Neurosurgery for the Neurologist: Peripheral Nerve Injury and Compression (What can be Fixed?)
This chapter will review the current management of patients with peripheral nerve injuries and nerve compression syndromes that result in favorable surgical outcomes when appropriately evaluated and referred in a timely fashion. Given the fact that neurologists frequently evaluate patients with these conditions and refer patients to neurosurgeons, it is important for them to be aware of the indications for, types and timing of surgical procedures, and expected outcomes with the various types of interventions. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Megan M. Jack, Brandon W. Smith, Robert J. Spinner Source Type: research
Surgery, Stereotactic Radiosurgery, and Systemic Therapy in the Management of Operable Brain Metastasis
Brain metastasis represents the most common intracranial tumor. Surgery has a key role in patients with an unknown primary, solitary site, large intracranial lesion, or those with neurologic symptomatology due to associated vasogenic edema and mass effect. There is also a resurgence in interest in biopsy or resection in patients with actionable alterations with discordant responses to targeted therapy or those proceeding to immunotherapy to reduce corticosteroid requirements. Moreover, advancements in radiotherapy have led to several options in patients with resectable brain metastasis including postoperative whole-brain r...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Rupesh Kotecha, Manmeet S. Ahluwalia, Vitaly Siomin, Michael W. McDermott Source Type: research
Surgical Neuro-Oncology
Gliomas are the most common intrinsic brain tumor in adults. Although maximal tumor resection improves survival, this must be balanced with preservation of neurologic function. Technological advancements have greatly expanded our ability to safely maximize tumor resection and design innovative therapeutic trials that take advantage of intracavitary delivery of therapeutic agents after resection. In this article, we review the role of surgical intervention for both low-grade and high-grade gliomas and the innovations that are driving and expanding the role of surgery in this therapeutically challenging group of malignancies...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Dana Mitchell, Jack M. Shireman, Mahua Dey Source Type: research
Degenerative Spine Disorders and Multiple Sclerosis
Multiple sclerosis (MS) is an autoimmune inflammatory disease that results in demyelination of the central nervous system (CNS). MS affects as many as 350,000 individuals in the United States and commonly presents before the age of 45 years. Patients with MS, as the general population, are likely to encounter degenerative changes of the spine as they age, and this can pose a unique challenge to both patients with MS and physicians, as both conditions can have a great deal of symptomatic overlap despite stark differences in management. Currently there is no definitive approach that allows physicians to distinguish between t...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Kyle McGrath, Jonathan Lee, Michael Steinmetz Source Type: research
Update on Spinal Fusion
Spinal fusion is frequently performed for a variety of indications. It is performed to treat instability due to trauma, infection, or neoplasm. It may be used to treat regional or global spinal deformity. There are even occasions when it is appropriate as a treatment of low back pain without overt instability or deformity. One common indication for fusion is as an adjunct to decompression for patients with neurogenic claudication or radiculopathy caused by stenosis associated with spondylolisthesis. There have been a number of high-quality publications in high-quality journals that have reported conflicting results regardi...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Daniel K. Resnick, Bradley T. Schmidt Source Type: research
Intraoperative Monitoring for Spinal Surgery
The use of intraoperative neuromonitoring (IONM) can improve surgical outcomes. Although inclusion of IONM is considered standard practice in more complicated spine surgeries, there are no national-level guidelines for the usage of IONM in spine surgery. Technical advancement in IONM has increased both its sensitivity and specificity, and with a recently developed algorithmic checklist it can be more easily adopted by the surgical team in their practice. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Nitin Agarwal, Saman Shabani, Jeremy Huang, Alma Rechav Ben-Natan, Praveen V. Mummaneni Source Type: research
Chiari Malformation (Update on Diagnosis and Treatment)
Chiari Malformation Type I (CMI) is a congenital malformation diagnosed by MRI findings of at least 5 mm of cerebellar ectopy below the foramen magnum. CM1 is frequently associated with syringomyelia. Herein, we discuss the history of CMI and syringomyelia, including early pathological and surgical studies. We also describe recent investigations into the pathogenesis and pathophysiology of CMI and their practical implications on management and surgical intervention. We also highlight the recent development of the Common Data Elements for CMI, providing a framework for ongoing investigations. Finally, we discuss current c...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Jared S. Rosenblum, I. Jonathan Pomeraniec, John D. Heiss Source Type: research
Current State of the Art in Endovascular Stroke Treatment
Following the successful completion of 5 major trials establishing the clinical efficacy of endovascular thrombectomy for ELVO in the setting of AIS, there has been a tremendous focus on identifying additional patient populations that may benefit from the intervention. Improved imaging modalities and subsequent trials found thrombectomy to be highly efficacious in patients presenting up to 24 hours after stroke onset, particularly with good collaterals and large penumbral regions. Iterative catheter and device development have improved the safety profile and enhanced the efficacy of the procedure with the introduction of...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: David Dornbos, Adam S. Arthur Source Type: research
Decompressive Craniectomy for Stroke: Who, When, and How
Malignant cerebral edema after large hemispheric infarct is a highly morbid condition, and major, randomized trials over the last 2 decades have affirmed the beneficial effect of surgical intervention in the form of decompressive craniectomy. Early ( (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Gregory J. Cannarsa, J. Marc Simard Source Type: research
Intraoperative Neuromonitoring
Intraoperative neuromonitoring encompasses a variety of different modalities in which different neuropathways are monitored either continuously or at defined time points throughout a neurosurgical procedure. Surgical morbidity can be mitigated with careful patient selection and thoughtful implementation of the appropriate neuromonitoring modalities through the identification of eloquent areas or early detection of iatrogenic pathway disruption. Modalities covered in this article include somatosensory and motor evoked potentials, electromyography, electroencephalography, brainstem auditory evoked responses, and direct corti...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Andrew K. Wong, Jay L. Shils, Sepehr B. Sani, Richard W. Byrne Source Type: research
Current Indications for Management Options in Pseudotumor Cerebri
There are surgical options available for those patients with idiopathic intracranial hypertension (IIH) who have significant visual threat or visual deterioration despite best medical management or whose visual deterioration is rapid enough to warrant urgent intervention. Optic nerve sheath fenestrations, venous sinus stenting, and cerebrospinal fluid diversion via ventriculoperitoneal and lumboperitoneal shunting are useful adjuncts in the management of this condition. Significant resources are used in the care of patients with IIH. Further understanding of the pathophysiology of IIH will likely direct future treatment op...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Asad Akhter, Lauren Schulz, Hillary Inger, John M. McGregor Source Type: research
Familial Neoplastic Syndromes
Familial neoplastic syndromes commonly impact the central and peripheral nervous systems. The most common neoplastic syndromes clinically relevant to neurology and neurologic surgery, include neurofibromatosis type 1, neurofibromatosis type 2, and Von Hippel-Lindau disease. We define the epidemiology, genetics, clinical presentation, and manifestations, as well as screening recommendations and management paradigms for these syndromes and other familial neoplastic syndromes that affect the nervous system. To ensure the optimal care of patients with neoplastic syndromes requires a multi-disciplinary approach and a comprehens...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Ryan G. Eaton, Russell R. Lonser Source Type: research
Neurosurgical Mimics
The goal of the following article is to help the practicing physician learn to recognize conditions that mimic conditions requiring neurosurgical intervention. Each case vignette is presented with relevant clinical history and examination, imaging studies and findings, as well as other testing results. The management for the corresponding diagnosis is presented. Finally, the relevant mimics and differentiating features are discussed. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Robert J. Rothrock, Turki Elarjani, Allan D. Levi Source Type: research
Surgical Indications and Options for Hypertensive Hemorrhages
This article reviews the data surrounding the surgical management of intracerebral hemorrhage, including open and minimally invasive techniques and discusses the controversies and future directions surrounding surgical management. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Kelsey M. Bowman, Azam S. Ahmed Source Type: research
Closed-Loop Brain Stimulation and Paradigm Shifts in Epilepsy Surgery
This article describes the state-of-the-art in epilepsy surgery and related changes in how we define indications for diagnostic and therapeutic surgical intervention. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: R. Mark Richardson Source Type: research
