Browsing by Author "Jea, Andrew"

Now showing 1 - 7 of 7
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    Editorial. Pediatric neurosurgery along with Children's Hospitals' innovations are rapid and uniform in response to the COVID-19 pandemic
    (American Association of Neurological Surgeons, 2020-04) Weiner, Howard L.; Adelson, P. David; Brockmeyer, Douglas L.; Maher, Cormac O.; Gupta, Nalin; Smyth, Matthew D.; Jea, Andrew; Blount, Jeffrey P.; Riva-Cambrin, Jay; Lam, Sandi K.; Ahn, Edward S.; Albert, Gregory W.; Leonard, Jeffrey R.; Neurological Surgery, School of Medicine
    The COVID-19 pandemic is an unprecedented international crisis, with enormous health, economic, and social consequences, the likes of which have not been experienced in recent human history. The global medical community is facing historic practical and ethical challenges that require an urgent response. This situation has necessitated swift decision-making in the neurosurgery community. An inspiring and consistent message emerged from the resultant conversation, demonstrating our discipline’s response to this tragedy, which was strikingly rapid, uniform, and thoughtful across the many centers represented. Not surprisingly, pediatric neurosurgeons are able to lead their teams through this unprecedented time with creative decision-making and a razor-sharp focus on the health of both patients and colleagues. At the time of this writing, each center reported either no or only a small number of COVID-19–positive cases at their pediatric hospital, among either patients or staff, and a range of documented coronavirus community transmissions. Several notably consistent themes emerged from this exchange among the 13 members of the Journal of Neurosurgery: Pediatrics Editorial Board, the common concept being that decision-making remains dynamic and is modified as needed on a daily basis.
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    Pediatric neurosurgery along with children’s hospitals’ innovations are rapid and uniform in response to the COVID-19 pandemic
    (AANS, 2020) Weiner, Howard L.; Adelson, P. David; Brockmeyer, Douglas L.; Maher, Cormac O.; Gupta, Nalin; Smyth, Matthew D.; Jea, Andrew; Blount, Jeffrey P.; Riva-Cambrin, Jay; Lam, Sandi K.; Ahn, Edward S.; Albert, Gregory W.; Leonard, Jeffrey R.; Neurological Surgery, School of Medicine
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    Pediatric Otogenic Sigmoid Sinus Thrombosis: Case Report and Literature Reappraisal
    (SAGE Publications, 2017-11-03) Scherer, Andrea; Jea, Andrew; Surgery, School of Medicine
    The purpose of this study was to review our experience with a single case of mastoiditis associated with sigmoid sinus thrombosis and increased intracranial pressure, and to review the experience of others through prior publications. We reviewed a case of a 6-year-old boy with an acute otitis media and mastoiditis, with associated ipsilateral sigmoid sinus and contralateral distal transverse sinus thrombosis. Based on the literature and our own experience, we conclude that most children with dural sinus thrombosis from acute otitis media and mastoiditis, in the setting of increased intracranial pressure, attain a good neurological outcome with a conservative neurosurgical approach. The mainstay of treatment seems to be appropriate antibiotic coverage and anticoagulation. Surgeries such as external ventricular drain, serial lumbar punctures, intracranial pressure monitor, and endovascular thrombectomy are reserved for patients with neurological deterioration despite maximal medical treatment.
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    Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas
    (Springer Nature, 2022-11-26) Budnick, Hailey C.; Baygani, Shawyon; Easwaran, Teresa; Vortmeyer, Alexander; Jea, Andrew; Desai, Virendra; Raskin, Jeffrey; Neurological Surgery, School of Medicine
    Objective: Pediatric low-grade gliomas (LGGs) are found in approximately one to three percent of patients with childhood epilepsy. Epilepsy in these patients is often medically refractory and therefore represents a unique cohort with significant morbidity from concomitant pathology. Similar studies in adult patients with low-grade gliomas have identified predictors of seizure freedom including gross-total resection, preoperative seizure control on antiepileptic medication and duration of seizures of less than one year. This study aims to identify similar predictors of seizure freedom in operatively managed pediatric LGGs. Methods: A retrospective chart review was performed for patients diagnosed with World Health Organization (WHO) Grade I and II gliomas in patients ≤18 years old at a single institution (Indiana University School of Medicine at Riley Hospital for Children in Indianapolis, IN) from 2007-2017. Infratentorial and purely intraventricular lesions were excluded. WHO classification and histologic diagnosis were based on surgical pathology. Tumor grade, location, laterality, seizure status at presentation, and AED requirements pre- and post-operatively were recorded. Chi-squared analyses for independence were performed controlling for age at presentation, resection extent, seizure type, and Engel Class for seizure freedom post-operatively. Results: Forty-two patients met the inclusion criteria. Preoperative seizures were observed in 23 patients (55%). Presentation with preoperative seizures was highly associated with continued seizure burden post-operatively, independent of the extent of surgical resection. Supratentorial location and the administration of prophylactic pre- and post-operative AEDs were associated with Engel Class I seizure freedom. Temporal location was not significantly associated with medically refractory epilepsy compared with extra-temporal locations. Conclusions: In our cohort of pediatric LGGs, we find that patients that did not initially present with seizures and those who were treated with prophylactic pre- and post-operative AEDs, were more likely to achieve Engel Class I seizure freedom post-operatively. Tumors located in the temporal location were not significantly associated with a higher seizure burden than other supratentorial, extra-temporal tumors. Neither extent of resection nor electrocorticography-guided resection correlated with improved seizure freedom outcomes during glioma resection.
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    Rapid Improvement Project: Improving Caregivers’ Understanding of Safety Recommendations for Neurosurgical Devices
    (Wolters Kluwer, 2020-12-28) Anokwute, Miracle C.; Seibold, Dianne; Jea, Andrew; Ackerman, Laurie L.; Raskin, Jeffrey S.; Neurological Surgery, School of Medicine
    There has been a proliferation in the development of indwelling neuromodulatory devices with varied safety recommendations, making it difficult for providers to remain up-to-date. This deficit presents an opportunity for significant improvement in patient safety. Methods: We performed a search for monopolar electrocautery and magnetic resonance imaging safety recommendations for several indwelling neuromodulatory devices. We developed a questionnaire followed by an educational compendium and a posttest for 50 care providers. Results: Overall, there was a poor performance on the pretest (mean 39%, SD 19%) but significant improvement on the posttest (mean 71%, SD 16%), P < 0.0001. We placed the educational compendium that included all manufacturer recommendations in the operating room for easy reference. A 2.4 times decrease in the case start times of vagus nerve stimulator cases is evidence of its effectiveness. Conclusions: The authors highlight the lack of knowledge about manufacturer safety recommendations for indwelling neurosurgical devices, which led to the creation of operating room supplements and educational devices.
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    Surgical Management of Trigeminal Neuralgia in Children
    (Elsevier, 2019-01) Chicoine, Nicole H.; Yaacoub, Alan P.; Jea, Andrew; Raskin, Jeffrey S.; Neurological Surgery, School of Medicine
    Background Trigeminal neuralgia (TN) is a well-recognized facial pain syndrome. Discrete forms with disparate pain symptoms include classic and atypical. However, atypical facial pain includes neuralgiform pain along a spectrum. Most cases of TN are diagnosed in the adult population. Case reports and series of children have presented TN as a similar entity, with treatment similar to that for adults. We reviewed the pertinent data and present 2 pediatric TN cases successfully treated with microvascular decompression (MVD). Case Description Two pediatric patients (age 12 and 15 years) with TN refractory to previous medical therapy were identified. Both patients were deemed appropriate surgical candidates and underwent MVD to manage their TN. TN compression was arterial in both cases and involved portions of the anterior inferior cerebellar artery. Patient 1 was pain free 6 months after the procedure. Patient 2 was pain free immediately after the procedure and had been weaned off preoperative symptomatic management at the latest follow-up visit. The most recent follow-up examination was 12 and 8 months for patients 1 and 2, respectively, with both experiencing continued freedom from pain. Conclusions Few studies have reported on the effectiveness of MVD in the pediatric population for the management of TN. The supporting data and our 2 cases have demonstrated that MVD is effective for pediatric patients to treat their TN. Furthermore, the side effects appear to be minimal, with excellent pain relief after MVD in this patient population.
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    Trigeminal schwannoma presenting with malocclusion: A case report and review of the literature
    (Medknow Publications, 2020-08-08) Bertot, Brandon Emilio; Presti, Melissa Lo; Stormes, Katie; Raskin, Jeffrey S.; Jea, Andrew; Chelius, Daniel; Lam, Sandi; Neurological Surgery, School of Medicine
    Background: Trigeminal schwannomas are rare tumors of the trigeminal nerve. Depending on the location, from which they arise along the trigeminal nerve, these tumors can present with a variety of symptoms that include, but are not limited to, changes in facial sensation, weakness of the masticatory muscles, and facial pain. Case Description: We present a case of a 16-year-old boy with an atypical presentation of a large trigeminal schwannoma: painless malocclusion and unilateral masticatory weakness. This case is the first documented instance; to the best of our knowledge, in which a trigeminal schwannoma has led to underbite malocclusion; it is the 19th documented case of unilateral trigeminal motor neuropathy of any etiology. We discuss this case as a unique presentation of this pathology, and the relevant anatomy implicated in clinical examination aid in further understanding trigeminal nerve pathology. Conclusion: We believe our patient’s underbite malocclusion occurred secondary to his trigeminal schwannoma, resulting in associated atrophy and weakness of the muscles innervated by the mandibular branch of the trigeminal nerve. Furthermore, understanding the trigeminal nerve anatomy is crucial in localizing lesions of the trigeminal nerve.