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Daniel M, Stone LE, Plonsker JH, Sattar S, Ravindra V, Gonda D. De novo cerebral pseudoaneurysm formation: a rare delayed complication of stereotactic electroencephalography in children. Childs Nerv Syst 2024; 40:1501-1506. [PMID: 38240787 DOI: 10.1007/s00381-024-06278-y] [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: 10/02/2023] [Accepted: 01/03/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To describe the rare complication of cerebral pseudoaneurysm formation following stereotactic electroencephalography (sEEG) lead implantation in children. METHODS A retrospective chart review of all pediatric patients undergoing sEEG procedures between 2015 and 2020 was performed. Cases of pseudoaneurysm were identified and reviewed. RESULTS Cerebral pseudoaneurysms were identified in two of 58 total cases and 610 implanted electrodes. One lesion was detected 1 year after sEEG explantation and required craniotomy and clipping. The other was detected 3 months post-explantation and underwent coil embolization. Neither patient had any neurologic deficits associated with the pseudoaneurysm before or after treatment. CONCLUSIONS Pseudoaneurysm formation post-sEEG explantation is rare and likely underreported. Routine, post-explantation/treatment imaging is warranted to detect this rare but potentially lethal complication.
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Affiliation(s)
- Manjari Daniel
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Lauren E Stone
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Jillian H Plonsker
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Shifteh Sattar
- Division of Child Neurology, Rady Children's Hospital, San Diego, CA, USA
| | - Vijay Ravindra
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
- Division of Pediatric Neurosurgery, Rady Children's Hospital, 7910 Frost Street, Suite 120, San Diego, CA, 92123, USA
| | - David Gonda
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA.
- Division of Pediatric Neurosurgery, Rady Children's Hospital, 7910 Frost Street, Suite 120, San Diego, CA, 92123, USA.
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Findlay MC, Tenhoeve S, Terry SA, Iyer RR, Brockmeyer DL, Kelly MP, Kestle JRW, Gonda D, Ravindra VM. Disparities in indications and outcomes reporting for pediatric tethered cord surgery: The need for a standardized outcome assessment tool. Childs Nerv Syst 2024; 40:1111-1120. [PMID: 38072858 DOI: 10.1007/s00381-023-06246-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/29/2023] [Indexed: 03/28/2024]
Abstract
PURPOSE Tethered cord syndrome (TCS) is characterized by abnormal attachment of the spinal cord neural elements to surrounding tissues. The most common symptoms include pain, motor or sensory dysfunction, and urologic deficits. Although TCS is common in children, there is a significant heterogeneity in outcomes reporting. We systematically reviewed surgical indications and postoperative outcomes to assess the need for a grading/classification system. METHODS PubMed and EMBASE searches identified pediatric TCS literature published between 1950 and 2023. Studies reporting surgical interventions, ≥ 6-month follow-up, and ≥ 5 patients were included. RESULTS Fifty-five studies representing 3798 patients were included. The most commonly reported non-urologic symptoms were nonspecific lower-extremity motor disturbances (36.4% of studies), lower-extremity/back pain (32.7%), nonspecific lower-extremity sensory disturbances (29.1%), gait abnormalities (29.1%), and nonspecific bowel dysfunction/fecal incontinence (25.5%). Urologic symptoms were most commonly reported as nonspecific complaints (40.0%). After detethering surgery, retethering was the most widely reported non-urologic outcome (40.0%), followed by other nonspecific findings: motor deficits (32.7%), lower-extremity/back/perianal pain (18.2%), gait/ambulation function (18.2%), sensory deficits (12.7%), and bowel deficits/fecal incontinence (12.7%). Commonly reported urologic outcomes included nonspecific bladder/urinary deficits (27.3%), bladder capacity (20.0%), bladder compliance (18.2%), urinary incontinence/enuresis/neurogenic bladder (18.2%), and nonspecific urodynamics/urodynamics score change (16.4%). CONCLUSION TCS surgical literature is highly variable regarding surgical indications and reporting of postsurgical outcomes. The lack of common data elements and consistent quantitative measures inhibits higher-level analysis. The development and validation of a standardized outcomes measurement tool-ideally encompassing both patient-reported outcome and objective measures-would significantly benefit future TCS research and surgical management.
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Affiliation(s)
- Matthew C Findlay
- School of Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Samuel Tenhoeve
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Skyler A Terry
- College of Social and Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Rajiv R Iyer
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Douglas L Brockmeyer
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Michael P Kelly
- Division of Pediatric Orthopedics, Rady Children's Hospital, San Diego, CA, USA
| | - John R W Kestle
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - David Gonda
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA.
- Department of Neurological Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
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Melhado C, Durand R, Russell KW, Polukoff NE, Rampton J, Iyer RR, Acker SN, Koehler R, Prendergast C, Stence N, O'Neill B, Padilla BE, Jamshidi R, Vaughn JA, Ronecker JS, Selesner L, Lofberg K, Regner M, Thiessen J, Sayama C, Spurrier RG, Ross EE, Liu CSJ, Chu J, McNevin K, Beni C, Robinson BRH, Linnau K, Buckley RT, Chao SD, Sabapaty A, Tong E, Prolo LM, Ignacio R, Floan Sachs G, Kruk P, Gonda D, Ryan M, Pandya S, Koral K, Braga BP, Auguste K, Jensen AR. The Sensitivity of Limited-Sequence MRI in Identifying Pediatric Cervical Spine Injury: A Western Pediatric Surgery Research Consortium Multicenter Retrospective Cohort Study. J Trauma Acute Care Surg 2024:01586154-990000000-00674. [PMID: 38523120 DOI: 10.1097/ta.0000000000004271] [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: 03/26/2024]
Abstract
INTRODUCTION Clinical clearance of a child's cervical spine after trauma is often challenging due to impaired mental status or an unreliable neurologic examination. Magnetic resonance imaging (MRI) is the gold standard for excluding ligamentous injury in children but is constrained by long image acquisition times and frequent need for anesthesia. Limited-sequence MRI (LSMRI) is used in evaluating the evolution of traumatic brain injury and may also be useful for cervical spine clearance while potentially avoiding the need for anesthesia. The purpose of this study was to assess the sensitivity and negative predictive value of LSMRI as compared to gold standard full-sequence MRI as a screening tool to rule out clinically significant ligamentous cervical spine injury. METHODS We conducted a ten-center, five-year retrospective cohort study (2017-2021) of all children (0-18y) with a cervical spine MRI after blunt trauma. MRI images were re-reviewed by a study pediatric radiologist at each site to determine if the presence of an injury could be identified on limited sequences alone. Unstable cervical spine injury was determined by study neurosurgeon review at each site. RESULTS We identified 2,663 children less than 18 years of age who underwent an MRI of the cervical spine with 1,008 injuries detected on full-sequence studies. The sensitivity and negative predictive value of LSMRI were both >99% for detecting any injury and 100% for detecting any unstable injury. Young children (age < 5 years) were more likely to be electively intubated or sedated for cervical spine MRI. CONCLUSION LSMRI is reliably detects clinically significant ligamentous injury in children after blunt trauma. To decrease anesthesia use and minimize MRI time, trauma centers should develop LSMRI screening protocols for children without a reliable neurologic exam. LEVEL OF EVIDENCE 2 (Diagnostic Tests or Criteria).
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Affiliation(s)
- Caroline Melhado
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA
| | - Rachelle Durand
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erin E Ross
- Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Jason Chu
- Children's Hospital Los Angeles, Los Angeles, CA
| | - Kathryn McNevin
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | - Catherine Beni
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | - Bryce R H Robinson
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | - Ken Linnau
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | - Robert T Buckley
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | | | | | | | | | | | | | - Peter Kruk
- University of California San Diego, San Diego, CA
| | - David Gonda
- University of California San Diego, San Diego, CA
| | - Mark Ryan
- University of Texas Southwestern, and Children's Medical Center, Dallas, TX
| | - Samir Pandya
- University of Texas Southwestern, and Children's Medical Center, Dallas, TX
| | - Korgun Koral
- University of Texas Southwestern, and Children's Medical Center, Dallas, TX
| | - Bruno P Braga
- University of Texas Southwestern, and Children's Medical Center, Dallas, TX
| | | | - Aaron R Jensen
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA
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Singh R, Zamanian C, Bcharah G, Stonnington H, George DD, Bhandarkar AR, Shahrestani S, Brown N, Abraham ME, Mammis A, Bydon M, Gonda D. High-Value Epilepsy Care in the United States: Predictors of Increased Costs and Complications from the National Inpatient Sample Database 2016-2019. World Neurosurg 2024:S1878-8750(24)00446-7. [PMID: 38514037 DOI: 10.1016/j.wneu.2024.03.061] [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: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND For patients with medically refractory epilepsy, newer minimally invasive techniques such as laser interstitial thermal therapy (LITT) have been developed in recent years. This study aims to characterize trends in the utilization of surgical resection versus LITT to treat medically refractory epilepsy, characterize complications, and understand the cost of this innovative technique to the public. METHODS The National Inpatient Sample database was queried from 2016 to 2019 for all patients admitted with a diagnosis of medically refractory epilepsy. Patient demographics, hospital length of stay, complications, and costs were tabulated for all patients who underwent LITT or surgical resection within these cohorts. RESULTS A total of 6019 patients were included, 223 underwent LITT procedures, while 5796 underwent resection. Significant predictors of increased patient charges for both cohorts included diabetes (odds ratio: 1.7, confidence interval [CI]: 1.44-2.19), infection (odds ratio: 5.12, CI 2.73-9.58), and hemorrhage (odds ratio: 2.95, CI 2.04-4.12). Procedures performed at nonteaching hospitals had 1.54 greater odds (CI 1.02-2.33) of resulting in a complication compared to teaching hospitals. Insurance status did significantly differ (P = 0.001) between those receiving LITT (23.3% Medicare; 25.6% Medicaid; 44.4% private insurance; 6.7 Other) and those undergoing resection (35.3% Medicare; 22.5% Medicaid; 34.7% private Insurance; 7.5% other). When adjusting for patient demographics, LITT patients had shorter length of stay (2.3 vs. 8.9 days, P < 0.001), lower complication rate (1.9% vs. 3.1%, P = 0.385), and lower mean hospital ($139,412.79 vs. $233,120.99, P < 0.001) and patient ($55,394.34 vs. $37,756.66, P < 0.001) costs. CONCLUSIONS The present study highlights LITT's advantages through its association with lower costs and shorter length of stay. The present study also highlights the associated predictors of LITT versus resection, such as that most LITT cases happen at academic centers for patients with private insurance. As the adoption of LITT continues, more data will become available to further understand these issues.
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Affiliation(s)
- Rohin Singh
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA.
| | - Cameron Zamanian
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - George Bcharah
- Department of Neurosurgery, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Derek D George
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | | | - Shane Shahrestani
- Department of Neurosurgery, Cedars-Sinai Hospital, Los Angeles, California, USA
| | - Nolan Brown
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - Mickey E Abraham
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Antonios Mammis
- Departmernt of Neurosurgery, New York University, New York, New York, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David Gonda
- Department of Neurosurgery, University of California, San Diego, California, USA
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Upadhye A, Meza Landeros KE, Ramírez-Suástegui C, Schmiedel BJ, Woo E, Chee SJ, Malicki D, Coufal NG, Gonda D, Levy ML, Greenbaum JA, Seumois G, Crawford J, Roberts WD, Schoenberger SP, Cheroutre H, Ottensmeier CH, Vijayanand P, Ganesan AP. Intra-tumoral T cells in pediatric brain tumors display clonal expansion and effector properties. Nat Cancer 2024:10.1038/s43018-023-00706-9. [PMID: 38228835 DOI: 10.1038/s43018-023-00706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
Brain tumors in children are a devastating disease in a high proportion of patients. Owing to inconsistent results in clinical trials in unstratified patients, the role of immunotherapy remains unclear. We performed an in-depth survey of the single-cell transcriptomes and clonal relationship of intra-tumoral T cells from children with brain tumors. Our results demonstrate that a large fraction of T cells in the tumor tissue are clonally expanded with the potential to recognize tumor antigens. Such clonally expanded T cells display enrichment of transcripts linked to effector function, tissue residency, immune checkpoints and signatures of neoantigen-specific T cells and immunotherapy response. We identify neoantigens in pediatric brain tumors and show that neoantigen-specific T cell gene signatures are linked to better survival outcomes. Notably, among the patients in our cohort, we observe substantial heterogeneity in the degree of clonal expansion and magnitude of T cell response. Our findings suggest that characterization of intra-tumoral T cell responses may enable selection of patients for immunotherapy, an approach that requires prospective validation in clinical trials.
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Affiliation(s)
- Aditi Upadhye
- La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Kevin E Meza Landeros
- La Jolla Institute for Immunology, La Jolla, CA, USA
- Center for Genomic Sciences, National Autonomous University of Mexico, Cuernavaca, Mexico
| | | | | | - Edwin Woo
- Southampton University Hospitals NHS Trust, Southampton, UK
| | - Serena J Chee
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Denise Malicki
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Nicole G Coufal
- Rady Children's Hospital, San Diego, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - David Gonda
- Rady Children's Hospital, San Diego, CA, USA
- Department of Neurological Surgery, University of California San Diego, La Jolla, CA, USA
| | - Michael L Levy
- Rady Children's Hospital, San Diego, CA, USA
- Department of Neurological Surgery, University of California San Diego, La Jolla, CA, USA
| | | | | | - John Crawford
- Rady Children's Hospital, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
- Children's Hospital Orange County, Irvine, CA, USA
| | - William D Roberts
- Rady Children's Hospital, San Diego, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | | | | | - Christian H Ottensmeier
- La Jolla Institute for Immunology, La Jolla, CA, USA
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Clatterbridge Cancer Center NHS Foundation Trust, Liverpool, UK
| | - Pandurangan Vijayanand
- La Jolla Institute for Immunology, La Jolla, CA, USA.
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.
- Department of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Anusha-Preethi Ganesan
- La Jolla Institute for Immunology, La Jolla, CA, USA.
- Rady Children's Hospital, San Diego, CA, USA.
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
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Ran J, Karamian P, Robinow Z, Lui F, Gonda D. Anterolateral Thoracic Myelomeningocele With Split Cord Malformation. Cureus 2023; 15:e46496. [PMID: 37927626 PMCID: PMC10624557 DOI: 10.7759/cureus.46496] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
We present a case of a two-year-old male with a history of congenital scoliosis and anterolateral thoracic meningocele. He was able to walk and run, but his parents reported left leg weakness and a frequent cough. The patient had normal neurological examination findings. Magnetic resonance imaging (MRI) of the spine without contrast showed left convex upper thoracic congenital scoliosis and rightward anterolateral meningocele inferiorly to T3, with the spinal cord tethered at this location. Neurosurgical cord detethering and repair of the meningocele were performed simultaneously with scoliosis repair by orthopedics. During the dissection of the meningocele, the bulging neural tissue was found to be a split cord ending in a blind stump. The split cord was determined to be nonfunctional via Prass probe (Medtronic, Minneapolis, MN) stimulation and was subsequently dissected. Detethering of the spinal cord was followed by repair of the dural outpouching and dural closure. The patient was stable post-surgery, but long-term results remain to be seen.
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Affiliation(s)
- Jessica Ran
- Neurosurgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Preny Karamian
- Neurosurgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Zoe Robinow
- Neurosurgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Forshing Lui
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
| | - David Gonda
- Neurosurgery, Rady Children's Hospital-San Diego, San Diego, USA
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Abe N, Gardiner M, Dory C, Gonda D, Harvey H, Hilfiker M, Hollenbach K, Kanegaye JT. Predictive Factors for Delayed Surgical Intervention in Children With Epidural Hematomas. Pediatr Emerg Care 2023; 39:402-407. [PMID: 36730955 DOI: 10.1097/pec.0000000000002825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Optimal treatment of children with traumatic intracranial epidural hematomas (EDHs) is unknown. We sought to identify clinical and radiographic predictors of delayed surgical intervention among children with EDH admitted for observation. METHODS We retrospectively identified patients younger than 15 years with acute traumatic EDHs evaluated at our level 1 pediatric trauma center. We excluded patients with penetrating head injuries, recent surgical evacuation of EDH, or depressed skull fracture requiring surgical repair and assigned the remaining subjects to the immediate surgery group if they underwent immediate surgical evacuation, to the supportive-therapy-only group if they underwent observation only, and to the delayed surgery group if they underwent surgery after observation. We abstracted clinical and laboratory findings, surgical interventions, and neurological outcome and measured EDH dimensions and volumes, adjusting for cranial size. We compared clinical and radiographic characteristics among groups and performed receiver-operator characteristic analyses of predictors of delayed surgery. RESULTS Of 172 patients with EDH, 103 patients met the inclusion criteria, with 6 (6%) in the immediate surgery group, 87 (84%) in the supportive-therapy-only group, and 10 (10%) in the delayed surgery group. Headache, prothrombin time of >14 seconds, EDH maximal thickness of ≥1.1 cm, volume of ≥14 mL, EDH thickness/cranial width index of ≥0.08 and EDH volume/cranial volume index of ≥0.18, and mass effect were associated with delayed surgical intervention. There was no difference in length of stay or functional impairment between the immediate and delayed surgery groups. However, patients in delayed surgery group were more likely to have subjective symptoms at discharge than those in immediate surgery group. CONCLUSIONS Among patients with EDH admitted for observation, larger EDH, mass effect, headaches, and prothrombin time of >14 seconds were associated with delayed surgical intervention. A larger-scale study is warranted to identify independent predictors of delayed surgery in children under observation for EDH.
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Loya J, Brown NJ, Gonda D, Levy M. Challenging, giant occipital encephalocele in a pediatric saipanese male. Clin Case Rep 2023; 11:e7380. [PMID: 37215965 PMCID: PMC10196437 DOI: 10.1002/ccr3.7380] [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: 12/26/2022] [Revised: 04/01/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Key Clinical Message Giant occipital encephalocele is a rare form of congenital anomaly that involves protrusion of brain tissue (greater in size than the patient's cranial cavity) from a defect in the skull. This case reports illustrates repair of a giant encephalocele and emphasizes important methods to reduce risk for blood loss and other complications. Abstract A rare form of congenital anomaly, giant occipital encephalocele involves protrusion of brain tissue from a defect in the skull (in this case from the occiput). While encephalocele itself is a fairly rare entity, those qualifying as "giant"-defined by size of the deformity exceeding that of the skull itself - require very technically challenging surgery.
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Affiliation(s)
- Joshua Loya
- Department of NeurosurgeryUniversity of California San Diego, Rady's Children's HospitalSan DiegoCaliforniaUSA
| | - Nolan J. Brown
- Department of NeurosurgeryUniversity of California San Diego, Rady's Children's HospitalSan DiegoCaliforniaUSA
| | - David Gonda
- Department of NeurosurgeryUniversity of California San Diego, Rady's Children's HospitalSan DiegoCaliforniaUSA
| | - Michael Levy
- Department of NeurosurgeryUniversity of California San Diego, Rady's Children's HospitalSan DiegoCaliforniaUSA
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9
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Arocho-Quinones EV, Lew SM, Handler MH, Tovar-Spinoza Z, Smyth MD, Bollo RJ, Donahue D, Perry MS, Levy M, Gonda D, Mangano FT, Kennedy BC, Storm PB, Price AV, Couture DE, Oluigbo C, Duhaime AC, Barnett GH, Muh CR, Sather MD, Fallah A, Wang AC, Bhatia S, Eastwood D, Tarima S, Graber S, Huckins S, Hafez D, Rumalla K, Bailey L, Shandley S, Roach A, Alexander E, Jenkins W, Tsering D, Price G, Meola A, Evanoff W, Thompson EM, Brandmeir N. Magnetic resonance imaging-guided stereotactic laser ablation therapy for the treatment of pediatric epilepsy: a retrospective multiinstitutional study. J Neurosurg Pediatr 2023:1-14. [PMID: 36883640 PMCID: PMC10193482 DOI: 10.3171/2022.12.peds22282] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/30/2022] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The authors of this study evaluated the safety and efficacy of stereotactic laser ablation (SLA) for the treatment of drug-resistant epilepsy (DRE) in children. METHODS Seventeen North American centers were enrolled in the study. Data for pediatric patients with DRE who had been treated with SLA between 2008 and 2018 were retrospectively reviewed. RESULTS A total of 225 patients, mean age 12.8 ± 5.8 years, were identified. Target-of-interest (TOI) locations included extratemporal (44.4%), temporal neocortical (8.4%), mesiotemporal (23.1%), hypothalamic (14.2%), and callosal (9.8%). Visualase and NeuroBlate SLA systems were used in 199 and 26 cases, respectively. Procedure goals included ablation (149 cases), disconnection (63), or both (13). The mean follow-up was 27 ± 20.4 months. Improvement in targeted seizure type (TST) was seen in 179 (84.0%) patients. Engel classification was reported for 167 (74.2%) patients; excluding the palliative cases, 74 (49.7%), 35 (23.5%), 10 (6.7%), and 30 (20.1%) patients had Engel class I, II, III, and IV outcomes, respectively. For patients with a follow-up ≥ 12 months, 25 (51.0%), 18 (36.7%), 3 (6.1%), and 3 (6.1%) had Engel class I, II, III, and IV outcomes, respectively. Patients with a history of pre-SLA surgery related to the TOI, a pathology of malformation of cortical development, and 2+ trajectories per TOI were more likely to experience no improvement in seizure frequency and/or to have an unfavorable outcome. A greater number of smaller thermal lesions was associated with greater improvement in TST. Thirty (13.3%) patients experienced 51 short-term complications including malpositioned catheter (3 cases), intracranial hemorrhage (2), transient neurological deficit (19), permanent neurological deficit (3), symptomatic perilesional edema (6), hydrocephalus (1), CSF leakage (1), wound infection (2), unplanned ICU stay (5), and unplanned 30-day readmission (9). The relative incidence of complications was higher in the hypothalamic target location. Target volume, number of laser trajectories, number or size of thermal lesions, or use of perioperative steroids did not have a significant effect on short-term complications. CONCLUSIONS SLA appears to be an effective and well-tolerated treatment option for children with DRE. Large-volume prospective studies are needed to better understand the indications for treatment and demonstrate the long-term efficacy of SLA in this population.
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Affiliation(s)
- Elsa V. Arocho-Quinones
- Departments of Neurosurgery and
- Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Sean M. Lew
- Departments of Neurosurgery and
- Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Michael H. Handler
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Zulma Tovar-Spinoza
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Matthew D. Smyth
- Division of Neurosurgery, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Robert J. Bollo
- Department of Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah
| | | | - M. Scott Perry
- Neurology, Cook Children’s Medical Center, Fort Worth, Texas
| | - Michael Levy
- Department of Neurosurgery, Rady Children’s Hospital San Diego, San Diego, California
| | - David Gonda
- Department of Neurosurgery, Rady Children’s Hospital San Diego, San Diego, California
| | | | - Benjamin C. Kennedy
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Phillip B. Storm
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Angela V. Price
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel E. Couture
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Chima Oluigbo
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | | | - Gene H. Barnett
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Carrie R. Muh
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- Department of Neurosurgery, Maria Fareri Children’s Hospital, Valhalla, New York
| | - Michael D. Sather
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Aria Fallah
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Anthony C. Wang
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Sanjiv Bhatia
- Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida
| | - Daniel Eastwood
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey Tarima
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah Graber
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Sean Huckins
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel Hafez
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri; and
| | - Kavelin Rumalla
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri; and
| | | | | | - Ashton Roach
- Department of Neurosurgery, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Erin Alexander
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wendy Jenkins
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Deki Tsering
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - George Price
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Antonio Meola
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Wendi Evanoff
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Eric M. Thompson
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | | | - for the Pediatric Stereotactic Laser Ablation Workgroup
- Departments of Neurosurgery and
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, University of Texas at Austin/Dell Medical School, Austin, Texas
- Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
- Division of Neurosurgery, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
- Department of Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah
- Departments of Neurosurgery and
- Neurology, Cook Children’s Medical Center, Fort Worth, Texas
- Department of Neurosurgery, Rady Children’s Hospital San Diego, San Diego, California
- Department of Neurosurgery, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
- Department of Neurosurgery, Children’s National Health System, Washington, DC
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
- Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri; and
- Department of Neurosurgery, Maria Fareri Children’s Hospital, Valhalla, New York
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10
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Alasfour A, Gabriel P, Jiang X, Shamie I, Melloni L, Thesen T, Dugan P, Friedman D, Doyle W, Devinsky O, Gonda D, Sattar S, Wang S, Halgren E, Gilja V. Spatiotemporal dynamics of human high gamma discriminate naturalistic behavioral states. PLoS Comput Biol 2022; 18:e1010401. [PMID: 35939509 PMCID: PMC9387937 DOI: 10.1371/journal.pcbi.1010401] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/18/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
In analyzing the neural correlates of naturalistic and unstructured behaviors, features of neural activity that are ignored in a trial-based experimental paradigm can be more fully studied and investigated. Here, we analyze neural activity from two patients using electrocorticography (ECoG) and stereo-electroencephalography (sEEG) recordings, and reveal that multiple neural signal characteristics exist that discriminate between unstructured and naturalistic behavioral states such as “engaging in dialogue” and “using electronics”. Using the high gamma amplitude as an estimate of neuronal firing rate, we demonstrate that behavioral states in a naturalistic setting are discriminable based on long-term mean shifts, variance shifts, and differences in the specific neural activity’s covariance structure. Both the rapid and slow changes in high gamma band activity separate unstructured behavioral states. We also use Gaussian process factor analysis (GPFA) to show the existence of salient spatiotemporal features with variable smoothness in time. Further, we demonstrate that both temporally smooth and stochastic spatiotemporal activity can be used to differentiate unstructured behavioral states. This is the first attempt to elucidate how different neural signal features contain information about behavioral states collected outside the conventional experimental paradigm.
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Affiliation(s)
- Abdulwahab Alasfour
- Department of Electrical Engineering, Kuwait University, Kuwait City, Kuwait
- Department of Electrical and Computer Engineering, UC San Diego, San Diego, California, United States of America
- * E-mail:
| | - Paolo Gabriel
- Department of Electrical and Computer Engineering, UC San Diego, San Diego, California, United States of America
| | - Xi Jiang
- Department of Neurosciences, UC San Diego, San Diego, California, United States of America
| | - Isaac Shamie
- Department of Neurosciences, UC San Diego, San Diego, California, United States of America
| | - Lucia Melloni
- Comprehensive Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York City, New York, United States of America
| | - Thomas Thesen
- Comprehensive Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York City, New York, United States of America
- Department of Biomedical Sciences, College of Medicine, University of Houston, Houston, Texas, United States of America
| | - Patricia Dugan
- Comprehensive Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York City, New York, United States of America
| | - Daniel Friedman
- Comprehensive Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York City, New York, United States of America
| | - Werner Doyle
- Comprehensive Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York City, New York, United States of America
| | - Orin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York City, New York, United States of America
| | - David Gonda
- Department of Neurosciences, UC San Diego, San Diego, California, United States of America
- Rady Children’s Hospital San Diego, San Diego, California, United States of America
| | - Shifteh Sattar
- Department of Neurosciences, UC San Diego, San Diego, California, United States of America
- Rady Children’s Hospital San Diego, San Diego, California, United States of America
| | - Sonya Wang
- Rady Children’s Hospital San Diego, San Diego, California, United States of America
- Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Eric Halgren
- Department of Neurosciences, UC San Diego, San Diego, California, United States of America
| | - Vikash Gilja
- Department of Electrical and Computer Engineering, UC San Diego, San Diego, California, United States of America
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11
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Gilbert K, Plonsker JH, Barnett J, Al Jammal O, Wali AR, Gupta M, Gonda D. Shunt freedom in slit ventricle syndrome: using paradoxical ventriculomegaly following lumbar shunting to our advantage. Illustrative cases. Journal of Neurosurgery: Case Lessons 2022; 3:CASE20151. [PMID: 36303512 PMCID: PMC9379694 DOI: 10.3171/case20151] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/16/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
The authors present two cases of paradoxical ventriculomegaly after lumboperitoneal (LP) shunting in patients with slit ventricle syndrome (SVS).
OBSERVATIONS
After placement of an LP shunt, both patients rapidly developed radiographic and clinically symptomatic ventricular enlargement. The then generous ventricular corridors allowed both patients to be treated by endoscopic third ventriculostomy (ETV) with concurrent removal of their LP shunt. The patients then underwent staged increases in their shunt resistance to the maximum setting and remain asymptomatic.
LESSONS
The authors suggest that this paradoxical ventriculomegaly may have resulted from a pressure gradient between the shunt systems in the intra- and extraventricular spaces due to a noncommunicating etiology of their hydrocephalus. ETV may successfully exploit this newfound obstructive hydrocephalus and provide resolution of the radiographic and clinical hydrocephalus through allowing for improved communication between the cranial and lumbar cerebrospinal fluid spaces in SVS.
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Affiliation(s)
- Kevin Gilbert
- School of Medicine, University of California, San Diego, San Diego, California
| | - Jillian H. Plonsker
- Department of Neurological Surgery, University of California San Diego, San Diego, California; and
| | - Jessica Barnett
- School of Medicine, University of California, San Diego, San Diego, California
| | - Omar Al Jammal
- School of Medicine, University of California, San Diego, San Diego, California
| | - Arvin R. Wali
- Department of Neurological Surgery, University of California San Diego, San Diego, California; and
| | - Mihir Gupta
- Department of Neurological Surgery, University of California San Diego, San Diego, California; and
| | - David Gonda
- Department of Neurological Surgery, University of California San Diego, San Diego, California; and
- Division of Neurosurgery and Pediatric Critical Care, Rady Children’s Hospital, San Diego, California
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12
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Martin JR, Gabriel P, Gold J, Haas R, Davis S, Gonda D, Sharpe C, Wilson S, Nierenberg N, Scheuer M, Wang S. Optical Flow Estimation Improves Automated Seizure Detection in Neonatal EEG. J Clin Neurophysiol 2022; 39:235-239. [PMID: 32810002 PMCID: PMC7887141 DOI: 10.1097/wnp.0000000000000767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Existing automated seizure detection algorithms report sensitivities between 43% and 77% and specificities between 56% and 90%. The algorithms suffer from false alarms when applied to neonatal EEG because of the high degree of nurse handling and rhythmic patting used to soothe neonates. Computer vision technology that quantifies movement in real time could distinguish artifactual motion and improve automated neonatal seizure detection algorithms. METHODS The authors used video EEG recordings from 43 neonates undergoing monitoring for seizures as part of the NEOLEV2 clinical trial. The Persyst neonatal automated seizure detection algorithm ran in real time during study EEG acquisitions. Computer vision algorithms were applied to extract detailed accounts of artifactual movement of the neonate or people near the neonate though dense optical flow estimation. RESULTS Using the methods mentioned above, 197 periods of patting activity were identified and quantified, of which 45 generated false-positive automated seizure detection events. A binary patting detection algorithm was trained with a subset of 470 event videos. This supervised detection algorithm was applied to a testing subset of 187 event videos with 8 false-positive events, which resulted in a 24% reduction in false-positive automated seizure detections and a 50% reduction in false-positive events caused by neonatal care patting, while maintaining 11 of 12 true-positive seizure detection events. CONCLUSIONS This work presents a novel approach to improving automated seizure detection algorithms used during neonatal video EEG monitoring. This artifact detection mechanism can improve the ability of a seizure detector algorithm to distinguish between artifact and true seizure activity.
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Affiliation(s)
- Joel R Martin
- Department of Electrical Engineering, University of California, San Diego, La Jolla, CA
| | - Paolo Gabriel
- Department of Electrical Engineering, University of California, San Diego, La Jolla, CA
| | - Jeffrey Gold
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Richard Haas
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Sue Davis
- Auckland District Health Board, Auckland, New Zealand
| | - David Gonda
- Department of Surgery, University of California, San Diego, La Jolla, CA
| | - Cia Sharpe
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | | | | | | | - Sonya Wang
- Department of Neurology, University of Minnesota, Minneapolis, MN
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13
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Liu MA, Gendreau JL, Loya JJ, Brown NJ, Keith A, Sahyouni R, Abraham ME, Gonda D, Levy ML. Management of pediatric clival chordoma with extension to the craniocervical junction and occipito-cervical fusion: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 2:CASE21434. [PMID: 36060426 PMCID: PMC9435547 DOI: 10.3171/case21434] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chordomas are rare malignant neoplasms that develop from the primitive notochord with < 5% of the tumors occurring in pediatric patients younger than the age of 20. Of these pediatric chordomas, those affecting the craniocervical junction (C1–C2) are even more rare; therefore, parameters for surgical management of these pediatric tumors are not well characterized. OBSERVATIONS In this case, a 3-year-old male was found to have a clival chordoma on imaging with extension to the craniocervical junction resulting in spinal cord compression. Endoscopic-assisted transoral transclival approach for clival tumor resection was performed first. As a second stage, the patient underwent a left-sided far lateral craniotomy and cervical laminectomy for resection of the skull base chordoma and instrumented fusion of the occiput to C3. He made excellent improvements in strength and dexterity during rehab and was discharged after 3 weeks. LESSONS In pediatric patients with chordoma with extension to the craniocervical junction and spinal cord compression, decompression with additional occipito-cervical fusion appears to offer a good clinical outcome. Fusion performed as a separate surgery before or at the same time as the initial tumor resection surgery may lead to better outcomes.
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Affiliation(s)
- Matthew A. Liu
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Julian L. Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland
| | - Joshua J. Loya
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Nolan J. Brown
- Department of Neurosurgery, University of California Irvine, Orange, California; and
| | - Amber Keith
- Department of Neurosurgery, University of California Irvine, Orange, California; and
| | - Ronald Sahyouni
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Mickey E. Abraham
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - David Gonda
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
- Rady Children’s Hospital San Diego, California
| | - Michael L. Levy
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
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14
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Ravindra VM, Lee S, Gonda D, Patino I, Ruggieri L, Ikeda DS, Curry DJ. Magnetic resonance-guided laser interstitial thermal therapy for pediatric periventricular nodular heterotopia-related epilepsy. J Neurosurg Pediatr 2021:1-6. [PMID: 34560627 DOI: 10.3171/2021.5.peds21171] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Periventricular nodular heterotopia (PVNH) is a result of disrupted neuronal migration from the ventricular system and can be a rare cause of refractory focal epilepsy. The goal of this case series was to describe the treatment of pediatric PVNH-related epilepsy with MR-guided laser interstitial thermal ablation. METHODS Patients treated at a single institution with MR-guided laser interstitial thermal therapy (MRgLITT) for PVNH-related epilepsy were identified. Preoperative and postoperative seizure outcomes and procedural information were evaluated. RESULTS Five children with PVNH treated with MRgLITT were reviewed; 1 child was treated twice. Three patients were female; the median age was 10.9 years. Five of 6 treatments were preceded by stereoelectroencephalography phase II monitoring. Three children experienced unilateral PVNH, and 2 had bilateral seizures. The median number of seizures recorded during phase II monitoring was 2; the median number of ablation targets was 2 (range 1-4). All patients experienced a decrease in seizure frequency; 4 patients (80%) had an Engel class ≤ III at the last follow-up (range I-IV). One child experienced right hemianopia posttreatment. CONCLUSIONS This case series investigation has illustrated a novel, minimally invasive approach for treating pediatric PVNH-related epilepsy. Further study of this technique with comparison with other surgical techniques is warranted.
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Affiliation(s)
- Vijay M Ravindra
- 1Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston; and.,2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Sungho Lee
- 3Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - David Gonda
- 4Department of Neurosurgery, Rady Children's Hospital, University of California, San Diego, California; and
| | - Ilana Patino
- 1Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston; and
| | - Lucia Ruggieri
- 1Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston; and
| | - Daniel S Ikeda
- 5Department of Neurosurgery, US Naval Hospital Okinawa, Okinawa, Japan
| | - Daniel J Curry
- 1Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston; and.,3Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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15
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Aristizabal P, Burns LP, Kumar NV, Perdomo BP, Rivera-Gomez R, Ornelas MA, Gonda D, Malicki D, Thornburg CD, Roberts W, Levy ML, Crawford JR. Improving Pediatric Neuro-Oncology Survival Disparities in the United States-Mexico Border Region: A Cross-Border Initiative Between San Diego, California, and Tijuana, Mexico. JCO Glob Oncol 2021; 6:1791-1802. [PMID: 33216645 PMCID: PMC7713516 DOI: 10.1200/go.20.00377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Treatment of children with CNS tumors (CNSTs) demands a complex, interdisciplinary approach that is rarely available in low- and middle-income countries. We established the Cross-Border Neuro-Oncology Program (CBNP) between Rady Children's Hospital, San Diego (RCHSD), and Hospital General, Tijuana (HGT), Mexico, to provide access to neuro-oncology care, including neurosurgic services, for children with CNSTs diagnosed at HGT. Our purpose was to assess the feasibility of the CBNP across the United States-Mexico border and improve survival for children with CNSTs at HGT by implementing the CBNP. PATIENTS AND METHODS We prospectively assessed clinicopathologic profiles, the extent of resection, progression-free survival, and overall survival (OS) in children with CNSTs at HGT from 2010 to 2017. RESULTS Sixty patients with CNSTs participated in the CBNP during the study period. The most common diagnoses were low-grade glioma (24.5%) and medulloblastoma (22.4%). Of patients who were eligible for surgery, 49 underwent resection at RCHSD and returned to HGT for collaborative management. Gross total resection was achieved in 78% of cases at RCHSD compared with 0% at HGT (P < .001) and was a predictor of 5-year OS (hazard ratio, 0.250; 95% CI, 0.067 to 0.934; P = .024). Five-year OS improved from 0% before 2010 to 52% in 2017. CONCLUSION The CBNP facilitated access to complex neuro-oncology care for underserved children in Mexico through binational exchanges of resources and expertise. Survival for patients in the CBNP dramatically improved. Gross total resection at RCHSD was associated with higher OS, highlighting the critical role of experienced neurosurgeons in the treatment of CNSTs. The CBNP model offers an attractive alternative for children with CNSTs in low- and middle-income countries who require complex neuro-oncology care, particularly those in close proximity to institutions in high-income countries with extensive neuro-oncology expertise.
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Affiliation(s)
- Paula Aristizabal
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Diego, La Jolla, CA.,Population Sciences, Disparities and Community Engagement, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Luke P Burns
- School of Medicine, University of California, San Diego, La Jolla, CA
| | - Nikhil V Kumar
- School of Medicine, University of California, San Diego, La Jolla, CA
| | - Bianca P Perdomo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Rebeca Rivera-Gomez
- Hospital General de Tijuana/Universidad Autónoma de Baja California Tijuana, Baja California, Mexico
| | - Mario A Ornelas
- Hospital General de Tijuana/Universidad Autónoma de Baja California Tijuana, Baja California, Mexico
| | - David Gonda
- Department of Neurosciences, University of California, San Diego, La Jolla, CA.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California, San Diego, La Jolla, CA
| | - Denise Malicki
- Department of Pathology, University of California, San Diego, La Jolla, CA
| | - Courtney D Thornburg
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - William Roberts
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Michael L Levy
- Department of Neurosciences, University of California, San Diego, La Jolla, CA.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California, San Diego, La Jolla, CA
| | - John R Crawford
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Diego, La Jolla, CA.,Department of Neurosciences, University of California, San Diego, La Jolla, CA.,Division of Pediatric Neurology, Department of Pediatrics, University of California San Diego, La Jolla, CA
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16
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Ravindra VM, Karas PJ, Hartnett S, Patino I, North R, Tatsui CE, Gonda D, Schwabe A, Curry DJ. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Palliative Rhizotomy: A Novel Technical Application. Oper Neurosurg (Hagerstown) 2021; 20:413-418. [PMID: 33377153 DOI: 10.1093/ons/opaa415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Spastic cerebral palsy is caused by an insult to the developing brain. Various medical and surgical procedures are used to reduce tone. OBJECTIVE To describe a novel method of magnetic resonance-guided laser interstitial thermal ablation for palliative rhizotomy. METHODS Patients treated at a single institution with percutaneous rhizotomy using magnetic resonance-guided laser interstitial thermal therapy were identified. Preoperative and postoperative Modified Ashworth Scale scores were collected as well as procedural information. RESULTS Two male children (7.8 and 19 yr, respectively) with spastic quadriparesis were treated using this technique. Neither patient experienced surgical or perioperative complications, and both were discharged from the hospital within 48 h. Each of them demonstrated improvement in his Modified Ashworth Scale score with no need for retreatment for spasticity at last follow-up. CONCLUSION These 2 cases illustrate a novel technique for treating spasticity in the setting of cerebral palsy. Further study of this technique in additional patients, and comparison with traditional methods of surgical tone reduction, are warranted.
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Affiliation(s)
- Vijay M Ravindra
- Division of Pediatric Neurosurgery, Texas Children's Hospital Baylor College of Medicine, Houston, Texas.,Division of Pediatric Neurosurgery, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Patrick J Karas
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sara Hartnett
- Department of Neurosurgery, University of South Florida, Tampa, Florida
| | - Ilana Patino
- Division of Pediatric Neurosurgery, Texas Children's Hospital Baylor College of Medicine, Houston, Texas
| | - Robert North
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Claudio E Tatsui
- Department of Neurosurgery, Division of Surgery, MD Anderson Cancer Center, Houston, Texas
| | - David Gonda
- Division of Pediatric Neurosurgery, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Aloysia Schwabe
- Department of Physical Medicine and Rehabilitation Medicine, Baylor College of Medicine, Section of Pediatric Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, Texas
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Texas Children's Hospital Baylor College of Medicine, Houston, Texas.,Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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17
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Arocho-Quinones EV, Lew SM, Handler MH, Tovar-Spinoza Z, Smyth M, Bollo R, Donahue D, Perry MS, Levy ML, Gonda D, Mangano FT, Storm PB, Price AV, Couture DE, Oluigbo C, Duhaime AC, Barnett GH, Muh CR, Sather MD, Fallah A, Wang AC, Bhatia S, Patel K, Tarima S, Graber S, Huckins S, Hafez DM, Rumalla K, Bailey L, Shandley S, Roach A, Alexander E, Jenkins W, Tsering D, Price G, Meola A, Evanoff W, Thompson EM, Brandmeir N. Magnetic resonance-guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors: a multiinstitutional retrospective study. J Neurosurg Pediatr 2020; 26:13-21. [PMID: 32217793 PMCID: PMC7885863 DOI: 10.3171/2020.1.peds19496] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess the safety and efficacy of MR-guided stereotactic laser ablation (SLA) therapy in the treatment of pediatric brain tumors. METHODS Data from 17 North American centers were retrospectively reviewed. Clinical, technical, and radiographic data for pediatric patients treated with SLA for a diagnosis of brain tumor from 2008 to 2016 were collected and analyzed. RESULTS A total of 86 patients (mean age 12.2 ± 4.5 years) with 76 low-grade (I or II) and 10 high-grade (III or IV) tumors were included. Tumor location included lobar (38.4%), deep (45.3%), and cerebellar (16.3%) compartments. The mean follow-up time was 24 months (median 18 months, range 3-72 months). At the last follow-up, the volume of SLA-treated tumors had decreased in 80.6% of patients with follow-up data. Patients with high-grade tumors were more likely to have an unchanged or larger tumor size after SLA treatment than those with low-grade tumors (OR 7.49, p = 0.0364). Subsequent surgery and adjuvant treatment were not required after SLA treatment in 90.4% and 86.7% of patients, respectively. Patients with high-grade tumors were more likely to receive subsequent surgery (OR 2.25, p = 0.4957) and adjuvant treatment (OR 3.77, p = 0.1711) after SLA therapy, without reaching significance. A total of 29 acute complications in 23 patients were reported and included malpositioned catheters (n = 3), intracranial hemorrhages (n = 2), transient neurological deficits (n = 11), permanent neurological deficits (n = 5), symptomatic perilesional edema (n = 2), hydrocephalus (n = 4), and death (n = 2). On long-term follow-up, 3 patients were reported to have worsened neuropsychological test results. Pre-SLA tumor volume, tumor location, number of laser trajectories, and number of lesions created did not result in a significantly increased risk of complications; however, the odds of complications increased by 14% (OR 1.14, p = 0.0159) with every 1-cm3 increase in the volume of the lesion created. CONCLUSIONS SLA is an effective, minimally invasive treatment option for pediatric brain tumors, although it is not without risks. Limiting the volume of the generated thermal lesion may help decrease the incidence of complications.
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Affiliation(s)
| | - Sean M. Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin,Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Michael H. Handler
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Zulma Tovar-Spinoza
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Matthew Smyth
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Robert Bollo
- Department of Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah
| | - David Donahue
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - M. Scott Perry
- Department of Neurology, Cook Children’s Hospital, Fort Worth, Texas
| | - Michael L. Levy
- Department of Neurosurgery, Rady Children’s Hospital-San Diego, California
| | - David Gonda
- Department of Neurosurgery, Rady Children’s Hospital-San Diego, California
| | | | - Phillip B. Storm
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Angela V. Price
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel E. Couture
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Chima Oluigbo
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Gene H. Barnett
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Carrie R. Muh
- Department of Neurosurgery, Duke Children’s Hospital, Durham, North Carolina
| | - Michael D. Sather
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Aria Fallah
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Anthony C. Wang
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Sanjiv Bhatia
- Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida
| | - Kadam Patel
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey Tarima
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah Graber
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Sean Huckins
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel M. Hafez
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Kavelin Rumalla
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Laurie Bailey
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - Sabrina Shandley
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - Ashton Roach
- Department of Neurosurgery, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Erin Alexander
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Wendy Jenkins
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Deki Tsering
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - George Price
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Antonio Meola
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Wendi Evanoff
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Eric M. Thompson
- Department of Neurosurgery, Duke Children’s Hospital, Durham, North Carolina
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Yekula A, Grant C, Gupta M, Santiago-Dieppa DR, Duddleston PJ, Gonda D, Levy M. Clinical and genetic characterization of patients with Pierre Robin sequence and spinal disease: review of the literature and novel terminal 10q deletion. Childs Nerv Syst 2020; 36:1367-1377. [PMID: 32399800 PMCID: PMC7300078 DOI: 10.1007/s00381-020-04642-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Pierre-Robin sequence (PRS) is a pattern of congenital facial abnormalities comprising micrognathia, glossoptosis, and airway obstruction. Associated spinal pathologies have rarely been reported with PRS. METHODS We explore the molecular genetic basis of this association through a systematic review of spinal disease in patients with PRS. We also present an illustrative case of a PRS patient with tethered cord in the setting of chromosome 10q terminal deletion. RESULTS Our systematic literature review of spinal disease in patients with PRS revealed several patterns in the underlying genetic syndromes causing these conditions to co-occur. These principles are illustrated in the case of a 6-month-old female with PRS and a 14.34-Mb terminal deletion of chromosome 10q, who was found to have a sacral dimple during a routine outpatient checkup. Magnetic resonance imaging of the spine revealed a lumbar syrinx associated with tethered spinal cord. Surgical de-tethering was undertaken, with subsequent improvement in motor function and decrease in the size of the syrinx. The deletion of chromosome 10q in our patient had not previously been described in association with tethered cord or PRS. CONCLUSION Spinal pathologies are understudied contributors to disease burden in patients with PRS. The range of predisposing syndromes and mutations in patients with both PRS and spinal disorders remains poorly characterized but may be more defined than previously conceived. Clinical screening is most critical during neonatal and adolescent developmental periods with continued neurological assessment. This study emphasizes the need for early genetic testing and counseling in this patient population, in parallel with research efforts to develop molecular classifications to guide clinical management.
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Affiliation(s)
- Anudeep Yekula
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA USA
| | - Connor Grant
- Department of Neurosurgery, University of California San Diego, La Jolla, CA USA
| | - Mihir Gupta
- Department of Neurosurgery, University of California San Diego, La Jolla, CA, USA. .,, San Diego, CA, USA.
| | | | | | - David Gonda
- Department of Neurosurgery, University of California San Diego, La Jolla, CA USA ,Department of Pediatric Neurosurgery, Rady Children’s Hospital, San Diego, CA USA
| | - Michael Levy
- Department of Neurosurgery, University of California San Diego, La Jolla, CA USA ,Department of Pediatric Neurosurgery, Rady Children’s Hospital, San Diego, CA USA
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19
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Gabriel PG, Chen KJ, Alasfour A, Pailla T, Doyle WK, Devinsky O, Friedman D, Dugan P, Melloni L, Thesen T, Gonda D, Sattar S, Wang SG, Gilja V. Neural correlates of unstructured motor behaviors. J Neural Eng 2019; 16:066026. [DOI: 10.1088/1741-2552/ab355c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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20
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Hoshide R, Rennert RC, Calayag M, Gonda D, Meltzer H, Crawford JR, Levy ML. Pediatric Intracavernous Sinus Lesions: A Single Institutional Surgical Case Series and Review of the Literature. Oper Neurosurg (Hagerstown) 2019; 17:354-364. [DOI: 10.1093/ons/opz004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/06/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Pediatric intracavernous sinus tumors are exceedingly rare and thus poorly characterized. Their neurosurgical management is challenging and diagnostic, and management guidelines are limited.
OBJECTIVE
To report our institutional experience with the surgical resection of pediatric intracavernous sinus tumors. We also compare and contrast our results with the 14 cases of pediatric intracavernous sinus lesions in the current literature.
METHODS
A retrospective descriptive analysis of consecutive pediatric patients (ages 0-18 yr) presenting to our institution with a diagnosis of an intracavernous sinus lesion was performed. From January 2012 to January 2017, 5 cases were identified. Eleven patients with secondary invasion of the cavernous sinus (2 meningiomas, 7 pituitary adenomas) or dermoid tumors involving the cavernous sinus (2) were not included in our review.
RESULTS
Surgical resection via a frontotemporal orbitozygomatic approach was performed in all cases by a single senior neurosurgeon (M.L.). There were no perioperative or postoperative complications attributable to the surgery or approach. Four of 5 patients remained neurologically stable throughout the perioperative and postoperative period. The fifth patient had a complete resolution of their cranial neuropathies postoperatively. A pathological diagnosis that guided long-term management was obtained in all cases.
CONCLUSION
Neurosurgical management of pediatric cavernous sinus lesions can be safely performed and critically guide future therapies. Surgeon familiarity with cavernous sinus and skull-base anatomy is critical to the successful management of these patients. The benefits of surgery should be balanced against the potential complications and need for a tissue diagnosis in children. The senior author had a significant experience with cavernous sinus approaches in adults prior to initiating use of the approach in the pediatric population.
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Affiliation(s)
- Reid Hoshide
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California – San Diego, San Diego, California
| | - Robert C Rennert
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California – San Diego, San Diego, California
| | - Mark Calayag
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California – Irvine, Irvine, California
| | - David Gonda
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California – San Diego, San Diego, California
| | - Hal Meltzer
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California – San Diego, San Diego, California
| | - John R Crawford
- Department of Neurosciences and Pediatrics, University of California – San Diego, Rady Children's Hospital-San Diego, San Diego, California
| | - Michael L Levy
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California – San Diego, San Diego, California
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21
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Alasfour A, Gabriel P, Jiang X, Shamie I, Melloni L, Thesen T, Dugan P, Friedman D, Doyle W, Devinsky O, Gonda D, Sattar S, Wang S, Halgren E, Gilja V. Coarse behavioral context decoding. J Neural Eng 2019; 16:016021. [DOI: 10.1088/1741-2552/aaee9c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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22
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Dalle Ore CL, Rennert RC, Schupper AJ, Gabel BC, Gonda D, Peterson B, Marshall LF, Levy M, Meltzer HS. The identification of a subgroup of children with traumatic subarachnoid hemorrhage at low risk of neuroworsening. J Neurosurg Pediatr 2018; 22:559-566. [PMID: 30095347 DOI: 10.3171/2018.5.peds18140] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/21/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVEPediatric traumatic subarachnoid hemorrhage (tSAH) often results in intensive care unit (ICU) admission, the performance of additional diagnostic studies, and ICU-level therapeutic interventions to identify and prevent episodes of neuroworsening.METHODSData prospectively collected in an institutionally specific trauma registry between 2006 and 2015 were supplemented with a retrospective chart review of children admitted with isolated traumatic subarachnoid hemorrhage (tSAH) and an admission Glasgow Coma Scale (GCS) score of 13-15. Risk of blunt cerebrovascular injury (BCVI) was calculated using the BCVI clinical prediction score.RESULTSThree hundred seventeen of 10,395 pediatric trauma patients were admitted with tSAH. Of the 317 patients with tSAH, 51 children (16%, 23 female, 28 male) were identified with isolated tSAH without midline shift on neuroimaging and a GCS score of 13-15 at presentation. The median patient age was 4 years (range 18 days to 15 years). Seven had modified Fisher grade 3 tSAH; the remainder had grade 1 tSAH. Twenty-six patients (51%) had associated skull fractures; 4 involved the petrous temporal bone and 1 the carotid canal. Thirty-nine (76.5%) were admitted to the ICU and 12 (23.5%) to the surgical ward. Four had an elevated BCVI score. Eight underwent CT angiography; no vascular injuries were identified. Nine patients received an imaging-associated general anesthetic. Five received hypertonic saline in the ICU. Patients with a modified Fisher grade 1 tSAH had a significantly shorter ICU stay as compared to modified Fisher grade 3 tSAH (1.1 vs 2.5 days, p = 0.029). Neuroworsening was not observed in any child.CONCLUSIONSChildren with isolated tSAH without midline shift and a GCS score of 13-15 at presentation appear to have minimal risk of neuroworsening despite the findings in some children of skull fractures, elevated modified Fisher grade, and elevated BCVI score. In this subgroup of children with tSAH, routine ICU-level care and additional diagnostic imaging may not be necessary for all patients. Children with modified Fisher grade 1 tSAH may be particularly unlikely to require ICU-level admission. Benefits to identifying a subgroup of children at low risk of neuroworsening include improvement in healthcare efficiency as well as decreased utilization of unnecessary and potentially morbid interventions, including exposure to ionizing radiation and general anesthesia.
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Affiliation(s)
- Cecilia L Dalle Ore
- 1Department of Neurosurgery, University of California San Diego School of Medicine; and
| | - Robert C Rennert
- 1Department of Neurosurgery, University of California San Diego School of Medicine; and
| | - Alexander J Schupper
- 1Department of Neurosurgery, University of California San Diego School of Medicine; and
| | - Brandon C Gabel
- 1Department of Neurosurgery, University of California San Diego School of Medicine; and
| | - David Gonda
- 1Department of Neurosurgery, University of California San Diego School of Medicine; and.,Divisions of2Neurosurgery and
| | - Bradley Peterson
- 3Pediatric Critical Care, Rady Children's Hospital, San Diego, California
| | - Lawrence F Marshall
- 1Department of Neurosurgery, University of California San Diego School of Medicine; and
| | - Michael Levy
- 1Department of Neurosurgery, University of California San Diego School of Medicine; and.,Divisions of2Neurosurgery and
| | - Hal S Meltzer
- 1Department of Neurosurgery, University of California San Diego School of Medicine; and.,Divisions of2Neurosurgery and
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23
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Chen K, Gabriel P, Alasfour A, Gong C, Doyle WK, Devinsky O, Friedman D, Dugan P, Melloni L, Thesen T, Gonda D, Sattar S, Wang S, Gilja V. Patient-Specific Pose Estimation in Clinical Environments. IEEE J Transl Eng Health Med 2018; 6:2101111. [PMID: 30483453 PMCID: PMC6255526 DOI: 10.1109/jtehm.2018.2875464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/04/2018] [Accepted: 09/30/2018] [Indexed: 11/11/2022]
Abstract
Reliable posture labels in hospital environments can augment research studies on neural correlates to natural behaviors and clinical applications that monitor patient activity. However, many existing pose estimation frameworks are not calibrated for these unpredictable settings. In this paper, we propose a semi-automated approach for improving upper-body pose estimation in noisy clinical environments, whereby we adapt and build around an existing joint tracking framework to improve its robustness to environmental uncertainties. The proposed framework uses subject-specific convolutional neural network models trained on a subset of a patient's RGB video recording chosen to maximize the feature variance of each joint. Furthermore, by compensating for scene lighting changes and by refining the predicted joint trajectories through a Kalman filter with fitted noise parameters, the extended system yields more consistent and accurate posture annotations when compared with the two state-of-the-art generalized pose tracking algorithms for three hospital patients recorded in two research clinics.
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Affiliation(s)
- Kenny Chen
- Department of Electrical and Computer EngineeringUniversity of California at San DiegoLa JollaCA92093USA
| | - Paolo Gabriel
- Department of Electrical and Computer EngineeringUniversity of California at San DiegoLa JollaCA92093USA
| | - Abdulwahab Alasfour
- Department of Electrical and Computer EngineeringUniversity of California at San DiegoLa JollaCA92093USA
| | - Chenghao Gong
- Department of Electrical and Computer EngineeringUniversity of California at San DiegoLa JollaCA92093USA
| | - Werner K. Doyle
- Comprehensive Epilepsy Center, NYU Langone Medical CenterNew YorkNY10016USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, NYU Langone Medical CenterNew YorkNY10016USA
| | - Daniel Friedman
- Comprehensive Epilepsy Center, NYU Langone Medical CenterNew YorkNY10016USA
| | - Patricia Dugan
- Comprehensive Epilepsy Center, NYU Langone Medical CenterNew YorkNY10016USA
| | - Lucia Melloni
- Comprehensive Epilepsy Center, NYU Langone Medical CenterNew YorkNY10016USA
| | - Thomas Thesen
- Comprehensive Epilepsy Center, NYU Langone Medical CenterNew YorkNY10016USA
| | - David Gonda
- Rady Children’s Hospital of San DiegoSan DiegoCA92123USA
- Department of PediatricsUniversity of California at San DiegoLa JollaCA92093USA
| | - Shifteh Sattar
- Rady Children’s Hospital of San DiegoSan DiegoCA92123USA
- Department of PediatricsUniversity of California at San DiegoLa JollaCA92093USA
| | - Sonya Wang
- Department of NeurologyUniversity of Minnesota Twin CitiesMinneapolisMN55455USA
| | - Vikash Gilja
- Department of Electrical and Computer EngineeringUniversity of California at San DiegoLa JollaCA92093USA
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24
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Steinberg JA, Wali AR, Martin J, Santiago-Dieppa DR, Gonda D, Taylor W. Spinal Shortening for Recurrent Tethered Cord Syndrome via a Lateral Retropleural Approach: A Novel Operative Technique. Cureus 2017; 9:e1632. [PMID: 29104840 PMCID: PMC5663326 DOI: 10.7759/cureus.1632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spine shortening via vertebral osteotomy (SSVO) for recurrent tethered cord syndrome (TCS) is a novel surgical technique that avoids the complication profile associated with revision detethering. While SSVO has previously been described via a posterior approach, we describe a lateral retropleural approach for SSVO in recurrent TCS in a 21-year-old female. Our patient presented with progressive lower extremity weakness, bowel and bladder incontinence, and back pain in the setting of childhood repair of myelomeningocele and two previous detethering procedures. SSVO was offered to the patient as further detethering was deemed to have significant risk. A discectomy at T11-T12 via the lateral retropleural approach was performed, followed by a T12 partial corpectomy removing the vertebral body down to the inferior aspect of the T12 pedicle, followed by the removal of the ipsilateral pedicle. The T10, T11, L1, and L2 pedicle screws were then placed in the prone position and temporary rods were placed for temporary stability, followed by a laminectomy at T12 and a facetectomy for posterior element release. The remaining pedicle was removed, permanent rods were sequentially placed, and spinal column shortening was achieved by compression against the rods. Standing lateral radiographs demonstrated 19 millimeters (mm) of shortening after the intervention. The patient remained at her neurologic baseline postoperatively. At the six-month follow-up, the patient reported decreased lower extremity radicular pain and improved bowel and bladder function. This operative report demonstrates that SSVO via a lateral retropleural approach is a viable treatment for the recurrence of TCS. The advantages of this minimally invasive approach compared to the posterior approach are direct access to the vertebral body and disc space, avoiding the need to operate around the spinal cord. Further studies are necessary to assess this minimally invasive approach to spinal shortening and to see if a complete minimally invasive approach is possible.
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Affiliation(s)
| | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego
| | - Joel Martin
- Department of Neurosurgery, University of California, San Diego
| | | | - David Gonda
- Department of Neurosurgery, University of California, San Diego
| | - William Taylor
- Department of Neurosurgery, University of California, San Diego
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25
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Abstract
OBJECTIVE The endoscopic third ventriculostomy (ETV) is an established and effective treatment for obstructive hydrocephalus. In its most common application, surgeons plan their entry point and the endoscope trajectory for the procedure based on anatomical landmarks, then control the endoscope freehand. Recent studies report an incidence of neural injuries as high as 16.6% of all ETVs performed in North America. The authors have introduced the ROSA system to their ETV procedure to stereotactically optimize endoscope trajectories, to reduce risk of traction on neural structures by the endoscope, and to provide a stable mechanical holder of the endoscope. Here, they present their series in which the ROSA system was used for ETVs. METHODS At the authors' institution, they performed ETVs with the ROSA system in 9 consecutive patients within an 8-month period. Patients had to have a favorable expected response to ETV (ETV Success Score ≥ 70) with no additional endoscopic procedures (e.g., choroid plexus cauterization, septum pellucidum fenestration). The modality of image registration (CT, MRI, surface mapping, or bone fiducials) was dependent on the case. RESULTS Nine pediatric patients with an age range of 1.5 to 16 years, 4 girls and 5 boys, with ETV Success Scores ranging from 70 to 90, underwent successful ETV surgery with the ROSA system within an 8-month period. Their intracranial pathologies included tectal tumors (n = 3), communicating hydrocephalus from hemorrhage or meningeal disease (n = 2), congenital aqueductal stenosis (n = 1), compressive porencephalic cyst (n = 1), Chiari I malformation (n = 1), and pineal region mass (n = 1). Robotic assistance was limited to the ventricular access in the first 2 procedures, but was used for the entirety of the procedure for the following 7 cases. Four of these cases were combined with another procedural objective (3 stereotactic tectal mass biopsies, 1 Chiari decompression). A learning curve was observed with each subsequent surgery as registration and surgical times became shorter and more efficient. All patients had complete resolution of their preprocedural symptoms. There were no complications. CONCLUSIONS The ROSA system provides a stable, precise, and minimally invasive approach to ETVs.
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Affiliation(s)
- Reid Hoshide
- Division of Neurosurgery, Rady Children's Hospital, San Diego, California
| | - Mark Calayag
- Division of Neurosurgery, Rady Children's Hospital, San Diego, California
| | - Hal Meltzer
- Division of Neurosurgery, Rady Children's Hospital, San Diego, California
| | - Michael L Levy
- Division of Neurosurgery, Rady Children's Hospital, San Diego, California
| | - David Gonda
- Division of Neurosurgery, Rady Children's Hospital, San Diego, California
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26
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Hoshide R, Meltzer H, Dalle-Ore C, Gonda D, Guillaume D, Chen CC. Impact of ventricular-peritoneal shunt valve design on clinical outcome of pediatric patients with hydrocephalus: Lessons learned from randomized controlled trials. Surg Neurol Int 2017; 8:49. [PMID: 28480111 PMCID: PMC5402330 DOI: 10.4103/sni.sni_11_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/24/2017] [Indexed: 11/05/2022] Open
Abstract
Hydrocephalus is one of the most common diseases managed by pediatric neurosurgeons. Cerebrospinal fluid (CSF) shunting has been the mainstay of durable treatment for hydrocephalus for many decades. There are two main categories of shunt designs for regulating the extent of CSF diversion: (1) Fixed-parameter valves and (2) adjustable valves. Furthermore, these valves can also function with and without an anti-siphon device. Here, we review randomized controlled trials (RCTs) that examined the impact of these valve designs on the clinical outcome of pediatric patients afflicted with hydrocephalus. All three RCTs suggested no significant differences in clinical outcome as a function of shunt design. Implications of these findings are discussed.
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Affiliation(s)
- Reid Hoshide
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Hal Meltzer
- Division of Neurosurgery, Rady Children's Hospital, San Diego, California, USA
| | - Cecilia Dalle-Ore
- Division of Neurosurgery, Rady Children's Hospital, San Diego, California, USA
| | - David Gonda
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Daniel Guillaume
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Clark C Chen
- Department of Neurosurgery, University of California, San Diego, California, USA
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27
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Desai V, Gonda D, Ryan SL, Briceño V, Lam SK, Luerssen TG, Syed SH, Jea A. The effect of weekend and after-hours surgery on morbidity and mortality rates in pediatric neurosurgery patients. J Neurosurg Pediatr 2015; 16:726-31. [PMID: 26406160 DOI: 10.3171/2015.6.peds15184] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Several studies have indicated that the 30-day morbidity and mortality risks are higher among pediatric and adult patients who are admitted on the weekends. This "weekend effect" has been observed among patients admitted with and for a variety of diagnoses and procedures, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. In this study, morbidity and mortality outcomes for emergency pediatric neurosurgical procedures carried out on the weekend or after hours are compared with emergency surgical procedures performed during regular weekday business hours. METHODS A retrospective analysis of operative data was conducted. Between December 1, 2011, and August 20, 2014, a total of 710 urgent or emergency neurosurgical procedures were performed at Texas Children's Hospital in children younger than than 18 years of age. These procedures were then stratified into 3 groups: weekday regular hours, weekday after hours, and weekend hours. By cross-referencing these events with a prospectively collected morbidity and mortality database, the impact of the day and time on complication incidence was examined. Outcome metrics were compared using logistic regression models. RESULTS The weekday regular hours and after-hours (weekday after hours and weekends) surgery groups consisted of 341 and 239 patients and 434 and 276 procedures, respectively. There were no significant differences in the types of cases performed (p = 0.629) or baseline preoperative health status as determined by American Society of Anesthesiologists classifications (p = 0.220) between the 2 cohorts. After multivariate adjustment and regression, children undergoing emergency neurosurgical procedures during weekday after hours or weekends were more likely to experience complications (p = 0.0227). CONCLUSIONS Weekday after-hours and weekend emergency pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared with procedures performed during weekday regular hours.
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Affiliation(s)
- Virendra Desai
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - David Gonda
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sheila L Ryan
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Valentina Briceño
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Thomas G Luerssen
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sohail H Syed
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Andrew Jea
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Kozono D, Li J, Sampetrean O, Gonda D, Kushwaha D, Merzon D, Nitta M, Ramakrishnan V, Zhu S, Zhu K, Matsui H, Harismendy O, Hua W, Mao Y, Kwon CH, Saya HI, Nakano I, Pizzo D, Vandenberg S, Chen C. EPIG-02DYNAMIC EPIGENETIC MODULATION OF GLIOBLASTOMA TUMORIGENICITY BY INHIBITION OF LYSINE-SPECIFIC DEMETHYLASE 1 (LSD1). Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov214.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Li J, Taich Z, Goyal A, Gonda D, Akers J, Adhikari B, Patel K, Vandenberg S, Yan W, Bao Z, Carter B, Wang R, Mao Y, Chen C. EPIG-03EPIGENETIC SUPPRESSION OF EGFR SIGNALING IN G-CIMP + GLIOBLASTOMAS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov214.03] [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: 11/13/2022] Open
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30
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Marcus L, Marshall D, McCutcheon B, Gonda D, Goetsch S, Hattangadi J, Carter B, Yamamoto M, Chen C. BMET-09CUMULATIVE INTRACRANIAL TUMOR VOLUME (CITV) ENHANCES THE PROGNOSTIC VALUE OF THE LUNG-SPECIFIC-GRADED PROGNOSTIC ASSESSMENT (GPA) MODEL. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov208.09] [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: 11/14/2022] Open
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31
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Chen C, Kozono D, Li J, Nitta M, Sampetrean O, Ng K, Gonda D, Kushwaha DS, Merzon D, Ramakrishnan V, Zhu S, Zhu K, Matsui H, Harismendy O, Hua W, Mao Y, Kwon CH, Ligon KL, Saya H, Carter BS, Pizzo DP, VandenBerg SR, Furnari F, Cavenee W. Abstract PR02: Dynamic epigenetic regulation of glioblastoma tumorigenicity through a LSD1-MYC-OLIG2 axis. Mol Cancer Res 2015. [DOI: 10.1158/1557-3125.myc15-pr02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Glioblastoma is one of the most devastating of human cancers, with near-uniform fatality within two years of diagnosis. Therapeutic failure is thought to be related to small subpopulation of cells that exhibit the properties of self-renewal and tumorigenicity. Understanding how such subpopulations attain and retain these properties remains a central question in oncology. One fundamental issue is whether tumorigenicity exists within a static population of elite cells or whether the capacity is stochastically acquired. To test these models, we assayed the tumorigenicity of single-cell subclones derived from long-terms passaged and primary patient-derived xenograft (PDX) glioblastoma lines. Our findings were best described by a hybrid model that is largely deterministic (elite) but with opportunities for dynamic (stochastic) interchange between non-tumorigenic and tumorigenic states. To identify molecular determinants of tumorigenicity, we performed gene expression profiling of the subclones. Analysis of the data suggested that tumorigenicity in glioblastoma is a dynamic property driven by variation in MYC expression, which in turn regulates Olig2 expression, a neural stem cell marker. Ectopic expression of MYC conferred tumorigenicty and MYC silencing abolished tumorigenicity in vitro and in vivo for multiple PDX and GEMM models. Transition between tumorigenic and non-tumorigenic cell states was associated with changes in histone modification at the MYC locus mediated by expression of lysine-specific demethylase 1 (LSD1). The model suggests a critical LSD1-MYC-OLIG2 axis that regulates the dynamic transition between glioblastoma cell states of differing tumorigenicity and unveils a novel framework for glioblastoma therapeutic development.
Citation Format: Clark Chen, David Kozono, Jie Li, Masayuki Nitta, Oltea Sampetrean, Kimberly Ng, David Gonda, Deepa S. Kushwaha, Dmitry Merzon, Valya Ramakrishnan, Shan Zhu, Kaya Zhu, Hiroko Matsui, Olivier Harismendy, Wei Hua, Ying Mao, Chang-Hyuk Kwon, Keith L. Ligon, Hideyuki Saya, Bob S. Carter, Donald P. Pizzo, Scott R. VandenBerg, Frank Furnari, Webster Cavenee. Dynamic epigenetic regulation of glioblastoma tumorigenicity through a LSD1-MYC-OLIG2 axis. [abstract]. In: Proceedings of the AACR Special Conference on Myc: From Biology to Therapy; Jan 7-10, 2015; La Jolla, CA. Philadelphia (PA): AACR; Mol Cancer Res 2015;13(10 Suppl):Abstract nr PR02.
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Affiliation(s)
- Clark Chen
- 1University of California, San Diego, La Jolla, CA,
| | | | - Jie Li
- 1University of California, San Diego, La Jolla, CA,
| | | | | | | | - David Gonda
- 1University of California, San Diego, La Jolla, CA,
| | | | | | | | - Shan Zhu
- 2Dana-Farber Cancer Institute, Boston, MA,
| | - Kaya Zhu
- 2Dana-Farber Cancer Institute, Boston, MA,
| | | | | | - Wei Hua
- 4Huashan Hospital, Shanghai, China,
| | - Ying Mao
- 4Huashan Hospital, Shanghai, China,
| | | | - Keith L. Ligon
- 6Brigham and Women's Hospital and Harvard Medical School, Boston, MA,
| | | | | | | | | | - Frank Furnari
- 7Ludwig Institute for Cancer Research, San Diego, CA
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Li J, Taich ZJ, Goyal A, Gonda D, Akers J, Adhikari B, Patel K, Vandenberg S, Yan W, Bao Z, Carter BS, Wang R, Mao Y, Jiang T, Chen CC. Epigenetic suppression of EGFR signaling in G-CIMP+ glioblastomas. Oncotarget 2015; 5:7342-56. [PMID: 25277177 PMCID: PMC4202127 DOI: 10.18632/oncotarget.2350] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The intrinsic signaling cascades and cell states associated with the Glioma CpG Island Methylator Phenotype (G-CIMP) remain poorly understood. Using published mRNA signatures associated with EGFR activation, we demonstrate that G-CIMP+ tumors harbor decreased EGFR signaling using three independent datasets, including the Chinese Glioma Genome Atlas(CGGA; n=155), the REMBRANDT dataset (n=288), and The Cancer Genome Atlas (TCGA; n=406). Additionally, an independent collection of 25 fresh-frozen glioblastomas confirmed lowered pERK levels in G-CIMP+ specimens (p<0.001), indicating suppressed EGFR signaling. Analysis of TCGA glioblastomas revealed that G-CIMP+ glioblastomas harbored lowered mRNA levels for EGFR and H-Ras. Induction of G-CIMP+ state by exogenous expression of a mutated isocitrate dehydrogenase 1, IDH1-R132H, suppressed EGFR and H-Ras protein expression as well as pERK accumulation in independent glioblastoma models. These suppressions were associated with increased deposition of the repressive histone markers, H3K9me3 and H3K27me3, in the EGFR and H-Ras promoter regions. The IDH1-R132H expression-induced pERK suppression can be reversed by exogenous expression of H-RasG12V. Finally, the G-CIMP+ Ink4a-Arf−/− EGFRvIII glioblastoma line was more resistant to the EGFR inhibitor, Gefitinib, relative to its isogenic G-CIMP- counterpart. These results suggest that G-CIMP epigenetically regulates EGFR signaling and serves as a predictive biomarker for EGFR inhibitors in glioblastoma patients.
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Affiliation(s)
- Jie Li
- Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego. Contributed equally to this work
| | - Zachary J Taich
- Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego. Contributed equally to this work
| | - Amit Goyal
- Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego
| | - David Gonda
- Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego
| | - Johnny Akers
- Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego
| | - Bandita Adhikari
- Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego
| | - Kunal Patel
- Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego
| | | | - Wei Yan
- Department of Neurosurgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhaoshi Bao
- Department of Neurosurgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bob S Carter
- Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tao Jiang
- Department of Neurosurgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Clark C Chen
- Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego
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Abstract
Traumatic retrolisthesis of the lumbar spine is a rare clinical entity. Only a few case reports have shown retrolisthesis of the fractured fragment over the inferior vertebral body. Fracture dislocations of the spine are unstable injuries that require operative fixation to restore alignment and prevent progressive deformity. We present the case of a traumatic L5-S1 fracture dislocation with retrolisthesis of the L5 vertebral body over the superior aspect of S1 managed with anterior, middle, and posterior column reconstruction. The patient presented with paraplegia and bowel and bladder incontinence. Retrolisthesis fracture dislocations injuries are rare, and as such, there are no guidelines regarding their management. In our case, we performed an L5 vertebrectomy with anterior, middle, and posterior column reconstruction via a posterior approach using a lumbosacral-pelvic construct. The patient did not regain function in his distal lower extremities postoperatively.
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Affiliation(s)
| | - Erik Curtis
- Neurosurgery, University of California, San Diego
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Santiago-Dieppa DR, Steinberg J, Gonda D, Cheung VJ, Carter BS, Chen CC. Extracellular vesicles as a platform for 'liquid biopsy' in glioblastoma patients. Expert Rev Mol Diagn 2015; 14:819-25. [PMID: 25136839 DOI: 10.1586/14737159.2014.943193] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Extracellular vesicles (EVs) are cell-secreted vesicles that range from 30-2000 nm in size. These vesicles are secreted by both normal and neoplastic cells. Physiologically, EVs serve multiple critical biologic functions, including cellular remodeling, intracellular communication, modulation of the tumor microenvironment and regulation of immune function. Because EVs contain genetic and proteomic contents that reflect the cell of origin, it is possible to detect tumor-specific material in EVs secreted by cancer cells. Importantly, EVs secreted by cancer cells transgress anatomic compartments and can be detected in the blood, cerebrospinal fluid, and other biofluids of cancer patients. In this context, there is a growing interest in analyzing EVs from the biofluid of cancer patients as a means of disease diagnosis and therapeutic monitoring. In this article, we review the development of EVs as a diagnostic platform for the most common form of brain cancer, glioblastoma, discuss potential clinical translational opportunities and identify the central challenges associated with future clinical applications.
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Affiliation(s)
- David R Santiago-Dieppa
- Division of Neurosurgery, University of California, 3855 Health Science Drive #0987 La Jolla, San Diego, CA 92093-0987, USA
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McCabe N, Hanna C, Walker SM, Gonda D, Li J, Wikstrom K, Savage KI, Butterworth KT, Chen C, Harkin DP, Prise KM, Kennedy RD. Mechanistic Rationale to Target PTEN-Deficient Tumor Cells with Inhibitors of the DNA Damage Response Kinase ATM. Cancer Res 2015; 75:2159-65. [DOI: 10.1158/0008-5472.can-14-3502] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/24/2015] [Indexed: 11/16/2022]
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36
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Kozono D, Li J, Nitta M, Sampetrean O, Ng K, Gonda D, Kushwaha D, Hiroko M, Harismendy O, Becher O, Kwon CH, Ligon KL, Saya H, Carter BS, Pizzo D, Vandenberg S, Chen CC. Abstract PR13: Epigenetic regulation of MYC drives dynamic transition between tumor initiating states in glioblastoma. Cancer Res 2015. [DOI: 10.1158/1538-7445.chtme14-pr13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Glioblastoma is the most common form of brain cancer and remains a devastating disease. Recent studies revealed significant intra-tumoral heterogeneity in the genetic and epigenetic make-up of glioblastomas. One level of heterogeneity involves subpopulations of cells capable of tumor initiation (TI). Here we provide data suggesting that the transition between TI- and non-TI is a dynamic process governed by spontaneous fluctuation in the level of MYC. In vitro culturing of sub-clones derived from long-term passaged and primary glioblastoma lines revealed that only a subset of the sub-clones possess TI capacity. The property of TI for each individual sub-clone appeared stable through serial passages. However, a small fraction of the non-TI clones will spontaneously acquire the TI ability. This phenomenon was observed both in vitro and in vivo.
Transcriptome profiling of the sub-clones with varied TI capacity revealed a gene signature enriched for genes regulated by MYC. Among various sub-clones, MYC expression levels correlated with TI capacity tightly. More direct evidence was provided by MYC overexpression which augmented TI capacity in both xenograft and genetic murine models. Reversely, MYC silencing abolished glioblastoma capacity for TI. Importantly, the sub-clones that spontaneously acquired capacity exhibited enhanced MYC expression.
In freshly resected glioblastoma specimens, overall MYC expression levels of the specimens correlated with their xenograft-forming ability. When these specimens were sub-fractionated by A2B5, a cell surface marker enriched in TI glioblastoma populations, the MYC level was significantly elevated in the A2B5+ fraction relative to the A2B5- fraction. In The Cancer Genome Atlas (TCGA) glioblastoma specimens, the expression level of a MYC signature directly correlated with mRNA signatures associated with the Cancer Stem Cell states. In dual immunofluorescence staining of clinical glioblastoma specimens, C-MYC co-stained with MIB1, suggesting that MYC expression support in vivo tumor proliferation.
Since the various sub-clones were genetically identical based on SNP array profiling, we hypothesized that fluctuations in MYC expression was regulated through epigenetic regulation. Supporting our hypothesis, the primary glioblastoma tumor lines that demonstrated high MYC levels showed higher ratios of H3K4me3 to H3K27me3 at the MYC locus. Culturing conditions that enhanced TI capacity of glioblastoma cell lines also increased the ratio of H3K4me3 to H3K27me3 and induced MYC expression.
In sum, our results suggest a threshold model in which TI capacity is driven by epigenetic regulation of MYC. MYC inhibition constitutes an attractive therapeutic target since this inhibition reduces dynamic cell state transition and reduce the complexity of the tumor heterogeneity.
This abstract is also presented as Poster B75.
Citation Format: David Kozono, Jie Li, Masayuki Nitta, Oltea Sampetrean, Kimberly Ng, David Gonda, Deepa Kushwaha, Matsui Hiroko, Olivier Harismendy, Oren Becher, Chang-Hyuk Kwon, Keith L. Ligon, Hideyuki Saya, Bob S. Carter, Donald Pizzo, Scott Vandenberg, Clark C. Chen. Epigenetic regulation of MYC drives dynamic transition between tumor initiating states in glioblastoma. [abstract]. In: Abstracts: AACR Special Conference on Cellular Heterogeneity in the Tumor Microenvironment; 2014 Feb 26-Mar 1; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2015;75(1 Suppl):Abstract nr PR13. doi:10.1158/1538-7445.CHTME14-PR13
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Affiliation(s)
| | - Jie Li
- 2University of California San Diego, La Jolla, CA,
| | | | | | | | - David Gonda
- 2University of California San Diego, La Jolla, CA,
| | | | | | | | - Oren Becher
- 4Duke University Medical Center, Durham, NC,
| | | | | | | | | | - Donald Pizzo
- 2University of California San Diego, La Jolla, CA,
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Hochberg FH, Atai NA, Gonda D, Hughes MS, Mawejje B, Balaj L, Carter RS. Glioma diagnostics and biomarkers: an ongoing challenge in the field of medicine and science. Expert Rev Mol Diagn 2014; 14:439-52. [PMID: 24746164 DOI: 10.1586/14737159.2014.905202] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Glioma is the most common brain tumor. For the more aggressive form, glioblastoma, standard treatment includes surgical resection, irradiation with adjuvant temozolomide and, on recurrence, experimental chemotherapy. However, the survival of patients remains poor. There is a critical need for minimally invasive biomarkers for diagnosis and as measures of response to therapeutic interventions. Glioma shed extracellular vesicles (EVs), which invade the surrounding tissue and circulate within both the cerebrospinal fluid and the systemic circulation. These tumor-derived EVs and their content serve as an attractive source of biomarkers. In this review, we discuss the current state of the art of biomarkers for glioma with emphasis on their EV derivation.
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Affiliation(s)
- Fred H Hochberg
- Department of Neurology and Program in Neuroscience, Massachusetts General Hospital and Harvard Medical School, Suite 340, 175 Cambridge Street, Boston, MA 02114, USA
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Chen C, Gonda D, Kim T, Goetsch S, Kawabe T, Watanabe S, Alksne J, Hattangadi J, Ott K, Hodgens D, Carter B, Yamamoto M. BM-08 * PROGNOSTIC FACTORS FOR SRS-TREATED PATIENTS WITH CEREBRAL METASTASIS: IMPLICATIONS ON RANDOMIZED CONTROL TRIAL DESIGN AND INTER-INSTITUTIONAL COLLABORATIVE EFFORTS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou240.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chen C, Kozono D, Li J, Nitta M, Sampetrean O, Gonda D, Kushwaha D, Vandenberg S, Ramakrishnan V, Zhu S, Furnari F, Matsui H, Harismendy O, Cavenee W, Mao Y, Becher O, Kwon CH, Ligon K, Saya H, Carter B. CB-04 * EPIGENETIC REGULATION OF GLIOBLASTOMA TUMORIGENICITY: A HYBRID MODEL. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou241.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Li J, Zhu S, Kozono D, Futulan D, Gonda D, Kushwaha D, Kahle K, Elledge S, Chen CC. Abstract 4366: ShRNA-based cellular proliferation signaling analysis revealed DRD2 as a novel therapeutic target for glioblastoma. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-4366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Glioblastoma remains one of the deadliest of human cancers, with most patients succumbing to the disease within one year of diagnosis. Our best current understanding of its etiology is that glioblastoma involves genetic and epigenetic changes that subvert the inherent molecular circuitry of glial cells to drive uncontrolled cellular proliferation. Unfortunately, this molecular circuitry in glioblastoma appears sufficiently complex and redundant that disruption at any particular point tends to redirects signaling through the remaining circuit. In this context, meaningful therapeutic gains will require the identification of therapeutic agents that target critical nodes within this circuit. To identify novel therapeutic agents that target critical nodes which regulate cellular proliferation, a genome-wide retroviral shRNA library screen was conducted in two glioblastoma cell lines (U87MG and A172) and two lung carcinoma lines (A549 and NCI-H460). Pathway analysis of the pro-proliferative genes using both PANTHER and Ingenuity software revealed an over-representation of G-protein coupled neurotransmitter receptors (GPCR), including dopamine receptor subtype 2 (DRD2), which was also highly expressed in glioblastoma specimens relative to the matched normal parentchymal. Further investigation demonstrated that DRD2 signal regulates cell growth by GNAI2-induced ERK activation. Moreover, Haloperidol, one of DRD2 antagonists, enhances significantly anti-tumor efficacy of EGFR inhibitor AG1478 using U87 and mesenchymal neuroshpere xenografy mouse models. Given that both AG1478 and DRD2 antagonists have been approved for the treatment of glioblastoma and psychotics, separtately, Haloperidol combined with chemotherapy represents a novel and likely conducted strategy for the treatment of glioblastoma.
Citation Format: Jie Li, Shan Zhu, David Kozono, Diahnn Futulan, David Gonda, Deepa Kushwaha, Kristopher Kahle, Stephen Elledge, Clark C. Chen. ShRNA-based cellular proliferation signaling analysis revealed DRD2 as a novel therapeutic target for glioblastoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4366. doi:10.1158/1538-7445.AM2013-4366
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Affiliation(s)
- Jie Li
- 1Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Shan Zhu
- 2Division of Genomic Instability and DNA Repair, Department of Radiation Oncology, Dana- Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - David Kozono
- 2Division of Genomic Instability and DNA Repair, Department of Radiation Oncology, Dana- Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Diahnn Futulan
- 1Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - David Gonda
- 1Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Deepa Kushwaha
- 2Division of Genomic Instability and DNA Repair, Department of Radiation Oncology, Dana- Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kristopher Kahle
- 3Division of Genomic Instability and DNA Repair, Department of Genetics, Harvard Medical School, Boston, MA
| | - Stephen Elledge
- 3Division of Genomic Instability and DNA Repair, Department of Genetics, Harvard Medical School, Boston, MA
| | - Clark C. Chen
- 1Moores Cancer Center, University of California, San Diego, La Jolla, CA
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Baird LC, Gonda D, Cohen SR, Evers LH, LeFloch N, Levy ML, Meltzer HS. Craniofacial reconstruction as a treatment for elevated intracranial pressure. Childs Nerv Syst 2012; 28:411-8. [PMID: 22068642 DOI: 10.1007/s00381-011-1615-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 10/10/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Craniofacial procedures may be needed to address symptomatic intracranial hypertension. The authors review their institutional experience in the treatment of children with symptomatic increased intracranial pressure (ICP) utilizing craniofacial reconstructive procedures. METHODS The senior authors' (HSM, SRC) craniofacial experience of 222 patients over a 7-year period from 2000 to 2007 at a single institution (Rady Children's Hospital, San Diego) is reviewed. Seventeen patients were identified who were felt to be candidates for craniofacial surgery with symptomatic increased ICP. RESULTS Patient diagnoses included single-suture craniosynostosis, craniofacial dysostoses, shunt-induced craniostenosis, and shunt-associated intracranial hypertension (slit-ventricle syndrome). Seventeen patients underwent 21 craniofacial procedures. Age at surgery ranged from 3 months to 13 years with a mean of 5 years. Preoperative symptoms and signs included headaches, unexplained irritability, seizures, papilledema, and visual loss. All patients had diagnostic neuroimaging. Seven patients had preoperative invasive ICP measurements. Surgery was deferred on three of these patients based on these measurements. The mean total operative (including anesthetic preparation) and surgical times were 3 h 12 min and 2 h 20 min, respectively. Percentage operative blood loss averaged 11.3%. In six procedures, no transfusions were required. Average hospital stay was 4 days. There was no perioperative mortality or significant surgery associated morbidity. All patients have had postoperative clinical improvement in signs and symptoms of increased ICP. CONCLUSIONS Using modern diagnostic and surgical techniques, including invasive ICP monitoring, increased intracranial pressure can be successfully managed by an experienced, multidisciplinary, craniofacial team. Our treatment paradigm and operative management scheme is discussed.
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Affiliation(s)
- Lissa C Baird
- Division of Neurosurgery, University of California at San Diego, San Diego, CA, USA.
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Keshavarzi S, Park MS, Aryan HE, Newman CB, Amene CS, Gonda D, Taylor WR. Minimally invasive thoracic corpectomy and anterior fusion in a patient with metastatic disease: case report and review of the literature. ACTA ACUST UNITED AC 2009; 52:141-3. [PMID: 19650018 DOI: 10.1055/s-0029-1231067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
For patients with metastatic disease to the spine there are numerous surgical approaches for decompression of neural elements and maintenance of mechanical stability. The challenge is to accomplish this while minimizing patient morbidity. Here we report on the feasibility and utility of a minimally invasive extreme lateral approach to the mid to high thoracic spine for anterior decompression and fusion.
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Affiliation(s)
- S Keshavarzi
- Division of Neurosurgery, University of California, San Diego, California 92103-8893, USA.
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Flory SS, Tsang J, Muniyappa K, Bianchi M, Gonda D, Kahn R, Azhderian E, Egner C, Shaner S, Radding CM. Intermediates in homologous pairing promoted by RecA protein and correlations of recombination in vitro and in vivo. Cold Spring Harb Symp Quant Biol 1984; 49:513-23. [PMID: 6397306 DOI: 10.1101/sqb.1984.049.01.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Radding CM, Flory J, Wu A, Kahn R, DasGupta C, Gonda D, Bianchi M, Tsang SS. Three phases in homologous pairing: polymerization of recA protein on single-stranded DNA, synapsis, and polar strand exchange. Cold Spring Harb Symp Quant Biol 1983; 47 Pt 2:821-8. [PMID: 6345077 DOI: 10.1101/sqb.1983.047.01.094] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Bates RF, Care AD, Gonda D. Proceedings: Stimulation of calcitonin secretion by strontium. J Physiol 1974; 238:76P-78P. [PMID: 4838849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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