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Zhang DY, Pearce JJ, Petrosyan E, Borghei A, Byrne RW, Sani S. Minimizing pneumocephalus during deep brain stimulation surgery. Clin Neurol Neurosurg 2024; 238:108174. [PMID: 38422743 DOI: 10.1016/j.clineuro.2024.108174] [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: 12/07/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) surgery is an effective treatment for movement disorders. Introduction of intracranial air following dura opening in DBS surgery can result in targeting inaccuracy and suboptimal outcomes. We develop and evaluate a simple method to minimize pneumocephalus during DBS surgery. METHODS A retrospective analysis of prospectively collected data was performed on patients undergoing DBS surgery at our institution from 2014 to 2022. A total of 172 leads placed in 89 patients undergoing awake or asleep DBS surgery were analyzed. Pneumocephalus volume was compared between leads placed with PMT and leads placed with standard dural opening. (112 PMT vs. 60 OPEN). Immediate post-operative high-resolution CT scans were obtained for all leads placed, from which pneumocephalus volume was determined through a semi-automated protocol with ITK-SNAP software. Awake surgery was conducted with the head positioned at 15-30°, asleep surgery was conducted at 0°. RESULTS PMT reduced pneumocephalus from 11.2 cm3±9.2 to 0.8 cm3±1.8 (P<0.0001) in the first hemisphere and from 7.6 cm3 ± 8.4 to 0.43 cm3 ± 0.9 (P<0.0001) in the second hemisphere. No differences in adverse events were noted between PMT and control cases. Lower rates of post-operative headache were observed in PMT group. CONCLUSION We present and validate a simple yet efficacious technique to reduce pneumocephalus during DBS surgery.
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Affiliation(s)
- Daniel Y Zhang
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - John J Pearce
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Edgar Petrosyan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Alireza Borghei
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
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2
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Kolcun JPG, Kolb BL, Mazza JM, Traynelis VC, Byrne RW, Fontes RBV. In Reply: The Evolving Role of Postgraduate Year 7 in Neurological Surgery Residency. Neurosurgery 2024; 94:e41. [PMID: 38078908 DOI: 10.1227/neu.0000000000002795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- John Paul G Kolcun
- Department of Neurological Surgery, Rush University Medical Center, Chicago , Illinois , USA
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3
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Kolcun JPG, Mazza JM, Pawlowski KD, Varela JR, Kolb B, Traynelis VC, Byrne RW, Fontes RBV. The Evolving Role of Postgraduate Year 7 in Neurological Surgery Residency. Neurosurgery 2024; 94:350-357. [PMID: 37706880 DOI: 10.1227/neu.0000000000002685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/23/2023] [Accepted: 07/25/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In 2013, all neurosurgery programs were mandated to adopt a 7-year structure. We sought to characterize how programs use the seventh year of training (postgraduate year 7 [PGY7]). METHODS We surveyed all accredited neurosurgery programs in the United States regarding the PGY7 residents' primary role and the availability of enfolded fellowships. We compiled responses from different individuals in each program: chair, program director, program coordinator, and current chiefs. RESULTS Of 120 accredited neurological surgery residency programs within the United States, 91 (76%) submitted responses. At these programs, the primary roles of the PGY7 were chief of service (COS, 71%), enfolded fellowships (EFF, 18%), transition to practice (10%), and elective time (1%). Most residencies have been 7-year programs for >10 years (52, 57%). Sixty-seven programs stated that they offer some form of EFF (73.6%). The most common EFFs were endovascular (57, 62.6%), spine (49, 53.9%), critical care (41, 45.1%), and functional (37, 40.7%). These were also the most common specialties listed as Committee on Advanced Subspecialty Training accredited by survey respondents. Spine and endovascular EFFs were most likely to be restricted to PGY7 (24.2% and 23.1%, respectively), followed by neuro-oncology (12, 13.2%). The most common EFFs reported as Committee on Advanced Subspecialty Training accredited but not restricted to PGY7 were endovascular (24, 26.4%) and critical care (23, 25.3%). CONCLUSION Most accredited neurological surgery training programs use the COS as the primary PGY7 role. Programs younger in their PGY7 structure seem to maintain the traditional COS role. Those more established seem to be experimenting with various roles the PGY7 year can fill, including enfolded fellowships and transition-to-practice years, predominantly. Most programs offer some form of enfolded fellowship. This serves as a basis for characterization of how neurological surgery training may develop in years to come.
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Affiliation(s)
- John Paul G Kolcun
- Department of Neurological Surgery, Rush University Medical Center, Chicago , Illinois , USA
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4
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Joshi KC, Kolb B, Khalili BF, Munich SA, Byrne RW. Surgical Strategies in the Treatment of Giant Pituitary Adenomas. Oper Neurosurg (Hagerstown) 2024; 26:4-15. [PMID: 37655871 DOI: 10.1227/ons.0000000000000896] [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: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The management of giant pituitary adenomas (GPAs) is challenging due to associated endocrinopathies and the close proximity of these tumors to critical structures, such as the optic nerves, structures of the cavernous sinus, and hypothalamus. The objective of this review article was to summarize the current management strategies for giant pituitary adenomas, including the role of open and endoscopic surgical approaches and the role of medical and radiation therapy in conjunction with surgery. METHODS We conducted a retrospective review of GPAs operated at our institute between January 2010 and March 2023. Surgical approaches, extent of resection, and associated complications were documented. Furthermore, we conducted a thorough literature review to identify relevant studies published in the past decade, which were incorporated along with insights gained from our institutional case series of GPAs to analyze and integrate both the existing knowledge base and our institution's firsthand experience in the management of GPAs. RESULTS A total of 46 giant pituitary adenomas (GPAs) were operated on, using various surgical approaches. Transsphenoidal approach was used in 25 cases and a staged approach using transsphenoidal and pterional was used in 15 cases. Other approaches included transcortical-transventricular, transcallosal, pterional/orbitozygomatic, and subfrontal approaches. Complications and technical nuances were reported. CONCLUSION The management of giant pituitary adenomas remains complex, often involving several modalities-open or endoscopic resection, radiosurgery, and medical management of both the tumor and associated endocrinopathies. Surgical resections are often challenging procedures that require careful consideration of several factors, including patient characteristics, tumor location, and size, and the experience and skill of the surgical team.
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Affiliation(s)
- Krishna C Joshi
- Department of Neurosurgery, Rush University Medical Center, Chicago , Illinois , USA
| | - Bradley Kolb
- Department of Neurosurgery, Rush University Medical Center, Chicago , Illinois , USA
| | | | - Stephan A Munich
- Department of Neurosurgery, Rush University Medical Center, Chicago , Illinois , USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago , Illinois , USA
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5
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Kolcun JPG, Kolb BL, Mazza JM, Traynelis VC, Byrne RW, Fontes RBV. "It's a 7-Year Program"-Allostasis in Neurosurgical Training. World Neurosurg 2023; 180:236-237. [PMID: 37925252 DOI: 10.1016/j.wneu.2023.10.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Affiliation(s)
- John Paul G Kolcun
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bradley L Kolb
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jacob M Mazza
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vincent C Traynelis
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard W Byrne
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ricardo B V Fontes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
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6
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Pearce JJ, Byrne RW. Book Review: Posttraumatic Epilepsy: Basic and Clinical Aspects. Neurosurgery 2023; 92:e111-e112. [PMID: 37067282 DOI: 10.1227/neu.0000000000002438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 03/18/2023] Open
Affiliation(s)
- John J Pearce
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
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7
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Nunna RS, Wiet RM, Byrne RW. Transotic Approach for Resection of Expansile Endolymphatic Sac Tumor. Skull Base Surg 2022; 83:e665-e666. [PMCID: PMC9719828 DOI: 10.1055/s-0042-1757617] [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: 05/31/2020] [Accepted: 08/31/2022] [Indexed: 12/07/2022]
Abstract
Objectives and Design
Endolymphatic sac tumors (ELSTs) are rare and indolent tumors that arise from the endolymphatic sac in the posterior petrous ridge. We present a video case report illustrating the use of a transotic approach for resection of an expansile ELST.
Setting and Participants
A 25-year-old male presented with a multiyear history of worsening left-sided hearing loss, vertigo, and headaches. Otoscopy revealed a red mass behind an intact tympanic membrane. Computed tomography revealed a large, locally aggressive mass centered in the posterior petrous temporal bone. Magnetic resonance imaging demonstrated a heterogeneously enhancing 2.4 × 3.1 × 2.4 cm tumor that exerted mass effect on the cerebellar surface with extension into the jugular foramen, tympanic cavity, internal auditory canal, and cistern of the cerebellopontine angle. A transotic approach was planned to obtain the necessary generous exposure.
Main Outcome Measures and Results
Preoperative angiography revealed arterial supply via the ascending pharyngeal and tumor embolization with Onyx was performed. Surgical resection began with a blind-sac closure created from the external auditory canal. The tympanic membrane and malleus were removed and the incustapedial joint was transected. A subtotal petrosectomy was performed for partial tumor exposure. The facial canal and sigmoid sinus were carefully skeletonized and a labrynthectomy was performed. The tumor was resected using a combination of bipolar cautery and blunt and sharp dissection. For closure, an abdominal fat graft was secured with overlying resorbable mesh followed by sequential closure of all skin layers. Histopathologic analysis revealed an ELST.
Conclusion
The transotic approach offers wide exposure and facilitates large, complex tumor removal.
The link to the video can be found at
https://youtu.be/YvhyN8iVi44
.
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Affiliation(s)
- Ravi S. Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United States,Address for correspondence Ravi S. Nunna, MD Department of Neurosurgery, University of Illinois at Chicago912 S. Wood Street, 451-N Chicago, IL, 60612United Sates
| | - R Mark Wiet
- Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois, United States,Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard W. Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
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8
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Hobaiter C, Graham KE, Byrne RW. Are ape gestures like words? Outstanding issues in detecting similarities and differences between human language and ape gesture. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210301. [PMID: 35934962 PMCID: PMC9358316 DOI: 10.1098/rstb.2021.0301] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/24/2022] [Indexed: 12/30/2022] Open
Abstract
Opinion piece: ape gestures are made intentionally, inviting parallels with human language; but how similar are their gestures to words? Here we ask this in three ways, considering: flexibility and ambiguity, first- and second-order intentionality, and usage in interactive exchanges. Many gestures are used to achieve several, often very distinct, goals. Such apparent ambiguity in meaning is potentially disruptive for communication, but-as with human language-situational and interpersonal context may largely resolve the intended meaning. Our evidence for first-order intentional use of gesture is abundant, but how might we establish a case for the second-order intentional use critical to language? Finally, words are rarely used in tidy signal-response sequences but are exchanged in back-and-forth interaction. Do gestures share this property? In this paper, we examine these questions and set out ways in which they can be resolved, incorporating data from wild chimpanzees. This article is part of the theme issue 'Cognition, communication and social bonds in primates'.
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Affiliation(s)
- Catherine Hobaiter
- Origins of Mind Group, School of Psychology and Neuroscience, University of St Andrews, St Andrews KY16 9JP, UK
| | - Kirsty E. Graham
- Origins of Mind Group, School of Psychology and Neuroscience, University of St Andrews, St Andrews KY16 9JP, UK
| | - Richard W. Byrne
- Origins of Mind Group, School of Psychology and Neuroscience, University of St Andrews, St Andrews KY16 9JP, UK
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9
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Woodward J, Meza S, Richards D, Koro L, Keegan KC, Joshi KC, Munoz LF, Byrne RW, John S. The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes. Front Surg 2022; 9:914798. [PMID: 35756465 PMCID: PMC9218208 DOI: 10.3389/fsurg.2022.914798] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction The SARS-CoV-2 (COVID-19) pandemic continues to substantially alter previously established clinical practice patterns and has transformed patient care in American healthcare. However, studies to evaluate the impact of COVID-19 on neuroemergent patient care and associated clinical outcomes are limited. Herein, we describe the impact of COVID-19 on the Neuroemergency Transfer Program (NTP) - a novel, urban, high volume interhospital patient transfer program. Objective To evaluate and describe the clinical impact of the COVID-19 pandemic on the NTP. Study Design A single-center retrospective study of prospectively collected consecutive neuroemergent patient transfer data between 2018–2021 was analyzed. Adult patients were divided based upon transfer date into a Pre-COVID (PCOV) or COVID cohort. Patient demographics, transfer characteristics and clinical data and outcomes were analyzed. Results 3,096 patients were included for analysis. Mean age at transfer in the PCOV and COVID cohorts were 62.4 ± 0.36 and 61.1 ± 0.6 years. A significant decrease in mean transfers per month was observed between cohorts (PCOV = 97.8 vs. COV = 68.2 transfers/month, p < 0.01). Total transfer time in the PCOV cohort was 155.1 ± 3.4 min which increased to 169.3 ± 12.8 min in the COVID cohort (p = 0.13). Overall mean transfer distance was significantly longer in the PCOV cohort at 22.0 ± 0.4 miles vs. 20.3 ± 0.67 miles in the COV cohort (p = 0.03). The relative frequency of transfer diagnoses was unchanged between cohorts. A significant increase in mean inpatient length of stay was noted, 7.9 ± 0.15 days to 9.6 ± 0.33 days in the PCOV vs. COVID cohorts (p < 0.01). Ultimately, no difference in the frequency of good vs. poor clinical outcome were noted between the PCOV (79.8% and 19.4%) vs. COV (78.8% and 20.4%) cohorts. Conclusion The impact of COVID-19 on current healthcare dynamics are far reaching. Here, we show a significant decrease in interhospital patient transfers and increased length of stay between a Pre-COVID and COVID cohort. Further work to better elucidate the specific interplay of clinical contributors to account for these changes is indicated.
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Affiliation(s)
- Josha Woodward
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Samuel Meza
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Dominick Richards
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Lacin Koro
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Kevin C. Keegan
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Krishna C. Joshi
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Lorenzo F. Munoz
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Richard W. Byrne
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Sayona John
- Department of Neurology, Rush University Medical Center, Chicago, IL, United States
- Correspondence: Sayona John
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10
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Riley JL, Noble DWA, Stow AJ, Bolton PE, While GM, Dennison S, Byrne RW, Whiting MJ. Socioecology of the Australian Tree Skink (Egernia striolata). Front Ecol Evol 2021. [DOI: 10.3389/fevo.2021.722455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is great diversity in social behavior across the animal kingdom. Understanding the factors responsible for this diversity can help inform theory about how sociality evolves and is maintained. The Australian Tree Skink (Egernia striolata) exhibits inter- and intra-population variability in sociality and is therefore a good system for informing models of social evolution. Here, we conducted a multi-year study of a Tree Skink population to describe intra-population variation in the social organization and mating system of this species. Skinks aggregated in small groups of 2–5 individuals, and these aggregations were typically associated with shared shelter sites (crevices and hollows within rocks and trees). Aggregations were typically made up of one or more adult females and, often, one male and/or juvenile(s). Social network and spatial overlap analyses showed that social associations were strongly biased toward kin. Tree skinks also exhibited high site fidelity regardless of age or sex. There were high levels of genetic monogamy observed with most females (87%) and males (68%) only breeding with a single partner. Our results indicate that Tree Skinks reside in small family groups and are monogamous, which corresponds with existing research across populations. Similar to previous work, our study area consisted of discrete habitat patches (i.e., rock outcrops, trees, or both), which likely limits offspring dispersal and promotes social tolerance between parents and their offspring. Our study clearly demonstrates that there is intra-population variability in Tree Skink social behavior, but it also provides evidence that there is a high degree of inter-population consistency in sociality across their geographic range. We also highlight promising possible avenues for future research, specifically discussing the importance of studying the nature and extent of Tree Skink parental care and quantifying the fitness outcomes of kin-based sociality in this species, which are topics that will further our understanding of the mechanisms underlying variation in vertebrate social behavior.
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11
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Khalid SI, Nunna RS, Maasarani S, Shanker RM, Behbahani M, Edmondson CP, Mehta AI, Gupta SK, Chan EY, Torquati A, Byrne RW, Adogwa O. Laparoscopic-Assisted Versus Mini-Open Laparotomy for Ventriculoperitoneal Shunt Placement in the Medicare Population. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa541_s115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Riley JL, Stow A, Bolton PE, Dennison S, Byrne RW, Whiting MJ. Sperm Storage in a Family-Living Lizard, the Tree Skink (Egernia striolata). J Hered 2021; 112:526-534. [PMID: 34409996 DOI: 10.1093/jhered/esab048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/19/2021] [Accepted: 08/16/2021] [Indexed: 11/14/2022] Open
Abstract
The ability to produce viable offspring without recently mating, either through sperm storage or parthenogenesis, can provide fitness advantages under a suite of challenging ecological scenarios. Using genetic analysis, we demonstrate that 3 wild-caught female Tree Skinks (Egernia striolata) reproduced in captivity with no access to males for over a year, and that this is best explained by sperm storage. To the best of our knowledge, this is the first time female sperm storage has been documented in any monogamous family-living reptile, including social Australian egerniine skinks (from the subfamily Egerniinae). Furthermore, by using paternal reconstruction of genotypes we show that captive-born offspring produced by the same females in the preceding year, presumably without sperm storage, were sired by different males. We qualitatively compared aspects of these females' mates and offspring between years. The parents of each litter were unrelated, but paternal and offspring genotypes from litters resulting from stored sperm were more heterozygous than those inferred to be from recent matings. Family-living egerniine skinks generally have low rates of multiple paternity, yet our study suggests that female sperm storage, potentially from outside social partners, offers the real possibility of benefits. Possible benefits include increasing genetic compatibility of mates and avoiding inbreeding depression via cryptic female choice. Sperm storage in Tree Skinks, a family-living lizard with a monogamous mating system, suggests that females may bet-hedge through extra-pair copulation with more heterozygous males, reinforcing the idea that females could have more control on reproductive outcomes than previously thought.
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Affiliation(s)
- Julia L Riley
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia.,Department of Biology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Biology, Mount Allison University, Sackville, New Brunswick, Canada
| | - Adam Stow
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Peri E Bolton
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia.,Department of Biology, East Carolina University, Greenville, NC
| | - Siobhan Dennison
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Richard W Byrne
- School of Psychology and Neuroscience, University of St. Andrews, St. Andrews, Fife, UK
| | - Martin J Whiting
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia
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13
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Selden NR, Barbaro NM, Barrow DL, Batjer HH, Branch CL, Burchiel KJ, Byrne RW, Dacey RG, Day AL, Dempsey RJ, Derstine P, Friedman AH, Giannotta SL, Grady MS, Harsh GR, Harbaugh RE, Mapstone TB, Muraszko KM, Origitano TC, Orrico KO, Popp AJ, Sagher O, Selman WR, Zipfel GJ. Neurosurgery residency and fellowship education in the United States: 2 decades of system development by the One Neurosurgery Summit organizations. J Neurosurg 2021; 136:565-574. [PMID: 34359022 DOI: 10.3171/2020.10.jns203125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/13/2020] [Accepted: 10/05/2020] [Indexed: 11/06/2022]
Abstract
The purpose of this report is to chronicle a 2-decade period of educational innovation and improvement, as well as governance reform, across the specialty of neurological surgery. Neurological surgery educational and professional governance systems have evolved substantially over the past 2 decades with the goal of improving training outcomes, patient safety, and the quality of US neurosurgical care. Innovations during this period have included the following: creating a consensus national curriculum; standardizing the length and structure of neurosurgical training; introducing educational outcomes milestones and required case minimums; establishing national skills, safety, and professionalism courses; systematically accrediting subspecialty fellowships; expanding professional development for educators; promoting training in research; and coordinating policy and strategy through the cooperation of national stakeholder organizations. A series of education summits held between 2007 and 2009 restructured some aspects of neurosurgical residency training. Since 2010, ongoing meetings of the One Neurosurgery Summit have provided strategic coordination for specialty definition, neurosurgical education, public policy, and governance. The Summit now includes leadership representatives from the Society of Neurological Surgeons, the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the American Board of Neurological Surgery, the Review Committee for Neurological Surgery of the Accreditation Council for Graduate Medical Education, the American Academy of Neurological Surgery, and the AANS/CNS Joint Washington Committee. Together, these organizations have increased the effectiveness and efficiency of the specialty of neurosurgery in advancing educational best practices, aligning policymaking, and coordinating strategic planning in order to meet the highest standards of professionalism and promote public health.
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Affiliation(s)
- Nathan R Selden
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Nicholas M Barbaro
- 2Department of Neurosurgery, University of Texas, Dell Medical School, Austin, Texas
| | - Daniel L Barrow
- 3Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - H Hunt Batjer
- 4Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Charles L Branch
- 5Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Kim J Burchiel
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Richard W Byrne
- 6Department of Neurosurgery, Rush University, Chicago, Illinois
| | - Ralph G Dacey
- 7Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Arthur L Day
- 8Department of Neurosurgery, University of Texas Houston Health Science Center, Houston, Texas
| | - Robert J Dempsey
- 9Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Pamela Derstine
- 10Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Allan H Friedman
- 11Department of Neurosurgery, Duke University Health System, Durham, North Carolina
| | - Steven L Giannotta
- 12Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - M Sean Grady
- 13Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Griffith R Harsh
- 14Department of Neurological Surgery, University of California Davis, Sacramento, California
| | - Robert E Harbaugh
- 15Department of Neurosurgery, Pennsylvania State University, Hershey, Pennsylvania
| | - Timothy B Mapstone
- 16Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Karin M Muraszko
- 17Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Thomas C Origitano
- 18Neuroscience and Spine Institute, Kalispell Regional Healthcare, Kalispell, Montana
| | | | - A John Popp
- 20Department of Neurosurgery, Albany Medical College and Albany Medical Center Hospital, Albany, New York; and
| | - Oren Sagher
- 17Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Warren R Selman
- 21Department of Neurosurgery, University Hospitals Cleveland and Case Western Reserve University, Cleveland, Ohio
| | - Gregg J Zipfel
- 7Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
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14
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Abstract
BACKGROUND Cranioplasty (CP) is associated with high complication rates compared to other common neurosurgical procedures. Several graft materials are used for CP, which may contribute to the high complication rates, but data in the literature regarding the influence of graft material on post-CP outcomes are inconsistent making it difficult to determine if, when, and to what extent the graft material impacts the rate of perioperative complications. There is an increased demand to identify and develop superior graft materials. OBJECTIVE To review and compare the indications, risks, complications, and patient results associated with the use of different graft materials for cranial reconstructions. DESIGN A search through EBSCOhost was conducted using the keywords "craniectomy" or "decompressive craniectomy," "cranioplasty," and "materials." The search was limited to literature published in the English language from 2005 until the present. Ultimately, 69 articles were included in this review. Due to the heterogeneity of the study populations, results, statistical analyses, and collecting methods, no statistical analyses could be performed. CONCLUSIONS Several graft materials have been adapted for use in cranial reconstructions with inconsistent results making it unclear if or when one material may be indicated over others. Advances in computer-aided design have led to improved patient-specific implants, but the ideal graft material is still being sought after in ongoing research efforts. Reviewing materials currently available, as well as those in clinical trials, is important to identify the limitations associated with different implants and to guide future research.
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Affiliation(s)
- Haley Meyer
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL, USA
| | - Syed I. Khalid
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL, USA
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Amir H. Dorafshar
- Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Richard W. Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
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15
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Khalid SI, Nunna RS, Maasarani S, Shanker RM, Behbahani M, Edmondson CP, Mehta AI, Gupta SK, Chan EY, Torquati A, Byrne RW, Adogwa O. Laparoscopic-Assisted Versus Mini-Open Laparotomy for Ventriculoperitoneal Shunt Placement in the Medicare Population. Neurosurgery 2021; 88:812-818. [PMID: 33475722 DOI: 10.1093/neuros/nyaa541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/08/2020] [Accepted: 10/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Placement of the distal shunt catheter into the peritoneum during ventriculoperitoneal shunt (VPS) surgery can be done with either laparoscopic assistance or laparotomy. OBJECTIVE To compare outcomes in laparoscopic-assisted vs laparotomy for placement of VPS in the Medicare population. METHODS Patients undergoing VPS placement, between 2004 and 2014, were identified by International Classification of Disease, Ninth Revision and Current Procedural Terminology codes in the Medicare database. Demographic data including age, sex, comorbidities, and indications were collected. Six- and twelve-month complication rates were analyzed. RESULTS A total of 1966 (3.2%) patients underwent laparoscopic-assisted VPS and 60 030 (96.8%) patients underwent nonlaparoscopic-assisted VPS placement. Compared with traditional open VPS placement, the laparoscopic approach was associated with decreased odds of distal revision at 6- and 12-mo postoperatively (6 mo: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.21-0.74; 12 mo: OR = 0.60, 95% CI: 0.39-0.94). At 6- and 12-mo postoperatively, multivariable regression analysis demonstrated increased odds of distal revision in patients with a body mass index (BMI) > 30 Kg/M2, history of open abdominal surgery, and history of laparoscopic abdominal surgery. Additionally, history of prior abdominal surgery and BMI > 30 Kg/M2 were significantly associated with increase odds of shunt infection at 6 and 12-mo, respectively. CONCLUSION In the largest retrospective analysis to date, patients with a history of abdominal surgery and obesity were found to be at increased risk of infection and distal revision after VPS placement. However, the laparoscopic approach for abdominal placement of the distal catheter was associated with reduced rates of distal revision in this population, suggesting an avenue for reducing complications in well-selected patients.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Samantha Maasarani
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Rachyl M Shanker
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Corbin P Edmondson
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Samir K Gupta
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Edie Y Chan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Alfonso Torquati
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical School, Dallas, Texas
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16
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Janmaat KRL, de Guinea M, Collet J, Byrne RW, Robira B, van Loon E, Jang H, Biro D, Ramos-Fernández G, Ross C, Presotto A, Allritz M, Alavi S, Van Belle S. Using natural travel paths to infer and compare primate cognition in the wild. iScience 2021; 24:102343. [PMID: 33997670 PMCID: PMC8101046 DOI: 10.1016/j.isci.2021.102343] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Indexed: 11/25/2022] Open
Abstract
Within comparative psychology, the evolution of animal cognition is typically studied either by comparing indirect measures of cognitive abilities (e.g., relative brain size) across many species or by conducting batteries of decision-making experiments among (typically) a few captive species. Here, we propose a third, complementary approach: inferring and comparing cognitive abilities through observational field records of natural information gradients and the associated variation in decision-making outcomes, using the ranging behavior of wild animals. To demonstrate the feasibility of our proposal, we present the results of a global survey assessing the availability of long-term ranging data sets from wild primates and the willingness of primatologists to share such data. We explore three ways in which such ranging data, with or without the associated behavioral and ecological data often collected by primatologists, might be used to infer and compare spatial cognition. Finally, we suggest how ecological complexity may be best incorporated into comparative analyses. Comparing animal ranging decisions in natural habitats has untapped potential How decisions vary with natural information gradients reveals wild animal cognition Ranging data on at least 164 populations of 105 wild primate species are available We present three thought analyses to compare cognition and explain its evolution
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Affiliation(s)
- Karline R L Janmaat
- Evolutionary and Population Biology, Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands.,Department of Cognitive Psychology, Faculty of Social Sciences, Leiden University, Leiden, the Netherlands.,ARTIS Amsterdam Royal zoo, Amsterdam, the Netherlands
| | - Miguel de Guinea
- Department of Social Sciences, Oxford Brookes University, Oxford, UK
| | - Julien Collet
- Oxford Navigation Group, Department of Zoology, Oxford University, Oxford, UK
| | - Richard W Byrne
- Centre for Social Learning and Cognitive Evolution, School of Psychology and Neuroscience, University of St Andrews, St Andrew, UK.,Scottish Primate Research Group, Scotland, UK
| | - Benjamin Robira
- Centre d'Écologie Fonctionnelle et Évolutive, Université de Montpellier, Montpellier, France.,Eco-anthropologie, Muséum National d'Histoire Naturelle, CNRS, Université de Paris, Paris, France
| | - Emiel van Loon
- Theoretical and Computational Ecology, Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands
| | - Haneul Jang
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Dora Biro
- Oxford Navigation Group, Department of Zoology, Oxford University, Oxford, UK.,Department of Brain and Cognitive Sciences, University of Rochester, Rochester, USA
| | - Gabriel Ramos-Fernández
- Department of Mathematical Modelling of Social Systems, Institute for Research on Applied Mathematics and Systems, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Center for Complexity Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Cody Ross
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Andrea Presotto
- Department of Geography and Geosciences, Salisbury University, Salisbury, MA, USA
| | - Matthias Allritz
- School of Psychology and Neuroscience, University of St Andrews, Scotland, UK
| | - Shauhin Alavi
- Department for the Ecology of Animal Societies, Max Planck Institute of Animal Behaviour, Konstanz, Germany.,Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany.,Department of Biology, University of Konstanz, Konstanz, Germany
| | - Sarie Van Belle
- Department of Anthropology, University of Austin at Texas, Austin, TX, USA
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17
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Brahimaj BC, Kochanski RB, Pearce JJ, Guryildirim M, Gerard CS, Kocak M, Sani S, Byrne RW. Structural and Functional Imaging in Glioma Management. Neurosurgery 2021; 88:211-221. [PMID: 33313852 DOI: 10.1093/neuros/nyaa360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/19/2020] [Accepted: 04/26/2020] [Indexed: 01/08/2023] Open
Abstract
The goal of glioma surgery is maximal safe resection in order to provide optimal tumor control and survival benefit to the patient. There are multiple imaging modalities beyond traditional contrast-enhanced magnetic resonance imaging (MRI) that have been incorporated into the preoperative workup of patients presenting with gliomas. The aim of these imaging modalities is to identify cortical and subcortical areas of eloquence, and their relationship to the lesion. In this article, multiple modalities are described with an emphasis on the underlying technology, clinical utilization, advantages, and disadvantages of each. functional MRI and its role in identifying hemispheric dominance and areas of language and motor are discussed. The nuances of magnetoencephalography and transcranial magnetic stimulation in localization of eloquent cortex are examined, as well as the role of diffusion tensor imaging in defining normal white matter tracts in glioma surgery. Lastly, we highlight the role of stimulated Raman spectroscopy in intraoperative histopathological diagnosis of tissue to guide tumor resection. Tumors may shift the normal arrangement of functional anatomy in the brain; thus, utilization of multiple modalities may be helpful in operative planning and patient counseling for successful surgery.
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Affiliation(s)
- Bledi C Brahimaj
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan B Kochanski
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - John J Pearce
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Melike Guryildirim
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland
| | - Carter S Gerard
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Mehmet Kocak
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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18
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Nunna RS, Borghei A, Brahimaj BC, Lynn F, Garibay-Pulido D, Byrne RW, Rossi MA, Sani S. Responsive Neurostimulation of the Mesial Temporal White Matter in Bilateral Temporal Lobe Epilepsy. Neurosurgery 2021; 88:261-267. [PMID: 33026439 DOI: 10.1093/neuros/nyaa381] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/06/2019] [Accepted: 06/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Responsive neuromodulation (RNS) is a treatment option for patients with medically refractory bilateral mesial temporal lobe epilepsy (MTLE). A paucity of data exists on the feasibility and clinical outcome of hippocampal-sparing bilateral RNS depth lead placements within the parahippocampal white matter or temporal stem. OBJECTIVE To evaluate seizure reduction outcomes with at least a 1-yr follow-up in individuals with bilateral MTLE undergoing hippocampus-sparing implantation of RNS depth leads. METHODS A retrospective analysis of prospectively collected data was performed on patients at our institution with bilateral MTLE who were implanted with RNS depth leads along the longitudinal extent of bitemporal parahippocampal white matter or temporal stem. Baseline and postoperative seizure frequency, previous surgical interventions, and postimplantation electrocorticography and stimulation data were analyzed. RESULTS Ten patients were included in the study (7 male, 3 female). Overall seizure frequency declined by a median 44.25% at 3.13 yr (standard deviation 3.31) postimplantation. Four patients (40%) achieved 50% responder rate at latest follow-up. Two of four patients with focal onset bilateral tonic-clonic seizures became completely seizure-free. Forty percent of patients were previously implanted with a vagus nerve stimulator, and 20% underwent a prior temporal lobectomy. All depth lead placements were confirmed as radiographically located in the parahippocampal white matter or temporal stem without hippocampus violation. There were no cases of lead malposition. CONCLUSION Extrahippocampal or temporal stem white matter targeting during RNS surgery for bitemporal MTLE is feasible and allows for electrographic seizure detection. Larger controlled studies with longer follow-up are needed to validate these preliminary findings.
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Affiliation(s)
- Ravi S Nunna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Alireza Borghei
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Bledi C Brahimaj
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Fiona Lynn
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Diego Garibay-Pulido
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Marvin A Rossi
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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19
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Yaeger KA, Munich SA, Byrne RW, Germano IM. Trends in United States neurosurgery residency education and training over the last decade (2009-2019). Neurosurg Focus 2021; 48:E6. [PMID: 32114562 DOI: 10.3171/2019.12.focus19827] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [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: 10/30/2019] [Accepted: 12/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postgraduate training in medicine has been under scrutiny in the last 10 years, with a focus on improving residents' education. The aim of this study was to quantify trends in neurosurgery residency (NSR) training and education over the last 10 years. METHODS The authors assessed Accreditation Council for Graduate Medical Education (ACGME), National Resident Matching Program, and American Board of Neurological Surgeons records and searched PubMed to collate 2009-2019 data. Analyzed trends included residents' demographic data, programs' characteristics, graduation and attrition rates, match data, resident case logs, and qualitative educational curriculum changes. RESULTS Significant increases in residents' demographic data (p < 0.05) included the number of female residents (from 12.7% to 17.6%) and the absolute number of residents (from 1112 to 1462). Age (mean 28.8 years), ethnicity, and number of residents per program (mean 13 residents per program) were unchanged. There were 16 new ACGME NSR programs, with currently 115 programs nationwide. The number of applicants per year (324 applicants per year) and the matching rate (mean 64%) remained stable. The mean attrition rate of 2.6% (range 2%-4%) was higher than the mean 2.1% ACGME attrition rate, a rate that decreased from 3% in 2009 to 1.6% in 2019. Education curriculum changes aimed at the standardization of training across the US included residents' boot camp (2009), the Milestones project (2012), and mandatory 7-year training initiated in 2013. An increase in endovascular, functional, trauma, and spine resident caseload was noted. The number of yearly publications about US NSR education has significantly increased (p < 0.05). CONCLUSIONS NSR education has received greater attention over the last decade in the US. Standardization of training has been implemented. A steady number of students remain interested in neurosurgery, with an increased number of women entering the field. Attention to wellness, in addition to high-quality education, should be further assessed as a factor to improve the overall NSR training and retention rate.
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Affiliation(s)
- Kurt A Yaeger
- 1Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York; and
| | - Stephan A Munich
- 2Department of Neurological Surgery, Rush Medical College, Chicago, Illinois
| | - Richard W Byrne
- 2Department of Neurological Surgery, Rush Medical College, Chicago, Illinois
| | - Isabelle M Germano
- 1Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York; and
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20
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Nunna RS, Khalid SI, Patel S, Sethi A, Behbahani M, Mehta AI, Adogwa O, Byrne RW. Outcomes and Patterns of Care in Elderly Patients with Glioblastoma Multiforme. World Neurosurg 2021; 149:e1026-e1037. [PMID: 33482415 DOI: 10.1016/j.wneu.2021.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/07/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults, with an increased incidence among the elderly. However, the optimal treatment strategy in elderly patients remains unclear. This study seeks to investigate the effect of patient selection and treatment strategies on survival trends in these patients. METHODS Patients with diagnosis codes specific for GBM were queried from the National Cancer Database during 2004-2016. Univariate and multivariate Cox regression analysis was performed to investigate outcomes. Survival curves and 5-year survival were also generated based on patient-specific factors. RESULTS Among 104,456 patients with GBM identified, elderly patients were less likely to receive radiotherapy (61.3% vs. 77.8%; P < 0.001) or chemotherapy (47.2% vs. 62.9%; P < 0.001) or to undergo surgical resection (68.3% vs. 81.8; P < 0.001). Mean overall survival was 9.1 months (standard deviation, 10.0) and 5-year survival was 5.3%. Multivariate analysis showed age 75-84 years (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.12-1.73; P = 0.003) and lower Karnofsky Performance Status (50-70: HR, 1.68, 95% CI, 1.35-2.08, P < 0.001; ≤40: HR, 1.79, 95% CI 1.18-2.72, P = 0.006) were associated with decreased overall survival, whereas surgical resection (subtotal resection: HR, 0.52, 95% CI, 0.38-0.71, P < 0.001; gross total resection: HR, 0.29, 95% CI, 0.21-0.41, P < 0.001), radiotherapy (HR, 0.65; 95% CI, 0.47-0.91; P = 0.012), and chemotherapy (HR, 0.65; 95% CI, 0.48-0.88; P = 0.006) were associated with increased overall survival in elderly patients. CONCLUSIONS In an analysis of 104,456 patients with GBM, all treatment modalities were found to be used less frequently in elderly patients. Increasing age and poor performance status were associated with worsened survival. Gross total resection was associated with the greatest survival benefit, and chemotherapy and radiotherapy also improved survival outcomes. These treatment options improved outcomes regardless of performance status. Although maximal treatment strategies may improve survival in elderly patients with GBM, these treatment strategies must be balanced against patient-specific factors and quality-of-life concerns.
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Affiliation(s)
- Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Syed I Khalid
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abhishek Sethi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
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21
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Khalid SI, Nunna RS, Edmondson CP, Behbahani M, Byrne RW, Mehta AI. Laparoscopic-assisted versus Mini-open Laparotomy for Ventriculoperitoneal Shunt Placement in the Medicare Population. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Khanna R, Rumalla K, Corley J, Hoeppner T, Byrne RW. Epilepsy Characteristics and Risk of Seizures During Functional Mapping. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Rumalla K, Khanna R, Corley J, Hoeppner T, Byrne RW. Threshold for Seizures During Cortical Stimulation Mapping. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Whitmeyer M, Brahimaj BC, Beer-Furlan A, Alvi S, Epsten MJ, Crawford F, Byrne RW, Wiet RM. Resection of vestibular schwannomas after stereotactic radiosurgery: a systematic review. J Neurosurg 2020:1-9. [PMID: 34331121 DOI: 10.3171/2020.7.jns2044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/05/2020] [Accepted: 07/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple short series have evaluated the efficacy of salvage microsurgery (MS) after stereotactic radiosurgery (SRS) for treatment of vestibular schwannomas (VSs); however, there is a lack of a large volume of patient data available for interpretation and clinical adaptation. The goal of this study was to provide a comprehensive review of tumor characteristics, management, and surgical outcomes of salvage of MS after SRS for VS. METHODS The Medline/PubMed, Scopus, CINAHL, Cochrane Library, and Google Scholar databases were queried according to PRISMA guidelines. All English-language and translated publications were included. Studies lacking adequate study characteristics and outcomes were excluded. Cases involving neurofibromatosis type 2, previous MS, or malignant transformation were excluded when possible. RESULTS Twenty studies containing 297 cases met inclusion criteria. Three additional cases from Rush University Medical Center were added for 300 total cases. Tumor growth with or without symptoms was the primary indication for salvage surgery (92.3% of cases), followed by worsening of symptoms without growth (4.6%) and cystic enlargement (3.1%). The average time to MS after SRS was 39.4 months. The average size and volume of tumor at surgery were 2.44 cm and 5.92 cm3, respectively. The surgical approach was retrosigmoid (42.8%) and translabyrinthine (57.2%); 59.5% of patients had a House-Brackmann (HB) grade of I or II. The facial nerve was preserved in 91.5% of cases. Facial nerve preservation and HB grades were lower for the translabyrinthine versus retrosigmoid approach (p = 0.31 and p = 0.18, respectively); however, fewer complications were noted in the translabyrinthine approach (p = 0.29). Gross-total resection (GTR) was completed in 55.7% of surgeries. Studies that predominantly used subtotal resection (STR) were associated with a lower rate of facial nerve injury (5.3% vs 11.3%, p = 0.07) and higher rate of HB grade I or II (72.9% vs 48.0%, p = 0.00003) versus those using predominantly GTR. However, majority STR was associated with a recurrence rate of 3.6% as compared to 1.4% for majority GTR (p = 0.29). CONCLUSIONS This study showed that the leading cause of MS after SRS was tumor growth at an average of 39.4 months after radiation. There were no significant differences in outcomes of facial nerve preservation, postoperative HB grade, or complication rate based on surgical approach. Patients who underwent STR showed statistically significant better HB outcomes compared with GTR. MS after SRS was considered by most authors to be more difficult than primary MS. These data support the notion that the surgical goals of salvage surgery are debulking of tumor mass, decreasing compression of the brainstem, and not necessarily pursuing GTR.
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Affiliation(s)
- Max Whitmeyer
- 1Ohio State University College of Medicine, Columbus, Ohio
| | - Bledi C Brahimaj
- 2Department of Neurological Surgery, Rush University Medical Center, Chicago
| | - André Beer-Furlan
- 2Department of Neurological Surgery, Rush University Medical Center, Chicago
| | | | | | | | - Richard W Byrne
- 2Department of Neurological Surgery, Rush University Medical Center, Chicago
| | - R Mark Wiet
- 2Department of Neurological Surgery, Rush University Medical Center, Chicago.,5Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois
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25
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Wong AK, Eddelman DB, Kramer DE, Munich SA, Byrne RW. Surgical Resection of Clinoidal Meningiomas without Routine Use of Clinoidectomy. World Neurosurg 2020; 146:e467-e472. [PMID: 33130137 DOI: 10.1016/j.wneu.2020.10.112] [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: 08/31/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Meningiomas of the anterior clinoid process (ACP) present significant surgical challenges given their anatomic relation to critical neurovascular structures. Routine anterior clinoidectomy is often described as a critical step in the resection of these tumors to reduce recurrence and improve visual outcomes. Anterior clinoidectomy, however, is not without risk and its benefits have not been clearly delineated. We present the outcomes of our series of surgically managed ACP meningiomas in which an anterior clinoidectomy was not routinely employed. METHODS A retrospective review of all ACP meningiomas operated on between August 1997 and March 2019 was conducted. Patients with a recurrent tumor or with <6 months of follow-up were excluded. Resection was typically carried out via a frontotemporal craniotomy followed by intradural removal of the tumor. Anterior clinoidectomy was only performed if hyperostosis of the ACP caused mass effect on the optic nerve. RESULTS Twenty-nine patients were included in this study. Anterior clinoidectomy was performed in 3 patients (10.3%). Gross total resection was achieved in 22 patients (75.9%). Of the 21 patients (72.4%) who presented with visual deficits, vision improved in 18 patients (85.7%) and worsened in 2 (9.5%). Tumor recurrence occurred in 5 patients (17.2%) at a mean follow-up of 64.9 months. Perioperative morbidity was 10.3%. Permanent morbidity and mortality were 6.9% (vision deterioration) and 0%, respectively. CONCLUSIONS Resection of ACP meningiomas without routine anterior clinoidectomy minimizes potential risk while achieving gross total resection, recurrence, and visual improvement rates comparable with those in previously reported series.
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Affiliation(s)
- Andrew K Wong
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | | | - Dallas E Kramer
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | - Stephan A Munich
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA.
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Wang MC, Boop FA, Kondziolka D, Resnick DK, Kalkanis SN, Koehnen E, Selden NR, Heilman CB, Valadka AB, Cockroft KM, Wilson JA, Ellenbogen RG, Asher AL, Byrne RW, Camarata PJ, Huang J, Knightly JJ, Levy EI, Lonser RR, Connolly ES, Meyer FB, Liau LM. Continuous improvement in patient safety and quality in neurological surgery: the American Board of Neurological Surgery in the past, present, and future. J Neurosurg 2020:1-7. [PMID: 33065539 DOI: 10.3171/2020.6.jns202066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
The American Board of Neurological Surgery (ABNS) was incorporated in 1940 in recognition of the need for detailed training in and special qualifications for the practice of neurological surgery and for self-regulation of quality and safety in the field. The ABNS believes it is the duty of neurosurgeons to place a patient's welfare and rights above all other considerations and to provide care with compassion, respect for human dignity, honesty, and integrity. At its inception, the ABNS was the 13th member board of the American Board of Medical Specialties (ABMS), which itself was founded in 1933. Today, the ABNS is one of the 24 member boards of the ABMS.To better serve public health and safety in a rapidly changing healthcare environment, the ABNS continues to evolve in order to elevate standards for the practice of neurological surgery. In connection with its activities, including initial certification, recognition of focused practice, and continuous certification, the ABNS actively seeks and incorporates input from the public and the physicians it serves. The ABNS board certification processes are designed to evaluate both real-life subspecialty neurosurgical practice and overall neurosurgical knowledge, since most neurosurgeons provide call coverage for hospitals and thus must be competent to care for the full spectrum of neurosurgery.The purpose of this report is to describe the history, current state, and anticipated future direction of ABNS certification in the US.
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Affiliation(s)
- Marjorie C Wang
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Frederick A Boop
- 2Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- 3Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Daniel K Resnick
- 4Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Steven N Kalkanis
- 5Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | | | - Nathan R Selden
- 7Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Carl B Heilman
- 8Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Alex B Valadka
- 9Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Kevin M Cockroft
- 10Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - John A Wilson
- 11Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Richard G Ellenbogen
- 12Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Anthony L Asher
- 13Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Richard W Byrne
- 14Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Paul J Camarata
- 15Department of Neurosurgery, University of Kansas, Kansas City, Kansas
| | - Judy Huang
- 16Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Elad I Levy
- 18Department of Neurosurgery, University at Buffalo, New York
| | - Russell R Lonser
- 19Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - E Sander Connolly
- 20Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Fredric B Meyer
- 21Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | - Linda M Liau
- 22Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Smet AF, Byrne RW. African elephants interpret a trunk gesture as a clue to direction of interest. Curr Biol 2020; 30:R926-R927. [PMID: 32810448 DOI: 10.1016/j.cub.2020.06.070] [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] [Indexed: 11/20/2022]
Abstract
Orienting to gaze-direction is widespread among animal species, but evidence for spontaneous use of gesture for direction is limited [1]. Remarkably, African elephants (Loxodonta africana) have been found able to follow human pointing, including subtle actions in which the contralateral hand is used, and in which the body silhouette is not broken [2,3]. The natural origin of this ability is puzzling, as the species is not reported to use trunk- or limb-gesture for showing directions [4]. One natural gesture, the 'periscope-sniff' presumed to be used to enhance olfactory sampling by an elephant in circumstances of alarm or curiosity [5], might also betray the elephant's direction of focal attention. Here we investigate what information elephants gain from seeing periscope-sniff. When one elephant in a group gave a periscope-sniff, we recorded the location and orientation of the next periscope-sniff given. Elephants that could not see the first gesturer only gestured themselves if immediately adjacent to the first or closer to the presumed stimulus of interest. In contrast, elephants able to see the first signaller's periscope-sniff were often a considerable distance behind it, further from the stimulus. Focusing on these cases, where making the periscope-sniff was apparently caused by seeing the first gesture, we found its orientation significantly matched the first, suggesting that direction information was gained from seeing the periscope-sniff. Elephants' ability to use a conspecific's periscope-sniff as if it were an ostensive pointing gesture enables them to react to the presence and location of potential dangers.
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Affiliation(s)
- Anna F Smet
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife KY16 9JP, UK
| | - Richard W Byrne
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife KY16 9JP, UK.
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Case TI, Stevenson RJ, Byrne RW, Hobaiter C. The animal origins of disgust: Reports of basic disgust in nonhuman great apes. Evolutionary Behavioral Sciences 2020. [DOI: 10.1037/ebs0000175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Raseman J, Guryildirim M, Beer-Furlan A, Jhaveri M, Tajudeen BA, Byrne RW, Batra PS. Preoperative Computed Tomography Imaging of the Sphenoid Sinus: Striving Towards Safe Transsphenoidal Surgery. J Neurol Surg B Skull Base 2020; 81:251-262. [PMID: 32499999 DOI: 10.1055/s-0039-1691831] [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: 10/24/2018] [Accepted: 04/04/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction Preoperative high-resolution computed tomography (HRCT) is essential in patients undergoing transsphenoidal surgery to identify potential high-risk anatomic variations. There is no consensus in the literature, as to which grading system to use to describe these variants, leading to inconsistent terminology between studies. In addition, substantial variability exists in the reported incidence of anatomic variants. In this study, we performed an institutional imaging analysis and literature review with the objective of consolidating and clearly defining these sphenoid sinus anatomical variations. In addition, we highlighted their surgical implications and propose a checklist for a systematic assessment of the sphenoid sinus on preoperative CT. Methods Review of the literature and retrospective analysis assessing several imaging parameters in 81 patients who underwent preoperative HRCT imaging for endoscopic transsphenoidal tumor resection from January 2008 through July 2015 at Rush University Medical Center. Results The most common sphenoid pneumatization patterns were sellar (45%) and postsellar (49%) types. Anterior clinoid process (ACP) pneumatization was seen in 17% of patients with high concordance of ipsilateral optic nerve (ON) protrusion. ON protrusion and dehiscence was present in 17 and 6% of patients, respectively. Internal carotid artery (ICA) protrusion and dehiscence was present in 30 and 5% of patients, respectively. Dehiscence rates from local bone invasion overlying the ICA and ON occurred in 17 and 4% of cases, respectively. Conclusions Our study highlights and reviews the key variants that have potential to impact surgical complications and outcomes in a heterogeneous patient population. The proposed preoperative CT checklist for patients, undergoing transsphenoidal surgery, consistently identifies these higher risk anatomical variants.
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Affiliation(s)
- John Raseman
- Department of Diagnostic Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
| | - Melike Guryildirim
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - André Beer-Furlan
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Miral Jhaveri
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard W Byrne
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
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Byrne N, Kochanski RB, Tajudeen B, Byrne RW. Symptomatic Primary Tethered Optic Chiasm: Technical Case Report. Oper Neurosurg (Hagerstown) 2020; 19:E440-E445. [DOI: 10.1093/ons/opaa093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/14/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Symptomatic tethering of the optic nerves and chiasm is a rare occurrence and has been reported following both surgical and medical treatment of pituitary adenoma. Here we present a case of primary optic chiasm tethering in a patient with empty sella syndrome.
CLINICAL PRESENTATION
The patient was a 61-yr-old female who presented with progressively worsening bitemporal hemianopsia. Magnetic resonance imaging (MRI) brain revealed an empty sella with herniation of the optic chiasm into the sella. The patient underwent an endoscopic, endonasal/trans-sphenoidal approach to the sella, where the optic chiasm was then detethered via lysis of arachnoid adhesions and ultimately buttressed with an abdominal fat graft. Postoperatively, the patient did well with subjective and objective improvements in her visual fields.
CONCLUSION
We report a rare case of primary tethered optic chiasm, which was successfully treated via an endoscopic, endonasal approach with abdominal fat graft harvest.
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Affiliation(s)
- Nika Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan B Kochanski
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Bobby Tajudeen
- Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Brahimaj BC, Beer-Furlan A, Crawford F, Nunna R, Urban M, Wu G, Abello E, Chauhan V, Kocak M, Muñoz L, Wiet RM, Byrne RW. Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma. J Neurol Surg B Skull Base 2019; 82:e3-e8. [PMID: 34306911 DOI: 10.1055/s-0039-3400296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/31/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
Abstract
Introduction Dural venous sinus thrombosis (DVST) is a relatively understudied complication of vestibular schwannoma (VS) surgery. Several studies have examined this topic; however, there is limited data on the incidence, clinical progression, and proper management of this patient population. Methods A retrospective review was performed for patients undergoing surgery for VS at a single institution. All postoperative imaging was reviewed for incidence of DVST. Demographic data were collected including tumor and surgical characteristics along with postoperative course. Results A total of 63 patients underwent resection of their VS. The incidence of DVST was 34.9%. The operative time was greater in the dural venous sinus thrombosis (DSVT) group, at an average of 6.69 hours versus 4.87 in the no DSVT cohort ( p = 0.04). Tumor size was correlationally significant ( p = 0.051) at 2.75 versus 2.12 cm greatest diameter. The translabyrinthine approach was most prevalent (68.2%). The side of the thrombosis was ipsilateral to the tumor and surgery in all patients. The sigmoid sinus was most commonly involved (95.5%). Of them, 85% patients had a codominant or thrombus contralateral to the dominant sinus. All patients were asymptomatic. No patients were treated with anticoagulation. Resolution of thrombus was seen in five (22.7%) of the patients on last follow-up imaging. There were no hemorrhagic complications. Conclusion The overall incidence of DVST was (34.9%) of 63 patients who underwent VS surgery. All patients were asymptomatic and none were treated with anticoagulation. In our study, continuing to observe asymptomatic patients did not lead to any adverse events.
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Affiliation(s)
- Bledi C Brahimaj
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Andre Beer-Furlan
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Fred Crawford
- Rush University College of Medicine, Chicago, Illinois, United States
| | - Ravi Nunna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Matthew Urban
- Rush University College of Medicine, Chicago, Illinois, United States
| | - Gary Wu
- Rush University College of Medicine, Chicago, Illinois, United States
| | - Eric Abello
- Rush University College of Medicine, Chicago, Illinois, United States
| | - Vikrant Chauhan
- Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois, United States
| | - Mehmet Kocak
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - Lorenzo Muñoz
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard M Wiet
- Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
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Brahimaj BC, Beer-Furlan A, Crawfrod FC, Nunna RS, Urban M, Wu G, Abello E, Chauhan V, Kocak M, Wiet RM, Byrne RW. Dural Venous Sinus Thrombosis After Vestibular Schwannoma Surgery: The Anticoagulation Dilemma. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_156] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pines AR, Alghoul MS, Hamade YJ, Sattur MG, Aoun RJN, Halasa TK, Krishna C, Zammar SG, El Tecle NE, El Ahmadieh TY, Aoun SG, Byrne RW, Harrop JS, Ragel BT, Resnick DK, Lonser RR, Selden NR, Bendok BR. Assessment of the Interrater Reliability of the Congress of Neurological Surgeons Microanastomosis Assessment Scale. Oper Neurosurg (Hagerstown) 2019; 13:108-112. [PMID: 28931262 DOI: 10.1227/neu.0000000000001403] [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: 11/24/2015] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The potential for simulation-based learning in neurosurgical training has led the Congress of Neurosurgical Surgeons to develop a series of simulation modules. The Northwestern Objective Microanastomosis Assessment Tool (NOMAT) was created as the corresponding assessment tool for the Congress of Neurosurgical Surgeons Microanastomosis Module. The face and construct validity of the NOMAT have been previously established. OBJECTIVE To further validate the NOMAT by determining its interrater reliability (IRR) between raters of varying levels of microsurgical expertise. METHODS The NOMAT was used to assess residents' performance in a microanastomosis simulation module in 2 settings: Northwestern University and the Society of Neurological Surgeons 2014 Boot Camp at the University of Indiana. At Northwestern University, participants were scored by 2 experienced microsurgeons. At the University of Indiana, participants were scored by 2 postdoctoral fellows and an experienced microsurgeon. The IRR of NOMAT was estimated by computing the intraclass correlation coefficient using SPSS v22.0 (IBM, Armonk, New York). RESULTS A total of 75 residents were assessed. At Northwestern University, 21 residents each performed microanastomosis on 2 model vessels of different sizes, one 3 mm and one 1 mm. At the University of Indiana, 54 residents performed a single microanastomosis procedure on 3-mm vessels. The intraclass correlation coefficient of the total NOMAT scores was 0.88 at Northwestern University and 0.78 at the University of Indiana. CONCLUSION This study indicates high IRR for the NOMAT. These results suggest that the use of raters with varying levels of expertise does not compromise the precision or validity of the scale. This allows for a wider adoption of the scale and, hence, a greater potential educational impact.
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Affiliation(s)
- Andrew R Pines
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Mohammed S Alghoul
- Departm-ent of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Youssef J Hamade
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Mithun G Sattur
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | | | - Tariq K Halasa
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | | | - Najib E El Tecle
- Department of Neurological Surgery, St. Louis University Hospital, St. Louis, Missouri
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | - Richard W Byrne
- Departm-ent of Neurological Surgery, Rush Univ-ersity Medical Center, Chicago, Illinois
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Brian T Ragel
- Departm-ent of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Daniel K Resnick
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Russell R Lonser
- Department of Neurological Surgery, Ohio State University, Columbus, Ohio
| | - Nathan R Selden
- Departm-ent of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
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Bayne T, Brainard D, Byrne RW, Chittka L, Clayton N, Heyes C, Mather J, Ölveczky B, Shadlen M, Suddendorf T, Webb B. What is cognition? Curr Biol 2019; 29:R608-R615. [DOI: 10.1016/j.cub.2019.05.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Surgery for lower grade glioma requires the use of brain mapping techniques to identify functional boundaries, which represent the limit of the resection. Two stimulation paradigms are currently available and their use should be tailored to the clinical context to extend tumor removal and decrease the odds of postoperative permanent deficits.
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Affiliation(s)
- Marco Rossi
- Unit of Neurosurgical Oncology, Department of Hematology and Hemato-Oncology Università degli Studi di Milano, Via Manzoni 56, 20089 Rozzano (MI), Italy; Neurosurgical Oncology, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, 600 S Paulina Street, Chicago, IL 60612, USA
| | - Marco Conti Nibali
- Unit of Neurosurgical Oncology, Department of Hematology and Hemato-Oncology Università degli Studi di Milano, Via Manzoni 56, 20089 Rozzano (MI), Italy; Neurosurgical Oncology, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy
| | - Luca Fornia
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milano 20089, Italy
| | - Lorenzo Bello
- Unit of Neurosurgical Oncology, Department of Hematology and Hemato-Oncology Università degli Studi di Milano, Via Manzoni 56, 20089 Rozzano (MI), Italy; Neurosurgical Oncology, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy.
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, 600 S Paulina Street, Chicago, IL 60612, USA
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Cheng K, Byrne RW. Why human environments enhance animal capacities to use objects: Evidence from keas (Nestor notabilis) and apes (Gorilla gorilla, Pan paniscus, Pongo abelii, Pongo pygmaeus). J Comp Psychol 2018; 132:419-426. [DOI: 10.1037/com0000121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Richard W. Byrne
- 1Rush University Medical Center, Department of Neurosurgery, Chicago, Illinois
| | - Nader Sanai
- 2Barrow Neurological Institute, Neurological Surgery, Phoenix, Arizona
| | - Jose A. Landeiro
- 3Centro de Ciências da Saúde, Faculdade de Medicina, Chefe do Serviço de Neurocirurgia do HUAP/UFF, Niteroi, Rio de Janeiro, Brazil; and
| | - Hugues Duffau
- 4Gui de Chauliac, CHU de Montpellier, Neurosurgery, Montpellier, France
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Szabo B, Noble DW, Byrne RW, Tait DS, Whiting MJ. Subproblem learning and reversal of a multidimensional visual cue in a lizard: evidence for behavioural flexibility? Anim Behav 2018. [DOI: 10.1016/j.anbehav.2018.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Farmer K, Krüger K, Byrne RW, Marr I. Sensory laterality in affiliative interactions in domestic horses and ponies (Equus caballus). Anim Cogn 2018; 21:631-637. [PMID: 29948296 PMCID: PMC6097077 DOI: 10.1007/s10071-018-1196-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 11/17/2017] [Revised: 05/14/2018] [Accepted: 06/02/2018] [Indexed: 11/29/2022]
Abstract
Many studies have been carried out into both motor and sensory laterality of horses in agonistic and stressful situations. Here we examine sensory laterality in affiliative interactions within four groups of domestic horses and ponies (N = 31), living in stable social groups, housed at a single complex close to Vienna, Austria, and demonstrate for the first time a significant population preference for the left side in affiliative approaches and interactions. No effects were observed for gender, rank, sociability, phenotype, group, or age. Our results suggest that right hemisphere specialization in horses is not limited to the processing of stressful or agonistic situations, but rather appears to be the norm for processing in all social interactions, as has been demonstrated in other species including chicks and a range of vertebrates. In domestic horses, hemispheric specialization for sensory input appears not to be based on a designation of positive versus negative, but more on the perceived need to respond quickly and appropriately in any given situation.
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Affiliation(s)
- Kate Farmer
- School of Psychology and Neuroscience, University of St. Andrews, St. Mary's Quad, South Street, St. Andrews, Fife, Scotland, KY16 9JP, UK.
| | - Konstanze Krüger
- University of Regensburg, Zoology/Evolutionary Biology, Universitaetsstraße 31, 93053, Regensburg, Germany.,Department Equine Economics, Faculty Agriculture, Economics and Management, Nuertingen-Geislingen University, Neckarsteige 6-10, 72622, Nürtingen, Germany
| | - Richard W Byrne
- School of Psychology and Neuroscience, University of St. Andrews, St. Mary's Quad, South Street, St. Andrews, Fife, Scotland, KY16 9JP, UK
| | - Isabell Marr
- Department Equine Economics, Faculty Agriculture, Economics and Management, Nuertingen-Geislingen University, Neckarsteige 6-10, 72622, Nürtingen, Germany
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Riley JL, Guidou C, Fryns C, Mourier J, Leu ST, Noble DWA, Byrne RW, Whiting MJ. Isolation rearing does not constrain social plasticity in a family-living lizard. Behav Ecol 2018. [DOI: 10.1093/beheco/ary007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Julia L Riley
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia
- School of Biological, Earth, and Environmental Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Côme Guidou
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Caroline Fryns
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Johann Mourier
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia
- Labex CORAIL, PSL Université Paris, EPHE-UPVD-CNRS, USR 3278 CRIOBE, Perpignan, France
| | - Stephan T Leu
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia
- School of Biological Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Daniel W A Noble
- School of Biological, Earth, and Environmental Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Richard W Byrne
- School of Psychology and Neuroscience, University of St. Andrews, St. Andrews, Fife, United Kingdom
| | - Martin J Whiting
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, Australia
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Abstract
STUDY DESIGN Case report and review of literature. OBJECTIVE To present an exceedingly rare occurrence of obstructive hydrocephalus secondary to intraventricular hemorrhage after incidental durotomy during lumbar spine surgery. SUMMARY OF BACKGROUND DATA Incidental durotomies are uncommon but well recognized complications associated with spine surgery. Whereas mostly considered benign with no untoward clinical sequele, it can be symptomatic and present with spinal headaches, pseudomeningoceles, wound infection, meningitis and rarely intracerebral hemorrhage. METHODS A 76-year-old woman underwent L3-S1 laminectomies and fusion for lumbar spondylosis and stenosis. Intraoperatively, a small incidental durotomy was encountered and primarily repaired. RESULTS The patient developed altered mental status on postoperative day 2. Computed tomography of the brain revealed obstructive hydrocephalus and intraventricular hemorrhage. The patient was immediately transferred to the neurosurgery intensive care unit and an external ventricular drain was placed emergently with high opening pressure. Her mental status improved immediately after cerebral spinal fluid diversion. The external ventricular drain was successfully removed after 8 days. The patient made a full recovery and was discharged in stable condition. CONCLUSION Obstructive hydrocephalus after intraventricular hemorrhage is an exceptionally rare but potentially life-threatening complication of incidental durotomies. Spine surgeons should be aware of this rare but serious complication. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | | | - Howard S An
- Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Graham KE, Hobaiter C, Ounsley J, Furuichi T, Byrne RW. Bonobo and chimpanzee gestures overlap extensively in meaning. PLoS Biol 2018; 16:e2004825. [PMID: 29485994 PMCID: PMC5828348 DOI: 10.1371/journal.pbio.2004825] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
Abstract
Cross-species comparison of great ape gesturing has so far been limited to the physical form of gestures in the repertoire, without questioning whether gestures share the same meanings. Researchers have recently catalogued the meanings of chimpanzee gestures, but little is known about the gesture meanings of our other closest living relative, the bonobo. The bonobo gestural repertoire overlaps by approximately 90% with that of the chimpanzee, but such overlap might not extend to meanings. Here, we first determine the meanings of bonobo gestures by analysing the outcomes of gesturing that apparently satisfy the signaller. Around half of bonobo gestures have a single meaning, while half are more ambiguous. Moreover, all but 1 gesture type have distinct meanings, achieving a different distribution of intended meanings to the average distribution for all gesture types. We then employ a randomisation procedure in a novel way to test the likelihood that the observed between-species overlap in the assignment of meanings to gestures would arise by chance under a set of different constraints. We compare a matrix of the meanings of bonobo gestures with a matrix for those of chimpanzees against 10,000 randomised iterations of matrices constrained to the original data at 4 different levels. We find that the similarity between the 2 species is much greater than would be expected by chance. Bonobos and chimpanzees share not only the physical form of the gestures but also many gesture meanings.
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Affiliation(s)
- Kirsty E. Graham
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, United Kingdom
- Department of Psychology, University of York, York, United Kingdom
- * E-mail: (KEG); (RWB)
| | - Catherine Hobaiter
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, United Kingdom
| | - James Ounsley
- School of Biology, University of St Andrews, St Andrews, United Kingdom
| | | | - Richard W. Byrne
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, United Kingdom
- * E-mail: (KEG); (RWB)
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Lukas RV, Wu J, Dey M, Buerki RA, Byrne RW, Dohrmann GJ. A Survey of the Neuro-Oncology Landscape. J Clin Neurol 2018; 14:8-15. [PMID: 29141278 PMCID: PMC5765260 DOI: 10.3988/jcn.2018.14.1.8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 11/17/2022] Open
Abstract
The field of neuro-oncology is evolving rapidly. Many important advances have recently been reported, and other promising investigations have the potential to soon make substantial impacts in the field, especially in the areas of high-grade gliomas and brain metastases. We present an overview of the current status of this field, highlighting the key recent advances as well as representative work of key clinical investigations, since these concepts have the potential to influence clinical management if they are demonstrated to be safe and efficacious. This overview includes some work that has only appeared in abstract form in order to provide a timely understanding of how the field is actively changing and what may lie on the horizon. We focus on both medical and surgical neuro-oncology advances in this highly multidisciplinary subspecialty.
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Affiliation(s)
- Rimas V Lukas
- Department of Neurology, Northwestern University, Chicago, IL, USA.
| | - Jing Wu
- Neuro-Oncology Branch, National Institutes of Health, Bethesda, MD, USA
| | - Mahua Dey
- Department of Neurosurgery, Indiana University, Indianapolis, IN, USA
| | - Robin A Buerki
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University, Chicago, IL, USA
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47
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Fedorova N, Evans CL, Byrne RW. Living in stable social groups is associated with reduced brain size in woodpeckers ( Picidae). Biol Lett 2017; 13:rsbl.2017.0008. [PMID: 28275166 DOI: 10.1098/rsbl.2017.0008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 01/05/2017] [Accepted: 02/15/2017] [Indexed: 11/12/2022] Open
Abstract
Group size predicts brain size in primates and some other mammal groups, but no such relationship has been found in birds. Instead, stable pair-bonding and bi-parental care have been identified as correlates of larger brains in birds. We investigated the relationship between brain size and social system within the family Picidae, using phylogenetically controlled regression analysis. We found no specific effect of duration or strength of pair-bonds, but brain sizes were systematically smaller in species living in long-lasting social groups of larger sizes. Group-living may only present a cognitive challenge in groups in which members have individually competitive relationships; we therefore propose that groups functioning for cooperative benefit may allow disinvestment in expensive brain tissue.
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Affiliation(s)
- Natalia Fedorova
- School of Psychology, University of St Andrews, St Andrews, Fife KY16 9JP, UK
| | - Cara L Evans
- School of Biology, University of St Andrews, St Andrews, Fife KY16 9ST, UK
| | - Richard W Byrne
- School of Psychology, University of St Andrews, St Andrews, Fife KY16 9JP, UK
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48
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Byrne RW, Cartmill E, Genty E, Graham KE, Hobaiter C, Tanner J. Great ape gestures: intentional communication with a rich set of innate signals. Anim Cogn 2017; 20:755-769. [PMID: 28502063 PMCID: PMC5486474 DOI: 10.1007/s10071-017-1096-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/13/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
Abstract
Great apes give gestures deliberately and voluntarily, in order to influence particular target audiences, whose direction of attention they take into account when choosing which type of gesture to use. These facts make the study of ape gesture directly relevant to understanding the evolutionary precursors of human language; here we present an assessment of ape gesture from that perspective, focusing on the work of the "St Andrews Group" of researchers. Intended meanings of ape gestures are relatively few and simple. As with human words, ape gestures often have several distinct meanings, which are effectively disambiguated by behavioural context. Compared to the signalling of most other animals, great ape gestural repertoires are large. Because of this, and the relatively small number of intended meanings they achieve, ape gestures are redundant, with extensive overlaps in meaning. The great majority of gestures are innate, in the sense that the species' biological inheritance includes the potential to develop each gestural form and use it for a specific range of purposes. Moreover, the phylogenetic origin of many gestures is relatively old, since gestures are extensively shared between different genera in the great ape family. Acquisition of an adult repertoire is a process of first exploring the innate species potential for many gestures and then gradual restriction to a final (active) repertoire that is much smaller. No evidence of syntactic structure has yet been detected.
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Affiliation(s)
- R W Byrne
- Centre for Social Learning and Cognitive Evolution, School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife, KY16 9JP, UK.
| | - E Cartmill
- Centre for Social Learning and Cognitive Evolution, School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife, KY16 9JP, UK
- Department of Anthropology, University of California, Los Angeles, 375 Portola Plaza, 341 Haines Hall, Box 951553, Los Angeles, CA, 90095, USA
| | - E Genty
- Centre for Social Learning and Cognitive Evolution, School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife, KY16 9JP, UK
- Laboratoire de cognition comparée, Institut de Biologie, Université de Neuchâtel, Rue Emile-Argand 11, 2000, Neuchâtel, Switzerland
| | - K E Graham
- Centre for Social Learning and Cognitive Evolution, School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife, KY16 9JP, UK
| | - C Hobaiter
- Centre for Social Learning and Cognitive Evolution, School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife, KY16 9JP, UK
| | - J Tanner
- Centre for Social Learning and Cognitive Evolution, School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife, KY16 9JP, UK
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Kerolus MG, Sen N, Mayekar S, Templeton A, Turian J, Diaz A, Munoz L, Byrne RW, Sani S. Truebeam Radiosurgery for the Treatment of Trigeminal Neuralgia: Preliminary Results at a Single Institution. Cureus 2017; 9:e1362. [PMID: 28721330 PMCID: PMC5511044 DOI: 10.7759/cureus.1362] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Radiosurgery is now an established method of satisfactory pain control in patients with trigeminal neuralgia (TN). The Varian Truebeam STx (Varian Medical Systems, Palo Alto, CA) linear accelerator (LINAC) system is an arc-based, frameless stereotactic radiosurgery system used for the treatment of TN. To our knowledge, there has been only one published series of patient histories that documents the use of a frameless LINAC system for the treatment of TN. We describe the treatment parameters, patient outcomes, and complications associated with the treatment of TN. Methods All patients treated with the Truebeam system for TN between 2012 and 2015, with at least a six-month follow-up, were identified. A dose of 90 Gy was delivered to the isocenter using a 0.5 cm diameter cone. The cisternal segment of the trigeminal nerve was placed at the location of the LINAC isocenter using an ExacTrac™ (Brainlab, Munich, Germany) image guidance system. The radiosurgical dose, Barrow Neurologic Institute pain score (BNI PS), symptom recurrence, magnetic resonance imaging (MRI) radiographic changes, and other complications, including Barrow Neurologic Institute facial numbness score (BNI FN), were analyzed. Results A total of 18 patients—15 women and 3 men—with a mean age of 58 years (median: 59 years; range: 22-84 years) were treated at our institution. Fourteen patients (78%) had a BNI PS of IIIb or better, which was considered successful treatment. Twelve patients had excellent (BNI PS I) pain relief and two patients had good (BNI PS II-IIIB; recurrence after one year) pain relief. The pain of four patients recurred after a mean of 10 months. Conclusion Truebeam radiosurgery can provide effective and safe treatment for patients suffering from TN. The efficacy appears similar to other frame- and frameless-based systems
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Affiliation(s)
| | - Neilayan Sen
- Radiation Oncology, Rush University Medical Center
| | | | | | | | - Aidnag Diaz
- Radiation Oncology, Rush University Medical Center
| | | | | | - Sepehr Sani
- Neurosurgery, Rush University Medical Center
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50
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Hobaiter C, Byrne RW, Zuberbühler K. Wild chimpanzees' use of single and combined vocal and gestural signals. Behav Ecol Sociobiol 2017; 71:96. [PMID: 28596637 PMCID: PMC5446553 DOI: 10.1007/s00265-017-2325-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 11/30/2022]
Abstract
ABSTRACT We describe the individual and combined use of vocalizations and gestures in wild chimpanzees. The rate of gesturing peaked in infancy and, with the exception of the alpha male, decreased again in older age groups, while vocal signals showed the opposite pattern. Although gesture-vocal combinations were relatively rare, they were consistently found in all age groups, especially during affiliative and agonistic interactions. Within behavioural contexts rank (excluding alpha-rank) had no effect on the rate of male chimpanzees' use of vocal or gestural signals and only a small effect on their use of combination signals. The alpha male was an outlier, however, both as a prolific user of gestures and recipient of high levels of vocal and gesture-vocal signals. Persistence in signal use varied with signal type: chimpanzees persisted in use of gestures and gesture-vocal combinations after failure, but where their vocal signals failed they tended to add gestural signals to produce gesture-vocal combinations. Overall, chimpanzees employed signals with a sensitivity to the public/private nature of information, by adjusting their use of signal types according to social context and by taking into account potential out-of-sight audiences. We discuss these findings in relation to the various socio-ecological challenges that chimpanzees are exposed to in their natural forest habitats and the current discussion of multimodal communication in great apes. SIGNIFICANCE STATEMENT All animal communication combines different types of signals, including vocalizations, facial expressions, and gestures. However, the study of primate communication has typically focused on the use of signal types in isolation. As a result, we know little on how primates use the full repertoire of signals available to them. Here we present a systematic study on the individual and combined use of gestures and vocalizations in wild chimpanzees. We find that gesturing peaks in infancy and decreases in older age, while vocal signals show the opposite distribution, and patterns of persistence after failure suggest that gestural and vocal signals may encode different types of information. Overall, chimpanzees employed signals with a sensitivity to the public/private nature of information, by adjusting their use of signal types according to social context and by taking into account potential out-of-sight audiences.
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Affiliation(s)
- C Hobaiter
- School of Psychology and Neuroscience, University of St Andrews, St Marys College, South Street, St Andrews, KY16 9JP Scotland
- Budongo Conservation Field Station, Masindi, Uganda
| | - R W Byrne
- School of Psychology and Neuroscience, University of St Andrews, St Marys College, South Street, St Andrews, KY16 9JP Scotland
| | - K Zuberbühler
- School of Psychology and Neuroscience, University of St Andrews, St Marys College, South Street, St Andrews, KY16 9JP Scotland
- Budongo Conservation Field Station, Masindi, Uganda
- Department of Comparative Cognition, University of Neuchatel, Neuchâtel, Switzerland
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