Publications by authors named "Dia R Halalmeh"

10 Publications

  • Page 1 of 1

Use of Dental Bisphenol A-Glycidyl Methacrylate Composite to Repair Refractory Cerebrospinal Fluid Leaks Associated With Large-Scale Anterior Skull Base Defects.

J Craniofac Surg 2021 Jul-Aug 01;32(5):1805-1809

Department of Surgery, Faculty of Medicine and Biomedical Sciences, Yaounde Central Hospital, Yaounde, Cameroon.

Abstract: Treatment of refractory cerebrospinal fluid (CSF) leaks, particularly those associated with large skull base defects, is challenging. A variety of synthetic biomaterial-based systems have been investigated in experimental models and/or humans for reconstructing cranial base defects. A widely used dental composite (bisphenol A-glycidyl methacrylate [bis-GMA]) has been shown to be effective for reconstruction of anterior skull base defects in animal models. Here, we report 4 patients who underwent reconstruction of large anterior skull base defects (1405.8 ± 511 mm2) secondary to tumor resection and traumatic injury using the dental bis-GMA resin-based composite. A vascularized pericranial flap with fibrin glue was initially performed in all patients with concurrent use of dental bis-GMA during the primary surgery in 2 patients, and later use (in a repeat surgery) in other 2 cases. In these latter 2, CSF rhinorrhea persisted after the initial surgery (in the absence of bis-GMA use) despite external CSF drainage with lumbar drain. Following treatment with bis-GMA, rigid structural support and watertight closure of the defect were successfully achieved. At the follow-up, CSF leak did not recur and none of the patients had any complications related to the surgery or the composite. The results obtained from this series are promising, and dental bis-GMA resin seems to provide an effective and feasible material for the treatment and prevention of CSF leaks related to large-scale anterior skull base defects. However, further studies with longer clinical follow-up and larger number of patients are required to prove the safety and efficacy of this matrix in the long run.
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http://dx.doi.org/10.1097/SCS.0000000000007568DOI Listing
July 2021

Use of Local Morselized Bone Autograft in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Cost Analysis.

World Neurosurg 2021 02 28;146:e544-e554. Epub 2020 Oct 28.

Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, Michigan, USA.

Objective: Few studies have investigated the financial influence of surgical site local morselized bone autograft (LMBA) on the overall cost of spinal arthrodesis procedures. The purpose of this study is to evaluate the potential savings from introducing LMBA in spinal fusion procedures compared with no LMBA use.

Methods: Retrospectively, cost analysis was conducted on a single-center data collected from 266 patients who underwent minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) ranging from L1 through S1 during a period of approximately 4 years. Cost data were obtained from individual patient invoices from the distributor. Sensitivity analyses were also conducted for different costs of allograft and LMBA.

Results: A total of 282 levels were grafted in 266 subjects. The total quantity of LMBA harvested was 2433.5 mL, and a total of 1610 mL of allograft (Trinity Elite, ORTHOFIX, Lewisville, Texas, USA) were used. The overall cost savings from introducing LMBA in MI-TLIF surgery were $1,094,931 over the 4-year period with mean direct cost saving of $4116.28 per patient based on reduction in allograft. Results for cost savings per patient were sensitive to different direct costs of allograft and LMBA. A >95% fusion rate was achieved based on dynamic radiographs evaluated by an independent radiologist.

Conclusions: LMBA is a cost-saving bone graft extender option in MI-TLIF procedures while achieving high fusion rates. The savings are mainly achieved by reducing the amount of allograft needed and subsequent reduction in the total bone graft costs. Further research needs to be performed regarding long-term economic benefit.
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http://dx.doi.org/10.1016/j.wneu.2020.10.126DOI Listing
February 2021

Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part III Lumbosacral Spine.

Cureus 2020 Jul 28;12(7):e9433. Epub 2020 Jul 28.

Neurosurgery, Wayne State University/Detroit Medical Center, Detroit, USA.

Spine surgery at the wrong level is an undesirable event and unique pitfall in spine surgery. It is detrimental to the relationship between the patient and the surgeon and typically results in profound medical and legal consequences. It falls under the wrong-site surgery sentinel events reporting system. This error is most frequently observed in lumbosacral spine. Several risk factors are implicated; however, anatomical variations of the lumbosacral spine are a major risk factor. The aim of this article was to provide a detailed description of these high-risk anatomical variations, including transitional vertebrae, lumbar ribs, butterfly vertebrae, hemivertebra, block/fused vertebrae, and spinal dysraphism. A literature review was performed in the database PubMed to obtain all relative English-only articles concerning these anatomical variations and their implication in the development of lumbosacral spine surgery at the wrong level. We also described patient characteristics that can lead to lumbosacral surgery at the wrong level such as tumors, infection, previous lumbosacral surgery, obesity, and osteoporosis. Certain techniques to prevent such incorrect surgery were explained. Lumbosacral spine anatomical variations are surgically significant. Awareness of their existence may provide better pre-operative planning and surgical intervention, leading to avoidance of incorrect-level surgery and potentially better clinical outcomes. In addition, collaboration with radiologists and careful examination of patient's anatomy and characteristics should be exercised, especially in difficult cases.
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http://dx.doi.org/10.7759/cureus.9433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450882PMC
July 2020

Anatomical Variations That Can Lead to Spine Surgery at The Wrong Level: Part II Thoracic Spine.

Cureus 2020 Jun 18;12(6):e8684. Epub 2020 Jun 18.

Neurosurgery, Detroit Medical Center, Detroit, USA.

Spine surgery at the wrong level is a detrimental ordeal for both surgeon and patient, and it falls under the wrong-site surgery sentinel events reporting system. While there are several methods designed to limit the incidence of these events, they continue to occur and can result in significant morbidity for the patient and malpractice lawsuits for the surgeon. In thoracic spine, numerous risk factors influence the development of this misadventure. These include anatomical variations such as transitional vertebrae, rib variants, hemivertebra, and block/fused vertebrae as well as patient characteristics, such as tumors, infections, previous thoracic spine surgery, obesity, and osteoporosis. An extensive literature search of the PubMed database up to 2019 was completed on each of the anatomical entities and their influence on developing thoracic spine surgery at the wrong level, taking into consideration patient's individual factors. A reliable protocol and effective techniques were described to prevent this error. In addition, the surgeon should collaborate with radiologists, particularly in challenging cases. A thorough understanding of the surgical anatomy and its variants coupled with patients characteristic is crucial for maximal patient benefit and avoidance of thoracic spine surgery at the wrong level.
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http://dx.doi.org/10.7759/cureus.8684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370605PMC
June 2020

Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part I, Cervical Spine.

Cureus 2020 Jun 17;12(6):e8667. Epub 2020 Jun 17.

Neurosurgery, Detroit Medical Center, Detroit, USA.

Spine surgery at the wrong level is an adversity that many spine surgeons will encounter in their career, and it falls under the wrong-site surgery sentinel events reporting system. The cervical spine is the second most common location in the spine at which surgery is performed at the wrong level. Anatomical variations of the cervical spine are one of the most important incriminating risk factors. These anomalies include craniocervical junction abnormalities, cervical ribs, hemivertebrae, and block/fused vertebrae. In addition, patient characteristics, such as tumors, infection, previous cervical spine surgery, obesity, and osteoporosis, play an important role in the development of cervical surgery at the wrong level. These were described, and several effective techniques to prevent this error were provided. A thorough review of the English-language literature was performed in the database PubMed between 1981 and 2019 to review and summarize these risk factors. Compulsive attention to these factors is essential to ensure patient safety. Therefore, the surgeon must carefully review the patient's anatomy and characteristics through imaging and collaborate with radiologists to reduce the likelihood of performing cervical spine surgery at the wrong level.
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http://dx.doi.org/10.7759/cureus.8667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370673PMC
June 2020

The Neural Sulcus of the Cervical Vertebrae: A Review of Its Anatomy and Surgical Perspectives.

Cureus 2020 Jan 18;12(1):e6693. Epub 2020 Jan 18.

Neurological Surgery, Detroit Medical Center, Detroit, USA.

The neural sulcus is a bony channel that spans the transverse process in the subaxial cervical spine. It is located between the anterior and posterior tubercles on either side of the transverse foramen, housing the spinal nerve as it passes through the intervertebral foramina. Although numerous studies have evaluated the anatomy of the cervical spine, very little data on detailed anatomy of the neural sulcus and its implication in cervical spine surgery exist. Here, we review the anatomy of the neural sulcus and surgical considerations. The neural sulcus has important surgical implications, and knowledge of its anatomy is important in considering and planning posterior cervical segmented instrumentation. This increases the ability of the neurosurgeon to choose the best suitable surgical approach to the subaxial cervical spine, allowing good outcomes for the patient.
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http://dx.doi.org/10.7759/cureus.6693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026867PMC
January 2020

Delayed Cerebral Ischemia of the Corpus Callosum: A Case Report.

Cureus 2019 Dec 13;11(12):e6379. Epub 2019 Dec 13.

Neurological Surgery, Detroit Medical Center, Detroit, USA.

Ischemic infarction of the corpus callosum is a rare condition due to its rich vascular supply and therefore has been infrequently reported. Here, we present a case of a patient who developed a delayed infarct of the corpus callosum in the body. The condition was characterized by bilateral lower extremity weakness and visual disturbances following intraventricular hemorrhage managed with ventriculostomy. Understanding the anatomy and function of the corpus callosum is crucial to understanding the etiology of infarctions as well as their clinical significance. It is also essential to distinguish between relatively common post-shunting changes and true infarction and to recognize the limited consequences of corpus callosum infarction. Increased awareness of this rare infarct would help to prevent unnecessary interventions and increase the ability of the physician to provide optimal care for the patient.
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http://dx.doi.org/10.7759/cureus.6379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957044PMC
December 2019

Reattachment of the Multifidus Tendon in Lumbar Surgery to Decrease Postoperative Back Pain: A Technical Note.

Cureus 2019 Dec 12;11(12):e6366. Epub 2019 Dec 12.

Neurological Surgery, Detroit Medical Center, Detroit, USA.

The posterior midline approach to the lumbar spine requires significant manipulation of the paraspinal muscles. Muscle detachment and retraction results in iatrogenic damage such as crush injury, devascularization, and denervation, all of which have been associated with postoperative pain. The muscle most directly affected by the posterior approach is the lumbar multifidus (LM), the largest and most medial of the deep lumbar paraspinal muscles. The effects of the posterior approach on the integrity of the LM is concerning, as multiple studies have demonstrated that intraoperative injuries sustained by the LM lead to postoperative muscle atrophy and potentially worsening low back pain. Given the inevitability of intraoperative paraspinal muscle manipulation when using the posterior approach, this technical note describes methods by which surgeons may minimize LM tissue disruption and restore the anatomical position of the LM to ultimately expedite recovery, minimize postoperative pain, and improve patient satisfaction.
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http://dx.doi.org/10.7759/cureus.6366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957038PMC
December 2019

Comparison of Lumbar Laminectomy Alone, Lumbar Laminectomy and Fusion, Stand-alone Anterior Lumbar Interbody Fusion, and Stand-alone Lateral Lumbar Interbody Fusion for Treatment of Lumbar Spinal Stenosis: A Review of the Literature.

Cureus 2019 Sep 18;11(9):e5691. Epub 2019 Sep 18.

Neurosurgery, Wayne State University, Detroit Medical Center, Detroit, USA.

Lumbar spinal stenosis is defined as narrowing of the lumbar spinal canal, which causes compression of the spinal cord and nerves. Spinal stenosis can cause leg pain and potentially back pain that can affect the quality of life. Ultimately, surgical decompression is required to alleviate the symptoms. In this review, we first utilize several important studies to compare lumbar laminectomy alone versus lumbar laminectomy and fusion. We also compare the effectiveness of more novel surgical approaches, stand-alone anterior lumbar interbody fusion (ALIF), and stand-alone lateral lumbar interbody fusion (LLIF). These techniques have their own advantages and disadvantages in which many factors must be taken into account before choosing a surgical approach. In addition, the patient's anatomy and pathology, lifestyle, and desires should be analyzed to help determine the ideal surgical strategy.
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http://dx.doi.org/10.7759/cureus.5691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823012PMC
September 2019

Operative Intervention for Lumbar Foraminal Gunshot Wounds: Case Report and Review of the Literature.

Cureus 2019 Jul 29;11(7):e5269. Epub 2019 Jul 29.

Neurosurgery, Seattle Science Foundation, Seattle, USA.

Gunshot wounds represent the second most frequent cause of spinal cord injury after vehicular trauma. The thoracic region is most commonly involved, followed by the thoracolumbar spine. Numerous studies have demonstrated that improvement of neurological recovery, especially after decompression surgery, is likely to be seen in lumbosacral spine, but not in the thoracic or cervical spine. Herein, we present a case of a gunshot wound causing lumbar 5 nerve root compression with neurological deficits that improved remarkably after urgent decompression surgery. This signifies a potential neurological benefit to prompt surgical intervention in lumbar gunshot wounds with radiographic evidence of neural compression. A relevant review of the literature was performed along with discussion, the clinical history, and radiological findings.
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http://dx.doi.org/10.7759/cureus.5269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764617PMC
July 2019
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