Publications by authors named "Marc D Moisi"

20 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

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

Quality and Clinical Care Development in Spine Surgery-Connecting the Dots: An Expanded Clinical Narrative.

Global Spine J 2020 Jan 6;10(1 Suppl):10S-16S. Epub 2020 Jan 6.

Detroit Medical Center, Seattle, WA, USA.

Our health care system is an evidenced-based quality-centric environment. Pursuit of quality is a process that encompasses knowledge development and care advancements through collaboration and expertise. Depicted here is the foundational knowledge, process, and contributions that hallmark successful clinical quality programs. Beginning with methodology, followed by process and form, we create the foundational knowledge and exemplars demonstrating framework and continuum of process in pursuit and attainment of successful clinical quality and care development for patients. Although our protocol has been devised for complex spine care, this could be implemented across all health care specialties to provide individualized and high-quality care for all current and future patients, all while creating a culture of accountability for physicians.
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http://dx.doi.org/10.1177/2192568219871248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947679PMC
January 2020

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

Cervical spondylodiscitis caused by in a non-immunocompromised patient: A case report and review of literature.

Surg Neurol Int 2019 2;10:151. Epub 2019 Aug 2.

Department of Neurosurgery, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan.

Background: Fungal cervical spondylodiscitis is rare and accounts for less than 1% of all cervical, thoracic, and lumbar vertebral osteomyelitis and discitis.

Case Description: A 32-year-old non-immunocompromised male presented with persistent neck pain and paresthesias. The magnetic resonance imaging of the cervical spine demonstrated a contrast-enhancing erosive lesion involving the cervical C6 and C7 vertebral bodies accompanied by epidural phlegmon. Blood culture was negative. The patient underwent a C6 and C7 anterior corpectomy with instrumented fusion (e.g., expandable cage C5 to T1). Intraoperatively, frank pus was noted within the C6-C7 disc space and was accompanied by thick prevertebral and epidural phlegmon extending from C5 to T1. Intraoperative cultures grew . Three days later, a C6-C7 laminectomy with C4-T2 posterior instrumented fusion was performed; the cultures again grew . The patient was treated with intravenous micafungin for 14 days followed by 6-12 months of 400 mg oral fluconazole daily.

Conclusion: There are few cases in literature where non-immunocompromised patients developed fungal cervical spondylodiscitis. Prompt diagnosis and appropriate management are critical to effectively treat these patients. Surgical intervention may warrant corpectomy, discectomy, and operative debridement followed by long-term targeted antifungal therapy.
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http://dx.doi.org/10.25259/SNI_240_2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744757PMC
August 2019

Candida parapsilosis Infection of Ventriculoperitoneal Shunt in Adult: Case Report and Literature Review.

World Neurosurg 2018 Nov 13;119:290-293. Epub 2018 Aug 13.

Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA.

Background: Candida parapsilosis is an incredibly rare cause of ventriculoperitoneal (VP) shunt infections, with only 1 adult case reported in the literature to date.

Case Description: We describe the case of a 45-year-old man admitted for a traumatic fall and subsequently treated with VP shunt placement for obstructive hydrocephalus secondary to a cerebellar contusion and intraventricular hemorrhage. Eight months following VP shunt placement, the patient presented with a 2-month history of clear fluid leakage through a dehiscent surgical abdominal wound overlying the distal VP shunt. Cerebrospinal fluid cultures were obtained and grew C. parapsilosis. The patient subsequently underwent VP shunt externalization and began antifungal treatment with intravenous liposomal amphotericin B. Cerebrospinal fluid studies continued to redemonstrate C. parapsilosis infection, for which VP shunt removal and external ventricular drain placement was performed. Three days into treatment with amphotericin B, he endured significant nephrotoxicity necessitating a switch to oral fluconazole. Following 3 weeks of oral fluconazole treatment with negative serial cerebrospinal fluid cultures, the patient underwent external ventricular drain removal and VP shunt insertion. Following the procedure and 22 total days of oral fluconazole treatment, our patient recovered well and was discharged to a rehabilitation facility in stable condition.

Conclusions: In our report, we describe the clinical course of our patient and offer a review and analysis of the most up-to-date literature concerning C. parapsilosis shunt infections, as well as treatment guidelines for central nervous system candidiasis.
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http://dx.doi.org/10.1016/j.wneu.2018.08.023DOI Listing
November 2018

Extraforaminal compression of the L5 nerve: An anatomical study with application to failed posterior decompressive procedures.

J Clin Neurosci 2017 Jul 10;41:139-143. Epub 2017 Apr 10.

Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA 98122, USA; Swedish Neuroscience Institute, Swedish Medical Center, 550 17th Avenue, Suite 500, Seattle, WA 98122, USA.

This anatomical study was performed to elucidate the pertinent foraminal and lateral L5 nerve anatomy to enhance our understanding of possible neurologic causes of failed decompression surgery. Persistent extraforaminal L5 nerve compression is a possible cause of persistent symptoms following lumbosacral surgery. The amount of extraforaminal space for the L5 ventral ramus was examined in fifty adult human skeletons (100 sides). Based on morphology, the specimens were then categorized (types I-IV) on the basis of the bony space available for the nerve at this location. Next, 25 embalmed adult cadavers (50 sides) underwent bilateral dissection of the lower lateral lumbar region. The type of bony extraforaminal outlet was documented for each cadaver on the basis of our skeletal analysis. Lastly, segments (intra- and extra-foraminal) of the L5 ventral ramus were excised and examined histologically. Types I-IV outlets were found in 43, 31, 20 and 6 skeletal sides, respectively. For cadavers, 22,15, 10 and 3 sides were found to have types I-IV bony outlets, respectively. In cadavers, all type IV outlets and 70% of the type III bony configurations adjacent to the L5 ventral ramus had signs of neural irritation/injury including vascular hyalinization and increased fibrosis distal to the intervertebral foramen. No distal segments of type I and type II outlets showed histological signs of neural compromise. Patients with symptoms referable to L5 nerve compression for whom no proximal pathology is identified could warrant investigation of the more distal extraforaminal segment of this nerve.
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http://dx.doi.org/10.1016/j.jocn.2017.03.051DOI Listing
July 2017

Advancement of Surgical Visualization Methods: Comparison Study Between Traditional Microscopic Surgery and a Novel Robotic Optoelectronic Visualization Tool for Spinal Surgery.

World Neurosurg 2017 Feb 9;98:273-277. Epub 2016 Nov 9.

Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.

Introduction: The operating microscope (OM) has become instrumental in aiding surgeons during key microdissection with greater safety and detail. An exoscope offers similar detail with improved functionality and greater implications for live teaching and improved operating room flow.

Methods: Eleven senior neurosurgery residents and fellows performed unilateral, single-level laminotomies on fresh cadavers using an OM and exoscope. Three attending spine surgeons blinded for the visualization technique used then reviewed and graded each decompression. Data points gathered included time of procedure, grading of decompression (1-5), and complications, including dural tear, nerve root injury, and pars fracture.

Results: Operative times between the 2 systems were not significantly different (14.9 minutes OM vs. 15.6 minutes exoscope, P = 0.766). Despite high variability between evaluators in assessing complications and adequacy of decompression, there was no significant difference between either system. Postprocedural surveys indicated greater comfort with the exoscope, greater ease of use, and superior teaching potential for the exoscope over the standard OM.

Conclusion: In our simulated operating room model, an exoscope is a valid alternative to the standard OM that affords the surgeon greater comfort with greater teaching potential while maintaining many of the microscope's benefits.
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http://dx.doi.org/10.1016/j.wneu.2016.11.003DOI Listing
February 2017

Cervical fracture from chronic steroid usage presenting as a stroke: A case report.

Int J Surg Case Rep 2016 29;28:135-138. Epub 2016 Sep 29.

Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States.

Introduction: Misdiagnosis of Brown-Séquard-like presentations can delay treatment; potentially endangering the positive outcomes a patient might otherwise have had. Stroke mimics can be perceived as signaling the end of urgent investigation and care once stroke is ruled out; however, stroke mimics themselves can require prompt care. Herein, we discuss an extremely rare case where stroke was ruled out, resulting in a lapse in care that lead to an exacerbated hemiparesis over the following week.

Presentation Of Case: We present a patient with an occult cervical spine fracture with extension of the neck, caused by reduced bone density from a chronic steroid regimen. Nine days after the initial onset of her neurological symptoms, the patient presented to the ED with the complaint of left sided weakness and right-sided sensory loss. She was determined to have a left- sided Brown Séquard syndrome, which resolved following anterior cervical discectomy and fusion at C4-C6 and a laminectomy from C4-C6.

Discussion: This case indicated that patients with dangerously low bone density should be weaned off chronic steroid therapy to prevent the onset of osteoporotic symptoms early in adulthood. Furthermore, this case emphasizes the importance of continued investigation of symptoms if a stroke is ruled out and the need for more diligent monitoring of bone density of chronic steroid users.

Conclusion: Stroke mimics can require the same urgency in care and diagnosis as strokes themselves.
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http://dx.doi.org/10.1016/j.ijscr.2016.09.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5048694PMC
September 2016

New Landmark for Localizing the Site of the Subdental Synchondrosis Remnant: Application to Discerning Pathology from Normal on Imaging.

World Neurosurg 2016 Dec 31;96:80-84. Epub 2016 Aug 31.

Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.

Objective: We hypothesized that the entry site of the basivertebral vein into the basivertebral foramen of C2 might localize the subdental synchondrosis between the odontoid process and body of C2, which may be helpful for odontoid fracture classification.

Methods: Twenty-five dry adult C2 specimens underwent thin-cut computed tomography and were sectioned sagittally. The basivertebral foramen was then correlated to internal bony anatomy. Fifty magnetic resonance images were reviewed, and the location of the subdental synchondrosis was determined.

Results: A basivertebral foramen was identified on the posterior surface of all dry C2 specimens. The openings were found at a distance of 30%-44% on an inferosuperior point along the vertical height of C2. For bony specimens with a subdental synchondrosis remnant (75%), entry of acupuncture needles into the basivertebral foramen was always directly at the level of the synchondrosis remnant. For magnetic resonance imaging (MRI), a subdental synchondrosis or its remnants were seen on all studies. The distance from the base of C2 to the subdental synchondrosis ranged from 9-13 mm. This equated to an inferosuperior point 32%-43% along the vertical height of C2. A strong correlation existed when comparing the location of the basivertebral foramen of bony specimens and the subdental synchondrosis location on MRI.

Conclusions: The basivertebral foramen is a consistently present anatomic reference point for the subdental synchondrosis even if the latter cannot be seen on conventional radiographic imaging. Our MRI data might also be useful in helping differentiate lesions affecting C2 from normal subdental cartilaginous remnants that can be encountered on imaging.
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http://dx.doi.org/10.1016/j.wneu.2016.08.096DOI Listing
December 2016

Dynamic susceptibility contrast and dynamic contrast-enhanced MRI characteristics to distinguish microcystic meningiomas from traditional Grade I meningiomas and high-grade gliomas.

J Neurosurg 2017 Apr 10;126(4):1220-1226. Epub 2016 Jun 10.

Swedish Neuroscience Institute, Swedish Medical Center, and.

OBJECTIVE Microcystic meningioma (MM) is a meningioma variant with a multicystic appearance that may mimic intrinsic primary brain tumors and other nonmeningiomatous tumor types. Dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) MRI techniques provide imaging parameters that can differentiate these tumors according to hemodynamic and permeability characteristics with the potential to aid in preoperative identification of tumor type. METHODS The medical data of 18 patients with a histopathological diagnosis of MM were identified through a retrospective review of procedures performed between 2008 and 2012; DSC imaging data were available for 12 patients and DCE imaging data for 6. A subcohort of 12 patients with Grade I meningiomas (i.e., of meningoepithelial subtype) and 54 patients with Grade IV primary gliomas (i.e., astrocytomas) was also included, and all preoperative imaging sequences were analyzed. Clinical variables including patient sex, age, and surgical blood loss were also included in the analysis. Images were acquired at both 1.5 and 3.0 T. The DSC images were acquired at a temporal resolution of either 1500 msec (3.0 T) or 2000 msec (1.5 T). In all cases, parameters including normalized cerebral blood volume (CBV) and transfer coefficient (kTrans) were calculated with region-of-interest analysis of enhancing tumor volume. The normalized CBV and kTrans data from the patient groups were analyzed with 1-way ANOVA, and post hoc statistical comparisons among groups were conducted with the Bonferroni adjustment. RESULTS Preoperative DSC imaging indicated mean (± SD) normalized CBVs of 5.7 ± 2.2 ml for WHO Grade I meningiomas of the meningoepithelial subtype (n = 12), 4.8 ± 1.8 ml for Grade IV astrocytomas (n = 54), and 12.3 ± 3.8 ml for Grade I meningiomas of the MM subtype (n = 12). The normalized CBV measured within the enhancing portion of the tumor was significantly higher in the MM subtype than in typical meningiomas and Grade IV astrocytomas (p < 0.001 for both). Preoperative DCE imaging indicated mean kTrans values of 0.49 ± 0.20 min in Grade I meningiomas of the meningoepithelial subtype (n = 12), 0.27 ± 0.12 min for Grade IV astrocytomas (n = 54), and 1.35 ± 0.74 min for Grade I meningiomas of the MM subtype (n = 6). The kTrans was significantly higher in the MM variants than in the corresponding nonmicrocystic Grade 1 meningiomas and Grade IV astrocytomas (p < 0.001 for both). Intraoperative blood loss tended to increase with increased normalized CBV (R = 0.45, p = 0.085). CONCLUSIONS An enhancing cystic lesion with a normalized CBV greater than 10.3 ml or a kTrans greater than 0.88 min should prompt radiologists and surgeons to consider the diagnosis of MM rather than traditional Grade I meningioma or high-grade glioma in planning surgical care. Higher normalized CBVs tend to be associated with increased intraoperative blood loss.
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http://dx.doi.org/10.3171/2016.3.JNS14243DOI Listing
April 2017

Commentary on: "Remote Cerebellar Hemorrhage after Revision Lumbar Spine Surgery".

Global Spine J 2015 Dec;5(6):538

Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, United States.

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http://dx.doi.org/10.1055/s-0035-1567837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671894PMC
December 2015

Bullet Fragment of the Lumbar Spine: The Decision Is More Important Than the Incision.

Global Spine J 2015 Dec;5(6):523-6

Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States.

Study Design Case report. Objective Treatment of gunshot wounds to the spine is a topic of continued discussion and controversy. The following case study provides a description of a patient with a gunshot wound to the lumbar spine with a retained bullet in the intrathecal space. Methods Immediately after gunshot injury, a patient developed lumbar and radicular pain, as well as neurologic deficits. He was taken for surgery to remove the retained bullet. Results Following surgery, pain and neurologic function improved. The operative techniques and the postoperative clinical management are discussed in this report. Conclusion In our opinion, it was necessary to remove the bullet to avoid migration and possible worsening of neurologic function. However, surgical intervention is not appropriate in every case, and ultimately decisions should be based on patient presentation, symptomology, and imaging.
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http://dx.doi.org/10.1055/s-0035-1566231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671882PMC
December 2015

Primary intracranial sarcomatoid carcinoma arising from a recurrent/residual epidermoid cyst of the cerebellopontine angle: a case report.

Am J Surg Pathol 2011 Aug;35(8):1238-43

Department of Pathology and Laboratory Medicine, The Methodist Hospital, Houston, TX 77030, USA.

Primary intracranial squamous cell carcinomas (SCCs) are rare and mostly associated with an intracranial epidermoid or dermoid cyst. Sarcomatoid carcinoma is a rare biphasic tumor composed of both carcinomatous and sarcomatous components and has not previously been reported as a primary intracranial tumor. Here, we present a case of a 60-year-old man with a primary intracranial sarcomatoid carcinoma, arising from the remnants of the previously resected epidermoid cyst in the cerebellopontine angle. The resected material had portions of an epidermoid cyst lined by normal and dysplastic squamous epithelia and invasive keratinizing SCC. This area was in continuity with areas of highly pleomorphic, anaplastic sarcomatoid cells. Brisk mitotic activity and extensive areas of necrosis were found. On immunohistochemical staining, the cells of the conventional SCC were positive for cytokeratin 5/6, pancytokeratin, epithelial membrane antigen, p63, and p53. The sarcomatoid cells were diffusely and strongly positive for vimentin, p53, smooth muscle actin, and, focally, muscle-specific actin. Occasional sarcomatoid cells coexpressed cytokeratin 5/6, pancytokeratin, p63, and S100 protein. The patient subsequently developed leptomeningeal spread and died 4 months after the second surgery. This rare entity expands the morphologic spectrum encountered in primary intracranial carcinoma.
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http://dx.doi.org/10.1097/PAS.0b013e318223ee29DOI Listing
August 2011
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