Day 3 :
Keynote Forum
Walter Bini
Healthpoint Hospital, UAE
Keynote: Lumbar spinal canal stenosis: Surgical management strategies, quo vadis (where to)
Time : 10:00-10:40
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 spinal stenosis (LSS) is characterized by a narrowing of the lumbar spinal canal and/or the intervertebral foramina resulting from disc degeneration, bulging of the annulus, facet joint hypertrophy and infolding of the ligamentum flavum. With increase of the aging population and advances in diagnostic imaging capabilities, lumbar spinal stenosis in its different stages or types is becoming more frequently diagnosed with an estimated prevalence of up to 13%. This along with newer technical advances being introduced in the surgical management of LSS continues to pose a topic of discussion among neurologists as well as orthopedic and neurosurgeons as far as treatment strategies are concerned.
Especially the cases of moderate or soft stenosis, very different than the bony or consolidated type, warrant a detailed analysis of the primary interspinous devices used for both types along with a proposal for a decision making protocol. Based on our experience with the management of these two entities, we will focus on our results and future considerations with less invasive procedures which are proving over the last two decades to be a viable alternative for stenosis patients. Core of our presentation are our results with a minimal invasive procedure performed in 121 patients and their corresponding initial follow-up over one year with a 92% success rate evaluated by an independent observer. This is clearly in contrast with the 40-90% success rates and 14-35% complication rates reported and associated with standard decompression surgeries. Furthermore, we will present our considerations of a further novel technique and the direction treatment options are developing towards the corresponding scheduled clinical-trial.
Keynote Forum
Walter Bini
Healthpoint Hospital, UAE
Keynote: Lumbar spinal canal stenosis: Surgical management strategies, quo vadis (where to)
Time : 10:00-10:40
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 spinal stenosis (LSS) is characterized by a narrowing of the lumbar spinal canal and/or the intervertebral foramina resulting from disc degeneration, bulging of the annulus, facet joint hypertrophy and infolding of the ligamentum flavum. With increase of the aging population and advances in diagnostic imaging capabilities, lumbar spinal stenosis in its different stages or types is becoming more frequently diagnosed with an estimated prevalence of up to 13%. This along with newer technical advances being introduced in the surgical management of LSS continues to pose a topic of discussion among neurologists as well as orthopedic and neurosurgeons as far as treatment strategies are concerned.
Especially the cases of moderate or soft stenosis, very different than the bony or consolidated type, warrant a detailed analysis of the primary interspinous devices used for both types along with a proposal for a decision making protocol. Based on our experience with the management of these two entities, we will focus on our results and future considerations with less invasive procedures which are proving over the last two decades to be a viable alternative for stenosis patients. Core of our presentation are our results with a minimal invasive procedure performed in 121 patients and their corresponding initial follow-up over one year with a 92% success rate evaluated by an independent observer. This is clearly in contrast with the 40-90% success rates and 14-35% complication rates reported and associated with standard decompression surgeries. Furthermore, we will present our considerations of a further novel technique and the direction treatment options are developing towards the corresponding scheduled clinical-trial.
Keynote Forum
Walter Bini
Healthpoint Hospital, UAE
Keynote: Lumbar spinal canal stenosis: Surgical management strategies, quo vadis (where to)
Time : 10:00-10:40
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 spinal stenosis (LSS) is characterized by a narrowing of the lumbar spinal canal and/or the intervertebral foramina resulting from disc degeneration, bulging of the annulus, facet joint hypertrophy and infolding of the ligamentum flavum. With increase of the aging population and advances in diagnostic imaging capabilities, lumbar spinal stenosis in its different stages or types is becoming more frequently diagnosed with an estimated prevalence of up to 13%. This along with newer technical advances being introduced in the surgical management of LSS continues to pose a topic of discussion among neurologists as well as orthopedic and neurosurgeons as far as treatment strategies are concerned.
Especially the cases of moderate or soft stenosis, very different than the bony or consolidated type, warrant a detailed analysis of the primary interspinous devices used for both types along with a proposal for a decision making protocol. Based on our experience with the management of these two entities, we will focus on our results and future considerations with less invasive procedures which are proving over the last two decades to be a viable alternative for stenosis patients. Core of our presentation are our results with a minimal invasive procedure performed in 121 patients and their corresponding initial follow-up over one year with a 92% success rate evaluated by an independent observer. This is clearly in contrast with the 40-90% success rates and 14-35% complication rates reported and associated with standard decompression surgeries. Furthermore, we will present our considerations of a further novel technique and the direction treatment options are developing towards the corresponding scheduled clinical-trial.
Keynote Forum
Hugues Duffau
Gui de Chauliac Hospital, France
Keynote: Surgery of insular and paralimbic diffuse low-grade gliomas: Technical considerations
Time : 10:40-11:20
Biography:
Hugues Duffau is a Professor and Chairman of Neurosurgery department at Montpellier University Medical Center and Head of the INSERM 1051 Team "Plasticity of the central nervous system, human stem cells and glial tumors" at Institute for Neurosciences of Montpellier (France). He is an expert in the awake cognitive neurosurgery of slow-growing brain tumors, as low-grade gliomas, a routine which he has developed since 20 years. His fundamental approach is centered on the concepts of the brain connectomics and neuroplasticity, breaking with the traditional localizationist view of cerebral processing. He has written four textbooks and over 335 publications in international journals ranging from neurosurgery to fundamental neurosciences, including cognitive sciences and brain plasticity for a total of more than 20,500 citations and with an h-index of 77. He is member of editorial boards of many journals and Reviewer for around 100 journals including: New England Journal of Medicine, Lancet Oncology, Nature Medicine, Nature Reviews Neuroscience, Nature Reviews Neurology, Annals of Neurology, Brain, Cerebral Cortex, Trends in Cognitive
Abstract:
Aim: Once considered a ‘‘no man’s land’’ especially when invaded by a diffuse low grade glioma (DLGG), the insula/paralimbic system remains today a surgical challenge. Surgery for insular/paralimbic DLGG involves consideration of its hidden location under the potentially eloquent operculae, the proximity to vascular tree and high density of functions not only in the insular cortex but also in the white fiber pathways passing under the insular lobe. Here, a personal consecutive series of 150 patients who underwent an insular/paralimbic DLGG revealed by seizures, with long-term follow-up, is detailed. Based upon functional and oncological results, advances and limitations of this challenging surgery are discussed.
Methods: The preoperative examination was normal in 88% of patients. All surgeries were performed under cortico-subcortical stimulation, in 134 patients while awake. A transopercular approach was favored, even in pure insular DLGG. Despite an immediate postoperative worsening in 59% of cases, all patients but two (98%) returned to baseline or better. On control MRI, 80% of resections were total or subtotal. 15 patients underwent a second or third surgery, with no additional deficit. 82% of patients are still alive with a mean follow-up of seven years.
Conclusions: This is the largest series ever reported with insular/paralimbic DLGG surgery. The better knowledge of the functional anatomy and the connectivity of the insula as well as the use of intraoperative direct stimulation mapping enabled to minimize the risk of permanent deficit (and even to improve the quality of life) while increasing the extent of resection; thus, the impact on the natural history. Therefore, surgical removal has to be considered systematically for insular/paralimbic DLGG. However, this surgery remains challenging, especially within the anterior perforating substance and the posterior part of the (dominant) insula. Repeated operations can be suggested when the first resection was not complete.
- Neurological Disorders| Pediatric Neurosurgery | Neuroaesthetics and Critical Care
Location: Sunset 1
Chair
Roberto Cartolari
S. Giovanni Hospital, Switzerland
Session Introduction
Gabriel Fernando Todeschi Variane
Neuro-NICU of Santa Casa de Sao Paulo, Brazil
Title: Neurological neonatal ICU: New approaches for neonates at high risk for brain injury and the South American centers experience
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.
Sarah Adelaide Crawford
Southern Connecticut State University, USA
Title: Prenatal screening of maternal immune antigen biomarkers linked to microglial regulation of brain development may predict autism risk
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
Chair
Radu Mutihac
University of Bucharest, Romania
Session Introduction
Radu Mutihac
University of Bucharest, Romania
Title: Brain connectivity dynamics in neurological dysfunctions
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
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.
Simona Spînu
University of Bucharest, Romania
Title: Visual Memory in a Factorial Event-Related Paradigm
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.
Sniedze Murniece
Riga East University Hospital, Latvia
Title: Prone positions influence on regional cerebral oxygen saturation in patients undergoing spinal neurosurgery
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
Chair
Roberto Cartolari
S. Giovanni Hospital, Switzerland
Session Introduction
Afif AFIF
Pierre Wertheimer Hospital, France
Title: The importance of somatotopy to achieve clinical benefit in motor cortex stimulation for pain relief
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.
Lan B. Hoang -Minh
University of Florida, USA
Title: Key roles of mitochondrial function and lipid metabolism in slow-cycling glioblastoma cells
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:
Mohamed Gaber Abdel Tawab
Fayoum University, Egypt
Title: Long term outcome of microdiscectomy: Three years follow up
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
Chair
Vera Novak
Harvard Medical School, USA
Session Introduction
Vera Novak
Harvard Medical School, USA
Title: Brain signatures of metabolic syndrome and new treatment options for cognitive decline
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
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.
Surentheran S
Khoo Teck Puat Hospital, Singapore
Title: Predictive factors of mortality for primary pontine haemorrhage in an Asian population
Biography:
Abstract:
- Workshop: Regenerative Medicine : options for the treatment of degenerated spinal discs
Location: Sunset 2
Chair
Walter BIni
Healthpoint Hospital, UAE
Session Introduction
Walter Bini
Healthpoint Hospital, UAE
Title: Degenerative disc disease: Up-front considerations regarding treatment with mesenchymal adipose tissue derived stem cells
Time : 11:50-12:20
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.
Karin Wuertz-Kozak
ETH Zurich, Switzerland
Title: Biology and Regenerative Medicine Aspects of the Intervertebral Disc
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.
Katy Moncivais
Celling Biosciences, USA
Title: Toward scientifically informed stem cell therapies in spine surgery
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
Chair
Walter Bini
Healthpoint Hospital, UAE
Session Introduction
Mohamed Gaber Abdel Tawab
Fayoum University, Egypt
Title: Dural fenestrations versus duraplasty in traumatic acute subdural hematoma
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.
Ahmed Rezk
Cairo University, Egypt
Title: Testing the effect of novel molecules on glioblastoma cells
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
Muduroglu Aynur
Nisantasi University, Turkey
Title: Is the safe method evaluate Nanotechnologic products in Neuronal modulation of Neuronal oscillations
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.