply: Commentary: The Importance of the Temporary Clip Removal Phase on Exposure to Hypoxia: On-Line Measurement of Temporal Lobe Oxygen Levels During Surgery for Middle Cerebral Artery Aneurysms. Neurosurgery 2023; 92:e57. [PMID: 36729764 DOI: 10.1227/neu.0000000000002299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - Tamara Wipplinger
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Cattaneo A, Wipplinger C, Geske C, Semmler F, Wipplinger TM, Griessenauer CJ, Weiland J, Beez A, Ernestus RI, Westermaier T, Kunze E, Stetter C. Investigating the relationship between high-dose norepinephrine administration and the incidence of delayed cerebral infarction in patients with aneurysmal subarachnoid hemorrhage: A single-center retrospective evaluation. PLoS One 2023; 18:e0283180. [PMID: 36943859 PMCID: PMC10030022 DOI: 10.1371/journal.pone.0283180] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/05/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND One of the longest-standing treatments to prevent delayed cerebral infarction (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains raising the blood pressure to a certain level of mean arterial pressure. This may require high doses of norepinephrine, which has been associated with severe end organ damage. With this study, we aimed to investigate the effects of norepinephrine on the incidence of DCI in a clinical setting. METHODS We conducted a retrospective evaluation of patients with aSAH admitted to our institution between November 2018 and March 2021. Potential risk factors for DCI were analyzed and significant predictors were assessed by means of a logistic regression analysis to account for potential confounders. RESULTS In this study, 104 patients were included. Hereof, 39 (38%) showed radiologic signs of DCI between day three and 14 post-intervention. These patients had more frequent vasospasms (n = 37 vs. 30, p = 0.022), a higher Hunt & Hess score (3 ± 2 vs. 2 ± 1, p = 0.004), a lower initial Glasgow Coma Scale score (9 ± 5 vs. 12 ± 4, p = 0.003) and received a higher median norepinephrine dose (20,356μg vs. 6,508μg, p < 0.001). A logistic regression analysis revealed that only high-dose norepinephrine administration (OR 2.84, CI 1.56-7.8) and vasospasm (OR 3.07, CI 1.2-7.84) appeared to be significant independent risk factors for DCI. CONCLUSION Our results indicate a significant association between higher dose norepinephrine administration and the occurrence of DCI. Future research including greater sample sizes and a prospective setting will be necessary to further investigate the relationship.
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Affiliation(s)
- Andrea Cattaneo
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | | | - Caroline Geske
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Florian Semmler
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Tamara M Wipplinger
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States of America
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Judith Weiland
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Alexandra Beez
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, Helios-Amper Klinikum Dachau, Dachau, Germany
| | - Ekkehard Kunze
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Christian Stetter
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
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6
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Wipplinger C, Lener S, Orban C, Wipplinger TM, Abramovic A, Lang A, Hartmann S, Thomé C. Technical nuances and approach-related morbidity of anterolateral and posterolateral lumbar corpectomy approaches-a systematic review of the literature. Acta Neurochir (Wien) 2022; 164:2243-2256. [PMID: 35689694 PMCID: PMC9338118 DOI: 10.1007/s00701-022-05240-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/29/2022] [Indexed: 11/27/2022]
Abstract
Purpose Approaches for lumbar corpectomies can be roughly categorized into anterolateral (AL) and posterolateral (PL) approaches. It remains controversial to date whether one approach is superior to the other, and no comparative studies exist for the two approaches for lumbar corpectomies. Methods A systematic review of the literature was performed through a MEDLINE/PubMed search. Studies and case reports describing technique plus outcomes and possible complications were included. Thereafter, estimated blood loss (EBL), length of operation (LOO), utilized implants, neurological outcomes, complication rates, and reoperation rates were analyzed. Results A total of 64 articles reporting on 702 patients including 513 AL and 189 PL corpectomies were included in this paper. All patients in the PL group were instrumented via the same approach used for corpectomy, while in the AL group the majority (68.3%) of authors described the use of an additional approach for instrumentation. The EBL was higher in the AL group (1393 ± 1341 ml vs. 982 ± 567 ml). The LOO also was higher in the AL group (317 ± 178 min vs. 258 ± 93 min). The complication rate (20.5% vs. 29.1%, p = 0.048) and the revision rate (3.1% vs. 9.5%, p = 0.004) were higher in the PL group. Neurological improvement rates were 43.8% (AL) vs. 39.2% (PL), and deterioration was only noted in the AL group (6.0%), while 50.2% (AL) and 60.8% (PL) showed no change from initial presentation to the last follow-up. Conclusion While neurological outcomes of both approaches are comparable, the results of the present review demonstrated lower complication and revision rates in anterolateral corpectomies. Nevertheless, individual patient characteristics must be considered in decision-making.
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Affiliation(s)
- Christoph Wipplinger
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Sara Lener
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christoph Orban
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Tamara M Wipplinger
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Anto Abramovic
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anna Lang
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Schmidt FA, Lekuya HM, Kirnaz S, Hernandez RN, Hussain I, Chang L, Navarro-Ramirez R, Wipplinger C, Rawanduzy C, Härtl R. Novel MIS 3D NAV Single Step Pedicle Screw System (SSPSS): Workflow, Accuracy and Initial Clinical Experience. Global Spine J 2022; 12:1098-1108. [PMID: 33430625 PMCID: PMC9210221 DOI: 10.1177/2192568220976393] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Prospective case series. OBJECTIVE SSPSS (single step pedicle screw system) was developed for minimally invasive spine surgery. We performed this study to report on safety, workflow, and our initial clinical experience with this novel technique. METHODS The prospective study was conducted on patients who underwent pedicle screw fixation between October 2017 and April 2018 using a novel single step 3D navigated pedicle screw system for MIS. Outcome measurements were obtained from intraoperative computerized tomography. The images were evaluated to determine pedicle wall penetration. We used a grading system to assess the severity of the pedicle wall penetration. Breaches were classified as grade 1 (<2 mm), grade 2 (2-4 mm), or grade 3 (<4 mm),1 and as cranial, caudal, medial, and lateral. RESULTS Our study includes 135 screws in 24 patients. SSPSS eliminated K-wires and multiple steps traditionally necessary for MIS pedicle screw insertion. The median time per screw was 2.45 minutes. 3 screws were corrected intraoperatively. Pedicle wall penetration occurred in 14 screws (10%). Grade 1 breaches occurred in 4 screws (3%) and grade 2 breaches occurred in 10 screws (7%). Lateral breaches were observed more often than medial breaches. The accuracy rate in our study was 90% (Grade 0 breach). No revision surgeries were needed and no complications occurred. CONCLUSIONS Our study suggests that SSPSS could be a safe, accurate, and efficient tool. Our accuracy rate is comparable to that found in the literature.
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Affiliation(s)
- Franziska A. Schmidt
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA.,Franziska A. Schmidt, Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY 10065, USA.
| | - Hervé M. Lekuya
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Robert Nick Hernandez
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Louis Chang
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Cameron Rawanduzy
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
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8
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Goldberg JL, Wipplinger C, Kirnaz S, Xia J, Sommer F, Meng A, Schwarz J, Giantini-Larsen A, Meaden RM, Sugino R, Gadjradj P, Medary B, Carnevale JA, Navarro R, Tsiouris AJ, Hussain I, Härtl R. Clinical Significance of Redundant Nerve Roots in Patients with Lumbar Stenosis Undergoing Minimally Invasive Tubular Decompression. World Neurosurg 2022; 164:e868-e876. [PMID: 35598849 DOI: 10.1016/j.wneu.2022.05.061] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/14/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Symptomatic lumbar spinal stenosis (LSS) is a common indication for surgery in the elderly. Preoperative radiographic evaluation of patients with LSS often reveals redundant nerve roots (RNRs). The clinical significance of RNRs is uncertain. RNRs have not been studied in the setting of minimally invasive surgery. This study investigates the relationship between RNRs and clinical outcomes after minimally invasive tubular decompression. METHODS Chart review was performed for patients with degenerative LSS who underwent minimally invasive decompression. Preoperative magnetic resonance imaging parameters were assessed, and patient-reported outcomes were analyzed. RESULTS Fifty-four patients underwent surgery performed at an average of 1.8 ± 0.8 spinal levels. Thirty-one patients (57%) had RNRs. Patients with RNRs were older (median = 72 years vs. 66 years, P = 0.050), had longer median symptom duration (32 months vs. 15 months, P < 0.01), and had more levels operated on (2.1 vs. 1.4; P < 0.01). The median follow-up after surgery was 2 months (range = 1.3-12 months). Preoperative and postoperative patient-reported outcomes were similar based on RNR presence. Patients without RNRs had larger lumbar cross-sectional areas (CSAs) (median = 121 mm2 vs. 95 mm2, P = 0.014) and the index-level CSA (52 mm2 vs. 34 mm2, P = 0.007). The CSA was not correlated with RNR morphology or location. CONCLUSIONS Preoperative RNRs are associated with increased age, symptom duration, and lumbar stenosis severity. Patients improved after minimally invasive decompression regardless of RNR presence. RNR presence had no effect on short-term clinical outcomes. Further study is required to assess their long-term significance.
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Affiliation(s)
- Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA.
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Jimmy Xia
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Alicia Meng
- Department of Neuroradiology, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Justin Schwarz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Alexandra Giantini-Larsen
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Ross M Meaden
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Rafael Sugino
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Pravesh Gadjradj
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Joseph A Carnevale
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Rodrigo Navarro
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - A John Tsiouris
- Department of Neuroradiology, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
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9
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Wipplinger C, Wipplinger TM, Griessenauer CJ. Commentary: The Importance of the Temporary Clip Removal Phase on Exposure to Hypoxia: On-Line Measurement of Temporal Lobe Oxygen Levels During Surgery for Middle Cerebral Artery Aneurysms. Neurosurgery 2022; 90:e118-e120. [PMID: 35199653 DOI: 10.1227/neu.0000000000001888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Tamara M Wipplinger
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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10
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Lener S, Wipplinger C, Lang A, Hartmann S, Abramovic A, Thomé C. A scoring system for the preoperative evaluation of prognosis in spinal infection: the MSI-20 score. Spine J 2022; 22:827-834. [PMID: 34958935 DOI: 10.1016/j.spinee.2021.12.015] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 11/09/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal infection (SI) is a life-threatening condition and its treatment remains challenging. Recent studies have supported early and aggressive surgery, but mortality still reaches 5% to 10% and it remains unclear, if an aggressive surgical strategy also applies for severely sick patients. PURPOSE The aim of this analysis was to generate an assessment score to predict mortality of SI in order to facilitate decision-making. STUDY DESIGN Retrospective risk factor analysis. PATIENT SAMPLE Two hundred fifty-two patients were retrospectively analyzed. OUTCOME MEASURES Physiologic measures, functional measures. METHODS Diagnosis was based on clinical presentation, imaging findings and inflammatory markers. Factors associated with mortality were identified by multivariate analysis, weighted according to their relative risk ratio (RR) and included in the novel assessment score. RESULTS Eight parameters were included: (1) BMI, (2) ASA score, (3) presence of sepsis, (4) age-adjusted Charlson Comorbidity Index, (5) presence and degree of renal failure, (6) presence of hepatopathy, (7) neurological deficits and (8) CRP levels at diagnosis. Each parameter was assigned a certain range of points, resulting in a maximum total score of 20. The mortality in spinal infection (MSI-20) score - indicating poorer status with higher values - was obtained for each patient and correlated with mortality. CONCLUSION An MSI-20 score of 11 or more points seems to identify the small group of patients being "too sick to undergo surgery," while early surgery can be recommended in the remainder (MSI-20 ≤10). Our results need to be confirmed in prospective studies, but may give guidance for indicating surgery even in rather sick and comorbid patients.
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Affiliation(s)
- Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, A-6020, Austria.
| | - Christoph Wipplinger
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, A-6020, Austria
| | - Anna Lang
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, A-6020, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, A-6020, Austria
| | - Anto Abramovic
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, A-6020, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, A-6020, Austria
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11
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Wipplinger C, Wipplinger T, Griessenauer CJ. Commentary: Longitudinal Cost-Profiles of Pipeline Embolization Device Versus Stent-Assisted Coiling in Propensity-Matched Unruptured Small Anterior Circulation Aneurysms. Neurosurgery 2021; 89:E310-E311. [PMID: 34624083 DOI: 10.1093/neuros/nyab374] [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: 08/07/2021] [Accepted: 08/21/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Tamara Wipplinger
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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12
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Sloan SR, Wipplinger C, Kirnaz S, Navarro-Ramirez R, Schmidt F, McCloskey D, Pannellini T, Schiavinato A, Härtl R, Bonassar LJ. Combined nucleus pulposus augmentation and annulus fibrosus repair prevents acute intervertebral disc degeneration after discectomy. Sci Transl Med 2021; 12:12/534/eaay2380. [PMID: 32161108 DOI: 10.1126/scitranslmed.aay2380] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
Tissue-engineered approaches for the treatment of early-stage intervertebral disc degeneration have shown promise in preclinical studies. However, none of these therapies has been approved for clinical use, in part because each therapy targets only one aspect of the intervertebral disc's composite structure. At present, there is no reliable method to prevent intervertebral disc degeneration after herniation and subsequent discectomy. Here, we demonstrate the prevention of degeneration and maintenance of mechanical function in the ovine lumbar spine after discectomy by combining strategies for nucleus pulposus augmentation using hyaluronic acid injection and repair of the annulus fibrosus using a photocrosslinked collagen patch. This combined approach healed annulus fibrosus defects, restored nucleus pulposus hydration, and maintained native torsional and compressive stiffness up to 6 weeks after injury. These data demonstrate the necessity of a combined strategy for arresting intervertebral disc degeneration and support further translation of combinatorial interventions to treat herniations in the human spine.
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Affiliation(s)
- Stephen R Sloan
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Sertaç Kirnaz
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Franziska Schmidt
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Duncan McCloskey
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Tania Pannellini
- Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY 10065, USA
| | | | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA. .,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
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13
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Hernandez RN, Wipplinger C, Navarro-Ramirez R, Soriano-Solis S, Kirnaz S, Hussain I, Schmidt FA, Soriano-Sánchez JA, Härtl R. Ten-Step Minimally Invasive Cervical Decompression via Unilateral Tubular Laminotomy: Technical Note and Early Clinical Experience. Oper Neurosurg (Hagerstown) 2021; 18:284-294. [PMID: 31245806 DOI: 10.1093/ons/opz156] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/12/2018] [Accepted: 03/18/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Minimally invasive techniques utilizing tubular retractors have become an increasingly popular approach to the spinal column. The concept of a unilateral laminotomy for bilateral decompression (ULBD), first applied in the lumbar spine, has recently been applied to the cervical spine for the treatment of cervical spondylotic myelopathy (CSM). A better understanding of the indications and surgical techniques is required to effectively educate surgeons on how to appropriately and safely perform tubular cervical laminotomy via ULBD. OBJECTIVE To describe a 10-step technique for minimally invasive cervical laminotomy and report our early clinical experience. METHODS A retrospective review identified 15 patients with CSM who were treated with this procedure. Visual analogue scale (VAS), neck disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) scores were obtained pre- and postoperatively. RESULTS The mean age of the 15 patients was 73.1 ± 6.8 yr. The median number of levels treated was 1 (range 1-3). Mean operative time was 125.3 ± 30.8 or 81.7 ± 19.2 min per level. Mean estimated blood loss was 57.3 ± 24.6 cc. Median postoperative hospital length of stay was 36 h. No complications were encountered. Median follow-up was 18 mo. Mean pre- and postoperative VAS were 6.4 ± 2.4 and 1.0 ± 0.8, respectively (P < .001). Mean pre- and postoperative NDI were 46.4 ± 19.2 and 7.0 ± 6.9, respectively (P < .001). Mean pre- and postoperative Mjoa were 11.3 ± 2.5 and 14.5 ± 0.5, respectively (P < .001). CONCLUSION In our early clinical experience, minimally invasive cervical ULBD is safe and effective. Adherence to the presented 10-step technique will allow surgeons to safely address bilateral cervical pathology while avoiding complications.
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Affiliation(s)
- Robert Nick Hernandez
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York.,Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rodrigo Navarro-Ramirez
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Sergio Soriano-Solis
- Soriano Institute for Minimally Invasive Spine Surgery, ABC Hospital, Mexico City, Mexico
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Ibrahim Hussain
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Franziska Anna Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | | | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
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14
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Kirnaz S, Wipplinger C, Wong T, Schmidt FA, Nangunoori R, Härtl R. Less Invasive Cervical Decompression via Unilateral Tubular Laminotomy Using 3-Dimensional Total Navigation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 19:E418. [PMID: 32195546 DOI: 10.1093/ons/opaa059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/14/2019] [Accepted: 02/02/2020] [Indexed: 11/13/2022] Open
Abstract
This video demonstrates the step-by-step surgical technique for a less invasive cervical unilateral laminotomy for bilateral decompression (cervical ULBD). This technique allows surgeons to address bilateral cervical pathology while minimizing approach-related complications.1 In the video, we present the case of a 72-yr-old female patient with a past medical history of C3-C4 anterior cervical discectomy and fusion who presented in clinic with persistent posterior spinal cord compression and signal change. The patient had bilateral hand numbness, weakness, poor dexterity, and a positive Hoffman's sign. The patient was treated via a C3-C4 less invasive cervical ULBD using a mobile 3-dimensional (3D) C-arm (Ziehm Vision RFD 3D®, Nürnberg, Germany) combined with 3D computer navigation. Patient consent was obtained prior to performing the procedure. Contrary to anterior techniques, posterior cervical approaches avoid potential dysphasia, recurrent laryngeal nerve injury, and adjacent segment degeneration. Furthermore, the less invasive cervical ULBD results in decreased pain and postoperative narcotic usage, shorter hospital stays and fewer infections compared to open approaches, as well as a lower risk for postlaminectomy kyphosis and deformity, since it requires less muscle disruption and bony removal. Additionally, the use of total 3D navigation facilitates the workflow and minimizes radiation exposure.
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Affiliation(s)
- Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Taylor Wong
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Franziska Anna Schmidt
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Raj Nangunoori
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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15
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Wipplinger C, Griessenauer CJ. Commentary: Machine Learning-Driven Metabolomic Evaluation of Cerebrospinal Fluid: Insights Into Poor Outcomes After Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2021; 88:E412-E414. [PMID: 33582769 DOI: 10.1093/neuros/nyab033] [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: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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16
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Lener S, Wipplinger C, Hartmann S, Rietzler A, Thomé C, Tschugg A. Gender-Specific Differences in Presentation and Management of Spinal Infection: A Single-Center Retrospective Study of 159 Cases. Global Spine J 2021; 11:430-436. [PMID: 32875875 PMCID: PMC8119926 DOI: 10.1177/2192568220905804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN A retrospective single-center analysis of 159 cases. OBJECTIVE To investigate differences between male and female patients, as spinal infection (SI) represents a life-threatening condition and numerous factors may facilitate the course and outcome of SI, including patients' age and comorbidities, as well as gender. To date, no comparative data investigating sex differences in SI is available. Thus, the purpose of the present retrospective trial was to investigate differences between male and female patients. METHODS A total of 159 patients who were treated for a spinal infection between 2010 and 2016 at our department were included in the analysis. The patients were categorized into 2 groups based on gender. Evaluation included magnetic resonance imaging, laboratory values, clinical outcome, and conservative/operative management. RESULTS Male patients suffered from SI significantly more often than female patients (n = 101, 63.5% vs n = 58, 36.5%, P = .001). However, female patients were initially affected more severely, as infection parameters were significantly higher (P = .032) and vertebral destruction was more serious (P = .018). Furthermore, women suffered from intraoperative complications more often (P = .024) and received erythrocyte concentrates more frequently (P = .01). Nevertheless, mortality rates and outcome were comparable. Pain scales were significantly higher in female patients at 12-month follow-up (P = .042). CONCLUSION Although male patients show a higher incidence for SI, the course of disease and the management is more challenging in female patients. Nevertheless, outcome after 12 months is comparably good. Underlying mechanisms may include a better immune response and dissimilar effects of antibiotic treatment in women. Pain management in female patients is still unsatisfactory after 12 months.
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Affiliation(s)
- Sara Lener
- Medical University of
Innsbruck, Innsbruck, Austria,Sara Lener, Clinical Department of
Neurosurgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck,
Austria.
| | | | | | | | | | - Anja Tschugg
- Medical University of
Innsbruck, Innsbruck, Austria
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17
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Hubertus V, Gempt J, Mariño M, Sommer B, Eicker SO, Stangenberg M, Dreimann M, Janssen I, Wipplinger C, Wagner A, Lange N, Jörger AK, Czabanka M, Rohde V, Schaller K, Thomé C, Vajkoczy P, Onken JS, Meyer B. Surgical management of spinal metastases involving the cervicothoracic junction: results of a multicenter, European observational study. Neurosurg Focus 2021; 50:E7. [PMID: 33932937 DOI: 10.3171/2021.2.focus201067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/15/2020] [Accepted: 02/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical management of spinal metastases at the cervicothoracic junction (CTJ) is highly complex and relies on case-based decision-making. The aim of this multicentric study was to describe surgical procedures for metastases at the CTJ and provide guidance for clinical and surgical management. METHODS Patients eligible for this study were those with metastases at the CTJ (C7-T2) who had been consecutively treated in 2005-2019 at 7 academic institutions across Europe. The Spine Instability Neoplastic Score, neurological function, clinical status, medical history, and surgical data for each patient were retrospectively assessed. Patients were divided into four surgical groups: 1) posterior decompression only, 2) posterior decompression and fusion, 3) anterior corpectomy and fusion, and 4) anterior corpectomy and 360° fusion. Endpoints were complications, surgical revision rate, and survival. RESULTS Among the 238 patients eligible for inclusion this study, 37 were included in group 1 (15%), 127 in group 2 (53%), 18 in group 3 (8%), and 56 in group 4 (24%). Mechanical pain was the predominant symptom (79%, 189 patients). Surgical complications occurred in 16% (group 1), 20% (group 2), 11% (group 3), and 18% (group 4). Of these, hardware failure (HwF) occurred in 18% and led to surgical revision in 7 of 8 cases. The overall complication rate was 34%. In-hospital mortality was 5%. CONCLUSIONS Posterior fusion and decompression was the most frequently used technique. Care should be taken to choose instrumentation techniques that offer the highest possible biomechanical load-bearing capacity to avoid HwF. Since the overall complication rate is high, the prevention of in-hospital complications seems crucial to reduce in-hospital mortality.
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Affiliation(s)
- Vanessa Hubertus
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin
| | - Jens Gempt
- 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich
| | - Michelle Mariño
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin
| | - Björn Sommer
- 3Department of Neurosurgery, Universitätsmedizin Göttingen
| | - Sven O Eicker
- 4Department of Neurosurgery and Interdisciplinary University Spine Center, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Martin Stangenberg
- 5Department of Trauma and Orthopedic Surgery and Interdisciplinary University Spine Center, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Dreimann
- 5Department of Trauma and Orthopedic Surgery and Interdisciplinary University Spine Center, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Insa Janssen
- 6Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland; and
| | - Christoph Wipplinger
- 7Department of Neurosurgery, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Arthur Wagner
- 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich
| | - Nicole Lange
- 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich
| | - Ann-Kathrin Jörger
- 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich
| | - Marcus Czabanka
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin
| | - Veit Rohde
- 3Department of Neurosurgery, Universitätsmedizin Göttingen
| | - Karl Schaller
- 6Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland; and
| | - Claudius Thomé
- 7Department of Neurosurgery, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin
| | - Julia S Onken
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin
| | - Bernhard Meyer
- 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich
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18
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Schmidt FA, Mullally M, Lohmann M, Hiepe P, Kirnaz S, Chidambaram S, Wipplinger C, Härtl R. Elastic Image Fusion Software to Coregister Preoperatively Planned Pedicle Screws With Intraoperative Computed Tomography Data for Image-Guided Spinal Surgery. Int J Spine Surg 2021; 15:295-301. [PMID: 33900987 DOI: 10.14444/8039] [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] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND For complex spinal cases, especially when robotic guidance is used, preoperative planning of pedicle screws can be helpful. Transfer of these preoperatively planned pedicle screws to intraoperative 3-dimensional imaging is challenging because of changes in anatomic alignment between preoperative supine and intraoperative prone imaging, especially when multiple levels are involved. In the spine, where each individual vertebra is subject to independent movement from adjacent level, rigid image fusion is confined to a single vertebra and can display fusion inaccuracies on adjacent levels. A novel elastic fusion algorithm is introduced to overcome these disadvantages. This study aimed to investigate image registration accuracy of preoperatively planned pedicle screws with an elastic fusion algorithm vs. rigid fusion for intraoperative placement with image-guided surgery. METHODS A total of 12 patients, were selected depending on the availability of a preoperative spinal computed tomography (CT) and an intraoperative AIRO CT scan (BrainLAB AG, Munich, Germany) of the same spinal region. To verify accuracy differences between rigid fusion and elastic fusion 76 bilateral screw trajectories were virtually defined in the preoperative CT image, and they were transferred via either rigid fusion or elastic fusion to the intraoperative CT scan. Accuracy of the transferred screws in the rigid and elastic fusion group was determined by measuring pedicle breaches on the intraoperative CT. RESULTS In the rigid fusion group 1.3% of screws showed a breach of less than 2 mm, 9.2% showed breaches between 2 and 4 mm, and 18.4% of the screws showed an error above 4 mm. The elastic fusion group showed no breaches and provided high accuracy between preoperative and intraoperative screw placement. CONCLUSION Elastic fusion provides high registration accuracy and represents a considerable step towards efficiency and safety in CT-based image-guided surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Franziska A Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | | | | | | | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Swathi Chidambaram
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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19
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Ghorbani M, Griessenauer CJ, Wipplinger C, Jabbour P, Asl MK, Rahbarian F, Mortazavi A. Adenosine-induced transient circulatory arrest in transvenous embolization of cerebral arteriovenous malformations. Neuroradiol J 2021; 34:509-516. [PMID: 33657933 DOI: 10.1177/1971400921998972] [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: 11/15/2022] Open
Abstract
Due to advances in interventional techniques, the transvenous approach may present an effective treatment option for embolization of brain arteriovenous malformations (AVMs). Contrary to the transarterial method, the transvenous approach can only be utilized in a specific subset of patients and is not suitable as a standard procedure for all AVM lesions. While this technique can be helpful in certain patients, careful patient selection to ensure patient safety and favorable clinical outcomes is important. However, especially in high-flow AVMs, targeted deposition of embolic materials through a transvenous access can be challenging. Therefore, a temporary flow arrest may prove helpful. Transient cardiac arrest by use of adenosine has been applied in cerebrovascular surgery but is not common for endovascular embolization. Adenosine-induced arrest and systemic hypotension may be a feasible, safe method to reduce flow and help endovascular transvenous embolization of certain AVMs. Our study evaluated the efficiency and safety of adenosine-induced circulatory arrest for transvenous embolization of cerebral AVMs.
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Iran
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Health System, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | - Pascal Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, USA
| | - Mahdi Kadkhodazadeh Asl
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Iran
| | - Farhad Rahbarian
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Iran
| | - Abolghasem Mortazavi
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Iran
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20
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Sloan SR, Wipplinger C, Kirnaz S, Delgado R, Huang S, Shvets G, Härtl R, Bonassar LJ. Imaging the local biochemical content of native and injured intervertebral disc using Fourier transform infrared microscopy. JOR Spine 2020; 3:e1121. [PMID: 33392456 PMCID: PMC7770196 DOI: 10.1002/jsp2.1121] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022] Open
Abstract
Alterations to the biochemical composition of the intervertebral disc (IVD) are hallmarks of aging and degeneration. Methods to assess biochemical content, such as histology, immunohistochemistry, and spectrophotometric assays, are limited in their ability to quantitatively analyze the spatial distribution of biochemical components. Fourier transform infrared (FTIR) microscopy is a biochemical analysis method that can yield both quantitative and high-resolution data about the spatial distribution of biochemical components. This technique has been largely unexplored for use with the IVD, and existing methods use complex analytical techniques that make results difficult to interpret. The objective of the present study is to describe an FTIR microscopy method that has been optimized for imaging the collagen and proteoglycan content of the IVD. The method was performed on intact and discectomized IVDs from the sheep lumbar spine after 6 weeks in vivo in order to validate FTIR microscopy in healthy and degenerated IVDs. FTIR microscopy quantified collagen and proteoglycan content across the entire IVD and showed local changes in biochemical content after discectomy that were not observed with traditional histological methods. Changes in collagen and proteoglycans content were found to have strong correlations with Pfirrmann grades of degeneration. This study demonstrates how FTIR microscopy is a valuable research tool that can be used to quantitatively assess the local biochemical composition of IVDs in development, degeneration, and repair.
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Affiliation(s)
- Stephen R. Sloan
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
| | - Christoph Wipplinger
- Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Sertaç Kirnaz
- Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Robert Delgado
- Applied Engineering and PhysicsCornell UniversityIthacaNew YorkUSA
| | - Steven Huang
- Applied Engineering and PhysicsCornell UniversityIthacaNew YorkUSA
| | - Gennady Shvets
- Applied Engineering and PhysicsCornell UniversityIthacaNew YorkUSA
| | - Roger Härtl
- Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Lawrence J. Bonassar
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
- Sibley School of Mechanical and Aerospace EngineeringCornell UniversityIthacaNew YorkUSA
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21
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Lener S, Wipplinger C, Stocsits A, Hartmann S, Hofer A, Thomé C. Early surgery may lower mortality in patients suffering from severe spinal infection. Acta Neurochir (Wien) 2020; 162:2887-2894. [PMID: 32728904 PMCID: PMC7550317 DOI: 10.1007/s00701-020-04507-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Spinal infection (SI) is a life-threatening condition and treatment remains challenging. Numerous factors influence the outcome of SI and both conservative and operative care can be applied. As SI is associated with mortality rates between 2 and 20% even in developed countries, the purpose of the present study was to investigate the occurrence and causes of death in patients suffering from SI. METHODS A retrospective analysis was performed on 197 patients, categorized into two groups according to their outcome: D (death) and S (survival). The diagnosis was based on clinical and imaging (MRI) findings. Data collected included demographics, clinical characteristics, comorbidities, infection parameters, treatment details, outcomes, and causes of death. RESULTS The number of deaths was significantly higher in the conservative group (n = 9/51, 18%) compared with the operative counterpart (n = 8/146, 6%; p = 0.017). Death caused by septic multiorgan failure was the major cause of fatalities (n = 10/17, 59%) followed by death due to cardiopulmonary reasons (n = 4/17, 24%). The most frequent indication for conservative treatment in patients of group D included "highest perioperative risk" (n = 5/17, 29%). CONCLUSION We could demonstrate a significantly higher mortality rate in patients solely receiving conservative treatment. Mortality is associated with number and type of comorbidities, but also tends to be correlated with primarily acquired infection. As causes of death are predominantly associated with a septic patient state or progression of disease, our data may call for an earlier and more aggressive treatment. Nevertheless, prospective clinical trials will be mandatory to better understand the pathogenesis and course of spinal infection, and to develop high quality, evidence-based treatment recommendations.
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22
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Butenschoen VM, Hubertus V, Janssen IK, Onken J, Wipplinger C, Mende KC, Eicker SO, Kehl V, Thomé C, Vajkoczy P, Schaller K, Gempt J, Meyer B, Wostrack M. Surgical treatment and neurological outcome of infiltrating intramedullary astrocytoma WHO II-IV: a multicenter retrospective case series. J Neurooncol 2020; 151:181-191. [PMID: 33094355 PMCID: PMC7875841 DOI: 10.1007/s11060-020-03647-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/14/2020] [Accepted: 10/09/2020] [Indexed: 01/19/2023]
Abstract
Introduction Primary malignant spinal astrocytomas present rare oncological entities with limited median survival and rapid neurological deterioration. Evidence on surgical therapy, adjuvant treatment, and neurological outcome is sparse. We aim to describe the treatment algorithm and clinical features on patients with infiltrating intramedullary astrocytomas graded WHO II–IV. Methods The following is a multicentered retrospective study of patients treated for spinal malignant glioma WHO II–IV in five high-volume neurosurgical departments from 2008 to 2019. Pilocytic astrocytomas were excluded. We assessed data on surgical technique, perioperative neurological status, adjuvant oncological therapy, and clinical outcome. Results 40 patients were included (diffuse astrocytoma WHO II n = 11, anaplastic astrocytoma WHO III n = 12, WHO IV n = 17). Only 40% were functionally independent before surgery, most patients presented with moderate disability (47.5%). Most patients underwent a biopsy (n = 18, 45%) or subtotal tumor resection (n = 15, 37.5%), and 49% of the patients deteriorated after surgery. Patients with WHO III and IV tumors were treated with combined radiochemotherapy. Median overall survival (OS) was 46.5 months in WHO II, 25.7 months in WHO III, and 7.4 months in WHO IV astrocytomas. Preoperative clinical status and WHO significantly influenced the OS, and the extent of resection did not. Conclusion Infiltrating intramedullary astrocytomas WHO II–IV present rare entities with dismal prognosis. Due to the high incidence of surgery-related neurological impairment, the aim of the surgical approach should be limited to obtaining the histological tissue via a biopsy or, tumor debulking in cases with rapidly progressive severe preoperative deficits.
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Affiliation(s)
- Vicki M Butenschoen
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Vanessa Hubertus
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Insa K Janssen
- Department of Neurosurgery, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Julia Onken
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Wipplinger
- Department of Neurosurgery, University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Klaus C Mende
- Department of Neurosurgery, University Hospital Hamburg Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Sven O Eicker
- Department of Neurosurgery, University Hospital Hamburg Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Victoria Kehl
- School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Technical University Munich, Grillparzerstr. 18, 81675, Munich, Germany
| | - Claudius Thomé
- Department of Neurosurgery, University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
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23
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Ghorbani M, Griessenauer CJ, Shojaei H, Wipplinger C, Hejazian E. Endovascular reconstruction of iatrogenic internal carotid artery injury following endonasal surgery: a systematic review. Neurosurg Rev 2020; 44:1797-1804. [PMID: 32860104 DOI: 10.1007/s10143-020-01379-z] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/30/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
The objective of this study is to provide an update on endovascular treatments for iatrogenic internal carotid artery (ICA) injuries following endonasal surgery. A systematic review of the literature was performed by using Medline, Cochrane library, and Scopus from 1999 to 2019. We used a combination of the MeSH terms "internal carotid artery," "iatrogenic disease," and "endovascular procedure." Twenty-six articles including 46 patients were identified for in this systematic review. The mean age of the patients was 49 years (CI: ± 4.2). The most common site of ICA injury was in cavernous segment (18 patients; 39%). The most common type of iatrogenic ICA injury was a traumatic pseudoaneurysm documented in 28 patients (60%). Endoluminal reconstruction was performed using covered stents in 28 patients, the Pipeline embolization device (PED) in 13 patients, the Surpass flow diverter device in three, the SILK flow diverter in one, and one case was treated using a combined approach of a covered stent and a PED. Flow diversion and covered stents resulted in a good clinical outcome in 94% and 89% of patients, respectively. This difference did not reach statistical significance (p = 1.0). Even though this systematic review was limited due to articles of small sample sizes and considerable heterogeneity, the results indicate that flow diverting devices and covered stents are good therapeutic options for endoluminal reconstruction of iatrogenic ICA injuries following endonasal surgery.
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamidreza Shojaei
- Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
| | | | - Ebrahim Hejazian
- Department of Neurosurgery, Babol University of Medical Sciences, Babol, Mazandaran, Iran
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24
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Wipplinger C, Griessenauer CJ. Commentary: Women With First-Hand Tobacco Smoke Exposure Have a Higher Likelihood of Having an Unruptured Intracranial Aneurysm Than Nonsmokers: A Nested Case-Control Study. Neurosurgery 2020; 87:E628-E630. [PMID: 32674151 DOI: 10.1093/neuros/nyaa302] [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: 05/07/2020] [Accepted: 05/24/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Christoph J Griessenauer
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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25
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Wipplinger C, Griessenauer CJ. Commentary: George Chance and Frank Holdsworth: Understanding Spinal Instability and the Evolution of Modern Spine Injury Classification Systems. Neurosurgery 2020; 86:E519-E520. [PMID: 32297636 DOI: 10.1093/neuros/nyaa084] [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: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Christoph J Griessenauer
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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26
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Ghorbani M, Wipplinger C, Griessenauer CJ, Shojaei H, Abdolhoseinpour H. Successful endoluminal reconstruction of a pseudoaneurysm of the internal carotid artery following a transorbital stab injury. Clin Neurol Neurosurg 2020; 194:105838. [PMID: 32305824 DOI: 10.1016/j.clineuro.2020.105838] [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: 03/03/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
Traumatic penetrating injuries to the internal carotid artery (ICA) resulting in the formation of a traumatic pseudoaneurysm are potentially devastating injuries. Previously treatment included, open surgical occlusion of the affected vessel or endovascular embolization. However, with the advent of flow diverter stents, endoluminal reconstruction has become a viable treatment option. In this case report we describe the successful managment of an ICA pseudoaneurysm due to a transorbital stab injury. Endoluminal reconstruction in a traumatic aneurysm is a feasible option. Considering the risk of hemorrhagic complications due to dual antiplatelet therapy required after flow diverter placement, this treatment should only be chosen if insufficient collateral supply is found and occlusion of the affected vessel is not a viable option.
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Christoph Wipplinger
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamidreza Shojaei
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Abdolhoseinpour
- Deptment of Neurosurgery, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
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27
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Hussain I, Sloan SR, Wipplinger C, Navarro-Ramirez R, Zubkov M, Kim E, Kirnaz S, Bonassar LJ, Härtl R. Mesenchymal Stem Cell-Seeded High-Density Collagen Gel for Annular Repair: 6-Week Results From In Vivo Sheep Models. Neurosurgery 2020; 85:E350-E359. [PMID: 30476218 DOI: 10.1093/neuros/nyy523] [Citation(s) in RCA: 32] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 10/04/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Our group has previously demonstrated in vivo annulus fibrosus repair in animal models using an acellular, riboflavin crosslinked, high-density collagen (HDC) gel. OBJECTIVE To assess if seeding allogenic mesenchymal stem cells (MSCs) into this gel yields improved histological and radiographic benefits in an in vivo sheep model of annular injury. METHODS Fifteen lumbar intervertebral discs (IVDs) were randomized into 4 groups: intact, injury only, injury + acellular gel treatment, or injury + MSC-seeded gel treatment. Sheep were sacrificed at 6 wk. Disc height index (DHI), Pfirrmann grade, nucleus pulposus area, and T2 relaxation time (T2-RT) were calculated for each IVD and standardized to healthy controls from the same sheep. Quantitative histological assessment was also performed using the Han scoring system. RESULTS All treated IVDs retained gel plugs on gross assessment and there were no adverse perioperative complications. The MSC-seeded gel treatment group demonstrated statistically significant improvement over other experimental groups in DHI (P = .002), Pfirrmann grade (P < .001), and T2-RT (P = .015). There was a trend for greater Han scores in the MSC-seeded gel-treated discs compared with injury only and acellular gel-treated IVDs (P = .246). CONCLUSION MSC-seeded HDC gel can be delivered into injured IVDs and maintained safely in live sheep to 6 wk. Compared with no treatment and acellular HDC gel, our data show that MSC-seeded HDC gel improves outcomes in DHI, Pfirrmann grade, and T2-RT. Histological analysis shows improved annulus fibrosus and nucleus pulposus reconstitution and organization over other experimental groups as well.
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Affiliation(s)
- Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Stephen R Sloan
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Micaella Zubkov
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Eliana Kim
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
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28
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Wipplinger C, Kim E, Lener S, Navarro-Ramirez R, Kirnaz S, Hernandez RN, Melcher C, Paolicelli M, Maryam F, Schmidt FA, Härtl R. Tandem Microscopic Slalom Technique: The Use of 2 Microscopes Simultaneously Performing Unilateral Laminotomy for Bilateral Decompression in Multilevel Lumbar Spinal Stenosis. Global Spine J 2020; 10:88S-93S. [PMID: 32528812 PMCID: PMC7263332 DOI: 10.1177/2192568219871918] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Technical note, retrospective case series. OBJECTIVE Lumbar stenosis can be effectively treated using tubular unilateral laminotomy for bilateral decompression (ULBD). For multilevel stenosis, a multilevel ULBD through separate, alternating crossover approaches has been described as the "slalom technique." To increase efficacy, we introduced this approach with 2 microscopes simultaneously. METHODS We collected data on 13 patients, with multilevel lumbar stenosis, operated at our institution between 2015 and 2016 by the aforementioned technique. We assessed surgical time (ST), estimated blood loss (EBL), complications, and revision surgeries. Furthermore, we provide a stepwise instruction for performing the tandem microscopic slalom technique in a safe and efficient manner. RESULTS The mean age of the patients was 68 ± 8 years. The ST per level was 68 ± 19 minutes with an EBL per level of 39 ± 30 mL. We had no intraoperative complications and none of our patients required a revision surgery during a mean follow-up of 12 months. CONCLUSIONS We have shown that this technique is feasible and can be performed safely for multisegmental lumbar spinal stenosis with minimal tissue trauma and low EBL. Furthermore, randomized controlled studies with a larger sample size may be necessary to drive any final conclusions.
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Affiliation(s)
- Christoph Wipplinger
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
- Christoph Wipplinger and Eliana Kim contributed equally to the work
| | - Eliana Kim
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
- Christoph Wipplinger and Eliana Kim contributed equally to the work
| | - Sara Lener
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | | | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | - R. Nick Hernandez
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | - Carolin Melcher
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | - Michelle Paolicelli
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | - Farah Maryam
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | | | - Roger Härtl
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
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29
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Kirnaz S, Navarro-Ramirez R, Gu J, Wipplinger C, Hussain I, Adjei J, Kim E, Schmidt FA, Wong T, Hernandez RN, Härtl R. Indirect Decompression Failure After Lateral Lumbar Interbody Fusion-Reported Failures and Predictive Factors: Systematic Review. Global Spine J 2020; 10:8S-16S. [PMID: 32528813 PMCID: PMC7263336 DOI: 10.1177/2192568219876244] [Citation(s) in RCA: 20] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In patients with symptomatic lumbar stenosis undergoing lateral transpsoas approach for lumbar interbody fusion (LLIF) surgery, it is not always clear when indirect decompression is sufficient in order to achieve symptom resolution. Indirect decompression failure (IDF), defined as "postoperative persistent symptoms of nerve compression with or without a second direct decompression surgery to reach adequate symptom resolution," is not widely reported. This information, however, is critical to better understand the indications, the potential, and the limitations of indirect decompression. OBJECTIVE The purpose of this study was to systematically review the current literature on IDF after LLIF. METHODS A literature search was performed on PubMed. We included randomized controlled trials and prospective, retrospective, case-control studies, and case reports. Information on sample size, demographics, procedure, number and location of involved levels, follow-up time, and complications were extracted. RESULTS After applying the exclusion criteria, we included 9 of the 268 screened articles that reported failure. A total of 632 patients were screened in these articles and detailed information was provided. Average follow-up time was 21 months. Overall reported incidence of IDF was 9%. CONCLUSION Failures of decompression via LLIF are inconsistently reported and the incidence is approximately 9%. IDF failure in LLIF may be underreported or misinterpreted as a complication. We propose to include the term "IDF" as described in this article to differentiate them from complications for future studies. A better understanding of why IDF occurs will allow surgeons to better plan surgical intervention and will avoid revision surgery.
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Affiliation(s)
- Sertac Kirnaz
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
- These authors contributed equally to this work
| | - Rodrigo Navarro-Ramirez
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
- These authors contributed equally to this work
| | - Jiaao Gu
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | | | - Ibrahim Hussain
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Joshua Adjei
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Eliana Kim
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | | | - Taylor Wong
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | | | - Roger Härtl
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
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30
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Abstract
Innovative technology and techniques have revolutionized minimally invasive spine surgery (MIS) within the past decade. The introduction of navigation and image-guided surgery has greatly affected spinal surgery and will continue to make surgery safer and more efficient. Eventually, it is conceivable that fluoroscopy will be completely replaced with image guidance. These advancements, among others such as robotics and virtual and augmented reality technology, will continue to drive the value of 3-dimensional navigation in MIS. In this review, we cover pertinent features of navigation in MIS and explore their evolution over time. Moreover, we aim to discuss the key features germane to surgical advancement, including technique and technology development, accuracy, overall health care costs, operating room time efficiency, and radiation exposure.
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Affiliation(s)
- Ibrahim Hussain
- Weill Cornell Medical College, New York–Presbyterian Hospital, New York, NY, USA
- Ibrahim Hussain and Murat Cosar are equal contributors to this study
| | - Murat Cosar
- Weill Cornell Medical College, New York–Presbyterian Hospital, New York, NY, USA
- Ibrahim Hussain and Murat Cosar are equal contributors to this study
| | - Sertac Kirnaz
- Weill Cornell Medical College, New York–Presbyterian Hospital, New York, NY, USA
| | - Franziska A. Schmidt
- Weill Cornell Medical College, New York–Presbyterian Hospital, New York, NY, USA
| | - Christoph Wipplinger
- Weill Cornell Medical College, New York–Presbyterian Hospital, New York, NY, USA
| | - Taylor Wong
- Weill Cornell Medical College, New York–Presbyterian Hospital, New York, NY, USA
| | - Roger Härtl
- Weill Cornell Medical College, New York–Presbyterian Hospital, New York, NY, USA
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31
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Lener S, Wipplinger C, Hernandez RN, Hussain I, Kirnaz S, Navarro-Ramirez R, Schmidt FA, Kim E, Härtl R. Defining the MIS-TLIF: A Systematic Review of Techniques and Technologies Used by Surgeons Worldwide. Global Spine J 2020; 10:151S-167S. [PMID: 32528800 PMCID: PMC7263344 DOI: 10.1177/2192568219882346] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To date there is no consensus among surgeons as to what defines an MIS-TLIF (transforaminal lumbar interbody fusion using minimally invasive spine surgery) compared to an open or mini-open TLIF. This systematic review aimed to examine the MIS-TLIF techniques reported in the recent body of literature to help provide a definition of what constitutes the MIS-TLIF, based on the consensus of the majority of surgeons. METHODS We created a database of articles published about MIS-TLIF between 2010 and 2018. We evaluated the technical components of the MIS-TLIF including instruments and incisions used as well the order in which key steps are performed. RESULTS We could identify several patterns for MIS-TLIF performance that seemed agreed upon by the majority of MIS surgeons: use of paramedian incisions; use of a tubular retractor to perform a total facetectomy, decompression, and interbody cage implantation; and percutaneous insertion of the pedicle-screw rod constructs with intraoperative imaging. CONCLUSION Based on this review of the literature, the key features used by surgeons performing MIS TLIF include the use of nonexpandable or expandable tubular retractors, a paramedian or lateral incision, and the use of a microscope or endoscope for visualization. Approaches using expandable nontubular retractors, those that require extensive subperiosteal dissection from the midline laterally, or specular-based retractors with wide pedicle to pedicle exposure are far less likely to be promoted as an MIS-based approach. A definition is necessary to improve the communication among spine surgeons in research as well as patient education.
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Affiliation(s)
- Sara Lener
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
- Medical University of Innsbruck, Innsbruck, Austria
- These authors contributed equally to this work
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
- Medical University of Innsbruck, Innsbruck, Austria
- These authors contributed equally to this work
| | - R Nick Hernandez
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
- These authors contributed equally to this work
| | - Ibrahim Hussain
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Eliana Kim
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
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32
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Wipplinger C, Griessenauer CJ. Commentary: A Cohort Comparison Analysis of Fixed Pressure Ventriculoperitoneal Shunt Valves With Programmable Valves for Hydrocephalus Following Nontraumatic Subarachnoid Hemorrhage. Oper Neurosurg (Hagerstown) 2020; 18:E102-E103. [PMID: 31745556 DOI: 10.1093/ons/opz264] [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: 06/03/2019] [Accepted: 06/08/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Christoph J Griessenauer
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Wipplinger C, Griessenauer CJ. Commentary: Antiplatelet Therapy in Flow Diversion. Neurosurgery 2020; 86:E231-E233. [PMID: 31844900 DOI: 10.1093/neuros/nyz462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/23/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Christoph J Griessenauer
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Schmidt FA, Kirnaz S, Wipplinger C, Kuzan-Fischer CM, Härtl R, Hoffman C. Review of the Highlights from the First Annual Global Neurosurgery 2019: A Practical Symposium. World Neurosurg 2020; 137:46-54. [PMID: 31996336 DOI: 10.1016/j.wneu.2020.01.140] [Citation(s) in RCA: 4] [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: 07/21/2019] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
This paper provides a detailed report of Global Neurosurgery 2019: A Practical Symposium held January 18-19, 2019, at Weill Cornell Medical College, New York, New York, USA. The meeting convened an international faculty and audience, leaders in the world of global neurosurgery (GNS), and junior faculty and residents beginning their contribution to the field. Remote access for the symposium was provided to include faculty practicing in developing countries. The goal of the symposium was to present the state of the union of GNS initiatives worldwide, to use this forum as a means to centralize resources and converge parallel efforts, and to identify the largest areas of need and successful means of advancing training and care in these areas. The meeting also served as a conduit for the presentation of funding and training opportunities for junior faculty and trainees looking for avenues to gain support and mentorship in pursuing academic and clinical endeavors globally.
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Affiliation(s)
- Franziska A Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Claudia M Kuzan-Fischer
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Caitlin Hoffman
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA.
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Kirnaz S, Wipplinger C, Schmidt FA, Hernandez RN, Hussain I, Härtl R. Minimally Invasive Laminotomy for Contralateral “Over-the-Top” Foraminal Decompression Using 3-Dimensional Total Navigation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2019; 19:E296. [DOI: 10.1093/ons/opz399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 11/04/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
This video demonstrates the step-by-step surgical technique for the minimally invasive laminotomy for contralateral “over-the-top” foraminal decompression. This technique allows for excellent decompression with clearance of the contralateral recess and foramen. In the video, we present the case of a 51-yr-old female patient with a past medical history of left L5-S1 microdiscectomy who presented in clinic with residual/recurrent foraminal disc herniation at L5-S1 compressing the left L5 nerve root. The patient had left lower extremity pain in the left hip and thigh that radiated down the front and side of the leg, as well as tingling and numbness in the left foot. The patient was treated via a L5-S1 microdiscectomy using a portable intraoperative computed tomography scanner, (Airo®, Brainlab AG, Feldkirchen, Germany), combined with 3-dimensional (3D) computer navigation. Patient consent was obtained prior to performing the procedure. The main advantage of this technique is the direct “over-the-top” trajectory to the foraminal pathology that minimizes the need of facet joint resection. The use of 3D navigation facilitates surgical planning and further minimizes facet joint compromise. Particularly, the inferior facet contralateral to the approach side as well as its outer capsular surroundings can be preserved. Recent biomechanical studies have shown that “over-the-top” decompression produces significantly less instability than a traditional open midline laminectomy.
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Affiliation(s)
- Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Franziska Anna Schmidt
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - R Nick Hernandez
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | | | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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Wipplinger C, Griessenauer CJ. Flow Diverters Take an Ever Bigger Piece of the Aneurysm Treatment Pie: But How Do Individual Devices Compare? World Neurosurg 2019; 132:439-440. [PMID: 31810145 DOI: 10.1016/j.wneu.2019.09.070] [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] [Indexed: 11/28/2022]
Affiliation(s)
| | - Christoph J Griessenauer
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Ghorbani M, Griessenauer CJ, Wipplinger C, Abdolhoseinpour H, Bahrami R, Asaadi S, Mortazavi A. Combined Endovascular and Endoscopic Approach for Treatment of Concomitant Sphenoid Sinus Giant Traumatic Aneurysm and Direct Carotid Cavernous Fistulas. World Neurosurg 2019; 134:211-214. [PMID: 31678447 DOI: 10.1016/j.wneu.2019.10.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/14/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct carotid cavernous fistulas (CCFs) and sphenoid sinus traumatic aneurysms are well-known pathologies that can present concomitantly in rare cases. Patients with both lesions are usually symptomatic from both the CCF and the traumatic aneurysm. Symptoms include proptosis, chemosis, bruit, epistaxis, visual field defects, and loss of vision. Surgical treatment can be challenging, and for most cases an endovascular approach is the treatment of choice. CASE DESCRIPTION We present an unusual case of a direct CCF with an associated large traumatic aneurysm in the sphenoid sinus due to a history of trauma presenting with unusual symptoms that was treated by a combined endoscopic and endovascular approach. CONCLUSIONS Concurrent occurrence of a traumatic CCF and traumatic aneurysm of the cavernous segment is extremely rare. Early diagnosis and treatment of these lesions are important considering their high mortality rate. Complete occlusion of the fistula and aneurysm while preserving the patency of the carotid artery via an endovascular approach is the treatment of choice for these lesions.
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Affiliation(s)
- Mohammad Ghorbani
- Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran, University of Medical Sciences, Tehran, Iran
| | | | | | - Hesam Abdolhoseinpour
- Department of Neurosurgery, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Reza Bahrami
- Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran, University of Medical Sciences, Tehran, Iran
| | - Sina Asaadi
- Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran, University of Medical Sciences, Tehran, Iran
| | - Abolghasem Mortazavi
- Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran, University of Medical Sciences, Tehran, Iran.
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Jiang EY, Sloan SR, Wipplinger C, Kirnaz S, Härtl R, Bonassar LJ. Proteoglycan removal by chondroitinase ABC improves injectable collagen gel adhesion to annulus fibrosus. Acta Biomater 2019; 97:428-436. [PMID: 31425894 DOI: 10.1016/j.actbio.2019.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/24/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
Abstract
Intervertebral disc (IVD) herniations are currently treated with interventions that leave the IVD with persistent lesions prone to further herniations. Annulus fibrosus (AF) repair has become of interest as a method to seal defects in the IVD and prevent reherniation, but this requires strong adhesion of the implanted biomaterial to the native AF tissue. Our group has previously developed a high-density collagen (HDC) gel for AF repair and tested its efficacy in vivo, but its adhesion to the AF could be improved. Increased cell adhesion to cartilage has previously been reported through chondroitinase ABC (ChABC) digestion, which removes proteoglycans and increases access to cell binding motifs. Such approaches could also increase biomaterial adhesion to tissue, but the effects of ChABC digestion on AF have yet to be investigated. In this study, ovine AF tissue was digested with either 10 U/mL ChABC or saline for up to 10 min and the effect of this treatment on collagen adhesion between AF tissue samples was investigated by histology and mechanical testing in a lap-shear configuration. ChABC digestion removed proteoglycans within the AF in a time-dependent fashion and enhanced adhesion of the HDC gel to the AF. ChABC digestion increased the elastic toughness and total shear energy of the HDC gel-AF interface by 88% and 46% respectively. ChABC treatment enhanced the adhesion of the HDC gel to the AF without significantly decreasing native AF cell viability. Thus, ChABC digestion is a viable method to improve adhesion of biomaterials for AF repair. STATEMENT OF SIGNIFICANCE: Intervertebral disc herniations are currently treated with interventions that leave persistent lesions in the annulus fibrosus that are prone to further herniations. Annular repair is a promising method to seal lesions and prevent reherniation, but requires strong adhesion of the implanted biomaterial to native annulus fibrosus. Since large proteoglycans like aggrecan occupy regions of the extracellular matrix between collagen fibers in the annulus fibrosus, we hypothesized that removing proteoglycans via chondroitinase digestion would increase the adhesion of annular repair hydrogels. This investigation demonstrated that chondroitinase removed proteoglycans within annulus fibrosus tissue, enhanced the interaction of an injected collagen gel with the native tissue, and mechanically improved adhesion between the collagen gel and annulus fibrosus. This is the first study of its kind to evaluate the biochemical and mechanical effects of short-term chondroitinase digestion on annulus fibrosus tissue.
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Vaishnav AS, Saville P, McAnany S, Kirnaz S, Wipplinger C, Navarro-Ramirez R, Hartl R, Yang J, Gang CH, Qureshi SA. Retrospective Review of Immediate Restoration of Lordosis in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison of Static and Expandable Interbody Cages. Oper Neurosurg (Hagerstown) 2019; 18:518-523. [DOI: 10.1093/ons/opz240] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/29/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Sagittal alignment is an important consideration in spine surgery. The literature is conflicted regarding the effect of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) on sagittal parameters and the role of expandable cage technology.
OBJECTIVE
To compare lordosis generated by static and expandable cages and to determine what factors affect postoperative sagittal parameters.
METHODS
Preoperative regional lordosis (RL), segmental lordosis (SL), and posterior disc height (PDH) were compared to postoperative values in single-level MI-TLIF performed using expandable or static cages. Patients were stratified based on preoperative SL: low lordosis (<15 degrees), moderate lordosis (15-25 degrees), and high lordosis (>25 degrees). Regression analyses were conducted to determine factors associated with postoperative SL and PDH.
RESULTS
Of the 171 patients included, 111 were in the static and 60 in the expandable cohorts. Patients with low preoperative lordosis experienced an increase in SL and maintained RL regardless of cage type. Those with moderate to high preoperative lordosis experienced a decrease in SL and RL with the static cage, but maintained SL and RL with the expandable cage. Although both cohorts showed an increase in PDH, the increase in the expandable cohort was greater. Preoperative SL was predictive of postoperative SL; preoperative SL, preoperative PDH, and cage type were predictive of postoperative PDH.
CONCLUSION
Expandable cages showed favorable results in restoring disc height and maintaining lordosis in the immediate postoperative period. Preoperative SL was the most significant predictor of postoperative SL. Thus, preoperative radiographic parameters and goals of surgery should be important considerations in surgical planning.
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Affiliation(s)
| | | | | | | | | | | | - Roger Hartl
- Weill Cornell Medical College, New York, New York
| | | | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, New York
- Weill Cornell Medical College, New York, New York
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Kirnaz S, Sloan S, Wipplinger C, Schmidt FA, Hartl R, Bonassar LJ. Combined Nucleus Pulposus Augmentation and Annulus Fibrosus Repair Prevents Intervertebral Disc Degeneration After Discectomy. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
The objective of the current study is to assess the efficacy of combined annulus fibrosus (AF) using a high-density collagen (HDC) gel and nucleus pulposus (NP) repair using a hyaluronic acid (HA) gel in an in Vivo sheep model.
METHODS
We performed an anterolateral, retroperitoneal prepsoas approach to access the IVDs L1-6 in a total of 8 skeletally mature Finn sheep. IVDs were randomized into 5 groups: (1) intact, (2) injured via 3 × 10 mm box annulotomy and removal of 200 mg of NP, (3) injury and HDC gel patch for AF repair, (4) injury and injection of a HA gel into the NP, and (5) injury and HDC AF repair and NP HA replacement. At 6 wk postoperatively, sheep were sacrificed and underwent postmortem 3T-MRI scans as well as gross anatomical and histological evaluation. Disc height index (DHI) analysis and Pfirrmann grading (PG) were performed on each segment using MR images.
RESULTS
Intact control discs were not degenerated and had an average PG of 1 while injured, and untreated discs had a significant degeneration with an average PG of 3. Discs receiving the combined injection and collagen AF patch individually showed fewer signs of degeneration than injured alone, and the combined treatment resulted in the least amount of degeneration with PG not significantly different from the intact controls. DHI confirmed the trends seen in the PG, where injured discs lost 20% of the intact disc height, the individual NP and AF repairs restored 5% to 10% of intact disc height, and the combined repairs preserved 90% of the intact disc height.
CONCLUSION
PG and DHI results demonstrate that individual NP and AF repairs are able to prevent disc degeneration better than no treatment at all; however, the greatest preservation of disc health was seen with combined AF and NP repairs.
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Ghorbani M, Wipplinger C, Griessenauer CJ, Hejazian SE, Abadi FZ, Asaadi S. Pial Arteriovenous Fistula with Multiple Venous Aneurysms Resembling a Vein of Galen Aneurysmal Malformation; Case Report and Review of Literature. World Neurosurg 2019; 127:245-248. [DOI: 10.1016/j.wneu.2019.04.061] [Citation(s) in RCA: 3] [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: 02/04/2019] [Revised: 04/06/2019] [Accepted: 04/06/2019] [Indexed: 12/01/2022]
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Abstract
Minimally invasive surgical approaches for the treatment of spinal pathologies have accelerated over the past three decades and resulted in superior functional outcomes with less complications. Yet cervical pathologies have been slower to gain traction for multiple anatomical factors and its "high-risk" profile. Various minimally invasive techniques for cervical disease have now been described and validated in long-term studies with comparable outcomes to traditional open approaches and concomitant reduction in morbidity and socioeconomic costs. Transnasal operations can be used to treat ventral upper cervical disease, circumventing traditional and morbid transoral approaches. Posterior-based focused treatments for radiculopathy and myelopathy such as tubular-guided foraminotomies and unilateral laminotomies for bilateral cord decompression have also been described and becoming increasingly less invasive. Cervical fusions can now be performed percutaneously through modified, stand-alone facet joint cages that can be packed with allogeneic bone graft. These advances have been facilitated by the development of intraoperative imaging technologies (intraoperative CT) and 3-dimensional stereotactic navigation software. While this review focuses on these procedures and evidence-based outcomes data, the future for MIS applications in cervical spine surgery will continue to evolve over the coming years with wider indications and technological adjuncts.
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Affiliation(s)
- Ibrahim Hussain
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Franziska A Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
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Abstract
The unilateral laminotomy for bilateral decompression initially was described in the late 1990s and has evolved in conjunction with minimally invasive surgical instrumentation. This technique has been shown to significantly improve bilateral symptoms regardless of the side of approach. It also can be used for multilevel decompressions using the slalom technique with alternating lateralizing sites of access. The over-the-top technique involving a unilateral approach for bilateral decompression helps preserve the posterior tension band and can accomplish the operative goals with better clinical outcomes than traditional open approaches.
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Affiliation(s)
- Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY 10065, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY 10065, USA.
| | - Gibran Wibawa
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY 10065, USA
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY 10065, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY 10065, USA
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Schmidt FA, Navarro-Ramirez R, Chang L, Kirnaz S, Wipplinger C, Härtl R. Neural decompression in challenging cases: advantages and disadvantages. J Neurosurg Sci 2019; 63:541-547. [PMID: 30942055 DOI: 10.23736/s0390-5616.19.04705-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The peculiarity of extreme lateral interbody fusion (LLIF) is the achievement of indirect neural decompression of the spinal canal while distracting the intervertebral disc space using an interbody cage. In this manuscript we will review the potentials and limitations of this technique when treating degenerative disc disease of the lumbar spine. A literature search of the PubMed-National Library of Medicine was performed. Only articles in English were included. The current available literature demonstrates that LLIF is an effective method to decompress foraminal and central canal stenosis. Based on the current available literature LLIF effects on lateral recess stenosis are less consistent. The aim of this review is to provide with a thorough overview of the latest literature available and provide the audience with targeted-oriented published results that will eventually improve the decision-making process when using the LLIF technique.
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Affiliation(s)
- Franziska A Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, Cornell University, New York Presbyterian Hospital, New York, NY, USA
| | - Rodrigo Navarro-Ramirez
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, Cornell University, New York Presbyterian Hospital, New York, NY, USA
| | - Louis Chang
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, Cornell University, New York Presbyterian Hospital, New York, NY, USA
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, Cornell University, New York Presbyterian Hospital, New York, NY, USA
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, Cornell University, New York Presbyterian Hospital, New York, NY, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, Cornell University, New York Presbyterian Hospital, New York, NY, USA -
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Kirnaz S, Navarro-Ramirez R, Wipplinger C, Schmidt FA, Hussain I, Kim E, Härtl R. Minimally Invasive Transforaminal Lumbar Interbody Fusion using 3-Dimensional Total Navigation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2019; 18:E9-E10. [DOI: 10.1093/ons/opz042] [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: 08/07/2018] [Accepted: 02/14/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
This video demonstrates the workflow of a minimally invasive transforaminal interbody fusion (MIS-TLIF) using a portable intraoperative CT (iCT) scanner, (Airo®, Brainlab AG, Feldkirchen, Germany), combined with state-of-the-art total 3D computer navigation. The navigation is used not only for instrumentation but also for intraoperative planning throughout the procedure, inserting the cage, therefore, completely eliminating the need for fluoroscopy. In this video, we present a case of a 72-yr-old female patient with a history of lower back pain, right lower extremity radicular pain and weakness for 2 yr due to L4-L5 spondylolisthesis with instability and severe lumbar spinal stenosis. The patient is treated by a L4-L5 unilateral laminotomy for bilateral decompression (ULBD) and MIS-TLIF. MIS-TLIF using total 3D navigation significantly improves the workflow of the conventional TLIF procedure. The tailored access to the spine is translated into smaller but more efficient surgical corridors. This modification in a “total navigation” modality minimizes the staff radiation exposure to 0 by navigating in real time over iCT obtained images that can be acquired while the surgical staff is protected or outside the OR. Furthermore, this technique makes real-time and virtual intraoperative imaging of screws and their planned trajectory feasible. 3D Navigation eliminates the need for K-Wires, thus decreasing the risk of vascular penetration injury due to K-Wire malpositioning. 3D navigation can also predict the positioning of the interbody cage, thereby, decreasing the risk of malpositioning or subsidence. Patient consent was obtained prior to performing the procedure.
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Affiliation(s)
- Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Franziska Anna Schmidt
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Eliana Kim
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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Hernandez RN, Wipplinger C, Navarro-Ramirez R, Patsalides A, Tsiouris AJ, Stieg PE, Kirnaz S, Schmidt FA, Härtl R. Bow Hunter Syndrome with Associated Pseudoaneurysm. World Neurosurg 2019; 122:53-57. [DOI: 10.1016/j.wneu.2018.10.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 02/08/2023]
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Wipplinger C, Melcher C, Hernandez RN, Lener S, Navarro-Ramirez R, Kirnaz S, Schmidt FA, Kim E, Härtl R. "One and a half" minimally invasive transforaminal lumbar interbody fusion: single level transforaminal lumbar interbody fusion with adjacent segment unilateral laminotomy for bilateral decompression for spondylolisthesis with bisegmental stenosis. J Spine Surg 2018; 4:780-786. [PMID: 30714010 DOI: 10.21037/jss.2018.10.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Symptomatic lumbar spondylolisthesis is commonly accompanied by spinal stenosis in multiple segments. These pathologies are routinely treated by multilevel decompression and instrumented fusion. However, it was hypothesized that a minimally invasive surgery (MIS) fusion in the unstable segment combined with a unilateral laminotomy for bilateral decompression (ULBD) in the adjacent stenotic segment is a biomechanically feasible alternative to a two-level fusion and superior to open laminectomy adjacent to a fused segment. This concept has demonstrated success in a recently published biomechanical cadaver study performed by our group. The present article offers a detailed step by step technical description for an MIS-TLIF (transforaminal lumbar interbody fusion) with adjacent ULBD.
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Affiliation(s)
- Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Carolin Melcher
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - R Nick Hernandez
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Sara Lener
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Franziska Anna Schmidt
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Eliana Kim
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
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Moriguchi Y, Borde B, Berlin C, Wipplinger C, Sloan SR, Kirnaz S, Pennicooke B, Navarro-Ramirez R, Khair T, Grunert P, Kim E, Bonassar L, Härtl R. In vivo annular repair using high-density collagen gel seeded with annulus fibrosus cells. Acta Biomater 2018; 79:230-238. [PMID: 29981494 DOI: 10.1016/j.actbio.2018.07.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 05/25/2018] [Accepted: 07/03/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim is assessing the in vivo efficacy of annulus fibrosus (AF) cells seeded into collagen by enhancing the reparative process around annular defects and preventing further degeneration in a rat-tail model. SUMMARY OF BACKGROUND DATA Treating disc herniation with discectomy may relieve the related symptoms but does not address the underlying pathology. The persistent annular defect may lead to re-herniation and further degeneration. We recently demonstrated that riboflavin crosslinked high-density collagen gels (HDC) can facilitate annular repair in vivo. METHODS 42 rats, tail disc punctured with an 18-gauge needle, were divided into 3 groups: untreated (n = 6), injected with crosslinked HDC (n = 18), and injected with AF cell-laden crosslinked HDC (n = 18). Ovine AF cells were mixed with HDC gels prior to injection. X-rays and MRIs were conducted over 5 weeks, determining disc height index (DHI), nucleus pulposus (NP) size, and hydration. Histological assessments evaluated the viability of implanted cells and degree of annular repair. RESULTS Although average DHIs of both HDC gel groups were higher than those of the puncture control group at 5 weeks, the retention of disc height, NP size and hydration at 1 and 5 weeks was significant for the cellular group compared to the punctured, and at 5 weeks to the acellular group. Histological assessment indicated that AF cell-laden HDC gels have accelerated reparative sealing compared to acellular HDC gels. CONCLUSIONS AF cell-laden HDC gels have the ability of better repairing annular defects than acellular gels after needle puncture. STATEMENT OF SIGNIFICANCE This project addresses the compelling demand of a sufficient treatment strategy for degenerative disc disease (DDD) perpetuated by annulus fibrosus (AF) injury, a major cause of morbidity and burden to health care systems. Our study is designed to answer the question of whether injectable, photo-crosslinked, high density collagen gels can seal defects in the annulus fibrosus of rats and prevent disc degeneration. Furthermore, we investigated whether the healing of AF defects will be enhanced by the delivery of AF cells (fibrochondrocytes) to these defects. The use of cell-laden collagen gels in spine surgery holds promise for a wide array of applications, from current discectomy procedures to future nucleus pulposus reparative therapies, and our group is excited about this potential.
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Wipplinger C, Simian A, Hernandez RN, Navarro-Ramirez R, Kim E, Kirnaz S, Schmidt FA, Fink ME, Härtl R. Superficial Siderosis of Central Nervous System as Primary Clinical Manifestation Secondary to Intradural Thoracic Disk Herniation. World Neurosurg 2018; 119:40-44. [PMID: 30048787 DOI: 10.1016/j.wneu.2018.07.117] [Citation(s) in RCA: 2] [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: 05/19/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Superficial siderosis of the central nervous system is a rare neurologic disorder characterized by the superficial deposition of hemosiderin in the subpial layer resulting in iron-related progressive neurodegeneration. CASE DESCRIPTION In this report, we present a case of superficial siderosis of the central nervous system secondary to an intradural thoracic disk herniation causing a cerebrospinal fluid (CSF) leak. CONCLUSIONS The patient was successfully treated with T6-T8 transpedicular partial corpectomy, as well as diskectomy with decompression followed by watertight closure of the CSF leak. Intraoperative watertight closure of the CSF leak was achieved.
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Affiliation(s)
- Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Andrea Simian
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, New York, USA
| | - R Nick Hernandez
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Eliana Kim
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Franziska Anna Schmidt
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Matthew E Fink
- Department of Neurology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, New York, USA.
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50
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Tschugg A, Kavakebi P, Hartmann S, Lener S, Wipplinger C, Löscher WN, Neururer S, Wildauer M, Thomé C. Clinical and radiological effect of medialized cortical bone trajectory for lumbar pedicle screw fixation in patients with degenerative lumbar spondylolisthesis: study protocol for a randomized controlled trial (mPACT). Trials 2018; 19:129. [PMID: 29463278 PMCID: PMC5819638 DOI: 10.1186/s13063-018-2504-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/30/2016] [Accepted: 01/29/2018] [Indexed: 12/26/2022] Open
Abstract
Background Spinal fusion with pedicle screw fixation represents the gold standard for lumbar degenerative disc disease with instability. Although it is an established technique, it is nevertheless an invasive intervention with high complication rates. Therefore, minimally invasive approaches have been developed, the medialized bilateral screw pedicel fixation (mPACT) being one of them. The study objective is to evaluate prospectively the efficacy and safety of the mPACT technique compared with the traditional trajectory for degenerative lumbar spondylolisthesis. Methods/design This is a single-center, randomized, controlled, parallel group, superiority trial. A total of 154 adult patients are allocated in a ratio of 1:1. Sample size and power calculation were performed to detect the minimal clinically important difference of 10%, with an expected standard deviation of 20% in the primary outcome parameter, the Oswestry Disability Index, with power of 80%, based on an assumed maximal dropout rate of 20%. Secondary outcome parameters include the EuroQoL 5-Dimension questionnaire, the Beck Depression Inventory, the painDETECT questionnaire and the “timed up and go” test. Furthermore, radiological and health economic outcomes will be evaluated. Follow up is performed until 5 years after surgery. Major inclusion criteria are lumbar degenerative spondylolisthesis with Meyerding grade I or II, which qualifies for decompression and fusion by medialised posterior screw placement with cortical trajectory (mPACT) or by a traditional trajectory for lumbar pedicle screw placement. Discussion This trial will contribute to the understanding of the short-term and long-term clinical and radiological postoperative course in patients with lumbar degenerative disc disease, in which the mPACT technique is used. Trial registration ISRCTN registry, ISRCTN99263604. Registered on 3 November 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2504-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja Tschugg
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria.
| | - Pujan Kavakebi
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Christoph Wipplinger
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabrina Neururer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Wildauer
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
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