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Wang AS, Murnin JC, Wiginton Iv J, Tchalukov K, Stout CE, Duong J, Sweiss R. Pre-operative Embolization of a Cerebellar Hemangioblastoma Using Polyvinyl Alcohol (PVA) and Target Tetra 360 Detachable Coil. Cureus 2024; 16:e56891. [PMID: 38659508 PMCID: PMC11042672 DOI: 10.7759/cureus.56891] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
Due to its hypervascularity, hemangioblastoma, a rare primary central nervous system intracranial tumor, has been treated with pre-operative embolization prior to surgical resection. Here, we describe a case treated as such. A 37-year-old male presented with worsening chronic headache and right ear tinnitus was found to have a hypervascular, heterogeneous right cerebellar lesion suspicious for arteriovenous malformation or hemangioblastoma. He underwent polyvinyl alcohol (PVA) and Target Tetra 360 (Fremont, CA: Stryker Neurovascular) detachable coil embolization followed by complete tumor resection. Pathology was consistent with hemangioblastoma. He presented with complete resolution of his symptoms immediately post-operatively and at a two-week follow-up. Our case highlighted the importance of pre-operative embolization to help achieve complete tumor resection which is considered curative in the treatment of hypervascular hemangioblastoma. The Target Tetra 360 detachable coil embolization is another material that can be considered.
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Affiliation(s)
- Alice S Wang
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - John C Murnin
- Medicine, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - James Wiginton Iv
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Konstantin Tchalukov
- Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Charles E Stout
- Neurointerventional Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Jason Duong
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | - Raed Sweiss
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
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Ngoy A, Tchalukov K, Pollock G, Thomson B, Nguyen C. The First-Reported Presentation of Quadruple Locations of Elastofibroma Dorsi: A Case Report and Review of the Literature. Cureus 2023; 15:e41425. [PMID: 37546062 PMCID: PMC10403338 DOI: 10.7759/cureus.41425] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Elastofibroma dorsi (EFD) is an uncommon benign tumor of mesenchymal origin that usually occurs in the subscapular region. Bilateral and triple EFD are frequently reported in the literature but cases with more lesions have never been described. Our patient is a 50-year-old female with quadruple locations of bilateral suprascapular and subscapular EFD who presented with left shoulder pain and swelling over the affected area. Clinical presentation, computed tomography (CT) and magnetic resonance imaging (MRI), and biopsy were consistent with EFD. Therapeutic excision was performed and successfully alleviated the patient's discomfort. This report presents the first case of quadruple locations of EFD and highlights the value of MRI in the diagnosis of EFD, especially when there are multiple masses with indistinct margins are deeply located in the chest wall.
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Affiliation(s)
- April Ngoy
- Department of Radiology, Kaweah Health, Visalia, USA
| | - Konstantin Tchalukov
- Department of Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Gabriel Pollock
- Department of Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Bryon Thomson
- Department of Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Christopher Nguyen
- Department of Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
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Straus D, Eddelman DB, Byrne N, Tchalukov K, Wewel J, Munich SA, Kocak M, Byrne R. Anatomical Predictors of Transcranial Surgical Access to the Suprasellar Space. J Neurol Surg B Skull Base 2021; 82:365-369. [PMID: 34026414 DOI: 10.1055/s-0039-3400298] [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: 07/03/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022] Open
Abstract
Objective The suprasellar space is a common location for intracranial lesions. The position of the optic chiasm (prefixed vs. postfixed) results in variable sizes of operative corridors and is thus important to identify when choosing a surgical approach to this region. In this study, we aim to identify relationships between suprasellar anatomy and external cranial metrics to guide in preoperative planning. Methods T2-weighted magnetic resonance images (MRIs) from 50 patients (25 males and 25 females) were analyzed. Various intracranial and extracranial metrics were measured. Statistical analysis was performed to determine any associations between metrics. Results Interoptic space (IOS) size correlated with interpupillary distance (IPD; a = 7.3, 95% confidence interval [CI] = 4.5-10.0, R 2 = 0.3708, p = 0.0009). IOS size also correlated with fixation of the optic chiasm, for prefixed chiasms ( n = 7), the mean IOS is 205.14 mm 2 , for normal chiasm position ( n = 33) the mean IOS is 216.94 mm 2 and for postfixed chiasms ( n = 10) the mean IOS is 236.20 mm 2 ( p = 0.002). IPD correlates with optic nerve distance (OND; p = 0.1534). Cranial index does not predict OND, IPD, or IOS. Conclusion This study provides insight into relationships between intracranial structures and extracranial metrics. This is the first study to describe a statistically significant correlation between IPD and IOS. Surgical approach can be guided in part by the size of the IOS and its correlates. Particularly small intraoptic space may guide the surgeon away from a subfrontal approach.
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Affiliation(s)
- David Straus
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Daniel B Eddelman
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Nika Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Konstantin Tchalukov
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, United States
| | - Josh Wewel
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Stephan A Munich
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Mehmet Kocak
- Department of Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
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Harada GK, Khan JM, Vetter C, Basques BA, Sayari AJ, Hayani Z, Tchalukov K, Louie PK, Colman M, An HS. Does the Number of Levels Fused Affect Spinopelvic Parameters and Clinical Outcomes Following Posterolateral Lumbar Fusion for Low-Grade Spondylolisthesis? Global Spine J 2021; 11:116-121. [PMID: 32875855 PMCID: PMC7734270 DOI: 10.1177/2192568220901527] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES To determine how the number of fused intervertebral levels affects radiographic parameters and clinical outcomes in patients undergoing open posterolateral lumbar fusion (PLF) for low-grade degenerative spondylolisthesis. METHODS This was a retrospective cohort study on patients who underwent open PLF for low-grade spondylolisthesis at a single institution from 2011 to 2018. Patients were divided into groups based on number of levels fused during their procedure (1, 2, or 3 or more). Preoperative and postoperative spinopelvic radiographic parameters, patient-reported outcomes (Visual Analog Scale [VAS]-back, VAS-leg, Oswestry Disability Index [ODI]), and postoperative complications were compared. RESULTS Of the 316 patients eligible (203 one-level, 95 two-level, 18 three or more levels), change in initial postoperative to final pelvic incidence-lumbar lordosis was greatest in 2-level fusions (P = .039), while 3 or more level fusions had worse final pelvic tilt measures (P = .021). In addition, multilevel fusions had worse final VAS-back scores (2-level: P = .015; 3 or more levels: P = .011), higher rates of dural tears (2-level: P = .001), reoperation (2-level: P = .039), and discharge to facility (3 or more levels: P = .047) when compared with 1-level fusions. CONCLUSIONS Patients in multilevel fusions experienced less improvement in back pain, had more complications, and were more commonly discharged to a facility compared with single-level PLF patients. These findings are important for operative planning, for setting appropriate preoperative expectations, and for risk stratification in patients undergoing posterior lumbar fusion for low-grade spondylolisthesis.
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Affiliation(s)
| | | | | | - Bryce A. Basques
- Rush University Medical Center, Chicago, IL, USA,Bryce A. Basques, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL 60612, USA.
| | | | - Zayd Hayani
- Rush University Medical Center, Chicago, IL, USA
| | | | | | | | - Howard S. An
- Rush University Medical Center, Chicago, IL, USA
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Khan JM, Harada GK, Basques BA, Nolte MT, Louie PK, Iloanya M, Tchalukov K, Berkowitz M, Derman P, Colman M, An HS. Patients with predominantly back pain at the time of lumbar fusion for low-grade spondylolisthesis experience similar clinical improvement to patients with predominantly leg pain: mid-term results. Spine J 2020; 20:276-282. [PMID: 31563578 DOI: 10.1016/j.spinee.2019.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients with back pain predominance (BPP) have traditionally been thought to derive less predictable symptomatic relief from lumbar fusion surgery. PURPOSE To compare postoperative clinical outcomes as well as degree of improvement in clinical outcome measures between patients with BPP and patients with leg pain predominance (LPP) undergoing open posterior lumbar fusion. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Analysis of patients who underwent an open posterior lumbar fusion for low-grade (Meyerding Grade I or II) degenerative or isthmic spondylolisthesis from 2011 to 2018 was conducted. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. Patients were excluded if they were under 18 years of age at the time of surgery, had less than 6 months of follow-up, presented with a lumbar vertebral body fracture, tumor, or infection, or underwent a fusion surgery that extended to the thoracic spine, high-grade spondylolisthesis, or concomitant deformity. OUTCOME MEASURES Radiographs obtained at preoperative, immediate postoperative, and final visits were evaluated for presence or absence of fusion. Patient-reported outcomes were recorded at preoperative and final clinic visits that included: visual analog scale (VAS) back/leg pain, and Oswestry disability index (ODI). Achievement of minimal clinically important difference (MCID) was analyzed, along with rates of postoperative complication and reoperation. METHODS Preoperative and final patient-reported outcomes were obtained. Achievement of MCID was evaluated using following thresholds: ODI 14.9, VAS-back pain 2.1, VAS-leg pain 2.8. For analysis, patients were divided into two groups based on predominant location of pain: predominantly VAS-back pain (BPP) and predominantly VAS-leg pain (LPP). RESULTS One hundred forty-one patients met inclusion criteria. Of these, 71 had LPP, and 70 had BPP. Patients with preoperative LPP experienced greater improvements in VAS-leg (p<.001) compared to those with BPP, whereas patients with preoperative BPP experienced greater improvements in VAS-back (p=.011) postoperatively compared to those with LPP. There were no differences in the final clinical outcomes. Additionally, LPP achieved MCID for VAS-leg (p=.027) at significantly higher proportion than BPP and BPP achieved MCID for VAS-back (p=.050) at significantly higher proportion than LPP. CONCLUSIONS Patients with low-grade spondylolisthesis who underwent an open posterior lumbar fusion had improvement in symptoms regardless of presentation with BPP or LPP. In properly indicated patients, posterior spinal fusion is effective for those with BPP in the setting of experiencing both leg and back pain, and clinicians can use this information for perioperative discussions and surgical decision-making.
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Affiliation(s)
- Jannat M Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael Iloanya
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Konstantin Tchalukov
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mark Berkowitz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Peter Derman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Khanna R, Brahimaj B, Tchalukov K, Byrne K, Adogwa O, Jhaveri M, Byrne R. A case of recurrent gliosarcoma mimicking subdural hematoma. Interdisciplinary Neurosurgery 2019. [DOI: 10.1016/j.inat.2018.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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