Nicholas Theodore



  1. Soriano Baron H, Newcomb A, Malhotra D, Martinez Del Campo E, Palma A, Theodore N, et al. Biomechanical Effects of an Oblique Lumbar PEEK Cage and Posterior Augmentation. World Neurosurg. 2019;: pubmed publisher
    ..Adding posterior instrumentation to the interbody spacer increased the construct stability significantly, regardless of cage insertion trajectory or screw type. ..
  2. Walker C, Sonntag V. Odontoid Fusion. Acta Neurochir Suppl. 2019;125:289-294 pubmed publisher
    ..In this chapter, we review traditional screw placement techniques and highlight the trends in technical improvements that improve the safety and efficacy of these procedures. ..
  3. Godzik J, Dalton J, Martinez Del Campo E, Newcomb A, Dominguez F, Reyes P, et al. Biomechanical Evaluation of Cervicothoracic Junction Fusion Constructs. World Neurosurg. 2018;: pubmed publisher
    ..The screw-rod construct resulted in certain biomechanical advantages compared with the screw-connector-rod construct, and both were significantly superior to the hook-rod construct. ..
  4. Bohl M, Mooney M, Catapano J, Almefty K, TURNER J, Chang S, et al. Pedicled Vascularized Bone Grafts for Posterior Lumbosacral Fusion: A Cadaveric Feasibility Study and Case Report. Spine Deform. 2018;6:498-506 pubmed publisher
    ..Patients at high risk for nonunion may benefit from these strategies. Further clinical experience with these techniques is warranted. Level IV. ..
  5. Ramey W, Martirosyan N, Zabramski J, Spetzler R, Kalani M. A hierarchical model for the development of cerebral arteriovenous malformations. Clin Neurol Neurosurg. 2014;126:126-9 pubmed publisher
  6. Elhadi A, Zehri A, Zaidi H, Almefty K, Preul M, Theodore N, et al. Surgical efficacy of minimally invasive thoracic discectomy. J Clin Neurosci. 2015;22:1708-13 pubmed publisher
    ..Disc herniations confined to a single level, with small or no calcifications, are ideal for such an approach, whereas patients with calcified discs adherent to the dura would benefit from an open approach. ..
  7. Kalb S, Zaidi H, Ribas Nijkerk J, Sindhwani M, Clark J, Martirosyan N, et al. Persistent Outpatient Hypertension Is Independently Associated with Spinal Cord Dysfunction and Imaging Characteristics of Spinal Cord Damage among Patients with Cervical Spondylosis. World Neurosurg. 2015;84:351-7 pubmed publisher
    ..Perioperative management of blood pressure may serve to improve clinical outcomes. Larger prospective trials are necessary to further validate these findings. ..
  8. Spetzler R, McDougall C, Albuquerque F, Zabramski J, Hills N, Partovi S, et al. The Barrow Ruptured Aneurysm Trial: 3-year results. J Neurosurg. 2013;119:146-57 pubmed publisher
    ..In post hoc analysis examining only anterior circulation aneurysms, no outcome difference between the 2 treatment cohorts was observed at any recorded time point. CLINICAL TRIAL REGISTRATION NO.: NCT01593267 ( ). ..
  9. Kalani M, Rangel Castilla L, Ramey W, Nakaji P, Albuquerque F, McDougall C, et al. Indications and results of direct cerebral revascularization in the modern era. World Neurosurg. 2015;83:345-50 pubmed publisher
    ..In experienced hands, the morbidity and mortality of patients undergoing cerebral revascularization procedures are low and long-term outcomes generally excellent. ..

More Information


  1. Zaidi H, Awad A, Chowdhry S, Fusco D, Nakaji P, Spetzler R. Microvascular decompression for hemifacial spasm secondary to vertebrobasilar dolichoectasia: surgical strategies, technical nuances and clinical outcomes. J Clin Neurosci. 2015;22:62-8 pubmed publisher
    ..In recalcitrant cases, sling transposition can be used to further augment the decompression. Careful attention must be paid to prevent vascular kinking and preserve brainstem perforators. ..
  2. Kalani M, Cavallo C, Coons S, Lettieri S, Nakaji P, Porter R, et al. Long-term follow-up of surgical resection of microcystic meningiomas. J Clin Neurosci. 2015;22:713-7 pubmed publisher
    ..Following surgical resection these tumors have a positive prognosis with a benign course. The surgical outcomes seem to be associated with the risks related to the surgical procedure. ..
  3. Zaidi H, Elhadi A, Lei T, Preul M, Little A, Nakaji P. Minimally Invasive Endoscopic Supracerebellar-Infratentorial Surgery of the Pineal Region: Anatomical Comparison of Four Variant Approaches. World Neurosurg. 2015;84:257-66 pubmed publisher
    ..These differences in surgical freedom and angle of attack to the pineal region may be useful to consider when planning minimal-access approaches. ..
  4. Belykh E, Onaka N, Zhao X, Cavallo C, Yagmurlu K, Lei T, et al. Endoscopically Assisted Targeted Keyhole Retrosigmoid Approaches for Microvascular Decompression: Quantitative Anatomic Study. World Neurosurg. 2018;119:e1-e15 pubmed publisher
    ..Endoscope assistance complements the standard microsurgical technique by maximizing the visualization and identification of the delicate neurovascular structures. ..
  5. Belykh E, Kalinin A, Martirosyan N, Kerimbayev T, Theodore N, Preul M, et al. Facet Joint Fixation and Anterior, Direct Lateral, and Transforaminal Lumbar Interbody Fusions for Treatment of Degenerative Lumbar Disc Diseases: Retrospective Cohort Study of a New Minimally Invasive Technique. World Neurosurg. 2018;114:e959-e968 pubmed publisher
    ..ALIF, DLIF, and TLIF combined with this technique showed good early postoperative clinical and radiologic outcomes. Further studies are needed to assess long-term results and compare them with other fusion methods. ..
  6. Soriano Baron H, Newcomb A, Malhotra D, Palma A, Martinez Del Campo E, Crawford N, et al. Biomechanical Analysis of an Expandable Lumbar Interbody Spacer. World Neurosurg. 2018;114:e616-e623 pubmed publisher
    ..CSR, PSR, and CSR/PSR hybrid constructs were all effective in augmenting the expandable interbody spacer system and improving its stability. ..
  7. Russin J, Rangel Castilla L, Kalani M, Spetzler R. Surgical management, outcomes, and recurrence rate of orbital lymphangiomas. J Clin Neurosci. 2015;22:877-82 pubmed publisher
    ..Orbital lymphangiomas are challenging surgical lesions in which gross total resection is frequently not possible. Subtotal resection is safe and effective for symptomatic relief. ..
  8. Hlubek R, Theodore N, Chang S. CT/MRI Fusion for Vascular Mapping and Navigated Resection of a Paraspinal Tumor. World Neurosurg. 2016;89:732.e7-732.e12 pubmed publisher
    ..This case highlights both the feasibility and the advantages of applying CT/MRI fusion technology to the surgical treatment of spinal pathology. ..
  9. request reprint
    Sun H, Safavi Abbasi S, Spetzler R. Retractorless surgery for intracranial aneurysms. J Neurosurg Sci. 2016;60:54-69 pubmed
  10. Kalani M, Yagmurlu K, Martirosyan N, Spetzler R. The Retrosigmoid Petrosal Fissure Transpeduncular Approach to Central Pontine Lesions. World Neurosurg. 2016;87:235-41 pubmed publisher
  11. Godzik J, Martinez Del Campo E, Newcomb A, Reis M, Perez Orribo L, Whiting A, et al. Biomechanical Stability Afforded by Unilateral Versus Bilateral Pedicle Screw Fixation with and without Interbody Support Using Lateral Lumbar Interbody Fusion. World Neurosurg. 2018;113:e439-e445 pubmed publisher
    ..In addition, LLIF does not appear to contribute significantly to immediate stability when BPS is used. ..
  12. Zabramski J, Kalani M, Filippidis A, Spetzler R. Propranolol Treatment of Cavernous Malformations with Symptomatic Hemorrhage. World Neurosurg. 2016;88:631-9 pubmed publisher
    ..Propranolol may offer a safe and effective treatment for patients who have cavernous malformations with symptomatic hemorrhage. Additional studies are needed to confirm these findings. ..
  13. Levitt M, Park M, Albuquerque F, Moon K, Kalani M, McDougall C. Posterior Inferior Cerebellar Artery Patency after Flow-Diverting Stent Treatment. AJNR Am J Neuroradiol. 2016;37:487-9 pubmed publisher
    ..67-27.9 months), the PICA patency rate remained 100%. Flow-diverting stent placement across the PICA ostium in the treatment of vertebral and vertebrobasilar artery aneurysms may not result in immediate or midterm PICA occlusion. ..
  14. Sun H, Wilson C, Ozpinar A, Safavi Abbasi S, Zhao Y, Nakaji P, et al. Perioperative Complications and Long-Term Outcomes After Bypasses in Adults with Moyamoya Disease: A Systematic Review and Meta-Analysis. World Neurosurg. 2016;92:179-188 pubmed publisher
    ..26; 95% CI, 1.03-1.54; P = 0.02). Overall, our analyses suggest that direct bypass with or without indirect augmentation provides the best outcomes for adults with MD. ..
  15. Park M, Kilburg C, Taussky P, Albuquerque F, Kallmes D, Levy E, et al. Pipeline Embolization Device with or without Adjunctive Coil Embolization: Analysis of Complications from the IntrePED Registry. AJNR Am J Neuroradiol. 2016;37:1127-31 pubmed publisher
    ..5% versus 7.8%; P = .13). These data suggest that either strategy represents an acceptable risk profile in the treatment of complex cerebral aneurysms and warrants further investigation. ..
  16. Kalani M, Spetzler R. Internal carotid artery-to-posterior cerebral artery bypass for revascularization of the brainstem. J Clin Neurosci. 2016;24:151-4 pubmed publisher
    ..Although the bypass remained patent, the patient suffered an acute thrombosis of the aneurysm, resulting in fatal pontine infarction. ..
  17. Moon K, Nanaszko M, Levitt M, Gross B, Zabramski J, Spetzler R, et al. Carotid Endarterectomy on Antiplatelet Agents in the Era of Point-of-Care Testing. World Neurosurg. 2016;93:215-20 pubmed publisher
    ..Patients with PRU <170 were more likely to have estimated blood loss ?100 mL during surgery and surgery lasting ?3 hours. ..
  18. Belykh E, Giers M, Preul M, Theodore N, Byvaltsev V. Prospective Comparison of Microsurgical, Tubular-Based Endoscopic, and Endoscopically Assisted Diskectomies: Clinical Effectiveness and Complications in Railway Workers. World Neurosurg. 2016;90:273-280 pubmed publisher
    ..The endoscopically assisted diskectomy technique allows for minimally invasive surgery and offers enhanced visualization of the anatomy that is hidden from view in microscopic procedures. ..
  19. Gross B, Albuquerque F, Moon K, McDougall C. New frontiers in venous sinus stenting: Illustrative cases. J Clin Neurosci. 2016;33:241-244 pubmed publisher
    ..At 3-month and 1-month follow-up, respectively, ophthalmologic examinations showed vision improvement. The first patient also had improved cognition, and the second patient also had improved headaches. ..
  20. Sun G, Yagmurlu K, Belykh E, Lei T, Preul M. Management Strategy of a Transorbital Penetrating Pontine Injury by a Wooden Chopstick. World Neurosurg. 2016;95:622.e7-622.e15 pubmed publisher
    ..A trajectory through the superior orbital fissure and paralateral to the cavernous sinus and into the pons seems to be the most prevalent and influences management of removal and injuries. ..
  21. Boroumand M, Kalani M, Spetzler R. Combined endovascular and microsurgical treatment of a complex spinal arteriovenous fistula associated with CLOVES syndrome in an adult patient. J Clin Neurosci. 2016;34:232-234 pubmed publisher
  22. Bohl M, Forseth J, Nakaji P. Transient Diabetes Insipidus After Discontinuation of Vasopressin in Neurological Intensive Care Unit Patients: Case Series and Literature Review. World Neurosurg. 2017;97:479-488 pubmed publisher
    ..Future research includes a large prospective study to determine risk factors for tDI, its incidence, and its pathophysiology. ..
  23. request reprint
    Sun H, Safavi Abbasi S, Spetzler R. Retractorless surgery for intracranial aneurysms. J Neurosurg Sci. 2015;: pubmed
    ..We show that dynamic retraction without fixed retractors, when combined with optimal patient position and neuroprotective anesthetics, can provide the surgeon with adequate visualization of aneurysms and excellent surgical outcomes. ..
  24. Hlubek R, Bohl M, Cole T, Morgan C, Xu D, Chang S, et al. Safety and accuracy of freehand versus navigated C2 pars or pedicle screw placement. Spine J. 2018;18:1374-1381 pubmed publisher
    ..Complication rates did not differ between the two techniques in this study. ..
  25. Zaidi H, Montoure A, Nakaji P, Bice A, Tumialán L. A 5-Year Retrospective Analysis of Exposure to Ionizing Radiation by Neurosurgery Residents in the Modern Era. World Neurosurg. 2016;86:220-5 pubmed publisher
    ..Although the total dose is not high, a better understanding of the impact of radiation exposure on practitioners may help to drive institutional policies to reduce occupational exposure. ..
  26. Bohl M, Hlubek R, Kakarla U, Chang S. Divergent Bilateral Posterior Lumbar Interbody Fusion with Cortical Screw Fixation: Description of New Trajectory for Interbody Technique from Midline Exposure. World Neurosurg. 2018;113:e480-e485 pubmed publisher
    ..The prospective collection of outcome data for patients who undergo lumbosacral fusion using the divergent PLIF technique is ongoing. ..
  27. Snyder L, Martinez Del Campo E, Neal M, Zaidi H, Awad A, Bina R, et al. Lumbar Spinal Fixation with Cortical Bone Trajectory Pedicle Screws in 79 Patients with Degenerative Disease: Perioperative Outcomes and Complications. World Neurosurg. 2016;88:205-13 pubmed publisher
    ..Mean follow-up was 13.2 months. As CBTPS becomes increasingly popular among spine surgeons performing lumbar fusion, this report provides an important evaluation of technique safety and acceptable perioperative outcomes. ..
  28. Gross B, Moon K, Kalani M, Albuquerque F, McDougall C, Nakaji P, et al. Clinical and Anatomic Insights From a Series of Ethmoidal Dural Arteriovenous Fistulas at Barrow Neurological Institute. World Neurosurg. 2016;93:94-9 pubmed publisher
    ..Surgical disconnection remains the gold standard in the treatment of ethmoidal dAVFs. Embolization is a consideration for well-selected cases with favorable arterial or venous access anatomy. ..
  29. Kalani M, Spetzler R, Wanebo J. Keyhole Supraorbital Craniotomy for Aneurysm Clipping in the Setting of Bypass for Moyamoya Disease. World Neurosurg. 2016;94:442-446 pubmed publisher
  30. Fennell V, Martirosyan N, Atwal G, Kalani M, Spetzler R, Lemole G, et al. Effective Surgical Management of Competitive Venous Outflow Restriction After Radiosurgery for Cerebral AVMs: Report of 2 Cases. World Neurosurg. 2017;98:882.e1-882.e7 pubmed publisher
    ..Optimal outcomes may be achieved in patients with a visual deficit that is anatomically correlated to their AVMs. ..
  31. Safavi Abbasi S, Moron F, Sun H, Wilson C, Frock B, Oppenlander M, et al. Techniques and Outcomes of Gore-Tex Clip-Wrapping of Ruptured and Unruptured Cerebral Aneurysms. World Neurosurg. 2016;90:281-290 pubmed publisher
    ..Gore-Tex clip-wrapping can be used safely for microsurgical management of ruptured and unruptured cerebral aneurysms with acceptable recurrence and rehemorrhage rates. ..
  32. Belykh E, Krutko A, Baykov E, Giers M, Preul M, Byvaltsev V. Preoperative estimation of disc herniation recurrence after microdiscectomy: predictive value of a multivariate model based on radiographic parameters. Spine J. 2017;17:390-400 pubmed publisher
    ..The software developed from this model may be implemented during patient counseling or decision making when choosing the type of primary surgery for LDH. ..
  33. Hoyt A, Smith K. Selective Amygdalohippocampectomy. Neurosurg Clin N Am. 2016;27:1-17 pubmed publisher
    ..This article describes the 3 most common surgical approaches for performing selective amygdalohippocampectomy and discusses their relative merits and risks. ..
  34. Bohl M, Ponce F. Assessing the Relevancy of Highly Cited Works in Neurosurgery. Part I: The 100 Most Relevant Papers in Neurosurgical Journals. World Neurosurg. 2017;104:927-938 pubmed publisher
  35. Giers M, Munter B, Eyster K, Ide G, Newcomb A, Lehrman J, et al. Biomechanical and Endplate Effects on Nutrient Transport in the Intervertebral Disc. World Neurosurg. 2017;99:395-402 pubmed publisher
    ..Compressive load was a negligible benefit or hindrance to transport. Traction hindered transport in the short term. This method can be used to study strategies for increasing nutrient transport in IVDs. ..
  36. Belykh E, Yagmurlu K, Hong Y, Mooney M, Bozkurt B, Byvaltsev V, et al. Quantitative Comparison of Three Endoscopic Approaches to the Parasellar Region: Laboratory Investigation. World Neurosurg. 2017;108:383-392 pubmed publisher
    ..The contralateral transmaxillary route provided a more lateral view, increasing exposure on average by 48%, with shorter surgical depth; however, surgical freedom was inferior to that of the binostril approach. ..
  37. Belykh E, Xu D, Yagmurlu K, Lei T, Byvaltsev V, Dickman C, et al. Repair of V2 Vertebral Artery Injuries Sustained During Anterior Cervical Diskectomy. World Neurosurg. 2017;105:796-804 pubmed publisher
    ..Familiarity with relevant vascular surgical anatomy allows neurosurgeons to be prepared in cases of VA injury and may facilitate repair when the VA is injured during anterior cervical spine surgery. ..
  38. Mulholland C, Kalani M, Albuquerque F. Endovascular management of intracranial dural arteriovenous fistulas. Handb Clin Neurol. 2017;143:117-123 pubmed publisher
    ..Those that cannot be fully treated by endovascular means are approached with either adjuvant surgery or radiotherapy. ..
  39. Atwal G, Sarris C, Spetzler R. Brainstem and cerebellar cavernous malformations. Handb Clin Neurol. 2017;143:291-295 pubmed publisher
    ..The clinical presentation of the patient, the location of the lesion, and the surgical risk assessment all play critical roles in management decision-making. ..
  40. Bohl M, TURNER J, Little A, Nakaji P, Ponce F. Assessing the Relevancy of "Citation Classics" in Neurosurgery. Part II: Foundational Papers in Neurosurgery. World Neurosurg. 2017;104:939-966 pubmed publisher
  41. Martinez Del Campo E, Kalb S, Rangel Castilla L, Moon K, Moran A, Gonzalez O, et al. Spinal Coccidioidomycosis: A Current Review of Diagnosis and Management. World Neurosurg. 2017;108:69-75 pubmed publisher
    ..Emphasis should be placed on continuous and lifelong appropriate azole therapy. Spinal instability and neurologic compromise are surgical indications for decompression and fusion. ..
  42. Xu D, Sun H, Spetzler R. Spinal arteriovenous malformations: surgical management. Handb Clin Neurol. 2017;143:153-160 pubmed publisher
    ..Intramedullary and conus AVMs are amenable to safe surgical resection when combined with endovascular embolization and use of a pial dissection technique that spares entry into the neural parenchyma. ..
  43. Yagmurlu K, Kalani M, Martirosyan N, Safavi Abbasi S, Belykh E, Laarakker A, et al. Maxillary Artery to Middle Cerebral Artery Bypass: A Novel Technique for Exposure of the Maxillary Artery. World Neurosurg. 2017;100:540-550 pubmed publisher
    ..The MaxA can be exposed without zygomatic osteotomies or resection of the middle fossa floor. Anatomic landmarks for exposing the MaxA include the anterior and posterior deep temporal arteries and the pterygomaxillary fissure. ..
  44. Mooney M, Zabramski J. Developmental venous anomalies. Handb Clin Neurol. 2017;143:279-282 pubmed publisher
    ..Surgical or endovascular obliteration of DVAs carries a significant risk of venous infarction; thus, conservative management is the treatment of choice for patients with these lesions. ..
  45. Narayanan M, Atwal G, Nakaji P. Multimodality management of cerebral arteriovenous malformations. Handb Clin Neurol. 2017;143:85-96 pubmed publisher
    ..Some AVMs may also be treated with partial therapy to reduce the risk of hemorrhage or to ameliorate symptoms. In this chapter, we review the key factors that influence whether and how to manage AVMs with multimodality treatment. ..
  46. Sarris C, Atwal G, Nakaji P. Thalamic cavernous malformations. Handb Clin Neurol. 2017;143:297-302 pubmed publisher
    ..Careful attention to safe entry zones and image guidance can allow safe removal of these lesions when necessary. ..
  47. Williamson R, Abla A, Zabramski J, Nakaji P, Spetzler R, Wanebo J. Revascularization of Moyamoya Angiopathy in Older Adults. World Neurosurg. 2017;99:37-40 pubmed publisher
    ..Although uncommon, moyamoya angiopathy can manifest in older adults. Surgical revascularization is a reasonable treatment option with good functional outcomes and an acceptable complication rate. ..
  48. Crain I, Elias P, Chapple K, Scheck A, Karis J, Preul M. Improving the utility of 1H-MRS for the differentiation of glioma recurrence from radiation necrosis. J Neurooncol. 2017;133:97-105 pubmed publisher
    ..58 (sensitivity 56%, specificity 95%). Application of our ratio criteria in prospective studies may offer an alternative to biopsy or visual spectral pattern recognition to distinguish RT from PTRE in patients with gliomas. ..
  49. Chen T, Mirzadeh Z, Ponce F. "Asleep" Deep Brain Stimulation Surgery: A Critical Review of the Literature. World Neurosurg. 2017;105:191-198 pubmed publisher
    ..Initial evidence suggests that asleep DBS can be performed safely for PD and ET with good clinical outcomes. Long-term follow-up, larger cohorts, and double-armed studies are needed to validate these initial results. ..
  50. Martirosyan N, Patel A, Carotenuto A, Kalani M, Bohl M, Preul M, et al. The role of therapeutic hypothermia in the management of acute spinal cord injury. Clin Neurol Neurosurg. 2017;154:79-88 pubmed publisher
    ..Future research should focus on defining the optimal levels of parameters. Large, multicenter, controlled clinical trials are needed to investigate its therapeutic potential. ..
  51. Tumialan L, Theodore N, Narayanan M, Marciano F, Nakaji P. Anatomic Basis for Minimally Invasive Resection of Intradural Extramedullary Lesions in Thoracic Spine. World Neurosurg. 2018;109:e770-e777 pubmed publisher
  52. Belykh E, Miller E, Lei T, Chapple K, Byvaltsev V, Spetzler R, et al. Face, Content, and Construct Validity of an Aneurysm Clipping Model Using Human Placenta. World Neurosurg. 2017;105:952-960.e2 pubmed publisher
    ..The Objective Structured Assessment of Aneurysm Clipping Skills scale is a feasible tool to assess aneurysm clipping skills quantitatively. ..
  53. Gross B, Moon K, McDougall C. Endovascular management of arteriovenous malformations. Handb Clin Neurol. 2017;143:59-68 pubmed publisher
    ..With appropriate patient selection and well-defined goals of embolization, the risk of procedural morbidity can be outweighed by its benefit. ..
  54. Xu D, Hlubek R, Mulholland C, Knievel K, Smith K, Nakaji P. Use of Intracranial Pressure Monitoring Frequently Refutes Diagnosis of Idiopathic Intracranial Hypertension. World Neurosurg. 2017;104:167-170 pubmed publisher
    ..Direct ICP monitoring is the gold standard for determining ICP and can be safely and effectively applied to the work-up and treatment of patients with IIH to reduce the occurrence of misdiagnosis and unnecessary surgery. ..