Browsing by Subject "Neurosurgical Procedures"
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Item Neurosurgery in Resource-Poor Settings: Improving Access to Surgical Education and Outcomes Analysis of Spine Surgery in a Training Hospital in Cambodia(2019-03-26) Still, Megan Elizabeth Hermann; Bagley, Carlos; Patel, Toral; Lega, Bradley C.BACKGROUND: Access to basic surgical care, and neurosurgery in particular, has historically been a neglected topic in the global health sphere. However, up to 30% of the global burden of disease is surgical in nature and great strides have been made in the past few years to spotlight and begin to rectify the huge gap in access to safe, timely, and affordable surgical care around the globe. Spine pathology is a common reason for admission to neurosurgical units in low- and middle- income countries (LMICs) and can have high morbidity rates from lack of specialized institutes. However, good surgical outcomes and quality of life scores have been reported in LMICs. OBJECTIVE: This study details the complication rates and predictive factors from spine surgery at a large hospital in Cambodia, aiming to identify high-risk patients to improve surgeon understanding of these complications for improved pre-operative planning and patient counseling. METHODS: This is a retrospective review of patients admitted for spine conditions to Preah Kossamak Hospital, in Phnom Penh (2013-2017). Univariate analysis was conducted on potential predictive factors; variables with p<0.1 were entered into multivariate logistic regression models. RESULTS: 773 patients were included. 46 patients had complications including wrong level surgery, hardware failure, and infection. On multivariate analysis, patients from the provinces of Kratie (p=0.009) or Sihanoukville (p=0.036), and delay to evaluation of over one year (p=0.027) were significant predictive factors of postoperative complications and ASIA A injury (p=0.020) was a predictive factor of poor outcome. CONCLUSION: Many factors play a role in spine surgery complications in LMICs, including limited access to intra-operative technology, low follow-up rates, and minimal physiotherapy and rehabilitation capabilities. Patients with long delays in presentation, ASIA A injuries, and lumbar-level surgery may be especially susceptible to complications and post-operative morbidity. Despite this, institutions have reported encouraging spine trauma outcomes, and spine surgeries are becoming more accepted and safe operations in many LMICs. Additionally, various groups are working towards equality and training in neurosurgery around the globe using different approaches towards education.Item A Newly Discovered Frontotemporal Nerve: Implications in Treatment of Migraine Headache and Migraine Surgery(2017-01-17) Chung, Michael; Pezeshk, Ronnie; Li, Xingchen; Amirlak, BardiaBACKGROUND: Migraine headaches are a debilitating disease affecting 37 million people, with an incidence of 18% for women and 6% of men. Due to incomplete efficacy of traditional medications, patients often seek more invasive treatments. Surgical decompression of peripheral cranial and spinal nerves at several anatomically studied trigger sites has demonstrated significant efficacy in bringing permanent relief to migraine sufferers. However, some patients who undergo surgery still have residual pain. Up to 17.8% of patients have emergence of pain at a secondary site postoperatively. A theory to explain incomplete surgical outcome is failure to identify and release unknown culprit nerves. In our experience doing frontal nerve decompression on migraine patients, we noticed a previously undescribed accessory nerve in the frontotemporal area. This study reports the incidence and location of this nerve. METHODS: A retrospective review of 103 patients who underwent migraine decompression surgery at UT Southwestern was done. 27 patients were excluded, as they did not undergo frontal site decompression and the area was not visualized. For the included 76 patients, measurements of this nerve had been taken intraoperatively using high-definition endoscopic assistance. RESULTS: Of the original 103 patients reviewed, 76 patients had received frontal endoscopic decompression. Of that group, 56 were female. This frontotemporal nerve was present in 55%, and bilateral incidence was 57%. An accompanying vessel was also present 81% of the time. Both nerve and vessel varied in size. Consistently, the nerve exited a foramen in the frontal bone on average 3.4 cm (SD = 0.47 cm) superior to the lateral canthus. CONCLUSION: The identification and avulsion of this nerve may result in a better surgical response rate. Additionally, this nerve should be considered during nerve block and onabotulinum toxin injections to improve outcome and accuracy. A review of available anatomical textbooks and current literature did not yield a nerve similar to the one described here. Our description of this newly discovered nerve may have implications for other anatomical and surgical uses.Item [News](1981-01-05) Rutherford, SusanItem A Parent's Guide to Pediatric Epilepsy Surgery(2011-02-01) Bagnall, Kristen Marie; Calver, Lewis E.The goal of this project was to create an online parent education resource to guide parents through the process of pediatric epilepsy surgery. I created an interactive, web-based program that included photographs documenting the process, brain scans, illustrations of brain anatomy, success-story videos, frequently asked questions, a glossary, helpful links, and printable PDFs. The program was created for English-speaking families, but it was built with the intention of adding a Spanish version at a later date. The program was also designed as a trusted resource for the families considering epilepsy surgery at Children’s Medical Center, Dallas. The doctors of the Epilepsy Team at Children’s evaluated the program for its clinical relevance and usefulness for their current and future patients. Further testing and feedback from parents can be acquired after the Spanish version is complete and the program is integrated into the website of the Comprehensive Epilepsy Center.Item Pre-Surgical fMRI Mapping of Language: Accuracy of Mapping Language Regions in Patients with Mass Lesions(2017-01-17) Thrikutam, Nikhitha; O'Neill, Thomas; Yetkin, Zerrin; Patel, ToralOBJECTIVES: (1) To introduce a novel methodology for co-registration of pre- and post-surgical clinical imaging. (2) To document prognostic imaging correlates of functional imaging/tractography to post-surgical outcome. BACKGROUND: The accuracy, reproducibility, and clinical applicability of pre-surgical imaging evaluation of language in patients with mass lesions near language areas has been previously demonstrated by this group. The accuracy and clinical applicability of pre-surgical mapping can be confirmed by correlating pre-surgical imaging to post-surgical imaging and then to any related language deficits. It is hypothesized that if the surgical resection cavity includes areas of language activation language deficits will result. Correlation of outcomes with language mapping and post-surgical imaging has not been documented in the literature. MATERIALS AND METHODS: Pre-surgical functional maps and diffusion tensor tracts were created utilizing AFNI and DynaSuite software following fMRI/DTI tractography protocol to evaluate language regions. Post-surgical follow-up of speech deficits was obtained from the medical charts. A computerized method was used to co-register pre- and post-surgical images. Multiple variables including structural, functional, and clinical findings were documented and analyzed for correlation to outcome. RESULTS: 13 patients with left-sided mass lesions with complete pre- and post-surgical clinical imaging and clinical evaluation were included in this retrospective study. Of the 13 patients only 1 patient was noted to have a severe post-operative language deficit and 4 patients were noted to have moderate post-operative laguage deficits. Accurate co-registration was achieved in all cases. Prognostic indicators of language deficits included proximity of activation to the resection cavity, the level of resection, and involvement of the adjacent trajectory of arcuate fasciculus. CONCLUSIONS: (1) Pre-surgical fMRI was accurately co-registered with post-surgical images. (2) Structural, functional, and DTI images were shown to have prognostic value for post-surgical language deficits.