This site usescookies, tags, and tracking settings to store information that help give you the very best browsing experience. Dismiss this warning

Filter

Refine by Publication

Refine by Date
—

Refine by Access

Refine By Subjects

  • Print
  • Save

Search Results

You are looking at1-10of11items for

  • Author or Editor: Julian Gendreaux
  • Refine by Access: allx
Clear All Modify Search
Restricted access

Spinal robotics in cervical spine surgery: a systematic review with key concepts and technical considerations

Ryan S. Beyer, Andrew Nguyen, Nolan J. Brown, Julian L. Gendreau, Matthew J. Hatter, Omead Pooladzandi, and Martin H. Pham

OBJECTIVE

Spinal robotics for thoracolumbar procedures, predominantly employed for the insertion of pedicle screws, is currently an emerging topic in the literature. The use of robotics in instrumentation of the cervical spine has not been broadly explored. In this review, the authors aimed to coherently synthesize the existing literature of intraoperative robotic use in the cervical spine and explore considerations for future directions and developments in cervical spinal robotics.

开云体育世界杯赔率

科学的网络文献检索,斯高帕斯,and PubMed databases was performed for the purpose of retrieving all articles reporting on cervical spine surgery with the use of robotics. For the purposes of this study, randomized controlled trials, nonrandomized controlled trials, retrospective case series, and individual case reports were included. The Newcastle-Ottawa Scale was utilized to assess risk of bias of the studies included in the review. To present and synthesize results, data were extracted from the included articles and analyzed using the PyMARE library for effect-size meta-analysis.

RESULTS

On careful review, 6 articles published between 2016 and 2022 met the inclusion/exclusion criteria, including 1 randomized controlled trial, 1 nonrandomized controlled trial, 2 case series, and 2 case reports. These studies featured a total of 110 patients meeting the inclusion criteria (mean age 53.9 years, range 29–77 years; 64.5% males). A total of 482 cervical screws were placed with the use of a surgical robot, which yielded an average screw deviation of 0.95 mm. Cervical pedicle screws were the primary screw type used, at a rate of 78.6%. According to the Gertzbein-Robbins classification, 97.7% of screws in this review achieved a clinically acceptable grade. The average duration of surgery, blood loss, and postoperative length of stay were all decreased in minimally invasive robotic surgery relative to open procedures. Only 1 (0.9%) postoperative complication was reported, which was a surgical site infection, and the mean length of follow-up was 2.7 months. No mortality was reported.

CONCLUSIONS

Robot-assisted cervical screw placement is associated with acceptable rates of clinical grading, operative time, blood loss, and postoperative complications—all of which are equal to or improved relative to the metrics seen in the conventional use of fluoroscopy or computer-assisted navigation for cervical screw placement.

In开云手机版app下载安装最新版脊柱神经外科杂志:签证开云体育app官方网站下载入口官lume 38: Issue 1 (Jan 2023)

Restricted access

Letter to the Editor. Stratifying by publication type inCharting Outcomes in the Matchreports

Yusuf Mehkri, Ramy Sharaf, Sophie Liu, Moshe Shalom, and Julian Gendreau

InJournal of Neurosurgery Volume 138: Issue 3 (Mar 2023)

Free access

Navigation-guided neuroendoscopic removal of an intracranial migratory pellet from the thalamus of a 4-year-old girl

Pate J. Duddleston, Julian L. Gendreau, Kristen A. Little, Amber Andrews, and Willard D. Thompson Jr.

Extraction of a bullet fragment seated in deep brain parenchyma utilizing a neuroendoscope has not been previously reported in the literature. The authors report the case of a 4-year-old patient who presented after a pellet gun injury with a projectile located 6 cm intracranially and lodged within the posterior thalamus and near the posterior limb of the internal capsule. Initial operative repair included repair of a CSF leak with duraplasty, minimal brain debridement, and elevation of a depressed skull fracture. Subsequent CT at 2 months postoperatively revealed migration of the deep intracranial pellet. This finding correlated with intermittent worsening neurological symptoms and signs. A rigid 3-mm neuroendoscope with CT stereotactic navigation was then used to remove the pellet fragment from the thalamus. The patient returned home with alleviation of clinical symptoms and an uneventful postoperative recovery. This case demonstrates that navigation-guided neuroendoscopy can be successfully used to remove projectile fragments from deep brain structures, especially when the migration is along the initial path of the bullet. This technique represents another low-risk curative option in the management of retained bullet fragments in gunshot wound injuries to the head.

InJournal of Neurosurgery: Pediatrics Volume 26: Issue 4 (Oct 2020)

Restricted access

Radiotherapy after gross-total resection and subtotal resection of spinal chordoma: a SEER database analysis of overall survival outcomes

Julian Gendreau, Cathleen C. Kuo, Yusuf Mehkri, Sachiv Chakravarti, Brian Lu, Daniel Lubelski, Kristin J. Redmond, Chetan Bettegowda, and Debraj Mukherjee

OBJECTIVE

Chordomas are most frequently found in the sacrum, vertebral column, and skull base. Achieving gross-total resection (GTR) has been shown to optimize overall survival (OS); however, the efficacy of radiotherapy (RT) for patients with GTR is currently not well understood. Given that RT may negatively impact patient quality of life, the aim of this study was to evaluate the utility of RT for improving OS in patients who have undergone GTR of spinal chordoma through analysis of the national Surveillance, Epidemiology, and End Results (SEER) database.

开云体育世界杯赔率

The SEER database (1975–2018) was queried for all adult patients (≥ 21 years) who underwent GTR for spinal chordoma. Bivariate analysis was conducted using chi-square testing for categorical variables, and the log-rank test was performed to find the associations of clinical variables with OS. Cox proportional hazards models were generated for multivariate analyses of the associations among clinical variables and OS.

RESULTS

A total of 263 spinal chordomas that underwent GTR were identified. The mean age of all included patients was 58.72 years, and 63.9% of patients were male. In addition, 0.4% had dedifferentiated histology. The mean follow-up was 75.54 months. Of all patients, 152 (57.8%) received no RT and 111 (42.2%) received RT. Patients with sacral tumor location (80.9% vs 51.4%, p < 0.001) were more likely not to undergo RT when compared to patients with vertebral column location. In multivariate analysis, only age ≥ 65 years was associated with poorer OS (HR 3.16, CI 1.54–5.61, p < 0.001). RT did not have a statistically significant association with OS.

CONCLUSIONS

RT after GTR of chordoma did not improve OS among SEER chordoma patients to a value that achieved statistical significance. Additional multicenter prospective studies are needed to determine the true efficacy of RT after GTR of spinal chordoma.

In开云手机版app下载安装最新版脊柱神经外科杂志:签证开云体育app官方网站下载入口官lume 39: Issue 3 (Sep 2023)

Restricted access

Stroke management and outcomes in low-income and lower-middle-income countries: a meta-analysis of 8535 patients

Alexander O. Aguirre, James L. Rogers, Taylor Reardon, Nathan A. Shlobin, Alexander M. Ballatori, Nolan J. Brown, Julian Gendreau, and Shane Shahrestani

OBJECTIVE

Strokes affect almost 13 million new people each year, and whereas the outcomes of stroke have improved over the past several decades in high-income countries, the same cannot be seen in low-income and lower-middle-income countries. This is the first study to identify the availability of diagnostic tools along with the rates of stroke mortality and other poststroke complications in low-income and lower-middle-income countries.

开云体育世界杯赔率

A review of the literature was completed with a search of the MEDLINE, Embase, and Scopus databases, with adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they reported any outcomes of stroke in low-income and lower-middle-income countries as designated by the World Bank classification. A meta-analysis calculating pooled prevalence rates of diagnostic characteristics and stroke outcomes was completed for all endpoint variables.

RESULTS

A total of 19 studies were included, of which 6 came from Ethiopia, 3 from Zambia, and 2 each from Tanzania and Iran. Single studies from Zimbabwe, Botswana, Senegal, Cameroon, Uganda, and Sierra Leone were included. A total of 5265 (61.7%) patients had an ischemic stroke, 2124 (24.9%) had hemorrhagic stroke, with the remaining 1146 (13.4%) having an unknown type. Among 6 studies the pooled percentage of patients presenting to hospital within 1 day was 48.37% (95% CI 38.59%–58.27%; I2= 97.0%, p < 0.01). The pooled in-hospital mortality rate was 19.81% (95% CI 15.26%–25.31%; I2= 91%, p < 0.01), but was higher in a hemorrhagic subgroup (27.07% [95% CI 22.52%–32.15%; I2= 54%, p = 0.05]) when compared to an ischemic group (13.16% [95% CI 8.60%–19.62%; I2= 87%, p < 0.01]). The 30-day pooled mortality rate was 23.24% (95% CI 14.17%–35.70%; I2= 93%, p < 0.01). At 30 days, the functional independence (modified Rankin Scale score 0–2) pooled rate was 13.10% (95% CI 7.50%–21.89%; I2= 82%, p < 0.01).

CONCLUSIONS

A severe healthcare disparity is present in low-income and lower-middle-income countries, where there is delayed diagnosis of strokes and increased rates of poor clinical outcomes for these patients.

In开云手机版app下载安装最新版神经外科杂志》发布之前开云体育app官方网站下载入口打印开云体育app苹果版下载

Restricted access

The influence of facility type on intracranial meningioma treatment and outcomes: predicting overall survival using the National Cancer Database

Nolan J. Brown, Julian Gendreau, Sachiv Chakravarti, Benjamin M. Abraham Jr., Yusuf Mehkri, Cathleen C. Kuo, Naib Chowdhury, and Aaron Cohen-Gadol

OBJECTIVE

There is a growing body of evidence demonstrating improved outcomes for patients with CNS neoplasms treated at academic centers (ACs) versus nonacademic centers (non-ACs), which represents a potential healthcare disparity within neurosurgery. In this paper, the authors sought to investigate the relationship between facility type and surgical outcomes in meningioma patients.

开云体育世界杯赔率

The National Cancer Database was queried for adult patients diagnosed with intracranial meningioma between 2004 and 2019. Patients were stratified by facility type, and the Mann-Whitney U-test and Fisher exact test were used for bivariate comparisons of continuous and categorical variables, respectively. Multivariate logistic regression was used to assess whether demographic variables were associated with treatment at ACs. Furthermore, multivariate Cox proportional hazards models were used to determine whether facility type was associated with overall survival (OS) outcomes.

RESULTS

Data on 139,304 patients (74% male, 84% White) were retrieved. Patients were stratified by facility type, with 50,349 patients (36%) treated at ACs and 88,955 patients (64%) treated at non-ACs. Patients treated at ACs were more likely to have private insurance (41% vs 34%, p < 0.001) and less likely to have Medicare (46% vs 57%, p < 0.001). Patients treated at ACs were more likely to have larger tumors (36.91 mm vs 33.57 mm, p < 0.001) and more likely to undergo surgery (47% vs 34%, p < 0.001). Interestingly, patients treated at ACs had decreased comorbidities (Charlson Comorbidity Index rating 0: 74% vs 69%) and similar income levels (income ≥ $46,000: 44% vs 43%). With respect to survival outcomes, patients treated at ACs demonstrated a higher median OS at 10 years than patients treated at non-ACs (65.2% vs 54.1%). The association of improved OS in patients treated at ACs continued to be true when adjusting for all other clinical and demographic variables (HR 0.900, 95% CI 0.882–0.918; p < 0.001).

CONCLUSIONS

The results of this study indicate that facility type is associated with disparate survival outcomes in the treatment of intracranial meningiomas. Namely, patients treated at non-ACs appear to have a survival disadvantage even when controlling for additional comorbidities.

In开云手机版app下载安装最新版神经外科杂志》发布之前开云体育app官方网站下载入口打印开云体育app苹果版下载

Restricted access

Robot-assisted percutaneous pedicle screw placement accuracy compared with alternative guidance in lateral single-position surgery: a systematic review and meta-analysis

Neal A. Patel, Cathleen C. Kuo, Zach Pennington, Nolan J. Brown, Julian Gendreau, Rohin Singh, Shane Shahrestani, Candler Boyett, Luis Daniel Diaz-Aguilar, and Martin H. Pham

OBJECTIVE

While single-position surgery (SPS) eliminates the need for patient repositioning, the placement of screws in the unconventional lateral position poses unique challenges related to asymmetry relative to the surgical table. Use of robotic guidance or intraoperative navigation can help to overcome this. The aim of this study was to compare the relative accuracies offered by these various navigation modalities for pedicle screws placed in lateral SPS.

开云体育世界杯赔率

According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed/Medline, Embase, and Cochrane Library databases were queried for studies reporting pedicle screw placement accuracy using fluoroscopic, CT-navigated, O-arm, or robotic guidance in lateral SPS, and a systematic review and meta-analysis was performed. Included studies all compared evaluated screw placement accuracy in lateral SPS using a single navigation method. Quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system; risk of bias was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs Institute checklist. The primary outcome, rate of pedicle screw breach, was analyzed using random-effects meta-analysis.

RESULTS

Eleven studies were included comprising 548 patients who underwent the placement of instrumentation with 2488 screws. For the fluoroscopic, CT-navigated, O-arm, and robotic guidance cohorts, there were 3, 2, 3, and 3 studies, respectively. Breach rates by modality were as follows: fluoroscopic guidance (6.6%), CT navigation (4.7%), O-arm (3.9%), and robotic guidance (3.9%). Random-effects meta-analysis showed a significant difference between studies, with an overall breach rate of 4.9% (95% CI 3.1%–7.5%; p < 0.001); however, testing for subgroup differences failed to show a significant difference between guidance modalities (QM= 0.69, df = 3; p = 0.88). Heterogeneity between studies was significant (I2= 79.0%, τ2= 0.41,χ2= 47.65, df = 10; p < 0.001).

CONCLUSIONS

Robotic guidance of screws is noninferior to alternative guidance modalities in lateral SPS; however, additional prospective studies directly comparing different guidance types are merited.

InJournal of Neurosurgery: Spine Publish Before Print

Restricted access

Retrospective single-surgeon study of prone versus lateral robotic pedicle screw placement: a CT-based assessment of accuracy

Nolan J. Brown, Zach Pennington, Cathleen C. Kuo, Shane Shahrestani, Justin Gold, Luis D. Diaz-Aguilar, Yusuf Mehkri, Rohin Singh, Julian Gendreau, and Martin H. Pham

OBJECTIVE

Lateral lumbar interbody fusion including anterior-to-psoas oblique lumbar interbody fusion has conventionally relied on pedicle screw placement (PSP) for construct stabilization. Single-position surgery with lumbar interbody fusion in the lateral decubitus position with concomitant PSP has been associated with increased operative efficiency. What remains unclear is the accuracy of PSP with robotic guidance when compared with the more familiar prone patient positioning. The present study aimed to compare robot-assisted screw placement accuracy between patients with instrumentation placed in the prone and lateral positions.

开云体育世界杯赔率

The authors identified all consecutive patients treated with interbody fusion and PSP in the prone or lateral position by a single surgeon between January 2019 and October 2022. All pedicle screws placed were analyzed using CT scans to determine appropriate positioning according to the Gertzbein-Robbins classification grading system (grade C or worse was considered as a radiographically significant breach). Multivariate logistic regression models were constructed to identify risk factors for the occurrence of a radiographically significant breach.

RESULTS

Eighty-nine consecutive patients (690 screws) were included, of whom 46 (477 screws) were treated in the prone position and 43 (213 screws) in the lateral decubitus position. There were fewer breaches in the prone (n = 13, 2.7%) than the lateral decubitus (n = 15, 7.0%) group (p = 0.012). Nine (1.9%) radiographically significant breaches occurred in the prone group compared with 10 (4.7%) in the lateral decubitus group (p = 0.019), for a prone versus lateral decubitus PSP accuracy rate of 98.1% versus 95.3%. There were no significant differences in BMI between prone versus lateral decubitus cohorts (30.1 vs 29.6) or patients with screw breach versus those without (31.2 vs 29.5). In multivariate models, the prone position was the only significant protective factor for screw accuracy; no other significant risk factors for screw breach were identified.

CONCLUSIONS

The present data suggest that pedicle screws placed with robotic assistance have higher placement accuracy in the prone position. Further studies will be needed to validate the accuracy of PSP in the lateral position as single-position surgery becomes more commonplace in the treatment of spinal disorders.

InJournal of Neurosurgery: Spine Publish Before Print

Free access

The role of frailty in the clinical management of neurofibromatosis type 1: a mixed-effects modeling study using the Nationwide Readmissions Database

Shane Shahrestani, Nolan J. Brown, Ben A. Strickland, Joshua Bakhsheshian, Seyed Mohammadreza Ghodsi, Tasha Nasrollahi, Michela Borrelli, Julian Gendreau, Jacob J. Ruzevick, and Gabriel Zada

OBJECTIVE

脆弱体现医疗vuln增加的状态erability that is most often secondary to age-associated decline. Recent literature has highlighted the role of frailty and its association with significantly higher rates of morbidity and mortality in patients with CNS neoplasms. There is a paucity of research regarding the effects of frailty as it relates to neurocutaneous disorders, namely, neurofibromatosis type 1 (NF1). In this study, the authors evaluated the role of frailty in patients with NF1 and compared its predictive usefulness against the Elixhauser Comorbidity Index (ECI).

开云体育世界杯赔率

Publicly available 2016–2017 data from the Nationwide Readmissions Database was used to identify patients with a diagnosis of NF1 who underwent neurosurgical resection of an intracranial tumor. Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups frailty-defining indicator. ECI scores were collected in patients for quantitative measurement of comorbidities. Propensity score matching was performed for age, sex, ECI, insurance type, and median income by zip code, which yielded 60 frail and 60 nonfrail patients. Receiver operating characteristic (ROC) curves were created for complications, including mortality, nonroutine discharge, financial costs, length of stay (LOS), and readmissions while using comorbidity indices as predictor values. The area under the curve (AUC) of each ROC served as a proxy for model performance.

RESULTS

After propensity matching of the groups, frail patients had an increased mean ± SD hospital cost ($85,441.67 ± $59,201.09) compared with nonfrail patients ($49,321.77 ± $50,705.80) (p = 0.010). Similar trends were also found in LOS between frail (23.1 ± 14.2 days) and nonfrail (10.7 ± 10.5 days) patients (p = 0.0020). For each complication of interest, ROC curves revealed that frailty scores, ECI scores, and a combination of frailty+ECI were similarly accurate predictors of variables (p > 0.05). Frailty+ECI (AUC 0.929) outperformed using only ECI for the variable of increased LOS (AUC 0.833) (p = 0.013). When considering 1-year readmission, frailty (AUC 0.642) was outperformed by both models using ECI (AUC 0.725, p = 0.039) and frailty+ECI (AUC 0.734, p = 0.038).

CONCLUSIONS

These findings suggest that frailty and ECI are useful in predicting key complications, including mortality, nonroutine discharge, readmission, LOS, and higher costs in NF1 patients undergoing intracranial tumor resection. Consideration of a patient’s frailty status is pertinent to guide appropriate inpatient management as well as resource allocation and discharge planning.

InNeurosurgical Focus Volume 52 (2022): Issue 5 (May 2022): Neurocutaneous Disorders

Open access

Management of pediatric clival chordoma with extension to the craniocervical junction and occipito-cervical fusion: illustrative case

Matthew A. Liu, Julian L. Gendreau, Joshua J. Loya, Nolan J. Brown, Amber Keith, Ronald Sahyouni, Mickey E. Abraham, David Gonda, and Michael L. Levy

BACKGROUND

Chordomas are rare malignant neoplasms that develop from the primitive notochord with < 5% of the tumors occurring in pediatric patients younger than the age of 20. Of these pediatric chordomas, those affecting the craniocervical junction (C1–C2) are even more rare; therefore, parameters for surgical management of these pediatric tumors are not well characterized.

OBSERVATIONS

In this case, a 3-year-old male was found to have a clival chordoma on imaging with extension to the craniocervical junction resulting in spinal cord compression. Endoscopic-assisted transoral transclival approach for clival tumor resection was performed first. As a second stage, the patient underwent a left-sided far lateral craniotomy and cervical laminectomy for resection of the skull base chordoma and instrumented fusion of the occiput to C3. He made excellent improvements in strength and dexterity during rehab and was discharged after 3 weeks.

LESSONS

In pediatric patients with chordoma with extension to the craniocervical junction and spinal cord compression, decompression with additional occipito-cervical fusion appears to offer a good clinical outcome. Fusion performed as a separate surgery before or at the same time as the initial tumor resection surgery may lead to better outcomes.

InJournal of Neurosurgery: Case Lessons Volume 2 (2021): Issue 21 (Nov 2021)

Baidu
map