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Article ; Online: Overcoming the challenge of a thin skull in a 2-year-old patient undergoing laser interstitial thermal therapy using an individualized stereotactic platform: illustrative case.

Lau, Spencer / Menousek, Joseph / Pistone, Tyler / Klugh, Arnett / Salehi, Afshin

Journal of neurosurgery. Case lessons

2024 Volume 7, Issue 1

Abstract: Background: Ependymoma is the third most common pediatric brain tumor that can present with headaches, cranial nerve deficits, nausea, vomiting, and ataxia. Current treatment is maximal safe resection followed by radiation therapy. More recently, laser ... ...

Abstract	Background: Ependymoma is the third most common pediatric brain tumor that can present with headaches, cranial nerve deficits, nausea, vomiting, and ataxia. Current treatment is maximal safe resection followed by radiation therapy. More recently, laser interstitial thermal therapy (LITT) has become an alternative to traditional resection. In this report, the authors describe the utilization of a single-use, patient-specific stereotactic platform for the treatment of supratentorial ependymoma with LITT. Observations: A 2-year-old female had a complex history of supratentorial ependymoma after multiple craniotomies for repeated tumor progression and ventriculoperitoneal shunt placement. Imaging demonstrated an enlarging, complex, enhancing mass in the right occipital region. LITT was decided on for treatment. Given the thinness of the patient's skull, which precluded traditional means of stereotaxy, the authors elected to use a personalized stereotactic platform. Immediate postoperative imaging captured complete laser ablation of the tumor, with long-term imaging demonstrating a decreased tumor size. Lessons: Individualized stereotactic platforms are increasingly used in adult populations, but pediatric use continues to be infrequent. In this report, the authors present the youngest reported case using a personalized stereotactic platform and show the effectiveness of this system for performing LITT in the youngest of populations with very thin skulls.
Language	English
Publishing date	2024-01-01
Publishing country	United States
Document type	Journal Article
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE23513
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Article ; Online: Perception and Representation of LGBTQ+ Individuals in U.S. Neurosurgical Training.

Menousek, Joseph / Rezaii, Elhaum G / Sayles, Harlan / Anderson, Matthew J / Strong, Sheritta / Fornoff, Linden E

World neurosurgery

2024 Volume 185, Page(s) e1169–e1176

Abstract: Objective: The aim of this study is to gauge the current social climate in neurosurgical residency training and attitudes regarding sexual orientation and gender identity.: Methods: We conducted a cross-sectional study through a 35-question ... ...

Abstract	Objective: The aim of this study is to gauge the current social climate in neurosurgical residency training and attitudes regarding sexual orientation and gender identity. Methods: We conducted a cross-sectional study through a 35-question questionnaire distributed to roughly 1700 residents at all U.S. neurosurgical residency programs. Results: A total of 107 responses were obtained. Seventeen residents (16%) identified as being an LGBTQ+ individual. The majority (76%) of LGBTQ+ residents were concerned about how their sexual orientation would be perceived while applying to programs, and 47% endorsed purposefully concealing sexual orientation at work for fear of rejection or reprisal. More than half (56%) of those surveyed have witnessed homophobic/transphobic remarks by patients. While at work, 29% of LGBTQ+ individuals stated they are uncomfortable being open with their sexual orientation, and 3 LGBTQ+ individuals admitted being the target of direct homophobic/transphobic comments. Conclusions: This is the first study to our knowledge that has been conducted assessing the presence, perception, and treatment of LGBTQ+ trainees in neurosurgical residency. Our study outlines the challenges LGBTQ+ individuals face when applying to neurosurgical programs, which involves the perception of their sexual orientation, their witnessed instances of homophobic and transphobic comments by coworkers and patients, and their hesitation with discussing their social lives compared with their non-LGBTQ+ peers at work for fear of judgment or reprisal. Ongoing research is needed to address these issues to obtain workplace respect and fairness in this population and thus create an accepting atmosphere and achieve social justice in neurosurgery training.
MeSH term(s)	Humans ; Internship and Residency ; Sexual and Gender Minorities/psychology ; Male ; Female ; United States ; Cross-Sectional Studies ; Neurosurgery/education ; Surveys and Questionnaires ; Adult ; Attitude of Health Personnel ; Sexual Behavior/psychology
Language	English
Publishing date	2024-03-19
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.2024.03.043
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Article ; Online: Ultrasound as a Therapy for Brain Tumors.

Mezzacappa, Frank M / Menousek, Joseph / Avecillas-Chasin, Josue M

World neurosurgery

2022 Volume 164, Page(s) 237–238

MeSH term(s)	Brain/pathology ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/pathology ; Brain Neoplasms/surgery ; Humans ; Ultrasonography
Language	English
Publishing date	2022-05-21
Publishing country	United States
Document type	Letter
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2022.05.082
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Article: A Unique Case of Frontotemporal Dermoid Cyst Presenting as Orbital Cellulitis.

Menousek, Joseph P / Pistone, Tyler / Klugh Iii, Arnett / Vargo, James / Wong, Judith

Cureus

2023 Volume 15, Issue 4, Page(s) e37050

Abstract: Dermoid cysts are benign developmental anomalies that can occur anywhere along the neuroaxis or embryonic lines of fusion. While intracranial dermoid cysts at the midline frequently have an associated nasal or subcutaneous sinus tract, it is quite rare ... ...

Abstract	Dermoid cysts are benign developmental anomalies that can occur anywhere along the neuroaxis or embryonic lines of fusion. While intracranial dermoid cysts at the midline frequently have an associated nasal or subcutaneous sinus tract, it is quite rare to encounter an intracranial dermoid cyst off the midline with a lateral sinus tract. Standard practice for the treatment of dermoid cysts is surgical resection to minimize the risks of meningitis, abscess, mass effect, neurologic deficit, and/or death. A 3-year-old male with a history of DiGeorge syndrome presented with right orbital cellulitis and a right-sided dermal pit. Computed Tomography (CT) imaging demonstrated a dermal sinus tract with an associated lytic bone lesion within the right sphenoid wing and posterolateral orbital wall with intracranial extension. The patient was taken to the operating room in conjunction with plastic surgery for resection of the dermal sinus tract and intraosseous dermoid. This case presents a rare occurrence of a non-midline, frontotemporal dermal sinus tract associated with a dermoid cyst with intracranial extension presenting with pre- and post-septal orbital cellulitis. Important considerations include preservation of the frontal branch of the facial nerve, preservation of orbital structure and volume, complete surgical resection to prevent infectious complications including meningitis, and a multidisciplinary surgical approach with plastic surgery, ophthalmology, and/or otolaryngology.
Language	English
Publishing date	2023-04-03
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.37050
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Article ; Online: Immunopathogenesis of Craniotomy Infection and Niche-Specific Immune Responses to Biofilm.

de Morais, Sharon Db / Kak, Gunjan / Menousek, Joseph P / Kielian, Tammy

Frontiers in immunology

2021 Volume 12, Page(s) 625467

Abstract: Bacterial infections in the central nervous system (CNS) can be life threatening and often impair neurological function. Biofilm infection is a complication following craniotomy, a neurosurgical procedure that involves the removal and replacement of a ... ...

Abstract	Bacterial infections in the central nervous system (CNS) can be life threatening and often impair neurological function. Biofilm infection is a complication following craniotomy, a neurosurgical procedure that involves the removal and replacement of a skull fragment (bone flap) to access the brain for surgical intervention. The incidence of infection following craniotomy ranges from 1% to 3% with approximately half caused by
MeSH term(s)	Animals ; Biofilms/growth & development ; Central Nervous System Bacterial Infections/immunology ; Central Nervous System Bacterial Infections/metabolism ; Central Nervous System Bacterial Infections/microbiology ; Central Nervous System Bacterial Infections/therapy ; Craniotomy/adverse effects ; Host-Pathogen Interactions ; Humans ; Immunity, Innate ; Myeloid Differentiation Factor 88/metabolism ; Staphylococcal Infections/immunology ; Staphylococcal Infections/metabolism ; Staphylococcal Infections/microbiology ; Staphylococcal Infections/therapy ; Staphylococcus aureus/growth & development ; Staphylococcus aureus/immunology ; Surgical Wound Infection/immunology ; Surgical Wound Infection/metabolism ; Surgical Wound Infection/microbiology ; Surgical Wound Infection/therapy ; Toll-Like Receptor 2/metabolism
Chemical Substances	Myeloid Differentiation Factor 88 ; Toll-Like Receptor 2
Language	English
Publishing date	2021-02-23
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2021.625467
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Article ; Online: Presacral mature cystic teratoma associated with Currarino syndrome in an adolescent with androgen insensitivity: illustrative case.

Koskay, Grant / Opperman, Patrick / Mezzacappa, Frank M / Menousek, Joseph / Fuller, Megan K / Fornoff, Linden / Surdell, Daniel

Journal of neurosurgery. Case lessons

2022 Volume 4, Issue 18

Abstract: Background: Currarino syndrome is a rare disorder that classically presents with the triad of presacral mass, anorectal malformation, and spinal dysraphism. The presacral mass is typically benign, although malignant transformation is possible. Surgical ... ...

Abstract	Background: Currarino syndrome is a rare disorder that classically presents with the triad of presacral mass, anorectal malformation, and spinal dysraphism. The presacral mass is typically benign, although malignant transformation is possible. Surgical treatment of the mass and exploration and repair of associated dysraphism are indicated for diagnosis and symptom relief. There are no previous reports of Currarino syndrome in an androgen-insensitive patient. Observations: A 17-year-old female patient presented with lack of menarche. Physical examination and laboratory investigation identified complete androgen insensitivity. Imaging analysis revealed a presacral mass lesion, and the patient was taken to surgery for resection of the mass and spinal cord untethering. Intraoperative ultrasound revealed a fibrous stalk connecting the thecal sac to the presacral mass, which was disconnected without the need for intrathecal exploration. The presacral mass was then resected, and pathological analysis revealed a mature cystic teratoma. Postoperatively, the patient recovered without neurological or gastrointestinal sequelae. Lessons: Diagnosis of incomplete Currarino syndrome may be difficult but can be identified via work-up of other disorders, such as androgen insensitivity. Intraoperative ultrasound is useful for surgical decision making and may obviate the need for intrathecal exploration during repair of dysraphism in the setting of Currarino syndrome.
Language	English
Publishing date	2022-10-31
Publishing country	United States
Document type	Journal Article
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE22351
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Article ; Online: Transcriptional Profiling of Phagocytic Leukocytes and Microglia Reveals a Critical Role for Reactive Oxygen Species in Biofilm Containment during Staphylococcus aureus Craniotomy Infection.

Menousek, Joseph / Horn, Christopher M / Heim, Cortney E / Van Roy, Zachary / Korshoj, Lee E / Kielian, Tammy

Journal of immunology (Baltimore, Md. : 1950)

2022 Volume 209, Issue 10, Page(s) 1973–1986

Abstract: Craniotomies are performed to treat a variety of intracranial pathology. Surgical site infection remains a complication of craniotomy despite the use of prophylactic antibiotics and universal sterile precautions. Infections occur in 1-3% of procedures, ... ...

Abstract	Craniotomies are performed to treat a variety of intracranial pathology. Surgical site infection remains a complication of craniotomy despite the use of prophylactic antibiotics and universal sterile precautions. Infections occur in 1-3% of procedures, with approximately half caused by Staphylococcus aureus that forms a biofilm on the bone flap and is recalcitrant to systemic antibiotic therapy. We used an S. aureus-dsRed construct to compare the phagocytic capacity of leukocytes and microglia in vitro and in vivo using a mouse model of craniotomy infection. In addition, single-cell RNA sequencing (scRNA-seq) was applied to determine whether a transcriptional signature could be identified for phagocytic versus nonphagocytic cells in vivo. S. aureus was phagocytosed to equivalent extents in microglia, macrophages, neutrophils, and granulocytic myeloid-derived suppressor cells in vitro; however, microglial uptake of S. aureus was limited in vivo, whereas the other leukocyte populations exhibited phagocytic activity. scRNA-seq comparing the transcriptional signatures of phagocytic (S. aureus-dsRed+) versus nonphagocytic (S. aureus-dsRed-) leukocytes identified classical pathways enriched in phagocytic cells (i.e., reactive oxygen species [ROS]/reactive nitrogen species, lysosome, iron uptake, and transport), whereas nonphagocytic populations had increased ribosomal, IFN, and hypoxia signatures. scRNA-seq also revealed a robust ROS profile, which led to the exploration of craniotomy infection in NADPH oxidase 2 knockout mice. S. aureus burden, leukocyte recruitment, and intracellular bacterial load were significantly increased in NADPH oxidase 2 KO compared with wild-type animals. Collectively, these results highlight the importance of ROS generation in phagocytes for S. aureus biofilm containment, but not clearance, during craniotomy infection.
MeSH term(s)	Animals ; Mice ; Microglia ; Staphylococcus aureus ; Reactive Oxygen Species ; NADPH Oxidase 2 ; Phagocytes ; Staphylococcal Infections ; Leukocytes ; Biofilms ; Craniotomy
Chemical Substances	Reactive Oxygen Species ; NADPH Oxidase 2 (EC 1.6.3.-)
Language	English
Publishing date	2022-11-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	3056-9
ISSN	1550-6606 ; 0022-1767 ; 1048-3233 ; 1047-7381
ISSN (online)	1550-6606
ISSN	0022-1767 ; 1048-3233 ; 1047-7381
DOI	10.4049/jimmunol.2200503
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Article ; Online: Correlation Between Neurosurgical Residency Written Board Scores and Case Logs.

McGahan, Ben G / Hatef, Jeffrey / Gibbs, David / Leonard, Jeffrey / Menousek, Joseph / Thorell, William E / Powers, Ciarán J

World neurosurgery

2021 Volume 155, Page(s) e236–e239

Abstract: Objective: There are few objective measures for evaluating individual performance throughout surgical residency. Two commonly used objective measures are the case log numbers and written board examination scores. The objective of this study was to ... ...

Abstract	Objective: There are few objective measures for evaluating individual performance throughout surgical residency. Two commonly used objective measures are the case log numbers and written board examination scores. The objective of this study was to investigate possible correlations between these measures. Methods: We conducted a retrospective review of the American Board of Neurological Surgery (ABNS) written board scores and the Accreditation Council for Graduate Medical Education case logs of 27 recent alumni from neurologic surgery residency training programs at The Ohio State Wexner Medical Center and the University of Nebraska Medical Center. Results: The number of spine cases logged was significantly correlated with the ABNS written examination performance in univariate linear regression (r Conclusions: Identifying which objective measures correlate most closely with resident education could help optimize the structure of residency training programs. We believe that early exposure to focused aspects of neurosurgery helps the young resident learn quickly and efficiently and ultimately score highly on standardized examinations. Therefore program directors may want to ensure focused exposure during the early years of residency, with particular attention to worthwhile rotations in spine neurosurgery.
MeSH term(s)	Accreditation/standards ; Clinical Competence/standards ; Humans ; Internship and Residency ; Neurosurgery/education ; Retrospective Studies ; Specialty Boards/standards
Language	English
Publishing date	2021-08-20
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.2021.08.055
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Article ; Online: Does Surgical Volume Influence the Need for Second Surgery? A Pilot Study.

Judge, Paul D / Menousek, Joseph / Schramm, Jordan C / Cusick, Robert / Lydiatt, William

OTO open

2017 Volume 1, Issue 3, Page(s) 2473974X17728257

Abstract: Objective: To examine outcomes of pediatric thyroidectomy in the context of training background, institution, and experience of the surgeon.: Study design: Case series with chart review.: Setting: A tertiary academic medical center and a pediatric ...

Abstract	Objective: To examine outcomes of pediatric thyroidectomy in the context of training background, institution, and experience of the surgeon. Study design: Case series with chart review. Setting: A tertiary academic medical center and a pediatric hospital. Subjects and methods: Eighty-one thyroidectomy patients younger than 18 years. Outcomes were major complications (recurrent laryngeal nerve injury, permanent hypocalcemia, and wound infection), length of stay (LOS), and need for repeat surgery. Results: Eighty-one patients, 39 from the University of Nebraska Medical Center and 42 from the Children's Hospital and Medical Center-Omaha, were identified over a 12-year time period. No difference was found in surgeon training (otolaryngology/head and neck surgery vs general/pediatric surgery) for complications (1 vs 1, odds ratio [OR] = 0.76, 95% confidence interval [CI] = [0.05, 13.1]), LOS >1 day (5 vs 13, OR = 0.39, 95% CI = [0.13, 1.24]), or need for second surgery (4 vs 7, OR = 1.47, 95% CI = [0.39, 5.49]). Higher surgeon volume (≥12 surgeries) was found to be significant for decreased need for second surgery (3 vs 8, OR = 6.67, 95% CI = [1.57, 27.17]). Patients of higher-volume surgeons were 4.2 times more likely to stay in the hospital 1 day or less compared with those patients operated on by surgeons with less experience (7 vs 11, 95% CI = [1.59, 15.0]). Conclusions: Need for second surgery in pediatric thyroidectomy may be predicted by surgical volume.
Language	English
Publishing date	2017-08-24
Publishing country	United States
Document type	Journal Article
ISSN	2473-974X
ISSN (online)	2473-974X
DOI	10.1177/2473974X17728257
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Article: Database screening and in vivo efficacy of antimicrobial peptides against methicillin-resistant Staphylococcus aureus USA300

Menousek, Joseph / Mishra, Biswajit / Hanke, Mark L / Heim, Cortney E / Kielian, Tammy / Wang, Guangshun

International journal of antimicrobial agents. 2012 May, v. 39, no. 5

2012

Abstract: Natural antimicrobial peptides (AMPs) are promising candidates for developing a generation of new antimicrobials to meet the challenge of antibiotic-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). To facilitate the search ... ...

Abstract	Natural antimicrobial peptides (AMPs) are promising candidates for developing a generation of new antimicrobials to meet the challenge of antibiotic-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). To facilitate the search for new candidates, we have utilised the Antimicrobial Peptide Database (APD), which contains natural AMPs from bacteria, fungi, plants and animals. This study demonstrates the identification of novel templates against MRSA by screening 30 peptides selected from the APD. These peptides are short (<25 residues), cysteine-free, cationic and represent candidates from different biological sources such as bacteria, insects, arachnids, tunicates, amphibians, fish and mammals. Six peptides, including ascaphin-8, database-screened antimicrobial peptide 1 (DASamP1), DASamP2, lycotoxin I, maculatin 1.3 and piscidin 1, were found to exert potent antimicrobial activity against an MRSA USA300 isolate. Although five of the six peptides showed broad-spectrum antibacterial activity, DASamP1 displayed killing of MRSA in vitro but not of Escherichia coli, Bacillus subtilis or Pseudomonas aeruginosa. In addition, DASamP1 suppressed early biofilm formation in a mouse model of catheter-associated MRSA infection. DASamP1 is a novel, short and potent peptide that will be a useful starting template for further developing novel anti-MRSA peptides.
Keywords	Arachnida ; Bacillus subtilis ; Escherichia coli ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Tunicata ; amphibians ; animal models ; antibacterial properties ; antibiotic resistance ; antimicrobial peptides ; bacteria ; biofilm ; databases ; fish ; fungi ; insects ; mammals ; methicillin ; pathogens ; screening
Language	English
Dates of publication	2012-05
Size	p. 402-406.
Publishing place	Elsevier B.V.
Document type	Article
ZDB-ID	1093977-5
ISSN	0924-8579
ISSN	0924-8579
DOI	10.1016/j.ijantimicag.2012.02.003
Database	NAL-Catalogue (AGRICOLA)

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