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  1. Article ; Online: Intraoperative navigation assisted placement of percutaneous pedicle screws.

    Upadhyaya, Cheerag D / Fewel, Matthew E

    Neurosurgical focus

    2013  Volume 35, Issue 2 Suppl, Page(s) Video 16

    Abstract: Minimally invasive surgical (MIS) approaches are gaining popularity in many surgical fields. Potential advantages include reduced blood loss, shorter length of stay, and less soft-tissue trauma. Potential disadvantages include inadequate deformity ... ...

    Abstract Minimally invasive surgical (MIS) approaches are gaining popularity in many surgical fields. Potential advantages include reduced blood loss, shorter length of stay, and less soft-tissue trauma. Potential disadvantages include inadequate deformity correction, increased fluoroscopy, longer operative times, and decreased posterolateral fusion surface area exposure. This video demonstrates the key steps in our mini-open transforaminal lumbar interbody fusion (TLIF) using an expandable tubular retractor, placement of cannulated pedicle instrumentation, and subsequent deformity correction. The video demonstrates positioning, surgical opening through a midline incision, a bilateral Wiltse plane tubular approach for the TLIF, placement of bilateral cannulated pedicle screws, and deformity correction. The video can be found here: http://youtu.be/Jj7w4i2DTMQ.
    MeSH term(s) Bone Screws ; Humans ; Lumbar Vertebrae/pathology ; Lumbar Vertebrae/surgery ; Minimally Invasive Surgical Procedures/methods ; Monitoring, Intraoperative/methods ; Spinal Cord/abnormalities ; Spinal Cord/pathology ; Spinal Cord/surgery ; Spinal Fusion/methods ; Surgery, Computer-Assisted/methods ; Video Recording/methods
    Language English
    Publishing date 2013-07
    Publishing country United States
    Document type Journal Article ; Video-Audio Media
    ZDB-ID 2026589-X
    ISSN 1092-0684 ; 1092-0684
    ISSN (online) 1092-0684
    ISSN 1092-0684
    DOI 10.3171/2013.V2.FOCUS13220
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: The emerging role of recombinant-activated factor VII in neurocritical care.

    Fewel, Matthew E / Park, Paul

    Neurocritical care

    2004  Volume 1, Issue 1, Page(s) 19–29

    Abstract: Recombinant-activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Denmark) was developed specifically for the management of bleeding in hemophiliacs with inhibitors to factors VIII or IX. Several recent case reports and small clinical studies also ... ...

    Abstract Recombinant-activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Denmark) was developed specifically for the management of bleeding in hemophiliacs with inhibitors to factors VIII or IX. Several recent case reports and small clinical studies also suggest that rFVIIa may be useful as a general hemostatic agent in nonhemophilic patients. The mechanism by which rFVIIa acts is controversial with both tissue factor-dependent and -independent mechanisms proposed. Regardless of the specific mechanism, rFVIIa enhances hemostasis at the site of injury without systemic activation of the coagulation cascade. Several features make rFVIIa an ideal candidate for reversal of coagulopathy in central nervous system (CNS) hemorrhage. It acts almost immediately, requires negligible volume for infusion, poses no risk of transfer of blood-borne pathogens, and has few apparent complications. To date, clinically proven efficacy for rFVIIa by randomized controlled trials has been accomplished mainly for hemophilic patients. However, there are ongoing or planned clinical trials for rapid reversal of coagulopathy in trauma and liver disease, as well as CNS hemorrhage associated with oral anticoagulation and minimization of hematoma expansion after intracerebral hemorrhage. These trials will hopefully answer unresolved questions regarding risk-benefit ratio, therapeutic index, efficacy, safety, indications, optimal dosing, monitoring, and cost-effectiveness of rFVIIa in nonhemophilic patients.
    MeSH term(s) Critical Care ; Factor VII/pharmacology ; Factor VII/therapeutic use ; Factor VIIa ; Hemostatics/pharmacology ; Hemostatics/therapeutic use ; Humans ; Intracranial Hemorrhages/drug therapy ; Neurosurgical Procedures ; Recombinant Proteins/pharmacology ; Recombinant Proteins/therapeutic use
    Chemical Substances Hemostatics ; Recombinant Proteins ; Factor VII (9001-25-6) ; recombinant FVIIa (AC71R787OV) ; Factor VIIa (EC 3.4.21.21)
    Language English
    Publishing date 2004
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2381896-7
    ISSN 1556-0961 ; 1541-6933
    ISSN (online) 1556-0961
    ISSN 1541-6933
    DOI 10.1385/NCC:1:1:19
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6538: Show issues Location:
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  3. Article: Migration of distal ventriculoperitoneal shunt catheter into the heart. Case report and review of the literature.

    Fewel, Matthew E / Garton, Hugh J L

    Journal of neurosurgery

    2004  Volume 100, Issue 2 Suppl Pediatrics, Page(s) 206–211

    Abstract: Migration of distal ventriculoperitoneal shunt tubing is known to occur in a wide of variety of locations. The authors report an unusual complication involving a previously confirmed intraperitoneal shunt catheter that migrated into the heart and ... ...

    Abstract Migration of distal ventriculoperitoneal shunt tubing is known to occur in a wide of variety of locations. The authors report an unusual complication involving a previously confirmed intraperitoneal shunt catheter that migrated into the heart and pulmonary vasculature. Radiographic evidence suggested that this occurred secondary to cannulation of a segment of the external jugular vein with a shunt trochar during tunneling of the distal catheter. This is the sixth reported case of a peritoneal shunt tube migrating proximally into the heart. The authors review the literature regarding migration of distal tubing into the heart and pulmonary artery. Based on imaging studies obtained in the present case, the authors posit that the mechanism for this unusual type of shunt migration is inadvertent penetration of either the internal or external jugular vein during the initial tunneling procedure. Negative intrathoracic pressure and slow venous flow then draws the catheter out of the peritoneum and into the vasculature. The distal catheter then migrates into the right side of the heart and pulmonary artery. Diagnosis and management of this type of complication is discussed.
    MeSH term(s) Adolescent ; Brain Concussion/complications ; Brain Concussion/diagnostic imaging ; Equipment Failure ; Foreign-Body Migration/diagnostic imaging ; Heart/diagnostic imaging ; Humans ; Hydrocephalus/diagnostic imaging ; Hydrocephalus/surgery ; Male ; Postoperative Complications/diagnostic imaging ; Pulmonary Artery/diagnostic imaging ; Tomography, X-Ray Computed ; Ventriculoperitoneal Shunt/instrumentation
    Language English
    Publishing date 2004-02
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/ped.2004.100.2.0206
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Uk I Zs.135: Show issues Location:
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  4. Article ; Online: Spontaneous intracerebral hemorrhage: a review.

    Fewel, Matthew E / Thompson, B Gregory / Hoff, Julian T

    Neurosurgical focus

    2003  Volume 15, Issue 4, Page(s) E1

    Abstract: Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic ... ...

    Abstract Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.
    MeSH term(s) Adult ; Aged ; Blood Coagulation Disorders/complications ; Brain Neoplasms/complications ; Cerebral Amyloid Angiopathy/complications ; Cerebral Hemorrhage/diagnosis ; Cerebral Hemorrhage/epidemiology ; Cerebral Hemorrhage/etiology ; Cerebral Hemorrhage/physiopathology ; Cerebral Hemorrhage/therapy ; Cerebrovascular Disorders/complications ; Clinical Trials as Topic ; Combined Modality Therapy ; Craniotomy ; Diagnostic Imaging/methods ; Female ; Humans ; Hypertension/complications ; Hypertension/drug therapy ; Male ; Middle Aged ; Pregnancy ; Pregnancy Complications, Hematologic ; Randomized Controlled Trials as Topic ; Risk Factors ; Rupture, Spontaneous ; Seizures/etiology ; Seizures/prevention & control ; Treatment Outcome
    Language English
    Publishing date 2003-10-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2026589-X
    ISSN 1092-0684 ; 1092-0684
    ISSN (online) 1092-0684
    ISSN 1092-0684
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Intracerebral hemorrhage: pathophysiology and therapy.

    Xi, Guohua / Fewel, Matthew E / Hua, Ya / Thompson, B Gregory / Hoff, Julian T / Keep, Richard F

    Neurocritical care

    2005  Volume 1, Issue 1, Page(s) 5–18

    Abstract: Spontaneous intracerebral hemorrhage, from several sources, causes instantaneous mass effect, disruption of surrounding brain, and often an early neurological death. If the patient survives the initial event, the hematoma can lead to secondary brain ... ...

    Abstract Spontaneous intracerebral hemorrhage, from several sources, causes instantaneous mass effect, disruption of surrounding brain, and often an early neurological death. If the patient survives the initial event, the hematoma can lead to secondary brain injury, neurological deficits, and, occasionally, delayed fatality. The mechanisms that trigger pathophysiological changes in and around the hematoma are becoming better understood, offering new therapeutic opportunities.
    MeSH term(s) Blood Coagulation/physiology ; Brain Edema/etiology ; Brain Edema/physiopathology ; Cerebral Hemorrhage/complications ; Cerebral Hemorrhage/physiopathology ; Cerebral Hemorrhage/therapy ; Cerebrovascular Circulation/physiology ; Erythrocytes/physiology ; Hemoglobins/physiology ; Humans
    Chemical Substances Hemoglobins
    Language English
    Publishing date 2005-09-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 2381896-7
    ISSN 1556-0961 ; 1541-6933
    ISSN (online) 1556-0961
    ISSN 1541-6933
    DOI 10.1385/ncc:1:1:5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 6538: Show issues Location:
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  6. Article: Recombinant activated factor VII for the rapid correction of coagulopathy in nonhemophilic neurosurgical patients.

    Park, Paul / Fewel, Matthew E / Garton, Hugh J / Thompson, B Gregory / Hoff, Julian T

    Neurosurgery

    2003  Volume 53, Issue 1, Page(s) 34–8; discussion 38–9

    Abstract: Objective: Coagulopathy is a significant contraindication for neurosurgery. Unfortunately, many coagulopathic patients require urgent neurosurgical intervention. Standard use of blood products, including fresh-frozen plasma or prothrombin complexes, to ... ...

    Abstract Objective: Coagulopathy is a significant contraindication for neurosurgery. Unfortunately, many coagulopathic patients require urgent neurosurgical intervention. Standard use of blood products, including fresh-frozen plasma or prothrombin complexes, to correct the coagulopathy often leads to significant delays in treatment. Recombinant activated factor VII (rFVIIa) is a medication originally designed to treat bleeding in hemophiliacs but also seems to correct a wide variety of coagulopathies rapidly and safely in nonhemophilic patients.
    Methods: The medical records of nine patients with coagulopathy requiring urgent neurosurgical intervention were reviewed retrospectively. Each patient was given a dose ranging from 40 to 90 microg/kg of rFVIIa before undergoing surgery. Pre-rFVIIa coagulation and post-rFVIIa coagulation parameters were obtained. Once correction of the coagulopathy was verified, each patient underwent the appropriate neurosurgical procedure.
    Results: The average age of the patients was 40.9 years; six were women. The causes of the coagulopathy included anticoagulant medication, liver dysfunction, and dilutional coagulopathy after traumatic hemorrhage. Neurosurgical indications included intraparenchymal/intraventricular hemorrhage, hydrocephalus, diffuse cerebral edema, and epidural hematoma. Post-rFVIIa coagulation parameters obtained as early as 20 minutes after infusion of the medication showed normalization of values. There were no procedural or operative complications and no postoperative hemorrhagic complications. No associated thromboembolic or other complications with the use of rFVIIa were observed.
    Conclusion: The use of rFVIIa for the urgent surgical treatment of coagulopathic patients is quite promising. Further studies, including randomized, prospective trials using rFVIIa to address issues such as optimal dosing, efficacy, surgical indications, cost-effectiveness, morbidity, and mortality are needed.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Coagulation Disorders/diagnostic imaging ; Blood Coagulation Disorders/drug therapy ; Brain Diseases/diagnostic imaging ; Brain Diseases/surgery ; Child ; Contraindications ; Factor VIIa/pharmacology ; Factor VIIa/therapeutic use ; Female ; Hemophilia A/diagnostic imaging ; Hemophilia A/drug therapy ; Humans ; Infant ; Male ; Neurosurgical Procedures ; Outcome Assessment (Health Care) ; Preoperative Care ; Recombinant Proteins/pharmacology ; Recombinant Proteins/therapeutic use ; Retrospective Studies ; Time Factors ; Tomography, X-Ray Computed
    Chemical Substances Recombinant Proteins ; Factor VIIa (EC 3.4.21.21)
    Language English
    Publishing date 2003-05-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 135446-2
    ISSN 1524-4040 ; 0148-396X
    ISSN (online) 1524-4040
    ISSN 0148-396X
    DOI 10.1227/01.neu.0000068830.54968.a8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1424: Show issues Location:
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    Zs.MO 539: Show issues

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  7. Article ; Online: Surgical Treatment of 95 Children with 102 Intracranial Arachnoid Cysts

    Fewel, Matthew E. / Levy, Michael L. / McComb, Gordon

    Pediatric Neurosurgery

    1996  Volume 25, Issue 4, Page(s) 165–173

    Abstract: Our review of 95 children with 102 intracranial arachnoid cysts treated surgically from 1976 to 1996 is presented. These patients are divided into two groups, those initially treated from 1976 to 1986 and those treated from 1987 to May 1996, to see ... ...

    Abstract Our review of 95 children with 102 intracranial arachnoid cysts treated surgically from 1976 to 1996 is presented. These patients are divided into two groups, those initially treated from 1976 to 1986 and those treated from 1987 to May 1996, to see whether any improvement in outcome had occurred. There were 31 patients (20 males/11 females) with 34 cysts treated from 1976 to 1986 and 64 patients (45 males/19 females) with 68 cysts treated from 1987 to 1996. The mean age at presentation for all cases was 4.9 years (range from 3 days to 17.8 years). The most common cyst location was the middle fossa. Treatment options for the management of intracranial arachnoid cysts include fenestration or shunting. We consider the avoidance of a shunt as a primary goal in the management of these patients. Accordingly, 82 (80%) of the cysts in our series were treated initially by fenestration. Fifty percent of those initially fenestrated from 1976 to 1986 required no further treatment as compared with 60% fenestrated from 1987 to 1996. The success rate of fenestration among those patients without associated hydrocephalus was significantly higher than in those with hydrocephalus; 73% without hydrocephalus required no additional treatment versus 32% with hydrocephalus. Seventeen percent of the patients treated from 1976 to 1986 required a subsequent ven-triculoperitoneal shunt as compared with 22% treated from 1987 to 1996. Twenty-nine percent of those patients initially fenestrated from 1976 to 1986 required a subsequent cystoperitoneal shunt as compared with only 12% treated from 1987 to 1996. Although not statistically significant, the second group of patients had a lower rate of reoperation, fewer complications, and a better clinical outcome than the first group. We recommend that in patients without evidence of hydrocephalus, cyst fenestration be considered as the primary procedure, as 73% of the patients in the two series remain shunt free. In those patients with hydrocephalus, we still recommend cyst fenestration, but with a ventriculoperitoneal shunt inserted before fenestration if the hydrocephalus is marked or after fenestration if the hydrocephalus is progressive.
    Keywords Arachnoid cysts ; Cystoperitoneal shunt ; Fenestration ; Hydrocephalus
    Language English
    Publisher S. Karger AG
    Publishing place Basel
    Publishing country Switzerland
    Document type Article ; Online
    ZDB-ID 1091757-3
    ISSN 1423-0305 ; 1016-2291 ; 1016-2291
    ISSN (online) 1423-0305
    ISSN 1016-2291
    DOI 10.1159/000121119
    Database Karger publisher's database

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    Zs.A 1133: Show issues Location:
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