Cervical spinal cord stimulation for prevention and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: clinical and radiographic outcomes of a prospective single-center clinical pilot study.

Background: Cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of high morbidity and mortality, for which there is no consistently effective treatment. Cervical spinal cord stimulation (cSCS) has been shown to induce vasodilatation and improve peripheral and cerebral blood flow in both animal and human studies. This pilot study was performed to assess the clinical effect and long-term results of cSCS treatment in aSAH patients.

Nucleus Accumbens as a Novel Target for Deep Brain Stimulation in the Treatment of Addiction: A Hypothesis on the Neurochemical and Morphological Basis.

Addiction is a major cause of mortality and morbidity. Apart from psychotropic substances, alcohol and nicotine remain the common addictive materials responsible for the majority of deaths. Conventional conservative therapies are beneficial to certain populations, but the majority may require interventional treatments such as deep brain stimulation (DBS) in view of increasing mortality from drug abuse in recent years.

Quantifying sulcal and gyral topography in relation to deep seated and ventricular lesions: cadaveric study for basing surgical approaches and review of literature.

Objective: Numerical implication of sulcal and gyral topography for surgical approaches has not been studied.

Methods: Percentage gain of distance using sulci as compared to that of gyri was calculated by measuring distances toward the ventricles in 15 hemispheres.

Results: Superior frontal sulcus was closest proving greater than 50% gain in distance compared to superior frontal gyrus; inferior temporal sulcus provided greater gain in the temporal lobe.

Radio-anatomic measurements and statistical generation of a safe surgical corridor to enter the ventricular trigone while avoiding injury to the optic radiations.

Objective: To find a safe operative corridor to the ventricular trigone avoiding injury to the optic radiations (ORs).

Methods: In 24 adult hemispheres, dimensions of the atrium, height of the OR, and the cortex-to-atrium distance were measured. Superior parietal lobule (SPL), parieto-occipital sulcus (POS), and middle temporal gyrus (MTG) traced approaches were used to measure maximum safe angles to enter the atrium without traversing the OR.

Frontolateral pins for halo ring placement: reassessment of a common neurosurgical procedure with CT measurements of skull thickness.

Object: Halo orthosis placement is a common neurosurgical procedure for the treatment of cervical spine injuries. Frontal sinus puncture by the anterior pins may occur using standard techniques, and up to 30% are dissatisfied with forehead scarring, especially women and African Americans.

Methods: The authors describe a frontolateral (FL) anterior pin site placement supported by high-resolution CT scan skull thickness measurements.

Chronic epilepsy due to low grade temporal lobe tumors and due to hippocampal sclerosis: do they differ in post-surgical outcome?

Chronic seizures as a presenting feature of low grade temporal lobe gliomas and hippocampal sclerosis (HS) are reported to have similar outcomes although the prognostic indicators may not be the same. This study seeks to identify the variables that are associated with poor surgical outcome in both conditions. A retrospective analysis from our epilepsy data base was performed.

A novel method of identifying the internal acoustic canal in the middle fossa approach in a cadaveric study-the rule of 2s.

Objective Multiple landmarks and anatomic relationships exist to identify internal acoustic canal (IAC) in middle fossa approach for removing intracanalicular schwannomas. We attempted to identify a reproducible, practical method to quickly identify the IAC that would be applicable when an expanded middle fossa approach is required. Design Middle fossa approach was performed on 10 cadavers (21 dissections).

The need in dural graft suturing in Chiari I malformation decompression: A prospective, single-blind, randomized trial comparing sutured and sutureless duraplasty materials.

Background: This study compared the use of two commonly utilized dural closure techniques used in augmentation duraplasty for Chiari malformation I (CM I) and evaluated their efficacy and outcome in terms of quality of life assessments.

Methods: This prospective randomized study compared sutureless (DuraGen) and suturable (Dura-Guard) techniques in CM I decompression. Clinical parameters, cost analysis, and SF-36 Quality of Life Questionnaire (QLQ) were utilized to assess outcome.

Temporal lobe gangliogliomas associated with chronic epilepsy: long-term surgical outcomes.

Objective: To review the clinical features and surgical outcome in patients with temporal lobe gangliogliomas associated with intractable chronic epilepsy.

Methods: The Rush University Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of temporal lobe gangliogliomas at Rush University Medical Center. Medical records were reviewed for age of seizure onset, delay to referral for surgery, seizure frequency and characteristics, pre-operative MRI results, extent of resection, pathological diagnosis, complications, length of follow-up, and seizure improvement.

Modified brainstem auditory evoked responses in patients with non-brainstem compressive cerebral lesions.

The brainstem auditory evoked response (BAER) is sensitive to pontomesencephalic integrity, transtentorial brain herniation, and at times increased intracranial pressure (ICP). The authors report their experience utilizing a recently described rapid rate, binaural, click and 1,000-Hz tone-burst modification of the BAER (MBAER) in 22 symptomatic non-trauma patients with non-brainstem compressive space-taking cerebral lesions. The majority presented with mild to moderate clinical signs suggestive of increased ICP, and focal neurological deficits.

Cardiac troponin I levels are a marker of myocardial dysfunction in subarachnoid hemorrhage and predicts poor neurologic outcome.

We evaluated the prognostic significance of myocardial dysfunction and associated cardiac troponin I elevation in patients with subarachnoid hemorrhage (SAH). Forty-one patients with no prior cardiac history and who presented with spontaneous SAH were prospectively studied. The LV ejection fraction (LVEF) and regional wall motion by echocardiogram were studied upon admission (Day 0), Day 1 and Day 3 following SAH.

Repositioning of supraorbital nerve stimulation electrode using retrograde needle insertion: a technical note.

Introduction: With growing interest and acceptance of peripheral nerve stimulation (PNS) approach, there is now an increasing need in developing clear procedural details to resolve frequent complications and minimize associated tissue injury. Migration and suboptimal positioning of PNS electrodes are one of the most commonly observed complications of PNS approach.

Materials And Methods: We present a simple technique for repositioning a supraorbital electrode using retrograde insertion of introducer needle that allows one to place percutaneous (cylindrical) PNS electrode into appropriate anatomical location with minimal additional injury to surrounding tissues.

Frederic Gibbs and his contributions to epilepsy surgery and electroencephalography.

Frederic Gibbs' (1903-1992) long research career was devoted to the understanding and treatment of epileptic phenomena and closely associated with the development of electroencephalography (EEG). After medical school, he joined the Harvard Neurological Unit at Boston City Hospital directed by Stanley Cobb. In the early 1930s, Gibbs developed a thermoelectric blood flow probe and, with William Lennox, proved in animals and humans that a seizure increases cerebral blood flow.

Extracranial infrasellar ectopic craniopharyngioma: a case report and review of the literature.

We present a case of a purely infrasellar craniopharyngioma that initially presented as a sphenoid sinus mass. Craniopharyngiomas are usually located within the sella. Purely infrasellar craniopharyngiomas have only rarely been reported in the literature.

The use of bioabsorbable screws to fix Type II odontoid fractures: a biomechanical study.

Object: Anterior screw fixation of the Type II odontoid fracture stabilizes the odontoid without restricting the motion of the cervical spine. The metal screw may limit bone remodeling because of stress shielding (if not placed properly) and limit imaging of the fracture. The use of bioabsorbable screws can overcome such shortcomings of the metal screws.

Spinal cord stimulation: Current applications for treatment of chronic pain.

Spinal cord stimulation (SCS) is thought to relieve chronic intractable pain by stimulating nerve fibers in the spinal cord. The resulting impulses in the fibers may inhibit the conduction of pain signals to the brain, according to the pain gate theory proposed by Melzack and Wall in 1965 and the sensation of pain is thus blocked. Although SCS may reduce pain, it will not eliminate it.

Evaluation of the prognostic indicators of giant intracranial aneurysms.

The indicators of poor outcome in giant intracranial aneurysms have been the subject of several studies in the literature. We conducted a retrospective analysis to evaluate the predictors of poor outcome in giant intracranial aneurysms. We studied consecutive cases with aneurysms admitted over a 9-year period in our institution.

Fusiform aneurysms of the anterior communicating artery: illustrative series of 5 cases with operative techniques.

Background: Fusiform anterior communicating artery (ACoA) aneurysms (ACoAAs) are rare, and a series of these aneurysms has not been reported. Large fusiform ACoAA are easily identifiable, whereas smaller ones can coexist with a saccular component.

Objective: To provide a clear-cut definition, report the incidence of these aneurysms, present a series with follow-up data, and discuss operative nuances and clip application techniques.

Middle turbinectomy for exposure in endoscopic endonasal transsphenoidal surgery: when is it necessary?

Objectives: To evaluate the benefits of middle turbinectomy on the exposure of the skull base structures.

Design: An anatomical study on 20 fresh cadaver heads.

Methods: The extent of the exposure of the skull base structures during endoscopic endonasal approach has not been addressed specifically in respect to the whether or not the middle turbinectomy is performed.