Neurosurgery
Physician insights on operative techniques, spinal disorders, neuro-oncology, cerebrovascular disease, and functional neurosurgery.
Recent Discussions
Under what circumstances do you send next generation sequencing or tempus for patients after a brain tumor resection?
I obtain NGS for all gliomas and most brain metastases. I also obtain NGS for high-risk meningiomas (based on clinical, radiographic, or histopathological findings). The NCCN guidelines have reflected the increasing importance of NGS testing for these tumor types in order to accurately grade these p...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
How do you manage glioblastoma presenting with leptomeningeal dissemination?
Hospice is a very legitimate option. As physicians, we recommend this far too infrequently.
Under what circumstances do you decide to place an EVD for patients with cerbellar ischemic stroke?
Although placement of an EVD in a patient with cerebellar infarction can be lifesaving, I rarely use it as a sole treatment for that condition due to the risk of upward herniation. Typically, when the cerebellar infarction has created enough mass effect to cause hydrocephalus, the patient also requi...
How would you advise a younger patient with residual/recurrent optic nerve meningioma, proceeding with radiotherapy, about the risks of malignant transformation or induction of other brain malignancies because of radiation?
The risk of malignant transformation of an optic nerve sheath meningioma (ONSM) after RT appears to be remarkably low, much lower than the risk of blindness from an untreated, progressive ONSM. In a younger patient, I would lean toward RT for patients with imaging progression or early visual loss, ...
What is the best time frame to utilize intra arterial verapamil for vasospasm after subarachnoid hemorrhage?
We do not use AA verapamil prophylactically. We follow our patients in the Neuro ICU with daily transcranial Doppler. If they have clinical signs or symptoms of vasospasm and TCD and CTA evidence of spasm, we take them immediately and usually perform IA injections daily until radiographically and cl...
Do you recommend a prolonged duration of antibiotics and/or suppression for patients without pre-existing hardware who have placement of new hardware after decompression/washout of a Staphylococcus aureus epidural abscess?
If the hardware is placed in the setting of active infection, then I usually chronically suppress the patient indefinitely after treating for the acute infection.
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 ...
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
For which patients do you consider placing a lumbar drain prior to endoscopic endonasal resection for pituitary adenoma with suprasellar extension?
The use of a lumbar drain for suprasellar pituitary tumors is the subject of much discussion, and surgeon preference plays a role in how and how frequently drains are used. I am an advocate for more routine use of lumbar drains for almost all patients that have significant suprasellar extension. The...