Surg Neurol. 2009 Oct 12.
Commentary
Maroon JC.

Tri-State Neurosurgical Associates-UPMC Pittsburgh, PA 15213, USA. Refers to:

Successful treatment of intraorbital lymphangioma with tissue fibrin glue
Surgical Neurology, Volume 72, Issue 6, December 2009, Pages 722-724,
Aiko Hayasaki, Hideo Nakamura, Tadashi Hamasaki, Keishi Makino, Shigetoshi Yano, Motohiro Morioka, Jun-ichi Kuratsu

Surg Neurol. 2009 Apr;71(4):466-8. Epub 2009 Jan 14.
Pneumatic Kerrison rongeur: technical note
Maroon JC, El-Kadi M, Bost J.

Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

BACKGROUND: We report our experience with the Aesculap Pneumatic Powered Kerrison Rongeur (Aesculap AG Company) Tuttlingen, Germany. METHODS: Between February 2007 and January 2008, 125 patients underwent spinal surgery for the treatment of spinal stenosis, spinal tumors, degenerative disk disease, and herniated disks in the cervical, thoracic, and lumbar areas using the pneumatic-powered Kerrison rongeur for bone and tissue removal. RESULTS: All bone removal for procedures ranging from cervical and lumbar microdiscectomies to extensive multilevel laminectomies was carried out with no complications from instrument design or malfunction. Most importantly, the manual labor required to forcefully squeeze and bite bone was virtually eliminated. The learning curve for instrument application was negligible. Operating room personnel similarly had no difficulty with the simplified tubing connections to an air supply and the Kerrison handle with interchangeable, multisized shafts. CONCLUSION: The new pneumatically powered Kerrison rongeur not only is safe and easy to use but also virtually eliminates the manual fatigue and, at times, pain associated with prolonged bone removal from the use of standard Kerrison rongeurs.

PMID: 19147188 [PubMed - indexed for MEDLINE]

J Neurosurg Spine. 2007 Apr;6(4):356-63.
Cervical neurapraxia in elite athletes: evaluation and surgical treatment. Report of five cases.
Maroon JC, El-Kadi H, Abla AA, Wecht DA, Bost J, Norwig J, Bream T.

Department of Neurosurgery, University of Pittsburgh School of Medicine-Presbyterian Hospital, Pennsylvania 15213, USA. maroonjc@upmc.edu

Comment in:

OBJECT: Neurapraxia, transient posttraumatic paralysis of the motor and/or sensory tracts in the spinal cord, may be a career-ending event in an athlete. Management, rehabilitation, and return-to-play decisions remain controversial. METHODS: Five elite football players were evaluated after experiencing episodes of neurapraxia. All patients experienced bilateral paresthesias–three in all four extremities and two in the upper extremities–lasting a few minutes to more than 24 hours. Transient motor deficits occurred in two individuals but caused no permanent sequelae. Neuroimaging confirmed the presence of herniated discs, focal cord compression, and no parenchymal changes in all cases. All patients underwent anterior cervical microdiscectomy and fusion, and cervical plates were placed in four. After aggressive rehabilitation and confirmation of fusion ranging from 9 weeks to 8 months postoperatively, the players were allowed to return to active play. Two of the players developed recurrent career-ending disc herniations, one above and the other below the fusion level. One player required repeated spinal cord decompression. CONCLUSIONS: Neurologically intact athletes with focal cord compression due to a single-level herniated disc may safely return to football after undergoing decompressive surgery and confirmation of fusion. It appears, however, that there may be an increased chance of repeated herniation above or below a fused level.

PMID: 17436927 [PubMed - indexed for MEDLINE]

Appl Neuropsychol. 2006;13(3):166-74.
Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale.
Lovell MR, Iverson GL, Collins MW, Podell K, Johnston KM, Pardini D, Pardini J, Norwig J, Maroon JC.

UPMC Center for Sports Medicine; 3200 South Water Street, Pittsburgh, PA 15203, USA. lovellmr@upmc.edu

It is important to carefully evaluate self-reported symptoms in athletes with known or suspected concussions. This article presents data on the psychometric and clinical properties of a commonly used concussion symptom inventory-the Post-Concussion Scale. Normative and psychometric data are presented for large samples of young men (N = 1,391) and young women (N = 355). In addition, data gathered from a concussed sample of athletes (N = 260) seen within 5 days of injury are presented. These groups represent samples of both high school and collegiate athletes. Data from a subsample of 52 concussed athletes seen 3 times post-injury are presented to illustrate symptom reporting patterns during the initial recovery period. General guidelines for the clinical use of the scale are provided.

PMID: 17361669 [PubMed - indexed for MEDLINE]

Surg Neurol. 2007 Feb;67(2):163-8; discussion 168. Epub 2006 Oct 6.

“Golfer’s stroke”: golf-induced stroke from vertebral artery dissection.

Maroon JC, Gardner P, Abla AA, El-Kadi H, Bost J.

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. maroonjc@upmc.edu

PMID: 17254877 [PubMed - indexed for MEDLINE]

Neurosurg Focus. 2006 Oct 15;21(4):E11.
Natural antiinflammatory agents for pain relief in athletes.
Maroon JC, Bost JW, Borden MK, Lorenz KM, Ross NA.

Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Most athletes experience musculoskeletal injuries during their sports activity that require rest at a minimum, and occasionally injuries are severe enough to necessitate surgical repair. Neurosurgeons are often consulted for athletically sustained injuries and prescribe medications for the associated pain. The use of both over-the-counter and prescription nonsteroidal medications is frequently recommended, but recent safety concerns must now be considered. The authors discuss the biochemical pathways of nonsteroidal drugs and review the potentially serious side effects of these medications. They also review the use of natural supplements, which may be a safer, and often as effective, alternative treatment for pain relief.

PMID: 17112189 [PubMed - indexed for MEDLINE]

Surg Neurol. 2006 Apr;65(4):326-31.
Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.
Maroon JC, Bost JW.

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. maroonjc@upmc.edu

Comment in:

Surg Neurol. 2006 Apr;65(4):325.

Surg Neurol. 2006 Nov;66(5):552; author reply 552-3.

Surg Neurol. 2006 Nov;66(5):552; author reply 552-3.

BACKGROUND: The use of NSAID medications is a well-established effective therapy for both acute and chronic nonspecific neck and back pain. Extreme complications, including gastric ulcers, bleeding, myocardial infarction, and even deaths, are associated with their use. An alternative treatment with fewer side effects that also reduces the inflammatory response and thereby reduces pain is believed to be omega-3 EFAs found in fish oil. We report our experience in a neurosurgical practice using fish oil supplements for pain relief. METHODS: From March to June 2004, 250 patients who had been seen by a neurosurgeon and were found to have nonsurgical neck or back pain were asked to take a total of 1200 mg per day of omega-3 EFAs (eicosapentaenoic acid and decosahexaenoic acid) found in fish oil supplements. A questionnaire was sent approximately 1 month after starting the supplement. RESULTS: Of the 250 patients, 125 returned the questionnaire at an average of 75 days on fish oil. Seventy-eight percent were taking 1200 mg and 22% were taking 2400 mg of EFAs. Fifty-nine percent discontinued to take their prescription NSAID medications for pain. Sixty percent stated that their overall pain was improved, and 60% stated that their joint pain had improved. Eighty percent stated they were satisfied with their improvement, and 88% stated they would continue to take the fish oil. There were no significant side effects reported. CONCLUSIONS: Our results mirror other controlled studies that compared ibuprofen and omega-3 EFAs demonstrating equivalent effect in reducing arthritic pain. omega-3 EFA fish oil supplements appear to be a safer alternative to NSAIDs for treatment of nonsurgical neck or back pain in this selective group.

PMID: 16531187 [PubMed - indexed for MEDLINE]

Neurosurgery. 2006 Feb;58(2):275-86; discussion 275-86.
Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study.
Collins M, Lovell MR, Iverson GL, Ide T, Maroon J.

University of Pittsburgh Medical Center Sports Concussion Program, Department of Orthopaedic Surgery/University of Pittsburgh Medical Center for Sports Medicine, Pennsylvania 15206, USA. collinsmw@upmc.edu

OBJECTIVE: The purpose of this study was to compare concussion rates and recovery times for athletes wearing newer helmet technology compared to traditional helmet design. METHODS: This was a three-year, prospective, naturalistic, cohort study. Participants were 2,141 high school athletes from Western Pennsylvania. Approximately half of the sample wore the Revolution helmet manufactured by Riddell, Inc. (n = 1,173) and the remainder of the sample used standard helmets (n = 968). Athletes underwent computerized neurocognitive testing through the use of ImPACT at the beginning of the study. Following a concussion, players were reevaluated at various time intervals until recovery was complete. RESULTS: In the total sample, the concussion rate in athletes wearing the Revolution was 5.3% and in athletes wearing standard helmets was 7.6% [chi (1, 2, 141) = 4.96, P < 0.027]. The relative risk estimate was 0.69 (95% confidence interval = 0.499- 0.958). Wearing the Revolution helmet was associated with approximately a 31% decreased relative risk and 2.3% decreased absolute risk for sustaining a concussion in this cohort study. The athletes wearing the Revolution did not differ from athletes wearing standard helmets on the mechanism of injury (e.g., head-to-head strike), on-field concussion markers (e.g., amnesia or loss of consciousness), or on-field presentation of symptoms (e.g., headaches, dizziness, or balance problems). CONCLUSION: Recent sophisticated laboratory research has better elucidated injury biomechanics associated with concussion in professional football players. This data has led to changes in helmet design and new helmet technology, which appears to have beneficial effects in reducing the incidence of cerebral concussion in high school football players.

PMID: 16462481 [PubMed - indexed for MEDLINE]

Neurosurg Focus. 2005 Jul 15;19(1):E1.
Skull base surgery: past, present, and future trends.
Maroon JC.

Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. maroonjc@upmc.edu

The author outlines the history of skull base surgery and describes the new paradigm emerging with increasing use of endoscopic microneurosurgery.

PMID: 16078812 [PubMed - indexed for MEDLINE]

J Neurosurg. 2005 May;102(5):850-5.
Posttraumatic migraine characteristics in athletes following sports-related concussion.
Mihalik JP, Stump JE, Collins MW, Lovell MR, Field M, Maroon JC.

Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh Medical Center, Pennsylvania 15203, USA.

Comment in:

J Neurosurg. 2005 Nov;103(5):934-5; author reply 935.

OBJECT: The object of this study was to compare symptom status and neurocognitive functioning in athletes with no headache (non-HA group), athletes complaining of headache (HA group), and athletes with characteristics of posttraumatic migraine (PTM group). METHODS: Neurocognitive tests were undertaken by 261 high-school and collegiate athletes with a mean age of 16.36 +/- 2.6 years. Athletes were separated into three groups: the PTM group (74 athletes with a mean age of 16.39 +/- 3.06 years), the HA group (124 athletes with a mean age of 16.44 +/- 2.51 years), and the non-HA group (63 patients with a mean age of 16.14 +/- 2.18 years). Neurocognitive summary scores (outcome measures) for verbal and visual memory, visual motor speed, reaction time, and total symptom scores were collected using ImPACT, a computer software program designed to assess sports-related concussion. Significant differences existed among the three groups for all outcome measures. The PTM group demonstrated significantly greater neurocognitive deficits when compared with the HA and non-HA groups. The PTM group also exhibited the greatest amount of departure from baseline scores. CONCLUSIONS: The differences among these groups can be used as a basis to argue that PTM characteristics triggered by sports-related concussion are related to increased neurocognitive dysfunction following mild traumatic brain injury. Thus, athletes suffering a concussion accompanied by PTM should be examined in a setting that includes symptom status and neurocognitive testing to address their recovery more fully. Given the increased impairments observed in the PTM group, in this population clinicians should exercise increased caution in decisions about treatment and when the athlete should be allowed to return to play.

PMID: 15926709 [PubMed - indexed for MEDLINE]

Neurosurg Focus. 2002 Aug 15;13(2):E3.
Lumbar microdiscectomy: a historical perspective and current technical considerations.
Koebbe CJ, Maroon JC, Abla A, El-Kadi H, Bost J.

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. chriskoebbe@hotmail.com

A historical review is presented of the original descriptions of lumbar discectomy, focusing on the evolution toward a less invasive surgical approach following the introduction of the operating microscope. From the initial work in Europe by Yasargil and Caspar to the popularization of microdiscectomy by Williams and Wilson in the United States, this procedure has successfully reduced operative time, surgical morbidity, and incision size while allowing patients to return to work faster. Emphasis is placed on the importance of a careful preoperative clinical and radiographic evaluation by identifying factors that may help in the prediction of a successful surgical outcome. A modification of the lumbar microdiscectomy technique is described including patient positioning in the lateral position as well as minimal disc space and nerve root manipulation. In their experience performing more than 3000 microdiscectomies, the authors have produced good-to-excellent clinical results in nearly 90% of patients, with the majority returning to work within 1 month. The complication rate of dural tears, discitis, or root injury has been less than 2%, with a reoperation rate of 5%. The authors believe that lumbar microdiscectomy remains the gold standard with which all other discectomy techniques must be compared.

PMID: 15916400 [PubMed - indexed for MEDLINE]

AJNR Am J Neuroradiol. 2005 Feb;26(2):417-20.
Teflon granuloma in the nasopharynx: a potentially false-positive PET/CT finding.
Harrigal C, Branstetter BF 4th, Snyderman CH, Maroon J.

Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15215, USA.

Positron emission tomography (PET) has become a critical diagnostic tool in the discovery and staging of malignancies in the head and neck. Although PET is accurate for detecting cancer, increased 18 F-fluorodeoxyglucose (FDG) uptake can be seen in healthy tissues such as muscle, fat, and glands and uptake can be seen in tissues affected by inflammation or granulomatous disease. Combined PET and CT (PET/CT) can often overcome these difficulties by fusing anatomic and physiological data, but radiographic findings of some disease processes can be confusing even with fused imaging techniques. We present two cases of FDG uptake in the posterior pharynx, localized by combined PET/CT, which was initially interpreted as squamous cell carcinoma. The increased activity was ultimately attributed to Teflon-induced granulomas. It is important for radiologists to recognize potential causes of false-positive PET/CT findings to improve our diagnostic accuracy and to avoid unnecessary biopsies and surgeries.

PMID: 15709148 [PubMed - indexed for MEDLINE]

Clin J Sport Med. 2003 Jul;13(4):222-9.
On-field predictors of neuropsychological and symptom deficit following sports-related concussion.
Collins MW, Iverson GL, Lovell MR, McKeag DB, Norwig J, Maroon J.

UPMC Sports Concussion Program, Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203, U.S.A. collinsmw@msx.upmc.edu

Comment in:

Clin J Sport Med. 2004 Jul;14(4):253.

OBJECTIVE: Investigate the relationship between on-field markers of concussion severity and postinjury neuropsychological and symptom presentation in an athlete-specific population. DESIGN: Case control study. SETTING: Multicenter analysis of high school and college athletes. PARTICIPANTS: A total of 78 athletes sustaining sports-related concussion were selected from a larger sample of 139 concussed athletes. ASSESSMENT OF PREDICTOR VARIABLES: On-field presence of disorientation, posttraumatic amnesia, retrograde amnesia, and loss of consciousness. MAIN OUTCOME MEASURES: ImPACT, a computerized neuropsychological test battery, was administered pre-season and, on average, 2 days postinjury. Good postinjury presentation (n = 44) was defined as no measurable change, relative to baseline, in terms of both ImPACT memory and symptom composite scores. Poor presentation (n = 34) was defined as a 10-point increase in symptom reporting and 10-point decrease in memory functioning (exceeding the 80% confidence interval for measurement error on ImPACT). Athletes failing to meet good or poor selection criteria (n = 61) were not included in the analysis. RESULTS: Odds ratios revealed that athletes demonstrating poor presentation at 2 days postinjury were over 10 times more likely (P < 0.001) to have exhibited retrograde amnesia following concussive injury when compared with athletes exhibiting good presentation. Similarly, athletes with poor presentation were over 4 times more likely (P < 0.013) to have exhibited posttraumatic amnesia and at least 5 minutes of mental status change. There were no differences between good and poor presentation groups in terms of on-field loss of consciousness. CONCLUSIONS: The presence of amnesia, not loss of consciousness, appears predictive of symptom and neurocognitive deficits following concussion in athletes. Athletes presenting with on-field amnesia should undergo comprehensive and individualized assessment prior to returning to sport participation. Continued refinement of sports concussion grading scales is warranted in lieu of consistent findings that brief loss of consciousness is not predictive of concussion injury severity.

PMID: 12855924 [PubMed - indexed for MEDLINE]

J Pediatr. 2003 May;142(5):546-53.
Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes.
Field M, Collins MW, Lovell MR, Maroon J.

Department of Neurological Surgery, University of Pittsburgh School of Medicine Center for Sports Medicine, Pennsylvania 15213, USA. fieldm@msx.upmc.edu

OBJECTIVE: To evaluate symptoms and neurocognitive recovery patterns after sports-related concussion in high school and college athletes. STUDY DESIGN: College athletes (n = 371) and high school athletes (n = 183) underwent baseline neuropsychological evaluation between 1997 and 2000. Individuals who received a concussion during athletic competition (n = 54) underwent serial neuropsychologic evaluation after injury and were compared with a noninjured within-sample control group (n = 38). Main outcome measures included structured interview, four memory measures, and Concussion Symptom Scale ratings. Baseline to postinjury change scores and multiple analyses of variance were used to compare recovery curves within and between groups. RESULTS: High school athletes with concussion had prolonged memory dysfunction compared with college athletes with concussion. High school athletes performed significantly worse than age-matched control subjects at 7 days after injury (F = 2.90; P <.005). College athletes, despite having more severe in-season concussions, displayed commensurate performance with matched control subjects by day 3 after concussion. Self-report of postconcussion symptoms by student athletes was not predictive of poor performance on neuropsychologic testing. CONCLUSIONS: Caution and systematic evaluation should be undertaken before returning athletes with concussion to competition. Sole reliance on the self-report of the athlete may be inadequate. Preliminary data may suggest a more protracted recovery from concussion in high school athletes.

PMID: 12756388 [PubMed - indexed for MEDLINE]

Am J Sports Med. 2003 Mar-Apr;31(2):168-73.
Relationship between postconcussion headache and neuropsychological test performance in high school athletes.
Collins MW, Field M, Lovell MR, Iverson G, Johnston KM, Maroon J, Fu FH.

Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15203, USA.

BACKGROUND: The relevance of headache to outcome after sports-related concussion is poorly understood. HYPOTHESES: High school athletes reporting headache approximately 1 week after injury will have significantly more other concussion symptoms and will perform more poorly on neuropsychological tests than athletes not experiencing headache. STUDY DESIGN: Prospective cohort study. METHODS: Study participants included 109 high school athletes who had sustained concussion and who were divided into two groups: those reporting headache 7 days after injury and those reporting no headaches. The two groups were compared regarding on-field markers of concussion severity at the time of injury and symptoms and neurocognitive test results collected via ImPACT, a computerized neuropsychological test battery and postconcussion symptom scale, at a mean of 6.8 days after injury. RESULTS: Athletes reporting posttraumatic headache demonstrated significantly worse performance on reaction time and memory ImPACT neurocognitive composite scores. These athletes also reported significantly more symptoms other than headache and were more likely to have demonstrated on-field anterograde amnesia. CONCLUSIONS: Findings suggest that any degree of postconcussion headache in high school athletes 7 days after injury is likely associated with an incomplete recovery after concussion. Copyright 2003 American Orthopaedic Society for Sports Medicine

PMID: 12642248 [PubMed - indexed for MEDLINE]

J Neurosurg. 2003 Feb;98(2):296-301.
Recovery from mild concussion in high school athletes.
Lovell MR, Collins MW, Iverson GL, Field M, Maroon JC, Cantu R, Podell K, Powell JW, Belza M, Fu FH.

Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. lovellmr@msx.upmc.edu

OBJECT: A computerized neuropsychological test battery was conducted to evaluate memory dysfunction and self-reporting of symptoms in a group of high school athletes who had suffered concussion. METHODS: Neuropsychological performance prior to and following concussion was compared with the test performance of an age-matched control group. Potentially important diagnostic markers of concussion severity are discussed and linked to recovery within the 1st week of injury. CONCLUSIONS: High school athletes who had suffered mild concussion demonstrated significant declines in memory processes relative to a noninjured control group. Statistically significant differences between preseason and postinjury memory test results were still evident in the concussion group at 4 and 7 days postinjury. Self-reported neurological symptoms such as headache, dizziness, and nausea resolved by Day 4. Duration of on-field mental status changes such as retrograde amnesia and posttraumatic confusion was related to the presence of memory impairment at 36 hours and 4 and 7 days postinjury and was also related to slower resolution of self-reported symptoms. The results of this study suggest that caution should be exercised in returning high school athletes to the playing field following concussion. On-field mental status changes appear to have prognostic utility and should be taken into account when making return-to-play decisions following concussion. Athletes who exhibit on-field mental status changes for more than 5 minutes have longer-lasting postconcussion symptoms and memory decline.

PMID: 12593614 [PubMed - indexed for MEDLINE]

Clin Neurosurg. 2002;49:319-32.
The evaluation of athletes with cerebral concussion.
Maroon JC, Field M, Lovell M, Collins M, Bost J.

Department of Neurological Surgery, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania, USA.

PMID: 12506561 [PubMed - indexed for MEDLINE]

Neurosurgery. 2002 Nov;51(5):1175-9; discussion 1180-1.

Cumulative effects of concussion in high school athletes.

Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M.

Department of Orthopaedic Surgery, Sports Medicine Concussion Program, University of Pittsburgh Medical Center, 3200 S. Water Street, Pittsburgh, PA 15203, USA. collinsmw@msx.upmc.edu

Comment in:

Neurosurgery. 2003 Jul;53(1):247; author reply 247-8.

OBJECTIVE: A common assumption in sports medicine is that a history of concussion is predictive of a lower threshold for, as well as a worse outcome after, subsequent concussive injury. The current study was conducted to investigate the relationship between concussion history in high school athletes and the on-field presentation of symptoms after subsequent concussion. METHODS: One hundred seventy-three athletes who experienced sports-related concussion composed the initial study group. Binary groups were subsequently created on the basis of concussion history. Sixty athletes with no concussion history were compared with 28 athletes with a history of three or more concussions. The groups were compared in terms of the on-field presentation of symptoms after an in-study concussion. Dependent variables included the postinjury presence of loss of consciousness, anterograde amnesia, retrograde amnesia, and confusion. RESULTS: Athletes with three or more prior concussions were more likely to experience on-field positive loss of consciousness (chi(2) = 8.0, P = 0.005), anterograde amnesia (chi(2) = 5.5, P = 0.019), and confusion (chi(2) = 5.1, P = 0.024) after a subsequent cerebral concussion. An odds ratio revealed that athletes with a history of three concussions were 9.3 times more likely than athletes with no history of concussion to demonstrate three to four abnormal on-field markers of concussion severity. CONCLUSION: This study is the first to suggest a cumulative effect of concussion in high school athletes. A more severe on-field presentation of concussion markers is evidenced in high school athletes with a pronounced history of concussion. This study’s findings highlight the need for more long-term outcome studies in high school athletes who sustain sports-related concussions.

PMID: 12383362 [PubMed - indexed for MEDLINE]

Neurosurgery. 2002 Nov;51(5 Suppl):S137-45.
Current concepts in minimally invasive discectomy.
Maroon JC.

Department of Neurological Surgery, University of Pittsburgh Medical Center, Presbyterian-University Hospital, Pittsburgh, Pennsylvania 15213, USA. maroonjc@msx.upmc.edu

OBJECTIVE: The purpose of this study was to evaluate the various minimally invasive procedures available for the treatment of lumbar disc disease. METHODS: A review of the literature, as well as my personal experience with minimally invasive approaches to the lumbar discs, was performed. This review included the percutaneous and open surgical approaches currently available and used for the treatment of lumbar disc disease. RESULTS: The primary minimally invasive procedures for the treatment of lumbar disc disease include the following: 1) chemonucleolysis, introduced by Lyman Smith in 1964; 2) percutaneous manual nucleotomy, introduced by Hijikata in 1975; 3) microdiscectomy, first performed by Yaşargil in 1968; 4) automated percutaneous lumbar discectomy, introduced by Onik in 1984; 5) laser discectomy, first performed by Ascher and Choy in 1987; 6) endoscopic discectomy, first used by Schreiber and Suezawa in 1986 and improved by Mayer, Brock, and Mathews; 7) microendoscopic discectomy, introduced by Smith and Foley in 1995; and intradiscal electrothermy, first reported by Saal and Saal in 2000. CONCLUSION: Although all percutaneous techniques have been reported to yield high success rates, to date no studies have demonstrated any of these to be superior to microsurgical discectomy, which continues to be regarded as the standard with which all other techniques must be compared.

PMID: 12234441 [PubMed - indexed for MEDLINE]

Neurosurgery. 2002 May;50(5):1129-31; discussion 1131-2.
Visual field deficit caused by vascular compression from a suprasellar meningioma: case report.
Bejjani GK, Cockerham KP, Kennerdell JS, Maroon JC.

Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. bejjanigk@msx.upmc.edu

OBJECTIVE AND IMPORTANCE: Suprasellar meningiomas typically cause bitemporal hemianopsia by direct compression of the chiasm, its blood supply, or both. We report another mechanism for visual loss in suprasellar meningiomas, whereby compression by the suprajacent vascular complex is the offending agent. CLINICAL PRESENTATION: A 78-year-old woman with a suprasellar meningioma was diagnosed incidentally. During the follow-up period, she developed an inferior homonymous wedge defect consistent with superior compression, without any detectable radiological progression. It was decided to resect her tumor. INTERVENTION: The patient underwent a fronto-orbital approach for tumoral excision. Intraoperatively, a groove by the anterior cerebral artery complex was found along the superior surface of the chiasm. Postoperatively, the patient’s visual deficit resolved. CONCLUSION: This case illustrates an unusual visual field deficit associated with a suprasellar meningioma. It also emphasizes the importance of frequent and careful visual field monitoring, which can precede radiological and symptomatic progression.

PMID: 11950417 [PubMed - indexed for MEDLINE]

J.C. Maroon, et al: Surgical approaches to the orbit. J Neurosurg 60: 1226-1235, 1984.

JOSEPH C. MAROON, M.D., AND JOHN S. KENNERDELL, M.D.

The authors review their experience with over 300 patients with orbital tumors, and summarize their surgical techniques and indications for each surgical approach. A fronto-orbital approach is described which is used for tumors with intracranial extension and for those located in the orbital apex and deep medial orbital compartment. Lateral micro-orbitotomy is used for tumors located in the superior, temporal, or inferior compartment of the orbit and those in the lateral apex. A medial microsurgical approach is used for tumors located medial to the optic nerve but not deep in the apex. By thus approaching tumors directly, optimal exposure is obtained and functional deficits are minimized. The pertinent surgical anatomy is illustrated and the technique of fine-needle aspiration biopsy is discussed. (J Neurosurg 60: 1226-1235, 1984)

J.C.Maroon, et al: Recurrent spheno-orbital meningioma. J Neurosurg 80: 202-208, 1994.

JOSEPH C. MAROON, M.D.9 JOHN S. KENNERDELI,G M.D.9 DANKO V. VIDOVICH M.D., ADNAN ABLA, M.D., AND LINDA STERNAU, M.D.

A series of 15 patients who underwent neurosurgical procedures for recurrent spheno-orbital meningioma is reported. There were I I women and four men, with a mean age of 46 years. The mean duration between the first and second operations was 46 months. Progressive proptosis without neurological deficit was the most common symptom. All tumors were large at the time of reoperation and involved the greater and lesser wings of the sphenoid bone and the orbit. Aggressive resection in all patients resulted in no deaths and only slight morbidity, with the exception of one patient who developed blindness 24 hours after surgery due to central retinal artery occlusion. Fourteen patients were improved cosmetically and one patient, treated early in the series, had persistent proptosis due to inadequate bone removal. No attempt was made to remove tumor within the cavernous sinus in patients who were neurologically normal. Although postoperative imaging demonstrated complete gross excision of tumor in nine patients, 10 underwent conventional radiation therapy for residual tumor visualized at the time of surgery in the dura of the superior orbital fissure, the cavernous sinus, or the basal optic canal. Although this study is inconclusive and requires further long-term documentation, no recurrences have been seen to date in the follow-up period, ranging from 16 to 95 months. The following important points are discussed: 1)the failure by experienced surgeons to radically excise bone, tumor, and involved dura at the first operation. 2)the importance of early aggressive therapy, depending upon the patient’s age and medical condition; 3) the almost invariable intracranial dural involvement, which at times was seen only by gadolinium-enhanced magnetic resonance imaging and not visualized on computerized tomography; 4) an illustrated stepwise surgical technique for complete resection through a small craniotomy without the need for complicated reconstruction of the orbit or temporal fossa; 5) the role of radiation therapy when removal is incomplete or deemed hazardous because of cavernous sinus involvement; and 6) the excellent cosmetic results possible with minimal morbidity and no mortality. (J Neurosurg 80: 202-208, 1994)

J.C.Maroon, et al: Cryosurgery re-visited for the removal and destruction of brain, spinal and orbital tumors. Neurological Research 14: 294-302, 1992.

Advances in neuroimaging and cryosurgical techniques have prompted us to re-evaluate the potential of cryosurgical techniques for the removal and the destruction of various neoplasms. We have used cryosurgical instrumentation to remove tumors in the brain, spine and orbit in 71 patients without complications. Cryosurgery was used to facilitate removal and extraction in 64 and to destroy residual neoplasms when removal was incomplete in 7. lntraoperative real time ultrasonic imaging permitted precise delimitation of tumors from surrounding tissues and allowed monitoring during the production of cryosurgical lesions thus permitting heretofore unavailable visualization of the production of cryogenic lesions in the central nervous system. New cryosurgical instrumentation was used to produce lesions up to three times larger than similar sized probes previously available. Our results reconfirm that cryosurgery facilitates the removal of tumors in the brain, spinal cord and orbit, reduces blood loss in vascular tumors, and is effective in ablating residual neoplasms involving the superior saggital sinus, torcula and parasaggital areas. A Doppler flowmeter proved useful for monitoring saggital sinus blood flow during the production of cryosurgical ablation of residual tumor attached to the walls of the saggital sinus. Recent advances in ultrasonic and neuroimaging coupled with stereotactic techniques and improvements in cryosurgical instrumentation may prove useful in the future percutaneous destruction of selective intracranial neoplasms. [Neurol Res 1992; 14: 294-302]

John S. Kennerdell, et al: Use of the Carbon Dioxide Laser in the Management of Orbital Plexiform Neurofibromas. Ophthalmic Surgery Vol 21, No. 2: 138-140, 1990.

John S. Kennerdell, MD, Joseph C. Maroon, MD

ABSTRACT We present one of three cases in which we have used the carbon dioxide laser to successfully perform subtotal surgical removal of plexiform neurofibromas of the lid and orbit. (Ophthalmic Surgery Vol 21, No. 2: 138-140, 1990)