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Sepehr sani

Marco Rossi, Sepehr Sani, Marco Conti Nibali, Luca Fornia, Lorenzo Bello, Richard W Byrne
Surgery for lower grade glioma requires the use of brain mapping techniques to identify functional boundaries, which represent the limit of the resection. Two stimulation paradigms are currently available and their use should be tailored to the clinical context to extend tumor removal and decrease the odds of postoperative permanent deficits.
January 2019: Neurosurgery Clinics of North America
Kristen L Kraimer, Ryan B Kochanski, Fiona Lynn, Michael Smith, Sepehr Sani
BACKGROUND AND IMPORTANCE: Abdominal epilepsy is a rare seizure disorder characterized by episodic gastrointestinal symptoms with electroencephalogram abnormalities. It is typically well treated with anti-epileptic medications; however, little is known about treatment of refractory cases. CLINICAL PRESENTATION: The patient is a 16-yr-old male who began experiencing episodic abdominal pain and distension at the age of 2. After undergoing an extensive negative gastrointestinal workup, he was referred for neurological examination...
November 10, 2018: Operative Neurosurgery (Hagerstown, Md.)
Ryan B Kochanski, Jay Shils, Leo Verhagen Metman, Gian Pal, Sepehr Sani
PURPOSE: Local field potential recordings from deep brain stimulation (DBS) leads provide insight into the pathophysiology of Parkinson disease (PD). We recorded local field potential activity from DBS leads within the subthalamic nucleus in patients with PD undergoing DBS surgery to identify reproducible pathophysiological signatures of the disease. METHODS: Local field potentials were recorded in 11 hemispheres from patients with PD undergoing subthalamic nucleus-DBS...
November 8, 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Sander Bus, Gian Pal, Bichun Ouyang, Pepijn van den Munckhof, Maarten Bot, Sepehr Sani, Leo Verhagen Metman
BACKGROUND/AIMS: Microelectrode recording (MER)-guided deep brain stimulation (DBS) aims to place the DBS lead in the optimal electrophysiological target. When single-track MER or test stimulation yields suboptimal results, trajectory adjustments are made. The accuracy of these trajectory adjustments is unknown. Intraoperative computed tomography can visualize the microelectrode (ME) and verify ME adjustments. We aimed to determine the accuracy of ME movements in patients undergoing MER-guided DBS...
2018: Stereotactic and Functional Neurosurgery
Rebecca O'Dwyer, Richard Byrne, Fiona Lynn, Pouya Nazari, Travis Stoub, Michael C Smith, Sepehr Sani
BACKGROUND: A quarter of patients with newly diagnosed epilepsy are older, yet they are less likely to be offered resective surgery potentially because of clinical bias that they incur increased surgical risks. There are few peer-reviewed case series that address this cohort and their outcomes. OBJECTIVE: In the context of current literature, the objective of this study was to report on all epilepsy surgeries in patients aged 50 years or older from a tertiary care center over 15 years with an average follow-up period of 6 years...
July 8, 2018: Epilepsy & Behavior: E&B
Blake Beehler, Ryan B Kochanski, Richard Byrne, Sepehr Sani
BACKGROUND: Approximately 10%-13% of the population is left-handed (LH), and certain professions have varied representation of LH individuals. LH surgeons must overcome unique difficulties owing to the right-handed (RH) operative environment. This study assesses prevalence and impact of left-handedness on training and operative experience of neurosurgeons. METHODS: An e-mail survey was designed and sent to 5109 U.S. neurosurgeons and neurosurgical trainees. The survey was completed by 1482 responders (29...
June 2018: World Neurosurgery
Ryan B Kochanski, Pouya Nazari, Sepehr Sani
BACKGROUND: The impact of vancomycin powder on reducing postoperative surgical site infections (SSIs) in spine surgery has been studied extensively and is considered standard of care at many institutions. More recently, vancomycin powder has been shown to reduce SSI in cranial neurosurgery; however, limited studies have been performed assessing its impact in reducing SSIs in deep brain stimulation (DBS) surgery. OBJECTIVE: To investigate the use of vancomycin powder as an adjunct to the current antibiotic prophylaxis regimen in DBS surgery in a large cohort of patients...
November 1, 2018: Operative Neurosurgery (Hagerstown, Md.)
Ryan B Kochanski, Robert Dawe, Mehmet Kocak, Sepehr Sani
BACKGROUND: The massa intermedia (MI) or interthalamic adhesion is an inconsistent band spanning between bilateral medial thalami that is absent in up to 20%-30% of individuals. Little is known of its significance, especially in regard to functional pathways. Probabilistic diffusion tensor imaging (DTI) has recently been used to seed the lateral habenula and define its afferent white matter pathway, the stria medullaris thalami (SM). We sought to determine whether the MI serves as a conduit for crossing of limbic fibers such as the SM...
April 2018: World Neurosurgery
Bledi Brahimaj, Ryan B Kochanski, Sepehr Sani
Microelectrode recording (MER) provides vital neurophysiological information about target nuclei during deep brain stimulation (DBS). There have been extensive studies looking at the accuracy of DBS lead placement; however, to date, no large series have assessed the accuracy of the microelectrode. In this study, we report the accuracy of microelectrode tip placement in comparison to preoperatively planned radiographic target. Patients who underwent DBS with MER from 2014 to 2016 were included in the study. At the authors' institution, intra-operative CT (iCT) is routinely performed after the first microelectrode track to confirm tip accuracy...
April 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Ryan B Kochanski, Sepehr Sani
Advancements in neuroimaging have led to a trend toward direct, image-based targeting under general anesthesia without the use of microelectrode recording (MER) or intraoperative test stimulation, also referred to as "asleep" deep brain stimulation (DBS) surgery. Asleep DBS, utilizing imaging in the form of intraoperative computed tomography (iCT) or magnetic resonance imaging (iMRI), has demonstrated reliable targeting accuracy of DBS leads implanted within the globus pallidus and subthalamic nucleus while also improving clinical outcomes in patients with Parkinson's disease...
January 19, 2018: Brain Sciences
Sander Bus, Pepijn van den Munckhof, Maarten Bot, Gian Pal, Bichun Ouyang, Sepehr Sani, Leo Verhagen Metman
BACKGROUND: It is unclear which magnetic resonance imaging (MRI) sequence most accurately corresponds with the electrophysiological subthalamic nucleus (STN) obtained during microelectrode recording (MER, MER-STN). CT/MRI fusion allows for comparison between MER-STN and the STN visualized on preoperative MRI (MRI-STN). OBJECTIVE: To compare dorsal and ventral STN borders as seen on 3-Tesla T2-weighted (T2) and susceptibility weighted images (SWI) with electrophysiological STN borders in deep brain stimulation (DBS) for Parkinson's disease (PD)...
February 2018: Acta Neurochirurgica
Mena G Kerolus, Neilayan Sen, Sonal Mayekar, Alistar Templeton, Julius Turian, Aidnag Diaz, Lorenzo Munoz, Richard W Byrne, Sepehr Sani
INTRODUCTION: Radiosurgery is now an established method of satisfactory pain control in patients with trigeminal neuralgia (TN). The Varian Truebeam STx (Varian Medical Systems, Palo Alto, CA) linear accelerator (LINAC) system is an arc-based, frameless stereotactic radiosurgery system used for the treatment of TN. To our knowledge, there has been only one published series of patient histories that documents the use of a frameless LINAC system for the treatment of TN. We describe the treatment parameters, patient outcomes, and complications associated with the treatment of TN...
June 16, 2017: Curēus
Daniel Eddelman, Joshua Wewel, R Mark Wiet, Leo V Metman, Sepehr Sani
BACKGROUND: Patients with previously implanted cranial devices pose a special challenge in deep brain stimulation (DBS) surgery. We report the implantation of bilateral DBS leads in a patient with a cochlear implant. Technical nuances and long-term interdevice functionality are presented. CASE DESCRIPTION: A 70-year-old patient with advancing Parkinson's disease and a previously placed cochlear implant for sensorineural hearing loss was referred for placement of bilateral DBS in the subthalamic nucleus (STN)...
2017: Surgical Neurology International
Ryan B Kochanski, Sander Bus, Gian Pal, Leo Verhagen Metman, Sepehr Sani
BACKGROUND: Microelectrode recording (MER) is used to confirm targeting accuracy during deep brain stimulation (DBS) surgery. We describe a technique using intraoperative computed tomography (CT) extrapolation (iCTE) to predetermine and adjust the trajectory of the guide tube to improve microelectrode targeting accuracy. We hypothesized that this technique would decrease the number of MER tracks and operative time, while increasing the recorded length of the subthalamic nucleus (STN)...
July 2017: World Neurosurgery
Mena G Kerolus, Ryan B Kochanski, Marvin Rossi, Michael Stein, Richard W Byrne, Sepehr Sani
INTRODUCTION: Implantation of responsive neurostimulation (RNS) system has been previously discussed in the literature but there is a paucity of data on target accuracy and the use of intraoperative imaging. We describe our experience with 8 patients using intraoperative computed tomography (iCT) during implantation of the NeuroPace RNS system. METHODS: A frame-based system was used. CT images were obtained and merged with preoperative magnetic resonance imaging and metabolic imaging studies to calculate target coordinates...
July 2017: World Neurosurgery
Ryan B Kochanski, Gian Pal, Sander Bus, Leo Verhagen Metman, Sepehr Sani
Microelectrode recording (MER) is used to confirm electrophysiological signals within intended anatomic targets during deep brain stimulation (DBS) surgery. We describe a novel technique called intraoperative CT-guided extrapolation (iCTE) to predict the intended microelectrode trajectory and, if necessary, make corrections in real-time before dural opening. Prior to dural opening, a guide tube was inserted through the headstage and rested on dura. Intraoperative CT (iCT) was obtained, and a trajectory was extrapolated along the path of the guide tube to target depth using targeting software...
June 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Ryan B Kochanski, Robert Dawe, Daniel B Eddelman, Mehmet Kocak, Sepehr Sani
BACKGROUND: Deep brain stimulation (DBS) via anatomical targeting of white matter tracts defined by diffusion tensor imaging (DTI) may be a useful tool in the treatment of pathologic neurophysiologic circuits implicated in certain disease states like treatment resistant depression (TRD). We sought to determine if DTI could be used to define the stria medullaris thalami (SM), the major afferent white matter pathway to the lateral habenula (LHb), a thalamic nucleus implicated in the pathophysiology of TRD...
2016: NeuroImage: Clinical
Ryan B Kochanski, Mena G Kerolus, Gian Pal, Leo Verhagen Metman, Sepehr Sani
OBJECTIVES: Intraoperative computed tomography (iCT) is currently used to confirm the target location of the microelectrode (ME) during microelectrode recording (MER) and ultimate location of deep brain stimulation (DBS) leads at our institution. We evaluated whether iCT can be used to predict the trajectory and accuracy of the ME track. PATIENTS AND METHODS: Intraoperative imaging profiles of ten consecutive patients who had undergone DBS surgery were retrospectively reviewed...
November 2016: Clinical Neurology and Neurosurgery
Carter S Gerard, Leo Verhagen Metman, Gian Pal, Jessica Karl, Sepehr Sani
INTRODUCTION: Symptomatic edema around a deep-brain stimulation (DBS) lead is a rare complication of DBS surgery. Although this phenomenon is not fully understood, clinical presentation of DBS lead edema can be severe enough to prompt treatment. There is a paucity of literature on the clinical course and treatment of DBS lead edema. CASE REPORT: We present a 65-year-old man with Parkinson disease who developed unilateral DBS lead edema after bilateral subthalamic nucleus lead placement...
July 2016: Neurologist
Mena G Kerolus, Jyothi Patil, Abraham Kurian, Sepehr Sani
BACKGROUND CONTEXT: Cavernous lymphangioma is a rare slow-growing tumor that can cause neurologic compromise when it involves the central nervous system. Involvement of the spinal column is rare but may involve the osseous structures or the epidural space of the spinal column. PURPOSE: We report the first case of an intradural, extramedullary cavernous lymphangioma involving the thoracic spinal cord. METHODS: An 83-year-old woman presented with progressive gait ataxia, bilateral lower extremity weakness, and a band-like sensation in the middle and lower thoracic dermatomes...
August 2016: Spine Journal: Official Journal of the North American Spine Society
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