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Codd, Patrick James

Positions:

Assistant Professor of Neurosurgery

Neurosurgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2008

M.D. — Harvard Medical School

General Surgery Intern, General Surgery

Massachusetts General Hospital

Neurosurgery Resident, Surgery

Massachusetts General Hospital

News:

Publications:

Pigmented Lesions of the Nervous System and the Neural Crest: Lessons From Embryology.

Neurosurgeons encounter a number of pigmented tumors of the central nervous system in a variety of locations, including primary central nervous system melanoma, blue nevus of the spinal cord, and melanotic schwannoma. When examined through the lens of embryology, pigmented lesions share a unifying connection: They occur in structures that are neural crest cell derivatives. Here, we review the important progress made in the embryology of neural crest cells, present 3 cases of pigmented tumors of the nervous system, and discuss these clinical entities in the context of the development of melanoblasts. Pigmented lesions of the nervous system arise along neural crest cell migration routes and from neural crest-derived precursors. Awareness of the evolutionary clues of vertebrate pigmentation by the neurosurgical and neuro-oncological community at large is valuable for identifying pathogenic or therapeutic targets and for designing future research on nervous system pigmented lesions. When encountering such a lesion, clinicians should be aware of the embryological basis to direct additional evaluation, including genetic testing, and to work with the scientific community in better understanding these lesions and their relationship to neural crest developmental biology.

Authors
Agarwalla, PK; Koch, MJ; Mordes, DA; Codd, PJ; Coumans, J-V
MLA Citation
Agarwalla, PK, Koch, MJ, Mordes, DA, Codd, PJ, and Coumans, J-V. "Pigmented Lesions of the Nervous System and the Neural Crest: Lessons From Embryology." Neurosurgery 78.1 (January 2016): 142-155. (Review)
PMID
26355366
Source
epmc
Published In
Neurosurgery
Volume
78
Issue
1
Publish Date
2016
Start Page
142
End Page
155
DOI
10.1227/neu.0000000000001010

Initial Experience with High-Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery.

The usefulness of existing neuroendoscopes has been limited by either decreased range of motion or suboptimal image resolution. The flexible high-definition chip-camera endoscope has emerged as a potential solution to the shortcomings of available instruments by combining superior flexibility and image quality in order to better operate within spatially constrained intraventricular operations.Here we describe a 36-year-old woman who presented with hydrocephalus caused by an obstructive mass arising from the tectum. A high-definition camera-on-a-chip flexible neuroendoscope was used to sample the tectal mass after a traditional neuroendoscope was used to perform a third ventriculostomy.As demonstrated by this initial experience, the use of high-definition camera-on-a-chip flexible endoscopy may provide enhanced intraoperative visualization and application for intraventricular neurosurgery.

Authors
Friedman, GN; Grannan, BL; Nahed, BV; Codd, PJ
MLA Citation
Friedman, GN, Grannan, BL, Nahed, BV, and Codd, PJ. "Initial Experience with High-Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery." World neurosurgery 84.6 (December 2015): 2053-2058.
PMID
26255242
Source
epmc
Published In
World Neurosurgery
Volume
84
Issue
6
Publish Date
2015
Start Page
2053
End Page
2058
DOI
10.1016/j.wneu.2015.07.056

Ablation of porcine ligamentum flavum with Ho:YAG, q-switched Ho:YAG, and quadrupled Nd:YAG lasers.

Ligamentum flavum (LF) is a tough, rubbery connective tissue providing a portion of the ligamentous stability to the spinal column, and in its hypertrophied state forms a significant compressive pathology in degenerative spinal stenosis. The interaction of lasers and this biological tissue have not been thoroughly studied. Technological advances improving endoscopic surgical access to the spinal canal makes selective removal of LF using small, flexible tools such as laser-coupled fiber optics increasingly attractive for treatment of debilitating spinal stenosis. Testing was performed to assess the effect of Ho:YAG, Q-switched Ho:YAG, and frequency quadrupled Nd:YAG lasers on samples of porcine LF. The objective was to evaluate the suitability of these lasers for surgical removal of LF.LF was resected from porcine spine within 2 hours of sacrifice and stored in saline until immediately prior to laser irradiation, which occurred within an additional 2 hours. The optical absorbance of a sample was measured over the spectral band from 190 to 2,360 nm both before and after dehydration. For the experiments using the Ho:YAG (λ = 2,080 nm, tp  = 140 µs, FWHM) and Q-Switched Ho:YAG (λ = 2,080 nm, tp  = 260 ns, FWHM) lasers, energy was delivered to the LF through a laser-fiber optic with 600 µm core and NA = 0.39. For the experiment using the frequency quadrupled Nd:YAG laser (λ = 266 nm, tp  = 5 ns FWHM), rather than applying the laser energy through a laser-fiber, the energy was focused through an aperture and lens directly onto the LF. Five experiments were conducted to evaluate the effect of the given lasers on LF. First, using the Ho:YAG laser, the single-pulse laser-hole depth versus laser fluence was measured with the laser-fiber in direct contact with the LF (1 g force) and with a standoff distance of 1 mm between the laser-fiber face and the LF. Second, with the LF remaining in situ and the spine bisected along the coronal plane, the surface temperature of the LF was measured with an IR camera during irradiation with the Ho:YAG laser, with and without constant saline flush. Third, the mass loss was measured over the course of 450 Ho:YAG pulses. Fourth, hole depth and temperature were measured over 30 pulses of fixed fluence from the Ho:YAG and Q-Switched Ho:YAG lasers. Fifth, the ablation rate and surface temperature were measured as a function of fluence from the Nd:YAG laser. Several LF staining and hole-depth measurement techniques were also explored.Aside from the expected absorbance peaks corresponding to the water in the LF, the most significant peaks in absorbance were located in the spectral band from 190 to 290 nm and persisted after the tissue was dehydrated. In the first experiment, using the Ho:YAG laser and with the laser-fiber in direct contact with the LF, the lowest single-pulse fluence for which LF was visibly removed was 35 J/cm(2) . Testing was conducted at 6 fluences between 35 and 354 J/cm(2) . Over this range the single-pulse hole depth was shown to be near linear (R(2)  = 0.9374, M = 1.6), ranging from 40 to 639 µm (N = 3). For the case where the laser-fiber face was displaced 1 mm from the LF surface, the lowest single-pulse fluence for which tissue was visibly removed was 72 J/cm(2) . Testing was conducted at 4 energy densities between 72 and 180 J/cm(2) . Over this range the single-pulse hole depth was shown to be near linear (R(2)  = 0.8951, M = 1.4), ranging from 31 to 220 µm (N = 3). In the second experiment, with LF in situ, constant flushing with room temperature saline was shown to drastically reduce surface temperature during exposure to Ho:YAG at 5 Hz with the laser-fiber in direct contact with the LF. Without saline, over 1 minute of treatment with a per-pulse fluence of 141 mJ/cm(2) , the average maximum surface temperature measured 110°C. With 10 cc's of saline flushed over 1 minute and a per-pulse laser fluence of 212 mJ/cm(2) , the average maximum surface temperature was 35°C. In the third experiment, mass loss was shown to be linear over 450 pulses of 600 mJ from the Ho:YAG laser (212 J/cm(2) , direct contact, N = 4; 108 J/cm(2) , 1 mm standoff, N = 4). With the laser-fiber in direct contact, an average of 53 mg was removed (R(2)  = 0.996, M = 0.117) and with 1 mm laser-fiber standoff, an average of 44 mg was removed (R(2)  = 0.9988, M = 0.097). In the fourth experiment, 30 pulses of the Ho:YAG and Q-Switched Ho:YAG lasers at 1 mm standoff, and 5 Hz produced similar hole depths for the tested fluences of 9 J/cm(2) (151 and 154 µm, respectively) and 18 J/cm(2) (470 and 442 µm, respectively), though the Ho:YAG laser produced significantly more carbonization around the rim of the laser-hole. The increased carbonization was corroborated by higher measured LF temperature. In all tests with the Ho:YAG and Q-Switched Ho:YAG, an audible photo-acoustic affect coincided with the laser pulse. In the fifth experiment, with the frequency quadrupled Nd:YAG laser at 15 Hz for 450 pulses, ablation depth per pulse was shown to be linear for the fluence range of 0.18 - 0.73 J/cm(2) (R(2)  = 0.989, M = 2.4). There was no noticeable photo-acoustic effect nor charring around the rim of the laser-hole.The Ho:YAG, Q-Switched Ho:YAG, and frequency quadrupled Nd:YAG lasers were shown to remove ligamentum flavum (LF). A single pulse of the Ho:YAG laser was shown to cause tearing of the tissue and a large zone of necrosis surrounding the laser-hole. Multiple pulses of the Ho:YAG and Q-Switched Ho:YAG lasers caused charring around the rim of the laser-hole, though the extent of charring was more extensive with the Ho:YAG laser. Charring caused by the Ho:YAG laser was shown to be mitigated by continuously flushing the affected LF with saline during irradiation. The Nd:YAG laser was shown to ablate LF with no gross visible indication of thermal damage to surrounding LF.

Authors
Johnson, MR; Codd, PJ; Hill, WM; Boettcher, T
MLA Citation
Johnson, MR, Codd, PJ, Hill, WM, and Boettcher, T. "Ablation of porcine ligamentum flavum with Ho:YAG, q-switched Ho:YAG, and quadrupled Nd:YAG lasers." Lasers in surgery and medicine 47.10 (December 2015): 839-851.
PMID
26415136
Source
epmc
Published In
Lasers in Surgery and Medicine
Volume
47
Issue
10
Publish Date
2015
Start Page
839
End Page
851
DOI
10.1002/lsm.22424

Ventriculoperitoneal shunt placement for POEMS syndrome.

We report a 41-year-old woman with a history of an uncomplicated spinal hemangioma resection, who developed acute onset sensory-motor polyneuropathy following influenza vaccine administration. With extensive workup she was diagnosed with POEMS syndrome with progressive headaches, visual loss with papilledema, and repeated elevated lumbar puncture opening pressures despite treatment with acetazolamide and immunosuppressive therapy. Her symptoms dramatically improved following ventriculoperitoneal shunt placement. POEMS syndrome is a paraneoplastic disorder involving a constellation of clinical symptoms including polyneuropathy, organomegaly, endocrinopathy, monoclonal protein elevation, and skin changes. The progression of the disease involves a number of neurovascular sequelae, including symmetric sensory-motor polyneuropathy resembling chronic inflammatory demyelinating polyneuropathy, cerebrovascular accidents, and papilledema associated with increased intracranial pressure. Despite the association of POEMS with papilledema, treatment for this finding typically includes acetazolamide and therapeutic large volume lumbar punctures. To our knowledge, this is the first report of cerebrospinal fluid shunting for the symptomatic management of hydrocephalus associated with POEMS syndrome.

Authors
Alvarez-Breckenridge, CA; Attiah, MA; Zachariah, M; Gummadavelli, A; Yang, J; Codd, PJ
MLA Citation
Alvarez-Breckenridge, CA, Attiah, MA, Zachariah, M, Gummadavelli, A, Yang, J, and Codd, PJ. "Ventriculoperitoneal shunt placement for POEMS syndrome." Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 22.10 (October 2015): 1672-1674.
PMID
26077937
Source
epmc
Published In
Journal of Clinical Neuroscience
Volume
22
Issue
10
Publish Date
2015
Start Page
1672
End Page
1674
DOI
10.1016/j.jocn.2015.03.042

Rapid growth of an infectious intracranial aneurysm with catastrophic intracranial hemorrhage.

Infectious intracranial aneurysms are rare vascular lesions that classically occur in patients with infective endocarditis. We present a 49-year-old man with altered mental status and headache with rapid growth and rupture of an infectious intracranial aneurysm with catastrophic intracranial hemorrhage, and review issues related to open neurosurgical and endovascular interventions.

Authors
Koffie, RM; Stapleton, CJ; Torok, CM; Yoo, AJ; Leslie-Mazwi, TM; Codd, PJ
MLA Citation
Koffie, RM, Stapleton, CJ, Torok, CM, Yoo, AJ, Leslie-Mazwi, TM, and Codd, PJ. "Rapid growth of an infectious intracranial aneurysm with catastrophic intracranial hemorrhage." Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 22.3 (March 2015): 603-605.
PMID
25455738
Source
epmc
Published In
Journal of Clinical Neuroscience
Volume
22
Issue
3
Publish Date
2015
Start Page
603
End Page
605
DOI
10.1016/j.jocn.2014.09.007

Concentric Tube Robot Design and Optimization Based on Task and Anatomical Constraints

Authors
Bergeles, C; Gosline, AH; Vasilyev, NV; Codd, PJ; del Nido, PJ; Dupont, PE
MLA Citation
Bergeles, C, Gosline, AH, Vasilyev, NV, Codd, PJ, del Nido, PJ, and Dupont, PE. "Concentric Tube Robot Design and Optimization Based on Task and Anatomical Constraints." IEEE Transactions on Robotics 31.1 (February 2015): 67-84.
Source
crossref
Published In
IEEE Transactions on Robotics
Volume
31
Issue
1
Publish Date
2015
Start Page
67
End Page
84
DOI
10.1109/TRO.2014.2378431

Concentric Tube Robot Design and Optimization Based on Task and Anatomical Constraints

Concentric tube robots are catheter-sized continuum robots that are well suited for minimally invasive surgery inside confined body cavities. These robots are constructed from sets of precurved superelastic tubes and are capable of assuming complex 3-D curves. The family of 3-D curves that the robot can assume depends on the number, curvatures, lengths, and stiffnesses of the tubes in its tube set. The robot design problem involves solving for a tube set that will produce the family of curves necessary to perform a surgical procedure. At a minimum, these curves must enable the robot to smoothly extend into the body and to manipulate tools over the desired surgical workspace while respecting anatomical constraints. This paper introduces an optimization framework that utilizes procedure- or patient-specific image-based anatomical models along with surgical workspace requirements to generate robot tube set designs. The algorithm searches for designs that minimize robot length and curvature and for which all paths required for the procedure consist of stable robot configurations. Two mechanics-based kinematic models are used. Initial designs are sought using a model assuming torsional rigidity. These designs are then refined using a torsionally compliant model. The approach is illustrated with clinically relevant examples from neurosurgery and intracardiac surgery.

Authors
Bergeles, C; Gosline, AH; Vasilyev, NV; Codd, PJ; Nido, PJD; Dupont, PE
MLA Citation
Bergeles, C, Gosline, AH, Vasilyev, NV, Codd, PJ, Nido, PJD, and Dupont, PE. "Concentric Tube Robot Design and Optimization Based on Task and Anatomical Constraints." IEEE Transactions on Robotics (2015).
Source
scival
Published In
IEEE Transactions on Robotics
Publish Date
2015
DOI
10.1109/TRO.2014.2378431

Motor developmental delay in a healthy 11-month-old infant.

Authors
Thum, JA; Codd, PJ; Butler, WE
MLA Citation
Thum, JA, Codd, PJ, and Butler, WE. "Motor developmental delay in a healthy 11-month-old infant." Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 21.8 (August 2014): 1436-1471.
PMID
25152945
Source
epmc
Published In
Journal of Clinical Neuroscience
Volume
21
Issue
8
Publish Date
2014
Start Page
1436
End Page
1471

Motor developmental delay in a healthy 11-month-old infant: question

Authors
Thum, JA; Codd, PJ; Butler, WE
MLA Citation
Thum, JA, Codd, PJ, and Butler, WE. "Motor developmental delay in a healthy 11-month-old infant: question." Journal of Clinical Neuroscience 21.8 (August 2014): 1436-1436.
Source
crossref
Published In
Journal of Clinical Neuroscience
Volume
21
Issue
8
Publish Date
2014
Start Page
1436
End Page
1436
DOI
10.1016/j.jocn.2013.11.037

Three-dimensional brain surface visualization for epilepsy surgery of focal cortical dysplasia.

Focal cortical dysplasia (FCD) causes medically intractable seizures in 5-10% of adult epilepsy patients, but patients can become seizure free through surgical resection. The authors present the utility of three-dimensional surface visualization (3DSV) that expands on existing imaging datasets to highlight surface vasculature as a tool for achieving more successful resections in patients with FCD. In this prospective series of six patients, preoperative 3DSV was performed for planning the surgical approach to the lesion and for intraoperative guidance. Reconstructions involved volume rendering of a contrast-enhanced dataset to visualize surface venous vasculature. Postoperatively, five of the six patients had complete resections, with one patient having a subtotal resection due to proximity to crucial vasculature. We report that 3DSV is a useful tool for surgical planning, since topographical relationships between lesion location and surface vasculature landmarks are less likely to change with surgical progress.

Authors
Yang, JC; Aronson, JP; Dunn, GP; Codd, PJ; Buchbinder, BR; Eskandar, EN
MLA Citation
Yang, JC, Aronson, JP, Dunn, GP, Codd, PJ, Buchbinder, BR, and Eskandar, EN. "Three-dimensional brain surface visualization for epilepsy surgery of focal cortical dysplasia." Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 21.7 (July 2014): 1230-1232.
PMID
24485033
Source
epmc
Published In
Journal of Clinical Neuroscience
Volume
21
Issue
7
Publish Date
2014
Start Page
1230
End Page
1232
DOI
10.1016/j.jocn.2013.12.004

Novel pressure-sensing skin for detecting impending tissue damage during neuroendoscopy: Laboratory investigation

Object. Endoscopy plays an increasingly important role in minimally invasive neurosurgery. Visual feedback from the endoscope tip helps the surgeon prevent unwanted tissue contact. However, critical feedback regarding tissue deformation and trauma from proximal endoscope components is currently unavailable. A system for force feedback along the endoscope length could provide significant clinical benefit by warning of impending damage. The authors manufactured and tested a novel pressure-sensing polymer skin for use in pressure feedback during intracranial endoscopy. Methods. A photolithography process on a silicon wafer was used to produce a pattern of 80-mm-tall extrusions to serve as a positive mold for the sensor array. A thin layer of polydimethylsiloxane polymer was molded onto these features. Demolding the polymer from the wafer and sealing with another polymer layer resulted in microchannels. These microchannels were filled with a conductive liquid metal and connected to recording hardware. Spiral channel patterns were designed to create a 3 x 3 array of pressure-sensor pads, which were wrapped around a standard neuroendoscope operating sheath. Pressure readings from the compressed sensor array were translated into a colorcoded graphic user interface. Calibration experiments were conducted, and the sensor was evaluated through cortical compression tests on explanted ovine brain. Results. The sensing endoscope operating sheath was successfully calibrated to detect and display pressures within a range consistent with normal and tissue-threatening compressions. Conclusions. Force-feedback mechanisms for the neuroendoscopist are critically lacking with contemporary endoscopes. The authors designed a pressure-sensing skin technology for improved pressure feedback during endoscopy as a means for minimizing collateral tissue damage during endoscopy. ©AANS, 2014.

Authors
Codd, PJ; Veaceslav, A; Gosline, AH; Dupont, PE
MLA Citation
Codd, PJ, Veaceslav, A, Gosline, AH, and Dupont, PE. "Novel pressure-sensing skin for detecting impending tissue damage during neuroendoscopy: Laboratory investigation." Journal of Neurosurgery: Pediatrics 13.1 (January 1, 2014): 114-121.
Source
scopus
Published In
Journal of neurosurgery. Pediatrics
Volume
13
Issue
1
Publish Date
2014
Start Page
114
End Page
121
DOI
10.3171/2013.9.PEDS12595

Endoscopic burr hole evacuation of an acute subdural hematoma.

Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient. While endoscopic minimally invasive approaches to chronic subdural collections have been successfully demonstrated, this technique has not previously been applied to acute subdural hematomas. The authors report their experience with an 87-year-old patient presenting with a large acute right-sided subdural hematoma successfully evacuated via an endoscopic minimally invasive technique. The operative approach is outlined, and the literature on endoscopic subdural collection evacuation reviewed.

Authors
Codd, PJ; Venteicher, AS; Agarwalla, PK; Kahle, KT; Jho, DH
MLA Citation
Codd, PJ, Venteicher, AS, Agarwalla, PK, Kahle, KT, and Jho, DH. "Endoscopic burr hole evacuation of an acute subdural hematoma." Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 20.12 (December 2013): 1751-1753.
PMID
23962631
Source
epmc
Published In
Journal of Clinical Neuroscience
Volume
20
Issue
12
Publish Date
2013
Start Page
1751
End Page
1753
DOI
10.1016/j.jocn.2013.02.019

Kernohan-Woltman Notch Phenomenon in Acute Subdural Hematoma

Authors
Codd, PJ; Agarwalla, PK; Berry-Candelario, J; Nahed, BV
MLA Citation
Codd, PJ, Agarwalla, PK, Berry-Candelario, J, and Nahed, BV. "Kernohan-Woltman Notch Phenomenon in Acute Subdural Hematoma." JAMA Neurology 70.9 (September 1, 2013): 1194-1194.
Source
crossref
Published In
JAMA Neurology
Volume
70
Issue
9
Publish Date
2013
Start Page
1194
End Page
1194
DOI
10.1001/2013.jamaneurol.54

Percutaneous steerable robotic tool delivery platform and metal microelectromechanical systems device for tissue manipulation and approximation: closure of patent foramen ovale in an animal model.

Beating-heart image-guided intracardiac interventions have been evolving rapidly. To extend the domain of catheter-based and transcardiac interventions into reconstructive surgery, a new robotic tool delivery platform and a tissue approximation device have been developed. Initial results using these tools to perform patent foramen ovale closure are described.A robotic tool delivery platform comprising superelastic metal tubes provides the capability of delivering and manipulating tools and devices inside the beating heart. A new device technology is also presented that uses a metal-based microelectromechanical systems-manufacturing process to produce fully assembled and fully functional millimeter-scale tools. As a demonstration of both technologies, patent foramen ovale creation and closure was performed in a swine model. In the first group of animals (n=10), a preliminary study was performed. The procedural technique was validated with a transcardiac hand-held delivery platform and epicardial echocardiography, video-assisted cardioscopy, and fluoroscopy. In the second group (n=9), the procedure was performed percutaneously using the robotic tool delivery platform under epicardial echocardiography and fluoroscopy imaging. All patent foramen ovales were completely closed in the first group. In the second group, the patent foramen ovale was not successfully created in 1 animal, and the defects were completely closed in 6 of the 8 remaining animals.In contrast to existing robotic catheter technologies, the robotic tool delivery platform uses a combination of stiffness and active steerability along its length to provide the positioning accuracy and force-application capability necessary for tissue manipulation. In combination with a microelectromechanical systems tool technology, it can enable reconstructive procedures inside the beating heart.

Authors
Vasilyev, NV; Gosline, AH; Butler, E; Lang, N; Codd, PJ; Yamauchi, H; Feins, EN; Folk, CR; Cohen, AL; Chen, R; Zurakowski, D; del Nido, PJ; Dupont, PE
MLA Citation
Vasilyev, NV, Gosline, AH, Butler, E, Lang, N, Codd, PJ, Yamauchi, H, Feins, EN, Folk, CR, Cohen, AL, Chen, R, Zurakowski, D, del Nido, PJ, and Dupont, PE. "Percutaneous steerable robotic tool delivery platform and metal microelectromechanical systems device for tissue manipulation and approximation: closure of patent foramen ovale in an animal model." Circulation. Cardiovascular interventions 6.4 (August 2013): 468-475.
PMID
23899870
Source
epmc
Published In
Circulation: Cardiovascular Interventions
Volume
6
Issue
4
Publish Date
2013
Start Page
468
End Page
475
DOI
10.1161/circinterventions.112.000324

Endoscopic burr hole evacuation of an acute subdural hematoma.

Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient. While endoscopic minimally invasive approaches to chronic subdural collections have been successfully demonstrated, this technique has not previously been applied to acute subdural hematomas. The authors report their experience with an 87-year-old patient presenting with a large acute right-sided subdural hematoma successfully evacuated via an endoscopic minimally invasive technique. The operative approach is outlined, and the literature on endoscopic subdural collection evacuation reviewed. Copyright © 2013. Published by Elsevier Ltd.

Authors
Codd, PJ; Venteicher, AS; Agarwalla, PK; Kahle, KT; Jho, DH
MLA Citation
Codd, PJ, Venteicher, AS, Agarwalla, PK, Kahle, KT, and Jho, DH. "Endoscopic burr hole evacuation of an acute subdural hematoma." Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 20.12 (January 1, 2013): 1751-1753.
Source
scopus
Published In
Journal of Clinical Neuroscience
Volume
20
Issue
12
Publish Date
2013
Start Page
1751
End Page
1753

Robotic neuro-emdoscope with concentric tube augmentation

Surgical robots are gaining favor in part due to their capacity to reach remote locations within the body. Continuum robots are especially well suited for accessing deep spaces such as cerebral ventricles within the brain. Due to the entry point constraints and complicated structure, current techniques do not allow surgeons to access the full volume of the ventricles. The ability to access the ventricles with a dexterous robot would have significant clinical implications. This paper presents a concentric tube manipulator mated to a robotically controlled flexible endoscope. The device adds three degrees of freedom to the standard neuroendoscope and roboticizes the entire package allowing the operator to conveniently manipulate the device. To demonstrate the improved functionality, we use an in-silica virtual model as well as an ex-vivo anatomic model of a patient with a treatable form of hydrocephalus. In these experiments we demonstrate that the augmented and roboticized endoscope can efficiently reach critical regions that a manual scope cannot. © 2012 IEEE.

Authors
Butler, EJ; Hammond-Oakley, R; Chawarski, S; Gosline, AH; Codd, P; Anor, T; Madsen, JR; Dupont, PE; Lock, J
MLA Citation
Butler, EJ, Hammond-Oakley, R, Chawarski, S, Gosline, AH, Codd, P, Anor, T, Madsen, JR, Dupont, PE, and Lock, J. "Robotic neuro-emdoscope with concentric tube augmentation." IEEE International Conference on Intelligent Robots and Systems (December 1, 2012): 2941-2946.
Source
scopus
Published In
Proceedings of the ... IEEE/RSJ International Conference on Intelligent Robots and Systems. IEEE/RSJ International Conference on Intelligent Robots and Systems
Publish Date
2012
Start Page
2941
End Page
2946
DOI
10.1109/IROS.2012.6386022

Device Innovation in Neurosurgery

Authors
Babu, MA; Heary, RF; Nahed, BV
MLA Citation
Babu, MA, Heary, RF, and Nahed, BV. "Device Innovation in Neurosurgery." Neurosurgery 70.4 (April 2012): 789-795.
Source
crossref
Published In
Neurosurgery
Volume
70
Issue
4
Publish Date
2012
Start Page
789
End Page
795
DOI
10.1227/NEU.0b013e318237a68b

Diffuse central neurocytoma with craniospinal dissemination.

Central neurocytomas (CN) are benign central nervous system (CNS) tumors of neuroglial origin that represent 0.25 to 0.5% of all intracranial tumors in adults and an even smaller proportion of pediatric CNS tumors. These tumors characteristically occur in the subependymal layer of the lateral ventricle near the foramen of Monro and appear as sharply demarcated, solitary lesions. Surgical resection is considered curative, as the reported recurrence rate is less than 5% for patients with localized disease. In this report, we describe the case of a three-year-old boy with a diffuse CN with craniospinal dissemination identified at the time of diagnosis. Given the extensive nature of the disease, surgical resection was not indicated and he underwent a chemotherapeutic regimen of vincristine and carboplatin. At 18 months followup, the patient has completed 6 of 8 total cycles of vincristine and carboplatin and serial imaging shows stable disease within the craniospinal axis.

Authors
Stapleton, CJ; Walcott, BP; Kahle, KT; Codd, PJ; Nahed, BV; Chen, L; Robison, NJ; Delalle, I; Goumnerova, LC; Jackson, EM
MLA Citation
Stapleton, CJ, Walcott, BP, Kahle, KT, Codd, PJ, Nahed, BV, Chen, L, Robison, NJ, Delalle, I, Goumnerova, LC, and Jackson, EM. "Diffuse central neurocytoma with craniospinal dissemination." Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 19.1 (January 2012): 163-166.
PMID
22088950
Source
epmc
Published In
Journal of Clinical Neuroscience
Volume
19
Issue
1
Publish Date
2012
Start Page
163
End Page
166
DOI
10.1016/j.jocn.2011.07.016

Fourth ventricular neurocystercercosis presenting with acute hydrocephalus.

Neurocysticercosis is an infection caused by the larvae of the pork tapeworm Taenia solium. Parenchymal lesions commonly present with seizure activity and intraventricular lesions can cause hydrocephalus. A 33-year-old female patient presented in a comatose state with acute hydrocephalus and a fourth ventricle lesion. She underwent placement of an external ventricular drain. Resection of the fourth ventricle lesion through a suboccipital approach allowed for restoration of normal cerebrospinal fluid (CSF) flow and relief of midbrain compression. The lesion was resected intact and the patient returned to normal neurological function. No CSF diversion procedure was necessary. The patient was discharged on cysticidal and steroid therapy. We concluded that surgical resection of lesions in the fourth ventricle attributed to neurocysticercosis is appropriate when brainstem compression is prominent. Resection may also avoid the need for permanent CSF diversion. We also reviewed the evidence-based management strategies described in the literature.

Authors
Hanak, BW; Walcott, BP; Codd, PJ; Jones, PS; Nahed, BV; Butler, WE; Asaad, WF
MLA Citation
Hanak, BW, Walcott, BP, Codd, PJ, Jones, PS, Nahed, BV, Butler, WE, and Asaad, WF. "Fourth ventricular neurocystercercosis presenting with acute hydrocephalus." Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 18.6 (June 2011): 867-869.
PMID
21507657
Source
epmc
Published In
Journal of Clinical Neuroscience
Volume
18
Issue
6
Publish Date
2011
Start Page
867
End Page
869
DOI
10.1016/j.jocn.2010.12.002

Primary pediatric intraspinal sarcomas. Report of 3 cases.

Sarcomas that arise from within the spinal canal are rare, particularly within the pediatric population. In general, these primary intraspinal sarcomas are highly aggressive, posing unique treatment challenges with respect to surgery and choice of adjuvant therapy. The goal must be to obtain the most complete resection possible to minimize the risk of recurrence and metastasis, while preventing potential neurological deficits that may result from aggressive surgery. Among these primary intraspinal sarcomas are malignant peripheral nerve sheath tumors and members of the Ewing sarcoma family of tumors. The authors present 3 cases of unique spinal sarcomas in children-2 malignant peripheral nerve sheath tumors in patients without neurofibromatosis and an intradural extraosseous Ewing sarcoma arising from the sensory component of a lumbar spinal nerve-and discuss their management and outcome with a review of the current literature.

Authors
Klimo, P; Codd, PJ; Grier, H; Goumnerova, LC
MLA Citation
Klimo, P, Codd, PJ, Grier, H, and Goumnerova, LC. "Primary pediatric intraspinal sarcomas. Report of 3 cases." Journal of neurosurgery. Pediatrics 4.3 (September 2009): 222-229.
PMID
19772405
Source
epmc
Published In
Journal of neurosurgery. Pediatrics
Volume
4
Issue
3
Publish Date
2009
Start Page
222
End Page
229
DOI
10.3171/2009.3.peds08272

Seckel syndrome and moyamoya.

Seckel syndrome is an autosomal recessive disorder characterized by intrauterine and postnatal growth delay, microcephaly with mental retardation, and facial dysmorphisms including micrognathia, a recessed forehead, and a large beaked nose. Occurring in 1 in 10,000 children without sex preference, it is the most common primordial microcephalic osteodysplastic dwarfism and has been associated with a variety of congenital brain malformations and intracranial aneurysms. Moyamoya syndrome is an idiopathic, chronic, progressive cerebrovascular disorder marked by stenosis of the intracranial internal carotid arteries and concurrent development of hypertrophied collateral vessels. These tortuous arterial collaterals appear radiographically as "puffs of smoke," giving the syndrome its name. In this report, the authors describe the case of a 16-year-old girl with coincident Seckel and moyamoya syndromes. To their knowledge, this is the first reported case of such an association being treated with surgical revascularization. The patient presented with persistent headaches and a 2-year history of progressive hand, arm, and face numbness. Imaging studies revealed multiple completed cerebral infarcts, global ischemic changes, and vascular anatomy consistent with moyamoya syndrome. Bilateral pial synangioses successfully revascularized each hemisphere with resolution of the patient's symptoms. The patient died 1 year later of complications related to treatment of a rapidly progressing intracranial aneurysm. This report documents the first case associating moyamoya and Seckel syndromes. In addition, the report reveals the rapid development of an intracranial aneurysm in a patient with this syndrome. When coupled with previous reports of other types of cerebrovascular disease in patients with Seckel syndrome or other primordial dwarfisms, the authors' findings are important because they suggest that physicians treating patients with dwarfism should consider the diagnosis of moyamoya syndrome when symptoms suggestive of cerebral ischemia are present. Prompt diagnosis and treatment of moyamoya syndrome, including the use of proven surgical revascularization procedures such as pial synangiosis, may significantly improve the long-term outcomes of these patients.

Authors
Codd, PJ; Scott, RM; Smith, ER
MLA Citation
Codd, PJ, Scott, RM, and Smith, ER. "Seckel syndrome and moyamoya." Journal of neurosurgery. Pediatrics 3.4 (April 2009): 320-324.
PMID
19338412
Source
epmc
Published In
Journal of neurosurgery. Pediatrics
Volume
3
Issue
4
Publish Date
2009
Start Page
320
End Page
324
DOI
10.3171/2008.12.peds08205

A recurrent cerebral arteriovenous malformation in an adult.

Arteriovenous malformations are generally considered to be cured following angiographically proven complete resection. However, rare instances of AVM recurrence despite negative findings on postoperative angiography have been reported in both children and adults. In this paper, the authors present the case of a 33-year-old woman with 2 AVM recurrences. This patient represents the oldest case of recurrent AVM, and the first adult double recurrence reported in the literature. The case is presented, the radiological and surgical features are considered, and the literature on recurrent AVMs is reviewed.

Authors
Codd, PJ; Mitha, AP; Ogilvy, CS
MLA Citation
Codd, PJ, Mitha, AP, and Ogilvy, CS. "A recurrent cerebral arteriovenous malformation in an adult." Journal of neurosurgery 109.3 (September 2008): 486-491.
PMID
18759581
Source
epmc
Published In
Journal of neurosurgery
Volume
109
Issue
3
Publish Date
2008
Start Page
486
End Page
491
DOI
10.3171/jns/2008/109/9/0486

MSH6 inactivation and emergent temozolomide resistance in human glioblastomas.

Authors
Cahill, DP; Codd, PJ; Batchelor, TT; Curry, WT; Louis, DN
MLA Citation
Cahill, DP, Codd, PJ, Batchelor, TT, Curry, WT, and Louis, DN. "MSH6 inactivation and emergent temozolomide resistance in human glioblastomas." Clinical neurosurgery 55 (January 2008): 165-171.
PMID
19248684
Source
epmc
Published In
Clinical neurosurgery
Volume
55
Publish Date
2008
Start Page
165
End Page
171

Loss of the mismatch repair protein MSH6 in human glioblastomas is associated with tumor progression during temozolomide treatment.

Glioblastomas are treated by surgical resection followed by radiotherapy [X-ray therapy (XRT)] and the alkylating chemotherapeutic agent temozolomide. Recently, inactivating mutations in the mismatch repair gene MSH6 were identified in two glioblastomas recurrent post-temozolomide. Because mismatch repair pathway inactivation is a known mediator of alkylator resistance in vitro, these findings suggested that MSH6 inactivation was causally linked to these two recurrences. However, the extent of involvement of MSH6 in glioblastoma is unknown. We sought to determine the overall frequency and clinical relevance of MSH6 alterations in glioblastomas.The MSH6 gene was sequenced in 54 glioblastomas. MSH6 and O(6)-methylguanine methyltransferase (MGMT) immunohistochemistry was systematically scored in a panel of 46 clinically well-characterized glioblastomas, and the corresponding patient response to treatment evaluated.MSH6 mutation was not observed in any pretreatment glioblastoma (0 of 40), whereas 3 of 14 recurrent cases had somatic mutations (P = 0.015). MSH6 protein expression was detected in all pretreatment (17 of 17) cases examined but, notably, expression was lost in 7 of 17 (41%) recurrences from matched post-XRT + temozolomide cases (P = 0.016). Loss of MSH6 was not associated with O(6)-methylguanine methyltransferase status. Measurements of in vivo tumor growth using three-dimensional reconstructed magnetic resonance imaging showed that MSH6-negative glioblastomas had a markedly increased rate of growth while under temozolomide treatment (3.17 versus 0.04 cc/mo for MSH6-positive tumors; P = 0.020).Loss of MSH6 occurs in a subset of post-XRT + temozolomide glioblastoma recurrences and is associated with tumor progression during temozolomide treatment, mirroring the alkylator resistance conferred by MSH6 inactivation in vitro. MSH6 deficiency may therefore contribute to the emergence of recurrent glioblastomas during temozolomide treatment.

Authors
Cahill, DP; Levine, KK; Betensky, RA; Codd, PJ; Romany, CA; Reavie, LB; Batchelor, TT; Futreal, PA; Stratton, MR; Curry, WT; Iafrate, AJ; Louis, DN
MLA Citation
Cahill, DP, Levine, KK, Betensky, RA, Codd, PJ, Romany, CA, Reavie, LB, Batchelor, TT, Futreal, PA, Stratton, MR, Curry, WT, Iafrate, AJ, and Louis, DN. "Loss of the mismatch repair protein MSH6 in human glioblastomas is associated with tumor progression during temozolomide treatment." Clinical cancer research : an official journal of the American Association for Cancer Research 13.7 (April 2007): 2038-2045.
PMID
17404084
Source
epmc
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
13
Issue
7
Publish Date
2007
Start Page
2038
End Page
2045
DOI
10.1158/1078-0432.ccr-06-2149

Vertebra plana due to an aneurysmal bone cyst of the lumbar spine. Case report and review of the literature.

Aneurysmal bone cysts (ABCs) are benign, highly vascular osseous lesions characterized by cystic, blood-filled spaces surrounded by thin perimeters of expanded bone. Children and young adults are most often affected by spinal ABCs; more than 75% of patients are younger than 20 years old at presentation. Although ABCs have been documented in all areas of the axial and appendicular skeleton, ABCs of the spine present unique challenges due to the risk of vertebral destabilization, pathological fracture and vertebral body (VB) collapse, and neurological compromise. The authors describe the case of an 8-year-old child who presented with low-back pain and was subsequently found to have a lumbar ABC causing vertebra plana of the L-3 VB. They also review the literature on ABCs of the spine. This case highlights the importance of considering an ABC in the differential diagnosis when vertebra plana is seen in pediatric patients.

Authors
Codd, PJ; Riesenburger, RI; Klimo, P; Slotkin, JR; Smith, ER
MLA Citation
Codd, PJ, Riesenburger, RI, Klimo, P, Slotkin, JR, and Smith, ER. "Vertebra plana due to an aneurysmal bone cyst of the lumbar spine. Case report and review of the literature." Journal of neurosurgery 105.6 Suppl (December 2006): 490-495. (Review)
PMID
17184084
Source
epmc
Published In
Journal of neurosurgery
Volume
105
Issue
6 Suppl
Publish Date
2006
Start Page
490
End Page
495
DOI
10.3171/ped.2006.105.6.490
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