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McVige J.W.,Dent Neurologic Institute | Leonardo J.,State University of New York at Buffalo | Leonardo J.,University at Buffalo Neurosurgery
Neurologic Clinics | Year: 2014

Chiari malformations are anatomic anomalies that comprise a broad spectrum of neurologic conditions. The most common malformation, a Chiari type I malformation, can present with a variety of signs and symptoms, most frequently an occipital Valsalva-induced headache. Cranial and spinal magnetic resonance (MR) imaging is used to identify the degree of tonsillar descent and document the presence of syringohydromyelia. The advent of cine-MR flow imaging (cine as in "cinema") has provided new insight as to the dynamic process involved in the evolution of this pathophysiology. This article reviews the neuroimaging of this fascinating disorder. © 2014 Elsevier Inc.

Grand W.,State University of New York at Buffalo | Grand W.,University at Buffalo Neurosurgery | Chamczuk A.J.,State University of New York at Buffalo | Leonardo J.,State University of New York at Buffalo | Snyder K.V.,State University of New York at Buffalo
Acta Neurochirurgica | Year: 2011

Background: To review the outcome after endoscopic third ventriculostomy (ETV) for symptomatic, persistent hydrocephalus in three patients with perimesencephalic angiographically negative subarachnoid hemorrhage (PNH) who were dependent on an external ventricular drain (EVD). Methods: All patients initially presented with severe headache, nuchal rigidity, confusion and lethargy (Hunt-Hess Grade II or III), and persistent, EVD-dependent hydrocephalus. Cranial CT images in each revealed acute hydrocephalus and perimesencephalic hemorrhage pattern with a heavy clot burden (Fisher grade 3). A 3D-CT angiogram on admission and two four-vessel cerebral angiograms failed to demonstrate a bleeding source. All three patients failed trial EVD clamping, with clinical deterioration and elevated intracranial pressure (ICP). ETV was performed with a 0-degree endoscope in a 4.6-mm irrigating sheath using an endoscopic-coring/"cookie-cut" technique. An EVD was left in place for postoperative ICP monitoring but was clamped. Results: ETV was accomplished in all patients. In one case, a tiny basilar tip aneurysm was seen during the endoscopic procedure. Intraoperatively, the prepontine cistern revealed dense, degraded blood products. Postprocedure ICP measurements were reduced to normal range. Clinical improvement, normal ICP readings, and/or radiographic evidence of resolution of hydrocephalus allowed uneventful removal of the EVD within 36-48 h post-ETV in all patients. All remained headache-free, with a normal neurological examination, during a follow-up period of 10, 11, and 12 months, respectively. Conclusion: To our knowledge, this is the first report of ETV for PNH with hydrocephalus and the first report of a basilar tip microaneurysm seen intraoperatively during ETV. ETV is a viable treatment option for refractory hydrocephalus secondary to a perimesencephalic pattern of subarachnoid hemorrhage (SAH). Its early application can avoid placement of a ventriculoperitoneal shunt, curtail the extended use of an EVD, and reduce the associated infection risks. Despite thorough angiographic investigation for an aneurysmal cause of SAH, a "microaneurysm" of the basilar artery was found at ETV. No complication or rebleeding was encountered. © 2011 Springer-Verlag.

McVige J.W.,Dent Neurologic Institute | Leonardo J.,State University of New York at Buffalo | Leonardo J.,University at Buffalo Neurosurgery
Current Pain and Headache Reports | Year: 2015

Chiari malformation type I (CMI) involves the caudal displacement of the cerebellar tonsils through the foramen magnum with resultant brainstem compression in some individuals. Due to pathophysiologic changes, secondary conditions may arise, such as syringohydromyelia (SH) and scoliosis. This disorder is unique, as the diagnosis is confirmed through radiologic findings. At times CMI is discovered incidentally on neuroimaging, but more frequently a patient will present with specific symptoms, the most common being a prototypic occipital headache. Although the true etiology of this complex condition remains speculative, the advent of neuroimaging has allowed for clarification of the enigmatic relationship between cerebrospinal fluid (CSF) dynamics, neuroanatomical compression, and clinical symptoms. Recent advancements in magnetic resonance imaging (MRI) such as diffusion tensor imaging (DTI) and CSF flow studies show promise in clarifying the underlying fluid dynamics in CMI patients and can aid in the prognosis and diagnosis of this complex disorder. © 2015, Springer Science+Business Media New York.

Siasios I.,State University of New York at Buffalo | Siasios I.,University at Buffalo Neurosurgery | Fountas K.,University of Thessaly | Dimopoulos V.,State University of New York at Buffalo | Pollina J.,State University of New York at Buffalo
Neurosurgical Review | Year: 2016

Dysphagia is a common postoperative symptom for patients undergoing anterior cervical spine procedures. The purpose of this study is to present the current literature regarding the effect of steroid administration in dysphagia after anterior cervical spine procedures. We performed a literature search in the PubMed database, using the following terms: “dysphagia,” “ACDF,” “cervical,” “surgery,” “anterior,” “spine,” “steroids,” “treatment,” and “complications.” We included in our review any study correlating postoperative dysphagia and steroid administration in anterior cervical spine surgery. Studies, which did not evaluate, pre- and postoperatively, dysphagia with a specific clinical or laboratory methodology were excluded from our literature review. Five studies were included in our results. All were randomized, prospective studies, with one being double blinded. Steroid administration protocol was different in every study. In two studies, dexamethasone was used. Methylprednisolone was administrated in three studies. In four studies, steroids were applied intravenously, while in one study, locally in the retropharyngeal space. Short-term dysphagia and prevertebral soft tissue edema were diminished by steroid administration, according to the results of two studies. In one study, prevertebral soft tissue edema was not affected by the steroid usage. Furthermore, short-term osseous fusion rate was impaired by the steroid administration, according to the findings of one study. The usage of steroids in patients undergoing anterior cervical spine procedures remains controversial. Multicenter, large-scale, randomized, prospective studies applying the same protocol of steroid administration and universal outcome criteria should be performed for extracting statistically powerful and clinically meaningful results. © 2016 Springer-Verlag Berlin Heidelberg

Dumont T.M.,University at Buffalo Neurosurgery | Dumont T.M.,Gates Vascular Institute | Eller J.L.,University at Buffalo Neurosurgery | Eller J.L.,Gates Vascular Institute | And 7 more authors.
Neurosurgery | Year: 2014

Recent advancements in all phases of endovascular aneurysm treatment, including medical therapy, diagnostics, devices, and implants, abound. Advancements in endovascular technologies and techniques have enabled treatment of a wide variety of intracranial aneurysms. In this article, technical advances in endovascular treatment of cerebral aneurysms are discussed, with an effort to incorporate a clinically relevant perspective. Advancements in diagnostic tools, medical therapy, and implants are reviewed and discussed. Copyright © 2014 by the Congress of Neurological Surgeons.

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