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17. Combined use of minimal access craniotomy, intraoperative magnetic resonance imaging, and awake functional mapping for the resection of gliomas in 61 patients

Author

Whiting, Benjamin B., primary, Lee, Bryan S., additional, Mahadev, Vaidehi, additional, Borghei-Razavi, Hamid, additional, Ahuja, Sanchit, additional, Jia, Xuefei, additional, Mohammadi, Alireza M., additional, Barnett, Gene H., additional, Angelov, Lilyana, additional, Rajan, Shobana, additional, Avitsian, Rafi, additional, and Vogelbaum, Michael A., additional

Published
2020
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18. List of Contributors

Author

Abtahi, Ali R., Adogwa, Owoicho, Ahmed, A. Karim, Ainechi, Ana, Alan, Nima, Albanese, Jessica, Aleem, Ilyas, Almeida, Joao Paulo, Alshabab, Basel Sheikh, Alvarado, Anthony M., Alvi, Mohammed Ali, Amer, Aboubakr, Ames, Christopher P., Ammanuel, Simon G., Anand, Neel, Anderson, Paul A., Angelov, Lilyana, Arnold, Paul M., Aubin, Carl-Eric, Bae, Junseok, Bain, Mark, Barber, Joshua, Baron, Eli M., Basi, Hersimren Kaur, Bawahab, Asef, Benzel, Edward C., Berven, Sigurd H., Bevan, Adam K., Bice, Miranda, Bilsky, Mark, Bisson, Erica F., Blaskiewicz, Donald, Boody, Barrett S., Bowles, Daniel, Branch, Charles, Brooks, Nathaniel, Buckland, Aaron J., Buell, Thomas J., Burch, Shane, Burke, John F., Butt, Bilal B., Bydon, Mohamad, Camara, Joaquin, Canseco, Jose A., Casper, David S., Cassidy, Matthew, Chao, Samuel T., Chatain, Grégoire P., Chieng, Lee Onn, Cho, Woojin, Choi, Hoon, Christopher, Susan R., Chung, Andrew S., Clark, Aaron J., Coric, Domagoj, Corriveau, Mark D., Cottrill, Ethan, Cychosz, Christopher, Daubs, Gregory, Daubs, Michael D., Davin, Sara, DeMicco, Russell C., de Padua, Ashley, Derman, Peter B., Dhall, Sanjay S., Diab, Mohammad, DiGiorgio, Anthony M., Dimar, John R., II, Dru, Alexander B., Dubousset, Jean, Dunbar, Melissa R., Ebrahim, Zeyd, Ehresman, Jeff, Elder, J. Bradley, Ellenbogen, Richard G., El Naga, Ashraf N., Emans, John B., Engstrom, John W., Errico, Thomas J., Farag, Ehab, Farber, S. Harrison, Fatima, Nida, Fedorak, Graham T., Fehlings, Michael G., Feigenbaum, Frank, Ferrara, Lisa, Fessler, Richard G., Finn, Michael, Fischgrund, Jeffrey S., Fisher, Mark D., Fontes, Ricardo B.V., Fox, Michael A., Freedman, Brett A., Frenkel, Mark, Fridley, Jared, Gabet, Joelle, Garg, Sumeet, German, John W., Ghogawala, Zoher, Gibbs, Christopher M., Gillick, John L., Gilligan, Christopher J., Gillis, Christopher C., Goel, Atul, Gokaslan, Ziya L., Goldstein, Zachary H., Grant, Gerald A., Grasso, Mackenzie, Grossbach, Andrew J., Guan, Jian, Guinn, Jeremy, Gupta, Raghav, Gussous, Yazeed M., Guyer, Richard D., Haddad, Alexander F., Hamilton, Kirsty, Harland, Tessa, Harrop, James S., Hart, David J., Hart, Robert A., Hassan, Waqaas A., Hayes, Amanda W., Heary, Robert F., Hedequist, Daniel, Henderson, Fraser C., Sr., Henzel, M. Kristi, Herring, Eric Z., Higgins, Dominique, Hilibrand, Alan S., Hindoyan, Kevork N., Hines, Kevin, Hitchon, Patrick W., Hoffmann, Jacob C., Hoh, Daniel J., Holt, Joshua, Hsia, Augusto, Hsieh, Jason, Hsu, Wellington K., Hurlbert, John, Hwang, Steven W., Iordanou, Jordan C., Jack, Andrew S., Janich, Karl, Jiang, Bowen, Jiang, Fan, Jimenez, Xavier F., Johnson, J. Patrick, Jones, G. Alexander, Jones, Kristen E., Joseph, Jacob R., Joshi, Rushikesh S., Juthani, Rupa G., Kalfas, Iain H., Kalra, Ricky R., Kang, James D., Kanter, Adam S., Kasliwal, Manish K., Kaushal, Mayank, Kerolus, Mena G., Kesler, Kyle, Kessler, Remi A., Khalaf, Tagreed, Khalil, Jad G., Kim, Terrence T., Kimball, Jon, Kisinde, Stanley, Klineberg, Eric O., Kondylis, Efstathios, Kramer, Dallas E., Krauss, William E., Krishnaney, Ajit A., Krogue, Justin, Kshettry, Varun R., Kumar, Neeraj, Kurpad, Shekar N., Labak, Collin M., Labelle, Hubert, Ladd, Bryan, Lafage, Virginie, Laratta, Joseph L., Lark, Robert, Lau, Darryl, Laufer, Ilya, Lavelle, William F., Le, Hai V., Lee, Andrew, Lee, Nathan J., Lee, Sang-Ho, Lehman, Ronald A., Jr., Lehner, Kurt, Lenke, Lawrence G., Li, Yingda, Lieberman, Isador H., Ling, Marcus Z., Lo, Victor P., Lollis, S. Scott, Lombardi, Joseph M., Long, Donlin, Long, Roger, Lotz, Jeffrey, Lyons, Joseph G., Mac-Thiong, Jean-Marc, Machado, Andre, Mallow, Gary M., Malone, David G., Manjila, Sunil, Maroon, Joseph C., Maslak, Joseph P., Massaad, Elie, Matsumoto, Morio, Martini, Michael L., Mayer, E. Kano, Mayer, Rory, Mazanec, Daniel J., McCormick, Kyle L., McCormick, Paul C., McGrath, Kyle, McNeill, Ian T., Medress, Zachary A., Mendelis, Joseph R., Mendis, Phillip G., Metz, Lionel, Midha, Rajiv, Miele, Vincent J., Mijatovic, Desimir, Mikula, Anthony L., Min, Elliot, Mizuno, Shuichi, Moghaddamjou, Ali, Molenda, Joseph E., Momin, Arbaz, Momin, Eric, Moore, Nina Z., Morris, Dylan, Morrissette, Cole R., Mroz, Thomas E., Mummaneni, Praveen V., Mundis, Gregory M., Munoz, Tess, Naderi, Sait, Nagel, Sean J., Nagoshi, Narihito, Nail, Tara Jayde, Nair, Dileep, NaPier, Zachary, Neifert, Sean N., Nemunaitis, Gregory, Nessim, Adam, Niu, Tianyi, Norwig, John A., Ong, Binnan, Onwuzulike, Kaine C., Oren, Jonathan, Orr, R. Douglas, O’Toole, John E., Ozpinar, Alp, Padua, Fortunato G., Page, Paul, Park, Paul J., Parmar, Vikas, Patel, Arati, Patel, Parthik, Patel, Rakesh, Pelle, Dominic, Peña, Enrique, Pendleton, Courtney, Pennicooke, Brenton, Pennington, Zach, Perez-Cruet, Mick J., Petersen-Fitts, Graysen R., Peterson, Thomas A., Piche, Joshua, Placide, Rick, Platt, Andrew, Polifka, Adam J., Polly, David W., Poree, Lawrence, Rajasekaran, S., Rammo, Richard, Rasouli, Jonathan J., Ratliff, John K., Rawlinson, Jeremy J., Ray, Wilson Z., Recinos, Pablo F., Recinos, Violette M., Reid, Patrick, Renfrow, Jackie, Resnick, Daniel K., Resser, Tina, Rhines, Laurence D., Richardson, Dusty, Riesenburger, Ron, Rispinto, Sarah, Rivera, Joshua, Rosenquist, Richard Wayne, Ross, Lindsey, Rossi, Vincent, Rudisill, Samuel S., Ruggieri, Paul, Ryu, Won Hyung A., Sabourin, Victor, Safaee, Michael M., Safain, Mina, Salaheen, Zaid, Samartzis, Dino, Samdani, Amer F., Samtani, Rahul G., Sasso, Rick, Satin, Alexander M., Savage, Jason W., Sawin, Paul D., Sawires, Andrew N., Sawyer, Aenor, Schmidt, Bradley T., Schmidt, Eric, Schmidt, Meic H., Schwab, Frank J., Sciubba, Daniel M., Sellin, Jonathan N., Shaaya, Elias, Shabani, Saman, Shaffrey, Christopher I., Shankar, Ganesh M., Shao, Jianning, Sharan, Alok D., Shaw, Jeremy D., Shen, Jian, Shenoy, Kartik, Shetty, Ajoy Prasad, Shin, John H., Shook, Steven J., Singh, Harminder, Singh, Rahul, Sissman, Ethan, Siyaji, Zakariah K., Smith, Gabriel A., Smith, John T., Smith, Justin S., Spinner, Robert J., Spurgas, Morgan P., Stefanelli, Anthony J., Steinmetz, Michael P., Sundar, Swetha J., Swarup, Ishaan, Takeoka, Yoshiki, Tatsui, Claudio E., Teferi, Nahom, Telfeian, Albert E., Theodore, Nicholas, Theologis, Alekos A., Thiyagarajah, Nishanth, Thorp, Brian D., Traynelis, Vincent C., Trost, Gregory R., Truong, Huy Q., Tsiang, John T., Tumialán, Luis M., Tymchak, Zane A., Udayasankar, Unni, Umansky, Daniel, Uribe, Juan S., Vaccaro, Alexander R., Vargovich, Alison M., Vaziri, Sasha, Veeravagu, Anand, Venezia, Michael, Verma, Kushagra, Vilarello, Brandon, Viljoen, Stephanus V., Viswanathan, Vibhu Krishnan, Volovetz, Josephine, Vorster, Sarel J., Walker, Corey T., Wallace, Daniel J., Wang, Anthony C., Wang, Jeffrey C., Wang, Marjorie C., Wang, Michael Y., Wang, Xiaoyu, Weinstein, Stuart L., Weisman, Michael H., Weissmann, Karen, Wentworth, Kelly, Whiting, Benjamin, Whitmore, Robert G., Wick, Joseph, Williams, Michelle, Wilson, James R., Wilson, Leslie, Witham, Timothy, Wolfla, Christopher E., Wolinsky, Jean-Paul, Woodard, Eric J., Wu, Hao-Hua, Yang, Michael, Yezdani, Samir G., Yoganandan, Narayan, Yolcu, Yagiz, Young, Robin, Zanation, Adam, Zehri, Aqib, and Zileli, Mehmet

Published
2022
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24. Lateral hypothalamic area deep brain stimulation for refractory obesity: a pilot study with preliminary data on safety, body weight, and energy metabolism

Author

Whiting, Donald M., Tomycz, Nestor D., Bailes, Julian, De Jonge, Lilian, Lecoultre, Virgile, Wilent, Bryan, Alcindor, Dunbar, Prostko, E. Richard, Cheng, Boyle C., Angle, Cynthia, Cantella, Diane, Whiting, Benjamin B., Mizes, J. Scott, Finnis, Kirk W., Ravussin, Eric, and Oh, Michael Y.

Subjects
Male, Psychological Tests, Deep Brain Stimulation, Body Weight, Bariatric Surgery, Pilot Projects, Feeding Behavior, Middle Aged, Article, Hypothalamic Area, Lateral, Body Image, Humans, Female, Tretoquinol, Obesity, Energy Metabolism, Follow-Up Studies
Abstract

Deep brain stimulation (DBS) of the lateral hypothalamic area (LHA) has been suggested as a potential treatment for intractable obesity. The authors present the 2-year safety results as well as early efficacy and metabolic effects in 3 patients undergoing bilateral LHA DBS in the first study of this approach in humans.Three patients meeting strict criteria for intractable obesity, including failed bariatric surgery, underwent bilateral implantation of LHA DBS electrodes as part of an institutional review board- and FDA-approved pilot study. The primary focus of the study was safety; however, the authors also received approval to collect data on early efficacy including weight change and energy metabolism.No serious adverse effects, including detrimental psychological consequences, were observed with continuous LHA DBS after a mean follow-up of 35 months (range 30-39 months). Three-dimensional nonlinear transformation of postoperative imaging superimposed onto brain atlas anatomy was used to confirm and study DBS contact proximity to the LHA. No significant weight loss trends were seen when DBS was programmed using standard settings derived from movement disorder DBS surgery. However, promising weight loss trends have been observed when monopolar DBS stimulation has been applied via specific contacts found to increase the resting metabolic rate measured in a respiratory chamber.Deep brain stimulation of the LHA may be applied safely to humans with intractable obesity. Early evidence for some weight loss under metabolically optimized settings provides the first "proof of principle" for this novel antiobesity strategy. A larger follow-up study focused on efficacy along with a more rigorous metabolic analysis is planned to further explore the benefits and therapeutic mechanism behind this investigational therapy.

Published
2013

28. Model Theory & International Relations Theory: Positivism, Ontology and the Nature of Social Science.

Author

Whiting, Benjamin J. and Carlson, Jon

Subjects
*INTERNATIONAL relations, *POSITIVISM, *ONTOLOGY, *SOCIAL sciences, *NATURAL history
Abstract

When it comes to scientific investigation, positivism is no longer the only game in town, nor is it even the most prominent theory of how science works. Model Theory has become ascendent within the natural sciences, yet is still not explicitly rpesent in IR Theorizing. This paper seeks to rectify this shortcoming. Model Theory is a fundamentally different understanding of the nature of science, including different ontological and explanatory commitments. This paper argues that Model Theory does a far better job than positivism in accounting for the descriptive nature of mainstream IR Theory, and we argue that much of IR Theory is already working in a Model Theoretic framework. In accepting such a framework, we posit that IR theorists may bypass a number of important (and often unquestioned) issues arising from their ontological commitments to positivism, while not betraying their commitment to keeping the discipline scientific. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Published
2008

29. Preparing Residents to Navigate Neurosurgical Careers in the 21 st Century: Implementation of a Yearlong Enhanced Didactics Curriculum.

Author

Sundar SJ, Whiting BB, Li S, Nelson CN, Schlenk RP, Krishnaney AA, Benzel EC, Habboub G, Steinmetz MP, and Benzil DL

Abstract

Background and Objective: Neurosurgery residency, known for its rigorous training, must adapt to evolving healthcare demands. Formal education should now encompass areas like quality improvement and patient safety (QIPS), machine learning, career planning, research infrastructure, grant funding, and socioeconomics. We share our institution's experience with a yearlong enhanced didactics curriculum, complementing our traditional teaching., Methods: Our resident and faculty team evaluated essential skills for trainee success and leadership, identified knowledge gaps, and addressed them with 31 lectures. We conducted pre- and 6-month surveys using a Likert scale (1 = strongly disagree, 3 = neutral, 5 = strongly agree) to assess resident education. Survey results were analyzed using Student t-tests, with p < 0.05 indicating statistical significance., Results: Eleven out of twelve residents completed the pre- and 6-month surveys. The surveys revealed improved scores in areas such as research career preparation (3.0/5 to 4.33/5, p=0.002), building research skills (3.18/5 to 4.33/5, p=0.002), and comfort with quality and patient safety (4.09/5 to 4.75, p=0.04). Residents found the lectures highly effective in supplementing their residency training (4.58/5). Qualitative feedback from faculty was highly positive as well., Conclusions: Organized neurosurgery excels in clinical and technical training for residents but lacks formalized training in crucial nonclinical areas, such as QIPS, machine learning/artificial intelligence, research infrastructure, and socioeconomics. Our formal curriculum focused on these topics, with positive resident engagement and feedback over the first six months. However, continuous longitudinal monitoring is needed to confirm the curriculum's efficacy. This program may guide other neurosurgery departments in enhancing resident education in these areas., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Published
2024
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30. Combined use of minimal access craniotomy, intraoperative magnetic resonance imaging, and awake functional mapping for the resection of gliomas in 61 patients.

Author

Whiting BB, Lee BS, Mahadev V, Borghei-Razavi H, Ahuja S, Jia X, Mohammadi AM, Barnett GH, Angelov L, Rajan S, Avitsian R, and Vogelbaum MA

Abstract

Objective: Current management of gliomas involves a multidisciplinary approach, including a combination of maximal safe resection, radiotherapy, and chemotherapy. The use of intraoperative MRI (iMRI) helps to maximize extent of resection (EOR), and use of awake functional mapping supports preservation of eloquent areas of the brain. This study reports on the combined use of these surgical adjuncts., Methods: The authors performed a retrospective review of patients with gliomas who underwent minimal access craniotomy in their iMRI suite (IMRIS) with awake functional mapping between 2010 and 2017. Patient demographics, tumor characteristics, intraoperative and postoperative adverse events, and treatment details were obtained. Volumetric analysis of preoperative tumor volume as well as intraoperative and postoperative residual volumes was performed., Results: A total of 61 patients requiring 62 tumor resections met the inclusion criteria. Of the tumors resected, 45.9% were WHO grade I or II and 54.1% were WHO grade III or IV. Intraoperative neurophysiological monitoring modalities included speech alone in 23 cases (37.1%), motor alone in 24 (38.7%), and both speech and motor in 15 (24.2%). Intraoperative MRI demonstrated residual tumor in 48 cases (77.4%), 41 (85.4%) of whom underwent further resection. Median EOR on iMRI and postoperative MRI was 86.0% and 98.5%, respectively, with a mean difference of 10% and a median difference of 10.5% (p < 0.001). Seventeen of 62 cases achieved an increased EOR > 15% related to use of iMRI. Seventeen (60.7%) of 28 low-grade gliomas and 10 (30.3%) of 33 high-grade gliomas achieved complete resection. Significant intraoperative events included at least temporary new or worsened speech alteration in 7 of 38 cases who underwent speech mapping (18.4%), new or worsened weakness in 7 of 39 cases who underwent motor mapping (18.0%), numbness in 2 cases (3.2%), agitation in 2 (3.2%), and seizures in 2 (3.2%). Among the patients with new intraoperative deficits, 2 had residual speech difficulty, and 2 had weakness postoperatively, which improved to baseline strength by 6 months., Conclusions: In this retrospective case series, the combined use of iMRI and awake functional mapping was demonstrated to be safe and feasible. This combined approach allows one to achieve the dual goals of maximal tumor removal and minimal functional consequences in patients undergoing glioma resection.

Published
2019
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31. Misplacement of Stent Into Epidural Venous Plexus With Resultant Cauda Equina Syndrome and Open Surgical Treatment: A Case Report.

Author

Whiting BB, Mulholland CB, Daniels L, Kakarla UK, Theodore N, and Snyder LA

Subjects
Aged, Cauda Equina Syndrome surgery, Decompression, Surgical, Humans, Laminectomy, Male, Spinal Fusion, Treatment Outcome, Cauda Equina Syndrome etiology, Femoral Artery surgery, Peripheral Vascular Diseases surgery, Stents adverse effects
Abstract

Background and Importance: Endovascular therapy has proven to be a safe, minimally invasive treatment for multiple etiologies, but proper precautions must be taken to avoid complications. When complications occur, they should be promptly identified and corrected when possible. This case report describes endovascular stents misplaced into the epidural spinous venous plexus rather than the iliofemoral arteries, causing cauda equina syndrome, as well as the spinal procedure performed to treat the resulting spinal canal compression., Clinical Presentation: A 67-yr-old man had undergone what he thought was iliofemoral arterial stenting at an outside hospital for peripheral vascular disease. He presented 8 d later to our hospital with cauda equina syndrome comprising back pain, right L5 radiculopathy, perianal numbness, urinary retention, and constipation. Scans demonstrated stents deployed into the venous system, traversing the spinal canal and the right L5-S1 neural foramen, resulting in severe spinal canal stenosis, right L5-S1 foraminal stenosis, and moderate left S1-S2 foraminal stenosis. The patient underwent an L5-S1 laminectomy with full right L5-S1 facetectomy and left S1-S2 medial facetectomy, with associated L5-S1 posterolateral fusion with fixation to remove the stent and decompress the neural elements., Conclusion: Although stent misplacement is an uncommon complication of endovascular therapy, this case demonstrates the importance of ensuring access to the proper vessel before stent placement. Once this complication was recognized, safe removal of the stents was possible and the patient demonstrated meaningful postoperative improvement in symptoms and strength.

Published
2018
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32. Thalamic Deep Brain Stimulation.

Author

Whiting BB, Whiting AC, and Whiting DM

Subjects
Brain Injuries, Traumatic surgery, Drug Resistant Epilepsy surgery, Essential Tremor surgery, Humans, Neuralgia surgery, Obsessive-Compulsive Disorder surgery, Tourette Syndrome surgery, Tremor surgery, Brain Injuries, Traumatic therapy, Deep Brain Stimulation methods, Drug Resistant Epilepsy therapy, Essential Tremor therapy, Neuralgia therapy, Obsessive-Compulsive Disorder therapy, Thalamus surgery, Tourette Syndrome therapy, Tremor therapy
Abstract

The use of deep brain stimulation (DBS) of the thalamus has been proven to be a safe and efficacious treatment for the management of many diseases. The most common indication for thalamic DBS remains essential tremor (ET), one of the most common movement disorders in the world. ET patients should be considered for surgical intervention when their tremor has demonstrated to be refractory to medication, a characteristic estimated to be present in roughly 50% of ET cases. Advantages of DBS over thalamotomy include its reversibility, the ability to adjust stimulation settings to optimize efficacy and minimize side effects, the ability to perform bilateral procedures safely, and an association with a lower risk of postoperative cognitive problems. The most common target of DBS for ET is the ventralis intermedius (VIM) of the thalamus, and the optimal electrode location corresponds to the anterior margin of the VIM. Other indications for thalamic DBS include non-ET tremor, obsessive-compulsive disorder, neuropathic pain, traumatic brain injury, Tourette's syndrome, and drug-resistant epilepsy among others., (© 2018 S. Karger AG, Basel.)

Published
2018
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