Stereotactic and Functional Neurosurgery Convection-Enhanced Delivery of Autologous Cerebrospinal Fluid Enhances Basal Ganglia Visualization during MRI-Guided Deep Brain Stimulation Surgery.

Introduction: The aim of this study was to determine the safety and feasibility of convection-enhanced delivery of autologous cerebrospinal fluid (CSF) for enhancing intraoperative magnetic resonance imaging (MRI) of the basal ganglia during stereotactic neurosurgery.

Methods: This pilot study was conducted in 4 patients with Parkinson's disease (PD) who underwent MRI-guided deep brain stimulation of the globus pallidus internus (GPi). CSF was obtained via lumbar puncture after general anesthesia and prior to incision.

Effect of Nanopore Geometry in the Conformation and Vibrational Dynamics of a Highly Confined Molecular Glass.

The effect of nanoporous confinement on the glass transition temperature () strongly depends on the type of porous media. Here, we study the molecular origins of this effect in a molecular glass, -bis(3-methylphenyl)--diphenylbenzidine (TPD), highly confined in concave and convex geometries. When confined in controlled pore glass (CPG) with convex pores, TPD's vibrational spectra remained unchanged and two 's were observed, consistent with previous studies.

Focused ultrasound thalamotomy in Parkinson disease: Nonmotor outcomes and quality of life.

Objective: To examine nonmotor outcomes and correlates of quality of life (QoL) 3 and 12 months after unilateral focused ultrasound thalamotomy in tremor-dominant Parkinson disease (TDPD).

Methods: Twenty-seven patients with TDPD in a double-blind, sham-controlled, randomized clinical trial underwent comprehensive neuropsychological evaluations. These included assessment of mood, behavior, and QoL at baseline, 3 months, 3 months post crossover in the sham group, and 12 months after active treatment.

Predicting lesion size during focused ultrasound thalamotomy: a review of 63 lesions over 3 clinical trials.

OBJECTIVE The goal of this study was to improve the predictability of lesion size during focused ultrasound (FUS) thalamotomy procedures. METHODS Treatment profiles and T2-weighted MRI (T2 MRI) studies obtained in 63 patients who participated in 3 clinical trials of FUS thalamotomy from February 2011 to March 2015 were reviewed retrospectively. Four damage estimate models were compared with lesion sizes measured on postprocedural T2 MRI.

Transcranial magnetic resonance imaging-guided focused ultrasound thalamotomy for tremor: technical note.

Although the use of focused ultrasound (FUS) in neurosurgery dates to the 1950s, its clinical utility was limited by the need for a craniotomy to create an acoustic window. Recent technological advances have enabled efficient transcranial delivery of US. Moreover, US is now coupled with MRI to ensure precise energy delivery and monitoring.

Safety and Efficacy of Focused Ultrasound Thalamotomy for Patients With Medication-Refractory, Tremor-Dominant Parkinson Disease: A Randomized Clinical Trial.

Importance: Clinical trials have confirmed the efficacy of focused ultrasound (FUS) thalamotomy in essential tremor, but its effectiveness and safety for managing tremor-dominant Parkinson disease (TDPD) is unknown.

Objective: To assess safety and efficacy at 12-month follow-up, accounting for placebo response, of unilateral FUS thalamotomy for patients with TDPD.

Design, Setting, And Participants: Of the 326 patients identified from an in-house database, 53 patients consented to be screened.

Convection-enhanced delivery improves MRI visualization of basal ganglia for stereotactic surgery.

OBJECTIVE Stereotactic deep brain stimulation surgery is most commonly performed while patients are awake. This allows for intraoperative clinical assessment and electrophysiological target verification, thereby promoting favorable outcomes with few side effects. Intraoperative CT and MRI have challenged this concept of clinical treatment validation.

Complicated Pseudomeningocele Repair After Chiari Decompression: Case Report and Review of the Literature.

Background: Pseudomeningocele is a recognised complication after posterior fossa decompression for Chiari malformation. Its management can be challenging and treatment options vary in literature.

Case Description: A difficult-to-treat case of a pseudomeningocele after posterior fossa decompression for a Chiari I malformation is presented.

Concurrent Alzheimer's pathology in patients with clinical normal pressure hydrocephalus: correlation of high-volume lumbar puncture results, cortical brain biopsies, and outcomes.

Objective: Normal pressure hydrocephalus (NPH) remains most often a clinical diagnosis and has been widely considered responsive to the placement of a cerebrospinal fluid (CSF) shunt. The high incidence of patients with Alzheimer's disease (AD) with NPH symptoms leads to poorer outcomes than would be expected in patients with NPH alone. This article reviews a series of patients operated on for presumed NPH in whom preoperative high-volume lumbar puncture (HVLP) and intraoperative cortical brain biopsies were performed.

Changes in cerebrospinal fluid flow assessed using intraoperative MRI during posterior fossa decompression for Chiari malformation.

OBJECT The authors completed a prospective, institutional review board-approved study using intraoperative MRI (iMRI) in patients undergoing posterior fossa decompression (PFD) for Chiari I malformation. The purpose of the study was to examine the utility of iMRI in determining when an adequate decompression had been performed. METHODS Patients with symptomatic Chiari I malformations with imaging findings of obstruction of the CSF space at the foramen magnum, with or without syringomyelia, were considered candidates for surgery.

Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp Grades 0-2 nonfunctioning pituitary macroadenomas at a single institution.

Object: The object of this study was to compare surgical outcomes and complications in a contemporaneous series of patients undergoing either microscopic or endoscopic transsphenoidal surgery for nonfunctioning pituitary macroadenomas without imaging evidence of cavernous sinus invasion.

Methods: This is a retrospective analysis of a prospectively collected database from a single institution. Data were collected from patients whose surgery had occurred in the period from June 2010 to January 2013.

Spinal arachnoid cysts in the pediatric population: report of 31 cases and a review of the literature.

Object: The goal of this study was to review all cases of pediatric spinal arachnoid cysts (SACs) surgically treated at the authors' institution between 1992 and 2008 and to compare these cases to the published literature for the general population.

Methods: The charts of all pediatric patients with SACs were reviewed for demographics, medical history, presenting symptoms, imaging findings, operative procedure(s), complications, and outcomes. Following a complete literature review, the pediatric data were compared with data from the general population and unique findings associated with pediatric patients were identified.

Incidence trends in the anatomic location of primary malignant brain tumors in the United States: 1992-2006.

Background: This study sought to determine incidence trends of the anatomical origin of primary malignant brain tumors.

Methods: Incidence data for histologically confirmed brain tumors were obtained from the Los Angeles County Cancer Surveillance Program (LAC), the California Cancer Registry (CCR), and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for 1992 to 2006. Age-adjusted incidence rates (AAIR) and annual percent changes (APC) were calculated by histologic subtypes and anatomic subsites.

Operative strategies for minimizing hearing loss and other major complications associated with microvascular decompression for trigeminal neuralgia.

Objective: To retrospectively assess the surgical outcomes and complication rates following microvascular decompression (MVD) for trigeminal neuralgia, using a targeted, restricted retrosigmoid approach.

Methods: During the period 1994-2009, a total of 119 patients underwent MVD for trigeminal neuralgia. A retrospective review was conducted in order to assess pain outcomes following surgery and at most recent follow-up.

Ultrasound-determined diameter measurements are more accurate than axial computed tomography after endovascular aortic aneurysm repair.

Objective: This study evaluated the correlation of ultrasound (US)-derived aortic aneurysm diameter measurements with centerline, three-dimensional (3-D) reconstruction computed tomography (CT) measurements after endovascular aortic aneurysm repair (EVAR).

Methods: Concurrent CT and US examinations from 82 patients undergoing post-EVAR surveillance were reviewed. The aortic aneurysm diameter was defined as the major axis on the centerline images of 3-D CT reconstruction.

The influence of stents on the performance of an ultrasonic navigation system for endovascular procedures.

Objective: Image-guided surgery provides a mechanism to accurately and quickly assess the location of surgical tools relative to a preoperative image. Traditional image-guided surgery relies on infrared or radiofrequency triangulation to determine an instrument location relative to a preoperative image and has been primarily used in head and neck procedures. Advances in ultrasonic tracking devices, designed for tracking catheters within vessels, may provide an opportunity for image-guided endovascular procedures.

An ultrasonic navigation system for endovascular aortic repair.

The objective of our research is to develop an ultrasound, time-of-flight triangulation based system for real-time, intraoperative 3-dimensional tracking of minimally invasive surgical instruments. We have chosen to first apply this technology towards tracking catheters used in endovascular aortic stent-grafting. To demonstrate the feasibility of this concept, we have developed a system involving a custom catheter based transducer and performed an experiment in excised porcine tissue with a model aorta.

Exenatide (Byetta) as a novel treatment option for type 2 diabetes mellitus.

Exenatide is the first drug in the incretin mimetic class and is indicated for treatment of type 2 diabetes mellitus. Although structurally similar to the native glucagon-like peptide, this synthetic form has a much longer duration of action. Randomized trials have shown exenatide to be efficacious in improving glycemic control when combined with either metformin or a sulfonylurea.