Publications by authors named "Michael Spadola"

Background: Three column osteotomies (3CO) are a powerful tool for the correction of rigid sagittal spinal deformities. However, 3CO surgeries are technically demanding procedures that are associated with prolonged operative times, large amounts of intraoperative blood loss, and high rates of post-operative neurological and medical complications. The purpose of this retrospective cross-sectional study is to delineate the effects of blood loss, blood transfusion, and tranexamic acid use on perioperative outcomes following 3CO.

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 Arterial compression of the trigeminal nerve at the root entry zone has been the long-attributed cause of compressive trigeminal neuralgia despite numerous studies reporting distal and/or venous compression. The impact of compression type on patient outcomes has not been fully elucidated.  We categorized vascular compression (VC) based on vessel and location of compression to correlate pain outcomes based on compression type.

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Objective: The authors designed a low-profile device for reliable ventricular access and prospectively studied its safety, efficacy, and accuracy at a large academic center.

Methods: A novel device for ventricular entry, the Device for Intraventricular Entry (DIVE) guide, was designed and created by the first and senior authors. Fifty patients undergoing external ventricular drainage (EVD) or shunt placement were prospectively enrolled for DIVE-assisted catheter placement at a single academic center.

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Article Synopsis
  • This study compares the outcomes and costs of staged (ST) versus same-day (SD) circumferential spinal fusion surgeries for adult spinal deformity correction over a period from 2013 to 2018.
  • A total of 211 patients were reviewed, focusing on factors such as surgical details, complications, readmissions, and hospital costs, applying statistical methods to account for differences in patient characteristics between the two groups.
  • Results indicated that while ST procedures had higher rates of postoperative pulmonary embolism and longer hospital stays, overall 30-day readmission and reoperation rates were similar between the ST and SD groups after statistical adjustment.
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Background: Lumbar drain (LD) placement can be a difficult procedure leading to postprocedure complications, particularly in patients with persistent cerebrospinal fluid leaks or a large body habitus. The objective of this technical case report is to describe the use of Medtronic's SureTrak Navigation system for navigated LD placement.

Case Description: The patient was an 18-year-old morbidly obese male who initially underwent a suboccipital craniectomy with duraplasty and a C1 laminectomy for Chiari Malformation.

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Article Synopsis
  • Posterior cervical foraminotomy (PCF) and anterior cervical discectomy and fusion (ACDF) are two surgical methods for treating cervical radiculopathy, and this study compares their effectiveness.
  • The research analyzed data from patients who underwent either surgery from 2014 to 2021, including factors like demographics, surgery details, and reoperation rates.
  • Findings showed no significant difference in reoperation rates or effectiveness between the two procedures, but ACDF resulted in longer hospital stays and higher readmission rates.
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Background: Intraoperative hypotension (IOH) has been found to be associated with organ damage, including cardiac injury and acute kidney injury (AKI). However, to our knowledge, this relationship has not been studied in a neurosurgery-specific patient population. In this report, we review our institutional experience to understand the magnitude of association between IOH in spinal fusion operations and incidence of postoperative AKI.

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Objective: Preoperative magnetic resonance imaging (MRI) studies are routinely ordered for trigeminal neuralgia (TN), though with contested reliability in contemporary literature. A potential reason for this disagreement is inconsistency in MRI reading methodologies. Here, we compare the rate of reported neurovascular compression on preoperative MRI by radiologists employed in community or private practice settings and academic neuroradiologists.

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Study Design: : Retrospective Chart Review.

Objectives: Incidental durotomies (IDs) are common spine surgery complications. In this study, we present a review on the most commonly utilized management strategies, report our institutional experience with case examples, and describe a stepwise management algorithm.

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Background: Rigid fixation using a three-point skull clamp is a common practice during cranial surgery. Despite its frequency of use, rigid fixation is not without risk of complications including hemodynamic changes, skull fractures and venous thromboembolism. Given this, alternative head fixation should be considered when clinically appropriate.

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Introduction By identifying drivers of healthcare disparities, providers can better support high-risk patients and develop risk-mitigation strategies. Household income is a social determinant of health known to contribute to healthcare disparities. The present study evaluates the impact of household income on short-term morbidity and mortality following supratentorial meningioma resection.

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Background: Surgical site infections (SSIs) after spine surgery are a significant cause of morbidity. Surgeons often prescribe oral antibiotics in the postoperative setting for infected-appearing wounds to prevent reoperation for infection; however, the efficacy of this practice has not been well studied.

Methods: Neurosurgical spine patients with clinical concerns for SSI at the University of Pennsylvania were retrospectively studied from 2014 to 2018.

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 The present study examines the effect of median household income on mid- and long-term outcomes in a posterior fossa brain tumor resection population.  This is a retrospective regression analysis.  The study conducted at a single, multihospital, urban academic medical center.

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A 57-year-old female with eight years of hemifacial spasm (HFS) underwent endoscopic microvascular decompression (MVD) of the facial nerve. Baseline stimulation of the zygomatic branch of the facial nerve activated at 1.2 mA.

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Background: We present a "Do-It-Yourself" method to build an affordable augmented reality heads-up display system (AR-HUD) capable of displaying intraoperative images. All components are commercially available products, which the surgeons may use in their own practice for educational and research purposes.

Methods: Moverio BT 35-E smart glasses were connected to operating room imaging modalities (ie, fluoroscopy and 3D navigation platforms) via a high-definition multimedia interface (HDMI) converter, allowing for continuous high-definition video transmission.

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Glossopharyngeal neuralgia (GN) is a nerve compression syndrome that presents with episodes of unilateral sharp, stabbing pain in the distribution of the ninth cranial nerve. This syndrome may present with cardiac and autonomic manifestations - a condition termed vagoglossopharyngeal neuralgia (VGPN). Most cases of VGPN arise from neurovascular insult at the cerebellopontine angle.

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Objective: This study assesses the impact of Median Household Income (MHI) on short- and long-term morbidity and mortality following supratentorial meningioma resection.

Patients And Methods: 351 consecutive patients undergoing supratentorial meningioma tumor resection, at a single health system over a six-year period (June 09, 2013 to April 26, 2019) were analyzed retrospectively. Outcomes assessed included readmission, emergency department (ED) evaluation, and mortality within 90 days of surgery.

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Background And Importance: Extracorporeal membrane oxygenation (ECMO) represents a life-saving therapy in cases of refractory hypoxia and has been utilized in patients suffering from the most severe forms of coronavirus disease 2019 (COVID-19). A strikingly high mortality rate of 94% was described in early reports of patients with COVID-19 transitioned to ECMO. Later case reports and series demonstrating successful recovery from COVID-19 after ECMO have revived interest in this therapeutic modality, including the recent approval of ECMO for COVID-19 patients by the Food and Drug Administration (FDA).

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Background: In a standard surgical operating room, advanced imaging is projected on a separate monitor screen away from the surgical field of view. This setup requires surgeons to repeatedly shift their attention between the operative field and a screen. Such movement may result in a disruption of focus that can extend surgical time, cause physical strain, and lead to surgical errors.

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Objective: Endoscopic-microvascular decompression (E-MVD) is a well-described treatment for trigeminal neuralgia (TGN), but there has been debate on the safety of intraoperative sacrifice of the petrosal vein (PV) due to concern for subsequent venous insufficiency. Our objective was to investigate the risk of PV sacrifice during E-MVD in TGN and subsequent postoperative complications and pain outcomes.

Methods: 5 five-year review yielded 201 patients who underwent MVD for TGN.

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Chordomas are rare, locally aggressive neoplasms that develop from remnants of the notochord. The typical approach to chordomas of the clivus and axial cervical spine often limits successful en bloc resection. In this case report, authors describe the first-documented transoral approach using both transoral robotic surgery (TORS) for exposure and the Sonopet bone scalpel under navigational guidance to achieve en bloc resection of a cervical chordoma.

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