The use of ultrasound-guided imaging to localize peripheral nerve injury in pediatric patients: A case report.

Background: The use of ultrasonography to diagnose and manage peripheral nerve injury is not routinely performed, but is an advantageous alternative to magnetic resonance imaging (MRI) in the pediatric population.

Case Description: The authors report a case of a toddler-aged female who sustained a supracondylar fracture and subsequent median and ulnar nerve injuries. All preoperative and postoperative imaging was performed through high-resolution ultrasound as opposed to MRI.

Brain and lung metastasis of uterine leiomyosarcoma: illustrative case.

Background: Uterine leiomyosarcoma is a rare, extremely aggressive tumor with a high rate of metastasis. Five-year survival for individuals with metastatic disease is only 10%-15%. Metastases to the brain are exceptionally rare and are associated with poor survival.

Structural Changes in the Cervicomedullary Junction in Adult Chiari Patients.

Objective: To assess volumetric changes in the spinal cord at the cervicomedullary junction, diameter of the cervicomedullary cord, and width of the brainstem following posterior fossa decompression (PFD).

Methods: A retrospective analysis of adult patients with Chiari malformation who underwent PFD was performed. Segmentations were done on clinical quality T2-weighted cervical magnetic resonance images obtained before and after decompression using ITK-SNAP.

High-Dose Rate Interstitial Spine Brachytherapy Using an Intraoperative Mobile Computed Tomography-Guided Surgical Navigation System.

Background: Up to 15% of previously irradiated metastatic spine tumors will progress. Re-irradiation of these tumors poses a significant risk of exceeding the radiation tolerance to the spinal cord. High-dose rate (HDR) brachytherapy is a treatment alternative.

Perioperative dual antiplatelet therapy for patients undergoing spine surgery soon after drug eluting stent placement.

Background: Performing emergent spinal surgery within 6 months of percutaneous placement of drug-eluting coronary stent (DES) is complex. The risks of spinal bleeding in a "closed space" must be compared with the risks of stent thrombosis or major cardiac event from dual antiplatelet therapy (DAPT) interruption.

Methods: Eighty relevant English language papers published in PubMed were reviewed in detail.

Predicting Spinal Surgery Candidacy From Imaging Data Using Machine Learning.

Background: The referral process for consultation with a spine surgeon remains inefficient, given a substantial proportion of referrals to spine surgeons are nonoperative.

Objective: To develop a machine-learning-based algorithm which accurately identifies patients as candidates for consultation with a spine surgeon, using only magnetic resonance imaging (MRI).

Methods: We trained a deep U-Net machine learning model to delineate spinal canals on axial slices of 100 normal lumbar MRI scans which were previously delineated by expert radiologists and neurosurgeons.

Eigenrank by committee: Von-Neumann entropy based data subset selection and failure prediction for deep learning based medical image segmentation.

Manual delineation of anatomy on existing images is the basis of developing deep learning algorithms for medical image segmentation. However, manual segmentation is tedious. It is also expensive because clinician effort is necessary to ensure correctness of delineation.

Clinical and surgical management of holocervical spinal cord ependymomas.

Background: Spinal ependymomas are rare tumors of the central nervous system, and those spanning the entire cervical spine are atypical. Here, we present two unusual cases of holocervical (C1-C7) spinal ependymomas.

Case Description: Two patients, a 32-year-old female and a 24-year-old male presented with neck pain, motor, and sensory deficits.

Comparison of Clinical Outcomes Stratified by Target Delineation for Patients Undergoing Stereotactic Body Radiotherapy for Spinal Metastases.

Objective: Stereotactic body radiotherapy (SBRT) is an effective treatment of spinal metastases in the vertebral body. However, variation has existed between practitioners regarding the appropriate target delineation. As such, we compared the tumor control, rates of compression fractures, and pain control for patients who had undergone SBRT for spinal metastases to either the lesion only (LO) or the full vertebral body (FVB).

Natural history of the aging spine: a cross-sectional analysis of spinopelvic parameters in the asymptomatic population.

Objective: There have been numerous studies demonstrating increased pain and disability when patients' spinopelvic parameters fall outside of certain accepted ranges. However, these values were established based on patients suffering from spinal deformities. It remains unknown how these parameters change over a lifetime in asymptomatic individuals.

Prediction of post-operative delayed hyponatremia after endoscopic transsphenoidal surgery.

Objectives: Delayed symptomatic hyponatremia is a known phenomenon occurring > 3 days after transsphenoidal surgery. This is a significant cause of post-operative emergency room visits and re-admissions. We describe and characterize post-operative hyponatremia in patients undergoing endoscopic transsphenoidal surgery, identify predictive factors, and create a clinical tool for predicting high risk patients.

Quantitative Analysis of Neural Foramina in the Lumbar Spine: An Imaging Informatics and Machine Learning Study.

Purpose: To use machine learning tools and leverage big data informatics to statistically model the variation in the area of lumbar neural foramina in a large asymptomatic population.

Materials And Methods: By using an electronic health record and imaging archive, lumbar MRI studies in 645 male (mean age, 50.07 years) and 511 female (mean age, 48.

Epithelioid Osteoblastoma of the Temporal Bone: A Case Report.

Background: Epithelioid osteoblastoma of the cranium is extremely rare and can mimic other etiologies on radiographic imaging, pathology, and symptomatology.

Case Description: An 18-year-old male patient had a 3-week history of a palpable left temporal mass. Magnetic resonance imaging revealed a large, extra-axial, hypervascular mass in the left temporal bone, with bony erosion and intracranial extension.

Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients.

Background: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons.

Multi-Parameter Ensemble Learning for Automated Vertebral Body Segmentation in Heterogeneously Acquired Clinical MR Images.

The development of quantitative imaging biomarkers in medicine requires automatic delineation of relevant anatomical structures using available imaging data. However, this task is complicated in clinical medicine due to the variation in scanning parameters and protocols, even within a single medical center. Existing literature on automatic image segmentation using MR data is based on the analysis of highly homogenous images obtained using a fixed set of pulse sequence parameters (TR/TE).

A Rodent Model of Dynamic Facial Reanimation Using Functional Electrical Stimulation.

Facial paralysis can be a devastating condition, causing disfiguring facial droop, slurred speech, eye dryness, scarring and blindness. This study investigated the utility of closed-loop functional electric stimulation (FES) for reanimating paralyzed facial muscles in a quantitative rodent model. The right buccal and marginal mandibular branches of the rat facial nerve were transected for selective, unilateral paralysis of whisker muscles.

Direct versus indirect revascularization procedures for moyamoya disease: a comparative effectiveness study.

OBJECTIVE Moyamoya disease (MMD) is a chronic cerebrovascular disease that can lead to devastating neurological outcomes. Surgical intervention is the definitive treatment, with direct, indirect, and combined revascularization procedures currently employed by surgeons. The optimal surgical approach, however, remains unclear.

Long-term quality of life after posterior cervical foraminotomy for radiculopathy.

Objectives: Cervical radiculopathy may cause symptoms and loss of function that can lead to a significant reduction in health related quality of life (HRQOL). As part of a comprehensive review of long-term outcomes, we examined HRQOL in a large cohort of patients undergoing posterior cervical foraminotomy (FOR) for radiculopathy.

Patients And Methods: 338 patients who underwent FOR between 1990 and 2009 participated in a telephone interview designed to measure symptomatic and functional improvements following surgery.

The effects of acute cortical somatosensory deafferentation on grip force control.

Grip force control involves mechanisms to adjust to unpredictable and predictable changes in loads during manual manipulation. Somatosensory feedback is critical not just to reactive, feedback control but also to updating the internal representations needed for proactive, feedforward control. The role of primary somatosensory cortex (S1) in these control strategies is not well established.

Anterior temporal lobectomy compared with laser thermal hippocampectomy for mesial temporal epilepsy: A threshold analysis study.

Purpose: Anterior Temporal Lobectomy (ATL) is the gold standard surgical treatment for refractory temporal lobe epilepsy (TLE), but it carries the risks associated with invasiveness, including cognitive and visual deficits and potential damage to eloquent structures. Laser thermal hippocampectomy (LTH) is a new procedure that offers a less invasive alternative to the standard open approach. In this decision analysis, we determine the seizure freedom rate at which LTH would be equivalent to ATL.

Giant cystic sacral schwannoma mimicking tarlov cyst: a case report.

Purpose: To present a rare case of a giant schwannoma of the sacrum mimicking a Tarlov cyst.

Methods: A 58-year-old woman had a 1-year history of low back pain. MRI revealed a large cystic mass in the sacral canal with bony erosion.

Imaging patterns predict patient survival and molecular subtype in glioblastoma via machine learning techniques.

Background: MRI characteristics of brain gliomas have been used to predict clinical outcome and molecular tumor characteristics. However, previously reported imaging biomarkers have not been sufficiently accurate or reproducible to enter routine clinical practice and often rely on relatively simple MRI measures. The current study leverages advanced image analysis and machine learning algorithms to identify complex and reproducible imaging patterns predictive of overall survival and molecular subtype in glioblastoma (GB).

Reducing surgical site infections following craniotomy: examination of the use of topical vancomycin.

Object: Although the use of topical vancomycin has been shown to be safe and effective for reducing postoperative infection rates in patients after spine surgery, its use in cranial wounds has not been studied systematically. The authors hypothesized that topical vancomycin, applied in powder form directly to the subgaleal space during closure, would reduce cranial wound infection rates.

Methods: A cohort of 150 consecutive patients who underwent craniotomy was studied retrospectively.

Ventriculoperitoneal shunt placement for POEMS syndrome.

We report a 41-year-old woman with a history of an uncomplicated spinal hemangioma resection, who developed acute onset sensory-motor polyneuropathy following influenza vaccine administration. With extensive workup she was diagnosed with POEMS syndrome with progressive headaches, visual loss with papilledema, and repeated elevated lumbar puncture opening pressures despite treatment with acetazolamide and immunosuppressive therapy. Her symptoms dramatically improved following ventriculoperitoneal shunt placement.