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Item Metabolic transcriptomics dictate responses of cone photoreceptors to retinitis pigmentosa(Cell Press, 2023) Lee, Sang Joon; Emery, Douglas; Vukmanic, Eric; Wang, Yekai; Lu, Xiaoqin; Wang, Wei; Fortuny, Enzo; James, Robert; Kaplan, Henry J.; Liu, Yongqing; Du, Jianhai; Dean, Douglas C.; Neurological Surgery, School of MedicineMost mutations in retinitis pigmentosa (RP) arise in rod photoreceptors, but cone photoreceptors, responsible for high-resolution daylight and color vision, are subsequently affected, causing the most debilitating features of the disease. We used mass spectroscopy to follow 13C metabolites delivered to the outer retina and single-cell RNA sequencing to assess photoreceptor transcriptomes. The S cone metabolic transcriptome suggests engagement of the TCA cycle and ongoing response to ROS characteristic of oxidative phosphorylation, which we link to their histone modification transcriptome. Tumor necrosis factor (TNF) and its downstream effector RIP3, which drive ROS generation via mitochondrial dysfunction, are induced and activated as S cones undergo early apoptosis in RP. The long/medium-wavelength (L/M) cone transcriptome shows enhanced glycolytic capacity, which maintains their function as RP progresses. Then, as extracellular glucose eventually diminishes, L/M cones are sustained in long-term dormancy by lactate metabolism.Item A Contemporary Clinico-Anatomical Guide to Craniovertebral Junction Surgery(Thieme, 2022-09-28) Spiessberger, Alexander; Gruter, Basil; Prashant, Giyarpuram; Haegler, Joshua; Eisenberg, Mark; Cohen-Gadol, Aaron A.; Dehdashti, Amir R.; Neurological Surgery, School of MedicineBackground: Surgical treatment of ventral and ventrolateral lesions of the craniocervical junction are among the most challenging neurosurgical pathologies to treat. Three surgical techniques, the far lateral approach (and its variations), the anterolateral approach, and the endoscopic far medial approach can be used to approach and resect lesions in this area. Objective: The aim of the study is to examine the surgical anatomy of three skull base approaches to the craniocervical junction and review surgical cases to better understand the indications and possible complications for each of these approaches. Methods: Cadaveric dissections with standard microsurgical and endoscopic instruments were performed for each of the three surgical approaches, and key steps and surgically relevant anatomy were documented. Six patients with appropriate pre-, post-, and intraoperative imaging and video documentation are presented and discussed accordingly. Results: Based on our institutional experience, all three approaches can be utilized to safely and effectively approach a wide variety of neoplastic and vascular pathology. Unique anatomical characteristics, lesion morphology and size, and tumor biology should all be considered when determining the optimal approach. Conclusion: Preoperative assessment of surgical corridors with 3D illustrations helps to define the best surgical corridor. 360 degree knowledge of the anatomy of craniovertebral junction allows safe surgical approach and treatment of ventral and ventrolateral located lesions using one of the three approaches.Item A Retrospective Review of 30-Day Hospital Readmission Risk After Open Heart Surgery in Patients With Atrial Fibrillation(Springer Nature, 2023-09-22) Rao, Varun; DeLeon, Genaro; Thamba, Aish; Flanagan, Mindy; Nickel, Kathleen; Gerue, Michael; Gray, Douglas; Neurological Surgery, School of MedicineIntroduction: Readmission rates after open heart surgery (OHS) remain an important clinical issue. The causes are varied, with identifying risk factors potentially providing valuable information to reduce healthcare costs and the rate of post-operative complications. This study aimed to characterize the reasons for 30-day hospital readmission rates of patients after open heart surgery. Methods: All patients over 18 years of age undergoing OHS at a community hospital from January 2020 through December 2020 were identified. Demographic data, medical history, operative reports, post-operative complications, and telehealth interventions were obtained through chart review. Descriptive statistics and readmission rates were calculated, along with a logistic regression model, to understand the effects of medical history on readmission. Results: A total of 357 OHS patients met the inclusion criteria for the study. Within the population, 8.68% of patients experienced readmission, 10.08% had an emergency department (ED) visit, and 95.80% had an outpatient office visit. A history of atrial fibrillation (AFib) significantly predicted 30-day hospital readmissions but not ED or outpatient office visits. Telehealth education was delivered to 66.11% of patients. Conclusion: The study investigated factors associated with 30-day readmission following OHS. AFib patients were more likely to be readmitted than patients without atrial fibrillation. No other predictors of readmission, ED visits, or outpatient office visits were found. Patients reporting symptoms of tachycardia, pain, dyspnea, or "other" could be at increased risk for readmission.Item Examination and Scientific Analysis of Thoracic Vertebral Fractures(Springer Nature, 2023-09-09) Singh, Gurbinder; Rao, Varun; Thamba, Aish; Roth, Dylan; Zaazoue, Mohamed A.; Neurological Surgery, School of MedicineBackground: Thoracic vertebral fractures are clinically important due to their association with the thoracic spinal cord and the potential to cause devastating neurological injury. Using the National Electronic Injury Surveillance System (NEISS) data, this study investigated fracture patterns to understand associated factors to improve prevention strategies. We explored different factors associated with thoracic vertebral fractures to improve our understanding of preventative strategies and patient care standards, focusing on spatial distribution, sex-age dynamics, and location of injury. Methodology: This retrospective, cross-sectional study examines thoracic vertebral fractures across diverse age groups from 2013 to 2022, utilizing the NEISS database from the U.S. Consumer Product Safety Commission. Inclusion criteria based on specific terms related to thoracic fractures were employed. Descriptive statistics illustrated fracture distribution by age groups and associated products. Statistical analyses, including chi-square tests and multivariate logistic regressions, were conducted to explore associations between fracture occurrence, locations, products, age, and gender. Results: The analysis of thoracic vertebral fractures by location and associated products yielded several statistically significant findings. Notably, the prevalence of fractures at home (39.67%) was significantly higher than in other locations, and these differences in fracture distribution were statistically significant (χ² = 7.34, p < 0.001). Among the associated products, ladders (10.46%) emerged as the most frequent product associated with fractures. Multivariate logistic regression analysis showed that the age groups of 41-50, 51-60, and 61-70 had increased odds of fractures with adjusted odds ratios (AORs) of 1.08 (95% confidence interval (CI) = 1.04-1.42, p < 0.05), 1.21 (95% CI = 1.13-1.56, p < 0.001), and 1.17 (95% CI = 1.08-1.39, p < 0.001), respectively. The likelihood of thoracic vertebral fractures did not significantly differ between males and females (AOR = 1.12, 95% CI = 0.87-1.53, p = 0.262). Fracture distribution by age groups and products indicated increasing ladder-related fractures within the 41-50 age group and 51-60 age group. Football-related fractures peaked within the 21-30 age group. Fracture distribution patterns for bicycles had increased prevalence within the 11-20 and 21-30 age groups, and football-related fractures in younger age groups. Conclusions: This study analyzed factors associated with thoracic vertebral fractures, showing the significance of targeted preventative interventions, such as earlier screening, physical therapy, and nutritional status assessment, in the setting of significant location and age-related susceptibilities. The observed patterns of injury provide a foundation for future research to elucidate the underlying mechanisms between different environments and the likelihood of injury to improve preventive strategies.Item Indirect Bypass With Pericranial Transposition for Moyamoya Syndrome in an Infant(Springer Nature, 2023-08-24) Ajala, Rodiyah T.; Nguyen, Anthony; Lyon, Kristopher; Qaiser, Rabia; Neurological Surgery, School of MedicineMoyamoya syndrome (MMS) is a progressive disease that can result in debilitating strokes. Surgical revascularization is the mainstay of treatment. Selection of the proper bypass technique depends on the vascular anatomy and location of the hypoperfused cerebral territory. We describe here a case of successful indirect bypass utilizing a pericranial flap as well as dural inversion. A seven-month-old female was transferred from an outside facility to our institution for further evaluation and surgical treatment of MMS. She presented with bilateral brain infarcts worse on the left, with right-sided body weakness. After medical stabilization and hyperhydration, she was taken to the operating room for a left-sided indirect bypass. The superficial temporal artery (STA) was traced utilizing doppler but was determined to be too diminutive for transposition, so the decision was made to proceed with encephalo-duro-pericranio-synangiosis (EDPS). A pericranial graft was successfully affixed to the cortical surface in the hypoperfused middle cerebral artery (MCA) territory, and the dura was inverted. Postoperatively, the patient developed a pseudomeningocele, so a revision surgery was performed. She was discharged shortly after this and returned for encephalo-duro-arterio-synangiosis (EDAS) of the contralateral side. She followed up three months after her initial bypass surgery at age 10 months and was crawling without any focal deficits. She was lost to follow-up thereafter. EDPS is a safe technique for infants with MMS whose STA is too diminutive to be used for bypass surgery. This may be an effective method for indirect bypass in these patients.Item Subarachnoid haemorrhage associated with pituitary apoplexy and radiographically occult supraclinoid internal carotid artery aneurysms(BMJ, 2023-09-18) Christodoulides, Alexei; Burket, Noah J.; Virtanen, Piiamaria; Lane, Brandon C.; Neurological Surgery, School of MedicineIn patients with pituitary adenomas, incidental intracranial aneurysms have been documented. Previous studies have highlighted the importance of preoperative imaging in these patients. However, imaging may be limited and fail to show the presence of vascular abnormalities. In this report, we discuss a case of a man in his 30s presenting with a newly diagnosed pituitary adenoma. CT and MRI, on admission, showed a pituitary mass with extension into the right cavernous sinus. After a sudden neurological deterioration, emergent CT/CT angiography revealed pituitary apoplexy with subarachnoid extension without vascular abnormalities. Successful emergency transsphenoidal hypophysectomy was followed by digital subtraction angiography which revealed the presence of two right supraclinoid internal carotid artery aneurysms. With this case, we aim to highlight the need for further vascular imaging in patients with pituitary apoplexy and subarachnoid haemorrhage, as preoperative imaging may be negative for vascular abnormalities especially in the setting of cavernous sinus invasion.Item Orbital Exenteration for Craniofacial Lesions: A Systematic Review and Meta-Analysis of Patient Characteristics and Survival Outcomes(MDPI, 2023-08-27) Qedair, Jumanah; Haider, Ali S.; Balasubramanian, Kishore; Palmisciano, Paolo; Hassan, Taimur; Shahbandi, Ataollah; Sabahi, Mohammadmahdi; Kharbat, Abdurrahman F.; Abou-Al-Shaar, Hussam; Yu, Kenny; Cohen-Gadol, Aaron A.; El Ahmadieh, Tarek Y.; Bin-Alamer, Othman; Neurological Surgery, School of MedicineBackground: The outcomes of orbital exenteration (OE) in patients with craniofacial lesions (CFLs) remain unclear. The present review summarizes the available literature on the clinical outcomes of OE, including surgical outcomes and overall survival (OS). Methods: Relevant articles were retrieved from Medline, Scopus, and Cochrane according to PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management, and outcomes. Results: A total of 33 articles containing 957 patients who underwent OE for CFLs were included (weighted mean age: 64.3 years [95% CI: 59.9-68.7]; 58.3% were male). The most common lesion was squamous cell carcinoma (31.8%), and the most common symptom was disturbed vision/reduced visual acuity (22.5%). Of the patients, 302 (31.6%) had total OE, 248 (26.0%) had extended OE, and 87 (9.0%) had subtotal OE. Free flaps (33.3%), endosseous implants (22.8%), and split-thickness skin grafts (17.2%) were the most used reconstructive methods. Sino-orbital or sino-nasal fistula (22.6%), flap or graft failure (16.9%), and hyperostosis (13%) were the most reported complications. Regarding tumor recurrences, 38.6% were local, 32.3% were distant, and 6.7% were regional. The perineural invasion rate was 17.4%, while the lymphovascular invasion rate was 5.0%. Over a weighted mean follow-up period of 23.6 months (95% CI: 13.8-33.4), a weighted overall mortality rate of 39% (95% CI: 28-50%) was observed. The 5-year OS rate was 50% (median: 61 months [95% CI: 46-83]). The OS multivariable analysis did not show any significant findings. Conclusions: Although OE is a disfiguring procedure with devastating outcomes, it is a viable option for carefully selected patients with advanced CFLs. A patient-tailored approach based on tumor pathology, extension, and overall patient condition is warranted.Item Spine Injuries in Household Environments: A Comprehensive Analysis(Springer Nature, 2023-08-28) Singh, Gurbinder; Rao, Varun; Thamba, Aish; Pahwa, Bhavya; Zaazoue, Mohamed; Neurological Surgery, School of MedicineIntroduction: Recognizing the concerns posed by spine injuries within homes, stemming from falls, interactions with furnishings, and daily activities, it is imperative to consider preventive strategies. Our analysis of spine injuries utilizing the National Electronic Injury Surveillance System (NEISS) data sheds light on falls, furnishings, age-specific risks, recreation, technology, and socioeconomic disparities as contributing elements, accentuating the need for targeted interventions. This study aims to provide insights into the prevalence of spine injuries in different household locations, associated products, age groups, and gender, thus informing injury prevention strategies for safer living environments. Methods: This is a retrospective, cross-sectional study utilizing data between 2013 to 2022 from the National Electronic Injury Surveillance System database. Specific household product codes and demographic data, such as age and gender, were analyzed. Statistical analysis in R (R Foundation for Statistical Computing, Vienna, Austria) involved descriptive statistics and multivariate logistic regressions. Results: In analyzing 44,267 spine injuries, the study revealed location-specific variations in spine injuries within households. Living rooms and bedrooms had the highest injury rates at 34.17% and 21.65%, respectively. Significant differences in injury rates between males and females across various home locations. Females accounted for 51.78% of injuries in the living room and 59.99% in the bedroom. In the kitchen, females experienced 53.21% of injuries, while males accounted for 46.79% of cases. Notably, overall spine injuries exhibited a significant difference between males and females, with females having a higher total likelihood of injuries (AOR = 1.21, 95% CI: 1.14-1.77, p < 0.001). Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, accounting for 17.98% of total cases. Notably, the age group of 61-70 years exhibited a substantial proportion of injuries at 17.12%, while the age group of 71-80 years accounted for 14.39%. The age group of 41-50 years also displayed a notable injury rate of 14.12%. The youngest age group, 0-10 years, demonstrated the lowest percentage of injuries at 4.79%. This age-based analysis provides valuable insights into the distribution of spine injuries across different demographic segments. Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, comprising 17.98% of total cases. Age groups of 41-50 and 61-70 years also showed substantial proportions of injuries, accounting for 14.12% and 17.12%, respectively. The youngest age group, 0-10, exhibited the lowest percentage of injuries at 4.79%. Conclusion: The study focuses on the occurrence of spinal injuries in common sites of injury in the household, such as the living room, bedroom, kitchen, and stairs. There is increased prevalence amongst females and increased risk vulnerability amongst people 51 to 60 years of age. Our research emphasizes the necessity of implementing specific injury prevention measures tailored to different demographic groups within their home setting. This approach should involve collaborative decision-making with patients while prioritizing patient education to create a safer living environment and reduce the likelihood of spine injuries.Item Neuroprotective effects of interleukin 10 in spinal cord injury(Frontiers Media, 2023-07-10) Li, Juan; Wang, Pei; Zhou, Ting; Jiang, Wenwen; Wu, Hang; Zhang, Shengqi; Deng, Lingxiao; Wang, Hongxing; Neurological Surgery, School of MedicineSpinal cord injury (SCI) starts with a mechanical and/or bio-chemical insult, followed by a secondary phase, leading progressively to severe collapse of the nerve tissue. Compared to the peripheral nervous system, injured spinal cord is characterized by weak axonal regeneration, which leaves most patients impaired or paralyzed throughout lifetime. Therefore, confining, alleviating, or reducing the expansion of secondary injuries and promoting functional connections between rostral and caudal regions of lesion are the main goals of SCI therapy. Interleukin 10 (IL-10), as a pivotal anti-inflammatory and immunomodulatory cytokine, exerts a wide spectrum of positive effects in the treatment of SCI. The mechanisms underlying therapeutic effects mainly include anti-oxidative stress, limiting excessive inflammation, anti-apoptosis, antinociceptive effects, etc. Furthermore, IL-10 displays synergistic effects when combined with cell transplantation or neurotrophic factor, enhancing treatment outcomes. This review lists pleiotropic mechanisms underlying IL-10-mediated neuroprotection after SCI, which may offer fresh perspectives for clinical translation.Item Susceptibility-Weighted MRI Approximates Intraoperative Microelectrode Recording During Deep Brain Stimulation of the Subthalamic Nucleus for Parkinson's Disease(Elsevier, 2024-01) Budnick, Hailey C.; Schneider, Dylan; Zauber, S. Elizabeth; Witt, Thomas C.; Gupta, Kunal; Neurological Surgery, School of MedicineBackground Deep brain stimulation of the subthalamic nucleus (STN-DBS) for Parkinson's disease can be performed with intraoperative neurophysiological and radiographic guidance. Conventional T2-weighted magnetic resonance imaging sequences, however, often fail to provide definitive borders of the STN. Novel magnetic resonance imaging sequences, such as susceptibility-weighted imaging (SWI), might better localize the STN borders and facilitate radiographic targeting. We compared the radiographic location of the dorsal and ventral borders of the STN using SWI with intraoperative microelectrode recording (MER) during awake STN-DBS for Parkinson's disease. Methods Thirteen consecutive patients who underwent placement of 24 STN-DBS leads for Parkinson's disease were analyzed retrospectively. Preoperative targeting was performed with SWI, and MER data were obtained from intraoperative electrophysiology records. The boundaries of the STN on SWI were identified by a blinded investigator. Results The final electrode position differed significantly from the planned coordinates in depth but not in length or width, indicating that MER guided the final electrode depth. When we compared the boundaries of the STN by MER and SWI, SWI accurately predicted the entry into the STN but underestimated the length and ventral boundary of the STN by 1.2 mm. This extent of error approximates the span of a DBS contact and could affect the placement of directional contacts within the STN. Conclusions MER might continue to have a role in STN-DBS. This could potentially be mitigated by further refinement of imaging protocols to better image the ventral boundary of the STN.