1
|
D'Angiolillo JC, Patel NV, Hernandez RN, Hanft S. Bilateral Lumbar Radiculopathy Secondary to Myxopapillary Ependymoma: A Case Report. J Chiropr Med 2021; 20:170-175. [DOI: 10.1016/j.jcm.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 10/18/2022] Open
|
2
|
Hernandez RN, Carminucci A, Patel P, Hargreaves EL, Danish SF. Magnetic Resonance-Guided Laser-Induced Thermal Therapy for the Treatment of Progressive Enhancing Inflammatory Reactions Following Stereotactic Radiosurgery, or PEIRs, for Metastatic Brain Disease. Neurosurgery 2020; 85:84-90. [PMID: 29860422 DOI: 10.1093/neuros/nyy220] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 12/20/2017] [Accepted: 04/28/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In patients who have previously undergone maximum radiation for metastatic brain tumors, a progressive enhancing inflammatory reaction (PEIR) that represents either tumor recurrence or radiation necrosis, or a combination of both, can occur. Magnetic resonance-guided laser-induced thermal therapy (LITT) offers a minimally invasive treatment option for this problem. OBJECTIVE To report our single-center experience using LITT to treat PEIRs after radiosurgery for brain metastases. METHODS Patients with progressive, enhancing reactions at the site of prior radiosurgery for metastatic brain tumors and who had a Karnofsky performance status of ≥70 were eligible for LITT. The primary endpoint was local control. Secondary end points included dexamethasone use and procedure-related complications. RESULTS Between 2010 and 2017, 59 patients who underwent 74 LITT procedures for 74 PEIRs met inclusion criteria. The mean pre-LITT PEIR size measured 3.4 ± 0.4 cm3. At a median follow-up of 44.6 wk post-LITT, the local control rate was 83.1%. Most patients were weaned off steroids post-LITT. Patients experiencing a post-LITT complication were more likely to remain on steroids indefinitely. The rate of new permanent neurological deficit was 3.4%. CONCLUSION LITT is an effective treatment for local control of PEIRs after radiosurgery for metastatic brain disease. When possible, we recommend offering LITT once PEIRs are identified and prior to the initiation of high-dose steroids for symptom relief.
Collapse
Affiliation(s)
- R Nick Hernandez
- Department of Neurological Surgery, Rutgers University, New Brunswick, New Jersey
| | - Arthur Carminucci
- Department of Neurological Surgery, Rutgers University, New Brunswick, New Jersey
| | - Purvee Patel
- Department of Neurological Surgery, Rutgers University, New Brunswick, New Jersey
| | - Eric L Hargreaves
- Department of Neurological Surgery, Rutgers University, New Brunswick, New Jersey
| | - Shabbar F Danish
- Department of Neurological Surgery, Rutgers University, New Brunswick, New Jersey
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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]
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Del Castillo-Calcáneo J, Navarro-Ramirez R, Gimenez-Gigon M, Adjei J, Damolla A, Nakhla J, Hernandez RN, Hartl R. Principles and Fundamentals of Minimally Invasive Spine Surgery. World Neurosurg 2018. [DOI: 10.1016/j.wneu.2018.06.205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
9
|
Bustillo MA, Lien CA, Mack PF, Kopman DJ, Safavynia SA, Rubin L, Stein D, Hartl R, Stieg PE, Hernandez RN, Goldstein PA. Optimizing Patient Access During an Emergency While Using Intraoperative Computed Tomography. World Neurosurg 2018; 121:274-278.e1. [PMID: 30266700 DOI: 10.1016/j.wneu.2018.09.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND As minimally invasive spine surgery evolves, spine surgeons increasingly rely on advanced intraoperative computed tomography (iCT). iCT provides rapid acquisition of high-resolution images, reduces radiation exposure, improves surgical accuracy, and decreases operative time. However, all iCT systems currently available pose a patient safety risk as their physical space requirements limit patient access in the event of an emergency, particularly when patients are in the prone position. After a near-cardiac arrest at our institution during posterior cervical spine surgery, it was apparent that the presence of the iCT complicated the ability to rapidly reposition the patient in order to provide appropriate resuscitation. METHODS To ensure our ability to provide timely care during an emergency, we determined that a process which included all members of the operating room (OR) team was required. We held an initial planning meeting where a detailed plan-of-action was created, reviewed, and revised in response to feedback from all stakeholders. We then simulated a cardiac arrest to test our resuscitation plan with all members of the neurosurgery team. A mannequin was positioned prone on an OR table within the iCT, and a resuscitation plan was created. RESULTS The team orchestrated the mock resuscitation, and the time of cardiac arrest in the prone position to supine repositioning required 110 seconds. The simulation was recorded for post-"code" performance review. Application of the protocol during an actual cardiac arrest was associated with successful restoration of spontaneous circulation and full recovery. CONCLUSIONS The development and rehearsal of an emergency plan of action greatly facilitated the timely responsiveness of the neurosurgical OR team during a simulated cardiac arrest and was an effective way to identify and address key logistical issues regarding the use of an iCT system.
Collapse
Affiliation(s)
- Maria A Bustillo
- Division of Neuroanesthesiology, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA.
| | - Cynthia A Lien
- Division of Neuroanesthesiology, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Patricia Fogarty Mack
- Division of Neuroanesthesiology, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - David J Kopman
- Division of Neuroanesthesiology, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Seyed A Safavynia
- Division of Neuroanesthesiology, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Lori Rubin
- Division of Neuroanesthesiology, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - David Stein
- Division of Neuroanesthesiology, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Roger Hartl
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - R Nick Hernandez
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Peter A Goldstein
- Division of Neuroanesthesiology, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA; Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Abstract
PURPOSE Mondini dysplasia is a rare congenital inner ear malformation that presents with abnormal cochlear development with accompanied vestibular dilation and vestibular aqueduct enlargement. This dysfunctional anatomy provides the potential for sensorineural hearing deficits, cerebrospinal fluid leaks, and severe cases of recurrent meningitis. METHODS We present the case of a child with Mondini dysplasia who presented with unilateral hearing loss and cerebrospinal fluid (CSF) otorrhea that was surgically repaired through a combined middle fossa/transmeatal middle ear approach to alleviate any recurrence of infection and cerebrospinal fluid otorrhea. RESULTS Postoperatively, the patient remained neurologically stable without any further CSF leakage. CSF cultures revealed a Pseudomonas aeruginosa infection, a rare occurrence within the context of Mondini dysplasia. Retrograde bacterial spread from the external ear canal into the CSF space has been theorized as the possible pathogenesis of the resulting meningitis. The patient was successfully treated with intravenous antibiotics without any neurologic complications. CONCLUSIONS Although Mondini dysplasia is a rare malformation, the life-threatening sequelae of meningitis that can result from the dysfunctional anatomy makes it a condition that requires elevated clinical vigilance, especially when considering children with hearing loss associated with recurrent meningitis, otorrhea, or rhinorrhea.
Collapse
Affiliation(s)
- R Nick Hernandez
- Department of Neurological Surgery, New Jersey Medical School, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | | | | | | | | |
Collapse
|
12
|
Hernandez RN, Feinberg RL, Vaurio R, Passanante NM, Thompson RE, Kaufmann WE. Autism spectrum disorder in fragile X syndrome: a longitudinal evaluation. Am J Med Genet A 2009; 149A:1125-37. [PMID: 19441123 DOI: 10.1002/ajmg.a.32848] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study extends our previous work on characterizing the autistic behavior profile of boys with fragile X syndrome (FXS) who meet Diagnostic and Statistical Manual for Mental Disorders, 4th Edition criteria for autism spectrum disorder (ASD) into a longitudinal evaluation of ASD in FXS (FXS + ASD). Specifically, we aimed to determine the stability of the diagnosis and profile of ASD in FXS over time. Through regression models, we also evaluated which autistic and social behaviors and skills were correlates of diagnosis and autistic behavior severity (i.e., Autism Diagnostic Interview-Revised total scores). Finally, we assessed the evolution of cognitive parameters in FXS + ASD. A population of 56 boys (30-88 months at baseline) with FXS was evaluated using measures of autistic, social, and cognitive behaviors and skills at three yearly evaluations. We found that the diagnosis of ASD in FXS was relatively stable over time. Further emphasizing this stability, we found a set of behaviors and skills, particularly those related to peer relationships and adaptive socialization, that differentiated FXS + ASD from the rest of the FXS cohort (FXS + None) and contributed to autistic severity at all time points. Nevertheless, the general improvement in autistic behavior observed in FXS + ASD coupled with the concurrent worsening in FXS + None resulted in less differentiation between the groups over time. Surprisingly, FXS + ASD IQ scores were stable while FXS + None non-verbal IQ scores declined. Our findings indicate that ASD is a distinctive subphenotype in FXS characterized by deficits in complex social interaction, with similarities to ASD in the general population.
Collapse
|