Browsing by Author "Ayoub, Chakib M"

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    ItemOpen Access
    Awake spinal anesthesia facilitates spine surgery in poor surgical candidates: A case series.
    (Neuro-Chirurgie, 2023-05) Sykes, David AW; Tabarestani, Troy Q; Salven, David S; Chaudhry, Nauman S; Wang, Timothy Y; Gottfried, Oren N; Shaffrey, Christopher I; Guinn, Nicole R; Gadsden, Jeffrey; Ayoub, Chakib M; Bullock, W Michael; Berger, Miles; Abd-El-Barr, Muhammad M

    Background

    Annually, hundreds of thousands of patients undergo surgery for degenerative spine disease (DSD). This represents only a fraction of patients that present for surgical consideration. Procedures are often avoided due to comorbidities that make patients poor candidates for general anesthesia (GA) and its associated risks. With increasing interest in awake surgery under spinal anesthesia (SA), the authors have observed that SA may facilitate spine surgery in patients with relative contraindications to GA. With this in mind, the authors set out to summarize the outcomes of a series of highly comorbid patients who received surgery under SA.

    Methods

    Case logs of a single surgeon were reviewed, and patients undergoing spine surgery under SA were identified. Within this group, patients were identified with relative contraindications to GA, such as advanced age and medical comorbidities. For these patients, for whom surgery was facilitated by SA, the medical records were consulted to report demographic information and patient outcomes.

    Results

    Ten highly comorbid patients were identified who received lumbar spine surgery for DSD under SA. Comorbidities included octogenarian status, obesity, and chronic health conditions such as heart disease. The cohort had a mean age of 75.5 and a mean American Society of Anesthesiologists Physical Status (ASA-PS) score of 3.1. The patients were predicted to have a 2.74-fold increase of serious complications compared to the average patient. There were no adverse events.

    Conclusion

    For patients with symptomatic, refractory DSD and relative contraindications to GA, SA may facilitate safe surgical intervention with excellent outcomes.
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    Microendoscopic Ultrasound-Guided Percutaneous Tracheostomy (MUGPT): A Case Series Describing a Novel Technique for Performing Percutaneous Tracheostomy.
    (Case Rep Crit Care, 2023) Msheik, Mayyas M; Khalili, Amro F; Nahle, Mustapha A; Ayoub, Chakib M; Al Ghabour, Yara M; Abdul-Kader, Hachem Y; Rizk, Marwan S
    A percutaneous tracheostomy is a common surgical procedure done in intensive care. Several different techniques have been described. Recently, the addition of bronchoscopy or ultrasound has been advocated to decrease the risks and complications associated with the procedure; however, both aids used alone, bronchoscopy or ultrasound, have some drawbacks and pitfalls. In this manuscript, we describe a new technique implementing a new technology, Microendoscopy coupled with ultrasound to perform percutaneous dilation tracheostomy MUGPT. MUGPT relies on dual real-time feedback microendoscopy and ultrasound to perform percutaneous dilation tracheostomy. This technique helps reduce the risk of bleeding, airway loss, tracheal wall injury, tracheal ring fracture, damage to adjacent structures, pneumothorax, pneumomediastinum, subcutaneous emphysema, false placement, hypoxia, carbon dioxide retention bronchospasm, cardiac dysrhythmias, and cost reduction. Methods. This is a case series of 6 patients who underwent single-step percutaneous dilation tracheostomy using the MUGPT technique. All the patients were in ICU and were candidates for tracheostomy. Intraoperative data collection, vital signs, oxygen saturation, and end-tidal CO2 were measured. No postoperative or intraoperative complications were documented. Conclusion. Microendoscopic ultrasound-guided percutaneous tracheostomy (MUGPT) is a promising technique with minimal complications. It is a procedure that can be performed and taught easily to Junior physicians and is a lifesaver in difficult cases.
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    Novel Merging of CT and MRI to Allow for Safe Navigation into Kambin's Triangle for Percutaneous Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy.
    (Operative neurosurgery (Hagerstown, Md.), 2023-03) Tabarestani, Troy Q; Sykes, David AW; Sykes, David AW; Maquoit, Gisselle; Wang, Timothy Y; Ayoub, Chakib M; Shaffrey, Christopher I; Wiggins, Walter F; Abd-El-Barr, Muhammad M

    Background

    For percutaneous lumbar fusion (percLIF), magnetic resonance imaging and computed tomography are critical to defining surgical corridors. Currently, these scans are performed separately, and surgeons then use fluoroscopy or neuromonitoring to guide instruments through Kambin's triangle. However, anatomic variations and intraoperative positional changes are possible, meaning that safely accessing Kambin's triangle remains a challenge because nerveroot visualization without endoscopes has not been thoroughly described.

    Objective

    To overcome the known challenges of percLIF and reduce the likelihood of iatrogenic injuries by showing real-time locations of neural and bony anatomy.

    Methods

    The authors demonstrate an intraoperative navigational platform that applies nerve root segmentation and image fusion to assist with percLIF. Five patients from a single institution were included.

    Results

    Of the 5 patients, the mean age was 71 ± 8 years and 3 patients (60%) were female. One patient had general anesthesia while the remaining 4 patients underwent awake surgery with spinal anesthesia. The mean area for the L4-L5 Kambin's triangle was 76.1 ± 14.5 mm 2 . A case example is shown where the side of approach was based on the fact that Kambin's triangle was larger on one side compared with the other. The mean operative time was 170 ± 17 minutes, the mean blood loss was 32 ± 16 mL, and the mean hospital length of stay was 19.6 ± 8.3 hours. No patients developed postoperative complications.

    Conclusion

    This case series demonstrates the successful and safe application of nerve segmentation using magnetic resonance imaging/computed tomography fusion to perform percLIF and provide positive patient outcomes.