Neurosurgery
Physician insights on operative techniques, spinal disorders, neuro-oncology, cerebrovascular disease, and functional neurosurgery.
Recent Discussions
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
Under what circumstances would you consider awake mapping for DBS placement?
DBS outcomes data now clearly support the notion that asleep image-guided DBS electrode placement outcomes for Parkinson's Disease are at least equivalent to awake surgery, with or without microelectrode recording. The real question at this point is under what conditions an awake DBS surgery is ever...
Under what circumstances would you consider utilizing deep brain stimulation for treatment of obesity?
Probably not indicated for obesity, given the new GLP therapies that have emerged in the past few years. I am not a proponent of the idea of "food addiction" either, which may be the rationale for nucleus accumbens DBS. Dr. Casey Halpern at U Penn may be a better person to ask about that.
Under what circumstances would you utilize a radial approach versus a femoral approach for vascular access during an angiogram?
The choice of radial vs femoral access for neuro-interventional procedures is typically based on provider preference and experience but is influenced by several important considerations: The first consideration is local site-specific disease and anatomy, i.e., peripheral vascular disease, presence ...
Under what circumstances would you treat intractable drug-resistant epilepsy with focused ultrasound rather than other surgical approaches?
Essentially, the only condition of intractable epilepsy that might be considered treatable with high-intensity focused ultrasound would be intractable seizures associated with a hypothalamic hamartoma.
How do you decide between an ALIF vs. a TLIF for L5-S1 spondylolisthesis?
ALiF if robust likelihood of fusion and restoration of optimal lordosis.
Under what circumstances do you consider an enbloc resection versus biopsy for a lower lumbar spinal column tumor?
Typically, a biopsy is performed prior to en bloc resection rather than “either or.” A biopsy is necessary if there is a differential diagnosis based on imaging, and if the diagnosis will affect management: radiation and chemotherapy alone vs. intralesional resection/debulking and adjuvant therapy v...