Jamie Ullman - Academia.edu (original) (raw)

Papers by Jamie Ullman

Journal of neurotrauma, 2007

There are insufficient data to support a Level I recommendation for this topic. B. Level II Proph... more There are insufficient data to support a Level I recommendation for this topic. B. Level II Prophylactic use of phenytoin or valproate is not recommended for preventing late posttraumatic seizures (PTS).

Acquired Brain Injury, 2019

An integrated neuro-rehabilitation approach toward the treatment of acquired brain injuries begin... more An integrated neuro-rehabilitation approach toward the treatment of acquired brain injuries begins with a fundamental understanding of neurosurgical pathologies. Improvements in the neurosurgical knowledge of not only the neuro-rehabilitation team but also the patient family unit allow more cohesive participation and improvements in patient’s outcomes. The purpose of this chapter is to provide a framework for the epidemiology, symptoms, diagnoses, treatment paradigm, and outcomes of the most frequently encountered operative neurosurgical pathologies in the contemporary era. This chapter will seek to illustrate the symptoms, diagnosis, treatment, and outcomes from ABI as a result of traumatic brain injury (concussion, epidural hematoma, subdural hematoma, and penetrating injury) or nontraumatic brain injury (spontaneous intracranial hemorrhage, malignant cerebral infraction, brain tumor, and aneurysmal subarachnoid hemorrhage). It is expected that this information can be utilized by ...

Clinical Neurology and Neurosurgery

BACKGROUND It is widely known that some patients surgically treated for subdural hematoma (SDH) e... more BACKGROUND It is widely known that some patients surgically treated for subdural hematoma (SDH) experience neurologic deficits not clearly explained by the acute brain injury or known sequelae like seizures. There is increasing evidence that cortical spreading depolarization (CSD) may be the cause. A recent article demonstrated that CSD occurred at a rate of 15 % and was associated with neurological deterioration in a subset of patients following chronic subdural hematoma evacuation. Furthermore, CSD can lead to ischemia leading to worsening neurologic deficits. CSD is usually detected on electrocorticography (ECoG) and needs cortical strip electrode placement with equipment and expertise that may not be readily available. CASE DESCRIPTION We report three cases of patients with subdural hematoma (SDH) not undergoing ECoG in whom CSD was suspected to be the cause of their neurologic deficits post evacuation. Extensive workup including neuroimaging and electroencephalography (EEG) were inconclusive. Patients were subsequently treated with ketamine infusion and had resultant neurological recovery. CONCLUSIONS Ketamine infusion can help reverse neurologic deficits in patients with SDH in whom the deficits are not explained by neuroimaging or electrographic seizure. CSD is a known phenomenon that can result in neurological injury and must remain in the differential diagnosis of such patients. Though only limited cases are discussed (n = 3), this small case series provides the basis for conducting clinical trials evaluating the efficacy of ketamine in improving functional outcome in brain-injured patients demonstrating evidence of CSD.

Intensive Care Medicine

Background: Current guidelines for the treatment of adult severe traumatic brain injury (sTBI) co... more Background: Current guidelines for the treatment of adult severe traumatic brain injury (sTBI) consist of high-quality evidence reports, but they are no longer accompanied by management protocols, as these require expert opinion to bridge the gap between published evidence and patient care. We aimed to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place. Methods: Our consensus working group consisted of 42 experienced and actively practicing sTBI opinion leaders from six continents. Having previously established a protocol for the treatment of patients with ICP monitoring alone, we addressed patients who have a brain oxygen monitor in addition to an ICP monitor. The management protocols were developed through a Delphi-method-based consensus approach and were finalized at an in-person meeting. Results: We established three distinct treatment protocols, each with three tiers whereby higher tiers involve therapies with higher risk. One protocol addresses the management of ICP elevation when brain oxygenation is normal. A second addresses management of brain hypoxia with normal ICP. The third protocol addresses the situation when both intracranial hypertension and brain hypoxia are present. The panel considered issues pertaining to blood transfusion and ventilator management when designing the different algorithms.

Acta Neurochirurgica

Background Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) fo... more Background Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low-and middle-income countries. Results The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Neurosurgery

To the Editor: We thank Drs Picetti, Iaccarino, and Servadei for their thoughtful comments1 in re... more To the Editor: We thank Drs Picetti, Iaccarino, and Servadei for their thoughtful comments1 in relation to the recently published Guidelines for theManagement of Severe Traumatic Brain Injury, Fourth Edition.2 We share their distress and disappointment with the gaps that exist in current evidence for important topics. It is our great hope that the fourth edition guidelines will inspire investigators to complete high-quality studies that will fill these gaps. We also fully agree with the Parma group1 that published guidelines should not be viewed as “formally correct.” The Guidelines should serve as a starting point for individualized patient care protocols, integrating broad information specific to patient characteristics. The science of guidelines and making evidence-based recommendations has evolved substantially since the first edition of the Brain Trauma Foundation’s Guidelines for the Management of Severe Traumatic Brain Injury3—the first published guidelines produced by any surgical specialty. Indeed, much has changed even since the publication of the previous, third edition in 2007.4 The Institute of Medicine’s “Clinical Practice Guidelines We Can Trust” (2011)5 has played a particularly important role in setting the modern standard for high-quality guidelines documents. Our authorship group was challenged by the fact that the evidence supporting widely adopted recommendations in our previous guidelines—such as indications for intracranial pressure (ICP) monitoring—no longer meets current evidence standards prompting the pragmatic but carefully considered approach of restating select old recommendations. The Brain Trauma Foundation prides itself on producing rigorous and transparent evidence-based guidelines of the highest standard. The authors underwent a period of discussion and introspection in preparation for the fourth edition. As the fourth edition2 will serve as the foundation for the “Living Guidelines,” it was essential that the nature of this foundation be very carefully considered. We recognize that the consensus statements recently produced by the Neurocritical Care Society and by the American College of Surgeons supplement evidence with expert opinion. The Brain Trauma Foundation decided not to take this approach. We are mindful that expert opinion can be wrong: noteworthy examples include prophylactic hyperventilation and administration of corticosteroids, which used to be commonplace in the care of the severely brain injured. Evidence has ultimately shown these practices to be harmful. Moreover, the methodology inherent to building consensus-based recommendations or treatment protocols is distinct from those used in a rigorous evidence-based review. With these issues in mind and in the context of current guidelines standards, we made the difficult and important decision to keep our recommendations focused on a strict interpretation of available evidence. In doing so, we believe we have filled a different niche than that occupied by recently published consensus statements. The Brain Trauma Foundation recognizes the tremendous demand for an updated consensus-based treatment protocol which can serve as a template for local protocols reflecting local preferences and resources. The treatment algorithm that the Brain Trauma Foundation developed and published in conjunction with the first3 and second6 edition of the guidelines were very frequently requested reprints. We have been developing an updated protocol7 that conceptualizes the treatment of elevated ICP or brain hypoxia in 3 tiers based on efficacy and risk. This conceptual approach is the basis for what has been adopted by recent high-profile studies including PRoTECT III and TRACKTBI. We are making plans to further develop this protocol incorporating the recommendations of the fourth edition guidelines. We believe that collaboration with other societies and stakeholders will be important to prevent multiple independent efforts, which would result in a further fragmentation of recommendations and conflicting protocols. Although there is much evidence supporting improved outcomes from ICP-directed therapies, evidence does not currently support selective ICP monitoring in severe TBI patient subgroups. We agree with the Parma group that published consensus statements are helpful. We are mindful, though, of the 1982 paper by Narayan et al.8 Though this paper does not meet current evidence standards, it made the important finding that patients in coma with 2 or more of hypotension, posturing, or age over 40 are at risk for ICP elevation despite a normal head computed tomography. This paper has been influential and led some to mandate the exclusion of ICP elevation prior to making a diagnosis of diffuse axonal injury.We recognize that the question of which patients should undergo ICP monitoring remains an appropriately debated aspect of TBI patient care, and we hope that in the future new high-quality data will inform this issue. The ICP…

Current Surgery Reports, 2016

Purpose of ReviewThere is still substantial controversy surrounding the utility of decompressive ... more Purpose of ReviewThere is still substantial controversy surrounding the utility of decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). Some surgeons readily perform these operations, while others are more hesitant due to concerns about patient outcomes in severe TBI.Recent FindingsIn this paper, the authors outline recent literature regarding the use of DC in TBI patients, starting with a brief background on surgical methods then examining the results of recent retrospective studies, case series, and randomized trials.SummaryDespite the controversy, and while a new randomized control trial is pending publication, DC remains an important tool in managing patients with TBI.

Atlas of Emergency Neurosurgery, 2015

Frontiers in Neurology

Decompressive craniectomy (DC) for the treatment of severe traumatic brain injury (TBI) has been ... more Decompressive craniectomy (DC) for the treatment of severe traumatic brain injury (TBI) has been established to decrease mortality. Despite the conclusion of the two largest randomized clinical trials associating the effectiveness of decompressive craniectomy vs. medical management for patients with traumatic brain injury (TBI), there is still clinical equipoise concerning the usefulness of DC in the management of refractory intracranial hypertension. Primary outcome data from these studies reveal either potential harm or that decreased mortality only leads to an upsurge in survivors with severe neurologic incapacity. In this chapter, we seek to review the results of the most recent clinical trials, highlight the prevailing controversies, and offer potential solutions to address this dilemma.

World neurosurgery, Jan 27, 2015

Systematic review of the literature to evaluate the role of decompressive craniectomy (DC) after ... more Systematic review of the literature to evaluate the role of decompressive craniectomy (DC) after severe traumatic brain injury (TBI), comparing the first major randomized clinical trial on this topic (DECRA) with subsequent literature. A systematic literature search was performed from 2011 to 2015. Citations were selected using the following inclusion criteria: closed severe TBI and DC. Exclusion criteria included: majority of patients <18 years old, <20 subjects, review articles, DC for reasons other than TBI or surgical procedures other than DC. Primary Outcomes included: mortality and Glasgow Outcome Scale (GOS) at discharge, 6 months and 1 year after injury. Assessment of Risk of bias (RoB) of the randomized control studies (RCT) was also performed. Only 12 of 5528 articles satisfied eligibility criteria, of these studies 3 were RCT. DC in specific populations does not offer GOS or mortality advantages compared to medical treatment, on the other hand, when DC with open dur...

Multiple Organ Failure, 2000

Otolaryngology - Head and Neck Surgery, 1997

P n e u m o c e p h a l u s usually occurs as a result of trauma, tumor, infection, or congenital... more P n e u m o c e p h a l u s usually occurs as a result of trauma, tumor, infection, or congenital abnormalities but rarely occurs spontaneously. We report a case of spontaneous pneumocephalus resulting from an idiopathic bony defect in the mastoid cavity.

Neurosurgery, 1995

Ten cases of symptomatic cavernous malformations affecting the spine and spinal cord were retrosp... more Ten cases of symptomatic cavernous malformations affecting the spine and spinal cord were retrospectively reviewed. The cases display a spectrum of pathological findings involving the vertebral body, vertebral body with epidural extension, epidural space without bony involvement, intradural extramedullary space, and intramedullary lesions. Lesions at all locations are identical histologically, electron microscopically, and immunohistochemically. This perspective, in which cavernous malformations are envisioned as a single entity arising at numerous locations, runs contrary to the view found in the neurosurgical literature. In most discussions of cavernous malformations, vertebral body lesions are depicted as separate entities from intradural lesions. Cavernous malformations, also called cavernous hemangiomas, are developmental vascular hamartomas that, by definition, do not grow by mitotic activity. Yet, the expansion of these lesions is well documented both in the literature and among our cases. The therapeutic modalities used in our series included observation, embolization, radiation, and surgical resection alone or in combination. All modalities are effective but must be tailored to the specific needs and condition of the patient. The embryology, methods of treatment, and proposed mechanisms of growth, plus similarities and differences between cavernous malformations at each location, are reviewed. Analogies between spinal and intracranial lesions are presented. On the basis of this series and a review of the literature, we conclude that cavernous malformations represent a single entity regardless of location. Segregation based on location, as is prevalent throughout the neurosurgical literature, hinders an overall understanding of these lesions. Cavernous malformations are more appropriately viewed as a single pathological entity arising in a multitude of locations. The difficulties encountered when managing cavernous malformations at various locations are unique to the location and not the lesion.

Neurosurgery, 1999

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Ent... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining ...

Journal of Neurosurgery, 2008

PREFACE: The leadership of Women in Neurosurgery (WINS) has been asked by the Board of Directors ... more PREFACE: The leadership of Women in Neurosurgery (WINS) has been asked by the Board of Directors of the American Association of Neurological Surgeons (AANS) to compose a white paper on the recruitment and retention of female neurosurgical residents and practitioners. Neurosurgery must attract the best and the brightest. Women now constitute a larger percentage of medical school classes than men, representing approximately 60% of each graduating medical school class. Neurosurgery is facing a potential crisis in the US workforce pipeline, with the number of neurosurgeons in the US (per capita) decreasing. The number of women entering neurosurgery training programs and the number of board-certified female neurosurgeons is not increasing. Personal anecdotes demonstrating gender inequity abound among female neurosurgeons at every level of training and career development. Gender inequity exists in neurosurgery training programs, in the neurosurgery workplace, and within organized neurosurgery. The consistently low numbers of women in neurosurgery training programs and in the workplace results in a dearth of female role models for the mentoring of residents and junior faculty/practitioners. This lack of guidance contributes to perpetuation of barriers to women considering careers in neurosurgery, and to the lack of professional advancement experienced by women already in the field. There is ample evidence that mentors and role models play a critical role in the training and retention of women faculty within academic medicine. The absence of a critical mass of female neurosurgeons in academic medicine may serve as a deterrent to female medical students deciding whether or not to pursue careers in neurosurgery. There is limited exposure to neurosurgery during medical school. Medical students have concerns regarding gender inequities (acceptance into residency, salaries, promotion, and achieving leadership positions). Gender inequity in academic medicine is not unique to neurosurgery; nonetheless, promotion to full professor, to neurosurgery department chair, or to a national leadership position is exceedingly rare within neurosurgery. Bright, competent, committed female neurosurgeons exist in the workforce, yet they are not being promoted in numbers comparable to their male counterparts. No female neurosurgeon has ever been president of the AANS, Congress of Neurological Surgeons, or Society of Neurological Surgeons (SNS), or chair of the American Board of Neurological Surgery (ABNS). No female neurosurgeon has even been on the ABNS or the Neurological Surgery Residency Review Committee and, until this year, no more than 2 women have simultaneously been members of the SNS. Gender inequity serves as a barrier to the advancement of women within both academic and community-based neurosurgery. To overcome the issues identified above, the authors recommend that the AANS join WINS in implementing a strategic plan, as follows: 1) Characterize the barriers. 2) Identify and eliminate discriminatory practices in the recruitment of medical students, in the training of residents, and in the hiring and advancement of neurosurgeons. 3) Promote women into leadership positions within organized neurosurgery. 4) Foster the development of female neurosurgeon role models by the training and promotion of competent, enthusiastic, female trainees and surgeons.

Critical Care Clinics, 1996