Publications by authors named "Aaron S Dumont"

274 Publications

Bilateral venous sinuses of Kelch.

Anat Cell Biol 2021 Apr 26. Epub 2021 Apr 26.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.

Knowledge of the variant anatomy of the intradural venous sinuses is important to anatomists and clinicians alike. Herein, we report a cadaveric case of the rare venous sinus of Kelch, which some have believed is a remnant of the cranio-orbital sinuses. To our knowledge, only one other cadaveric case has been reported in the extant medical literature. Clinically, knowledge of such a variant venous sinus can minimize misdiagnoses such as when anatomical variations are noted on imaging. Surgically, such an understanding can avoid intraoperative complications such as iatrogenic hemorrhage.
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http://dx.doi.org/10.5115/acb.21.042DOI Listing
April 2021

Social Perception and Academic Trends on Women in the Field of Neurosurgery: A Bibliometric Analysis.

World Neurosurg 2021 Apr 22. Epub 2021 Apr 22.

Department of Neurosurgery, Ochsner Neuroscience Institute, New Orleans, LA, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.

Background: The ongoing trend of societal evolution in contemporary civilization has allowed increased inclusion of heterogenous identity groups into fields, such as neurosurgery, where certain groups have traditionally been underrepresented. In regard to the field of neurosurgery, the increasing recognition of the disparities faced by women is illustrated by a growing body of academic literature.

Methods: We conducted a bibliometric analysis querying the PubMed, Web of Science (WoS), Scopus, and Embase databases for articles on women in neurosurgery using the MeSH terms "woman," "women," "gender," neurosurgery," neurological surgery," and "neurosurgeon". Articles were excluded if they do not concern societal impact of non-male population in the context of neurosurgery. Total citations, mean citations per year, publishing journal information, and author demographics were abstracted from included reports. Associations between abstracted continuous variables was evaluated using the Pearson correlation coefficient. Derived p-values of less than 0.05 were taken as significant.

Results: A total of 49 articles were included. Total numbers of citations per report were positively associated with mean citations per year (r=0.7289, p=0.0253) the latter of which was slightly negatively associated with the age of the report (r=-0.0413, p=0.0009). Age of publication year was found to be negatively correlated with the number of reports published per year (r=-0.648, p=0.0066). Total citations per reports were significantly correlated with increased numbers of citations during the last completed calendar year (2019: r=0.8956, p=0.0397).

Conclusion: ecognition in societal evolutionary trends as evidenced by academic activity has shown increased focus on the explicit and intrinsic biases faced by women in neurosurgery. Recent years have seen significant increases in published reports concerning the subject as well as rising academic impact per a given report. This phenomenon is speculated to continue and understanding to broaden as societal perception continues to develop.
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http://dx.doi.org/10.1016/j.wneu.2021.04.056DOI Listing
April 2021

#15 Versus #15c Scalpel Blades for Skin Incisions: Accuracy With and Without Magnification.

Dermatol Surg 2021 Apr 13. Epub 2021 Apr 13.

Departments of Neurosurgery, Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Division of General Dentistry, Nippon Dental University Hospital, Tokyo, Japan; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana.

Background: Use of a #15 blade is the most popular way for making skin incisions in dermatology. For finer and more accurate incisions, a #15c blade can be used. However, there is no evidence that demonstrates the superiority of the #15c blade over the #15 blade.

Objective: This study aimed to compare the skin incisions made with a #15 blade and #15c blade using varied magnifications.

Methods And Materials: Twenty fresh chicken thighs with intact skin were used in this study. Incisions were made on the skin using #15 and #15c blades with ×1.0, ×2.5, and ×5.0 magnification. The accuracy of the incision (length and depth) made by the different scalpel blades and magnifications was analyzed using the 2 × 3 chi-squared test. Logistic regression analysis was applied to determine factors of the incision depth and length.

Results: No statistically significant differences were found in the evaluations of length or depth using the 2 × 3 chi-squared test. However, the multiple logistic regression analyses showed that the incision length and depth were associated with use of the #15c scalpel blade.

Conclusion: Use of a #15c scalpel blade with ×5.0 magnification is recommended for making incisions when less than 1- to 2-mm accuracy is required.
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http://dx.doi.org/10.1097/DSS.0000000000002993DOI Listing
April 2021

Commentary: Neurosurgery Resident Interviews: The Prevalence and Impact of Inappropriate and Potentially Illegal Questions.

Neurosurgery 2021 Apr 7. Epub 2021 Apr 7.

Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA.

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http://dx.doi.org/10.1093/neuros/nyab117DOI Listing
April 2021

Lateral Supracondylar Spur Process of the Humerus.

Cureus 2021 Feb 23;13(2):e13514. Epub 2021 Feb 23.

Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA.

The supracondylar process is a rare but commonly reported anatomical variant of the humerus. Though it is usually asymptomatic, it can lead to serious symptoms. In this report, a lateral supracondylar process of the humerus was found. This is much rarer than a medial supracondylar process, and to our knowledge, it has not been reported previously. Surgeons and radiologists must account for supracondylar process variations to diagnose neurovascular pathology in the forearm accurately and quickly to optimize surgical outcomes. Here, we describe the origin and clinical importance of the supracondylar process variant.
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http://dx.doi.org/10.7759/cureus.13514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009452PMC
February 2021

Effects of the COVID-19 Pandemic on Operative Volume and Residency Training at Two Academic Neurosurgery Centers in New Orleans.

World Neurosurg 2021 Mar 31. Epub 2021 Mar 31.

Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA.

Background: Medical subspecialties including neurosurgery have seen a dramatic shift in operative volume in the wake of the coronavirus disease 2019 (COVID-19) pandemic. The goal of this study was to quantify the effects of the COVID-19 pandemic on operative volume at 2 academic neurosurgery centers in New Orleans, Louisiana, USA from equivalent periods before and during the COVID-19 pandemic.

Methods: A retrospective review was conducted analyzing neurosurgical case records for 2 tertiary academic centers from March to June 2020 and March to June 2019. The records were reviewed for variables including institution and physician coverage, operative volume by month and year, cases per subspecialty, patient demographics, mortality, and morbidity.

Results: Comparison of groups showed a 34% reduction in monthly neurosurgical volume per institution during the pandemic compared with earlier time points, including a 77% decrease during April 2020. There was no change in mortality and morbidity across institutions during the pandemic.

Conclusions: The COVID-19 pandemic has had a significant impact on neurosurgical practice and will likely continue to have long-term effects on patients at a time when global gross domestic products decrease and relative health expenditures increase. Clinicians must anticipate and actively prepare for these impacts in the future.
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http://dx.doi.org/10.1016/j.wneu.2021.03.122DOI Listing
March 2021

Split Azygos Vein: A Case Report.

Cureus 2021 Feb 15;13(2):e13362. Epub 2021 Feb 15.

Neurosurgery, Tulane University School of Medicine, New Orleans, USA.

The azygos venous system, which comprises the azygos, hemiazygos, and accessory hemiazygos veins, assists in blood drainage into the superior vena cava (SVC) from the thoracic cage and portions of the posterior mediastinum. Routine dissection of a fresh-frozen cadaveric specimen revealed a split azygos vein. The azygos vein branched off the inferior vena cava (IVC) at the level of the second lumbar vertebra as a single trunk and then split into two tributaries after forming a venous plexus. The right side of this system drained into the SVC and, inferiorly, the collective system drained into the IVC. Variant forms in the venous system, especially the vena cavae, are prone to dilation and tortuosity, leading to an increased likelihood of injury. Knowledge of the anatomical variations of the azygos vein is important for surgeons who use an anterior approach to the spine for diverse procedures.
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http://dx.doi.org/10.7759/cureus.13362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970156PMC
February 2021

Review of the external carotid plexus: anatomy, function, and clinical manifestations.

Anat Cell Biol 2021 Mar 18. Epub 2021 Mar 18.

Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.

The external carotid plexus is a combination of postganglionic sympathetic fibers derived from the superior cervical ganglion. This plexus travels along the external carotid artery and continues onto the artery's branches. The external carotid plexus plays an important role in innervating the mid and lower face. Therefore, implications to the plexus may result in facial abnormalities. Herein, we review the anatomy, function, and review its clinical applications.
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http://dx.doi.org/10.5115/acb.20.308DOI Listing
March 2021

Commentary: Intracerebral Hemorrhage Volume Reduction and Timing of Intervention Versus Functional Benefit and Survival in the MISTIE III and STICH Trials.

Neurosurgery 2021 Apr;88(5):E391-E393

Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA.

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http://dx.doi.org/10.1093/neuros/nyab016DOI Listing
April 2021

The Global Burden of Neural Tube Defects and Disparities in Neurosurgical Care.

World Neurosurg 2021 May 1;149:e803-e820. Epub 2021 Feb 1.

Department of Neurosurgery, Tulane University Medical Center, New Orleans, Louisiana, USA.

Background: Despite the success of folic acid fortification programs, neural tube defects (NTDs) such as spina bifida, encephalocele, and anencephaly remain among the most substantial causes of childhood morbidity and mortality worldwide. Although these are complicated conditions that require an interdisciplinary approach to care, definitive treatment of survivable NTDs is often neurosurgical.

Methods: Using Global Burden of Disease data, we examined the global burden of NTDs as related to a nation's wealth, health care quality, and access to neurosurgical care. We abstracted data for death by cause, years lived with disability (YLD), gross domestic product (GDP), United Nations geoscheme, Food Fortification Initiative participation, and Healthcare Access and Quality Index. We compared means using 1-way analysis of variance and proportions using Fisher exact tests, with statistical significance as α = 0.05.

Results: Seventeen of 20 (85%) nations with the most deaths caused by NTDs (P < 0.0001) and 15/20 (75%) nations with the highest YLD (P < 0.0001) were in the lowest GDP quartile. Deaths and YLD were negatively correlated with increasing GDP and Healthcare Access and Quality Index (P < 0.0001). The nations with the highest disease burdens also had the fewest neurosurgeons per capita.

Conclusions: Despite the success of folic acid fortification programs, greater global public health efforts should be placed on improving access to neurosurgical care in low and middle-income nations through sustainable initiatives such as surgeon exchange programs and the establishment of neurosurgery residency training programs.
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http://dx.doi.org/10.1016/j.wneu.2021.01.096DOI Listing
May 2021

Anatomical Study of the Posterior Spinal Artery Branches to the Medulla Oblongata.

World Neurosurg 2021 May 8;149:e1098-e1104. Epub 2021 Jan 8.

Department of Neurosurgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada.

Background: The posterior spinal arteries (PSAs), branches of the intracranial segment of the vertebral artery or posterior inferior cerebellar artery, run bilaterally along the spinal cord and are integral to the blood supply primarily to the posterior one third of this structure. However, a less well-described distribution of the PSAs is their supply to the posterior medulla. The purpose of this study is to examine the medullary branches of the PSA anatomically.

Methods: We conducted a cadaveric study to evaluate for branches of the PSA supplying the medulla oblongata.

Results: All 14 sides had medullary branches arising from the PSAs. The average number of branches supplying the medulla oblongata on each side was 6. Most of these branches traveled laterally to anastomose with medullary branches arising from the anterior spinal artery. Additionally, lateral and ascending branches were noted.

Conclusions: Physicians who interpret imaging of the craniocervical junction, in particular arteriograms, should be aware of ascending medullary branches arising from the anterior spinal artery. Additionally, neurosurgeons operating this region must be careful in dissecting over the posterior medulla and manipulating the cerebellar tonsils, as in telovelar approaches to the fourth ventricle, in order to avoid iatrogenic injury to these vessels. Additionally, variable stroke patterns involving the vertebral artery or posterior inferior cerebellar artery might include ischemia to the medulla oblongata via PSA branches, and this anatomy should be kept in mind by interventionalists, radiologists, and neurologists alike.
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http://dx.doi.org/10.1016/j.wneu.2020.12.161DOI Listing
May 2021

Aneurysmal subarachnoid hemorrhage during pregnancy: a comprehensive and systematic review of the literature.

Neurosurg Rev 2021 Jan 7. Epub 2021 Jan 7.

Department of Neurological Surgery, Tulane University, New Orleans, LA, USA.

Aneurysmal subarachnoid hemorrhage (aSAH) is an emergent condition requiring rapid intervention and prolonged monitoring. There are few recommendations regarding the management of aSAH in pregnancy. We identified all available literature and compiled management decisions as well as reported outcomes through a systematic literature review without meta-analysis to provide recommendations for management of aSAH during pregnancy. We included a total of 23 articles containing 54 cases of pregnancy-related aSAH in our review. From these reports and other literature, we evaluated information on aSAH pathophysiology, diagnosis, and management with respect to pregnancy. Early transfer to an appropriate facility with neurocritical care, a high-risk obstetric service, and a neurosurgery team available is crucial for the management of aSAH in pregnancy. Intensive monitoring and a multidisciplinary approach remain fundamental to ensure maternal and fetal health.
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http://dx.doi.org/10.1007/s10143-020-01457-2DOI Listing
January 2021

Update: Microdialysis for Monitoring Cerebral Metabolic Dysfunction after Subarachnoid Hemorrhage.

J Clin Med 2020 Dec 30;10(1). Epub 2020 Dec 30.

Clinical Neuroscience Research Center, Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.

Cerebral metabolic dysfunction has been shown to extensively mediate the pathophysiology of brain injury after subarachnoid hemorrhage (SAH). The characterization of the alterations of metabolites in the brain can help elucidate pathophysiological changes occurring throughout SAH and the relationship between secondary brain injury and cerebral energy dysfunction after SAH. Cerebral microdialysis (CMD) is a tool that can measure concentrations of multiple bioenergetics metabolites in brain interstitial fluid. This review aims to provide an update on the implication of CMD on the measurement of metabolic dysfunction in the brain after SAH. A literature review was conducted through a general PubMed search with the terms "Subarachnoid Hemorrhage AND Microdialysis" as well as a more targeted search using MeSh with the search terms "Subarachnoid hemorrhage AND Microdialysis AND Metabolism." Both experimental and clinical papers were reviewed. CMD is a suitable tool that has been used for monitoring cerebral metabolic changes in various types of brain injury. Clinically, CMD data have shown the dramatic changes in cerebral metabolism after SAH, including glucose depletion, enhanced glycolysis, and suppressed oxidative phosphorylation. Experimental studies using CMD have demonstrated a similar pattern of cerebral metabolic dysfunction after SAH. The combination of CMD and other monitoring tools has also shown value in further dissecting and distinguishing alterations in different metabolic pathways after brain injury. Despite the lack of a standard procedure as well as the presence of limitations regarding CMD application and data interpretation for both clinical and experimental studies, emerging investigations have suggested that CMD is an effective way to monitor the changes of cerebral metabolic dysfunction after SAH in real-time, and alternatively, the combination of CMD and other monitoring tools might be able to further understand the relationship between cerebral metabolic dysfunction and brain injury after SAH, determine the severity of brain injury and predict the pathological progression and outcomes after SAH. More translational preclinical investigations and clinical validation may help to optimize CMD as a powerful tool in critical care and personalized medicine for patients with SAH.
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http://dx.doi.org/10.3390/jcm10010100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794715PMC
December 2020

In Reply to the Letter to the Editor Regarding "'Two-Birds-One-Stone' Approach for Treating an Infant with Chiari I Malformation and Hydrocephalus: Is Cerebrospinal Fluid Diversion as Sole Treatment Enough?"

World Neurosurg 2021 Jan;145:528-529

Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Medical Center, New Orleans, Louisiana, USA.

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http://dx.doi.org/10.1016/j.wneu.2020.09.112DOI Listing
January 2021

Muscle Sparing C1-C2 Laminoplasty: Cadaveric Feasibility Study.

World Neurosurg 2021 Mar 13;147:e234-e238. Epub 2020 Dec 13.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, Grenada, West Indies; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.

Background: Posterior cervical approaches for atlantoaxial and craniovertebral junction pathologies with or without instrumentation are often associated with excessive soft tissue dissection and bleeding consequent with disruption of the venous plexus. A few minimally invasive approaches to this region have been reported from clinical and cadaveric studies in an effort to minimize blood loss, reduce soft tissue dissection, and decrease postoperative pain; however, unilateral minimally invasive approaches have not been described. Here, we describe a minimally invasive atlantoaxial and craniovertebral approach.

Methods: Using fresh cadavers, we performed a novel, right-sided, muscle-sparing minimally invasive C1-C2 laminotomy with laminoplasty for access to the atlantoaxial level and craniovertebral junction and used the traditional approach on left sides.

Results: Using this approach, the atlantoaxial space and craniovertebral junction with wide and generous exposure via unilateral soft tissue dissection and muscle splitting was achieved. After exposure, the musculoosseous unit was easily repositioned, thus allowing for C1-C2 laminoplasty. Grossly, no damage to the vertebral artery or regional nerves was noted.

Conclusions: We present a novel, unilateral minimally invasive approach to reach the atlantoaxial and craniovertebral junction. This could allow for faster postoperative recovery, less pain and opioid requirement, and increased maintenance of atlantoaxial stability. Such a technique, after being confirmed in patients, could optimize this surgical technique.
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http://dx.doi.org/10.1016/j.wneu.2020.12.028DOI Listing
March 2021

Lymphatic System of the Head and Neck.

J Craniofac Surg 2020 Nov 16. Epub 2020 Nov 16.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine.

An intimate knowledge of the lymphatic drainage of the head and neck is needed by the clinician examining and diagnosing patients with lesion of this region.It is considered that approximately 150 to 300 lymph nodes are located in the neck region. The classification of cervical lymph nodes by Rouvière has long been most widely referenced in textbooks and articles because it covers most of the lymph nodes of the head and neck region. Anatomical review of the lymphatic system of the head and neck helps surgeons understand and treat the patients who have any cancers and cancer metastasis in and around the head and neck regions. Regardless, comprehensive review of the lymphatic system of the head and neck has been rarely discussed. This paper details the anatomy of the lymphatics of these regions by reviewing related publications, books, official reports from the academic society and also describes the clinical manifestations and levels used in staging of the various lymph nodes with illustrations and computed tomographic images.
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http://dx.doi.org/10.1097/SCS.0000000000007230DOI Listing
November 2020

Chiari 1.5 malformation, accessory odontoid synchondrosis, and ventral compression: case report.

Anat Cell Biol 2021 Mar;54(1):128-131

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.

The pathogenesis of Chiari 1 malformations has been explained in several different ways, but extensive evidence suggests a relationship between loss of volume within the posterior cranial fossa and Chiari 1 presentations. It is important to be able to differentiate Chiari 1.5 from Chiari 1 malformations as they have similar clinical presentations, but the latter have progressed further and are characterized by caudal herniations of the brain stem through the foramen magnum. Despite the similarities of presentation, Chiari 1.5 malformations have greater rates of complications following posterior decompression surgeries, which are typically performed to relieve ventral compression. An improved understanding of the odontoid synchondroses could lead to better understanding of Chiari malformations and lead to improved treatment of patients with these presentations. Here we present a rare case of an accessory odontoid synchondrosis in a patient with a Chiari 1.5 malformation and ventral compression.
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http://dx.doi.org/10.5115/acb.20.264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017460PMC
March 2021

Sacral fractures: An updated and comprehensive review.

Injury 2021 Mar 6;52(3):366-375. Epub 2020 Nov 6.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.

Sacral fractures are often underdiagnosed but are relatively frequent in the setting of pelvic ring injury. Causes include traumatic insults and osteoporosis. Sacral fractures have become more frequent owing to the growth of the elderly population worldwide as osteoporosis is an age-related disease. Misdiagnosed and neglected sacral fractures can result in chronic back pain, spine deformity, and instability. Unfortunately, the wide range of classification systems hinders adequate communication among clinicians. Therefore, a complete understanding of the pathology, and communication within the interdisciplinary team, are necessary to ensure adequate treatment and satisfactory clinical outcomes. The aim of this manuscript is to present the current knowledge available regarding classification systems, clinical assessment, decision-making factors, and current treatment options.
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http://dx.doi.org/10.1016/j.injury.2020.11.015DOI Listing
March 2021

Anatomic Study Quantifying the Relationship Between the Arcuate Eminence and the Root of the Zygoma: Application to Skull Base Surgery.

World Neurosurg 2021 Feb 9;146:e773-e778. Epub 2020 Nov 9.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada.

Objective: The aim of this study was to define the structural relationship between the arcuate eminence (AE) and a known fixed external bony landmark, the root of the zygoma (ZR), and to determine its reliability as a consistent guide for guiding surgical approaches. To our knowledge, this is the only anatomic study to quantify the relationship between the AE and ZR.

Methods: Twenty-one dry temporal bones were measured using digital calipers. The distance from the posterior aspect of the ZR to the midpoint of the AE was measured. Additionally, the anteroposterior distance between the ZR and AE and vertical distance between the 2 structures were measured. Student's t-test was used to compare the left and right sides.

Results: An AE was found in every specimen. The mean ZR to AE distance was 30.9 mm. On most sides (91%), the ZR was located more inferiorly than the AE with a mean distance of 3 mm between the 2 structures. The mean distance between the AE and ZR was 17 mm. On all sides, the AE was located posterior to the ZR. No significant differences were found between sides. No anatomic variations or pathologic conditions were noted in any of the specimens.

Conclusions: The ZR is an easily identifiable and consistent bony landmark often used by skull base surgeons. In this investigation, we measured the anatomic relationships between the ZR and AE. Such data might assist in planning surgical trajectories and minimizing complications when skull base pathologies are approached.
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http://dx.doi.org/10.1016/j.wneu.2020.11.014DOI Listing
February 2021

Increased Utilization of Social Media in Neurosurgery During the COVID-19 Pandemic.

World Neurosurg 2020 11;143:575-576

Department of Neurological Surgery, Tulane University Medical Center, New Orleans, Louisiana, USA.

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http://dx.doi.org/10.1016/j.wneu.2020.08.199DOI Listing
November 2020

Triangular-Shaped Odontoid Process With Chiari 1 Malformation Patient.

Cureus 2020 Oct 4;12(10):e10788. Epub 2020 Oct 4.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA.

Several anatomical variations of osseous structures around the craniovertebral junction (CVJ) have been observed in those presenting with Chiari 1 malformation (CM-1) due to the junction's unique embryology and its pivotal role in neck stability. During a clinic visit, a 14-year-old female presented with the classic symptoms of CM-1. Upon follow-up imaging and confirmation of the inferiorly displaced cerebellar tonsils, a unique triangular-shaped odontoid process was identified. To our knowledge, this osseous malformation of the dens has not been reported in the current literature. This unique deviation may cause ligamentous instability and decreased motion capacity and predispose a patient to axial fractures. Thus, we aim to further discuss this case, cervical vertebrae axis (C2) embryology, and the resulting clinical significance of this observed odontoid process variant.
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http://dx.doi.org/10.7759/cureus.10788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606170PMC
October 2020

Direct drainage of the basal vein of Rosenthal into the superior petrosal sinus: a literature review.

Anat Cell Biol 2020 Dec;53(4):379-384

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.

An adult male was found to have a variation of the left basal vein of Rosenthal after presenting with complaints of headache and balance issues. In this case, the vein drained directly into the left superior petrosal sinus (SPS) instead of the great vein of Galen. Anatomical variation of the basal vein is likely due to embryonic development of the deep cerebral venous system as primitive structures either differentiate regress or further with age. These changes may result in the uncommon presentation seen in this case. To our knowledge, this is the first case that shows the basal vein drains into the SPS. The normal and variant anatomy of this vessel are discussed.
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http://dx.doi.org/10.5115/acb.20.199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769095PMC
December 2020

Duplication of the odontoid process with other congenital defects of the craniocervical Junction: case report and review of the literature.

Anat Cell Biol 2020 Dec;53(4):522-526

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.

Duplication of the odontoid process remains a rare developmental pathology that is underrepresented in the current literature. As the pivot point for the craniovertebral junction, the odontoid process is vital for the integrity of the atlanto-axial joint and the ability of the head and cervical spine to rotate correctly. The pathogenesis being incompletely understood, it has been proposed that odontoid process duplication involves faulty sclerotome migration and disruption of the axis ossification center. Patients presenting with this pathology usually have associated structural abnormalities. A detailed anatomical and embryological understanding of the odontoid process is necessary for successful management and treatment of patients presenting with odontoid process duplication. We present a rare case of a patient with a duplicated odontoid process in association with C2-C3 fusion, incomplete anterior arch of C1, variant inferior bony process of the transverse process of C1, and enlarged right jugular foramen.
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http://dx.doi.org/10.5115/acb.20.189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769104PMC
December 2020

Diabetes Mellitus/Poststroke Hyperglycemia: a Detrimental Factor for tPA Thrombolytic Stroke Therapy.

Transl Stroke Res 2021 Jun 2;12(3):416-427. Epub 2020 Nov 2.

Clinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA, 70122, USA.

Intravenous administration of tissue-type plasminogen activator (IV tPA) therapy has long been considered a mainstay in ischemic stroke management. However, patients respond to IV tPA therapy unequally with some subsets of patients having worsened outcomes after treatment. In particular, diabetes mellitus (DM) is recognized as a clinically important vascular comorbidity that leads to lower recanalization rates and increased risks of hemorrhagic transformation (HT). In this short-review, we summarize the recent advances in understanding of the underlying mechanisms involved in post-IV tPA worsening of outcome in diabetic stroke. Potential pathologic factors that are related to the suboptimal tPA recanalization in diabetic stroke include higher plasma plasminogen activator inhibitor (PAI)-1 level, diabetic atherogenic vascular damage, glycation of the tPA receptor annexin A2, and alterations in fibrin clot density. While factors contributing to the exacerbation of HT in diabetic stroke include hyperglycemia, vascular oxidative stress, and inflammation, tPA neurovascular toxicity and imbalance in extracellular proteolysis are discussed. Besides, impaired collaterals in DM also compromise the efficacy of IV tPA therapy. Additionally, several tPA combination approaches developed from experimental studies that may help to optimize IV tPA therapy are also briefly summarized. In summary, more research efforts are needed to improve the safety and efficacy of IV tPA therapy in ischemic stroke patients with DM/poststroke hyperglycemia.
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http://dx.doi.org/10.1007/s12975-020-00872-3DOI Listing
June 2021

Anatomical Considerations for Endovascular Intervention for Extracranial Carotid Disease: A Review of the Literature and Recommended Guidelines.

J Clin Med 2020 Oct 27;9(11). Epub 2020 Oct 27.

Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA.

Patient selection for endovascular intervention in extracranial carotid disease is centered on vascular anatomy. We review anatomical considerations for non-traumatic disease and offer guidelines in patient selection and management. We conducted a systematic literature review without meta-analysis for studies involving anatomical considerations in extracranial carotid intervention for non-traumatic disease. Anatomical considerations discussed included aortic arch variants, degree of vessel stenosis, angulation, tortuosity, and anomalous origins, and atheromatous plaque morphology, composition, and location. Available literature suggests that anatomical risks of morbidity are largely secondary to increased procedural times and difficulties in intervention system delivery. We recommend the prioritization of endovascular techniques on an individual basis in cases where accessible systems and surgeon familiarity provide an acceptable likelihood of rapid access and device deployment.
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http://dx.doi.org/10.3390/jcm9113460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693974PMC
October 2020

A comprehensive review of the great auricular nerve graft.

Neurosurg Rev 2020 Oct 20. Epub 2020 Oct 20.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA.

The great auricular nerve (GAN) is a superficial branch of the cervical plexus that innervates parts of the mandible, auricle, and earlobe. Over the past 30 years, the GAN has become the nerve graft donor of choice for many surgeons for reconstructing injured facial nerves. In this review, we discuss the anatomy and function of the GAN, while focusing on surgical landmarks and the characteristics that make it a suitable nerve graft donor. In addition, we present and summarize published case reports on use of the GAN for grafting. We hope that this review will provide surgeons with an up-to-date and concise reference.
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http://dx.doi.org/10.1007/s10143-020-01426-9DOI Listing
October 2020

Medium Vessel Occlusion and Acute Ischemic Stroke: A Call for Treatment Paradigm Reappraisal.

Stroke 2020 11 19;51(11):3200-3202. Epub 2020 Oct 19.

Department of Neurological Surgery, Tulane University School of Medicine (A.S.D.).

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http://dx.doi.org/10.1161/STROKEAHA.120.032357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018715PMC
November 2020

Revisiting the Vertebral Venous Plexus-A Comprehensive Review of the Literature.

World Neurosurg 2021 Jan 10;145:381-395. Epub 2020 Oct 10.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies.

The venous drainage of the vertebral and paravertebral regions is important for a better understanding of hematogenous disease spread. Moreover, the spine surgeon must be well acquainted with this anatomy to minimize intraoperative and postoperative complications. A comprehensive review of the vertebral venous plexus (Batson plexus) was performed with a concentration on the clinical and surgical correlations of this venous network.
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http://dx.doi.org/10.1016/j.wneu.2020.10.004DOI Listing
January 2021