Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs (Series in Medical Physics and Biomedical Engineering) 1st Edition

Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs (Series in Medical Physics and Biomedical Engineering) 1st Edition

Developed by Dr. Todd A. Kuiken and Dr. Gregory A. Dumanian, targeted muscle reinnervation (TMR) is a new approach to accessing motor control signals from peripheral nerves after amputation and providing sensory feedback to prosthesis users. This practical approach has many advantages over other neural-machine interfaces for the improved control of artificial limbs. Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs provides a template for the clinical implementation of TMR and a resource for further research in this new area of science.

After describing the basic scientific concepts and key principles underlying TMR, the book presents surgical approaches to transhumeral and shoulder disarticulation amputations. It explores the possible role of TMR in the prevention and treatment of end-neuromas and details the principles of rehabilitation, prosthetic fitting, and occupational therapy for TMR patients. The book also describes transfer sensation and discusses the surgical and functional outcomes of the first several TMR patients. It concludes with emerging research on using TMR to further improve the function and quality of life for people with limb loss.

With contributions from renowned leaders in the field, including Drs. Kuiken and Dumanian, this book is a useful guide to implementing TMR in patients with high-level upper limb amputations. It also supplies the foundation to enable improvements in TMR techniques and advances in prosthetic technology.

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Hydrocephalus after posterior fossa decompression for Chiari type 1 deformity

Hydrocephalus after posterior fossa decompression for Chiari type 1 deformity

Hydrocephalus may be seen in association with Chiari type 1 deformity, likely because of disruptions in normal CSF flow. Although patients sometimes demonstrate evidence of hydrocephalus during their initial presentation for CM-I, a subset of patients appear to develop hydrocephalus only after posterior fossa decompression. These patients may present with evidence of raised intracranial pressure, ventricular dilation on imaging, or persistent cerebrospinal fluid leakage postoperatively. To date, there are no reports in the literature investigating what factors are associated with the need for CSF diversion after PFD is performed to treat CM-I.

Guan et al. performed a retrospective clinical chart review of all patients who underwent PFD surgery and duraplasty for CM-I at the Primary Children’s Hospital in Utah from June 1, 2005, through May 31, 2015. Patients were dichotomized based on the need for long-term CSF diversion after PFD. Analysis included both univariate and multivariable logistic regression analyses.

The authors identified 297 decompressive surgeries over the period of the study, 22 of which required long-term postoperative CSF diversion. On multivariable analysis, age < 6 years old (OR 3.342, 95% CI 1.282-8.713), higher intraoperative blood loss (OR 1.003, 95% CI 1.001-1.006), and the presence of a fourth ventricular web (OR 3.752, 95% CI 1.306-10.783) were significantly associated with the need for long-term CSF diversion after decompressive surgery.

Younger patients, those with extensive intraoperative blood loss, and those found during surgery to have a fourth ventricular web were at higher risk for the development of CRH. Clinicians should be alert to evidence of CRH in this patient population after PFD surgery. 1) 2).

Elton et al. present three patients who developed infratentorial supracerebellar hygromas causing acute hydrocephalus after posterior cranial fossa decompression 3).

A 34-year-old woman presented with strain-related suboccipital headache and myelopathy for 6 months. Imaging revealed tonsillar herniation up to C2 level and cervical syringomyelia. A standard FMD, C1 posterior arch removal, and tonsillar reduction was performed. After an initial uneventful postoperative course, she had 2 readmissions with headache, vomiting, and ataxia. Imaging showed a tense pseudomeningocele and concomitant supratentorial and infratentorial (initially right-sided, followed by left-sided) SDHs with ventriculomegaly. She was conservatively managed with antiedema measures and had excellent relief of symptoms. For the literature review, only cases with concomitant supratentorial and infratentorial SDHs with hydrocephalus were searched online and analyzed.

Including this, 10 cases have been reported. Mean age was 25.3 years. The male-to-female ratio was 1:2.3. Symptoms appeared an average of 12.6 days postoperatively. Treatment was with conservative management in 3 cases, and 3 cases required permanent cerebrospinal fluid diversions. Mean follow-up duration was 9.4 months (range, 1-27 months).

Coexistent supratentorial and infratentorial SDHs with hydrocephalus after Chiari decompression is a very rare occurrence. Treatment needs to be individualized based on the predominant symptomatic lesion, and surgical options need to be judiciously considered. Good prognosis is the rule in most cases 4).


A 2-year-old girl with the Chiari 1 malformation underwent FMD, including suboccipital craniotomy, C1 laminectomy and durotomy without opening the arachnoid.

After initial postoperative improvement, the patient deteriorated, developing subdural hygromas and hydrocephalus. These were treated successfully with observation and acetazolamide.

Subdural hygromas may complicate FMD. A slit valve opening in the arachnoid might be part of the pathophysiology. While surgical intervention may be necessary in some circumstances, non-operative measures may be effective as well 5).

1)

Guan J, Riva-Cambrin J, Brockmeyer DL. Chiari-related hydrocephalus: assessment of clinical risk factors in a cohort of 297 consecutive patients. Neurosurg Focus. 2016 Nov;41(5):E2. PubMed PMID: 27798986.
2)

Pereira EA, Magdum SA. Foramen magnum decompression – from hygromas to hydrocephalus. Br J Neurosurg. 2016 Jun;30(3):355. doi: 10.3109/02688697.2016.1173198. Epub 2016 Apr 21. PubMed PMID: 27100816.
3)

Elton S, Tubbs RS, Wellons JC 3rd, Blount JP, Grabb PA, Oakes WJ. Acute hydrocephalus following a Chiari I decompression. Pediatr Neurosurg. 2002 Feb;36(2):101-4. PubMed PMID: 11893893.
4)

Prasad GL, Menon GR. Coexistent Supratentorial and Infratentorial Subdural Hygromas with Hydrocephalus After Chiari Decompression Surgery: Review of Literature. World Neurosurg. 2016 Sep;93:208-14. doi: 10.1016/j.wneu.2016.06.025. Epub 2016 Jun 16. Review. PubMed PMID: 27319314.
5)

Filis AK, Moon K, Cohen AR. Symptomatic Subdural Hygroma and Hydrocephalus following Chiari I Decompression. Pediatr Neurosurg. 2009;45(6):425-8. doi: 10.1159/000270159. Epub 2009 Dec 24. PubMed PMID: 20051703.

EANS Advanced Course in Spinal Surgery

EANS Advanced Course in Spinal Surgery

October 29 — October 31

Munich, Germany

Part I: Extended indications and advanced operative techniques

Registration will open in May 2017. Click HERE to register your interest via the course website.

Part II,  ‘complications and management’, is planned again for 2018.

PART I:

LECTURE TOPICS: Craniocervical junction / Cervicothoracic junction / Thoracic spine / Adolescent idiopathic scoliosis (AIS) / Lumbar degenerative scoliosis / High-grade lumbar spondylolisthesis / Sacrum / Intramural tumours

CADAVER LAB TEACHING: OC/C1/C2 Instrumentation / Thoracic en bloc vertebrectomies / Lumbar osteotomies / Endoscopic odontoid resection / transoral approaches / Cervicothoracic pedicle screws / Posterolateral corcectomies / Sacral resections and sacropelvic fixation techniques

INVITED FACULTY:

Emre Acaroglu (Turkey)
Massimo Balsano (Italy)
Stephanie Combs (Germany)
Maarten Coppes (NL)
Bart Depreitere (Belgium)
John Duff (Switzerland)
Joerg Franke (Germany)
Cumhur Kilincer (Turkey)
Heiko Koller (Germany)
Jesús Lafuente (Spain)
Jens Lehmberg (Germany)
Bernhard Meyer (Germany)
Wouter Moojen (NL)
Wilco Peul (NL)
Dominique A Rothenfluh (UK)
Yu-Mi Riyang (Germany)
Ehab Shiban (Germany)
Claudius Thomé (Austria)
Carmen Vleggeert-Lankamp (NL)

Flow Diversion of Cerebral Aneurysms

Flow Diversion of Cerebral Aneurysms
By Min S. Park, Philipp Taussky, Felipe C. Albuquerque, Cameron G. McDougal

Flow Diversion of Cerebral Aneurysms

List Price: $149.99

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From detachable balloons and GDC coils to the recent advent of flow diversion, practitioners of have endovascular neurosurgery been fortunate to work in an era of rapid and exciting advances. The first commercially available flow diverter in the U.S. was approved specifically for a small subset of cerebral aneurysms. Recent experience has demonstrated its utility in treating challenging or otherwise untreatable aneurysms, safely and efficaciously. The design of these devices requires learning radically different methods than those used in the deployment of other, non-braided stents.

Flow Diversion of Cerebral Aneurysms by Min Park, Philipp Taussky, Felipe Albuquerque, and Cameron McDougall provides step-by-step guidance on utilization of flow diversion technology in clinical practice. Reflecting the combined experience and knowledge of pioneers in neurointerventional surgery, this comprehensive book fills a gap in available resources. Twenty-one chapters cover fundamentals to advanced concepts – historical perspective to future developments.

Key Features

  • More than 250 high quality graphics and illustrative case studies reinforce key concepts
  • Techniques and nuances of Pipeline, Silk (Balt Extrusion), Surpass Streamline, and Flow-Redirection Endoluminal Device (FRED) deployment
  • An overview of current flow diversion devices, discussion of coil embolization versus flow diversion, off-label uses, adjuvant approaches, and hemodynamic modifications
  • Pharmacology, flow diversion grading scales, and post-procedure radiographic imaging
  • Clinical pearls on ruptured aneurysms, intraprocedural/postprocedural complications, and management of aneurysm residuals

The ultimate goal of incorporating cutting-edge flow diversion techniques into the aneurysm treatment paradigm is improved efficacy and patient outcome. The knowledge gleaned from this outstanding resource will help residents and fellows learn to deploy flow diverters for the first time and enable seasoned clinicians to expand their neurointerventional radiology skills.


Product Details

  • Published on: 2017-10-25
  • Original language: English
  • Dimensions: 8.50″ h x .0″ w x 11.00″ l,
  • Binding: Hardcover
  • 176 pages