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https://www.readbyqxmd.com/read/29997038/age-is-but-a-number-when-considering-epilepsy-surgery-in-older-adults
#1
Rebecca O'Dwyer, Richard Byrne, Fiona Lynn, Pouya Nazari, Travis Stoub, Michael C Smith, Sepehr Sani
BACKGROUND: A quarter of patients with newly diagnosed epilepsy are older, yet they are less likely to be offered resective surgery potentially because of clinical bias that they incur increased surgical risks. There are few peer-reviewed case series that address this cohort and their outcomes. OBJECTIVE: In the context of current literature, the objective of this study was to report on all epilepsy surgeries in patients aged 50 years or older from a tertiary care center over 15 years with an average follow-up period of 6 years...
July 8, 2018: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/29609085/prevalence-and-impact-of-left-handedness-in-neurosurgery
#2
Blake Beehler, Ryan B Kochanski, Richard Byrne, Sepehr Sani
BACKGROUND: Approximately 10%-13% of the population is left-handed (LH), and certain professions have varied representation of LH individuals. LH surgeons must overcome unique difficulties owing to the right-handed (RH) operative environment. This study assesses prevalence and impact of left-handedness on training and operative experience of neurosurgeons. METHODS: An e-mail survey was designed and sent to 5109 U.S. neurosurgeons and neurosurgical trainees. The survey was completed by 1482 responders (29...
June 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29444303/the-utility-of-vancomycin-powder-in-reducing-surgical-site-infections-in-deep-brain-stimulation-surgery
#3
Ryan B Kochanski, Pouya Nazari, Sepehr Sani
BACKGROUND: The impact of vancomycin powder on reducing postoperative surgical site infections (SSIs) in spine surgery has been studied extensively and is considered standard of care at many institutions. More recently, vancomycin powder has been shown to reduce SSI in cranial neurosurgery; however, limited studies have been performed assessing its impact in reducing SSIs in deep brain stimulation (DBS) surgery. OBJECTIVE: To investigate the use of vancomycin powder as an adjunct to the current antibiotic prophylaxis regimen in DBS surgery in a large cohort of patients...
February 10, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29408589/identification-of-stria-medullaris-fibers-in-the-massa-intermedia-using-diffusion-tensor-imaging
#4
Ryan B Kochanski, Robert Dawe, Mehmet Kocak, Sepehr Sani
BACKGROUND: The massa intermedia (MI) or interthalamic adhesion is an inconsistent band spanning between bilateral medial thalami that is absent in up to 20%-30% of individuals. Little is known of its significance, especially in regard to functional pathways. Probabilistic diffusion tensor imaging (DTI) has recently been used to seed the lateral habenula and define its afferent white matter pathway, the stria medullaris thalami (SM). We sought to determine whether the MI serves as a conduit for crossing of limbic fibers such as the SM...
April 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29396073/microelectrode-accuracy-in-deep-brain-stimulation-surgery
#5
Bledi Brahimaj, Ryan B Kochanski, Sepehr Sani
Microelectrode recording (MER) provides vital neurophysiological information about target nuclei during deep brain stimulation (DBS). There have been extensive studies looking at the accuracy of DBS lead placement; however, to date, no large series have assessed the accuracy of the microelectrode. In this study, we report the accuracy of microelectrode tip placement in comparison to preoperatively planned radiographic target. Patients who underwent DBS with MER from 2014 to 2016 were included in the study. At the authors' institution, intra-operative CT (iCT) is routinely performed after the first microelectrode track to confirm tip accuracy...
April 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29351243/awake-versus-asleep-deep-brain-stimulation-surgery-technical-considerations-and-critical-review-of-the-literature
#6
REVIEW
Ryan B Kochanski, Sepehr Sani
Advancements in neuroimaging have led to a trend toward direct, image-based targeting under general anesthesia without the use of microelectrode recording (MER) or intraoperative test stimulation, also referred to as "asleep" deep brain stimulation (DBS) surgery. Asleep DBS, utilizing imaging in the form of intraoperative computed tomography (iCT) or magnetic resonance imaging (iMRI), has demonstrated reliable targeting accuracy of DBS leads implanted within the globus pallidus and subthalamic nucleus while also improving clinical outcomes in patients with Parkinson's disease...
January 19, 2018: Brain Sciences
https://www.readbyqxmd.com/read/29275518/borders-of-stn-determined-by-mri-versus-the-electrophysiological-stn-a-comparison-using-intraoperative-ct
#7
Sander Bus, Pepijn van den Munckhof, Maarten Bot, Gian Pal, Bichun Ouyang, Sepehr Sani, Leo Verhagen Metman
BACKGROUND: It is unclear which magnetic resonance imaging (MRI) sequence most accurately corresponds with the electrophysiological subthalamic nucleus (STN) obtained during microelectrode recording (MER, MER-STN). CT/MRI fusion allows for comparison between MER-STN and the STN visualized on preoperative MRI (MRI-STN). OBJECTIVE: To compare dorsal and ventral STN borders as seen on 3-Tesla T2-weighted (T2) and susceptibility weighted images (SWI) with electrophysiological STN borders in deep brain stimulation (DBS) for Parkinson's disease (PD)...
February 2018: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28721330/truebeam-radiosurgery-for-the-treatment-of-trigeminal-neuralgia-preliminary-results-at-a-single-institution
#8
Mena G Kerolus, Neilayan Sen, Sonal Mayekar, Alistar Templeton, Julius Turian, Aidnag Diaz, Lorenzo Munoz, Richard W Byrne, Sepehr Sani
INTRODUCTION: Radiosurgery is now an established method of satisfactory pain control in patients with trigeminal neuralgia (TN). The Varian Truebeam STx (Varian Medical Systems, Palo Alto, CA) linear accelerator (LINAC) system is an arc-based, frameless stereotactic radiosurgery system used for the treatment of TN. To our knowledge, there has been only one published series of patient histories that documents the use of a frameless LINAC system for the treatment of TN. We describe the treatment parameters, patient outcomes, and complications associated with the treatment of TN...
June 16, 2017: Curēus
https://www.readbyqxmd.com/read/28480109/deep-brain-stimulation-with-a-pre-existing-cochlear-implant-surgical-technique-and-outcome
#9
Daniel Eddelman, Joshua Wewel, R Mark Wiet, Leo V Metman, Sepehr Sani
BACKGROUND: Patients with previously implanted cranial devices pose a special challenge in deep brain stimulation (DBS) surgery. We report the implantation of bilateral DBS leads in a patient with a cochlear implant. Technical nuances and long-term interdevice functionality are presented. CASE DESCRIPTION: A 70-year-old patient with advancing Parkinson's disease and a previously placed cochlear implant for sensorineural hearing loss was referred for placement of bilateral DBS in the subthalamic nucleus (STN)...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28408262/optimization-of-microelectrode-recording-in-deep-brain-stimulation-surgery-using-intraoperative-computed-tomography
#10
Ryan B Kochanski, Sander Bus, Gian Pal, Leo Verhagen Metman, Sepehr Sani
BACKGROUND: Microelectrode recording (MER) is used to confirm targeting accuracy during deep brain stimulation (DBS) surgery. We describe a technique using intraoperative computed tomography (CT) extrapolation (iCTE) to predetermine and adjust the trajectory of the guide tube to improve microelectrode targeting accuracy. We hypothesized that this technique would decrease the number of MER tracks and operative time, while increasing the recorded length of the subthalamic nucleus (STN)...
July 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28391021/implantation-of-responsive-neurostimulation-for-epilepsy-using-intraoperative-computed-tomography-technical-nuances-and-accuracy-assessment
#11
Mena G Kerolus, Ryan B Kochanski, Marvin Rossi, Michael Stein, Richard W Byrne, Sepehr Sani
INTRODUCTION: Implantation of responsive neurostimulation (RNS) system has been previously discussed in the literature but there is a paucity of data on target accuracy and the use of intraoperative imaging. We describe our experience with 8 patients using intraoperative computed tomography (iCT) during implantation of the NeuroPace RNS system. METHODS: A frame-based system was used. CT images were obtained and merged with preoperative magnetic resonance imaging and metabolic imaging studies to calculate target coordinates...
July 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28262405/improving-the-accuracy-of-microelectrode-recording-in-deep-brain-stimulation-surgery-with-intraoperative-ct
#12
Ryan B Kochanski, Gian Pal, Sander Bus, Leo Verhagen Metman, Sepehr Sani
Microelectrode recording (MER) is used to confirm electrophysiological signals within intended anatomic targets during deep brain stimulation (DBS) surgery. We describe a novel technique called intraoperative CT-guided extrapolation (iCTE) to predict the intended microelectrode trajectory and, if necessary, make corrections in real-time before dural opening. Prior to dural opening, a guide tube was inserted through the headstage and rested on dura. Intraoperative CT (iCT) was obtained, and a trajectory was extrapolated along the path of the guide tube to target depth using targeting software...
June 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27872807/identification-of-the-stria-medullaris-thalami-using-diffusion-tensor-imaging
#13
Ryan B Kochanski, Robert Dawe, Daniel B Eddelman, Mehmet Kocak, Sepehr Sani
BACKGROUND: Deep brain stimulation (DBS) via anatomical targeting of white matter tracts defined by diffusion tensor imaging (DTI) may be a useful tool in the treatment of pathologic neurophysiologic circuits implicated in certain disease states like treatment resistant depression (TRD). We sought to determine if DTI could be used to define the stria medullaris thalami (SM), the major afferent white matter pathway to the lateral habenula (LHb), a thalamic nucleus implicated in the pathophysiology of TRD...
2016: NeuroImage: Clinical
https://www.readbyqxmd.com/read/27685657/use-of-intraoperative-ct-to-predict-the-accuracy-of-microelectrode-recording-during-deep-brain-stimulation-surgery-a-proof-of-concept-study
#14
Ryan B Kochanski, Mena G Kerolus, Gian Pal, Leo Verhagen Metman, Sepehr Sani
OBJECTIVES: Intraoperative computed tomography (iCT) is currently used to confirm the target location of the microelectrode (ME) during microelectrode recording (MER) and ultimate location of deep brain stimulation (DBS) leads at our institution. We evaluated whether iCT can be used to predict the trajectory and accuracy of the ME track. PATIENTS AND METHODS: Intraoperative imaging profiles of ten consecutive patients who had undergone DBS surgery were retrospectively reviewed...
November 2016: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/27348140/severe-symptomatic-self-limited-unilateral-dbs-lead-edema-following-bilateral-subthalamic-nucleus-implantation-case-report-and-review-of-the-literature
#15
Carter S Gerard, Leo Verhagen Metman, Gian Pal, Jessica Karl, Sepehr Sani
INTRODUCTION: Symptomatic edema around a deep-brain stimulation (DBS) lead is a rare complication of DBS surgery. Although this phenomenon is not fully understood, clinical presentation of DBS lead edema can be severe enough to prompt treatment. There is a paucity of literature on the clinical course and treatment of DBS lead edema. CASE REPORT: We present a 65-year-old man with Parkinson disease who developed unilateral DBS lead edema after bilateral subthalamic nucleus lead placement...
July 2016: Neurologist
https://www.readbyqxmd.com/read/26970599/intradural-cavernous-lymphangioma-of-the-thoracic-spine-case-report-technical-considerations-and-review-of-the-literature
#16
REVIEW
Mena G Kerolus, Jyothi Patil, Abraham Kurian, Sepehr Sani
BACKGROUND CONTEXT: Cavernous lymphangioma is a rare slow-growing tumor that can cause neurologic compromise when it involves the central nervous system. Involvement of the spinal column is rare but may involve the osseous structures or the epidural space of the spinal column. PURPOSE: We report the first case of an intradural, extramedullary cavernous lymphangioma involving the thoracic spinal cord. METHODS: An 83-year-old woman presented with progressive gait ataxia, bilateral lower extremity weakness, and a band-like sensation in the middle and lower thoracic dermatomes...
August 2016: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/26909452/implementation-of-an-integrated-neuroscience-unit
#17
Rory P Breslin, Lauren Franker, Suzanne Sterchi, Sepehr Sani
Many challenges exist in today's health care delivery system, and much focus and research are invested into ways to improve care with cost-effective measures. Specialty-specific dedicated care units are one solution for inpatient hospital care because they improve outcomes and decrease mortality. The neuroscience population encompasses a wide variety of diagnoses of spinal to cranial issues with a wide spectrum of needs varying from one patient to the next. Neuroscience care must be patient-specific during the course of frequent acuity changes, and one way to achieve this is through a neuroscience-focused unit...
February 2016: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/25970836/acute-global-ischemic-stroke-after-cranioplasty-case-report-and-review-of-the-literature
#18
REVIEW
Erwin Mangubat, Sepehr Sani
INTRODUCTION: Cranioplasty procedures are performed usually after devastating neurological injuries requiring craniectomies. Although relatively safe, global intracerebral infarction is a poorly understood, and most often, lethal complication after cranioplasty. We report here one such case with a thorough literature review with insight as to possible etiologies of this injury. CASE REPORT: A 14-year-old girl underwent a left-sided decompressive hemicraniectomy for treatment of a subdural hematoma and cerebral edema...
May 2015: Neurologist
https://www.readbyqxmd.com/read/24404402/microsurgical-anatomy-of-the-transsylvian-translimen-insula-approach-to-the-mediobasal-temporal-lobe-technical-considerations-and-case-illustration
#19
David Straus, Richard W Byrne, Sepehr Sani, Anthony Serici, Roham Moftakhar
BACKGROUND: Various vascular, neoplastic, and epileptogenic pathologies occur in the mediobasal temporal region. A transsylvian translimen insula (TTI) approach can be used as an alternative to temporal transcortical approach to the mediobasal temporal region. The aim of this study was to demonstrate the surgical anatomy of the TTI approach, including the gyral, sulcal, and vascular anatomy in and around the limen insula. The use of this approach is illustrated in the resection of a complex arteriovenous malformation...
2013: Surgical Neurology International
https://www.readbyqxmd.com/read/21435909/medically-intractable-temporal-lobe-epilepsy-in-patients-with-normal-mri-surgical-outcome-in-twenty-one-consecutive-patients
#20
Adam P Smith, Sepehr Sani, Andres M Kanner, Travis Stoub, Matthew Morrin, Susan Palac, Donna C Bergen, Antoaneta Balabonov, Michael Smith, Walter W Whisler, Richard W Byrne
INTRODUCTION: Abnormal MRI findings localizing to the mesial temporal lobe predict a favorable outcome in temporal lobe epilepsy surgery. The purpose of this study is to summarize the surgical outcome of patients who underwent a tailored antero-temporal lobectomy (ATL) with normal 1.5 T MRI. Specifically, factors that may be associated with favorable post-surgical seizure outcome are evaluated. METHODS: A retrospective analysis of the Rush University Medical Center surgical epilepsy database between 1992 and 2003 was performed...
July 2011: Seizure: the Journal of the British Epilepsy Association
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