Jeffrey Raskin, MS MD FAANS FAAP

The education committee of NANS has published the fifth curriculum document suggesting a common competence across disciplines for clinicians implanting or managing VNS for epilepsy. Have a look at this important educational document from our society.

www.sciencedirect.com

I’m really excited to share this innovative Baclofen pump strategy for complex patients with spinal fusions. As I posted recently, drilling through the spine is an option for accessing the CSF space in the setting of a spinal fusion. But some patients need the pump placed in an atypical location as well. This report shows how effective a pectoral pocket and C1-2 puncture for cervical catheter placement can be. This patient also had a lumbosacral ventral-dorsal rhizotomy. It’s free online. Take a look!

Multimodal surgical strategy for mixed refractory hypertonia in a patient with cerebral palsy: C1-2 puncture and pectoral pocket for baclofen pump implantation following lumbosacral ventral-dorsal rhizotomy. Illustrative case - PubMed Surgical complexity prompts creative problem-solving. It is critical to consider the nuances of each patient's history and body habitus to promote ITBP longevity. The authors present the case of a patient with CP who underwent catheter access via C1-2 puncture and pectoral pocket creation. In this c...

Congratulations to the whole group for this fairly complex study using electrophysiology to show the importance of brain development in children. This study highlights new information about the development of the prefrontal cortex in attention and memory.

The development of aperiodic neural activity in the human brain - PubMed The neurophysiological mechanisms supporting brain maturation are fundamental to attention and memory capacity across the lifespan. Human brain regions develop at different rates, with many regions developing into the third and fourth decades of life. Here, in this preregistered study (https://osf.i...

Patient- and surrogate-reported outcomes are increasingly recognized as important and historically limited dimensions of satisfaction with medical care. We identified caregiver satisfaction with the neurosurgical management of pediatric movement disorders as a key quality metric and report our results across an institutional experience.

We found that caregivers were overwhelmingly satisfied with the neurosurgical care for PMDs and would recommend the functional pediatric neurosurgery program to others, and that there was a perception disparity between caregiver- and hospital-identified complications. Caregiver satisfaction remains an important quality dimension and future research may benefit from more objective metrics.

Take a look!

Caregiver-reported satisfaction with pediatric movement disorder surgery - PubMed Caregivers were overwhelmingly satisfied with the neurosurgical care for PMDs and would recommend the functional pediatric neurosurgery program to others. A large percentage would again submit to the surgery. There is a perception disparity between caregiver- and hospital-identified complications; i...

Sometimes we use different devices for management strategies that overlap in their side effects. This is what we found using a bladder stimulator and Baclofen pump simultaneously. Something to think about for providers when combining electrical and pharmacological neuromodulation techniques.

Intrathecal baclofen obviating the need for bladder stimulator use in a patient with secondary dystonia: illustrative case BACKGROUND Children with cerebral palsy often have neurogenic bladders. Bladder function is further affected by complex medical management and multifactorial disease processes, leading to worsened function and poorer quality of life. Intrathecal baclofen (ITB) therapy has been used to treat hyperton...

Abdominal pseudocysts are inflammatory collections sometimes found around the distal shunt catheter. These are commonly indolent forms of bacterial infection, but not always. The management of an infectious vs inflammatory pseudocyst is entirely different, and some patients without evidence of infection can be discharged more quickly from the hospital on less medicine.

We identified a cohort of inflammatory pseudocysts using PCR. This may help distinguish between future patients.

Re-examining the classification of abdominal pseudocysts as surgical site infections through review of broad-range polymerase chain reaction results - PubMed Few abdominal pseudocysts had organisms identified by BRPCR, suggesting that not all pseudocysts are due to infectious causes. Consideration should be given to alternate causes of pseudocyst development when cultures are negative.

I was invited to participate in the JNS journal club discussing a recent publication on ventral dorsal rhizotomy with Drs. Burchiel, Cohen-Gadol, Sufianov, and Couldwell. You can check out the brief discussion with these luminary surgeons at the link below.

It was a highlight of my career to be invited to discuss this manuscript on the JNS platform by my previous Chairman, Dr. Kim Burchiel.

Neurosurgical Focus Volume 56 Issue 6: Spasticity and Other Movement Disorders (2024) "Volume 56 (2024): Issue 6 (Jun 2024): Spasticity and Other Movement Disorders" published on Jun 2024 by American Association of Neurological Surgeons.

This manuscript is number 4 in a series of social media studies in neurosurgery. This one focuses on residency program use!

Neurosurgery Residency Programs on Twitter (X): Current Use and Future Potential - PubMed

Neurosurgery Residency Programs on Twitter (X): Current Use and Future Potential - PubMed The majority of US neurosurgery residency programs actively use Twitter (X), primarily to showcase academic achievements and aid in recruitment. The correlation between Twitter following and program ranking suggests that online engagement reflects program visibility and impact, underscoring the impo...

WHY PIMPING WORKS

Abraham Flexner describes it upon a 1916 visit to Johns Hopkins, “Rounded with Osler today. Riddles house officers with questions. Like a Gatling gun. Welch says medical students call it ‘pimping.’ Delightful”.

I’ve been writing this manuscript for about a decade, rejected over and over, and thanks to Med Jimenez and Pranish Kantak it’s finally published.

Medical training is transformative, and should be. The pedagogical methodology called “pimping” is extremely effective at helping learners consolidate long-term memories. But how does this work?

We explore the neuroscience behind this memory consolidation. It’s free online, have a read!

Also, I am not a psycho. There’s a humane way to engage in “pimping.” Humiliation is always unacceptable. But stimulating emotion during learning works. 😜

Why Pimping Works: The Neurophysiology of Emotional Memories A time-honored medical ritual that combines emotion and cognition into a seamless consolidation of lucid memories is a feared teaching method in medical education. The resulting neurophysiology is explained from a neurosurgeon’s perspective - equal parts guilt and dread as a prescription for an im...

Combined ventral-dorsal rhizotomies (VDR) can be a reasonable choice for patients with non-generalized conditions because it can address their spasticity via dorsal rhizotomy and their dystonia through ventral rhizotomy. Though lumbosacral rhizotomy is more popular, cervical rhizotomy has shown success in the treatment of upper limb spasticity, traumatic hypertonia, and torticollis

There’s a paradigm shift happening towards the aggressive surgical management of hypertonia in children. Decreasing medically refractory hypertonia is likely to prevent joint and bone dysfunction and improve quality of life.

Have a look at this important manuscript applying ventral dorsal rhizotomy to the cervical nerve roots.

Cervicothoracic ventral-dorsal rhizotomy for treatment of brachial hypertonia in cerebral palsy - Child's Nervous System Purpose Cervicothoracic ventral-dorsal rhizotomy (VDR) is a potential treatment of medically refractory hypertonia in patients who are not candidates for intrathecal baclofen, particularly in cases of severe upper limb hypertonia with limited to no function. A longitudinal cohort was identified to h...

Research is often impeded by heterogeneous diagnoses and therapies. Sometimes we do the same things but use different terms and jargon.

It was a privilege to contribute to this piece highlighting a need for a common language for intracranial monitoring with stereo EEG.

https://buff.ly/3XGpxCK

Severe seizure disorders can start suddenly and be difficult to diagnose and treat. In some cases, affected children actually stay in the ICU intubated for weeks in a medically induced coma.

We present a case using sEEG and MRgLITT of the corpus callosum to lateralize seizure onset and also treat this child. It’s free online.

Using magnetic resonance-guided laser interstitial thermal therapy corpus callosotomy to lateralize a seizure focus for staged surgical approach New onset refractory status epilepticus (NORSE) is an etiologically heterogeneous condition that is associated with high morbidity and mortality. NORSE is often refractory to medical management prom