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Daniel M, Stone LE, Plonsker JH, Sattar S, Ravindra V, Gonda D. De novo cerebral pseudoaneurysm formation: a rare delayed complication of stereotactic electroencephalography in children. Childs Nerv Syst 2024; 40:1501-1506. [PMID: 38240787 DOI: 10.1007/s00381-024-06278-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/03/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To describe the rare complication of cerebral pseudoaneurysm formation following stereotactic electroencephalography (sEEG) lead implantation in children. METHODS A retrospective chart review of all pediatric patients undergoing sEEG procedures between 2015 and 2020 was performed. Cases of pseudoaneurysm were identified and reviewed. RESULTS Cerebral pseudoaneurysms were identified in two of 58 total cases and 610 implanted electrodes. One lesion was detected 1 year after sEEG explantation and required craniotomy and clipping. The other was detected 3 months post-explantation and underwent coil embolization. Neither patient had any neurologic deficits associated with the pseudoaneurysm before or after treatment. CONCLUSIONS Pseudoaneurysm formation post-sEEG explantation is rare and likely underreported. Routine, post-explantation/treatment imaging is warranted to detect this rare but potentially lethal complication.
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Affiliation(s)
- Manjari Daniel
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Lauren E Stone
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Jillian H Plonsker
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Shifteh Sattar
- Division of Child Neurology, Rady Children's Hospital, San Diego, CA, USA
| | - Vijay Ravindra
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
- Division of Pediatric Neurosurgery, Rady Children's Hospital, 7910 Frost Street, Suite 120, San Diego, CA, 92123, USA
| | - David Gonda
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA.
- Division of Pediatric Neurosurgery, Rady Children's Hospital, 7910 Frost Street, Suite 120, San Diego, CA, 92123, USA.
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Plonsker JH, Stone L, Wali AR, Daniel M, Ravindra V, Gonda DD, Khan U, Sattar S. 341 Post-Operative Outcomes and Rare Complications in Pediatric Stereotactic Electroencephalography: A Retrospective Review from a High Volume Pediatric Epilepsy Center. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_341] [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: 03/18/2023] Open
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Venkataraman SS, Herbert J, Ravindra V, Bollo RJ, Cox CS, Gannon S, Limbrick DD, Naftel RP, Ugalde I, Weiner H, Yorkgitis B, Shah MN. 805 External Validation of the McGovern Score for Predicting Pediatric Blunt Cerebrovascular Injury. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_805] [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: 03/18/2023] Open
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LoPresti MA, Athukuri P, Khan AB, Prablek M, Patel R, Mayer R, Bauer DF, Gerow FT, Morris SA, Lam S, Ravindra V. Thoracolumbar Scoliosis in Pediatric Patients With Loeys-Dietz Syndrome: A Case Series. Cureus 2023; 15:e36372. [PMID: 37090272 PMCID: PMC10113178 DOI: 10.7759/cureus.36372] [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] [Accepted: 03/14/2023] [Indexed: 03/21/2023] Open
Abstract
Background Loeys-Dietz syndrome (LDS) is a genetic connective tissue disorder that predominantly affects cardiovascular, skeletal, and craniofacial structures. Associated thoracolumbar scoliosis in LDS can be challenging to manage, though other etiologies of pediatric scoliosis have better-defined management guidelines. We examined our institutional experience regarding the treatment of pediatric patients with LDS and scoliosis. Methodology In this retrospective study, all patients seen at our pediatric tertiary care center from 2004 through 2018 with a diagnosis of LDS were reviewed, and those with radiographic diagnoses of scoliosis (full-length scoliosis X-rays) were included. Demographic, clinical, and radiographic parameters were collected, and management strategies were reported. Results A total of 39 LDS patients whose ages ranged between seven and 13 years were identified. A total of nine patients were radiographically diagnosed with scoliosis, but three patients were excluded due to incomplete medical records, leaving six patients. The median age at scoliosis diagnosis was 11.5 years, with a median follow-up of 51 months. Two patients were successfully managed with observation (average initial Cobb angle (CA): 14°, average final CA: 20.5°). Two were braced, one successfully (initial CA: 15°, final CA: 30°) and one with a progressive disease requiring surgery (initial CA: 40°, final CA: 58°). Of the two who were offered surgical correction, one underwent surgery with a durable correction of spinal deformity (CA: 33° to 19°). One patient underwent a recent correction of aortic root dilatation and was not a candidate for scoliosis surgery. Conclusions Principles of adolescent idiopathic scoliosis management such as bracing for CA of 20-50° and surgery for CA of >50° can be applied to LDS patients with good outcomes. This augments our understanding of the treatment algorithm for pediatric patients with LDS.
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Tadlock MD, Olson EJ, Gasques D, Champagne R, Krzyzaniak MJ, Belverud SA, Ravindra V, Kerns J, Choi PM, Deveraux J, Johnson J, Sharkey T, Yip M, Weibel N, Davis K. Mixed reality surgical mentoring of combat casualty care related procedures in a perfused cadaver model: Initial results of a randomized feasibility study. Surgery 2022; 172:1337-1345. [PMID: 36038376 DOI: 10.1016/j.surg.2022.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Most telemedicine modalities have limited ability to enhance procedural and operative care. We developed a novel system to provide synchronous bidirectional expert mixed reality-enabled virtual procedural mentoring. In this feasibility study, we evaluated mixed reality mentoring of combat casualty care related procedures in a re-perfused cadaver model. METHODS Novices received real-time holographic mentoring from experts using augmented reality via Hololens (Microsoft Inc, Redmond, WA). The experts maintained real-time awareness of the novice's operative environment using virtual reality via HTC-Vive (HTC Corp, Xindian District, Taiwan). Additional cameras (both environments) and novel software created the immersive, shared, 3-dimensional mixed reality environment in which the novice and expert collaborated. The novices were prospectively randomized to either mixed reality or audio-only mentoring. Blinded experts independently evaluated novice procedural videos using a 5-point Likert scale-based questionnaire. Nonparametric variables were evaluated using the Wilcoxon rank-sum test and comparisons using the χ2 analysis; significance was defined at P < .05. RESULTS Surgeon and nonsurgeon novices (14) performed 69 combat casualty care-related procedures (38 mixed reality, 31 audio), including various vascular exposures, 4-compartment lower leg fasciotomy, and emergency neurosurgical procedures; 85% were performed correctly with no difference in either group. Upon video review, mixed reality-mentored novices showed no difference in procedural flow and forward planning (3.67 vs 3.28, P = .21) or the likelihood of performing individual procedural steps correctly (4.12 vs 3.59, P = .06). CONCLUSION In this initial feasibility study, our novel mixed reality-based mentoring system successfully facilitated the performance of a wide variety of combat casualty care relevant procedures using a high fidelity re-perfused cadaver model. The small sample size and limited variety of novice types likely impacted the ability of holographically mentored novices to demonstrate improvement over the audio-only control group. Despite this, using virtual, augmented, and mixed reality technologies for procedural mentoring demonstrated promise, and further study is needed.
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Affiliation(s)
- Matthew D Tadlock
- 1st Medical Battalion, 1st Marine Logistics Group, Camp Pendleton, CA; Department of Surgery, Navy Medicine Readiness and Training Command (NMRTC), San Diego, CA; Bioskills Training Center, NMRTC, San Diego, CA.
| | - Erik J Olson
- Department of Surgery, Navy Medicine Readiness and Training Command (NMRTC), San Diego, CA
| | - Danilo Gasques
- Department of Computer Science and Engineering, University of California San Diego, CA
| | | | - Michael J Krzyzaniak
- Department of Surgery, Navy Medicine Readiness and Training Command (NMRTC), San Diego, CA
| | | | | | - Jakob Kerns
- Virtual Medical Center, NMRTC, San Diego, CA
| | - Pamela M Choi
- Department of Surgery, Navy Medicine Readiness and Training Command (NMRTC), San Diego, CA
| | | | - Janet Johnson
- Department of Computer Science and Engineering, University of California San Diego, CA
| | - Thomas Sharkey
- Department of Computer Science and Engineering, University of California San Diego, CA
| | - Michael Yip
- Department of Electrical and Computer Engineering, University of California San Diego, CA
| | - Nadir Weibel
- Department of Computer Science and Engineering, University of California San Diego, CA
| | - Konrad Davis
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Medical Group, Scripps Health System, San Diego, CA
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Prablek MA, LoPresti M, Bertot B, Morris SA, Bauer D, Lam S, Ravindra V. Evaluation of cervical spine pathology in children with Loeys-Dietz syndrome. Surg Neurol Int 2022; 13:96. [PMID: 35399906 PMCID: PMC8986760 DOI: 10.25259/sni_48_2022] [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: 01/12/2022] [Accepted: 02/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Loeys-Dietz syndrome (LDS) is a genetic connective tissue disorder associated with multiple musculoskeletal anomalies, including cervical spine instability. We sought to examine the nature of imaging for cervical spine instability in children with LDS due to likely pathogenic or pathogenic variants in TGFBR1, TGFBR2, TGFB2, SMAD3, or TGFB3. Methods: A retrospective chart review was conducted, examining relevant data for all children with LDS screened at our institution from 2004 through 2021. Cervical spine X-rays were used to assess cervical instability, cervical lordosis, and basilar impression. Results: A total of 39 patients were identified; 16 underwent cervical spine screening (56.25% male). Median age at initial screening was 7 years (Q1-Q3: 3.75–14, range: 0.1–19). Six of 16 patients evaluated (37.5%) had radiographical evidence of cervical instability. Mean angles of cervical lordosis were 20° (SD = 14.1°, range = 4°–33°) and 17.3° (SD = 16.4°, range = 2°–41°), respectively. Three patients demonstrated radiographical basilar impression. Radiographic progression of cervical instability was seen in one case. All but two were managed conservatively with observation, one patient underwent surgical fixation and fusion of C1-2, the other underwent complex cervical reconstruction anterior and posterior instrumentation. Conclusion: Cervical spine evaluation is important in this cohort; we identified 37.5% had evidence of cervical spine instability, and many had concurrent spinal pathology. From our experience, we agree with the recent advisement for screening at diagnosis and for those previously diagnosed that have not undergone screening. Future study may outline more specific screening practices.
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Affiliation(s)
| | - Melissa LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas,
| | - Brandon Bertot
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,
| | | | - David Bauer
- Departments of Neurosurgery, Texas Children’s Hospital, Houston, Texas,
| | - Sandi Lam
- Department of Neurosurgery, Lurie Children’s Hospital, Chicago, Illinois,
| | - Vijay Ravindra
- Department of Neurosurgery, University of California San Diego, San Diego, California, United States
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Ravindra V, Grandhi R, de Havenon A. 409 Impact of COVID-19 on the Hospitalization, Treatment, and Outcomes of Intracerebral Hemorrhage and Subarachnoid Hemorrhage in the United States. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_409] [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: 11/18/2022] Open
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Khan M, Joyce E, Horn J, Scoville JP, Ravindra V, Menacho ST. Postoperative bowel complications after non-shunt-related neurosurgical procedures: case series and review of the literature. Neurosurg Rev 2021; 45:275-283. [PMID: 34297261 DOI: 10.1007/s10143-021-01609-y] [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: 03/26/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Postoperative bowel complications after non-shunt-related neurosurgical procedures are relatively rare. In an effort to identify the primary risk factors, we evaluated postoperative bowel complications in cranial, endovascular, and spinal procedures in neurosurgery patients using our own institutional case series along with a literature review.We identified severe postoperative bowel complications that occurred at our institution after non-shunt-related neurosurgical procedures between July 2016 and December 2018. We also completed a systematic review of PubMed/MEDLINE using search terms related to bowel complications.At our institution, 7 patients (average age 49.7 ± 9.5 years, range 34-60; no apparent sex predilection) had severe postoperative bowel complications after undergoing a total of 10 neurosurgical procedures. Diagnosis was on average 1 week postoperatively (range 5-13 days), and the time between radiographic/clinical diagnosis and either surgery or death was 1.3 ± 1.4 days (range 0-4 days). Bowel perforation occurred in 4 patients. Five of the patients died, 3 as a direct result of the bowel complication. In the literature review, we identified 6487 spine and 66 cranial and/or endovascular bowel complications after neurosurgical procedures.Our case series and literature review demonstrate that severe postoperative bowel complications after non-shunt-related neurosurgical procedures, while rare, carry significant morbidity/mortality despite prompt and aggressive management. These can also happen without direct injury to bowel tissue, instead occurring as sequelae of inflammatory processes, as well as from delayed mobility, extended use of opiate narcotics, and lack of standardized protocols to ensure early bowel movements that likely stems from unfamiliarity with this potentially devastating complication.
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Affiliation(s)
- Majid Khan
- University of Nevado, Reno School of Medicine, Reno, NV, USA
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Jeffrey Horn
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Jonathan P Scoville
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Vijay Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Sarah T Menacho
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA.
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Du RY, LoPresti M, Ravindra V, Iacobas I, Bergstrom K, Goethe EA, Lam S. Gene Mutations Related to Pathogenesis and Development of Cerebral Arteriovenous Malformations in Pediatric Populations. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_345] [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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Ganeshamurthy AN, Ravindra V, Rupa TR, Bhatt RM. Carbon Sequestration Potential of Mango Orchards in the Tropical Hot and Humid Climate of Konkan Region, India. CURR SCI INDIA 2019. [DOI: 10.18520/cs/v116/i8/1417-1423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ravindra V, Rekha CV, Annamalai S, Sharmin DD, Norouzi-Baghkomeh P. A comparative evaluation between cheiloscopic patterns and the permanent molar relationships to predict the future malocclusions. J Clin Exp Dent 2019; 11:e553-e557. [PMID: 31346376 PMCID: PMC6645262 DOI: 10.4317/jced.55776] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background To assess the correlation between different cheiloscopic patterns with the permanent molar relationships. Material and Methods 300 children who are 14-16 years old with completely erupted 2nd permanent molars upto occlusal table were recruited and the pattern of molar terminal plane was recorded in the proforma. Lip prints of these subjects were recorded with lipstick-cellophane method and middle 10mm of lower lip was analysed for the lip print pattern as suggested by Sivapathasundharam et al. The pattern were classified based on Tsuchihashi and Suzuki classification. Results Type II (branched) pattern was the most predominant cheiloscopic pattern. The predominant patterns which related to the Angle’s classification were; type I (complete vertical) pattern for class I, type IV (reticular) pattern for class II and presence of type IV (reticular) pattern and absence of type I’ (incomplete vertical) pattern for class III. In class III molar relationship, males showed an increased type II (branched) pattern and females showed an increased type IV (reticluar) pattern. Conclusions Lip prints can provide an alternative to dermatoglyphics to predict malocclusions in permanent dentition. Further studies with larger sample size are required to provide an insight into its significant correlations. Key words:Cheiloscopy, Angle’s classification, malocclusion.
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Greenberg JK, Jeffe D, Carpenter CR, Yan Y, Pineda JA, Lumba-Brown A, Keller MS, Berger D, Bollo RJ, Ravindra V, Naftel RP, Dewan M, Shah MN, Burns EC, O’Neill BR, Hankinson TC, Whitehead WE, Adelson PD, Tamber MS, McDonald PJ, Ahn ES, Titsworth W, West AN, Brownson RC, Limbrick DD. North American survey on the post-neuroimaging management of children with mild head injuries. J Neurosurg Pediatr 2018; 23:227-235. [PMID: 30485194 PMCID: PMC6717430 DOI: 10.3171/2018.7.peds18263] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThere remains uncertainty regarding the appropriate level of care and need for repeating neuroimaging among children with mild traumatic brain injury (mTBI) complicated by intracranial injury (ICI). This study's objective was to investigate physician practice patterns and decision-making processes for these patients in order to identify knowledge gaps and highlight avenues for future investigation.METHODSThe authors surveyed residents, fellows, and attending physicians from the following pediatric specialties: emergency medicine; general surgery; neurosurgery; and critical care. Participants came from 10 institutions in the United States and an email list maintained by the Canadian Neurosurgical Society. The survey asked respondents to indicate management preferences for and experiences with children with mTBI complicated by ICI, focusing on an exemplar clinical vignette of a 7-year-old girl with a Glasgow Coma Scale score of 15 and a 5-mm subdural hematoma without midline shift after a fall down stairs.RESULTSThe response rate was 52% (n = 536). Overall, 326 (61%) respondents indicated they would recommend ICU admission for the child in the vignette. However, only 62 (12%) agreed/strongly agreed that this child was at high risk of neurological decline. Half of respondents (45%; n = 243) indicated they would order a planned follow-up CT (29%; n = 155) or MRI scan (19%; n = 102), though only 64 (12%) agreed/strongly agreed that repeat neuroimaging would influence their management. Common factors that increased the likelihood of ICU admission included presence of a focal neurological deficit (95%; n = 508 endorsed), midline shift (90%; n = 480) or an epidural hematoma (88%; n = 471). However, 42% (n = 225) indicated they would admit all children with mTBI and ICI to the ICU. Notably, 27% (n = 143) of respondents indicated they had seen one or more children with mTBI and intracranial hemorrhage demonstrate a rapid neurological decline when admitted to a general ward in the last year, and 13% (n = 71) had witnessed this outcome at least twice in the past year.CONCLUSIONSMany physicians endorse ICU admission and repeat neuroimaging for pediatric mTBI with ICI, despite uncertainty regarding the clinical utility of those decisions. These results, combined with evidence that existing practice may provide insufficient monitoring to some high-risk children, emphasize the need for validated decision tools to aid the management of these patients.
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Affiliation(s)
- Jacob K Greenberg
- Departments of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Donna Jeffe
- Departments of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Christopher R Carpenter
- Division of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Yan Yan
- Departments of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jose A Pineda
- Departments of Pediatrics Washington University School of Medicine in St. Louis, St. Louis, MO.,Departments of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Martin S Keller
- Departments of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Daniel Berger
- Departments of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Robert J. Bollo
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Vijay Ravindra
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Robert P Naftel
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Manish N. Shah
- Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX
| | - Erin C Burns
- Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Brent R. O’Neill
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO
| | - Todd C Hankinson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO
| | | | - P David Adelson
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
| | - Mandeep S Tamber
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Edward S Ahn
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William Titsworth
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alina N West
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Ross C Brownson
- Departments of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO.,Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO.,Prevention Research Center, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - David D Limbrick
- Departments of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
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Abou-Al-Shaar H, Karsy M, Ravindra V, Joyce E, Mahan MA. Acute repair of traumatic pan-brachial plexus injury: technical considerations and approaches. Neurosurg Focus 2018; 44:V4. [PMID: 29291296 DOI: 10.3171/2018.1.focusvid.17569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Particularly challenging after complete brachial plexus avulsion is reestablishing effective hand function, due to limited neurological donors to reanimate the arm. Acute repair of avulsion injuries may enable reinnervation strategies for achieving hand function. This patient presented with pan-brachial plexus injury. Given its irreparable nature, the authors recommended multistage reconstruction, including contralateral C-7 transfer for hand function, multiple intercostal nerves for shoulder/triceps function, shoulder fusion, and spinal accessory nerve-to-musculocutaneous nerve transfer for elbow flexion. The video demonstrates distal contraction from electrical stimulation of the avulsed roots. Single neurorrhaphy of the contralateral C-7 transfer was performed along with a retrosternocleidomastoid approach. The video can be found here: https://youtu.be/GMPfno8sK0U .
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Ravindra V, Rekha V, Annamalai S, Sharmin D, Norouzi-Baghkomeh P. A comparative evaluation between dermatoglyphic patterns and different terminal planes in primary dentition. J Clin Exp Dent 2018; 10:e1149-e1154. [PMID: 30697372 PMCID: PMC6343981 DOI: 10.4317/jced.55259] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/03/2018] [Indexed: 11/05/2022] Open
Abstract
Background Material and Methods Results Conclusions
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Ravindra V, Riva-Cambrin J. In Reply. Neurosurgery 2017; 81:E76. [DOI: 10.1093/neuros/nyx443] [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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Ravindra V, Mazur M, Park M, Kumpati G, Patel A, Couldwell W, Taussky P. E-137 carotid artery stenosis in the setting of trans-catheter aortic valve replacement: clinical and technical considerations of carotid stenting. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.211] [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: 11/04/2022]
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