35 results on '"Brian V. Nahed"'
Search Results
2. A Crowdsourced Consensus on Supratotal Resection Versus Gross Total Resection for Anatomically Distinct Primary Glioblastoma
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Brad E. Zacharia, Andrew S. Venteicher, Jon D. Weingart, Michael E. Ivan, Ezequiel Goldschmidt, Michael Lim, Ray M Chu, Raymond Sawaya, Mateo Ziu, Gary L. Gallia, Jason P. Sheehan, Mitchel S. Berger, Yoshua Esquenazi, John S. Yu, Brian V. Nahed, Adam N. Mamelak, Adham M. Khalafallah, Edjah K. Nduom, Debraj Mukherjee, Bob S. Carter, Maureen Rakovec, Christopher M. Jackson, and Chetan Bettegowda
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Primary Glioblastoma ,medicine.medical_specialty ,Randomization ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Gross Total Resection ,Resection ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,030220 oncology & carcinogenesis ,medicine ,Surgery ,Neurology (clinical) ,Radiology ,Tumor location ,business ,030217 neurology & neurosurgery ,Glioblastoma - Abstract
BACKGROUND Gross total resection (GTR) of contrast-enhancing tumor is associated with increased survival in primary glioblastoma. Recently, there has been increasing interest in performing supratotal resections (SpTRs) for glioblastoma. OBJECTIVE To address the published results, which have varied in part due to lack of consensus on the definition and appropriate use of SpTR. METHODS A crowdsourcing approach was used to survey 21 neurosurgical oncologists representing 14 health systems nationwide. Participants were presented with 11 definitions of SpTR and asked to rate the appropriateness of each definition. Participants reviewed T1-weighed postcontrast and fluid-attenuated inversion-recovery magnetic resonance imaging for 22 anatomically distinct glioblastomas. Participants were asked to assess the tumor location's eloquence, the perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans. RESULTS Most neurosurgeons surveyed (n = 18, 85.7%) agree that GTR plus resection of some noncontrast enhancement is an appropriate definition for SpTR. Overall, moderate inter-rater agreement existed regarding eloquence, equipoise, and personal treatment plans. The 4 neurosurgeons who had performed >10 SpTRs for glioblastomas in the past year were more likely to recommend it as their treatment plan (P
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- 2021
3. 380 A Rapid CSF Assay Accelerates Diagnosis and Treatment Initiation for CNS Neoplasms
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Mihir Gupta, Joseph Bradley, Elie Massaad, Evan Burns, Deborah Forst, Daniel P. Cahill, Frederick George Barker, Justin Jordan, Jorg Dietrich, Jochen K. Lennerz, Brian V. Nahed, Bob S. Carter, and Ganesh Shankar
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Surgery ,Neurology (clinical) - Published
- 2023
4. Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight
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Gary S. Solomon, Christopher M Bonfield, Mark E. Oppenlander, Robert C. Cantu, Graeme F. Woodworth, Vincent J. Miele, Michael J. Ellis, Scott L. Zuckerman, Alan R Tang, Hank Feuer, Shelly D. Timmons, Mitchel S. Berger, Kathryn Beauchamp, Aaron M Yengo-Kahn, Gavin A Davis, Charles H. Tator, Richard G. Ellenbogen, Geoff Manley, Paul J. Camarata, Peter Heppner, Stephen Honeybul, Eric W. Sherburn, Julian E. Bailes, David O. Okonkwo, Joseph C. Maroon, Mark Sheridan, Eric Guazzo, Uzma Samadani, Nicholas Theodore, Brian V. Nahed, Jerry Petty, Odette A. Harris, H Ian Sabin, and Allen K. Sills
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medicine.medical_specialty ,Intracranial pathology ,Traumatic brain injury ,medicine.medical_treatment ,Decision Making ,03 medical and health sciences ,0302 clinical medicine ,Midline shift ,Brain Injuries, Traumatic ,medicine ,Humans ,Brain Concussion ,Craniotomy ,biology ,Athletes ,business.industry ,030229 sport sciences ,biology.organism_classification ,medicine.disease ,Return to play ,Return to Sport ,Systematic review ,Expert opinion ,Athletic Injuries ,Physical therapy ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Sports - Abstract
Background Sport-related structural brain injury (SRSBI) is intracranial pathology incurred during sport. Management mirrors that of non-sport-related brain injury. An empirical vacuum exists regarding return to play (RTP) following SRSBI. Objective To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. Methods A systematic literature review of SRSBI from 2012 to present in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a cross-sectional survey of RTP in SRSBI by 31 international neurosurgeons was conducted. Results Of 27 included articles out of 241 systematically reviewed, 9 (33.0%) case reports provided RTP information for 12 athletes. To assess expert opinion, 31 of 32 neurosurgeons (96.9%) provided survey responses. For acute, asymptomatic SRSBI, 12 (38.7%) would not operate. Of the 19 (61.3%) who would operate, midline shift (63.2%) and hemorrhage size > 10 mm (52.6%) were the most common indications. Following SRSBI with resolved hemorrhage, with or without burr holes, the majority of experts (>75%) allowed RTP to high-contact/collision sports at 6 to 12 mo. Approximately 80% of experts did not endorse RTP to high-contact/collision sports for athletes with persistent hemorrhage. Following craniotomy for SRSBI, 40% to 50% of experts considered RTP at 6 to 12 mo. Linear regression revealed that experts allowed earlier RTP at higher levels of play (β = -0.58, 95% CI -0.111, -0.005, P = .033). Conclusion RTP decisions following structural brain injury in athletes are markedly heterogeneous. While individualized RTP decisions are critical, aggregated expert opinions from 31 international sports neurosurgeons provide key insight. Level of play was found to be an important consideration in RTP determinations.
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- 2021
5. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults With Metastatic Brain Tumors
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Andrew E. Sloan, Timothy C. Ryken, John S. Kuo, Christopher Alvarez-Breckenridge, Brian V. Nahed, Priscilla K. Brastianos, Mario Ammirati, Jeffrey J. Olson, Steven N. Kalkanis, and Helen A. Shih
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Adult ,Male ,medicine.medical_specialty ,Evidence-based practice ,medicine.medical_treatment ,Tumor resection ,Recursive partitioning ,Radiosurgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Craniotomy ,Chemotherapy ,Performance status ,Brain Neoplasms ,business.industry ,Disease Management ,Guideline ,Congresses as Topic ,Combined Modality Therapy ,Surgery ,Neurosurgeons ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Female ,Neurology (clinical) ,Cranial Irradiation ,business ,030217 neurology & neurosurgery - Abstract
Please see the full-text version of this guideline https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_2) for the target population of each recommendation listed below. SURGERY FOR METASTATIC BRAIN TUMORS AT NEW DIAGNOSIS QUESTION: Should patients with newly diagnosed metastatic brain tumors undergo surgery, stereotactic radiosurgery (SRS), or whole brain radiotherapy (WBRT)? Recommendations Level 1: Surgery + WBRT is recommended as first-line treatment in patients with single brain metastases with favorable performance status and limited extracranial disease to extend overall survival, median survival, and local control. Level 3: Surgery plus SRS is recommended to provide survival benefit in patients with metastatic brain tumors Level 3: Multimodal treatments including either surgery + WBRT + SRS boost or surgery + WBRT are recommended as alternatives to WBRT + SRS in terms of providing overall survival and local control benefits. SURGERY AND RADIATION FOR METASTATIC BRAIN TUMORS QUESTION: Should patients with newly diagnosed metastatic brain tumors undergo surgical resection followed by WBRT, SRS, or another combination of these modalities? Recommendations Level 1: Surgery + WBRT is recommended as superior treatment to WBRT alone in patients with single brain metastases. Level 3: Surgery + SRS is recommended as an alternative to treatment with SRS alone to benefit overall survival. Level 3: It is recommended that SRS alone be considered equivalent to surgery + WBRT. SURGERY FOR RECURRENT METASTATIC BRAIN TUMORS QUESTION: Should patients with recurrent metastatic brain tumors undergo surgical resection? Recommendations Level 3: Craniotomy is recommended as a treatment for intracranial recurrence after initial surgery or SRS. SURGICAL TECHNIQUE AND RECURRENCE QUESTION A: Does the surgical technique (en bloc resection or piecemeal resection) affect recurrence? Recommendation Level 3: En bloc tumor resection, as opposed to piecemeal resection, is recommended to decrease the risk of postoperative leptomeningeal disease when resecting single brain metastases. Question b Does the extent of surgical resection (gross total resection or subtotal resection) affect recurrence? Recommendation Level 3: Gross total resection is recommended over subtotal resection in recursive partitioning analysis class I patients to improve overall survival and prolong time to recurrence. The full guideline can be found at https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_2.
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- 2019
6. Commentary: Deficiencies in Socioeconomic Training During Neurosurgical Training
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Chaim B. Colen, Brian V. Nahed, Michael S. Park, John A. Braca, Nicolaus M. Barbaro, Debraj Mukherjee, Michael Karsy, Mitchel S. Berger, and Kimon Bekelis
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medicine.medical_specialty ,business.industry ,Family medicine ,Medicine ,Surgery ,Neurology (clinical) ,business ,Training (civil) ,Socioeconomic status - Published
- 2018
7. Commentary: The Importance of Increased Funding Opportunities to Empower Global Neurosurgeons From Low-Middle Income Countries
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Brian V. Nahed, Vanessa B. Kerry, Deen L. Garba, and Myron L. Rolle
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Economic growth ,Neurosurgeons ,business.industry ,Middle income countries ,Neurosurgery ,MEDLINE ,Humans ,Medicine ,Surgery ,Neurology (clinical) ,Global Health ,business ,Developing Countries - Published
- 2021
8. Intraventricular Delivery and CRISPR-Cas9 Disruption of PD-1 is Required for CAR T-cell Efficacy in Glioblastoma
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Daniel P. Cahill, Brian V. Nahed, Bob S. Carter, William T. Curry, Bryan D. Choi, Xiaoling Yu, and Marcela V. Maus
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Tumor microenvironment ,Cell cycle checkpoint ,business.industry ,T-cell receptor ,medicine.disease ,Apoptosis ,Glioma ,medicine ,Cancer research ,CRISPR ,Surgery ,Chimeric Antigen Receptor T-Cell Therapy ,Neurology (clinical) ,Signal transduction ,business - Published
- 2020
9. 213 5-Aminolevulinic Acid for Enhanced Surgical Visualization of High-Grade Gliomas: A Prospective, Multicenter Study
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Alexander J. Schupper, Rebecca Baron, William Cheung, Jessica Rodriguez, Steven N. Kalkanis, Mohammad Chohan, Brian V. Nahed, Brad E. Zacharia, Randy L. Jensen, Jeffrey Olsen, Jonathan Sherman, Gabrielle Prince, Bob S. Carter, Isabelle M. Germano, Constantinos G. Hadjipanayis, and Raymund L. Yong
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Surgery ,Neurology (clinical) - Published
- 2022
10. Commentary: Chimeric Antigen Receptor T-Cell Therapy: Updates in Glioblastoma Treatment
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Elizabeth R. Gerstner, Brian V. Nahed, Xiaoling Yu, Daniel P. Cahill, Bryan D. Choi, Marcela V. Maus, Bob S. Carter, and William T. Curry
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Receptors, Chimeric Antigen ,Brain Neoplasms ,business.industry ,Cell- and Tissue-Based Therapy ,Review ,medicine.disease ,Immunotherapy, Adoptive ,Text mining ,Cancer research ,Humans ,Medicine ,Surgery ,Chimeric Antigen Receptor T-Cell Therapy ,Neurology (clinical) ,Glioblastoma ,business - Abstract
Glioblastoma multiforme (GBM) are the most common and among the deadliest brain tumors in adults. Current mainstay treatments are insufficient to treat this tumor, and therefore, more effective therapies are desperately needed. Immunotherapy, which takes advantage of the body's natural defense mechanism, is an exciting emerging field in neuro-oncology. Adoptive cell therapy with chimeric antigen receptor (CAR) T cells provides a treatment strategy based on using patients’ own selected and genetically engineered cells that target tumor-associated antigens. These cells are harvested from patients, modified to target specific proteins expressed by the tumor, and re-introduced into the patient with the goal of destroying tumor cells. Here, we review the history of CAR T-cell therapy, and describe the characteristics of various generations of CAR T therapies, and the challenges inherent to treatment of GBM. Finally, we describe recent and current CAR T clinical trials designed to combat GBM.
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- 2021
11. Does the Open Payments Database Provide Sunshine on Neurosurgery?
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Brian V. Nahed, Maya A. Babu, and Robert F. Heary
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medicine.medical_specialty ,Databases, Factual ,media_common.quotation_subject ,Neurosurgery ,MEDLINE ,Medicare ,computer.software_genre ,03 medical and health sciences ,Physician specialty ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Reimbursement ,media_common ,Database ,Medicaid ,business.industry ,Payment ,United States ,Insurance, Health, Reimbursement ,Surgery ,Neurology (clinical) ,business ,computer ,030217 neurology & neurosurgery - Abstract
Background The Open Payments Database (OPD) was launched by the Centers for Medicare & Medicaid Services in 2014. Through this online searchable database, the public can explore physician-industry interactions. To date, there is no published literature on the accuracy of the database for neurosurgeons or any physician specialty. Objective To study the accuracy of published records and scope of industry-neurosurgeon relationships between neurosurgeons and industry within the OPD. Methods We searched 4.3 million records in 2013 and 11.41 million records in 2014 in the OPD for board-certified neurosurgeons verified by the American Board of Neurological Surgery. Delimit software was used to condense these data, Microsoft Access for database queries, and STATA to perform descriptive analyses. Results Of the 3240 neurosurgeons in the OPD in 2013, 2020 were identified correctly as neurosurgeons within the database (62%). Of the 3593 neurosurgeons in the OPD in 2014, 2433 were identified correctly as neurosurgeons (68%). Within the OPD in 2013, there were 72 066 attributed records for neurosurgeons; within the 2014 OPD, there were 160 563 attributed records for neurosurgeons. Total payments to neurosurgeons in 2013 (for the 9 months published in OPD): $61 802 659.37; in 2014: $117 127 824.00. Conclusion The OPD details physician interactions with industry and has multiple inaccuracies. Publicly availing inaccurate information through a searchable governmental website that can be accessed by patients and journalists alike has the potential to tarnish individual neurosurgeons and undermine professional credibility. Abbreviations CMS, Centers for Medicare & Medicaid ServicesOPD, Open Payments Database.
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- 2016
12. Laser Interstitial Thermal Therapy Technology, Physics of Magnetic Resonance Imaging Thermometry, and Technical Considerations for Proper Catheter Placement During Magnetic Resonance Imaging–Guided Laser Interstitial Thermal Therapy
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Jon T. Willie, Matthew K. Mian, R. Jason Stafford, Robert E. Gross, Nitesh V Patel, Shabbar F. Danish, and Brian V. Nahed
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medicine.medical_specialty ,Thermal therapy ,Thermometry ,Magnetic Resonance Imaging, Interventional ,Catheterization ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Laser therapy ,Laser Interstitial Thermal Therapy ,law ,Humans ,Medicine ,Medical physics ,Physics ,Laser ablation ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Hyperthermia, Induced ,Laser ,Catheter ,Surgery, Computer-Assisted ,Surgery ,Laser Therapy ,Neurology (clinical) ,business ,Catheter placement ,030217 neurology & neurosurgery - Abstract
Laser-induced thermal therapy has become a powerful tool in the neurosurgical armamentarium. The physics of laser therapy are complex, but a sound understanding of this topic is clinically relevant, as many centers have incorporated it into their treatment algorithm, and educated patients are demanding consideration of its use for their disease. Laser ablation has been used for a wide array of intracranial lesions. Laser catheter placement is guided by stereotactic planning; however, as the procedure has popularized, the number of ways in which the catheter can be inserted has also increased. There are many technical nuances for laser placement, and, to date, there is not a clear understanding of whether any one technique is better than the other. In this review, we describe the basic physics of magnetic resonance-guided laser-induced thermal therapy and describe the several common techniques for accurate Visualase laser catheter placement in a stepwise fashion. ABBREVIATIONS MRg-LITT, magnetic resonance-guided laser-induced thermal therapyPAD, precision aiming device.
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- 2016
13. In Reply: Congress of Neurological Surgeons Systematic Review and Evidence-Based Practice Guidelines on the Role of Surgery in the Management of Adults With Metastatic Brain Tumors
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Brian V. Nahed and Christopher Alvarez-Breckenridge
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medicine.medical_specialty ,Evidence-based practice ,Neurosurgeons ,business.industry ,Brain Neoplasms ,General surgery ,Evidence-Based Practice ,medicine ,MEDLINE ,Humans ,Surgery ,Neurology (clinical) ,business - Published
- 2019
14. Letter: The European and North American Consortium and Registry for Intraoperative Stimulation Mapping: Framework for a Transatlantic Collaborative Research Initiative
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Mitchel S. Berger, Brian V. Nahed, Marike L. D. Broekman, Steven De Vleeschouwer, Philippe Schucht, Jasper Kees Wim Gerritsen, and Arnaud J P E Vincent
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Intra operative ,Nursing ,business.industry ,MEDLINE ,Medicine ,Surgery ,Neurology (clinical) ,610 Medicine & health ,Research initiative ,business - Published
- 2021
15. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Emerging and Investigational Therapties for the Treatment of Adults With Metastatic Brain Tumors
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Mark E. Linskey, Jeffrey J. Olson, J. Bradley Elder, and Brian V. Nahed
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Oncology ,Adult ,medicine.medical_specialty ,Afatinib ,Breast Neoplasms ,Lapatinib ,Gefitinib ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Vemurafenib ,Protein Kinase Inhibitors ,Sunitinib ,business.industry ,Brain Neoplasms ,Dabrafenib ,Drugs, Investigational ,Congresses as Topic ,medicine.disease ,Neurosurgeons ,Treatment Outcome ,Practice Guidelines as Topic ,Surgery ,Female ,Neurology (clinical) ,Erlotinib ,business ,medicine.drug ,Brain metastasis - Abstract
QUESTION What evidence is available regarding emerging and investigational treatment options for metastatic brain tumors? TARGET POPULATION Adult patients with brain metastases. RECOMMENDATIONS INTERSTITIAL MODALITIES There is insufficient evidence to make a recommendation regarding the routine use of existing local therapies, such as interstitial chemotherapy, brachytherapy, or other local modalities, aside from their use in approved clinical trials. IMMUNE MODULATORS There is insufficient evidence to make a recommendation regarding the use of immune therapy for brain metastases. MOLECULAR TARGETED AGENTS Level 1: The use of afatinib is not recommended in patients with brain metastasis due to breast cancer.There is insufficient evidence to make recommendations regarding: the use of epidermal growth factor receptor inhibitors erlotinib and gefitinib in patients with brain metastasis due to nonsmall cell lung cancerthe use of BRAF inhibitors dabrafenib and vemurafenib in the treatment of patients with brain metastases due to metastatic melanomathe use of HER2 agents trastuzumab and lapatinib to treat patients with brain metastases due to metastatic breast cancerthe use of vascular endothelial growth factor agents bevacizumab, sunitinib, and sorafenib in the treatment of patients with solid tumor brain metastases.The full guideline can be found at: https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_9.
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- 2018
16. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Treatment Options for Adults With Multiple Metastatic Brain Tumors
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David W. Andrews, Clark C. Chen, Brian V. Nahed, Mario Ammirati, and Jeffrey J. Olson
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Adult ,Male ,medicine.medical_specialty ,Evidence-based practice ,medicine.medical_treatment ,Tumor resection ,Radiosurgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,business.industry ,Brain Neoplasms ,Cancer ,Treatment options ,Guideline ,Congresses as Topic ,medicine.disease ,Radiation therapy ,Neurosurgeons ,Treatment Outcome ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Surgery ,Female ,Neurology (clinical) ,Radiology ,business ,Neurocognitive ,030217 neurology & neurosurgery - Abstract
Target population These recommendations apply to adult patients newly diagnosed with multiple (more than 1) brain metastases. Question 1 In what circumstances should whole brain radiation therapy be recommended to improve tumor control and survival in patients with multiple brain metastases? Recommendation Level 2: It is recommended that whole brain radiation therapy can be added to stereotactic radiosurgery to improve local and distant control keeping in mind the potential for worsened neurocognitive outcomes and that there is unlikely to be a significant impact on overall survival. Question 2 In what circumstances should stereotactic radiosurgery be recommended to improve tumor control and survival in patients with multiple brain metastases? Recommendations Level 1: In patients with 2 to 3 brain metastases not amenable to surgery, the addition of stereotactic radiosurgery to whole brain radiation therapy is not recommended to improve survival beyond that obtained with whole brain radiation therapy alone. Level 3: The use of stereotactic radiosurgery alone is recommended to improve median overall survival for patients with more than 4 metastases having a cumulative volume Question 3 In what circumstances should surgery be recommended to improve tumor control and survival in patients with multiple brain metastases? Recommendation Level 3: In patients with multiple brain metastases, tumor resection is recommended in patients with lesions inducing symptoms from mass effect that can be reached without inducing new neurological deficit and who have control of their cancer outside the nervous system.The full guideline can be found at https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_6.
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- 2018
17. 218 Divergent Clonal Evolution of Melanoma Brain Metastases in Response to Immunotherapy
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Christopher Alvarez-Breckenridge, Devin McCabe, Brian V. Nahed, Corey M. Gill, Craig Horbinski, Daniel P. Cahill, Priscilla K. Brastianos, William T. Curry, Mario L. Suvà, Maria Martinez-Lage Alvarez, Farshad Nassiri, Ryan J. Sullivan, Rasheed Zakaria, Naema Nayyar, Gelareh Zadeh, Jackson Stocking, Benjamin Izar, Scott L. Carter, Matt Lastrapes, Mia Bertalan, and Alexander Kaplan
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Tumor microenvironment ,business.industry ,medicine.medical_treatment ,Melanoma ,Disease progression ,Trees (plant) ,Immunotherapy ,medicine.disease ,Somatic evolution in cancer ,FOXP3 gene ,Gene expression profiling ,Cancer research ,Medicine ,Surgery ,Neurology (clinical) ,business - Published
- 2018
18. Bispecific T-Cell Engager -Armored Chimeric Antigen Receptor T Cells Overcome Antigen Escape From EGFRvIII-Targeted Therapy For Glioblastoma
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Brian V. Nahed, Matthew J. Frigault, Curtis L. Cetrulo, Andrea Schmidts, Ana P. Castano, Hiroaki Wakimoto, Amanda A. Bouffard, Irene Scarfò, Shadmehr Demehri, Bob S. Carter, Xiaoling Yu, William T. Curry, Stefanie R. Bailey, Daniel P. Cahill, Mark B. Leick, Marcela V. Maus, Rebecca C. Larson, Bryan D. Choi, and Angela C. Boroughs
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Tumor microenvironment ,business.industry ,Transgene ,medicine.medical_treatment ,T cell ,Immunotherapy ,medicine.disease ,Chimeric antigen receptor ,Targeted therapy ,medicine.anatomical_structure ,Antigen ,Cancer research ,Medicine ,Surgery ,Neurology (clinical) ,business ,Glioblastoma - Published
- 2019
19. Device Innovation in Neurosurgery
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Brian V. Nahed, Maya A. Babu, and Robert F. Heary
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medicine.medical_specialty ,Scrutiny ,Trademark ,media_common.quotation_subject ,Neurosurgery ,Legislation ,Neurosurgical Procedures ,Patents as Topic ,Physician payment ,Peripheral nerve ,Physicians ,Loyalty ,medicine ,Humans ,Cooperative Behavior ,media_common ,Conflict of Interest ,business.industry ,Legislature ,Surgical Instruments ,medicine.disease ,United States ,Surgery ,Neurology (clinical) ,Medical emergency ,business - Abstract
Innovation in medicine has led to advances directly benefitting patients. Yet recent legislation has created intense scrutiny of the relationship between surgeons and industry. Critics argue that surgeon-held patents and royalties incentivize surgeon loyalty, influencing decision making as to which devices are used intraoperatively. We explored the potential for inventor-related conflicts of interest. We searched patent records from the United States Patent and Trademark Office for every diplomate recognized by the American Board of Neurological Surgeons (4868 neurosurgeons). We also searched physician payment registries of the 5 largest device makers; of these, Medtronic, DePuy, and Zimmer were the only companies with available registries. A total of 147 neurosurgeons (3.0%) hold a total of 582 patents; the number of patents held per neurosurgeon ranges from 1 to 53. The fields in which patents are held include tumor (125), spine (98), vascular (54), trauma (27), stereotaxy/image guidance (88), pain (19), peripheral nerve (2), electrical stimulation (63), and pediatrics (9); surgical instruments (59), drug delivery (17), and other (21) account for the remainder. The total amount of royalties received by neurosurgeons in 2010 is expected to be $13,223,000 (minimum: $7K, maximum: $8.261M). Despite public and legislative perceptions of widespread conflicts of interest, there are relatively few neurosurgeons who hold patents and receive significant royalties.
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- 2012
20. 315 The Neural Architecture of Human Syntax in Wernicke's Area Revealed by Cortical Recordings and Stimulation
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Brian V. Nahed, Ziv Williams, Daniel P. Cahill, and Daniel K. Lee
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Cognitive science ,Intra operative ,business.industry ,Medicine ,Surgery ,Stimulation ,Neurology (clinical) ,Architecture ,business ,Wernicke's area ,Syntax - Published
- 2017
21. Is Trauma Transfer Influenced by Factors Other Than Medical Need? An Examination of Insurance Status and Transfer in Patients With Mild Head Injury
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Brian V. Nahed, Marc DeMoya, William T. Curry, and Maya A. Babu
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Adult ,Male ,Patient Transfer ,Emergency Medical Services ,medicine.medical_specialty ,Legislation, Medical ,Adolescent ,Databases, Factual ,Population ,Comorbidity ,Insurance Coverage ,Young Adult ,Trauma Centers ,Ethnicity ,Craniocerebral Trauma ,Humans ,Medicine ,Glasgow Coma Scale ,Registries ,Child ,education ,Aged ,education.field_of_study ,Abbreviated Injury Scale ,business.industry ,Trauma center ,Head injury ,Infant, Newborn ,Infant ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Texas ,Emergency Medical Treatment and Active Labor Act ,Hospitals ,United States ,Treatment Outcome ,Massachusetts ,Socioeconomic Factors ,Child, Preschool ,Emergency medicine ,Physical therapy ,Injury Severity Score ,Female ,Surgery ,Neurology (clinical) ,business - Abstract
BACKGROUND The Emergency Medical Treatment and Active Labor Act was meant to provide access to emergency medical care irrespective of financial resources. Yet, many Level I trauma Centers have raised concerns about the financial drivers influencing transfer. OBJECTIVE : To study the relationship between insurance status and transfer, we focused on patients with mild head injury to tease apart the medical necessity for transfer from other potential drivers, such as financial factors. METHODS Using the 2002 to 2006 American College of Surgeons National Trauma Databank and Massachusetts General Hospital's Trauma Databank from 1993 to 2009, we conducted a retrospective study and limited our population to patients with mild head injuries and mild to moderate systemic injuries as determined by the Glasgow Coma Scale, Abbreviated Injury Scale, or Injury Severity Score. Statistical analyses were conducted with STATA software. RESULTS In a nationalized database, (1) uninsured patients with mild head injury are more likely to be transferred out of a Level II or III facility (adjusted odds ratio [OR]: 2.07; P = .000) compared with privately insured patients and (2) uninsured patients are less likely to be accepted by a Level II or III facility for transfer compared with privately insured patients (adjusted OR: = .143; P = .000l). For transfers received by 1 Level I trauma center (Massachusetts General Hospital), uninsured patients are more likely to be transferred to (1) Massachusetts General Hospital between midnight and 6 am (adjusted OR: 5.201; P = .000) compared with other time periods throughout the day and (2) Massachusetts General Hospital on Sunday (adjusted OR: 1.09; P = .000) compared with other days of the week. CONCLUSION Insurance status appears to influence transfer patterns.
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- 2011
22. 197 Prescription Drug Monitoring Programs and the Neurosurgeon
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Maya A Babu, Brian V Nahed, and Robert F Heary
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Surgery ,Neurology (clinical) - Published
- 2018
23. GENETICS OF INTRACRANIAL ANEURYSMS
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Fatih Bayrakli, Ali K. Ozturk, Kaya Bilguvar, Mohamad Bydon, Murat Gunel, and Brian V. Nahed
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medicine.medical_specialty ,Pathology ,Genetic Linkage ,business.industry ,Genetic heterogeneity ,Intracranial Aneurysm ,Disease ,Evidence-based medicine ,Bioinformatics ,medicine.disease ,symbols.namesake ,Aneurysm ,Risk Factors ,Genetic linkage ,Epidemiology ,Mendelian inheritance ,symbols ,Humans ,Medicine ,Genetic Predisposition to Disease ,Surgery ,Neurology (clinical) ,business ,Genetic association - Abstract
Despite advances in the treatment of intracranial aneurysms (IA) in recent years, the overall outcome of patients with aneurysmal subarachnoid hemorrhage has shown only modest improvement. Given this poor prognosis, diagnosis of IA before rupture is of paramount importance. Currently, there are no reliable methods other than screening imaging studies of high-risk individuals to diagnose asymptomatic patients. Multiple levels of evidence suggest that environmental factors acting in concert with genetic susceptibilities lead to the formation, growth, and rupture of aneurysms in these patients. Epidemiological studies have already identified aneurysm-specific risk factors such as size and location, as well as patient-specific risk factors, such as age, sex, and presence of medical comorbidities, such as hypertension. In addition, exposure to certain environmental factors such as smoking have been shown to be important in the formation of IA. Furthermore, substantial evidence proves that certain loci contribute genetically to IA pathogenesis. Genome-wide linkage studies using relative pairs or rare families that are affected with the Mendelian forms of IA have already shown genetic heterogeneity of IA, suggesting that multiple genes, alone or in combination, are important in the disease pathophysiology. The linkage results, along with association studies, will ultimately lead to the identification of IA susceptibility genes. Identification of the genes important in IA pathogenesis will not only provide novel insights into the primary determinants of IA, but will also result in new opportunities for early diagnosis in the preclinical setting. Ultimately, novel therapeutic strategies based on biology will be developed, which will target these newly elucidated genetic susceptibilities.
- Published
- 2007
24. Hypertension, Age, and Location Predict Rupture of Small Intracranial Aneurysms
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Abigail A. Hawkins, Arun P. Amar, Thomas M. Morgan, Koray Özduman, Eylem Ocal, Kristopher T. Kahle, Brian V. Nahed, Michael L. DiLuna, Murat Gunel, and Andrea Chamberlain
- Subjects
medicine.medical_specialty ,Subarachnoid hemorrhage ,medicine.diagnostic_test ,Vascular disease ,business.industry ,medicine.disease ,Confidence interval ,Surgery ,Blood pressure ,Aneurysm ,Predictive value of tests ,Angiography ,medicine ,Neurology (clinical) ,Age of onset ,business - Abstract
BACKGROUND Although current guidelines for the management of unruptured intracranial aneurysms (IAs) suggest aneurysms larger than 7 mm should be considered for treatment, a significant number of subarachnoid hemorrhages are caused by IAs 7 mm or smaller. Thus, we sought to identify risk factors associated with the rupture of IAs 7 mm or smaller. METHODS We identified 100 patients with subarachnoid hemorrhage resulting from IAs 7 mm or smaller between January 2001 and 2004. Patients were compared with controls (n = 51) with unruptured IAs 7 mm or smaller, diagnosed by conventional angiography or three-dimensional computerized angiography, with respect to aneurysm characteristics (size, location, and age of presentation) and risk factors (hypertension, smoking, cocaine use, and family history). RESULTS Hypertensive patients with IAs 7 mm or smaller were 2.6 times more likely to experience rupture (P = 0.01; 95% confidence interval, 1.21-5.53) than patients with normal blood pressure. Posterior circulation aneurysms were 3.5 times more likely to rupture than anterior circulation aneurysms (P = 0.048; 95% confidence interval, 0.95-19.4). After adjustment for location and hypertension, the age of patient on presentation was associated with a trend toward inverse correlation with aneurysmal rupture risk (P = 0.07). Hypertension and posterior location remained significant independent predictors in the logistic regression model. CONCLUSION Among patients with small aneurysms (< or = 7 mm), hypertension, relatively young age, and posterior circulation were significant risk factors for rupture. Given the minimal long-term morbidity and mortality of treatment of unruptured aneurysms in large, tertiary medical centers, management of unruptured aneurysms 7 mm or smaller should be governed by factors other than size, specifically age, history of hypertension, and location.
- Published
- 2005
25. Defensive medicine in neurosurgery: does state-level liability risk matter?
- Author
-
Brian V. Nahed, Timothy R. Smith, Ali Habib, Robert F. Heary, George R. Cybulski, Joshua M. Rosenow, Maya A. Babu, Richard G. Fessler, and H. Hunt Batjer
- Subjects
Adult ,Defensive Medicine ,Male ,Risk ,medicine.medical_specialty ,education ,Neurosurgery ,Defensive medicine ,Malpractice ,Patient-Centered Care ,Surveys and Questionnaires ,Health care ,medicine ,Humans ,State liability ,Psychiatry ,Response rate (survey) ,business.industry ,Liability ,Odds ratio ,Tort ,Surgery ,Female ,Neurology (clinical) ,business ,Delivery of Health Care - Abstract
Background Defensive medicine is prevalent among US neurosurgeons due to the high risk of malpractice claims. This study provides national estimates of US neurosurgeons' defensive behaviors and perceptions. Objective To examine the relationship of defensive medicine-both "assurance" behaviors and "avoidance" behaviors-to the liability environment. Methods A 51-question online survey was sent to 3344 US neurosurgeon members of the American Board of Neurological Surgeons (ABNS). The survey was anonymous and conducted over 6 weeks in the spring of 2011. The previously validated questionnaire contained questions on neurosurgeon, patient, and practice characteristics; perceptions of the liability environment; and defensive-medicine behaviors. Bivariate and multivariate analyses examined the state liability risk environment as a predictor of a neurosurgeon's likelihood of practicing defensive medicine. Results A total of 1026 neurosurgeons completed the survey (31% response rate). Neurosurgeons' perceptions of their state's liability environment generally corresponded well to more objective measures of state-level liability risk because 83% of respondents correctly identified that they were practicing in a high-risk environment. When controlling for surgeon experience, income, high-risk patient load, liability history, and type of patient insurance, neurosurgeons were 50% more likely to practice defensive medicine in high-risk states compared with low-risk-risk states (odds ratio: 1.5, P Conclusion Both avoidance and assurance behaviors are prevalent among US neurosurgeons and are correlated with subjective and objective measures of state-level liability risk. Defensive medicine practices do not align with patient-centered care and may contribute to increased inefficiency in an already taxed health care system.
- Published
- 2014
26. 142 Genetic and Nongenetic Determinants of Cellular Architecture in IDH1-Mutant Oligodendrogliomas and Astrocytomas Using Single-Cell Transcriptome Analysis
- Author
-
Mario L. Suvà, David N. Louis, Andrew S. Venteicher, Christine Hebert, Daniel P. Cahill, Bradley E. Bernstein, Aviv Regev, Brian V. Nahed, Robert L. Martuza, William T. Curry, Leah E. Escalante, and Itay Tirosh
- Subjects
Genetics ,IDH1 ,Cellular architecture ,business.industry ,Mutant ,RNA ,Histogenesis ,Bioinformatics ,01 natural sciences ,0104 chemical sciences ,010404 medicinal & biomolecular chemistry ,03 medical and health sciences ,0302 clinical medicine ,Single cell transcriptome ,030220 oncology & carcinogenesis ,Mutation (genetic algorithm) ,Mutational status ,Medicine ,Surgery ,Neurology (clinical) ,business - Abstract
INTRODUCTION:Gliomas are among the most lethal malignancies and their histogenesis in humans remains unresolved. IDH1 mutational status and co-occurring genetic alterations define major clinical and prognostic classes of gliomas that closely mirror their histologic classification into astrocytic or
- Published
- 2016
27. Trapped fourth ventricle phenomenon following aneurysm rupture of the posterior circulation: case reports
- Author
-
Maya A. Babu, Brian P. Walcott, Manuel Ferreira, Richard G. Ellenbogen, Brian V. Nahed, and Laligam N. Sekhar
- Subjects
Adult ,Male ,medicine.medical_specialty ,Dilated fourth ventricle ,Fourth ventricle ,Ventriculoperitoneal Shunt ,Aneurysm ,Cerebrospinal fluid ,Pregnancy ,Cerebrospinal fluid diversion ,medicine ,Humans ,Retrospective Studies ,Fourth Ventricle ,business.industry ,Intracranial Aneurysm ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,medicine.anatomical_structure ,Syringobulbia ,Ventricle ,Female ,Neurology (clinical) ,business ,Syringomyelia - Abstract
Background and importance Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. Clinical presentation A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal cerebrospinal fluid diversion. These patients had no evidence of infection of the cerebrospinal fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal cerebrospinal fluid diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. Conclusion Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal cerebrospinal fluid diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.
- Published
- 2011
28. Physician-owned hospitals, neurosurgeons, and disclosure: lessons from law and the literature
- Author
-
Maya A. Babu, Brian V. Nahed, and Joshua M. Rosenow
- Subjects
medicine.medical_specialty ,Scope (project management) ,business.industry ,Conflict of Interest ,Control (management) ,Ownership ,Conflict of interest ,Specialty ,Neurosurgery ,Legislation ,Disclosure ,Hospitals, Special ,Hospital-Physician Relations ,Patient satisfaction ,Family medicine ,Physicians ,Patient experience ,Medicine ,Surgery ,Neurology (clinical) ,business ,health care economics and organizations ,Health reform - Abstract
Physician ownership of hospitals has been a subject of controversy for years. Opponents claim that physician ownership and the hospital profits that result from imaging, laboratory tests, and procedures create a conflict of interest for physicians in providing impartial patient care. Proponents argue that having an ownership stake in a hospital means that physicians can have control over all facets of the patient experience, which leads potentially to better patient satisfaction and outcomes. With passage of health reform legislation, physician-owned specialty hospitals have been under renewed attack and now face more restrictive limitations on their growth and expansion. The following review explores the history of physician-owned specialty hospitals, the controversy surrounding physician ownership, and the scope of neurosurgeon ownership in specialty hospitals and offers 2 models for disclosure of potential conflicts of interest.
- Published
- 2011
29. 138 Effect of Medicare Eligibility on Utilization of Deferrable Spine Surgery
- Author
-
Brian V. Nahed, Joshua P. Aronson, and Leila Agha
- Subjects
medicine.medical_specialty ,Spine surgery ,business.industry ,Medicine ,Surgery ,Neurology (clinical) ,business - Published
- 2014
30. Hypertension, age, and location predict rupture of small intracranial aneurysms
- Author
-
Brian V, Nahed, Michael L, DiLuna, Thomas, Morgan, Eylem, Ocal, Abigail A, Hawkins, Koray, Ozduman, Kristopher T, Kahle, Andrea, Chamberlain, Arun P, Amar, and Murat, Gunel
- Subjects
Adult ,Male ,Age Factors ,Intracranial Aneurysm ,Aneurysm, Ruptured ,Middle Aged ,Logistic Models ,Predictive Value of Tests ,Risk Factors ,Hypertension ,Multivariate Analysis ,Humans ,Female ,Retrospective Studies - Abstract
Although current guidelines for the management of unruptured intracranial aneurysms (IAs) suggest aneurysms larger than 7 mm should be considered for treatment, a significant number of subarachnoid hemorrhages are caused by IAs 7 mm or smaller. Thus, we sought to identify risk factors associated with the rupture of IAs 7 mm or smaller.We identified 100 patients with subarachnoid hemorrhage resulting from IAs 7 mm or smaller between January 2001 and 2004. Patients were compared with controls (n = 51) with unruptured IAs 7 mm or smaller, diagnosed by conventional angiography or three-dimensional computerized angiography, with respect to aneurysm characteristics (size, location, and age of presentation) and risk factors (hypertension, smoking, cocaine use, and family history).Hypertensive patients with IAs 7 mm or smaller were 2.6 times more likely to experience rupture (P = 0.01; 95% confidence interval, 1.21-5.53) than patients with normal blood pressure. Posterior circulation aneurysms were 3.5 times more likely to rupture than anterior circulation aneurysms (P = 0.048; 95% confidence interval, 0.95-19.4). After adjustment for location and hypertension, the age of patient on presentation was associated with a trend toward inverse correlation with aneurysmal rupture risk (P = 0.07). Hypertension and posterior location remained significant independent predictors in the logistic regression model.Among patients with small aneurysms (or = 7 mm), hypertension, relatively young age, and posterior circulation were significant risk factors for rupture. Given the minimal long-term morbidity and mortality of treatment of unruptured aneurysms in large, tertiary medical centers, management of unruptured aneurysms 7 mm or smaller should be governed by factors other than size, specifically age, history of hypertension, and location.
- Published
- 2005
31. Transcallosal transchoroidal approach to tumors of the third ventricle
- Author
-
Brian V. Nahed, Joseph M. Piepmeier, and Hahnah J. Kasowski
- Subjects
Adult ,medicine.medical_specialty ,Surgical approach ,Preoperative planning ,Third ventricle ,business.industry ,MEDLINE ,Preoperative care ,Cerebrospinal Fluid Shunts ,Surgery ,Corpus Callosum ,medicine.anatomical_structure ,Choroid Plexus ,medicine ,Humans ,Occipital nerve stimulation ,Female ,Neurology (clinical) ,business ,Cerebral Ventriculography ,Cerebral Ventricle Neoplasms ,Craniotomy ,Mirroring ,Third Ventricle - Abstract
ALTHOUGH THE LITERATURE is rich with descriptions of the approach to the third ventricle, surgeons remain cautiously reserved. In this report, we demonstrate that the transcallosal approach can be easily performed provided that preoperative planning is adequate. Familiarity with the course of major cortical and deep draining veins grants the surgeon a wide exposure of the posterior third ventricle. We discuss the indications, surgical technique, and pitfalls to this approach while providing an accompanying video mirroring our discussion.
- Published
- 2005
32. American Brain Tumor Association Young Investigator Award 198 Circulating Tumor Cells in Patients With Glioblastoma
- Author
-
Samantha M. Oliveira, Hiro Wakimoto, Daniel A. Haber, Deepak Bhere, Brian V. Nahed, Mehmet Toner, Andrew S. Chi, Ajay Shah, Simeon Springer, Tracy T. Batchelor, Marissa W. Madden, David N. Louis, Phil Spuhler, Shyamala Maheswaran, and James P. Sullivan
- Subjects
Pathology ,medicine.medical_specialty ,Polysomy ,Angiogenesis ,business.industry ,medicine.medical_treatment ,Brain tumor ,medicine.disease ,Chemotherapy regimen ,Radiation therapy ,Circulating tumor cell ,Breast cancer ,medicine ,Surgery ,Neurology (clinical) ,business ,American Brain Tumor Association - Published
- 2014
33. 115 Differences in Defensive Practices between Neurosurgeons in Malpractice Crisis vs Non-Crisis States
- Author
-
Timothy R. Smith, Brian V. Nahed, Robert F. Heary, and Maya A. Babu
- Subjects
business.industry ,Malpractice ,Medicine ,Surgery ,Neurology (clinical) ,Criminology ,business ,Defensive Practices - Published
- 2012
34. Genetic Heterogeneity of Intracranial Aneurysm
- Author
-
Ali K. Ozturk, Gulsah Bademci, Brian V. Nahed, Murat Gunel, Bulent Guclu, Mohamad Bydon, Arun P. Amar, Ethem Goksu, and Kaya Bilguvar
- Subjects
Aneurysm ,business.industry ,Genetic heterogeneity ,Medicine ,Surgery ,Neurology (clinical) ,business ,Bioinformatics ,medicine.disease - Published
- 2006
35. 765 Genome-wide Linkage Analysis of Intracranial Aneurysms
- Author
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Abigail A. Hawkins, Brian V. Nahed, Murat Gunel, Michael L. DiLuna, Bulent Guclu, Mathew W. State, Askin Seker, and Andrea Chamberlain
- Subjects
business.industry ,Medicine ,Surgery ,Computational biology ,Neurology (clinical) ,business ,Genome wide linkage - Published
- 2004
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