surgical-technique-for-spinal-cord-delivery-therapies-demonstration

Surgical Technique for Spinal Cord Delivery of Therapies: Demonstration of Procedure in Gottingen Minipigs

This is a  compact visual description of a combination of surgical technique and device  for the  delivery of (gene and cell) therapies into the spinal ...

a-contusion-model-of-severe-spinal-cord-injury-in-rats

A Contusion Model of Severe Spinal Cord Injury in Rats

The translational potential of novel treatments should be investigated in severe spinal cord injury (SCI) contusion models. A detailed methodology is ...

Medical University of South Carolina

Pulsatile arterial compression (AC) of the ventrolateral medulla (VLM) is hypothesized to produce the hypertension in a subset of patients with essential hypertension. In animals, a network of subpial neuronal aggregates in the VLM has been shown to control cardiovascular functions. Although histochemically similar, neurons have been identified in the retro-olivary sulcus (ROS) of the human VLM, but their function is unclear.

Preliminary observations on the vasomotor responses to electrical stimulation of the ventrolateral surface of the human medulla.

Recent evidence indicates that multidisciplinary care improves patient outcomes in cerebrovascular (CV) disease. A multidisciplinary integrated CV program was recently instituted at a high-volume tertiary referral center, providing the opportunity to evaluate patient outcomes before and after its introduction.

Impact of integrated cerebrovascular program on outcomes in patients with intracranial aneurysms.

Studies on risk factors for subarachnoid hemorrhage (SAH) show heterogeneity. For example, hypertension has been found to be a significant risk factor in some studies but not in others. The authors hypothesized that differences in the ethnicity of the populations studied could account for these findings.

Ethnic differences in risk factors for subarachnoid hemorrhage.

Concomitant lymphoma and cryptococcosis in a patient with acquired immune deficiency syndrome.

We review the development of neurosurgery at the Medical University of South Carolina (MUSC) and the emergence of MUSC as a leading academic neurosurgical center in South Carolina. Historical records from the Waring Historical Library were studied, former and current faculty members were interviewed, and the personal records of Dr Phanor J Perot were examined. Dr Frederick E Kredel was the first to perform cerebral revascularization in stroke patients using omental flaps and the first to culture glioma cells in artificial media. The MUSC Neurosurgery residency program was established in 1964 by its first formally trained neurosurgeon, Julian Youmans, MD. The first graduate of the program, Dr Russell Travis, went on to become the President of the American Association of Neurological Surgeons. In 1968, the longest serving chairman, Dr Perot, joined the department and conducted significant research in spinal cord injury, receiving a continuous, 20-year award from the National Institute of Neurological Disorders and Stroke. A major change in the neurosurgery program occurred in 2004 when Dr Sunil Patel accepted the chairmanship. He integrated neurosurgery, neurology, and basic neuroscience departments into a comprehensive Department of Neurosciences to provide integrated clinical care. This department now ranks second in the country in National Institutes of Health research funding. Recently, the Center for Global Health and Global Neurosurgery was established with a vision of caring for patients beyond national borders. Neurosurgery at MUSC has been influenced by Drs Kredel and Perot and the current leadership is moving forward with a uniquely integrated department with novel areas such as global neurosurgery.

History and current state of neurosurgery at the Medical University of South Carolina.

Neurosurgical patients commonly require mechanical ventilation and monitoring in a neurocritical care unit. There are only few studies that specifically address the process of liberation from mechanical ventilation in this population. Patients who remain ventilator or artificial airway dependent receive a tracheostomy. The appropriate timing for the procedure is not well defined and may be different among an inhomogeneous population of critically ill patients. In this article, we review the general principles of liberation and the current literature as it pertains to neurosurgical patients with primary brain injury. The criteria for "readiness of extubation" include a combination of neurologic assessment, hemodynamic, and respiratory parameters. Future studies are required to better assess indicators for extubation readiness, evaluate the predictors of extubation failure in brain-injured patients, and define the most appropriate timing for a tracheostomy.

Liberation of neurosurgical patients from mechanical ventilation and tracheostomy in neurocritical care.

Meta-analysis: vertebroplasty for vertebral compression fracture ineffective in improving pain and function.

Spinal cord infarction associated with subarachnoid hemorrhage.

Decompressive craniectomy (DC) is used to relieve intractable intracranial hypertension and/or to prevent or reverse cerebral herniation. Significant controversy exists on selection of candidates, timing of the procedure and neurologic outcomes. Furthermore, the cerebral hemodynamic consequences post-DC have been researched only recently. We report on two consecutive patients who underwent DC in our institution and reviewed the literature on cerebral blood flow changes post-craniectomy. One patient had unilateral DC and the second had a suboccipital decompression (SOC). Cerebral blood flow velocities (FV) and pulsatility indices (PI) were recorded via transcranial Doppler (TCD). To our knowledge, this is the first report on FV/PI monitoring after SOC. TCD is a readily available, non-invasive test. The PI may provide useful information regarding timing and effectiveness of DC.

Cerebral blood flow velocity changes and the value of the pulsatility index post decompressive craniectomy.

Cervical pseudomeningocele as a cause of neurological decline after posterior cervical spine surgery.

There is considerable interest in translating laboratory advances in neuronal regeneration following spinal cord injury (SCI). A multimodality approach has been advocated for successful functional neuronal regeneration. With this goal in mind several biomaterials have been employed as neuronal bridges either to support cellular transplants, to release neurotrophic factors, or to do both. A systematic review of this literature is lacking. Such a review may provide insight to strategies with a high potential for further investigation and potential clinical application.

Biomaterial-based interventions for neuronal regeneration and functional recovery in rodent model of spinal cord injury: a systematic review.

The preservation of functional neural tissue after spinal cord injury (SCI) is the basis for spontaneous neurological recovery. Some injured patients in acute phase have more potential for recovery than others. This fact is problematic for the construction of clinical trials because enrollment of subjects with variable recovery potential makes it difficult to detect effects, requires large sample sizes, and risks Type II errors. In addition, the current methods to assess injury and recovery are non-quantitative and not very sensitive. It is likely that therapeutic combinations will be necessary to cause substantially improved function after SCI, thus we need highly sensitive techniques to evaluate changes in motor, sensory, autonomic and other functions. We review several emerging neurophysiological techniques with high sensitivity. Quantitative methods to evaluate residual tissue sparing after severe acute spinal cord injury (SCI) have not entered widespread clinical use. This reduces the ability to correlate structural preservation with clinical outcome following SCI resulting in enrollment of subjects with varying patterns of tissue preservation and injury into clinical trials. We propose that the inclusion of additional measures of injury severity, pattern, and individual genetic characteristics may enable stratification in clinical trials to making the testing of therapeutic interventions more effective and efficient. New imaging techniques to assess tract injury and demyelination and methods to quantify tissue injury, inflammatory markers, and neuroglial biochemical changes may improve the evaluation of injury severity, correlation with neurological outcome and measure the effects of treatment more robustly than is currently possible. The ability to test such a multimodality approach will require a high degree of collaboration between clinical and research centers and government research support. When the most informative of these assessments is determined it may be possible to identify patients with substantial recovery potential, improve selection criteria and conduct more efficient clinical trials.

ArticleTotal : 2	Year
Publication title Cited by 23	2012
Publication title Cited by 41	2013

Article	Year
Preliminary observations on the vasomotor responses to electrical stimulation of the ventrolateral surface of the human medulla. Journal of neurosurgery\| PubMed ID: 22540399	2012
Impact of integrated cerebrovascular program on outcomes in patients with intracranial aneurysms. Journal of neurointerventional surgery\| PubMed ID: 22496066	2013
Ethnic differences in risk factors for subarachnoid hemorrhage. Journal of neurosurgery\| PubMed ID: 17886550	2007
Concomitant lymphoma and cryptococcosis in a patient with acquired immune deficiency syndrome. The American journal of the medical sciences\| PubMed ID: 20739871	2010
History and current state of neurosurgery at the Medical University of South Carolina. Neurosurgery\| PubMed ID: 21368698	2011
Liberation of neurosurgical patients from mechanical ventilation and tracheostomy in neurocritical care. Journal of critical care\| PubMed ID: 22033050	2012
Meta-analysis: vertebroplasty for vertebral compression fracture ineffective in improving pain and function. Evidence-based medicine\| PubMed ID: 22044795	2012
Spinal cord infarction associated with subarachnoid hemorrhage. Clinical neurology and neurosurgery\| PubMed ID: 22386902	2012
Cerebral blood flow velocity changes and the value of the pulsatility index post decompressive craniectomy. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia\| PubMed ID: 22555129	2012
Cervical pseudomeningocele as a cause of neurological decline after posterior cervical spine surgery. Neurology India\| PubMed ID: 22626724
Biomaterial-based interventions for neuronal regeneration and functional recovery in rodent model of spinal cord injury: a systematic review. The journal of spinal cord medicine\| PubMed ID: 23809587	2013
Spinal cord injury: How can we improve the classification and quantification of its severity and prognosis? Journal of neurotrauma\| PubMed ID: 23895105	2013

Vibhor Krishna

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