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Kappel AD, Jha R, Guggilapu S, Smith WJ, Feroze AH, Dmytriw AA, Vicenty-Padilla J, Alcedo Guardia RE, Gessler FA, Patel NJ, Du R, See AP, Peruzzi PP, Aziz-Sultan MA, Bernstock JD. Endovascular Applications for the Management of High-Grade Gliomas in the Modern Era. Cancers (Basel) 2024; 16:1594. [PMID: 38672676 DOI: 10.3390/cancers16081594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
High-grade gliomas (HGGs) have a poor prognosis and are difficult to treat. This review examines the evolving landscape of endovascular therapies for HGGs. Recent advances in endovascular catheter technology and delivery methods allow for super-selective intra-arterial cerebral infusion (SSIACI) with increasing precision. This treatment modality may offer the ability to deliver anti-tumoral therapies directly to tumor regions while minimizing systemic toxicity. However, challenges persist, including blood-brain barrier (BBB) penetration, hemodynamic complexities, and drug-tumor residence time. Innovative adjunct techniques, such as focused ultrasound (FUS) and hyperosmotic disruption, may facilitate BBB disruption and enhance drug penetration. However, hemodynamic factors that limit drug residence time remain a limitation. Expanding therapeutic options beyond chemotherapy, including radiotherapy and immunobiologics, may motivate future investigations. While preclinical and clinical studies demonstrate moderate efficacy, larger randomized trials are needed to validate the clinical benefits. Additionally, future directions may involve endovascular sampling for peri-tumoral surveillance; changes in drug formulations to prolong residence time; and the exploration of non-pharmaceutical therapies, like radioembolization and photodynamic therapy. Endovascular strategies hold immense potential in reshaping HGG treatment paradigms, offering targeted and minimally invasive approaches. However, overcoming technical challenges and validating clinical efficacy remain paramount for translating these advancements into clinical care.
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Affiliation(s)
- Ari D Kappel
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Rohan Jha
- Harvard Medical School, Boston, MA 02115, USA
| | | | - William J Smith
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Abdullah H Feroze
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Adam A Dmytriw
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Juan Vicenty-Padilla
- Neurosurgery Section, School of Medicine University of Puerto Rico, Medical Sciences Campus, San Juan P.O. Box 365067, Puerto Rico
| | - Rodolfo E Alcedo Guardia
- Neurosurgery Section, School of Medicine University of Puerto Rico, Medical Sciences Campus, San Juan P.O. Box 365067, Puerto Rico
| | - Florian A Gessler
- Department of Neurosurgery, Rostock University Hospital, 18057 Rostock, Germany
| | - Nirav J Patel
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Rose Du
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Alfred P See
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - Pier Paolo Peruzzi
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Mohammad A Aziz-Sultan
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Joshua D Bernstock
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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Kappel AD, Feroze AH, Torio E, Sukumaran M, Du R. Management of moyamoya disease: a review of current and future therapeutic strategies. J Neurosurg 2024:1-8. [PMID: 38626477 DOI: 10.3171/2024.1.jns221977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/25/2024] [Indexed: 04/18/2024]
Abstract
Moyamoya disease (MMD) is characterized by idiopathic, progressive stenosis of the circle of Willis and the terminal portion of the internal carotid arteries with the development of prominent small collateral vessels and a characteristic moyamoya or puff-of-smoke radiographic appearance. The incidence and prevalence of MMD varies by region, age, and sex, with higher rates in Asian and East Asian populations compared to North American or European populations. There is a bimodal distribution of patients diagnosed with MMD. Pediatric patients are more commonly diagnosed within the 1st decade of life, whereas adult patients present in the 5th or 6th decade of life. Overall, there is a nearly 2:1 female-to-male ratio. Ischemic symptoms are the most common presentation in pediatric and adult populations, but adult patients are nearly twice as likely to present with intracranial hemorrhage compared to their pediatric counterparts. Surgical revascularization is indicated in symptomatic cases, and antiplatelet therapy may be a useful adjunct to prevent recurrent symptoms. Direct and combined bypass procedures seem to be more effective in adults, whereas children respond well to indirect bypass. The identification of key genetic, molecular, and environmental factors including RNF213 and GUCY1A3 loss-of-function mutations, angiogenic growth factors, autoantibodies, CNS infections, and radiation exposure suggest multiple pathways for the development of moyamoya arteriopathy. Further research is needed to better understand the heterogeneity of pathogenetic mechanisms that lead to moyamoya and to identify novel therapeutic targets to prevent, stabilize, and treat MMD.
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Bonda D, Kelly KA, Boop S, Feroze AH, Randle SC, Bindschadler M, Marashly A, Owens J, Lockrow J, Bozarth X, Novotny E, Friedman S, Goldstein HE, Grannan BL, Durfy S, Ojemann JG, Ko AL, Hauptman JS. Deep Brain Stimulation of Bilateral Centromedian Thalamic Nuclei in Pediatric Patients with Lennox-Gastaut Syndrome: An Institutional Experience. World Neurosurg 2024:S1878-8750(24)00312-7. [PMID: 38403017 DOI: 10.1016/j.wneu.2024.02.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Surgical management of pediatric patients with nonlesional, drug-resistant epilepsy, including patients with Lennox-Gastaut syndrome (LGS), remains a challenge given the lack of resective targets in most patients and shows seizure freedom rates <50% at 5 years. The efficacy of deep brain stimulation (DBS) is less certain in children than in adults. This study examined clinical and seizure outcomes for pediatric patients with LGS undergoing DBS targeting of the centromedian thalamic nuclei (CMTN). METHODS An institutional review board-approved retrospective analysis was performed of patients aged ≤19 years with clinical diagnosis of LGS undergoing bilateral DBS placement to the CMTN from 2020 to 2021 by a single surgeon. RESULTS Four females and 2 males aged 6-19 years were identified. Before surgery, each child experienced at least 6 years of refractory seizures; 4 children had experienced seizures since infancy. All took antiseizure medications at the time of surgery. Five children had previous placement of a vagus nerve stimulator and 2 had a previous corpus callosotomy. The mean length of stay after DBS was 2 days. No children experienced adverse neurologic effects from implantation; the mean follow-up time was 16.3 months. Four patients had >60% reduction in seizure frequency after surgery, 1 patient experienced 10% reduction, and 1 patient showed no change. No children reported worsening seizure symptoms after surgery. CONCLUSIONS Our study contributes to the sparse literature describing CMTN DBS for children with drug-resistant epilepsy from LGS. Our results suggest that CMTN DBS is a safe and effective therapeutic modality that should be considered as an alternative or adjuvant therapy for this challenging patient population. Further studies with larger patient populations are warranted.
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Affiliation(s)
- David Bonda
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Katherine A Kelly
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Scott Boop
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Stephanie C Randle
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mike Bindschadler
- Center for Respiratory Therapy and Biologics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ahmad Marashly
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - James Owens
- Department of Pediatrics, Section of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Jason Lockrow
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Xiuhua Bozarth
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Edward Novotny
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Seth Friedman
- Center for Respiratory Therapy and Biologics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Hannah E Goldstein
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Benjamin L Grannan
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew L Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.
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Pan J, Feroze AH, McGrath M, Eaton J, Abecassis IJ, Temkin N, Chesnut RM, Bonow RH. Incidence and Risk Model of Post-Traumatic Hydrocephalus in Patients with Traumatic Brain Injury. World Neurosurg 2024:S1878-8750(24)00257-2. [PMID: 38369109 DOI: 10.1016/j.wneu.2024.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/10/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Post-traumatic hydrocephalus (PTH) is a complication following traumatic brain injury (TBI). Early diagnosis and treatment are essential to improving outcomes. We report the incidence and risk factors of PTH in a large TBI population while considering death as a competing risk. METHODS We conducted a retrospective cohort study on consecutive TBI patients with radiographic intracranial abnormalities admitted to our academic medical center from 2009 to 2015. We assessed patient demographics, perioperative data, and in-hospital data as risk factors for PTH using survival analysis with death as a competing risk. RESULTS Among 7,473 patients, the overall incidence of PTH requiring shunt surgery was 0.94%. The adjusted cumulative incidence was 0.99%. The all-cause cumulative hazard for death was 32.6%, which was considered a competing risk during analysis. Craniectomy (HR 11.53, P < 0.001, 95% CI 5.57-223.85), venous sinus injury (HR 4.13, P = 0.01, 95% CI 1.53-11.16), and age ≤5 (P < 0.001) were significant risk factors for PTH. Glasgow Coma Score (GCS) > 13 was protective against shunt placement (HR 0.50, P = 0.04, 95% CI 0.26-0.97). Shunt surgery occurred after hospital discharge in 60% of patients. CONCLUSIONS We describe the incidence and risk factors for PTH in a large traumatic brain injury (TBI) population. Most cases of PTH were diagnosed after hospital discharge, suggesting that close follow-up and multidisciplinary diagnostic vigilance for PTH are needed to prevent morbidity and disability.
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Affiliation(s)
- James Pan
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA; Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Margaret McGrath
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jessica Eaton
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Issac J Abecassis
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA; Harborview Injury Prevention Research Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Randall M Chesnut
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Robert H Bonow
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kappel AD, Chen JA, Chalif JI, Bass DI, Torio EF, Feroze AH, Patel NJ. Craniocervical dural arteriovenous fistula: Microsurgical clipping and technical nuances with ICG. J Clin Neurosci 2024; 119:64-65. [PMID: 37984190 DOI: 10.1016/j.jocn.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
A 48-year-old male with progressive congestive myelopathy had a craniocvervical DAVF treated with surgical clipping using ICG to confirm solitary inflow.
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Affiliation(s)
- Ari D Kappel
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Jason A Chen
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Joshua I Chalif
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - David I Bass
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Erickson F Torio
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Abdullah H Feroze
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Nirav J Patel
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Young CC, Bass DI, Cruz MJ, Carroll K, Vanent KN, Lee C, Sen RD, Feroze AH, Williams JR, Levy S, McCray D, Kelly CM, Barber J, Kim LJ, Levitt MR. Clopidogrel hyper-response increases peripheral hemorrhagic complications without increasing intracranial complications in endovascular aneurysm treatments requiring dual antiplatelet therapy. J Clin Neurosci 2022; 105:66-72. [PMID: 36113244 DOI: 10.1016/j.jocn.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/09/2022] [Accepted: 09/03/2022] [Indexed: 10/31/2022]
Abstract
Clinical significance of increased clopidogrel response measured by VerifyNow P2Y12 assay is unclear; management guidelines are lacking in the context of neuroendovascular intervention. Our objective was to assess whether increased clopidogrel response predicts complications from endovascular aneurysm treatment requiring dual antiplatelet therapy. A single-institution, 9-year retrospective study of patients undergoing endovascular treatments for ruptured and unruptured aneurysms requiring aspirin and clopidogrel was conducted. Patients were grouped according to preoperative platelet inhibition in response to clopidogrel measured by the VerifyNow P2Y12 assay (VNP; P2Y12 reactivity units, PRU). Demographic and clinical features were compared across groups. Hemorrhagic complication rates (intracranial, major extracranial, minor extracranial) and thromboembolic complications (in-stent stenosis, stroke/transient ischemic attack) were compared, controlling for potential confounders and multiple comparisons. Data were collected from 284 patients across 317 procedures. Pre-operative VNP assays identified 9 % Extreme Responders (PRU ≤ 15), 13 % Hyper-Responders (PRU 16-60), 62 % Therapeutic Responders (PRU 61-214), 16 % Hypo-Responders (PRU ≥ 215). Increased response to clopidogrel was associated with increased risk of any hemorrhagic complication (≤60 PRU vs > 60 PRU; 39 % vs 24 %, P = 0.050); all intracranial hemorrhages occurred in patients with PRU > 60. Thromboembolic complications were similar between therapeutic and subtherapeutic patients (<215 PRU vs ≥ 215 PRU; 15 % vs 16 %, P = 0.835). Increased preoperative clopidogrel response is associated with increased rate of extracranial hemorrhagic complications in endovascular aneurysm treatments. Hyper-responders (16-60 PRU) and Extreme Responders (≤15 PRU) were not associated with intracranial hemorrhagic or thrombotic complications. Hypo-responders who underwent adjustment of antiplatelet therapy and neurointerventions did not experience higher rates of complications.
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Affiliation(s)
- Christopher C Young
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - David I Bass
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Michael J Cruz
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Kate Carroll
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Kevin N Vanent
- School of Medicine, University of Washington, Seattle, WA 98104, USA
| | - Chungeun Lee
- School of Medicine, Washington State University, Spokane, WA 99202, USA
| | - Rajeev D Sen
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - John R Williams
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Samuel Levy
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA; Stroke & Applied Neurosciences Center, University of Washington, Seattle, WA 98104, USA
| | - Denzel McCray
- Stroke & Applied Neurosciences Center, University of Washington, Seattle, WA 98104, USA
| | - Cory M Kelly
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA; Stroke & Applied Neurosciences Center, University of Washington, Seattle, WA 98104, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA; Stroke & Applied Neurosciences Center, University of Washington, Seattle, WA 98104, USA; Department of Radiology, University of Washington, Seattle, WA 98104, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA; Stroke & Applied Neurosciences Center, University of Washington, Seattle, WA 98104, USA; Department of Radiology, University of Washington, Seattle, WA 98104, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA 98104, USA.
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Park JH, Feroze AH, Emerson SN, Mihalas AB, Keene CD, Cimino PJ, de Lomana ALG, Kannan K, Wu WJ, Turkarslan S, Baliga NS, Patel AP. A single-cell based precision medicine approach using glioblastoma patient-specific models. NPJ Precis Oncol 2022; 6:55. [PMID: 35941215 PMCID: PMC9360428 DOI: 10.1038/s41698-022-00294-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/22/2022] [Indexed: 02/08/2023] Open
Abstract
Glioblastoma (GBM) is a heterogeneous tumor made up of cell states that evolve over time. Here, we modeled tumor evolutionary trajectories during standard-of-care treatment using multi-omic single-cell analysis of a primary tumor sample, corresponding mouse xenografts subjected to standard of care therapy, and recurrent tumor at autopsy. We mined the multi-omic data with single-cell SYstems Genetics Network AnaLysis (scSYGNAL) to identify a network of 52 regulators that mediate treatment-induced shifts in xenograft tumor-cell states that were also reflected in recurrence. By integrating scSYGNAL-derived regulatory network information with transcription factor accessibility deviations derived from single-cell ATAC-seq data, we developed consensus networks that modulate cell state transitions across subpopulations of primary and recurrent tumor cells. Finally, by matching targeted therapies to active regulatory networks underlying tumor evolutionary trajectories, we provide a framework for applying single-cell-based precision medicine approaches to an individual patient in a concurrent, adjuvant, or recurrent setting.
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Affiliation(s)
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Samuel N Emerson
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Anca B Mihalas
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Patrick J Cimino
- Department of Pathology, University of Washington, Seattle, WA, USA
| | | | | | - Wei-Ju Wu
- Institute for Systems Biology, Seattle, WA, USA
| | | | - Nitin S Baliga
- Institute for Systems Biology, Seattle, WA, USA.
- Departments of Microbiology, Biology, and Molecular Engineering Sciences, University of Washington, Seattle, WA, USA.
| | - Anoop P Patel
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
- Brotman-Baty Institute for Precision Medicine, University of Washington, Seattle, WA, USA.
- Department of Neurosurgery, Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC, USA.
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Cruz MJ, Nieblas-Bedolla E, Young CC, Feroze AH, Williams JR, Ellenbogen RG, Levitt MR. In Reply: United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons. Neurosurgery 2022; 90:e53. [PMID: 34995233 DOI: 10.1227/neu.0000000000001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michael J Cruz
- School of Medicine , University of Washington, Seattle , Washington , USA
| | | | - Christopher C Young
- Department of Neurological Surgery , University of Washington, Seattle , Washington , USA
| | - Abdullah H Feroze
- Department of Neurological Surgery , University of Washington, Seattle , Washington , USA
| | - John R Williams
- Department of Neurological Surgery , University of Washington, Seattle , Washington , USA
| | - Richard G Ellenbogen
- Department of Neurological Surgery , University of Washington, Seattle , Washington , USA
- Stroke & Applied Neurosciences Center , University of Washington, Seattle , Washington , USA
| | - Michael R Levitt
- Department of Neurological Surgery , University of Washington, Seattle , Washington , USA
- Stroke & Applied Neurosciences Center , University of Washington, Seattle , Washington , USA
- Department of Radiology , University of Washington, Seattle , Washington , USA
- Department of Mechanical Engineering , University of Washington, Seattle , Washington , USA
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9
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Cruz MJ, Nieblas-Bedolla E, Young CC, Feroze AH, Williams JR, Ellenbogen RG, Levitt MR. United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons. Neurosurgery 2021; 89:364-371. [PMID: 34133724 PMCID: PMC8344865 DOI: 10.1093/neuros/nyab185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/03/2021] [Indexed: 01/14/2023] Open
Abstract
Telemedicine has received increased attention in recent years as a potential solution to expand clinical capability and patient access to care in many fields, including neurosurgery. Although patient and physician attitudes are rapidly shifting toward greater telemedicine use in light of the COVID-19 pandemic, there remains uncertainty about telemedicine's regulatory future. Despite growing evidence of telemedicine's utility, there remain a number of significant medicolegal barriers to its mass adoption and wider implementation. Herein, we examine recent progress in state and federal regulations in the United States governing telemedicine's implementation in quality of care, finance and billing, privacy and confidentiality, risk and liability, and geography and interstate licensure, with special attention to how these concern teleneurosurgical practice. We also review contemporary topics germane to the future of teleneurosurgery, including the continued expansion of reciprocity in interstate licensure, expanded coverage for homecare services for chronic conditions, expansion of Center for Medicare and Medicaid Services reimbursements, and protections of store-and-forward technologies. Additionally, we discuss recent successes in teleneurosurgery, stroke care, and rehabilitation as models for teleneurosurgical best practices. As telemedicine technology continues to mature and its expanse grows, neurosurgeons' familiarity with its benefits, limitations, and controversies will best allow for its successful adoption in our field to maximize patient care and outcomes.
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Affiliation(s)
- Michael J Cruz
- School of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Christopher C Young
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - John R Williams
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Stroke and Applied Neurosciences Center, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Stroke and Applied Neurosciences Center, University of Washington, Seattle, Washington, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
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10
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Abecassis IJ, Zeeshan Q, Feroze AH, Ene C, Vellimana AK, Sekhar LN. Subtemporal, Transapical, and Transcavernous Approach to Clip Low-Lying Basilar Tip Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E436. [PMID: 33548927 DOI: 10.1093/ons/opab005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/20/2020] [Indexed: 11/12/2022] Open
Abstract
Basilar tip aneurysm clipping is technically challenging because of the depth of operative corridor, rarity in presentation, and important perforators supplying deep, critical structures. Two major approaches to basilar tip aneurysms include (1) a frontotemporal (transorbital) trans-sylvian approach for most aneurysms and (2) a modified subtemporal approach for aneurysms with low-lying necks. A 53-yr-old woman presented to our institution with a large unruptured basilar tip aneurysm notable for a low, broad neck (6.4 mm). After discussion of risks and benefits of endovascular vs surgical options, the patient consented to operative intervention. She underwent a right frontotemporal craniotomy with zygomatic osteotomy, intradural petrous apicectomy, elective sectioning of the fourth cranial nerve (CN IV), and intracavernous removal of the dorsum sellae and posterior clinoid process to provide more space for aneurysm dissection. After temporary clipping of the basilar artery, the perforating arteries were dissected free from the aneurysm and the aneurysm occluded with 2 fenestrated clips. Important technical nuances of the approach include (1) achieving ample working room for temporary occlusion aneurysm dissection, (2) careful dissection of the perforators and contralateral P1, and (3) utilization of 2 fenestrated clips to accommodate and preserve the ipsilateral P1 segment. Postoperative angiogram showed complete aneur-ysmal occlusion. Postoperatively, the patient demonstrated mild cognitive impairment and a right CN IV palsy. At 6-wk follow-up, cognition recovered to normalcy. More recently, at 12-mo follow-up, the patient noted intermittent diplopia. Formal neuro-ophthalmologic assessment confirmed persistence of a CN IV palsy treated with prism lenses but no other neurological deficits.
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Affiliation(s)
| | - Qazi Zeeshan
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Abdullah H Feroze
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Chibawanye Ene
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Ananth K Vellimana
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Laligam N Sekhar
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
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Gibson AW, Feroze AH, Greil ME, McGrath ME, Sivakanthan S, White-Dzuro GA, Williams JR, Young CC, Hofstetter CP. Cellular allograft for multilevel stand-alone anterior cervical discectomy and fusion. Neurosurg Focus 2021; 50:E7. [PMID: 34062509 DOI: 10.3171/2021.3.focus2150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is the most common treatment for degenerative disease of the cervical spine. Given the high rate of pseudarthrosis in multilevel stand-alone ACDF, there is a need to explore the utility of novel grafting materials. In this study, the authors present a single-institution retrospective study of patients with multilevel degenerative spine disease who underwent multilevel stand-alone ACDF surgery with or without cellular allograft supplementation. METHODS In a prospectively collected database, 28 patients who underwent multilevel ACDF supplemented with cellular allograft (ViviGen) and 25 patients who underwent multilevel ACDF with decellularized allograft between 2014 and 2020 were identified. The primary outcome was radiographic fusion determined by a 1-year follow-up CT scan. Secondary outcomes included change in Neck Disability Index (NDI) scores and change in visual analog scale scores for neck and arm pain. RESULTS The study included 53 patients with a mean age of 53 ± 0.7 years who underwent multilevel stand-alone ACDF encompassing 2.6 ± 0.7 levels on average. Patient demographics were similar between the two cohorts. In the cellular allograft cohort, 2 patients experienced postoperative dysphagia that resolved by the 3-month follow-up. One patient developed cervical radiculopathy due to graft subsidence and required a posterior foraminotomy. At the 1-year CT, successful fusion was achieved in 92.9% (26/28) of patients who underwent ACDF supplemented with cellular allograft, compared with 84.0% (21/25) of patients who underwent ACDF without cellular allograft. The cellular allograft cohort experienced a significantly greater improvement in the mean postoperative NDI score (p < 0.05) compared with the other cohort. CONCLUSIONS Cellular allograft is a low-morbidity bone allograft option for ACDF. In this study, the authors determined favorable arthrodesis rates and functional outcomes in a complex patient cohort following multilevel stand-alone ACDF supplemented with cellular allograft.
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Affiliation(s)
| | - Abdullah H Feroze
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Madeline E Greil
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Margaret E McGrath
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Sananthan Sivakanthan
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | | | - John R Williams
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Christopher C Young
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
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12
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McGrath M, Feroze AH, Nistal D, Robinson E, Saigal R. Impact of surgeon rhBMP-2 cost awareness on complication rates and health system costs for spinal arthrodesis. Neurosurg Focus 2021; 50:E5. [PMID: 34062498 DOI: 10.3171/2021.3.focus2152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recombinant human bone morphogenetic protein-2 (rhBMP-2) is used in spinal arthrodesis procedures to enhance bony fusion. Research has suggested that it is the most cost-effective fusion enhancer, but there are significant upfront costs for the healthcare system. The primary objective of this study was to determine whether intraoperative dosing and corresponding costs changed with surgeon cost awareness. The secondary objective was to describe surgical complications before and after surgeon awareness of rhBMP-2 cost. METHODS A retrospective medical record review was conducted to identify patients who underwent spinal arthrodesis procedures performed by a single surgeon, supplemented with rhBMP-2, from June 2016 to June 2018. Collected data included rhBMP-2 dosage, rhBMP-2 list price, and surgical complications. Expected Medicare reimbursement was calculated. Data were analyzed before and after surgeon awareness of rhBMP-2 cost. RESULTS Forty-eight procedures were performed using rhBMP-2, 16 before and 32 after surgeon cost awareness. Prior to cost awareness, the most frequent rhBMP-2 dosage level was x-small (38.9%, n = 7), followed by large (27.8%, n = 5) and small (22.2%, n = 4). After cost awareness, the most frequent rhBMP-2 dosage was xx-small (56.8%, n = 21), followed by x-small (21.6%, n = 8) and large (13.5%, n = 5). The rhBMP-2 average cost per surgery was $4116.56 prior to surgeon cost awareness versus $2268.38 after. Two complications were observed in the pre-cost awareness surgical group; 2 complications were observed in the post-cost awareness surgical group. CONCLUSIONS Surgeon awareness of rhBMP-2 cost resulted in use of smaller rhBMP-2 doses, decreased rhBMP-2 cost per surgery, and decreased overall hospital admission charges, without a detectable increase in surgical complications.
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Affiliation(s)
| | | | | | - Emily Robinson
- 2School of Medicine, University of Washington, Seattle, Washington
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13
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Abecassis IJ, Young CC, Caldwell DJ, Feroze AH, Williams JR, Meyer RM, Kellogg RT, Bonow RH, Chesnut RM. The Kempe incision for decompressive craniectomy, craniotomy, and cranioplasty in traumatic brain injury and stroke. J Neurosurg 2021:1-10. [PMID: 34020415 DOI: 10.3171/2020.11.jns203567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Decompressive craniectomy (DC) is an effective, lifesaving option for reducing intracranial pressure (ICP) in traumatic brain injury (TBI), stroke, and other pathologies with elevated ICP. Most DCs are performed via a standard trauma flap shaped like a reverse question mark (RQM), which requires sacrificing the occipital and posterior auricular arteries and can be complicated by wound dehiscence and infections. The Ludwig Kempe hemispherectomy incision (Kempe) entails a T-shaped incision, one limb from the midline behind the hairline to the inion and the other limb from the root of the zygoma to the coronal suture. The authors' objective in this study was to define their implementation of the Kempe incision for DC and craniotomy, report clinical outcomes, and quantify the volume of bone removed compared with the RQM incision. METHODS A retrospective review of a single-surgeon experience with DC in TBI and stroke was performed. Patient demographics, imaging, and outcomes were collected for all DCs from 2015 to 2020, and the incisions were categorized as either Kempe or RQM. Preoperative and postoperative CT scans were obtained and processed using a combination of automatic segmentation (in Python and SimpleITK) with manual cleanup and further subselection in ITK-SNAP. The volume of bone removed was quantified, and the primary outcome was percentage of hemicranium removed. Postoperative surgical wound infections, estimated blood loss (EBL), and length of surgery were compared between the two groups as secondary outcomes. Cranioplasty data were collected. RESULTS One hundred thirty-six patients were included in the analysis; there were 57 patients in the craniotomy group (44 patients with RQM incisions and 13 with Kempe incisions) and 79 in the craniectomy group (41 patients with RQM incisions and 38 Kempe incisions). The mean follow-up for the entire cohort was 251 ± 368 days. There was a difference in the amount of decompression between approaches in multivariate modeling (39% ± 11% of the hemicranium was removed via the Kempe incision vs 34% ± 10% via the RQM incision, p = 0.047), although this did not achieve significance in multivariate modeling. Wound infection rates, EBL, and length of surgery were comparable between the two incision types. No wound infections in either cohort were due to wound dehiscence. Cranioplasty outcomes were comparable between the two incision types. CONCLUSIONS The Kempe incision for craniectomy or craniotomy is a safe, feasible, and effective alternative to the RQM. The authors advocate the Kempe incision in cases in which contralateral operative pathology or subsequent craniofacial/skull base repair is anticipated.
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Affiliation(s)
| | | | | | | | | | | | - Ryan T Kellogg
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert H Bonow
- 1Department of Neurological Surgery and.,3Harborview Injury Prevention Research Center, University of Washington, Seattle, Washington; and
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14
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Wu SJ, Furlan SN, Mihalas AB, Kaya-Okur HS, Feroze AH, Emerson SN, Zheng Y, Carson K, Cimino PJ, Keene CD, Sarthy JF, Gottardo R, Ahmad K, Henikoff S, Patel AP. Single-cell CUT&Tag analysis of chromatin modifications in differentiation and tumor progression. Nat Biotechnol 2021; 39:819-824. [PMID: 33846646 DOI: 10.1038/s41587-021-00865-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
Methods for quantifying gene expression1 and chromatin accessibility2 in single cells are well established, but single-cell analysis of chromatin regions with specific histone modifications has been technically challenging. In this study, we adapted the CUT&Tag method3 to scalable nanowell and droplet-based single-cell platforms to profile chromatin landscapes in single cells (scCUT&Tag) from complex tissues and during the differentiation of human embryonic stem cells. We focused on profiling polycomb group (PcG) silenced regions marked by histone H3 Lys27 trimethylation (H3K27me3) in single cells as an orthogonal approach to chromatin accessibility for identifying cell states. We show that scCUT&Tag profiling of H3K27me3 distinguishes cell types in human blood and allows the generation of cell-type-specific PcG landscapes from heterogeneous tissues. Furthermore, we used scCUT&Tag to profile H3K27me3 in a patient with a brain tumor before and after treatment, identifying cell types in the tumor microenvironment and heterogeneity in PcG activity in the primary sample and after treatment.
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Affiliation(s)
- Steven J Wu
- Basic Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Molecular Engineering & Sciences Institute, University of Washington, Seattle, WA, USA
| | - Scott N Furlan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA.,Brotman-Baty Institute for Precision Medicine, University of Washington, Seattle, WA, USA
| | - Anca B Mihalas
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Hatice S Kaya-Okur
- Basic Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Howard Hughes Medical Institute, Seattle, WA, USA.,Altius Institute for Biomedical Sciences, Seattle, WA, USA
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Samuel N Emerson
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Ye Zheng
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kalee Carson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Patrick J Cimino
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - C Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Jay F Sarthy
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Raphael Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kami Ahmad
- Basic Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Steven Henikoff
- Basic Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,Howard Hughes Medical Institute, Seattle, WA, USA.
| | - Anoop P Patel
- Brotman-Baty Institute for Precision Medicine, University of Washington, Seattle, WA, USA. .,Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
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15
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Williams JR, Meyer MR, Ricard JA, Sen R, Young CC, Feroze AH, Greil ME, Barros G, Durfy S, Hanak B, Morton RP, Temkin NR, Barber JK, Mac Donald CL, Chesnut RM. Re-examining decompressive craniectomy medial margin distance from midline as a metric for calculating the risk of post-traumatic hydrocephalus. J Clin Neurosci 2021; 87:125-131. [PMID: 33863519 DOI: 10.1016/j.jocn.2021.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/14/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Decompressive craniectomy (DC) is a life-saving procedure in severe traumatic brain injury, but is associated with higher rates of post-traumatic hydrocephalus (PTH). The relationship between the medial craniectomy margin's proximity to midline and frequency of developing PTH is controversial. The primary study objective was to determine whether average medial craniectomy margin distance from midline was closer to midline in patients who developed PTH after DC for severe TBI compared to patients that did not. The secondary objective was to determine if a threshold distance from midline could be identified, at which the risk of developing PTH increased if the DC was performed closer to midline than this threshold. A retrospective review was performed of 380 patients undergoing DC at a single institution between March 2004 and November 2014. Clinical, operative and demographic variables were collected, including age, sex, DC parameters and occurrence of PTH. Statistical analysis compared mean axial craniectomy margin distance from midline in patients with versus without PTH. Distances from midline were tested as potential thresholds. No significant difference was identified in mean axial craniectomy margin distance from midline in patients developing PTH compared with patients with no PTH (n = 24, 12.8 mm versus n = 356, 16.6 mm respectively, p = 0.086). No significant cutoff distance from midline was identified (n = 212, p = 0.201). This study, the largest to date, was unable to identify a threshold with sufficient discrimination to support clinical recommendations in terms of DC margins with regard to midline, including thresholds reportedly significant in previously published research.
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Affiliation(s)
- John R Williams
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA.
| | - Michael R Meyer
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Jocelyn A Ricard
- University of Minnesota, 3 Morrill Hall, 100 Church St. S.E, Minneapolis, MN 55455, USA
| | - Rajeev Sen
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Christopher C Young
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Abdullah H Feroze
- Department of Neurosurgery, Loma Linda University Health, 11234 Anderson St., Suite 2562B, Loma Linda, CA 92354, USA
| | - Madeline E Greil
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Guilherme Barros
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Brian Hanak
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Ryan P Morton
- Department of Neurosurgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, TX 78229, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Jason K Barber
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Christine L Mac Donald
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Randall M Chesnut
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
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16
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Feroze AH, McGrath M, Williams JR, Young CC, Ene CI, Buckley RT, Cole BL, Ojemann JG, Hauptman JS. Laser interstitial thermal therapy for pediatric atypical teratoid/rhabdoid tumor: case report. Neurosurg Focus 2021; 48:E11. [PMID: 31896085 DOI: 10.3171/2019.10.focus19746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/16/2019] [Indexed: 11/06/2022]
Abstract
Herein, the authors describe the successful use of laser interstitial thermal therapy (LITT) for management of metastatic craniospinal disease for biopsy-proven atypical teratoid/rhabdoid tumor in a 16-month-old boy presenting to their care. Specifically, LITT was administered to lesions of the right insula and left caudate. The patient tolerated 2 stages of LITT to the aforementioned lesions without complication and with evidence of radiographic improvement of lesions at the 2- and 6-month follow-up appointments. To the authors' knowledge, this represents the first such published report of LITT for management of atypical teratoid/rhabdoid tumor.
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Affiliation(s)
| | - Margaret McGrath
- 1Department of Neurological Surgery, University of Washington; and
| | - John R Williams
- 1Department of Neurological Surgery, University of Washington; and
| | | | - Chibawanye I Ene
- 1Department of Neurological Surgery, University of Washington; and
| | - Robert T Buckley
- 1Department of Neurological Surgery, University of Washington; and
| | - Bonnie L Cole
- 3Pathology, Seattle Children's Hospital, Seattle, Washington
| | - Jeffrey G Ojemann
- 1Department of Neurological Surgery, University of Washington; and.,Departments of2Neurological Surgery and
| | - Jason S Hauptman
- 1Department of Neurological Surgery, University of Washington; and.,Departments of2Neurological Surgery and
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17
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Williams JR, Young CC, Vitanza NA, McGrath M, Feroze AH, Browd SR, Hauptman JS. Progress in diffuse intrinsic pontine glioma: advocating for stereotactic biopsy in the standard of care. Neurosurg Focus 2021; 48:E4. [PMID: 31896081 DOI: 10.3171/2019.9.focus19745] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/20/2019] [Indexed: 11/06/2022]
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a universally fatal pediatric brainstem tumor affecting approximately 300 children in the US annually. Median survival is less than 1 year, and radiation therapy has been the mainstay of treatment for decades. Recent advances in the biological understanding of the disease have identified the H3K27M mutation in nearly 80% of DIPGs, leading to the 2016 WHO classification of diffuse midline glioma H3K27M-mutant, a grade IV brainstem tumor. Developments in epigenetic targeting of transcriptional tendencies have yielded potential molecular targets for clinical trials. Chimeric antigen receptor T cell therapy has also shown preclinical promise. Recent clinical studies, including prospective trials, have demonstrated the safety and feasibility of pediatric brainstem biopsy in the setting of DIPG and other brainstem tumors. Given developments in the ability to analyze DIPG tumor tissue to deepen biological understanding of this disease and develop new therapies for treatment, together with the increased safety of stereotactic brainstem biopsy, the authors present a case for offering biopsy to all children with suspected DIPG. They also present their standard operative techniques for image-guided, frameless stereotactic biopsy.
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Affiliation(s)
- John R Williams
- 1Department of Neurological Surgery, University of Washington
| | | | - Nicholas A Vitanza
- 2Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital; and
| | | | | | - Samuel R Browd
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Jason S Hauptman
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
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18
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Abecassis IJ, Young CC, Caldwell D, Feroze AH, Williams JR, Meyer RM, Kellogg RT, Bonow R, Chesnut RM. Description, Penetrance, and Analysis of Outcomes with the “Kempe” Incision for Decompressive Craniectomy in Traumatic Brain Injury and Stroke. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Young CC, Williams JR, Feroze AH, McGrath M, Ravanpay AC, Ellenbogen RG, Ojemann JG, Hauptman JS. Pediatric functional hemispherectomy: operative techniques and complication avoidance. Neurosurg Focus 2020; 48:E9. [DOI: 10.3171/2020.1.focus19889] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Abstract
Functional hemispherectomy/hemispherotomy is a disconnection procedure for severe medically refractory epilepsy where the seizure foci diffusely localize to one hemisphere. It is an improvement on anatomical hemispherectomy and was first performed by Rasmussen in 1974. Less invasive surgical approaches and refinements have been made to improve seizure freedom and minimize surgical morbidity and complications. Key anatomical structures that are disconnected include the 1) internal capsule and corona radiata, 2) mesial temporal structures, 3) insula, 4) corpus callosum, 5) parietooccipital connection, and 6) frontobasal connection. A stepwise approach is indicated to ensure adequate disconnection and prevent seizure persistence or recurrence. In young pediatric patients, careful patient selection and modern surgical techniques have resulted in > 80% seizure freedom and very good functional outcome. In this report, the authors summarize the history of hemispherectomy and its development and present a graphical guide for this anatomically challenging procedure. The use of the osteoplastic flap to improve outcome and the management of hydrocephalus are discussed.
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Affiliation(s)
| | | | | | | | - Ali C. Ravanpay
- 1Department of Neurological Surgery, University of Washington
- 3Department of Neurological Surgery, VA Puget Sound Healthcare System, Seattle, Washington
| | - Richard G. Ellenbogen
- 1Department of Neurological Surgery, University of Washington
- 2Department of Neurological Surgery, Seattle Children’s Hospital; and
| | - Jeffrey G. Ojemann
- 1Department of Neurological Surgery, University of Washington
- 2Department of Neurological Surgery, Seattle Children’s Hospital; and
| | - Jason S. Hauptman
- 1Department of Neurological Surgery, University of Washington
- 2Department of Neurological Surgery, Seattle Children’s Hospital; and
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20
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Chu JK, Feroze AH, Collins K, McGrath LB, Young CC, Williams JR, Browd SR. Variation in hospital charges in patients with external ventricular drains: comparison between the intensive care and surgical floor settings. J Neurosurg Pediatr 2019; 24:29-34. [PMID: 31003227 DOI: 10.3171/2019.2.peds18545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Placement of an external ventricular drain (EVD) is a common and potentially life-saving neurosurgical procedure, but the economic aspect of EVD management and the relationship to medical expenditure remain poorly studied. Similarly, interinstitutional practice patterns vary significantly. Whereas some institutions require that patients with EVDs be monitored strictly within the intensive care unit (ICU), other institutions opt primarily for management of EVDs on the surgical floor. Therefore, an ICU burden for patients with EVDs may increase a patient's costs of hospitalization. The objective of the current study was to examine the expense differences between the ICU and the general neurosurgical floor for EVD care. METHODS The authors performed a retrospective analysis of data from 2 hospitals within a single, large academic institution-the University of Washington Medical Center (UWMC) and Seattle Children's Hospital (SCH). Hospital charges were evaluated according to patients' location at the time of EVD management: SCH ICU, SCH floor, or UWMC ICU. Daily hospital charges from day of EVD insertion to day of removal were included and screened for days that would best represent baseline expenses for EVD care. Independent-samples Kruskal-Wallis analysis was performed to compare daily charges for the 3 settings. RESULTS Data from a total of 261 hospital days for 23 patients were included in the analysis. Ten patients were cared for in the UWMC ICU and 13 in the SCH ICU and/or on the SCH neurosurgical floor. The median values for total daily hospital charges were $19,824.68 (interquartile range [IQR] $12,889.73-$38,494.81) for SCH ICU care, $8,620.88 (IQR $6,416.76-$11,851.36) for SCH floor care, and $10,002.13 (IQR $8,465.16-$12,123.03) for UWMC ICU care. At SCH, it was significantly more expensive to provide EVD care in the ICU than on the floor (p < 0.001), and the daily hospital charges for the UWMC ICU were significantly greater than for the SCH floor (p = 0.023). No adverse clinical event related to the presence of an EVD was identified in any of the settings. CONCLUSIONS ICU admission solely for EVD care is costly. If safe EVD care can be provided outside of the ICU, it would represent a potential area for significant cost savings. Identifying appropriate patients for EVD care on the floor is multifactorial and requires vigilance in balancing the expenses associated with ICU utilization and optimal patient care.
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Affiliation(s)
- Jason K Chu
- 1Department of Neurosurgery, University of Southern California.,2Division of Neurosurgery, Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, California; and
| | - Abdullah H Feroze
- 3Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington
| | - Kelly Collins
- 3Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington
| | - Lynn B McGrath
- 3Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington
| | - Christopher C Young
- 3Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington
| | - John R Williams
- 3Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington
| | - Samuel R Browd
- 3Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington
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21
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Kuo CH, Feroze AH, Poliachik SL, Hauptman JS, Novotny EJ, Ojemann JG. Laser Ablation Therapy for Pediatric Patients with Intracranial Lesions in Eloquent Areas. World Neurosurg 2018; 121:e191-e199. [PMID: 30261370 DOI: 10.1016/j.wneu.2018.09.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is an alternative, less-invasive, and, in some circumstances, effective treatment for patients with intracranial pathology including epilepsy and some tumors. For intracranial lesions in eloquent areas, resection by conventional craniotomy proves often to be a challenge, including in the care of pediatric patients. Herein, we reviewed our experience with magnetic resonance imaging (MRI)-guided LITT as treatment for pediatric patients with intracranial lesions in eloquent areas and evaluate neurologic function and clinical outcomes. METHODS We retrospectively reviewed consecutive patients with intracranial lesions in eloquent speech and motor areas who underwent MRI-guided LITT. Clinical evaluation, including neurologic function and neuropsychological testing, was conducted according to clinical considerations. MRI pre- and postoperative imaging was reviewed to compare the change of lesion size. RESULTS Five pediatric patients received MRI-guided LITT of intracranial lesions in eloquent cortex. One patient experienced complications secondary to MRI-guided LITT, but neither was discharged with a neurologic deficit. CONCLUSIONS For intracranial lesions in the eloquent cortex, conventional craniotomy with surgical resection is a challenge for neurosurgeons, especially pediatric patients. MRI-guided LITT provides a less-invasive and potentially effective option for treatment in the management of pediatric epilepsy and tumors.
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Affiliation(s)
- Chao-Hung Kuo
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sandra L Poliachik
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA; Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Edward J Novotny
- Department of Neurology, University of Washington, Seattle, Washington, USA; Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
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22
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Tian W, Rockson SG, Jiang X, Kim J, Begaye A, Shuffle EM, Tu AB, Cribb M, Nepiyushchikh Z, Feroze AH, Zamanian RT, Dhillon GS, Voelkel NF, Peters-Golden M, Kitajewski J, Dixon JB, Nicolls MR. Leukotriene B 4 antagonism ameliorates experimental lymphedema. Sci Transl Med 2018; 9:9/389/eaal3920. [PMID: 28490670 DOI: 10.1126/scitranslmed.aal3920] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 11/22/2016] [Accepted: 04/04/2017] [Indexed: 12/14/2022]
Abstract
Acquired lymphedema is a cancer sequela and a global health problem currently lacking pharmacologic therapy. We have previously demonstrated that ketoprofen, an anti-inflammatory agent with dual 5-lipoxygenase and cyclooxygenase inhibitory properties, effectively reverses histopathology in experimental lymphedema. We show that the therapeutic benefit of ketoprofen is specifically attributable to its inhibition of the 5-lipoxygenase metabolite leukotriene B4 (LTB4). LTB4 antagonism reversed edema, improved lymphatic function, and restored lymphatic architecture in the murine tail model of lymphedema. In vitro, LTB4 was functionally bimodal: Lower LTB4 concentrations promoted human lymphatic endothelial cell sprouting and growth, but higher concentrations inhibited lymphangiogenesis and induced apoptosis. During lymphedema progression, lymphatic fluid LTB4 concentrations rose from initial prolymphangiogenic concentrations into an antilymphangiogenic range. LTB4 biosynthesis was similarly elevated in lymphedema patients. Low concentrations of LTB4 stimulated, whereas high concentrations of LTB4 inhibited, vascular endothelial growth factor receptor 3 and Notch pathways in cultured human lymphatic endothelial cells. Lymphatic-specific Notch1-/- mice were refractory to the beneficial effects of LTB4 antagonism, suggesting that LTB4 suppression of Notch signaling is an important mechanism in disease maintenance. In summary, we found that LTB4 was harmful to lymphatic repair at the concentrations observed in established disease. Our findings suggest that LTB4 is a promising drug target for the treatment of acquired lymphedema.
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Affiliation(s)
- Wen Tian
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.,Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Xinguo Jiang
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.,Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeanna Kim
- Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Adrian Begaye
- Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Eric M Shuffle
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.,Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Allen B Tu
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.,Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew Cribb
- Georgia Institute of Technology, Atlanta, GA 30332, USA
| | | | | | | | | | | | | | - Jan Kitajewski
- University of Illinois at Chicago, Chicago, IL 60612, USA
| | | | - Mark R Nicolls
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA. .,Stanford University School of Medicine, Stanford, CA 94305, USA
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23
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Gholamin S, Mitra SS, Feroze AH, Liu J, Kahn SA, Zhang M, Esparza R, Richard C, Ramaswamy V, Remke M, Volkmer AK, Willingham S, Ponnuswami A, McCarty A, Lovelace P, Storm TA, Schubert S, Hutter G, Narayanan C, Chu P, Raabe EH, Harsh G, Taylor MD, Monje M, Cho YJ, Majeti R, Volkmer JP, Fisher PG, Grant G, Steinberg GK, Vogel H, Edwards M, Weissman IL, Cheshier SH. Disrupting the CD47-SIRPα anti-phagocytic axis by a humanized anti-CD47 antibody is an efficacious treatment for malignant pediatric brain tumors. Sci Transl Med 2017; 9:9/381/eaaf2968. [PMID: 28298418 DOI: 10.1126/scitranslmed.aaf2968] [Citation(s) in RCA: 274] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/25/2016] [Accepted: 12/07/2016] [Indexed: 12/17/2022]
Abstract
Morbidity and mortality associated with pediatric malignant primary brain tumors remain high in the absence of effective therapies. Macrophage-mediated phagocytosis of tumor cells via blockade of the anti-phagocytic CD47-SIRPα interaction using anti-CD47 antibodies has shown promise in preclinical xenografts of various human malignancies. We demonstrate the effect of a humanized anti-CD47 antibody, Hu5F9-G4, on five aggressive and etiologically distinct pediatric brain tumors: group 3 medulloblastoma (primary and metastatic), atypical teratoid rhabdoid tumor, primitive neuroectodermal tumor, pediatric glioblastoma, and diffuse intrinsic pontine glioma. Hu5F9-G4 demonstrated therapeutic efficacy in vitro and in vivo in patient-derived orthotopic xenograft models. Intraventricular administration of Hu5F9-G4 further enhanced its activity against disseminated medulloblastoma leptomeningeal disease. Notably, Hu5F9-G4 showed minimal activity against normal human neural cells in vitro and in vivo, a phenomenon reiterated in an immunocompetent allograft glioma model. Thus, Hu5F9-G4 is a potentially safe and effective therapeutic agent for managing multiple pediatric central nervous system malignancies.
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Affiliation(s)
- Sharareh Gholamin
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA.,Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Siddhartha S Mitra
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA. .,Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Abdullah H Feroze
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jie Liu
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Suzana A Kahn
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA.,Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael Zhang
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Rogelio Esparza
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Chase Richard
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Marc Remke
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Division of Pediatric Neurooncology, German Consortium for Translational Cancer Research, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Anne K Volkmer
- Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA.,Department of Gynecology and Obstetrics, University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Stephen Willingham
- Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Anitha Ponnuswami
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Aaron McCarty
- Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Patricia Lovelace
- Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Theresa A Storm
- Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Simone Schubert
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gregor Hutter
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Cyndhavi Narayanan
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Pauline Chu
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Eric H Raabe
- Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Griffith Harsh
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael D Taylor
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Michelle Monje
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA.,Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yoon-Jae Cho
- Department of Pediatrics and Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97231, USA
| | - Ravi Majeti
- Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA.,Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jens P Volkmer
- Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Paul G Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gerald Grant
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Hannes Vogel
- Departments of Pathology and Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael Edwards
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Irving L Weissman
- Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA.,Departments of Pathology and Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Samuel H Cheshier
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA. .,Institute for Stem Cell Biology and Regenerative Medicine and the Stanford Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA 94305, USA
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24
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Ajlan AM, Abdulqader SB, Achrol AS, Aljamaan Y, Feroze AH, Katznelson L, Harsh GR. Diabetes Insipidus following Endoscopic Transsphenoidal Surgery for Pituitary Adenoma. J Neurol Surg B Skull Base 2017; 79:117-122. [PMID: 29868315 DOI: 10.1055/s-0037-1604363] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/14/2017] [Indexed: 12/27/2022] Open
Abstract
Objectives Pituitary adenoma (PA), among the most commonly encountered sellar pathologies, accounts for 10% of primary intracranial tumors. The reported incidence of postoperative diabetes insipidus (DI) is highly variable. In this study, we report our experience with DI following endoscopic transsphenoidal surgery (TSS) for PAs, elucidating the risk factors of postoperative DI, the likelihood of long-term DI, and the impact of DI on the length of stay (LOS). Methods The study included 178 patients who underwent endoscopic resection of PAs. Early DI was defined as that occurring within the first postoperative week. The mean follow-up was 36 months. Long-term DI was considered as DI apparent in the last follow-up visit. Results Of the 178 patients included in the study, 77% of the tumors were macroadenomas. Forty-seven patients (26%) developed early DI. Long-term DI was observed in 18 (10.1%) of the full cohort. Age younger than 50 years was significantly associated with a higher incidence of long-term DI ( p = 0.02). Macroadenoma and gross total resection were significantly associated with higher incidence of early DI ( p = 0.05 and p = 0.04, respectively). The mean LOS was 4 days for patients with early postoperative DI and 3 days for those without it. Conclusion The reported incidence of postoperative DI is significantly variable. We identified age younger than 50 years a risk factor for developing long-term postoperative DI. Gross total surgical resection and tumor size (> 1 cm) were associated with development of early DI. Early DI increased the LOS on average by 1 day.
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Affiliation(s)
- Abdulrazag M Ajlan
- Department of Neurosurgery, Stanford University, Palo Alto, California, United States.,Department of Neurosurgery, King Saud University, Riyadh, Saudi Arabia
| | | | - Achal S Achrol
- Department of Neurosurgery, Stanford University, Palo Alto, California, United States
| | - Yousef Aljamaan
- College of Medicine, University of Dammam, Dammam, Saudi Arabia
| | - Abdullah H Feroze
- Department of Neurosurgery, Stanford University, Palo Alto, California, United States
| | - Laurence Katznelson
- Department of Neurosurgery, Stanford University, Palo Alto, California, United States.,Department of Medicine, Stanford University, Palo Alto, California, United States
| | - Griffith R Harsh
- Department of Neurosurgery, Stanford University, Palo Alto, California, United States
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25
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Ajlan A, Achrol AS, Albakr A, Feroze AH, Westbroek EM, Hwang P, Harsh GR. Cavernous Sinus Involvement by Pituitary Adenomas: Clinical Implications and Outcomes of Endoscopic Endonasal Resection. J Neurol Surg B Skull Base 2017; 78:273-282. [PMID: 28603683 DOI: 10.1055/s-0036-1598022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022] Open
Abstract
Background Parasellar invasion of pituitary adenomas (PAs) into the cavernous sinus (CS) is common. The management of the CS component of PA remains controversial. Objective The objective of this study was to analyze CS involvement in PA treated with endoscopic endonasal approaches, including incidence, surgical risks, surgical strategies, long-term outcomes, and our treatment algorithm. Methods We reviewed a series of 176 surgically treated PA with particular attention to CS involvement and whether the CS tumor was approached medial or lateral to the internal carotid artery. Results The median duration of follow-up was 36 months. Macroadenomas and nonfunctional adenomas represented 77 and 60% of cases, respectively. CS invasion was documented in 23% of cases. CS involvement was associated with a significantly diminished odds of gross total resection (47 vs. 86%, odds ratio [OR]: 5.2) and increased the need for subsequent intervention (4 vs. 40%, OR: 14.4). Hormonal remission was achieved in 15% of hormonally active tumors. Rates of surgical complication were similar regardless of CS involvement. Conclusion Our tailored strategy beginning with a medial approach and adding lateral exposure as needed resulted in good outcomes with low morbidity in nonfunctional adenomas. Functional adenomas involving the CS were associated with low rates of hormonal remission necessitating higher rates of additional treatment.
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Affiliation(s)
- Abdulrazag Ajlan
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.,Department of Neurosurgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Achal S Achrol
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
| | - Abdulrahman Albakr
- Department of Neurosurgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah H Feroze
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
| | - Erick M Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Peter Hwang
- Department of Otolaryngology, Stanford University School of Medicine, California, United States
| | - Griffith R Harsh
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
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26
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Mitra SS, Feroze AH, Gholamin S, Richard C, Esparza R, Zhang M, Azad TD, Alrfaei B, Kahn SA, Hutter G, Guzman R, Creasey GH, Plant GW, Weissman IL, Edwards MSB, Cheshier S. Neural Placode Tissue Derived From Myelomeningocele Repair Serves as a Viable Source of Oligodendrocyte Progenitor Cells. Neurosurgery 2016. [PMID: 26225855 DOI: 10.1227/neu.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The presence, characteristics, and potential clinical relevance of neural progenitor populations within the neural placodes of myelomeningocele patients remain to be studied. Neural stem cells are known to reside adjacent to ependyma-lined surfaces along the central nervous system axis. OBJECTIVE Given such neuroanatomic correlation and regenerative capacity in fetal development, we assessed myelomeningocele-derived neural placode tissue as a potentially novel source of neural stem and progenitor cells. METHODS Nonfunctional neural placode tissue was harvested from infants during the surgical repair of myelomeningocele and subsequently further analyzed by in vitro studies, flow cytometry, and immunofluorescence. To assess lineage potential, neural placode-derived neurospheres were subjected to differential media conditions. Through assessment of platelet-derived growth factor receptor α (PDGFRα) and CD15 cell marker expression, Sox2+Olig2+ putative oligodendrocyte progenitor cells were successfully isolated. RESULTS PDGFRαCD15 cell populations demonstrated the highest rate of self-renewal capacity and multipotency of cell progeny. Immunofluorescence of neural placode-derived neurospheres demonstrated preferential expression of the oligodendrocyte progenitor marker, CNPase, whereas differentiation to neurons and astrocytes was also noted, albeit to a limited degree. CONCLUSION Neural placode tissue contains multipotent progenitors that are preferentially biased toward oligodendrocyte progenitor cell differentiation and presents a novel source of such cells for use in the treatment of a variety of pediatric and adult neurological disease, including spinal cord injury, multiple sclerosis, and metabolic leukoencephalopathies.
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Affiliation(s)
- Siddhartha S Mitra
- ‡Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California; §Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California; ¶Department of Neurosurgery, VA Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, California; ∥Department of Neurological Surgery, University of Washington, Seattle, Washington
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27
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Itakura H, Achrol AS, Mitchell LA, Loya JJ, Liu T, Westbroek EM, Feroze AH, Rodriguez S, Echegaray S, Azad TD, Yeom KW, Napel S, Rubin DL, Chang SD, Harsh GR, Gevaert O. Magnetic resonance image features identify glioblastoma phenotypic subtypes with distinct molecular pathway activities. Sci Transl Med 2016; 7:303ra138. [PMID: 26333934 DOI: 10.1126/scitranslmed.aaa7582] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Glioblastoma (GBM) is the most common and highly lethal primary malignant brain tumor in adults. There is a dire need for easily accessible, noninvasive biomarkers that can delineate underlying molecular activities and predict response to therapy. To this end, we sought to identify subtypes of GBM, differentiated solely by quantitative magnetic resonance (MR) imaging features, that could be used for better management of GBM patients. Quantitative image features capturing the shape, texture, and edge sharpness of each lesion were extracted from MR images of 121 single-institution patients with de novo, solitary, unilateral GBM. Three distinct phenotypic "clusters" emerged in the development cohort using consensus clustering with 10,000 iterations on these image features. These three clusters--pre-multifocal, spherical, and rim-enhancing, names reflecting their image features--were validated in an independent cohort consisting of 144 multi-institution patients with similar tumor characteristics from The Cancer Genome Atlas (TCGA). Each cluster mapped to a unique set of molecular signaling pathways using pathway activity estimates derived from the analysis of TCGA tumor copy number and gene expression data with the PARADIGM (Pathway Recognition Algorithm Using Data Integration on Genomic Models) algorithm. Distinct pathways, such as c-Kit and FOXA, were enriched in each cluster, indicating differential molecular activities as determined by the image features. Each cluster also demonstrated differential probabilities of survival, indicating prognostic importance. Our imaging method offers a noninvasive approach to stratify GBM patients and also provides unique sets of molecular signatures to inform targeted therapy and personalized treatment of GBM.
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Affiliation(s)
- Haruka Itakura
- Division of Biomedical Informatics, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Achal S Achrol
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Lex A Mitchell
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Joshua J Loya
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Tiffany Liu
- Division of Biomedical Informatics, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Erick M Westbroek
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Abdullah H Feroze
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Scott Rodriguez
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Sebastian Echegaray
- Department of Electrical Engineering, Stanford University, Stanford, CA 94305, USA
| | - Tej D Azad
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Kristen W Yeom
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Sandy Napel
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Daniel L Rubin
- Division of Biomedical Informatics, Department of Medicine, Stanford University, Stanford, CA 94305, USA. Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Griffith R Harsh
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Olivier Gevaert
- Division of Biomedical Informatics, Department of Medicine, Stanford University, Stanford, CA 94305, USA.
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28
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Ali R, Connolly ID, Feroze AH, Awad AJ, Choudhri OA, Grant GA. Epilepsy: A Disruptive Force in History. World Neurosurg 2016; 90:685-690. [PMID: 26709155 DOI: 10.1016/j.wneu.2015.11.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
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29
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Walmsley GG, McArdle A, Tevlin R, Momeni A, Atashroo D, Hu MS, Feroze AH, Wong VW, Lorenz PH, Longaker MT, Wan DC. Nanotechnology in bone tissue engineering. Nanomedicine 2015; 11:1253-63. [PMID: 25791811 PMCID: PMC4476906 DOI: 10.1016/j.nano.2015.02.013] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/23/2014] [Accepted: 02/21/2015] [Indexed: 02/04/2023]
Abstract
Nanotechnology represents a major frontier with potential to significantly advance the field of bone tissue engineering. Current limitations in regenerative strategies include impaired cellular proliferation and differentiation, insufficient mechanical strength of scaffolds, and inadequate production of extrinsic factors necessary for efficient osteogenesis. Here we review several major areas of research in nanotechnology with potential implications in bone regeneration: 1) nanoparticle-based methods for delivery of bioactive molecules, growth factors, and genetic material, 2) nanoparticle-mediated cell labeling and targeting, and 3) nano-based scaffold construction and modification to enhance physicochemical interactions, biocompatibility, mechanical stability, and cellular attachment/survival. As these technologies continue to evolve, ultimate translation to the clinical environment may allow for improved therapeutic outcomes in patients with large bone deficits and osteodegenerative diseases. FROM THE CLINICAL EDITOR Traditionally, the reconstruction of bony defects has relied on the use of bone grafts. With advances in nanotechnology, there has been significant development of synthetic biomaterials. In this article, the authors provided a comprehensive review on current research in nanoparticle-based therapies for bone tissue engineering, which should be useful reading for clinicians as well as researchers in this field.
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Affiliation(s)
- Graham G Walmsley
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Adrian McArdle
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ruth Tevlin
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Arash Momeni
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - David Atashroo
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael S Hu
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Abdullah H Feroze
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Victor W Wong
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter H Lorenz
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Derrick C Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Purger D, Feroze AH, Choudhri O, Lee L, Lopez J, Dodd RL. Detection of acute femoral artery ischemia during neuroembolization by somatosensory and motor evoked potential monitoring. Interv Neuroradiol 2015; 21:397-400. [PMID: 26015519 DOI: 10.1177/1591019915583219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neuromonitoring can be used to map out particular neuroanatomical tracts, define physiologic deficits secondary to specific pathology or intervention, or predict postoperative outcome and proves essential in the detection of central and peripheral ischemic events during neurosurgical intervention. Herein, we describe an instance of elective balloon-assisted coiling of a recurrent basilar tip aneurysm in a 61-year-old woman, where intraoperative somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were lost in the right lower extremity intraoperatively. We aim to highlight that targeted use of monitoring proves advantageous in both the open surgical and endovascular setting, even in the avoidance of potential iatrogenic peripheral nerve damage and limb ischemia as documented herein. Consideration of the increased risk for peripheral ischemia in the neurointerventional setting is especially imperative in particular populations where blood vessels might be of diminished size, such as in infants, young children, and severely deconditioned adults.
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Affiliation(s)
- David Purger
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Abdullah H Feroze
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Omar Choudhri
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA Department of Neuroradiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Leslie Lee
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jaime Lopez
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert L Dodd
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Affiliation(s)
- Abdullah H. Feroze
- Stanford University School of Medicine, Stanford University Hospital and Clinics, Stanford, CA
| | - Graham G. Walmsley
- Stanford University School of Medicine, Stanford University Hospital and Clinics, Stanford, CA
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Feroze AH, Walmsley GG, Choudhri O, Lorenz HP, Grant GA, Edwards MSB. Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends. J Neurosurg 2015; 123:1098-107. [PMID: 25699411 DOI: 10.3171/2014.11.jns14622] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cranial bone repair is one of the oldest neurosurgical practices. Reconstructing the natural contours of the skull has challenged the ingenuity of surgeons from antiquity to the present day. Given the continuous improvement of neurosurgical and emergency care over the past century, more patients survive such head injuries, thus necessitating more than ever before a simple, safe, and durable means of correcting skull defects. In response, numerous techniques and materials have been devised as the art of cranioplasty has progressed. Although the goals of cranioplasty remain the same, the evolution of techniques and diversity of materials used serves as testimony to the complexity of this task. This paper highlights the evolution of these materials and techniques, with a particular focus on the implications for managing pediatric calvarial repair and emerging trends within the field.
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Affiliation(s)
- Abdullah H Feroze
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
| | - Graham G Walmsley
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
| | - Omar Choudhri
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucille Packard Children's Hospital; and
| | - H Peter Lorenz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
| | - Gerald A Grant
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucille Packard Children's Hospital; and
| | - Michael S B Edwards
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucille Packard Children's Hospital; and
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Choudhri O, Gupta M, Feroze AH, Heit JJ, Do HM. Endovascular management of external ventricular drain-associated cerebrovascular injuries. Surg Neurol Int 2015; 5:167. [PMID: 25558425 PMCID: PMC4278086 DOI: 10.4103/2152-7806.145930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/27/2014] [Indexed: 11/09/2022] Open
Abstract
Background: Placement of external ventricular drains (EVDs) is a common, life-saving neurosurgical procedure indicated across a variety of settings. While advances have made the procedure quite safe, the potential for iatrogenic morbidity and mortality continues. We document our experience with the endovascular management of three pseudoaneurysms associated with EVD placement and discuss the endovascular treatment options for EVD-associated cerebrovascular injury. Methods: We performed a retrospective analysis to identify all EVDs placed from 2008 through 2013 at our institution. In instances of EVD-associated cerebrovascular injury, all admission and subsequent radiographic studies were reviewed, including cerebral angiograms and computed tomography (CT) scans where available. Angiograms were reviewed to record the extent of vascular injury and outcomes after treatment. Results: One female and two male patients (age range, 40-75 years) were found to have developed vascular injuries associated with EVD placement. Three pseudoaneurysms, of the posterior communicating artery (PCOM), pericallosal artery branch, and the middle meningeal artery, respectively, were treated by coil and/or glue embolization. Conclusions: Although EVD-associated cerebrovascular injury remains a rare phenomenon, such procedures are not entirely benign. Endovascular repair for such lesions proves a viable, effective option.
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Affiliation(s)
- Omar Choudhri
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Mihir Gupta
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Abdullah H Feroze
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Huy M Do
- Department of Radiology, Stanford University School of Medicine, Stanford, California 94305, USA
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Feroze AH, Lee KS, Gholamin S, Wu Z, Weissman I, Lu B, Mitra SS, Cheshier S. Abstract LB-207: mTORC2/Akt signaling is modulated by noncanonical mitochondrial Notch1/PINK1 interaction in myc-amplified medulloblastoma tumorigenesis. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-lb-207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Medulloblastoma is known to be the most malignant pediatric brain tumor. The armamentarium of targeted therapies to currently treat medulloblastoma and similar pediatric central nervous system malignancies is extremely limited, often necessitating the need to combat such tumors with modified regimens of therapeutic options designed originally to target adult neoplasms. Given such limited therapies, a budding focus on the role of mitochondrial dysregulation in the tumorigenesis of such pathologies merits consideration. Mitochondria are known to play fundamental roles in multiple processes conserved across eukaryotic species. Aside from their key role in energy production through oxidative phosphorylation, the organelles also serve as the sites of essential metabolic pathways, redox regulation, calcium homeostasis, apoptosis, and cell fate determination and differentiation.
Recently, we documented the role of noncanonical Notch signaling and mitochondrial involvement in adult glioblastoma brain tumor-initiating cells (Lee KS et al., Genes and Development, 2013). Although the canonical Notch pathway and is generally well-characterized, involving the ligand-induced cleavage of Notch for transcriptional regulation, only more recently has credible evidence surfaced documenting the role of a second noncanonical pathway, where Notch can function independently of ligand and transcription through a mechanism that remains to be fully elucidated. The regulatory self-renewal versus differentiation choice of Drosophila and mammalian human neural stem cells requires Notch signaling, and in our work, we found noncanonical Notch pathway interaction with PTEN-induced putative kinase 1 (PINK1) to influence mitochondrial function, activating mTORC2/Akt signaling. siRNA-induced knockdown preferentially impaired the maintenance of Drosophila and human glioblastoma cancer stem cell-like tumor-forming cells to a far greater degree than normal stem cell counterparts.
Further experiments have elucidated similar findings of increased Notch1/PINK1 mitochondrial interaction and mTORC2/Akt activity in patient-derived Group 3 (myc-amplified) medulloblastoma primary lines to levels greater than normal or glioblastoma samples. Additionally these medulloblastoma samples appear to be more susceptible to siRNA-induced knockdown of PINK1 than their counterparts. In vivo experiments are ongoing to address the role of mitochondrial Notch1/Pink1 interaction in tumor initiation and its targeting by small molecule inhibitors. Such results underscore the importance of mitochondria in both normal and cancer stem cell biology, a highly conserved mechanism across species, with exciting implications for the treatment of pediatric central nervous system malignancies.
Citation Format: Abdullah H. Feroze, Kyu-Sun Lee, Sharareh Gholamin, Zhihao Wu, Irving Weissman, Bingwei Lu, Siddhartha S. Mitra, Samuel Cheshier. mTORC2/Akt signaling is modulated by noncanonical mitochondrial Notch1/PINK1 interaction in myc-amplified medulloblastoma tumorigenesis. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-207. doi:10.1158/1538-7445.AM2014-LB-207
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Affiliation(s)
| | - Kyu-Sun Lee
- Stanford University School of Medicine, Stanford, CA
| | | | - Zhihao Wu
- Stanford University School of Medicine, Stanford, CA
| | | | - Bingwei Lu
- Stanford University School of Medicine, Stanford, CA
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Feroze AH, Kushkuley J, Choudhri O, Heit JJ, Steinberg GK, Do HM. Development of Arteriovenous Fistula After Revascularization Bypass for Moyamoya Disease. Oper Neurosurg (Hagerstown) 2014; 11 Suppl 2:E202-6. [DOI: 10.1227/neu.0000000000000558] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Moyamoya disease is a rare cerebrovascular disorder often treated by direct and indirect revascularization bypass techniques as a result of a typically devastating disease course and poor response to medical therapy. In this report, we describe the formation and subsequent management of a de novo arteriovenous fistula identified in the setting of a patient treated with direct bypass surgery, a previously unreported phenomenon.
CLINICAL PRESENTATION
A 51-year-old woman presenting with Suzuki stage IV bilateral moyamoya disease underwent bilateral extracranial-to-intracranial superficial temporal artery--to--middle cerebral artery bypass without complication at our institution. At the 6-month follow-up, she demonstrated no evidence of residual neurological deficits or continued symptoms despite documentation of an arteriovenous fistula arising at the site of the right extracranial-to-intracranial bypass on routine follow-up cerebral angiography.
CONCLUSION
We present the first reported case of de novo arteriovenous fistula formation after superficial temporal artery-to-middle cerebral artery bypass for the treatment of moyamoya disease. Treatment of such iatrogenic arteriovenous fistulae fed by a patent bypass vessel may prove challenging without associated compromise of the bypass, meriting careful evaluation of all potential therapeutic options. The fistula described herein most likely occurred secondary to recanalization of a previously thrombosed vein of Trolard. This case demonstrates the possibility of arteriovenous fistula formation as a potential sequela of revascularization bypass surgery and lends support to the previously described traumatic origin of fistula formation.
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Affiliation(s)
- Abdullah H Feroze
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Jacob Kushkuley
- Department of Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Omar Choudhri
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Jeremy J Heit
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Huy M Do
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Nitta RT, Gholamin S, Feroze AH, Agarwal M, Cheshier SH, Mitra SS, Li G. Casein kinase 2α regulates glioblastoma brain tumor-initiating cell growth through the β-catenin pathway. Oncogene 2014; 34:3688-99. [PMID: 25241897 PMCID: PMC4369469 DOI: 10.1038/onc.2014.299] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/28/2014] [Accepted: 07/31/2014] [Indexed: 12/12/2022]
Abstract
Glioblastoma (GBM) is the most common and fatal primary brain tumor in humans and it is essential that new and better therapies are developed to treat this disease. Previous research suggests that casein kinase 2 (CK2), may be a promising therapeutic target for GBMs. CK2 has enhanced expression or activity in numerous cancers, including GBM and it has been demonstrated that inhibitors of CK2 regressed tumor growth in GBM xenograft mouse models. Our studies demonstrate that the CK2 subunit, CK2α, is overexpressed in and plays an important role in regulating brain tumor initiating cells (BTIC) in GBM. Initial studies showed that two GBM cell lines (U87-MG and U138) transduced with CK2α had enhanced proliferation and anchorage-independent growth. Inhibition of CK2α using siRNA or small molecule inhibitors (TBBz, CX-4945) reduced cell growth and decreased tumor size and increased the survival rate in GBM xenograft mouse models. We also verified that inhibition of CK2α decreased the activity of a well-known GBM initiating cell regulator, β-catenin. Loss of CK2α decreased two β-catenin-regulated genes that are involved in GBM initiating cell growth, OCT4 and NANOG. To determine the importance of CK2α in GBM stem cell maintenance, we reduced CK2α activity in primary GBM samples and tumor spheres derived from GBM patients. We discovered that loss of CK2α activity reduced the sphere forming capacity of BTIC and decreased numerous GBM stem cell markers including CD133, CD90, CD49f, and A2B5. Our study suggests that CK2α is involved in GBM tumorigenesis by maintaining BTIC through the regulation of β-catenin.
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Affiliation(s)
- R T Nitta
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - S Gholamin
- 1] Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA [2] Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - A H Feroze
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M Agarwal
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - S H Cheshier
- 1] Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA [2] Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S S Mitra
- 1] Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA [2] Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - G Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Choudhri O, Feroze AH, Lad EM, Kim JW, Plowey ED, Karamchandani JR, Chang SD. Co-occurrence of a cerebral cavernous malformation and an orbital cavernous hemangioma in a patient with seizures and visual symptoms: Rare crossroads for vascular malformations. Surg Neurol Int 2014; 5:S148-54. [PMID: 25071938 PMCID: PMC4109172 DOI: 10.4103/2152-7806.134810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/01/2014] [Indexed: 01/17/2023] Open
Abstract
Background: Cerebral cavernous malformations (CCMs) are angiographically occult vascular malformations of the central nervous system. As a result of hemorrhage and mass effect, patients may present with focal neurologic deficits, seizures, and other symptoms necessitating treatment. Once symptomatic, most often from hemorrhage, CCMs are treated with microsurgical resection. Orbital cavernous hemangiomas (OCHs) are similar but distinct vascular malformations that present within the orbital cavity. Even though CCMs and OCHs are both marked by dilated endothelial-lined vascular channels, they are infrequently seen in the same patient. Case Description: We provide a brief overview of the two related pathologies in the context of a patient presenting to our care with concomitant lesions, which were both resected in full without complication. Conclusion: This is the first known report that describes a case of concomitant CCM and OCH and explores the origins of two pathologies that are rarely encountered together in neurosurgical practice. Recognition of disparate symptomatologies is important for properly managing these patients.
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Affiliation(s)
- Omar Choudhri
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, Canada
| | - Abdullah H Feroze
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, Canada
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, Canada
| | - Jonathan W Kim
- Department of Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, Canada
| | - Edward D Plowey
- Department of Pathology, Stanford University Medical Center, Stanford, California, Canada
| | - Jason R Karamchandani
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Steven D Chang
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, Canada
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Lee KS, Wu Z, Song Y, Mitra SS, Feroze AH, Cheshier SH, Lu B. Roles of PINK1, mTORC2, and mitochondria in preserving brain tumor-forming stem cells in a noncanonical Notch signaling pathway. Genes Dev 2014; 27:2642-7. [PMID: 24352421 PMCID: PMC3877754 DOI: 10.1101/gad.225169.113] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Notch signaling maintains Drosophila and mammalian neural stem cells (NSCs). Lee et al. find that canonical and noncanonical Notch signaling cooperate in NSC regulation. In the noncanonical pathway, Notch interacts with PINK1 to influence mitochondrial function, activating mTORC2/AKT signaling and enhancing neuroblast growth. Inhibiting noncanonical Notch signaling preferentially impaired the maintenance of Drosophila and human cancer stem cell (CSC)-like cells. This study identifies a noncanonical Notch signaling pathway preferentially required by brain CSC-like cells. The self-renewal versus differentiation choice of Drosophila and mammalian neural stem cells (NSCs) requires Notch (N) signaling. How N regulates NSC behavior is not well understood. Here we show that canonical N signaling cooperates with a noncanonical N signaling pathway to mediate N-directed NSC regulation. In the noncanonical pathway, N interacts with PTEN-induced kinase 1 (PINK1) to influence mitochondrial function, activating mechanistic target of rapamycin complex 2 (mTORC2)/AKT signaling. Importantly, attenuating noncanonical N signaling preferentially impaired the maintenance of Drosophila and human cancer stem cell-like tumor-forming cells. Our results emphasize the importance of mitochondria to N and NSC biology, with important implications for diseases associated with aberrant N signaling.
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Affiliation(s)
- Kyu-Sun Lee
- Department of Pathology, Stanford University School of Medicine, Stanford, California 94305, USA
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Gholamin S, Feroze AH, Mitra SS, Kahn SA, Cheshier SH. Establishment of Stereotactic Orthotopic Brain Tumor Xenografts in Mice: Technical Report. Cureus 2013. [DOI: 10.7759/cureus.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Jiang B, Veeravagu A, Feroze AH, Lee M, Harsh GR, Soltys SG, Gibbs IC, Adler JR, Chang SD. CyberKnife radiosurgery for the management of skull base and spinal chondrosarcomas. J Neurooncol 2013; 114:209-18. [DOI: 10.1007/s11060-013-1172-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/26/2013] [Indexed: 12/31/2022]
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Kim YW, Liu TJ, Koul D, Tiao N, Feroze AH, Wang J, Powis G, Yung WKA. Identification of novel synergistic targets for rational drug combinations with PI3 kinase inhibitors using siRNA synthetic lethality screening against GBM. Neuro Oncol 2011; 13:367-75. [PMID: 21430111 DOI: 10.1093/neuonc/nor012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Several small molecules that inhibit the PI3 kinase (PI3K)-Akt signaling pathway are in clinical development. Although many of these molecules have been effective in preclinical models, it remains unclear whether this strategy alone will be sufficient to interrupt the molecular events initiated and maintained by signaling along the pathways because of the activation of other pathways that compensate for the inhibition of the targeted kinase. In this study, we performed a synthetic lethality screen to identify genes or pathways whose inactivation, in combination with the PI3K inhibitors PX-866 and NVPBEZ-235, might result in a lethal phenotype in glioblastoma multiforme (GBM) cells. We screened GBM cells (U87, U251, and T98G) with a large-scale, short hairpin RNA library (GeneNet), which contains 43 800 small interfering RNA sequences targeting 8500 well-characterized human genes. To decrease off-target effects, we selected overlapping genes among the 3 cell lines that synergized with PX-866 to induce cell death. To facilitate the identification of potential targets, we used a GSE4290 dataset and The Cancer Genome Atlas GBM dataset, identifying 15 target genes overexpressed in GBM tissues. We further analyzed the selected genes using Ingenuity Pathway Analysis software and showed that the 15 genes were closely related to cancer-promoting pathways, and a highly interconnected network of aberrations along the MYC, P38MAPK, and ERK signaling pathways were identified. Our findings suggest that inhibition of these pathways might increase tumor sensitivity to PX-866 and therefore represent a potential clinical therapeutic strategy.
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Affiliation(s)
- Yong-Wan Kim
- Brain Tumor Center, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Ishaq M, Feroze AH, Shahid M, Baig MA, Ameen SS, Feroze SH, Chishti RA. Intravitreal steroids may facilitate treatment of Eales' disease (idiopathic retinal vasculitis): an interventional case series. Eye (Lond) 2006; 21:1403-5. [PMID: 16980931 DOI: 10.1038/sj.eye.6702551] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Eales' disease is an idiopathic peripheral perivasculitis leading to proliferative vascular retinopathy, recurrent vitreous haemorrhages, and tractional retinal detachment. It is an elusive cause of blindness in young, otherwise healthy individuals. We studied the effects of intravitreal triamcinolone acetonide (IVTA) in patients of Eales' disease, which may eventually reduce the side effects and cost of management, with results equivalent to or better than oral steroids. METHODS Ethics approval and prior patient consent were obtained. Fluorescein fundus angiograms (FFAs) of 12 eyes of 12 Eales' disease patients were taken before enrolment. These patients received 0.1 ml of 40 mg/ml (4 mg) intravitreal triamcinolone through pars plana under topical anaesthesia. Regular weekly follow-ups were initiated to ascertain Snellen visual acuity, intraocular pressure (IOP) with Goldman tonometer, and triple mirror examination. Fluorescein fundus angiography was again performed in the 8th week to monitor response to treatment. Decrease in areas of late perivascular dye extravasation on fluorescein angiography was used as marker for improvement. RESULTS Ten out of a total of 12 (83.33%) eyes treated with IVTA showed significant reduction of late leakage from retinal vessels on fluorescein fundus angiography. Two out of 12 eyes (16.67%) did not show considerable decrease in late perivascular fluorescein dye leakage after 8 weeks of intravitreal triamcinolone injection. Two patients (16.67%) had a significant rise in IOP after IVTA. CONCLUSION Intravitreal steroids may be advocated for management of idiopathic retinal vasculitis without complications of systemic steroids, and minimize need for more invasive procedures.
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Affiliation(s)
- M Ishaq
- Department of Ophthalmology, Army Medical College, Rawalpindi, Pakistan
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Abbas A, Khan B, Feroze AH, Hyman GF. Thalidomide prevents donor corneal graft neovascularization in an alkali burn model of corneal angiogenesis. J PAK MED ASSOC 2002; 52:476-82. [PMID: 12553678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Thalidomide is a potent inhibitor of angiogenesis. We evaluated the effects of Thalidomide on corneal angiogenesis and on tissue survival of grafts in rabbit eyes with pre-existing neovascularization secondary to alkali burn. METHODS Sixteen rabbits received alkali burns to one cornea. One month post-injury, assessments of corneal neovascularization were performed followed by corneal transplantation. Four rabbits received oral Thalidomide and ten got placebo (powdered sugar) for thirty days. Total corneal neovascularization (NV), clock hours (CH) involved in (NV), longest (NV) pedicle length (NVP) and the duration of time required for NV to develop were assessed. RESULTS Thalidomide significantly decreased the total neovascularization (p<0.0072), the number of (CH) involved (p<0.0002) and the longest (NVP) length (p<0.0001). There was also a significant delay in the earliest development of NV in the test group (p<0.0064). The test group retained corneal clarity significantly longer than the control group (p<0.0008). CONCLUSION Thalidomide is an effective inhibitor of corneal angiogenesis and prolongs graft survival as measured by graft clarity in donor corneas in eyes with previous neovascularization secondary to alkali injury. CLINICAL RELEVANCE Thalidomide may be used as a modulator of corneal angiogenesis to prolong graft survival in eyes with pre-existing corneal neovascularization.
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Affiliation(s)
- A Abbas
- Department of Ophthalmology, The Aga Khan University, Karachi
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Contois JH, Wu AH, Li Z, Feroze AH, Grunenberger F, Haller J, deGroot L, Lammi-Keefe CJ. Distribution of serum apolipoproteins A-I and B and lipoprotein(a) in European elderly. The SENECA study. Clin Chim Acta 2000; 295:1-12. [PMID: 10767390 DOI: 10.1016/s0009-8981(00)00187-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study is to describe sex and geographic differences in apolipoproteins (apo) A-I and B and lipoprotein(a) [Lp(a)] concentrations in elderly Europeans. Subjects were 2164 elderly participants of the SENECA study from different regions of Europe. Sera for apo A-I, apo B, and Lp(a) measurement were available for 1703 individuals. In men, mean values ranged from 1.38 to 1.79 g/l for apo A-I, 1.03-1.36 g/l for apo B, and 0.26-0.67 g/l for Lp(a). In women, mean values ranged from 1.54 to 1.98, 1.20-1.51, and 0.26-0.68 g/l for apo A-I, apo B, and Lp(a), respectively. A comparison of northern (Norway, Denmark, Netherlands), middle (France, Switzerland), and southern (Portugal, Spain, Italy, Greece) communities showed a less atherogenic profile in the south, including lower LDL cholesterol, apo B, TC/HDL cholesterol ratio, and apoB/apo A-I ratio. Men, but not women, also had significantly higher HDL cholesterol and apo A-I concentrations in the South. Paradoxically, Lp(a) concentrations were generally high among all elderly and were significantly higher in the southern communities. These data show that the elderly in Europe are very heterogeneous with respect to plasma lipoproteins, including apo A-I, apo B, and Lp(a).
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Affiliation(s)
- J H Contois
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA.
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