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Pahwa B, Kazim SF, Vellek J, Alvarez-Crespo DJ, Shah S, Tarawneh O, Dicpinigaitis AJ, Grandhi R, Couldwell WT, Schmidt MH, Bowers CA. Frailty as a predictor of poor outcomes in patients with chronic subdural hematoma (cSDH): A systematic review of literature. World Neurosurg X 2024; 23:100372. [PMID: 38638610 PMCID: PMC11024655 DOI: 10.1016/j.wnsx.2024.100372] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Objective In recent years, frailty has been reported to be an important predictive factor associated with worse outcomes in neurosurgical patients. The purpose of the present systematic review was to analyze the impact of frailty on outcomes of chronic subdural hematoma (cSDH) patients. Methods We performed a systematic review of literature using the PubMed, Cochrane library, Wiley online library, and Web of Science databases following PRISMA guidelines of studies evaluating the effect of frailty on outcomes of cSDH published until January 31, 2023. Results A comprehensive literature search of databases yielded a total of 471 studies. Six studies with 4085 patients were included in our final qualitative systematic review. We found that frailty was associated with inferior outcomes (including mortality, complications, recurrence, and discharge disposition) in cSDH patients. Despite varying frailty scales/indices used across studies, negative outcomes occurred more frequently in patients that were frail than those who were not. Conclusions While the small number of available studies, and heterogenous methodology and reporting parameters precluded us from conducting a pooled analysis, the results of the present systematic review identify frailty as a robust predictor of worse outcomes in cSDH patients. Future studies with a larger sample size and consistent frailty scales/indices are warranted to strengthen the available evidence. The results of this work suggest a strong case for using frailty as a pre-operative risk stratification measure in cSDH patients.
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Affiliation(s)
- Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - John Vellek
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Smit Shah
- Department of Neurology, PRISMA Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Omar Tarawneh
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - William T. Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
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Pahwa B, Tayal A, Garg K. Contributions of Machine Learning in the Management of Stroke: A Bibliometric Analysis of the 50 Most Cited Articles. World Neurosurg 2024; 184:152-160. [PMID: 38244687 DOI: 10.1016/j.wneu.2024.01.059] [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: 07/26/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Though currently considered a 'black box,' machine learning (ML) has a promising future to ameliorate the health-care burden of stroke which is the second leading cause of mortality worldwide. Through this study, we sought to review the most influential articles on the applications of ML in stroke. METHODS Web of Sciences database was searched, and a list of the top 50 most cited articles, assessing the application of ML in stroke, was prepared by 2 authors, independently. Subsequently, a detailed analysis was performed to characterize the most impactful studies. RESULTS The total number of citations to the top 50 articles were 2959 (range 35-243 citations) with a median of 47 citations. Highest number of articles were published in the journal Stroke and the United States was the major contributing country. The majority of the studies focused on the utilization of ML to improve stroke risk prediction, diagnosis, and outcome prediction. Statistical analysis revealed an insignificant association between the total and mean number of citations and the impact factor of the journal (P = 0.516 and 0.987, respectively). CONCLUSIONS Recent years have witnessed a surge in the application of ML in stroke, with an enhancement in interest and funding over the years. ML has revolutionized the management of stroke and continues to aid in the neurosurgical decision-making and care in stroke patients.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Anish Tayal
- Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, India.
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Pahwa B, Shukla A. Role and contributions of women in revolutionizing neurosurgery. World Neurosurg X 2024; 22:100284. [PMID: 38444868 PMCID: PMC10914579 DOI: 10.1016/j.wnsx.2024.100284] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
We owe it to the women neurosurgeons for paving the way to a more gender-inclusive world of medicine. Their dedication and sacrifices have led them and their followers to scale unimaginable heights in terms of administrative positions, leadership, and academics. In today's scenario, it is safe to say that society has progressed considerably. Past years have seen an uprise in the number of females enrolling in a medical degree programme however, this proportion is highly distorted when it comes to specialties such as Neurosurgery. This disparity seems to be evolving and leveling out in all specialties, as more and more women are stepping out of their comfort zone and challenging the established standards of the society. It is with the collective efforts of all stakeholders and women that we see more women not only choosing such specialties which were previously uncharted terrain, but also leading organizations globally and excelling on the administrative and academic fronts. Veteran female surgeons have revolutionized neurosurgery and its subspecialties in unimaginable ways and the present as well as the future generation neurosurgeons continue to take inspiration from them and follow their footsteps. This paper has put together the contributions of female neurosurgeons in various subspecialties of neurosurgery as well as giving an account of the leadership and administrative positions served by women. We also shed light on the role of women as an academician and a researcher.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences, Delhi, India
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Tayal A, Gupta N, Pahwa B. Letter: Association Between Pseudoprogression of Vestibular Schwannoma After Radiosurgery and Radiological Features of Solid and Cystic Components. Neurosurgery 2024:00006123-990000000-01105. [PMID: 38529998 DOI: 10.1227/neu.0000000000002932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/07/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
- Anish Tayal
- University College of Medical Sciences and G.T.B. Hospital, Delhi, India
| | - Namrata Gupta
- Kasturba Medical College Manipal, Udupi, Karnataka, India
| | - Bhavya Pahwa
- University College of Medical Sciences and G.T.B. Hospital, Delhi, India
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Pahwa B, Tayal A, Chandra A, Das JM. Subdural Hematoma due to Dural Metastasis: A Systematic Review on Frequency, Clinical Characteristics, and Neurosurgical Management. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38437862 DOI: 10.1055/s-0044-1782141] [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: 03/06/2024]
Abstract
BACKGROUND Subdural hematoma (SDH) occasionally accompanies dural metastasis and is associated with high recurrence rate, significantly impacting patient morbidity and mortality. This systematic review aims to evaluate the characteristics, management options, and outcomes of patients with SDH associated with dural metastasis. METHODS A comprehensive search of the PubMed and Cochrane databases was conducted for English-language studies published from inception to March 20, 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors reviewed cases of histopathologically confirmed SDH with non-central nervous system (non-CNS) tumor metastasis, focusing on therapeutic management of SDH. Statistical analysis was performed using SPSS software, with a significance level set at 0.05. RESULTS This review included 32 studies comprising 37 patients with 43 SDH cases associated with dural metastasis. Chronic SDH was the most frequently observed presentation (n = 28, 65.12%). The systemic malignancies most commonly associated with SDH due to dural metastasis were prostate carcinoma (n = 9, 24.32%) and gastric carcinoma (n = 5, 13.51%). A statistically significant association was found between metastatic melanoma and subacute SDH (p = 0.010). The majority of patients were treated with burr holes (n = 15, 40.54%) or craniotomies (n = 14, 37.84%), with no statistically significant difference in mortality rates between the two techniques (p = 0.390). Adjuvant therapy was administered to a limited number of patients (n = 5, 13.51%), including chemotherapy (n = 2, 5.41%), whole brain radiotherapy (n = 1, 2.70%), a combination of chemotherapy and whole brain radiotherapy (n = 1, 2.70%), and transcatheter arterial chemoembolization (n = 1, 2.70%). The overall recurrence rate was 45.95% (n = 17), with burr holes being the most common management approach (n = 4, 10.81%). Within a median of 8 days, 67.57% (n = 25) of patients succumbed, primarily due to rebleeding (n = 3, 8.11%), disseminated intravascular coagulation (n = 3, 8.11%), and pneumonia (n = 3, 8.11%). CONCLUSION This review highlights the need for improving existing neurosurgical options and exploring novel treatment methods. It also emphasizes the importance of dural biopsy in patients with suspected metastasis to rule out a neoplastic etiology.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Anish Tayal
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Atulya Chandra
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Joe M Das
- Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom
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Idrees A, Rehman AU, Mehmood MA, Pahwa B, Mohsin A, Shaikh T, Jesrani EK, Chaurasia B. Perception of Neurosurgery as a Career Choice Among Early Career Doctors in Pakistan: A Nationwide Cross-Sectional Survey. World Neurosurg 2024; 183:e598-e602. [PMID: 38181874 DOI: 10.1016/j.wneu.2023.12.151] [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: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND A low neurosurgeon-to-patient ratio persists in many developing nations including Pakistan. We aimed to investigate the perceptions of medical students regarding neurosurgery as a first step toward recognizing this problem and potentially suggesting ways to solve it. METHODS A questionnaire was designed comprising 3 sections: 1) demographics, 2) possible challenges and perceptions regarding neurosurgery as a profession, and 3) general perceptions about neurosurgery. Statistical analysis was conducted, and a P value < 0.05 was considered significant. RESULTS Of 387 responses received, 44.4% of male respondents and 50.6% of female respondents revealed intent to consider opting for neurosurgery as a profession. Regression analysis revealed inadequate dexterity (P = 0.001) and inability to carry out private practice (P = 0.002) were responsible for increased likelihood of opting out of neurosurgery by medical students. CONCLUSIONS This study identified the perceptions that may influence the decision to pursue neurosurgical training among physicians early in their careers. Interventions including availability of day care facilities for children and introduction of curricula to promote neurosurgical knowledge in clinical training are expected to encourage the decision to pursue neurosurgery among medical students in Pakistan.
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Affiliation(s)
- Aiman Idrees
- King Edward Medical University, Lahore, Pakistan
| | | | | | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, Delhi, India.
| | | | | | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Pour‐Rashidi A, Pahwa B, Khanmirzaie MH, Fallahpour M, Hanif H, Shirani M. Risk factors and surgical approaches in neglected subaxial cervical spine fractures-dislocations: Experiences with two cases and literature review. Clin Case Rep 2024; 12:e8421. [PMID: 38223516 PMCID: PMC10784752 DOI: 10.1002/ccr3.8421] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024] Open
Abstract
This case report describes our experience of surgical strategies of two patients with neglected subaxial cervical spine fracture-dislocation that came to our center with subsequent follow-ups. Subaxial cervical spine fracture-dislocation must be immediately diagnosed and treated. However, it can be neglected in some cases, especially in developing health care systems and patients with low socioeconomic status. We reported two neglected subaxial cervical fracture-dislocation with a mean age of 54 years old who presented with axial cervical pain, and decreased muscle forces. In one out of two, cervical closed traction was applied, then unsuccessful result led to circumferential decompression and fixation via anterior-posterior (AP) approach. Accordingly, we used AP approach without applying closed reduction in another patient successfully. Except one of our cases who died after 2 weeks of surgery due to aspiration pneumonia, other one found complete improvement at the end of 6-month follow-up. Our study emphasizes the importance of AP approach in patients with irreducible joint dislocations. The approach can minimize the surgical risks and increase the cost-benefit as compared to three or more staged approaches. Our approach is less intensive than some other AP approaches while is a safe and efficacious procedure since the posterior reduction is not performed before discectomy and decompression.
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Affiliation(s)
- Ahmad Pour‐Rashidi
- Department of Neurosurgery, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB HospitalDelhiIndia
| | | | - Mahshid Fallahpour
- Department of Public HealthSan Diego State University (SDSU)‐University of California San Diego (UCSD)San DiegoCaliforniaUSA
| | - Hamed Hanif
- Department of Neurosurgery, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Mohammad Shirani
- Department of Neurosurgery, Sina HospitalTehran University of Medical SciencesTehranIran
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Nousheen R, Surendran AK, Nagre A, Pahwa B. Letter to the Editor. Geospatial clustering analysis in neurosurgery and the need for gender diversity. J Neurosurg 2023; 140:1207-1208. [PMID: 38157523 DOI: 10.3171/2023.10.jns232327] [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] [Indexed: 01/03/2024]
Affiliation(s)
| | | | | | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, Delhi, India
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Tayal A, Pahwa B, Chaurasia B, Gendle C, Sahoo SK, Singh A, Gupta SK, Dhandapani S. The Call for Neuroendoscopy Cadaveric Workshops in Lower-Middle Income Countries. World Neurosurg 2023; 180:e537-e549. [PMID: 37778622 DOI: 10.1016/j.wneu.2023.09.108] [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: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE This study aims to assess the impact of the workshops organized during Neuroendocon 23 on the perspective and confidence of neurosurgeons toward endoscopy in a lower-middle income country. METHODS Neuroendocon 23 had cranial and spinal endoscopy cadaveric workshops with 30 delegates each. A pre and postworkshop survey was disseminated among the delegates, and statistical analysis was performed with SPSS (version 26) using P < 0.05. RESULTS A total of 24 delegates (40%) consented to participate in the study, with only 1 female respondent (4.17%). After the cranial endoscopy workshop, there was an increase in the level of confidence of delegates in cranial endoscopic approaches (P < 0.001). Similarly, after the spine endoscopy workshop, the respondents had increased confidence in managing spine conditions with the endoscopic approach (P = 0.040), to the extent that they preferred the endoscopic over the microsurgical technique (P < 0.001). All respondents (n = 24, 100%) believed that endoscopy should be promoted in lower-middle income countries and integrated into residency curricula. CONCLUSIONS Cranial and spinal endoscopy cadaveric workshops could be the first step in stimulating the interest of neurosurgeons in endoscopy.
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Affiliation(s)
- Anish Tayal
- Medical Student, University College of Medical Sciences and G.T.B. Hospital, Delhi, India
| | - Bhavya Pahwa
- Medical Student, University College of Medical Sciences and G.T.B. Hospital, Delhi, India
| | - Bipin Chaurasia
- Consultant Neurosurgeon, Neurosurgery Clinic, Birgunj, Nepal
| | | | | | | | - Sunil K Gupta
- Department of Neurosurgery, PGIMER, Chandigarh, India
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Tayal A, Pahwa B, Garg K. Reoperation rate and risk factors of reoperation for ossification of the posterior longitudinal ligament (OPLL): a systematic review and meta-analysis. Neurosurg Rev 2023; 46:313. [PMID: 37996772 DOI: 10.1007/s10143-023-02215-w] [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: 07/25/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
Revision surgery for OPLL is undesirable for both patients and physicians. However, the risk factors for reoperation are not clear. Thus, we sought to review the existing literature and determine the factors associated with higher reoperation rates in patients with OPLL. A search was performed using Pubmed, Embase, Web of Sciences, and Ovid to include studies regarding the risk factors of reoperation for OPLL. RoBANS (Risk of Bias Assessment tool for Nonrandomized Studies) was used for risk of bias analysis. Heterogeneity of studies and publication bias was assessed, and sensitivity analysis was performed. Statistical analysis was performed with a p-value < 0.05 using SPSS software (version 23). Twenty studies with 129 reoperated and 2,793 non-reoperated patients were included. The pooled reoperation rate was 5% (95% CI: 4% to 7). The most common cause of reoperation was residual OPLL or OPLL progression (n = 51, 39.53%). An increased risk of additional surgery was found with pre-operative cervical or thoracic angle (Standardized mean difference = -0.44; 95% CI: -0.69 to -0.19; p = 0.0061), post-operative CSF leak (Odds ratio, OR = 4.97; 95% CI: 2.48 to 9.96; p = 0.0005), and graft and/or hardware failure (OR = 192.09; 95% CI: 6.68 to 5521.69; p = 0.0101). Apart from the factors identified in our study, the association of other variables with the risk of second surgery could not be ruled out, owing to the complexity of the relationship and significant bias in the current literature.
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Affiliation(s)
- Anish Tayal
- University College of Medical Sciences and G.T.B. Hospital, Delhi, India
| | - Bhavya Pahwa
- University College of Medical Sciences and G.T.B. Hospital, Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, India.
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Trivedi J, Sabharwal I, Rao V, Pahwa B. Letter to the Editor. Evaluating leadership in pediatric neurosurgery fellowships. J Neurosurg Pediatr 2023; 33:105-107. [PMID: 37948700 DOI: 10.3171/2023.8.peds23377] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Jaimin Trivedi
- Pandit Deendayal Upadhyay Medical College, Rajkot, India
| | | | - Varun Rao
- Indiana University School of Medicine, Indianapolis, IN
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, Delhi, India
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Pahwa B, Azad TD, Liu J, Ran K, Liu CJ, Tracz J, Sattari SA, Khalifeh JM, Judy BF, Bydon A, Witham TF. Assessing the Accuracy of Spinal Instrumentation Using Augmented Reality (AR): A Systematic Review of the Literature and Meta-Analysis. J Clin Med 2023; 12:6741. [PMID: 37959207 PMCID: PMC10649145 DOI: 10.3390/jcm12216741] [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: 08/15/2023] [Revised: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Technological advancements, particularly in the realm of augmented reality (AR), may facilitate more accurate and precise pedicle screw placement. AR integrates virtual data into the operator's real-world view, allowing for the visualization of patient-specific anatomy and navigated trajectories. We aimed to conduct a meta-analysis of the accuracy of pedicle screw placement using AR-based systems. A systematic review of the literature and meta-analysis was performed using the PubMed/MEDLINE database, including studies reporting the accuracy of pedicle screw placement using AR. In total, 8 studies with 163 patients and 1259 screws were included in the analysis. XVision (XVS) was the most commonly used AR system (595 screws) followed by the Allura AR surgical navigation system (ARSN) (462 screws). The overall accuracy was calculated as 97.2% (95% CI 96.2-98.1% p < 0.001). Subgroup analysis revealed that there was no statistically significant difference in the accuracy rates achieved by XVS and Allura ARSN (p = 0.092). AR enables reliable, accurate placement of spinal instrumentation. Future research efforts should focus on comparative studies, cost effectiveness, operative time, and radiation exposure.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences, GTB Hospital, New Delhi 110095, India;
| | - Tej D. Azad
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Jiaqi Liu
- School of Medicine, Georgetown University, Washington, DC 20007, USA
| | - Kathleen Ran
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Connor J. Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Jovanna Tracz
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Jawad M. Khalifeh
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Brendan F. Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Timothy F. Witham
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
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Pahwa B, Tayal A, Chowdhury D, Umana GE, Chaurasia B. Endoscopic versus microscopic discectomy for pathologies of lumbar spine: A nationwide cross-sectional study from a lower-middle-income country. J Craniovertebr Junction Spine 2023; 14:373-380. [PMID: 38268688 PMCID: PMC10805162 DOI: 10.4103/jcvjs.jcvjs_39_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/21/2023] [Indexed: 01/26/2024] Open
Abstract
Objective We conducted a cross-sectional study to assess the preference of spine surgeons between MD for microdiscectomy and endoscopic discectomy (ED) surgery for the management of lumbar pathologies in a lower-middle-income country (LMIC). Methodology An online survey assessing the preference of spine surgeons for various lumbar pathologies was developed and disseminated in "Neurosurgery Cocktail" a social media platform. Statistical analyses were performed using SPSS software with a level of significance <0.05. Results We received responses from 160 spine surgeons having a median experience of 6.75 years (range 0-42 years) after residency. Most of the spine surgeons preferred MD over ED, preference being homogeneous across all lumbar pathologies. In ED, the interlaminar approach was preferred more frequently than the transforaminal approach. The most commonly chosen contraindication for the interlaminar approach and transforaminal approach was ≥ 3 levels lumbar disc herniation (LDH) (n = 117, 73.1%) and calcified LDH (n = 102, 63.8%), respectively. There was no significant association between the type of approach preferred (MD vs. ED; and interlaminar vs. translaminar endoscopic approach) with the type of workplace and the level of experience. Conclusion Spine surgeons were inclined toward MD over ED, due to various reasons, such as a steep learning curve, lack of training opportunities, and upfront expenses. There is a pressing need for the upliftment of ED in LMICs which requires global action.
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Affiliation(s)
- Bhavya Pahwa
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Anish Tayal
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Dhiman Chowdhury
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Ahmed MF, Rana S, Zahan KFI, Munira S, Islam MS, Haque M, Pahwa B, Aydin L, Umana GEE, Chaurasia B. Brain Abscess: A Comparison of Surgical Outcomes between Conventional Burr Hole Aspiration and Endoscope-assisted Evacuation. J Neurol Surg A Cent Eur Neurosurg 2023. [PMID: 37703913 DOI: 10.1055/a-2175-3018] [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: 09/15/2023]
Abstract
OBJECTIVE Brain abscess is a major health problem with a significant morbidity and mortality rate. The objective of this study was to compare the surgical efficacy between endoscope-assisted evacuations of brain abscess with a single burr hole aspiration procedure in a tertiary health care center. METHODS This single center non-randomized clinical study was conducted in our Department of Neurosurgery during the period of July 2020 to December 2021. Patients under 30 years of age of both genders presented with brain abscess were enrolled in this study. Patients were treated with two different techniques and divided into 2 groups: conventional burr hole aspiration group and endoscope-assisted evacuation group. RESULTS Thirty patients were enrolled for this study. The mean age was 13.0 ± 6.3 years in burr hole group and is 13.1 ± 6.4 years in endoscope-assisted group. This study showed ≥75.0% evacuation of brain abscess at 1st post-operative day in 13 (92.9%) patients in endoscope-assisted group and 5 (33.3%) patients in burr hole group. This study showed mortality rate of 6.7% in both the groups. Mean residual volume at 30th post-operative day was 0.75 ml in endoscope-assisted group and 1.75 ml in burr hole aspiration group. No patients treated with required endoscope-assisted evacuation required a repeated surgery, whereas 5 patients (33.3%) of patients treated with conventional burr hole required it. CONCLUSIONS This study showed that endoscope-assisted procedure has better rate of abscess evacuation, less chance of residual and repeated surgeries than conventional burr hole.
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Affiliation(s)
- Md Farhad Ahmed
- Neurosurgery, National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Bangladesh
| | - Sumon Rana
- Neurosurgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | | | - Shirazum Munira
- Neurosurgery, Directorate General of Health Services,Dhaka, Dhaka, Bangladesh
| | | | - Monzurul Haque
- Neurosurgery, Dhaka National Medical College and Hospital, Dhaka, Bangladesh
| | - Bhavya Pahwa
- medical student, University College of Medical Sciences, Delhi, India
| | - Levent Aydin
- Neurosurgery, Mus State Hospital, istanbul, Turkey
| | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery clinic ,Birgunj,Nepal, Birgunj, Nepal
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15
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Pahwa B, Das S, Singh G, Anu MM. Association of predictive factors and neurosurgical postoperative infections: A retrospective analysis. Clin Neurol Neurosurg 2023; 232:107880. [PMID: 37454601 DOI: 10.1016/j.clineuro.2023.107880] [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: 04/19/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To identify the factors that predispose neurosurgical patients to surgical site infections (SSI) as well as assess the risk factors attached to infection by a specific microorganism. METHODOLOGY A retrospective case-control study was conducted at University College of Medical Sciences and G.T.B. Hospital, Delhi. Adult patients (>18 years) undergoing a neurosurgical procedure with a diagnosis of SSI in the year 2021 having a minimum follow up of 30 days postoperatively or until death if they survived less than 30 days were included. Statistical analysis was performed using the SPSS 16 software with level of significance at 0.05. RESULTS An incidence of 3.15% was observed at our center. Mean age of the study population was 39.2 ± 13.07 years (range 22-70 years) with a male: female ratio of 3:1. Having an underlying infection (p = 0.024), ASA score> 2 (p = 0.041), duration of surgery> 4 h (p = 0.025), diabetes (p = 0.027) and preoperative stay at the hospital (p = 0.036) were found to be statistically significant risk factors in the prediction of SSI in neurosurgical patients which were utilised to create a regression model with an accuracy of 70% and AUC of 0.833. Deep infections were found to have a significant association with positive culture on the collected samples (p = 0.035). CONCLUSIONS This study is a starting point to identify which factors could predict the presence of a particular organism isolated from the site of infection in neurosurgical patients, thereby minimizing AMR.
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Affiliation(s)
- Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India.
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Gurbachan Singh
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - M M Anu
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
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Pahwa B, Tayal A, Shukla A. Learnings from Asia's first ever medical student neurosurgery Conference: NEUROFEST, 2022. J Clin Neurosci 2023; 115:114-120. [PMID: 37544206 DOI: 10.1016/j.jocn.2023.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/23/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
The study lays out the design and learnings of Neurofest, Asia's first ever medical student Neurosurgery conference organized by Walter E Dandy Medical Student Neurosurgery Club, India. Neurofest was conducted in October 2022 inclusive of various events: workshops, talks and contests. An online post-conference questionnaire was disseminated among the delegates to record their experience and feedback for the conference. Statistical analysis was performed using SPSS with a level of significance p < 0.05. Of the 158 total delegates, 65.2% (n = 103) participated in this study. The majority of the responders were satisfied with the events at the conference. 85.4% (n = 88) of the respondents reported an increased interest in neurosurgery, probably due to the quality of workshops (p = 0.004), talks by faculty (p = 0.023), contacts with the faculty (p = 0.025) and confidence in approaching a faculty (p < 0.001). 92.2% (n = 95) of the respondents claimed to recommend Neurofest to their colleagues. The reasons for this were found to be the quality of workshops (p = 0.001) and confidence in approaching a faculty (p = 0.030). Nearly all respondents believed that such conferences are important in empowering medical students (n = 100, 97.1%). Similar conferences are required to provide medical students with early exposure to neurosurgery. In the future, continued research is required to optimize neurosurgical conferences and endorse the prospect of neurosurgery as a career option in Lower-Middle Income countries.
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Affiliation(s)
- Bhavya Pahwa
- Organizing Chairperson, Neurofest; Founding President, Walter E. Dandy Neurosurgical Club, India; Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India.
| | - Anish Tayal
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Anushruti Shukla
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
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Singh G, Rao V, Thamba A, Pahwa B, Zaazoue M. Spine Injuries in Household Environments: A Comprehensive Analysis. Cureus 2023; 15:e44275. [PMID: 37645670 PMCID: PMC10462396 DOI: 10.7759/cureus.44275] [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] [Accepted: 08/28/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Recognizing the concerns posed by spine injuries within homes, stemming from falls, interactions with furnishings, and daily activities, it is imperative to consider preventive strategies. Our analysis of spine injuries utilizing the National Electronic Injury Surveillance System (NEISS) data sheds light on falls, furnishings, age-specific risks, recreation, technology, and socioeconomic disparities as contributing elements, accentuating the need for targeted interventions. This study aims to provide insights into the prevalence of spine injuries in different household locations, associated products, age groups, and gender, thus informing injury prevention strategies for safer living environments. Methods This is a retrospective, cross-sectional study utilizing data between 2013 to 2022 from the National Electronic Injury Surveillance System database. Specific household product codes and demographic data, such as age and gender, were analyzed. Statistical analysis in R (R Foundation for Statistical Computing, Vienna, Austria) involved descriptive statistics and multivariate logistic regressions. Results In analyzing 44,267 spine injuries, the study revealed location-specific variations in spine injuries within households. Living rooms and bedrooms had the highest injury rates at 34.17% and 21.65%, respectively. Significant differences in injury rates between males and females across various home locations. Females accounted for 51.78% of injuries in the living room and 59.99% in the bedroom. In the kitchen, females experienced 53.21% of injuries, while males accounted for 46.79% of cases. Notably, overall spine injuries exhibited a significant difference between males and females, with females having a higher total likelihood of injuries (AOR = 1.21, 95% CI: 1.14-1.77, p < 0.001). Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, accounting for 17.98% of total cases. Notably, the age group of 61-70 years exhibited a substantial proportion of injuries at 17.12%, while the age group of 71-80 years accounted for 14.39%. The age group of 41-50 years also displayed a notable injury rate of 14.12%. The youngest age group, 0-10 years, demonstrated the lowest percentage of injuries at 4.79%. This age-based analysis provides valuable insights into the distribution of spine injuries across different demographic segments. Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, comprising 17.98% of total cases. Age groups of 41-50 and 61-70 years also showed substantial proportions of injuries, accounting for 14.12% and 17.12%, respectively. The youngest age group, 0-10, exhibited the lowest percentage of injuries at 4.79%. Conclusion The study focuses on the occurrence of spinal injuries in common sites of injury in the household, such as the living room, bedroom, kitchen, and stairs. There is increased prevalence amongst females and increased risk vulnerability amongst people 51 to 60 years of age. Our research emphasizes the necessity of implementing specific injury prevention measures tailored to different demographic groups within their home setting. This approach should involve collaborative decision-making with patients while prioritizing patient education to create a safer living environment and reduce the likelihood of spine injuries.
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Affiliation(s)
- Gurbinder Singh
- Department of Orthopaedic Surgery, University of California-San Francisco School of Medicine, San Francisco, USA
| | - Varun Rao
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Aish Thamba
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bhavya Pahwa
- Medical School, University College of Medical Sciences, New Delhi, Delhi, IND
| | - Mohamed Zaazoue
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
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Montemurro N, Pierozzi E, Inchingolo AM, Pahwa B, De Carlo A, Palermo A, Scarola R, Dipalma G, Corsalini M, Inchingolo AD, Inchingolo F, Rapone B. New biograft solution, growth factors and bone regenerative approaches in neurosurgery, dentistry, and orthopedics: a review. Eur Rev Med Pharmacol Sci 2023; 27:7653-7664. [PMID: 37667943 DOI: 10.26355/eurrev_202308_33419] [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] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Bone regeneration following surgery, trauma, or any other condition is an autologous process that can fail, necessitating the requirement of novel procedures and materials. Recently, significant progress has been made in the research related to regenerative medicine. At the same time, biomedical implants in spine surgery, orthopedics, and dentistry are facing many challenges and posing clinical concerns. A PubMed, MEDLINE, and Scopus review was carried out to identify all studies dealing with bone regenerative approaches in dentistry, orthopedics, and neurosurgery from database inception to December 2022. There has been an upsurge in the implication of a multitude of materials in the enhancement of bone regeneration and/or neo-bone formation, including blood-derived growth factors, new biografts, biosynthetic polymers, inorganic compounds, and sea corals, in the very recent years. Stem cells (SCs) have been found to be efficacious and safe modalities in osteogenesis. Furthermore, bone regeneration/formation depends on the host's immune system and metabolic condition. Epidermal growth factors (EGFs) and their receptors (EGFRs) are important in the mechanism of wound repairing and healing through the recruitment of stromal stem cells for epidermal and dermal regeneration. Similarly, biocomposite developed from Silica assembled with calcium and phosphorous has been utilized in the treatment of broken bones. In this review, we summarized the clinical and laboratory evidence of bone regenerative approaches in the field of spine surgery, orthopedics, and dentistry. An accurate pre-operative screening is the key to managing and carefully planning all surgical steps and achieving the final success.
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Affiliation(s)
- N Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy.
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Malhotra A, Bajaj S, Garg T, Khunte M, Pahwa B, Wu X, Payabvash S, Mukherjee S, Gandhi D, Forman HP. American College of Radiology Appropriateness Criteria®: a bibliometric analysis of panel members. Insights Imaging 2023; 14:113. [PMID: 37395838 PMCID: PMC10317907 DOI: 10.1186/s13244-023-01456-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/12/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE To assess the features of panel members involved in the writing of the ACR-AC and identify alignment with research output and topic-specific research publications. METHODS A cross-sectional analysis was performed on the research output of panel members of 34 ACR-AC documents published in 2021. For each author, we searched Medline to record total number of papers (P), total number of ACR-AC papers (C) and total number of previously published papers that are relevant to the ACR-AC topic (R). RESULTS Three hundred eighty-three different panel members constituted 602 panel positions for creating 34 ACR-AC in 2021 with a median panel size of 17 members. Sixty-eight (17.5%) of experts had been part of ≥10 previously published ACR-AC papers and 154 (40%) were members in ≥ 5 published ACR-AC papers. The median number of previously published papers relevant to the ACR-AC topic was 1 (IQR: 0-5). 44% of the panel members had no previously published paper relevant to the ACR-AC topic. The proportion of ACR-AC papers (C/P) was higher for authors with ≥ 5 ACR-AC papers (0.21) than authors with < 5 ACR-AC papers (0.11, p < 0.0001); however, proportion of relevant papers per topic (R/P) was higher for authors with < 5 ACR-AC papers (0.10) than authors with ≥ 5 ACR-AC papers (0.07). CONCLUSION The composition of the ACR Appropriateness Criteria panels reflects many members with little or no previously published literature on the topic of consideration. Similar pool of experts exists on multiple expert panels formulating imaging appropriateness guidelines. KEY POINTS There were 68 (17.5%) panel experts on ≥ 10 ACR-AC panels. Nearly 45% of the panel experts had zero median number of relevant papers. Fifteen panels (44%) had > 50% of members having zero relevant papers.
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Affiliation(s)
- Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA.
| | - Suryansh Bajaj
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mihir Khunte
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Bhavya Pahwa
- University College of Medical Sciences, Delhi, India
| | - Xiao Wu
- Department of Radiology, University of California at San Francisco, San Francisco, USA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Suresh Mukherjee
- Radiology and Radiation Oncology, University of Illinois, Peoria, IL and Robert Wood Johnson Medical School, Newark, NJ, USA
| | - Dheeraj Gandhi
- Interventional Neuroradiology, Nuclear Medicine, Neurology and Neurosurgery, University of Maryland School of Medicine, Maryland, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
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Uppal S, Pahwa B, Saggar V, Uppal S, Uppal A, Sharma M, Chaurasia B. Intracranial Fungal Granuloma Mimicking as Meningioma in Immunocompetent Patient. Neurol India 2023; 71:788-789. [PMID: 37635523 DOI: 10.4103/0028-3886.383843] [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] [Indexed: 08/29/2023]
Affiliation(s)
- Shikhil Uppal
- Department of Neurosciences, Uppal Neuro Hospital, Amritsar, Punjab, India
| | - Bhavya Pahwa
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Vineet Saggar
- Department of Neurosciences, Uppal Neuro Hospital, Amritsar, Punjab, India
| | - Salil Uppal
- Department of Neurosciences, Uppal Neuro Hospital, Amritsar, Punjab, India
| | - Ashok Uppal
- Department of Neurosciences, Uppal Neuro Hospital, Amritsar, Punjab, India
| | - Manisha Sharma
- Department of Pathology, Uppal Neuro Hospital, Amritsar, Punjab, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Pahwa B, Leskinen S, Didia E, Huda S, D'Amico RS. Role of nutritional adjuncts in the management of gliomas: A systematic review of literature. Clin Neurol Neurosurg 2023; 231:107853. [PMID: 37390567 DOI: 10.1016/j.clineuro.2023.107853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND A variety of dietary adjuncts are known to affect the pathophysiology of glioma, making them a potential therapeutic adjunct to standard of care. We systematically reviewed clinical outcomes in glioma patients treated with one or more nutritional adjunct and/or an antimetabolite drug. METHODOLOGY A systematic review of the literature following PRISMA guidelines was performed using Pubmed from inception till February 2023. In total, 22 manuscripts on nutrition representing 828 patients were included in the review. Statistical analyses were performed to compare the outcomes of various adjuncts. RESULTS The median overall survival (OS) increased for newly diagnosed (21 months) and recurrent cases (10 months) when compared to historical data. For newly diagnosed cases, a ketogenic diet had the highest median OS of all the adjuncts (42.6 months) while in recurrent cases, a low copper diet coupled with 1 g penicillamine had the highest median OS (18.5 months). However, no statistically significant difference was observed in OS or progression-free survival (PFS) of newly diagnosed or recurrent gliomas. CONCLUSION While nutritional adjuncts may offer a therapeutic benefit in the treatment of glioma, more human subject research is needed to derive meaningful conclusions.
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Affiliation(s)
- Bhavya Pahwa
- Department of Neurosurgery, UCMS and GTB Hospital, Delhi, India
| | - Sandra Leskinen
- State University of New York Downstate Medical School, New York, USA
| | | | - Shayan Huda
- City University of New York School of Medicine, New York, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
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Pahwa B, Tayal A, Shukla A, Soni U, Gupta N, Bassey E, Sharma M. Utility of Machine learning in the Management of Normal Pressure Hydrocephalus (NPH): A Systematic Review. World Neurosurg 2023:S1878-8750(23)00847-1. [PMID: 37356488 DOI: 10.1016/j.wneu.2023.06.080] [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: 04/02/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND In the past decade many machine learning (ML) models have been utilized in the management of normal pressure hydrocephalus (NPH). This study aims at systematically reviewing those ML models. METHODS Pubmed, EMBASE and Web of Science databases were searched for studies reporting applications of ML in NPH. Quality assessment was performed using PROBAST and TRIPOD adherence reporting guidelines and statistical analysis was performed with level of significance <0.05. RESULTS A total of 22 studies with 53 models were included in the review of which convolutional neural network (CNN) was the most utilized model. Inputs used to train various models included clinical features, CT scan, MRI, intracranial pulse waveform characteristics and perfusion infusion. The overall mean accuracy of the models was 77% (highest for CNN, 98% while lowest for Decision tree (DT), 55% p=0.176). There was a statistically significant difference in the accuracy and AUC of diagnostic and interventional models (accuracy; 83.4% vs 69.4%, AUC; 0.882 vs 0.729, p <0.001). Overall, 59.09% (n = 13) and 81.82% (n = 18) of the studies had high-risk bias and high-applicability, respectively, on PROBAST assessment; however only 55.15% of the studies adhered to the TRIPOD statement. CONCLUSIONS Though highly accurate, there are many challenges to current ML models necessitating the need to standardize the ML models to enable comparison across the studies and enhance the NPH decision making and care.
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Affiliation(s)
- Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Anish Tayal
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Anushruti Shukla
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Ujjwal Soni
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Namrata Gupta
- Medical Student, KMC Manipal, Udupi, Karnataka, India
| | - Esther Bassey
- Student of BSc physiology, University of Uyo, Uyo, Akwa Ibom, Nigeria
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America.
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23
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Montemurro N, Pahwa B, Tayal A, Shukla A, De Jesus Encarnacion M, Ramirez I, Nurmukhametov R, Chavda V, De Carlo A. Macrophages in Recurrent Glioblastoma as a Prognostic Factor in the Synergistic System of the Tumor Microenvironment. Neurol Int 2023; 15:595-608. [PMID: 37218976 DOI: 10.3390/neurolint15020037] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 03/12/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Glioblastoma (GBM) is a common and highly malignant primary tumor of the central nervous system in adults. Ever more recent papers are focusing on understanding the role of the tumor microenvironment (TME) in affecting tumorigenesis and the subsequent prognosis. We assessed the impact of macrophages in the TME on the prognosis in patients with recurrent GBM. A PubMed, MEDLINE and Scopus review was conducted to identify all studies dealing with macrophages in the GBM microenvironment from January 2016 to December 2022. Glioma-associated macrophages (GAMs) act critically in enhancing tumor progression and can alter drug resistance, promoting resistance to radiotherapy and establishing an immunosuppressive environment. M1 macrophages are characterized by increased secretion of proinflammatory cytokines, such as IL-1ß, tumor necrosis factor (TNF), IL-27, matrix metalloproteinase (MMPs), CCL2, and VEGF (vascular endothelial growth factor), IGF1, that can lead to the destruction of the tissue. In contrast, M2 is supposed to participate in immunosuppression and tumor progression, which is formed after being exposed to the macrophage M-CSF, IL-10, IL-35 and the transforming growth factor-ß (TGF-β). Because there is currently no standard of care in recurrent GBM, novel identified targeted therapies based on the complex signaling and interactions between the glioma stem cells (GSCs) and the TME, especially resident microglia and bone-marrow-derived macrophages, may be helpful in improving the overall survival of these patients in the near future.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | - Anish Tayal
- University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | - Anushruti Shukla
- University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | | | - Issael Ramirez
- Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Renat Nurmukhametov
- Department of Spinal Surgery, Central Clinical Hospital of the Russian Academy of Sciences, 121359 Moscow, Russia
| | - Vishal Chavda
- Department of Pathology, Stanford of School of Medicine, Stanford University Medical Centre, Palo Alto, CA 94305, USA
| | - Antonella De Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
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Sharma M, Wang D, Ugiliweneza B, Pahwa B, Boakye M, Williams BJ, Abecassis I. Trends and Impact of Treatment modalities (Surgery and Radiation Therapy) on Health Care utilization in patients with Glomus Jugulare Tumors (GJTs): An Inverse Probability of Treatment Weight Analysis. World Neurosurg 2023:S1878-8750(23)00542-9. [PMID: 37087034 DOI: 10.1016/j.wneu.2023.04.057] [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: 03/17/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVES The trend of practice pattern and impact on healthcare utilization for surgery and radiation therapy (RT) in patients with glomus Jugulare tumors (GJTs) is not well defined. MATERIALS AND METHODS MarketScan database was queried using the ICD-9/10 and CPT 4th edition, 2000-2020. We included patients ≥ 18 years of age who underwent either surgery or RT with at-least 1-year follow-up. We compared the health care utilization at 3-month, 6-month and 1-year follow up using the inverse probability of treatment weight (IPTW) technique. RESULTS A cohort of 333 patients was identified. Of these, 72.7% (n=242) underwent RT and 27.3% (n=91) underwent surgery. RT use increased from 2002-2004 (50%) to 2017-2019 (91%). Patients in the surgery cohort were younger (median age 49 vs. 56 years, p<0.0001) and had a higher 3+ comorbidity index (34% vs. 30%, p=0.43) compared to patients in the RT cohort. Patient who underwent surgery had higher complications at index hospitalization (22% vs. 6%, p<0.0001) and at 30 days (14% vs. 5%, p=0.0042). No difference in combined index and 6- or 12-months payments were noted (6-months: surgery, $66108, RT: $43509, p=0.1034; 12-months: surgery, $73259, RT: $51576, p=0.1817). Only 4% of patients who had initial RT underwent RT and none underwent surgery at 12 months, whereas 6% of patients who had initial surgery underwent RT and 2% underwent surgery at 12 months. CONCLUSION RT plays an increasingly important role in the treatment for patients with GJTs, with less complications and a comparable health care utilization at 1 year.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, U.S.A, 40202; Department of Neurosurgery, University of Minnesota, MMC 96, 420 Delaware St. SE, Minneapolis, MN, 55455.
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, U.S.A, 40202
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, U.S.A, 40202
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, U.S.A, 40202
| | - Brian J Williams
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, U.S.A, 40202
| | - Isaac Abecassis
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, U.S.A, 40202
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Sitaraman S, S H, Pahwa B, Tayal A, Shukla A. Letter to the Editor Regarding Reevaluating Innovations in Medical Student Neurosurgery Education: Lessons Learned Today from Data Collected Before COVID-19. World Neurosurg 2023; 172:102. [PMID: 37012708 DOI: 10.1016/j.wneu.2022.12.030] [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] [Received: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 03/31/2023]
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Chaurasia B, Pahwa B, Shah A, Vantha T, Chaurasia RK, Diyora B, Garg K, Maggiora P, Moez K, Boubaker A, Dantas FLR, Beraldo RF, Ragab AbdelSalam A, Fergany Ali MH, Tatarchuk M, M F El-Ghandour N. In Memorium: Neurosurgeons We Lost in 2022. World Neurosurg 2023; 173:S1878-8750(23)00183-3. [PMID: 36894489 PMCID: PMC9978927 DOI: 10.1016/j.wneu.2023.02.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Abhidha Shah
- Department of Neurosurgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Tho Vantha
- Department of Neurosurgery, Kantha Bopha Hospital, Phnom Penh, Cambodia
| | | | - Batuk Diyora
- Department of Neurosurgery, LTMMC and LTMG General Hospital, Mumbai, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Khemakhem Moez
- Department of Neurosurgery, Kharj Military Hospital, Riyadh, Saudi Arabia
| | - Adnen Boubaker
- Department of Neurosurgery, King Abdulaziz Hospital, Taif, Saudi Arabia
| | - Fernando Luiz Rolemberg Dantas
- Department of Neurosurgery, Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, Brazil
| | - Renato Fedatto Beraldo
- Department of Neurosurgery, Hospital Universitario Cajuru, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
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Pahwa B, Chaurasia B, Garg K, Bozkurt I, Deora H. Factors Affecting the Choice of Neurosurgery Subspecialty: A Geographic and Gender-Wise Analysis. World Neurosurg 2023; 171:e864-e873. [PMID: 36623726 DOI: 10.1016/j.wneu.2023.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/03/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To understand the factors that affect decision-making when choosing a specific subspecialty while exploring gender and geographic variables. METHODS A cross-sectional, 13-item, nonrandomized online survey was created and shared over various social media platforms of the Neurosurgery Cocktail. Data were collected between January and April 2022. The survey focused on the amount of exposure to subspecialties during training, along with factors affecting the decision in choosing a specific subspecialty. RESULTS A total of 207 respondents, predominantly from Asian and European countries, with an 83.6% dominance of male respondents, completed the survey. The most common subspecialties with maximum exposure were neurosurgical oncology, spine, and neurocritical care and trauma, whereas peripheral nerve surgery and stereotactic and functional neurosurgery were the least exposed. In total, 70% of the respondents had no training or degree in a subspecialty, which was the greatest in Asian and African countries (P = 0.0205). Respondents found the prestige and lifestyle of a skull base neurosurgeon very attractive (P = 0.027, 0.034 respectively), whereas the lifestyle and salary of spine neurosurgeons made it a popular subspecialty (P < 0.001, 0.008, respectively). Personal interest in neurosurgical oncology established its popularity among the respondents (P = 0.028). CONCLUSIONS Stereotactic and functional neurosurgery and peripheral nerve surgery are the emerging subspecialties and hence their exposure and access are highly limited to the developed world whereas spine and neurosurgical oncology branches had a homogenous geographic presence. Pediatric neurosurgery had the most female representation, thereby necessitating the need to uplift women in other subspecialties.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences, New Delhi, India.
| | | | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ismail Bozkurt
- Department of Neurosurgery, Medical Park Batikent Hospital, Ankara, Turkey
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
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Naik V, Pahwa B, Singh M, Kale S, Agrawal D. Correlation Based on the WHO Grading with Tumor Control and Clinical Outcome Following Gamma Knife Radiosurgery in Meningiomas. Neurol India 2023; 71:S140-S145. [PMID: 37026345 DOI: 10.4103/0028-3886.373628] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Background and Aim The aim of this study was to study the effect of Gamma Knife (GK) on meningiomas based on the World Health Organization's (WHO) grading system in terms of tumor control and final clinical outcome. Methodology This retrospective study included clinicoradiological and GK characteristics of patients who had undergone GK for meningiomas at our institute from April 1997 until December 2009. Results Of 440 patients, 235 underwent secondary GK for residual/recurrent lesion and 205 received primary GK. Of the 137 patients whose biopsy slide could be reviewed, 111 patients had grade I, 16 had grade II, and 10 had grade III meningiomas. Good tumor control rates were seen in 96.3% of grade I meningioma patients, 62.5% of 16 grade II, and 10% of grade III meningioma patients at median follow-up of 40 months. Age, sex, Simpson's grade of excision, and increasing peripheral dose of GK did not affect the response to radiosurgery (P > 0.05). Multivariate analysis showed that high-grade tumor and radiotherapy prior to GK were important negative predictors for progression of tumor size after GK radiosurgery (GKRS) (P < 0.05). In patients with WHO grade I meningioma, radiation therapy prior to GKRS and repeat surgery were predictors for poorer outcome. Conclusion In WHO grades II and III meningiomas, no factors affected tumor control except the histology itself.
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Affiliation(s)
- Vikas Naik
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Kale
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
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Sri Krishna GS, Pahwa B, Jagdevan A, Singh M, Kale S, Agrawal D. Tumor Control and Hearing Preservation After Gamma Knife Radiosurgery for Vestibular Schwannomas in Neurofibromatosis Type 2-A Retrospective Analysis of 133 Tumors. World Neurosurg 2023; 171:e820-e827. [PMID: 36587894 DOI: 10.1016/j.wneu.2022.12.118] [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: 11/04/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study was conducted with the aim to estimate long-term tumor control and hearing preservation rates in patients with neurofibromatosis 2 (NF2)-related vestibular schwannoma (VS), document retreatment success rate, and assess the associated predictive factors. METHODS This was a retrospective analysis of patients with NF2-associated VS who underwent Gamma Knife radiosurgery (GKRS) between 2009 and 2020 and had a minimum follow-up of 1 year. Loss of tumor control was defined as greater than 10% increase in volume in more than one follow-up imaging or the need for retreatment in the form of repeat GKRS or surgery. The Kaplan-Meier method was used to evaluate actuarial tumor control and hearing preservation rates. RESULTS In total, 85 patients with 133 VSs were included in the study. The mean age was 29.8 years. In total, 57 tumors showed tumor regression, 35 showed stable disease, and 23 progressed in size at last follow up. Actuarial tumor control rates after 1, 3, 5, and 9 years were 95%, 79%, 75%, and 55%, respectively, with overall tumor control rate being 85%. Hearing worsened in 39 patients, and facial nerve dysfunction occurred in 4 patients. Five tumors underwent retreatment with GKRS at a median duration of 27.6 months (19-36 months) following the first GKRS. CONCLUSIONS This is the largest radiosurgical series of NF2-associated VS reported to date. GKRS provides a high rate of long-term local tumor control with a low risk of neurologic deprivation for patients with these tumors. The need for retreatment with GKRS, although low, is associated with good tumor control and lesser complications.
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Affiliation(s)
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Aman Jagdevan
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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Pahwa B, Zaazoue MA. Letter: Characteristics and Outcomes of Discharge Against Medical Advice and 30-Day Readmissions After Concussion: Analysis of the Nationwide Readmissions Database. Neurosurgery 2023; 92:e11. [PMID: 36519867 DOI: 10.1227/neu.0000000000002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/12/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences, Delhi, India
| | - Mohamed A Zaazoue
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Pahwa B, Singh N, Singh G, Chavda V, Montemurro N, Chaurasia B. Surgical Approaches to Cavernous Sinus: A Narrative Review of the Literature with Anatomical Drawings. J Neurol Surg A Cent Eur Neurosurg 2022. [PMID: 36584879 DOI: 10.1055/a-2005-0482] [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: 01/01/2023]
Abstract
IIntroduction. The cavernous sinus (CS) is a paired venous sinus in the human brain that is classified as a true dural venous sinus rather than a venous plexus. The entire CS is separated by septa into two small cavities called caves. The CS has a very close resemblance to various key structures present in the head. The CS is a blood compartment that contains ligaments, endothelium, and trabeculae. It is clinically significant because of its position and relationship with several cranial nerves. Clinical implications. For effective management and treatment of CS syndrome, CS thrombosis, carotid-cavernous fistula, and other CS-related problems, CS surgery became necessary. As a result of the lack of sophisticated surgical techniques in the past, CS surgery was exceedingly challenging, complicated, and deadly. The surgery of CSs can benefit from a variety of surgical procedures, including extradural and intradural, endoscopic endonasal, rhomboid, and temporopolar trans cavernous approaches. In this review, numerous surgical procedures for CS are discussed along with their intended uses. Conclusions. A greater understanding of the CS was made possible by the quick modifications and improvements in surgical methods, which aided in neurosurgery procedures.
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Affiliation(s)
| | - Narinder Singh
- -, Indian Institute of Management Amritsar, Amritsar, India
| | | | - Vishal Chavda
- Pathology, Stanford University School of Medicine, Stanford, United States
| | | | - Bipin Chaurasia
- Department of Neurosurgery, Tribhuvan University Institute of Medicine Nursing Campus Birgunj, Birgunj, Nepal
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Javed S, Pahwa B, Chaurasia B. Pakistan signatory to global neurosurgery. Brain Spine 2022; 3:101710. [PMID: 36685707 PMCID: PMC9845389 DOI: 10.1016/j.bas.2022.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
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Pahwa B, Goyal S, Chaurasia B. Understanding anterior communicating artery aneurysms: A bibliometric analysis of top 100 most cited articles. J Cerebrovasc Endovasc Neurosurg 2022; 24:325-334. [PMID: 36480823 PMCID: PMC9829559 DOI: 10.7461/jcen.2022.e2022.01.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/16/2022] [Indexed: 12/13/2022] Open
Abstract
Bibliometric analysis is of paramount importance in assessing the research impact wherein studies are ranked on the basis of citations received. It also brings out the excellent contribution of authors and journals in adding evidence for future research. This study aimed at evaluating the top 100 most cited articles on anterior communicating artery (ACoA) Aneurysms. Scopus database was searched using title specific search for the aneurysm of ACoA and top 100 most cited articles along with their authors, author IDs, affiliated institutions, countries and funding bodies were identified. Search yielded 841 articles and top 100 articles were identified to include in this analysis which secured 5615 citations. Citations per year was also calculated to minimize the risk of bias. Maximum citations by any article were 242. The United States was the major contributor to the number of articles while Kessler Institute for Rehabilitation became the highest contributing institution. DeLuca J proved to be a pioneer in this specialized area as he penned 6 studies being first author in 4 of them, making him the most frequent author. National Institutes of Health and the U.S. Department of Health and Human Services were the main funding bodies. Subcategory analysis revealed, 50% studies provided evidence for the treatment and the surgical outcome of the aneurysm. Studies like these can aid in better neurological and neurosurgical management in decision making of ACoA aneurysm.
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Affiliation(s)
- Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, New Delhi, India,Correspondence to Bhavya Pahwa Medical Student, University College of Medical Sciences, Tahirpur Rd, GTB Enclave, Dilshad Garden, New Delhi, Delhi 110095, India Tel +91-826-414-0281 E-mail ORCID https://orcid.org/0000-0002-4010-8951
| | - Sarvesh Goyal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Bhawani Hospital and Research Centre, Birgunj, Nepal
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de Macêdo Filho LJM, Diógenes AVG, Barreto EG, Pahwa B, Samson SL, Chaichana K, Quinones-Hinojosa A, Almeida JP. Endoscopic Endonasal Resection of the Medial Wall of the Cavernous Sinus and Its Impact on Outcomes of Pituitary Surgery: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12101354. [PMID: 36291288 PMCID: PMC9599381 DOI: 10.3390/brainsci12101354] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction. Pituitary adenomas have the potential to infiltrate the dura mater, skull, and the venous sinuses. Tumor extension into the cavernous sinus is often observed in pituitary adenomas and techniques and results of surgery in this region are vastly discussed in the literature. Infiltration of parasellar dura and its impact for pituitary surgery outcomes is significantly less studied but recent studies have suggested a role of endoscopic resection of the medial wall of the cavernous sinus, in selected cases. In this study, we discuss the techniques and outcomes of recently proposed techniques for selective resection of the medial wall of the cavernous sinus in endoscopic pituitary surgery. Methods. We performed a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and protocol and a total of 4 studies with 106 patients that underwent an endoscopic approach for resection of pituitary tumors with resection of medial wall from cavernous sinus were included. Clinical and radiological data were extracted (sex, mean age, Knosp, prior surgery, tumor size and type, complication rate, and remission) and a meta-analysis using the RevMan 5.4 software was performed. Results. A total of 5 studies with 208 patients were included in this analysis. The mean age of the study population was 48.87 years (range 25−82) with a female/male ratio of 1:1.36. Majority of the patients had Knosp Grade 1 (n = 77, 37.02%) and Grade 2 (n = 53, 25.48%). The complication rate was 4.81% (n = 33/106) and the most common complication observed was a new transient CN dysfunction and diplopia. Early disease remission was observed in 94.69% of the patients (n = 196/207). The prevalence rate of CS medial wall invasion varied from 10.4 % up to 36.7%. This invasion rate increased in frequency with higher Knosp Grade. The forest plot of persistent disease vs. remission in this surgery approach showed a p < 0.00001 and heterogeneity (I^2 = 0%). Discussion. Techniques to achieve resection of the medial wall of the cavernous sinus via the endoscopic endonasal approach include the “anterior to posterior” technique (opening of the anterior wall of the cavernous sinus) and the “medial to lateral” technique (opening of the inferior intercavernous sinus and). Although potentially related with improved endocrinological outcomes, these are advanced surgical techniques and require extensive anatomical knowledge and extensive surgical experience. Furthermore, to avoid procedure complications, extensive study of the patient’s configuration of cavernous ICA, Doppler-guided intraoperative imaging, surgical navigation system, and blunt tip knives to dissect the ICA’s plane are recommended. Conclusion. Endoscopic resection of the medial wall of the cavernous sinus has been associated with reports of high rates of postoperative hormonal control in functioning pituitary adenomas. However, it represents a more complex approach and requires advanced experience in endoscopic skull base surgery. Additional studies addressing case selection and studies evaluating long term results of this technique are still necessary.
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Affiliation(s)
- Leonardo J. M. de Macêdo Filho
- Health Science Center, University of Fortaleza, Av. Washington Soares 1321, Fortaleza 60811-905, Ceará, Brazil
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Ana Vitória G. Diógenes
- Health Science Center, University of Fortaleza, Av. Washington Soares 1321, Fortaleza 60811-905, Ceará, Brazil
| | - Esther G. Barreto
- Health Science Center, University of Fortaleza, Av. Washington Soares 1321, Fortaleza 60811-905, Ceará, Brazil
| | - Bhavya Pahwa
- Department of Medicine, University College of Medical Sciences, 2, Tahirpur Rd, GTB Enclave, Dilshad Garden, New Delhi, Delhi 110095, India
| | - Susan L. Samson
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
- Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Kaisorn Chaichana
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | | | - Joao Paulo Almeida
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
- Correspondence:
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Pahwa B, Medani K, Lu VM, Elarjani T. Proton beam therapy for skull base chordomas: a systematic review of tumor control rates and survival rates. Neurosurg Rev 2022; 45:3551-3563. [PMID: 36181614 DOI: 10.1007/s10143-022-01880-7] [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: 07/14/2022] [Revised: 09/04/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Abstract
The management of base of skull (BS) chordomas is a neurosurgical conundrum owing to their close proximity to the critical neurovascular structures. Surgical resection is the gold standard treatment followed by adjuvant radiotherapy which includes photon therapy, proton beam therapy (PBT), gamma knife radiosurgery, etc. PBT has become an unparalleled therapeutic modality in the management of BS chordomas. The aim of this systematic review was to assess the outcomes in BS chordoma patients who received PBT as a primary or adjuvant therapy. PubMed and Cochrane databases were screened till May 2022. Following the PRISMA guidelines, studies were reviewed thoroughly, and the data of the included study was extracted. Statistical analysis was performed using the SAS 9.4 with P value < .05 considered as significant. Sixteen studies with 752 patients were included. The majority of the patients were adults (> 18 years) with a male:female ratio of 1.2. The most common clinical features were cranial nerve (3rd, 6th, or 12th) palsy and hearing impairment. Ninety-five percent of the patients underwent surgical resection before PBT. The mean PBT dose received was 74.02 cGe (cobalt gray equivalent). Eighty percent of the patients showed a positive response to the therapy defined in terms of tumor regression. Five-year local control (LC), overall survival (OS), and progression-free survival (PFS) were calculated as 76.6%, 79.6%, and 89%, respectively. Statistical analysis revealed none of the factors had any significant association with 5-year LC. PBT is a growing therapeutic technique that has revolutionized the treatment of BS chordomas.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Khalid Medani
- Department of Preventive Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Turki Elarjani
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Pahwa B, Kalyani M, Jain I, Bhattacharjee S. Will you choose neurosurgery as your career? An Indian female medical student perspective. J Clin Neurosci 2022; 105:1-8. [PMID: 36049362 DOI: 10.1016/j.jocn.2022.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 04/29/2022] [Revised: 08/11/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aim at recognising the reasons that discourage female medical students to consider neurosurgery as a career, from an Indian perspective. METHODOLOGY An online survey was disseminated in various medical colleges of India. The study included female medical students (both cis and trans). The questionnaire consisted of objective questions on mentorship, opportunities and exposure. Their concerns on long working hours and the reasons for the same were recorded. RESULTS 348 responses were included of which 79.9 % of students felt they didn't receive proper exposure to neurosurgery in their medical school. 87.4 % of the respondents faced a lack of opportunity and mentorship for research. 65.2 % of students felt that they would be more interested in neurosurgery if a female professor were to mentor them. Long working hours and Reduced Family and Personal time were identified as statistically significant factors (p < 0.001) that play a role in demotivating female medical students towards neurosurgery. Altered quality of life was the most frequent (79.49 %) and significant reason (p = 0.004) as to why long working hours were a concern for them. 65.07 % of participants did not consider physical strength to be a hurdle (p = 0.008). Approximately 37.6 % participants felt that maternity and neurosurgery could be incompatible (p = 0.005). CONCLUSIONS The study brings out the notions that female medical students have regarding the long working hours and decreased family and personal time, complicated by pregnancy and maternal leave in the life of female neurosurgeon.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, New Delhi, India.
| | | | - Ishika Jain
- North DMC Medical College & Hindu Rao Hospital, New Delhi, India
| | - Suchanda Bhattacharjee
- Additional. Professor Department of Neurosurgery, Nizam's Institute Of Medical Sciences, Hyderabad, India
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Pahwa B, Zaazoue MA. Letter to the Editor. Global trends of female representation in neurosurgery. J Neurosurg 2022; 137:1872-1873. [PMID: 35986723 DOI: 10.3171/2022.6.jns221388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Bhavya Pahwa
- 1University College of Medical Sciences, Delhi, India
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Pahwa B, Agrawal D. LINC-02. Gamma Knife Radiosurgery as an efficacious treatment for Pediatric Central Nervous System Tumors: A Retrospective Study of 61 Neoplasms. Neuro Oncol 2022. [PMCID: PMC9164958 DOI: 10.1093/neuonc/noac079.601] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: Brain tumors have an incidence of 1.15 to 5.14 cases per 100,000 children and are associated with significant morbidity and mortality. Radiosurgery has become a promising approach to manage these pediatric CNS tumors. The aim of the present study was to analyse the efficacy of radiosurgery in the treatment of a variety of pediatric tumors of CNS METHODS: This retrospective study was conducted from 1997-2012 at a single Neurosurgery centre. All paediatric patients (≤ 18 years of age) with CNS tumours who were treated with gamma knife radiosurgery (GKRS) and had a minimum follow up of 6 months were included in the study. Patients with lesions other than tumours were excluded. Clinical, radiological and GKRS planning data was collected and analysed in all patients. RESULTS: A total of 76 children with brain tumors had GKRS during the study period. Of these, 40 children (with 61 neoplasms) had follow up available and were included in the study. The mean age was 16 years (6-18 years). 17 patients received primary GKRS, 20 patients received secondary and 3 patients received both. The median tumor volume was 3.3cm3 (0.14 - 38.9 cm3). The mean dose was 12.56 Gy at 50% isodose line. The majority of the tumors were Meningioma (n=20) followed by Acoustic Schwannoma (n=17). The mean treatment time was 67.04 minutes. 33 tumors responded favourably to GKRS, 24 showed a stable size, 3 had no response while 1 progressed requiring surgery. CONCLUSION: GKRS has the potential to become an indispensable tool in the management of pediatric brain neoplasms
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Saini R, Pahwa B, Agrawal D, Singh P, Gujjar H, Mishra S, Jagdevan A, Misra M. Efficacy and outcome of bone marrow derived stem cells transplanted via intramedullary route in acute complete spinal cord injury – A randomized placebo controlled trial. J Clin Neurosci 2022; 100:7-14. [DOI: 10.1016/j.jocn.2022.03.033] [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] [Received: 11/25/2021] [Revised: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Mishra H, Pahwa B, Agrawal D, M Ch MS, M Ch SSK. Gamma knife radiosurgery as an efficacious treatment for paediatric central nervous system tumours: a retrospective study of 61 neoplasms. Childs Nerv Syst 2022; 38:909-918. [PMID: 35290486 DOI: 10.1007/s00381-022-05463-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Brain tumours have an incidence of 1.15 to 5.14 cases per 100,000 children and are associated with significant morbidity and mortality. Radiosurgery has become a promising approach to manage these paediatric CNS tumours. The aim of the present study was to analyse the efficacy of radiosurgery in the treatment of a variety of paediatric tumours of CNS. METHODS This retrospective study was conducted from 1997 to 2012 at a single Neurosurgery centre. All paediatric patients (≤ 18 years of age) with CNS tumours who were treated with gamma knife radiosurgery (GKRS) and had a minimum follow up of 6 months were included in the study. Patients with lesions other than tumours were excluded. Clinical, radiological and GKRS planning data was collected and analysed in all patients. RESULTS A total of 76 children with brain tumours had GKRS during the study period. Of these, 40 children (with 61 neoplasms) had follow-up available and were included in the study. The mean age was 16 years (6-18 years). Seventeen patients received primary GKRS, 20 patients received secondary, and 3 patients received both. The median tumour volume was 3.3 cm3 (0.14-38.9 cm3). The mean dose was 12.56 Gy at 50% isodose line. The majority of the tumours were meningioma (n = 20) followed by acoustic schwannoma (n = 17). The mean treatment time was 67.04 min. Thirty-three tumours responded favourably to GKRS, 24 showed a stable size, 3 had no response while 1 progressed, requiring surgery. CONCLUSION GKRS has the potential to become an indispensable tool in the management of paediatric brain neoplasms.
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Affiliation(s)
- Harshit Mishra
- Consultant Neurosurgeon, We Care Hospital, Raipur, Chhattisgarh, India
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Manmohan Singh M Ch
- Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S S Kale M Ch
- Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029, India
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Saini R, Pahwa B, Agrawal D, Singh P, Gurjar H, Mishra S, Jagdevan A, Misra MC. Safety and feasibility of intramedullary injected bone marrow-derived mesenchymal stem cells in acute complete spinal cord injury: phase 1 trial. J Neurosurg Spine 2022; 37:1-8. [PMID: 35395638 DOI: 10.3171/2022.2.spine211021] [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: 07/31/2021] [Accepted: 02/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The intramedullary route holds the potential to provide the most concentration of stem cells in cases of spinal cord injury (SCI). However, the safety and feasibility of this route need to be studied in human subjects. The aim of this study was to evaluate the safety and feasibility of intramedullary injected bone marrow-derived mesenchymal stem cells (BM-MSCs) in acute complete SCI. METHODS In this prospective study conducted over a 2-year period, 27 patients with acute (defined as within 1 week of injury) and complete SCI were randomized to receive BM-MSC or placebo through an intramedullary route intraoperatively at the time of spinal decompression and fusion. Institutional ethics approval was obtained, and informed consent was obtained from all patients. Safety was assessed using laboratory and clinicoradiological parameters preoperatively and 3 and 6 months after surgery. RESULTS A total of 180 patients were screened during the study period. Of these, 27 were enrolled in the study. Three patients withdrew, 3 patients were lost to follow-up, and 8 patients died, leaving a total of 13 patients for final analysis. Seven of these patients were in the stem cell group, and 6 were in the control group. Both groups were well matched in terms of sex, age, and weight. No adverse events related to stem cell injection were noted for laboratory and radiological parameters. Five patients in the control group and 3 patients in the stem cell group died during the follow-up period. CONCLUSIONS Intramedullary injection of BM-MSCs was found to be safe and feasible for use in patients with acute complete SCI.
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Affiliation(s)
- Renu Saini
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Bhavya Pahwa
- 2University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India
| | - Deepak Agrawal
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Pankaj Singh
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Hitesh Gurjar
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Shashwat Mishra
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Aman Jagdevan
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Mahesh Chandra Misra
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
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Pahwa B, Kurwale N, Agrawal D. Evaluation of periprocedural anxiety during Gamma Knife Radiosurgery (GKRS) Frame fixation for brain lesions. Clin Neurol Neurosurg 2022; 217:107242. [DOI: 10.1016/j.clineuro.2022.107242] [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] [Received: 02/01/2022] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
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Kular S, Tse G, Pahwa B, Goddard T, Saleem N, Nagaraja S, Dyde R, Patankar T. Micro-balloon-assisted embolization of anterior cranial fossa dural arteriovenous fistula via a trans-ophthalmic approach — a technical report and case series. Neuroradiology 2022; 64:1269-1274. [PMID: 35307749 PMCID: PMC9117364 DOI: 10.1007/s00234-022-02929-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/04/2022] [Indexed: 11/27/2022]
Abstract
Purpose Dural arteriovenous fistulas (dAVF) account for approximately 10–15% of all intracranial arteriovenous abnormalities. dAVFs carry a significant risk of mortality, particularly in cases of acute hemorrhage, of up to 10%. A small proportion of these dAVFs are found in the anterior cranial fossa (ACF), of which the rate of hemorrhage can be as high as up to 91%. The Scepter Mini (SM) is the smallest dual-lumen micro-balloon (MB) available for neurointerventional practice. It consists of a 2.8 French outer diameter, with a 2.2 mm × 9 mm semi-compliant balloon providing a working length of 165 cm. The SM is navigated with a 0.008-inch wire making it a particularly attractive tool accessible to the pedicles normally reached with liquid embolization micro-catheters. Methods Five consecutive patients over a 1-year period between 2020 and 2021 were evaluated and treated for ACF dAVF using a liquid embolization approach using the SM balloon. All patients were treated using ethylene–vinyl alcohol copolymer (EVOH), of which Squid 18 and/or Squid 12 were the chosen viscosities. Control angiograms were performed for all patients post-embolization. Results All patients demonstrated complete occlusion of the ACF dAVF on immediate post-treatment angiography. No immediate complications were encountered; particularly, there were no reports of visual field deficit in any of the patients. Conclusion The MB is a valuable adjunctive tool that can enhance the safety and efficacy of trans-ophthalmic embolization of ACF dAVFs, providing additional protection to the retinal and posterior ciliary arteries against unwanted reflux of liquid embolic agent.
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Pahwa B, Goyal S, Kedia S. Letter to the Editor Regarding "Academic Accomplishments of Female Neurosurgeons Currently in Practice in the United States". World Neurosurg 2021; 154:197. [PMID: 34583490 DOI: 10.1016/j.wneu.2021.06.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences & G.T.B. Hospital, Dilshad Garden, New Delhi, India
| | - Sarvesh Goyal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta Kedia
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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Ferrarez CE, Bertani R, Pahwa B, Perret C, Batista S, Leal da Silveira R. Transcallosal-Transchoroidal Approach for a Symptomatic Third Ventricular Cavernous Malformation in a Pediatric Patient: Surgical Video. World Neurosurg 2021; 156:59. [PMID: 34555574 DOI: 10.1016/j.wneu.2021.09.043] [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: 08/06/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
Cavernous malformations of the third ventricle are rare, deep-seated lesions that pose a formidable surgical challenge due to the rich, surrounding anatomy. Despite the potential morbidity of surgical treatment, the possibility of catastrophic, spontaneous hemorrhage in this location is even more feared and aggressive treatment is warranted, especially if the patient had suffered previous hemorrhages and is currently symptomatic. We demonstrate this approach (Video 1) on a 16-year-old boy who presented with right-sided hemiparesis (power grade 4), intense headaches, difficulties with learning and concentration, and memory loss, mainly affecting short-term memory. The patient had a previous unsuccessful excision at another center 3 months after initial hemorrhage. The absence of hydrocephalus and medial thalamic location favored a modified transcallosal transchoroidal (or subchoroidal) approach. Due to the anatomy of the lesion, no other microsurgical approaches were considered. The surgery at our center (second attempt) was performed 5 months after initial hemorrhage. The head was placed in neutral position, with a slight elevation of the vertex and the midline in a vertical position. A callosotomy had already been performed during the patient's first excision attempt at another center. Although dissection through the tela choroidea is commonly performed medially to the choroidal fissure when one wants to enter the third ventricle, we chose to carefully dissect through this structure laterally, because this thalamic lesion extended almost into the ependymal surface of the third ventricle. This way, the choroidal plexus became a protective cushion for the fornix. On entering the third ventricle, a mulberry-like lesion was readily identified and the cavernoma was located. The central contents of the cavernoma were dissected initially, causing relative deflation of the lesion and more maneuverability to dissect it away from the surrounding structures. Neuromonitoring was used to avoid brainstem injury. Postoperative magnetic resonance imaging showed complete resection with no signs of hemorrhage or ischemia. The patient was discharged on postoperative day 5 with no new neurologic deficits. The patient was also able to return to school after 1 month and showed complete recovery. Unfortunately, neuropsychologic evaluation was unavailable to understand his improvement better. Microsurgical dissection images in this video are a courtesy of the Rhoton Collection, American Association of Neurological Surgeons (AANS)/Neurosurgical Research and Education Foundation (NREF).
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Affiliation(s)
| | | | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Caio Perret
- Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Kedia S, Pahwa B, Bali O, Goyal S. Applications of Machine Learning in Pediatric Hydrocephalus: A Systematic Review. Neurol India 2021; 69:S380-S389. [DOI: 10.4103/0028-3886.332287] [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: 11/04/2022]
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