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1.
J Vis Exp ; (150)2019 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-31449264

RESUMO

The Translational Brain Mapping Program at the University of Rochester is an interdisciplinary effort that integrates cognitive science, neurophysiology, neuroanesthesia, and neurosurgery. Patients who have tumors or epileptogenic tissue in eloquent brain areas are studied preoperatively with functional and structural MRI, and intraoperatively with direct electrical stimulation mapping. Post-operative neural and cognitive outcome measures fuel basic science studies about the factors that mediate good versus poor outcome after surgery, and how brain mapping can be further optimized to ensure the best outcome for future patients. In this article, we describe the interdisciplinary workflow that allows our team to meet the synergistic goals of optimizing patient outcome and advancing scientific understanding of the human brain.


Assuntos
Centros Médicos Acadêmicos/métodos , Mapeamento Encefálico/métodos , Encéfalo/diagnóstico por imagem , Monitorização Neurofisiológica Intraoperatória/métodos , Medicina de Precisão/métodos , Pesquisa Translacional Biomédica/métodos , Encéfalo/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Procedimentos Neurocirúrgicos/métodos
2.
J Neurosurg ; 129(4): 1063-1066, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29192861

RESUMO

The authors report the case of a 52-year-old man who presented with rapid-onset lancinating facial pain consistent with trigeminal neuralgia. Magnetic resonance imaging revealed a nonenhancing small lesion on the right trigeminal nerve concerning for an atypical schwannoma or neuroma. The patient underwent resection of the mass via a right retrosigmoid approach. His facial pain completely resolved immediately postoperatively and had not recurred at 6 months after surgery. The mass was consistent with normal brain tissue (neurons and glial cells) without evidence of mitoses. A final histopathological diagnosis of ectopic brain tissue with neural tissue demonstrating focal, chronic T-cell inflammation was made. The partial rhizotomy during resection was curative for the facial pain. To the authors' knowledge, this is the first report of neuroglial ectopia causing trigeminal neuralgia.


Assuntos
Encéfalo , Coristoma/complicações , Neuralgia do Trigêmeo/etiologia , Coristoma/diagnóstico , Coristoma/patologia , Coristoma/cirurgia , Craniotomia/métodos , Diagnóstico Diferencial , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nervo Trigêmeo/patologia , Nervo Trigêmeo/cirurgia , Neuralgia do Trigêmeo/patologia , Neuralgia do Trigêmeo/cirurgia
3.
World Neurosurg ; 108: 317-324, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28887282

RESUMO

BACKGROUND: Burst fractures involve the anterior and middle columns with an intact posterior column. Deforming forces are magnified at areas of transition, making the thoracolumbar junction highly susceptible to injury. METHODS: This is a retrospective review of 42 consecutive patients who underwent single-level anterior lumbar corpectomy using an obelisc expandable titanium cage and lateral fixation for traumatic lumbar burst fractures. RESULTS: Myelopathy and sensory dysfunction were the most frequent neurologic deficits initially, occurring in 16 (38%) and 15 (36%) patients, respectively, which both decreased to 5 (13%). At follow-up, 26 patients (68%) were able to ambulate independently. No patient had significant cage displacement or needed cage replacement. Subsidence was minimal in 32 of 39 patients (82%). There were no hardware infections or surgical site infections. Options for stabilization include posterior instrumentation and fusion, anterior corpectomy with interbody fusion, and combination procedures. We believe anterior stabilization is superior because the aim is structural restoration of anterior and middle columns. The aim of posterior fixation is to replace the posterior tension band, which is not affected. There are 3 major surgical components to consider. First is anterior versus posterior decompression of the spinal canal. Second is the choice of autograft or titanium graft. Third is whether to stabilize posteriorly or anterolateral. CONCLUSIONS: Anterior corpectomy with an expandable titanium cage and lateral rod fixation is safe and effective with minimal complications. It is a viable alternative to posterior decompression and instrumentation.


Assuntos
Fixação Interna de Fraturas , Fixadores Internos , Vértebras Lombares/cirurgia , Procedimentos de Cirurgia Plástica , Fraturas da Coluna Vertebral/cirurgia , Titânio , Adolescente , Adulto , Idoso , Descompressão Cirúrgica , Discotomia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
4.
Epilepsy Behav ; 71(Pt A): 17-22, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28441637

RESUMO

This was a prospective observational study to correlate the clinical symptoms, electrophysiology, imaging, and surgical pathology of patients with temporal lobe epilepsy (TLE) without hippocampal sclerosis. We selected consecutive patients with TLE and normal MRI undergoing temporal lobe resection between April and September 2015. Clinical features, imaging, and functional data were reviewed. Intracranial monitoring and language mapping were performed when it was required according to our team recommendation. Prior to hippocampal resection, intraoperative electrocorticography was performed using depth electrodes in the amygdala and the hippocampus. The resected hippocampus was sent for pathological analysis. RESULTS: Five patients with diagnosis with non-lesional TLE were included. We did not find distinctive clinical features that could be a characteristic of non-lesional TLE. The mean follow-up was 13.2months (11-15months); 80% of patients achieved Engel Class I outcome. There was no distinctive electrographic findings in these patients. Histopathologic analysis was negative for mesial temporal sclerosis. A second blinded independent neuropathologist with expertise in epilepsy found ILAE type I focal cortical dysplasia in the parahippocampal gyrus in all patients. A third independent neuropathologist reported changes in layer 2 with larger pyramidal neurons in 4 cases but concluded that none of these cases met the diagnostic criteria of FCD. Subtle pathological changes could be associated with a parahippocampal epileptic zone and should be investigated in patients with MRI-negative TLE. This study also highlights the lack of interobserver reliability for the diagnosis of mild cortical dysplasia. Finally, selective amygdalo-hippocampectomy or laser ablation of the hippocampus may not control intractable epilepsy in this specific population.


Assuntos
Epilepsia do Lobo Temporal/patologia , Epilepsia do Lobo Temporal/cirurgia , Neocórtex/patologia , Neocórtex/cirurgia , Adulto , Eletrocorticografia/métodos , Eletroencefalografia/métodos , Epilepsia do Lobo Temporal/psicologia , Feminino , Hipocampo/patologia , Hipocampo/cirurgia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Giro Para-Hipocampal/patologia , Giro Para-Hipocampal/cirurgia , Estudos Prospectivos , Reprodutibilidade dos Testes , Lobo Temporal/patologia , Lobo Temporal/cirurgia
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