Minimally invasive exoscope-assisted coccygectomy: A novel approach for chronic refractory coccydynia.

Background: This technical note presents a novel minimally invasive exoscope assisted coccygectomy to treat chronic refractory coccydynia. Traditional treatments often fail to provide adequate relief for this debilitating condition, prompting the need to explore surgical approaches.

Case Description: A 40-year-old female patient with persistent pain unresponsive to conservative treatments underwent this advanced procedure.

Spinal brachytherapy.

Brachytherapy remains an underrecognized and underutilized radiation therapy modality for the treatment of spinal tumors. This article summarizes the existing body of medical literature on the usage, indications, techniques, and outcomes of brachytherapy for the treatment of spine tumors. The disease pathology most commonly treated with brachytherapy is metastatic spine cancer, rather than primary bone tumors of the spine.

Craniocervical instability in patients with Ehlers-Danlos syndrome: controversies in diagnosis and management.

Ehlers-Danlos syndrome (EDS) is a rare hereditary condition that can result in ligamentous laxity and hypermobility of the cervical spine. A subset of patients can develop clinical instability of the craniocervical junction associated with pain and neurological dysfunction, potentially warranting treatment with occipitocervical fixation (OCF). Surgical decision-making in patients with EDS can be complicated by difficulty distinguishing from hypermobility inherent in the disease and true pathological instability necessitating intervention.

Vascular Myelopathy Secondary to Compression of the Artery of Adamkiewicz From an Intrathecal Catheter: A Technical Case Report.

Background And Importance: Although catheter-related complications in intrathecal drug delivery systems are relatively common, vascular myelopathy secondary to occlusion of the artery of Adamkiewicz (AoA) from an abutting intrathecal catheter has not yet been reported. In this study, we present a case of this extremely rare presentation, which resolved after decompression of the artery.

Clinical Presentation: A 39-year-old woman presented with lower extremity weakness and paresthesia.

Endoscope-Assisted Retroperitoneal Prepsoas Approach to Lumbar Intervertebral Disk Decompression. Technical Note.

Background: Increasingly there is an impetus on the part of surgeons to find more minimally invasive approaches to treat spinal pathologies. Retroperitoneal prepsoas and transpsoas approaches to the lumbar spine are one such example gaining increased attention. Endoscope-assisted approaches may help further reduce soft tissue dissection.

Fifty years later: the "rule of Spence" is finally ready for retirement.

Determination of the optimal approach to traumatic atlas fractures with or without transverse atlantal ligament (TAL) injury requires a nuanced understanding of the biomechanics of the atlantoaxial complex. The "rule of Spence" (ROS) was created in 1970 in a landmark effort to streamline management of burst-type atlas fractures. The ROS states that radiographic evidence of lateral mass displacement (LMD) (i.

Laser interstitial thermal therapy (LITT) for intracranial lesions: a single-institutional series, outcomes, and review of the literature.

Introduction: Laser interstitial thermal therapy (LITT) is a minimally invasive treatment method in managing primary brain neoplasms, brain metastases, radiation necrosis, and epileptogenic lesions, many of which are located in operative corridors that would be difficult to address. Although the use of lasers is not a new concept in neurosurgery, advances in technology have enabled surgeons to perform laser treatment with the aid of real-time MRI thermography as a guide. In this report, we present our institutional series and outcomes of patients treated with LITT.

Transcranial Dopplers Revisited: Development of Novel Markers for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage.

Background Cerebral vasospasm has been monitored by conventional angiography or transcranial Doppler (TCD). While angiography is the most accurate and reliable method for detection, TCDs are a noninvasive alternative to monitor onset and resolution of vasospasm. We aim to determine whether alternative TCD parameters rather than Lindegaard ratio lead to an improved method to diagnose and potentially prevent cerebral vasospasm.

Case Series of Skull Base Meningioma Resection in the Octogenarian Population.

 The geriatric population is the fastest growing segment of the American population, and octogenarians are increasingly seen by neurosurgeons for relatively common lesions such as meningiomas. Unfortunately, providers do not have clear data to guide decision-making regarding these lesions, particularly if they involve the skull base. Current research in outcomes among the elderly looks at a wide range of ages, often anyone older than 65.

The clinical impact and safety profile of high-dose intra-arterial verapamil treatment for cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

Background: Cerebral vasospasm (CVS) leads to delayed cerebral ischemia (DCI) and cerebral infarction, a potential cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). The objective of this study was to evaluate the clinical efficacy and safety profile of high-dose IA verapamil for aSAH in a large series of patients.

Methods: Between 2011-2019, a retrospective cohort of 188 consecutive patients presenting with aSAH were reviewed.

The use of hospital consumer assessment of healthcare services and the Press Ganey medical practice surveys in guiding surgical patient care practices.

Background: Patient satisfaction questionaries have become popular in the past decade after the institution of the Patient Care and Affordable Care Act of 2010. This study evaluated whether the Hospital Consumer Assessment of Healthcare Services (H-CAHPS) and Press Ganey scores improved after institutional changes to the rounding system.

Methods: In the summer of 2017, utilizing H-CAHPS and Press Ganey scores, we asked whether switching from mid-level rounding providers to resident physicians improved patient care.

The transpalpebral approach "eyelid incision" for surgical management of intracranial tumors: A 10-years' experience.

Background: The minimally invasive approaches to the anterior skull base region through fronto-orbital craniotomy remain a highly accepted option that gains countenance and predilection over time. The transpalpebral "eyelid" incision is an under-utilized and more recent technique that offers a safe efficient corridor to manage a wide variety of lesions.

Methods: We carried a retrospective study of 44 patients operated on by the fronto-orbital craniotomy through transpalpebral "eyelid" incision for intracranial tumors, in the time period from March 2007 to July 2016.

Single-Surgeon Direct Comparison of O-arm Neuronavigation versus Mazor X Robotic-Guided Posterior Spinal Instrumentation.

Objective: We sought to compare intraoperative surgical instrumentation techniques with image-guidance versus robotic-guided procedures for posterior spinal fusion.

Methods: A retrospective review of institutional data collected from a single surgeon was used to compare surgical outcomes between O-arm neuronavigation and the Mazor X robotic-assistance system for placement of posterior spinal instrumentation in a consecutive series of patients. Univariate statistical significance testing compared time spent in the operating room, blood loss, screw accuracy, and wound healing.

Covalent Attachment of P15 Peptide to Ti Alloy Surface Modified with Polymer to Enhance Osseointegration of Implants.

Titanium (Ti) and its alloys are used in orthopedic and dental implants due to their excellent physical properties and biocompatibility. Although Ti exhibits superior osteoconductive properties compared to those of polymer-based implants, improved bone-on growth properties are required for enhanced surgical outcomes and improved recovery surgical interventions. Herein, we demonstrate a novel surface modification strategy to enhance the osteoconductivity of Ti surfaces through the grafting-from procedure of a reactive copolymer via surface-initiated atom transfer radical polymerization (SI-ATRP).

Clinical Outcomes After Spine Surgery for Traumatic Injury in the Octogenarian Population.

Objective: To review the surgical outcomes of the octogenarian population at a single institution after spinal traumatic injury.

Methods: Patients with both radiographic and clinical evidence of acute traumatic spine injury were reviewed using an institutional trauma survey to determine patient demographics and outcome data in a population of patients aged 80 years and older.

Results: Thirty-nine patients aged 80 years and older underwent surgical intervention for acute spinal trauma.

Osteoconductive Enhancement of Polyether Ether Ketone: A Mild Covalent Surface Modification Approach.

Polyether ether ketone (PEEK, ) is an important material for the fabrication of implants employed in spinal fusion surgery. Although its radiolucency and favorable elastic modulus have made PEEK an attractive choice for interbody fusion devices, its poor osseointegrative properties prevent the formation of a strong union between implant and surrounding bone structures and remain a major liability. Recent advancements in PEEK surface technology have resulted in improved osseointegration; however, the identification of an ideal implant material has proven challenging.

Vagal Nerve Stimulation: Indications for Revision in Adult Refractory Epilepsy.

Objective: The goal of this study was to assess the indications of revision for vagal nerve stimulation at a single institution in an adult population with drug-resistant epilepsy.

Methods: This was a retrospective review of a prospectively collected database who underwent vagal nerve stimulator implantation for drug-resistant epilepsy during 1992-2017. Patients receiving vagal nerve stimulation (VNS) implants were monitored throughout their perioperative and postoperative course and were classified according to type of seizure at the time of diagnosis and indications for VNS revision.

Cationic Hyperbranched Polymers with Biocompatible Shells for siRNA Delivery.

Cationic hyperbranched polymers (HBP) were prepared by self-condensing vinyl polymerization of an atom transfer radical polymerization (ATRP) inimer containing a quaternary ammonium group. Two types of biocompatible shells, poly(oligoethylene glycol) methacrylate (polyOEGMA) and poly(2-(methylsulfinyl) ethyl methacrylate) (polyDMSO), were grafted respectively from HBP core to form core-shell structures with low molecular weight dispersity and high biocompatibility, polyOEGMA-HBP and polyDMSO-HBP. Both of the structures showed low cytotoxicity and good siRNA complexing ability.

A consideration for the utility of the post-operative Oswestry Disability Index for measuring outcomes after sacroiliac joint fusion.

Sacroiliac joint (SIJ) dysfunction and its surgical treatment remain a controversial topic in spine surgery. Determining success after SIJ fusion may be difficult due to preexisting back pain, lumbar fusion (LF), and functional disability. We examine the utility of Oswestry Disability Index (ODI) as a measure of clinical outcomes after minimally invasive SIJ fusion.

Craniotomy for subdural hematoma after deep brain stimulation surgery: Outcomes and satisfaction in a case series of two patients.

Objective: To determine whether salvage of DBS hardware is beneficial for Parkinson's Disease (PD) patients by looking at follow-up patient's outcomes and satisfaction after their craniotomy operation.

Patients And Methods: This was a retrospective review of a prospective, single-center deep brain stimulation (DBS) database between 2002-2016 identifying patients with PD who developed subdural hematomas (SDH) due to trauma after their DBS surgery. Of the 636 DBS cases that were performed, 3 PD-DBS patients with significant traumatic SDH managed via craniotomy were identified.

Factor Eight Inhibitor Bypassing Agent (FEIBA) for Reversal of Target-Specific Oral Anticoagulants in Life-Threatening Intracranial Bleeding.

Introduction: As increasing number of patients present to emergency departments with life threatening hemorrhages, particularly intracranial hemorrhage on anticoagulation physicians must be cognizant of the limitations of the available reversal options. Based upon the available literature, our institution formulated a reversal algorithm for patients with life-threatening bleeding on factor Xa inhibitors by administering factor eight inhibitor bypassing agent (FEIBA) 20 units/kg.

Methods: A retrospective chart review was performed to include all patients who received FEIBA per institutional protocol.