Neurosurgery
Physician insights on operative techniques, spinal disorders, neuro-oncology, cerebrovascular disease, and functional neurosurgery.
Recent Discussions
How do you determine timing and frequency of stability scans for a patient with spontaneous, non-aneurysmal intracerebral hemorrhage?
We typically obtain a follow-up “stability scan” about 6 hours from the index scan. The AHA guidelines do not mention a specific timeframe. Situations, where we would consider sooner repeat imaging, would be clinical deterioration (increase in NIHSS by 4 or more points or decline in GCS by 2 or more...
What antibiotics would you use for empiric treatment of a brain abscess in patients allergic to penicillin, metronidazole, and vancomycin?
Linezolid/Bactrim/Ceftaroline?
Should follow-up imaging for unruptured intracranial aneurysms include MRA head and MRI brain to evaluate for arterial wall enhancement?
I prefer CTA to assess asymptomatic intracranial aneurysms if there are no concerning morphological features (e.g., daughter-sac, bi-lobed, or dysplastic/irregular shape) and if the size is less than 5 mm (although size/rupture risk can vary depending on the location of the aneurysm). CTA is easier ...
How would you manage a local recurrence of a spinal hemangioblastoma following prior surgical resection alone?
Hemangioblastomas are benign rare tumors that arise from the linings of blood vessels (embryonically arrested hemangioblasts) and can form in the brain, spinal cord, and retina. When they occur in the spine, they have a tendency to recur ~25% of the time. The primary treatment for a recurrent spinal...
Do you routinely recommend suppressive antibiotic therapy for patients with spinal hardware infections who have undergone surgical debridement with retention of hardware?
Executive Summary: "State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections" was published in Clinical Infectious Diseases, December 15, 2024 issue, by Tai and colleagues from the University of Minnesota, Mayo Clinic, Hospital for Special Surgery (New York) and the University ...
Under what conditions would you offer observation for asymptomatic low volume brain metastases?
This is becoming an increasingly more common scenario with patients undergoing routine brain MR for staging, even in the absence of symptoms, and also, with a very modestly small number of settings demonstrating excellent radiographic responses to targeted agent or immune checkpoint inhibitors (ICI)...
When do you consider treating intracerebral hemorrhage associated with cerebral amyloid angiopathy as an inflammatory CAA?
Inflammatory CAA should have areas of edema, often with microhemorrhages within.
When do you consider lumbar spinal fluid drainage after acute spinal cord injury?
Extremely rarely indicated.
Do you take any special precautions when treating cervical spine metastases?
For each spine met case, it's important to determine whether it's a surgical or radiotherapy case. Spinal instability neoplastic score (SINS) and Bilsky grade (epidural cord compression) are two important parameters to consider. If SINS is 6 or below and if Bilsky grade is 1c or below, surgical inte...
What is your approach to management and surveillance in low grade traumatic blunt ICA injury?
For blunt cerebrovascular injury (BCVI), I use the Biffl scale to evaluate the extent of vessel trauma. The extracranial neck vessels, such as the cervical ICA or VA, are most commonly affected. The Biffl classification consists of five categories, with Grade 1 representing a low-grade injury. This ...