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Neuro and Spine Surgery

How to Direct the Neuronal Growth Process in Peripheral Nerve Regeneration: Future Strategies for Nanosurfaces Scaffold and Magnetic Nanoparticles
Andrea Poggetti, MD, Orthopaedic Surgeon, 1st Orthopaedic Department, University of Pisa, Pisa, Italy, Pietro Battistini, MD, Orthopaedic Surgeon, 1st Orthopaedic Department, University of Pisa, Pisa, Italy, Paolo Domenico Parchi, MD, PhD+, Orthopaedic Surgeon, 1st Orthopaedic Department, University of Pisa, Pisa, Italy, Michela Novelli, PhD, Associate Professor, Pathology Unit, University of Pisa, Pisa, Italy, Simona Raffa, PhD, Associate Professor, Institute for Medical Science, and Technology, Scotland, United Kingdom, Marco Cecchini, PhD, Research Assistant, NEST Istituto Nanoscienze-CNR, University of Pisa, Pisa, Italy, Anna Maria Nucci, MD, Resident, 1st Orthopaedic Department, University of Pisa, Pisa, Italy, Michele Lisanti, MD, PhD, Professor in Chief, 1st Orthopaedic Department, University of Pisa, Pisa, Italy

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Abstract


Currently, the gold standard to repair large nerve defects is the autologous nerve graft. These solutions offer a mechanical support, adhesion substrates, and, with Schwann cells (SC), a source of neurotropic factors for axonal growth. The technical limits are the donor side damage, multiple surgical accesses, and the unavailability of large amounts of grafts. In recent years, several researchers focused their attention on the interaction between cells (nervous and glial) and physic-chemical cues that arise from the extracellular milieu. Nanotechnologies produce surfaces that mimic the topographical signals (physical stimuli) that arise from enterprise content management (ECM) to modulate the forces acting during axonal elongation. The use of magnetic nanoparticles (MNPs) seems to be able to guide and to boost the nerve regeneration. Both research areas could be improved through surfaces functionalization by biological molecules (proteins/peptides, growth factors, etc.). In the future, the aim will be to help recovery after peripheral nerve lesion by producing a tridimensional structured conduit, then repeat the ECM architecture and take advantage of MNPs internalized by cells and guide them through tension forces by external magnetic fields to stimulate and direct axon growing. The aims of this review were to evaluate the findings of studies that used physical stimuli (nanoscaffold surfaces and MNPs) used for peripheral nerve regeneration support. The future trends in the field of peripheral nerve regeneration continue to produce a wide variety of new techniques to improve the opportunity for advances to treat peripheral nerve injuries.

 

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A Portable Shoulder-Mounted Camera System for Surgical Education in Spine Surgery
Martin H. Pham, MD, Neurosurgery Resident, Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, Ifije E. Ohiorhenuan, MD, PhD, Neurosurgery Resident, Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, Neil N. Patel, MD, Orthopedic Surgery Spine Fellow, Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, Andre M. Jakoi, MD, Orthopedic Surgery Spine Fellow, Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, Patrick C. Hsieh, MD, Associate Professor, Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, Frank L. Acosta, MD, Associate Professor, Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, Jeffrey C. Wang, MD, Professor, Chief, Orthopedic Spine Service, Co-Director, USC Spine Center, Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, John C. Liu, MD, Professor, Co-Director, USC Spine Center, Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California

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Abstract


The past several years have demonstrated an increased recognition of operative videos as an important adjunct for resident education. Currently lacking, however, are effective methods to record video for the purposes of illustrating the techniques of minimally invasive (MIS) and complex spine surgery. We describe here our experiences developing and using a shoulder-mounted camera system for recording surgical video. Our requirements for an effective camera system included wireless portability to allow for movement around the operating room, camera mount location for comfort and loupes/headlight usage, battery life for long operative days, and sterile control of on/off recording. With this in mind, we created a shoulder-mounted camera system utilizing a GoPro™ HERO3+, its Smart Remote (GoPro, Inc., San Mateo, California), a high-capacity external battery pack, and a commercially available shoulder-mount harness. This shoulder-mounted system was more comfortable to wear for long periods of time in comparison to existing head-mounted and loupe-mounted systems. Without requiring any wired connections, the surgeon was free to move around the room as needed. Over the past several years, we have recorded numerous MIS and complex spine surgeries for the purposes of surgical video creation for resident education. Surgical videos serve as a platform to distribute important operative nuances in rich multimedia. Effective and practical camera system setups are needed to encourage the continued creation of videos to illustrate the surgical maneuvers in minimally invasive and complex spinal surgery. We describe here a novel portable shoulder-mounted camera system setup specifically designed to be worn and used for long periods of time in the operating room.

 

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Biosurgical Hemostatic Agents in Neurosurgical Intracranial Procedures
Roberto Gazzeri, MD, Neurosurgery Consultant, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy, Marcelo Galarza, MD, Neurosurgery Consultant, Regional Service of Neurosurgery, School of Medicine, University of Murcia, Murcia, Spain, Giorgio Callovini, MD, Neurosurgery Consultant, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy, Alex Alfieri, MD, Chairman of Neurosurgery, Department of Neurosurgery, and Spinal Surgery, Ruppiner Kliniken, Neuruppin, Germany

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Abstract


Intraoperative hemostasis during neurosurgical procedures is one of the most important aspects of intracranial surgery. Hemostasis is mandatory to keep a clean operative field and to prevent blood loss and postoperative hemorrhage. In neurosurgical practice, biosurgical hemostatic agents have proved to be extremely useful to complete the more classic use of electrocoagulation. During recent years, many biosurgical topical hemostatic agents were created. Although routinely used during neurosurgical procedures, there is still a great deal of confusion concerning optimal use of these products, because of the wide range of products, as absorbable topical agents, antifibrinolytics agents, fibrin sealants and hemostatic matrix, which perform their hemostatic action in different ways. The choice of the hemostatic agent and the strategy for local hemostasis are correlated with the neurosurgical approach, the source of bleeding, and the neurosurgeon’s practice. In this study, the authors review all the different sources of bleeding during intracranial surgical approaches and analyze how to best choose the right topical hemostatic agent to stop bleeding, from the beginning of the surgical approach to the end of the extradural hemostasis after dural closure, along all the steps of the neurosurgical procedure.

 

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Scalp Metastasis from Glioblastoma Multiforme: A Case Report and Literature Review
Marco Mammi, MD, Resident, Unit of Neurosurgery, Roberto Altieri, MD, Resident, Unit of Neurosurgery, Alessandro Agnoletti, MD, Neurosurgeon, Unit of Neurosurgery, Paolo Pacca, MD, Neurosurgeon, Unit of Neurosurgery, Federica Franchino, MD, Neuro-Oncologist, Unit of Neuro-Oncology, Diego Garbossa, MD, Neurosurgeon, Unit of Neurosurgery, Alessandro Ducati, MD, Professor of Neurosurgery, Director of Unit of Neurosurgery, Antonio Melcarne, MD, Neurosurgeon, Unit of Neurosurgery, Department of Neuroscience, University School of Medicine, Turin, Italy

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Abstract


Glioblastoma multiforme (GBM) is a common malignant brain tumor that rarely metastasizes extracranially, despite its aggressive clinical course. This report details the case of a young man presenting with a single subcutaneous localization of GBM that arose six months after initial surgery and recurred after excision. Only six other cases of scalp metastasis of GBM following surgery have been described in the literature, each with peculiar features. Whenever feasible, surgery is the most effective way to obtain local control of disease. However, a correct approach must be carefully planned to minimize the risks of recurrence and wound dehiscence.

 

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An Anterior Inferior Iliac Spine Avulsion Fracture in a 14-Year Old Boy on Human Growth Hormone
Anthony J. Scillia, MD, Associate Professor, Todd P. Pierce, MD, Research Fellow, Anthony Festa, MD, Associate Professor, Peter Goljan, MD, PGY2 Resident, Vincent K. McInerney, MD, Orthopaedic Surgery Residency Program Director, Seton Hall University, School of Health and Medical Sciences, Department of Orthopaedics, South  Orange, New Jersey

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Abstract

We present the case of a young man with an anterior inferior iliac spine (AIIS) avulsion fracture who was taking human growth hormone (HGH) at the time his injury was diagnosed. He presented with chronic hip pain and no traumatic event. Physical exam revealed symptoms of hip impingement. Upon imaging, he was diagnosed with an AIIS avulsion fracture and underwent surgical repair. He returned to full activity six months post-operatively. At 18-months post-operatively, he was pain-free and performing all activities without difficulty. The role of HGH in his injury or recovery is not well understood and must be studied with large database studies.

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Is Pseudotumor Cerebri An Unusual Expression of Chiari Syndrome? A Case Report and Review of the Literature
Paolo Pacca, MD, Neurosurgeon, Division of Neurosurgery, Department of Neuroscience, University of Torino, Torino, Italy, Roberto Altieri, MD, Resident, Division of Neurosurgery, Department of Neuroscience, University of Torino, Torino, Italy, Francesco Zenga, MD, Neurosurgeon, Division of Neurosurgery, Department of Neuroscience, University of Torino, Torino, Italy, Diego Garbossa, MD, Neurosurgeon, Division of Neurosurgery, Department of Neuroscience, University of Torino, Torino, Italy, Alessandro Ducati, MD, Professor of Neurosurgery, Director of Neurosurgery Unit, Division of Neurosurgery, Department of Neuroscience, University of Torino, Torino, Italy, Michele Lanotte, MD, Professor of Neurosurgery, Division of Neurosurgery, Department of Neuroscience, University of Torino, Torino, Italy

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Abstract

The Chiari I malformation (CM-I) is a developmental alteration of the posterior cranial fossa (PCF), radiographically defined as the descent of the cerebellar tonsils ≥ 5 mm below the foramen magnum (FM) inside the cervical canal. Headache is the most frequent symptom associated with CM-I. The association of CM-I and neurological symptoms configures with Chiari syndrome. A rare symptom associated with Chiari syndrome is intracranial hypertension syndrome with cephalea and papilloedema—the typical findings of pseudotumor cerebri (PTC). PTC is a syndrome characterized by signs and symptoms of increased intracranial pressure (ICP) in the absence of space-occupying masses and/or obstruction of the ventricular system detectable by neuroimaging. The most common symptoms are headache and visual disturbances. Literature reports that the association between CM-I and PTC has a prevalence of 2–6%. More recently, a prevalence of 11% has been described in a specific subset of obese or overweight female patients between 20 and 40 years old. Here we report the case of a 38-year-old woman who came to our observation with a clinical picture and neuroradiological examinations compatible with both CM-I and PTC. We discuss the clinical case and the significant improvement after surgical occipito-cervical decompression.

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