The Experts below are selected from a list of 246 Experts worldwide ranked by ideXlab platform
George I. Jallo - One of the best experts on this subject based on the ideXlab platform.
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intramedullary Spinal Cord Tumor resection
Neurosurgical Focus, 2012Co-Authors: Mari L Groves, Patricia L Zadnik, Pablo F Recinos, Violette Renard, George I. JalloAbstract:The authors present a case of a 27-year-old patient who presented with spastic gait and worsening difficulty walking over a 6 month period. Spinal MR imaging revealed a heterogeneously enhancing intramedullary Spinal Cord Tumor (IMSCT) with associated syrinx in the cervical spine. The lesion was resected through posterior en bloc laminotomy, durotomy, and microscopic resection of the intramedullary component followed by laminoplasty reconstruction. Surgical resections with a goal of gross total resection can significantly improve overall survival and progression free survival in patients with low-grade IMSCT. The procedure is presented in an edited, high-definition format with accompanying narrative. The video can be found here: http://youtu.be/Ui9bn82PtP8.
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intramedullary Spinal Cord Tumor surgery can we do it without intraoperative neurophysiological monitoring
Childs Nervous System, 2010Co-Authors: Chetan Bettegowda, George I. JalloAbstract:Objective The objective of this review is to discuss the utilization of intraoperative neurophysiological monitoring (IONM) during Spinal Cord Tumor surgery.
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defining future directions in Spinal Cord Tumor research proceedings from the national institutes of health workshop
Journal of Neurosurgery, 2010Co-Authors: Elizabeth B Claus, May Abdelwahab, Peter C Burger, Herbert H Engelhard, David W Ellison, Nicholas Gaiano, David H Gutmann, Daniel A Heck, Eric C Holland, George I. JalloAbstract:The relative rarity of Spinal Cord Tumors has hampered the study of these uncommon nervous system malignancies. Consequently, the understanding of the fundamental biology and optimal treatment of Spinal Cord Tumors is limited, and these cancers continue to inflict considerable morbidity and mortality in children and adults. As a first step to improving the outcome of patients affected with Spinal Cord Tumors, the National Institutes of Health Office of Rare Diseases Research in cooperation with the National Cancer Institute and the National Institute of Neurological Disorders and Stroke convened a workshop to discuss the current status of research and clinical management of these Tumors. The overall goal of this meeting was to initiate a process that would eventually translate fundamental basic science research into improved clinical care for this group of patients. Investigational priorities for each of these areas were established, and the opportunities for future multidisciplinary research collaborations were identified.
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The Evolution of Intramedullary Spinal Cord Tumor Surgery
Neurosurgery, 2009Co-Authors: Daniel M. Sciubba, Daniel Liang, Karl F. Kothbauer, Joseph C. Noggle, George I. JalloAbstract:Resections of intramedullary Spinal Cord Tumors were attempted as early as 1890. More than a century after these primitive efforts, profound advancements in imaging, instrumentation, and operative techniques have greatly improved the modern surgeon's ability to treat such lesions successfully, often with curative results. We review the history of intramedullary Spinal Cord Tumor surgery, as well as the evolution and advancement of technologies and surgical techniques that have defined the procedure over the past 100 years. Surgery to remove intramedullary Spinal Cord Tumors has evolved to include sophisticated imaging equipment to pinpoint Tumor location, laser scalpel systems to provide precise incisions with minimal damage to surrounding tissue, and physiological monitoring to detect and prevent intraoperative motor deficits. Modern surgical devices and techniques have developed dramatically with the availability of new technologies. As a result, continual advancements have been achieved in intramedullary Spinal Cord Tumor surgery, thus increasing the safety and effectiveness of Tumor resection, and progressively improving the overall outcomes in patients undergoing such procedures.
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THE EVOLUTION OF INTRAMEDULLARY Spinal Cord Tumor SURGERY. COMMENTARIES
Neurosurgery, 2009Co-Authors: Daniel M. Sciubba, Daniel Liang, Karl F. Kothbauer, Joseph C. Noggle, George I. Jallo, Jacques Brotchi, James Tait Goodrich, Edward C. Benzel, Michael Y. WangAbstract:OBJECTIVE: Resections of intramedullary Spinal Cord Tumors were attempted as early as 1890. More than a century after these primitive efforts, profound advancements in imaging, instrumentation, and operative techniques have greatly improved the modern surgeon's ability to treat such lesions successfully, often with curative results. METHODS: We review the history of intramedullary Spinal Cord Tumor surgery, as well as the evolution and advancement of technologies and surgical techniques that have defined the procedure over the past 100 years. RESULTS: Surgery to remove intramedullary Spinal Cord Tumors has evolved to include sophisticated imaging equipment to pinpoint Tumor location, laser scalpel systems to provide precise incisions with minimal damage to surrounding tissue, and physiological monitoring to detect and prevent intraoperative motor deficits. CONCLUSION: Modern surgical devices and techniques have developed dramatically with the availability of new technologies. As a result, continual advancements have been achieved in intramedullary Spinal Cord Tumor surgery, thus increasing the safety and effectiveness of Tumor resection, and progressively improving the overall outcomes in patients undergoing such procedures.
A. Korn - One of the best experts on this subject based on the ideXlab platform.
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continuous mapping of the corticoSpinal tracts in intramedullary Spinal Cord Tumor surgery using an electrified ultrasonic aspirator
Journal of Neurosurgery, 2017Co-Authors: Ori Barzilai, Zvi Lidar, Khalil Salame, S. Constantini, Yifat Bitantalmor, A. KornAbstract:Intramedullary Spinal Cord Tumors (IMSCTs) represent a rare entity, accounting for 4%–10% of all central nervous system Tumors. Microsurgical resection of IMSCTs is currently considered the primary treatment modality. Intraoperative neurophysiological monitoring (IONM) has been shown to aid in maximizing Tumor resection and minimizing neurological morbidity, consequently improving patient outcome. The gold standard for IONM to date is multimodality monitoring, consisting of both somatosensory evoked potentials, as well as muscle-based transcranial electric motor evoked potentials (tcMEPs). Monitoring of tcMEPs is optimal when combining transcranial electrically stimulated muscle tcMEPs with D-wave monitoring. Despite continuous monitoring of these modalities, when classic monitoring techniques are used, there can be an inherent delay in time between actual structural or vascular-based injury to the corticoSpinal tracts (CSTs) and its revelation. Often, tcMEP stimulation is precluded by the surgeon’s prefe...
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Continuous mapping of the corticoSpinal tracts in intramedullary Spinal Cord Tumor surgery using an electrified ultrasonic aspirator
Journal of Neurosurgery: Spine, 2017Co-Authors: Ori Barzilai, Zvi Lidar, Khalil Salame, Yifat Bitan-talmor, S. Constantini, A. KornAbstract:Intramedullary Spinal Cord Tumors (IMSCTs) represent a rare entity, accounting for 4%-10% of all central nervous system Tumors. Microsurgical resection of IMSCTs is currently considered the primary treatment modality. Intraoperative neurophysiological monitoring (IONM) has been shown to aid in maximizing Tumor resection and minimizing neurological morbidity, consequently improving patient outcome. The gold standard for IONM to date is multimodality monitoring, consisting of both somatosensory evoked potentials, as well as muscle-based transcranial electric motor evoked potentials (tcMEPs). Monitoring of tcMEPs is optimal when combining transcranial electrically stimulated muscle tcMEPs with D-wave monitoring. Despite continuous monitoring of these modalities, when classic monitoring techniques are used, there can be an inherent delay in time between actual structural or vascular-based injury to the corticoSpinal tracts (CSTs) and its revelation. Often, tcMEP stimulation is precluded by the surgeon's preference that the patient not twitch, especially at the most crucial times during resection. In addition, D-wave monitoring may require a few seconds of averaging until updating, and can be somewhat indiscriminate to laterality. Therefore, a method that will provide immediate information regarding the vulnerability of the CSTs is still needed. The authors performed a retrospective series review of resection of IMSCTs using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the Spinal Cord, along with classic muscle-based tcMEP and D-wave monitoring. The authors present their preliminary experience with 6 patients who underwent resection of an IMSCT using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the Spinal Cord, together with classic muscle-based tcMEP and D-wave monitoring. This fusion of technologies can potentially assist in optimizing resection while preserving neurological function in these challenging surgeries.
Yukihiro Matsuyama - One of the best experts on this subject based on the ideXlab platform.
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tuberculous meningitis with dementia as the presenting symptom after intramedullary Spinal Cord Tumor resection
Nagoya Journal of Medical Science, 2015Co-Authors: Kazuyoshi Kobayashi, Yukihiro Matsuyama, Shiro Imagama, Kei Ando, Hideki Yagi, Ryuichi Shinjo, Tetsuro Hida, Yoshimoto Ishikawa, Naoki IshiguroAbstract:Early-stage TB meningitis has no specific symptoms in patients, potentially leading to delayed diagnosis and consequently worsening prognosis. The authors present the fatal case with a delayed diagnosis of tuberculous (TB) meningitis with dementia as the presenting symptom after intramedullary Spinal Cord Tumor resection. The medical reCords, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. A 77-year-old man who underwent thoracic intramedullary hemangioblastoma resection for 2 times. The postoperative course was uneventful, but 1.5 months after surgery, the patient suffered from dementia with memory loss and diminished motivation and speech in the absence of a fever. No abnormalities were detected on blood test, brain computed tomography and cerebroSpinal fluid (CSF) analysis. A sputum sample was negative for Mycobacterium tuberculosis in the QuantiFERON®-TB Gold (QFT-G) In-Tube Test and the tuberculin skin test was also negative. The patient was diagnosed with senile dementia by a psychiatrist. However, the patient’s symptoms progressively worsened. Despite the absence of TB meningitis findings, we suspected TB meningitis from the patient’s history, and administered a four-drug regimen. However the patient died 29 days after admission, subsequently M. tuberculosis was detected in the CSF sample. This case is a rare case of TB meningitis initially mistaken for dementia after intramedullary Spinal Cord Tumor resection. Symptoms of dementia after intramedullary Spinal Cord Tumor resection should first be suspected as one of TB meningitis, even if the tests for meningitis are negative. We propose that anti-tuberculosis therapy should be immediately initiated in cases of suspected TB meningitis prior to positive identification on culture.
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the cutoff amplitude of transcranial motor evoked potentials for transient postoperative motor deficits in intramedullary Spinal Cord Tumor surgery
Spine, 2014Co-Authors: Akio Muramoto, Yukihiro Matsuyama, Shiro Imagama, Kei Ando, Ryoji Tauchi, Tomohiro Matsumoto, Hiroaki Nakashima, Naoki IshigroAbstract:Abstract Retrospective clinical study of intraoperative transcranial motor evoked potential (TcMEP) amplitudes and postoperative motor deficits (PMDs). To determine the quantifiable cutoff amplitude of TcMEP for predicting transient PMDs in intramedullary Spinal Cord Tumor (IMSCT) surgery. The "presence or absence" criterion is reliable and widely used the alarm criterion for preventing permanent PMDs in IMSCT surgery. However, we wanted to prevent PMDs even if it is transient. The cutoff amplitude for transient PMDs should be identified. We conducted a retrospective study to identify the cutoff amplitude for predicting transient PMDs in IMSCT surgery. Thirty-seven patients were included in the study. We examined intraoperative electrophysiological changes and perioperative motor status in these patients. Receiver operating characteristic analyses were performed to identify the cutoff amplitudes for predicting transient PMDs in IMSCT surgery. The incidence of PMDs and cutoff TcMEP amplitude in cervical and thoracic lesions were compared. Thirteen cases demonstrated transient PMDs. Among 280 monitorable muscles in 37 cases, 51 muscles in 13 patients showed PMDs. Through receiver operating characteristic analysis, the relative and the absolute cutoff amplitudes at the intraoperative point of deterioration were identified to be 12% residual of baseline amplitude and 3.2 μV, respectively. Sensitivity/specificity for those cutoff points are 86%/74% and 88%/78%, respectively. The incidence of PMD was significantly higher, and the cutoff amplitude was lower in the thoracic lesions than in the cervical lesions. We determined the cutoff TcMEP amplitude for predicting transient PMDs in IMSCT surgery. The cutoff amplitude for the cervical lesions was higher than that for the thoracic lesions. The results suggest the need for setting different alarm criteria in different level of spine. 3.
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surgical results of intramedullary Spinal Cord Tumor with Spinal Cord monitoring to guide extent of resection
Journal of Neurosurgery, 2009Co-Authors: Yukihiro Matsuyama, Koji Sato, Shiro Imagama, Yoshihito Sakai, Yoshito Katayama, Norimitsu Wakao, Mitsuhiro Kamiya, Yasutsugu Yukawa, Tokumi Kanemura, Makoto YanaseAbstract:Object The authors investigated the outcome of intramedullary Spinal Cord Tumor surgery, focusing on the effect of preoperative neurological status on postoperative mobility and the extent of Tumor excision guided by intraoperative Spinal Cord monitoring prospectively. Methods Intramedullary Spinal Cord Tumor surgery was performed in 131 patients between 1997 and 2007. The authors compared the pre- and postoperative neurological status and examined the type of surgery in 106 of these patients. A modified McCormick Scale (Grades I–V) was used to assess ambulatory ability (I = normal ambulation; II = mild motor sensory deficit, independent without external aid; III = independent with external aid; IV = care required; and V = wheelchair required). The type of surgery was classified into 4 levels: total resection, subtotal resection, partial resection, and biopsy. Results The 106 patients consisted of 47 females and 59 males, whose average age was 42.5 years (range 6–75 years). The mean follow-up period was 7...
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Infantile Spinal Cord Tumor: diagnostic difficulties. A case report.
Journal of Pediatric Orthopaedics B, 2002Co-Authors: Taichi Tsuji, Yukihiro Matsuyama, Koji Sato, Hisashi IwataAbstract:We report an infant with a thoracic intradural extramedullary Tumor to illustrate the presentation of an infantile Spinal Cord Tumor and the difficulty in establishing a diagnosis. An infant presented with edema of the legs, motor loss in the lower extremities, and anuria at 3 months of age. Magnetic resonance imaging of the lumbar region did not reveal any abnormalities. At 1 year of age, the patient underwent surgery to correct urinary incontinence of unknown etiology. The patient developed gait disturbance and had abdominal pain at 17 months of age. Magnetic resonance imaging of the thoracic spine revealed an intradural extramedullary Tumor at T2-T5. The Spinal Cord Tumor was completely resected and pathologic findings indicated an endodermal cyst. All symptoms improved after the operation. Infants who present with weakness of the lower legs, urinary incontinence and unknown abdominal pain should be evaluated for a Spinal Cord Tumor.
S. Constantini - One of the best experts on this subject based on the ideXlab platform.
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continuous mapping of the corticoSpinal tracts in intramedullary Spinal Cord Tumor surgery using an electrified ultrasonic aspirator
Journal of Neurosurgery, 2017Co-Authors: Ori Barzilai, Zvi Lidar, Khalil Salame, S. Constantini, Yifat Bitantalmor, A. KornAbstract:Intramedullary Spinal Cord Tumors (IMSCTs) represent a rare entity, accounting for 4%–10% of all central nervous system Tumors. Microsurgical resection of IMSCTs is currently considered the primary treatment modality. Intraoperative neurophysiological monitoring (IONM) has been shown to aid in maximizing Tumor resection and minimizing neurological morbidity, consequently improving patient outcome. The gold standard for IONM to date is multimodality monitoring, consisting of both somatosensory evoked potentials, as well as muscle-based transcranial electric motor evoked potentials (tcMEPs). Monitoring of tcMEPs is optimal when combining transcranial electrically stimulated muscle tcMEPs with D-wave monitoring. Despite continuous monitoring of these modalities, when classic monitoring techniques are used, there can be an inherent delay in time between actual structural or vascular-based injury to the corticoSpinal tracts (CSTs) and its revelation. Often, tcMEP stimulation is precluded by the surgeon’s prefe...
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Continuous mapping of the corticoSpinal tracts in intramedullary Spinal Cord Tumor surgery using an electrified ultrasonic aspirator
Journal of Neurosurgery: Spine, 2017Co-Authors: Ori Barzilai, Zvi Lidar, Khalil Salame, Yifat Bitan-talmor, S. Constantini, A. KornAbstract:Intramedullary Spinal Cord Tumors (IMSCTs) represent a rare entity, accounting for 4%-10% of all central nervous system Tumors. Microsurgical resection of IMSCTs is currently considered the primary treatment modality. Intraoperative neurophysiological monitoring (IONM) has been shown to aid in maximizing Tumor resection and minimizing neurological morbidity, consequently improving patient outcome. The gold standard for IONM to date is multimodality monitoring, consisting of both somatosensory evoked potentials, as well as muscle-based transcranial electric motor evoked potentials (tcMEPs). Monitoring of tcMEPs is optimal when combining transcranial electrically stimulated muscle tcMEPs with D-wave monitoring. Despite continuous monitoring of these modalities, when classic monitoring techniques are used, there can be an inherent delay in time between actual structural or vascular-based injury to the corticoSpinal tracts (CSTs) and its revelation. Often, tcMEP stimulation is precluded by the surgeon's preference that the patient not twitch, especially at the most crucial times during resection. In addition, D-wave monitoring may require a few seconds of averaging until updating, and can be somewhat indiscriminate to laterality. Therefore, a method that will provide immediate information regarding the vulnerability of the CSTs is still needed. The authors performed a retrospective series review of resection of IMSCTs using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the Spinal Cord, along with classic muscle-based tcMEP and D-wave monitoring. The authors present their preliminary experience with 6 patients who underwent resection of an IMSCT using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the Spinal Cord, together with classic muscle-based tcMEP and D-wave monitoring. This fusion of technologies can potentially assist in optimizing resection while preserving neurological function in these challenging surgeries.
Ori Barzilai - One of the best experts on this subject based on the ideXlab platform.
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continuous mapping of the corticoSpinal tracts in intramedullary Spinal Cord Tumor surgery using an electrified ultrasonic aspirator
Journal of Neurosurgery, 2017Co-Authors: Ori Barzilai, Zvi Lidar, Khalil Salame, S. Constantini, Yifat Bitantalmor, A. KornAbstract:Intramedullary Spinal Cord Tumors (IMSCTs) represent a rare entity, accounting for 4%–10% of all central nervous system Tumors. Microsurgical resection of IMSCTs is currently considered the primary treatment modality. Intraoperative neurophysiological monitoring (IONM) has been shown to aid in maximizing Tumor resection and minimizing neurological morbidity, consequently improving patient outcome. The gold standard for IONM to date is multimodality monitoring, consisting of both somatosensory evoked potentials, as well as muscle-based transcranial electric motor evoked potentials (tcMEPs). Monitoring of tcMEPs is optimal when combining transcranial electrically stimulated muscle tcMEPs with D-wave monitoring. Despite continuous monitoring of these modalities, when classic monitoring techniques are used, there can be an inherent delay in time between actual structural or vascular-based injury to the corticoSpinal tracts (CSTs) and its revelation. Often, tcMEP stimulation is precluded by the surgeon’s prefe...
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Continuous mapping of the corticoSpinal tracts in intramedullary Spinal Cord Tumor surgery using an electrified ultrasonic aspirator
Journal of Neurosurgery: Spine, 2017Co-Authors: Ori Barzilai, Zvi Lidar, Khalil Salame, Yifat Bitan-talmor, S. Constantini, A. KornAbstract:Intramedullary Spinal Cord Tumors (IMSCTs) represent a rare entity, accounting for 4%-10% of all central nervous system Tumors. Microsurgical resection of IMSCTs is currently considered the primary treatment modality. Intraoperative neurophysiological monitoring (IONM) has been shown to aid in maximizing Tumor resection and minimizing neurological morbidity, consequently improving patient outcome. The gold standard for IONM to date is multimodality monitoring, consisting of both somatosensory evoked potentials, as well as muscle-based transcranial electric motor evoked potentials (tcMEPs). Monitoring of tcMEPs is optimal when combining transcranial electrically stimulated muscle tcMEPs with D-wave monitoring. Despite continuous monitoring of these modalities, when classic monitoring techniques are used, there can be an inherent delay in time between actual structural or vascular-based injury to the corticoSpinal tracts (CSTs) and its revelation. Often, tcMEP stimulation is precluded by the surgeon's preference that the patient not twitch, especially at the most crucial times during resection. In addition, D-wave monitoring may require a few seconds of averaging until updating, and can be somewhat indiscriminate to laterality. Therefore, a method that will provide immediate information regarding the vulnerability of the CSTs is still needed. The authors performed a retrospective series review of resection of IMSCTs using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the Spinal Cord, along with classic muscle-based tcMEP and D-wave monitoring. The authors present their preliminary experience with 6 patients who underwent resection of an IMSCT using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the Spinal Cord, together with classic muscle-based tcMEP and D-wave monitoring. This fusion of technologies can potentially assist in optimizing resection while preserving neurological function in these challenging surgeries.