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Louisville, KY, United States

Seifert T.D.,Norton Neuroscience Institute
Headache | Year: 2013

Despite an incidence of approximately 3.8 million sports-related concussions per year, the pathophysiological basis of this injury remains poorly understood. Associated post-traumatic headache, both acute and chronic, can also provide a unique treatment challenge for medical personnel. The presence of new onset or persistent headache following injury often complicates return to play decisions. It is also now evident that recurrent head trauma may be associated with the development of some chronic neurodegenerative disorders. Although anecdotal reports and consensus guidelines are utilized in the management of sports concussion and associated post-traumatic headache, further evidence-based data are needed. Improved prevention and management of this injury will occur with ongoing educational and research efforts. As such advances are made, it is imperative the headache specialist have continued understanding of this evolving field. © 2013 American Headache Society.

Zhang Y.P.,Norton Neuroscience Institute
Journal of visualized experiments : JoVE | Year: 2013

Use of genetically modified mice enhances our understanding of molecular mechanisms underlying several neurological disorders such as a spinal cord injury (SCI). Freehand manual control used to produce a laceration model of SCI creates inconsistent injuries often associated with a crush or contusion component and, therefore, a novel technique was developed. Our model of cervical laceration SCI has resolved inherent difficulties with the freehand method by incorporating 1) cervical vertebral stabilization by vertebral facet fixation, 2) enhanced spinal cord exposure, and 3) creation of a reproducible laceration of the spinal cord using an oscillating blade with an accuracy of ± 0.01 mm in depth without associated contusion. Compared to the standard methods of creating a SCI laceration such as freehand use of a scalpel or scissors, our method has produced a consistent lesion. This method is useful for studies on axonal regeneration of corticospinal, rubrospinal, and dorsal ascending tracts.

Gump W.,Norton Neuroscience Institute
Neurosurgical Focus | Year: 2010

The practice of induced skull deformity has long existed in numerous disparate cultures, but for the first time in history it can be applied to adults. While extremely limited in application, some ideas have persisted in the far fringes of modern Western culture with remarkable tenacity. Practitioners of extreme body modification undergo procedures, outside the sphere of traditional medical practice, to make striking, permanent, nontraditional esthetic tissue distortions with the goal of transgressing societal norms. The International Trepanation Advocacy Group represents another example of a fringe cultural movement, whose goal, rather than being purely aesthetic in nature, is to promote elective trepanation as a method for achieving a heightened level of consciousness. Both movements have relatively short and well-defined histories. Despite their tiny numbers of adherents, neurosurgeons may be called on to address relevant patient concerns preprocedurally, or complications postprocedurally, and would benefit from awareness of these peculiar subcultures.

Gump W.C.,Norton Neuroscience Institute
Journal of Neurological Surgery, Part B: Skull Base | Year: 2015

Techniques of endoscopic endonasal surgery, initially developed primarily for intracranial neoplasms, have been adapted to treat a wide variety of pathologies previously addressed with open craniotomy including congenital and acquired defects of the anterior skull base. Congenital defects can lead to herniation of leptomeninges containing cerebrospinal fluid alone or with brain tissue. Specific types of encephalocele can be defined on the basis of the associated abnormal bony anatomy. Endoscopic endonasal surgery represents a relatively recent development in the treatment of these entities. Technical considerations include relatively younger age range of the patient population, dimensions of preexisting bony defect, volume of herniated meninges and brain tissue, and distorted anatomy from abnormal development of the affected craniofacial skeleton. Recent highly detailed anatomical studies have quantitatively verified the utility of endoscopic endonasal surgery in the pediatric population. Particular attention has been directed toward adequacy of nasoseptal flap reconstruction in pediatric patients. Several reports have described patients with encephalocele of the anterior cranial fossa successfully treated with endoscopic surgery. The literature on endoscopic repair of congenital encephalocele is reviewed. Outcomes have generally been reported as favorable, although long-term follow-up and systematic studies have not been pursued. © 2015 Georg Thieme Verlag KG Stuttgart. New York.

Mutchnick I.S.,Norton Neuroscience Institute | Maugans T.A.,Cincinnati Childrens Hospital Medical Center
Journal of Neurosurgery: Pediatrics | Year: 2012

Object. Multiple surgical procedures have been described for the management of isolated nonsyndromic sagittal synostosis. Minimally invasive techniques have been recently emphasized, but these techniques necessitate the use of an endoscope and postoperative helmeting. The authors assert that a safe and effective, more "minimalistic" approach is possible, avoiding the use of endoscopic visualization and routine postoperative application of a cranial orthosis. Methods. A single-institution cohort analysis was performed on 18 cases involving infants treated for isolated nonsyndromic sagittal synostosis between 2008 and 2010 using a nonendoscopic, minimally invasive calvarial vault remodeling (CVR) procedure without postoperative helmeting. The surgical technique is described. Variables analyzed were: age at time of surgery, sex, estimated blood loss (EBL), operative time, intraoperative complications, postoperative complications, length of stay, pre- and postoperative cephalic index (CI), clinical impressions, and results of a 5-question nonstandardized questionnaire administered to patient caregivers regarding outcome. Results. Eleven male and 7 female infants (mean age 2.3 months) were included in the study. The mean duration of follow-up was 16.4 months (range 6-38 months). The mean procedural time was 111 minutes (range 44-161 minutes). The mean length of stay was 2.3 days (range 2-3 days). The mean EBL in all 18 patients was 101.4 ml (range 30-475 ml). One patient had significant bone bleeding resulting in an EBL of 475 ml. Excluding this patient, the mean EBL was 79.4 ml (range 30-150 ml). There were no deaths or intraoperative complications; one patient had a superficial wound infection. The mean CI was 69 preoperatively versus 79 postoperatively, a statistically significant difference (p < 0.0001). Two patients were offered helmeting for suboptimal surgical outcome; one family declined and the single helmeted patient showed improvement at 2 months. No patient has undergone further surgery for correction of primary deformity, secondary deformities, or bony irregularities. Complete questionnaire data were available for 14 (78%) of the 18 patients; 86% of the respondents were pleased with the cosmetic outcome, 92% were happy to have avoided helmeting, 72% were doubtful that helmeting would have provided more significant correction, and 86% were doubtful that further surgery would be necessary. Small, palpable, aesthetically insignificant skull irregularities were reported by family members in 6 cases (43%). Conclusions. The authors present a nonendoscopic, minimally invasive CVR procedure without postoperative helmeting. Their small series demonstrates this to be a safe and efficacious procedure for isolated nonsyndromic sagittal synostosis, with improvements in CI at a mean follow-up of 16.1 months, commensurate with other techniques, and with overall high family satisfaction. Use of a CVR cranial orthosis in a delayed fashion can be effective for the infrequent patient in whom this approach results in suboptimal correction.

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