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  1. Article ; Online: Effect of Body Mass Index on Paddle Lead Spinal Cord Stimulator Safety Implantation for Chronic Pain Management.

    Sommer, Taylor W / Ivankovic, Sven / McCall, Todd D

    World neurosurgery

    2022  Volume 170, Page(s) e712–e715

    Abstract: Objective: Spinal cord stimulators (SCS) represent an effective treatment for patients with chronic pain issues. This study examines extremely obese patients (body mass index [BMI] ≥40) as appropriate surgical candidates for paddle lead SCS trial via ... ...

    Abstract Objective: Spinal cord stimulators (SCS) represent an effective treatment for patients with chronic pain issues. This study examines extremely obese patients (body mass index [BMI] ≥40) as appropriate surgical candidates for paddle lead SCS trial via partial thoracic laminectomy and whether obesity impacts implantation safety.
    Methods: A retrospective review of patients treated with partial thoracic laminectomy and paddle lead SCS trial between October 1, 2016 and September 30, 2019 was performed. The primary outcome was implantation safety (complication rate within minimum of 90 days) in patients with extreme obesity (BMI ≥40) compared with patients with BMI <40 and secondary outcome was effectiveness (successful trial leading to final implantation). Seventy-three patients underwent SCS trial.
    Results: Four (5.48%) patients developed complications with only 1 patient in the BMI ≥40 cohort (not statistically significant). Overall trial success rate was 82.2% (60/73) with statistically significant higher success rates among patients with a BMI ≥40 (93.3% vs. 74.4%, P = 0.0183).
    Conclusions: We conclude that paddle lead SCS trial in extremely obese patients is reasonable to offer with the expectation of similar safety concerns as those for patients with a lower BMI.
    MeSH term(s) Humans ; Body Mass Index ; Pain Management ; Electrodes, Implanted/adverse effects ; Spinal Cord Stimulation/adverse effects ; Chronic Pain/therapy ; Chronic Pain/etiology ; Treatment Outcome ; Retrospective Studies ; Spinal Cord/surgery ; Obesity/etiology
    Language English
    Publishing date 2022-11-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2022.11.101
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    Zs.A 1159: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  2. Article ; Online: Posterior fossa ischemic infarction: single-center retrospective review of non-surgical and surgical cases.

    Winslow, Nolan / Olson, Elsa / Martin, Ryan / Ivankovic, Sven / Garst, Jonathan / Maldonado, Andres

    Neurosurgical review

    2023  Volume 46, Issue 1, Page(s) 35

    Abstract: Cerebellar ischemic stroke (CIS) is a morbid neurological event, with potentially fatal consequences. There is currently no objective standard of care regarding when surgical procedures are required for this entity. We retrospectively reviewed 763 ... ...

    Abstract Cerebellar ischemic stroke (CIS) is a morbid neurological event, with potentially fatal consequences. There is currently no objective standard of care regarding when surgical procedures are required for this entity. We retrospectively reviewed 763 patients with CIS, 247 patients of which had a stroke larger than 1 cm in greatest dimension on cranial imaging. In this subgroup, 11% of patients received ventriculostomy, 12% suboccipital craniectomy, and 9% mechanical endovascular thrombectomy. Various clinical and radiographic variables were examined for relationship to surgical procedures, 30-day mortality rate, and modified Rankin scores. The smallest volume of stroke requiring a surgical procedure was 15.5 mL
    MeSH term(s) Humans ; Retrospective Studies ; Treatment Outcome ; Stroke ; Craniotomy ; Ischemic Stroke ; Infarction
    Language English
    Publishing date 2023-01-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 6907-3
    ISSN 1437-2320 ; 0344-5607
    ISSN (online) 1437-2320
    ISSN 0344-5607
    DOI 10.1007/s10143-022-01939-5
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    Zs.A 1445: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  3. Article ; Online: High-resistance proximal "scaled" ventricular catheters.

    Qi, David / Olson, Elsa / Ivankovic, Sven / Sommer, Taylor / Nair, Kalyani / Morris, Martin / Lin, Julian

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

    2021  Volume 38, Issue 2, Page(s) 333–341

    Abstract: Purpose: Prove the concept of high-resistance proximal catheters for valve-independent treatment of hydrocephalus.: Methods: A preliminary design process yielded optimal high-resistance proximal ventricular catheters with a "scaled" design and ... ...

    Abstract Purpose: Prove the concept of high-resistance proximal catheters for valve-independent treatment of hydrocephalus.
    Methods: A preliminary design process yielded optimal high-resistance proximal ventricular catheters with a "scaled" design and parallel-oriented, U-shaped inlets. Prototypes were manually constructed using carving tools to stamp through silicone tubings. A testing apparatus was developed to simulate cerebrospinal fluid flow through a catheter, and the prototypes were tested against a control catheter for exhibition of an "on/off" phenomenon whereby no flow occurs at low pressures, and flow begins beyond a pressure threshold. Flow distribution was visualized with India ink. Regression analysis was performed to determine linearity.
    Results: The new designs showed varying amounts of improved flow control with the "scaled" design showing the most practical flow rate control across various pressures, compared to the standard catheter; however, no true "on/off" phenomenon was observed. The "scaled" design showed various degrees of dynamism; its flow rate can be time dependent, and certain maneuvers such as flushing and bending increased flow rate temporarily. Variation in the number of inlets within each "scaled" prototype also affected flow rate. Contrastingly, the flow rate of standard catheters was found to be independent of the number of inlet holes. Ink flow showed even flow distribution in "scaled" prototypes.
    Conclusions: This initial feasibility study showed that high-resistance ventricular catheters can be designed to mimic the current/valved system. The "scaled" design demonstrated the best flow control, and its unique features were characterized.
    MeSH term(s) Catheters ; Catheters, Indwelling ; Cerebral Ventricles/surgery ; Cerebrospinal Fluid Shunts ; Equipment Design ; Humans ; Hydrocephalus
    Language English
    Publishing date 2021-10-15
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-021-05390-7
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    Zs.A 2036: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  4. Article ; Online: Evaluation of factors associated with interhospital transfers to pediatric and adult tertiary level of care: A study of acute neurological disease cases.

    Iacob, Stanca / Wang, Yanzhi / Peterson, Susan C / Ivankovic, Sven / Bhole, Salil / Tracy, Patrick T / Elwood, Patrick W

    PloS one

    2022  Volume 17, Issue 12, Page(s) e0279031

    Abstract: Introduction: Patient referrals to tertiary level of care neurological services are often potentially avoidable and result in inferior clinical outcomes. To decrease transfer burden, stakeholders should acquire a comprehensive perception of specialty ... ...

    Abstract Introduction: Patient referrals to tertiary level of care neurological services are often potentially avoidable and result in inferior clinical outcomes. To decrease transfer burden, stakeholders should acquire a comprehensive perception of specialty referral process dynamics. We identified associations between patient sociodemographic data, disease category and hospital characteristics and avoidable transfers, and differentiated factors underscoring informed decision making as essential care management aspects.
    Materials and methods: We completed a retrospective observational study. The inclusion criteria were pediatric and adult patients with neurological diagnosis referred to our tertiary care hospital. The primary outcome was potentially avoidable transfers, which included patients discharged after 24 hours from admission without requiring neurosurgery, neuro-intervention, or specialized diagnostic methodologies and consult in non-neurologic specialties during their hospital stay. Variables included demographics, disease category, health insurance and referring hospital characteristics.
    Results: Patient referrals resulted in 1615 potentially avoidable transfers. A direct correlation between increasing referral trends and unwarranted transfers was observed for dementia, spondylosis and trauma conversely, migraine, neuro-ophthalmic disease and seizure disorders showed an increase in unwarranted transfers with decreasing referral trends. The age group over 90 years (OR, 3.71), seizure disorders (OR, 4.16), migraine (OR, 12.50) and neuro-ophthalmic disease (OR, 25.31) significantly associated with higher probability of avoidable transfers. Disparities between pediatric and adult transfer cases were identified for discrete diagnoses. Hospital teaching status but not hospital size showed significant associations with potentially avoidable transfers.
    Conclusions: Neurological dysfunctions with overlapping clinical symptomatology in ageing patients have higher probability of unwarranted transfers. In pediatric patients, disease categories with complex symptomatology requiring sophisticated workup show greater likelihood of unwarranted transfers. Future transfer avoidance recommendations include implementation of measures that assist astute disorder assessment at the referring hospital such as specialized diagnostic modalities and teleconsultation. Additional moderators include after-hours specialty expertise provision and advanced directives education.
    MeSH term(s) Humans ; Child ; Adult ; Aged, 80 and over ; Patient Transfer ; Retrospective Studies ; Referral and Consultation ; Hospitals ; Migraine Disorders
    Language English
    Publishing date 2022-12-14
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0279031
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  5. Article ; Online: Perioperative prophylaxis for surgical site infections in pediatric spinal surgery: a systematic review and network meta-analysis.

    Shaffer, Annabelle / Naik, Anant / MacInnis, Bailey / Chen, Michael / Ivankovic, Sven / Paisan, Gabriella / Garst, Jonathan R / Hassaneen, Wael / Arnold, Paul M

    Journal of neurosurgery. Pediatrics

    2022  Volume 31, Issue 1, Page(s) 43–51

    Abstract: Objective: Postoperative infections in pediatric spinal surgery commonly occur and necessitate reoperation(s). However, pediatric-specific infection prophylaxis guidelines are not available. This network meta-analysis compares perioperative prophylaxis ... ...

    Abstract Objective: Postoperative infections in pediatric spinal surgery commonly occur and necessitate reoperation(s). However, pediatric-specific infection prophylaxis guidelines are not available. This network meta-analysis compares perioperative prophylaxis methods including Betadine irrigation, saline irrigation, intrawound vancomycin powder, combination therapy (Betadine, vancomycin, gentamicin, and cefuroxime), Betadine irrigation plus vancomycin powder, and no intervention to determine the most efficacious prevention method.
    Methods: A systematic review was performed by searching the PubMed, EBSCO, Scopus, and Web of Science databases for peer-reviewed articles published prior to February 2022 comparing two or more infection prophylaxis methods in patients younger than 22 years of age. Data were extracted for treatment modalities, patient demographics, and patient outcomes such as total number of infections, surgical site infections, deep infections, intraoperative blood loss, operative time, follow-up time, and postoperative complications. Quality and risk of bias was assessed using National Institutes of Health tools. A network meta-analysis was performed with reduction of infections as the primary outcome.
    Results: Overall, 10 studies consisting of 5164 procedures were included. There was no significant difference between prophylactic treatment options in reduction of infection. However, three treatment options showed significant reduction in total infection compared with no prophylactic treatment: Betadine plus vancomycin (OR 0.22, 95% CI 0.09-0.54), vancomycin (OR 3.26, 95% CI 1.96-5.44), and a combination therapy (Betadine, vancomycin, gentamicin, and cefuroxime) (OR 0.24, 95% CI 0.07-0.75). P-Score hierarchical ranking estimated Betadine plus vancomycin to be the superior treatment to prevent total infections, deep infections, and surgical site infections (P-score 0.7876, 0.7175, and 0.7291, respectively). No prophylaxis treatment-related complications were reported.
    Conclusions: The results of this network meta-analysis show the strongest support for Betadine plus vancomycin as a method to reduce infections following pediatric spinal surgery. There was heterogeneity among studies and inconsistent outcome reporting; however, three effective treatment options are identified.
    MeSH term(s) Humans ; Child ; Vancomycin/therapeutic use ; Surgical Wound Infection/etiology ; Surgical Wound Infection/prevention & control ; Surgical Wound Infection/drug therapy ; Anti-Bacterial Agents/therapeutic use ; Povidone-Iodine/therapeutic use ; Cefuroxime/therapeutic use ; Powders/therapeutic use ; Network Meta-Analysis ; Antibiotic Prophylaxis/methods ; Gentamicins/therapeutic use
    Chemical Substances Vancomycin (6Q205EH1VU) ; Anti-Bacterial Agents ; Povidone-Iodine (85H0HZU99M) ; Cefuroxime (O1R9FJ93ED) ; Powders ; Gentamicins
    Language English
    Publishing date 2022-10-28
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 2403985-8
    ISSN 1933-0715 ; 1933-0707
    ISSN (online) 1933-0715
    ISSN 1933-0707
    DOI 10.3171/2022.9.PEDS22316
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    Uk I Zs.135 -Pediatrics-: Show issues Location:
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  6. Article ; Online: Educational impact of early COVID-19 operating room restrictions on neurosurgery resident training in the United States: A multicenter study.

    Zhang, Justin K / Del Valle, Armando / Ivankovic, Sven / Patel, Niel / Alexopoulos, Georgios / Khan, Maheen / Durrani, Sulaman / Patel, Mayur / Tecle, Najib El / Sujijantarat, Nanthiya / Jenson, Amanda V / Zammar, Samer G / Huntoon, Kristin / Goulart, Carlos R / Wilkinson, Brandon M / Bhimireddy, Sujit / Britz, Gavin W / DiLuna, Michael / Prevedello, Daniel M /
    Dinh, Dzung H / Mattei, Tobias A

    North American Spine Society journal

    2022  Volume 9, Page(s) 100104

    Abstract: Background: The coronavirus (COVID-19) pandemic has caused unprecedented suspensions of neurosurgical elective surgeries, a large proportion of which involve spine procedures. The goal of this study is to report granular data on the impact of early ... ...

    Abstract Background: The coronavirus (COVID-19) pandemic has caused unprecedented suspensions of neurosurgical elective surgeries, a large proportion of which involve spine procedures. The goal of this study is to report granular data on the impact of early COVID-19 pandemic operating room restrictions upon neurosurgical case volume in academic institutions, with attention to its secondary impact upon neurosurgery resident training. This is the first multicenter quantitative study examining these early effects upon neurosurgery residents caseloads.
    Methods: A retrospective review of neurosurgical caseloads among seven residency programs between March 2019 and April 2020 was conducted. Cases were grouped by ACGME Neurosurgery Case Categories, subspecialty, and urgency (elective vs. emergent). Residents caseloads were stratified into junior (PGY1-3) and senior (PGY4-7) levels. Descriptive statistics are reported for individual programs and pooled across institutions.
    Results: When pooling across programs, the 2019 monthly mean (SD) case volume was 214 (123) cases compared to 217 (129) in January 2020, 210 (115) in February 2020, 157 (81), in March 2020 and 82 (39) cases April 2020. There was a 60% reduction in caseload between April 2019 (207 [101]) and April 2020 (82 [39]). Adult spine cases were impacted the most in the pooled analysis, with a 66% decrease in the mean number of cases between March 2020 and April 2020. Both junior and senior residents experienced a similar steady decrease in caseloads, with the largest decreases occurring between March and April 2020 (48% downtrend).
    Conclusions: Results from our multicenter study reveal considerable decreases in caseloads in the neurosurgical specialty with elective adult spine cases experiencing the most severe decline. Both junior and senior neurosurgical residents experienced dramatic decreases in case volumes during this period. With the steep decline in elective spine cases, it is possible that fellowship directors may see a disproportionate increase in spine fellowships in the coming years. In the face of the emerging Delta and Omicron variants, programs should pay attention toward identifying institution-specific deficiencies and developing plans to mitigate the negative educational effects secondary to such caseloads reduction.
    Language English
    Publishing date 2022-02-19
    Publishing country United States
    Document type Journal Article
    ISSN 2666-5484
    ISSN (online) 2666-5484
    DOI 10.1016/j.xnsj.2022.100104
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