Honors & Awards

  • Harvard High-Value Surgical Systems Program Scholarship, Harvard Medical School (2022)
  • Travel Scholarship for GlobalNeuro Complex Cranial Access Course, Rome, Italy, GlobalNeuro (2021)
  • Best Poster Presentation, Stanford University Neuroscience Forum (2019)
  • Gates Cambridge Scholarship, University of Cambridge (2019-2023)
  • Cullen Travel Fellow, MD Anderson Cancer Center (March 2015)
  • Commencement Speaker, Williams College (June 2015)
  • Gates Cambridge Scholarship, The Gates Foundation (February 2019)
  • The Frederick C. Hagedorn, Jr. Pre-Medical Prize, Williams College (June 2015)

Professional Affiliations and Activities

  • Member, American Association of Neurological Surgeons (2016 - Present)
  • Member, Massachusetts Medical Society (2018 - Present)

Membership Organizations

  • Neurosurgery Interest Group, Co-President
  • OIH: Organization of International Health

Education & Certifications

  • Bachelor of Arts, Williams College, Chemistry (2015)
  • PhD, University of Cambridge, Clinical Neuroscience (2024)
  • BA, Williams College, Chemistry and Comparative Literature (2015)

Current Clinical Interests

  • Neurosurgery
  • Traumatic Brain Injury
  • Pediatric Neurosurgery

Research Projects

  • Global Neurotrauma Outcomes Study (GNOS) (Scholarly Concentration Project)


    University of Cambridge


    University of Cambridge


Work Experience

  • Intern, Emergency and Essential Surgical Care Program, World Health Organization (6/1/2017 - 8/2017)


    World Health Organization, switzerland

All Publications

  • Innovative Solutions for Patients Who Undergo Craniectomy: Protocol for a Scoping Review. JMIR research protocols Fernandez, L. L., Griswold, D., Khun, I., Rodriguez De Francisco, D. V. 2024; 13: e50647


    BACKGROUND: Decompressive craniectomy (DC) is a widely used procedure to alleviate high intracranial pressure. Multidisciplinary teams have designed and implemented external medical prototypes to improve patient life quality and avoid complications following DC in patients awaiting cranioplasty (CP), including 3D printing and plaster prototypes when available.OBJECTIVE: This scoping review aims to understand the extent and type of evidence about innovative external prototypes for patients who undergo DC while awaiting CP.METHODS: This scoping review will use the Joanna Briggs Institute methodology for scoping reviews. This scoping review will include noninvasive medical devices for adult patients who undergo DC while waiting for CP. The search strategy will be implemented in MEDLINE, Embase, Web of Science, Scielo, Scopus, and the World Health Organization (WHO) Global Health Index Medicus. Patent documents were also allocated in Espacenet, Google Patents, and the World Intellectual Property Organization (WIPO) database.RESULTS: This scoping review is not subject to ethical approval as there will be no involvement of patients. The dissemination plan includes publishing the review findings in a peer-reviewed journal and presenting results at conferences that engage the most pertinent stakeholders in innovation and neurosurgery.CONCLUSIONS: This scoping review will serve as a baseline to provide evidence for multidisciplinary teams currently designing these noninvasive innovations to reduce the risk of associated complications after DC, hoping that more cost-effective models can be implemented, especially in low- and middle-income countries.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50647.

    View details for DOI 10.2196/50647

    View details for PubMedID 38451601

  • Anatomical variations of the atlas arches: prevalence assessment, systematic review and proposition for an updated classification system. Frontiers in neuroscience Baena-Caldas, G. P., Mier-Garcia, J. F., Griswold, D. P., Herrera-Rubio, A. M., Peckham, X. 2024; 18: 1348066


    Objective and background: This study focuses on the atlas, a pivotal component of the craniovertebral junction, bridging the cranium and spinal column. Notably, variations in its arches are documented globally, necessitating a thorough assessment and categorization due to their significant implications in clinical, diagnostic, functional, and therapeutic contexts. The primary objective is to ascertain the frequency of these anatomical deviations in the atlas arches among a Colombian cohort using cone-beam computed tomography (CBCT).Methodology: Employing a descriptive, cross-sectional approach, this research scrutinizes the structural intricacies of the atlas arches in CBCT scans. Analytical parameters included sex distribution and the nature of anatomical deviations as per Currarino's classification. Statistical analyses were conducted to identify significant differences, including descriptive statistics and Chi-square tests. A systematic review of the literature was conducted in order to enhance the current Currarino's classification.Results: The study examined 839 CBCT images, with a nearly equal sex distribution (49.7% female, 50.3% male). Anatomical variations were identified in 26 instances (3%), displaying a higher incidence in females (X2 [(1, N=839)=4.0933, p=0.0430]). The most prevalent variation was Type A (2.5%), followed by Type B (0.4%), and Type G (0.2%) without documenting any other variation. The systematic review yielded 7 studies. A novel classification system for these variations is proposed, considering global prevalence data in the cervical region.Conclusion: The study highlights a statistically significant predominance of Type A variations in the female subset. Given the critical nature of the craniovertebral junction and supporting evidence, it recommends an amendment to Currarino's classification to better reflect these clinical observations. A thorough study of anatomical variations of the upper cervical spine is relevant as they can impact important functional aspects such as mobility as well as stability. Considering the intricate anatomy of this area and the pivotal function of the atlas, accurately categorizing the variations of its arches is crucial for clinical practice. This classification aids in diagnosis, surgical planning, preventing iatrogenic incidents, and designing rehabilitation strategies.

    View details for DOI 10.3389/fnins.2024.1348066

    View details for PubMedID 38482143

  • Global Neurosurgery: Progress and Resolutions at the 75th World Health Assembly. Neurosurgery Garcia, R. M., Ghotme, K. A., Arynchyna-Smith, A., Mathur, P., Koning, M., Boop, F., Peterson, D., Sheneman, N., Johnson, W. D., Park, K. B., Griswold, D., Aukrust, C. G., Barthélemy, E. J., Ibbotson, G., Blount, J. P., Rosseau, G. L. 2023


    Neurosurgical advocates for global surgery/neurosurgery at the 75th World Health Assembly gathered in person for the first time after the COVID-19 pandemic in Geneva, Switzerland, in May 2022. This article reviews the significant progress in the global health landscape targeting neglected neurosurgical patients, emphasizing high-level policy advocacy and international efforts to support a new World Health Assembly resolution in mandatory folic acid fortification to prevent neural tube defects. The process of developing global resolutions through the World Health Organization and its member states is summarized. Two new global initiatives focused on the surgical patients among the most vulnerable member states are discussed, the Global Surgery Foundation and the Global Action Plan on Epilepsy and other Neurological Disorders. Progress toward a neurosurgery-inspired resolution on mandatory folic acid fortification to prevent spina bifida-folate is described. In addition, priorities for moving the global health agenda forward for the neurosurgical patient as it relates to the global burden of neurological disease are reviewed after the COVID-19 pandemic.

    View details for DOI 10.1227/neu.0000000000002472

    View details for PubMedID 37010299

  • Hyperosmolar therapies for neurological deterioration in mild and moderate traumatic brain injury: A scoping review. Brain injury Marchesini, N., Fernandez Londono, L. L., Boaro, A., Kuhn, I., Griswold, D., Sala, F., Rubiano, A. M. 2023: 1-9


    OBJECTIVE: To explore the available evidence on hyperosmolar therapies(HT) in mild and moderate traumatic brain injury(TBI) and to evaluate the effects on outcomes.A scoping review was conducted according to the Joanna Briggs Institute methodology. Inclusion criteria: (a)randomized controlled trials(RCTs), prospective and retrospective cohort studies and case-control studies; (b)all-ages mild and moderate TBIs; (c)HT administration; (d)functional outcomes recorded; (e)comparator group.RESULTS: From 4424 records, only 3 respected the inclusion criteria. In a retrospective cohort study of adult moderate TBIs, the Glasgow Coma Scale(GCS) remained the same at 48hours in those treated with hypertonic saline(HTS) while it worsened in the non-treated. A trend toward increased pulmonary infections and length of stay was found. In an RCT of adult severe and moderate TBIs, moderate TBIs treated with HTS showed a trend toward better secondary outcomes than standard care alone, with similar odds of adverse effects. An RCT enrolling children with mild TBI found a significant improvement in concussive pain immediately after HTS administration and after 2-3days. No adverse events occurred.CONCLUSIONS: A gap in the literature about HTs' role in mild and moderate TBI was found. Some benefits may exist with limited side effects and further studies are desirable.

    View details for DOI 10.1080/02699052.2023.2191010

    View details for PubMedID 36929819

  • Future Directions for Global Clinical Neurosurgical Training: Challenges and Opportunities WORLD NEUROSURGERY Hoffman, C., Hartl, R., Shlobin, N. A., Tshimbombu, T. N., Elbabaa, S. K., Haglund, M. M., Rubiano, A. M., Dewan, M. C., Stippler, M., Mahmud, M., Barthelemy, E. J., Griswold, D. P., Wohns, R., Shabani, H. K., Rocque, B., Sandberg, D., Lafuente, J., Dempsey, R., Rosseau, G. 2022; 166: E404-E418


    Expanded access to training opportunities is necessary to address 5 million essential neurosurgical cases not performed annually, nearly all in low- and middle-income countries. To target this critical neurosurgical workforce issue and advance positive collaborations, a summit (Global Neurosurgery 2019: A Practical Symposium) was designed to assemble stakeholders in global neurosurgical clinical education to discuss innovative platforms for clinical neurosurgery fellowships.The Global Neurosurgery Education Summit was held in November 2021, with 30 presentations from directors and trainees in existing global neurosurgical clinical fellowships. Presenters were selected based on chain referral sampling from suggestions made primarily from young neurosurgeons in low- and middle-income countries. Presentations focused on the perspectives of hosts, local champions, and trainees on clinical global neurosurgery fellowships and virtual learning resources. This conference sought to identify factors for success in overcoming barriers to improving access, equity, throughput, and quality of clinical global neurosurgery fellowships. A preconference survey was disseminated to attendees.Presentations included in-country training courses, twinning programs, provision of surgical laboratories and resources, existing virtual educational resources, and virtual teaching technologies, with reference to their applicability to hybrid training fellowships. Virtual learning resources developed during the coronavirus disease 2019 pandemic and high-fidelity surgical simulators were presented, some for the first time to this audience.The summit provided a forum for discussion of challenges and opportunities for developing a collaborative consortium capable of designing a pilot program for efficient, sustainable, accessible, and affordable clinical neurosurgery fellowship models for the future.

    View details for DOI 10.1016/j.wneu.2022.07.030

    View details for Web of Science ID 000878175000013

    View details for PubMedID 35868506

  • A Case Series of Stereotactic Biopsy of Brainstem Lesions through the Transfrontal Approach. Journal of neurological surgery reports Escobar-Vidarte, O. A., Griswold, D. P., Orozco-Mera, J., Mier-Garcia, J. F., Peralta Pizza, F. 2022; 83 (4): e123-e128


    Background and Importance Brainstem lesions may be unresectable or unapproachable. Regardless, the histopathological diagnosis is fundamental to determine the most appropriate treatment. We present our experience with transfrontal stereotactic biopsy technique for brainstem lesions as a safe and effective surgical route even when contralateral transhemispheric approach is required for preservation of eloquent tissue. Clinical Presentation Twenty-five patients underwent surgery by transfrontal approach. Medical records were reviewed for establishing the number of patients who had postoperative histopathological diagnosis and postoperative complications. Twenty-four patients (18 adults and 7 children) had histopathological diagnosis. There were 18 astrocytomas documented, of which 12 were high grade and 6 low grade. The other diagnoses included viral encephalitis, post-renal transplant lymphoproliferative disorder, nonspecific chronic inflammation, Langerhans cell histiocytosis, and two metastases. No case was hindered by cerebrospinal fluid loss or ventricular entry. Complications included a case of mesencephalic hemorrhage with upper limb monoparesis and a case of a partially compromised third cranial nerve in another patient without associated bleeding. Conclusion Stereotactic biopsy of brainstem lesions by transfrontal ipsilateral or transfrontal transhemispheric contralateral approaches is a safe and effective surgical approach in achieving a histopathological diagnosis in both pediatric and adult populations.

    View details for DOI 10.1055/s-0042-1758696

    View details for PubMedID 36467870

  • An Umbrella Review With Meta-Analysis of Chest Computed Tomography for Diagnosis of COVID-19: Considerations for Trauma Patient Management FRONTIERS IN MEDICINE Gempeler, A., Griswold, D. P., Rosseau, G., Johnson, W. D., Kaseje, N., Kolias, A., Hutchinson, P. J., Rubiano, A. M. 2022; 9: 900721


    RT-PCR testing is the standard for diagnosis of COVID-19, although it has its suboptimal sensitivity. Chest computed tomography (CT) has been proposed as an additional tool with diagnostic value, and several reports from primary and secondary studies that assessed its diagnostic accuracy are already available. To inform recommendations and practice regarding the use of chest CT in the in the trauma setting, we sought to identify, appraise, and summarize the available evidence on the diagnostic accuracy of chest CT for diagnosis of COVID-19, and its application in emergency trauma surgery patients; overcoming limitations of previous reports regarding chest CT accuracy and discussing important considerations regarding its role in this setting.We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. The review was conducted following the JBI methodology for systematic reviews. The Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267).Thirty studies that fulfilled selection criteria were included; 19 primary studies provided estimates of sensitivity (0.91, 95%CI = [0.88-0.93]) and specificity (0.73, 95%CI = [0.61; 0.82]) of chest CT for COVID-19. No correlation was found between sensitivities and specificities (ρ = 0.22, IC95% [-0.33; 0.66]). Diagnostic odds ratio was estimated at: DOR = 27.5, 95%CI (14.7; 48.5). Evidence for sensitivity estimates was graded as MODERATE, and for specificity estimates it was graded as LOW.The value of chest CT appears to be that of an additional screening tool that can easily detect PCR false negatives, which are reportedly highly frequent. Upon the absence of PCR testing and impossibility to perform RT-PCR in trauma patients, chest CT can serve as a substitute with increased value and easy implementation.[www.crd.york.ac.uk/prospero], identifier [CRD42020198267].

    View details for DOI 10.3389/fmed.2022.900721

    View details for Web of Science ID 000891267900001

    View details for PubMedID 35957847

    View details for PubMedCentralID PMC9360488

  • GLOBAL CHALLENGES IN NEUROTRAUMA Hutchinson, P., Griswold, D., Clark, D., Bashford, T., Smith, B., Mohan, M., Budohoska, K., Turner, C., Whiffin, C., Budohoska, N., Joannides, A., Trivedi, R., Menon, D., Kolias, A., NIHR Global Hlth Res Grp MARY ANN LIEBERT, INC. 2022: A4
  • Implementing a Neurotrauma Registry in Latin America and the Caribbean. Journal of neurosciences in rural practice Rolle, M. L., Garba, D. L., Griswold, D. P., Fernández, L. L., Sánchez, D. M., Clavijo, A., Rubiano, A. M. 2022; 13 (3): 525-528


    Background  Traumatic brain injury (TBI) has a disproportionately greater impact in low- and middle-income countries (LMICs). One strategy to reduce the burden of disease in LMICs is through the implementation of a trauma registry that standardizes the assessment of each patient's management of care. Objective  This study aims to ascertain the interest of Latin America and the Caribbean (LAC) nations in establishing a shared neurotrauma registry in the regional block, based on an existing framework for collaboration. Methods  A descriptive review was performed regarding the interests of LAC nations in implementing a shared neurotrauma registry in their region. We convened a meeting with seven Caribbean and five Latin American nations. Results  One hundred percent ( n  = 12) of the LAC representatives including neurosurgeons, neurointensivists, ministers of health, and chief medical officers/emergency medical technicians (EMTs) agreed to adopt the registry for tracking the burden of TBI and associated pathologies within the region. Conclusion  The implementation of a neurotrauma registry can benefit the region through a shared database to track disease, improve outcomes, build research, and ultimately influence policy.

    View details for DOI 10.1055/s-0042-1745816

    View details for PubMedID 35946020

    View details for PubMedCentralID PMC9357496

  • Protocol for a Multicenter, Prospective, Observational Pilot Study on the Implementation of Resource-Stratified Algorithms for the Treatment of Severe Traumatic Brain Injury Across Four Treatment Phases: Prehospital, Emergency Department, Neurosurgery, and Intensive Care Unit. Neurosurgery Griswold, D. P., Carney, N., Ballarini, N. M., Fernandez, L. L., Kolias, A., Hutchinson, P. J., Rubiano, A. M. 2022


    BACKGROUND: Severe traumatic brain injury (sTBI) is a public health issue with great disparity among low- and middle-income countries where the implementation of evidence-based guidelines is challenging because resources are often unavailable. A consensus process including experts in the prehospital, emergency department, neurosurgery, and intensive care unit took place in Colombia to develop a set of stratified protocols called BOOTStraP, targeting resource-poor environments, but it has not been systematically implemented and tested.OBJECTIVE: To identify the facilitators of, and barriers to, collecting data about patients with sTBI and to implement a stratified protocol across the treatment phases of prehospital, emergency department, neurosurgery, and intensive care unit in low-resource settings. We also aim to identify a possible association between adherence to these protocols and outcomes for these patients.METHODS: A prospective, observational, before and after, pilot study will be performed in three phases as follows: before implementation, implementation, and after implementation. The BOOTStraP protocols will be implemented in three Colombian centers.EXPECTED OUTCOMES: We expect to find numerous barriers during the implementation phase. We also expect moderate adherence to the protocols. However, we expect to find an increase in the survival rate to hospital discharge and an improvement in neurological outcomes at discharge.DISCUSSION: This pilot study will serve as a first step to identify variables that are critical to successful implementation, to be considered for the design of a future large-scale international study to measure the effectiveness of resource-based protocols and to improve outcomes from sTBI.

    View details for DOI 10.1227/neu.0000000000002004

    View details for PubMedID 35485862

  • Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study LANCET NEUROLOGY Clark, D., Joannides, A., Adeleye, A., Bajamal, A., Bashford, T., Biluts, H., Budohoski, K., Ercole, A., Fernandez-Mendez, R., Figaji, A., Gupta, D., Hartl, R., Iaccarino, C., Khan, T., Laeke, T., Rubiano, A., Shabani, H. K., Sichizya, K., Tewari, M., Tirsit, A., Thu, M., Tripathi, M., Trivedi, R., Devi, B., Servadei, F., Menon, D., Kolias, A., Hutchinson, P., Global Neurotrauma Outcomes Study 2022; 21 (5): 438-449


    Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development.We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation.Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49).Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices.National Institute for Health Research Global Health Research Group.

    View details for DOI 10.1016/S1474-4422(22)00037-0

    View details for Web of Science ID 000821423000017

    View details for PubMedID 35305318

  • Early Stages Management of traumatic Spinal Cord Injury in Latin America: A Scoping Review. World neurosurgery Marchesini, N., Fernandez Londono, L. L., Griswold, D., Rubiano, A. M. 2022


    STUDY DESIGN: scoping review OBJECTIVES: to understand the extent and type of evidence on diagnosis, clinical presentation, management, outcomes, and costs of traumatic spinal cord injury (TSCI) in the early stages in Latin America.METHODS: the Joanna Briggs Institute (JBI) methodology for scoping reviews was followed. Extracted data included study aim, country, methodology, population characteristics, and outcome measures.RESULTS: thirteen studies met the inclusion criteria. Studies were grouped into five categories: associated lesions and intensive care unit (ICU); treatment; complications; neurological outcomes; length of hospital stay (LOS), costs, and mortality. Studies were from Brazil, Mexico, Argentina, Colombia, Chile, and one included several countries. A significant number of patients had associated injuries, little information was found about ICU management. A high variability existed in the surgical and conservative management rate. Some medical therapies were found to be used that could partially alleviate the neurological symptoms. Most complications were preventable, not always directly related to the event, and could be associated with increased mortality. LOS could be related to complications and to the type of interventions required that, in turn, could increase the in-hospital costs.CONCLUSIONS: the information about the management of TSCI in the early stages in Latin America is far from being exhaustive and a high variability exists among the studies in all the examined sections. Nevertheless, many patients are polytraumatized, and little is known about ICU requirement. Treatment is heterogeneous and the complications are in many cases preventable conditions that can increase LOS, costs, and mortality.

    View details for DOI 10.1016/j.wneu.2022.03.021

    View details for PubMedID 35283361

  • Deep Brain Stimulation for Severe and Intractable Aggressive Behavior. Stereotactic and functional neurosurgery Escobar Vidarte, O. A., Griswold, D. P., Orozco Mera, J., Arango Uribe, G. J., Salcedo, J. C. 1800: 1-4


    Aggressive behavior in patients with intellectual disability can be resistant to pharmacological treatment and have detrimental consequences to themselves, family members, and caregivers. Hypothalamic deep brain stimulation (DBS) has been used to improve this type of behavior in severe and refractory cases. Here, we present the description and analysis of DBS of the posteromedial hypothalamus (PMH) and its long-term impact as treatment to improve severe and refractory aggressive behaviors, even with previous bilateral hypothalamotomy without improvement in patients with intellectual disability. Eleven patients underwent bilateral DBS of the PMH. Their medical records were reviewed, and the impact on behavior was measured using preoperative and postoperative Modified Overt Aggression Scale (MOAS) during the last follow-up medical visit. Nine of 11 patients presented a significant decrease in the severity of aggressive behavior, with a preoperative and postoperative MOAS average value of 50.5 and 18.7, respectively. An overall improvement of 63% was seen with a mean follow-up time of 4 years. A patient who previously underwent a bilateral hypothalamotomy via radiofrequency was included in this group. During follow-up, 3 patients presented deterioration of symptoms subsequent to pulse generator depletion but made a full clinical recovery after battery replacement. We posit that DBS of the PMH may be a safe and effective in improving severe and refractory aggressive behavior in patients with long-term intellectual disability.

    View details for DOI 10.1159/000521766

    View details for PubMedID 35100596

  • Management of severe traumatic brain injury in regions with limited resources. Brain injury Rubiano, A. M., Griswold, D. P., Jibaja, M., Rabinstein, A. A., Godoy, D. A. 2021: 1-9


    IMPORTANCE: Severe traumatic brain injury (sTBI) is a critical health problem in regions of limited resources (RLRs). Younger populations are among the most impacted. The objective of this review is to analyze recent consensus-based algorithms, protocols and guidelines proposed for the care of patients with TBI in RLRs.OBSERVATIONS: The principal mechanisms for sTBI in RLRs are road traffic injuries (RTIs) and violence. Limitations of care include suboptimal or non-existent pre-hospital care, overburdened emergency services, lack of trained human resources, and surgical and intensive care. Low-cost neuromonitoring systems are currently in testing, and formal neurotrauma registries are forming to evaluate both long-term outcomes and best practices at every level of care from hospital transport to the emergency department (ED), to the operating room and intensive care unit (ICU).CONCLUSIONS AND RELEVANCE: The burden of sTBI is highest in RLRs. As working-age adults are the predominantly affected age-group, an increase in disability-adjusted life years (DALYs) generates a loss of economic growth in regions where economic growth is needed most. Four multi-institutional collaborations between high-income countries (HICs) and LMICs have developed evidence and consensus-based documents focused on capacity building for sTBI care as a means of addressing this substantial burden of disease.

    View details for DOI 10.1080/02699052.2021.1972149

    View details for PubMedID 34493135

  • Severe Pediatric TBI Management in a Middle-Income Country and a High-Income Country: A Comparative Assessment of Two Centers FRONTIERS IN SURGERY Arango, J., George, L., Griswold, D. P., Johnson, E. D., Suarez, M. N., Caquimbo, L. D., Molano, M., Echeverri, R. A., Rubiano, A. M., Adelson, P. 2021; 8
  • Severe Pediatric TBI Management in a Middle-Income Country and a High-Income Country: A Comparative Assessment of Two Centers. Frontiers in surgery Arango, J. I., George, L., Griswold, D. P., Johnson, E. D., Suarez, M. N., Caquimbo, L. D., Molano, M., Echeverri, R. A., Rubiano, A. M., Adelson, P. D. 2021; 8: 670546


    Background: Traumatic brain injury (TBI) is a global public health issue with over 10 million deaths or hospitalizations each year. However, access to specialized care is dependent on institutional resources and public health policy. Phoenix Children's Hospital USA (PCH) and the Neiva University Hospital, Colombia (NUH) compared the management and outcomes of pediatric patients with severe TBI over 5 years to establish differences between outcomes of patients managed in countries of varying resources availability. Methods: We conducted a retrospective review of individuals between 0 and 17 years of age, with a diagnosis of severe TBI and admitted to PCH and NUH between 2010 and 2015. Data collected included Glasgow coma scores, intensive care unit monitoring, and Glasgow outcome scores. Pearson Chi-square, Fisher exact, T-test, or Wilcoxon-rank sum test was used to compare outcomes. Results: One hundred and one subjects met the inclusion criteria. NUH employed intracranial pressure monitoring less frequently than PCH (p = 0.000), but surgical decompression and subdural evacuation were higher at PCH (p = 0.031 and p = 0.003). Mortality rates were similar between the institutions (15% PCH, 17% NUH) as were functional outcomes (52% PCH, 54% NUH). Conclusions: Differences between centers included time to specialized care and utilization of monitoring. No significant differences were evidenced in survival and the overall functional outcomes.

    View details for DOI 10.3389/fsurg.2021.670546

    View details for PubMedID 34458313

    View details for PubMedCentralID PMC8387927

  • International Neurotrauma Training Based on North-South Collaborations: Results of an Inter-institutional Program in the Era of Global Neurosurgery FRONTIERS IN SURGERY Rubiano, A. M., Griswold, D. P., Adelson, P., Echeverri, R. A., Khan, A. A., Morales, S., Sanchez, D. M., Amorim, R., Soto, A. R., Paiva, W., Paranhos, J., Carreno, J. N., Monteiro, R., Kolias, A., Hutchinson, P. J. 2021; 8: 633774


    Objective: Shortage of general neurosurgery and specialized neurotrauma care in low resource settings is a critical setback in the national surgical plans of low and middle-income countries (LMIC). Neurotrauma fellowship programs typically exist in high-income countries (HIC), where surgeons who fulfill the requirements for positions regularly stay to practice. Due to this issue, neurosurgery residents and medical students from LMICs do not have regular access to this kind of specialized training and knowledge-hubs. The objective of this paper is to present the results of a recently established neurotrauma fellowship program for neurosurgeons of LMICs in the framework of global neurosurgery collaborations, including the involvement of specialized parallel education for neurosurgery residents and medical students. Methods: The Global Neurotrauma Fellowship (GNTF) program was inaugurated in 2015 by a multi-institutional collaboration between a HIC and an LMIC. The course organizers designed it to be a 12-month program based on adapted neurotrauma international competencies with the academic support of the Barrow Neurological Institute at Phoenix Children's Hospital and Meditech Foundation in Colombia. Since 2018, additional support from the UK, National Institute of Health Research (NIHR) Global Health Research in Neurotrauma Project from the University of Cambridge enhanced the infrastructure of the program, adding a research component in global neurosurgery and system science. Results: Eight fellows from Brazil, Venezuela, Cuba, Pakistan, and Colombia have been trained and certified via the fellowship program. The integration of international competencies and exposure to different systems of care in high-income and low-income environments creates a unique environment for training within a global neurosurgery framework. Additionally, 18 residents (Venezuela, Colombia, Ecuador, Peru, Cuba, Germany, Spain, and the USA), and ten medical students (the United Kingdom, USA, Australia, and Colombia) have also participated in elective rotations of neurotrauma and critical care during the time of the fellowship program, as well as in research projects as part of an established global surgery initiative. Conclusion: We have shown that it is possible to establish a neurotrauma fellowship program in an LMIC based on the structure of HIC formal training programs. Adaptation of the international competencies focusing on neurotrauma care in low resource settings and maintaining international mentoring and academic support will allow the participants to return to practice in their home-based countries.

    View details for DOI 10.3389/fsurg.2021.633774

    View details for Web of Science ID 000685119500001

    View details for PubMedID 34395505

    View details for PubMedCentralID PMC8358677

  • Neurotrauma Registry Implementation in Colombia: A Qualitative Assessment JOURNAL OF NEUROSCIENCES IN RURAL PRACTICE Johnson, E. D., Oak, S., Griswold, D. P., Olaya, S., Puyana, J. C., Rubiano, A. M. 2021
  • Chest Computed Tomography for the Diagnosis of COVID-19 in Emergency Trauma Surgery Patients Who Require Urgent Care During the Pandemic: Protocol for an Umbrella Review JMIR RESEARCH PROTOCOLS Griswold, D., Gempeler, A., Rosseau, G., Kaseje, N., Johnson, W. D., Kolias, A., Hutchinson, P. J., Rubiano, A. M. 2021; 10 (5): e25207


    Many health care facilities in low- and middle-income countries are inadequately resourced. COVID-19 has the potential to decimate surgical health care services unless health systems take stringent measures to protect health care workers from viral exposure and ensure the continuity of specialized care for patients. Among these measures, the timely diagnosis of COVID-19 is paramount to ensure the use of protective measures and isolation of patients to prevent transmission to health care personnel caring for patients with an unknown COVID-19 status or contact during the pandemic. Besides molecular and antibody tests, chest computed tomography (CT) has been assessed as a potential tool to aid in the screening or diagnosis of COVID-19 and could be valuable in the emergency care setting.This paper presents the protocol for an umbrella review that aims to identify and summarize the available literature on the diagnostic accuracy of chest CT for COVID-19 in trauma surgery patients requiring urgent care. The objective is to inform future recommendations on emergency care for this category of patients.We will conduct several searches in the L·OVE (Living Overview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials, and over 30 other sources. The search results will be presented according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). This review will preferentially consider systematic reviews of diagnostic test accuracy studies, as well as individual studies of such design, if not included in the systematic reviews, that assessed the sensitivity and specificity of chest CT in emergency trauma surgery patients. Critical appraisal of the included studies for risk of bias will be conducted. Data will be extracted using a standardized data extraction tool. Findings will be summarized narratively, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to grade the certainty of evidence.Ethics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in October 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish the findings in a peer-reviewed journal and present our results at conferences that engage the most pertinent stakeholders.During the COVID-19 pandemic, protecting health care workers from infection is essential. Up-to-date information on the efficacy of diagnostic tests for detecting COVID-19 is essential. This review will serve an important role as a thorough summary to inform evidence-based recommendations on establishing effective policy and clinical guideline recommendations.PROSPERO International Prospective Register of Systematic Reviews CRD42020198267; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=198267.PRR1-10.2196/25207.

    View details for DOI 10.2196/25207

    View details for Web of Science ID 000658257400036

    View details for PubMedID 33878019

    View details for PubMedCentralID PMC8104001

  • Personal protective equipment for reducing the risk of COVID-19 infection among health care workers involved in emergency trauma surgery during the pandemic: An umbrella review JOURNAL OF TRAUMA AND ACUTE CARE SURGERY Griswold, D. P., Gempeler, A., Kolias, A., Hutchinson, P. J., Rubiano, A. M. 2021; 90 (4): E72-E80


    Health care facilities in low- and middle-income countries are inadequately resourced to adhere to current COVID-19 prevention recommendations. Recommendations for surgical emergency trauma care measures need to be adequately informed by available evidence and adapt to particular settings. To inform future recommendations, we set to summarize the effects of different personal protective equipment (PPE) on the risk of COVID-19 infection in health personnel caring for trauma surgery patients.We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. Systematic reviews of experimental and observational studies assessing the efficacy of PPE were included. Indirect evidence from other health care settings was also considered. Risk of bias was assessed with the AMSTAR II tool (Assessing the Methodological Quality of Systematic Reviews, Ottawa, ON, Canada), and the Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267).Eighteen studies that fulfilled the selection criteria were included. There is high certainty that the use of N95 respirators and surgical masks is associated with a reduced risk of COVID-19 when compared with no mask use. In moderate- to high-risk environments, N95 respirators are associated with a further reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion in this setting. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit.The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks. Decontamination and reuse appear feasible to overcome PPE shortages and enhance the allocation of limited resources. These effects are applicable to emergency trauma care and should inform future recommendations.Review, level II.

    View details for DOI 10.1097/TA.0000000000003073

    View details for Web of Science ID 000636723100001

    View details for PubMedID 33433175

    View details for PubMedCentralID PMC7996059

  • Traumatic subarachnoid hemorrhage: a scoping review. Journal of neurotrauma Griswold, D., Fernandez, L. L., Rubiano, A. 2021


    Sixty-nine million people suffer from traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. However, a limited number of studies evaluate recent trends in the diagnostic and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of traumatic subarachnoid hemorrhage. This scoping review was conducted following the JBI methodology for scoping reviews. The review included adults who suffered SAH secondary to trauma, where isolated TSAH (iTSAH) refers to the presence of a SAH in the absence of any other traumatic radiographic intracranial pathology, and TSAH refers to the presence of a SAH with the possibility or presence of additional traumatic radiographic intracranial pathology. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: TSAH associated with mild TBI (n=13), and severe TBI (n=3); clinical management and diagnosis (n=9); imaging (n=3); and 5) aneurysmal TSAH (n=1). Of the 30 studies, two came from a low-and middle-income country (LMIC); excluding China, nearly a high-income country. Patients with TSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be managed conservatively when considering ICU admission. The Helsinki and Stockholm CT scoring systems, in addition to the AIS, Cr, age decision tree, may be valuable tools to use when predicting outcome and mortality.

    View details for DOI 10.1089/neu.2021.0007

    View details for PubMedID 33637023

  • A consensus statement for trauma surgery capacity building in Latin America. World journal of emergency surgery : WJES Dasari, M., Johnson, E. D., Montenegro, J. H., Griswold, D. P., Jimenez, M. F., Puyana, J. C., Rubiano, A. M., Cartagena Consensus, Puyana, J. C., Rubiano, A. M., Montenegro, J. H., Dasani, M., Rodriguez, M. V., Asturias, S., Machain, G. M., Monteverde, E., Carreiro, P. R., Echeverri, R. A., Rodas, E. B., Mata, L. V., Ordonez, C. A., Salmeron, J. M., Salas, G., Jaime, R. F., Rodriguez, C., Garcia, A., Saul, M., Pereira Dohmen, M. D., Rodriguez, E. R., Coronado, J. L., Park, K., Reynolds, T., Johnson, W. 2021; 16 (1): 4


    BACKGROUND: Trauma is a significant public health problem in Latin America (LA), contributing to substantial death and disability in the region. Several LA countries have implemented trauma registries and injury surveillance systems. However, the region lacks an integrated trauma system. The consensus conference's goal was to integrate existing LA trauma data collection efforts into a regional trauma program and encourage the use of the data to inform health policy.METHODS: We created a consensus group of 25 experts in trauma and emergency care with previous data collection and injury surveillance experience in the LA. region. Experts participated in a consensus conference to discuss the state of trauma data collection in LA. We utilized the Delphi method to build consensus around strategic steps for trauma data management in the region. Consensus was defined as the agreement of ≥ 70% among the expert panel.RESULTS: The consensus conference determined that action was necessary from academic bodies, scientific societies, and ministries of health to encourage a culture of collection and use of health data in trauma. The panel developed a set of recommendations for these groups to encourage the development and use of robust trauma information systems in LA. Consensus was achieved in one Delphi round.CONCLUSIONS: The expert group successfully reached a consensus on recommendations to key stakeholders in trauma information systems in LA. These recommendations may be used to encourage capacity building in trauma research and trauma health policy in the region.

    View details for DOI 10.1186/s13017-021-00347-2

    View details for PubMedID 33516227

  • Personal protective equipment for reducing the risk of COVID-19 infection among healthcare workers involved in emergency trauma surgery during the pandemic: an umbrella review protocol BMJ OPEN Griswold, D. P., Gempeler, A., Kolias, A. G., Hutchinson, P. J., Rubiano, A. M. 2021; 11 (3): e045598


    Many healthcare facilities in low-income and middle-income countries are inadequately resourced and may lack optimal organisation and governance, especially concerning surgical health systems. COVID-19 has the potential to decimate these already strained surgical healthcare services unless health systems take stringent measures to protect healthcare workers (HCWs) from viral exposure and ensure the continuity of specialised care for patients. The objective of this broad evidence synthesis is to identify and summarise the available literature regarding the efficacy of different personal protective equipment (PPE) in reducing the risk of COVID-19 infection in health personnel caring for patients undergoing trauma surgery in low-resource environments.We will conduct several searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials and over 30 other sources. The search results will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. This review will preferentially consider systematic reviews of experimental and quasi-experimental studies, as well as individual studies of such designs, evaluating the effect of different PPE on the risk of COVID-19 infection in HCWs involved in emergency trauma surgery. Critical appraisal of eligible studies for methodological quality will be conducted. Data will be extracted using the standardised data extraction tool in Covidence. Studies will, when possible, be pooled in a statistical meta-analysis using JBI SUMARI. The Grading of Recommendations, Assessment, Development and Evaluation approach for grading the certainty of evidence will be followed and a summary of findings will be created.Ethical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.CRD42020198267.

    View details for DOI 10.1136/bmjopen-2020-045598

    View details for Web of Science ID 000626504600018

    View details for PubMedID 33653763

    View details for PubMedCentralID PMC7929636

  • Neurosurgical Randomized Trials in Low- and Middle-Income Countries. Neurosurgery Griswold, D. P., Khan, A. A., Chao, T. E., Clark, D. J., Budohoski, K., Devi, B. I., Azad, T. D., Grant, G. A., Trivedi, R. A., Rubiano, A. M., Johnson, W. D., Park, K. B., Broekman, M., Servadei, F., Hutchinson, P. J., Kolias, A. G. 2020


    BACKGROUND: The setting of a randomized trial can determine whether its findings are generalizable and can therefore apply to different settings. The contribution of low- and middle-income countries (LMICs) to neurosurgical randomized trials has not been systematically described before.OBJECTIVE: To perform a systematic analysis of design characteristics and methodology, funding source, and interventions studied between trials led by and/or conducted in high-income countries (HICs) vs LMICs.METHODS: From January 2003 to July 2016, English-language trials with >5 patients assessing any one neurosurgical procedure against another procedure, nonsurgical treatment, or no treatment were retrieved from MEDLINE, Scopus, and Cochrane Library. Income classification for each country was assessed using the World Bank Atlas method.RESULTS: A total of 73.3% of the 397 studies that met inclusion criteria were led by HICs, whereas 26.7% were led by LMICs. Of the 106 LMIC-led studies, 71 were led by China. If China is excluded, only 8.8% were led by LMICs. HIC-led trials enrolled a median of 92 patients vs a median of 65 patients in LMIC-led trials. HIC-led trials enrolled from 7.6 sites vs 1.8 sites in LMIC-led studies. Over half of LMIC-led trials were institutionally funded (54.7%). The majority of both HIC- and LMIC-led trials evaluated spinal neurosurgery, 68% and 71.7%, respectively.CONCLUSION: We have established that there is a substantial disparity between HICs and LMICs in the number of published neurosurgical trials. A concerted effort to invest in research capacity building in LMICs is an essential step towards ensuring context- and resource-specific high-quality evidence is generated.

    View details for DOI 10.1093/neuros/nyaa049

    View details for PubMedID 32171011

  • Essential surgery as a key component of primary health care: reflections on the 40th anniversary of Alma-Ata. BMJ global health Griswold, D. P., Makoka, M. H., Gunn, S. W., Johnson, W. D. 2018; 3 (Suppl 3): e000705

    View details for DOI 10.1136/bmjgh-2017-000705

    View details for PubMedID 30233836

    View details for PubMedCentralID PMC6135443

  • Simultaneous Clipping of a Basilar Apex Aneurysm and Right Middle Cerebral Artery Aneurysm: 3-Dimensional Operative Video. Operative neurosurgery (Hagerstown, Md.) Benet, A., Griswold, D., Tabani, H., Rubio, R. R., Yousef, S., Meybodi, A. T., Lawton, M. T. 2018; 15 (1): 97

    View details for DOI 10.1093/ons/opx227

    View details for PubMedID 29106660

  • Revascularization of the upper posterior circulation with the anterior temporal artery: an anatomical feasibility study JOURNAL OF NEUROSURGERY Meybodi, A., Lawton, M. T., Griswold, D., Mokhtari, P., Payman, A., Tabani, H., Yousef, S., Benet, A. 2018; 129 (1): 121–27


    OBJECTIVE In various disease processes, including unclippable aneurysms, a bypass to the upper posterior circulation (UPC) including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) may be needed. Various revascularization options exist, but the role of intracranial (IC) donors has not been scrutinized. The objective of this study was to evaluate the anatomical feasibility of utilizing the anterior temporal artery (ATA) for revascularization of the UPC. METHODS ATA-SCA and ATA-PCA bypasses were performed on 14 cadaver specimens. After performing an orbitozygomatic craniotomy and opening the basal cisterns, the ATA was divided at the M3-M4 junction and mobilized to the crural cistern to complete an end-to-side bypass to the SCA and PCA. The length of the recipient artery between the anastomosis and origin was measured. RESULTS Seventeen ATAs were found. Successful anastomosis was performed in 14 (82%) of the ATAs. The anastomosis point on the PCA was 14.2 mm from its origin on the basilar artery. The SCA anastomosis point was 10.1 mm from its origin. Three ATAs did not reach the UPC region due to a common opercular origin with the middle temporal artery. The ATA-SCA bypass was also applied to the management of an incompletely coiled SCA aneurysm. CONCLUSIONS The ATA is a promising IC donor for UPC revascularization. The ATA is exposed en route to the proximal SCA and PCA through the pterional-orbitozygomatic approach. Also, the end-to-side anastomosis provides an efficient and straightforward bypass without the need to harvest a graft or perform multiple or difficult anastomoses.

    View details for DOI 10.3171/2017.3.JNS162865

    View details for Web of Science ID 000440655000015

    View details for PubMedID 28937325

  • Anatomical Assessment of the Temporopolar Artery for Revascularization of Deep Recipients. Operative neurosurgery (Hagerstown, Md.) Tayebi Meybodi, A., Benet, A., Griswold, D., Dones, F., Preul, M. C., Lawton, M. T. 2018


    Intracranial-intracranial and extracranial-intracranial bypass options for revascularization of deep cerebral recipients are limited and technically demanding.To assess the anatomical feasibility of using the temporopolar artery (TPA) for revascularization of the anterior cerebral artery (ACA), posterior cerebral artery (PCA), and superior cerebellar arteries (SCA).Orbitozygomatic craniotomy was performed bilaterally on 8 cadaveric heads. The cisternal segment of the TPA was dissected. The TPA was cut at M3-M4 junction with its proximal and distal calibers and the length of the cisternal segment measured. Feasibility of the TPA-A1-ACA, TPA-A2-ACA, TPA-SCA, and TPA-PCA bypasses were assessed.A total of 17 TPAs were identified in 16 specimens. The average distal TPA caliber was 1.0 ± 0.2 mm, and the average cisternal length was 37.5 ± 9.4 mm. TPA caliber was ≥ 1.0 mm in 12 specimens (70%). The TPA-A1-ACA bypass was feasible in all specimens, whereas the TPA reached the A2-ACA, SCA, and PCA in 94% of specimens (16/17). At the point of anastomosis, the average recipient caliber was 2.5 ± 0.5 mm for A1-ACA, and 2.3 ± 0.7 mm for A2-ACA. The calibers of the SCA and PCA at the anastomosis points were 2.0 ± 0.6 mm, and 2.7 ± 0.8 mm, respectively.The TPA-ACA, TPA-PCA, and TPA-SCA bypasses are anatomically feasible and may be used when the distal caliber of the TPA stump is optimal to provide adequate blood flow. This study lays foundations for clinical use of the TPA for ACA revascularization in well-selected cases.

    View details for DOI 10.1093/ons/opy115

    View details for PubMedID 29850897

  • Clip Reconstruction of Large Posterior Inferior Cerebellar Artery Aneurysm: 3-Dimensional Operative Video. Operative neurosurgery (Hagerstown, Md.) Benet, A., Tabani, H., Griswold, D., Yousef, S., Meybodi, A. T., Lawton, M. T. 2018; 14 (5): 590

    View details for DOI 10.1093/ons/opx182

    View details for PubMedID 28961813

  • Supracerebellar-Infratentorial Approach for Resection of Tectal and Thalamic Cavernous Malformations: 3-Dimensional Operative Video. Operative neurosurgery (Hagerstown, Md.) Benet, A., Tabani, H., Griswold, D., Yousef, S., Rubio, R. R., Lawton, M. T. 2018; 14 (3): 316

    View details for DOI 10.1093/ons/opx135

    View details for PubMedID 28973695

  • Cross-Wise Counter Clipping of a Dolichoectatic Left Vertebral Artery Aneurysm: 3-Dimensional Operative Video OPERATIVE NEUROSURGERY Benet, A., Griswold, D., Tabani, H., Rubio, R., Yousef, S., Meybodi, A., Lawton, M. T. 2018; 14 (2): 204

    View details for Web of Science ID 000424228100040

    View details for PubMedID 28525613

  • Tentative Stacking Technique with Tandem Clipping and Bypass for an MCA Aneurysm: 3-Dimensional Operative Video OPERATIVE NEUROSURGERY Benet, A., Griswold, D., Tabani, H., Rubio, R., Yousef, S., Meybodi, A., Lawton, M. T. 2018; 14 (2): 202

    View details for DOI 10.1093/ons/opx077

    View details for Web of Science ID 000424228100037

    View details for PubMedID 29351680

  • Contralateral Anterior Interhemispheric Approach to Medial Frontal Arteriovenous Malformation: 3-Dimensional Operative Video OPERATIVE NEUROSURGERY Benet, A., Griswold, D., Tabani, H., Rubio, R., Yousef, S., Meybodi, A., Lawton, M. T. 2018; 14 (1): 86

    View details for DOI 10.1093/ons/opx065

    View details for Web of Science ID 000419563100038

    View details for PubMedID 28521028

  • Intracranial-Intracranial A1 ACA-SVG-M2 MCA+M2 MCA Double Reimplantation Bypass For a Giant Middle Cerebral Artery Aneurysm: 3-Dimensional Operative Video OPERATIVE NEUROSURGERY Benet, A., Yousef, S., Tabani, H., Griswold, D., Meybodi, A., Lawton, M. T. 2018; 14 (1): 84

    View details for DOI 10.1093/ons/opx062

    View details for Web of Science ID 000419563100035

  • Macrovascular Decompression of Brainstem and Lower Cranial Nerves: 3-Dimensional Operative Video OPERATIVE NEUROSURGERY Benet, A., Griswold, D., Tabani, H., Rubio, R., Yousef, S., Meybodi, A., Lawton, M. T. 2018; 14 (1): 81
  • Traumatic brain injury: a global challenge LANCET NEUROLOGY Johnson, W. D., Griswold, D. P. 2017; 16 (12): 949–50
  • The anterior temporal artery: an underutilized but robust donor for revascularization of the distal middle cerebral artery JOURNAL OF NEUROSURGERY Meybodi, A., Lawton, M. T., Griswold, D., Mokhtari, P., Payman, A., Benet, A. 2017; 127 (4): 740–47


    OBJECTIVE The anterior temporal artery (ATA) supplies an area of the brain that, if sacrificed, does not cause a noticeable loss of function. Therefore, the ATA may be used as a donor in intracranial-intracranial (IC-IC) bypass procedures. The capacities of the ATA as a donor have not been studied previously. In this study, the authors assessed the feasibility of using the ATA as a donor for revascularization of different segments of the distal middle cerebral artery (MCA). METHODS The ATA was studied in 15 cadaveric specimens (8 heads, excluding 1 side). First, the cisternal segment of the artery was untethered from arachnoid adhesions and small branches feeding the anterior temporal lobe and insular cortex, to evaluate its capacity for a side-to-side bypass to insular, opercular, and cortical segments of the MCA. Any branch entering the anterior perforated substance was preserved. Then, the ATA was cut at the opercular-cortical junction and the capacity for an end-to-side bypass was assessed. RESULTS From a total of 17 ATAs, 4 (23.5%) arose as an early MCA branch. The anterior insular zone and the frontal parasylvian cortical arteries were the best targets (in terms of mobility and caliber match) for a side-to-side bypass. Most of the insula was accessible for end-to-side bypass, but anterior zones of the insula were more accessible than posterior zones. End-to-side bypass was feasible for most recipient cortical arteries along the opercula, except for posterior temporal and parietal regions. Early ATAs reached significantly farther on the insular MCA recipients than non-early ATAs for both side-to-side and end-to-side bypasses. CONCLUSIONS The ATA is a robust arterial donor for IC-IC bypass procedures, including side-to-side and end-to-side techniques. The evidence provided in this work supports the use of the ATA as a donor for distal MCA revascularization in well-selected patients.

    View details for DOI 10.3171/2016.8.JNS161225

    View details for Web of Science ID 000411661400005

    View details for PubMedID 27834592

  • Assessment of the Temporopolar Artery as a Donor Artery for Intracranial-Intracranial Bypass to the Middle Cerebral Artery: Anatomic Feasibility Study WORLD NEUROSURGERY Meybodi, A., Lawton, M. T., Griswold, D., Mokhtari, P., Payman, A., Tabani, H., Yousef, S., Kola, O., Benet, A. 2017; 104: 171–79


    Intracranial-intracranial bypass is a valuable cerebral revascularization option. Despite several advantages, one of the main shortcomings of the intracranial-intracranial bypass is the possibility of ischemic complications of the donor artery. However, when sacrificed, the temporopolar artery (TPA) is not associated with major neurologic deficits. We sought to define the role of TPA as a donor for revascularization of the middle cerebral artery (MCA).Pterional craniotomy was performed on 14 specimens. The TPA was released from arachnoid trabecula, and the small twigs to the temporal lobe were cut. The feasibility of side-to-side and end-to-side bypass to the farthest arterial targets on insular, opercular, and cortical MCA branches was assessed. The distance of the bypass point was measured in reference to limen insulae.A total of 15 TPAs were assessed (1 specimen had 2 TPAs). The average cisternal length of the TPA was 37.3 mm. For side-to-side bypass, the TPA was a poor candidate as an intracranial donor, except for the cortical orbitofrontal artery, which was reached in 87% of cases. However, the end-to-side bypass was successfully completed for most arteries (87%-100%) on the anterior frontal operculum and more than 50% of the cortical or opercular middle and posterior temporal arteries. There was no correlation between the TPA's cisternal length and maximum bypass reach.When of favorable diameter, the TPA is a competent donor for intracranial-intracranial bypass to MCA branches at the anterior insula, and anterior frontal and middle temporal opercula (arteries anterior to the precentral gyrus coronal plane).

    View details for DOI 10.1016/j.wneu.2017.04.142

    View details for Web of Science ID 000407713100026

    View details for PubMedID 28465270

  • "To Operate" Versus "Not to Operate" in Low-Resource Settings: Example of Aneurysm Surgery in Rural Iran and Impact of Mastery of Neurosurgical Anatomy WORLD NEUROSURGERY Griswold, D., Benet, A., Tabani, H., Lawton, M. T., Meybodi, A. 2017; 100: 628–31


    Subarachnoid hemorrhage (SAH) has a global incidence of 9/100,000. In low-resource settings, where neurosurgical capacity is diminished through fewer human and technological resources, neurosurgeons may not be prepared to operate on aneurysm cases in emergent situations. We report a patient presented with aneurysmal SAH in rural Iran, creating the dilemma of the will for the neurosurgeon. We discuss the impact of the knowledge of neurosurgical anatomy on the resolution of this dilemma.A 30-year-old female presented with aneurysmal SAH to a remote medical facility in rural Iran. A safe and fast referral to a nearby vascular neurosurgery center was not available. A contrasted computed tomography (the only available imaging modality) revealed a carotid bifurcation aneurysm. The situation was explained to the patient and family, and they decided to proceed with surgery. With the minimum technical radiological and surgical equipment available, the surgeon managed to successfully treat the patient, aided by his mastery of the neurosurgical anatomy. The patient was discharged without any complication.We highlight the importance of mastery of neurosurgical anatomy, which was critical in achieving a favorable patient outcome. The necessity of developing low-cost platforms to enhance neurosurgical anatomy learning in neurosurgical residency programs of low-resource regions and countries is discussed.

    View details for DOI 10.1016/j.wneu.2017.01.111

    View details for Web of Science ID 000401930000082

    View details for PubMedID 28179175

  • Hearing Preservation During Anterior Petrosectomy: The "Cochlear Safety Line" WORLD NEUROSURGERY Guo, X., Tabani, H., Griswold, D., Meybodi, A., Sanchez, J., Lawton, M. T., Benet, A. 2017; 99: 618–22


    Identification and protection of the cochlea during anterior petrosectomy is key to prevent hearing loss. Currently, there is no optimal method to infer the position of the cochlea in relation to the Kawase quadrangle; therefore, damage to the cochlea during anterior petrosectomy remains a substantial risk.To identify and define landmarks available during anterior petrosectomy to locate the cochlea and prevent its damage.The Kawase approach was simulated in 11 cadaveric specimens. After a subtemporal craniotomy, foramen spinosum and ovale were identified. Anterior petrosectomy was performed, and the upper dural transitional fold (UDTF) was identified. Two virtual lines, from foramen spinosum (line A), and the lateral rim of the foramen ovale (line B), were projected to intersect the UDTF perpendicularly. The cochlea was exposed, and the distances between lines A and B and the closest point of the outer rim and membranous part of the cochlea were measured.The average distance between line A to the bony and membranous edges of the anteromedial cochlea was -0.62 ± 1.38 mm and 0.38 ± 1.63 mm, respectively. The average distance between line B to the bony and membranous edges of the cochlea was 1.82 ± 0.99 mm and 2.78 ± 1.29 mm, respectively. Line B (cochlear safety line) never intersected the cochlea.The cochlear safety line is a reliable landmark to avoid the cochlea during the Kawase approach. When expanding the anterior petrosectomy posteriorly, the cochlear safety line can be used as a reliable landmark to prevent exposure of the cochlea, thus preventing hearing loss.

    View details for DOI 10.1016/j.wneu.2016.11.019

    View details for Web of Science ID 000397190100085

    View details for PubMedID 27913265

  • Anterior Temporal Artery-to-Anterior Cerebral Artery Bypass: Anatomic Feasibility of a Novel Intracranial-Intracranial Revascularization Technique WORLD NEUROSURGERY Meybodi, A., Lawton, M. T., Griswold, D., Mokhtari, P., Payman, A., Yousef, S., Tabani, H., Benet, A. 2017; 99: 667–73


    Complex aneurysms of the anterior cerebral artery (ACA) may require a bypass procedure as part of their surgical management. Most current bypass paradigms recommend technically demanding side-to-side anastomosis of pericallosal arteries or use of interposition grafts, which involve longer ischemia times. The purpose of this study is to assess the feasibility of an anterior temporal artery (ATA) to ACA end-to-side bypass.Fourteen cadaveric specimens (17 ATAs) were prepared for surgical simulation. The cisternal course of the ATA was freed from perforating branches and arachnoid. The M3-M4 junction of the ATA was cut, and the artery was mobilized to the interhemispheric fissure. The feasibility of ATA bypass to the precommunicating and postcommunicating ACA was assessed in relation to the cisternal length and branching pattern of the middle cerebral artery.Successful anastomosis was feasible in 14 ATAs (82%). Three ATAs did not reach the ACA. These ATAs were branching distally and originated from the M3 (opercular) middle cerebral artery. In specimens where bypass was not feasible, the average cisternal length of the ATA was significantly shorter than the rest.ATA-ACA bypass is anatomically feasible and may be a useful alternative to other revascularization techniques in selected patients. It is technically simpler than A3-A3 in situ bypass. ATA-ACA bypass can be performed through the same pterional exposure used for the ACA aneurysms, sparing the patient an additional interhemispheric approach, required for the A3-A3 anastomosis.

    View details for DOI 10.1016/j.wneu.2016.12.007

    View details for Web of Science ID 000397190100092

    View details for PubMedID 27965074

  • Hearing Preservation during Anterior Petrosectomy: The “Cochlear Safety Line." Journal of Neurological Surgery Part B: Skull Base Tabani, H., Guo, X., Griswold, D., Yousef, S., Meybodi, A., Sanchez, J., Benet, A. 2017; 78 (1)
  • Combined Endoscopic Transoral and Endonasal Approach to the Jugular Foramen: A Multiportal Expanded Access to the Clivus WORLD NEUROSURGERY Zhang, X., Tabani, H., El-Sayed, I., Meybodi, A., Griswold, D., Mummaneni, P., Benet, A. 2016; 95: 62–70


    The expanded endoscopic endonasal ("far medial") approach to the inferior clivus provides a unique surgical corridor to the ventral surface of the pontomedullary and cervicomedullary junctions. However, exposing neoplasms involving the jugular foramen (JF) through this approach requires extensive nasopharyngeal resection and lateral dissection beyond the boundaries of the endonasal corridor, limiting the extent of resection and restricting to use of this approach to expert surgeons. Here we describe a multiportal endoscopic transoral and endonasal approach to maximize surgical access to the JF and clivus.A multiportal endoscopic transoral and endoscopic approach to the JF and lower clivus was simulated in 8 specimens. A transoral corridor was created through a soft palate incision. The JF and parapharyngeal space were dissected through the transoral trajectory under endoscopic endonasal view. The length of the corridor of the transnasal and transoral trajectories was measured.The JF was exposed intracranially and extracranially. The exposure extended superiorly to the sphenoid floor, inferiorly to the anterior atlanto-occipital space, and laterally to the internal acoustic meatus and parapharyngeal space. The cisternal parts of the cranial nerves VII-XII and C1 nerve bundles were accessible. Exposure of the JF contents and parapharyngeal space was possible using straight scopes, without Eustachian tube resection. The working corridor to the JF was significantly shorter through the mouth than through the nose (P < 0.0001).This approach provides access to the JF from a ventromedial trajectory, enabling panoramic views, and outlines an expanded surgical exposure (superolateral intradural and inferolateral extracranial). It may provide optimal access for resection of dumbbell-shaped lesions of the JF.

    View details for DOI 10.1016/j.wneu.2016.07.073

    View details for Web of Science ID 000390354800010

    View details for PubMedID 27481601

  • Meeting the Unmet Need: Training General Surgeons to Perform Life-Saving Neurosurgical Procedures in Low-Resource Settings WORLD NEUROSURGERY Griswold, D., Benet, A., Berger, M. S., Lawton, M. T. 2016; 93: 474

    View details for DOI 10.1016/j.wneu.2016.06.044

    View details for Web of Science ID 000390352000072

    View details for PubMedID 27637695

  • Topographic Surgical Anatomy of the Parasylvian Anterior Temporal Artery for Intracranial-Intracranial Bypass WORLD NEUROSURGERY Meybodi, A., Griswold, D., Tabani, H., Lawton, M. T., Mokhtari, P., Payman, A., Benet, A. 2016; 93: 67–72


    The anterior temporal artery (ATA) is an appealing donor artery for intracranial-intracranial bypass procedures. However, its identification may be difficult. Current literature lacks useful landmarks to help identify the ATA at the surface of the sylvian fissure. The objective of this study was to define the topographic anatomy of the cortical segment of the ATA relative to constant landmarks exposed during the pterional approach.The temporopolar artery (TPA), ATA, and middle temporal artery (MTA) were examined in 16 cadaveric specimens. The topographic anatomy and key landmarks of the arteries at the sylvian fissure were recorded. The distance between the point of emergence from the sylvian fissure to the lesser sphenoid wing and anterior tip of the temporal lobe was measured. The features of the inferior frontal gyrus relative to each of the arteries at the sylvian fissure were also recorded.The average distances from the lesser sphenoid wing to the TPA, ATA, and MTA were 3.7 mm, 21.2 mm, and 37 mm. The mean distances from the temporal pole were TPA, 14.7 mm; ATA, 32.0 mm; and MTA, 45.4 mm. The differences between the average distances were statistically significant (P < 0.0001). The ATA most frequently faced pars triangularis, whereas the TPA always faced pars orbitalis. The MTA was always found posterior to the junction of pars triangularis and pars opercularis.This article provides topographic evidence for efficient identification of the ATA in the parasylvian space. The key relationship and landmarks identified in this study may increase efficiency and safety when harvesting the ATA for intracranial-intracranial bypass.

    View details for DOI 10.1016/j.wneu.2016.05.050

    View details for Web of Science ID 000390352000012

    View details for PubMedID 27241097

  • Three-Dimensional Imaging in Neurosurgical Research and Education WORLD NEUROSURGERY Benet, A., Tabani, H., Griswold, D., Zhang, X., Kola, O., Meybodi, A., Lawton, M. T. 2016; 91: 317–25


    We describe the setup and use of different 3-dimensional (3-D) recording modalities (macroscopic, endoscopic, and microsurgical) in our laboratory and operating room and discuss their implications in neurosurgical research and didactics. We also highlight the utility of 3-D images in providing depth perception and discernment of structures compared with 2-dimensional (2-D) images.The technical details for equipment and laboratory setup for obtaining 3-D images were described. The stereoscopic pair of images was obtained using a modified "shoot-shift-shoot" method and later converged to a 3-D image. For microsurgical procedures, 3-D images were obtained using an integrated 3-D video camera coupled to the surgical microscope in both the laboratory and the operating room. Illustrative cases were used to compare 2-D and 3-D images.Side-by-side comparisons of 2-D and 3-D images obtained using all modalities revealed that 3-D imaging was superior to 2-D imaging in providing depth perception and structure identification.This is the first report in the literature of the methodology for obtaining 3-D endoscopic endonasal images using the 2-D endoscope. The use of 3-D imaging is invaluable in neurosurgical research and education, as it provides immediate depth perception (third dimension), allowing efficient understanding of key spatial relationships. Integration of 3-D imaging in neurosurgical residency programs may increase learning efficiency and shorten learning curves. However, use of 3-D imaging should not replace direct hands-on practice.

    View details for DOI 10.1016/j.wneu.2016.04.023

    View details for Web of Science ID 000380365000046

    View details for PubMedID 27102636

  • Using 3D Neuroanatomy Educational Resources as a Neurosurgical Teaching Tool in LMICs American Society of Clinical Oncology Griswold, D., Tabani, H., Meybodi, A., Benet, A. 2016