Publications by authors named "Ali Elhag"

Introduction: Dexamethasone is routinely prescribed for the management of peritumoral edema in brain tumor patients. Despite available orientations for its management in neuro-oncology patients, the individual needs according to the natural history of the disease and treatment options allied to a hierarchical system with multiple teams involved poses significant challenges in its real-world application.

Methods: We conducted a retrospective single-centre observational study of 316 brain tumor referrals to a tertiary neurosurgical center over a 3-month period.

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Onco-functional balance during motor-eloquent diffuse glioma resection is challenging. This balance is personal according to individual background, treatment expectations and surgical experience. Nevertheless, preservation of muscle contraction in isolation is no longer an accepted outcome.

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Background: The tubular retractor-assisted minimally invasive parafascicular approach (trMIPS) is a transsulcal approach to deep-seated brain tumours. It is a safe surgical approach but its impact on the microvascular dynamics of the retracted cortex and its clinical implications are unknown.

Methods: This was a single-centre prospective study including patients with deep-seated brain tumours operated on with a trMIPS (BrainPath Nico System).

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Intracranial dermoid cysts are benign lesions that may be diagnosed incidentally or present symptomatically due to mass effect-focal neurological deficits, seizures and/or hydrocephalus-or chemical meningitis secondary to spontaneous rupture. The use of tubular retractors in minimally invasive parafascicular surgery (tsMIPS) has been described extensively as a technique to preserve neurological function whilst safely maximizing the extent of resection. The authors present the first use of the tsMIPS approach for removal of a dermoid cyst in a 68-year-old female who presented with abulia and seizures due to a large Sylvian fissure dermoid cyst.

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Background: Supratentorial function-eloquent brain tumour surgeries challenge the balance between maximal tumour resection and preservation of neurological function. This study aims to evaluate the efficacy of preoperative and intraoperative mapping techniques on resection outcomes and post-operative deficits.

Methods: This systematic review and meta-analysis examined literature up to March 2023, sourced from PubMed, Embase, and Medline.

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Minimally invasive parafascicular surgery (MIPS) with the use of tubular retractors achieve a safe resection in deep seated tumours. Diffusion changes noted on postoperative imaging; the significance and clinical correlation of this remains poorly understood. Single centre retrospective cohort study of neuro-oncology patients undergoing MIPS.

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Background/objectives: 5-aminulevulinic acid (5-ALA)-guided surgery for high-grade gliomas remains a challenge in neuro-oncological surgery. Inconsistent fluorescence visualisation, subjective quantification and false negatives due to blood, haemostatic agents or optical impediments from the external light source are some of the limitations of the present technology.

Methods: The preliminary results from this single-centre retrospective study are presented from the first 35 patients operated upon with the novel Nico Myriad Spectra System©.

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Transcranial Magnetic Stimulation-Electroencephalography (TMS-EEG) is a non-operative technique that allows for magnetic cortical stimulation (TMS) and analysis of the electrical currents generated in the brain (EEG). Despite the regular utilization of both techniques independently, little is known about the potential impact of their combination in neurosurgical practice. This scoping review, conducted following PRISMA guidelines, focused on TMS-EEG in epilepsy, neuro-oncology, and general neurosurgery.

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Trans-sulcal minimally invasive parafascicular surgery is an emerging technique to approach deep lesions with minimal brain retraction. Localization of the tubular retractor during surgery is critical, and intraoperative magnetic resonance imaging and neuronavigation present limitations. We describe the intraoperative use of O-Arm® coupled with pre-operative tractography to precisely localize the tubular retractor.

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Article Synopsis
  • Deep brain stimulation (DBS) is a surgical method for treating neurological disorders but can lead to surgical site infections (SSIs) as a complication, prompting a study on antibiotic-impregnated envelopes (AIEs) to reduce infection rates.
  • A retrospective analysis from January 2017 to May 2024 included 178 patients, showing significantly lower infection rates (1.7% with AIE vs. 5% without AIE) and a 2.9 times higher infection risk without AIE.
  • The findings suggest that AIEs not only reduced SSIs in both initial and replacement procedures but also resulted in considerable cost savings, highlighting their effectiveness in DBS surgeries.
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Article Synopsis
  • The study examines the necessity of routine postoperative CT scans after elective cranial surgeries, revealing that they may not be essential for all patients.
  • The analysis of 236 patients who underwent brain biopsy surgery over four years showed that most had CT scans, but these scans did not significantly correlate with neurological outcomes or changes in management.
  • The findings suggest that routine CT scans increase hospital stay durations without providing substantial benefits, indicating that they should only be performed when clinical signs of complications are present.
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Cranial suture diastases are an uncommon clinical entity, with post craniotomy diastases being a previously undescribed finding in literature to our best knowledge. Herein, we report a case of a 28-year-old adult who underwent a second-stage low-grade glioma surgery 7 months after initial surgery. This study presents coronal suture diastases adjacent to the previously performed craniotomy.

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