Neurosurgery
Physician insights on operative techniques, spinal disorders, neuro-oncology, cerebrovascular disease, and functional neurosurgery.
Recent Discussions
How do you approach treatment of a young adult with an intracranial anaplastic ependymoma and a single intradural cervical spine metastasis?
A high-grade tumor, such as anaplastic ependymoma, carries a higher risk of CSF seeding down the neuroaxis than lower grades. Secondary spinal drop metastases are considered a serious but relatively rare complication in this disease. Assuming that the metastasis was detected at the time of diagnosi...
How do you manage spinal cord compression in a new suspected neuroblastoma diagnosis?
While there is evidence that chemotherapy, surgery, and radiation can all be effective for some patients,1 there are no definitive studies or data that prove the best approach for all patients. A 2017 systematic review concluded that the “currently available literature remains suboptimal as a guide ...
What specific exam findings or test changes prompt escalation of care when evaluating pediatric patients with optic disc drusen for possible increased intracranial pressure?
Both pediatric and adult patients with optic disc drusen can develop increased intracranial pressure, including IIH, like normal individuals. This is important to remember, especially if the symptoms and risk factors suggest elevated intracranial hypertension. In the pediatric group, especially youn...
When do you consider using general anesthesia for endovascular thrombectomy?
I perform all of my thrombectomy cases under general anesthesia. There is better hemodynamic control, no patient movement to manage, which increases procedural efficiency as a result. In moderate sedation cases, patients can feel aspiration and stent retriever passes through the vessel, which causes...
How do you determine when to transition a patient with a shunt placed at birth to an adult provider?
Ideally, when you have a pediatric patient with a longstanding shunt, you begin discussions with the family at the initial placement, helping them understand that a shunt is usually a lifelong device that will require follow-up in some manner the rest of the child's life. When the child is entering ...
What is your approach to treating a child with a new brain tumor who is unable tolerate an MRI?
Barring an anesthetic or ferrous implant contraindication, any child should be able to have an MRI, if necessary, with general anesthesia/CO2 control and monitor, particularly when ICP/hydrocephalus is a concern.
How frequently do you observe transient enlargement of a vestibular schwannoma after SRS?
Transient enlargement of a vestibular schwannoma is not uncommon, and it's appropriate to reassure patients. I image these patients once every 6 months until radiographic stability, and then once yearly.
What is your approach for testing speech in bilingual patients undergoing an awake craniotomy for glioma resection?
In a bilingual patient, it is important to assess the patient's language function in both languages. This would include pre-operative non-invasive functional mapping as well as intra-operative awake mapping. Areas of language function and connectivity are less discrete than sensory and motor functio...
What is your approach for surveillance of coiled unruptured aneurysm?
DSA 6 months after initial coiling MRA TOFTR (time-of-flight time-resolved) thereafter
Should ultra-short course RT be standard for elderly or poor performance status patients with glioblastoma?
The recent phase III randomized trial published by Roa et al. examining the efficacy of short course radiotherapy in elderly and/or frail patients with newly diagnosed GBM builds upon his previous work finding equivalent outcomes in elderly patients (age > 60 years) receiving 60 Gy in 30 fractions ...