A prospective evaluation of cellular bone matrix for posterolateral lumbar fusion.

Introduction: Autograft bone is the gold standard graft used in posterolateral lumbar intertransverse fusion (PLF) but can be limited by supply and donor site morbidity. Cadaveric cellular allografts represent an alternative source of graft material that avoids these limitations.

Objective: To assess the safety and efficacy of ViviGenCellular Bone Matrix in comparison to autograft bone in PLF.

Comparison of intra-operative skull fixation techniques on cervical sagittal parameters.

Background: There is limited literature concerning the use of bi-vector traction to a Mayfield following posterior cervical fusion with respect to cervical alignment parameters. The objective of this study was to determine how variability of intra-operative fixation methods for posterior cervical fusion affects post-operative cervical sagittal alignment parameters.

Methods: After institutional review board (IRB) approval, retrospective chart review of a total of 54 patients who underwent posterior cervical fusion from July 2017 to December 2019 was conducted.

Neurosurgical Management of Patients with Alpha-Gal Syndrome.

Alpha-gal syndrome (AGS) is an immunoglobulin E-mediated hypersensitivity to galatcose-alpha-1,3-galactose (alpha-gal), a carbohydrate compound present in nonprimate mammalian products. Initial exposure to alpha-gal most often occurs through a tick bite, most commonly the lone star tick in the United States. Repeated exposure to alpha-gal may elicit severe allergic reactions, including anaphylaxis.

Real-time ultrasound guidance in the endoscopic endonasal resection of a retro-odontoid pannus: Technical note and case illustration.

Background And Objectives: Odontoidectomy is a surgical procedure indicated in the setting of various pathologies, with the main goal of decompressing the ventral brain stem and spinal cord as a result of irreducible compression at the craniovertebral junction. The endoscopic endonasal approach has been increasingly used as an alternative to the transoral approach as it provides a straightforward, panoramic, and direct approach to the odontoid process. In addition, intraoperative ultrasound (US) guidance is a technique that can optimize safety and surgical outcomes in this context.

Surgical Characteristics of Intracranial Biopsy Using a Frameless Stereotactic Robotic Platform: A Single-Center Experience.

Background And Objectives: Cranial robotics are a burgeoning field of neurosurgery. To date, all cranial robotic systems described have been computerized, arm-based instruments that take up significant space in the operating room. The Medtronic Stealth Autoguide robot has a smaller operating room footprint and offers multiaxial, frame-based surgical targeting.

Middle Meningeal Artery Embolization for Membranous Versus Nonmembranous Subdural Hematomas: A Retrospective and Multicenter Cohort Study.

Background: Middle meningeal artery (MMA) embolization is a treatment option for chronic subdural hematomas (SDHs). The theorized mechanism of MMA embolization is devascularization of membranes that contribute to recurrence. In the present study, we aimed to determine whether MMA embolization is more efficacious for SDHs with radiographically visible membranes.

Long-term safety of MRI-guided administration of AAV2-GDNF and gadoteridol in the putamen of individuals with Parkinson's disease.

Direct putaminal infusion of adeno-associated virus vector (serotype 2) (AAV2) containing the human glial cell line-derived neurotrophic factor (GDNF) transgene was studied in a phase I clinical trial of participants with advanced Parkinson's disease (PD). Convection-enhanced delivery of AAV2-GDNF with a surrogate imaging tracer (gadoteridol) was used to track infusate distribution during real-time intraoperative magnetic resonance imaging (iMRI). Pre-, intra-, and serial postoperative (up to 5 years after infusion) MRI were analyzed in 13 participants with PD treated with bilateral putaminal co-infusions (52 infusions in total) of AAV2-GDNF and gadoteridol (infusion volume, 450 mL per putamen).

Current Indications for Management Options in Pseudotumor Cerebri.

There are surgical options available for those patients with idiopathic intracranial hypertension (IIH) who have significant visual threat or visual deterioration despite best medical management or whose visual deterioration is rapid enough to warrant urgent intervention. Optic nerve sheath fenestrations, venous sinus stenting, and cerebrospinal fluid diversion via ventriculoperitoneal and lumboperitoneal shunting are useful adjuncts in the management of this condition. Significant resources are used in the care of patients with IIH.

Sex differences in thrombosis as it affects acute ischemic stroke.

Ischemic stroke is a devastating health problem, affecting approximately 800,000 patients in the US every year, making it the leading cause of combined death and disability in the country. Stroke has historically been thought of as predominantly impacting men, however it is becoming increasingly clear that stroke affects women to a greater degree than men. Indeed, women have worse outcomes compared to men following ischemic stroke.

Static Cage Morphology in Short-Segment Transforaminal Lumbar Interbody Fusions Is Associated With Alterations in Foraminal Height But Not Clinical Outcomes.

Introduction: Steerable "banana" cages have been posited to increase segmental lordosis in short-segment transforaminal lumbar interbody fusions (TLIF). The same is not necessarily true for straight "bullet" cages. Although increased lordosis is generally thought to be advantageous, a potential complication is decreased foraminal height.

Negative pressure wound therapy in spinal fusion patients.

Post-operative wound complications are some of the most common acute complications following spine surgery. These surgical site infections (SSI) contribute to increased healthcare related costs. Negative pressure wound therapy (NPWT) has long been used for treatment of soft tissue injury or defects.

Direct convective delivery of adeno-associated virus gene therapy for treatment of neurological disorders.

Molecular biological insights have led to a fundamental understanding of the underlying genomic mechanisms of nervous system disease. These findings have resulted in the identification of therapeutic genes that can be packaged in viral capsids for the treatment of a variety of neurological conditions, including neurodegenerative, metabolic, and enzyme deficiency disorders. Recent data have demonstrated that gene-carrying viral vectors (most often adeno-associated viruses) can be effectively distributed by convection-enhanced delivery (CED) in a safe, reliable, targeted, and homogeneous manner across the blood-brain barrier.

C1-2 facet disarticulation for correction of iatrogenic cervical kyphosis following occipital-cervical fusion.

The patient is a 69-year-old woman with a history of atlantoaxial instability and cervical pain who underwent an occipital-cervical fusion at an outside hospital. Five days following the procedure she required a PEG tube due to progressive dysphagia. Compared with preoperative imaging, x-ray shows cervical spine hyperextension with a significant decrease in the occipital-C2 angle.

Transpedicular Vertebrectomy With Circumferential Spinal Cord Decompression and Reconstruction for Thoracic Spine Metastasis: A Consecutive Case Series.

Study Design: Retrospective case series.

Objective: To study the feasibility, outcomes, and complications of transpedicular vertebrectomy (TPV), and reconstruction for metastatic lesions to the thoracic spine.

Summary Of Background Data: Metastatic lesions to the thoracic spine may need surgical treatment requiring anterior-posterior decompression/stabilization.

Acute presentation of spinal gouty arthritis: A case report and review of literature.

Background: Gout is an inflammatory arthritis that results from faulty purine metabolism, affecting approximately 4% of adults in the US, and predominately affects people in the fourth decade of life. Further, spinal gout is rarely the first presentation of gout, especially in younger individuals.

Case Description: A 26-year-old male came to the emergency room with acute lower extremity numbness and weakness.

Intraosseous Orbital Cavernous Hemangioma with Frontal Extension and Dural Involvement.

Primary intraosseous cavernous hemangiomas are rare skull lesions that are not typically known to involve the orbital bones or the dura. We describe a rare case of a fronto-orbital bone cavernous hemangioma with extension into the dura. A 68-year-old female presented with a one-year history of diplopia with discomfort around her left orbit.

Cardiovascular Health in St. Louis Bosnian-Americans.

In Bosnia and Herzegovina, cardiovascular disease accounts for nearly 50% of deaths. Cardiovascular health of resettled Bosnian-Americans has not been well-characterized. Our study aimed to quantify cardiovascular risk in Bosnian-Americans in St.

Recurrent hemorrhage in hemangioblastoma involving the posterior fossa: Case report.

Background: Hemangioblastomas (HGBs) are the most common primary intra-axial posterior fossa tumor in adults. Although spontaneous hemorrhage of these tumors is exceedingly rare, despite their vascular nature, we describe a case of recurrent hemorrhage with associated tonsillar herniation, and demonstrate that a surgical approach can provide a suitable outcome.

Case Description: A 54-year-old female with von Hippel-Lindau (VHL) syndrome presented with acute loss of consciousness and Glasgow Coma Scale (GCS) was 4.

The temporoparietal fascia flap for coverage of cochlear reimplantation following extrusion.

The management of cochlear implant extrusion (CIE) can be challenging, particularly in the pediatric population in whom reconstructive options are limited. We describe the use of the temporoparietal fascia flap (TPFF) for this purpose due to its ease of use and limited morbidity. We present a case series of two pediatric patients who underwent explantation of their devices, followed by reimplantation with TPFF coverage.