Browsing by Author "Brown, Ethan D. L."

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Advances in Coccygectomy: A Comprehensive Review Evaluating Surgical Techniques for Coccygodynia
    (MDPI, 2025-02-19) Obeng-Gyasi, Barnabas; Brown, Ethan D. L.; Chinthala, Anoop Sai; Mao, Gordon; Neurological Surgery, School of Medicine
    Background: Coccygodynia presents significant challenges in diagnosis and treatment. While coccygectomy has emerged as a crucial intervention for refractory cases, significant heterogeneity exists in surgical techniques. Traditional approaches are increasingly complemented by novel methods, necessitating a comprehensive review of current surgical options. Methods: A comprehensive literature review was conducted using Ovid MEDLINE, Cochrane Library and Embase databases from inception to present. Search terms included "coccygectomy", "coccydynia", "coccygodynia", "coccyx pain" and "tailbone pain". We analyzed peer-reviewed studies focusing on surgical techniques, outcomes and complications of coccygectomy. Studies were excluded if non-peer-reviewed, non-English without translation, or not directly addressing surgical management. Results: Traditional midline approaches, while common, demonstrate increased wound complications compared to paramedian techniques. Minimally invasive methods, including coccygeoplasty and endoscopic coccygectomy, show promising early outcomes with reduced recovery times. Both partial and complete resections provide significant pain relief, with complete resection potentially offering superior results in severe cases. Wound closure technique significantly impacts surgical success. Conclusions: Optimal outcomes in coccygectomy require individualized surgical approaches incorporating modern techniques like paramedian incision and advanced wound closure. Emerging minimally invasive procedures may further reduce complications and enhance recovery. Treatment success depends on careful patient selection and surgical technique optimization.
  • Thumbnail Image
    Item
    Indocyanine Green as a Marker for Tissue Ischemia in Spinal Tumor Resections and Extended Revisions: A Technical Note
    (MDPI, 2025-01-30) Ward, Max; Schneider, Daniel; Brown, Ethan D. L.; Maity, Apratim; Obeng-Gyasi, Barnabas; Ber, Roee; Elsamadicy, Aladine A.; Sciubba, Daniel M.; Knobel, Denis; Lo, Sheng-Fu Larry; Neurological Surgery, School of Medicine
    Background/Objectives: The increasing complexity of spinal oncology procedures, particularly in en-bloc tumor resections, creates challenges in tissue perfusion assessment due to extended operative times and extensive surgical dissection. Real-time visualization of tissue perfusion can be achieved with ICG using commercially available handheld imaging systems, offering potential advantages in spinal oncology cases. This study assessed the utility of ICG in analyzing soft-tissue viability during complex spine procedures extending beyond 7.5 h, with a particular focus on oncologic resections. Methods: Three cases that required over 7.5 h of operative time were chosen for ICG utilization. These cases included an en-bloc malignant peripheral nerve sheath tumor resection, an en-bloc resection of a malignant epithelioid neoplasm, and a long-segment fusion revision for pseudoarthrosis. At the conclusion of the critical portion of the procedure, a handheld intraoperative fluorescence camera was utilized to visualize the tissue penetration of intravenous ICG. Results: Prior to injecting ICG, devascularized tissue was not clearly visible. Injecting ICG allowed clear separation of vascularized (fluorescing) and devascularized (non-fluorescing) tissues. One region of non-florescent tissue was later confirmed to be devascularized with MRI and experienced postoperative infection. Conclusions: As the complexity of spinal oncology procedures increases, ICG fluorescence imaging offers a novel method for real-time assessment of tissue perfusion. This technique may be particularly valuable in extensive tumor resections, post-radiation cases, and revision surgeries where tissue viability is at risk. Further investigation in the spinal oncology population could help establish whether early identification of poorly perfused tissues impacts wound healing outcomes.
  • Thumbnail Image
    Item
    Pituitary Adenoma and Social Determinants of Health: Tracing PAths to Better Outcomes
    (2024-09-28) Virtanen , Piiamaria S.; Obeng-Gyasi, Barnabas; Brown, Ethan D. L.; Colter, Austyn; Koenig, Jenna; Burket, Noah; Szilagyi, Halie; Williams, Greer; Halalmeh, Dia; Wang, Hannah S.; Tinkham, Shawn A.; Vetter, Cecelia J.; Richardson, Angela M.
  • Thumbnail Image
    Item
    The Thyroid Hormone Axis and Female Reproduction
    (MDPI, 2023-06-06) Brown, Ethan D. L.; Obeng-Gyasi, Barnabas; Hall, Janet E.; Shekhar, Skand; Medicine, School of Medicine
    Thyroid function affects multiple sites of the female hypothalamic-pituitary gonadal (HPG) axis. Disruption of thyroid function has been linked to reproductive dysfunction in women and is associated with menstrual irregularity, infertility, poor pregnancy outcomes, and gynecological conditions such as premature ovarian insufficiency and polycystic ovarian syndrome. Thus, the complex molecular interplay between hormones involved in thyroid and reproductive functions is further compounded by the association of certain common autoimmune states with disorders of the thyroid and the HPG axes. Furthermore, in prepartum and intrapartum states, even relatively minor disruptions have been shown to adversely impact maternal and fetal outcomes, with some differences of opinion in the management of these conditions. In this review, we provide readers with a foundational understanding of the physiology and pathophysiology of thyroid hormone interactions with the female HPG axis. We also share clinical insights into the management of thyroid dysfunction in reproductive-aged women.