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Finger G, Zimelewicz Oberman D, Loyola Godoy B, de Miranda Chaves Christiani M, Aversa A. Microsurgical Resection of Giant Radio-Induced Cavernous Malformation: 2- Dimensional Video. World Neurosurg 2024; 184:42-43. [PMID: 38218441 DOI: 10.1016/j.wneu.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
Radioinduced cavernous malformations (RICMs) are low-flow, angiographically occult vascular lesions. Giant radioinduced cavernous malformations (GRICMs) are a subtype of RICMs that are characterized by their large size. GRICMs are defined as RICMs that are larger than 3 cm in diameter.1 They are uncommon conditions accounting for 0.1% to 0.5% among patients who have received radiation therapy for head and neck cancer or brain tumors.2,3 The risk of developing GRICMs increases with the dose of radiation received and the length of time since radiation exposure.4 Other factors that may increase the risk of developing GRICMs include age, genetic predisposition, and underlying medical conditions.5 Due to the relatively low incidence of GRICMs and the limited number of studies on this condition, there are limited data about the management of this condition. This case report describes a 12-year-old female who was previously treated for a pilocytic astrocytoma in 2012. After undergoing stereotactic biopsy and whole-brain radiotherapy (50 gray in 28 sections), she was diagnosed with a radioinduced cavernous malformation in 2016 during follow-up imaging. The RICM was managed conservatively with imaging follow-up, which showed no increase in size between 2016 and 2019. However, in 2020, the patient experienced a seizure episode associated with left-sided hemiplegia. Further investigation with cranial magnetic resonance imaging and digital subtraction angiography showed a mixed-intensity image and surrounded by a low signal intensity rim on T2-weighted images, representing hemosiderin in the right central lobe, with intense perilesional edema, with no enhancement. Given the size and location of the mass, the patient underwent microsurgical resection of the RICM (Video 1). The surgery was successful, and the lesion was successfully resected. This case highlights the importance of careful monitoring for RICMs in patients who have received radiation therapy, as well as the potential for these lesions to cause significant symptoms and disability. The case also demonstrates that surgical intervention may be necessary in some cases to manage RICMs and that microsurgical resection can be an effective treatment option. The patient gave informed consent for surgery and video recording.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Bruno Loyola Godoy
- Department of Neurosurgery, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | | | - Antonio Aversa
- Department of Neurosurgery, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
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Khaleghi M, Finger G, Wu KC, Munjal V, Ghalib L, Kobalka P, Blakaj D, Dibs K, Carrau R, Prevedello D. Successful treatment of medically and surgically refractory lymphocytic hypophysitis with fractionated stereotactic radiotherapy: a single-center experience and systematic literature review. Pituitary 2024; 27:213-229. [PMID: 38270722 DOI: 10.1007/s11102-023-01367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To explore the potential role of focused radiotherapy in managing the lymphocytic hypophysitis (LH) refractory to medical therapy and surgery. METHOD A systematic literature review was conducted following PRISMA guidelines to identify the studies on radiation treatment for hypophysitis, along with the experience in our institution. RESULTS The study included eight patients, three from our institution and five from existing literature. The age at presentation ranged from 37 to 75 years old, with a median age of 58. The presenting symptoms involved headache in seven patients and diplopia in two patients. Pre-radiation visual field defects were noticed in four patients. All patients exhibited variable degrees of hypopituitarism before radiation, with oral corticosteroids being the initial medical treatment. Immunosuppressive therapy was attempted in two patients prior to radiation. Seven patients had a history of transsphenoidal surgery with a histologically confirmed LH. Three patients underwent stereotactic radiosurgery (SRS), while the remaining received FSRT, with a mean irradiation volume of 2.2 cm3. A single-session total dose of 12 -15 Gy was administered in the SRS group. In the FSRT group, doses ranged from 24 to 30 Gy with a median dose of 25 Gy, delivered in 2 Gy fractions. Four patients achieved a resolution of visual field defects, while another two patients demonstrated improvement in their associated focal neurologic deficits. No change in pre-existing endocrine status was shown after radiation, except in one patient. Clinical response was achieved in seven patients after a single course of radiation, while one patient required the second course. Six patients remained stable on low-dose glucocorticoid during at least a 12-month follow-up period, and one discontinued it entirely without experiencing relapse. Three patients demonstrated a complete radiologic response, while the remaining showed a partial radiologic response. CONCLUSIONS Focused radiation, including FSRT, can play a role in symptomatic relief, effective mass shrinkage, and minimizing radiation exposure to critical surrounding structures in patients with refractory LH. However, further research efforts are necessary to better clarify its effects and optimal dose planning.
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Affiliation(s)
- Mehdi Khaleghi
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Guilherme Finger
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kyle C Wu
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vikas Munjal
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Luma Ghalib
- Department of Endocrinology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter Kobalka
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dukagjin Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Khaled Dibs
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ricardo Carrau
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Vignolles-Jeong J, Finger G, McGahan BG, Beaumont TL, Weber MD, Wu KC, Prevedello DM. Management of recurrent giant hemangiopericytoma: illustrative cases. J Neurosurg Case Lessons 2024; 7:CASE2432. [PMID: 38531083 DOI: 10.3171/case2432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/22/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Hemangiopericytoma (HPC) is a rare malignancy accounting for 0.4% of intracranial tumors. HPCs are characterized by local aggressiveness, high rates of recurrence, and a tendency to metastasize to extracranial sites. These features make management of HPCs challenging, often requiring a combination of radical resection and radiation. Given their rarity, optimal treatment algorithms remain undefined. OBSERVATIONS The authors report a series of four patients who underwent resection of intracranial HPC. Mean age at presentation was 49.3 years. Three patients had reoperation for progression of residual tumor, and one patient was surgically retreated for recurrence. One patient received adjuvant radiotherapy following initial resection, and three patients received adjuvant radiotherapy following resection of recurrent or residual disease. There was one death in the series. Average progression-free survival and overall survival following the index procedure were 32.8 and 82 months, respectively. Progression occurred locally in all patients, with metastatic recurrence in one patient. LESSONS The current gold-standard treatment for intracranial HPC consists of gross-total resection followed by radiation therapy. This approach allows satisfactory local control; however, given the tendency for these tumors to recur either locally or distally within or outside of the central nervous system, there is a need for salvage therapies to improve long-term outcomes for patients.
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Affiliation(s)
| | - Guilherme Finger
- 2Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ben G McGahan
- 2Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Thomas L Beaumont
- 3Department of Neurological Surgery, University of California, San Diego School of Medicine, San Diego, California; and
| | | | - Kyle C Wu
- 2Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio
- 4The James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Daniel M Prevedello
- 2Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio
- 4The James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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Keister A, Wu KC, Finger G, Prevedello D. Endoscopic endonasal decompression of the optic nerve in the setting of compressive lesions: how I do it. Acta Neurochir (Wien) 2024; 166:129. [PMID: 38467944 DOI: 10.1007/s00701-024-05994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/07/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Many lesions in the anterior skull base may compress the optic nerve (ON), leading to vision loss, and even irreversible blindness. Although decompression of the optic nerve has traditionally been achieved transcranially, the endoscopic endonasal approach (EEA) is gaining traction as a minimally invasive approach recently. METHOD We describe the key steps of an EEA ON decompression. The relevant surgical anatomy with illustration is described. Additionally, a video detailing our technique and instruments on an illustrative case is provided. CONCLUSION Endoscopic endonasal approach ON decompression with a straight feather blade is a feasible, minimally invasive procedure to decompress the ON in the setting of anterior skull base mass lesions.
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Affiliation(s)
- Alexander Keister
- The Ohio State University College of Medicine, Columbus, OH, USA.
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Kyle C Wu
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Guilherme Finger
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Daniel Prevedello
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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Abuter R, Allouche F, Amorim A, Bailet C, Berdeu A, Berger JP, Berio P, Bigioli A, Boebion O, Bolzer ML, Bonnet H, Bourdarot G, Bourget P, Brandner W, Cao Y, Conzelmann R, Comin M, Clénet Y, Courtney-Barrer B, Davies R, Defrère D, Delboulbé A, Delplancke-Ströbele F, Dembet R, Dexter J, de Zeeuw PT, Drescher A, Eckart A, Édouard C, Eisenhauer F, Fabricius M, Feuchtgruber H, Finger G, Förster Schreiber NM, Garcia P, Garcia Lopez R, Gao F, Gendron E, Genzel R, Gil JP, Gillessen S, Gomes T, Gonté F, Gouvret C, Guajardo P, Guieu S, Hackenberg W, Haddad N, Hartl M, Haubois X, Haußmann F, Heißel G, Henning T, Hippler S, Hönig SF, Horrobin M, Hubin N, Jacqmart E, Jocou L, Kaufer A, Kervella P, Kolb J, Korhonen H, Lacour S, Lagarde S, Lai O, Lapeyrère V, Laugier R, Le Bouquin JB, Leftley J, Léna P, Lewis S, Liu D, Lopez B, Lutz D, Magnard Y, Mang F, Marcotto A, Maurel D, Mérand A, Millour F, More N, Netzer H, Nowacki H, Nowak M, Oberti S, Ott T, Pallanca L, Paumard T, Perraut K, Perrin G, Petrov R, Pfuhl O, Pourré N, Rabien S, Rau C, Riquelme M, Robbe-Dubois S, Rochat S, Salman M, Sanchez-Bermudez J, Santos DJD, Scheithauer S, Schöller M, Schubert J, Schuhler N, Shangguan J, Shchekaturov P, Shimizu TT, Sevin A, Soulez F, Spang A, Stadler E, Sternberg A, Straubmeier C, Sturm E, Sykes C, Tacconi LJ, Tristram KRW, Vincent F, von Fellenberg S, Uysal S, Widmann F, Wieprecht E, Wiezorrek E, Woillez J, Zins G. A dynamical measure of the black hole mass in a quasar 11 billion years ago. Nature 2024; 627:281-285. [PMID: 38286342 DOI: 10.1038/s41586-024-07053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024]
Abstract
Tight relationships exist in the local Universe between the central stellar properties of galaxies and the mass of their supermassive black hole (SMBH)1-3. These suggest that galaxies and black holes co-evolve, with the main regulation mechanism being energetic feedback from accretion onto the black hole during its quasar phase4-6. A crucial question is how the relationship between black holes and galaxies evolves with time; a key epoch to examine this relationship is at the peaks of star formation and black hole growth 8-12 billion years ago (redshifts 1-3)7. Here we report a dynamical measurement of the mass of the black hole in a luminous quasar at a redshift of 2, with a look back in time of 11 billion years, by spatially resolving the broad-line region (BLR). We detect a 40-μas (0.31-pc) spatial offset between the red and blue photocentres of the Hα line that traces the velocity gradient of a rotating BLR. The flux and differential phase spectra are well reproduced by a thick, moderately inclined disk of gas clouds within the sphere of influence of a central black hole with a mass of 3.2 × 108 solar masses. Molecular gas data reveal a dynamical mass for the host galaxy of 6 × 1011 solar masses, which indicates an undermassive black hole accreting at a super-Eddington rate. This suggests a host galaxy that grew faster than the SMBH, indicating a delay between galaxy and black hole formation for some systems.
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Affiliation(s)
- R Abuter
- European Southern Observatory, Garching, Germany
| | - F Allouche
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - A Amorim
- Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- CENTRA - Centro de Astrofísica e Gravitação, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
| | - C Bailet
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - A Berdeu
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - J-P Berger
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - P Berio
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - A Bigioli
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | - O Boebion
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - M-L Bolzer
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
- Department of Physics, Technical University Munich, Garching, Germany
- Univ. Lyon, Univ. Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon UMR5574, Saint-Genis-Laval, France
| | - H Bonnet
- European Southern Observatory, Garching, Germany
| | - G Bourdarot
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - P Bourget
- European Southern Observatory, Santiago, Chile
| | - W Brandner
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - Y Cao
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - R Conzelmann
- European Southern Observatory, Garching, Germany
| | - M Comin
- European Southern Observatory, Garching, Germany
| | - Y Clénet
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - B Courtney-Barrer
- European Southern Observatory, Santiago, Chile
- Research School of Astronomy and Astrophysics, College of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - R Davies
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - D Defrère
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | - A Delboulbé
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | | | - R Dembet
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - J Dexter
- Department of Astrophysical & Planetary Sciences, JILA, University of Colorado Boulder, Boulder, CO, USA
| | | | - A Drescher
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - A Eckart
- Max Planck Institute for Radio Astronomy, Bonn, Germany
- 1st Institute of Physics, University of Cologne, Cologne, Germany
| | - C Édouard
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - F Eisenhauer
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - M Fabricius
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - H Feuchtgruber
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - G Finger
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | | | - P Garcia
- CENTRA - Centro de Astrofísica e Gravitação, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - R Garcia Lopez
- School of Physics, University College Dublin, Belfield, Dublin 4, Ireland
| | - F Gao
- Max Planck Institute for Radio Astronomy, Bonn, Germany
| | - E Gendron
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - R Genzel
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
- Departments of Physics, University of California, Berkeley, Berkeley, CA, USA
- Department of Astronomy, University of California, Berkeley, Berkeley, CA, USA
| | - J P Gil
- European Southern Observatory, Santiago, Chile
| | - S Gillessen
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - T Gomes
- CENTRA - Centro de Astrofísica e Gravitação, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - F Gonté
- European Southern Observatory, Garching, Germany
| | - C Gouvret
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - P Guajardo
- European Southern Observatory, Santiago, Chile
| | - S Guieu
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - W Hackenberg
- European Southern Observatory, Garching, Germany
| | - N Haddad
- European Southern Observatory, Santiago, Chile
| | - M Hartl
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - X Haubois
- European Southern Observatory, Santiago, Chile
| | - F Haußmann
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - G Heißel
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
- Advanced Concepts Team, European Space Agency, TEC-SF, ESTEC, Noordwijk, The Netherlands
| | - Th Henning
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - S Hippler
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - S F Hönig
- School of Physics and Astronomy, University of Southampton, Southampton, UK
| | - M Horrobin
- 1st Institute of Physics, University of Cologne, Cologne, Germany
| | - N Hubin
- European Southern Observatory, Garching, Germany
| | - E Jacqmart
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - L Jocou
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - A Kaufer
- European Southern Observatory, Santiago, Chile
| | - P Kervella
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - J Kolb
- European Southern Observatory, Garching, Germany
| | - H Korhonen
- European Southern Observatory, Santiago, Chile
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - S Lacour
- European Southern Observatory, Garching, Germany
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - S Lagarde
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - O Lai
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - V Lapeyrère
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - R Laugier
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | | | - J Leftley
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - P Léna
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - S Lewis
- European Southern Observatory, Garching, Germany
| | - D Liu
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - B Lopez
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - D Lutz
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - Y Magnard
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - F Mang
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
- Department of Physics, Technical University Munich, Garching, Germany
| | - A Marcotto
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - D Maurel
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - A Mérand
- European Southern Observatory, Garching, Germany
| | - F Millour
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - N More
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - H Netzer
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - H Nowacki
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - M Nowak
- Institute of Astronomy, University of Cambridge, Cambridge, UK
| | - S Oberti
- European Southern Observatory, Garching, Germany
| | - T Ott
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - L Pallanca
- European Southern Observatory, Santiago, Chile
| | - T Paumard
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - K Perraut
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - G Perrin
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - R Petrov
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - O Pfuhl
- European Southern Observatory, Garching, Germany
| | - N Pourré
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - S Rabien
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - C Rau
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - M Riquelme
- European Southern Observatory, Garching, Germany
| | - S Robbe-Dubois
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - S Rochat
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - M Salman
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | - J Sanchez-Bermudez
- Max Planck Institute for Astronomy, Heidelberg, Germany
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - D J D Santos
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - S Scheithauer
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - M Schöller
- European Southern Observatory, Garching, Germany
| | - J Schubert
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - N Schuhler
- European Southern Observatory, Santiago, Chile
| | - J Shangguan
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | | | - T T Shimizu
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany.
| | - A Sevin
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - F Soulez
- Univ. Lyon, Univ. Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon UMR5574, Saint-Genis-Laval, France
| | - A Spang
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - E Stadler
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - A Sternberg
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
- Center for Computational Astrophysics, Flatiron Institute, New York, NY, USA
| | - C Straubmeier
- 1st Institute of Physics, University of Cologne, Cologne, Germany
| | - E Sturm
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - C Sykes
- School of Physics and Astronomy, University of Southampton, Southampton, UK
| | - L J Tacconi
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | | | - F Vincent
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | | | - S Uysal
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - F Widmann
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - E Wieprecht
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - E Wiezorrek
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - J Woillez
- European Southern Observatory, Garching, Germany
| | - G Zins
- European Southern Observatory, Garching, Germany
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Vignolles-Jeong J, Finger G, Magill ST, McGahan BG, Wu KC, Godil S, Prevedello DM. Supraorbital Eyebrow Approach for Translamina Terminalis Resection of Third Ventricle Metastasis: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01067. [PMID: 38376162 DOI: 10.1227/ons.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Tumors involving the third ventricle are rare, accounting for 0.6%-0.9% of all brain tumors. This deep-seated cavity is surrounded by critical neurovascular structures, making safe surgical resection of lesions in this region challenging. Traditionally, tumors of the third ventricle have been approached through a craniotomy and microsurgical resection.1-4 The supraorbital keyhole approach is a minimally invasive technique that can be used with minimal retraction of the brain and limited craniotomy while establishing a surgical field comparable with what can be achieved using traditional transcranial approaches. In this video, we describe the case of a 54-year-old man who underwent a supraorbital eyebrow approach for translamina terminalis resection of papillary thyroid carcinoma metastasis to the third ventricle. A gross total resection was achieved. The results achieved in our series are comparable with previously published reports of patients who underwent surgical resection of metastatic lesions involving the third ventricle.5-11 The patient consented to the procedure and to the publication of his image.
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Affiliation(s)
- Joshua Vignolles-Jeong
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Guilherme Finger
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Ben G McGahan
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kyle C Wu
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Saniya Godil
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Candy NG, Wu KC, Finger G, VanKoevering K, Prevedello DM. Management of frontoethmoidal osteoma causing pneumocephalus and cerebrospinal fluid leakage with minimally invasive techniques: illustrative cases. J Neurosurg Case Lessons 2024; 7:CASE23699. [PMID: 38315987 PMCID: PMC10849144 DOI: 10.3171/case23699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Osteoid osteoma is a common benign bone tumor frequently seen in the frontoethmoid region. However, involvement of the skull base is rare, with few cases previously reported. OBSERVATIONS The authors report two cases of spontaneous, symptomatic frontoethmoidal osteoma: one presented with neurological deficit secondary to tension pneumocephalus and the other with cerebrospinal fluid leakage. The first case was managed with a transfrontal sinus craniotomy and pneumocephalus decompression with osteoma resection and skull base reconstruction. The second case was managed with a uninaral endoscopic endonasal approach to the anterior skull base with osteoma resection and reconstruction. LESSONS Given the paucity of cases with associated tension pneumocephalus described in the literature, it was relevant to describe the authors' experience with surgical decision-making and the expected outcomes among patients with this pathology when using minimally invasive techniques.
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Affiliation(s)
- Nicholas G Candy
- 1Department of Surgery-Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kyle C Wu
- 2Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio; and
| | - Guilherme Finger
- 2Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio; and
| | - Kyle VanKoevering
- 3Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Ohio
| | - Daniel M Prevedello
- 2Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio; and
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Finger G, Ruiz MJC, Salem EH, Marquardt MD, Wu KC, Carlstrom LP, Carrau RL, Prevedello LM, Prevedello DM. The infundibulochiasmatic angle and the favorability of an endoscopic endonasal approach in type IV craniopharyngioma: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23545. [PMID: 38252928 PMCID: PMC10805591 DOI: 10.3171/case23545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/16/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Lesions located in the floor of the third ventricle are among the most difficult to access in neurosurgery. The neurovascular structures can limit transcranial exposure, whereas tumor extension into the third ventricle can limit visualization and access. The midline transsphenoidal route is an alternative approach to tumor invading the third ventricle if the tumor is localized at its anterior half and a working space between the optic apparatus and the pituitary infundibulum exists. The authors introduce the "infundibulochiasmatic angle," a valuable measurement supporting the feasibility of the translamina terminalis endoscopic endonasal approach (EEA) for resection of type IV craniopharyngiomas. OBSERVATIONS Due to a favorable infundibulochiasmatic angle measurement on preoperative magnetic resonance imaging (MRI), an endoscopic endonasal transsellar transtubercular approach was performed to resect a type IV craniopharyngioma. At 2-month follow-up, the patient's neurological exam was unremarkable, with improvement in bitemporal hemianopsia. Postoperative MRI confirmed gross-total tumor resection. LESSONS The infundibulochiasmatic angle is a radiological tool for evaluating the feasibility of EEA when resecting tumors in the anterior half of the third ventricle. Advantages include reduced brain retraction and excellent rates of resection, with minimal postoperative risks of cerebrospinal fluid leakage and permanent pituitary dysfunction.
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Affiliation(s)
- Guilherme Finger
- 1Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Maria Jose C Ruiz
- 2Department of Otolaryngology and Skull Base Surgery, Hospital Torrecardenas, Almeria, Spain
| | - Eman H Salem
- 3Department of Otolaryngology, Mansoura University, Mansoura, Egypt
| | | | - Kyle C Wu
- 1Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Lucas P Carlstrom
- 1Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ricardo L Carrau
- 5Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Luciano M Prevedello
- 6Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Daniel M Prevedello
- 1Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio
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Almeida JP, Finger G, Weber MD, Damante MA, Wu KC, Walz P, Leonard JR, Carrau RL, Prevedello DM. Intradural Pituitary Hemitransposition: Technical Note and Case Series Illustration. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-01003. [PMID: 38132563 DOI: 10.1227/ons.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Lesions located in the retrosellar region, interpeduncular cistern, and petroclival region are among the most difficult to access in neurosurgery. Transcranial approaches are useful; however, the large distance between the surgeon and the lesion as well as the presence of major neurovascular structures surrounding the lesion may limit surgical exposure. A midline transsphenoidal route avoids transgression of the neurovascular plane and provides direct access to the interpeduncular cistern. To safely access the interpeduncular fossa, it requires mobilization of the pituitary gland. The pituitary hemitransposition technique permits mobilization of the gland, while preserving its venous drainage and arterial supply to the gland on one of its sides, preserving gland function. The authors aim to describe the intradural pituitary hemitransposition technique and to demonstrate its safe application for resection of skull base tumors in the retrosellar space. METHODS The authors describe the surgical technique and illustrate its application in 5 cases of different types of skull base tumors, including a video demonstrating all the steps to perform this approach. In addition, the authors discuss the advantages and limitations of this technique compared with other approaches to the retrosellar space. RESULTS The intradural pituitary hemitransposition technique was used to safely resect a chondrosarcoma, chordoma, craniopharyngioma, teratoma, and meningioma involving the parasellar and retrosellar spaces, while minimizing endocrine morbidity. We had one patient with mild, albeit permanent hyperprolactinemia and hypothyroidism after surgery. No other patients had permanent dysfunction related to surgery. CONCLUSION The endonasal endoscopic intradural pituitary hemitransposition approach is an effective technique for resection of lesions located within the retrosellar and petroclival regions, allowing adequate exposure while potentially optimizing the preservation of the pituitary function.
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Affiliation(s)
- Joao Paulo Almeida
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Guilherme Finger
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthieu D Weber
- The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark A Damante
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kyle C Wu
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Patrick Walz
- Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey R Leonard
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Alsavaf MB, Wu KC, Gosal JS, Finger G, Koch B, Abouammo MD, Prevedello LM, Carrau RL, Prevedello DM. Endoscopic endonasal marsupialization of rathke cleft cysts: clinical outcomes and risk factors analysis of visual impairment, pituitary dysfunction, and CSF leak. Pituitary 2023; 26:696-707. [PMID: 37878234 DOI: 10.1007/s11102-023-01347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE This paper assesses the clinical and imaging characteristics, histopathological findings, and treatment outcomes of patients with Rathke's cleft cyst (RCC), as well as identifies potential risk factors for preoperative visual and pituitary dysfunction, intraoperative cerebrospinal fluid (CSF) leak, and recurrence. Through analyzing these factors, the study aims to contribute to the current understanding of the management of RCCs and identify opportunities for improving patient outcomes. METHODS We performed a retrospective analysis of 45 RCC patients between ages 18-80 treated by Endoscopic Endonasal Approach (EEA) and cyst marsupialization between 2010 and 2022 at a single institution. RESULTS The median patient age was 34, and 73% were female. The mean follow-up was 70 ± 43 months. Preoperative visual impairment correlated with cyst diameter (OR = 1.41, 95% CI = 1.07 to 1.85, p-value = 0.01) and older age (OR = 1.06, 95% CI = 1.01 to 1.11, p-value = 0.02). Intraoperative CSF leaks were 11 times more likely for cysts ≥ 2 cm (OR = 11.3, 95% CI = 1.25 to 97.37, p-value = 0.03), with the odds of leakage doubling for every 0.1 cm increase in cyst size (OR = 1.41, 95% CI = 1.08 to 1.84, p-value = 0.01). Preoperative RCC appearing hypointense on T1 images demonstrated significantly higher CSF leak rates than hyperintense lesions (OR = 122.88, 95% CI = 1.5 to 10077.54, p-value = 0.03). Preoperative pituitary hypofunction was significantly more likely in patients with the presence of inflammation on histopathology (OR = 20.53, 95% CI = 2.20 to 191.45, p-value = 0.008 ) and T2 hyperintensity on magnetic resonance imaging (MRI) sequences (OR = 23.2, 95% CI = 2.56 to 211.02, p-value = 0.005). Notably, except for the hyperprolactinemia, no postoperative improvement was observed in pituitary function. CONCLUSION Carefully considering risk factors, surgeons can appropriately counsel patients and deliver expectations for complications and long-term results. In contrast to preoperative visual impairment, preoperative pituitary dysfunction was found to have the least improvement post-surgery. It was the most significant permanent complication, with our data indicating the link to the cyst signal intensity on T2 MR and inflammation on histopathology. Earlier surgical intervention might improve the preservation of pituitary function.
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Affiliation(s)
- Mohammad Bilal Alsavaf
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave Columbus Ohio, Columbus, OH, USA
| | - Kyle C Wu
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave Columbus Ohio, Columbus, OH, USA
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Jaskaran S Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, 342005, Rajasthan, India
| | - Guilherme Finger
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave Columbus Ohio, Columbus, OH, USA
| | - Brandon Koch
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Moataz D Abouammo
- Department of Otolaryngology - Head and Neck Surgery, Tanta University, Tanta, Egypt
| | - Luciano M Prevedello
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Neuroradiology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave Columbus Ohio, Columbus, OH, USA
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave Columbus Ohio, Columbus, OH, USA.
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA.
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11
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Damante MA, Magill ST, Kreatsoulas D, McGahan BG, Finger G, Hatef J, Hatef A, Carrau RL, Hardesty DA, Prevedello DM. A modern approach to olfactory groove meningiomas. J Neurosurg 2023:1-8. [PMID: 37948686 DOI: 10.3171/2023.8.jns2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/30/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Management of olfactory groove meningiomas (OGMs) has changed significantly with the advances in extended endoscopic endonasal approaches (EEAs), which is an excellent approach for patients with anosmia since it allows early devascularization and minimizes retraction on the frontal lobes. Craniotomy is best suited for preservation of olfaction. However, not infrequently, a tumor presents after extending outside the reach of an EEA and a solely transcranial approach would require manipulation and retraction of the frontal lobes. These OGMs may best be treated by a staged EEA-craniotomy approach. In this study the authors' goal was to present their case series of patients with OGMs treated with their surgical approach algorithm. METHODS The authors conducted an IRB-approved, nonrandomized historic cohort including all consecutive cases of OGMs treated surgically between 2010 and 2020. Patient demographic information, presenting symptoms, operative details, and complications data were collected. Preoperative and postoperative tumor and T2/FLAIR intensity volumes were calculated using Visage Imaging software. RESULTS Thirty-one patients with OGMs were treated (14 craniotomy only, 11 EEA only, and 6 staged). There was a significant difference in the distribution of patients presenting with anosmia and visual disturbance by approach. Tumor size was significantly correlated with preoperative vasogenic edema. Gross-total resection was achieved in 90% of cases, with near-total resection occurring twice with EEA and once with a staged approach. T2/FLAIR hyperintensity completely resolved in 90% of cases and rates did not differ by approach. Complication rates were not significantly different by approach and included 4 CSF leaks (p = 0.68). CONCLUSIONS A staged approach for the management of large OGMs with associated anosmia and significant lateral extension is a safe and effective option for surgical management. Through utilization of the described algorithm, the authors achieved a high rate of GTR, and this strategy may be considered for large OGMs.
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Affiliation(s)
| | - Stephen T Magill
- Departments of1Neurosurgery
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | | | | | - Ricardo L Carrau
- 4Otolaryngology, The Ohio State Wexner Medical Center, Columbus, Ohio; and
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12
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Finger G, Gun R, Wu KC, Carrau RL, Prevedello DM. Endoscopic Endonasal Transpterygoid Approach: Technical Lessons. Oper Neurosurg (Hagerstown) 2023; 25:e272. [PMID: 37350591 DOI: 10.1227/ons.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/03/2023] [Indexed: 06/24/2023] Open
Abstract
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE The endoscopic endonasal transpterygoid approach (EETPA) provides direct access to the petrous apex, lateral clivus, inferior cavernous sinus compartment, jugular foramen, and infratemporal fossa. 1,2 In the coronal plane, it provides exposure far beyond a traditional sphenoidotomy. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT The pterygoid process of the sphenoid bone forms the junction between the body and greater sphenoid wing before bifurcating because it descends into medial and lateral plates. The key to this exposure lies in the region's bony foramina: the palatovaginal canal, vidian canal, and foramen rotundum. 3. ESSENTIALS STEPS OF THE PROCEDURE After performing a maxillary antrostomy, stepwise exposure of these foramina leads to the pterygopalatine fossa. The sphenopalatine artery is cauterized as it becomes the posterior septal artery at the sphenopalatine foramen, and the maxillary sinus' posterior wall is opened to expose the pterygopalatine fossa. After mobilizing and retracting the contents of the pterygopalatine fossa, the pterygoid process is removed, improving access in the coronal plane. 4. PITFALLS/AVOIDANCE OF COMPLICATIONS Vidian neurectomy causes decreased or absent lacrimation. Injury to the maxillary nerve or its branches results in facial, palatal, or odontogenic anesthesia or neuralgia. In addition, the EEPTA precludes the ability to raise an ipsilateral nasal septal flap, making it crucial to plan reconstruction preoperatively. 4,5. VARIANTS AND INDICATIONS FOR THEIR USE There are 5 variants of the EEPTA: extended pterygopalatine fossa, lateral recess of the sphenoid sinus, petrous apex, infratemporal fossa and petrous carotid artery, and middle and posterior skull base. 5The patient consented to the procedure.Images in the video used with permission as follows: images at 0:33 and 1:15 reused from Bozkurt et al, 3 © Georg Thieme Verlag KG; image at 0:39 from Prosser et al, 5 © John Wiley and Sons; images at 0:54, 9:03, and 9:38 from Kasemsiri et al, 1 © John Wiley and Sons; images at 1:07 and 9:44 from Falcon et al, 2 © John Wiley and Sons; image at 1:15 from Sandu et al, 4 © Springer Nature.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ramazan Gun
- Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kyle C Wu
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Finger G, Kaul VF, Adunka OF, Prevedello DM. Subfascial dissection and extended temporal muscle detachment for middle fossa approach. Acta Neurochir (Wien) 2023; 165:3473-3477. [PMID: 36625906 DOI: 10.1007/s00701-022-05483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The soft tissue dissection for the middle fossa approach requires adequate management of the neuro, vascular, and muscular structures in order to maximize exposure and diminish morbidities. METHODS An incision anterior to the tragus is performed, extending from the zygomatic process to the superior temporal line. The superior temporal artery is exposed, followed by a subfascial dissection of the frontalis nerve. The temporal muscle is dissected and released from the zygoma. All cranial landmarks are exposed for the 5 × 5 cm temporal fossa craniotomy. CONCLUSION This novel approach provides a safe and adequate access to perform an extended middle fossa craniotomy.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10Th Ave, Columbus, OH, 43210, USA.
| | - Vivian F Kaul
- Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Oliver F Adunka
- Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10Th Ave, Columbus, OH, 43210, USA
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Finger G, Wu KC, Vignolles-Jeong J, Godil SS, McGahan BG, Kreatsoulas D, Shujaat MT, Prevedello LM, Prevedello DM. A New Finding on Magnetic Resonance Imaging for Diagnosis of Hemifacial Spasm with High Accuracy and Interobserver Correlation. Brain Sci 2023; 13:1434. [PMID: 37891802 PMCID: PMC10605702 DOI: 10.3390/brainsci13101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
Among patients with clinical hemifacial spasm (HFS), imaging exams aim to identify the neurovascular conflict (NVC) location. It has been proven that the identification in the preoperative exam increases the rate of surgical success. Despite the description of specific magnetic resonance image (MRI) acquisitions, the site of neurovascular compression is not always visualized. The authors describe a new MRI finding that helps in the diagnosis of HFS, and evaluate the sensitivity, specificity, and interobserver correlation of the described sign. A cross-sectional study including cases of hemifacial spasm treated surgically from 1 August 2011 to 31 July 2021 was performed. The MRIs of the cases were independently evaluated by two experienced neuroradiologists, who were blinded regarding the side of the symptom. The neuroradiologists were assigned to evaluate the MRIs in two separate moments. Primarily, they evaluated whether there was a neurovascular conflict based on the standard technique. Following this initial analysis, the neuroradiologists received a file with the description of the novel sign, named Prevedello Sign (PS). In a second moment, the same neuroradiologists were asked to identify the presence of the PS and, if it was present, to report on which side. A total of 35 patients were included, mostly females (65.7%) with a mean age of 59.02 (+0.48). Since the 35 cases were independently evaluated by two neuroradiologists, a total of 70 reports were included in the analysis. The PS was present in 66 patients (sensitivity of 94.2%, specificity of 91.4% and positive predictive value of 90.9%). When both analyses were performed in parallel (standard plus PS), the sensitivity increased to 99.2%. Based on the findings of this study, the authors conclude that PS is helpful in determining the neurovascular conflict location in patients with HFS. Its presence, combined with the standard evaluation, increases the sensitivity of the MRI to over 99%, without increasing risks of harm to patients or resulting in additional costs.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (G.F.); (K.C.W.); (D.K.)
| | - Kyle C. Wu
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (G.F.); (K.C.W.); (D.K.)
| | - Joshua Vignolles-Jeong
- College of Medicine, The Ohio State University College of Medicine, Columbus, OH 43210, USA;
| | - Saniya S. Godil
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (G.F.); (K.C.W.); (D.K.)
| | - Ben G. McGahan
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (G.F.); (K.C.W.); (D.K.)
| | - Daniel Kreatsoulas
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (G.F.); (K.C.W.); (D.K.)
| | - Mohammad T. Shujaat
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH 43210, USA (L.M.P.)
| | - Luciano M. Prevedello
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH 43210, USA (L.M.P.)
| | - Daniel M. Prevedello
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (G.F.); (K.C.W.); (D.K.)
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15
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Weber MD, Finger G, Munjal V, Wu KC, Jawad B, Akhter AS, Chakravarthy VB, Carrau RL, Prevedello DM. Real-time ultrasound guidance in the endoscopic endonasal resection of a retro-odontoid pannus: Technical note and case illustration. J Craniovertebr Junction Spine 2023; 14:433-437. [PMID: 38268692 PMCID: PMC10805169 DOI: 10.4103/jcvjs.jcvjs_117_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/16/2023] [Indexed: 01/26/2024] Open
Abstract
Background and Objectives Odontoidectomy is a surgical procedure indicated in the setting of various pathologies, with the main goal of decompressing the ventral brain stem and spinal cord as a result of irreducible compression at the craniovertebral junction. The endoscopic endonasal approach has been increasingly used as an alternative to the transoral approach as it provides a straightforward, panoramic, and direct approach to the odontoid process. In addition, intraoperative ultrasound (US) guidance is a technique that can optimize safety and surgical outcomes in this context. It is used as an adjunct to neuronavigation and provides intraoperative confirmation of decompression of craniovertebral junction structures in real time. The authors aim to present the use and safe application of real-time intraoperative US guidance during endonasal endoscopic resection of a retro-odontoid pannus. Methods A retrospective chart review of a single case was performed and presented herein as a case report and narrated operative video. Results A minimally invasive US transducer was used intraoperatively to guide the resection of a retro-odontoid pannus and confirm spinal cord decompression in real time. Postoperative examination of the patient revealed immediate neurological improvement. Conclusions Intraoperative ultrasonography is a well described and useful modality in neurosurgery. However, the use of intraoperative US guidance during endonasal endoscopic approaches to the craniovertebral junction has not been previously described. As demonstrated in this technical note, the authors show that this imaging modality can be added to the ever-evolving armamentarium of neurosurgeons to safely guide the decompression of neural structures within the craniocervical junction with good surgical outcomes.
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Affiliation(s)
| | - Guilherme Finger
- The Ohio State University Wexner Medical Center, Department of Neurosurgery, Columbus, OH, USA
| | - Vikas Munjal
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kyle C. Wu
- The Ohio State University Wexner Medical Center, Department of Neurosurgery, Columbus, OH, USA
| | - Basit Jawad
- The Ohio State University Wexner Medical Center, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - Asad S. Akhter
- The Ohio State University Wexner Medical Center, Department of Neurosurgery, Columbus, OH, USA
| | - Vikram B. Chakravarthy
- The Ohio State University Wexner Medical Center, Department of Neurosurgery, Columbus, OH, USA
| | - Ricardo L. Carrau
- The Ohio State University Wexner Medical Center, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - Daniel M. Prevedello
- The Ohio State University Wexner Medical Center, Department of Neurosurgery, Columbus, OH, USA
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16
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Finger G, Wu KC, Gosal JS, Jawad B, Vignolles-Jeong J, Carrau RL, Prevedello DM. Endoscopic ultrasound guided resection of a Cushing's adenoma invading the medial cavernous sinus wall using the "interdural peeling" technique. Neurosurg Focus Video 2023; 9:V4. [PMID: 37416807 PMCID: PMC10321548 DOI: 10.3171/2023.4.focvid22150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/14/2023] [Indexed: 07/08/2023]
Abstract
Cushing's adenoma invading the cavernous sinus requires aggressive resection to be cured. MRI is frequently inconclusive for identifying microadenomas, and visualizing the involvement of the medial cavernous sinus is even more challenging. In this video, the authors present a patient with an adrenocorticotropic hormone (ACTH)-producing microadenoma with doubtful left medial cavernous sinus involvement on MRI. She underwent an endoscopic endonasal exploration of the medial compartment of the cavernous sinus. The abnormally thickened wall, confirmed by intraoperative endoscopic endonasal ultrasound, was safely excised using the "interdural peeling" technique. Complete resection of the tumor resulted in normalization of her postoperative cortisol levels and disease remission with no complications. The video can be found here: https://stream.cadmore.media/r10.3171/2023.4.FOCVID22150.
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Affiliation(s)
| | | | | | - Basit Jawad
- Otolaryngology, The Ohio State University Wexner Medical Center, Columbus; and
| | - Joshua Vignolles-Jeong
- The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio
| | - Ricardo L. Carrau
- Otolaryngology, The Ohio State University Wexner Medical Center, Columbus; and
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17
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Alsavaf MB, Wu KC, Finger G, Salem EH, Castello Ruiz MJ, Godil SS, Ghalib L, Carrau RL, Prevedello DM. A silent corticotroph adenoma: making the case for a pars intermedia origin. Illustrative case. J Neurosurg Case Lessons 2023; 5:CASE2350. [PMID: 37212418 PMCID: PMC10550526 DOI: 10.3171/case2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/08/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Silent corticotroph adenomas (SCAs) are the only pituitary adenomas thought to originate from the pars intermedia. This case report presents the rare finding of a multimicrocystic corticotroph macroadenoma displacing the anterior and posterior lobes of the pituitary gland on magnetic resonance imaging (MRI). This finding supports the hypothesis that silent corticotroph adenomas may originate from the pars intermedia and should be considered in the differential for tumors arising from this location. OBSERVATIONS A 55-year-old man presented with an episode of confusion and blurred vision. MRI demonstrated separation of the anterior and posterior glands by a solid-cystic lesion located within the pars intermedia that superiorly displaced the optic chiasm. Endocrinologic evaluation was unremarkable. The differential diagnosis included pituitary adenoma, Rathke cleft cyst, and craniopharyngioma. The tumor was confirmed to be an SCA on pathology and was completely removed through the endoscopic endonasal transsphenoidal approach. LESSONS The case highlights the importance of preoperative screening for subclinical hypercortisolism for tumors arising from this location. Knowledge of a patient's preoperative functional status is critical and dictates their postoperative biochemical assessment to determine remission. The case also illustrates surgical strategies for resecting pars intermedia lesions without injuring the gland.
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Affiliation(s)
| | - Kyle C. Wu
- Neurological Surgery, and
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio
| | | | - Eman H. Salem
- Department of Otolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; and
| | | | - Saniya S. Godil
- Neurological Surgery, and
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio
| | - Luma Ghalib
- Endocrinology, Diabetes, and Metabolism, Wexner Medical Center at The Ohio State University, Columbus, Ohio
| | - Ricardo L. Carrau
- Departments of Otolaryngology–Head and Neck Surgery
- Neurological Surgery, and
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio
| | - Daniel M. Prevedello
- Departments of Otolaryngology–Head and Neck Surgery
- Neurological Surgery, and
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio
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18
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Vialle EN, Falavigna A, Arruda ADO, Guasque JBCR, Pinto BMDO, Finger G, Sfreddo E, Cecchini AMDL. Comparison Between Surgical and Conservative Treatment for AOSpine Type A3 and A4 Thoracolumbar Fractures without Neurological Deficit: Prospective Observational Cohort Study. Rev Bras Ortop 2023; 58:42-47. [PMID: 36969773 PMCID: PMC10038708 DOI: 10.1055/s-0042-1749622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 04/28/2022] [Indexed: 03/26/2023] Open
Abstract
Objective
To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit.
Methods
Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up.
Results
Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6;
p
> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2;
p
> 0.05), quality of life (EQ-5D), and return to work (DWS).
Conclusion
Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.
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Affiliation(s)
- Emiliano Neves Vialle
- Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
- Endereço para correspondência Emiliano Neves Vialle, MD, MSc Alameda Princesa Izabel, 605, Mercês, Curitiba, PR, 80430-210Brazil
| | - Asdrubal Falavigna
- Serviço de Ortopedia e Traumatologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brasil
| | - André de Oliveira Arruda
- Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
| | | | - Bárbara Miroski de Oliveira Pinto
- Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
| | - Guilherme Finger
- Departamento de Neurocirurgia, Hospital Cristo Redentor, Porto Alegre, Brasil
| | - Ericson Sfreddo
- Departamento de Neurocirurgia, Hospital Cristo Redentor, Porto Alegre, Brasil
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19
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Finger G, Wu KC, Godil SS, Carrau RL, Hardesty D, Prevedello DM. Ultrasound-guided endoscopic endonasal resection of sellar and suprasellar craniopharyngiomas. Front Surg 2023; 10:1073736. [PMID: 36896257 PMCID: PMC9990524 DOI: 10.3389/fsurg.2023.1073736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Optimal planning and minimally invasive surgical approach are essential to complete craniopharyngiomas (CP) resection with limited postoperative morbidity. Given the nature of craniopharyngioma recurrence, complete resection of the neoplasm is crucial. Since CP arise from the pituitary stalk and may grow anteriorly or laterally, some cases require an extended endonasal craniotomy. The extension of the craniotomy is crucial to expose the whole tumor and to make its dissection from the surrounding structures feasible. In order to guide the extension of the approach, the intraoperative use of ultrasound is helpful for the surgeons. The objective of this paper is to describe and to demonstrate the applicability of the utilization of intraoperative ultrasound (US) guidance for planning and confirmation of craniopharyngioma resection in EES. Method The authors selected one operative video of a sellar-suprassellar craniopharyngioma gross-totally resected by EES. The authors demonstrate the extended sellar craniotomy, the anatomic landmarks that guide bone drilling and dural opening, the aspect of the intraoperative real time US, tumor resection and dissection from the surrounding structures. Results The solid component of the tumor was mostly isoechogenic in texture compared to the anterior pituitary gland, with several wide spread hyperechogenic images corresponding to calcifications and hypoechogenic vesicles corresponding to cysts inside the CF ("salt-and-pepper" pattern). Discussion The intraoperative endonasal US is a new surgical tool that allows for real-time active imaging for skull base procedures, such as sellar region tumors. Besides tumor evaluation, the intraoperative US helps the neurosurgeon to determine the size of craniotomy, to anticipate the relation between the tumor and vascular structures and to guide the best strategy for gross-total resection of the tumor. Conclusion The EES allows a straight access to the craniopharyngiomas located in the sellar region or that grow anteriorly or superiorly. This approach allows the surgeon to dissect the tumor with minimal manipulation of the surrounding structures, when compared to craniotomy approaches. In order to accomplish that, the use of intraoperative endonasal ultrasound helps the neurosurgeon to perform the most suitable strategy, optimizing the rate of success.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Kyle C Wu
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Sanyia S Godil
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ricardo L Carrau
- Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, OH, United States
| | - Douglas Hardesty
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, United States
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20
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Finger G, Shuha DL, Cecchini TPB, Nascimento TLD, Gripa MEC, Cecchini FMDL, Sfredo E, Cecchini AMDL, Falavigna A. SHORT ARTHRODESIS IS AS EFFECTIVE AS LONG ARTHRODESIS FOR THE TREATMENT OF TYPE B THORACOLUMBAR SPINE FRACTURES. Coluna/Columna 2022. [DOI: 10.1590/s1808-185120222103264651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: Thoracolumbar spine trauma is a world wide health concern that especially affects males of working age, being associated with an elevated morbidity. AO SPINE Type B fractures are unstable and require surgical stabilization. However, the decision between short or long fixation remains controversial. The objective of this study is to analyze the neurological, orthopedic and functional outcomes in patients with Type B spine fractures who have undergone short and long segment posterior arthrodesis. Methods: A prospective cohort study was performed at the Neurosurgery Department of Hospital Cristo Redentor from January 1, 2013 to December 31, 2018. Patients with spine fractures classified as AO SPINE Type B in the thoracic or thoracolumbar segments were eligible for the study. The variables analyzed included demographic data, information about the trauma, neurological status, the treatment performed, and the outcome. Results: A total of 31 patients were included in the study. The majority were Caucasian males with a mean age of 42.6(±15.6), and the main cause of the spine trauma was falling from height (N=18; 56.2%). Fifteen patients (48.3%) had subtype B1 fractures and 16 (51.6%) had subtype B2 fractures. Eleven (35.4%) patients were submitted to short arthrodesis and 20 (64.5%) were submitted to long arthrodesis. There was no statistical difference between groups in terms of neurological, orthopedic and functional outcomes. Conclusions: There is no difference in outcomes between short or long constructs for patients with type B single fracture in the thoracic, thoracolumbar and lumbar spine segments. Level of evidence III; Therapeutic Studies – Investigation of treatment results.
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21
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Rynkowski CB, Robba C, de Oliveira RV, Fabretti R, Rodrigues TM, Kolias AG, Finger G, Czosnyka M, Bianchin MM. A Comparative Study of the Effects of Early Versus Late Cranioplasty on Cognitive Function. Acta Neurochir Suppl 2021; 131:75-78. [PMID: 33839822 DOI: 10.1007/978-3-030-59436-7_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cranioplasty (CP) after decompressive craniectomy (DC) is associated with neurological improvement. We evaluated neurological recovery in patients who underwent late CP (more than 6 months after DC) in comparison with early CP. This prospective study of 51 patients investigated neurological function using the Addenbrooke's Cognitive Examination Revised (ACE-R), Mini-Mental State Examination (MMSE), Barthel Index (BI), and Modified Rankin Scale (mRS) prior to and after CP. Most patients with traumatic brain injury (74%) were young (mean age 33.4 ± 12.2 years) and male (33/51; 66%). There were general improvements in the patients' cognition and functional status, especially in the late-CP group. The ACE-R score increased from the time point before CP to 3 days after CP (51 ± 28.94 versus 53.1 ± 30.39, P = 0.016) and 90 days after CP (51 ± 28.94 versus 58.10 ± 30.43, P = 0.0001). In the late-CP group, increments also occurred from the time point before CP to 90 days after CP in terms of the MMSE score (18.54 ± 1.51 versus 20.34 ± 1.50, P = 0.003), BI score (79.84 ± 4.66 versus 85.62 ± 4.10, P = 0.028), and mRS score (2.07 ± 0.22 versus 1.74 ± 0.20, P = 0.015). CP is able to improve neurological outcomes even more than 6 months after DC.
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Affiliation(s)
- Carla B Rynkowski
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Adult Critical Care Unit, Hospital Cristo Redentor, Porto Alegre, Brazil.
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | | | - Rodrigo Fabretti
- Psychology Department, Hospital Cristo Redentor, Porto Alegre, Brazil
| | | | - Angelos G Kolias
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Guilherme Finger
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Marek Czosnyka
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marino Muxfeldt Bianchin
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,B.R.A.I.N., Division of Neurology, Hospital de Clínicas de Poro Alegre, Porto Alegre, Brazil
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22
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Rynkowski CB, Robba C, Loreto M, Theisen ACW, Kolias AG, Finger G, Czosnyka M, Bianchin MM. Effects of Cranioplasty After Decompressive Craniectomy on Neurological Function and Cerebral Hemodynamics in Traumatic Versus Nontraumatic Brain Injury. Acta Neurochir Suppl 2021; 131:79-82. [PMID: 33839823 DOI: 10.1007/978-3-030-59436-7_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
After decompressive craniectomy (DC), cranioplasty (CP) can help to normalize vascular and cerebrospinal fluid circulation besides improving the patient's neurological status. The aim of this study was to investigate the effects of CP on cerebral hemodynamics and on cognitive and functional outcomes in patients with and without a traumatic brain injury (TBI). Over a period of 3 years, 51 patients were included in the study: 37 TBI patients and 14 non-TBI patients. The TBI group was younger (28.86 ± 9.71 versus 45.64 ± 9.55 years, P = 0.0001), with a greater proportion of men than the non-TBI group (31 versus 6, P = 0.011). Both groups had improved cognitive outcomes (as assessed by the Mini-Mental State Examination) and functional outcomes (as assessed by the Barthel Index and Modified Rankin Scale) 90 days after CP. In the TBI group, the mean velocity of blood flow in the middle cerebral artery ipsilateral to the cranial defect increased between the time point before CP and 90 days after CP (34.24 ± 11.02 versus 42.14 ± 10.19 cm/s, P = 0.0001). In conclusion, CP improved the neurological status in TBI and non-TBI patients, but an increment in cerebral blood flow velocity after CP occurred only in TBI patients.
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Affiliation(s)
- Carla B Rynkowski
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Adult Critical Care Unit, Hospital Cristo Redentor, Porto Alegre, Brazil.
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Melina Loreto
- Adult Critical Care Unit, Hospital Divina Providência, Porto Alegre, Brazil
| | | | - Angelos G Kolias
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Guilherme Finger
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Marek Czosnyka
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marino Muxfeldt Bianchin
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,B.R.A.I.N., Division of Neurology, Hospital de Clínicas de Poro Alegre, Porto Alegre, Brazil
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23
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Finger G, Nascimento TLD, Tessaro JCL, Stefani ET, Gripa MEC, Tisbierek EE, Marrone LCP, Rynkowski CB. Traumatic Dissection of Arterial Cervical Vessels: Report of Two Cases and Literature Review. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020. [DOI: 10.1055/s-0040-1718422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractEven though traumatic dissection of cervical arterial vessels is the major cause of stroke among adults, it is still an underdiagnosed disease in neurosurgical emergencies, since most patients do not have or present subtle clinical signs in the acute phase. The authors report two interesting cases of cervical artery dissection with different traumatic mechanisms and present a broad literature review about this subject.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, RS, Brazil
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24
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Finger G, Worm PV, Dos Santos SC, do Nascimento TL, Gallo P, Stefani MA. Cerebrospinal Fluid Collected by Lumbar Puncture Has a Higher Diagnostic Accuracy than Collected by Ventriculostomy. World Neurosurg 2020; 138:e683-e689. [PMID: 32194271 DOI: 10.1016/j.wneu.2020.03.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients harboring an external ventricular drain (EVD) who develop signs of infection require screening for infection in the central nervous system (CNS). The cerebrospinal fluid (CSF) can be collected by the EVD or by lumbar puncture (LP). If only one sample is analyzed, the diagnosis might be dubious or false-negative. The objective of this study was to compare the diagnosis accuracy of CNS infection of CSF samples collected from EVD and LP. METHODS We conducted a transversal study where data were prospectively collected from 2016 to 2019. Patients harboring EVD with signs of infection were submitted to the CSF analysis collected by LP and EVD. Diagnosis sensibility and results correlation were analyzed using the kappa index. RESULTS The 141 samples from LP and 141 samples from EVD were collected from 108 patients. Among the 282 samples, a total of 77 had infection. Seventy CSF samples from LP fulfilled infection criteria. However, only 32 EVD samples demonstrated infection. Among the 70 cases of infection based on the LP sample, 25 CSF samples collected from the EVD were also suggestive of infection; but in 45 patients only the CSF samples from LP met infection criteria. Seven patients had diagnosis of infection only in the EVD sample. The kappa correlation index of the results obtained from LP and EVD was 0.260 and the McNemar χ2 test was <0.01. CONCLUSIONS The CSF analysis exclusive from the EVD has a low sensibility and negative predictive value. CSF collected from LP has a sensibility 2.18 times higher than EVD.
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Affiliation(s)
- Guilherme Finger
- Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil; Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil.
| | - Paulo Valdeci Worm
- Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil
| | | | - Tobias Ludwig do Nascimento
- Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil; Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Pasquale Gallo
- Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil
| | - Marco Antônio Stefani
- Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil
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25
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Finger G, de Lima Cecchini AM, Sfreddo E, de Lima Cecchini FM, Martins OG, Bozko Cecchini TP, Teles AR, Falavigna A. Subaxial spine arthrodesis in patients with spine fractures and facet joint dislocations: Is magnetic resonance imaging required to determine the optimal surgical approach? Surg Neurol Int 2019; 10:239. [PMID: 31893140 PMCID: PMC6911680 DOI: 10.25259/sni_512_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/13/2019] [Indexed: 11/12/2022] Open
Abstract
Background: The medical literature suggests that facet dislocations (FDs) must be managed surgically, even in the absence of spinal cord injury. In fact, there is no standard guideline for managing FD cases and whether magnetic resonance imaging (MRI) should be utilized for optimizing treatment planning. Methods: Fifteen cases of FD were evaluated twice by nine spine surgeons. The first assessment included computed tomography (CT) images only. Secondarily, original CT studies were supplemented with MRI. In each case, the participating surgeon had to acknowledge whether and what surgical treatment they would offer. Data for the two responses from all nine surgeons were then compared. Results: Based on CT images alone, there was no consensus regarding treatment choices in 13 cases, and a trend toward consensus in just two instances (κ = 0.01). When MRI scans were added to CT studies, among the 15 cases evaluated, 10 cases demonstrated a trend toward consensus, and in 1 case consensus was achieved. The Kappa interpersonal agreement based on MRI was 0.13. The analysis of the answers by each contributor in each case demonstrated that in 58.51% of cases the surgical treatment options were changed when analyzed by CT + MRI, in comparison to the options indicated based on CT alone. Conclusion: It appears that obtaining an MRI in addition to a CT before spine surgery for FD is essential mandatory, as it changed the treatment option in nearly 60% of cases.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, Brazil
| | | | - Ericson Sfreddo
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, Brazil
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26
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Finger G, Martins OG, Nesi WM, Casarin MC, de Almeida LP, Schiavo FL, Dos Santos SC, Stefani MA. Ruptured aneurysm in the posterior communicating segment of carotid artery presenting with contralateral oculomotor nerve palsy. Surg Neurol Int 2019; 10:177. [PMID: 31583174 PMCID: PMC6763677 DOI: 10.25259/sni_203_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Brain aneurysms are mostly discovered during the investigation of subarachnoid hemorrhage (SAH). Some patients present neurological signs that may suggest the aneurysm’s topography, and the oculomotor nerve palsy (ONP) of the same side of the aneurysm is the most common sign. Only one case report of contralateral palsy was previously described in the medical literature. Case Description: Authors describe a patient who presented a classic manifestation of SAH associated with complete ONP, whose vascular investigation demonstrated a brain aneurysm located in the contralateral intracranial carotid. The patient was surgically treated with great neurologic outcome, and late angiography did not evidence other vascular abnormalities. Conclusion: The ipsilateral ONP is a common sign found in posterior communicating artery aneurysms; however, such aneurysm can have different presentations due to the elevation of intracranial pressure, and, in rarer cases, the ONP cannot be operated as a localizing sign.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, Cristo Redentor Hospital.,Graduate Program in Surgical Sciences, Federal University of Rio Grande do Sul - Brazil, Porto Alegre
| | | | | | | | | | | | | | - Marco Antonio Stefani
- Graduate Program in Surgical Sciences, Federal University of Rio Grande do Sul - Brazil, Porto Alegre
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Ludwig do Nascimento T, Finger G, Sfreddo E, Martins de Lima Cecchini A, Martins de Lima Cecchini F, Stefani MA. Double-blind randomized clinical trial of vancomycin in spinal arthrodesis: no effects on surgical site infection. J Neurosurg Spine 2019; 32:1-8. [PMID: 31491758 DOI: 10.3171/2019.6.spine19120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) results in high morbidity and mortality in patients undergoing spinal fusion. Using intravenous antibiotics in anesthesia induction reduces the rate of postoperative infection, but it is not common practice to use them topically, despite recent reports that this procedure helps reduce infection. The objective of this study was to determine whether the topical use of vancomycin reduces the rate of postoperative SSI in patients undergoing thoracolumbar fusion. METHODS A randomized, double-blind clinical trial in a single hospital was performed comparing vancomycin and placebo in thoracolumbar fusion patients. RESULTS A total of 96 patients were randomized to placebo or vancomycin treatment. The mean patient age was 43 ± 14.88 years, 74% were male, and the most common etiology was fall from height (46.9%). The overall rate of postoperative SSI was 8.3%, and no difference was found between the groups: postoperative infection rates in the vancomycin and placebo groups were 8.2% and 8.5% (relative risk [RR] of SSI not using vancomycin 1.04, 95% confidence interval [CI] 0.28-3.93, p = 0.951), respectively. Patients with diabetes mellitus had higher SSI rates (RR 8.98, 95% CI 1.81-44.61, p = 0.007). CONCLUSIONS This is the first double-blind randomized clinical trial to evaluate the effects of topical vancomycin on postoperative infection rates in thoracolumbar fusion patients, and the results did not differ significantly from placebo.Clinical trial registration no.: RBR-57wppt (ReBEC; http://www.ensaiosclinicos.gov.br/).
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Affiliation(s)
- Tobias Ludwig do Nascimento
- 1Department of Neurosurgery, Hospital Cristo Redentor, Grupo Hospitalar Conceição, Porto Alegre; and
- 2Graduate School of Medicine, Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Finger
- 1Department of Neurosurgery, Hospital Cristo Redentor, Grupo Hospitalar Conceição, Porto Alegre; and
- 2Graduate School of Medicine, Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ericson Sfreddo
- 1Department of Neurosurgery, Hospital Cristo Redentor, Grupo Hospitalar Conceição, Porto Alegre; and
| | | | | | - Marco Antônio Stefani
- 2Graduate School of Medicine, Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Finger G, Cecchini AMDL, Sfreddo E, Cecchini FMDL, Lunardi LW, Nascimento TLD, Falavigna A. SPONDYLODISCITIS INVESTIGATION AND THERAPEUTIC PROTOCOL: NEUROSURGERY SERVICE RESULTS. Coluna/Columna 2019. [DOI: 10.1590/s1808-185120191802195906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: Spondylodiscitis is still a frequent pathology among neurosurgical services, and its correct treatment involves infectious, neurological and orthopedic goals. The authors describe the protocol and report the diagnostic and therapeutic results after its implementation. Methods: A prospective prognostic study (Level I) including patients with primary spondylodiscitis treated in the Neurosurgical Service of Cristo Redentor Hospital from January 2014 to March 2018. Demographic, spine, infectious and treatment-related variables were analyzed. The numerical variables are presented as mean and standard deviation or median and interquartile range (according to their parametricity), and are compared by the student's t-Test or Mann-Whitney U Test, respectively. Results: Thirty seven patients were included. The sexes were evenly distributed, with predominantly Caucasians, and a mean age of 56.89 ±15.33. Hypertension and type 2 diabetes were the most frequent comorbidities. Vertebral lumbar level was the most involved segment. Pathogens were identified in 34 cases (91%), with Staphylococcus aureus being the most prevalent, followed by Koch Bacilli. Inflammatory markers are higher in pyogenic infections at hospital admission, but lower at hospital discharge when compared to tuberculous discitis (p<0.01). Mean hospital stay was higher in the pyogenic group. Conclusion: The protocol described has a high diagnostic level of the pathogen, with cure of infection and satisfactory neurologic outcome in all cases. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test.
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Worm PV, Finger G, Brasil AVB, Teles AR. Postoperative Supine Position Increases the Risk of Infection After Spinal Surgery by Posterior Approach. World Neurosurg 2019; 126:e580-e585. [PMID: 30831303 DOI: 10.1016/j.wneu.2019.02.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Spine surgeries performed via the posterior approach have a higher infection rate. Several theories have been proposed, including poor hygienic condition of bed sheets and traumatized muscle associated with supine position promoting circulatory impairment. We investigated the influence of supine position on the rate of deep wound infection after spine surgery by the posterior approach. METHODS A total of 106 patients were randomly divided into 2 groups: lateral decubitus only versus dorsal and lateral decubitus. Patient follow-up after hospital discharge was performed at 30, 60, 180, and 360 days. Deep wound infection was diagnosed according to U.S. Centers for Disease Control and Prevention criteria. RESULTS Patient sample was mainly composed of patients with neoplastic disease and patients with trauma. Postoperative wound infection developed in 12 cases (11.3%), and Streptococcus aureus was the most common pathogen. Incidence of postsurgical deep wound infection was significantly greater in the control group (P = 0.004). CONCLUSIONS Supine position was significantly correlated with higher rates of wound infection among patients who underwent spine surgery by the posterior approach. Avoidance of supine position may represent a modifiable risk factor to diminish postoperative spine infection rates.
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Affiliation(s)
- Paulo Valdeci Worm
- Department of Neurological Surgery, Hospital São José, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Guilherme Finger
- Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil
| | - Albert Vincent Berthier Brasil
- Department of Neurological Surgery, Hospital São José, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Finger G, Martins OG, Basso LS, Ludwig do Nascimento T, Schiavo FL, Cezimbra Dos Santos S, Stefani MA. Acute Spontaneous Subdural Hematoma in Posterior Fossa: Great Outcome. World Neurosurg 2018; 119:146-150. [PMID: 30077031 DOI: 10.1016/j.wneu.2018.07.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute subdural hematomas are frequently seen in brain trauma-injured patients. However, spontaneous subdural hematomas are uncommon, especially those localized in the posterior fossa, where fewer than 10 case reports have been described in the medical literature. CASE DESCRIPTION We describe a patient who suddenly had a headache and progressed rapidly to coma and signs of brainstem compression. She was diagnosed with posterior fossa subdural hematoma after image examinations that were endorsed by surgical findings. A posterior fossa craniectomy was performed and was associated with blood drainage. CONCLUSIONS The patient had a great outcome, with no neurologic deficits at hospital discharge and the 1-year follow-up.
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Affiliation(s)
- Guilherme Finger
- Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Brazil; Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | | | | | - Tobias Ludwig do Nascimento
- Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Brazil; Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Marco Antonio Stefani
- Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Worm PV, do Nascimento TL, do Couto Nicola F, Sanches EF, Dos Santos Moreira CF, Rogério LPW, Dos Reis MM, Finger G, Collares MVM. Polymethylmethacrylate imbedded with antibiotics cranioplasty: An infection solution for moderate and large defects reconstruction? Surg Neurol Int 2016; 7:S746-S751. [PMID: 27904754 PMCID: PMC5114860 DOI: 10.4103/2152-7806.193725] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background: In cases where autologous bone graft reconstruction is not possible (such as comminuted fractures, bone graft reabsorption, or infection) and the use of synthetic material is required, polymethylmethacrylate (PMMA) use is a safe and efficient solution. Studies comparing the incidence of postoperative complications between autologous and synthetic cranioplasty are heterogeneous, not allowing a conclusion of which is the best material for skull defects reconstruction. Current medical literature lacks prospective well-delineated studies with long-term follow-up that analyze the impact of antibiotic use in PMMA cranial reconstruction of moderate and large defects. Methods: A prospective series of patients, who underwent cranioplasty reconstruction with PMMA impregnated with antibiotic, were followed for 2 years. Authors collected data regarding demographic status, clinical conditions, surgical information, and its complications. Results: A total of 58 patients completed full follow-up with a mean group age of 40 years and a male predominance (77%). Major complications that required surgical management were identified in 5 patients, and 10 patients evolved with minor complications. Postoperative surgical site infection incidence was 3.2%. Conclusion: The infection rate in patients submitted to PMMA flap cranioplasty impregnated with antibiotic is significantly inferior comparing to the data described in medical literature. A lower infection incidence impacts secondary endpoints such as minimizing surgical morbidity, mortality, hospitalization period, and, consequently, costs.
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Affiliation(s)
- Paulo Valdeci Worm
- Department of Surgical Sciences, Post Graduation Program in Medicine, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Fabricio do Couto Nicola
- Cerebral Ischemia Laboratory, Department of Biochemistry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Eduardo Farias Sanches
- Cerebral Ischemia Laboratory, Department of Biochemistry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | | | | | | | - Guilherme Finger
- Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcus Vinicius Martins Collares
- Department of Surgical Sciences, Post Graduation Program in Medicine, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Plastic and Craniomaxillofacial Surgery, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Abstract
Adipose lesions rarely affect the peripheral nerves. This can occur in two different ways: Direct compression by an extraneural lipoma, or by a lipoma originated from the adipose cells located inside the nerve. Since its first description, many terms have been used in the literature to mention intraneural lipomatous lesions. In this article, the authors report a case of a 62-year-old female who presented with an intraneural median nerve lipoma and review the literature concerning the classification of adipose lesions of the nerve, radiological diagnosis and treatment.
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Affiliation(s)
- Alisson Roberto Teles
- Department of Neurosurgery, Hospital São José - Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Guilherme Finger
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, RS, Brazil
| | - Marcelo N Schuster
- Department of Neurosurgery, Hospital São José - Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Pedro Luis Gobbato
- Department of Neurosurgery, Hospital São José - Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
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Worm PV, Ferreira NP, Finger G, Collares MVM. Autologous cranial bone graft use for trepanation reconstruction. J Craniomaxillofac Surg 2015; 43:1781-4. [PMID: 26343204 DOI: 10.1016/j.jcms.2015.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Esthetic deformities in the human skull are a subject of concern among neurosurgical patients and neurosurgeons; they can be disfiguring and harm the patient's social relationships. To access inner structures, neurosurgical operations require skull trepanation, a process that frequently involves loss of bone tissue and leads to esthetic problems. Satisfactory reconstruction is a challenge, and neurosurgeons search for an implant which ideally is organic and low cost and does not cause an immunological or allergic reaction. Therefore, autologous bone tissue remains the gold standard for reconstruction. OBJECTIVES To develop a technique that allows neurosurgeons to rebuild the trepanation hole with a better esthetic outcome. METHOD Craniotomy orifices in 108 patients were closed with a graft obtained from the cranial bone inner layer. In order to remove the graft a specially made trephine was used. RESULTS No grafts dislocated during follow-up. Cosmetic outcomes and results seen on image examinations were favorable for this new technique when compared with others previously described in medical literature. CONCLUSION The authors present a new and feasible trepanation reconstruction technique that allows a better esthetic outcome without increasing the surgical risk for the patient, or making the surgical procedure longer or more expensive.
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Affiliation(s)
- Paulo Valdeci Worm
- Post Graduation Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Neurological Surgery, São Jose Hospital, Santa Casa Hospital Complex, Porto Alegre, RS, Brazil; Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, RS, Brazil.
| | - Nelson Pires Ferreira
- Department of Neurological Surgery, São Jose Hospital, Santa Casa Hospital Complex, Porto Alegre, RS, Brazil
| | - Guilherme Finger
- Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, RS, Brazil
| | - Marcus Vinicius Martins Collares
- Post Graduation Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Plastic and Craniomaxillofacial Surgery, Hospital de Clínicas of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Falavigna A, Finger G, Sebben C, Silva PGD, Conzati LP, Peletti-Figueiro M. Motor and histological findings in a model of sci: comparison between posterior and lateral clips. Coluna/Columna 2014. [DOI: 10.1590/s1808-18512014130400474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objective: To evaluate the locomotor and histological impact on the spinal cord comparing lateral and posterior clip placement. Method: Randomized experimental trial. Twenty female Wistar rats, weighing between 250 and 300 grams and aged 12-14 weeks were randomized in two groups according to the placement of the clip: lateral group (N=10) and posterior group (N=10). After exposing the thoracic segment of the spine (T8-T10), a laminectomy was performed at the T9 level under microscopic view. The spinal cord injury was made using a 5 mm long aneurysm clip with a closing pressure of 50 grams. Locomotor behavior was evaluated by the Basso, Beattie and Bresnahan scale in days 1, 7, 14, 21, and 28 after surgery. The area of injury was assessed by histological analysis and measured by a software. Results: The histological evaluation showed a larger mean area of 4.8±1mm² of lesion (P=0.03) in the lateral group when compared with the posterior group mean area of 2.3±2mm². There was no significant difference between lateral and posterior groups with respect to locomotor scores from day 1 to 28 (P=0.361). Conclusion: The lesion area observed in the spinal cord histology after lateral placement of a clip was significantly bigger than in the posterior placement. The motor evaluation showed similar BBB scores regardless of the type of clamping method.
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Affiliation(s)
- Asdrubal Falavigna
- Laboratory of Clinical Studies and Basic Models of Spinal Disorders Universidade de Caxias do Sul, Brazil
| | - Guilherme Finger
- Laboratory of Clinical Studies and Basic Models of Spinal Disorders Universidade de Caxias do Sul, Brazil
| | - Cesar Sebben
- Laboratory of Clinical Studies and Basic Models of Spinal Disorders Universidade de Caxias do Sul, Brazil
| | - Pedro Guarise da Silva
- Laboratory of Clinical Studies and Basic Models of Spinal Disorders Universidade de Caxias do Sul, Brazil
| | - Lucas Piccoli Conzati
- Laboratory of Clinical Studies and Basic Models of Spinal Disorders Universidade de Caxias do Sul, Brazil
| | - Manuela Peletti-Figueiro
- Cell Therapy Laboratory and Clinical Studies and Basic Models of Spinal Disorders Laboratory of the Universidade de Caxias do Sul (UCS), Brazil
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Dos Santos RF, Blume E, Muniz MFB, Heckler LI, Finger G, Maciel CG, Harakawa R, Garrido LR. First Report of Ilyonectria macrodidyma Associated with Black Foot Disease of Grapevine in Brazil. Plant Dis 2014; 98:156. [PMID: 30708578 DOI: 10.1094/pdis-04-13-0424-pdn] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Cultivated grapevine (Vitis labrusca and V. vinifera) is of considerable economic importance to the Brazilian fruit industry for both fresh market consumption and for the production of wines, sparkling beverages, and juices. Black foot disease is caused by fungi of the genera Ilyonectria P. Chaverri & C. Salgado (anamorph: Cylindrocarpon Wollew.), Campylocarpon Halleen, Schroers & Crous, and Cylindrocladiella Boesew. In 2012, 4- to 40-year-old grapevines (Vitis spp.) showing reduced vigor, vascular lesions, necrotic root lesions, delayed budding, vine decline, and death were collected from seven locations at Rio Grande do Sul state, Brazil. Fungal isolations were made from root fragments and crown lesions (at least 2 cm above the bottom) on potato dextrose agar (PDA) medium added with 0.5 g L-1 streptomycin sulfate. Eight isolates were obtained and identified on the basis of morphological features and multi-gene analysis (rDNA-ITS, β-tubulin, and histone H3) as Ilyonectria macrodidyma (Halleen, Schroers & Crous) P. Chaverri & C. Salgado. One representative isolate (Cy5UFSM) was used for more detailed morphological and molecular characterization, and pathogenicity confirmation. When incubated in the dark at 20°C for 7 to 10 days, colonies of felty straw-colored mycelium (3) 4.79 cm diameter on average were observed. No sporodochia or other fruiting bodies were produced on carnation leaf agar (CLA) medium after 30 days. Microconidia that were produced after 5 weeks on spezieller nährstoffarmer agar (SNA) medium with addition of two pieces of 1 cm2 filter paper showed ovoid and ellipsoid shape (6.4 × 3.6 μm) and one-septate macroconidia (17.3 × 4.1 μm). To confirm the species, primer pairs ITS1 and ITS4 (4); Bt2a and Bt2b; and H3-1a and H3-1b (2) were used to amplify the ITS1-5.8S rRNA-ITS2, part of the β-tubulin and histone H3 genes, respectively. Sequences of these three regions showed 99, 100, and 100% of homology with I. macrodidyma, respectively. To confirm pathogenicity, 4-month-old rooted cuttings of V. labrusca cv. Bordô were inoculated by immersing them in a conidial suspension of the isolate (106 conidia ml-1) for 60 min (1). Thirty days later, inoculation was performed again by drenching the crown with 40 ml of 106 conidia ml-1 suspension to ensure infection of the roots. In the control treatment, plants were inoculated with sterile distilled water. Plants inoculated with I. macrodidyma showed necrosis of the leaf ribs, reduction in root mass, root and crown necrosis, browning of vessels, drying of shoots, and death. I. macrodidyma was re-isolated from the crown necrosis and vascular lesions, confirming Koch's postulates. To our knowledge, this is the first report of I. macrodidyma associated with black foot disease of grapevine in Brazil, which poses considerable threat to the industry unless management options are realized. References: (1) A. Cabral et al. Phytopathol. Mediterr. 51:340, 2012. (2) N. L. Glass et al. Appl. Environ. Microbiol. 61:1323, 1995. (3) R. W. Rayner. A Mycological Colour Chart. Commonwealth Mycological Institute and British Mycological Society, 1970. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.
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Affiliation(s)
- R F Dos Santos
- Department of Plant Pathology, Federal University of Santa Maria, Brazil
| | - E Blume
- Department of Plant Pathology, Federal University of Santa Maria, Brazil
| | - M F B Muniz
- Department of Plant Pathology, Federal University of Santa Maria, Brazil
| | - L I Heckler
- Department of Plant Pathology, Federal University of Santa Maria, Brazil
| | - G Finger
- Department of Plant Pathology, Federal University of Santa Maria, Brazil
| | - C G Maciel
- Department of Plant Pathology, Federal University of Santa Maria, Brazil
| | - R Harakawa
- Biological Institute of São Paulo, Brazil
| | - L R Garrido
- Brazilian Agricultural Research Corporation, Bento Gonçalves, Brazil
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Abstract
OBJECTIVE To review the effects of methylphenidate on cognitive enhancement, memory, and performance in medical students. METHODS A review of four databases (LILACS, PubMed, ScienceDirect, and SciELO), analyzing the title and abstract of all articles published between 1990 and 2012 in English, Portuguese, and Spanish. Selected articles were read in entirety, including in the review those that met the established criteria. RESULTS The prevalence of use among medical students reached 16%, with no gender difference. Most students began using the drug after entering the university, and the reasons cited to justify it are related to enhancing academic performance. CONCLUSION There is no evidence in the literature that the use of methylphenidate is beneficial in terms of memory or learning. The drug simply increases wakefulness and alertness, reducing the time of sleep.
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Affiliation(s)
- Guilherme Finger
- Medical School, Universidade de Caxias do Sul UCS, Caxias do Sul, RS, Brazil.
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Falavigna A, Cechetti F, Finger G, Ruschel LG, Marcon G, Silva PGD. Experimental Model of Spinal Cord Injury (SCI) in rats: management guidelines. Coluna/Columna 2013. [DOI: 10.1590/s1808-18512013000100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Surgical experiments with laboratory animals are necessary for medical research. These studies aim to clarify the mechanism of disease, investigate the action and efficacy of new drugs or biological markers, as well as develop and enhance new therapies and apply new techniques. Regarding the models of spinal cord injury (SCI), there are several different methods that address the handling of the animals, especially concerning the use of analgesics, antibiotics and pre- and postoperative management. The lack of uniformity and standardization among the studies does not allow the understanding of the model of SCI or the proper handling of the paraplegic animals, hampering the adequate interpretation and comparison of results. The goal of this study is to establish a standard protocol on the handling of animals subjected to experimental models of SCI.
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Abstract
Spinal cord injuries remain an important factor of morbimortality in current society, involving mainly males from adolescence to adulthood. Among the sequelae caused by spinal cord injuries, the impairment of the sexual system is highly relevant since it affects the quality of sexual life and paternity. Infertility is secondary to multiple events such as erectile dysfunction, anejaculation, seminal biochemical modification and morphology of spermatozoa. Current therapies for the infertile spinal cord injured patient focus on the ejaculation stimulus followed by intrauterine insemination, leaving seminal low quality as the major factor of infertility in these patients. In this scenario, therapy with hyperbaric oxygenation, which is still being studied, represents an alternative treatment since it focuses on the central nervous system injured by the trauma and the testicular tissue in order to decrease spinal damage and to preserve the physiological regulation of the urogenital system as a form of avoiding infertility.
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Busscher HJ, Jager D, Finger G, Schaefer N, van der Mei HC. Energy transfer, volumetric expansion, and removal of oral biofilms by non-contact brushing. Eur J Oral Sci 2010; 118:177-82. [PMID: 20487007 DOI: 10.1111/j.1600-0722.2010.00723.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Non-contact removal of oral biofilms offers advantages beyond the reach of bristles, but it is unknown how energy transfer for removal from brush-to-biofilm occurs. In the present study we evaluated non-contact, oral biofilm removal by oscillating-rotating and sonic toothbrushes, and their acoustic output up to 6 mm distance. Whereas some brushes removed biofilm when used at a distance of up to 6 mm, others lost efficacy at a distance of 2-4 mm from the biofilm. Loss of efficacy was accompanied with high standard deviations and volumetric biofilm expansion. Both sonic and oscillating-rotating brushes caused fluid flows and the inclusion of air-bubbles, while non-contact acoustic energy-transfer was demonstrated to decay with distance for both types of brushes. We put forward the following mechanism for non-contact removal: (i) brush energy is absorbed by biofilm, resulting in the visco-elastic expansion of the biofilm; (ii) if the energy absorbed is sufficient and deformation is beyond the yield point, biofilm removal occurs; and (iii) if deformation is in the plastic range but below the yield point (i.e. at the limiting distance for non-contact removal), biofilm is expanded but not removed.
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Affiliation(s)
- H J Busscher
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Finger G, Jahn E, Zeigan D, Zibrowius B, Szulzewsky K, Richter-Mendau J, Bülow M. Synthesis of Large-Sized Sapo-5 Crystals With Silicon Occupying Predominantly Phosphorus-T-Sites. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bscb.19890980501] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schueth F, Demuth D, Zibrowius B, Kornatowski J, Finger G. FTIR microscopy with polarized IR radiation for the analysis of SAPO-5 and p-xylene-loaded SAPO-5. J Am Chem Soc 2002. [DOI: 10.1021/ja00082a035] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Atopic dermatitis (AD) is frequently complicated by minor bacterial superinfections. Invasive infections such as osteomyelitis have rarely been reported. We describe two children with staphylococcal septicemia during an exacerbation of their AD. Cellulitis and underlying congenital heart disease, respectively, were considered predisposing factors for the development of bacteremia. Identical strains were isolated from the skin, and there was a significant increase in antibodies against Staphylococcus aureus capsular polysaccharide in one child. Our cases demonstrate the potential severity of bacterial skin infections in AD, especially when associated with an underlying condition that increases vulnerability to bacteremia. While their true incidence in children with AD is currently unknown, it is conceivable that systemic staphylococcal infections may be more common than previously thought. Staphylococcal bacteremia has to be considered in the differential diagnosis of fever in children with severe AD. Conversely, episodes of staphylococcal bacteremia should prompt a search for underlying predisposing factors.
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Affiliation(s)
- P H Hoeger
- Department of Pediatrics, University of Hamburg, Hamburg, Germany.
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Baur WH, Joswig W, Kassner D, Kornatowski J, Finger G. Structure of SAPO-31 refined from single-crystal diffraction data: substitution of P by Si established by diffraction methods. Acta Crystallogr B Struct Sci 1994. [DOI: 10.1107/s0108768193012625] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Finger G, Kornatowski J, Richter-mendau J, Jancke K, Rülow M, Rozwadowski M. On Controlled Growth of Sapo-5 Molecular Sieve Crystals of Different Sizes and Shapes. Studies in Surface Science and Catalysis 1991. [DOI: 10.1016/s0167-2991(08)62934-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Kornatowski J, Finger G, Schmitz W. Evaluation of experimental parameters influencing the growth of large crystals of NaX zeolite. Cryst Res Technol 1990. [DOI: 10.1002/crat.2170250105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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