Scientific Program

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

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Scientific Program Day 1
Scientific Program Day 2
Scientific Program Day 3

Day 2 :

Keynote Forum

Guy Hugues Fontaine

Universite Pierre et Marie Curie, France

Keynote: First Case of Brain Protection in Out of Hospital Cardiac Arrest
Conference Series Neurosurgery 2017 International Conference Keynote Speaker Guy Hugues Fontaine photo
Biography:

Abstract:

My wife Ilfat, a 73 year-old psychiatrist, experienced OHCA on June 2011 in the living room where she was watching the BBC world channel on TV. She suddenly stopped talking. I waited a few moments before turning towards her to check whether she might have fallen asleep. To my horror I found that she was cyanotic, her head drooped on her chest. It was obvious that she had signs of possible sudden cardiac arrest. I immediately laid her down on the floor. There was no femoral pulse. I initiated standard CPR including chest compression (90 compressions/minute) for about 30 seconds followed by mouth to mouth breathing. I then resumed cardiac massage since she did not regain consciousness and there was no femoral pulse. I had a defibrillator in the basement of my house because of my interest in the Fulguration procedure. Although the defibrillator was more than 30 years old I knew that this machine would work by electrical current from the outlet. The defibrillator was charged to allow for a first shock and a second shock to be delivered through metallic disk–shaped electrodes that were on this old machine.  Her body jumped but the shocks were ineffective. Since I had no gel to apply between the electrodes and the skin to decrease the impedance, I applied saliva to the electrodes and then gave a third shock.  This last shock was successful, and the femoral pulse returned strong and regular. Recurrent chest compression produced the characteristic sound make by a broken chondro-costal joint. The femoral pulse remained stable, regular and strong.  I estimated that about 5 to 6 minutes elapsed between her loss of consciousness and the return to a stable circulation. Since there was no sign of return to consciousness and she had bilateral pupillary dilation, I then addressed the issue of possible brain protection. Fortunately, I had a smaller portable bottle now called the “Fontaine bottle” (JACC 2016) that was designed with a gas regulator to be used with a nasal cannula inserted into the nose to provide protection of the brain by nasal cooling.

Because of the invasive insertion in fossa nasalis, Ilfat exhibited a pain reaction which I interpreted as a positive sign for her chances of survival. When the injector was in position I opened the valve of the cylinder and induced nasal cooling by expansion of the CO2. Her hospital course was notable for repeated episodes of ventricular fibrillation with the same ECG pattern of Torsade de Pointes-like tachycardia degenerating in Ventricular Fibrillation in a few seconds. The absence of Troponin release demonstrated that she had no acute myocardial infarction which was my main concern. When sedation was stopped, she was fully awake and the tracheal tube was removed.  Ilfat first question was whether she was treated with nasal cooling!  She refused amiodarone but was treated with bisoprolol which proved effective. After recovery from the implantation of a dual chamber defibrillator she had only thoracic pain which was a direct consequence of chest compression. This pain disappeared in two months. Psychological test showed that she had absolutely no neurologic deficit. In particular, she could remember 9 telephone numbers. During the follow-up, she experienced three more episodes of sudden death with drop (one with injury of the face) immediately converted by the defibrillator leading to an increase of Bisoprolol. However, she experienced a total obstruction of the trunk cerebral artery in November 2015 also treated in La Salpêtrière by thrombolysis and clot extraction 1:20 after the loss of consciousness. She again recovered with absolutely no neurological deficit except a slower rate of speaking. She is now treated by Eliquis and enjoy normal life and continue to see her patients. Thanks to advanced techniques of resuscitation techniques and clinical electrophysiology (my area of expertise) as well as interventional neurology 

Keynote Forum

Radu Mutihac

University of Bucharest, Romania

Keynote: Functional Neuroimaging Data Mining
Conference Series Neurosurgery 2017 International Conference Keynote Speaker Radu Mutihac photo
Biography:

Radu Mutihac is a Head of Medical Physics Section, works in Neuroscience, Signal Processing, Microelectronics and Artifi cial 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 scientifi c papers, 12 monographs and contributed with chapters in other 10 text books. He contributed to more than 150 scientifi c meetings with posters and oral presentations, seminars, invited and plenary lectures, as well as acting as Organizer, Chairman, and Keynote Speaker.

Abstract:

Imaging Neuroscience is aiming to reveal functional changes in brain activity and structural changes in neuroanatomy. Biomedical time series, particularly functional brain imaging data, are rich sources of information about physiological processes, but they are often contaminated with artifacts and noise, and typically recorded as mixtures of unknown combinations of sources summing up differently in time and/or space. In many cases, even the nature of sources is an open question. The interest in functional brain studies lays in the electrical activity of fi ring neurons, which cannot entirely be inferred by analyzing the vascular process because the hemodynamic lag varies in a complex way from tissue to tissue, and no theory on the relationship between the electrical and hemodynamic processes is available. Most of imaging Neuroscience relies on confi rmatory data analysis (CDA) like inferential hypothesis-led analysis, which makes use of spatially extended processes (e.g., statistical parametric mapping - SPM). Yet spatiotemporal characteristics of brain activity are frequently unknown and variable, which preclude their evaluation by confi rmatory methods only. Revealing unanticipated or missed patterns of activation, data mining (DM) and exploratory data analysis (EDA) allow to improve or even to change the original hypotheses. In contrast to CDA, exploratory methods entail no reference to prior knowledge of the structure in data and provides models whose characteristics are determined by the statistical properties of data only and no statistical model is required on the inferences to perform. However, some differences exist: while DM searches for consistent patterns and predictability, EDA looks for systematic relationships between variables. The contribution : In imaging Neuroscience, the dynamic interplay between hypothesis generation and hypothesis testing, a Hegelian synthesis of EDA and CDA, has the best chance of dealing successfully with the increasingly complex experiments, or the emerging broad range of theoretical and clinical studies. As such, confi rmatory and exploratory analyses appear more complementary rather than competitive.

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

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:

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.

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
Speaker

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
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.

Surentheran S

Khoo Teck Puat Hospital, Singapore

Title: Predictive factors of mortality for primary pontine haemorrhage in an Asian population
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