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  1. Article ; Online: Controversy: clipping of asymptomatic intracranial aneurysm that is < 7 mm: no.

    Piepgras, David G

    Stroke

    2013  Volume 44, Issue 6 Suppl 1, Page(s) S100–2

    MeSH term(s) Endovascular Procedures/methods ; Humans ; Intracranial Aneurysm/pathology ; Intracranial Aneurysm/surgery ; Vascular Surgical Procedures/methods
    Language English
    Publishing date 2013-06
    Publishing country United States
    Document type Comment ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 80381-9
    ISSN 1524-4628 ; 0039-2499 ; 0749-7954
    ISSN (online) 1524-4628
    ISSN 0039-2499 ; 0749-7954
    DOI 10.1161/STROKEAHA.111.000689
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    Zs.A 448: Show issues Location:
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  2. Article ; Online: Intracranial Hypotensive Crisis From an Insidious Spinal Cerebrospinal Fluid-Venous Fistula: A Case Report.

    Carlstrom, Lucas P / Oushy, Soliman / Graffeo, Christopher S / Perry, Avital / Wijdicks, Eelco F / Bydon, Mohamad / Van Gompel, Jamie / Piepgras, David G

    Operative neurosurgery (Hagerstown, Md.)

    2021  Volume 21, Issue 3, Page(s) E283–E288

    Abstract: Background and importance: Progressive episodic spells of altered levels of consciousness, often advancing to include paroxysmal autonomic instability, may be indicative of a diencephalic dysfunction underlying spontaneous intracranial hypotension (SIH). ...

    Abstract Background and importance: Progressive episodic spells of altered levels of consciousness, often advancing to include paroxysmal autonomic instability, may be indicative of a diencephalic dysfunction underlying spontaneous intracranial hypotension (SIH). A rare, and often indolent, etiology may be spinal cerebrospinal fluid (CSF) leak-an elusive diagnosis, especially in cases of CSF-venous fistula (CVF) that are often missed on routine computed tomography (CT) myelography and magnetic resonance imaging (MRI).
    Clinical presentation: We report an unusual case of a 50-yr-old woman who presented with rapidly progressive cyclical, self-resolving episodes of altered mentation and decreased arousal later in the day. Scrutiny of serial brain MRIs led to a diagnosis of SIH, with severe downward diencephalic and brain stem displacement-resulting in cerebral aqueduct occlusion with obstructive hydrocephalus. Initial clinical improvement occurred with CSF diversion, but the patient quickly deteriorated-developing diencephalic spells, including extensor posturing and severely depressed levels of consciousness. Clinical improvement was seen with stopping CSF diversion and Trendelenburg-positioning. After intensive spinal imaging, dynamic CT myelography identified a left T10 nerve root diverticula and CSF-venous fistula. Surgical obliteration resulted in rapid, profound neurological improvement, and ultimately full neurological recovery by 1 yr.
    Conclusion: In our patient, worsening episodes of confusion, postural headaches, and autonomic instability developed due to SIH, which induced profound downward displacement and compression of the diencephalon and brain stem, and accompanied by subsequent obstructive hydrocephalus. Diagnostic persistence identified the CVF, which had caused the complex multifold pathophysiology and clinical presentation. If suspicion remains high for CVF, persistent spinal imaging, particularly with dynamic myelography, may be crucial.
    MeSH term(s) Cerebrospinal Fluid Leak/complications ; Cerebrospinal Fluid Leak/diagnostic imaging ; Female ; Fistula ; Humans ; Intracranial Hypotension/complications ; Intracranial Hypotension/diagnostic imaging ; Middle Aged ; Myelography ; Spine
    Language English
    Publishing date 2021-06-07
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2767575-0
    ISSN 2332-4260 ; 2332-4252
    ISSN (online) 2332-4260
    ISSN 2332-4252
    DOI 10.1093/ons/opab154
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  3. Article: Certification of neurosurgeons: a transition from neurosurgical certification and recertification to maintenance of certification. Report from the American Board of Neurological Surgeons.

    Piepgras, David G

    Clinical neurosurgery

    2003  Volume 50, Page(s) 286–292

    MeSH term(s) Certification/standards ; Clinical Competence/standards ; Humans ; Neurosurgery/standards ; United States
    Language English
    Publishing date 2003
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 127548-3
    ISSN 0069-4827
    ISSN 0069-4827
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  4. Article: Unruptured aneurysms.

    Piepgras, David G

    Journal of neurosurgery

    2002  Volume 96, Issue 1, Page(s) 63

    MeSH term(s) Aneurysm, Ruptured/diagnosis ; Aneurysm, Ruptured/mortality ; Aneurysm, Ruptured/surgery ; Humans ; Intracranial Aneurysm/diagnosis ; Intracranial Aneurysm/mortality ; Intracranial Aneurysm/surgery ; Middle Aged ; Risk ; Subarachnoid Hemorrhage/diagnosis ; Subarachnoid Hemorrhage/mortality ; Subarachnoid Hemorrhage/surgery ; Survival Rate ; Treatment Outcome
    Language English
    Publishing date 2002-01
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/jns.2002.96.1.0063
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  5. Article ; Online: Dr Albert L. Rhoton Jr's Time at the Mayo Clinic: The Beginnings of a Remarkable Career.

    Rayan, Tarek / Carlson, Matthew L / Piepgras, David G / Link, Michael J / Van Gompel, Jamie J

    Neurosurgery

    2017  Volume 83, Issue 2, Page(s) 297–308

    Abstract: Dr Albert L. Rhoton Jr became the focal point of neurosurgery's evolution in understanding the intricate and complex microanatomy of the human brain over the last 4 decades. His pioneering work on cadaveric specimens proved to be a pivotal endeavor in ... ...

    Abstract Dr Albert L. Rhoton Jr became the focal point of neurosurgery's evolution in understanding the intricate and complex microanatomy of the human brain over the last 4 decades. His pioneering work on cadaveric specimens proved to be a pivotal endeavor in the pursuit to better understand the complex microsurgical anatomy of cranial surgery. This paper details his early career at the Mayo Clinic in Rochester, Minnesota. A comprehensive review and synthesis of data acquired from the institutional historical archives including the Annual Reports to the Executive Committee, the Reports to the Board of Directors, the MAYOVOX Newsletter, the illustration archives of the Mayo Clinic Division of Creative Media, staff biographies, curriculum vitae, personal interviews, as well as full-text journal articles, and book publications was performed. Dr Rhoton was engaged in a busy clinical practice as a young staff at the Mayo Clinic. Records show he focused on tackling complex intracranial pathologies along with numerous basic research and neuroanatomy projects that became a major part of his life's work and passion. He was a great teacher and friend to countless individuals and his work will continue to impact and improve the care provided to neurosurgery patients for generations to come.
    MeSH term(s) History, 20th Century ; Humans ; Minnesota ; Neuroanatomy/history ; Neurosurgery/history
    Language English
    Publishing date 2017-09-24
    Publishing country United States
    Document type Biography ; Historical Article ; Journal Article
    ZDB-ID 135446-2
    ISSN 1524-4040 ; 0148-396X
    ISSN (online) 1524-4040
    ISSN 0148-396X
    DOI 10.1093/neuros/nyx428
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    Zs.MO 539: Show issues

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  6. Article ; Online: Management of unruptured intracranial aneurysms: perspectives on endosaccular coiling and persistent uncertainties.

    Piepgras, David G / Brown, Robert D

    Stroke

    2008  Volume 39, Issue 3, Page(s) 743–744

    MeSH term(s) Embolization, Therapeutic/instrumentation ; Humans ; Intracranial Aneurysm/therapy ; Neurosurgical Procedures ; Uncertainty
    Language English
    Publishing date 2008-03
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 80381-9
    ISSN 1524-4628 ; 0039-2499 ; 0749-7954
    ISSN (online) 1524-4628
    ISSN 0039-2499 ; 0749-7954
    DOI 10.1161/STROKEAHA.107.501007
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  7. Article ; Online: Anomalous vertebral artery compression of the spinal cord at the cervicomedullary junction.

    Ball, Bret Gene / Krueger, Bruce R / Piepgras, David G

    Surgical neurology international

    2011  Volume 2, Page(s) 103

    Abstract: Background: Myelopathy from ectatic vertebral artery compression of the spinal cord at the cervicomedullary junction is a rare condition.: Case description: A 63-year-old female was originally diagnosed with occult hydrocephalus syndrome after ... ...

    Abstract Background: Myelopathy from ectatic vertebral artery compression of the spinal cord at the cervicomedullary junction is a rare condition.
    Case description: A 63-year-old female was originally diagnosed with occult hydrocephalus syndrome after presenting with symptoms of ataxia and urinary incontinence. Ventriculoperitoneal shunting induced an acute worsening of the patient's symptoms as she immediately developed a sensory myelopathy. An MR scan demonstrated multiple congenital abnormalities including cervicomedullary stenosis with anomalous vertebral artery compression of the dorsal spinal cord at the cervicomedullary junction. The patient was taken to surgery for a suboccipital craniectomy, C1-2 laminectomy, vertebral artery decompression, duraplasty, and shunt ligation. Intraoperative findings confirmed preoperative radiography with ectactic vertebral arteries deforming the dorsal aspect of the spinal cord. There were no procedural complications and at a 6-month follow-up appointment, the patient had experienced a marked improvement in her preoperative signs and symptoms.
    Conclusion: Myelopathy from ectatic vertebral artery compression at the cervicomedullary junction is a rare disorder amenable to operative neurovascular decompression.
    Language English
    Publishing date 2011-07-28
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2567759-7
    ISSN 2152-7806 ; 2152-7806
    ISSN (online) 2152-7806
    ISSN 2152-7806
    DOI 10.4103/2152-7806.83232
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  8. Article ; Online: Superficial siderosis: sealing the defect.

    Kumar, Neeraj / Lane, John I / Piepgras, David G

    Neurology

    2009  Volume 72, Issue 7, Page(s) 671–673

    MeSH term(s) Humans ; Hypovolemia/complications ; Hypovolemia/diagnosis ; Hypovolemia/surgery ; Male ; Middle Aged ; Siderosis/complications ; Siderosis/diagnosis ; Siderosis/surgery ; Subdural Effusion/complications ; Subdural Effusion/diagnosis ; Subdural Effusion/surgery ; Thoracic Vertebrae/pathology ; Tomography, X-Ray Computed
    Language English
    Publishing date 2009-02-17
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/01.wnl.0000342457.22536.af
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    Zs.MO 374: Show issues

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  9. Article ; Online: Procedural predictors of epidural blood patch efficacy in spontaneous intracranial hypotension.

    Pagani-Estévez, Gabriel L / Cutsforth-Gregory, Jeremy K / Morris, Jonathan M / Mokri, Bahram / Piepgras, David G / Mauck, William D / Eldrige, Jason S / Watson, James C

    Regional anesthesia and pain medicine

    2019  

    Abstract: Background and objective: Epidural blood patch (EBP) is a safe and effective treatment for spontaneous intracranial hypotension (SIH), but clinical and procedural variables that predict EBP efficacy remain nebulous.: Methods: This study is an ... ...

    Abstract Background and objective: Epidural blood patch (EBP) is a safe and effective treatment for spontaneous intracranial hypotension (SIH), but clinical and procedural variables that predict EBP efficacy remain nebulous.
    Methods: This study is an institutional review board-approved retrospective case series with dichotomized EBP efficacy defined at 3 months. The study included 202 patients receiving 604 EBPs; iatrogenic cerebrospinal fluid leaks were excluded.
    Results: Of the EBPs, 473 (78%) were single-level, 349 (58%) lumbar, 75 (12%) bilevel, and 56 (9%) multilevel (≥3 levels). Higher volume (OR 1.64; p<0.0001), bilevel (3.17, 1.91-5.27; p<0.0001), and multilevel (117.3, 28.04-490.67; p<0.0001) EBP strategies predicted greater efficacy. Only volume (1.64, 1.47-1.87; p<0.0001) remained significant in multivariate analysis. Site-directed patches were more effective than non-targeted patches (8.35, 0.97-72.1; p=0.033). Lower thoracic plus lumbar was the most successful bilevel strategy, lasting for a median of 74 (3-187) days.
    Conclusions: In this large cohort of EBP in SIH, volume, number of spinal levels injected, and site-directed strategies significantly correlated with greater likelihood of first EBP efficacy. Volume and leak site coverage likely explain the increased efficacy with bilevel and multilevel patches. In patients with cryptogenic leak site, and either moderate disability, negative prognostic brain MRI findings for successful EBP, or failed previous lumbar EBP, a low thoracic plus lumbar bilevel EBP strategy is recommended. Multilevel EBP incorporating transforaminal administration and fibrin glue should be considered in patients refractory to bilevel EBP. An algorithmic approach to treating SIH is proposed.
    Language English
    Publishing date 2019-01-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 1425299-5
    ISSN 1532-8651 ; 1098-7339 ; 0146-521X
    ISSN (online) 1532-8651
    ISSN 1098-7339 ; 0146-521X
    DOI 10.1136/rapm-2018-000021
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  10. Article ; Online: The early days of the neurosciences intensive care unit.

    Wijdicks, Eelco F M / Worden, Wendy R / Miers, Anne / Piepgras, David G

    Mayo Clinic proceedings

    2011  Volume 86, Issue 9, Page(s) 903–906

    MeSH term(s) Critical Care/history ; History, 19th Century ; History, 20th Century ; Hospitals, Religious/history ; Humans ; Intensive Care Units/history ; Nervous System Diseases/therapy ; Neurosurgical Procedures/history ; New York ; Triage
    Language English
    Publishing date 2011-10-22
    Publishing country England
    Document type Historical Article ; Journal Article
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.4065/mcp.2010.0815
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