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Hang G, Gong Y, Xie H, Xie T. A novel lateral myelotomy approach for the treatment of lateral or ventrolateral spinal gliomas. Acta Neurochir (Wien) 2024; 166:237. [PMID: 38809310 DOI: 10.1007/s00701-024-06139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To describe a novel surgical approach in which myelotomy was performed lateral to the dorsal root entry zone (LDREZ), for the treatment of lateral or ventrolateral spinal intramedullary glioma. METHODS This study reviewed six patients with lateral or ventrolateral spinal intramedullary glioma who received surgical treatments by using myelotomy technique of LDREZ approach. The patient's clinical characteristics, magnetic resonance imaging (MRI) results, and follow-up outcomes were analyzed. The neurological function of patients before and after operation was assessed based on the Frankel scale system. The anatomical feasibility, surgical techniques, advantages and disadvantages of LDREZ approach were analyzed. RESULTS Myelotomy technique of LDREZ approach was employed in all 6 patients. Gross total resections were achieved in 4 patients, and 2 patients with astrocytoma (case 2, 6) underwent partial removal. The perioperative recovery was all smooth and all the patients were discharged on schedule. All the patients who suffered from neuropathic pain were relieved. After surgery, neurological function remained unchanged in 3 patients. 2 patients improved from Frankel grade B to C, and 1 patient deteriorated from Frankel grade D to C immediately after surgery and returned to Frankel grade D at 3 months follow-up. Regarding to the poor prognosis of high-grade glioma, the two cases with WHO IV glioma didn't achieve long survival. CONCLUSION LDREZ approach is feasible and safe for the surgical removal of lateral or ventrolateral spinal gliomas. This approach can provide a direct pathway to lateral or ventrolateral spinal gliomas with minimal damage to normal spinal cord.
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Affiliation(s)
- Gai Hang
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Yukang Gong
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Hang Xie
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Tianhao Xie
- Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, Wuhan, China.
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Akinduro OO, Ghaith AK, Loizos M, Lopez AO, Goyal A, de Macêdo Filho L, Ghanem M, Jarrah R, Moniz Garcia DP, Abode-Iyamah K, Kalani MA, Chen SG, Krauss WE, Clarke MJ, Bydon M, Quiñones-Hinojosa A. What Factors Predict the Development of Neurologic Deficits Following Resection of Intramedullary Spinal Cord Tumors: A Multi-Center Study. World Neurosurg 2024; 182:e34-e44. [PMID: 37952880 DOI: 10.1016/j.wneu.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Intramedullary spinal cord tumors are challenging to resect, and their postoperative neurological outcomes are often difficult to predict, with few studies assessing this outcome. METHODS We reviewed the medical records of all patients surgically treated for Intramedullary spinal cord tumors at our multisite tertiary care institution (Mayo Clinic Arizona, Mayo Clinic Florida, Mayo Clinic Rochester) between June 2002 and May 2020. Variables that were significant in the univariate analyses were included in a multivariate logistic regression. "MissForest" operating on the Random Forest algorithm, was used for data imputation, and K-prototype was used for data clustering. Heatmaps were added to show correlations between postoperative neurological deficit and all other included variables. Shapley Additive exPlanations were implemented to understand each feature's importance. RESULTS Our query resulted in 315 patients, with 160 meeting the inclusion criteria. There were 53 patients with astrocytoma, 66 with ependymoma, and 41 with hemangioblastoma. The mean age (standard deviation) was 42.3 (17.5), and 48.1% of patients were women (n = 77/160). Multivariate analysis revealed that pathologic grade >3 (OR = 1.55; CI = [0.67, 3.58], P = 0.046 predicted a new neurological deficit. Random Forest algorithm (supervised machine learning) found age, use of neuromonitoring, histology of the tumor, performing a midline myelotomy, and tumor location to be the most important predictors of new postoperative neurological deficits. CONCLUSIONS Tumor grade/histology, age, use of neuromonitoring, and myelotomy type appeared to be most predictive of postoperative neurological deficits. These results can be used to better inform patients of perioperative risk.
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Affiliation(s)
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaelides Loizos
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Anshit Goyal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Marc Ghanem
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Ryan Jarrah
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Maziyar A Kalani
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Florida, USA
| | - Selby G Chen
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - William E Krauss
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle J Clarke
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Mayol del Valle M, Morales B, Philbrick B, Adeagbo S, Goyal S, Newman S, Frontera NL, Nduom E, Olson J, Neill S, Hoang K. Intramedullary Spinal Cord Tumors: Whole-Genome Sequencing to Assist Management and Prognosis. Cancers (Basel) 2024; 16:404. [PMID: 38254893 PMCID: PMC10814932 DOI: 10.3390/cancers16020404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Intramedullary spinal cord tumors (IMSCTs) harbor unique genetic mutations which may play a role in prognostication and management. To this end, we present the largest cohort of IMSCTs with genetic characterization in the literature from our multi-site institutional registry. A total of 93 IMSCT patient records were reviewed from the years 1999 to 2020. Out of these, 61 complied with all inclusion criteria, 14 of these patients had undergone genetic studies with 8 undergoing whole-genomic sequencing. Univariate analyses were used to assess any factors associated with progression-free survival (PFS) using the Cox proportional hazards model. Firth's penalized likelihood approach was used to account for the low event rates. Fisher's exact test was performed to compare whole-genome analyses and specific gene mutations with progression. PFS (months) was given as a hazard ratio. Only the absence of copy neutral loss of heterozygosity (LOH) was shown to be significant (0.05, p = 0.008). Additionally, higher risk of recurrence/progression was associated with LOH (p = 0.0179). Our results suggest LOH as a genetic predictor of shorter progression-free survival, particularly within ependymoma and glioblastoma tumor types. Further genomic research with larger multi-institutional datasets should focus on these mutations as possible prognostic factors.
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Affiliation(s)
- Miguel Mayol del Valle
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
| | - Bryan Morales
- Department of Neuropathology, Emory University Hospital, 1364 Clifton Road, NE Room H-184, Atlanta, GA 30322, USA; (B.M.); (S.N.)
| | - Brandon Philbrick
- Department of Neurosurgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA (S.A.)
| | - Segun Adeagbo
- Department of Neurosurgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA (S.A.)
| | - Subir Goyal
- Biostatistics Shared Resource Department, Winship Cancer Institute, Emory University, 1365-C Clifton Road, NE, Atlanta, GA 30322, USA;
| | - Sarah Newman
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
| | - Natasha L. Frontera
- School of Medicine, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan 00936-5067, Puerto Rico;
| | - Edjah Nduom
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
| | - Jeffrey Olson
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
| | - Stewart Neill
- Department of Neuropathology, Emory University Hospital, 1364 Clifton Road, NE Room H-184, Atlanta, GA 30322, USA; (B.M.); (S.N.)
| | - Kimberly Hoang
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
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Yagi T, Mizuno M, Kageyama H, Tatebayashi K, Endo T, Takeshima Y, Iwasaki M, Kurokawa R, Takai K, Nishikawa M, Hida K. Spinal Cord Subependymoma: A Subanalysis of the Neurospinal Society of Japan's Multicenter Study of Intramedullary Spinal Cord Tumors. Neurospine 2023; 20:735-746. [PMID: 37350166 PMCID: PMC10562242 DOI: 10.14245/ns.2346388.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the clinical characteristics, treatment strategies, and surgical outcomes of subependymoma patients from the 2022 Neurospinal Society of Japan multicenter intramedullary spinal cord tumor study. METHODS Twenty-six patients with spinal cord subependymoma who were included in the index study of 1,033 patients were retrospectively analyzed. RESULTS Mean patient age was 49.4 years. Seventeen patients were men and 9 were women. Sensory disturbance was reported in 22 patients and motor weakness in 18. Median duration of symptoms was 24 months. The tumor was eccentrically located in 19 patients (73.1%) and unilateral in 17 (65.4%). Gross total resection was achieved in 6 patients (23.1%). The same rate for ependymoma patients in the index study was significantly higher (74.8%). Median follow-up was 40.5 months (interquartile range, 18-68 months). In 2 patients who underwent only partial resection, reoperation was required owing to progression 68 and 90 months after surgery, respectively. No recurrence occurred in patients who underwent gross total resection. Five patients experienced neurological worsening after surgery. CONCLUSION Although spinal cord subependymoma can be difficult to distinguish from other intramedullary spinal cord lesions before surgery, it is characterized by an indolent clinical course and eccentric location. Surgical treatment should prioritize functional preservation because the prognosis is good even after subtotal resection.
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Affiliation(s)
- Takashi Yagi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Masaki Mizuno
- Department of Minimally Invasive Neurospinal Surgery, Mie University, Mie, Japan
| | - Hiroto Kageyama
- Department of Neurosurgery, Hyogo Medical University, Hyogo, Japan
| | | | - Toshiki Endo
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | | | - Motoyuki Iwasaki
- Department of Neurosurgery, Hokkaido University, Hokkaido, Japan
| | - Ryu Kurokawa
- Department of Neurosurgery, Dokkyo Medical University, Tochigi, Japan
| | - Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Misao Nishikawa
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, Osaka, Japan
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - for the Neurospinal Society of Japan Investigators of Intramedullary Spinal Cord Tumors
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
- Department of Minimally Invasive Neurospinal Surgery, Mie University, Mie, Japan
- Department of Neurosurgery, Hyogo Medical University, Hyogo, Japan
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Neurosurgery, Nara Medical University, Nara, Japan
- Department of Neurosurgery, Hokkaido University, Hokkaido, Japan
- Department of Neurosurgery, Dokkyo Medical University, Tochigi, Japan
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, Osaka, Japan
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
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Hersh AM, Jallo GI, Shimony N. Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics. Front Oncol 2022; 12:982089. [PMID: 36147920 PMCID: PMC9485889 DOI: 10.3389/fonc.2022.982089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Intramedullary astrocytomas represent approximately 30%–40% of all intramedullary tumors and are the most common intramedullary tumor in children. Surgical resection is considered the mainstay of treatment in symptomatic patients with neurological deficits. Gross total resection (GTR) can be difficult to achieve as astrocytomas frequently present as diffuse lesions that infiltrate the cord. Therefore, GTR carries a substantial risk of new post-operative deficits. Consequently, subtotal resection and biopsy are often the only surgical options attempted. A midline or paramedian sulcal myelotomy is frequently used for surgical resection, although a dorsal root entry zone myelotomy can be used for lateral tumors. Intra-operative neuromonitoring using D-wave integrity, somatosensory, and motor evoked potentials is critical to facilitating a safe resection. Adjuvant radiation and chemotherapy, such as temozolomide, are often administered for high-grade recurrent or progressive lesions; however, consensus is lacking on their efficacy. Biopsied tumors can be analyzed for molecular markers that inform clinicians about the tumor’s prognosis and response to conventional as well as targeted therapeutic treatments. Stratification of intramedullary tumors is increasingly based on molecular features and mutational status. The landscape of genetic and epigenetic mutations in intramedullary astrocytomas is not equivalent to their intracranial counterparts, with important difference in frequency and type of mutations. Therefore, dedicated attention is needed to cohorts of patients with intramedullary tumors. Targeted therapeutic agents can be designed and administered to patients based on their mutational status, which may be used in coordination with traditional surgical resection to improve overall survival and functional status.
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Affiliation(s)
- Andrew M. Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - George I. Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, United States
- *Correspondence: George I. Jallo,
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Le Bonheur Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, United States
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
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