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Umebayashi D, Naito K, Kurokawa R, Endo T, Mizuno M, Hoshimaru M, Kim P, Hida K, Takami T. Epidemiology and Comparative Analysis of Outcomes of Intramedullary Spinal Cord Tumor Between Pediatric and Adult Patients. Spine (Phila Pa 1976) 2024; 49:107-115. [PMID: 37466205 DOI: 10.1097/brs.0000000000004775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/01/2023] [Indexed: 07/20/2023]
Abstract
STUDY DESIGN This was as clinical retrospective study. OBJECTIVES We sought to evaluate the characteristics of Pediatric intramedullary spinal cord tumors (PISCTs) and to identify differences between pediatric and adult intramedullary spinal cord tumors. SUMMARY OF BACKGROUND DATA PISCTs represent a rare clinical entity with limited evidence-base in the literature. METHODS This study is a subanalysis of the retrospective multicenter observational study authorized by the Neurospinal Society of Japan, including consecutive patients with spinal intramedullary tumors treated surgically at 58 institutions between 2009 and 2020. Data on 1080 intramedullary spinal cord tumors were obtained, consisting of 91 pediatric and 939 adult patients. Survival was compared using Cox hazard regression while clinical differences were evaluated using multivariable logistic regression that controlled for confounders. RESULTS Pediatric patients had a shorter overall, and progression-free, survival than adults. Pediatric patients with ISCTs were likely to have scoliosis [odds ratio (OR) = 6.49, 95% CI: 2.26-18.7], short preoperative symptom duration (OR = 0.99, 95% CI: 0.98-0.99), lower incidence of paresthesia (OR = 0.41, 95% CI: 0.22-0.77), higher incidence of paresis (OR = 2.10, 95% CI: 1.01-4.35), histopathology of astrocytoma (OR = 2.97, 95% CI: 1.19-7.43), and postoperative functional deterioration upon discharge (OR = 2.83, 95% CI: 1.43-5.58). Age was not a statistically significant prognostic factor of overall survival among the pediatric cohort. CONCLUSION We found that the clinical characteristics of ISCTs differed between pediatric and adult patients. In terms of histopathological types, astrocytoma was most common in pediatric patients. ISCT occurring at an early age may not be an indicator for poor prognosis.
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Affiliation(s)
- Daisuke Umebayashi
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Kentaro Naito
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Japan
| | - Ryu Kurokawa
- Department of Neurologic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Toshiki Endo
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Miyagi, Japan
| | - Masaki Mizuno
- Department of Minimum-Invasive Neurospinal Surgery, Mie University, Mie, Japan
| | | | - Phyo Kim
- Neurologic Surgery, Symphony Clinic, Tochigi, Japan
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Hokkaido, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
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2
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Golpayegani M, Edalatfar M, Ahmadi A, Sadeghi-Naini M, Salari F, Hanaei S, Shokraneh F, Ghodsi Z, Vaccaro AR, Rahimi-Movaghar V. Complete Versus Incomplete Surgical Resection in Intramedullary Astrocytoma: Systematic Review with Individual Patient Data Meta-Analysis. Global Spine J 2023; 13:227-241. [PMID: 35486519 PMCID: PMC9837510 DOI: 10.1177/21925682221094766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Systematic reviewBackground: Considering the infiltrative nature of intramedullary astrocytoma, the goal of surgery is to have a better patient related outcome. OBJECTIVE To compare the overall survival (OS) and neurologic outcomes of complete vs incomplete surgical resection for patients with intramedullary astrocytoma. METHODS A comprehensive search of MEDLINE, CENTRAL and EMBASE was conducted by two independent reviewers. Individual patient data (IPD) analysis and multivariate Cox Proportional Hazard Model was developed to measure the effect of surgical strategies on OS, post-operative neurological improvement (PNI), and neurological improvement in the last follow up (FNI). RESULTS We included 1079 patients from 35 studies. Individual patient data of 228 patients (13 articles) was incorporated into the integrative IPD analysis. Kaplan-Meier survival analysis showed complete resection (CR) significantly improved OS in comparison with the incomplete resection (IR) (log-rank test, P = .004). In the multivariate IPD analysis, three prognostic factors had significant effect on the OS: (1) Extent of Resection, (2) pathology grade, and (3) adjuvant therapy. We observed an upward trend in the popularity of chemotherapy, but CR, IR, and radiotherapy had relatively stable trends during three decades. CONCLUSION Our study shows that CR can improve OS when compared to IR. Patients with spinal cord astrocytoma undergoing CR had similar PNI and FNI compared to IR. Therefore, CR should be the primary goal of surgery, but intraoperative decisions on the extent of resection should be relied on to prevent neurologic adverse events. Due to significant effect of adjuvant therapy on OS, PNI and FNI, it could be considered as the routine treatment strategy for spinal cord astrocytoma.
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Affiliation(s)
- Mehdi Golpayegani
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Maryam Edalatfar
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research
Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran,Department of Neurosurgery, Lorestan University of Medical
Sciences, Khoram-Abad, Iran
| | - Farhad Salari
- Eye Research Center, Farabi Eye
Hospital, Tehran University of Medical
Sciences, Tehran, Iran
| | - Sara Hanaei
- Department of Neurosurgery, Imam
Khomeini Hospital Complex, Tehran University of Medical Sciences
(TUMS), Tehran, Iran,Universal Scientific Education and
Research Network (USERN), Tehran, Iran
| | - Farhad Shokraneh
- Cochrane Schizophrenia Group, The Institute of Mental
Health, Nottingham, UK
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Alex R. Vaccaro
- Department of Orthopedics and
Neurosurgery, Thomas Jefferson University and the
Rothman Institute, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran,Universal Scientific Education and
Research Network (USERN), Tehran, Iran,Brain and Spinal Cord Injury
Research Center, Neuroscience Institute, Tehran University of Medical
Sciences, Tehran, Iran,Department of Neurosurgery,
Shariati Hospital, Tehran University of Medical
Sciences, Tehran, Iran,Institute of Biochemistry and
Biophysics, University of Tehran, Tehran, Iran,Visiting Professor, Spine
Program, University of Toronto, Toronto, ON, Canada,Vafa Rahimi-Movaghar, MD, Sina Trauma and
Surgery Research Center, Tehran University of Medical Sciences, Hassan-Abad
Square, Tehran 1136746911, Iran.
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3
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Noureldine MHA, Shimony N, Jallo GI. Benign Spinal Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:583-606. [PMID: 37452955 DOI: 10.1007/978-3-031-23705-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Benign spinal intradural tumors are relatively rare and include intramedullary tumors with a favorable histology such as low-grade astrocytomas and ependymomas, as well as intradural extramedullary tumors such as meningiomas and schwannomas. The effect on the neural tissue is usually a combination of mass effect and neuronal involvement in cases of infiltrative tumors. The new understanding of molecular profiling of different tumors allowed us to better define central nervous system tumors and tailor treatment accordingly. The mainstay of management of many intradural spinal tumors is maximal safe surgical resection. This goal is more achievable with intradural extramedullary tumors; yet, with a meticulous surgical approach, many of the intramedullary tumors are amenable for safe gross-total or near-total resection. The nature of these tumors is benign; hence, a different way to measure outcome success is pursued and usually depends on functional rather than oncological or survival outcomes.
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Affiliation(s)
- Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Nir Shimony
- Institute of Neuroscience, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, PA, USA
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Department of Surgery, St Jude Children's Research Hospital, Memphis, USA
| | - George I Jallo
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA.
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4
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Leveraging nano-engineered mesenchymal stem cells for intramedullary spinal cord tumor treatment. CHINESE CHEM LETT 2022. [DOI: 10.1016/j.cclet.2022.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Antkowiak L, Putz M, Sordyl R, Pokora S, Mandera M. Relevance of intraoperative motor evoked potentials and D-wave monitoring for the resection of intramedullary spinal cord tumors in children. Neurosurg Rev 2022; 45:2723-2731. [PMID: 35416529 DOI: 10.1007/s10143-022-01788-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/17/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate the reliability of motor evoked potentials (MEP), somatosensory evoked potentials (SSEP), and D-wave monitoring as predictors of postoperative neurological deficits in pediatric patients undergoing resection of intramedullary spinal cord tumors (IMSCTs). Additionally, we aimed to determine whether alerts in the intraoperative neurophysiological monitoring (IONM) influenced the extent of resection (EOR). A retrospective analysis of the pediatric patients who underwent resection of IMSCT between March 2010 and April 2021 with an IONM guidance was performed. IONM alerts were recorded and correlated with patients' clinical status at discharge. Twenty three pediatric patients were included. MEP and SSEP were successfully elicited in all patients, while D-wave monitoring was feasible for 14 of them (60.9%). Significant IONM alerts occurred in 6 individuals (26.1%) with monitorable MEP and SSEP and 2 patients with monitorable D-waves (14.3%). The sensitivity, specificity, positive predictive value, and negative predictive value accounted for 100%, 81.8%, 20%, 100% for MEP, 100%, 92.3%, 50%, 100% for D-wave, and 50%, 81%, 20%, 94.44% for SSEP, respectively. Both MEP (p < 0.001) and D-wave monitoring (p < 0.001) accurately predicted postoperative motor deficits, while SSEP failed to provide significant accuracy regarding sensory deficits (p = 0.491). Gross-total tumor resection was performed in 29.4% of patients without IONM alerts and 33.3% of patients with IONM alerts, indicating that IONM alerts did not limit the EOR (p = 0.0857). MEP and D-wave monitoring can be perceived as reliable IONM modalities in pediatric IMSCTs surgery. Caution is needed with the implementation of SSEP to guide surgical decisions.
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Affiliation(s)
- Lukasz Antkowiak
- Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland.
| | - Monika Putz
- Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Ryszard Sordyl
- Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Szymon Pokora
- Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Marek Mandera
- Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland
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Silva AHD, Constantinides M, Valetopoulou A, Sgardelis P, Mankad K, D'Arco F, Jankovic I, Thompson D. Paediatric spinal cord low-grade gliomas-evaluation and management of post-surgical residual disease. Childs Nerv Syst 2022; 38:577-586. [PMID: 34855000 DOI: 10.1007/s00381-021-05412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the evaluation and management of post-surgical residual disease for low-grade intramedullary spinal cord tumours (IMSCT) in childhood. METHODS A single-centre retrospective review of low-grade IMSCTs treated between 2000 and 2019. All surgeries were performed with intent of safe maximal resection guided by intra-operative neurophysiological monitoring (IONM). Pre- and post-operative MRIs were reviewed to assess the extent of resection (EOR), recorded as follows: gross total resection (GTR), near total resection (NTR), sub-total resection (STR) and partial resection (PR). Outcome measures were time to recurrence, need for and modality of additional therapy and ambulatory status at last follow-up. RESULTS Thirty patients underwent surgery for IMSCT (median age 6.9 years). EOR was GTR = 8, NTR = 4, STR = 9, PR = 9. All patients were alive at last follow-up (median follow-up 73 months [IQR 93 months]). Eighteen patients (60%) remained radiologically stable. Twelve patients (40%) developed recurrence during surveillance. Progression free survival was significantly better in cases with GTR + NTR in comparison to either STR or PR (p = 0.039). 10/30 (33%) patients were treated with additional therapy. At last follow-up, 26/30 patients were independently mobile. CONCLUSION Survival rates for low-grade IMSCT are excellent. Radical micro-surgical resection, guided by IONM provides effective means of balancing the objectives of maximal safe resection, functional outcome and tumour control. Whilst evidence of 'residual disease' was identified in over 2/3 of immediate post-operative MRI scans, additional treatment was required in only 1/3 of cases. Critical appraisal of post-operative imaging findings is required to better define 'residual disease'. Small volume residual disease (< 5%) does not compromise progression-free survival.
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Affiliation(s)
- A H D Silva
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - M Constantinides
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - A Valetopoulou
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - P Sgardelis
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - K Mankad
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - F D'Arco
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - I Jankovic
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - D Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
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Perwein T, Benesch M, Kandels D, Pietsch T, Schmidt R, Quehenberger F, Bison B, Warmuth-Metz M, Timmermann B, Krauss J, Thomale UW, Kortmann RD, Driever PH, Gnekow AK. High frequency of disease progression in pediatric spinal cord low-grade glioma (LGG): management strategies and results from the German LGG study group. Neuro Oncol 2021; 23:1148-1162. [PMID: 33346834 DOI: 10.1093/neuonc/noaa296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Knowledge on management of pediatric spinal cord low-grade glioma (LGG) is scarce. METHODS We analyzed clinical datasets of 128 pediatric patients with spinal LGG followed within the prospective multicenter trials HIT-LGG 1996 (n = 36), SIOP-LGG 2004 (n = 56), and the subsequent LGG-Interim registry (n = 36). RESULTS Spinal LGG, predominantly pilocytic astrocytomas (76%), harbored KIAA1549-BRAF fusion in 14/35 patients (40%) and FGFR1-TACC1 fusion in 3/26 patients (12%), as well as BRAFV600E mutation in 2/66 patients (3%). 10-year overall survival (OS) and event-free survival (EFS) was 93% ± 2% and 38% ± 5%, respectively. Disseminated disease (n = 16) was associated with inferior OS and EFS, while age ≥11 years and total resection were favorable factors for EFS. We observed 117 patients following total (n = 24) or subtotal/partial resection (n = 74), biopsy (n = 16), or radiologic diagnosis only (n = 3). Eleven patients were treated first with chemotherapy (n = 9) or irradiation (n = 2). Up to 20.8 years after diagnosis/initial intervention, 73/128 patients experienced one (n = 43) or up to six (n = 30) radiological/clinical disease progressions. Tumor resections were repeated in 36 patients (range, 2-6) and 47 patients required nonsurgical treatment (chemotherapy, n = 20; radiotherapy, n = 10; multiple treatment lines, n = 17). Long-term disease control for a median of 6.5 (range, 0.02-20) years was achieved in 73/77 patients following one (n = 57) or repeated (n = 16) resections, and in 35/47 patients after nonsurgical treatment. CONCLUSIONS The majority of patients experienced disease progression, even after years. Multiple interventions were required for more than a third, yet multimodal treatment enabled long-term disease control. Molecular testing may reveal therapeutic targets.
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Affiliation(s)
- Thomas Perwein
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Daniela Kandels
- Swabian Children's Cancer Center, University Hospital Augsburg, Augsburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy (DGNN), University of Bonn, Bonn, Germany
| | - René Schmidt
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Franz Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology, University of Würzburg, Würzburg, Germany
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University of Würzburg, Würzburg, Germany
| | - Beate Timmermann
- West German Proton Therapy Center Essen/Clinic for Particle Therapy, Essen University Hospital, Essen, Germany
| | - Jürgen Krauss
- Section of Pediatric Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Pablo Hernáiz Driever
- Department of Pediatric Oncology/Hematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Salari F, Golpayegani M, Sadeghi-Naini M, Hanaei S, Shokraneh F, Ahmadi A, Khayat-kashani HR, Vacarro AR, Rahimi-Movaghar V. Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:761-773. [PMID: 32783515 PMCID: PMC8165927 DOI: 10.1177/2192568220939523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To compare outcomes of complete versus incomplete resection in primary intramedullary spinal cord ependymoma. METHODS A comprehensive search of the MEDLINE, CENTRAL, and Embase databases was conducted by 2 independent investigators. Random-effect meta-analysis and meta-regression with seven covariates were performed to evaluate the reason for the heterogeneity among studies. We also used individual patient data in the integrative analysis to compare complete and incomplete resection based on 4 outcomes: progression-free survival (PFS), overall survival (OS), postoperative neurological improvement (PNI), and follow-up neurological improvement (FNI). RESULTS A total of 23 studies were identified, including 407 cases. Significant heterogeneity among included studies was observed in risk estimates (I2 for PFS, FNI, and PNI were 49.5%, 78.3%, and 87.2%, respectively). The mean follow-up time across cases was 48.6 ± 2.35 months. Cox proportional multivariable analysis revealed that the complete resection can prolong PFS (model, hazard ratio = 0.18, CI 0.05-0.54, P = .004,) and improve the FNI (binary logistic regression, adjusted odds ratio = 16.5, CI 1.6-171, P = .019). However, PNI and OS were similar in patients with incomplete resected spinal cord ependymoma compared with complete resection (binary logistic regression respectively and Cox multivariable analysis, P > .5). CONCLUSION The data presented in this study showed that OS was not significantly affected by the degree of surgery. However, complete resection of intramedullary ependymomas provides the optimal outcomes with longer PFS and better long-term neurological outcomes than incomplete resection.
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Affiliation(s)
- Farhad Salari
- Loghman Hakim Hospital, Shahid Beheshti University of medical science, Tehran, Iran
| | - Mehdi Golpayegani
- Loghman Hakim Hospital, Shahid Beheshti University of medical science, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Emam Hossein Hospital, Shahid Beheshti University of medical science, Tehran, Iran
| | - Sara Hanaei
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Farhad Shokraneh
- Cochrane Schizophrenia Group, the Institute of Mental Health, Nottingham, UK
| | - Ayat Ahmadi
- Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Vafa Rahimi-Movaghar, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran 111, Iran.
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9
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Choi HY, Kim KH, Cho BK, Wang KC, Phi JH, Lee JY, Park SH, Kim SK. Clinicopathological Features of Primary Solitary Spinal Cord Tumors in Pediatric Patients : A 32-Year Single Institution Experience. J Korean Neurosurg Soc 2021; 64:592-607. [PMID: 33853299 PMCID: PMC8273779 DOI: 10.3340/jkns.2020.0243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Few studies exist on primary spinal cord tumors (PSCTs) in pediatric patients. The purpose of this study was to perform descriptive analysis and detailed survival analysis for PSCTs. METHODS Between 1985 and 2017, 126 pediatric patients (male : female, 56 : 70) with PSCTs underwent surgery in a single institution. We retrospectively analyzed data regarding demographics, tumor characteristics, outcomes, and survival statistics. Subgroup analysis was performed for the intramedullary (IM) tumors and extradural (ED) tumors separately. RESULTS The mean age of the participants was 6.4±5.04 years, and the mean follow-up time was 69.5±46.30 months. The most common compartment was the ED compartment (n=57, 45.2%), followed by the IM (n=43, 34.1%) and intradural extramedullary (IDEM; n=16, 12.7%) compartments. Approximately half of PSCTs were malignant (n=69, 54.8%). The most common pathologies were schwannomas (n=14) and neuroblastomas (n=14). Twenty-two patients (17.5%) died from the disease, with a mean disease duration of 15.8±15.85 months. Thirty-six patients (28.6%) suffered from progression, with a mean period of 22.6±30.81 months. The 10-year overall survival (OS) rates and progression-free survival (PFS) rates were 81% and 66%, respectively. Regarding IM tumors, the 10-year OS rates and PFS rates were 79% and 57%, respectively. In ED tumors, the 10-year OS rates and PFS rates were 80% and 81%, respectively. Pathology and the extent of resection showed beneficial effects on OS for total PSCTs, IM tumors, and ED tumors. PFS was affected by both the extent of removal and pathology in total PSCTs and ED tumors; however, pathology was a main determinant of PFS rather than the extent of removal in IM tumors. The degree of improvement in the modified McCormick scale showed a trend towards improvement in patients with IM tumors who achieved gross total removal (p=0.447). CONCLUSION Approximately half of PSCTs were malignant, and ED tumors were most common. The most common pathologies were schwannomas and neuroblastomas. Both the pathology and extent of resection had a decisive effect on OS. For IM tumors, pathology was a main determinant of PFS rather than the extent of removal. Radical excision of IM tumors could be a viable option for better survival without an increased risk of worse functional outcomes.
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Affiliation(s)
- Ho Yong Choi
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Kyu-Chang Wang
- Neuro-oncology Clinic, National Cancer Center, Goyang, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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10
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Tariciotti L, Brunetto GMF, Landi A, Gregori F, Santoro F, Frati A, Delfini R, Santoro A. Outcome Features Analysis in Intramedullary Tumors of the Cervicomedullary Junction: A Surgical Series. J Neurol Surg A Cent Eur Neurosurg 2021; 82:225-231. [PMID: 33540453 DOI: 10.1055/s-0040-1719080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECT The aim of this study is to investigate the impact of surgery for different cervicomedullary lesions on symptomatic pattern expression and postoperative outcome. We focused on specific outcome features of the early and late postoperative assessments. The former relies on surgery-related transient and permanent morbidity and feasibility of radicality in eloquent areas, whereas the latter on long-term course in lower grade tumors and benign tumorlike lesions (cavernomas, etc.). MATERIAL AND METHODS We retrospectively analyzed 28 cases of intramedullary tumors of the cervicomedullary junction surgically treated at our institution between 1990 and 2018. All cases were stratified for gender, histology, macroscopic appearance, location, surgical approach, and presence of a plane of dissection (POD). Mean follow-up was 5.6 years and it was performed via periodic magnetic resonance imaging (MRI) and functional assessments (Karnofsky Performance Scale [KPS] and modified McCormick [MC] grading system). RESULTS In all, 78.5% were low-grade tumors (or benign lesions) and 21.5% were high-grade tumors. Sixty-one percent underwent median suboccipital approach, 18% a posterolateral approach, and 21% a posterior cervical approach. Gross total resection was achieved in 54% of cases, near-total resection (>90%) in 14%, and subtotal resection (50-90%) in 32% of cases. Early postoperative morbidity was 25%, but late functional evaluation in 79% of the patients showed KPS > 70 and MC grade I; only 21% of cases showed KPS < 70 and MC grades II and III at late follow-up. Mean overall survival was 7 years in low-grade tumors or cavernomas and 11.7 months in high-grade tumors. Progression-free survival at the end of follow-up was 71% (evaluated mainly on low-grade tumors). CONCLUSIONS The surgical goal should be to achieve maximal cytoreduction and minimal postoperative neurologic damage. Functional outcome is influenced by the presence of a POD, radicality, histology, preoperative status, and employment of advanced neuroimaging planning and intraoperative monitoring.
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Affiliation(s)
- Leonardo Tariciotti
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Lombardia, Italy.,Division of Neurosurgery, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Lombardia, Italy
| | | | - Alessandro Landi
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Gregori
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Francesca Santoro
- Department of Neuroradiology, Regional Hospital San Carlo, Potenza, Basilicata, Italy
| | - Alessandro Frati
- Division of Neurosurgery, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Molise, Italy
| | - Roberto Delfini
- Department of Neurology and Psychiatry, "Sapienza," University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, "Sapienza" University of Rome, Rome, Italy
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11
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Toll BJ, Pahys JM, Yezdani SG, Samdani AF, Hwang SW. Novel Use of Subcostal Polyethylene Bands to Manage Tumor-Related Scoliosis Requiring Serial Imaging: A Case Report. JBJS Case Connect 2021; 10:e0351. [PMID: 32224656 DOI: 10.2106/jbjs.cc.19.00351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 16-year-old male patient with severe kyphoscoliosis, paraplegia, and neurogenic bowel/bladder caused by a juvenile pilocytic astrocytoma was treated surgically using a hybrid fusion construct with polyethylene bands after neoplasm resection. Owing to the necessity of serial postoperative magnetic resonance imaging studies to evaluate the recurrence of pathology and known effect of metal artifact from spinal instrumentation, preservation of radiographic resolution was critical. CONCLUSION We describe the novel utility of polyethylene bands placed around the ribs as a safe and effective form of hybrid construct for reducing radiographic metal artifact in spinal deformity cases requiring serial imaging.
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Affiliation(s)
- Brandon J Toll
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Joshua M Pahys
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Samir G Yezdani
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Amer F Samdani
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Steven W Hwang
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
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12
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Nunna RS, Khalid S, Behbahani M, Mehta AI. Pediatric primary high-grade spinal glioma: a National Cancer Database analysis of current patterns in treatment and outcomes. Childs Nerv Syst 2021; 37:185-193. [PMID: 32533298 DOI: 10.1007/s00381-020-04722-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Pediatric primary high-grade spinal glioma (p-HGSG) is an extremely rare disease process, with little data within the current literature. Akin to primary high-grade gliomas, this cancer has been exemplified by dismal prognosis and poor response to modern treatment paradigms. This study seeks to investigate the current trends affecting overall survival using the National Cancer Database (NCDB). METHODS The NCDB was queried for p-HGSG between 2004 and 2016, by utilizing the designated diagnosis codes. Kaplan-Meier curves were generated, and log-rank testing was performed to analyze factors affecting overall survival. In addition, a Cox proportional-hazards model was used to perform multivariate regression analysis of survival outcomes. RESULTS A cohort of 97 patients was identified with a histologically confirmed p-HGSG. The overall incidence of p-HGSG in all pediatric spinal cord tumors is 7.5%, with a mean survival time of 25.3 months (SD, 21.0) and 5-year overall survival of 17.0%. The majority of patients underwent surgery (n = 87, 89.7%), radiotherapy (n = 73, 75.3%), and chemotherapy (n = 60, 61.9%). Univariate, multivariate, and Kaplan-Meier log-rank testing failed to demonstrate an association between performing surgery, extent of resection, radiotherapy, or chemotherapy with improved survival outcomes. CONCLUSIONS The current study constitutes the largest retrospective analysis of p-HGSGs to date, finding that current treatment options of surgery, radiotherapy, and chemotherapy have unclear benefit. This disease process has a poor prognosis without a current modality of treatment that conclusively alters survival. The risks and side effects of these treatment modalities must be carefully considered in such a highly aggressive disease process, especially given potentially limited survival benefits.
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Affiliation(s)
- Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood Street, 451-N, Chicago, IL, 60612, USA
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood Street, 451-N, Chicago, IL, 60612, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood Street, 451-N, Chicago, IL, 60612, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood Street, 451-N, Chicago, IL, 60612, USA.
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13
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Gwak SJ, Che L, Yun Y, Lee M, Ha Y. Combination Therapy by Tissue-Specific Suicide Gene and Bevacizumab in Intramedullary Spinal Cord Tumor. Yonsei Med J 2020; 61:1042-1049. [PMID: 33251778 PMCID: PMC7700877 DOI: 10.3349/ymj.2020.61.12.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/11/2020] [Accepted: 10/19/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Malignant gliomas are aggressive spinal cord tumors. In this study, we hypothesized that combination therapy using an anti-angiogenic agent, bevacizumab, and hypoxia-inducible glioblastoma-specific suicide gene could reduce tumor growth. MATERIALS AND METHODS In the present study, we evaluated the effect of combination therapy using bevacizumab and pEpo-NI2-SV-TK in reducing the proliferation of C6 cells and tumor growth in the spinal cord. Spinal cord tumor was generated by the injection of C6 cells into the T5 level of the spinal cord. Complexes of branched polyethylenimine (bPEI)/pEpo-NI2-SV-TK were injected into the spinal cord tumor. Bevacizumab was then administered by an intraperitoneal injection at a dose of 7 mg/kg. The anti-cancer effects of combination therapy were analyzed by histological analyses and magnetic resonance imaging (MRI). The Basso, Beattie and Bresnahan scale scores for all of the treatment groups were recorded every other day for 15 days to assess the rat hind-limb strength. RESULTS The complexes of bPEI/pEpo-NI2-SV-TK inhibited the viability of C6 cells in the hypoxia condition at 5 days after treatment with ganciclovir. Bevacizumab was decreased in the cell viability of human umbilical vein endothelial cells. Combination therapy reduced the tumor size by histological analyses and MRI. The combination therapy group showed improved hind-limb function compared to the other groups that were administered pEpo-NI2-SV-TK alone or bevacizumab alone. CONCLUSION This study suggests that combination therapy using bevacizumab with the pEpo-NI2-SV-TK therapeutic gene could be useful for increasing its therapeutic benefits for intramedullary spinal cord tumors.
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Affiliation(s)
- So Jung Gwak
- Department of Chemical Engineering, Wonkwang University, Iksan, Korea
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Lihua Che
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yeomin Yun
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Minhyung Lee
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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14
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Carey SS, Sadighi Z, Wu S, Chiang J, Robinson GW, Ghazwani Y, Liu APY, Acharya S, Merchant TE, Boop FA, Gajjar A, Qaddoumi I. Evaluating pediatric spinal low-grade gliomas: a 30-year retrospective analysis. J Neurooncol 2019; 145:519-529. [PMID: 31642023 DOI: 10.1007/s11060-019-03319-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/12/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Most pediatric spinal tumors are low-grade gliomas (LGGs). Characterization of these tumors has been difficult given their heterogeneity and rare incidence. The objective was to characterize such tumors diagnosed at our institution. METHODS Spinal tumors diagnosed in our pediatric patients between 1984 and 2014 were reviewed retrospectively. Demographics, presentation, pathology, imaging, management, and sequelae were examined. RESULTS Forty patients had spinal LGG tumors, 24 (62%) of which were pilocytic astrocytomas. The most common initial presentations were pain (n = 15), partial extremity paralysis (n = 13), and ataxia (n = 11), with the diagnosis frequently delayed by months (median = 5.9 months, range 4 days-6.2 years). Twenty-nine patients had some tumor resection, and 8 required adjuvant therapy with chemotherapy (n = 4) or radiation (n = 4) post-resection. Ten other patients received only biopsy for histologic diagnosis, who were treated with chemotherapy (n = 4) or radiation (n = 5) post biopsy. Tumor progression was noted in 16 patients (2 after gross-total resection; 10, partial resection; and 4, biopsy). During the evaluation period, 3 patients died secondary to tumor progression. BRAF status could have shortened progression-free survival: patients with BRAFV600E mutations (n = 3) all experienced progression within 10 months. Long-term sequelae of the disease/treatment were mostly residual neurologic deficits (paresthesia, paralysis), chemotherapy-induced hearing loss, and scoliosis. CONCLUSIONS Spinal LGG is a rare entity with significant long-term effects. Although surgery is the most common initial treatment option, more in-depth analysis of molecular biomarkers may improve stratification and prognostication.
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Affiliation(s)
- Steven S Carey
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Zsila Sadighi
- Department of Neurology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jason Chiang
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Giles W Robinson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yahya Ghazwani
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Anthony P Y Liu
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sahaja Acharya
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Frederick A Boop
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.,Semmes Murphey Clinic, Memphis, TN, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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15
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Kakareka M, Moncman R, Georges J, Yocom S, Storm PB, Kennedy B. Pediatric spinal cord biopsy: A case series from a high-volume referral center. J Clin Neurosci 2019; 65:34-40. [PMID: 31053399 DOI: 10.1016/j.jocn.2019.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/16/2019] [Accepted: 04/12/2019] [Indexed: 12/01/2022]
Abstract
Pediatric patients presenting with intramedullary spinal cord lesions often require specific diagnoses to guide their treatment plans. Though results from magnetic resonance imaging and lumbar puncture may narrow the differential diagnosis, these tests cannot always provide a definitive diagnosis. In such cases, spinal cord biopsy may be undertaken to provide a specific histopathologic diagnosis for guiding treatment. Data from the adult population show 24% of spinal cord biopsies can be nondiagnostic and the procedure may carry a 21% complication rate. Therefore, spinal cord biopsy may portend a similar high risk-to-benefit ratio in the pediatric population. Here, we review spinal cord biopsy cases scheduled for diagnosis, and not debulking, at a high volume pediatric referral center during a seventeen-year period. We report our experience with five patients who met our inclusion criteria. Due to the rarity of the procedure, statistically significant factors associated with improved diagnostic yield or peri-operative complication could not be identified. A definitive diagnosis which guided the post-operative treatment plan was obtained in four of our five patients. None of our patients developed post-operative motor deficits. However, these patients were susceptible to the same risks of open spine surgery, such as wound infections and spinal deformities. Our case series shows that intramedullary spinal cord biopsies may provide tissue for obtaining histopatholgic diagnoses. However, the potential risks of complication, and the possibility of obtaining nondiagnostic tissue, should be discussed with patients, families and their medical treatment teams.
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Affiliation(s)
- Michael Kakareka
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, PA, USA; Cooper University Hospital, Department of Neurosurgery, Camden, NJ, USA
| | - Ryan Moncman
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, PA, USA; Cooper University Hospital, Department of Neurosurgery, Camden, NJ, USA
| | - Joseph Georges
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, PA, USA; Cooper University Hospital, Department of Neurosurgery, Camden, NJ, USA.
| | - Steven Yocom
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, PA, USA; Cooper University Hospital, Department of Neurosurgery, Camden, NJ, USA
| | - Philip B Storm
- Children's Hospital of Philadelphia, Department of Neurosurgery, Philadelphia, PA, USA
| | - Benjamin Kennedy
- Children's Hospital of Philadelphia, Department of Neurosurgery, Philadelphia, PA, USA
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16
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Hamilton KR, Lee SS, Urquhart JC, Jonker BP. A systematic review of outcome in intramedullary ependymoma and astrocytoma. J Clin Neurosci 2019; 63:168-175. [PMID: 30833131 DOI: 10.1016/j.jocn.2019.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/29/2019] [Accepted: 02/20/2019] [Indexed: 01/15/2023]
Abstract
The objective was to determine the impact of surgical resection and adjuvant therapies on survival in intramedullary ependymoma and astrocytoma. Secondary goals were to determine predictors of survival in surgical patients including histological grading, age and gender. Searching of Medline, Embase and Clinicaltrials.gov databases were performed. Multivariate analyses were performed for overall survival (OS) and progression-free survival (PFS) through Monte Carlo methods and Maximum Likelihood Estimation. 57 articles detail results for 3022 patients. Meta-analysis revealed the following factors to have a statistically significant effect on OS. Patients undergoing gross-total resection (GTR) are 5.37 times more likely to survive than patients with lesser volumes of tumor resected (HR for OS 1.68, p < 0.01). High-grade tumors were associated with a 14 times risk of death over low-grade tumors (HR for OS 2.64, p < 0.01). Radiation increased the risk of mortality in low-grade tumors (HR for OS 5.20, p < 0.01), but decreased mortality in high-grade lesions (HR for OS 2.46, p < 0.01). Adult patients were more likely to die from disease compared with pediatric patients by a factor of 1.6 (HR for OS 0.47, p < 0.01). In PFS, radiotherapy was associated with a reduced time to recurrence (HR for PFS 1.90, p < 0.01). There was a male predominance of 58%. Gender did not influence survival. 79% of patients demonstrated stable or improved functional neurological outcomes six months post-operatively. Our data indicates GTR improves OS in all tumor grades. Radiation improves OS only in the presence of high-grade histology. Advancing age and high-grade histology are negative prognostic indicators.
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Affiliation(s)
- Kirsty R Hamilton
- Department of Neurosurgery, Sir Charles Gardner Hospital, Hospital Ave, Nedlands, WA 6009, Australia.
| | - Sharon Si Lee
- Department of Neurosurgery, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA 6009, Australia.
| | - James C Urquhart
- Queensland University of Technology, 2 George St, Brisbane City, QLD 4000, Australia.
| | - Benjamin P Jonker
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia.
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17
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Bhimani AD, Rosinski CL, Denyer S, Hobbs JG, Patel S, Shah K, Mudreac A, Diamond R, Behbahani M, Mehta AI. Acute Surgical Risk Profile of Intramedullary Spinal Cord Tumor Resection in Pediatric Patients: A Pediatric National Surgical Quality Improvement Program Analysis. World Neurosurg 2018; 121:e389-e397. [PMID: 30266692 DOI: 10.1016/j.wneu.2018.09.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/12/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The purpose of the present study was to characterize the acute (30-day) surgical risk profile of pediatric patients undergoing surgical resection of intramedullary spinal cord tumors (IMSCTs). METHODS Preoperative factors were collected from the Pediatric American College of Surgeons National Surgical Quality Improvement Program database for patients identified by Current Procedural Terminology codes for laminectomy and International Classification of Diseases codes for IMSCTs from 2012 to 2016. The postoperative outcomes were compared by tumor location and type. RESULTS The mean age of the 139 patients meeting all inclusion criteria was 8.7 years, with a male predominance (58.7%). The cervical and thoracic IMSCT populations had worst preoperative health status, as indicated by American Society of Anesthesiologists class, and a greater proportion of malignant tumors compared with the lumbar IMSCT population. No patient died; 8.6% of the patients were readmitted, and 6.5% required reoperation. Of the 12 readmissions, 8 were required for patients with malignant tumors. The patients with cervical IMSCTs returned to the operating room at a significantly greater rate than did the thoracic and lumbar IMSCT populations. Two common reasons for reoperation in the cervical population were issues related to respiration and hydrocephalus management. The complications included 13 cases of infection, 6 of urinary tract infection, and 5 cases of surgical site infection. CONCLUSIONS Resection of IMSCTs in the pediatric population is a relatively low-risk procedure in terms of acute surgical complications. However, surgeons operating in the cervical spine should be aware of the increased risk of reoperation, in particular as it pertains to respiratory issues and hydrocephalus.
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Affiliation(s)
- Abhiraj D Bhimani
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Clayton L Rosinski
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Steven Denyer
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jonathan G Hobbs
- Section of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Saavan Patel
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Koral Shah
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrew Mudreac
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ryne Diamond
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mandana Behbahani
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA.
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18
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Teng YD, Abd-El-Barr M, Wang L, Hajiali H, Wu L, Zafonte RD. Spinal cord astrocytomas: progresses in experimental and clinical investigations for developing recovery neurobiology-based novel therapies. Exp Neurol 2018; 311:135-147. [PMID: 30243796 DOI: 10.1016/j.expneurol.2018.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/07/2018] [Accepted: 09/16/2018] [Indexed: 12/25/2022]
Abstract
Spinal cord astrocytomas (SCAs) have discernibly unique signatures in regards to epidemiology, clinical oncological features, genetic markers, pathophysiology, and research and therapeutic challenges. Overall, there are presently very limited clinical management options for high grade SCAs despite progresses made in validating key molecular markers and standardizing tumor classification. The endeavors were aimed to improve diagnosis, therapy design and prognosis assessment, as well as to define more effective oncolytic targets. Efficacious treatment for high grade SCAs still remains an unmet medical demand. This review is therefore focused on research state updates that have been made upon analyzing clinical characteristics, diagnostic classification, genetic and molecular features, tumor initiation cell biology, and current management options for SCAs. Particular emphasis was given to basic and translational research endeavors targeting SCAs, including establishment of experimental models, exploration of unique profiles of SCA stem cell-like tumor survival cells, characterization of special requirements for effective therapeutic delivery into the spinal cord, and development of donor stem cell-based gene-directed enzyme prodrug therapy. We concluded that precise understanding of molecular oncology, tumor survival mechanisms (e.g., drug resistance, metastasis, and cancer stem cells/tumor survival cells), and principles of Recovery Neurobiology can help to create clinically meaningful experimental models of SCAs. Establishment of such systems will expedite the discovery of efficacious therapies that not only kill tumor cells but simultaneously preserve and improve residual neural function.
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Affiliation(s)
- Yang D Teng
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA.
| | - Muhammad Abd-El-Barr
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA; Current affiliation: Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Lei Wang
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA
| | - Hadi Hajiali
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA
| | - Liqun Wu
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA
| | - Ross D Zafonte
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA
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19
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Noh T, Vogt MS, Pruitt DW, Hummel TR, Mangano FT. Pediatric intramedullary spinal cord tumor outcomes using the WeeFIM scale. Childs Nerv Syst 2018; 34:1753-1758. [PMID: 29797065 DOI: 10.1007/s00381-018-3831-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The Functional Independence Measure for children (WeeFIM) is a user-friendly functional outcomes tool that has been validated across other traditional functional scales. Historically, the significant neurologic and functional deficits of intramedullary spinal cord tumors (IMSCTs) have been monitored by coarse or overbearing functional outcomes tools that make it difficult to measure the slow improvement/decline seen in these patients. This study is the first to report WeeFIM outcomes on a series of IMSCTs with emphasis on an aggressive surgical strategy. METHODS A retrospective review from 2005 to 2014 was performed for nine patients who underwent resective surgery for intramedullary spinal cord tumors with intraoperative ultrasound and neurophysiologic monitoring. WeeFIM scales were assessed at admission and discharge to evaluate changes in severity of disability and need for assistance. RESULTS At the time of this submission, 7/9 patients are alive. The mean WeeFIM improvement was 27 points (8-50 points) with a mean WeeFIM efficiency of 2.0 points/day. CONCLUSIONS The WeeFIM scale is an appropriate and useful scale for measuring postoperative improvements in patients with IMSCTs undergoing aggressive resective surgery. Attention to intraoperative spinal cord monitoring and prevention of spinal column instability may prevent morbidity related to surgery, and functional outcomes do not appear to be compromised by an aggressive surgical approach.
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Affiliation(s)
- Thomas Noh
- Department of Neurological Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Manuel S Vogt
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - David W Pruitt
- Department of Rehabilitation, Division of Pediatric Rehabilitation, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Trent R Hummel
- Cancer and Blood Diseases Institute, Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Francesco T Mangano
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA. .,Department of Neurological Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, MLC 2016, 3333 Burnet Avenue, Cincinnati, OH, 44529, USA.
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20
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Sadighi Z, Curtis E, Zabrowksi J, Billups C, Gajjar A, Khan R, Qaddoumi I. Neurologic impairments from pediatric low-grade glioma by tumor location and timing of diagnosis. Pediatr Blood Cancer 2018; 65:e27063. [PMID: 29741274 PMCID: PMC6310055 DOI: 10.1002/pbc.27063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND The neurologic outcomes of low-grade gliomas (LGGs) according to tumor location and duration of presenting symptoms remain poorly characterized in children. PROCEDURE We retrospectively reviewed neurologic impairments in 246 pediatric patients with LGGs (88 with optic pathway and midline tumors, 56 with posterior fossa tumors, 52 with cerebral hemisphere tumors, 35 with brainstem tumors, and 15 with spinal cord tumors) who were treated at St. Jude Children's Research Hospital between 1995 and 2005. We compared neurologic impairments (defined by Common Terminology Criteria for Adverse Events, version 4.03) by tumor location and prediagnosis symptom interval (PSI) (≥ 3 months or < 3 months) at first and last patient visits. RESULTS The median age of diagnosis was 7.1 years; median PSI was 2.1 months; and median time to last follow-up was 11.6 years. LGGs in the cerebral hemispheres resulted in significantly fewer neurologic impairments, compared with that of other locations at baseline (P < 0.001) and at last follow-up (P < 0.001). In all patients, PSIs greater than 3 months resulted in a significantly higher incidence of ataxia and dysmetria at last follow-up (42%, P = 0.003). Greater PSI was also significantly associated with worsening lower extremity motor weakness from cerebral hemisphere tumors; dysmetria from optic pathway and midline tumors; eye and visual dysfunction from posterior fossa tumors; and ear and vestibular disturbances from brainstem tumors (P ≤ 0.05). CONCLUSION Neurologic impairment in pediatric LGGs varies by tumor location, and PSIs greater than 3 months affect some functionally important neurologic outcomes.
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Affiliation(s)
- Zsila Sadighi
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Elizabeth Curtis
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jennifer Zabrowksi
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Catherine Billups
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Raja Khan
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Hydrocephalus: a rare initial manifestation of sporadic intramedullary hemangioblastoma : Intramedullary hemangioblastoma presenting as hydrocephalus. Childs Nerv Syst 2017; 33:1399-1403. [PMID: 28444460 DOI: 10.1007/s00381-017-3415-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intramedullary hemangioblastomas are rare benign vascular tumors, infrequent in pediatric patients. Clinical symptoms vary according to the age of presentation, tumor size, location, and concomitant syringomyelia. This is the second reported case of hemangioblastoma presenting with acute hydrocephalus. CASE PRESENTATION A 3-month-old infant with acute hydrocephalus was asymptomatic after a ventriculoperitoneal shunt was placed. She returned 3 months later with irritability, acute paraplegia, and respiratory distress. Magnetic resonance imaging (MRI) showed an intramedullary T8-T9 tumor with syringomyelia. She underwent surgical resection with good results during the 6-month follow-up. CONCLUSION Intramedullary tumors may present as hydrocephalus and other nonspecific symptoms, with invariably delayed diagnosis in children, but must be considered in suspicious cases.
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Shweikeh F, Quinsey C, Murayi R, Randle R, Nuño M, Krieger MD, Patrick Johnson J. Treatment patterns of children with spine and spinal cord tumors: national outcomes and review of the literature. Childs Nerv Syst 2017; 33:1357-1365. [PMID: 28484868 DOI: 10.1007/s00381-017-3433-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/26/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tumors of the spine in children are rare, and further clinical description is necessary. OBJECTIVE This study investigated epidemiology, interventions, and outcomes of pediatric patients with spine and spinal cord tumors. METHODS The National Inpatient Sample and Kids' Inpatient Database were used for the study. Outcomes were studied, and bivariate significant trends were analyzed in a multivariate setting. RESULTS Analysis of 2870 patients between 2000 and 2009 found a median age of diagnosis of 11 years (Tables 1 and 2). Most were white (65.2%) and had private insurance (62.3%), and 46.8% of procedures were emergent operations. Treatment occurred at teaching (93.6%) and non-children's hospitals (81.1%). Overall mortality rate was 1.7%, non-routine discharges occurred at a rate 19.9%, complications at 21.1%, and average total charges were $66,087. A majority of patients (87.5%) had no intervention, and of those patients receiving treatment, 78.2% underwent surgery and 23.1% had radiotherapy. Treatment with surgery alone increased significantly over time (p < 0.0001). Odds ratio (OR) of mortality was significantly higher in 2006 (OR 3.5) and 2009 (OR 2.6) when compared to 2000. Complications (OR 7.9) and disease comorbidities (OR 1.5) were associated with significantly increased odds of mortality. CONCLUSIONS Hospital characteristics, length of stay, and charges remained relatively unchanged. In recent years, there has been a decreasing incidence of spine and spinal cord tumors in children. Notably, a higher mortality rate is evident over time in addition to an increase in the proportion of patients undergoing surgery. The high percentage of emergent operations suggests a weak recognition of spine tumors in children and should prompt a call for increased awareness of this cancer. In spite of these findings, lack of tumor type identification was a limitation to this study.
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Affiliation(s)
- Faris Shweikeh
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd. Ste. A6600, Los Angeles, CA, 90048, USA. .,Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
| | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, USA
| | - Roger Murayi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Randle
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Miriam Nuño
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd. Ste. A6600, Los Angeles, CA, 90048, USA
| | - Mark D Krieger
- Department of Neurosurgery, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J Patrick Johnson
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd. Ste. A6600, Los Angeles, CA, 90048, USA
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