- Use of Tubular Retractors for Minimally Invasive Resection of Deep-Seated Cavernomas. [Journal Article]
- ONOper Neurosurg (Hagerstown) 2019 Jul 13
- CONCLUSIONS: Tubular retractors provide a low-profile, minimally invasive operative corridor for resection of subcortical cavernomas. There were no permanent neurologic complications in our series of 20 cases, and long-term seizure control was achieved in all patients. Thus, tubular retractors appear to be a safe and efficacious tool for resection of subcortical cavernomas.
- Uncal Herniation Due to External Hydrocephalus Post Intraventricular Surgery. [Journal Article]
- CJCan J Neurol Sci 2019; 46(4):472-474
- Gogi (Word Meaning) Aphasia and Its Relation with Semantic Dementia. [Journal Article]
- FNFront Neurol Neurosci 2019; 44:30-38
- In 1943, Tsuneo Imura, a neuropsychiatrist at Tokyo University, proposed a new aphasic syndrome and designated it as Gogi (word meaning) aphasia. According to Imura, it is characterized by (1) diffic…
In 1943, Tsuneo Imura, a neuropsychiatrist at Tokyo University, proposed a new aphasic syndrome and designated it as Gogi (word meaning) aphasia. According to Imura, it is characterized by (1) difficulty in comprehending spoken words despite good perception of sound, (2) disorders of expression due to loss of vocabulary and verbal paraphasia, (3) preserved ability of repetition, and (4) selective difficulty in reading and writing kanji (Japanese logographic character) with preserved ability of reading and writing kana (Japanese syllabic character). To be more specific, the difficulty in comprehending spoken words in Gogi aphasia is limited to substantive words as the name of the syndrome indicates, while comprehension of syntax remains unimpaired. Preserved repetition ability cannot be simply regarded as an automatic response, that is, echolalia, because the patient's attitude in repeating was quizzical, picking up the particular word he did not comprehend. Imura vaguely attributed the responsible lesion to the second and third temporal gyri on the left side. Although the general pattern of the syndrome can be placed in the category of transcortical sensory aphasia, its uniqueness as the syndrome still stands out. Another uniqueness of the syndrome is its characteristic pattern of dissociated kanji-kana difficulty in reading and writing. This linguistic symptomatology observed in Gogi aphasia was first introduced to the western academic world on a German neuropsychiatric journal by Panse and Shimoyama in 1955. Ever since, the existence of Gogi aphasia as an independent syndrome among disorders of spoken language has gradually gained international recognition. But whether the pattern of the kanji-kana dissociation described by Imura is an integral part of the syndrome remains unsettled. A recently proposed concept of semantic dementia suggests symptomatic continuation of word meaning loss with non-linguistic semantic memory loss.
- Colloid Cysts: Evolution of Surgical Approach Preference and Management of Recurrent Cysts. [Journal Article]
- ONOper Neurosurg (Hagerstown) 2019 Apr 10
- CONCLUSIONS: Surgical resection of recurrent colloid cysts should focus on complete removal of the cyst wall to minimize the chance of recurrence. Microsurgery has been shown to provide the highest success rates for cyst wall resection and lowest rates of recurrence and is therefore recommended for patients undergoing surgery for primary and recurrent colloid cysts.
- The supraorbital approach to the basal frontal lobe for resection of brain metastasis. [Journal Article]
- WNWorld Neurosurg 2019 Jun 14
- This video illustrates the use of the supraorbital craniotomy via an eyebrow incision for access to the basal frontal lobe. This approach is particularly useful for removal of lesions in the dominant…
This video illustrates the use of the supraorbital craniotomy via an eyebrow incision for access to the basal frontal lobe. This approach is particularly useful for removal of lesions in the dominant hemisphere where a transcortical approach could place speech centers at risk. The case is that of a 57-year-old woman who presented after a mental status change who was noted to have a large left frontal mass. The patient had a history of melanoma, and pathological analysis of the intracranial lesion was consistent with metastatic melanoma. The patient underwent an uneventful gross-total lesion resection. The step-by-step techniques for performing this operation are illustrated. Although not used in this case because we had an excellent view of the lesion, removal of the orbital rim allows the surgeon to obtain a better inferior-to-superior trajectory without using retraction. Of utmost importance to satisfactory cosmetic outcome are meticulous layer-by-layer closure of the eyebrow incision and maintaining pressure on the wound at the time of extubation. This pressure prevents accumulation of hematoma or cerebrospinal fluid, which places the wound under tension, impedes healing, and detrimentally affects cosmetic outcome. Additional adjuncts in this procedure may include hyperextending the head to bring the tumor into more direct view and drilling the skull base flush to expand the operative corridor. Minimally invasive approaches are excellent for the removal of metastasis because they are smaller incisions that remain well vascularized and heal quickly, allowing the patient to initiate adjuvant therapy sooner. The patient's family provided consent for publication.
- Characterization of bone ingrowth and interface mechanics of a new porous 3D printed biomaterial: an animal study. [Journal Article]
- BJBone Joint J 2019; 101-B(6_Supple_B):62-67
- CONCLUSIONS: At four and 12 weeks, the 3D printed porous implants exhibited consistent bone ingrowth and high mechanical shear strength. Based on the results of this study, we confirmed the suitability of this novel new additive manufacturing porous material for biological fixation by bone ingrowth. Cite this article: Bone Joint J 2019;101-B(6 Supple B):62-67.
- Language as a Threat: Multimodal Evaluation and Interventions for Overwhelming Linguistic Anxiety in Severe Aphasia. [Journal Article]
- FPFront Psychol 2019; 10:678
- Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behavior, and it is accentuated during language testing in persons with aphasia (PWA). The …
Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behavior, and it is accentuated during language testing in persons with aphasia (PWA). The presence of LA in PWA may jeopardize the interpretation of cognitive evaluations, leading to biased conclusions about the severity of the language alteration and the effectiveness of the treatments. In the present study, we report the case of a woman (Mrs. A) with severe chronic mixed transcortical aphasia due to left frontal and parietal hemorrhages that partially spared the perisylvian area. Mrs. A was treated with the dopamine agonist Rotigotine alone and combined with Intensive Language-Action Therapy (ILAT). Complementary evaluations included autonomic reactivity during the performance of different language tasks, resting state functional magnetic resonance imaging (rs-fMRI) and [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We found that formal language testing in a clinical setting triggered a dramatic increase of automatic echolalia, perseverations and frustration, making the task completion difficult. The treatment improved aphasia, but gains were more robust when evaluation was performed by Mrs. A's husband at home than by clinicians. Autonomic evaluation under Rotigotine revealed higher reactivity during tasks tapping an impaired function in comparison with a task evaluating a preserved function (verbal repetition). Baseline 18F-FDG-PET analysis showed decreased metabolic activity in left limbic-paralimbic areas, whereas rs-fMRI revealed compensatory activity in the right hemisphere. We also analyzed the different factors (e.g., premorbid personality traits, task difficulty) that may have contributed to LA in Mrs. A during language testing. Our findings emphasize the usefulness of implicating adequately trained laypersons in the evaluation and treatment of PWA showing LA. Further studies using multidimensional evaluations are needed to disentangle the interplay between anxiety and abnormal language as well as the neural mechanisms underpinning LA in PWA.
- Extraosseous marrow fat: an MRI sign of acute aggressive osteomyelitis. [Journal Article]
- BCBJR Case Rep 2019; 5(1):20180050
- MRI plays a critical role in the evaluation of osteomyelitis. However, MRI findings of osteomyelitis are not entirely specific and may mimic infiltrative tumors. We describe a case of extraosseous ex…
MRI plays a critical role in the evaluation of osteomyelitis. However, MRI findings of osteomyelitis are not entirely specific and may mimic infiltrative tumors. We describe a case of extraosseous extruded medullary fat with a tiny transcortical tract caused by acute osteomyelitis, diagnosed by MRI and confirmed with intraoperative findings and pathology. Identification of extruded medullary fat is a specific MRI finding that aids in the differentiation of acute osteomyelitis from infiltrative tumor thereby preventing unnecessary biopsy and facilitating prompt diagnosis and initiation of appropriate treatment.
- Ventricular Meningiomas: Surgical Strategies and a New Finding That Suggest an Origin From the Choroid Plexus Epithelium. [Journal Article]
- WNWorld Neurosurg 2019 May 20
- CONCLUSIONS: Transcortical approaches using intraoperative ultrasonography and intraoperative monitoring with avoidance of eloquent cortical areas can achieve good outcomes. Resection of the choroidal attachments should be attempted. Our results indicate that IVMs do not show arachnoid cap cell phenotype and the findings support that IVMs originate from the choroid plexus epithelium or the progenitors of the choroid plexus epithelium.
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- Non-microscopic Middle Ear Cholesteatoma Surgery: A Case Report of a Novel Head-Up Approach. [Journal Article]
- ONOtol Neurotol 2019; 40(6):777-781
- CONCLUSIONS: During endoscope-based surgery, in patients with cholesteatoma mastoid involvement, we can continue to perform the surgical procedure in a heads-up position utilizing a surgical 3D exoscope. The combination of transcanal endoscopic ear surgery and the postauricular transcortical mastoidectomy utilizing a surgical 3D exoscope is a very novel treatment strategy for cholesteatoma, and it gives us a comfortable and consistent working environment in endoscope-based ear surgery.