Aria Fallah - Academia.edu (original) (raw)
Papers by Aria Fallah
Journal of neurosurgery. Pediatrics, Jan 30, 2015
OBJECT Combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) h... more OBJECT Combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has been shown to improve the success rate compared with ETV alone in infants (less than 24 months) with hydrocephalus who were treated in developing countries. The authors sought to evaluate the safety and efficacy of this procedure, using a rigid neuroendoscope, in a single North American center, and to assess whether the ETV success score (ETVSS), the CURE Children's Hospital of Uganda ETVSS (CCHU ETVSS), and other pre- and intraoperative variables could predict success. METHODS The authors performed a retrospective review of consecutive ETV/CPC procedures performed using a rigid neuroendoscope to treat infantile hydrocephalus. The infants underwent the procedure at Miami Children's Hospital between January 2007 and 2014, with at least one postoperative follow-up. Duration of follow-up or time to failure of ETV/CPC, the primary outcome measure, was documented. A repeat CSF dive...
Neurosurgery, Jan 18, 2015
The evidence supporting the efficacy and safety of cerebral aqueductoplasty (CA) is limited to sm... more The evidence supporting the efficacy and safety of cerebral aqueductoplasty (CA) is limited to small surgical series. To perform an individual participant data meta-analysis to determine the efficacy and safety of CA and to determine the effect of patient's age, pathogenesis, surgical approach, and use of stent on success. Electronic databases (MEDLINE, EMBASE, and CINAHL) were searched with no language or date restrictions to identify cohort studies of consecutive participants undergoing CA (without concomitant endoscopic third ventriculostomy or cerebrospinal fluid [CSF] shunt) that reported outcome. Outcome was defined as the time elapsed from the index operation until a second procedure was performed for CSF diversion. Of 146 citations, 14 articles reporting on 137 participants were eligible. One hundred three participants (75%) did not require a second CSF diversion procedure. The mean duration until repeat CSF diversion procedure was 121.6 months (95% confidence interval [...
Journal of neurosurgery. Pediatrics, Jan 4, 2015
OBJECT Pediatric brain tumors may be associated with medically intractable epilepsy for which sur... more OBJECT Pediatric brain tumors may be associated with medically intractable epilepsy for which surgery is indicated. The authors sought to evaluate the efficacy of epilepsy surgery for seizure control in pediatric patients with brain tumors. METHODS The authors performed a retrospective review of consecutive patients undergoing resective epilepsy surgery related to pediatric brain tumors at Miami Children's Hospital between June 1986 and June 2014. Time-to-event analysis for seizure recurrence was performed; an "event" was defined as any seizures that occurred following resective epilepsy surgery, not including seizures and auras in the 1st postoperative week. The authors analyzed several preoperative variables to determine their suitability to predict seizure recurrence following surgery. RESULTS Eighty-four patients (47 males) with a mean age (± standard deviation) of 8.7 ± 5.5 years (range 0.5-21.6 years) were included. The study included 39 (46%) patients with gliom...
Neurosurgery, Jan 26, 2015
There are no established variables that predict the success of curative resective epilepsy surger... more There are no established variables that predict the success of curative resective epilepsy surgery in children with tuberous sclerosis complex (TSC). We performed a multicenter observational study to identify preoperative factors associated with seizure outcome in children with TSC undergoing resective epilepsy surgery. A retrospective chart review was performed in eligible children at New York Medical Center, Miami Children's Hospital, Cleveland Clinic Foundation, BC Children's Hospital, Hospital for Sick Children, and Sainte-Justine Hospital between January 2005 and December 2013. A time-to-event analysis was performed. The "event" was defined as seizures after resective epilepsy surgery. Seventy-four patients (41 male) were included. The median age of the patients at the time of surgery was 120 months (range, 3-216 months). The median time to seizure recurrence was 24.0 ± 12.7 months. Engel Class I outcome was achieved in 48 (65%) and 37 (50%) patients at 1- and...
Journal of neurosurgery. Pediatrics, Jan 22, 2015
Sickle cell disease (SCD) is an autosomal recessive hematological disorder, characterized by sick... more Sickle cell disease (SCD) is an autosomal recessive hematological disorder, characterized by sickling of the red blood cells in response to a hypoxic stress and vaso-occlusive crises. It is associated with moyamoya-like changes on cerebral angiographic imaging in 43% of patients. Cerebral aneurysms, arteriovenous malformations, and dural arteriovenous fistulas (AVFs) have been described in association with SCD and moyamoya disease. However, the description of a pial AVF (pAVF) in a patient with SCD and/or moyamoya formation has not yet been reported. The authors present the case of a 15-year-old boy with SCD-associated moyamoya disease harboring a pAVF who developed a de novo venous aneurysm 8 months after undergoing indirect superficial temporal artery-middle cerebral artery (MCA) bypass that was complicated by bilateral ischemia of the MCA territory. The pAVF was successfully treated with transarterial embolization using Onyx. The authors describe the possible pathophysiological m...
Canadian journal of surgery. Journal canadien de chirurgie, 2009
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 2010
A 53-year-old woman presented with progressive bilateral leg weakness that was managed conservati... more A 53-year-old woman presented with progressive bilateral leg weakness that was managed conservatively over the past eight years. The patient had no history of trauma. The physical examination revealed severe gait impairment, a dense spastic paraparesis, pyramidal distribution weakness, positive Babinski signs bilaterally and hyperreflexia in the lower limbs. The patient had preserved proprioception and sensation in the lower limbs. Magnetic resonance imaging of the spine revealed a congenital ventrally displaced spinal cord with focal herniation through the dura at the T4-T5 level ( ). This corresponded to a type K spinal cord herniation which is characterized by kinking. 1 The thoracic myelopathy was likely due to cord tethering and ischemia. The patient underwent a T4-T5 laminectomy with a left T5 transpedicular approach for an intra/extra-dural microscopic repair of the defect. Intraoperatively, there was ventral kinking of the spinal cord with a complex anterior herniation through a dural defect of gliotic tissue which was also tethered anteriorly to the posterior longitudinal ligament. To allow de-tethering of the spinal cord, the dura was ventrally marsupialized using a wide opening, as a primary dural repair was not deemed to be feasible. At six month postoperative follow-up, the patient had shown clinical signs of neurological improvement with reduced lower limb spasticity and improved gait.
Canadian journal of surgery. Journal canadien de chirurgie, 2010
Tumefactive demyelinating lesions: a diagnostic challenge T umefactive demyelinating lesion (TDL)... more Tumefactive demyelinating lesions: a diagnostic challenge T umefactive demyelinating lesion (TDL) is defined as a solitary demyelin ating lesion greater than 2 cm. Mass effect and contrast enhancement on neuroimaging make it difficult to distinguish this type of lesion from high-grade gliomas. 1,2 Multiple sclerosis (MS) accounts for most cases of TDL. 3 Even in patients with established MS, an atypical manifestation of a large lesion can suggest concurrent neoplasm, because the clinical manifestations are often similar. 1,4 When examined on magnetic resonance imaging (MRI) scans, TDLs have ill-defined borders, mass effect, perilesional edema, central necrosis, cystic degeneration, contrast enhancement and variable involvement of grey matter. 4 Unless specifically requested, pathological examin ation does not routinely include luxol fast blue staining, which can be used to detect demyelination. The presence of hypercellularity, atypical reactive astrocytes and mitotic figures can lead to an incorrect diagnosis of glial neoplasm. We present 3 cases of tumefactive demyelinating lesions that were clinically and radiologically challenging to distinguish from high-grade neoplasm.
Canadian journal of surgery. Journal canadien de chirurgie, 2008
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 2010
Surgical activity is probably the most important component of surgical training. During the first... more Surgical activity is probably the most important component of surgical training. During the first year of surgical residency, there is an early opportunity for the development of surgical skills, before disparities between the skill sets of residents increase in future years. It is likely that surgical skill is related to operative volumes. There are no published guidelines that quantify the number of surgical cases required to achieve surgical competency. The aim of this study was to describe the current trends in surgical activity in a recent cohort of first-year Canadian neurosurgical trainees. This study utilized retrospective database review and survey methodology to describe the current state of surgical training for first-year neurosurgical trainees. A committee of five residents designed this survey in an effort to capture factors that may influence the operative activity of trainees. Nine out of a cohort of 20 first-year Canadian neurosurgical trainees that began training i...
The Canadian Journal of Neurological Sciences, 2013
Canadian journal of surgery. Journal canadien de chirurgie, 2009
The Canadian Journal of Neurological Sciences, 2010
Specialization is generally independently associated with improved outcomes for most types of sur... more Specialization is generally independently associated with improved outcomes for most types of surgery. This is the first study comparing the immediate success of outpatient lumbar microdiscectomy with respect to acute complication and conversion to inpatient rate. Long-term pain relief is not examined in this study. Two separate prospective databases (one belonging to a neurosurgeon and brain tumor specialist, not specializing in spine (NS) and one belonging to four spine surgeons (SS)) were retrospectively reviewed. All acute complications as well as admission data of patients scheduled for outpatient lumbar microdiscectomy were extracted. In total, 269 patients were in the NS group and 137 patients were in the SS group. The NS group averaged 24 cases per year while the SS group averaged 50 cases per year. Chi-square tests revealed no difference in acute complication rate [NS (6.7%), SS (7.3%)] (p > 0.5) and admission rate [NS (4.1%), SS (5.8%)] (p = 0.4) while the SS group had a significantly higher proportion of patients undergoing repeat microdiscectomy [NS (4.1%), SS (37.2%)] (p < 0.0001). Excluding revision operations, there was no statistically significant difference in acute complication [NS (5.4%), SS (1.2%)] (p = 0.09) and conversion to inpatient [NS (4.3%), SS (4.6%)] (p > 0.5) rate. The combined acute complication and conversion to inpatient rate was 6.9% and 4.7% respectively. Based on this limited study, outpatient lumbar microdiscectomy can be apparently performed safely with similar immediate complication rates by both non-spine specialized neurosurgeons and spine surgeons, even though the trend favored the latter group for both outcome measures.
Epilepsy Research and Treatment, 2012
Temporal lobe epilepsy (TLE) is the most common form of adult epilepsy that is amenable to surgic... more Temporal lobe epilepsy (TLE) is the most common form of adult epilepsy that is amenable to surgical treatment. In the carefully selected patient, excellent seizure outcome can be achieved with minimal or no side effects from surgery. This may result in improved psychosocial functioning, achieving higher education, and maintaining or gaining employment. The objective of this paper is to discuss the surgical selection process of a patient with TLE. We define what constitutes a patient that has medically refractory TLE, describe the typical history and physical examination, and distinguish between mesial TLE and neocortical TLE. We then review the role of routine (ambulatory/sleep-deprived electroencephalography (EEG), video EEG, magnetic resonance imaging (MRI), neuropsychological testing, and Wada testing) and ancillary preoperative testing (positron emission tomography, single-photon emission computed tomography (SPECT), subtraction ictal SPECT correlated to MRI (SISCOM), magnetoencephalography, magnetic resonance spectroscopy, and functional MRI) in selecting surgical candidates. We describe the surgical options for resective epilepsy surgery in TLE and its commonly associated risks while highlighting some of the controversies. Lastly, we present teaching cases to illustrate the presurgical workup of patients with medically refractory TLE.
Journal of Neurosurgery: Spine, 2007
Journal of Neurosurgery: Spine, 2010
Journal of Clinical Neuroscience, 2012
Ewing&amp... more Ewing's sarcoma (ES) is a part of a larger family of round blue cell tumors, which occasionally manifest as osseous or extraosseous lesions adjacent to or within the central nervous system (CNS). While a large body of literature exists on ES of bone, data are lacking on tumors with cranial or spinal components that affect the CNS. Here, we perform a systematic review of the literature and summarize the best available evidence on diagnosis, treatment and outcomes of ES affecting the CNS with emphasis on the breadth of clinical presentations, diagnostic tools and emerging management options for these rare and challenging lesions. We include a review of known prognostic factors and propose several new considerations for prognostication of ES affecting the CNS.
Journal of Clinical Neuroscience, 2013
Epilepsy & Behavior, 2011
The widespread inclusion of surgical strategies in the treatment of medically intractable epileps... more The widespread inclusion of surgical strategies in the treatment of medically intractable epilepsy is largely justified by the medical and psychosocial burden of the illness. Performing these procedures in pediatric populations is associated with distinct challenges ranging from unique seizure etiologies to issues surrounding brain development and functional plasticity. As the trend toward more aggressive surgical intervention continues, the ethical foundation of current and emerging practices must be increasingly scrutinized. Here, we present the first article discussing ethical issues in the surgical management of medically intractable epilepsies in children. We discuss principles of informed consent, harm reduction, and justice in this vulnerable patient population. We also highlight the unique ethical challenge of surgical decision making concerning developmentally delayed children. The recognition of these issues is essential to providing patient-centered, responsible, and ethical care.
Journal of neurosurgery. Pediatrics, Jan 30, 2015
OBJECT Combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) h... more OBJECT Combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has been shown to improve the success rate compared with ETV alone in infants (less than 24 months) with hydrocephalus who were treated in developing countries. The authors sought to evaluate the safety and efficacy of this procedure, using a rigid neuroendoscope, in a single North American center, and to assess whether the ETV success score (ETVSS), the CURE Children's Hospital of Uganda ETVSS (CCHU ETVSS), and other pre- and intraoperative variables could predict success. METHODS The authors performed a retrospective review of consecutive ETV/CPC procedures performed using a rigid neuroendoscope to treat infantile hydrocephalus. The infants underwent the procedure at Miami Children's Hospital between January 2007 and 2014, with at least one postoperative follow-up. Duration of follow-up or time to failure of ETV/CPC, the primary outcome measure, was documented. A repeat CSF dive...
Neurosurgery, Jan 18, 2015
The evidence supporting the efficacy and safety of cerebral aqueductoplasty (CA) is limited to sm... more The evidence supporting the efficacy and safety of cerebral aqueductoplasty (CA) is limited to small surgical series. To perform an individual participant data meta-analysis to determine the efficacy and safety of CA and to determine the effect of patient's age, pathogenesis, surgical approach, and use of stent on success. Electronic databases (MEDLINE, EMBASE, and CINAHL) were searched with no language or date restrictions to identify cohort studies of consecutive participants undergoing CA (without concomitant endoscopic third ventriculostomy or cerebrospinal fluid [CSF] shunt) that reported outcome. Outcome was defined as the time elapsed from the index operation until a second procedure was performed for CSF diversion. Of 146 citations, 14 articles reporting on 137 participants were eligible. One hundred three participants (75%) did not require a second CSF diversion procedure. The mean duration until repeat CSF diversion procedure was 121.6 months (95% confidence interval [...
Journal of neurosurgery. Pediatrics, Jan 4, 2015
OBJECT Pediatric brain tumors may be associated with medically intractable epilepsy for which sur... more OBJECT Pediatric brain tumors may be associated with medically intractable epilepsy for which surgery is indicated. The authors sought to evaluate the efficacy of epilepsy surgery for seizure control in pediatric patients with brain tumors. METHODS The authors performed a retrospective review of consecutive patients undergoing resective epilepsy surgery related to pediatric brain tumors at Miami Children's Hospital between June 1986 and June 2014. Time-to-event analysis for seizure recurrence was performed; an "event" was defined as any seizures that occurred following resective epilepsy surgery, not including seizures and auras in the 1st postoperative week. The authors analyzed several preoperative variables to determine their suitability to predict seizure recurrence following surgery. RESULTS Eighty-four patients (47 males) with a mean age (± standard deviation) of 8.7 ± 5.5 years (range 0.5-21.6 years) were included. The study included 39 (46%) patients with gliom...
Neurosurgery, Jan 26, 2015
There are no established variables that predict the success of curative resective epilepsy surger... more There are no established variables that predict the success of curative resective epilepsy surgery in children with tuberous sclerosis complex (TSC). We performed a multicenter observational study to identify preoperative factors associated with seizure outcome in children with TSC undergoing resective epilepsy surgery. A retrospective chart review was performed in eligible children at New York Medical Center, Miami Children's Hospital, Cleveland Clinic Foundation, BC Children's Hospital, Hospital for Sick Children, and Sainte-Justine Hospital between January 2005 and December 2013. A time-to-event analysis was performed. The "event" was defined as seizures after resective epilepsy surgery. Seventy-four patients (41 male) were included. The median age of the patients at the time of surgery was 120 months (range, 3-216 months). The median time to seizure recurrence was 24.0 ± 12.7 months. Engel Class I outcome was achieved in 48 (65%) and 37 (50%) patients at 1- and...
Journal of neurosurgery. Pediatrics, Jan 22, 2015
Sickle cell disease (SCD) is an autosomal recessive hematological disorder, characterized by sick... more Sickle cell disease (SCD) is an autosomal recessive hematological disorder, characterized by sickling of the red blood cells in response to a hypoxic stress and vaso-occlusive crises. It is associated with moyamoya-like changes on cerebral angiographic imaging in 43% of patients. Cerebral aneurysms, arteriovenous malformations, and dural arteriovenous fistulas (AVFs) have been described in association with SCD and moyamoya disease. However, the description of a pial AVF (pAVF) in a patient with SCD and/or moyamoya formation has not yet been reported. The authors present the case of a 15-year-old boy with SCD-associated moyamoya disease harboring a pAVF who developed a de novo venous aneurysm 8 months after undergoing indirect superficial temporal artery-middle cerebral artery (MCA) bypass that was complicated by bilateral ischemia of the MCA territory. The pAVF was successfully treated with transarterial embolization using Onyx. The authors describe the possible pathophysiological m...
Canadian journal of surgery. Journal canadien de chirurgie, 2009
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 2010
A 53-year-old woman presented with progressive bilateral leg weakness that was managed conservati... more A 53-year-old woman presented with progressive bilateral leg weakness that was managed conservatively over the past eight years. The patient had no history of trauma. The physical examination revealed severe gait impairment, a dense spastic paraparesis, pyramidal distribution weakness, positive Babinski signs bilaterally and hyperreflexia in the lower limbs. The patient had preserved proprioception and sensation in the lower limbs. Magnetic resonance imaging of the spine revealed a congenital ventrally displaced spinal cord with focal herniation through the dura at the T4-T5 level ( ). This corresponded to a type K spinal cord herniation which is characterized by kinking. 1 The thoracic myelopathy was likely due to cord tethering and ischemia. The patient underwent a T4-T5 laminectomy with a left T5 transpedicular approach for an intra/extra-dural microscopic repair of the defect. Intraoperatively, there was ventral kinking of the spinal cord with a complex anterior herniation through a dural defect of gliotic tissue which was also tethered anteriorly to the posterior longitudinal ligament. To allow de-tethering of the spinal cord, the dura was ventrally marsupialized using a wide opening, as a primary dural repair was not deemed to be feasible. At six month postoperative follow-up, the patient had shown clinical signs of neurological improvement with reduced lower limb spasticity and improved gait.
Canadian journal of surgery. Journal canadien de chirurgie, 2010
Tumefactive demyelinating lesions: a diagnostic challenge T umefactive demyelinating lesion (TDL)... more Tumefactive demyelinating lesions: a diagnostic challenge T umefactive demyelinating lesion (TDL) is defined as a solitary demyelin ating lesion greater than 2 cm. Mass effect and contrast enhancement on neuroimaging make it difficult to distinguish this type of lesion from high-grade gliomas. 1,2 Multiple sclerosis (MS) accounts for most cases of TDL. 3 Even in patients with established MS, an atypical manifestation of a large lesion can suggest concurrent neoplasm, because the clinical manifestations are often similar. 1,4 When examined on magnetic resonance imaging (MRI) scans, TDLs have ill-defined borders, mass effect, perilesional edema, central necrosis, cystic degeneration, contrast enhancement and variable involvement of grey matter. 4 Unless specifically requested, pathological examin ation does not routinely include luxol fast blue staining, which can be used to detect demyelination. The presence of hypercellularity, atypical reactive astrocytes and mitotic figures can lead to an incorrect diagnosis of glial neoplasm. We present 3 cases of tumefactive demyelinating lesions that were clinically and radiologically challenging to distinguish from high-grade neoplasm.
Canadian journal of surgery. Journal canadien de chirurgie, 2008
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 2010
Surgical activity is probably the most important component of surgical training. During the first... more Surgical activity is probably the most important component of surgical training. During the first year of surgical residency, there is an early opportunity for the development of surgical skills, before disparities between the skill sets of residents increase in future years. It is likely that surgical skill is related to operative volumes. There are no published guidelines that quantify the number of surgical cases required to achieve surgical competency. The aim of this study was to describe the current trends in surgical activity in a recent cohort of first-year Canadian neurosurgical trainees. This study utilized retrospective database review and survey methodology to describe the current state of surgical training for first-year neurosurgical trainees. A committee of five residents designed this survey in an effort to capture factors that may influence the operative activity of trainees. Nine out of a cohort of 20 first-year Canadian neurosurgical trainees that began training i...
The Canadian Journal of Neurological Sciences, 2013
Canadian journal of surgery. Journal canadien de chirurgie, 2009
The Canadian Journal of Neurological Sciences, 2010
Specialization is generally independently associated with improved outcomes for most types of sur... more Specialization is generally independently associated with improved outcomes for most types of surgery. This is the first study comparing the immediate success of outpatient lumbar microdiscectomy with respect to acute complication and conversion to inpatient rate. Long-term pain relief is not examined in this study. Two separate prospective databases (one belonging to a neurosurgeon and brain tumor specialist, not specializing in spine (NS) and one belonging to four spine surgeons (SS)) were retrospectively reviewed. All acute complications as well as admission data of patients scheduled for outpatient lumbar microdiscectomy were extracted. In total, 269 patients were in the NS group and 137 patients were in the SS group. The NS group averaged 24 cases per year while the SS group averaged 50 cases per year. Chi-square tests revealed no difference in acute complication rate [NS (6.7%), SS (7.3%)] (p > 0.5) and admission rate [NS (4.1%), SS (5.8%)] (p = 0.4) while the SS group had a significantly higher proportion of patients undergoing repeat microdiscectomy [NS (4.1%), SS (37.2%)] (p < 0.0001). Excluding revision operations, there was no statistically significant difference in acute complication [NS (5.4%), SS (1.2%)] (p = 0.09) and conversion to inpatient [NS (4.3%), SS (4.6%)] (p > 0.5) rate. The combined acute complication and conversion to inpatient rate was 6.9% and 4.7% respectively. Based on this limited study, outpatient lumbar microdiscectomy can be apparently performed safely with similar immediate complication rates by both non-spine specialized neurosurgeons and spine surgeons, even though the trend favored the latter group for both outcome measures.
Epilepsy Research and Treatment, 2012
Temporal lobe epilepsy (TLE) is the most common form of adult epilepsy that is amenable to surgic... more Temporal lobe epilepsy (TLE) is the most common form of adult epilepsy that is amenable to surgical treatment. In the carefully selected patient, excellent seizure outcome can be achieved with minimal or no side effects from surgery. This may result in improved psychosocial functioning, achieving higher education, and maintaining or gaining employment. The objective of this paper is to discuss the surgical selection process of a patient with TLE. We define what constitutes a patient that has medically refractory TLE, describe the typical history and physical examination, and distinguish between mesial TLE and neocortical TLE. We then review the role of routine (ambulatory/sleep-deprived electroencephalography (EEG), video EEG, magnetic resonance imaging (MRI), neuropsychological testing, and Wada testing) and ancillary preoperative testing (positron emission tomography, single-photon emission computed tomography (SPECT), subtraction ictal SPECT correlated to MRI (SISCOM), magnetoencephalography, magnetic resonance spectroscopy, and functional MRI) in selecting surgical candidates. We describe the surgical options for resective epilepsy surgery in TLE and its commonly associated risks while highlighting some of the controversies. Lastly, we present teaching cases to illustrate the presurgical workup of patients with medically refractory TLE.
Journal of Neurosurgery: Spine, 2007
Journal of Neurosurgery: Spine, 2010
Journal of Clinical Neuroscience, 2012
Ewing&amp... more Ewing's sarcoma (ES) is a part of a larger family of round blue cell tumors, which occasionally manifest as osseous or extraosseous lesions adjacent to or within the central nervous system (CNS). While a large body of literature exists on ES of bone, data are lacking on tumors with cranial or spinal components that affect the CNS. Here, we perform a systematic review of the literature and summarize the best available evidence on diagnosis, treatment and outcomes of ES affecting the CNS with emphasis on the breadth of clinical presentations, diagnostic tools and emerging management options for these rare and challenging lesions. We include a review of known prognostic factors and propose several new considerations for prognostication of ES affecting the CNS.
Journal of Clinical Neuroscience, 2013
Epilepsy & Behavior, 2011
The widespread inclusion of surgical strategies in the treatment of medically intractable epileps... more The widespread inclusion of surgical strategies in the treatment of medically intractable epilepsy is largely justified by the medical and psychosocial burden of the illness. Performing these procedures in pediatric populations is associated with distinct challenges ranging from unique seizure etiologies to issues surrounding brain development and functional plasticity. As the trend toward more aggressive surgical intervention continues, the ethical foundation of current and emerging practices must be increasingly scrutinized. Here, we present the first article discussing ethical issues in the surgical management of medically intractable epilepsies in children. We discuss principles of informed consent, harm reduction, and justice in this vulnerable patient population. We also highlight the unique ethical challenge of surgical decision making concerning developmentally delayed children. The recognition of these issues is essential to providing patient-centered, responsible, and ethical care.