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In this issue of Neurosurgery News Fall 2014, Dr. D. Kojo Hamilton discusses when surgery is appropriate for Adjacent Segment Disease of the Lumbar Spine, Drs. Johnathan A. Engh and Nduka Amankulor provide an overview on Fluorescent-Guided Brain Tumor Surgery, and Dr. Paul Gardner discusses Setting a  New Standard of Care for Endoscopic Endonasal Cranial Base Surgery.

Educational Objectives:

Upon completion of this activity, participants should be able to:

  • Improve counseling of patients with high grade glioma with regard to effects of maximal resection and outcome
  • Increase knowledge of available fluorophores
  • Distinguish optical patterns of fluorescein from other fluorophores
  • Review the development of the endoscopic endonasal approach
  • Discuss the endoscopic endonasal approach for the treatment of chordomas and craniopharyngiomas
  • Discuss the role of the nasoseptal and inferior turbinate flaps in endonasal reconstruction
  • Discuss adjacent level disease
  • Review diagnostic requirements of adjacent level disease of the spine
  • Discuss management requirements of adjacent level disease of the spine

Reading Resources:

  1. Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ. Fluorescence-Guided Surgery With 5-Aminolevulinic Acid for Resection of Malignant Glioma: A Randomised Controlled Multicentre Phase III Trial. Lancet Oncol. 2006 May;7(5):392-401.
  2. Li Y, Rey-Dios R, Roberts DW, Valdés PA, Cohen-Gadol AA. Intraoperative Fluorescence-Guided Resection of High-Grade Gliomas: A Comparison of the Present Techniques and Evolution of Future Strategies. World Neurosurg. 2014 Jul-Aug;82(1-2):175-85.
  3. Acerbi F, Broggi M, Eoli M, Anghileri E, Cavallo C, Boffano C, Cordella R, Cuppini L, Pollo B, Schiariti M, Visintini S, Orsi C, La Corte E, Broggi G, Ferroli P. Is Fluorescein-Guided Technique Able to Help in Resection of High-Grade Gliomas? Neurosurg Focus. 2014 Feb;36(2):E5.
  4. Koutourousiou M, Gardner PA, Tormenti MJ, Henry SL, Stefko ST, Kassam AB, Fernandez-Miranda JC, Snyderman CH. Endoscopic Endonasal Approach for Resection of Skull Base Chordomas: Outcomes and Learning Curve. Neurosurgery. 2012 Sep;71(3):614-25.
  5. Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH. Endoscopic Endonasal Surgery for Craniopharyngiomas: Surgical Outcome in 64 Patients. J Neurosurg. 2013 Nov;1119(5):1194-207.
  6. Pinheiro-Neto CD, Ramos HF, Peris-Celda M, Fernandez-Miranda JC, Gardner PA, Snyderman CH, Sennes LU. Study of the Nasoseptal Flap for Endoscopic Anterior Cranial Base Reconstruction. Laryngoscope. 2011 Dec;121(12):2514-20. 
  7. Perez-Cruet MJ, Hussain NS, White GZ, Begun EM, Collins RA, Fahim DK, Hiremath GK, Adbi FM, Yacob SA. Quality-of-Life Outcomes With Minimally Invasive Transforaminal Lumbar Interbody Fusion Based on Long-Term Analysis of 304 Consecutive Patients. Spine (Phila Pa 1976).2014 Feb 1;39(3):E191-8.
  8. Choi KC, Kim JS, Shim HK, Ahn Y, Lee SH. Changes in the Adjacent Segment 10 Years After Anterior Lumbar Interbody Fusion for Low-Grade Isthmic Spondylolisthesis. Clin Orthop Relat Res. 2014 Jun;472(6):1845-54.
  9. Sakaura H, Yamashita T, Miwa T, Ohzono K, Ohwada T. Symptomatic Adjacent Segment Pathology After Posterior Lumbar Interbody Fusion for Adult Low-Grade Isthmic Spondylolisthesis. Global Spine J. 2013 Dec;3(4):219-24.


Drs. Nduka Amankulor, Johnathan Engh, Paul A. Gardner, and D. Kojo Hamilton have reported no relevant relationships with any entities producing health care goods or services. Dr. Carl Snyderman is a consultant and stockholder of SPIWay, LLC.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 12/10/2014 | Last Modified On: 12/10/2014 | Expires: 12/10/2015

This course has been expired.