JHN Journal最新文献

{"title":"Neurosurgical Applications of Magnetic Resonance Diffusion Tensor Imaging","authors":"B. D. Hirsch, B. Zussman, A. Flanders, A. Sharan","doi":"10.29046/JHNJ.007.1.002","DOIUrl":"https://doi.org/10.29046/JHNJ.007.1.002","url":null,"abstract":"Magnetic Resonance (MR) Diffusion Tensor Imaging (DTI) is a rapidly evolving technology that enables the visualization of neural fiber bundles, or white matter (WM) tracts. There are numerous neurosurgical applications for MR DTI including: (1) Tumor grading and staging; (2) Pre-surgical planning (determination of resectability, determination of surgical approach, identification of WM tracts at risk); (3) Intraoperative navigation (tumor resection that spares WM damage, epilepsy resection that spares WM damage, accurate location of deep brain stimulation structures); (4) Post-operative assessment and monitoring (identification of WM damage, identification of tumor recurrence). Limitations of MR DTI include difficulty tracking small and crossing WM tracts, lack of standardized data acquisition and post-processing techniques, and practical equipment, software, and timing considerations. Overall, MR DTI is a useful tool for planning, performing, and following neurosurgical procedures, and has the potential to significantly improve patient care. Technological improvements and increased familiarity with DTI among clinicians are next steps. Introduction Magnetic Resonance (MR) imaging uses magnetic fields to temporarily alter proton (hydrogen atom) orientation and then measures the energy emitted upon proton relaxation, enabling discrimination of tissues with different proton (water) compositions. Water molecules naturally diffuse in accordance with Brownian motion (imagine a drop of dye spreading out in a glass of water). A series of magnetic pulses can be applied to measure the inter-pulse magnitude and direction of proton diffusion. On a pixel-by-pixel basis, this diffusion is described by the Apparent Diffusion Coefficient (ADC), which can be determined in multiple axes. Mori et al1 found that application of the diffusion pulse in a minimum of six directional axes is sufficient to resolve a diffusion vector in three dimensional space describing the overall diffusion for a given pixel, called a tensor (thus the name diffusion tensor imaging (DTI)). This approach has been particularly useful in identifying myelinated axons.The term anisotropy refers to the degree by which protons diffuse predominantly in a single direction. Myelinated fibers are relatively anisotropic with diffusion preferentially along the axis of the fiber. DTI data are depicted in parametric maps that assign colors to different directions (e.g., anterior, posterior, ventral, dorsal, right, left). Thus, MR DTI visually depicts the water molecules within myelinated neurons, crudely outlining WM tracts. DTI has been validated by comparison with experimental histological specimens. Further proof of concept includes experiments where DTI-identified WM tracts were electrically stimulated and produced predicted physiologic responses. Traditionally, subcortical stimulation mapping has served as the gold standard for intraoperative neuronavigation, yet this technique does not visually deli","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130128417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing a 600-mg Loading Dose of Clopidogrel 24 Hours Prior to Pipeline Embolization Device Treatment","authors":"E. Atallah, H. Saad, K. Bekelis, N. Chalouhi, S. Tjoumakaris, D. Hasan, H. Zarzour, Michelle J. Smith, Md Mba Facs Faha Robert H. Rosenwasswer, P. Jabbour","doi":"10.29046/JHNJ.013.2.002","DOIUrl":"https://doi.org/10.29046/JHNJ.013.2.002","url":null,"abstract":"Background: Clopidogrel/aspirin antiplatelet therapy routinely is administered 7-10 days before pipeline aneurysm treatment. Our study assessed the safety and efficacy of a 600-mg loading dose of clopidogrel 24 hours before Pipeline Embolization Device (PED) treatment. Methods: In this retrospective cohort study, we included patients treated with PED from October 2010 to May 2016. A total of 39.7% (n = 158) of patients were dispensed a loading dose of 650 mg of aspirin plus at least 600 mg of clopidogrel 24 hours preceding PED deployment, compared to 60.3% (n = 240) of patients who received 81-325 mg of aspirin daily for 10 days with 75 mg of clopidogrel daily preprocedurally. The mean follow-up was 15.8 months (standard deviation [SD] 12.4 months). modified Rankin Scale (mRS) was registered before the discharge and at each follow-up visit. To control confounding, we used multivariable logistic regression and propensity score conditioning. Results: Of 398 patients, the proportion of female patients was ~16.5% (41/240) in both groups and shared the same mean of age ~56.46 years. ~12.2% (mean = 0.09; SD = 0.30) had a subarachnoid hemorrhage. 92% (mean = 0.29; SD = 0.70) from the pretreatment group and 85.7% (mean = 0.44; SD = 0.91) of the bolus group had a mRS ≤2. In multivariate analysis, bolus did not affect the mRS score, P = 0.24. Seven patients had a long-term recurrence, 2 (0.83%; mean = 0.01; SD = 0.10) of which from the pretreatment group. In a multivariable logistic regression, bolus was not associated with a long-term recurrence rate (odds ratio [OR] 1.91; 95% confidence interval [CI] 0.27-13.50; P = 0.52) or with thromboembolic accidents (OR 0.99; 95% CI 0.96-1.03; P = 0.83) nor with hemorrhagic events (OR 1.00; 95% CI 0.97-1.03; P = 0.99). Three patients died: one who received a bolus had an acute subarachnoid hemorrhage. The mean mortality rate was parallel in both groups ~0.25 (SD = 0.16). Bolus was not associated with mortality (OR 1.11; 95% CI 0.26-4.65; P = 0.89). The same associations were present in propensity score-adjusted models.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134274794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Risk Stratification of Neurosurgical Patients","authors":"A. Munshi","doi":"10.29046/jhnj.015.1.002","DOIUrl":"https://doi.org/10.29046/jhnj.015.1.002","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125228798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Drains After Evacuation of Chronic Subdural Hematomas","authors":"Chengyuan Wu","doi":"10.29046/JHNJ.005.1.003","DOIUrl":"https://doi.org/10.29046/JHNJ.005.1.003","url":null,"abstract":"A subdural hematoma (SDH) is a collection of blood that accumulates between the surface of the brain and its outermost covering, called the dura. These types of hematmas usually result from tears in bridging veins that cross this subdural space, which is typically the result of some form of trauma. A patient’s risk of developing a SDH increases with age as the brain tends to pull away from the dura, therefore stretching the bridging veins and increasing the subdural space. In addition the risk of progression of a SDH is greater if the patient is already regularly taking an anticoagulant such as Aspirin, Plavix, or Coumadin.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124217622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epilepsy Pipeline Conference Summary","authors":"D. Abrams","doi":"10.29046/JHNJ.011.2.006","DOIUrl":"https://doi.org/10.29046/JHNJ.011.2.006","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"516 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123568601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jefferson Neurologist Shows Two-Thirds Reduction in Mortality Rate after Epilepsy Surgery","authors":"Bs Nikolaos Mouchtouris","doi":"10.29046/jhnj.011.2.007","DOIUrl":"https://doi.org/10.29046/jhnj.011.2.007","url":null,"abstract":"Dr. Sperling and his colleagues Suzanne Barshow, Dr. Maromi Nei and Dr. Ali A. Asadi-Pooya reviewed 1,110 patients’ records to find that the mortality risk in patients with drug-resistant epilepsy who underwent surgery is one-third of the mortality risk in the medication-only group of patients with drug-resistant epilepsy. They attribute this reduction to the higher rate of seizure-freedom as well as the lower proportion of tonicclonic seizures in those who continued seizures after surgery.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124694764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the Quality of Neurosurgical Literature Improving","authors":"J. Harrop, M. Maltenfort","doi":"10.29046/JHNJ.007.1.001","DOIUrl":"https://doi.org/10.29046/JHNJ.007.1.001","url":null,"abstract":"Introduction: The advent of evidence-based medicine has resulted in higher quality journal manuscripts in numerous medical disciplines. However, the impact in the neurosurgical literature has not been reported. Objective: To quantify the impact of evidence-based medicine on the quality of articles published in the Neurosurgery literature. Methods: Articles published in the journal Neurosurgery (founded in 1977) were reviewed for 1978, 1988, 1998, and 2008. Each decade’s sample was classified as therapeutic, diagnostic and prognostic based on a published system for determining level of evidence. Results: 438 articles were reviewed. Articles not considered included any published under the heading “Case Report” (automatically Level IV evidence) and articles which otherwise did not directly look at patient outcome (i.e, cadaver or animal studies). The rate of Level I studies held steady at 4.5-6.0%. Level II evidence increased steadily from no articles in 1978 to 40.6% in 2008. The increases in Level I and II article publications was statistically significant (p < 0.001). Concurrently, Level IV articles decreased in rate (81.8% in 1978 to 42.4% in 2008), while Level III articles remained fairly constant (9.8%–13.6%). The largest category of Level II studies was prognostic, and the largest category for both Level III and IV studies was therapeutic. Among study types, the most dramatic increase was in the rate of prognostic studies (15.8% to 43.6%). Only 1% of all articles were economic analyses. Conclusion: The quality of neurosurgical literature has progressively improved over the last several decades. It is unclear how much of that is due to expanded activity in randomized, clinical trials or other Level I evidence as no significant increases were observed in Level I articles during the study period (1978–2008). Much of the literature improvement may be explained by the increase in retrospective, prognostic studies as neurosurgeons take advantage of years of accumulated data. The lack of any articles on economic and decision analyses suggests that the neurosurgical community has not yet studied the effect of costs in detail. Introduction Evidence-based medicine (EBM) has been established to define the quality of literature in medical specialties. It has resulted in an increase in quality of medical literature overall. However, over the last several decades there has been an emphasis by editors and professional societies on the importance of obtaining the highest quality of medical literature through reporting evidence-based medicine levels. This manuscript reviews the last three decades of a major neurosurgical journal in an attempt to identify if there have been significant changes in terms of quality as defined by contemporary evidence-based medicine schema. Specifically, evaluating if there has been an overall improvement in the quality of neurosurgery literature as defined by EBM grading schemes. Methods A retrospective review of articles publis","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"147 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129109163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aneurysmal Rupture Without Subarachnoid Hemorrhage: A Case Report Abstract","authors":"C. Harris, Amrith Jamoona, C. Randazzo","doi":"10.29046/JHNJ.008.1.006","DOIUrl":"https://doi.org/10.29046/JHNJ.008.1.006","url":null,"abstract":"Introduction: The present case study reports an intraparenchymal hemorrhage from a ruptured basilar tip aneurysm without subarachnoid hemorrhage. Case Report: A 57-year-old male presented with intraparenchymal hemorrhage from a ruptured basilar tip aneurysm without subarachnoid hemorrhage. The patient had successful endovascular embolization of his ruptured cerebral aneurysm 9 years previously. Discussion: Ruptured cerebral aneurysms without subarachnoid hemorrhage are extremely rare. Cerebral angiogram for atypical presentation of patients with intracranial hemorrhages should be considered. In patients with known cerebral aneurysms who present with an intracranial hemorrhage, rupture of that aneurysm or a de novo aneurysm must be ruled out.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130679228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Treatment in the Management of Low- Grade Gliomas","authors":"S. Tjoumakaris","doi":"10.29046/JHNJ.004.3.004","DOIUrl":"https://doi.org/10.29046/JHNJ.004.3.004","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132382088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ARUBA Trial: How Should We Manage Brain AVMs?","authors":"N. Mouchtouris, N. Chalouhi, Thana Theofanis, M. Zanaty, S. Tjoumakaris, R. Rosenwasser, P. Jabbour","doi":"10.29046/JHNJ.009.2.002","DOIUrl":"https://doi.org/10.29046/JHNJ.009.2.002","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130219686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}