Browsing by Author "Zaazoue, Mohamed A."
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Item A Sodium Oxychlorosene-Based Infection Prevention Protocol Safely Decreases Postoperative Wound Infections in Adult Spinal Deformity Surgery(Springer Nature, 2024-03-13) Alentado, Vincent J.; Kazi, Fezaan A.; Potts, Caroline A.; Zaazoue, Mohamed A.; Pott, Eric A.; Khairi, Saad A.; Neurological Surgery, School of MedicineIntroduction: This study sought to determine the efficacy of a complex multi-institutional sodium oxychlorosene-based infection protocol for decreasing the rate of surgical site infection after instrumented spinal surgery for adult spinal deformity (ASD). Infection prevention protocols have not been previously studied in ASD patients. Methods: A retrospective analysis was performed of patients who underwent posterior instrumented spinal fusion of the thoracic or lumbar spine for deformity correction between January 1, 2011, and May 31, 2019. The efficacy of a multi-modal infection prevention protocol was examined. The infection prevention bundle consisted of methicillin-resistant Staphylococcus aureus testing, chlorhexidine gluconate bathing preoperatively, sodium oxychlorosene rinse, vancomycin powder placement, and surgical drain placement at the time of surgery. Results: About 254 patients fit the inclusion criteria. Among these patients, nine (3.5%) experienced post-surgical deep-wound infection. Demographics and surgical characteristics amongst infected and non-infected cohorts were similar, although diabetes trended towards being more prevalent in patients who developed a postoperative wound infection (p=0.07). Among 222 patients (87.4%) who achieved a minimum of two years of follow-ups, 184 patients (82.9%) experienced successful fusion, comparing favorably with pseudarthrosis rates in the ASD literature. Rates of pseudarthrosis and proximal junction kyphosis were similar amongst infected and non-infected patients. Conclusion: An intraoperative comprehensive sodium oxychlorosene-based infection prevention protocol helped to provide a low rate of infection after major deformity correction without negatively impacting other postoperative procedure-related metrics.Item Examination and Scientific Analysis of Thoracic Vertebral Fractures(Springer Nature, 2023-09-09) Singh, Gurbinder; Rao, Varun; Thamba, Aish; Roth, Dylan; Zaazoue, Mohamed A.; Neurological Surgery, School of MedicineBackground: Thoracic vertebral fractures are clinically important due to their association with the thoracic spinal cord and the potential to cause devastating neurological injury. Using the National Electronic Injury Surveillance System (NEISS) data, this study investigated fracture patterns to understand associated factors to improve prevention strategies. We explored different factors associated with thoracic vertebral fractures to improve our understanding of preventative strategies and patient care standards, focusing on spatial distribution, sex-age dynamics, and location of injury. Methodology: This retrospective, cross-sectional study examines thoracic vertebral fractures across diverse age groups from 2013 to 2022, utilizing the NEISS database from the U.S. Consumer Product Safety Commission. Inclusion criteria based on specific terms related to thoracic fractures were employed. Descriptive statistics illustrated fracture distribution by age groups and associated products. Statistical analyses, including chi-square tests and multivariate logistic regressions, were conducted to explore associations between fracture occurrence, locations, products, age, and gender. Results: The analysis of thoracic vertebral fractures by location and associated products yielded several statistically significant findings. Notably, the prevalence of fractures at home (39.67%) was significantly higher than in other locations, and these differences in fracture distribution were statistically significant (χ² = 7.34, p < 0.001). Among the associated products, ladders (10.46%) emerged as the most frequent product associated with fractures. Multivariate logistic regression analysis showed that the age groups of 41-50, 51-60, and 61-70 had increased odds of fractures with adjusted odds ratios (AORs) of 1.08 (95% confidence interval (CI) = 1.04-1.42, p < 0.05), 1.21 (95% CI = 1.13-1.56, p < 0.001), and 1.17 (95% CI = 1.08-1.39, p < 0.001), respectively. The likelihood of thoracic vertebral fractures did not significantly differ between males and females (AOR = 1.12, 95% CI = 0.87-1.53, p = 0.262). Fracture distribution by age groups and products indicated increasing ladder-related fractures within the 41-50 age group and 51-60 age group. Football-related fractures peaked within the 21-30 age group. Fracture distribution patterns for bicycles had increased prevalence within the 11-20 and 21-30 age groups, and football-related fractures in younger age groups. Conclusions: This study analyzed factors associated with thoracic vertebral fractures, showing the significance of targeted preventative interventions, such as earlier screening, physical therapy, and nutritional status assessment, in the setting of significant location and age-related susceptibilities. The observed patterns of injury provide a foundation for future research to elucidate the underlying mechanisms between different environments and the likelihood of injury to improve preventive strategies.Item Geniculate neuralgia successfully treated with microvascular decompression(Elsevier, 2020-03) Pecoraro, Nathan C.; Zaazoue, Mohamed A.; Koivuniemi, Andrew S.; Savage, Jesse J.; Neurological Surgery, School of MedicineBackground First described by John Nottingham in 1857, geniculate neuralgia remains a rare condition associated with vascular compression of the nervus intermedius by the anterior inferior cerebellar artery (AICA), which results in paroxysmal unilateral periauricular pain. Furthermore, limited and controversial treatment options for symptom relief exist given the rarity of the condition and limited cases reported in the literature. Case description This is a case of a 37-year-old one-pack-per-day smoker with diabetes mellitus who presented to our clinic for evaluation of episodic lancinating pain localizing to the right periauricular region. The patients symptoms were attempted to be managed medically, however, remained refractory to medical management for a period greater than one year. The patient’s exam demonstrated a trigger point slightly anterior and inferior to the right tragus, and the pain was reproducible when touched or tapped. The patient was otherwise neurologically intact. Magnetic resonance imaging (MRI) was performed and demonstrated a loop of the AICA in contact with the root entry zone of the facial nerve. This patient was offered an elective microvascular decompression (MVD) for treatment of geniculate neuralgia. Conclusions Surgical microvascular decompression is a safe and effective treatment option for patients suffering from neuralgia refractory to medical therapy. Furthermore, our case report demonstrates that MVD is an effective treatment option for patients suffering from geniculate neuralgia with imaging evidence of AICA compression of the nervus intermedius that is refractory to medical management.Item Global trends of female representation in neurosurgery(AANS, 2022-08-19) Pahwa, Bhavya; Zaazoue, Mohamed A.; Neurological Surgery, School of MedicineItem Investigating Thoracic Vertebral Fractures in Residential Environments(Elsevier, 2024-09) Singh, Gurbinder; Rao, Varun; Kazi, Fezaan; Wague, Aboubacar; Zaazoue, Mohamed A.; Neurological Surgery, School of MedicineIntroduction Thoracic vertebral fractures within homes are pivotal public health concerns due to their associated morbidity and significant healthcare expenditures. This study aims to dissect the intricate epidemiology of these injuries, integrating comprehensive risk factors beyond conventional demographics and location analyses. Methods Utilizing a decade of data (2013–2022) from the National Electronic Injury Surveillance System, this study examines thoracic vertebral fractures across age and gender in household settings. Inclusion criteria targeted specific thoracic spine-related terms, analyzing fractures by location (e.g., kitchen, stairs) and associated products. Data processing employed R programming, with statistical analysis focusing on descriptive statistics and multivariate logistic regression, to identify fracture patterns and assess gender differences in fracture risks through Adjusted Odds Ratios (AORs). Results Analysis of 46,371 thoracic vertebral fractures identified stairs as the primary site (26.81%), with subsequent frequent locations being bedrooms (18.52%), living rooms (17.88%), and kitchens (16.29%). Gender-specific risk analysis revealed females had a higher likelihood of fractures on stairs (AOR = 1.24, 95% CI: 1.16–1.37, P < 0.001) and in bedrooms (AOR = 1.13, 95% CI: 1.09–1.54, P < 0.001). The most affected age group was 51–60, showcasing the multifaceted nature of risk factors beyond mere location. Discussion This study transcends prior insights by detailing the influence of various factors, including socioeconomic status and lifestyle, on fracture risk. It emphasizes the complexity of household fractures, highlighting gender and age as pivotal but not exclusive risk determinants. Conclusions By offering a comprehensive analysis that incorporates a wide array of risk factors, this study advances the understanding of thoracic vertebral fractures in residential environments. It underscores the necessity for targeted preventive measures that are cognizant of the multifactorial nature of these injuries, paving the way for improved safety interventions and public health policies.Item Letter: The Impact of the Coronavirus (COVID-19) Pandemic on Neurosurgeons Worldwide(Oxford University Press, 2020-05-20) El-Ghandour, Nasser M. F.; Elsebaie, Eman H.; Salem, Amany A.; Alkhamees, Abdullah F.; Zaazoue, Mohamed A.; Fouda, Mohammed A.; Elbadry, Rasha G.; Aly, Mohamed; Bakr, Hebatalla; Labib, Mohamed A.; Tobin, Matthew K.; Gragnaniello, Cristian; Gonzalez-Lopez, Pablo; Shamisa, Abdalla; Jhawar, Balraj S.; Soliman, Mohamed A. R.; Neurological Surgery, School of MedicineThe aim of our study was to explore the impact of this pandemic on neurosurgeons with the hope of improving preparedness for future crisis. We created a 20-question survey designed to explore demographics (nation, duration and scope of practice, and case-burden), knowledge (source of information), clinical impact (elective clinic/surgery cancellations), hospital preparedness (availability of personal protective equipment [PPE] and cost of the supplies), and personal factors (financial burden, workload, scientific and research activities). The survey was first piloted with 10 neurosurgeons and then revised. Surveys were distributed electronically in 7 languages (Chinese, English, French, German, Italian, Portuguese, and Spanish) between March 20 and April 3, 2020 using Google Forms, WeChat used to obtain responses, and Excel (Microsoft) and SPSS (IBM) used to analyze results. All responses were cross-verified by 2 members of our team. After obtaining results, we analyzed our data with histograms and standard statistical methods (Chi-square and Fisher's exact tests and logistic regression). Participants were first informed about the objectives of our survey and assured confidentiality after they agreed to participate (Helsinki declaration). We received 187 responses from 308 invitations (60.7%), and 474 additional responses were obtained from social media-based neurosurgery groups (total responses = 661). The respondents were from 96 countries representing 6 continents (Figure (Figure11A-A-11C).Item Molecular classification to refine surgical and radiotherapeutic decision-making in meningioma(Springer Nature, 2024) Wang, Justin Z.; Patil, Vikas; Landry, Alexander P.; Gui, Chloe; Ajisebutu, Andrew; Liu, Jeff; Saarela, Olli; Pugh, Stephanie L.; Won, Minhee; Patel, Zeel; Yakubov, Rebeca; Kaloti, Ramneet; Wilson, Christopher; Cohen-Gadol, Aaron; Zaazoue, Mohamed A.; Tabatabai, Ghazaleh; Tatagiba, Marcos; Behling, Felix; Almiron Bonnin, Damian A.; Holland, Eric C.; Kruser, Tim J.; Barnholtz-Sloan, Jill S.; Sloan, Andrew E.; Horbinski, Craig; Chotai, Silky; Chambless, Lola B.; Gao, Andrew; Rebchuk, Alexander D.; Makarenko, Serge; Yip, Stephen; Sahm, Felix; Maas, Sybren L. N.; Tsang, Derek S.; International Consortium on Meningiomas (ICOM); Rogers, C. Leland; Aldape, Kenneth; Nassiri, Farshad; Zadeh, Gelareh; Neurological Surgery, School of MedicineTreatment of the tumor and dural margin with surgery and sometimes radiation are cornerstones of therapy for meningioma. Molecular classifications have provided insights into the biology of disease; however, response to treatment remains heterogeneous. In this study, we used retrospective data on 2,824 meningiomas, including molecular data on 1,686 tumors and 100 prospective meningiomas, from the RTOG-0539 phase 2 trial to define molecular biomarkers of treatment response. Using propensity score matching, we found that gross tumor resection was associated with longer progression-free survival (PFS) across all molecular groups and longer overall survival in proliferative meningiomas. Dural margin treatment (Simpson grade 1/2) prolonged PFS compared to no treatment (Simpson grade 3). Molecular group classification predicted response to radiotherapy, including in the RTOG-0539 cohort. We subsequently developed a molecular model to predict response to radiotherapy that discriminates outcome better than standard-of-care classification. This study highlights the potential for molecular profiling to refine surgical and radiotherapy decision-making.Item The Natural History of Coiled Cerebral Aneurysms Stratified by Modified Raymond-Roy Occlusion Classification(Elsevier, 2019) Mendenhall, Stephen K.; Sahlein, Daniel H.; Wilson, Christopher D.; Filley, Anna C.; Ordaz, Josue; Ahluwalia, Rahul K.; Bakare, Wale A.; Huh, Andrew; Dancour, Elie; Zaazoue, Mohamed A.; Shapiro, Scott A.; Cohen-Gadol, Aaron A.; Neurological Surgery, School of MedicineObjective The natural history and long-term durability of Guglielmi detachable coil (GDC) embolization is still unknown. We hypothesize a stepwise decrease in durability of embolized cerebral aneurysms as stratified by the Modified Raymond-Roy Classification (MRRC). Methods First-time GDC-embolized cerebral aneurysms were retrospectively reviewed from 2004 to 2015. Loss of durability (LOD) was defined by change in aneurysm size or patency seen on serial radiographic follow-up. Kaplan-Meier survival analysis was performed to evaluate embolization durability. Multivariate Cox regression modeling was used to assess baseline aneurysm and patient characteristics for their effect on LOD. Results A total of 427 patients with 443 aneurysms met the inclusion criteria. Overall, 89 (21%) aneurysms met LOD criteria. Grade 1 aneurysms had statistically significantly greater durability than did all other MRRC grades. Grade 3b aneurysms had significantly worse durability than did all other aneurysm grades. There was no difference in durability between grade 2 and 3a aneurysms. Of aneurysms with LOD, 26 (29%) experienced worsening of MRRC grade. Thirty-five (24%) initial MRRC grade 2, 72 (45%) initial MRRC grade 3a, and 6 (22%) initial MRRC grade 3b aneurysms progressed to MRRC grade 1 without retreatment. In our multivariate analysis, only initial MRRC grade was statistically significantly associated with treatment durability (P < 0.001). Conclusions MRRC grade is independently associated with first-time GDC-embolized cerebral aneurysm durability. Achieving MRRC grade 1 occlusion outcome is significantly associated with greater long-term GDC durability. Although few aneurysms experience further growth and/or recanalization, most incompletely obliterated aneurysms tend to remain stable over time or even progress to occlusion. Grading scales such as the MRRC are useful for characterizing aneurysm occlusion but may lack sensitivity and specificity for characterizing changes in aneurysm morphology over time.Item Neurenteric cyst at the dorsal craniocervical junction in a child: Case report(Elsevier, 2018) Lai, Pui Man Rosalind; Zaazoue, Mohamed A.; Francois, Roosevelt; Dupervil, Daniel G.; Berkowitz, Aaron L.; Alexandrescu, Sanda; Proctor, Mark R.; Neurological Surgery, School of MedicineNeurenteric cysts, also known as enterogenous cysts, are uncommon, benign, congenital lesions that usually occur in the posterior mediastinum but can be seen at any level of the neuraxis. Here, we report a pediatric patient with a neurenteric cyst in the dorsal craniocervical junction as the only third reported pediatric case in the literature in this rare location, and describe the clinical course and pathologic findings with a review of the literature on this rare entity.Item Standard work tools for dynamic stereoelectroencephalography using ROSA: naming convention and perioperative planning(JNS, 2021-04) Bakr, Salma M.; Patel, Ajay; Zaazoue, Mohamed A.; Wagner, Kathryn; Lam, Sandi K.; Curry, Daniel J.; Raskin, Jeffrey S.; Neurological Surgery, School of MedicineOBJECTIVE The grid-based orthogonal placement of depth electrodes (DEs), initially defined by Jean Talairach and Jean Bancaud, is known as stereo-electroencephalography (sEEG). Although acceptance in the United States was initially slow, advances in imaging and technology have spawned a proliferation of North American epilepsy centers offering sEEG. Despite publications highlighting minimal access techniques and varied indications, standard work for phase I targeted DE has not been defined. In this article, the authors propose the term “dynamic sEEG” and define standard work tools and related common data elements to promote uniformity in the field. METHODS A multidisciplinary approach from July to August 2016 resulted in the production of 4 standard work tools for dynamic sEEG using ROSA: 1) a 34-page illustrated manual depicting a detailed workflow; 2) a planning form to collocate all the phase I data; 3) a naming convention for DEs that encodes the data defining it; and 4) a reusable portable perioperative planning and documentation board. A retrospective review of sEEG case efficiency was performed comparing those using standard work tools (between July 2016 and April 2017) with historical controls (between March 2015 and June 2016). The standard work tools were then instituted at another epilepsy surgery center, and the results were recorded. RESULTS The process for dynamic sEEG was formally reviewed, including anesthesia, positioning, perioperative nursing guidelines, surgical steps, and postoperative care for the workflow using cranial fixation and ROSA-guided placement. There was a 40% improvement in time per electrode, from 44.7 ± 9.0 minutes to 26.9 ± 6.5 minutes (p = 0.0007) following the development and use of the manual, the naming convention, and the reusable portable perioperative planning and documentation board. This standardized protocol was implemented at another institution and yielded a time per electrode of 22.3 ± 4.4 minutes. CONCLUSIONS The authors propose the term dynamic sEEG for stereotactic depth electrodes placed according to phase I workup data with the intention of converting to ablation. This workflow efficiency can be optimized using the standard work tools presented. The authors also propose a novel naming convention that encodes critical data and allows portability among providers. Use of a planning form for common data elements optimizes research, and global adoption could facilitate multicenter studies correlating phase I modality and seizure onset zone identification.