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Book Chapter
Hess, R. M., and M. A. R. Soliman, "Ependymal and Embryonal Tumors", Neuro-Oncology Explained Through Multiple Choice Questions, Cham, Springer International Publishing, pp. 163 - 176, 2023. Abstract

Embryonal tumors of the central nervous system are neuroepithelial-derived, highly aggressive, poorly differentiated tumors. They cover a variety of tumors, such as neuroblastoma, ganglioneuroblastoma, medulloblastoma, and medulloepithelioma. Ependymal neoplasms can form in the supratentorial compartment, the posterior fossa, or the spinal cord at any age and include several tumor types and subtypes. This chapter aims to provide a brief knowledge on these tumors aided by twenty five questions.

Soliman, M. A. R., C. Cavallo, S. Gandhi, X. Zhao, and M. A. Labib, "Trans-sulcal, Channel-Based Parafascicular Surgery for Subcortical and Intraventricular Lesions: Instruments and Technical Considerations", Subcortical Neurosurgery: Open and Parafascicular Channel-Based Approaches for Subcortical and Intraventricular Lesions, Cham, Springer International Publishing, pp. 121 - 136, 2022. Abstract

Brain lesions located in the subcortical, periventricular, and intraventricular areas are challenging from a surgical standpoint as they are associated with potentially high morbidity rates secondary to white matter tract injury. Traditionally, fixed blade retractors were used to facilitate access to deep lesions. However, the edges of these retractors may exert a significant constant pressure leading to ischemia. Furthermore, this iatrogenic injury can be aggravated by the repeated entry of surgical instruments into the surgical field. Due to the limitations mentioned earlier, the results of this conventional technique have not been considered satisfactory and have encouraged the development of new advances such as tubular retractors. This chapter will discuss the indications, different instrumentations used, technical considerations, and a quick review of the literature on the channel-based tubular retractor devices used in the trans-sulcal parafascicular approach.

Conference Paper
MAR, S., "Endovascular management of Giant aneurysms", 3rd Cairo-Greifswald International conference, Cairo, Egypt, 4 December, 2017.
, "Ventricular lavage improves the outcome in cerebral ventriculitis: A prospective randomized controlled study.", Annual section of endoscopic neurosurgery, neuronavigation and intraoperative imaging, Greifswald, April 2017.
Journal Article
Donnelly, B. M., D. E. Smolar, A. A. Baig, M. A. R. Soliman, A. Monteiro, K. J. Gibbons, E. I. Levy, and K. V. Snyder, "Analysis of craniectomy bone flaps stored in a neurosurgical cryopreservation freezer: microorganism culture results and reimplantation rates.", Acta neurochirurgica, vol. 165, issue 11, pp. 3187-3195, 2023. Abstract

BACKGROUND: Cryopreservation of bone flaps after decompressive craniectomies is a common practice. A frequent complication after bone flap reimplantation is postoperative infection, so culturing of frozen craniectomy bone flaps is a crucial practice that can prevent patient morbidity and mortality. Although many studies report on infection rates after cranioplasty, no study reports on the results of bone flaps stored in a cryopreservation freezer, reimplanted or otherwise. We sought to analyze the flaps in our medical center's bone bank freezer, including microorganism culture results and reimplantation rates of cryopreserved bone flaps.

METHODS: Patients who underwent craniectomy and had bone flaps cryopreserved between January 1, 2016, and July 1, 2022, were included in this retrospective study. Information about bone flap cultures and reimplantation or discard was obtained from a prospectively maintained cryopreservation database. Information including infection rates and mortality was acquired from a retrospective review of patient records. Culture results were obtained for all flaps immediately before cryopreservation and again at the time of reimplantation at the operator's discretion.

RESULTS: There were 148 bone flaps obtained from 145 patients (3 craniectomies were bilateral) stored in our center's freezer. Positive culture results were seen in 79 (53.4%) flaps. The most common microorganism genus was Propionibacterium with 47 positive flaps, 46 (97.9%) of which were P. acnes. Staphylococcus was the second most common with 23 positive flaps, of which 8 (34.8%) tested positive for S. epidermidis. Of the 148 flaps, 25 (16.9%) were reimplanted, 116 (78.4%) were discarded, and 7 (4.7%) are still being stored in the freezer. Postcranioplasty infections were seen in 3 (12%) patients who had flap reimplantation.

CONCLUSIONS: Considering the substantial number of positive cultures and limited reimplantation rate, we have reservations about the logistical efficiency of cryopreservation for flap storage. Future multicenter studies analyzing reimplantation predictors could help to reduce unnecessary freezing and culturing.

Mao, J. Z., M. A. R. Soliman, B. A. Karamian, A. Khan, A. G. Fritz, N. Avasthi, S. DiMaria, B. R. Levy, T. E. O'Connor, G. Schroeder, et al., "Anatomical and Technical Considerations of Robot-Assisted Cervical Pedicle Screw Placement: A Cadaveric Study.", Global spine journal, vol. 13, issue 7, pp. 1992-2000, 2023. Abstract

STUDY DESIGN: Cadaver study.

OBJECTIVES: Assess the feasibility of robot-assisted cervical pedicle screw (RA-CPS) placement and understand the anatomical considerations of this technique.

METHODS: Four cadaver specimens free from bony pathology were acquired. Anatomical considerations, such as pedicle width (PW) and height (PH), transverse pedicle angle (TPA), and maximal screw length (MSL), were recorded from preoperative computational tomography (CT) scans. Intraoperative cone-beam CT was acquired and registered to the robotic system. After cervical levels were segmented, screw sizes and trajectories were planned, and RA-CPS were placed. Accuracy was assessed using Gertzbein and Robbin's classification on postoperative CT scans.

RESULTS: Thirty-five RA-CPS were placed. Major breaches (≥Grade C) occurred in 28.57% screws. Grade A or B accuracy was found in 71.43% of screws, with the most common direction of breach being medial (81.3%). The greatest proportion of breach per level occurred in the upper subaxial levels, (C3:71.4%, C4 66.6%, C5:50%) which had the smallest PW (C3: 4.34 ± .96 mm, C4: 4.48 ± .60, C5: 5.76 ± 1.11). PH was greatest at C2 (8.14 ± 1.89 mm) and ranged subaxial from 6.36 mm (C3) to 7.48 mm (C7). The mean PW was 5.37 mm and increased caudally from 4.34 mm (C3) to 6.31 mm (C7). The mean TPA was 39.9° and decreased moving caudally 46.9°) to C7 (34.4°). The MSL was 37.1 mm and increased from C2 (26.3 mm) to C7 (41.0 mm).

CONCLUSION: RA-CPS has the potential to be feasible, but technological and instrument modifications are necessary to increase the accuracy in the cervical region.

Soliman, M. A. R., J. Pollina, K. Poelstra, S. Chaudhary, and K. Foley, "Can a Spine Robot Be More Efficient and Less Expensive While Maintaining Accuracy?", International journal of spine surgery, vol. 16, issue S2, pp. S50-S54, 2022. Abstract

BACKGROUND: Spinal surgical robots are in the early phases of development and adoption. These systems need to be easier to use, less costly, and more workflow-efficient.

METHODS: A portable, operating room table-mounted spine robot and camera system are described. Accuracy and workflow efficiency were assessed in comparison to another commonly utilized spinal robotic system.

RESULTS: For the surgical task of inserting 4 pedicle screws into 2 adjacent lumbar vertebrae, equivalent accuracy was seen with both systems. The new robotic system was more efficient in terms of total procedure time, system setup time, and screw planning to in-position time (p<0.05).

CONCLUSIONS: Spinal robotic systems can be more efficient and less expensive while maintaining accuracy.

CLINICAL RELEVANCE: Spinal robots are being increasingly utilized in clinical practice. Lowering the cost of these systems and increasing their workflow efficiency should help patients and spine surgeons alike.

Im, J., M. A. R. Soliman, A. F. Alkhamees, S. Eaton, E. Quint, S. Shahab, A. O'Connor, E. Haberfellner, and E. Dyer, Cervical Spine Chondrosarcoma in an Adult with a History of Wilms Tumor, , vol. 144, pp. 117 - 120, 2020. AbstractWebsite

IntroductionWe report the first case of cervical spine chondrosarcoma in a Wilms tumor survivor.
Case Description
A 52-year-old female patient presented with myelopathic symptoms including poor balance, difficulty walking, and numbness of both feet. A magnetic resonance imaging of the spine showed a mass at the right C7-T1 foramen causing significant cord compression. The patient's symptoms improved after posterior decompression and fusion with excision of the tumor.
Through our experience with this case, we would like to suggest a possible unknown genetic syndrome predisposing patients with Wilms tumor to chondrosarcoma as secondary neoplasms. We would also like to re-emphasize the need for vigilance when assessing patients with a history of Wilms tumor.

Aguirre, A. O., M. A. R. Soliman, C. C. Kuo, N. Ruggiero, J. Im, Y. Chintaluru, A. M. A. Khan, A. Khan, R. M. Hess, K. Rho, et al., "Cervical Vertebral Bone Quality Score Independently Predicts Distal Junctional Kyphosis After Posterior Cervical Fusion.", Neurosurgery, vol. 94, issue 3, pp. 461-469, 2024. Abstract

BACKGROUND AND OBJECTIVE: Posterior cervical fusion is the surgery of choice when fusing long segments of the cervical spine. However, because of the limited presence of this pathology, there is a paucity of data in the literature about the postoperative complications of distal junctional kyphosis (DJK). We aimed to identify and report potential associations between the preoperative cervical vertebral bone quality (C-VBQ) score and the occurrence of DJK after posterior cervical fusion.

METHODS: The authors retrospectively reviewed records of patients who underwent posterior cervical fusion at a single hospital between June 1, 2010, and May 31, 2020. Patient data were screened to include patients who were >18 years old, had baseline MRI, had baseline standing cervical X-ray, had immediate postoperative standing cervical X-ray, and had clinical and radiographic follow-ups of >1 year, including a standing cervical X-ray at least 1 year postoperatively. Univariate analysis was completed between DJK and non-DJK groups, with multivariate regression completed for relevant clinical variables. Simple linear regression was completed to analyze correlation between the C-VBQ score and total degrees of kyphosis angle change.

RESULTS: Ninety-three patients were identified, of whom 19 (20.4%) had DJK and 74 (79.6%) did not. The DJK group had a significantly higher C-VBQ score than the non-DJK group (2.97 ± 0.40 vs 2.26 ± 0.46; P < .001). A significant, positive correlation was found between the C-VBQ score and the total degrees of kyphosis angle change (r 2 = 0.26; P < .001). On multivariate analysis, the C-VBQ score independently predicted DJK (odds ratio, 1.46; 95% CI, 1.27-1.67; P < .001).

CONCLUSION: We found that the C-VBQ score was an independent predictive factor of DJK after posterior cervical fusion.

Soliman, M. A. R., S. Eaton, E. Quint, A. F. Alkhamees, S. Shahab, A. O'Connor, E. Haberfellner, J. Im, A. A. Elashaal, F. Ling, et al., "Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital", World neurosurgery, vol. 138: Elsevier Inc., pp. e940 - e954, 2020/06/. AbstractWebsite

BACKGROUND AND OBJECTIVE: Endoscopic endonasal surgery (EES) for the management of sellar, suprasellar, and anterior skull base lesions is gaining popularity. Our aim was to analyze and present the clinical outcomes of EES for the management of these lesions in a community hospital setting. METHODS: We retrospectively reviewed the charts of 56 patients with sellar, suprasellar, and anterior skull base lesions who underwent EES between 2010 and 2018. RESULTS: There was male predominance (53.6%) with a mean age of 54.9 ± 13.7 years. Lesions were 45 pituitary adenomas, 5 meningiomas, 3 metastatic, 1 craniopharyngioma, 1 Rathke cyst, and 1 mucocele. Gross total excision was achieved in 57.1%, subtotal excision occurred in 37.5%, and decompression and biopsy were achieved in 5.4% patients. Postoperative vision normalized or improved in 27 patients (86.1%) and was stable in 4 patients (13.9%). Recovery of a preexisting hormonal deficit occurred in 13 (23.2%) patients, and a new hormonal deficit occurred in 9 patients (16.1%). The mean hospital stay was 6.1 ± 4.9 days. Postoperative complications included cerebrospinal fluid leak in 8 patients (14.3%). Four patients (7.1%) had meningitis. Diabetes insipidus was present in 19 patients (33.9%), and postoperative intracranial hematoma requiring evacuation was necessary in 2 patients (3.6%). The mean follow-up duration was 47.5 ± 25.8 months. Lesion progression or recurrence requiring redo surgery occurred in 5 patients (8.9%). Regarding the learning curve, the postoperative cerebrospinal fluid leak, meningitis, new hormonal deficits, and diabetes insipidus decreased in the second half of the patients. CONCLUSIONS: EES provides an effective and safe surgical option with low morbidity and mortality for the treatment of sellar, suprasellar, and anterior skull base lesions in a community hospital setting.

Elkady, A., M. A. R. Soliman, and A. M. Ali, Clinical Outcomes of Infratentorial Meningioma Surgery in a Developing Country, , vol. 137, pp. e373 - e382, 2020. AbstractWebsite

BackgroundNo data are available on incidence, surgical approaches, complications, and survival for patients with infratentorial meningiomas in developing countries. Predictors for surgical resection, recurrence, and complications were analyzed based on the surgical outcomes of patients with infratentorial meningiomas.
A total of 101 consecutive cases of infratentorial meningiomas operated on between April 2012 and April 2017 at our institute were reviewed retrospectively. The patients had a mean age of 55.1 ± 5 years, a female predominance of 62.3%, and the mean duration of follow-up duration was 44.2 ± 15.5 months.
The most common surgical approach was retrosigmoid (n = 51) followed by suboccipital (n = 36), subtemporal (n = 8), and far lateral (n = 6). The preoperative presentation showed that affected cranial nerve was the most common presenting symptom (47.5%) followed by weakness (24.8%) and affected vision (16.8%) followed by headache (8.9%) and gait disturbance (6.9%). The extent of resection was grade I (n = 63), grade II (n = 15)and grade III (n = 23) according to the Simpson grading. The complication rate was 56 cases (55.4%); the most common complication was cranial nerve palsy (42.6%), followed by weakness (31.7%), hydrocephalus (16.8%), chest infection (8.9%), ataxia (4%), deep venous thrombosis (4%), cerebrospinal fluid leak (3%) and meningitis and pulmonary embolism (both 1%).
The location, surgical approach, preoperative Karnofsky Performance Status, and peritumor edema were significantly associated with complications. Compared with developed countries, we had a higher complication rate (P < 0.001), lower recurrence rate (P = 0.15), and slightly lower total resection rate (P = 0.29). These findings might be attributed to the patient's late presentation to the tertiary center and poor technical resources.

Soliman, M. A. R., A. Khan, and J. Pollina, "Comparison of Prone Transpsoas and Standard Lateral Lumbar Interbody Fusion Surgery for Degenerative Lumbar Spine Disease: A Retrospective Radiographic Propensity Score-Matched Analysis.", World neurosurgery, vol. 157, pp. e11-e21, 2022. Abstract

BACKGROUND: Prone transpsoas lateral lumbar interbody fusion (PTP-LLIF) is a recently introduced modification to standard LLIF. To date, no study has compared the radiographic outcomes of standard LLIF and PTP-LLIF. We performed a radiographic parameter-based propensity score-matched analysis to compare postoperative clinical and radiographic outcomes between PTP-LLIF and standard LLIF for degenerative lumbar spine disease.

METHODS: A total of 30 consecutive patients met the inclusion criteria. The preoperative standing scoliosis radiographs were retrospectively reviewed for global and segmental sagittal alignment. Propensity score matching was calculated using the baseline radiographic parameters. One-to-one matching of patients who had undergone PTP-LLIF with those who had a similar propensity score but had undergone standard LLIF was performed to compare the radiographic (primary) and clinical (secondary) outcomes.

RESULTS: Propensity score matching resulted in 10 pairs of PTP-LLIF and standard LLIF patients. The PTP-LLIF group had had significantly better improvement in lumbar lordosis (P = 0.047). The difference in the improvement in pelvic incidence minus lumbar lordosis mismatch approached statistical significance for the PTP-LLIF group (P = 0.05). This led to better improvement in the short-form 12-item physical score (P = 0.03) and Oswestry disability index (P = 0.1) in the PTP-LLIF group. No significant differences were found between the 2 groups in the other clinical and radiographic outcomes. The PTP-LLIF group had a shorter operative time (P = 0.4) and hospital stay (P = 0.1), without a statistically difference, and shorter radiation exposure time (P = 0.5). The standard LLIF group had experienced less intraoperative bleeding, without a statistically significant difference (P = 0.3). The mean follow-up time was 10.2 ± 5.2 months in the PTP-LLIF group and 30.9 ± 17.2 months in the standard LLIF group (P < 0.05).

CONCLUSIONS: The PTP-LLIF group showed significantly better improvement in lumbar lordosis and short-form 12-item physical score.

Soliman, M. A. R., A. O. Aguirre, N. Ruggiero, C. C. Kuo, B. L. Mariotti, A. Khan, J. P. Mullin, and J. Pollina, "Comparison of prone transpsoas lateral lumbar interbody fusion and transforaminal lumbar interbody fusion for degenerative lumbar spine disease: A retrospective radiographic propensity score-matched analysis.", Clinical neurology and neurosurgery, vol. 213, pp. 107105, 2022. Abstract

INTRODUCTION: This is the first study to compare the prone transpsoas (PTP) approach for lateral lumbar interbody fusion (LLIF) and transforaminal lumbar interbody fusion (TLIF) through an analysis of radiographic and clinical outcomes.

MATERIALS AND METHODS: A retrospective chart review of data for patients who underwent the PTP approach or TLIF for degenerative lumbar spine disease was conducted. Propensity score matching was completed through the utilization of a linear regression model with the classification of surgery (PTP vs. TLIF) being used as the indicator (dependent variable) and the radiographic outcomes as covariates (independent variables). Both cohorts (PTP and TLIF) were propensity score matched according to preoperative radiographic parameters using a 1-to-1 ratio to the nearest neighbor. Eleven patients in the TLIF group were matched to an equal number of patients in the PTP group who had similar propensity scores to perform a thorough analysis of clinical and radiographic outcomes.

RESULTS: The PTP approach significantly improved the lumbar lordosis angle, pelvic tilt, and the pelvic incidence minus lumbar lordosis value when compared to TLIF (p < 0.05). Clinically, the PTP group improved significantly in terms of the Oswestry Disability Index (p < 0.05). That approach also significantly minimized blood loss and hospital stay (p < 0.05). Furthermore, significantly more cages were placed anteriorly in the PTP group than in the TLIF group (p < 0.05). However, the PTP group had a significantly longer duration of radiation exposure (p < 0.05).

CONCLUSION: The PTP approach resulted in greater improvement in postoperative radiographic measurements as well as patient-reported outcomes.

Soliman, M. A. R., A. O. Aguirre, S. Khan, C. C. Kuo, N. Ruggiero, B. L. Mariotti, A. G. Fritz, S. Sharma, A. Nezha, B. R. Levy, et al., "Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine (C2-T1): systematic review and meta-analysis comprising 4,165 patients and 16,669 screws.", Neurosurgical review, vol. 46, issue 1, pp. 61, 2023. Abstract

Lateral mass screw (LMS) and cervical pedicle screw (CPS) fixation are among the most popular techniques for posterior fusion of the cervical spine. Early research prioritized the LMS approach as the trajectory resulted in fewer neurovascular complications; however, with the incorporation of navigation assistance, the CPS approach should be re-evaluated. Our objective was to report the findings of a meta-analysis focused on comparing the LMS and CPS techniques in terms of rate of various complications with inclusion of all levels from C2 to T1. We conducted a systematic review of PubMed and EMBASE databases with final inclusion criteria focused on identifying studies that reported outcomes and complications for either the CPS or LMS technique. These studies were then pooled, and statistical analyses were performed from the cumulative data. A total of 60 studies comprising 4165 participants and 16,669 screws placed within the C2-T1 levels were identified. Within these studies, the LMS group had a significantly increased odds for lateral mass fractures (odds ratio [OR] = 43.2, 95% confidence interval [CI] = 2.62-711.42), additional cervical surgeries (OR = 5.56, 95%CI = 2.95-10.48), and surgical site infections (SSI) (OR = 5.47, 95%CI = 1.65-18.16). No other significant differences between groups in terms of complications were identified. Within the subgroup analysis of navigation versus non-navigation-guided CPS placement, no significant differences were identified for individual complications, although collectively significantly fewer complications occurred with navigation (OR = 5.29, 95%CI = 2.03-13.78). The CPS group had significantly fewer lateral mass fractures, cervical revision surgeries, and SSIs. Furthermore, navigation-assisted CPS placement was associated with a significant reduction in complications overall.

Soliman, M. A. R., S. Khan, N. Ruggiero, B. L. Mariotti, A. O. Aguirre, C. C. Kuo, A. G. Fritz, S. Sharma, A. Nezha, B. R. Levy, et al., "Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine: systematic review and meta-analysis comprising 1768 patients and 8636 screws.", Neurosurgical review, vol. 45, issue 3, pp. 1941-1950, 2022. Abstract

Lateral mass screw (LMS) fixation for the treatment of subaxial cervical spine instability or deformity has been traditionally associated with few neurovascular complications. However, cervical pedicle screw (CPS) fixation has recently increased in popularity, especially with navigation assistance, because of the higher pullout strength of the pedicle screws. To their knowledge, the authors conducted the first meta-analysis comparing the complication rates during and/or after CPS and LMS placement for different pathologies causing cervical spine instability. A systematic literature search of PubMed and Embase from inception to January 12, 2021 was performed to identify studies reporting CPS and/or LMS-related complications. Complications were categorized into intraoperative and early postoperative (within 30 days of surgery) and late postoperative (after 30 days from surgery) complications. All studies that met the prespecified inclusion criteria were pooled and cumulatively analyzed. A total of 24 studies were conducted during the time frame of the search and comprising 1768 participants and 8636 subaxially placed screws met the inclusion criteria. The CPS group experienced significantly more postoperative C5 palsy (odds ratio [OR] = 3.48, 95% confidence interval [CI] = 1.27-9.53, p < 0.05). Otherwise, there were no significant differences between the LMS and CPS groups. There were no significant differences between the CPS and LMS groups in terms of neurovascular procedure-related complications other than significantly more C5 palsy in the CPS group.

Soliman, M. A. R., L. Diaz-Aguilar, C. C. Kuo, A. O. Aguirre, A. Khan, J. E. San Miguel-Ruiz, R. Amaral, M. M. Abd-El-Barr, I. L. Moss, T. Smith, et al., "Complications of the Prone Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spine Disease: A Multicenter Study.", Neurosurgery, vol. 93, issue 5, pp. 1106-1111, 2023. Abstract

BACKGROUND AND OBJECTIVES: The prone transpsoas (PTP) approach for lateral lumbar interbody fusion (LLIF) is a novel technique for degenerative lumbar spine disease. However, there is a paucity of information in the literature on the complications of this procedure, with all published data consisting of small samples. We aimed to report the intraoperative and postoperative complications of PTP in the largest study to date.

METHODS: A retrospective electronic medical record review was conducted at 11 centers to identify consecutive patients who underwent LLIF through the PTP approach between January 1, 2021, and December 31, 2021. The following data were collected: intraoperative characteristics (operative time, estimated blood loss [EBL], intraoperative complications [anterior longitudinal ligament (ALL) rupture, cage subsidence, vascular and visceral injuries]), postoperative complications, and hospital stay.

RESULTS: A total of 365 patients were included in the study. Among these patients, 2.2% had ALL rupture, 0.3% had cage subsidence, 0.3% had a vascular injury, 0.3% had a ureteric injury, and no other visceral injuries were reported. Mean operative time was 226.2 ± 147.9 minutes. Mean EBL was 138.4 ± 215.6 mL. Mean hospital stay was 2.7 ± 2.2 days. Postoperative complications included new sensory symptoms-8.2%, new lower extremity weakness-5.8%, wound infection-1.4%, cage subsidence-0.8%, psoas hematoma-0.5%, small bowel obstruction and ischemia-0.3%, and 90-day readmission-1.9%.

CONCLUSION: In this multicenter case series, the PTP approach was well tolerated and associated with a satisfactory safety profile.

Khan, A., M. A. R. Soliman, N. J. Lee, M. Waqas, J. M. Lombardi, V. Boddapati, L. C. Levy, J. Z. Mao, P. J. Park, J. Mathew, et al., "CT-to-fluoroscopy registration versus scan-and-plan registration for robot-assisted insertion of lumbar pedicle screws.", Neurosurgical focus, vol. 52, issue 1, pp. E8, 2022. Abstract

OBJECTIVE: Pedicle screw insertion for stabilization after lumbar fusion surgery is commonly performed by spine surgeons. With the advent of navigation technology, the accuracy of pedicle screw insertion has increased. Robotic guidance has revolutionized the placement of pedicle screws with 2 distinct radiographic registration methods, the scan-and-plan method and CT-to-fluoroscopy method. In this study, the authors aimed to compare the accuracy and safety of these methods.

METHODS: A retrospective chart review was conducted at 2 centers to obtain operative data for consecutive patients who underwent robot-assisted lumbar pedicle screw placement. The newest robotic platform (Mazor X Robotic System) was used in all cases. One center used the scan-and-plan registration method, and the other used CT-to-fluoroscopy for registration. Screw accuracy was determined by applying the Gertzbein-Robbins scale. Fluoroscopic exposure times were collected from radiology reports.

RESULTS: Overall, 268 patients underwent pedicle screw insertion, 126 patients with scan-and-plan registration and 142 with CT-to-fluoroscopy registration. In the scan-and-plan cohort, 450 screws were inserted across 266 spinal levels (mean 1.7 ± 1.1 screws/level), with 446 (99.1%) screws classified as Gertzbein-Robbins grade A (within the pedicle) and 4 (0.9%) as grade B (< 2-mm deviation). In the CT-to-fluoroscopy cohort, 574 screws were inserted across 280 lumbar spinal levels (mean 2.05 ± 1.7 screws/ level), with 563 (98.1%) grade A screws and 11 (1.9%) grade B (p = 0.17). The scan-and-plan cohort had nonsignificantly less fluoroscopic exposure per screw than the CT-to-fluoroscopy cohort (12 ± 13 seconds vs 11.1 ± 7 seconds, p = 0.3).

CONCLUSIONS: Both scan-and-plan registration and CT-to-fluoroscopy registration methods were safe, accurate, and had similar fluoroscopy time exposure overall.

Soliman, M. A. R., and A. Ali, "Decompression of lumbar canal stenosis with a bilateral interlaminar versus classic laminectomy technique: a prospective randomized study.", Neurosurgical focus, vol. 46, issue 5, pp. E3, 2019. Abstract

OBJECTIVEThe aim of this study was to compare the radiological and clinical results of bilateral interlaminar canal decompression and classic laminectomy in lumbar canal stenosis (LCS).METHODSTwo hundred eighteen patients with LCS were randomized to surgical treatment with classic laminectomy (group 1) or bilateral interlaminar canal decompression (group 2). Low-back and leg pain were evaluated according to the visual analog scale (VAS) both preoperatively and postoperatively. Disability was evaluated according to the Oswestry Disability Index (ODI) preoperatively and at 1 month, 1 year, and 3 years postoperatively. Neurogenic claudication was evaluated using the Zurich Claudication Questionnaire (ZCQ) preoperatively and 1 year postoperatively. The two treatment groups were compared in terms of neurogenic claudication, estimated blood loss (EBL), and intra- and postoperative complications.RESULTSPostoperative low-back and leg pain declined as compared to the preoperative pain. Both groups had significant improvement in VAS, ODI, and ZCQ scores, and the improvements in ODI and back pain VAS scores were significantly better in group 2. The average EBL was 140 ml in group 2 compared to 260 ml in group 1. Nine patients in the laminectomy group developed postoperative instability requiring fusion compared to only 4 cases in the interlaminar group (p = 0.15). Complications frequency did not show any statistical significance between the two groups.CONCLUSIONSBilateral interlaminar decompression is an effective method that provides sufficient canal decompression with decreased instability in cases of LCS and increases patient comfort in the postoperative period.

Ezzat, A. A. M., M. A. R. Soliman, M. Baraka, M. E. Shimy, A. Ezz, and E. E. L. Refaee, "Distant large acute epidural hematoma after closed cerebrospinal fluid tapping through the anterior fontanelle: A case report and its pathogenesis.", Surgical neurology international, vol. 12, pp. 59, 2021. Abstract

BACKGROUND: Cerebrospinal fluid (CSF) infection is one of the most common and serious complications of shunt placement. The CSF shunt infections are preferably treated with intravenous antibiotics, infected shunt removal, repeated tapping (infants) or placement of an external ventricular drainage (EVD) device, and placement of a new shunt once the CSF is sterile. The tapping through the anterior fontanelle is commonly used instead of the EVD in developing countries to manage CSF infection in open anterior fontanelle patients. To the best of our knowledge, this would be considered the first reported case of distant epidural hematoma after closed ventricular tapping.

CASE DESCRIPTION: We report a case of 6-months child with Chiari malformation (Type II) presenting to us with a shunt infection with possible obstruction. CSF was aspirated for examination through a tap through the anterior fontanelle followed by the development of extradural hemorrhage far from the tapping site.

CONCLUSION: EDH after a transfontanellar ventricular tap can rapidly evolve and lead to patient death. This report raises the awareness of the neurosurgeons to this possible complication that can happen and leads to major complications. Monitoring the conscious level would be needed after ventricular tapping to detect this possible complication.

Khan, A., J. Z. Mao, M. A. R. Soliman, K. Rho, R. M. Hess, R. M. Reynolds, J. P. Riley, J. P. Mullin, A. H. Siddiqui, E. I. Levy, et al., "The effect of COVID-19 on trainee operative experience at a multihospital academic neurosurgical practice: A first look at case numbers.", Surgical neurology international, vol. 12, pp. 271, 2021. Abstract

BACKGROUND: COVID-19 has had a significant impact on the economy, health care, and society as a whole. To prevent the spread of infection, local governments across the United States issued mandatory lockdowns and stay-at-home orders. In the surgical world, elective cases ceased to help "flatten the curve" and prevent the infection from spreading to hospital staff and patients. We explored the effect of the cancellation of these procedures on trainee operative experience at our high-volume, multihospital neurosurgical practice.

METHODS: Our department cancelled all elective cases starting March 16, 2020, and resumed elective surgical and endovascular procedures on May 11, 2020. We retrospectively reviewed case volumes for 54 days prelockdown and 54 days postlockdown to evaluate the extent of the decrease in surgical volume at our institution. Procedure data were collected and then divided into cranial, spine, functional, peripheral nerve, pediatrics, and endovascular categories.

RESULTS: Mean total cases per day in the prelockdown group were 12.26 ± 7.7, whereas in the postlockdown group, this dropped to 7.78 ± 5.5 ( = 0.01). In the spine category, mean cases per day in the prelockdown group were 3.13 ± 2.63; in the postlockdown group, this dropped to 0.96 ± 1.36 ( < 0.001). In the functional category, mean cases per day in the prelockdown group were 1.31 ± 1.51, whereas in the postlockdown group, this dropped to 0.11 ± 0.42 ( < 0.001). For cranial ( = 0.245), peripheral nerve ( = 0.16), pediatrics ( = 0.34), and endovascular ( = 0.48) cases, the volumes dropped but were not statistically significant decreases.

CONCLUSION: The impact of this outbreak on operative training does appear to be significant based solely on statistics. Although the drop in case volumes during this time can be accounted for by the pandemic, it is important to understand that this is a multifactorial effect. Further studies are needed for these results to be generalizable and to fully understand the effect this pandemic has had on trainee operative experience.

Soliman, M. A. R., A. Khan, A. O. Aguirre, N. Ruggiero, B. R. Levy, B. L. Mariotti, P. K. Jowdy, K. R. Rajjoub, R. M. Hess, Q. Zeeshan, et al., "Effectiveness and Safety of Continuous Infusion Regional Anesthesia Pumps for Pain After Thoracopelvic Fusion Surgery for Persistent Spinal Pain Syndrome.", World neurosurgery, vol. 154, pp. e815-e821, 2021. Abstract

BACKGROUND: Postoperative pain after complex revision spine surgery, especially for the treatment of persistent spinal pain syndrome (PSPS), is frequently severe and can be debilitating, requiring the use of intravenous and oral opioids. To the best of our knowledge, the present study is the first to evaluate the effectiveness and safety of a continuous infusion regional anesthesia pump placed after thoracopelvic fusion for the treatment of PSPS.

METHODS: We performed a retrospective comparative study of consecutive patients who had undergone thoracopelvic fusion for PSPS. The patients included in the present study had either had a continuous infusion regional anesthesia pump placed during surgery or had not (control). Demographics, use of preoperative and postoperative opioids, postoperative adverse events, length of hospital stay, and 90-day readmission were recorded.

RESULTS: The patients in the pump group (n = 14) had used fewer opioids during their hospital stay compared with the control group (n = 12; P = 0.6). This difference was greater for postoperative days 1 and 2 (P = 0.3 and P = 0.2, respectively). No significant difference was found in opioid usage during the first 14 days after surgery (P = 0.8) or at the 3-month postoperative follow-up evaluation (P = 0.8). Furthermore, no significant difference was found between the 2 groups in terms of postoperative complications. The pump group had a 1.4-day shorter hospital stay (P = 0.7). The control group had more 90-day readmissions than did the pump group (P = 0.2).

CONCLUSIONS: Despite showing a trend toward less usage of opioids during the first 2 days after surgery and a shorter hospital stay with no increased complications in the pump group, the study data failed to demonstrate a statistically significant difference between the two groups.

Soliman, M. A. R., M. Elbaroody, A. K. ElSamman, M. I. Refaat, E. Abd-Haleem, W. Elhalaby, H. Gouda, amr safwat, M. elShazly, H. Lasheen, et al., "Endoscopic endonasal skull base surgery during the COVID-19 pandemic: A developing country perspective", Surgical neurology international, vol. 11: Scientific Scholar, pp. 310 - 310, 2020/09/25. AbstractWebsite

BACKGROUND: Although primarily a respiratory disorder, the coronavirus pandemic has paralyzed almost all aspects of health-care delivery. Emergency procedures are likely continuing in most countries, however, some of them raises certain concerns to the surgeons such as the endoscopic endonasal skull base surgeries. The aim of this study is to present the current situation from a developing country perspective in dealing with such cases at the time of the COVID-19 pandemic. METHODS: A cross-sectional analytical survey was distributed among neurosurgeons who performed emergency surgeries during the COVID-19 pandemic in Cairo, Egypt, between May 8, 2020, and June 7, 2020. The survey entailed patients' information (demographics, preoperative screening, and postoperative COVID-19 symptoms), surgical team information (demographics and postoperative COVID-19 symptoms), and operative information (personal protective equipment [PPE] utilization and basal craniectomy). RESULTS: Our survey was completed on June 7, 2020 (16 completed, 100% response rate). The patients were screened for COVID-19 preoperatively through complete blood cell (CBC) (100%), computed tomography (CT) chest (68.8%), chest examination (50%), C-reactive protein (CRP) (50%), and serological testing (6.3%). Only 18.8% of the surgical team utilized N95 mask and goggles, 12.5% utilized face shield, and none used PAPRs. Regarding the basal craniectomy, 81.3% used Kerrison Rongeur and chisel, 25% used a high-speed drill, and 6.3% used a mucosal shaver. None of the patients developed any COVID-19 symptoms during the first 3 weeks postsurgery and one of the surgeons developed high fever with negative nasopharyngeal swabs. CONCLUSION: In developing countries with limited resources, preoperative screening using chest examination, CBC, and CT chest might be sufficient to replace Reverse transcription polymerase chain reaction. Developing countries require adequate support with screening tests, PPE, and critical care equipment such as ventilators.

Turner, J. D., A. J. Schupper, P. V. Mummaneni, J. S. Uribe, R. K. Eastlack, G. M. Mundis, P. G. Passias, J. D. DiDomenico, S. Harrison Farber, M. A. R. Soliman, et al., "Evolving concepts in pelvic fixation in adult spinal deformity surgery", Adult Spinal Deformity Surgery, vol. 35, issue 4, pp. 101060, 2023. AbstractWebsite

Long-segment adult spinal deformity (ASD) constructs carry a high risk of mechanical complications. Pelvic fixation was introduced to improve distal construct mechanics and has since become the standard for long constructs spanning the lumbosacral junction. Pelvic fixation strategies have evolved substantially over the years. Numerous techniques now use a variety of entry points, screw trajectories, and construct configurations. We review the various strategies for pelvic fixation in ASD in a systematic review of the literature and update the techniques employed in the International Spine Study Group Complex Adult Deformity Surgery database.

Hasanain, A. A., M. A. R. Soliman, R. Elwy, A. A. M. Ezzat, S. H. Abdel-Bari, S. Marx, A. Jenkins, E. E. L. Refaee, and A. Zohdi, "An eye on the future for defeating hydrocephalus, ciliary dyskinesia-related hydrocephalus: review article.", British journal of neurosurgery, vol. 36, issue 3, pp. 329-339, 2022. Abstract

Congenital hydrocephalus affects approximately one in 1000 newborn children and is fatal in approximately 50% of untreated cases. The currently known management protocols usually necessitate multiple interventions and long-term use of healthcare resources due to a relatively high incidence of complications, and many of them mostly provide a treatment of the effect rather than the cause of cerebrospinal fluid flow reduction or outflow obstruction. Future studies discussing etiology specific hydrocephalus alternative treatments are needed. We systematically reviewed the available literature on the effect of ciliary abnormality on congenital hydrocephalus pathogenesis, to open a discussion on the feasibility of factoring ciliary abnormality in future research on hydrocephalus treatment modalities. Although there are different forms of ciliopathies, we focused in this review on primary ciliary dyskinesia. There is growing evidence of association of other ciliary syndromes and hydrocephalus, such as the reduced generation of multiple motile cilia, which is distinct from primary ciliary dyskinesia. Data for this review were identified by searching PubMed using the search terms 'hydrocephalus,' 'Kartagener syndrome,' 'primary ciliary dyskinesia,' and 'immotile cilia syndrome.' Only articles published in English and reporting human patients were included. Seven studies met our inclusion criteria, reporting 12 cases of hydrocephalus associated with primary ciliary dyskinesia. The patients had variable clinical presentations, genetic backgrounds, and ciliary defects. The ependymal water propelling cilia differ in structure and function from the mucus propelling cilia, and there is a possibility of isolated non-syndromic ependymal ciliopathy causing only hydrocephalus with growing evidence in the literature for the association ependymal ciliary abnormality and hydrocephalus. Abdominal and thoracic situs in children with hydrocephalus can be evaluated, and secondary damage of ependymal cilia causing hydrocephalus in cases with generalized ciliary abnormality can be considered.

Lubanska, D., S. Alrashed, G. T. Mason, F. Nadeem, A. Awada, M. DiPasquale, A. Sorge, A. Malik, M. Kojic, M. A. R. Soliman, et al., "Impairing proliferation of glioblastoma multiforme with CD44+ selective conjugated polymer nanoparticles.", Scientific reports, vol. 12, issue 1, pp. 12078, 2022. Abstract

Glioblastoma is one of the most aggressive types of cancer with success of therapy being hampered by the existence of treatment resistant populations of stem-like Tumour Initiating Cells (TICs) and poor blood-brain barrier drug penetration. Therapies capable of effectively targeting the TIC population are in high demand. Here, we synthesize spherical diketopyrrolopyrrole-based Conjugated Polymer Nanoparticles (CPNs) with an average diameter of 109 nm. CPNs were designed to include fluorescein-conjugated Hyaluronic Acid (HA), a ligand for the CD44 receptor present on one population of TICs. We demonstrate blood-brain barrier permeability of this system and concentration and cell cycle phase-dependent selective uptake of HA-CPNs in CD44 positive GBM-patient derived cultures. Interestingly, we found that uptake alone regulated the levels and signaling activity of the CD44 receptor, decreasing stemness, invasive properties and proliferation of the CD44-TIC populations in vitro and in a patient-derived xenograft zebrafish model. This work proposes a novel, CPN- based, and surface moiety-driven selective way of targeting of TIC populations in brain cancer.