Published Case Study by our newest physician – Igor DeCastro, MD

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Medulloblastoma (MB) is an embryonal tumor. Most cases in this age group (adults) occur between the third and the fourth decade with a higher incidence in males. MB is associated with many familiar cancer syndromes, but there is no known cause for MB. Prenatal exposure to dietary N-nitroso compounds increases the risk. John Cunningham polyomavirus (JC Virus) T-antigen was identified in MB cells, suggesting a role of this viral infection in tumor physiopathology.
In the pediatric group, MB is the most common malignant brain tumor, but accounts for less than 1% of all adult intracranial tumors,[ 11 5 ] with an annual incidence of approximately only 0.5 per million individuals. Many studies have documented the differences between childhood and adult MBs in terms of location, histological subtypes, as well as the proliferation and apoptotic indices. There are four histological groups – classic and the variant forms (desmoplastic/nodular, anaplasic, and large cell), with desmoplastic/nodular being the most frequent variant. Transcriptional profiling studies have shown that MB is not a single disease. There are four major subgroups according to molecular configuration: wingless (WNT), sonic hedgehog (SHH), group 3, and group 4. These subgroups carry different prognostic outcomes and should be noted when planning the treatment strategy. The studies related to tumor biological and clinical features in adults are limited due to the low incidence of the disease in this age group. This article aims to briefly review the available literature and report a case of MB in a 19-year-old woman.

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Published Case Study by our very own Arthur Grigorian, MD

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Currently, microscopic or endoscopic transsphenoidal surgery (TSS) is the preferred method for the treatment of intrasellar pituitary adenomas.[13,17,19,32] Approximately 1,650 cases of TSS are performed annually for removal of pituitary adenomas in the United States.[1,29] One of the preoperative considerations for TSS is an exclusion of “kissing internal carotid arteries: (ICA), a rare anatomical variant and absolute contraindication for TSS.[25,28,38] However, even in the absence of this vascular configuration, the rate of intraoperative arterial injuries remains significant. In different case series, it has been reported to be as high as 1.1%.[2,8,9,14] Thus, the imputed number of iatrogenic vascular injuries encountered during TSS in the United States is approximately 18 cases per year, which is a significant cause of morbidity and mortality as well as physician liability. These injuries are mainly attributed to direct iatrogenic injury to the ICA.[3,18,25,39] However, there is some evidence suggesting that coincidental intracranial aneurysms are found almost seven times more frequently in pituitary adenomas when compared to other intracranial neoplasms.[6] The exact cause of this augmented incidence still remains unclear; however, it raises concern about encountering an ICA aneurysm during TSS, which in some cases may lead to hemorrhagic complications.
We present a case of a patient who was found to have a growth hormone (GH)-secreting pituitary adenoma and a coexisting cavernous ICA aneurysm embedded within the tumor. The patient underwent medical treatment of the adenoma. However, shrinkage of the tumor resulted in simultaneous enlargement of the observed aneurysm warranting endovascular intervention.

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GNI Featured In Neurosurgery Market Watch

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The article discusses the way we approach patient care with three core values: consistency, continuity, and compassion. Our neurosurgeons practice in a one-to-one ratio with six physician assistants, which is a great benefit to our patient care. It provides a familiarity between the providers and the patients, making for a quality experience. We truly care about our patients and we want to make sure that they feel properly cared for and attended to!

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Toward Healthcare Resource Stewardship

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Toward Healthcare Resource Stewardship

Joe Sam Robinson, M. Sami Walid, Aaron C. M. Barth

Nova Science Publishers, May 1, 2012 – Health & Fitness – 296 pages

The United States, as well as both developed and underdeveloped countries around the world, grapple with escalating healthcare costs. The number of healthcare consumers is increasing worldwide, and while most of such an increase tilts the demographic curve toward younger age groups, older age cohorts are also increasing. These older age cohorts are particularly noticeable in developed countries where useful scientific progress has evolved substantial and extensive healthcare technologies. Access to such expensive technologies has both been widely sought and become available to healthcare consumers. This book offers prescient insights upon various ways to diminish healthcare expenses.