Neurosurgery
Physician insights on operative techniques, spinal disorders, neuro-oncology, cerebrovascular disease, and functional neurosurgery.
Recent Discussions
Under what circumstances would you consider decompression alone for a stable grade 1 spondylolisthesis at L5-S1?
In general, a decompression alone can be performed in select cases in the setting of a degenerative spondylolisthesis in the absence of instability. Primary symptoms from spinal stenosis must be present and not related to foraminal height or foraminal stenosis in my practice. I look at the sacral sl...
How do you factor in pain catastrophizing in your decision to pursue surgery for degenerative lumbar spondylolisthesis?
I am a firm believer that surgery is the last resort for our patients. There are wants and needs in life and surgery for degenerative lumbar spondylolisthesis is elective surgery. Patients with severe pain in my practice still undergo all conservative measures. We work on preoperative optimization w...
How do you determine which site to utilize for ventricular peritoneal shunt placement - frontal or posterior?
Depends on the individual, anatomy, size, prior surgeries, etc. Preference is frontal for several reasons: with growth, the relative length of the catheter to overall head growth is less than with a parieto-occipital catheter and less likely to end up in the choroid plexus. Should septostomy be need...
How do you change the shunt setting after adding an antisiphon device?
In my practice, if I add an antisiphon device, I do not change the programmable valve setting at the time of surgery. I only adjust the setting based on patient symptoms several weeks to allow the patient to adjust to the new system.
Would you consider a stagged approach using gamma knife radiation for brain tumors larger than 3cm in diameter?
By staged, do you mean surgery followed by radiosurgery, fractionated radiosurgery, or something else?
How do you decide when to place a drain after a subdural hematoma evacuation?
Drain use following chronic subdural hematoma drainage has long been controversial. The risk of brain injury while placing subdural drains has been well described and should be carefully considered when making the decision to do so. On the other hand, studies have demonstrated that subdural drains r...
What is you approach to management of a traumatic pseudoaneurysm for a patient who has a concurrent traumatic ICH?
If the aneurysm is ruptured, then I treat acutes similar to a ruptured sacular aneurysm. If it is unruptured, then I get a short interval follow-up CTA in 3 days. If enlarging, then treat. If stable, then I will manage conservatively with serial imaging follow-up.
How do you approach treatment and management of angiogram negative non-aneurysmal subarachnoid hemorrhage?
We repeat the catheter-based angiogram 7-10 days after the initial angiogram negative angiogram. MRI of the brain, including the spine, if SAH is predominantly in the posterior fossa.
What is your approach to clearing the cervical spine in intubated patients more than 24 hours after their initial injury?
I think the answer to this depends upon the suspicion of injury. This then goes back to what was the incident that caused concern for clearing the cervical spine. Many times, we rely upon the CT scan of the cervical spine, and we look for fractures, dislocations, or soft tissue swelling. If the conc...
What is your approach to a reherniated lumbar disc that was initially treated with a minimally invasive hemilaminectomy and discectomy?
I am a firm believer that you can always do more for someone and you cannot undo anything you do. Barring any instability on imaging, I routinely perform a redo microdiscectomy. There are some case series to suggest a spinal fusion may provide a more definitive and sustained amount of relief in some...