Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 13th International Conference on Neurology and Neurosurgery Paris, France.

Day 1 :

Keynote Forum

Roberto Cartolari

S. Giovanni Hospital, Switzerland

Keynote: The diagnostic evaluation of the operated lumbar spine

Time : 9:30-10:10

Conference Series Neurosurgery 2017 International Conference Keynote Speaker Roberto Cartolari photo
Biography:

Born in Urbino (PU), Italy, in 1955, is married with Maria Chiara and , has one daughter, Ginevra. Degree in Medicine and Surgery, University of Modena, 1980, board  on Radiology, University of  Modena in 1984,  board on Neurology, University of Siena in 1994. He Patented the device, "Axial Loader” and development of neuroradiological imaging  techniques known as" Axial Loaded - Computed Tomography -  AL-CT " and " Axial  Loaded Magnetic Resonance - AL-MR "for the in vivo biomechanical study of the spine  in 1992. At present  is  Senior Assistant Radiologist at the  Radiology Service, Ospedale S. Giovanni – EOC Bellinzona, Switzerland. He has published as  Author and co-author many   scientific publications, abstracts and reports in    national and international journals. He also collaborated on several chapters on   international treaties of Neuroradiology. Main interests are Diagnostic and Spinal non-vascular Interventional Neuroradiology, with   special  reference to CT and MRI, Biomedical applications of Virtual Reality,”   Biomechanics of the spine and  joints. He is a Member of the Italian Association of Neuroradiology – AINR,- Full Member of the European Society of Neuroradiology - ESNR.

Abstract:

The so-called failed back surgery syndrome (FBSS) is a common problem that often remains without a clear diagnosis. The diagnostic workout is complex and usually based on conventional X-ray films, MRI, CT and sometimes myelography and myelo-CT, especially if some mechanical device has been implanted. In the most part of the cases, an exact cause for low back pain and/or sciatic pain is hard to define and this can influence a correct therapy. The most important consideration is the difficulty to have a functional approach to the operated spine since the most part of the diagnostic procedures are made with the patient in rest position (supine). On the other hand metallic implants can interfere with MR and CT acquisitions. The only dynamic diagnostic procedure (orthostatic functional X-ray plain film) has known lack of precision. In last years, the possibility of functional studies in real or simulated orthostatism (orthostatic MR and axial loaded CT and MR) has led to a deeper comprehension of the mechanics of the operated spine, especially of the instrumented spine. In this lecture, the results of more than 20 years of experience with axial loaded CT and MRI will be presented. The axial loaded CT imaging could be the gold standard in the evaluation of the post-op lumbar spine, in particular when a mechanical device has been implanted.

Keynote Forum

Xiaoping Ren

Harbin Medical University, China

Keynote: Spinal Cord Fusion in Acute Spinal Cord Injury of Dog

Time : 10:10-10:50

Conference Series Neurosurgery 2017 International Conference Keynote Speaker Xiaoping Ren photo
Biography:

Xiaoping Ren received his M.D in Harbin Medical University in 1984. He performed his Clinical and Research Hand Fellowship training in University of Louisville in Kentucky (1996-2000). Currently, he has professor position in Harbin Medical University in China and adjunct faculty in Loyola University Chicago in US. Dr. Ren has had over 60 publications in peer-reviewed journals and he is holding active Memberships of the American Association for Hand Surgery, Orthopedics and Neurological of American Academy and the American Heart Association. He also service as peer-reviewer of several journals. As well as practice as a Hand and Microsurgeon in clinic, his research interest is on protective strategies against ischemia/reperfusion of CNS and SCI functional recovery.

Abstract:

Employing an acute dog model of spinal cord injury (SCI) using a diamond knife to generate a clean cut with little crush injury, we show that application of PEG preparations on the severed ends effects considerable neuroprotection and repair. Our results show that electrical continuity starts to be detected one hour after injury, and that BBB scores reach approximately 50% of the sham levels after three to four weeks. This level of restoration of function continues out to 6 month, which is the longest we assessed the dog. Neurophysiological and DTI MR data confirm electrophysiological and anatomical continuity. This study suggests that a form of spinal cord injury can effectively be treated and points out a way to treat spinal cord injury patients by removing the injured segment and, along with vertebral shortening, reapproximating and fusing the two stumps.

  • Neurological Disorders| Pediatric Neurosurgery | Neuroaesthetics and Critical Care
Location: Sunset 1
Speaker

Chair

Roberto Cartolari

S. Giovanni Hospital, Switzerland

Biography:

Gabriel Fernando Todeschi Variane completed his graduation at Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo. She completed his/her Pediatric training and neonatal fellowship at Santa Casa de Sao Paulo, Brazil. He/she was Visiting Observer at McGill University, Canada (2014), University of Cambridge, UK (2015) and Stanford University, USA (2016). He is Coordinator of the Neuro-NICU of Santa Casa de Sao Paulo, a very large and one of the most important medical schools in Brazil. He is a Neonatologist responsible for Group’s Santa Joana Neuro-NICU.

Abstract:

Neonatology has experienced dramatically falls in mortality rates of critically ill neonates in the past few decades. However, many infants will develop severe neurological impairment. The big challenge consists in promoting survival with adequate quality of life. The implementation of a neurological neonatal ICU (Neuro-NICU) has been successfully described in several centers among the world. It consists in bringing to clinical practice new methodologies and a specific multidisciplinary approach in order to promote early diagnoses of brain injury and neuroprotection for infants at high risk. Four pillars are described: Neuro-monitoring (such as video aEEG/EEG and NIRS); neuroimaging (cranial ultrasound, tomography and MRI); neuro-assessment (close approach of neurology team and training neurological assessment tools for neonatologists and pediatricians in the NICU and after discharge and; neuroprotection (therapeutic hypothermia and strategies to minimize pain and stress for all infants). Newborns admitted to the Neuro-NICU include infants with hypoxic ischemic encephalopathy (HIE), seizures, extreme prematurity, large intra-ventricular hemorrhage, hydrocephalus, central nervous system infections and malformations (such as microcephaly), metabolic disease, and severe congenital heart diseases. Brain monitoring is specifically important in this population, since this is well described that 80 to 90 percent of seizures occurs with no clinical signs in the neonatal period. We have implemented and experienced the Neuro-NICU concept in five centers in Brazil, starting on 2015. Our Neuro-NICU has monitored over 300 infants. We found very high rates of seizures (47% of infants monitored, which 82% had subclinical seizures), and promoted cooling for over 80 infants with HIE.

Biography:

Sarah Adelaide Crawford completed her Doctoral degree at Columbia University College of Physicians and Surgeons, Department of Biochemistry and Biophysics. She completed her Master’s Degree in Biochemistry at Princeton University. Her Post-doctoral research was carried out at Memorial Sloan Kettering Cancer Center in New York. She is a Professor of Genetics at Southern Connecticut State University and Director of the Cancer Biology Research Laboratory. In 2013, she was awarded two patents [USA, Canada and Europe] for developing novel combined chemotherapy approaches using a new plant extract formulation for brain tumors and other malignancies. She has developed a new model to explain the causes of autism and its recent dramatic increase. Applications of this model can be used in preventive approaches to screen for autism risk factors to reduce the occurrence of this disorder.

Abstract:

Recent discoveries of the connections between the maternal immune system (IS) and prenatal brain development suggest that routine prenatal screening for chronic disorders associated with IS dysfunction may be useful in identifying women at heightened risk for giving birth to a child with autism. Epidemiological studies have shown that the incidence of IS disorders, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and chronic obesity in combination with insulin-resistant diabetes, has increased significantly over the past several decades and that pregnant women with these conditions are at increased risk for having a child with autism. For this reason, physiological parameters associated with these prenatal conditions that can be detected before onset or at early stages of disease may serve as biomarkers for increased autism risk. A physiological relationship between maternal IS dysfunction and impaired embryonic/fetal brain development may be defined by critical neurodevelopmental functions of brain microglia that are responsive to both neural and immunological stimuli. Impaired regulation of the developmentally versus immunologically defined functions of brain microglia may represent a primary cause of the neurological impairments characteristic of ASD. This critical cause/effect relationship provides the rationale for autism risk factor assessment using biomarkers associated with chronic immune conditions that impair the neurodevelopmental functions of microglia as a consequence of their inappropriate immunological activation. Moreover, the connection between abnormal IS function and impaired neural development suggests preventive approaches that can be used to decrease the overall risk for ASD in children born to mothers with these conditions. 

  • Special Session
Location: Sunset 1
Speaker

Chair

Radu Mutihac

University of Bucharest, Romania

Session Introduction

Radu Mutihac

University of Bucharest, Romania

Title: Brain connectivity dynamics in neurological dysfunctions
Speaker
Biography:

Radu Mutihac is a Head of Medical Physics Section, works in Neuroscience, Signal Processing, Microelectronics and Artificial Intelligence. As a Post-doc/Research Associate/Visiting Professor/Full Professor, he does his research at University of Bucharest, International Centre for Theoretical Physics (Italy), Ecole Polytechnique (France), Institute Henri Poincare (France) and KU Leuven (Belgium). His research in “Fused biomedical imaging modalities” was carried out at Johns Hopkins University, National Institutes of Health and Walter Reed Army Institute of Research, USA. He is a member of ISMRM, ESMRMB, OHBM, Romanian US Alumni Association, and Fellow of Signal Processing and Neural Networks Society IEEE. He has published over 100 scientific papers, 12 monographs and contributed with chapters in other 10 text books. He contributed to more than 150 scientific meetings with posters and oral presentations, seminars, invited and plenary lectures, as well as acting as Organizer, Chairman, and Keynote Speaker.

Abstract:

Studies on brain connectivity by means of functional neuroimaging data have increased the understanding of the organization of large-scale structural and functional brain networks. It has been argued that nonlinear analyses employing concepts like entropy, fractality and predictability provide significant diagnostic and prognostic information in a number of pathologies. The brain is like a mosaic of different and highly interconnected regions, so that knowledge of functional connectivity between brain regions is crucial to understanding perception, cognition, behavior, and differentiating healthy from sick subjects. Investigating functional connectivity constitute potential means to explore the causal relationship between the brain lesions and neuropsychological syndromes and, eventually, may suggest improved rehabilitation strategies for patients with brain injury through personalized treatment and recovery protocols. Spontaneous low-frequency (<0.1 Hz) fluctuations in BOLD resting-state fMRI signals are temporally coherent among brain areas that may be not structurally connected but functionally related. Neurological diseases stand for a range of conditions which primarily affect the neurons in the brain and are incurable and progressively result in degeneration and/or death of nerve cells. They are related with at least two brain functions: Memory loss and impaired judgment or language, and the inability to perform some common activities. Investigating the relationship between brain structure and function is a central issue in neuroscience research. The present work summarizes the specific changes in the resting-state networks univocally related to certain forms of neurological disorders and/or dementia phases, particularly among syndromes with relatively similar behavioral effects, on the basis of alterations in brain connectivity explored by the real-time fMRI during rest.

  • Neurology | Novel Therapeutics| Advance Techniques on Neurosurgery
Location: Sunset 1
Speaker

Chair

Radu Mutihac

University of Bucharest, Romania

Session Introduction

Marc Teichmann

Pitié-Salpêtrière Hospital, France

Title: Can non-invasive neurostimulation enhance language abilities in aphasic patients?
Biography:

Abstract:

Non-invasive brain stimulation including TMS and tDCS has been used as a potential therapy tool in various pathological conditions including aphasia. Despite a large number of studies on post-stroke aphasia and on degenerative language diseases such as primary progressive aphasia (PPA) stimulation results remain inconclusive because of methodological limitations. Here, I will discuss why post-stroke aphasia is a fragile lesion model for exploring potential therapeutic efficiency of non-invasive stimulation and how research in this filed could be improved by using PPA applying a rigorous methodological approach. More specifically, I will present recent data from a pre-therapeutic double-blind sham-controlled tDCS study in a relatively large and homogenous cohort of semantic variant PPA patients. The findings of this study demonstrate that a methodologically stringent application of non-invasive neurostimulation leads to efficient modulation of the targeted language system generating highly specific intra-semantic effects. These results provide ‘proof of concept’ for future applications of tDCS in therapeutic multi-day regimes, potentially driving sustained improvement of language processing, promoted by mechanisms of neuroplasticity. In addition, such rigorously controlled studies also provide insight in the functional and anatomical organization of the language/semantic system. 

Biography:

Thangarajan Sumathi completed her PhD in 2002 at University of Madras. Currently, she is working as an Assistant Professor in Department of Medical Biochemistry, University of Madras. She is guiding eight PhD students and four research scholars have been awarded PhD degree. She has 20 years of teaching and research experience. Her area of specialization is Neurodegenerative Diseases (Alzheimer’s disease, Parkinson’s disease and Huntington’s disease). She has more than 40 publications in reputed journals and sponsored research projects. She is a life member of ISAR, IAES, IABS, NJLS, ZSI, etc. She is a Reviewer of many international journals like Neurochemistry International, Experimental Biology and Medicine, etc. She is an Editorial Board Member of Current Updates in Gerontology and International Journal of Brain Disorder Therapy.

Abstract:

The amyloid-β (Aβ) is the major protein component of brain senile plaques in Alzheimer’s disease (AD) and is known to be directly responsible for the production of free radicals toxic to brain tissue. The present study was designed to elucidate the neuroprotective effect of Isorhamnetin (IRN), a flavone aglycones against the pathogenesis of AD. Experimental AD in rats was produced by intracerebroventricular administration of Aβ (25-35) peptide. Employing the following strategies of neurobehavioral, biochemical, immunohistochemistry, docking and molecular approach, we explored the attenuating effects of IRN against Aβ (25-35) peptide induced hippocampal neuronal loss and memory impairment. The present study has proven that IRN also reduced the expression of BACE-1 via inactivation of GSK3β and NFκB inhibition thereby inhibiting the accumulation of Aβ. Furthermore, IRN up regulated the phosphorylated GSK-3β and down regulated the expression of phosphorylated P-38 thereby inhibiting the Nrf-2 ubiquitination and improved the nuclear translocation of Nrf-2 which subsequently alleviated the expression of inflammatory cytokines which further reduced the ROS and RNS generation. Considering all the results, it can be suggested that IRN not only acts via antioxidant and anti-inflammatory activity but also by modulating the expression and function of AD related proteins. Hence, an amalgamation of in vivo, in vitro and in silico evidence might be supportive to delineate the neuroprotective potentials of IRN in the therapy of AD.

Biography:

Abstract:

Memory, especially visual memory is essential in the human social relation process and knowledge of brain correlates human body control is limited due to less accessibility in performing, using recently neuroimaging methods, controlled experimental paradigms. It is a fact that active repetition increases memory consolidation process and that all complex events are identified by making connections to prior knowledge.

Action understanding is a complex process depending on the type of action and, therefore, the brain hemodynamic activity in parietal cortex, which is quite often correlated with the processing of visual activities during functional magnetic resonance imaging (fMRI), analyzed in view of studying a factorial event-related face repetition/recognition (FR) task. The experimental paradigm has involved a healthy adult subject called to recognize the random repetition of one popular face among several unknown faces.

Inferential statistical analysis (CDA – Confirmatory Data Analysis) performed by the general linear model (GLM) in the framework of SPM (Statistical Parametric Mapping) has identified the areas of activation and the results have subsequently been confirmed by exploratory statistical analysis methods (EDA – Exploratory Data Analysis). Furthermore, in this work, we studied the transparency of statistical analysis methods creating a parallel between hypothesis-driven models and data-driven models. In the end, we found that inferential and exploratory analysis methods are efficient, associative and integrative for statistical analysis of an FR paradigm, being more complementary than competitive.

Biography:

Sniedze Murniece is working as a Neuroanesthesiologist at Riga East University Hospital, Latvia. Currently, she is pursuing her PhD in Medicine and doing her research in Spinal Neurosurgery and Cerebral Oxygen Saturation Monitoring.

Abstract:

Introduction: Cerebral hypoxia is a leading cause of adverse cerebral outcomes. Regional cerebral oxygenation intraoperative monitoring can prevent from complications like cognitive dysfunction, organ failure reducing hospitalization time.

Aim: The aim of the study was to determine whether prone position impacts cerebral oxygenation in spinal neurosurgical patients using near infrared spectroscopy device intraoperatively.

Materials & Methods: 25 patients (mean age 56 years) undergoing transpedicular fixation, microdiscectomy, removal of spinal tumors in prone position were included. Cerebral oxygen saturation (rScO2) was continuously monitored using INVOS 4100 NIRS device. We assessed cognitive dysfunction, blood loss, postoperative complications (stroke, organ dysfunction, days spent in ICU). Anesthesia induction: fentanyl 0.1-0.2 mg, propofol 1-2 mg/kg, cisatracurium 0.2 mg/kg; maintenance-fentanyl 0.03-0.06 μg/kg/min, cisatracurium 0.06-0.1 mg/kg/h, sevoflurane to MAC 0.7-1.0, FiO2 0.5.

Results: Mean rScO2 during induction was 72% for left side (L), 73% right side (R). In prone position L74%, R74%, was returning back to spinal position L74%, R73% during the whole surgery L73%, and R73%. Significant difference in calculated mean rScO2 values between supine and prone position was not observed. Despite the calculated mean rScO2 values 11/25 patients showed a slight up to significant decrease in rScO2 in prone position. The minimum rScO2 value observed was 55%. One patient with adipositas rScO2 values decreased for 26% from baseline values when turned to prone position (from 85% supine to 58% in prone position). No incidence of cognitive dysfunction, stroke, organ dysfunction was observed, no patients were admitted to ICU.

Conclusions: Although our first experience revealed that the mean intraoperative cerebral oxygen saturation changes during spinal neurosurgery in prone position from baseline values is not significant, almost half of the patients experienced mild to moderate decrease in cerebral oxygen saturation. Near infrared spectroscopy devices can be served as a supplementary tool in spinal neurosurgery to maintain adequate cerebral oxygen saturation.

  • Pain Management in Neurosurgery | Case reports in Neurosurgery | Functional Neurosurgery
Location: Sunset 1
Speaker

Chair

Roberto Cartolari

S. Giovanni Hospital, Switzerland

Biography:

Abstract:

Introduction: The aim of this study was to search the relationship between the anatomical location and the eventual analgesic effect of each contact.

Materials & Methods: 22 patients (14 men and 8 women) suffering from central and/or peripheral neuropathic pain were implanted with stimulation of the precentral cortex. The implantation of the electrodes was performed using intraoperative: Anatomical identification by neuronavigation with 3D MRI; somesthetic evoked potentials monitoring to check the potential reverse over the central sulcus; electrical stimulations through the dura to identify the motor responses and its somatotopy. In order to locate postoperatively the electrodes, a 3D-CT was performed in each case and fused with the preoperative MRI. The clinical analgesic effects of cortical stimulation were collected on a regular basis (VAS reduction >50%, drugs consumption). Data were analyzed to search a correlation between the anatomical position of contacts and analgesic effects.

Results: Post implantation analgesic effects were obtained in 18 (81.81%) patients out of 22. The analgesic effect was companied with reduction of the drugs consumption in 15 patients (68.18%). The post-operative 3D CT analysis shows a correspondence between the effective contacts localization and the motor cerebral cortex somatotopy in the patients with post-operative good analgesic effects. No correspondence was found between the contacts localization and the motor cerebral cortex somatotopy in the four patients with no analgesic effects. In three out of these four patients, analgesic effects were obtained after a new surgery allowing a replacement of the electrode position over the motor cortex somatotopy corresponding to the painful area.

Conclusion: This study shows the correlation between position of the contact over the precentral cortex and the analgesia obtained when the somatotopy of the stimulated cortex correspond to the painful area.

Biography:

Lan Hoang-Minh completed her doctoral studies in the Department of Biomedical Engineering at the University of Florida in Gainesville, Florida, USA. She is now a postdoctoral fellow in the laboratory of Dr. Matthew Sarkisian, studying the molecular and cellular mechanisms governing the proliferation of glioblastoma cells. Particularly, her postdoctoral work has focused on examining the role and characteristics of primary cilia, small cellular organelles recently frequently observed in human patients’ glioblastoma biopsies and derived cell lines. In collaboration with a strong team of brain tumor investigators at the University of Florida, she has been investigating how these organelles and associated proteins may be involved in tumor pathogenesis and possibly resistance to standard-of-care therapy. She has also been collaborating with Dr. Loic Deleyrolle in examining the metabolic characteristics of fast and slow-cycling glioblastoma cells and various metabolic strategies to target those cell populations. She recently received a two-year American Brain Tumor Association Basic Research Fellowship Grant.

Abstract:

Malignancies oft en exhibit rewired metabolism in order to satisfy the major energy and biosynthesis requirements of rapidly growing tumors. Despite the presence of suffi cient oxygen in their environment, tumors frequently exhibit elevated glycolysis. Th is metabolic reprogramming to glycolysis, known as the Warburg phenomenon, has commonly been associated with an impairment of mitochondrial function, thus restricting the metabolism of alternative substrates and limiting tumor cells’ metabolic diversity and adaptation. Here, we demonstrate that glioblastoma (GBM) tumor cells display metabolic heterogeneity, with fast-cycling cells harnessing anaerobic glycolysis and slow- cycling cells oxidative metabolism to support their growth and survival. We report the existence of SCCs in GBM, cells that display migration, invasion, and chemoresistance characteristics that might underlie tumor recurrence. SCCs consistently demonstrate heightened mitochondrial respiration activity as well as increased fatty acid metabolism. In addition, SCCs are more sensitive to inhibition of oxidative phosphorylation than to glucose deprivation, in vitro and in a murine xenograft model of GBM, and targeting both oxidative phosphorylation and the glycolytic pathway has a combinatorial inhibitory eff ect on GBM cell viability. Th ese results demonstrate the presence of cellular subpopulations that exhibit distinct metabolic activities in GBM and highlight the importance of comprehensive metabolic inhibition in the novel GBM treatment strategies.

Biography:

Mohamed Gaber Abdel Tawab is currently working as a Lecturer in Neurosurgery department at Fayoum University, Egypt. He completed his Resident of Neurosurgery at Cairo University Hospital in Egypt.

Abstract:

Objective: Retrospective study of 222 patients to determine the long-term outcome of microdiscectomy on relief of sciatic pain.

Methods: This was a retrospective observational study of 222 patients who underwent of microdiscectomy for sciatic pain during the period 2011 to 2013 in Faculty of Medicine at Cairo University. All patients were physically examined and interviewed. Recurrent procedures, multiple level discs were excluded from analysis. All procedures were done by same surgeon.

Results: Microdiscectomy yielded immediate complete pain relief in 215 patients. In seven patients, it yielded partial pain relief. Follow up to three years postoperatively, 205 patients remained absolutely pain free. Pain recurred in three patients after one year and in six patients during the first three years. Pain recurred in the same leg in eight patients, in the contralateral leg in two patients, and in both legs in one patient. One cases presented with foot drop preoperative showed improvement. New neurological deficits developed postoperatively in one case in the form of foot drop and improved during follow up period

Conclusions: Microdiscectomy provided immediate pain relief in about 96% of cases, and the long-term outcome of microdiscectomy has a very good satisfactory result.

  • Special Session
Location: Sunset 1
Speaker

Chair

Vera Novak

Harvard Medical School, USA

Speaker
Biography:

Abstract:

Metabolic Syndrome (MetS) epidemic is spreading around the world. MetS components (type 2 diabetes (T2DM), obesity and hypertension) have been shown to alter regional brain perfusion, vascular reactivity and micro- and macroscopic structural integrity. These cumulative effects subsequently result in functional decline of cognition and mobility. T2DM leads to gray matter (GM) atrophy and demyelination of white matter (WM) cognitive pathways in fronto-temporal and parietal networks, thus accelerating brain aging by ~ 5 years. In T2DM, worse performance on verbal fluency, learning and memory correlated with loss of WM microstructural integrity in the angular gyrus. An increasing BMI has been also linked to GM atrophy and an increase in WM fractional anisotropy in corpus callosum and other regions. Hypertension-related micro-infarcts and WM hyperintensities are signatures of slow gait speed and balance impairments. Central insulin plays a key role as neuromodulator of astrocyte-neuron signaling, cognition, homeostasis and food intake etc. In MetS, brain insulin resistance, inflammation and micro-vascular disease share a common pathophysiology of altered metabolism, hypoperfusion and WM degeneration. Intranasal insulin (INI) delivery directly across the blood-brain barrier has shown promise for treatment of cognitive and memory impairment. INI improves perfusion, functional connectivity and cognition in older adults and T2DM. New treatments targeting central effects (demyelination, hypoperfusion and inflammation) with direct delivery into the brain are needed to prevent and treat MetS-related cognitive and functional decline and dementia.

  • Neurosurgery | Cerebrovascular Surgery | Radiosurgery/CyberKnife
Location: Sunset 1
Speaker

Chair

Guy Hugues Fontaine

Université Pierre et Marie Curie, France

Session Introduction

Guy Hugues Fontaine

Université Pierre et Marie Curie, France

Title: Brain protection is used since the early 50s by cardiovascular surgeons
Biography:

Abstract:

PFC Cooling: This property was used by a neurologist from Cornell University in New York who had the original idea to cool the brain by evaporation of PFC in nasopharynx and fossa nasalis. PFC was evaporated in a flow of oxygen. A multicenter international prospective study has been performed but did not reach statistical significance. This was due to a too small number of cases and that cooling was initiated 23 after the drop. Author’s alternative was that the same result can be obtained by abrupt decompression of highly compressed gas. Choice of cooling gas: Joule-Thomson coefficient suggested that CO2 was the gas producing the strongest cooling during its adiabatic expansion. Water cooling: The first experiments were made in vitro in water. This demonstrated the formation of ice ball at the injector exit related to the low temperature at the site of CO2 expansion. Agar-agar cooling: A mock-up of the human brain was performed with agar-agar in which a blind tube was simulating the mouth and oropharynx. Infra-red imaging demonstrated the cooling by regular convection toward the brain and forced convection up to the exit. Therefore, cooling was not localized at the exit of the injector. Severed pig head cooling: Experiments demonstrated that the bones were not distorted by the cooling process as shown by infra-red imaging. It was concluded that mouth can be as good as fossa nasalis after a delay of few minutes. This fundamental experiment suggested that cooling through the mouth can be also used in stroke on the field as a public access device. Rabbit cooling: It was confirmed on this small animal model that CO2 was better than O2. A mixture of both gases can be considered CO2 replacing N2 with the same percentage of O2 (20%). Live pig cooling: The results demonstrated that it was possible to obtain the same cooling as PFC evaporation at WICCM (Fontaine EHRA Milano 2015). It was concluded that a pilot study in human was the next step forward.

Biography:

Abstract:

Aim: Primary pontine haemorrhage is the most devastating form of haemorrhage stroke accounting for about 10% of intra-cerebral haemorrhages with an overall mortality rate of 40-50% as reported in the literature. Th ere are various factors reported to have an association with outcome such as Glasgow Coma Scale score, clot location, clot volume, age and history of  hypertension. In our study, we analyzed the correlation between outcome, clinical and radiological parameters to determine the predictive factors and prognosis in primary pontine haemorrhage.
 
Methods: We retrospectively reviewed the clinical data of 47 patients admitted to Khoo Teck Puat Hospital, Singapore with a confi rmed radiological and clinical diagnosis of primary pontine haemorrhage from 2009 to 2015. Patient demographics, Glasgow Coma Scale scores, clinical and radiological parameters and outcomes were recorded. Subsequently, predictive factors
of mortality were identifi ed by statistical analyses. We also analyzed the correlation between acute blood pressure lowering and mortality.
 
Results: Out of the 47 patients, 31 were men. Overall 30-days mortality rate was 25.5%. Positive predictive factor of 48-hours mortality was mean systolic blood pressure of 160 mmHg or above in the fi rst 48 hours of admission (grade two and three hypertension). Positive predictive factor of 30-days mortality was Glasgow Coma Scale score of eight or less on arrival. Lowering of mean systolic blood pressure by 20% or more in the fi rst 48 hours correlates
with reduction in 48-hours and 30-days mortalities.
 
Conclusion: Th e overall 30-days mortality rate of 25.5% for patients with primary pontine haemorrhage in our study population is better than that reported in the literature. We attribute this to acute reduction of mean systolic blood pressure by 20% or more in the fi rst 48 hours of admission. Persistently raised mean systolic blood pressure in the fi rst 48 hours and Glasgow Coma Scale score of eight or less on arrival are positive predictors of mortality in primary pontine haemorrhage

  • Workshop: Regenerative Medicine : options for the treatment of degenerated spinal discs
Location: Sunset 2

Chair

Walter BIni

Healthpoint Hospital, UAE

Speaker
Biography:

Walter Bini has completed his Diploma at Westminster School, Simsbury Conn. USA and Post-graduate degree at Universidad de Zaragoza, Facultad de Medicina, Zaragoza-Spain. In 2014, he was the Middle East Chairman of ISLASS. He was Head of Neurosurgery at Sheikh Khalifa General Hospital, UAQ-UAE from 2014-2016. Currently, he is Consultant Neurosurgeon in Orthopedic department, spine section of Lanzo Hospital COF, Lanzo d’Intelvi in Italy and also Visiting Consultant Neurosurgeon in Orthopedic department at Healthpoint Hospital, UAE.

Abstract:

Lumbar degenerative disc disease (DDD) poses an ongoing challenge as far as treatment options and alternatives, especially when considering younger patients. Over 80% of the adult population presents with one or more episodes of ongoing-progressive low-back pain (LBP). The primary cause is associated with degeneration of the intervertebral disc and which is triggered by a decrease of the nucleus pulposus cell population, as evidenced in histological studies. Definitely, in the presence of a black disc without profusion and neurological compromise, microsurgery or even fusion surgery should not be contemplated. Numerous percutaneous techniques have been propagated as proper way to treat this condition throughout the literature in the past years. They have been primarily focused on the treatment of the pain generated by the involved disc and the subsequent segmental insufficiency, without addressing the degeneration of the disc and this have had limited success and remain as pain management tools. Some significant trials in the past (i.e. Chondrocyte transplantation trial) and the increasing recent research and achievements with more biological strategies as far as tissue regeneration have motivated the development of a new treatment concept initially applicable to the lumbar spine which will be presented and discussed. Advancements have led to a significant improvement in the understanding of the cell environment and tissue transplantation at a molecular, cellular and immunobiological level. Adipose tissue has already become a central source of clinical and research work involving adipose tissue derived progenitor cells. Endothelial and mesenchymal stem cells derived from adipose tissue are being considered and used in an array of clinical conditions and seem to have clear therapeutic benefits for many disease conditions including those affecting bone, cartilage and muscle. The use of an accessible source with abundant cells which have a high potential for regeneration clearly is superior in comparison to the chondrocyte option for the lumbar disc. Mesenchymal cells have a high self-renewal capacity and a potential for multi lineage differentiation. For this, adipose tissue derived MSCs (ADMSCs) are optimal candidates for tissue regeneration and can be obtained from the patient in a one-step procedure-treatment. 

Speaker
Biography:

Karin Wuertz-Kozak was born in 1978 in Germany. She received her degree in Pharmaceutical Sciences from the University of Regensburg, Germany in 2003 and her Ph.D. in Human Biology from the University of Ulm, Germany in 2006, based on her work in intervertebral disc cell mechanobiology. She was a Researcher at the University of Vermont, USA from 2006 to 2007 before joining and shortly thereafter taking over the Spine Research Unit at the University of Zurich, Switzerland. After having had a dual affiliation between xxx and xxx, she was promoted to a full-time research position at the ETH Zurich, Switzerland, one of the leading universities worldwide. In the subsequent years, she complemented her educational profile with an ETH habilitation as well as an MBA degree. Since July 2016, she is Assistant Professor for Immunoengineering & Regenerative Medicine at the ETH Zurich, with a focus on the pathophysiology and treatment of degenerative disc disease.

Abstract:

As a major weight bearing structure with limited nutritional support, the intervertebral disc is prone to degenerative changes early in life and contributes to the development of low back pain. Disc degeneration and low back pain are amongst the most relevant musculoskeletal disorders, resulting in high direct and indirect costs for our health care systems. As current treatment options are not satisfactory, the field of intervertebral disc regeneration has gained increasing importance amongst researchers as well as in the view of the World Health Organization.

This workshop will first provide a brief introduction to the biological processes occurring during intervertebral disc degeneration and will explain the molecular mechanisms that are hypothesized to contribute to pain development. Thereafter, various approaches to counteract degeneration and pain development will be explained. For each of the discussed novel treatments, the current state of the art as well as pitfalls that may hinder, limit and at least delay translation into clinical practice will be highlighted. Novel regenerative treatment examples to be demonstrated will include (1) tissue engineering of intervertebral disc (using a variety of modern techniques), (2) stem cell treatment (including an illustration on the use of fat-derived stem cells obtained directly in the OR) and (3) the use of biologics that have the potential to interfere with disc-typical pathological mechanisms.

Speaker
Biography:

Abstract:

Iliac crest bone graft (ICBG) is widely accepted as the gold standard for spinal fusion but is associated with donor site morbidities including hematoma, infection and prolonged chronic pain up to years after graft harvest. Bone graft substitutes and add-on biologics have been developed in an effort to combat these drawbacks of ICBG, but most have not considered the impact of their mechanical, biological and biochemical profiles on the process of osteogenesis. This presentation will highlight the signaling pathways associated with osteogenic differentiation of bone marrow derived mesenchymal stem cells and how those signaling pathways can be encouraged or inhibited by the properties of bone graft materials.

  • Neurosurgery and Nursing | Brain Tumour | Skullbase Neurosurgery
Location: Sunset 2
Speaker

Chair

Walter Bini

Healthpoint Hospital, UAE

Biography:

Mohamed Gaber Abdel Tawab is currently working as a Lecturer of Neurosurgery department at Fayoum University, Egypt. He completed his Residency of Neurosurgery at Cairo University Hospital in Egypt

Abstract:

Objective: Retrospective study of 222 patients was done to determine the long-term outcome of microdiscectomy on relief of sciatic pain.

Methods: This was a retrospective observational study of 222 patients who underwent microdiscectomy for sciatic pain during the period 2011 to 2013 at Faculty of Medicine, Cairo University. All patients were physically examined and interviewed. Recurrent procedures, multiple level discs were excluded from analysis. All procedures were done by same surgeon.

Results: Microdiscectomy yielded immediate complete pain relief in 215 patients. In seven patients, it yielded partial pain relief. Follow up to three years postoperatively, 205 patients remained absolutely pain free. Pain recurred in three patients after one year and in six patients during the first three years. Pain recurred in the same leg in eight patients, in the contralateral leg in two patients, and in both legs in one patient. One case presented with foot drop preoperative showed improvement. New neurological deficits developed postoperatively in one case in the form of foot drop and improved during follow up period.

Conclusions: Microdiscectomy provided immediate pain relief in about 96% of cases, and the long-term outcome of microdiscectomy has a very good satisfactory result.

Biography:

Abstract:

Introducton: Glioblastoma (GBM) is the most abundant malignant tumor in adults (McDowell et al., 2011, Bush et al., 2016) with an incidence of 3.19 cases per 100,000 person/year (Dolecek et al., 2012). GBM is the most aggressive brain neoplasm, with a high probability of recurrence. The pattern of growth of GBM is highly infiltrative which minimize chances for total resection of tumor. The traditional treatment for glioblastoma includes surgical removal followed by chemotherapy and

radiotherapy depending on clinical condiUon (Stupp et al., 2005). However, the recurrence rate is high and oXen resistance to both chemotherapy and radiotherapy ensues. In addition, it may affect the deeper brain tissues, thus preventing surgical option as an initial step for treatment (Weller et al., 2013). Therefore, new therapeutic tools are needed.

Aim of the study: The current study aims at assessing the effect on the human U87 glioma cell line of novel substances, synthesized by Prof. Zago<o’s laboratory, that can be used as promising therapeutic agents. The substances were chosen for showing some similarity in their structure with a component of the bee’s propolis and some plants, caffeic acid phenethyl ester (CAPE), which has been shown to have some effect in different cancer types (Chung et al. 2004).

Materials & methods:

• Cell culture techniques according to lab protocol

• Cells were treated for 24 or 72 hours with one of the 10 substances (see below)

• Wright staining, count cells to determine the percentage of apoptotic and necrotic cells

• Measurement of cell migration by In Vitro Scratch Assay (wound healing experiment)

• Statistical analysis: t-test, each treatment vs. control (DMSO at the same concentration used for treatments).

Results: Among 10 different novel substances tested, substances 5, 7, 8 and 9 showed variable effects, indicated by morphological and molecular evaluation. Effect ranges from apoptosis, necrosis and cytostatic effect on GBM cells.

Conclusions & future works: In conclusion, an initial screening of 10 substances, different in their molecular properties, highlighted a promising scaffold that will be explored in future works. More information will be added from ongoing experiments on the expression of various proteins

Biography:

Abstract:

Recent studies suggest that CNS lymphatic drainage pathway to extracranial lymph compartments may play an important role in the removal of substances in the brain and cerebrospinal fluid (CSF). After the onset of subarachnoid hemorrhage (SAH), large amount of macromolecular substances, such as cellular lysates, proteins, peptides, were accumulated in the brain tissue and CSF, which contribute to cerebral vasospasm and cerebral injury. The present experiment was carried out to investigate the possible role of cerebral lymphatic drainage pathway in the development of cerebral vasospasm and related cerebral injury and the influence of Ginkgo biloba extract. Wistar rats were used in the experiment and animals were divided into different groups. SAH models were replicated by double cisternal injection of autologous arterial hemolysate. In some animals the main cerebral lymphatic drainage way out being blocked (cerebral lymphatic blockade, CLB). Two different constituents, Ginkgolides and Ginkgo flavone, were given as interventions. It was found that SAH reduced the drainage of Evans blue-labeled albumin (EBA) from the brain to the olfactory bulbs, cervical lymph nodes and abdominal paraaortic lymph nodes. A kinetic analysis of 125I-labeled human serum albumin (125I-HSA), a cerebrospinal fluid (CSF) tracer, showed that the clearance rate of macromolecules in the CSF was significantly reduced after SAH. Furthermore, SAH reduced the diameters of basilar artery (BA) and increased thickness of BA. Prominent cerebral injury was found after induction of SAH. The spasm of BA and cerebral injury were partially antagonized by Ginkgolides and Ginkgo flavone. It was concluded that cerebral lymphatic drainage pathway exerts intrinsic protective effects against cerebral vasospasm and cerebral injury by removal of macromolecular substances in the brain and subarachnoid spaces. Ginkgolides and Ginkgo flavone may alleviate the exacerbated cerebral vasospasm and cerebral injury following SAH by CLB.

Key words: subarachnoid hemorrhage; lymphatic drainage; cerebral vasospasm; cerebral injury; Ginkgolides; Ginkgo flavone

Biography:

Abstract:

Undoubtedly, the greatest contribution of nanobiotechnology will be at neuroscience which still having a cloak of secrecy over and waiting to be discovered millions of issue to be clarified. Neuropharmacology and nanobiotechnological developments in the field of tissue engineering will provide the foundation stone in the development of neuroscience.

Get nutrients, dietary supplements and many drugs do not cross the blood brain barrier. The presence of this barrier, restricts medical interventions in the treatment of neurodegenerative and psychiatric diseases.

Besides, preventing several brain diseases or intervention to psychiatric conditions, prevents showing antioxidant properties of molecules and also allows us to improve and slowing down the aging brain.

The aim of our study is, molecules that can pass through the barrier at high rates, to increase the success of the production of new agents in the treatment of neural diseases. The first phase of our project is completed, it is intended to activate the cholinergic system using nanotechnology. Cholinergic system, increases awareness by activating visual, audial, and almost all the senses.

The R&D project that we realized by support of Ministry of Science and Industry, we have developed a product that supports the functional antioxidant which is first and only developed in our country. The useful molecules in Rosmarinus officinalis and Olea Europaea are purified. Product of our study of the effect by inhibiting acetylcholinesterase was implicated microparticles using nanobiotechnologic methods. Microparticles are in no way affected by gastric acid and protecting all the bioactive molecules from gastric acid content. The impact of the product over Central Nervous System, investigated over 22 channels of 100 volunteers and evaluated with Electroencephalogram recording system plus program. The ASA program was used for analysis.

The results obtained up to this time, the nanoparticle products, most notably frontal-temporal region, caused the increase in almost all parts of my brain alpha and beta frequency.

It has been monitored that nanobiotechnological products we obtained in our study, were able to pass the blood brain barrier and the effect lasted up to 24 hours. Changes in the frequency of brain waves in the frontal and temporal regions showed that, it is effective in gathering concentration of the product and attention. The results indicate the center of nanotechnology products could be used in evaluating the bioavailability of neuronal oscillations in the central nervous system.