Lucia Zamorano, MD, PLC

Brain & Spine Surgery

MICHIGAN BRAIN & SPINE

SURGERY CENTER

Surgical resection improves outcome of LGG brain tumors

chiari-malformationEarly and aggressive resection of low-grade gliomas (LGGs) leads to increased overall patient survival, decreased malignant progression, and better seizure control. This case series describes the authors’ approach to achieving optimal neurological and surgical outcomes in patients referred by outside neurosurgeons for stereotactic biopsy of tumors believed to be complex or a high surgical risk, due to their diffuse nature on neuroimaging and their obvious infiltration of functional cortex.

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Advanced Breast Cancer in Young American Women: On the Rise?

breast-cancerIn the past 30 years, there has been a small but significant increase in the incidence of advanced breast cancer in American women 25 to 39 years of age, according to a study published in the February 27 issue of JAMA.

During the same period, there was no increase in advanced disease in older women, according to the researchers, led by Rebecca H. Johnson, MD, from the Seattle Children’s Hospital and the University of Washington.

In the young women, the incidence of breast cancer with distant involvement at diagnosis increased from 1.53 per 100,000 women in 1976 to 2.90 per 100,000 women in 2009. This is an absolute difference of 1.37 per 100,000, and is an average compounded increase of 2.07% per year (P < .001) over a 34-year interval.

The findings come from an analysis of incidence trends from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database.

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White Matter Hyperintensities Linked to Alzheimer’s Disease

chiari-malformationA new study adds to a growing body of evidence pointing to small-vessel cerebrovascular disease as an important contributor to Alzheimer’s disease (AD).

The study shows that increased total white matter hyperintensities (WMHs) as seen on MRI independently predicted AD diagnosis, as did the brain amyloid tracer Pittsburgh compound B (PIB) measured by positron emission tomography (PET).

This finding suggests that although amyloidosis is necessary for a diagnosis of AD, it may not be sufficient to cause dementia and that WMH may represent another important pathogenetic factor that contributes to dementia.

“This study, along with a whole line of research that is coming out right now, is clearly highlighting the importance of vascular disease in Alzheimer’s disease,” said author Adam M. Brickman, PhD, assistant professor of neuropsychology at Columbia University, New York.

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New Ischemic Stroke Guidelines

guidelinesIschemic Stroke Guidelines released at the end of January 2013.

These guidelines were put together by an expert panel and touch on many aspects of acute stroke care, with a focus on ischemic stroke. The guidelines include dozens of recommendations. I am not going to talk about all of them today, but I would like to highlight some that are particularly important to treating clinicians.

First, the guidelines come out very strongly in favor of transporting patients with acute stroke to the nearest primary or comprehensive stroke center. This is a great idea because we know from numerous studies and analyses that care at these certified stroke centers really does make a difference in terms of improving outcomes and reducing complications. That is a very strong positive recommendation. In addition, the guidelines now say that these stroke centers should be certified by an independent body or agency, so we are moving away from the paradigm of self-certification [toward independent, objective certification], which is also a positive move.

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Neurostimulation Benefits Early Parkinson’s Disease

neuroSubthalamic nucleus deep brain stimulation (DBS) offers benefits earlier in the course of Parkinson’s disease (PD), before the appearance of severe disabling motor complications, according to results of a randomized controlled trial.

In a group of patients with relatively mild early motor complications of PD, subthalamic stimulation plus medical therapy was superior to medical therapy alone on several key measures of quality of life and motor function.

Results of the Controlled Trial of Deep Brain Stimulation in Early Patients with Parkinson’s Disease (EARLYSTIM) were published February 14 in the New England Journal of Medicine.

“The result of our study is that a new group of patients can do better with neurostimulation than with medication,” study investigator Gunther Deuschl, MD, from Christian Albrechts University in Kiel, Germany, told Medscape Medical News.… [Continue Reading]

Exercise Decreases Diabetic Neuropathic Pain

ExerciseRegular exercise reduces the development of painful diabetic neuropathy in animals—apparently related to increased expression of a protective substance called “heat shock protein” 72 (Hsp72), reports an experimental study in the February issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

The observations add to previous studies suggesting that “progressive exercise training markedly decreased diabetes associated neuropathic pain,” write Yu-Wen Chen, PhD, of China Medical University, Taichung, Taiwan, and colleagues. The link to Hsp72 offers a clue as to how exercise can prevent or slow the development of neuropathy—a major complication of diabetes.

Exercise Reduces Diabetic Nerve Pain in Rats
Neuropathic pain is a common and difficult-to-treat type of pain related to nerve damage—most commonly caused by diabetes. Affecting about half of patients with diabetes, diabetic neuropathy causes symptoms such as numbness, tingling, or pain in the arms and legs.… [Continue Reading]

Alzheimer’s Disease Cases May Triple by 2050

alzheimer_diseaseThe number of people with Alzheimer’s disease is expected to triple in the next 40 years, according to a new study published in the February 6, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“This increase is due to an aging baby boom generation. It will place a huge burden on society, disabling more people who develop the disease, challenging their caregivers, and straining medical and social safety nets,” said co-author Jennifer Weuve, MPH, ScD, assistant professor of medicine, Rush Institute for Healthy Aging at Rush University Medical Center in Chicago. “Our study draws attention to an urgent need for more research, treatments and preventive strategies to reduce this epidemic.”

For the study, researchers analyzed information from 10,802 African-American and Caucasian people living in Chicago, ages 65 and older, between 1993 and 2011. Participants were interviewed and assessed for dementia every three years. Age, race and level of education were factored into the research.… [Continue Reading]

New Endoscopic Spine Surgery in Michigan

New endoscopic spine surgery in Michigan for disc herniation and/or spinal stenosis.

Dr Zamorano and her team are the first and only performing this technique in MI.

endoscopic-spine-surgery-dr-zamorano

Dr. Zamorano performing transforaminal endoscopic discectomy and foraminotomy.

The Michigan Brain and Spine Surgery Center is the first and only practice in Michigan offering the transforaminal endoscopic approach for discetomy and foraminotomy. This minimally invasive technique is an excellent option for patients with disc herniations and/or spinal stenosis.

The procedure is done quite differently from traditional spine surgery. A small incision is made in the side of the patient, and the entire procedure is performed through a small scope. Most of the original disc is preserved and only the damaged portions of the disc are removed.

This technique has been performed in Europe for nearly a decade and has finally arrived in Michigan. The surgery can be performed on patients with prior spine surgery that have a recurrence of disc herniation, far lateral discs, extruded discs, and spinal stenosis.

Thanks to the combination of a growing body of endoscopic knowledge of the anatomy of the intra- and extraforaminal areas, the radiological determination of orientation points for the working zone around the dorsolateral area of the anulus by Kambin and the availability of smaller endoscopes, lateral access became possible. Different types of lateral access have been described by Anthony Yeung, Thomas Hoogland and Sang Ho Lee, et al. The TESSYS® method and joimax® technology combines the access methods and techniques applied by multiple users, as published in numerous articles, and has been applied successfully in thousands of procedures.… [Continue Reading]

MRI Improves Long-Term Outcome Prediction for Patients With Mild Traumatic Brain Injury

brain-mri-partTwenty-seven percent of mTBI patients with a normal CT scan showed evidence of abnormalities on brain MRI.

MRI may be better than CT scans at predicting whether patients with mild traumatic brain injuries (mTBI) are likely to have persistent neurologic problems, according to the results of a clinical trial published in the December 2012 Annals of Neurology.

Approximately 15% of patients with mTBI have measurable neurologic deficits at one year after injury, but clinicians have no definitive method of predicting patient outcomes.… [Continue Reading]

Deep Brain Stimulation a hope for Alzheimer

Deep Brain Stimulation a hope for Alzheimer‘Brain pacemakers’ trialled as way of staving off memory loss from Alzheimer’s disease

IT HAS the makings of a science fiction movie: Zap someone’s brain with mild jolts of electricity to try to stave off the creeping memory loss of Alzheimer’s disease.

And it’s not easy. Holes are drilled into the patient’s skull so tiny wires can be implanted into just the right spot.

A dramatic shift is beginning in the disappointing struggle to find something to slow the damage of this epidemic: The first US experiments with “brain pacemakers” for Alzheimer’s are getting under way. Scientists are looking beyond drugs to implants in the hunt for much-needed new treatments.… [Continue Reading]

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