Preliminary Outcomes Report for CO2 Laser Assisted Electric-Acoustic Cochlear Implantation.

Objective: Report on the safety/efficacy of a novel, carbon dioxide (CO2) laser-assisted protocol for hearing-preservation cochlear implantation (HPCI) and electric-acoustic stimulation (EAS).

Study Design: Retrospective case review.

Setting: Tertiary referral center.

Intraoperative neurophysiological monitoring team's communiqué with anesthesia professionals.

Background And Aims: Intraoperative neurophysiological monitoring (IONM) is the standard of care during many spinal, vascular, and intracranial surgeries. High-quality perioperative care requires the communication and cooperation of several multidisciplinary teams. One of these multidisciplinary services is intraoperative neuromonitoring (IONM), while other teams represent anesthesia and surgery.

Endoscopic transorbital route to the petrous apex: a feasibility anatomic study.

Background: While the subtemporal approach represents the surgical module milestone designed to reach the petrous apex, a novel ventral route, which is the superior eyelid endoscopic transorbital approach, has been proposed to access the skull base. Accordingly, we aimed to evaluate the feasibility of this route to the petrous apex, providing a qualitative and quantitative analysis of this relatively novel pathway.

Methods: Five human cadaveric heads were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona.

Closing the gap in cochlear implant access for African-Americans: a story of outreach and collaboration by our cochlear implant program.

Purpose Of Review: Minorities often lag behind in hearing loss evaluation and treatment. Our cochlear implant program aimed to identify the socioeconomic and cultural barriers that prevented our African-American cochlear implant candidates from seeking help for their hearing loss, specifically cochlear implant surgery.

Recent Findings: Our pilot study surveyed 11 African-Americans with cochlear implants and identified obstacles that included patient-physician mistrust, social stigma, financial cost, and lack of education about the devices and procedures.

White matter abnormalities in mild traumatic brain injury with and without post-traumatic stress disorder: a subject-specific diffusion tensor imaging study.

Mild traumatic brain injuries (mTBIs) are often associated with posttraumatic stress disorder (PTSD). In cases of chronic mTBI, accurate diagnosis can be challenging due to the overlapping symptoms this condition shares with PTSD. Furthermore, mTBIs are heterogeneous and not easily observed using conventional neuroimaging tools, despite the fact that diffuse axonal injuries are the most common injury.

M2 Monocyte Microparticles Are Increased in Intracerebral Hemorrhage.

Background: Intracerebral hemorrhage (ICH) is a severe neurologic condition with no proven treatment. Recent evidence suggests that monocytes, a heterogenous group of cells with M1 and M2 phenotypes, contribute to secondary damage following ICH. Microparticles are vesicles .

The Interlenticulostriate Approach to Very High-Riding Distal Basilar Trunk Aneurysms.

Background: Most high-riding distal basilar trunk aneurysms can be surgically approached via the transsylvian route and its orbitozygomatic variant. However, on rare occasions, the basilar bifurcation may be unusually high and an approach above the carotid terminus may be required.

Objective: In this cadaveric study, we sought to determine the feasibility and exposure limits of the interlenticulostriate approach (ILSA).

Point-of-care testing in the acute management of traumatic brain injury: Identifying the coagulopathic patient.

Background: The use of anticoagulants or antiplatelet medications has become increasingly common and is a well-established risk factor for worsening of hemorrhages in trauma patients. The current study addresses the need to investigate the efficacy of point-of-care tests (POC) as an adjunct to conventional coagulation testing in traumatic brain injury (TBI) patients.

Methods: A retrospective review of 190 TBI patients >18 years of age who underwent both conventional and POC testing as part of their admission coagulopathy workup was conducted.

Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges in Coma-Incidence and Interrater Reliability of Continuous EEG After a Standard Stimulation Protocol: A Prospective Study.

Purpose: Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are often seen during continuous electroencephalographic (cEEG) monitoring in coma. Given their uncertain clinical significance, our prospective study evaluated incidence of SIRPIDs in comatose patients in the neuroscience intensive care unit (NSICU) who underwent a standard stimulation protocol and defined interreader reliability for cEEG.

Methods: Of 146 patients prospectively screened who underwent cEEG during a 6-month period, 53 patients were included and 93 patients were excluded.

Middle Ear Obliteration with Blind-Sac Closure of the External Auditory Canal for Spontaneous CSF Otorrhea.

Outcome Objectives To (1) identify unique features of patients who underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal for spontaneous cerebrospinal fluid (CSF) otorrhea and (2) explore outcomes. Study Design Case series with chart review. Setting Tertiary care center.

Mechanical venous anastomosis in head and neck microvascular reconstruction as an equivalent to the gold standard.

To define the most successful and efficient manner to perform venous microvascular anastomoses, the effectiveness of mechanical venous anastomosis in head and neck microvascular reconstruction is reviewed. Head and neck reconstruction with free flap techniques has become the norm and gold standard for large defects. This retrospective, multicenter case series of a single microvascular surgeon's experience with mechanical venous anastomoses specifically assessed the effectiveness of head and neck reconstruction and the complications associated with it.

Spreading depolarization monitoring in neurocritical care of acute brain injury.

Purpose Of Review: Spreading depolarizations are unique in being discrete pathologic entities that are well characterized experimentally and also occur commonly in patients with substantial acute brain injury. Here, we review essential concepts in depolarization monitoring, highlighting its clinical significance, interpretation, and future potential.

Recent Findings: Cortical lesion development in diverse animal models is mediated by tissue waves of mass spreading depolarization that cause the toxic loss of ion homeostasis and limit energy substrate supply through associated vasoconstriction.

Pilot Study Evaluating the Impact of Otology Surgery Videos on Otolaryngology Resident Education.

Objectives: Use of videos as educational tools is not a novel concept; however, there is a paucity of high-quality video resources available to otolaryngology trainees. We hypothesized that residents would deem surgical-videos using a multimedia-style format more valuable as preparatory tools. Aims of this study: 1) develop portfolio of otology/neurotology videos overviewing key steps, anatomy, and pearls by a senior surgeon; 2) have residents rate the effectiveness of the videos as a preoperative tool.

Multi-site harmonization of diffusion MRI data in a registration framework.

Diffusion MRI (dMRI) data acquired on different scanners varies significantly in its content throughout the brain even if the acquisition parameters are nearly identical. Thus, proper harmonization of such data sets is necessary to increase the sample size and thereby the statistical power of neuroimaging studies. In this paper, we present a novel approach to harmonize dMRI data (the raw signal, instead of dMRI derived measures such as fractional anisotropy) using rotation invariant spherical harmonic (RISH) features embedded within a multi-modal image registration framework.

Analysis of Audiometric Outcomes following Combined Middle Cranial Fossa/Transmastoid Approaches for Spontaneous Cerebrospinal Fluid Otorrhea.

Outcome Objectives To (1) explore audiometric outcomes following use of a combined transmastoid/middle cranial fossa (TM-MCF) approach in the treatment of spontaneous cerebrospinal fluid (CSF) otorrhea and (2) determine the influence of dehiscence location and reconstructive methodology on audiometric outcomes. Study Design Case series with chart review. Setting Tertiary care center.

Isolated oculomotor nerve palsy after lumbar epidural steroid injection in a diabetic patient.

Background: In patients with diabetes mellitus, epidural steroid injections (ESI) have been noted to cause significant elevation of blood glucose levels, typically lasting 1-3 days. Here, we describe a previously unreported complication of a diabetic third nerve palsy associated with an ESI.

Case Description: A 66-year-old man with a history of coronary artery disease, hypertension, and insulin-dependent diabetes mellitus presented with low back pain and left lower extremity radiculopathy.

Thyroid Ultrasound-Guided Fine-Needle Aspiration Cytology Results: Observed Increase in Indeterminate Rate over the Past Decade.

Objectives To evaluate changes in distribution of reported thyroid nodule fine-needle aspiration (FNA) cytopathology results since implementation of the Bethesda classification and revised 2015 American Thyroid Association (ATA) guidelines for selecting nodules for biopsy. Study Design Retrospective review. Setting Tertiary academic medical center.

Impulse control behaviors and subthalamic deep brain stimulation in Parkinson disease.

To determine the clinical and demographic correlates of persistent, remitting, and new-onset impulse control behaviors (ICBs) before and after subthalamic deep brain stimulation (STN-DBS) in Parkinson's disease (PD). We compared the pre- and post-surgical prevalence of ICBs, classified as impulse control disorders (ICD), dopamine dysregulation syndrome (DDS), and punding in 150 consecutive PD STN-DBS-treated patients and determined the association with motor, cognitive, neuropsychological, and neuropsychiatric endpoints. At baseline (before STN-DBS), ICBs were associated with younger age (p = 0.

The Medial Extra-Sellar Corridor to the Cavernous Sinus: Anatomic Description and Clinical Correlation.

Objective: The zenith of surgical interest in the cavernous sinus peaked in the 1980s, as evidenced by reports of 10 surgical triangles that could access the contents of the lateral sellar compartment (LSC). However, these transcranial approaches later became marginalized, first by radiosurgery's popularity and lower morbidity, and then by clinical potential of endoscopic corridors noted in several qualitative studies. Our anatomic study, taking a contemporary look at the medial extra-sellar corridor, gives a detailed qualitative-quantitative analysis for its use with increasingly popular endoscopic endonasal approaches to the cavernous sinus.

Regional temperature and quantitative cerebral blood flow responses to cortical spreading depolarization in the rat.

Regional temperature and quantitative regional cerebral blood flow responses to cortical spreading depolarization in the rat were continuously monitored in the same tissue using a microfabricated thermal diffusion sensor that recalibrates and measures in 5-s cycles. The regional cerebral blood flow response had four phases, including early hyperemia (peak: 226% of baseline; duration: 113.1 ± 14.

Parsonage-Turner Syndrome: A Case of Idiopathic Upper Extremity Paresis Following Middle Cranial Fossa Resection of a Vestibular Schwannoma.

Objective: In this patient report, Parsonage-Turner syndrome (acute brachial neuropathy) developed in our patient 1 day after resection of a vestibular schwannoma by a middle cranial fossa approach. Aiming to increase awareness of this rare disorder among neurotologists, we describe differential diagnoses, work-up, and management strategies.

Patient: A 67-year-old man treated for vestibular schwannoma at a single tertiary referral center.

Direct current electrocorticography for clinical neuromonitoring of spreading depolarizations.

Spreading depolarizations cause cortical electrical potential changes over a wide spectral range that includes slow potentials approaching the direct current (or 0 Hz) level. The negative direct current shift (<0.05 Hz) is an important identifier of cortical depolarization and its duration is a measure of potential tissue injury associated with longer lasting depolarizations.

Impact of an Atrial Fibrillation Decision Support Tool on thromboprophylaxis for atrial fibrillation.

Background: Appropriate thromboprophylaxis for patients with atrial fibrillation (AF) remains a national challenge.

Methods: We hypothesized that provision of decision support in the form of an Atrial Fibrillation Decision Support Tool (AFDST) would improve thromboprophylaxis for AF patients. We conducted a cluster randomized trial involving 15 primary care practices and 1,493 adults with nonvalvular AF in an integrated health care system between April 2014 and February 2015.