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Robert A. Scranton, Kushal Shah and Aaron A. Cohen-Gadol

OBJECTIVE

Trigeminal neuralgia is a debilitating disease that can be treated effectively by a number of modalities. Percutaneous balloon compression rhizotomy of the gasserian ganglion is an important technique that can be offered as a primary or secondary strategy after failure of medical therapy. However, the commercial kit for this procedure was discontinued in the United States in early 2016 and therefore is not currently available. The authors describe a low-cost, effective solution for continuing to offer this procedure using equipment already available in most hospitals.

METHODS

The authors provide a detailed equipment list with step-by-step instructions on how to prepare all the necessary items and perform a percutaneous balloon compression rhizotomy.

RESULTS

The custom “homemade” kit and technique described have been utilized successfully since June 2016 in 34 patients. The kit is a low-cost alternative, and its application does not add any operative time beyond that required for the previously commercially available kit.

CONCLUSIONS

Percutaneous balloon compression rhizotomy of the gasserian ganglion is an important technique that should be readily available to patients who are not medically fit for microvascular decompression and need immediate relief of their pain. The alternative kit described here can be assembled easily using equipment that is readily available in most hospitals.

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Sindhura Pisipati, Kyle A. Smith, Kushal Shah, Koji Ebersole, Roukoz B. Chamoun and Paul J. Camarata

OBJECTIVE

Laser interstitial thermal therapy (LITT) is used in numerous neurosurgical applications including lesions that are difficult to resect. Its rising popularity can be attributed to its minimally invasive approach, improved accuracy with real-time MRI guidance and thermography, and enhanced control of the laser. One of its drawbacks is the possible development of significant edema, which contributes to extended hospital stays and often necessitates hyperosmolar or steroid therapy. Here, the authors discuss the use of minimally invasive craniotomy to resect tissue ablated with LITT in attempt to minimize cerebral edema.

METHODS

Five patients with glioblastoma multiforme prospectively underwent LITT followed by resection. The LITT was performed with the aid of an MR-compatible skull-mounted frame in the MRI suite. Ablated tumor was then resected via small craniotomy by using the NICO Myriad system or cavitron ultrasonic surgical aspirator. Postoperative management involved dexamethasone administration slowly tapered over several weeks.

RESULTS

The use of resection following LITT, as compared with open resection or LITT alone, did not extend the hospital stay except in 1 patient who required 3-day inpatient management of edema with a trapped ventricle. No new neurological deficits were encountered, although 1 patient developed seizures postoperatively. No increase in infection rates was identified.

CONCLUSIONS

Resection of ablated tumor is a viable option to reduce the incidence of neurological deficits due to edema following LITT. This approach appears to mitigate cerebral edema by increasing available volume for mass effect and reducing the tissue burden that may promote an inflammatory response.