Publications by authors named "Geoff Appelboom"

19 Publications

  • Page 1 of 1

Radiographic Rate and Clinical Impact of Pseudarthrosis in Spine Radiosurgery for Metastatic Spinal Disease.

Cureus 2018 Nov 25;10(11):e3631. Epub 2018 Nov 25.

Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA.

Purpose Pseudarthrosis within the spine tumor population is increased from perioperative radiation and complex stabilization for invasive and recurrent pathology. We report the radiographic and clinical rates of pseudarthrosis following multiple courses of instrumented fusion and perioperative stereotactic radiosurgery (SRS). Methods We performed a single institution review of 418 patients treated with non-isocentric SRS for spine between October 2002 and January 2013, identifying those with spinal instrumentation and greater than six months of follow-up. Surgical history, radiation planning, and radiographic outcomes were documented. Results Eleven patients who met criteria for inclusion underwent 21 sessions of spinal SRS and 16 instrumented operations. Radiographic follow-up was 48.9 months; 3/11 (27%) were with radiographic hardware failure, and one (9%) separate case ultimately warranted externalization due to tumor recurrence. SRS was administered to treat progression of disease in 12/21 (57%) procedures, and residual lesions in 7/11 (64%) procedures. Following first and second SRS, 8/11 (73%) and 2/7 (29%) patients were with symptomatic improvement, respectively. Conclusion Risk of pseudarthrosis following SRS for patients with oncologic spinal lesions will become increasingly apparent with the optimized management of and survival from spinal pathologies. We highlight how the need for local control outpaces the risk of instrumentation failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.3631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349573PMC
November 2018

Silicon Valley new focus on brain computer interface: hype or hope for new applications?

F1000Res 2018 21;7:1327. Epub 2018 Aug 21.

Department of Neurosurgery, Stanford University Medical Center, Brighton, USA.

In the last year there has been increasing interest and investment into developing devices to interact with the central nervous system, in particular developing a robust brain-computer interface (BCI). In this article, we review the most recent research advances and the current host of engineering and neurological challenges that must be overcome for clinical application. In particular, space limitations, isolation of targeted structures, replacement of probes following failure, delivery of nanomaterials and processing and understanding recorded data. Neural engineering has developed greatly over the past half-century, which has allowed for the development of better neural recording techniques and clinical translation of neural interfaces. Implementation of general purpose BCIs face a number of constraints arising from engineering, computational, ethical and neuroscientific factors that still have to be addressed. Electronics have become orders of magnitude smaller and computationally faster than neurons, however there is much work to be done in decoding the neural circuits. New interest and funding from the non-medical community may be a welcome catalyst for focused research and development; playing an important role in future advancements in the neuroscience community.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12688/f1000research.15726.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343225PMC
November 2019

Milestones in stereotactic radiosurgery for the central nervous system.

J Clin Neurosci 2019 Jan 26;59:12-19. Epub 2018 Oct 26.

Department of Neurosurgery, Stanford University School of Medicine, Stanford Health Care and Stanford Children's Health, Stanford Neuroscience Health Center, 213 Quarry Road, Palo Alto, CA 94304-5979, United States.

Introduction: Since Lars Leksell developed the first stereotactic radiosurgery (SRS) device in 1951, there has been growth in the technologies available and clinical indications for SRS. This expansion has been reflected in the medical literature, which is built upon key articles and institutions that have significantly impacted SRS applications. Our aim was to identify these prominent works and provide an educational tool for training and further inquiry.

Method: A list of search phrases relating to central nervous system applications of stereotactic radiosurgery was compiled. A topic search was performed using PubMed and Scopus databases. The journal, year of publication, authors, treatment technology, clinical subject, study design and level of evidence for each article were documented. Influence was proposed by citation count and rate.

Results: Our search identified a total of 10,211 articles with the top 10 publications overall on the study of SRS spanning 443-1313 total citations. Four articles reported on randomized controlled trials, all of which evaluated intracranial metastases. The most prominent subtopics included SRS for arteriovenous malformation, glioblastoma, and acoustic neuroma. Greatest representation by treatment modality included Gamma Knife, LINAC, and TomoTherapy.

Conclusions: This systematic reporting of the influential literature on SRS for intracranial and spinal pathologies underscores the technology's rapid and wide reaching clinical applications. Moreover the findings provide an academic guide to future health practitioners and engineers in their study of SRS for neurosurgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2018.09.029DOI Listing
January 2019

Long-term follow up data on difficult to treat intracranial arteriovenous malformations treated with the CyberKnife.

J Clin Neurosci 2019 Mar 23;61:120-123. Epub 2018 Dec 23.

Department of Neurological Surgery, Stanford Medical Center, Stanford University, Palo Alto, CA, USA.

Introduction: The CyberKnife, a frameless, robotic, stereotactic device, has been developed to radiosurgically treat arteriovenous malformations (AVMs). While most AVMs are obliterated within two-to-three years, a subset remain recalcitrant; long-term data on these difficult to treat AVMs are limited in the neurosurgical literature.

Materials And Methods: A retrospective analysis of all patients who underwent CyberKnife treatment for intracranial AVMs at a single U.S. institution between 2002 and 2012, whose AVMs had failed to obliterate within 48 months or longer from the treatment start date, were eligible for inclusion.

Results: Eleven patients (9 AVMs; 7 males, 2 females) were followed for an average of 85.2 months (range 56.2-119.4). The median lesion size was 3.5 cm (range: 2.8-8.0 cm) and median Spetzler-Martin grade was 3 (range: 2-5). All AVMs were treated with one radiation dose (median prescribed dose was 18.0 Gy; median D: 23.7 Gy). Six (66.7%) were obliterated in a median time of 84 months (range: 52-94 months), while 3 (33.3%) remained active after a median of 90.8 months (range 69.7-119.4). Transient, post-radiosurgery adverse radiation effects occurred in 5 (55.6%) cases. One (11.1%) patient had an acute hemorrhage from the AVM after radiosurgery. Four (44.4%) patients underwent repeat radiosurgery and/or embolization. Three of these lesions eventually obliterated, while 1 did not.

Conclusion: The median time to obliteration was 84 months. Two-thirds of AVMs which persisted for over 4 years following initial radiosurgery treatment eventually obliterated. Transient post-radiosurgery adverse effects were common; delayed hemorrhages were rare in our case series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2018.10.109DOI Listing
March 2019

Stereotactic modulation of blood-brain barrier permeability to enhance drug delivery.

Neuro Oncol 2016 12 11;18(12):1601-1609. Epub 2016 Jul 11.

Department of Neurosurgery, Stanford Medical Center, Stanford, California (G.A., S.D.C.); Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (A.D., S.K.); Institut Lumière Matière, Université Claude Bernard Lyon 1, Villeurbanne, France (A.D., O.T.); Department of Neurosurgery, Baylor College of Medicine, Houston, Texas (M.L.); Department of Neurological Surgery, Columbia University Medical Center, New York, New York (S.M.); Department of Nuclear Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium (S.G.).

Drug delivery in the CNS is limited by endothelial tight junctions forming the impermeable blood-brain barrier. The development of new treatment paradigms has previously been hampered by the restrictiveness of the blood-brain barrier to systemically administered therapeutics. With recent advances in stereotactic localization and noninvasive imaging, we have honed the ability to modulate, ablate, and rewire millimetric brain structures to precisely permeate the impregnable barrier. The wide range of focused radiations offers endless possibilities to disrupt endothelial permeability with different patterns and intensity following 3-dimensional coordinates offering a new world of possibilities to access the CNS, as well as to target therapies. We propose a review of the current state of knowledge in targeted drug delivery using noninvasive image-guided approaches. To this end, we focus on strategies currently used in clinics or in clinical trials such as targeted radiotherapy and magnetic resonance guided focused ultrasound, but also on more experimental approaches such as magnetically heated nanoparticles, electric fields, and lasers, techniques which demonstrated remarkable results both in vitro and in vivo. We envision that biodistribution and efficacy of systemically administered drugs will be enhanced with further developments of these promising strategies. Besides therapeutic applications, stereotactic platforms can be highly valuable in clinical applications for interventional strategies that can improve the targetability and efficacy of drugs and macromolecules. It is our hope that by showcasing and reviewing the current state of this field, we can lay the groundwork to guide future research in this realm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/neuonc/now137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5744238PMC
December 2016

Focused ultrasound to transiently disrupt the blood brain barrier.

J Clin Neurosci 2016 06 13;28:187-9. Epub 2016 Feb 13.

Cerebrovascular Laboratory, Department of Neurosurgery, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA; Neuro-Intensive Care Unit, Columbia University Medical Center, New York, NY, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2015.12.011DOI Listing
June 2016

Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia.

Aging Clin Exp Res 2016 Feb 30;28(1):47-58. Epub 2015 Dec 30.

Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain.

Purpose: Sarcopenia is an age-related muscle condition which is frequently a precursor of frailty, mobility disability and premature death. It has a high prevalence in older populations and presents a considerable social and economic burden. Potential treatments are under development but, as yet, no guidelines support regulatory studies for new drugs to manage sarcopenia. The objective of this position paper is therefore to suggest a set of potential endpoints and target population definitions to stimulate debate and progress within the medico-scientific and regulatory communities.

Methods: A multidisciplinary expert working group was hosted by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, which reviewed and discussed the recent literature from a perspective of clinical experience and guideline development. Relevant parallels were drawn from the development of definition of osteoporosis as a disease and clinical assessment of pharmaceutical treatments for that indication.

Results: A case-finding decision tree is briefly reviewed with a discussion of recent prevalence estimations of different relevant threshold values. The selection criteria for patients in regulatory studies are discussed according to the aims of the investigation (sarcopenia prevention or treatment) and the stage of project development. The possible endpoints of such studies are reviewed and a plea is made for the establishment of a core outcome set to be used in all clinical trials of sarcopenia.

Conclusions: The current lack of guidelines for the assessment of new therapeutic treatments for sarcopenia could potentially hinder the delivery of effective medicines to patients at risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40520-015-0517-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768478PMC
February 2016

Clinical and surgical applications of smart glasses.

Technol Health Care 2015 ;23(4):381-401

Cerebrovascular Laboratory, Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA.

Background: With the increased efforts to adopt health information technology in the healthcare field, many innovative devices have emerged to improve patient care, increase efficiency, and decrease healthcare costs. A recent addition is smart glasses: web-connected glasses that can present data onto the lenses and record images or videos through a front-facing camera.

Objective: In this article, we review the most salient uses of smart glasses in healthcare, while also denoting their limitations including practical capabilities and patient confidentiality.

Methods: Using keywords including, but not limited to, ``smart glasses'', ``healthcare'', ``evaluation'', ``privacy'', and ``development'', we conducted a search on Ovid-MEDLINE, PubMed, and Google Scholar. A total of 71 studies were included in this review.

Results: Smart glasses have been adopted into the healthcare setting with several useful applications including, hands-free photo and video documentation, telemedicine, Electronic Health Record retrieval and input, rapid diagnostic test analysis, education, and live broadcasting.

Conclusions: In order for the device to gain acceptance by medical professionals, smart glasses will need to be tailored to fit the needs of medical and surgical sub-specialties. Future studies will need to qualitatively assess the benefits of smart glasses as an adjunct to the current health information technology infrastructure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/THC-150910DOI Listing
July 2016

The role of age in intracerebral hemorrhages.

J Clin Neurosci 2015 Dec 12;22(12):1867-70. Epub 2015 Sep 12.

Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.

We aimed to identify the role of age in intracerebral hemorrhage (ICH), as well as characterize the most commonly used age cut off points in the literature, with the hope of understanding and guiding treatment. Strokes are one of the leading causes of death in the USA, and ICH is the deadliest type. Age is a strong risk factor, but it also affects the body in numerous ways, including changes to the cardiovascular and central nervous systems that interplay with the multiple risk factors for ICH. Understanding the role of age in risk and outcomes of ICH can guide treatment and future clinical trials. A current review of the literature suggests that the age cut offs for increased rates of mortality and morbidity vary from 60-80 years of age, with the most common age cut offs being at 65 or 70 years of age. In addition to age as a determinant of ICH outcomes, age has its own effects on the maturing body in terms of changes in physiology, while also increasing the risk of multiple chronic health conditions and comorbidities, including hypertension, diabetes, and anticoagulant treatment for atrial fibrillation, all of which contribute to the pathology of ICH. The interaction of these chronic conditions, changes in physiology, age, and ICH is evident. However, the exact mechanism and extent of the impacts remains unclear. The ambiguity of these connections may be further obscured by individual patient preferences, and there are limitations in the literature which guides the current recommendations for aging patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2015.04.020DOI Listing
December 2015

Mobile Phone-Connected Wearable Motion Sensors to Assess Postoperative Mobilization.

JMIR Mhealth Uhealth 2015 Jul 28;3(3):e78. Epub 2015 Jul 28.

Cerebrovascular Lab, Columbia University Medical Center, New York, NY, United States.

Background: Early mobilization after surgery reduces the incidence of a wide range of complications. Wearable motion sensors measure movements over time and transmit this data wirelessly, which has the potential to monitor patient recovery and encourages patients to engage in their own rehabilitation.

Objective: We sought to determine the ability of off-the-shelf activity sensors to remotely monitor patient postoperative mobility.

Methods: Consecutive subjects were recruited under the Department of Neurosurgery at Columbia University. Patients were enrolled during physical therapy sessions. The total number of steps counted by the two blinded researchers was compared to the steps recorded on four activity sensors positioned at different body locations.

Results: A total of 148 motion data points were generated. The start time, end time, and duration of each walking session were accurately recorded by the devices and were remotely available for the researchers to analyze. The sensor accuracy was significantly greater when placed over the ankles than over the hips (P<.001). Our multivariate analysis showed that step length was an independent predictor of sensor accuracy. On linear regression, there was a modest positive correlation between increasing step length and increased ankle sensor accuracy (r=.640, r(2)=.397) that reached statistical significance on the multivariate model (P=.03). Increased gait speed also correlated with increased ankle sensor accuracy, although less strongly (r=.444, r(2)=.197). We did not note an effect of unilateral weakness on the accuracy of left- versus right-sided sensors. Accuracy was also affected by several specific measures of a patient's level of physical assistance, for which we generated a model to mathematically adjust for systematic underestimation as well as disease severity.

Conclusions: We provide one of the first assessments of the accuracy and utility of widely available and wirelessly connected activity sensors in a postoperative patient population. Our results show that activity sensors are able to provide invaluable information about a patient's mobility status and can transmit this data wirelessly, although there is a systematic underestimation bias in more debilitated patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/mhealth.3785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705357PMC
July 2015

Aquaporin-4 gene variant independently associated with oedema after intracerebral haemorrhage.

Neurol Res 2015 Aug 22;37(8):657-61. Epub 2015 May 22.

Introduction: Aquaporin-4 (AQP4) is the prominent water-channel protein in the brain playing a critical role in controlling cell water content. After intracerebral haemorrhage (ICH), perihematomal oedema (PHE) formation leads to a rapid increase in intracranial pressure (ICP) after the initial bleed. We sought to investigate the effect of a common genomic variant in the AQP4 gene on PHE formation after ICH.

Methods: We reviewed the literature and identified a candidate polymorphism in AQP4 genes previously reported in Genome Wide Association Studies (GWAS). Between February 2009 and March 2011, 128 patients consented to genetic testing and were genotyped for single nucleotide polymorphism (SNP) on the AQP4 gene. Genomic DNA was extracted from buccal swabs using MasterAmp extraction kits (Epicentre, Madison, WI, USA). DNA extracted from buffy coats of whole blood samples was amplified via PCR. Linear regression with log-transformed ICH + PHE volume as the response variable was used to determine the association of SNP controlled for admission variables age, GCS, infratentorial location, hypertension, systolic blood pressure (SBP), blood urea nitrogen (BUN), glucose and alkaline phosphatase.

Results: Nine of 128 patients had the minor allele for SNP rs1058427. Presence of the minor allele was significant in the model (P = 0.021), and associated with an increase of 88% in ICH + PHE volume (β = 0.632, exp(β) = 1.88) after controlling for admission variables. The only other significant variables included in the model was GCS (P < 0.001).

Conclusion: The establishment of an independent association between rs1054827 and ICH + PHE volume provides evidence implicating the AQP4 gene in haematoma and oedema formation after ICH. Further investigation is needed to characterise this link.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1179/1743132815Y.0000000047DOI Listing
August 2015

Motion Sensors to Assess and Monitor Medical and Surgical Management of Parkinson Disease.

World Neurosurg 2015 Aug 28;84(2):561-6. Epub 2015 Mar 28.

Department of Neurosurgery, Columbia University, New York, NY, USA; Neurointensive Care Unit, Columbia University, New York, NY, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.

Patients with Parkinson disease (PD) often suffer from a resting tremor, bradykinesia, rigidity, postural instability, and gait difficulty. Determining a patient's candidacy for deep-brain stimulation (DBS) surgery and tracking their clinical response postoperatively requires that the frequency, duration, and severity of these symptoms be characterized in detail. Conventional means of assessing these symptoms, however, rely heavily on patient self-reporting, which often fails to provide the necessary level of detail. Wearable accelerometers are a novel tool that can detect and objectively characterize these movement abnormalities in both the clinical setting and the patient's home environment. In this article, we review the role of accelerometers in surgical candidate selection, recording and predicting falls, recording and predicting freezing of gait, evaluating surgical outcomes, and evaluating postoperative recovery and in altering DBS settings. Although accelerometry has yet to make it into the mainstream clinic, there is great promise for this technology in monitoring Parkinson patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2015.03.024DOI Listing
August 2015

Meta-analysis of telemonitoring to improve HbA1c levels: promise for stroke survivors.

J Clin Neurosci 2015 May 16;22(5):807-11. Epub 2015 Mar 16.

Department of Neurosurgery, Columbia University, 630 West 168th Street Suite 5-454, New York, NY 10032, USA; Columbia University, College of Physicians and Surgeons, New York, NY, USA; Neurointensive Care Unit, Columbia University Medical Center, New York, NY, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.

Monitoring glycemic control is useful not only in the primary prevention of stroke in diabetics, but also in the rehabilitation from and secondary prevention of stroke. In an often functionally and neurocognitively impaired population, however, poor compliance with treatment regimens is a major problem. Wireless, telemonitoring glucometers - often integrated into the patient's healthcare system - offer a solution to the compliance issue. We sought to evaluate the effectiveness of telemonitoring technologies in improving long-term glycemic control. A search on www.clinicaltrials.gov, using keywords such as "telemonitoring" and "self-care device" was performed, and five trials were identified that compared hemoglobin A1c (HbA1c) levels of a group receiving standard care (controls) to a group receiving a telemonitoring intervention. Four of the five studies showed a greater reduction in HbA1c in the intervention group compared to controls at 6 months, although only one was statistically significant. There was considerable heterogeneity between studies (I(2)=69.5%, p=0.02), and the random effects model estimated the aggregate effect size for mean difference in reduction of HbA1c levels to be 0.08% (95% confidence interval -0.12% to 0.28%), which was not statistically significant (p=0.42). The varying results may be due to specific factors in the trials that contributed to their large heterogeneity, and further trials are needed to support the role of telemonitoring in improving diabetes management in this population. Nonetheless, in the future telemonitoring may substantially help patients at risk of ischemic stroke and those who require close glucose monitoring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2014.11.009DOI Listing
May 2015

Smart wearable body sensors for patient self-assessment and monitoring.

Arch Public Health 2014 22;72(1):28. Epub 2014 Aug 22.

Neurodigital Initiative, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA.

Background: Innovations in mobile and electronic healthcare are revolutionizing the involvement of both doctors and patients in the modern healthcare system by extending the capabilities of physiological monitoring devices. Despite significant progress within the monitoring device industry, the widespread integration of this technology into medical practice remains limited. The purpose of this review is to summarize the developments and clinical utility of smart wearable body sensors.

Methods: We reviewed the literature for connected device, sensor, trackers, telemonitoring, wireless technology and real time home tracking devices and their application for clinicians.

Results: Smart wearable sensors are effective and reliable for preventative methods in many different facets of medicine such as, cardiopulmonary, vascular, endocrine, neurological function and rehabilitation medicine. These sensors have also been shown to be accurate and useful for perioperative monitoring and rehabilitation medicine.

Conclusion: Although these devices have been shown to be accurate and have clinical utility, they continue to be underutilized in the healthcare industry. Incorporating smart wearable sensors into routine care of patients could augment physician-patient relationships, increase the autonomy and involvement of patients in regards to their healthcare and will provide for novel remote monitoring techniques which will revolutionize healthcare management and spending.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/2049-3258-72-28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166023PMC
September 2014

The quantified patient: a patient participatory culture.

Curr Med Res Opin 2014 Dec 28;30(12):2585-7. Epub 2014 Aug 28.

Neurodigital Initiative, Department of Neurosurgery, Columbia University , New York , USA.

The Quantified Self Movement, which aims to improve various aspects of life and health through recording and reviewing daily activities and biometrics, is a new and upcoming practice of self monitoring that holds much promise. Now, the most underutilized resource in ambulatory health care, the patient, can participate like never before, and the patient's Quantified Self can be directly monitored and remotely accessed by health care professionals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1185/03007995.2014.954032DOI Listing
December 2014

Hematoma volume as the major determinant of outcomes after intracerebral hemorrhage.

J Neurol Sci 2014 Oct 5;345(1-2):3-7. Epub 2014 Jul 5.

Cerebrovascular Laboratory, Department of Neurosurgery Columbia University Medical Centre, 630 West 168th Street, New York, NY, United States.

Intracerebral hemorrhage (ICH) is a leading cause of morbidity and mortality, greatly linked to hematoma volume. Understanding the characteristics and size of hematoma is integral to evaluating severity and prognosis after ICH. Examination of the literature suggests that markers for hematoma size vary, but the key range between 20-30 mL is most widely used as the cut-off for classification of hematoma volume. The role of hematoma volume in episodes of hematoma expansion and re-bleeding further impact outcomes, with increased growth associated with larger hematoma volume. Additionally, many commonly used predictors of ICH outcomes are directly related to hematoma volume, implicating it as an important variable when determining outcomes. In conclusion, hematoma volume is likely the most significant determinant of outcomes in intracerebral hemorrhage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jns.2014.06.057DOI Listing
October 2014

Age selection for decompressive craniectomy in malignant middle cerebral artery infarction.

World Neurosurg 2015 Mar 14;83(3):301-2. Epub 2014 May 14.

Cerebrovascular Research Laboratory, Columbia University, New York, New York, USA; Department of Neurosurgery, Columbia University, New York, New York, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2014.05.012DOI Listing
March 2015

A critical assessment of approaches to outpatient monitoring.

Curr Med Res Opin 2014 Jul 4;30(7):1383-4. Epub 2014 Apr 4.

Columbia University Medical Center , New York, NY , USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1185/03007995.2014.904774DOI Listing
July 2014

The promise of wearable activity sensors to define patient recovery.

J Clin Neurosci 2014 Jul 9;21(7):1089-93. Epub 2013 Dec 9.

Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA.

The recent emergence of mobile health--the use of mobile telecommunication and wireless devices to improve health outcomes, services, and research--has inspired a patient-centric approach to monitor health metrics. Sensors embedded in wearable devices are utilized to acquire greater self-knowledge by tracking basic parameters such as blood pressure, heart rate, and body temperature as well as data related to exercise, diet, and psychological state. To that end, recent studies on utilizing wireless fitness activity trackers to monitor and promote functional recovery in patients suggest that collecting up-to-date performance data could help patients regain functional independence and help hospitals determine the appropriate length of stay for a patient. This manuscript examines existing functional assessment scales, discusses the use of activity tracking sensors in evaluating functional independence, and explores the growing application of wireless technology in measuring and promoting functional recovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2013.12.003DOI Listing
July 2014