Publications by authors named "Fraser Henderson"

64 Publications

Surgical strategies in the treatment of MR-negative Cushing's Disease: a systematic review and treatment algorithm.

Pituitary 2022 Aug 16;25(4):551-562. Epub 2022 Jun 16.

Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA.

Purpose: Several surgical strategies have been proposed to treat MRI-negative Cushing's Disease. These include tumor removal, if identified, and if a tumor is not identified, resection of varying degrees of the pituitary gland, often guided by inferior petrosal sinus sampling (IPSS). The relative risks and benefits of each strategy have never been compared.

Methods: This systematic review of the literature included only studies on the results of surgery for MRI-negative patients with Cushing's Disease in which the surgical strategy was clearly described and associated remission and/or hypopituitarism rates detailed for each strategy.

Results: We identified 12 studies that met inclusion criteria for remission rates and 5 studies for hypopituitarism rates. We divided cases into 6 resection strategies. Remission and hypopituitarism rates for each strategy were: (1) tumor identified, resect tumor only (68%, 0%); (2) resect tumor and surrounding capsule (85%, 0%); and if the tumor was not identified (3) resect inferior 1/3 of gland (78%, no data); (4) resect 30-50% of gland based on IPSS (68%, 13%); (5) resect > 50% but < 100% of gland (65%, 9%); (6) resect entire gland (66%, 67%). Strategy 3 only contained 9 patients.

Conclusion: Remission rates for MRI-negative Cushing's Disease support surgery as a reasonable approach. Results are best if a tumor is found. If a tumor is not identified, one can either remove one-third of the gland guided by IPSS lateralization, or remove both lateral portions along with the inferior portion leaving sufficient central gland to preserve function. Our recommendations are limited by the lack of rigorous and objective data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11102-022-01239-7DOI Listing
August 2022

Patient-Reported Outcomes Following Sectioning of the Filum Terminale for Treatment of Tethered Cord Syndrome Associated With Ehlers-Danlos Syndrome.

Cureus 2022 May 2;14(5):e24679. Epub 2022 May 2.

Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA.

Introduction Tethered cord syndrome (TCS) was first reported as a potential complication of Ehlers-Danlos Syndrome in 2009. However, there have been few publications on the subject since that time, and optimal treatment of TCS in the setting of the hypermobile Ehlers-Danlos Syndrome (hEDS) population remains unknown. The purpose of this study was to determine the safety and efficacy of surgical release of the filum terminale (FT) for the treatment of TCS in this patient population. Methods We performed a retrospective chart review of consecutive hEDS patients with TCS who were treated with surgical release after providing informed surgical consent over a 4.5-year period by a single neurosurgeon. Eighty-four patients were identified and asked to complete surveys with items regarding pre and postoperative symptoms, pain levels, and satisfaction. Results Thirty patients with a mean age of 30.8 ± 11.9 years, all female, were included. Low back pain was significantly improved across the entire cohort. For patients with both pre and postoperative data available, the distance they were able to walk also improved significantly. The majority of patients were "highly satisfied" with surgery (66%), followed by 21% "satisfied", 10% "neutral", and one patient who was "dissatisfied". One patient required repair of a dural leak one week postoperatively, and no other complications were noted. Conclusions Surgical release of the FT for TCS in patients with hEDS was safe and effective in this cohort. For most patients, there was a significant improvement in low back pain, urinary symptoms, and ability to ambulate distance. The majority of respondents reported subjective satisfaction with this operation. A further prospective study is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.24679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160501PMC
May 2022

Multilayered macular hemorrhages as an unusual complication of transorbital neuroendoscopic surgery.

Am J Ophthalmol Case Rep 2022 Jun 23;26:101556. Epub 2022 Apr 23.

Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA.

Purpose: To report a case of multilayered intraocular hemorrhage at the posterior pole as a complication of transorbital neuroendoscopic surgery.

Observations: Our patient underwent an uncomplicated endoscopic transorbital resection of a left sphenoid wing meningioma. In the immediate post-operative period, the patient reported blurred vision of her left eye, and dilated fundus examination demonstrated multilayered hemorrhages at the posterior pole. No intracranial hemorrhage was identified on post-operative imaging. Due to persistent subnormal visual acuity and non-clearing hemorrhage over several weeks of follow-up, a pars plana vitrectomy with peeling of the internal limiting membrane was performed to clear the hemorrhagic component obscuring the macula.

Conclusions And Importance: We report the first case of multilayered intraocular hemorrhages at the posterior pole, mimicking Terson syndrome, in the absence of intracranial hemorrhage or elevated intracranial pressure as a complication of transorbital surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajoc.2022.101556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9062224PMC
June 2022

Transorbital Endoscopic Eyelid Approach for Resection of Spheno-Orbital Meningioma: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2022 05;22(5):e224

Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1227/ons.0000000000000135DOI Listing
May 2022

Phanor L. Perot Jr.: South Carolina's father of academic neurosurgery.

J Neurosurg 2022 Feb 18:1-8. Epub 2022 Feb 18.

1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.

Phanor Leonidas Perot Jr., MD, PhD (1928-2011), was a gifted educator and pioneer of academic neurosurgery in South Carolina. As neurosurgical resident and then as a junior faculty member at the Montreal Neurological Institute, he advanced understandings of both epilepsy and spinal cord injury under Wilder Penfield, William Cone, and Theodore Rasmussen. In 1968, he moved to Charleston to lead neurosurgery. From his time spent with master physicians such as Isidor Ravdin and Wilder Penfield, Perot himself became "the ultimate teacher." His research spanned the fields of epilepsy to torticollis to spinal trauma, focusing the most on the basic pathophysiology of spinal cord damage elucidated through somatosensory evoked potentials. His research was distinguished by generous grant funding. By the time he stepped down as chairman in 1997, the division of neurosurgery had become a department and he had served as president of the American Academy of Neurological Surgery and the Society of Neurological Surgeons. Perot taught prolifically at the bedside, and considered the residency program at the Medical University of South Carolina his greatest achievement. Although Dr. Perot never fully retired, he also enjoyed active hobbies of fly-fishing, traveling, and hunting, until his death on February 2, 2011. He influenced many and earned his role in history as the father of academic neurosurgery in South Carolina.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2021.12.JNS212341DOI Listing
February 2022

Letter: A Scoping Review of Burnout in Neurosurgery.

Neurosurgery 2022 04;90(4):e98-e99

Department of Surgery, Tenwek Hospital, Bomet, Kenya.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1227/NEU.0000000000001848DOI Listing
April 2022

Endoscopic Transorbital Surgery: Another Leap of Faith?

World Neurosurg 2022 03 28;159:54-55. Epub 2021 Dec 28.

Department of Neurosurgery, Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2021.12.081DOI Listing
March 2022

Update on management of craniopharyngiomas.

J Neurooncol 2022 Jan 22;156(1):97-108. Epub 2021 Nov 22.

Department of Neurological Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 East 68th St, Box #99, New York, NY, 10065, USA.

Purpose/introduction: Craniopharyngiomas are locally-aggressive tumors arising along the hypothalamic-pituitary axis. Treatment is nuanced as a result of their proximity and adherence to vital neurovascular structures and responsiveness to surgery, radiation and, in some cases, chemotherapy.

Methods: We reviewed the literature discussing the current state of knowledge regarding craniopharyngioma biology and therapy.

Results: Recent advances in endoscopic endonasal surgery (EEA) have made surgery a safer and more effective option. While cure may be achieved with gross total resection (GTR), when felt to be too risky, a subtotal resection followed by radiation is often a more prudent strategy, particularly in children with hypothalamic invasion. Data on long-term outcome are mostly derived from older studies in which a craniotomy, rather than EEA, was performed. Long-term EEA outcome studies are lacking. Enhanced knowledge of the biological basis of papillary CPs has led to novel medical treatments for BRAFv variants that appear to be effective.

Conclusion: Endoscopic technology has improved surgical results for craniopharyngiomas and expanded the indications for the transsphenoidal approach. The goal of CP surgery goal is maximal safe resection to achieve cure, but subtotal resection and radiation may be equally effective. Early diagnosis of specific variants will facilitate enrollment in promising medical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11060-021-03906-4DOI Listing
January 2022

Case Report: Prolonged Survival Following EGFRvIII CAR T Cell Treatment for Recurrent Glioblastoma.

Front Oncol 2021 7;11:669071. Epub 2021 May 7.

Glioblastoma Translational Center of Excellence, The Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.

Autologous chimeric antigen receptor (CAR) T cells targeted to epidermal growth factor receptor variant III (CAR T-EGFRvIII) have been developed and administered experimentally to treat patients with IDH1 wildtype recurrent glioblastoma (rGBM) (NCT02209376). We report the case of a 59-year-old patient who received a single peripheral infusion of CAR T-EGFRvIII cells and survived 36 months after disease recurrence, exceeding expected survival for recurrent glioblastoma. Post-infusion histopathologic analysis of tissue obtained during a second stage surgical resection revealed immunosuppressive adaptive changes in the tumor tissue as well as reduced EGFRvIII expression. Serial brain imaging demonstrated a significant reduction in relative cerebral blood volume (rCBV), a measure strongly associated with tumor proliferative activity, at early time points following CAR T treatment. Notably, CAR T-EGFRvIII cells persisted in her peripheral circulation during 29 months of follow-up, the longest period of CAR T persistence reported in GBM trials to date. These findings in a long-term survivor show that peripherally administered CAR T-EGFRvIII cells can persist for years in the circulation and suggest that this cell therapy approach could be optimized to achieve broader efficacy in recurrent GBM patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fonc.2021.669071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138201PMC
May 2021

Enhanced Fiber Tractography Using Edema Correction: Application and Evaluation in High-Grade Gliomas.

Neurosurgery 2021 07;89(2):246-256

DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Background: A limitation of diffusion tensor imaging (DTI)-based tractography is peritumoral edema that confounds traditional diffusion-based magnetic resonance metrics.

Objective: To augment fiber-tracking through peritumoral regions by performing novel edema correction on clinically feasible DTI acquisitions and assess the accuracy of the fiber-tracks using intraoperative stimulation mapping (ISM), task-based functional magnetic resonance imaging (fMRI) activation maps, and postoperative follow-up as reference standards.

Methods: Edema correction, using our bi-compartment free water modeling algorithm (FERNET), was performed on clinically acquired DTI data from a cohort of 10 patients presenting with suspected high-grade glioma and peritumoral edema in proximity to and/or infiltrating language or motor pathways. Deterministic fiber-tracking was then performed on the corrected and uncorrected DTI to identify tracts pertaining to the eloquent region involved (language or motor). Tracking results were compared visually and quantitatively using mean fiber count, voxel count, and mean fiber length. The tracts through the edematous region were verified based on overlay with the corresponding motor or language task-based fMRI activation maps and intraoperative ISM points, as well as at time points after surgery when peritumoral edema had subsided.

Results: Volume and number of fibers increased with application of edema correction; concordantly, mean fractional anisotropy decreased. Overlay with functional activation maps and ISM-verified eloquence of the increased fibers. Comparison with postsurgical follow-up scans with lower edema further confirmed the accuracy of the tracts.

Conclusion: This method of edema correction can be applied to standard clinical DTI to improve visualization of motor and language tracts in patients with glioma-associated peritumoral edema.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/neuros/nyab129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279840PMC
July 2021

Refractory Syncope and Presyncope Associated with Atlantoaxial Instability: Preliminary Evidence of Improvement Following Surgical Stabilization.

World Neurosurg 2021 05 1;149:e854-e865. Epub 2021 Feb 1.

Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Background: The proclivity to atlantoaxial instability (AAI) has been widely reported for conditions such as rheumatoid arthritis and Down syndrome. Similarly, we have found a higher than expected incidence of AAI in hereditary connective tissue disorders. We demonstrate a strong association of AAI with manifestations of dysautonomia, in particular syncope and lightheadedness, and make preliminary observations as to the salutary effect of surgical stabilization of the atlantoaxial motion segment.

Methods: In an institutional review board-approved retrospective study, 20 subjects (16 women, 4 men) with hereditary connective tissue disorders had AAI diagnosed by computed tomography. Subjects underwent realignment (reduction), stabilization, and fusion of the C1-C2 motion segment. All subjects completed preoperative and postoperative questionnaires in which they were asked about performance, function, and autonomic symptoms, including lightheadedness, presyncope, and syncope.

Results: All patients with AAI reported lightheadedness, and 15 had refractory syncope or presyncope despite maximal medical management and physical therapy. Postoperatively, subjects reported a statistically significant improvement in lightheadedness (P = 0.003), presyncope (P = 0.006), and syncope (P = 0.03), and in the frequency (P < 0.05) of other symptoms related to autonomic function, such as nausea, exercise intolerance, palpitations, tremors, heat intolerance, gastroesophageal reflux, and sleep apnea.

Conclusions: This study draws attention to the potential for AAI to present with syncope or presyncope that is refractory to medical management, and for surgical stabilization of AAI to lead to improvement of these and other autonomic symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2021.01.084DOI Listing
May 2021

A brief note on the plastic adaptability of the central nervous system.

Br J Neurosurg 2020 Dec 28:1-2. Epub 2020 Dec 28.

Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02688697.2020.1864295DOI Listing
December 2020

Letter to the editor regarding "Atlantoaxial dislocation due to os odontoideum in patients with Down's syndrome: literature review and case reports".

Childs Nerv Syst 2021 04 17;37(4):1041-1043. Epub 2020 Sep 17.

Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, #2077, Baltimore, MD, 21287, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00381-020-04886-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009794PMC
April 2021

Molecular Correlates of Long Survival in IDH-Wildtype Glioblastoma Cohorts.

J Neuropathol Exp Neurol 2020 08;79(8):843-854

From the Department of Pathology, State University of New York, Upstate Medical University, Syracuse, New York.

IDH-wildtype glioblastoma is a relatively common malignant brain tumor in adults. These patients generally have dismal prognoses, although outliers with long survival have been noted in the literature. Recently, it has been reported that many histologically lower-grade IDH-wildtype astrocytomas have a similar clinical outcome to grade IV tumors, suggesting they may represent early or undersampled glioblastomas. cIMPACT-NOW 3 guidelines now recommend upgrading IDH-wildtype astrocytomas with certain molecular criteria (EGFR amplifications, chromosome 7 gain/10 loss, and/or TERT promoter mutations), establishing the concept of a "molecular grade IV" astrocytoma. In this report, we apply these cIMPACT-NOW 3 criteria to 2 independent glioblastoma cohorts, totaling 393 public database and institutional glioblastoma cases: 89 cases without any of the cIMPACT-NOW 3 criteria (GBM-C0) and 304 cases with one or more criteria (GBM-C1-3). In the GBM-C0 groups, there was a trend toward longer recurrence-free survival (median 12-17 vs 6-10 months), significantly longer overall survival (median 32-41 vs 15-18 months), younger age at initial diagnosis, and lower overall mutation burden compared to the GBM-C1-3 cohorts. These data suggest that while histologic features may not be ideal indicators of patient survival in IDH-wildtype astrocytomas, these 3 molecular features may also be important prognostic factors in IDH-wildtype glioblastoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jnen/nlaa059DOI Listing
August 2020

Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization.

Neurosurg Rev 2021 Jun 4;44(3):1553-1568. Epub 2020 Jul 4.

Medical and Molecular Genetics, Indiana University Health Physicians, Indianapolis, IN, USA.

Atlanto-axial instability (AAI) is common in the connective tissue disorders, such as rheumatoid arthritis, and increasingly recognized in the heritable disorders of Stickler, Loeys-Dietz, Marfan, Morquio, and Ehlers-Danlos (EDS) syndromes, where it typically presents as a rotary subluxation due to incompetence of the alar ligament. This retrospective, IRB-approved study examines 20 subjects with Fielding type 1 rotary subluxation, characterized by anterior subluxation of the facet on one side, with a normal atlanto-dental interval. Subjects diagnosed with a heritable connective tissue disorder, and AAI had failed non-operative treatment and presented with severe headache, neck pain, and characteristic neurological findings. Subjects underwent a modified Goel-Harms posterior C1-C2 screw fixation and fusion without complication. At 15 months, two subjects underwent reoperation following a fall (one) and occipito-atlantal instability (one). Patients reported improvement in the frequency or severity of neck pain (P < 0.001), numbness in the hands and lower extremities (P = 0.001), headaches, pre-syncope, and lightheadedness (all P < 0.01), vertigo and arm weakness (both P = 0.01), and syncope, nausea, joint pain, and exercise tolerance (all P < 0.05). The diagnosis of Fielding type 1 AAI requires directed investigation with dynamic imaging. Alignment and stabilization is associated with improvement of pain, syncopal and near-syncopal episodes, sensorimotor function, and exercise tolerance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10143-020-01345-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8121728PMC
June 2021

An online tumor board with international neurosurgical collaboration guides surgical decision-making in Western Kenya.

Childs Nerv Syst 2021 02 22;37(2):715-719. Epub 2020 Jun 22.

Department of Surgery, Tenwek Hospital, Bomet, Kenya.

Telecollaboration via web-based platforms has emerged as a tool to relieve constraints on the establishment of tumor boards for neurosurgical oncology. Challenging tumor cases arising in low- and middle-income countries may benefit from the use of such models. The case of a 5-year-old boy presenting in Western Kenya with a challenging tumor and symptomatic hydrocephalus was presented on a novel web platform to a multi-national audience of neurosurgeons. The treating neurosurgeon invited a physician network to review the case vignette and radiographic images. Respondents independently offered input during a prescribed response period. Three respondents provided surgical opinions during a 24-h response period. The treating neurosurgeon utilized the pooled input to determine a course of action for the patient. When a web-based platform is available, lone neurosurgeons in low-resource settings may nevertheless apply multi-national, multi-institutional perspectives to challenging oncology cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00381-020-04744-xDOI Listing
February 2021

The Neurosurgical Intraoperative Checklist for Surgery of the Craniocervical Junction and Spine.

Cureus 2020 Apr 8;12(4):e7588. Epub 2020 Apr 8.

Emergency Medicine, Creighton University School of Medicine, Omaha, USA.

Many sectors within healthcare have adapted checklists to improve quality control. Notwithstanding the reported successful implementation of surgical checklists in the operating theater, a dearth of literature addresses the specific challenges posed by complex surgery in the craniocervical junction and spine. The authors devised an intraoperative checklist to address the common errors and verify the completion of objectives unique to these surgeries. The data over six years is presented retrospectively; no historical control for comparison is available, as those omissions and surgical errors addressed by the checklist are not generally registered in any morbidity and mortality reports. Through six years and approximately 1200 surgeries, the checklist was implemented with 98% compliance. The checklist eliminated the occurrences of mundane surgical errors, minimized iatrogenic complications, and ensured completion of specific objectives. We discuss that preoperative checklists, now in general use in all hospitals, have not addressed the most common, intraoperative omissions. These technical omissions result in part from the complexity of spine surgery and directly impact the surgical outcome. The Neurosurgical Intraoperative Checklist is a practical, rapid, and comprehensive means to prevent common, avoidable errors and iatrogenic complications inherent to spine surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.7588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212711PMC
April 2020

Letter: For Whom the Bell Tolls: Overcoming the Challenges of the COVID Pandemic as a Residency Program.

Neurosurgery 2020 08;87(2):E207

Department of Neurosurgery The Medical University of South Carolina Charleston, South Carolina.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/neuros/nyaa166DOI Listing
August 2020

Optimizing Alignment Parameters During Craniocervical Stabilization and Fusion: A Technical Note.

Cureus 2020 Mar 2;12(3):e7160. Epub 2020 Mar 2.

Radiology, Doctors Community Hospital, Lanham, USA.

Proper craniocervical alignment during craniocervical reduction, stabilization, and fusion optimizes cerebrospinal fluid (CSF) flow through the foramen magnum, establishes the appropriate "gaze angle", avoids dysphagia and dyspnea, and, most importantly, normalizes the clival-axial angle (CXA) to reduce ventral brainstem compression. To illustrate the metrics of reduction that include CXA, posterior occipital cervical angle, orbital-axial or "gaze angle", and mandible-axial angle, we present a video illustration of a patient presenting with signs and symptoms of the cervical medullary syndrome along with concordant radiographic findings of craniocervical instability as identified on dynamic imaging and through assessment of the CXA, Harris, and Grabb-Oakes measurements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.7160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112711PMC
March 2020

Endoscopic decompression of epidural spinal metastasis causing lumbar radiculopathy through a transforaminal approach: report of two cases.

AME Case Rep 2020 20;4. Epub 2020 Jan 20.

Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.

Radiculopathy in patients with metastatic spine disease (MSD) may be palliated with open or microsurgical techniques. However, delay of chemoradiation, infection risk, extended hospitalization periods, and surgical site pain may complicate surgical efforts to improve these patients' lives. Endoscopic approaches, heretofore used almost exclusively in degenerative spine disease, may also palliate debilitating pain while mitigating the drawbacks of surgical intervention in providing focal tumor debulking. Specimen for histopathologic diagnosis, which is of increasing importance in oncology treatments, may also be obtained by the endoscopic approach. The first case is of a 61-year-old woman with right thigh pain and weakness referable to a foraminal component of metastatic disease who underwent transforaminal endoscopic decompression through a single port with resolution of her primary pain complaint. The second case is of a 50-year-old man with history of urothelial cancer who presented with L5 radicular pain referable to foraminal tumor compression who underwent similar procedure with stabilization of his primary pain complaints. Adequate tissue biopsy was obtained in both cases. Endoscopic technique may allow direct visualization with minimal morbidity for effective decompression of symptomatic metastatic disease resulting from compression of the exiting and traversing nerve roots. Patients compromised from systemic disease may benefit from this less invasive approach that requires neither endotracheal intubation nor extended hospital stay.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/acr.2019.12.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082234PMC
January 2020

F-Fluciclovine PET to distinguish treatment-related effects from disease progression in recurrent glioblastoma: PET fusion with MRI guides neurosurgical sampling.

Neurooncol Pract 2020 Mar 8;7(2):152-157. Epub 2019 Dec 8.

Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia.

Differentiation of true tumor progression from treatment-related effects remains a major unmet need in caring for patients with glioblastoma. Here, we report how the intraoperative combination of MRI withF-fluciclovine PET guided surgical sampling in 2 patients with recurrent glioblastoma.F-Fluciclovine PET is FDA approved for use in prostate cancer and carries an orphan drug designation in glioma. To investigate its utility in recurrent glioblastoma, we fused PET and MRI images using 2 different surgical navigation systems and performed targeted stereotactic biopsies from the areas of high ("hot") and low ("cold") radiotracer uptake. Concordant histopathologic and imaging findings suggest that a combinedF-fluciclovine PET-MRI-guided approach can guide neurosurgical resection of viable recurrent glioblastoma in the background of treatment-related effects, which can otherwise look similar on MRI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/nop/npz068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081387PMC
March 2020

Commentary: 5-Aminolevulinic Acid and Contrast-Enhanced Ultrasound: The Combination of the 2 Techniques to Optimize the Extent of Resection in Glioblastoma Surgery.

Neurosurgery 2020 06;86(6):E541-E543

Department of Neurological Surgery, Medical University of South Carolina, Charleston, South Carolina.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/neuros/nyaa061DOI Listing
June 2020

Second window indocyanine green localizes CNS lymphoma in real time in the operating room: report of two cases.

Br J Neurosurg 2020 Feb 3:1-5. Epub 2020 Feb 3.

Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

Intraoperative distinction of lesional tissue normal brain parenchyma can be difficult in neurosurgical oncology procedures. We report the successful, real-time visualization of central nervous system (CNS) lymphoma using the 'Second Window Indocyanine Green' (SWIG) method for two patients who underwent craniotomy for pathology that was determined to be large B cell lymphoma. Indocyanine green (ICG), when administered intravenously the day prior to cranial surgery, is a re-purposed fluorophore that may afford safe, immediate visual confirmation of on-target tissue resection, thereby providing a valuable adjunct to intraoperative navigation and decreasing reliance on frozen pathology analysis. These first reported cases of SWIG for lymphoma in the CNS indicate that further study of fluorophores to improve biopsy targeting and yield is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02688697.2020.1716945DOI Listing
February 2020

Tractography and the connectome in neurosurgical treatment of gliomas: the premise, the progress, and the potential.

Neurosurg Focus 2020 02;48(2):E6

1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania.

The ability of diffusion tensor MRI to detect the preferential diffusion of water in cerebral white matter tracts enables neurosurgeons to noninvasively visualize the relationship of lesions to functional neural pathways. Although viewed as a research tool in its infancy, diffusion tractography has evolved into a neurosurgical tool with applications in glioma surgery that are enhanced by evolutions in crossing fiber visualization, edema correction, and automated tract identification. In this paper the current literature supporting the use of tractography in brain tumor surgery is summarized, highlighting important clinical studies on the application of diffusion tensor imaging (DTI) for preoperative planning of glioma resection, and risk assessment to analyze postoperative outcomes. The key methods of tractography in current practice and crucial white matter fiber bundles are summarized. After a review of the physical basis of DTI and post-DTI tractography, the authors discuss the methodologies with which to adapt DT image processing for surgical planning, as well as the potential of connectomic imaging to facilitate a network approach to oncofunctional optimization in glioma surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2019.11.FOCUS19785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831974PMC
February 2020

The College of Surgeons of East, Central, and Southern Africa: Successes and Challenges in Standardizing Neurosurgical Training.

World Neurosurg 2020 Apr 17;136:172-177. Epub 2020 Jan 17.

Department of Surgery, Tenwek Hospital, Bomet, Kenya. Electronic address:

Background: The College of Surgeons of East, Central, and Southern Africa (COSECSA) is a regional accrediting body for general and specialty surgical training programs that has recently expanded to include neurosurgery. As neurosurgical services expand in sub-Saharan Africa, the structure of training and accreditation has become a vital issue.

Methods: We review the founding and current structures of COSECSA neurosurgical training, identifying accomplishments and challenges facing the expansion of neurosurgical training in this region.

Results: The COSECSA model has succeeded in several countries to graduate qualified neurosurgeons, but challenges remain. Programs must balance the long duration of training required to promote surgical excellence against an overwhelming clinical need that seeks immediate solutions.

Conclusion: Harnessing global collaboration, rapidly expanding local infrastructure, and a robust multinational training curriculum, COSECSA has emerged as a leader in the effort to train neurosurgeons and is anticipated to dramatically improve on the markedly unmet need for neurosurgical care in sub-Saharan Africa.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2020.01.084DOI Listing
April 2020

Commentary: The Role of Laser Interstitial Thermal Therapy in Surgical Neuro-Oncology: Series of 100 Consecutive Patients.

Neurosurgery 2020 08;87(2):E101-E103

Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/neuros/nyz528DOI Listing
August 2020

Presentation and management of traumatic occipital spur fracture.

Am J Emerg Med 2019 05 24;37(5):1005.e1-1005.e2. Epub 2019 Jan 24.

Department of Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA.

Occipital spur is an abnormal bony outgrowth of the external occipital protuberance (EOP). We describe an interesting and previously unreported case of fracture of an occipital spur following trauma. Our 20-year-old male patient was treated in the emergency department (ED) and discharged home without complication. Neurosurgical consultation was obtained but is not requisite for these injuries. Greater awareness of this unique presentation may help to expedite future emergency department treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2019.01.043DOI Listing
May 2019

Cervical medullary syndrome secondary to craniocervical instability and ventral brainstem compression in hereditary hypermobility connective tissue disorders: 5-year follow-up after craniocervical reduction, fusion, and stabilization.

Neurosurg Rev 2019 Dec 9;42(4):915-936. Epub 2019 Jan 9.

Medical University of South Carolina, Charleston, SC, USA.

A great deal of literature has drawn attention to the "complex Chiari," wherein the presence of instability or ventral brainstem compression prompts consideration for addressing both concerns at the time of surgery. This report addresses the clinical and radiological features and surgical outcomes in a consecutive series of subjects with hereditary connective tissue disorders (HCTD) and Chiari malformation. In 2011 and 2012, 22 consecutive patients with cervical medullary syndrome and geneticist-confirmed hereditary connective tissue disorder (HCTD), with Chiari malformation (type 1 or 0) and kyphotic clivo-axial angle (CXA) enrolled in the IRB-approved study (IRB# 10-036-06: GBMC). Two subjects were excluded on the basis of previous cranio-spinal fusion or unrelated medical issues. Symptoms, patient satisfaction, and work status were assessed by a third-party questionnaire, pain by visual analog scale (0-10/10), neurologic exams by neurosurgeon, function by Karnofsky performance scale (KPS). Pre- and post-operative radiological measurements of clivo-axial angle (CXA), the Grabb-Mapstone-Oakes measurement, and Harris measurements were made independently by neuroradiologist, with pre- and post-operative imaging (MRI and CT), 10/20 with weight-bearing, flexion, and extension MRI. All subjects underwent open reduction, stabilization occiput to C2, and fusion with rib autograft. There was 100% follow-up (20/20) at 2 and 5 years. Patients were satisfied with the surgery and would do it again given the same circumstances (100%). Statistically significant improvement was seen with headache (8.2/10 pre-op to 4.5/10 post-op, p < 0.001, vertigo (92%), imbalance (82%), dysarthria (80%), dizziness (70%), memory problems (69%), walking problems (69%), function (KPS) (p < 0.001). Neurological deficits improved in all subjects. The CXA average improved from 127° to 148° (p < 0.001). The Grabb-Oakes and Harris measurements returned to normal. Fusion occurred in 100%. There were no significant differences between the 2- and 5-year period. Two patients returned to surgery for a superficial wound infections, and two required transfusion. All patients who had rib harvests had pain related that procedure (3/10), which abated by 5 years. The results support the literature, that open reduction of the kyphotic CXA to lessen ventral brainstem deformity, and fusion/stabilization to restore stability in patients with HCTD is feasible, associated with a low surgical morbidity, and results in enduring improvement in pain and function. Rib harvest resulted in pain for several years in almost all subjects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10143-018-01070-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821667PMC
December 2019

Letter to the Editor. A resident's view of Penfield's Montreal Neurological Institute.

J Neurosurg 2018 12;130(2):671-673

2Medical University of South Carolina, Charleston, SC.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2018.10.JNS181898DOI Listing
December 2018
-->