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The evolution of surgical management for vertebral column tumors

JNSPG 75th Anniversary Invited Review Article

Jared Fridley and Ziya L. Gokaslan

, polymethylmethacrylate is injected into the fractured vertebral body via a percutaneous transpedicular approach. Kyphoplasty has the additional step of inflating a balloon in the vertebral body to create a cavity prior to cement injection, which can help reduce kyphotic deformity and increase the overall cement volume injected. Both procedures have been shown to improve pain scores (visual analog scale), reduce narcotic usage, and improve quality of life (SF-36). 12 These procedures can be particularly useful as an adjunct prior to SRS, 25 both to relieve mechanical back pain and

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Doniel Drazin, Ziya L. Gokaslan, Ehud Mendel and J. Patrick Johnson

-oncologic genetic standpoint, offering useful information about tumor location, extent of resection, and neurofibromatosis status. On an even larger scale, via 18,297 patients across 774 hospitals of the National Inpatient Sample, Kalakoti et al. examined risk factors that are associated with unfavorable outcomes following resection of intradural spine tumors and hospital volume in the United States with respect to discharge disposition and hospital costs. Ependymomas are the most common intramedullary tumor. The importance of tumor dissection and capsule integrity in

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Stephen J. Hentschel, Laurence D. Rhines, Franklin C. Wong, Ziya L. Gokaslan and Ian E. McCutcheon

high volume and the presence of β 2 -transferrin, which is specific for CSF in this setting. 21 Other presentations of SPF include postural headaches secondary to intracranial hypotension, which may also result in subdural effusions or hematomas and manifest as an altered mental state or even as focal neurological deficits. These symptoms and signs may be initially attributed to medications, electrolyte imbalance, or infection but should prompt an investigation of SPF as a possible cause. Pneumocephalus may present as an altered level of consciousness, headache, or

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Kaisorn L. Chaichana, Courtney Pendleton, Daniel M. Sciubba, Jean-Paul Wolinsky and Ziya L. Gokaslan

findings offer useful insights into the care of patients with MESCC. Nevertheless, prospective and higher-volume studies are needed to provide better data to guide clinical decision-making. Conclusions Recent studies have supported the efficacy of decompressive surgery at maintaining the ability to walk for patients with MESCC from solid primary tumors. These studies, however, have grouped patients with distinct types of primary cancers all into the same study population. Studies identifying differences between patients with different primary cancers remain few and

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Matthew J. McGirt, Beril Gok, Starane Shepherd, Joseph Noggle, Giannina L. Garcés Ambrossi, Ali Bydon and Ziya L. Gokaslan

inspection of the spinal cord and vertebral column to confirm epidural tumor progression and cord compression. To quantify the extent of epidural tumor growth within the spinal canal at the time of paralysis, all epidural tumor mass within the spinal canal was surgically inspected, aspirated, and measured in cubic centimeters. Data on daily hindlimb function (BBB score), time to paralysis, and epidural tumor volume at time of paralysis were compared between normoglycemic and hyperglycemic groups. Tumor Cell Line and Spinal Implantation The isolation and growth of the

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Frederick F. Lang, Nancy E. Olansen, Franco DeMonte, Ziya L. Gokaslan, Eric C. Holland, Christopher Kalhorn and Raymond Sawaya

insular component of the tumor, form the basis of this analysis. Table 1 lists the clinical, histological, and radiographic features of the 22 cases. There were seven male and 15 female patients with a median age of 36 years (range 2–78 years). The most common presenting symptoms were seizures (64%), mild-to-moderate weakness/hemiparesis (32%), and dysphasia/dysnomia (18%). TABLE 1 Characteristics of 22 patients who underwent resection of insular tumors * Tumor Features Tumor Volume (cm 3 ) Case No. Age

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Paul E. Kaloostian, Jennifer E. Kim, Ali Bydon, Daniel M. Sciubba, Jean-Paul Wolinsky, Ziya L. Gokaslan and Timothy F. Witham

system implementation that was not existent at the time of those encounters. Average hourly drain output before symptom onset was 9.2 ml per hour, or a daily average of 221 ml per day. The total volume of intraoperative CSF loss was not recorded, but all CSF leaks were repaired immediately upon detection. Intracranial Hemorrhage All 8 patients were symptomatic postoperatively. Symptom onset ranged from immediately after surgery to postoperative Day 3, and symptoms included headache (n = 1), aphasia (n = 1), seizure (n = 1), and altered mental status (n = 4). No

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Ryan M. Kretzer, Daniel M. Sciubba, Carlos A. Bagley, Jean-Paul Wolinsky, Ziya L. Gokaslan and Ira M. Garonzik

construct. The patient was discharged in stable condition 4 days after completion of the staged surgical procedure. F ig . 5 Postoperative anteroposterior x-ray film showing the spinal construct. F ig . 6 Postoperative axial (A) and volume-rendered sagittal (B) and coronal (C) reconstructed CT scans showing bilateral crossing T-1 translaminar screws. Discussion Although transpedicular screw fixation offers the benefits of known stability and high rates of fusion, the pedicular anatomy in the high thoracic spine makes PS placement at these levels

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Camilo A. Molina, Rachel Sarabia-Estrada, Ziya L. Gokaslan, Timothy F. Witham, Ali Bydon, Jean-Paul Wolinsky and Daniel M. Sciubba

tumor was excised and harvested from the female athymic carrier rats for intravertebral tumor implantation. Harvested solid tumor was maintained in sterile saline solution before its implantation, and the tissue was cut into approximately 0.1-cm 3 fragments, a volume smaller than that of the 1-mm drilled cavity, to leave sufficient room for additional placement of an absorbable bovine collagen sponge, which served as the drug delivery vehicle. Specifically, animals in the experimental cohort received sponges impregnated with 15 μg of rhBMP-2 (10 μl of 1.5-mg

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Claudia S. Robertson, Raj K. Narayan, Charles F. Contant, Robert G. Grossman, Ziya L. Gokaslan, Rajesh Pahwa, Pedro Caram Jr., Robert S. Bray Jr. and Arthur M. Sherwood

many secondary injury processes. Intracranial compliance has been proposed as an earlier, more sensitive indicator of impending neurological deterioration due to cerebral edema or mass lesions. 22 Volume-pressure response (VPR), which is the change in ICP after injection or withdrawal of 1 ml of cerebrospinal fluid (CSF) over 1 second, is a simple method of expressing intracranial compliance. A normal VPR is less than 2 mm Hg/ml. 15 A VPR of greater than 5 mm Hg/ml indicates a critical reduction in the volume-buffering capacity of the brain. 15 Pressure-volume