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Nanivadekar AC, Bose R, Petersen BA, Okorokova EV, Sarma D, Madonna TJ, Barra B, Farooqui J, Dalrymple AN, Levy I, Helm ER, Miele VJ, Boninger ML, Capogrosso M, Bensmaia SJ, Weber DJ, Fisher LE. Publisher Correction: Restoration of sensory feedback from the foot and reduction of phantom limb pain via closed-loop spinal cord stimulation. Nat Biomed Eng 2023:10.1038/s41551-023-01175-2. [PMID: 38155296 DOI: 10.1038/s41551-023-01175-2] [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] [Indexed: 12/30/2023]
Affiliation(s)
- Ameya C Nanivadekar
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Rohit Bose
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Bailey A Petersen
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Elizaveta V Okorokova
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Devapratim Sarma
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tyler J Madonna
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatrice Barra
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland
| | - Juhi Farooqui
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Ashley N Dalrymple
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Isaiah Levy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric R Helm
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vincent J Miele
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Douglas J Weber
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA.
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
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Nanivadekar AC, Bose R, Petersen BA, Okorokova EV, Sarma D, Madonna TJ, Barra B, Farooqui J, Dalrymple AN, Levy I, Helm ER, Miele VJ, Boninger ML, Capogrosso M, Bensmaia SJ, Weber DJ, Fisher LE. Restoration of sensory feedback from the foot and reduction of phantom limb pain via closed-loop spinal cord stimulation. Nat Biomed Eng 2023:10.1038/s41551-023-01153-8. [PMID: 38097809 DOI: 10.1038/s41551-023-01153-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/27/2023] [Indexed: 12/30/2023]
Abstract
Restoring somatosensory feedback in individuals with lower-limb amputations would reduce the risk of falls and alleviate phantom limb pain. Here we show, in three individuals with transtibial amputation (one traumatic and two owing to diabetic peripheral neuropathy), that sensations from the missing foot, with control over their location and intensity, can be evoked via lateral lumbosacral spinal cord stimulation with commercially available electrodes and by modulating the intensity of stimulation in real time on the basis of signals from a wireless pressure-sensitive shoe insole. The restored somatosensation via closed-loop stimulation improved balance control (with a 19-point improvement in the composite score of the Sensory Organization Test in one individual) and gait stability (with a 5-point improvement in the Functional Gait Assessment in one individual). And over the implantation period of the stimulation leads, the three individuals experienced a clinically meaningful decrease in phantom limb pain (with an average reduction of nearly 70% on a visual analogue scale). Our findings support the further clinical assessment of lower-limb neuroprostheses providing somatosensory feedback.
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Affiliation(s)
- Ameya C Nanivadekar
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Rohit Bose
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Bailey A Petersen
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Elizaveta V Okorokova
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Devapratim Sarma
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tyler J Madonna
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatrice Barra
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland
| | - Juhi Farooqui
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Ashley N Dalrymple
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Isaiah Levy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric R Helm
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vincent J Miele
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Douglas J Weber
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA.
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
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Alan N, Adams G, Agarwal N, Hamilton D, Miele VJ, Okonkwo DO, Kanter AS. 446 Utility of Intraoperative Motor-Evoked Potential in L4-5 Lateral Lumbar Interbody Fusion: 3-Year Prospective Study. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_446] [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: 11/19/2022] Open
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4
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Zuckerman SL, Yengo-Kahn AM, Tang AR, Bailes JE, Beauchamp K, Berger MS, Bonfield CM, Camarata PJ, Cantu RC, Davis GA, Ellenbogen RG, Ellis MJ, Feuer H, Guazzo E, Harris OA, Heppner P, Honeybul S, Manley G, Maroon JC, Miele VJ, Nahed BV, Okonkwo DO, Oppenlander ME, Petty J, Sabin HI, Samadani U, Sherburn EW, Sheridan M, Tator CH, Theodore N, Timmons SD, Woodworth GF, Solomon GS, Sills AK. Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight. Neurosurgery 2021; 88:E495-E504. [PMID: 33693899 DOI: 10.1093/neuros/nyab041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/07/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sport-related structural brain injury (SRSBI) is intracranial pathology incurred during sport. Management mirrors that of non-sport-related brain injury. An empirical vacuum exists regarding return to play (RTP) following SRSBI. OBJECTIVE To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. METHODS A systematic literature review of SRSBI from 2012 to present in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a cross-sectional survey of RTP in SRSBI by 31 international neurosurgeons was conducted. RESULTS Of 27 included articles out of 241 systematically reviewed, 9 (33.0%) case reports provided RTP information for 12 athletes. To assess expert opinion, 31 of 32 neurosurgeons (96.9%) provided survey responses. For acute, asymptomatic SRSBI, 12 (38.7%) would not operate. Of the 19 (61.3%) who would operate, midline shift (63.2%) and hemorrhage size > 10 mm (52.6%) were the most common indications. Following SRSBI with resolved hemorrhage, with or without burr holes, the majority of experts (>75%) allowed RTP to high-contact/collision sports at 6 to 12 mo. Approximately 80% of experts did not endorse RTP to high-contact/collision sports for athletes with persistent hemorrhage. Following craniotomy for SRSBI, 40% to 50% of experts considered RTP at 6 to 12 mo. Linear regression revealed that experts allowed earlier RTP at higher levels of play (β = -0.58, 95% CI -0.111, -0.005, P = .033). CONCLUSION RTP decisions following structural brain injury in athletes are markedly heterogeneous. While individualized RTP decisions are critical, aggregated expert opinions from 31 international sports neurosurgeons provide key insight. Level of play was found to be an important consideration in RTP determinations.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan R Tang
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julian E Bailes
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Kathryn Beauchamp
- Division of Neurological Surgery, Denver Health Medical Center, Department of Neurological Surgery University of Colorado, Denver, Colorado, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Christopher M Bonfield
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul J Camarata
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Gavin A Davis
- Department of Neurosurgery, Austin and Cabrini Health, Melbourne, Australia
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Michael J Ellis
- Department of Surgery and Pediatrics, Section of Neurosurgery, University of Manitoba, Pan Am Concussion Program, Winnipeg, Canada
| | - Hank Feuer
- Player Health and Safety Department, National Football League, New York, New York, USA
| | - Eric Guazzo
- Department of Neurosurgery, Townsville University Hospital, Townsville, Australia
| | - Odette A Harris
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Peter Heppner
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth Western Australia
| | - Geoff Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Joseph C Maroon
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vincent J Miele
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark E Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jerry Petty
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA
| | | | - Uzma Samadani
- Division of Neurosurgery, Minneapolis VAMC; Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eric W Sherburn
- The Center for Concussion, University of Oklahoma College of Medicine, Tulsa, Oklahoma, USA
| | - Mark Sheridan
- Department of Neurosurgery, Liverpool Hospital, Liverpool, Australia
| | - Charles H Tator
- Canadian Concussion Centre and Division of Neurosurgery, Toronto Western Hospital and University of Toronto, Toronto, Canada
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - Shelly D Timmons
- Department of Neurological Surgery, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, USA
| | - Graeme F Woodworth
- Department of Neurosurgery & R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Player Health and Safety Department, National Football League, New York, New York, USA
| | - Allen K Sills
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Player Health and Safety Department, National Football League, New York, New York, USA
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5
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Algattas HN, McCarthy D, Kujawski B, Agarwal N, Brown J, Forsythe RM, Leonardo J, Walsh K, Gross BA, Friedlander RM, Okonkwo DO, Whiting D, Miele VJ. Impact of Coronavirus Disease 2019 Shutdown on Neurotrauma Volume in Pennsylvania. World Neurosurg 2021; 151:e178-e184. [PMID: 33857673 PMCID: PMC8678926 DOI: 10.1016/j.wneu.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The 2020 coronavirus disease 2019 (COVID-19) pandemic resulted in state-specific quarantine protocols and introduced the concept of social distancing into modern parlance. We assess the impact of the COVID-19 pandemic on neurotrauma presentations in the first 3 months after shutdown throughout Pennsylvania. METHODS The Pennsylvania Trauma Systems Foundation was queried for registry data from the Pennsylvania Trauma Outcomes Study between March 12 and June 5 in each year from 2017 to 2020. RESULTS After the COVID-19 shutdown, there was a 27% reduction in neurotrauma volume, from 2680 cases in 2017 to 2018 cases in 2020, and a 28.8% reduction in traumatic brain injury volume. There was no significant difference in neurotrauma phenotype incurred relative to total cases. Injury mechanism was less likely to be motor vehicle collision and more likely caused by falls, gunshot wound, and recreational vehicle accidents (P < 0.05). Location of injury was less likely on roads and public locations and more likely at indoor private locations (P < 0.05). The proportion of patients with neurotrauma with blood alcohol concentration >0.08 g/dL was reduced in 2020 (11.4% vs. 9.0%; P < 0.05). Mortality was higher during 2020 compared with pre-COVID years (7.7% vs. 6.4%; P < 0.05). CONCLUSIONS During statewide shutdown, neurotrauma volume and alcohol-related trauma decreased and low-impact traumas and gunshot wounds increased, with a shift toward injuries occurring in private, indoor locations. These changes increased mortality. However, there was not a change in the types of injuries sustained.
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Affiliation(s)
- Hanna N Algattas
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
| | - David McCarthy
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Brandon Kujawski
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Joshua Brown
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raquel M Forsythe
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jody Leonardo
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Kevin Walsh
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Bradley A Gross
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Robert M Friedlander
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - David O Okonkwo
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Donald Whiting
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Vincent J Miele
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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Pease M, Semroc S, Arefan D, Kwiatkowski S, Simon A, Fagert V, Legarreta AD, Hamilton DK, Kaufmann DL, Miele VJ, Jankowitz BT. Prospective Trial of Anti-Epileptics for Early Seizure Prevention in Mild Traumatic Brain Injury. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_422] [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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7
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Bartsch AJ, Hedin D, Alberts J, Benzel EC, Cruickshank J, Gray RS, Cameron K, Houston MN, Rooks T, McGinty G, Kozlowski E, Rowson S, Maroon JC, Miele VJ, Ashton JC, Siegmund GP, Shah A, McCrea M, Stemper B. High Energy Side and Rear American Football Head Impacts Cause Obvious Performance Decrement on Video. Ann Biomed Eng 2020; 48:2667-2677. [PMID: 33111969 PMCID: PMC7674260 DOI: 10.1007/s10439-020-02640-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022]
Abstract
The objective of this study was to compare head impact data acquired with an impact monitoring mouthguard (IMM) to the video-observed behavior of athletes' post-collision relative to their pre-collision behaviors. A total of n = 83 college and high school American football players wore the IMM and were video-recorded over 260 athlete-exposures. Ex-athletes and clinicians reviewed the video in a two-step process and categorized abnormal post-collision behaviors according to previously published Obvious Performance Decrement (OPD) definitions. Engineers qualitatively reviewed datasets to check head impact and non-head impact signal frequency and magnitude. The ex-athlete reviewers identified 2305 head impacts and 16 potential OPD impacts, 13 of which were separately categorized as Likely-OPD impacts by the clinical reviewers. All 13 Likely-OPD impacts were in the top 1% of impacts measured by the IMM (ranges 40-100 g, 3.3-7.0 m/s and 35-118 J) and 12 of the 13 impacts (92%) were to the side or rear of the head. These findings require confirmation in a larger data set before proposing any type of OPD impact magnitude or direction threshold exists. However, OPD cases in this study compare favorably with previously published impact monitoring studies in high school and college American football players that looked for OPD signs, impact magnitude and direction. Our OPD findings also compare well with NFL reconstruction studies for ranges of concussion and sub-concussive impact magnitudes in side/rear collisions, as well as prior theory, analytical models and empirical research that suggest a directional sensitivity to brain injury exists for single high-energy impacts.
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Affiliation(s)
| | - Daniel Hedin
- Advanced Medical Electronics, Maple Grove, MN, USA
| | | | | | | | | | | | | | - Tyler Rooks
- United States Army Aeromedical Research Laboratory, Fort Rucker, AL, USA
| | - Gerald McGinty
- United States Air Force Academy, Air Force Academy, CO, USA
| | | | | | - Joseph C Maroon
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vincent J Miele
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Gunter P Siegmund
- School of Kinesiology, University of British Columbia, Vancouver, BC, USA
| | - Alok Shah
- Medical College of Wisconsin, Wauwatosa, WI, USA
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Bartsch AJ, McCrea MM, Hedin DS, Gibson PL, Miele VJ, Benzel EC, Alberts JL, Samorezov S, Shah A, Stemper BS. Laboratory and On-field Data Collected by a Head Impact Monitoring Mouthguard. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2068-2072. [PMID: 31946308 DOI: 10.1109/embc.2019.8856907] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although concussion continues to be a major source of acute and chronic injury in automotive, athletic and military arenas, concussion injury mechanisms and risk functions are ill-defined. This lack of definition has hindered efforts to develop standardized concussion monitoring, safety testing and protective countermeasures. Recent research has provided evidence of the role of repetitive head impact exposure as a predisposing factor for the onset of concussion using developed instrumented helmets and mouthguards.To overcome this knowledge gap, we have developed, tested and deployed a head impact monitoring mouthguard (IMM) system. In this study, we deployed the IMM system to gather high quality estimates of athlete head impacts in situ. And with enough longer-term data collection, potential concussive events or mild traumatic brain injuries (mTBIs) will be gathered and ideally will provide actionable risk-based threshold.
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McDowell MM, Parry PV, Agarwal N, Miele VJ, Maroon JC. Long term delay in onset of prevertebral hematoma following anterior cervical discectomy and fusion: A case report. J Clin Neurosci 2019; 62:234-237. [DOI: 10.1016/j.jocn.2018.12.031] [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] [Received: 11/26/2018] [Accepted: 12/23/2018] [Indexed: 11/16/2022]
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10
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Hwang R, Yung BH, Sedney C, Miele VJ. Treatment of holocord spinal epidural abscess via alternating side unilateral approach for bilateral laminectomy. W V Med J 2015; 111:14-18. [PMID: 26050292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To date, this is the first reported case of the surgical management of a holocord epidural abscess done through level-skipping laminectomies. It is also the first reported case of these laminectomies being performed via an alternating side unilateral approach for this condition. A 51-year-old patient presenting with progressive lower extremity weakness secondary to a spinal epidural abscess extending from C4 to S1. A minimally disruptive method of relieving the spinal cord compression via evacuation of the abscess was employed successfully. This report demonstrates the efficacy of level skipping laminectomies via a unilateral approach for holocord epidural abscesses (extending 20 vertebral levels). Performing the laminectomies via a unilateral approach as well as alternating the side of the approach minimized iatrogenic instability risk. Both strategies were designed to minimize incision size, tissue disruption, and the amount of muscular weakness/imbalance postoperatively.
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11
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Bartsch AJ, Benzel EC, Miele VJ, Morr DR, Prakash V. Boxing and mixed martial arts: preliminary traumatic neuromechanical injury risk analyses from laboratory impact dosage data. J Neurosurg 2012; 116:1070-80. [PMID: 22313361 DOI: 10.3171/2011.12.jns111478] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In spite of ample literature pointing to rotational and combined impact dosage being key contributors to head and neck injury, boxing and mixed martial arts (MMA) padding is still designed to primarily reduce cranium linear acceleration. The objects of this study were to quantify preliminary linear and rotational head impact dosage for selected boxing and MMA padding in response to hook punches; compute theoretical skull, brain, and neck injury risk metrics; and statistically compare the protective effect of various glove and head padding conditions.
Methods
An instrumented Hybrid III 50th percentile anthropomorphic test device (ATD) was struck in 54 pendulum impacts replicating hook punches at low (27–29 J) and high (54–58 J) energy. Five padding combinations were examined: unpadded (control), MMA glove–unpadded head, boxing glove–unpadded head, unpadded pendulum–boxing headgear, and boxing glove–boxing headgear. A total of 17 injury risk parameters were measured or calculated.
Results
All padding conditions reduced linear impact dosage. Other parameters significantly decreased, significantly increased, or were unaffected depending on padding condition. Of real-world conditions (MMA glove–bare head, boxing glove–bare head, and boxing glove–headgear), the boxing glove–headgear condition showed the most meaningful reduction in most of the parameters. In equivalent impacts, the MMA glove–bare head condition induced higher rotational dosage than the boxing glove–bare head condition. Finite element analysis indicated a risk of brain strain injury in spite of significant reduction of linear impact dosage.
Conclusions
In the replicated hook punch impacts, all padding conditions reduced linear but not rotational impact dosage. Head and neck dosage theoretically accumulates fastest in MMA and boxing bouts without use of protective headgear. The boxing glove–headgear condition provided the best overall reduction in impact dosage. More work is needed to develop improved protective padding to minimize linear and rotational impact dosage and develop next-generation standards for head and neck injury risk.
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Affiliation(s)
- Adam J. Bartsch
- 1Spine Research Laboratory and
- 2Cleveland Traumatic Neuromechanics Consortium
| | - Edward C. Benzel
- 1Spine Research Laboratory and
- 2Cleveland Traumatic Neuromechanics Consortium
- 3Department of Neurological Surgery, Neurological Institute, Cleveland Clinic
| | - Vincent J. Miele
- 3Department of Neurological Surgery, Neurological Institute, Cleveland Clinic
- 4United Hospital Center Neurosurgery & Spine Center, Clarksburg, West Virginia
| | - Douglas R. Morr
- 5Scientific Expert Analysis (SEA), Ltd., Columbus, Ohio; and
| | - Vikas Prakash
- 2Cleveland Traumatic Neuromechanics Consortium
- 6Department of Mechanical Engineering, Case Western Reserve University, Cleveland
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Miele VJ, Price KO, Bloomfield S, Hogg J, Bailes JE. A review of intrathecal morphine therapy related granulomas. Eur J Pain 2012; 10:251-61. [PMID: 15964775 DOI: 10.1016/j.ejpain.2005.05.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [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: 01/10/2005] [Revised: 04/25/2005] [Accepted: 05/05/2005] [Indexed: 11/16/2022]
Abstract
The development of catheter associated granulomatous masses in intrathecal morphine therapy is an uncommon, but potentially serious problem. While these systems have historically been used in patients with short life expectancies, more recently patients with pain from a benign source have benefited from this therapy, and new complications are being encountered secondary to the patients' longer life spans. Morphine is the most commonly used intrathecal opioid and evidence exists that the formation of granulomatous masses are related to the use of higher doses. When the patients' requirement of morphine increases significantly, the physician should be alert for signs of spinal cord compression, such as new neurological deficits, myelopathy, or radiculopathy. Patients that require these higher doses should be properly informed of the association with granulomas and their associated risks. Indolent infection may also be the etiology of granulomatous masses, and the presence of organisms, both aerobic and anaerobic, should be routinely investigated. Patients with catheter-associated granulomas appear to share several features. They exhibit the onset of symptoms several months following the initiation of intraspinal opioids and commonly present with an increase in pain that precedes signs and symptoms of neurological deterioration. While MRI might be the preferred method of detection of intrathecal granulomas, its cost and availability are prohibitive for routine screening. CT myelogram via pump side port injection of contrast can also be performed to detect catheter tip related granulomas/obstructions. Serial neurological examinations for new deficits may be performed and recorded during pump refill visits to recognize a granulomatous mass in its early stages. If an abnormality is identified, imaging studies are appropriate. Awareness of the condition and vigilance are the keys to successful management of this complication.
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Affiliation(s)
- Vincent J Miele
- Department of Neurosurgery, West Virginia University School of Medicine, P.O. Box 9183, Morgantown, WV 26506-9183, USA.
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Abstract
The field of biomechanics combines the disciplines of biology and engineering, attempting to quantitatively describe the complicated properties of biological materials. These properties depend not only upon the inherent attributes of its constituents but also upon how the constituents are arranged relative to each other. Its importance in understanding spinal column and spinal cord pathology cannot be overemphasized. This chapter is a primer on the application of biomechanical principles to the normal and pathological spine. The basic concepts of biomechanics will first be reviewed followed by a review of the structural anatomy of the osteoligamentous spinal column and the biomechanics of injury. Relevant spinal cord anatomy will then be addressed as well as current biomechanical theories of spinal cord injury.
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Affiliation(s)
- Vincent J Miele
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
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Kitab SA, Miele VJ, Lavelle WF, Benzel EC. PATHOANATOMIC BASIS FOR STRETCH-INDUCED LUMBAR NERVE ROOT INJURY WITH A REVIEW OF THE LITERATURE. Neurosurgery 2009; 65:161-7; discussion 167-8. [DOI: 10.1227/01.neu.0000347002.67982.8f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE
Persistent pain originating from a dysfunctional lumbar motion segment poses significant challenges in the clinical arena. Although the predominance of the existing spine literature has addressed nerve root compression as the principal cause of pain, it is equally likely that a stretch mechanism may be responsible for all or part of the pathology.
METHODS
The literature supporting the role of stretch damage as a primary cause of nerve root injury and pain was systematically reviewed. Pathoanatomic considerations between nerve roots and juxtaposed environment are described and correlated with the available literature. Potential anatomic relationships that may lead to stretch-induced injury are delineated.
RESULTS
A dynamic lumbar functional spinal unit that encloses a tethered nerve root can create significant stretch and/or compression. This phenomenon may be present in a variety of pathological conditions. These include anterior, posterior, and rotatory olisthesis as well as degenerative conditions such as the loss of disc interspace height and frank multisegment spinal deformity. Although numerous studies have demonstrated that stretch can result in nerve damage, the pathophysiology that may associate nerve stretch with chronic pain has yet to be determined.
CONCLUSION
The current literature concerning stretch-related injury to nerve roots is reviewed, and a conceptual framework for its diagnosis and treatment is proposed and graphically illustrated using cadaveric specimens. The dynamic biomechanical and functional interrelationships between neural structures and adjacent connective tissue elements are particularly important in the face of spinal deformity.
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Affiliation(s)
| | - Vincent J. Miele
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - William F. Lavelle
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward C. Benzel
- Department of Neurosurgery, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Miele VJ. Objectifying When to Halt a Boxing Match. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000333323.12211.6d] [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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Miele VJ. Objectifying When to Halt a Boxing Match. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000315879.80071.7a] [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: 11/19/2022] Open
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Abstract
OBJECTIVE Although numerous prestigious medical organizations have called for its abolishment, participation in the sport of boxing has reached an all-time high among both men and women, and its elimination is unlikely in the near future. Physicians should strive to increase boxing safety by improving the rules of competition, which have evolved minimally over the past two centuries. Currently, subjective criteria are used to determine whether or not a contest should be halted. Developing a standardized, objective method of determining when a contest should be halted would be a significant paradigm shift and could increase the safety of the sport's participants. This study analyzed the number and types of punches landed in a typical professional match, in bouts considered to be competitive and in those that ended in fatalities, to determine whether or not this would be a practical method of differentiating between these groups. METHODS Three groups of professional boxing matches were defined at the beginning of the study: 1) a "fatal" group, consisting of bouts that resulted in the death of a participant; 2) a "classic" group that represented competitive matches; and 3) a "control" group of 4000 professional boxing matches representing the average bout. A computer program known as Punchstat (Compubox, Inc., Manorville, NY) was used in the objective analysis of these matches via videotape playback. RESULTS Several statistically significant differences were discovered between matches that resulted in fatalities and the control group. These include the number of punches landed per round, the number of power punches landed per round, and the number of power punches thrown per round by losing boxers. However, when the fatal bouts were compared with the most competitive bouts, these differences were no longer evident. CONCLUSION Based on the data analyzed between the control and fatal-bout groups, a computerized method of counting landed blows at ringside could provide sufficient data to stop matches that might result in fatalities. However, such a process would become less effective as matches become more competitive, and implementing such a change would significantly decrease the competitive nature of the sport. Therefore, other methods of quantifying acceleration-deceleration brain injuries are necessary to improve the safety of boxing.
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Affiliation(s)
- Vincent J Miele
- Department of Neurological Surgery, West Virginia University, School of Medicine, Morgantown, West Virginia 26506-9183, USA.
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Miele VJ, Bailes JE, Martin NA. Participation in contact or collision sports in athletes with epilepsy, genetic risk factors, structural brain lesions, or history of craniotomy. Neurosurg Focus 2006; 21:E9. [PMID: 17112199] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Despite a plethora of guidelines for return to play following mild head injury, a discussion of when and if an athlete should be allowed to participate in contact or collision sports if he or she sustains a structural brain lesion or after a head injury requiring craniotomy is lacking. The structural lesions discussed include arachnoid cyst, Chiari malformation Type I, cavum septum pellucidum, and the presence of ventriculoperitoneal shunts. Issues unique to this population with respect to the possibility of increased risk of head injury are addressed. The population of athletes with epilepsy and certain genetic risk factors is also discussed. Finally, the ability of athletes to participate in contact or collision sports after undergoing craniotomies for traumatic or congenital abnormalities is evaluated. Several known instances of athletes returning to contact sports following craniotomy are also reviewed.
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Affiliation(s)
- Vincent J Miele
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia 26506-9183, USA.
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Miele VJ, Norwig JA, Bailes JE. Sideline and ringside evaluation for brain and spinal injuries. Neurosurg Focus 2006; 21:E8. [PMID: 17112198] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Participation in contact and collision sports carries an inherent risk of injury to the athlete, with damage to the nervous system producing the most potential for significant morbidity and death. Neurological injuries suffered during athletic competition must be treated promptly and correctly to optimize outcome, and differentiation between minor and serious damage is the foundation of sideline/ringside management of the injury. In this article the authors present a guide to the sideline or ringside identification and management of head and spinal injuries.
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Affiliation(s)
- Vincent J Miele
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia 26506-9183, USA.
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Miele VJ, Bailes JE, Cantu RC, Rabb CH. Subdural hematomas in boxing: the spectrum of consequences. Neurosurg Focus 2006; 21:E10. [PMID: 17112188] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Boxing is a violent sport in which every participant accepts the risk of brain damage or death. This sport has been linked to acute neurological injury and chronic brain damage. The most common life-threatening injury encountered by its participants is subdural hematoma (SDH), and the most feared consequence of chronic insult to the nervous system is dementia pugilistica, or punch drunkenness. Although advances in imaging and neuropsychological testing have improved our ability to diagnose these injuries, the unprecedented sensitivity and wide availability of these modalities have increased the detection of mild cognitive impairment and small, asymptomatic imaging abnormalities. The question has thus been raised as to where on the spectrum of these injuries an athlete should be permanently banned from the sport. In this report the authors describe six boxers who were evaluated for SDH sustained during participation in the sport, and who experienced remarkably different outcomes. Their presentations, clinical courses, and boxing careers are detailed. The athletes ranged in age from 24 to 55 years at the time of injury. Two were female and four were male; half of them were amateurs and half were professionals. Treatments ranged from observation only to decompressive craniectomy. Two of the athletes were allowed to participate in the sport after their injury (one following a lengthy legal battle), with no known sequelae. One boxer died within 48 hours of her injury and at least two suffered permanent neurological deficits. In a third, dementia pugilistica was diagnosed 40 years later, and the man died while institutionalized.
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Affiliation(s)
- Vincent J Miele
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia 26506-9183, USA.
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Abstract
✓Participation in contact and collision sports carries an inherent risk of injury to the athlete, with damage to the nervous system producing the most potential for significant morbidity and death. Neurological injuries suffered during athletic competition must be treated promptly and correctly to optimize outcome, and differentiation between minor and serious damage is the foundation of sideline/ringside management of the injury. In this article the authors present a guide to the sideline or ringside identification and management of head and spinal injuries.
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Miele VJ, Bailes JE, Martin NA. Participation in contact or collision sports in athletes with epilepsy, genetic risk factors, structural brain lesions, or history of craniotomy. Neurosurg Focus 2006. [DOI: 10.3171/foc.2006.21.4.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓Despite a plethora of guidelines for return to play following mild head injury, a discussion of when and if an athlete should be allowed to participate in contact or collision sports if he or she sustains a structural brain lesion or after a head injury requiring craniotomy is lacking. The structural lesions discussed include arachnoid cyst, Chiari malformation Type I, cavum septum pellucidum, and the presence of ventriculoperitoneal shunts. Issues unique to this population with respect to the possibility of increased risk of head injury are addressed. The population of athletes with epilepsy and certain genetic risk factors is also discussed. Finally, the ability of athletes to participate in contact or collision sports after undergoing craniotomies for traumatic or congenital abnormalities is evaluated. Several known instances of athletes returning to contact sports following craniotomy are also reviewed.
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Abstract
✓Boxing is a violent sport in which every participant accepts the risk of brain damage or death. This sport has been linked to acute neurological injury and chronic brain damage. The most common life-threatening injury encountered by its participants is subdural hematoma (SDH), and the most feared consequence of chronic insult to the nervous system is dementia pugilistica, or punch drunkenness. Although advances in imaging and neuropsychological testing have improved our ability to diagnose these injuries, the unprecedented sensitivity and wide availability of these modalities have increased the detection of mild cognitive impairment and small, asymptomatic imaging abnormalities. The question has thus been raised as to where on the spectrum of these injuries an athlete should be permanently banned from the sport.
In this report the authors describe six boxers who were evaluated for SDH sustained during participation in the sport, and who experienced remarkably different outcomes. Their presentations, clinical courses, and boxing careers are detailed. The athletes ranged in age from 24 to 55 years at the time of injury. Two were female and four were male; half of them were amateurs and half were professionals. Treatments ranged from observation only to decompressive craniectomy. Two of the athletes were allowed to participate in the sport after their injury (one following a lengthy legal battle), with no known sequelae. One boxer died within 48 hours of her injury and at least two suffered permanent neurological deficits. In a third, dementia pugilistica was diagnosed 40 years later, and the man died while institutionalized.
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Miele VJ, Price K, Bloomfield S, Hogg J, Bailes J. Intrathecal morphine therapy related granulomas: two case reports. W V Med J 2006; 102:16-8. [PMID: 17285949] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Intrathecal morphine infusions have historically been used in patients with short life expectancies. More recently, patients with pain from a benign source have benefited from this therapy. While use in this population has been well documented and found to be relatively safe, new complications are being encountered secondary to the patients' longer life spans. The development of granulomatous masses from catheter use in intrathecal morphine therapy is an uncommon, but potentially serious problem. At West Virginia University Hospital, we have implanted more than 700 intrathecal drug delivery systems (IT-DDS) since 1989, and have encountered two cases of granulomatous masses developing at the tip of the intrathecal catheter. This report describes these illustrative cases and provides a review of the literature.
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Affiliation(s)
- Vincent J Miele
- Dept. of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
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Miele VJ, Zeb S, Hogg JP, Bloomfield S. Diagnostic pitfall of computed tomography in patients with superficial siderosis of the central nervous system. W V Med J 2005; 101:172-5. [PMID: 16296199] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Superficial siderosis of the central nervous system (SSCN) is a well-described entity with distinct clinical presentation as well as computed tomography (CT) and magnetic resonance imaging (MRI) findings. However, it is critical that when a patient previously diagnosed with SSCN undergoes CT on the brain at a later date, that this scan not be misinterpreted as a new subarachnoid hemorrhage (SAH) so unecessary repeated angiograms are not performed. This report describes such a situation and discusses unique CT findings in SSCN that have been under-recognized and under-emphasized. While conditions such as SAH should not be ruled out, they would be considered atypical. Combined with an adequate prior diagnostic testing history, physicians should proceed to MRI without subjecting the patient to repeat angiography.
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Affiliation(s)
- Vincent J Miele
- Dept of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
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Miele VJ, Sadrolhefazi A, Bailes JE. Influence of head position on the effectiveness of twist drill craniostomy for chronic subdural hematoma. ACTA ACUST UNITED AC 2005; 63:420-3; discussion 423. [PMID: 15883061 DOI: 10.1016/j.surneu.2004.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 05/18/2004] [Accepted: 06/28/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Twist drill craniostomy with closed system drainage (TDC-CSD) is a well-accepted treatment of chronic subdural hematomas (CSDH). Although this intervention has a long track record of effectiveness, little is known of its relationship with the head position of the patient (flat vs elevated). This study evaluated if the position of the patient's head influences outcome. METHODS The database of a University Hospital Center was queried for patients who had CSDH treated by TDC-CSD between January 1997 and March 2001. Identified patients were grouped into 2 categories: head of bed (HOB) at 30% and HOB flat while undergoing treatment. Outcomes were then evaluated with regard to amount of drainage, complications, recurrence, and length of hospital stay (LOS). RESULTS Forty-four patients were identified who received TDC-CSD treatment of CSDH. Of these, 24 patients had flat HOB and 20 had HOB elevated to 30 degrees . Although patients with elevated HOB had higher amounts of drainage (239 vs 166 mL), this figure did not reach statistical significance (P = .23). The number of recurrences and complications likewise did not reach statistical significance. Despite these findings, a statistically significant difference in LOS was found between the groups (flat = 5.5 days, elevated = 8.1 days, P = .03). This was believed secondary to bias resulting from placing the HOB of healthier patients (based on Glasgow Coma Scale) flat. CONCLUSIONS Elevation of the patient's head during TDC-CSD treatment of CSDH does not seem to impact the amount of drainage, recurrence frequency, or complication rate. Although a statistically significant difference in LOS was observed based on this variable, it appeared to be the result of bias in patient selection for HOB elevation.
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Affiliation(s)
- Vincent J Miele
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26506-9183, USA.
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Miele VJ, Rosen CL, Carpenter J, Rai A, Bailes JE. Vertebral artery-to-middle cerebral artery bypass with coil embolization of giant internal carotid artery aneurysm: technical case report. Neurosurgery 2005; 56:E1159; discussion E1159. [PMID: 15854269] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2004] [Accepted: 11/01/2004] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Cerebral revascularization with extracranial-to-intracranial bypass is often required during the surgical treatment of complex intracranial aneurysms. This report is the first in which a vertebral artery (VA)-to-middle cerebral artery (MCA) bypass in conjunction with endovascular coil embolization is used in the successful treatment of a giant intracranial aneurysm. CLINICAL PRESENTATION A 68-year-old man previously diagnosed with a 6-cm internal carotid artery (ICA) aneurysm presented complaining of progressing left hemiparesis and mental status changes. His aneurysm had been treated previously by common carotid artery occlusion 20 years earlier. Arteriography defined the partially thrombosed, right supraclinoid ICA aneurysm arising at the junction of the posterior communicating artery and the supraclinoid ICA. INTERVENTION Because of the patient's worsening symptomatology, endovascular coiling with placement of a superficial temporal artery-to-MCA bypass was performed. The patient tolerated this procedure well, and his symptoms resolved. However, they recurred several months later, and imaging suggested poor right hemispheric perfusion despite a patent bypass. A VA-MCA bypass using a saphenous vein graft was then performed using the distal right VA at the level of cervical vertebra 1 (C1) as the donor vessel with a distal anastomotic site on the right MCA. Coil embolization of the aneurysm was repeated, and the feeding posterior communicating artery was sacrificed. The patient is currently asymptomatic more than 1 year after the second bypass and coil embolization. CONCLUSION This report describes a safe and definitive treatment option for a giant intracranial ICA aneurysm using a posterior-to-anterior circulation (VA-MCA) bypass, followed by endovascular coil embolization in a patient with previous ligation of the common carotid artery. VA-MCA high-flow saphenous vein bypass followed by coil embolization is a useful technique that is especially valuable in the subset of giant aneurysm patients who have previously been treated by carotid ligation.
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Affiliation(s)
- Vincent J Miele
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia 26506-9183, USA
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Abstract
INTRODUCTION Although the sport of female boxing has a long history, the activity's current popularity is unprecedented. As more women participate, we can expect them to experience many of the serious neurologic injuries observed in their male counterparts. We present the first reported subdural hematoma in a female secondary to boxing and critique management decisions made by the athlete's trainer/coach. CASE REPORT A 24-yr-old right-handed female boxer developed headaches of increasing intensity, nausea, and emesis after being knocked down while sparring. She was allowed to continue training despite persistent symptoms and participated in a match 2 wk after the incident that was stopped due to intolerable headache. Computed tomography scan of the brain revealed a large heterogeneous subdural fluid collection over the left cerebral hemisphere, causing effacement of the adjacent sulci and a large left-to-right midline shift, consistent with an acute on chronic subdural hematoma. After surgical evacuation, the patient reported persistent memory, concentration, and language problems. Neuropsychological evaluation was performed and revealed deficits in confrontational naming, information retrieval, and concentration difficulty. DISCUSSION Several factors may increase the female participants' risk for acute neurological injury. The activity's current popularity and high demand with fans results in rapid advancement of inexperienced fighters, which leads to dangerous mismatches. Intergender sparring is common, and return to competition guidelines utilized for male participants are often not adhered to. This report is timely in that female athletes are more often crossing into previously male dominated sports and should serve as a reminder that these participants are vulnerable to similar injuries. Previous safety guidelines should be utilized in this new population of participants.
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MESH Headings
- Adult
- Athletic Injuries/complications
- Boxing/injuries
- Brain/diagnostic imaging
- Craniotomy
- Emergency Medicine/methods
- Female
- Glasgow Coma Scale
- Head Injuries, Closed/complications
- Hematoma, Subdural, Acute/diagnosis
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural, Acute/surgery
- Hematoma, Subdural, Chronic/diagnosis
- Hematoma, Subdural, Chronic/etiology
- Hematoma, Subdural, Chronic/surgery
- Humans
- Nervous System Diseases/diagnosis
- Nervous System Diseases/etiology
- Radiography
- Treatment Outcome
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Affiliation(s)
- Vincent J Miele
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26506-9183, USA.
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Miele VJ, Bendok B, Bloomfield SM, Ondra SL, Bailes JE. Ventriculoperitoneal Shunt Dysfunction in Adults Secondary to Conditions Causing a Transient Increase in Intra-abdominal Pressure: Report of Three Cases. Neurosurgery 2004; 55:434. [PMID: 15314826 DOI: 10.1227/01.neu.0000130038.49240.6f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
Ventriculoperitoneal (VP) shunts function because of the pressure differential between the intracranial space and the peritoneal cavity. The pressure in the peritoneal cavity is the lower of the two in a properly functioning shunt; thus, cerebrospinal fluid flows distally. Although not reported in the literature, adult constipation, ileus, or small bowel obstruction can alter this pressure balance and cause dysfunction. If not recognized as a transient, easily treated phenomenon, patients may be subjected to unnecessary shunt revisions. This study analyzed the occurrence of shunt malfunction in three adults secondary to transient increases in intra-abdominal pressure.
CLINICAL PRESENTATION:
Three patients with clinical symptoms and radiographic evidence of VP shunt malfunction at presentation were found to have transient conditions causing a significant increase in intra-abdominal pressure. These patients' records were evaluated with an emphasis on risk factors, treatments, and outcomes.
INTERVENTION:
After resolution of the patients' abdominal issues, clinical signs and symptoms of VP shunt dysfunction resolved within 24 hours. Radiographic evidence of the resolution of shunt failure also was observed.
CONCLUSION:
Shunt malfunction or dysfunction consumes many person-hours and healthcare dollars. This study provides anecdotal evidence that transient and easily reversible increases in the intra-abdominal pressure of adults with VP shunts can result in dysfunction. Although it may not be practical to delay shunt revision while attempting to correct constipation, ileus, or small bowel obstruction, clinicians treating patients with these abdominal conditions should be aware that they could cause transient VP shunt failure. It would seem prudent that patients with VP shunts be started on a prophylactic bowel regimen before surgical procedures to decrease the risk of this somewhat preventable result.
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Affiliation(s)
- Vincent J Miele
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV, USA
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Carr AM, Bailes JE, Helmkamp JC, Rosen CL, Miele VJ. Neurological injury and death in all-terrain vehicle crashes in West Virginia: a 10-year retrospective review. Neurosurgery 2004; 54:861-6; discussion 866-7. [PMID: 15046651 DOI: 10.1227/01.neu.0000114922.46342.38] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [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: 04/08/2003] [Accepted: 11/17/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to profile all-terrain vehicle crash victims with neurological injuries who were treated at a Level I trauma center. METHODS We retrospectively reviewed trauma registry data for 238 patients who were admitted to the Jon Michael Moore Trauma Center at the West Virginia University School of Medicine after all-terrain vehicle crashes, between January 1991 and December 2000. Age, helmet status, alcohol and drug use, head injuries, length of stay, disposition, and hospital costs were studied. Death rates, head injuries, age, helmet use, and safety legislation in all 50 states were compared. RESULTS Eighty percent of victims were male, with an average age of 27.3 years. Only 22% of all patients were wearing helmets. Alcohol and/or drugs were involved in almost one-half of all incidents. Fifty-five of 238 patients sustained spinal axis injuries; only 5 were wearing helmets. One-third of victims (75 of 238 victims) were in the pediatric population, and only 21% were wearing helmets. Only 15% of victims less than 16 years of age were wearing helmets. There were a total of eight deaths; only one patient was wearing a helmet. CONCLUSION In the United States, all-terrain vehicles caused an estimated 240 deaths/yr between 1990 and 1994, which increased to 357 deaths/yr between 1995 and 2000. Brain and spine injuries occurred in 80% of fatal crashes. West Virginia has a fatality rate approximately eight times the national rate. Helmets reduce the risk of head injury by 64%, but only 21 states have helmet laws. Juvenile passengers on adult-driven vehicles are infrequently helmeted (<20%) and frequently injured (>65%). We conclude that safety legislation would save lives.
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Affiliation(s)
- Ann M Carr
- Department of Neurosurgery, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA
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Miele VJ, Bendok BR, Batjer HH. Unruptured aneurysm of the middle cerebral artery presenting with psychomotor seizures: case study and review of the literature. Epilepsy Behav 2004; 5:420-8. [PMID: 15145315 DOI: 10.1016/j.yebeh.2004.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2003] [Revised: 03/05/2004] [Accepted: 03/08/2004] [Indexed: 11/21/2022]
Abstract
An intracranial aneurysm would be low on the differential diagnosis of a patient presenting with behavioral or emotional changes. Nonetheless, complex partial seizures (CPS) may cause such symptoms and result from an unruptured intracranial aneurysm. Failure to diagnose and treat this condition in a timely manner increases the patient's risk of catastrophic aneurysmal rupture. This report describes a 55-year-old woman who presented following two CPS which began with the perception of a strange smell and culminated in a brief loss of consciousness. She had no history of seizure disorder or recent trauma. Magnetic resonance imaging (MRI) revealed a space-occupying lesion over the right temporal lobe near the amygdala. Magnetic resonance angiography (MRA) confirmed a 1.5-cm right middle cerebral artery aneurysm, with a dome projecting toward the amygdalohippocampal region. Following surgical ablation, the patient's CPS were well controlled. A review of the literature is performed on this unusual etiology and management strategies are discussed.
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Affiliation(s)
- Vincent J Miele
- Department of Neurological Surgery, West Virginia University School of Medicine, PO Box 9183, Morgantown, WV 26506-9183, USA.
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Bailes JE, Miele VJ. The science of sports medicine. Clin Neurosurg 2004; 51:91-101. [PMID: 15571132] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Julian E Bailes
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
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Abstract
Globus hystericus, a form of conversion disorder, is characterized by an uncomfortable sensation of a mass in the esophagus or airway. Evaluation proves no mass exists. Anxiety or psychological conflict is judged to be significantly related to the onset and progression of the sensation. The sensation may lead to difficulty swallowing or breathing and may become severe or life threatening. The disorder is poorly studied and understood. The differential diagnosis is vast. Management of the disorder is similar to that suggested for other conversion disorders. This article reviews the current literature about diagnosis, etiology, treatment, and prognosis of globus hystericus.
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Affiliation(s)
- Ryan Finkenbine
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA.
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Miele VJ, Bailes JE, Voelker JL. Boxing and the neurosurgeon. Clin Neurosurg 2003; 49:396-406. [PMID: 12506564] [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] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- Vincent J Miele
- West Virginia University, School of Medicine, Department of Neurosurgery, Morgantown, West Virginia, USA
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El-Kadi H, Miele VJ, Kaufman HH. Prognosis of chronic subdural hematomas. Neurosurg Clin N Am 2000; 11:553-67. [PMID: 10918029] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This article considers factors that may be of prognostic value in evaluating the chronic subdural hematoma (CSH) patient. It also examines conditions that predispose the development of a CSH. Variables such as admission neurologic status and presenting symptomatology are reviewed. Radiologic parameters (i.e., CSH density and midline shift) and intraoperative findings (i.e., pressure and pulse) are discussed.
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Affiliation(s)
- H El-Kadi
- Department of Neurosurgery, University of Pittsburgh School of Medicine, PA, USA
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