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2.
World Neurosurg ; 125: 55-66, 2019 05.
Article in English | MEDLINE | ID: mdl-30660875

ABSTRACT

The Medical College of Wisconsin Department of Neurosurgery delivers subspecialty adult and pediatric neurosurgical care that is patient-centered, evidence-informed, and value-based. Medical College of Wisconsin research advances the science of neurological disease with the goal of a positive translational effect on clinical care. The department supports an environment of education and scholarship for trainees, faculty, and staff alike. The journey to become a neurosurgical center of excellence was accomplished with the leadership and foresight of the men and women who turned their dreams into reality. The establishment and rise of the department as a national force for neurosurgery and spine is an elegant example of the combination of individual leadership and foresight with synergistic institutional support.


Subject(s)
Faculty, Medical/history , Hospital Departments/history , Hospitals, University/history , Neurosurgical Procedures/history , Schools, Medical/history , History, 19th Century , History, 20th Century , History, 21st Century , Humans , North America , Wisconsin
3.
Asian J Neurosurg ; 13(3): 848-850, 2018.
Article in English | MEDLINE | ID: mdl-30283563

ABSTRACT

Methotrexate (MTX) is a common antimetabolite agent that is widely used today in treating leukemia, lymphoma, and osteosarcoma. Its use has been associated with leukoencephalopathy causing seizures, paralysis, and even coma. To achieve the best possible outcome, it is important to be able to make a prompt diagnosis. Studies reported restricted diffusion on diffusion-weighted imaging (DWI) which is a reliable early sign of acute MTX-induced leukoencephalopathy. However, we report here the first case of MTX-induced leukoencephalopathy without typical restricted diffusion on DWI and the utility magnetic resonance spectroscopy to support this diagnosis in the difficult case such as the one being presented here.

4.
Asian J Neurosurg ; 13(2): 380-382, 2018.
Article in English | MEDLINE | ID: mdl-29682038

ABSTRACT

Chronic subdural hematoma (cSDH) is a common neurosurgical pathology associated with older age and complicated by antiplatelet/anticoagulant therapies. With improving medical care in an aging population, the incidence of cSDH will likely increase over the next 25 years, placing a burden on health care costs. Consequently, a simple and inexpensive treatment option is desirable. As such, we report a basic, but novel, technique to drain cSDH with an Integra Camino bolt. This technique was employed in two patients, where the significant resolution of cSDH and associated clinical symptoms were observed without complications.

5.
Asian J Neurosurg ; 13(2): 475-477, 2018.
Article in English | MEDLINE | ID: mdl-29682065

ABSTRACT

Medulloblastomas are categorized as the World Health Organization Grade IV neoplasms. Only 33 cases have been reported of extra-axial, mostly in the cerebellar pontine angle and lateral cerebellar hemisphere, medulloblastomas in the current literature. Our study showcases the first case of an extremely rare presentation of an extra-axial midline tentorial adult medulloblastoma with the dural-tail sign mimicking a meningioma. To achieve the best possible outcome, a high index of suspicion for medulloblastoma is critical especially in young patient with an atypical posterior fossa mass as treatment regimens drastically different between a medulloblastoma and a meningioma.

6.
Asian J Neurosurg ; 13(2): 485-486, 2018.
Article in English | MEDLINE | ID: mdl-29682068

ABSTRACT

Chronic subdural hematoma (CSDH) is a relatively common condition encountered in a neurosurgical practice. There have been increased efforts in creating different treatment regimens for CSDH to improve patients' outcomes, including the addition of tissue plasminogen activator (tPA) in drains to reduce recurrences. Here, we present the first case report of the safe use of tPA in conjunction with an Integra Camino bolt for maximized drainage of CSDH with a successful neurological recovery and the complete resolution of the hematoma.

7.
World Neurosurg ; 101: 69-75, 2017 May.
Article in English | MEDLINE | ID: mdl-28179171

ABSTRACT

INTRODUCTION: Surgery for meningioma is associated with significant blood loss. Preoperative embolization has been associated with reduction of blood loss and has been noted to decrease intensity on T1 + contrast sequences. We investigate potential relationships between blood loss and the extent of T1 + contrast intensity. METHODS: Forty-two patients who underwent surgical resection of intracranial meningioma were retrospectively reviewed from August 2009 to May 2016. Clinical data were extracted (age, gender, location of meningioma, grade of meningioma, need for blood transfusion during surgery, preoperative and postoperative hematocrit level, estimated blood loss [EBL], and duration of surgery). Using OsiriX MD, the tumor volume, sinus involvement, peritumoral edema, extent of resection, and T1 index (average T1+C intensity across the tumor normalized to value at basilar artery) were assessed. RESULTS: With EBL, univariate analysis for gender, tumor volume, and T1 index showed correlations with P value <0.1. A logistic regression to predict EBL <300 mL and ≥300 mL using the 3 variables yielded T1 index (odds ratio [OR], 31.22; 95% confidence interval [CI], 1.14-855.65), gender (OR, 0.17; 95% CI, 0.03-0.96), and tumor volume (OR, 1.05; 95% CI, 1.00-1.10) as significant predictors (all P < 0.05). With duration for surgery, gender, tumor volume, need for blood transfusion, and preoperative hematocrit exhibited P value <0.05; multivariate analysis did not show a significant model. CONCLUSIONS: Along with gender and tumor volume, extent of T1+C intensity is also an independent predictor of EBL. This finding may be helpful for surgical management of meningioma.


Subject(s)
Blood Loss, Surgical/physiopathology , Meningeal Neoplasms/surgery , Meningioma/surgery , Neurosurgical Procedures/adverse effects , Postoperative Complications/diagnosis , Adult , Aged , Blood Loss, Surgical/prevention & control , Contrast Media/metabolism , Embolization, Therapeutic/methods , Female , Hematocrit/methods , Humans , Magnetic Resonance Imaging , Male , Meningeal Neoplasms/diagnostic imaging , Meningioma/diagnostic imaging , Middle Aged , Postoperative Complications/etiology , Predictive Value of Tests , Retrospective Studies
8.
J Surg Case Rep ; 2016(9)2016 Sep 20.
Article in English | MEDLINE | ID: mdl-27651110

ABSTRACT

Intracranial subdural empyema (ISDE) is a life-threatening condition. The risk for ISDE increases in patients that have undergone prior intracranial procedures. The non-specificity in its clinical presentation often makes ISDE difficult to diagnose. Here, we present a rare case of ISDE mimicking a recurrent chronic subdural hematoma, emphasizing the significance of obtaining early magnetic resonance images of the brain for early diagnosis and treatment to achieve the optimal outcome.

9.
World Neurosurg ; 95: 85-90, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27476687

ABSTRACT

BACKGROUND: The fate of the bone flap is a significant decision during surgical treatment of acute subdural hematoma (SDH). A general guideline revolves around the surgeon's concern for brain edema. Limited studies, however, have focused on the factors that contribute to perioperative brain edema. METHODS: From 2012 to 2015, 38 patients who underwent decompressive craniectomy for acute SDH were reviewed. Clinical data were extracted (age, sex, initial Glasgow Coma Scale (GCS) score, sodium level, hematocrit, and intraoperative blood loss). From the preoperative scan, SDH volume, midline shift (MLS), and volume within the skull (to estimate baseline brain volume) were measured. From the postoperative scan, brain volume (including any herniating regions) was measured. Δ% was defined as the percentage change in postoperative brain volume compared with preoperative volume. Evident contralateral injury, contusions, and intraventricular hemorrhage (IVH) were noted. RESULTS: Fifteen patients demonstrated negative Δ%. Univariate analysis found significant correlations between Δ% and preoperative MLS, initial GCS, presence of IVH, and presence of contralateral injury (P < 0.05). A multiple regression for Δ% elicited a significant model (F [3, 34] = 17.387, P < 0.01) with R2 0.605, where Δ% = 16.197 - 1.246*GCS - 0.986 * MLS + 3.292 * IVH (with 0 = no IVH, 1 = presence of IVH). CONCLUSIONS: A high proportion of patients can exhibit negative Δ%, or relative brain compression after decompression of SDH. For these patients, replacement of the bone flap may be reasonable to avoid obligatory interval cranioplasty. Preoperative MLS, initial GCS, and presence of IVH can help predict whether overall brain volume will swell or compress within the normal confines of the skull. This can guide the decision to retain or remove the bone flap.


Subject(s)
Brain Edema/epidemiology , Decompressive Craniectomy/methods , Hematoma, Subdural, Acute/surgery , Hematoma, Subdural, Intracranial/surgery , Postoperative Complications/epidemiology , Skull/surgery , Adult , Blood Loss, Surgical , Brain/diagnostic imaging , Brain/pathology , Brain Contusion/epidemiology , Cerebral Hemorrhage/epidemiology , Female , Glasgow Coma Scale , Hematoma, Subdural, Acute/diagnostic imaging , Hematoma, Subdural, Acute/epidemiology , Hematoma, Subdural, Intracranial/diagnostic imaging , Humans , Linear Models , Male , Middle Aged , Multivariate Analysis , Organ Size , Plastic Surgery Procedures , Retrospective Studies , Surgical Flaps , Tomography, X-Ray Computed
10.
J Surg Case Rep ; 2016(5)2016 May 10.
Article in English | MEDLINE | ID: mdl-27165750

ABSTRACT

The gunshot wound to the head (GSWH) is associated with a mortality rate of 20-90% in adults and 20-65% in the pediatric population. Due to the high rates of mortality and morbidity, the management of these patients has been a topic of high interest in the neurosurgical community. We present an 18-year-old male suffering a GSWH with the bullet following a transventricular trajectory and crossing the midsagittal plane, creating extensive intracranial injuries. Despite a calculated mortality rate of >97% from these devastating injuries, the patient survived the GSWH and made a remarkable recovery. The young adult brain still maintains a high potential for neurological plasticity. This may partially explain why the young adult population with a severe GSWH can have a better than expected recovery course. Bifrontal GSW injuries may have much better outcomes than more posterior injuries as has been demonstrated in this patient in this case.

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