SUMMARY: The Major molecular disease process underlying many diseases in the 21st Century is Immuno-Excitotoxicity, the body's normal response to cellular injury and its over-reaction that leads to many disease states.  Aneurysm formation, SAH, Dementia, Parkinson, Alzheimer's, Autism Spectrum Disorders, Allergic encehpalopathy, ALS, Diabetes, Atherosclerosis, and even osteoarthritis, spinal cord injury  all have immunocompromised excitotoxicity as a fundamental biochemical and molecular process. Repeated Chronic Injures to the CNS and other systems will lead to activation of the microglia and immune system with resulting excitotoxicity that destroys cells. With 40 trillion cells in the body and each having thousands or millions of chemical reactions 24/7/365, the generation of Free Radicals from chemical reactions sets off an immune excitotoxic response that is damaging. This changes can be muted by the body's anti-oxidant system plus the external supplementation by a series of antioxidants, flavonoids, & minerals necessary to participate in this widespread metabolic symphony. Most people are deficient in basic chemicals to support this widespread metabolic activity. from dietary changes and external toxins in our environment. Which system prevails in this war between the pro-inflammatory and anti- inflammatory metabolic reactions will determine the outcome of various diseases. These events lead to a. chronic disease state and aging. This 5 part program is presented in its entirely of 90 minutes or in three 30 minute parts. (A,B,C) A, Part 1. Case example; 2. Basic Anatomy and Biochemistry of Immuno-excitotoxicity; B, 3, The Anti-oxidant system, and specific Antioxidants; C, 4-Microglial activation; and 5, Summary and influence of the Pharmaceutical industry to control Supplements , like antioxidants. (JIA)

SUMMARY: Dr. Nancy Epstein Reviews the literature on Cauda Equina Syndrome (CES) in regard to anatomy, imaging , clinical presentation, surgical tips to achieve an excellent result. She also discuss the malpractice implications seen in the treatment of CES and discusses how to avoid them. She also shows how to prevent and to treat CSF leaks which can also be malpractice issues. 30% of al suits involving spinal surgery involve the CES. The key message is to treat the disease as a surgical Emergency. This Video covers all three parts of the series and last for 104 minutes (JIA)

SUMMARY: This is a Four Part, 70 minute, Lecture and Interactive Discussion on Posterior approaches to Neurological Disorders involving the Cervical Spine. Part 1 (30 minutes) covers the Anatomy, Clinical presentations, Imaging involved in these root and cord diseases. Compared with Anterior approaches there are no recurrent laryngeal palsies, dysphagia, Horner's syndromes, neural injuries affecting the diaphragm, esophageal and carotid injuries, and less chance of vertebral artery injuries and CSF leak. Pseudo-arthroses anteriorly occur 4%, 24%,and 43% for one , two and three level anterior approaches, respectively. Patient selection is Key. For posterior approaches the presence of Cervical Lordosis is important. Dr. Epstein discusses OPLL, Shingled Laminae, and adequate decompression, cord migration. the use of the K-Line in choosing approaches posteriorly, also used in Anterior Approaches covered in previous lectures. Pros and cons of Laminoplasty are discussed. When is a Posterior Fusion necessary? In Part 2 (16 min) she presents many case examples and surgical tips to avoid complications. Fusion choices, lateral mass screw risks, Intra-Op imaging, CT, O-Arm and more. Part 3 (3 minutes) has the References for the Lecture. Capture them with screen shots. Part 4 (25 min) Is an Interactive Discussion with Drs. Epstein and Ausman on each step in the surgery being done posteriorly with valuable tips to achieve a successful outcome in any environment. How to do a simple fusion posteriorly without costly instrumentation and imaging for fixation. This is a Practical Lecture and Discussion for Spine surgeons everywhere. For Residents, Young, and Experienced Spine surgeons. 'Do it right the First Time.' 'No mistakes'. 'Plan ahead.' Excellent teaching, Excellent Interactive Discussion and Learning experience. (JIA) 

SUMMARY: Sub-Saharan African International Neurosurgery Grand Rounds; Professors N. Mwang'ombe (Kenya) presents two interesting cases of penetrating injuries of the skull and brain. He and the International audience comment on how these cases are treated in different places around the world. Questions & Answers from the global audience cover the spectrum of challenges faced by neurosurgeons in this on this topic. Should the Projectile or Bullet be removed; How?; leaving the bullet; removing the bullet with Neuro-navigation and ultra-sound guided surgery; What tests are needed before surgery?; time, cost, geographical location, location in brain or spinal canal, age of patient; compromising circumstances; antibiotics; and needs for drainage and more are discussed. (JIA) 

Dr. Epstein follows with a review of the disc lesions in the lumbar spine and their clinical presentations; and the prevention and management of CSF leaks. 100 minutes all with Discussion. (JIA)  

SUMMARY: This is the complete Lecture and Discussion series of this three part series which takes 1 1/2 hours of viewing. Dr. Epstein Covers the anatomy, pathology, imaging, and clinical presentations of Cervical Spine pathology. She then provides the keys to selecting the correct surgical approach to lesions in the C-Spine axis. She describes the use of the K line in making that determination with supporting data for all her statements and in the references at the end. Multiple case presentations with malpractice case experience. Excellent series for Young neurosurgeons, and staff and also as a refresher for experienced neurosurgeons with an update on the literature. Lecture and discussions 1.5 hrs. (JIA) 

SUMMARY: Dr. Epstein discusses the diagnosis of anterior spine lesions with proper imaging. Is ACDF, or Excision of the Verbal body(s) appropriate? Risks of two and more level body replacements; The need for posterior fusion; how to identify the Ossified Posterior Longitudinal Ligament (OPLL) and the various scenarios of involvement of the dura with potential CSF leak , and how to treat that problem, Management of CSF leak and autograft vs other graft replacements pros and cons; Avoidance of errors leading to poor outcomes and malpractice issues. 37 min Lecture and Discussion. (JIA)

SUMMARY: A new introduction to SNI Digital® and its 5.0 version covering all details of what features the Video Journal SNI Digital® offers the viewer and reader. All interactive with Discussion for highest learning percentages. Free to everyone, everywhere on the Internet. (11minutes ) (JIA)

SUMMARY: Drs. Elo Ibekwe and Vespa, UCLA Neuro-intensivists, discuss ICP measuring devices which can provide a non-invasive assessment of ICP between the clinical examination and intra ventricular catheter devices. In most hospitals in the world such devices are needed as the use of intra-ventricular monitoring is costly, difficult to use, and prone to infection. They describe three systems in use and compare their effectiveness, accuracy, and costs. Optic Nerve Sheath Diameter (ONSD) measurement is the longest studied, examining the change in the post- ocular bulb CSF intradural space within 3mm of the entry of the optic nerve into the eye. It is unique site to use. Ultrasound measurements are used to provide the data. It is not associated with clinical changes. The Trans-cranial Doppler (TCD) assesses the change in velocity of blood flow in the Middle Cerebral Artery using ultrasound. Both have the variability associated with hand held ultrasound devices. The Neuro-Pupillary Index device (NPi) Neuropupillometer) is placed on the face around the eye and emits a light, intimates a neural network reflex, causing pupillary constriction, the rate of which is measured by the instrument. This device is related to ICP. It is easy to use, is not user dependent, and provides useful data, in most cases. The costs were not known to the investigators. A very active discussion was held throughout the presentation and at the end (last 22 minutes) which is very engaging. If you have this clinical challenge, this presentation will provide you with some useful answers. It was from the SNI Digital Sub Saharan African Grand Rounds monthly meetings.

SUMMARY: Dr. Mgwam'ombe, the leading Neurosurgeon in Kenya, presents his detailed and complete review of the Management of Tuberculoma of the Brain and the approach to Tuberculosis which is endemic in Kenya. It is also a prevalent disease in South America, Africa and Asia and will be seen more commonly in the western world with immigration and travel. What he does with tuberculosis of the spine and how tuberculous meningitis presents and is treated. Everything one wants to know and more from an experienced clinician and scientist. (JIA)

SUMMARY: Dr. Jacques Morcos reviews his experience with Skull Base approaches to cranial lesions and the use of bypass surgery.