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Karuparti S, Dunbar A, Varagur K, Sudanagunta K, Mingo M, Bligard KH, Odibo A, Vrecenak J, McEvoy S, Limbrick D, Peglar Marsala L, Anadkat J, Mian A, Strahle JM. Predictors and timing of hydrocephalus treatment in patients undergoing prenatal versus postnatal surgery for myelomeningocele. J Neurosurg Pediatr 2024:1-10. [PMID: 38457812 DOI: 10.3171/2023.10.peds23327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/31/2023] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Although hydrocephalus rates have decreased with intrauterine surgery for myelomeningocele (MMC), 40%-85% of children with MMC still go on to develop hydrocephalus. Prenatal ventricle size is known to be associated with later development of hydrocephalus; however, it is not known how prediction measures or timing of hydrocephalus treatment differ between pre- and postnatal surgery for MMC. The goal of this study was to determine anatomical, clinical, and radiological characteristics that are associated with the need for and timing of hydrocephalus treatment in patients with MMC. METHODS The authors retrospectively identified patients from Barnes Jewish Hospital or St. Louis Children's Hospital between 2016 and 2021 who were diagnosed with MMC prenatally and underwent either pre- or postnatal repair. Imaging, clinical, and demographic data were examined longitudinally between treatment groups and hydrocephalus outcomes. RESULTS Fifty-eight patients were included (27 females, 46.6%), with a mean gestational age at birth of 36.8 weeks. Twenty-three patients (39.7%) underwent prenatal surgery. For the overall cohort, the ventricle size at prenatal ultrasound (HR 1.175, 95% CI 1.071-1.290), frontal-occipital horn ratio (FOHR) at birth > 0.50 (HR 3.603, 95% CI 1.488-8.720), and mean rate of change in head circumference (HC) in the first 90 days after birth (> 0.10 cm/day: HR 12.973, 95% CI 4.262-39.486) were identified as predictors of hydrocephalus treatment. The factors associated with hydrocephalus in the prenatal cohort were FOHR at birth > 0.50 (HR 27.828, 95% CI 2.980-259.846) and the rate of change in HC (> 0.10 cm/day: HR 39.414, 95% CI 2.035-763.262). The factors associated with hydrocephalus in the postnatal cohort were prenatal ventricle size (HR 1.126, 95% CI 1.017-1.246) and the mean rate of change in HC (> 0.10 cm/day: HR 24.202, 95% CI 5.119-114.431). FOHR (r = -0.499, p = 0.008) and birth HC (-0.409, p = 0.028) were correlated with time to hydrocephalus across both cohorts. For patients who underwent treatment for hydrocephalus, those in the prenatal surgery group were significantly more likely to develop hydrocephalus after 3 months than those treated with postnatal surgery, although the overall rate of hydrocephalus was significantly higher in the postnatal surgery group (p = 0.018). CONCLUSIONS Clinical and imaging factors associated with hydrocephalus treatment differ between those receiving pre- versus postnatal MMC repair, and while the overall rate of hydrocephalus is lower, those undergoing prenatal repair are more likely to develop hydrocephalus after 3 months of age. This has implications for clinical follow-up timing for patients treated prenatally, who may live at a distance from the treatment site.
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Affiliation(s)
- Sasidhar Karuparti
- Departments of1Neurosurgery
- 2University of Missouri School of Medicine, Columbia
| | | | | | - Kavya Sudanagunta
- 3Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis
| | - Mark Mingo
- 3Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis
| | - Katherine H Bligard
- 4Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Washington University in St. Louis School of Medicine, St. Louis; and
| | - Anthony Odibo
- 4Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Washington University in St. Louis School of Medicine, St. Louis; and
| | - Jesse Vrecenak
- 5Department of Surgery, Division of Pediatric Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | | | | | | | - Jagruti Anadkat
- 7Pediatrics, Washington University in St. Louis School of Medicine, St. Louis
| | - Ali Mian
- 3Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis
| | - Jennifer M Strahle
- Departments of1Neurosurgery
- 7Pediatrics, Washington University in St. Louis School of Medicine, St. Louis
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2
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Prince EW, Apps JR, Jeang J, Chee K, Medlin S, Jackson EM, Dudley R, Limbrick D, Naftel R, Johnston J, Feldstein N, Prolo LM, Ginn K, Niazi T, Smith A, Kilburn L, Chern J, Leonard J, Lam S, Hersh DS, Gonzalez-Meljem JM, Amani V, Donson AM, Mitra SS, Bandohpadhayay P, Martinez-Barbera JP, Hankinson TC. Unraveling the Complexity of the Senescence-Associated Secretory Phenotype in Adamantinomatous Craniopharyngioma Using Multi-Modal Machine Learning Analysis. Neuro Oncol 2024:noae015. [PMID: 38334125 DOI: 10.1093/neuonc/noae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Cellular senescence can have positive and negative effects on the body, including aiding in damage repair and facilitating tumor growth. Adamantinomatous Craniopharyngioma (ACP), the most common pediatric sellar/suprasellar brain tumor, poses significant treatment challenges. Recent studies suggest that senescent cells in ACP tumors may contribute to tumor growth and invasion by releasing a Senesecence-Associated Secretory Phenotype (SASP). However, a detailed analysis of these characteristics has yet to be completed. METHODS We analyzed primary tissue samples from ACP patients using single-cell, single-nuclei, and spatial RNA Sequencing. We performed various analyses, including gene expression clustering, inferred senescence cells from gene expression, and conducted cytokine signaling inference. We utilized LASSO to select essential gene expression pathways associated with senescence. Finally, we validated our findings through immunostaining. RESULTS We observed significant diversity in gene expression and tissue structure. Key factors such as NFKB, RELA, and SP1 are essential in regulating gene expression, while senescence markers are present throughout the tissue. SPP1 is the most significant cytokine signaling network among ACP cells, while the Wnt signaling pathway predominantly occurs between epithelial and glial cells. Our research has identified links between senescence-associated features and pathways, such as PI3K/Akt/mTOR, MYC, FZD, and Hedgehog, with increased P53 expression associated with senescence in these cells. CONCLUSIONS A complex interplay between cellular senescence, cytokine signaling, and gene expression pathways underlies ACP development. Further research is crucial to understand how these elements interact to create novel therapeutic approaches for patients with ACP.
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Affiliation(s)
- Eric W Prince
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
- Morgan Adams Foundation for Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - John R Apps
- Oncology Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham B4 6NH, UK
| | - John Jeang
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Keanu Chee
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Morgan Adams Foundation for Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Stephen Medlin
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Morgan Adams Foundation for Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Eric M Jackson
- Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, USA
| | - Roy Dudley
- McGill University, Department of Neurosurgery, Montreal, CAN
| | - David Limbrick
- Washington University School of Medicine, Department of Pediatrics, St. Louis, USA; Washington University School of Medicine, Department of Neurosurgery, St. Louis, USA
| | - Robert Naftel
- Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Neurological Surgery, Nashville, USA
| | - James Johnston
- University of Alabama at Birmingham, Department of Neurosurgery, Division of Pediatric Neurosurgery, Birmingham, USA
| | - Neil Feldstein
- Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA
| | - Laura M Prolo
- Stanford University School of Medicine, Lucile Packard Children's Hospital, Department of Neurosurgery, Division of Pediatric Neurosurgery, Palo Alto, USA
| | - Kevin Ginn
- Children's Mercy Hospital, The Division of Pediatric Hematology and Oncology, the Department of Pediatrics, Kansas City, USA
| | - Toba Niazi
- Nicklaus Children's Hospital, Department of Pediatric Neurosurgery, Miami, USA
| | - Amy Smith
- Arnold Palmer Hospital, Department of Pediatric Hematology-Oncology, Orlando, USA
| | - Lindsay Kilburn
- Children's National Health System, Center for Cancer and Blood Disorders, Washington, DC, USA; Children's National Health System, Brain Tumor Institute, Washington, DC, USA
| | - Joshua Chern
- Emory University School of Medicine, Department of Pediatrics and Neurosurgery, Atlanta, USA; Children's Healthcare of Atlanta, Department of Pediatric Neurosurgery, Atlanta, USA
| | - Jeffrey Leonard
- Nationwide Children's Hospital, Division of Pediatric Neurosurgery, Columbus, USA
| | - Sandi Lam
- Division of Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | | | - Vladimir Amani
- Morgan Adams Foundation for Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Andrew M Donson
- Morgan Adams Foundation for Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Siddhartha S Mitra
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Morgan Adams Foundation for Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | | | - Juan Pedro Martinez-Barbera
- Developmental Biology and Cancer, Birth Defects Research Centre, GOS Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Todd C Hankinson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Morgan Adams Foundation for Pediatric Brain Tumor Research Program, Aurora, CO, USA
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Stippler M, Blitz SE, Quinsey C, Limbrick D, Byrne R, Zipfel G, Selden NR. Active Teaching Techniques Using Virtual Didactics: Novel Experience From a National Neurosurgery Resident Course. J Surg Educ 2024; 81:312-318. [PMID: 38160110 DOI: 10.1016/j.jsurg.2023.11.006] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/11/2023] [Accepted: 11/03/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To investigate the attitudes of neurosurgery residents regarding active teaching techniques and virtual didactics based on a national neurosurgery resident sample. We also evaluated the relative cost and time commitment required for faculty participation in virtual versus in-person resident courses. DESIGN The Society of Neurological Surgeons (SNS) national junior resident courses (JRCs) were reformatted for active teaching in a virtual setting in 2020 due to the COVID-19 pandemic. We analyzed course evaluations from the virtual 2020 courses in comparison to the 2019 in-person SNS JRCs. We also compared course budgets and agendas from these courses to identify comparative costs and the time commitment for faculty participation using these 2 course models. SETTING Survey of nationwide participants in virtual junior resident courses. PARTICIPANTS A total of 122 residents from 80 ACGME neurosurgery residency training programs attended the 2020 virtual JRC. RESULTS The survey response rate of attendees was 36%. In-class engagement was thought to be good to great by 73% to 80% of the virtual learners. In-class activities and active learning techniques also were evaluated positively by 61% to 82% of respondents. Expenses were significantly lower for the virtual course, at $118 per course participant, than for the in-person course ($2722 per participant). There also was a 97.3% reduction of faculty hours and a 97.6% reduction of faculty cost for the virtual JRC compared to the in-person course. CONCLUSIONS Neurosurgeon residents embraced the active teaching techniques used to teach portions of the prepandemic JRCs in a virtual format. Other aspects of the course curriculum could not be replicated virtually. Virtual courses were dramatically less expensive to produce, used fewer faculty teachers and required less time per faculty member. The data from this study may inform the choice of active teaching techniques for other neurosurgery residency and continuing medical education courses to optimize learner engagement and participant satisfaction in the virtual setting. We recommend that the curriculum of in-person courses emphasize hands-on, experiential learning and professional enculturation that cannot be recreated in the virtual space. Curricular elements suitable to virtual learning should take advantage of lower costs, reduced faculty time requirements, and scalability. They should also utilize active teaching techniques to improve learner engagement.
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Affiliation(s)
- Martina Stippler
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | | | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Richard Byrne
- Department of Neurosurgery, Rush Medical College, Chicago, Illinois
| | - Greg Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Nathan R Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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Bell E, Webb A, Stanek J, Blue M, Patel P, Thomas D, Pierson C, Mladkova N, Fleming J, Miller K, Grischow O, Liszkay T, Olshefski R, Chi S, Comito M, Friedman G, Bendel A, Coven S, Hastings C, Sayour E, Garvin J, Davidson T, Cornelius A, Moertel C, Mazewski C, Walter A, Greiner R, Puccetti D, Gorsi H, Dorris K, Khatib Z, Chakravarti A, Cottrell C, Asgharzadeh S, Huang A, Rassekh R, Limbrick D, Boue D, Biegel J, Mardis E, Dhall G, Finlay J, Leonard J. BIOM-49. A PILOT STUDY OF CEREBROSPINAL FLUID EXOSOMAL SMALL RNA-SEQUENCING IN PEDIATRIC MEDULLOBLASTOMA PATIENTS ON THE NEXT CONSORTIUM “HEAD START” 4 PROTOCOL. Neuro Oncol 2022. [PMCID: PMC9660870 DOI: 10.1093/neuonc/noac209.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Head Start 4 is a randomized clinical trial to determine whether dose-intensive tandem consolidation, compared with a single cycle, with autologous hematopoietic progenitor cell rescue provides a survival benefit in pediatric patients with medulloblastoma or other embryonal tumors. The trial incorporates upfront molecular subgrouping and non-mandatory, prospective blood and cerebrospinal fluid (CSF) collection. This pilot study aimed to identify exosomal non-coding RNAs (exo-ncRNAs) that might serve as novel diagnostic and/or treatment response biomarkers.
METHODS
CSF(1-2mLs) from 11 controls (non-tumor) and 27 medulloblastoma participants including 23 obtained at baseline, 22 at the end of induction, 3 post-consolidation, and 4 relapse time points, were profiled. Exosome isolation and small RNA-sequencing were performed by System Biosciences. Differential gene expression (DGE) was performed in R (DESeq2). Variations in gene expression profiles between samples were visualized using principal component analysis.
RESULTS
After limiting to ncRNAs with expression of 2 counts per million in 50% or more of the samples in each comparison, ~9,500 ncRNAs were detected. DGE analyses revealed 118 ncRNAs with log2 fold change(FC) >2 and 1 ncRNA with log2FC< -2 in baseline CSF samples compared to controls. In contrast, 11 ncRNAs(log2FC >2) and 1 ncRNA(log2FC< -2) were detected in end of induction CSF samples compared to controls. Comparing end of induction to baseline CSF samples accounting for paired samples, 0 ncRNAs(log2FC >2) and 52 ncRNAs(log2FC< -2) were detected.
CONCLUSIONS
Overall, our data indicate that exosomal small RNA-sequencing of limited CSF volumes is feasible. Differential expression and distinct clustering between tumor baseline samples compared to non-tumor controls was observed. CSF-derived exo-ncRNAs at end of induction also demonstrated “normalization” of ncRNA profiles, signifying CSF biomarkers may serve a role in diagnosis and molecular response assessment. A comprehensive analysis including multi-marker predictive model development and molecular subgrouping will be undertaken at completion of study enrollment.
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Affiliation(s)
- Erica Bell
- The Ohio State University , Columbus , USA
| | - Amy Webb
- The Ohio State University , Columbus , USA
| | | | - Megan Blue
- Nationwide Children's Hospital , Columbus , USA
| | - Parth Patel
- Nationwide Children's Hospital , Columbus , USA
| | - Diana Thomas
- Nationwide Children's Hospital , Columbus, OH , USA
| | | | | | | | | | | | | | | | - Susan Chi
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center , Boston, MA , USA
| | | | | | - Anne Bendel
- Children's Minnesota , Minneapolis, MN , USA
| | | | | | | | | | - Tom Davidson
- Children's Hospital Los Angeles , Los Angeles , USA
| | | | | | | | | | | | | | - Hamza Gorsi
- Children's Hospital of Michigan , Detroit, MI , USA
| | - Kathleen Dorris
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO , Aurora , USA
| | | | | | | | | | - Annie Huang
- Hospital for Sick Children , Toronto , Canada
| | - Rod Rassekh
- British Columbia's Children's Hospital , Vancouver , Canada
| | | | - Daniel Boue
- Nationwide Children's Hospital , Columbus, OH , USA
| | - Jaclyn Biegel
- Children's Hospital Los Angeles , Los Angeles, CA , USA
| | | | - Girish Dhall
- University of Alabama at Birmingham , Birmingham, AL , USA
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5
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Cluster A, Cantor E, Meyer A, Ogle A, McEvoy S, Strahle J, Brossier N, Shatara M, Limbrick D, Abdelbaki M. RARE-27. Treatment and outcomes in atypical choroid plexus papilloma: a single institution experience. Neuro Oncol 2022. [PMCID: PMC9164698 DOI: 10.1093/neuonc/noac079.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Atypical choroid plexus papillomas (aCPP) are rare central nervous system (CNS) tumors often occurring in very young children. While surgical resection has been a mainstay of therapy, there is no consensus and limited data on the treatment of relapsed or metastatic tumors. METHODS: Retrospective review of the treatment and outcome of patients diagnosed with aCPP since 2011 was performed. RESULTS: Of the seven patients, 4 were male and 3 were female with a median age of 3 years at diagnosis (range: antenatal to 18 years old). All non-metastatic patients (six) were treated with surgery and all achieved gross total resection. Two patients had diffuse leptomeningeal contrast enhancement on diagnosis MRI that resolved after resection of primary tumor alone. One patient developed local relapse underwent re-resection with a GTR then was treated with 4 cycles of chemotherapy based on CPT-SIOP-2000 protocol (carboplatin, etoposide) and has not had further relapse in 24 months. One patient had metastatic disease at the time of diagnosis. They were treated with adjuvant chemotherapy, which stabilized disease for 36 months until they had progression. Additional four cycles were given and has again stabilized disease now 8 months from completion of that therapy. One non-metastatic patient died of unknown causes 28 months from diagnosis. CONCLUSIONS: Surgical resection remains the standard of care for patients with aCPP. However, chemotherapy based on the SIOP backbone may be useful to reduce the need for or to delay radiation therapy in select patients in the relapsed or metastatic setting.
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Affiliation(s)
| | - Evan Cantor
- Washington University, St. Louis , Missouri , USA
| | - Ashley Meyer
- Washington University, St. Louis , Missouri , USA
| | - Andrea Ogle
- Washington University, St. Louis , Missouri , USA
| | - Sean McEvoy
- Washington University, St. Louis , Missouri , USA
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6
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Rodemann A, Hartmann M, Limbrick D, Abdelbaki M, Cluster A. SWK-07. Family mental health screening early after a diagnosis of pediatric brain tumor. Neuro Oncol 2022. [PMCID: PMC9165156 DOI: 10.1093/neuonc/noac079.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION: A new diagnosis of a brain tumor in a child has significant emotional consequences for every member of the family. Nevertheless, early phases of oncologic care rarely provide formal mental health screening. METHODS: We implemented a mental health screening protocol for families and patients with a newly diagnosed brain tumor admitted to our pediatric intensive care unit (PICU) at the time of diagnosis. Screening instruments were selected based on their previous validation and relevance to both a brain tumor diagnosis and PICU admission. Parents were contacted by a member of our team within 2 weeks of their child’s diagnosis, and completed the screening independently within the next 2 weeks via an online interface. Parent proxy reports for the children were used when necessary. Scores were shared with the family and neuro-oncology team. When indicated, supportive counseling was offered. RESULTS: Eighteen patients have met criteria for mental health screening. Of these, 8 patient and parent dyads have completed the screening (mean patient age 8.6 years; 75% white; 50% female). Of the families that completed the evaluation, most parents (62.5%) reported that their child’s diagnosis negatively impacted their health-related quality of life (HRQL), while 87.5% of children themselves reported a lower HRQL. Most children (66.7%) self-reported having symptoms outside of normal range for anger, anxiety and depression and 100% had scores outside of normal range for pain interference with their daily lives. Only half of eligible families accepted referrals for new mental health support. CONCLUSION: Both children with a new diagnosis of brain tumor and their parents are at risk for impaired mental health and quality of life early after diagnosis. A systematic approach to these concerns at the time of diagnosis may be helpful.
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7
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Shatara M, Gauvain K, Cantor E, Meyer A, Ogle A, McHugh M, Beck M, Green T, King A, Cluster A, Brossier N, Shimony JS, Abdelbaki MS, Tran DD, Campian J, Leuthardt EC, Rubin J, Limbrick D. EPCT-07. Updated report on the pilot study of using MRI-guided laser heat ablation to induce disruption of the peritumoral blood brain barrier to enhance deliver and efficacy of treatment of pediatric brain tumors. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.135] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: MRI-guided laser interstitial thermal therapy (LITT) is a minimally invasive, cytoreductive surgery useful for managing unresectable brain tumors. LITT disrupts the blood brain barrier (BBB) and facilitates chemotherapy delivery. We report the toxicity and outcome for pediatric brain tumors treated on a pilot trial of LITT and chemotherapy. The primary objectives were to quantify peritumoral BBB disruption following LITT and evaluate toxicity and efficacy. METHODS: The trial had two arms, A: patients with newly diagnosed gliomas underwent LITT followed by standard of care management, and B: patients with relapsed malignant brain tumors received 6 weeks of weekly doxorubicin post-LITT followed by maintenance etoposide. RESULTS: Between 2015 – 2018, six patients were enrolled: five on arm A (four with low-grade gliomas, one with high-grade glioma), one on Arm B with progressive anaplastic astrocytoma. All patients tolerated the procedure well; four experienced a transient hemiparesis post-LITT. The Arm B patient progressed and died of disease 2 months and 22 months post-LITT, respectively. The HGG patient received standard therapy and remains without disease progression 44 months post-LITT. One patient with LGG required additional treatment for disease progression 14 months post-LITT. Two patients with LGGs did not require additional therapy, now 51 and 41 months post-LITT. One patient was alive 24 weeks post-LITT and subsequently lost to follow-up. Peritumoral BBB disruption was analyzed in two ways: serum abundance of brain-derived proteins and MRI Dynamic contrast enhancement (DCE). Neuron-specific enolase were measurable in the serum of all patients, using ELISA up to 84 days post-LITT. DCE 2 weeks post-LITT demonstrated increased enhancement and FLAIR signal, consistent with BBB disruption and vasogenic edema. This effect was evident up to 4 months post-procedure. CONCLUSION: LITT is safe in children with brain tumors and can be combined with chemotherapy. DCE and serum brain-derived proteins can measure BBB disruption.
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Affiliation(s)
- Margaret Shatara
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Karen Gauvain
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Evan Cantor
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Ashley Meyer
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Andrea Ogle
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Michele McHugh
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Mary Beck
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Tammy Green
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Allison King
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Andrew Cluster
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Nicole Brossier
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Joshua S Shimony
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Mohamed S Abdelbaki
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - David D Tran
- Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine , Gainesville, Florida , USA
| | - Jian Campian
- Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis , Missouri , USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University, St. Louis , Missouri , USA
| | - Joshua Rubin
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - David Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis , Missouri , USA
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8
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Dowling A, Seitzman B, Mitchell T, Olufawo M, Agamah M, Butler R, McMichael A, Dierker D, Anandarajah H, Dworetsky A, Coalson R, Jiang C, Gu H, Barbour D, Schlaggar B, Limbrick D, Strahle J, Rubin J, Shimony J, Perkins S. RONC-12. Evaluation of brain network segregation using resting state functional MRI in pediatric brain tumor patients treated with proton beam therapy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.666] [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: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION: Mechanisms of cognitive injury in pediatric brain tumor (BT) patients are poorly understood and biomarkers predicting cognitive deficits are lacking. Resting state functional MRI (rsfMRI) can evaluate large-scale brain networks to provide insight into neural changes that follow diagnosis and treatment. This project evaluated functional brain network segregation in pediatric BT patients treated with proton beam radiation therapy (PBRT). METHODS: rsfMRI scans were acquired from 21 pediatric patients (5 female, 16 male) with any brain tumor diagnosis treated with PBRT. Data were processed to reduce contamination, and correlation matrices were generated using all gray matter voxels. Brain network segregation (BNS) was measured and compared to 139 age-matched controls. Analysis included comparison of BNS in association systems (comprised of default mode, frontoparietal, dorsal attention, language, salience, and cingulo-opercular networks) and somatosensory systems (including auditory, visual, and somatomotor networks). Patient and clinical factors were evaluated for relationships with BNS. Patients underwent cognitive testing utilizing the NIH Toolbox Cognitive Domain (NIH-TCD). RESULTS: Median age at PBRT was 10 years (range 2.2-17.9). PBRT volume was whole brain in 10 and conformal in 11. rsfMRI occurred at a median of 2.9 years (range 1.0-5.6) after PBRT. Average BNS of association systems was significantly lower in patients than in controls (t= -8.1, p<10-10), but there was no significant difference in BNS of somatosensory systems (p=0.4). There was a trend towards worse BNS in association systems in patients <10 years old at PBRT (p=0.07). Patients demonstrated deficits in cognitive testing as assessed by the NIH-TCD; however, there were no significant relationships between score and network segregation. CONCLUSION: Pediatric BT patients treated with PBRT demonstrated normal BNS in somatosensory systems. However, BNS of association systems, which control high-level cognitive functions including social cognition, attention, and memory formation, was significantly decreased in BT patients treated with PBRT.
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Affiliation(s)
- Anna Dowling
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Benjamin Seitzman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Timothy Mitchell
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Michael Olufawo
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Miriam Agamah
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Rachel Butler
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Alana McMichael
- Department of Neurology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Hari Anandarajah
- Department of Pediatrics, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Ally Dworetsky
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Rebecca Coalson
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Catherine Jiang
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis , Missouri , USA
| | - Hongjie Gu
- Department of Biostatistics, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Dennis Barbour
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis , Missouri , USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Bradley Schlaggar
- Kennedy Krieger Institute , Baltimore, Maryland , USA
- Department of Neurology, Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA
| | - David Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Jennifer Strahle
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Joshua Rubin
- Department of Pediatrics, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis , Missouri , USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Joshua Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Stephanie Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis , Missouri , USA
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9
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Shatara M, Cantor E, Meyer A, Ogle A, Green T, Beck M, McHugh M, Brossier N, Cluster A, Rubin J, Mian A, Dahiya S, Perkins S, Abdelbaki MS, Strahle J, Limbrick D, McEvoy SD. OTHR-15. Papillary tumor of the pineal region: case series of this rare pediatric entity. Neuro Oncol 2022. [PMCID: PMC9165192 DOI: 10.1093/neuonc/noac079.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: The optimal management of pediatric papillary tumors of the pineal region (PTPR) is not yet established. We report three cases, as an addition to the existing literature. PATIENT 1: A 22-month-old female presented with progressive ataxia and incoordination, found to have an enhancing solid and cystic mass centered within the pineal region, with associated obstructive hydrocephalus. Tumor biopsy revealed PTPR, prompting a subsequent subtotal resection. No adjuvant therapy was recommended. Patient has remained without evidence of disease progression for 92 months, since resection. PATIENT 2: An 8-year-old female presented with progressive headaches and new-onset generalized seizures, found to have a heterogeneously enhancing pineal lesion, with associated obstructive hydrocephalus. Following a biopsy demonstrating PTPR, patient underwent subtotal resection of the tumor. A second resection was completed 6 months later followed by focal irradiation. Targeted next-generation sequencing (NGS) demonstrated two non-targetable genomic alterations (CREBBP and MLL2). The patient remains without tumor recurrence, now 37 months, since irradiation. PATIENT 3: A 7-year-old male with Autism spectrum disorder presented with new-onset focal complex seizures. A brain MRI showed a heterogeneously enhancing lesion in the region of the pineal gland, with associated obstructive hydrocephalus. A tumor biopsy revealed PTPR, prompting a subsequent gross total resection (GTR). NGS demonstrated no reportable genomic alterations. Methylome profiling classified the tumor as PTPR, group B. Post-operative imaging with no residual tumor and he has remained without tumor progression, now eight months, since resection. CONCLUSION: PTPR are extremely rare in the pediatric setting, and were initially introduced in the WHO 2007 classification as grade II-III pineal gland tumors with distinct morphologic and immunohistochemical features. GTR is the mainstay of treatment but post-surgical management remains controversial. The clinical course is characterized by frequent local recurrence, hence, adjuvant chemotherapy and/or irradiation may be necessary upon disease progression.
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Affiliation(s)
- Margaret Shatara
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Evan Cantor
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Ashley Meyer
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Andrea Ogle
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Tammy Green
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Mary Beck
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Michele McHugh
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Nicole Brossier
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Andrew Cluster
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Joshua Rubin
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Ali Mian
- The Division of Neuroradiology (A.M.), Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis , Missouri , USA
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Stephanie Perkins
- The Department of Radiation Oncology, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Mohamed S Abdelbaki
- The Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
| | - Jennifer Strahle
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis , Missouri , USA
| | - David Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis , Missouri , USA
| | - Sean D McEvoy
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis , Missouri , USA
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10
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Trudeau T, Prince E, Chatain O, Chee K, Jackson E, Limbrick D, Naftel R, Feldstein N, Grant G, Ginn K, Niazi T, Smith A, Kilburn L, Chern J, Drapeau A, Lam S, Johnston J, Dudley R, Staulcup S, Hankinson T. RARE-24. The use of novel in vitro models to study adamantinomatous craniopharyngioma disease biology and drug response. Neuro Oncol 2022. [PMCID: PMC9165211 DOI: 10.1093/neuonc/noac079.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Challenges around the design and investigation of cell culture models of adamantinomatous craniopharyngioma (ACP) have arisen from the cellular heterogeneity of these tumors, with populations that harbor disparate requirements in culture. Novel approaches to in vitro modeling of ACP are needed. METHODS: Intraoperatively collected tumor specimens were mechanically digested and plated under conditions tailored to the cell population of interest. ACP tumor-derived fibroblasts and epithelial cells were isolated using serum-containing and keratinocyte-specific media respectively. ACP-derived epithelial cells were immortalized via SV40 virus transfection and puromycin treatment for stable cell-line generation. Cell line validation included immunofluorescence with markers appropriate for the cell population of interest. RNA sequencing of cell lines was compared to ACP transcriptome reference data. Cell typing was conducted using short tandem repeat sequencing. RESULTS: ACP fibroblasts and ACP epithelial cells maintained spindle-like and cobblestone morphologies respectively, even after 4 passages. Immunofluorescence staining confirmed high levels of Vimentin expression in ACP-derived fibroblasts, and panCK and B-catenin in ACP-derived epithelial cells. Point mutation in exon 3 of the CTNNB1 gene was identified in ACP-derived epithelial cells. CONCLUSION: Initial limits related to cell line development in ACP may be addressed through the isolation and culture-specific ACP cell populations. This experience demonstrates the maintenance of validated markers of the cell populations of interest ex vivo. While preliminary, such cell lines offer promise as tools for the identification and study of potential therapeutic vulnerabilities in ACP.
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Affiliation(s)
- Tammy Trudeau
- University of Colorado, School of Medicine , Aurora, CO , USA
| | - Eric Prince
- University of Colorado, School of Medicine , Aurora, CO , USA
| | - Oscar Chatain
- University of Colorado, School of Medicine , Aurora, CO , USA
| | - Keanu Chee
- University of Colorado, School of Medicine , Aurora, CO , USA
| | - Eric Jackson
- Johns Hopkins Medicine, Neurosurgery Department , Baltimore, MD , USA
| | - David Limbrick
- Washington University School of Medicine in St. Louis, St. Louis , MO , USA
| | - Robert Naftel
- Vanderbilt University Medical Center , Nashville, TN , USA
| | - Neil Feldstein
- Columbia University Irving Medical Center, New York , NY , USA
| | | | - Kevin Ginn
- Children's Mercy Kansas City, Kansas City , MO , USA
| | - Toba Niazi
- Nicklaus Children's Hospital , Miami, FL , USA
| | - Amy Smith
- Orlando Health Arnold Palmer Hospital for Children , Orlando, FL , USA
| | | | - Joshua Chern
- Children's Healthcare of Atlanta , Atlanta, GA , USA
| | | | - Sandi Lam
- Ann & Robert H. Lurie Hospital of Chicago , Chicago, IL , USA
| | | | - Roy Dudley
- Montreal Children's Hospital , Montreal , Canada
| | - Susan Staulcup
- University of Colorado, School of Medicine , Aurora, CO , USA
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11
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Hariharan P, Sondheimer J, Petroj A, Gluski J, Jea A, Whitehead WE, Sood S, Ham SD, Rocque BG, Marupudi NI, McAllister JP, Limbrick D, Del Bigio MR, Harris CA. A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus. Fluids Barriers CNS 2021; 18:33. [PMID: 34289858 PMCID: PMC8293524 DOI: 10.1186/s12987-021-00262-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to characterize the histological features of VC obstructions and identify links to clinical factors. METHODS 343 VCs with relevant clinical data were collected from five centers. Each hole on the VCs was classified by degree of tissue obstruction after macroscopic analysis. A subgroup of 54 samples was analyzed using immunofluorescent labelling, histology and immunohistochemistry. RESULTS 61.5% of the 343 VCs analyzed had tissue aggregates occluding at least one hole (n = 211) however the vast majority of the holes (70%) showed no tissue aggregates. Mean age at which patients with occluded VCs had their first surgeries (3.25 yrs) was lower than in patients with non-occluded VCs (5.29 yrs, p < 0.02). Mean length of time of implantation of occluded VCs, 33.22 months was greater than for non-occluded VCs, 23.8 months (p = 0.02). Patients with myelomeningocele had a greater probability of having an occluded VC (p = 0.0426). VCs with occlusions had greater numbers of macrophages and astrocytes in comparison to non-occluded VCs (p < 0.01). Microglia comprised only 2-6% of the VC-obstructing tissue aggregates. Histologic analysis showed choroid plexus occlusion in 24%, vascularized glial tissue occlusion in 24%, prevalent lymphocytic inflammation in 29%, and foreign body giant cell reactions in 5% and no ependyma. CONCLUSION Our data show that age of the first surgery and length of time a VC is implanted are factors that influence the degree of VC obstruction. The tissue aggregates obstructing VCs are composed predominantly of astrocytes and macrophages; microglia have a relatively small presence.
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Affiliation(s)
- Prashant Hariharan
- Wayne State University Dept. of Biomedical Engineering, 6135 Woodward Avenue, Detroit, MI, 48202, USA
| | - Jeffrey Sondheimer
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Detroit, MI, 48202, USA
| | - Alexandra Petroj
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Detroit, MI, 48202, USA
| | - Jacob Gluski
- Dept. of Neurosurgery, Wayne State University School of Medicine, 540 E. Canfield Avenue, Detroit, MI, 48201, USA
| | - Andrew Jea
- Riley Hospital for Children at IU Health, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | | | - Sandeep Sood
- Departments of Neurosurgery and Pediatric Neurosurgery, Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - Steven D Ham
- Departments of Neurosurgery and Pediatric Neurosurgery, Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Neena I Marupudi
- Children's Hospital of Michigan Dept. of Neurosurgery, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - James P McAllister
- School of Medicine Dept. of Neurological Surgery, Washington University, 425 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - David Limbrick
- School of Medicine Dept. of Neurological Surgery, Washington University, 660 S. Euclid Avenue, St. Louis, MO, 6311, USA
| | - Marc R Del Bigio
- Department of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carolyn A Harris
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Detroit, MI, 48202, USA.
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12
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Pan S, Ye D, Yue Y, Yang L, Pacia C, Dahiya S, Limbrick D, Rubin J, Chen H, Strahle J. HGG-11. LEPTOMENINGEAL DISEASE AND TUMOR DISSEMINATION ALONG CSF PATHWAYS IN A MURINE DIPG MODEL: IMPLICATIONS FOR STUDY OF THE TUMOR-CSF-EPENDYMAL MICROENVIRONMENT. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab090.077] [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: 11/14/2022] Open
Abstract
Abstract
Background
Leptomeningeal disease and hydrocephalus are present in up to 30% of patients with diffuse intrinsic pontine glioma (DIPG), however there are no animal models of cerebrospinal fluid (CSF) dissemination. As the tumor-CSF-ependymal microenvironment may play an important role in tumor pathogenesis, we identified characteristics of the Nestin-tumor virus A (Nestin-Tva) genetically engineered mouse model (GEMM) that make it ideal to study the interaction of tumor cells with the CSF and its associated pathways with implications for the development of treatment approaches to address CSF dissemination in DIPG.
Methods
A Nestin-TVa model of DIPG utilizing the three most common DIPG genetic alterations (H3.3K27M, PDGF-B, p53) was used for this study. All animals underwent MR imaging and a subset underwent histopathologic analysis with H&E and beta-IV tubulin.
Results
Tumor dissemination within the CSF pathways (ventricles, leptomeninges) was present in 76% (25/33) of animals, with invasion of the choroid plexus, disruption of the ciliated ependyma and regional subependymal fluid accumulation. Ventricular enlargement consistent with hydrocephalus was present in 94% (31/33). Ventricle volume correlated with region specific transependymal CSF flow (periventricular T2 signal), localized anterior to the lateral ventricles. Subependymal tumor cells were also present subjacent to the 4th ventricle in a post-mortem human specimen.
Conclusions
This is the first study to report CSF pathway tumor dissemination an animal model of DIPG and is representative of CSF dissemination seen clinically. Understanding the CSF-tumor-ependymal microenvironment has significant implications for treatment of DIPG through targeting mechanisms of tumor spread within the CSF pathways.
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Affiliation(s)
- Shelei Pan
- Washington University in St. Louis, St. Louis, MO, USA
| | - Dezhuang Ye
- Washington University in St. Louis, St. Louis, MO, USA
| | - Yimei Yue
- Washington University in St. Louis, St. Louis, MO, USA
| | - Lihua Yang
- Washington University in St. Louis, St. Louis, MO, USA
| | | | - Sonika Dahiya
- Washington University in St. Louis, St. Louis, MO, USA
| | | | - Joshua Rubin
- Washington University in St. Louis, St. Louis, MO, USA
| | - Hong Chen
- Washington University in St. Louis, St. Louis, MO, USA
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13
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Seitzman B, Anandarajah H, McMichael A, Gu H, Barbour D, Limbrick D, Shimony J, Rubin J, Perkins S. OMIC-02. COGNITIVE DEFICITS AND ALTERED FUNCTIONAL BRAIN NETWORK ORGANIZATION IN PEDIATRIC BRAIN TUMOR PATIENTS. Neuro Oncol 2021. [PMCID: PMC8263160 DOI: 10.1093/neuonc/noab090.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pediatric brain tumor survivors experience significant cognitive sequelae from their diagnosis and treatment. The exact mechanisms of cognitive injury are poorly understood, and validated predictors of long-term cognitive outcome are lacking. Large-scale, distributed brain systems provide a window into brain organization and function that may yield insight into these mechanisms and outcomes. We evaluated functional network architecture, cognitive performance, and brain-behavior relationships in pediatric brain tumor patients. Patients ages 8–18 years old with diagnosis of a brain tumor underwent awake resting state functional Magnetic Resonance Imaging during regularly scheduled clinical visits and were tested with the National Institutes of Health Toolbox Cognition Battery. Age- and sex-matched typically developing children were used as controls. We observed that functional network organization was significantly altered in patients compared to controls (p < 0.001), with the integrity of the dorsal attention network particularly affected (p < 0.0001). Moreover, patients demonstrated significant impairments in multiple domains of cognitive performance, including attention (p < 0.0001). Finally, a significant amount of variance (R squared = 0.52, F = 3.2, p < 0.05) of age-adjusted total composite scores from the Toolbox was explained by changes in segregation between the dorsal attention and default mode networks. Our results suggest that changes in functional network organization may provide insight into long-term changes in cognitive function in pediatric brain tumor patients.
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Affiliation(s)
| | | | | | - Hongjie Gu
- Washington University, Saint Louis, MO, USA
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14
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Ravindra VM, Bollo RJ, Dewan MC, Riva-Cambrin JK, Tonetti D, Awad AW, Akbari SH, Gannon S, Shannon C, Birkas Y, Limbrick D, Jea A, Naftel RP, Kestle JR, Grandhi R. Comparison of anticoagulation and antiplatelet therapy for treatment of blunt cerebrovascular injury in children <10 years of age: a multicenter retrospective cohort study. Childs Nerv Syst 2021; 37:47-54. [PMID: 32468243 DOI: 10.1007/s00381-020-04672-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Blunt cerebrovascular injury (BCVI) is uncommon in the pediatric population. Among the management options is medical management consisting of antithrombotic therapy with either antiplatelets or anticoagulation. There is no consensus on whether administration of antiplatelets or anticoagulation is more appropriate for BCVI in children < 10 years of age. Our goal was to compare radiographic and clinical outcomes based on medical treatment modality for BCVI in children < 10 years. METHODS Clinical and radiographic data were collected retrospectively for children screened for BCVI with computed tomography angiography at 5 academic pediatric trauma centers. RESULTS Among 651 patients evaluated with computed tomography angiography to screen for BCVI, 17 patients aged less than 10 years were diagnosed with BCVI (7 grade I, 5 grade II, 1 grade III, 4 grade IV) and received anticoagulation or antiplatelet therapy for 18 total injuries: 11 intracranial carotid artery, 4 extracranial carotid artery, and 3 extracranial vertebral artery injuries. Eleven patients were treated with antiplatelets (10 aspirin, 1 clopidogrel) and 6 with anticoagulation (4 unfractionated heparin, 2 low-molecular-weight heparin, 1 transitioned from the former to the latter). There were no complications secondary to treatment. One patient who received anticoagulation died as a result of the traumatic injuries. In aggregate, children treated with antiplatelet therapy demonstrated healing on 52% of follow-up imaging studies versus 25% in the anticoagulation cohort. CONCLUSION There were no observed differences in the rate of hemorrhagic complications between anticoagulation and antiplatelet therapy for BCVI in children < 10 years, with a nonsignificantly better rate of healing on follow-up imaging in children who underwent antiplatelet therapy; however, the study cohort was small despite including patients from 5 hospitals.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Robert J Bollo
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Michael C Dewan
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jay K Riva-Cambrin
- Department of Clinical Neurosciences, Division of Pediatric Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Tonetti
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Al-Wala Awad
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - S Hassan Akbari
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA.,Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Stephen Gannon
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Chevis Shannon
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Yekaterina Birkas
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - David Limbrick
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA.,Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Andrew Jea
- Department of Neurosurgery, Indiana University, Bloomington, IN, USA.,Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, IN, USA
| | - Robert P Naftel
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John R Kestle
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA. .,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA.
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15
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Mirsky D, Prince E, Staulcup S, Hengartner A, Vijmasi T, Johnston J, Massimi L, Anderson R, Souweidane M, Naftel R, Limbrick D, Grant G, Niazi T, Dudley R, Kilburn L, Jackson E, Jallo G, Ginn K, Smith A, Chern J, Lee A, Drapeau A, Krieger M, Handler M, Hankinson T. RARE-11. QUANTITATIVE MR IMAGING FEATURES ASSOCIATED WITH UNIQUE TRANSCRIPTIONAL CHARACTERISTICS IN PEDIATRIC ADAMANTINOMATOUS CRANIOPHARYNGIOMA: A POTENTIAL GUIDE FOR THERAPY. Neuro Oncol 2020. [PMCID: PMC7715942 DOI: 10.1093/neuonc/noaa222.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
METHODS Through the Advancing Treatment for Pediatric Craniopharyngioma (ATPC) consortium we accumulated preoperative MRIs and tumor RNA for 50 unique ACP patients. MRIs were assessed quantitatively for 28 different features and analyzed using Multiple Factor Analysis (MFA) and optimal clustering was determined via maximization of Bayesian Information Criterion (BIC). Following bulk RNAseq, differential expression and pathway enrichment were performed using standard methodologies (i.e., DESeq2 and GSEA). RESULTS MRI features were well represented in the first 3 dimensions of MFA (variance explained=67.32%); specifically tumor/cyst size, ventricular size, and cyst fluid diffusivity. Using this three-way axis, we identified 3 patient subgroups. Transcriptional differences between these subgroups indicated one group was enriched for DNA damage response and MYC related pathways, one group enriched for SHH, and one group enriched for WNT/β-catenin and EMT-related pathways. CONCLUSION This preliminary work suggests that there may be unique gene expression variants within ACP, which may be identified preoperatively using easily quantifiable MRI parameters. These radiogenomic signatures could provide prognostic information and/or guidance in the selection of antitumor therapies for children with ACP.
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Affiliation(s)
| | - Eric Prince
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | | | | | - James Johnston
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luca Massimi
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mark Souweidane
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Robert Naftel
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Limbrick
- Washington University School of Medicine, St. Louis, MO, USA
| | - Gerald Grant
- Lucile Packard Children’s Hospital at Stanford University, Palo Alto, CA, USA
| | - Toba Niazi
- Nicklaus Children’s Hospital, Miami, FL, USA
| | | | | | - Eric Jackson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Jallo
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Kevin Ginn
- Children’s Mercy Hospital, Kansas City, MO, USA
| | - Amy Smith
- Arnold Palmer Hospital, Orlando, FL, USA
| | - Joshua Chern
- Emory University School of Medicine, Atlanta, GA, USA
| | - Amy Lee
- Seattle Children’s Hospital, Seattle, WA, USA
| | | | - Mark Krieger
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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16
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Yahanda A, Patel B, Shah A, Cahill D, Sutherland G, Honeycutt J, Jensen R, Rich K, Dowling J, Limbrick D, Dacey R, Kim A, Leuthardt E, Dunn G, Zipfel G, Leonard J, Smyth M, Shah M, Abram S, Evans J, Chicoine M. SURG-12. PREDICTORS OF SURVIVAL AND UTILITY OF INTRAOPERATIVE MRI FOR RESECTION OF GRADE II ASTROCYTOMAS AND OLIGODENDROGLIOMAS: A MULTICENTER ANALYSIS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.859] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative MRI (iMRI) in the resection of grade II gliomas. We assessed the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly-diagnosed grade II astrocytomas and oligodendrogliomas.
METHODS
Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS/PFS.
RESULTS
232 resections (112 astrocytomas, 120 oligodendrogliomas; 135 males; mean age 36.2 ± 0.9 years) were analyzed. Oligodendrogliomas had longer OS (p< 0.001) and PFS (p=0.009) than astrocytomas. Multivariate regression showed that extent of resection (EOR), including gross-total (GTR) versus near-total (NTR) resection (p=0.02, HR: 0.64, 95% CI: 0.25-.79) and GTR versus subtotal resection (STR) (p=0.006, HR: 0.23, 95% CI: 0.08-0.66), was associated with longer OS. GTR versus NTR (p=0.04, HR: 0.49, 95% CI: 0.29-.85), GTR versus STR (p=0.02, HR: .54, 95% CI: .32-.91) and iMRI use (p=0.02, HR: 0.54, 95% CI: 0.32-0.92) were associated with longer PFS. Frontal (p=0.048, HR: 2.11, 95% CI: 1.01-4.43) and occipital/parietal (p=0.003, HR: 3.59, 95% CI: 1.52-8.49) locations were associated with shorter PFS (versus temporal). Kaplan-Meier analyses showed longer OS with increasing EOR (p=0.03) and 1p/19q gene deletions (p=0.02). PFS improved with increasing EOR (p=0.01), GTR versus NTR (p=0.02), and resections above STR (p=0.04). Factors influencing adjuvant treatment (35.3% of patients) included age (p=0.002, OR: 1.04) and EOR (p=0.037, OR: 0.41 for NTR versus STR; p=0.003, OR: 0.39 for GTR versus STR), but not glioma subtype or location, as determined by logistic regression. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these cases.
CONCLUSIONS
EOR significantly improves OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.
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Affiliation(s)
| | - Bhuvic Patel
- Washington University School of Medicine, St. Louis, MO, USA
| | - Amar Shah
- Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel Cahill
- Department of Neurosurgery, Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Randy Jensen
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Keith Rich
- Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua Dowling
- Washington University School of Medicine, St. Louis, MO, USA
| | - David Limbrick
- Washington University School of Medicine, St. Louis, MO, USA
| | - Ralph Dacey
- Washington University School of Medicine, St. Louis, MO, USA
| | - Albert Kim
- Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Leuthardt
- Washington University School of Medicine, St. Louis, MO, USA
| | - Gavin Dunn
- Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory Zipfel
- Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Leonard
- Ohio State University College of Medicine, Columbus, OH, USA
| | - Matthew Smyth
- Washington University School of Medicine, St. Louis, MO, USA
| | - Mitesh Shah
- Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | | | - John Evans
- Washington University School of Medicine, St. Louis, MO, USA
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17
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Miles DK, Ponisio MR, Colvin R, Limbrick D, Greenberg JK, Brancato C, Leonard JR, Pineda JA. Predictors of intracranial hypertension in children undergoing ICP monitoring after severe traumatic brain injury. Childs Nerv Syst 2020; 36:1453-1460. [PMID: 31970473 DOI: 10.1007/s00381-020-04516-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/24/2019] [Accepted: 01/18/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Intracranial hypertension (ICH) is a common and treatable complication after severe traumatic brain injury (sTBI) in children. Describing the incidence and risk factors for developing ICH after sTBI could impact clinical practice. METHODS Retrospective cohort study from 2006 to 2015 at two university-affiliated level I pediatric trauma centers of children admitted with accidental or abusive TBI, a post-resuscitation Glasgow Coma Score (GCS) of 8 or less, and an invasive intracranial pressure (ICP) monitor. Bivariate and multivariable logistic regression analysis were performed to identify demographic, injury, and imaging characteristics in patients who received ICP directed therapies for ICH (ICP > 20 mmHg). RESULTS Eight to 5% (271/321) of monitored patients received ICP directed therapy for ICH during their PICU stay. Ninety-seven percent of patients had an abnormality on CT scan by either the Marshall or the Rotterdam score. Of the analyzed clinical and radiologic variables, only presence of hypoxia prior to PICU arrival, female sex, and a higher Injury Severity Score (ISS) were associated with increased risk of ICH (p < 0.05). CONCLUSIONS In this retrospective study of clinical practice of ICP monitoring in children after sTBI, the vast majority of children had an abnormal CT scan and experienced ICH requiring clinical intervention. Commonly measured clinical variables and radiologic classification scores did not significantly add to the prediction for developing of ICH and further efforts are needed to define low-risk populations that would not develop ICH.
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Affiliation(s)
- Darryl K Miles
- Department of Pediatrics, Division of Critical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA.
| | - Maria R Ponisio
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan Colvin
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - David Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob K Greenberg
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Celeste Brancato
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey R Leonard
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jose A Pineda
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
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18
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Luciano MG, Batzdorf U, Kula RW, Rocque BG, Maher CO, Heiss J, Martin BA, Bolognese PA, Ashley-Koch A, Limbrick D, Poppe DJ, Esposito KM, Odenkirchen J, Esterlitz JR, Ala’i S, Joseph K, Feldman RS, Riddle R. Development of Common Data Elements for Use in Chiari Malformation Type I Clinical Research: An NIH/NINDS Project. Neurosurgery 2019; 85:854-860. [PMID: 30690581 PMCID: PMC7054710 DOI: 10.1093/neuros/nyy475] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Received: 03/23/2018] [Indexed: 12/28/2022] Open
Abstract
The management of Chiari I malformation (CMI) is controversial because treatment methods vary and treatment decisions rest on incomplete understanding of its complex symptom patterns, etiologies, and natural history. Validity of studies that attempt to compare treatment of CMI has been limited because of variable terminology and methods used to describe study subjects. The goal of this project was to standardize terminology and methods by developing a comprehensive set of Common Data Elements (CDEs), data definitions, case report forms (CRFs), and outcome measure recommendations for use in CMI clinical research, as part of the CDE project at the National Institute of Neurological Disorders and Stroke (NINDS) of the US National Institutes of Health. A working group, comprising over 30 experts, developed and identified CDEs, template CRFs, data dictionaries, and guidelines to aid investigators starting and conducting CMI clinical research studies. The recommendations were compiled, internally reviewed, and posted online for external public comment. In October 2016, version 1.0 of the CMI CDE recommendations became available on the NINDS CDE website. The recommendations span these domains: Core Demographics/Epidemiology; Presentation/Symptoms; Co-Morbidities/Genetics; Imaging; Treatment; and Outcome. Widespread use of CDEs could facilitate CMI clinical research trial design, data sharing, retrospective analyses, and consistent data sharing between CMI investigators around the world. Updating of CDEs will be necessary to keep them relevant and applicable to evolving research goals for understanding CMI and its treatment.
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Affiliation(s)
- Mark G Luciano
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Ulrich Batzdorf
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Roger W Kula
- Chiari Neurosurgical Center at Neurological Surgery, P.C., Lake Success, New York
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Cormac O Maher
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - John Heiss
- Division of Intramural Research, National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Bryn A Martin
- Department of Biological Engineering, University of Idaho, Moscow, Idaho
| | - Paolo A Bolognese
- Chiari Neurosurgical Center at Neurological Surgery, P.C., Lake Success, New York
| | | | - David Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Joanne Odenkirchen
- Division of Neuroscience, National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | | | | | | | | | - Robert Riddle
- Division of Neuroscience, National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
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19
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Gupta N, Goumnerova LC, Manley P, Chi SN, Neuberg D, Puligandla M, Fangusaro J, Goldman S, Tomita T, Alden T, DiPatri A, Rubin JB, Gauvain K, Limbrick D, Leonard J, Geyer JR, Leary S, Browd S, Wang Z, Sood S, Bendel A, Nagib M, Gardner S, Karajannis MA, Harter D, Ayyanar K, Gump W, Bowers DC, Weprin B, MacDonald TJ, Aguilera D, Brahma B, Robison NJ, Kiehna E, Krieger M, Sandler E, Aldana P, Khatib Z, Ragheb J, Bhatia S, Mueller S, Banerjee A, Bredlau AL, Gururangan S, Fuchs H, Cohen KJ, Jallo G, Dorris K, Handler M, Comito M, Dias M, Nazemi K, Baird L, Murray J, Lindeman N, Hornick JL, Malkin H, Sinai C, Greenspan L, Wright KD, Prados M, Bandopadhayay P, Ligon KL, Kieran MW. Prospective feasibility and safety assessment of surgical biopsy for patients with newly diagnosed diffuse intrinsic pontine glioma. Neuro Oncol 2019; 20:1547-1555. [PMID: 29741745 DOI: 10.1093/neuonc/noy070] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Diagnosis of diffuse intrinsic pontine glioma (DIPG) has relied on imaging studies, since the appearance is pathognomonic, and surgical risk was felt to be high and unlikely to affect therapy. The DIPG Biology and Treatment Study (DIPG-BATS) reported here incorporated a surgical biopsy at presentation and stratified subjects to receive FDA-approved agents chosen on the basis of specific biologic targets. Methods Subjects were eligible for the trial if the clinical features and imaging appearance of a newly diagnosed tumor were consistent with a DIPG. Surgical biopsies were performed after enrollment and prior to definitive treatment. All subjects were treated with conventional external beam radiotherapy with bevacizumab, and then stratified to receive bevacizumab with erlotinib or temozolomide, both agents, or neither agent, based on O6-methylguanine-DNA methyltransferase status and epidermal growth factor receptor expression. Whole-genome sequencing and RNA sequencing were performed but not used for treatment assignment. Results Fifty-three patients were enrolled at 23 institutions, and 50 underwent biopsy. The median age was 6.4 years, with 24 male and 29 female subjects. Surgical biopsies were performed with a specified technique and no deaths were attributed to the procedure. Two subjects experienced grade 3 toxicities during the procedure (apnea, n = 1; hypertension, n = 1). One subject experienced a neurologic deficit (left hemiparesis) that did not fully recover. Of the 50 tumors biopsied, 46 provided sufficient tissue to perform the study assays (92%, two-stage exact binomial 90% CI: 83%-97%). Conclusions Surgical biopsy of DIPGs is technically feasible, associated with acceptable risks, and can provide biologic data that can inform treatment decisions.
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Affiliation(s)
- Nalin Gupta
- UCSF Benioff Children's Hospital & University of California San Francisco, San Francisco, California
| | - Liliana C Goumnerova
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Peter Manley
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Susan N Chi
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | | | | | - Jason Fangusaro
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Stewart Goldman
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Tadanori Tomita
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Tord Alden
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Arthur DiPatri
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Joshua B Rubin
- Washington University Medical Center & St. Louis Children's Hospital, St. Louis, Missouri
| | - Karen Gauvain
- Washington University Medical Center & St. Louis Children's Hospital, St. Louis, Missouri
| | - David Limbrick
- Washington University Medical Center & St. Louis Children's Hospital, St. Louis, Missouri
| | - Jeffrey Leonard
- Washington University Medical Center & St. Louis Children's Hospital, St. Louis, Missouri
| | - J Russel Geyer
- Seattle Children's Hospital & University of Washington, Seattle, Washington
| | - Sarah Leary
- Seattle Children's Hospital & University of Washington, Seattle, Washington
| | - Samuel Browd
- Seattle Children's Hospital & University of Washington, Seattle, Washington
| | - Zhihong Wang
- Children's Hospital of Michigan & Wayne State University, Detroit, Michigan
| | - Sandeep Sood
- Children's Hospital of Michigan & Wayne State University, Detroit, Michigan
| | - Anne Bendel
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Mahmoud Nagib
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | - William Gump
- University of Louisville & Norton's Children's Hospital, Louisville, Kentucky
| | - Daniel C Bowers
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bradley Weprin
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tobey J MacDonald
- Children's Healthcare of Atlanta & Emory University, Atlanta, Georgia
| | - Dolly Aguilera
- Children's Healthcare of Atlanta & Emory University, Atlanta, Georgia
| | | | | | - Erin Kiehna
- Children's Hospital Los Angeles, Los Angeles, California
| | - Mark Krieger
- Children's Hospital Los Angeles, Los Angeles, California
| | - Eric Sandler
- Nemours Children's Clinic, Wolfson's Children's Hospital & University of Florida, Jacksonville, Florida
| | - Philipp Aldana
- Nemours Children's Clinic, Wolfson's Children's Hospital & University of Florida, Jacksonville, Florida
| | - Ziad Khatib
- Nicklaus Children's Hospital, Miami, Florida
| | - John Ragheb
- Nicklaus Children's Hospital, Miami, Florida
| | | | - Sabine Mueller
- UCSF Benioff Children's Hospital & University of California San Francisco, San Francisco, California
| | - Anu Banerjee
- UCSF Benioff Children's Hospital & University of California San Francisco, San Francisco, California
| | - Amy-Lee Bredlau
- Medical University of South Carolina, South Carolina, Charleston, South Carolina
| | - Sri Gururangan
- Preston Robert Tisch Brain Tumor Center & Duke University Medical Center, Durham, North Carolina
| | - Herbert Fuchs
- Preston Robert Tisch Brain Tumor Center & Duke University Medical Center, Durham, North Carolina
| | | | | | - Kathleen Dorris
- Children's Hospital of Colorado & University of Colorado School of Medicine, Denver, Colorado
| | - Michael Handler
- Children's Hospital of Colorado & University of Colorado School of Medicine, Denver, Colorado
| | - Melanie Comito
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Mark Dias
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Kellie Nazemi
- Oregon Health & Science University & Doernbecher Children's Hospital, Portland, Oregon
| | - Lissa Baird
- Oregon Health & Science University & Doernbecher Children's Hospital, Portland, Oregon
| | - Jeff Murray
- Cook Children's Medical Center, Fort Worth, Texas
| | | | | | | | - Claire Sinai
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Karen D Wright
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Michael Prados
- UCSF Benioff Children's Hospital & University of California San Francisco, San Francisco, California
| | - Pratiti Bandopadhayay
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts.,Broad Institute, Cambridge, Massachusetts
| | - Keith L Ligon
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Mark W Kieran
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
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20
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Karsy M, Akbari SH, Limbrick D, Leuthardt EC, Evans J, Smyth MD, Strahle J, Leonard J, Cheshier S, Brockmeyer DL, Bollo RJ, Kestle JR, Honeycutt J, Donahue DJ, Roberts RA, Hansen DR, Riva-Cambrin J, Sutherland G, Gallagher C, Hader W, Starreveld Y, Hamilton M, Duhaime AC, Jensen RL, Chicoine MR. Evaluation of pediatric glioma outcomes using intraoperative MRI: a multicenter cohort study. J Neurooncol 2019; 143:271-280. [PMID: 30977059 DOI: 10.1007/s11060-019-03154-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/04/2019] [Accepted: 03/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of intraoperative MRI (iMRI) during treatment of gliomas may increase extent of resection (EOR), decrease need for early reoperation, and increase progression-free and overall survival, but has not been fully validated, particularly in the pediatric population. OBJECTIVE To assess the accuracy of iMRI to identify residual tumor in pediatric patients with glioma and determine the effect of iMRI on decisions for resection, complication rates, and other outcomes. METHODS We retrospectively analyzed a multicenter database of pediatric patients (age ≤ 18 years) who underwent resection of pathologically confirmed gliomas. RESULTS We identified 314 patients (mean age 9.7 ± 4.6 years) with mean follow-up of 48.3 ± 33.6 months (range 0.03-182.07 months) who underwent surgery with iMRI. There were 201 (64.0%) WHO grade I tumors, 57 (18.2%) grade II, 24 (7.6%) grade III, 9 (2.9%) grade IV, and 23 (7.3%) not classified. Among 280 patients who underwent resection using iMRI, 131 (46.8%) had some residual tumor and underwent additional resection after the first iMRI. Of the 33 tissue specimens sent for pathological analysis after iMRI, 29 (87.9%) showed positive tumor pathology. Gross total resection was identified in 156 patients (55.7%), but this was limited by 69 (24.6%) patients with unknown EOR. CONCLUSIONS Analysis of the largest multicenter database of pediatric gliomas resected using iMRI demonstrated additional tumor resection in a substantial portion of cases. However, determining the impact of iMRI on EOR and outcomes remains challenging because iMRI use varies among providers nationally. Continued refinement of iMRI techniques for use in pediatric patients with glioma may improve outcomes.
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Affiliation(s)
- Michael Karsy
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - S Hassan Akbari
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - David Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - John Evans
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew D Smyth
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer Strahle
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Leonard
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Samuel Cheshier
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | | | - Robert J Bollo
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - John R Kestle
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - John Honeycutt
- Department of Neurosurgery, Cook Children's Neurosciences, Forth Worth, TX, USA
| | - David J Donahue
- Department of Neurosurgery, Cook Children's Neurosciences, Forth Worth, TX, USA
| | - Richard A Roberts
- Department of Neurosurgery, Cook Children's Neurosciences, Forth Worth, TX, USA
| | - Daniel R Hansen
- Department of Neurosurgery, Cook Children's Neurosciences, Forth Worth, TX, USA
| | - Jay Riva-Cambrin
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | | | - Clair Gallagher
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Walter Hader
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Yves Starreveld
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Mark Hamilton
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Randy L Jensen
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA. .,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
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21
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Karsy M, Cheshier S, Akbari SH, Limbrick D, Leuthardt EC, Evans J, Smyth MD, Strahle J, Leonard J, Brockmeyer DL, Bollo RJ, Kestle JR, Honeycutt J, Donahue DJ, Roberts RA, Hansen DR, Sutherland G, Gallagher C, Hader W, Starreveld Y, Hamilton M, Duhaime AC, Jensen RL, Chicoine MR. LGG-32. EVALUATION OF PEDIATRIC GLIOMA OUTCOME USING INTRAOPERATIVE MRI: A COHORT STUDY USING I-MiND (IMRIS MULTICENTER iMRI NEUROSURGERY DATABASE). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael Karsy
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Samuel Cheshier
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - S Hassan Akbari
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - David Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - John Evans
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew D Smyth
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer Strahle
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Leonard
- Department of Neurosurgery; Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Robert J Bollo
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - John R Kestle
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - John Honeycutt
- Department of Neurosurgery, Cook Children’s Neurosciences, Forth Worth, TX, USA
| | - David J Donahue
- Department of Neurosurgery, Cook Children’s Neurosciences, Forth Worth, TX, USA
| | - Richard A Roberts
- Department of Neurosurgery, Cook Children’s Neurosciences, Forth Worth, TX, USA
| | - Daniel R Hansen
- Department of Neurosurgery, Cook Children’s Neurosciences, Forth Worth, TX, USA
| | | | - Clair Gallagher
- Department of Neurosurgery, University of Calgary, calgary, AB, Canada
| | - Walter Hader
- Department of Neurosurgery, University of Calgary, calgary, AB, Canada
| | - Yves Starreveld
- Department of Neurosurgery, University of Calgary, calgary, AB, Canada
| | - Mark Hamilton
- Department of Neurosurgery, University of Calgary, calgary, AB, Canada
| | | | - Randy L Jensen
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
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Ravindra VM, Dewan MC, Akbari H, Bollo RJ, Limbrick D, Jea A, Naftel RP, Riva-Cambrin JK. Management of Penetrating Cerebrovascular Injuries in Pediatric Trauma: A Retrospective Multicenter Study. Neurosurgery 2018; 81:473-480. [PMID: 28475705 DOI: 10.1093/neuros/nyx094] [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] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 02/09/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blunt cerebrovascular injury is uncommon in the pediatric population; penetrating cerebrovascular injuries are even rarer and are thus poorly understood. OBJECTIVE To describe the diagnosis and management of penetrating cerebrovascular injuries and describe outcomes of available treatment modalities. METHODS Clinical and radiographic data were collected retrospectively from a multicenter trauma registry for children screened for cerebrovascular injury during 2003 to 2013 at 4 academic pediatric trauma centers. RESULTS Among 645 pediatric patients evaluated with computed tomography angiography with blunt cerebrovascular injury, 130 also had a penetrating trauma indication. Seven penetrating cerebrovascular injuries were diagnosed in 7 male patients (mean age 12.4 years, range 12-18 years). Focal neurological deficit and concomitant intracranial injury were each seen in 2 patients. There were 2 intracranial carotid artery injuries, 4 extracranial carotid artery injuries, and 1 vertebral artery injury. The majority of injuries were higher than grade I (5/7; 71%): 2 were grade I, 1 grade II, 2 grade III, and 2 grade IV. The 2 patients with grade III injuries required open surgery, and 1 patient with a grade IV injury underwent endovascular treatment. Two patients suffered immediate stroke secondary to the penetrating cerebrovascular injury. There were no delayed neurological deficits from the penetrating injuries, and no patients died as a result of the injuries. CONCLUSION This is the largest series of penetrating cerebrovascular trauma in the pediatric literature. Although rare, penetrating cerebrovascular injuries can be high-grade injuries that require urgent recognition and may require aggressive endovascular and/or open surgery for treatment.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Chil-dren's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael C Dewan
- Department of Neurosurgery, Divi-sion of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vander-bilt, Vanderbilt University, Nashville, Ten-nessee
| | - Hassan Akbari
- Department of Neurosurgery, Division of Pediatric Neurosurgery, St. Louis Children's Hospital, Washington University, St. Louis, Missouri
| | - Robert J Bollo
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Chil-dren's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - David Limbrick
- Department of Neurosurgery, Division of Pediatric Neurosurgery, St. Louis Children's Hospital, Washington University, St. Louis, Missouri
| | - Andrew Jea
- Depart-ment of Neurosurgery, Baylor College of Medicine, Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
| | - Robert P Naftel
- Department of Neurosurgery, Divi-sion of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vander-bilt, Vanderbilt University, Nashville, Ten-nessee
| | - Jay K Riva-Cambrin
- Department of Clinical Neurosciences, Division of Pediatric Neurosurgery, University of Calgary, Cal-gary, Alberta, Canada
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Dewan MC, Ravindra VM, Gannon S, Prather CT, Yang GL, Jordan LC, Limbrick D, Jea A, Riva-Cambrin J, Naftel RP. Treatment Practices and Outcomes After Blunt Cerebrovascular Injury in Children. Neurosurgery 2017; 79:872-878. [PMID: 27465848 DOI: 10.1227/neu.0000000000001352] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pediatric blunt cerebrovascular injury (BCVI) lacks accepted treatment algorithms, and postinjury outcomes are ill defined. OBJECTIVE To compare treatment practices among pediatric trauma centers and to describe outcomes for available treatment modalities. METHODS Clinical and radiographic data were collected from a patient cohort with BCVI between 2003 and 2013 at 4 academic pediatric trauma centers. RESULTS Among 645 pediatric patients evaluated with computed tomography angiography for BCVI, 57 vascular injuries (82% carotid artery, 18% vertebral artery) were diagnosed in 52 patients. Grade I (58%) and II (23%) injuries accounted for most lesions. Severe intracranial or intra-abdominal hemorrhage precluded antithrombotic therapy in 10 patients. Among the remaining patients, primary therapy was an antiplatelet agent in 14 (33%), anticoagulation in 8 (19%), endovascular intervention in 3 (7%), open surgery in 1 (2%), and no treatment in 16 (38%). Among 27 eligible grade I injuries, 16 (59%) were not treated, and the choice to not treat varied significantly among centers (P < .001). There were no complications from medical management. Glasgow Coma Scale (GCS) score <8 and increasing injury grade were predictors of injury progression (P = .001 and .004, respectively). Poor GCS score (P = .02), increasing injury grade (P = .03), and concomitant intracranial injury (P = .02) correlated with increased risk of mortality. Treatment modality did not correlate with progression of vascular injury or mortality. CONCLUSION Treatment of BCVI with antiplatelet or anticoagulant therapy is safe and may confer modest benefit. Nonmodifiable factors, including presenting GCS score, vascular injury grade, and additional intracranial injury, remain the most important predictors of poor outcome. ABBREVIATIONS ATT, antithrombotic therapyBCVI, blunt cerebrovascular injuryCTA, computed tomography angiographyGCS, Glasgow Coma Scale.
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Affiliation(s)
- Michael C Dewan
- *Department of Neurosurgery, Vanderbilt University, Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; ‡Department of Neurosurgery, University of Utah School of Medicine, Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah; §Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University, Nashville, Tennessee; ¶Department of Neurosurgery, Washington University in St. Louis, Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri; ‖Department of Neurosurgery, Baylor College of Medicine, Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
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Perkins S, Rubin J, Schlaggar B, Shimony J, Barbour D, Limbrick D, Dosenbach N. PDCT-13. ASSESSMENT OF NEUROCOGNITION AND BRAIN CONNECTIVITY IN PEDIATRIC BRAIN TUMOR PATIENTS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.756] [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: 11/13/2022] Open
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Gupta N, Goumnerova L, Ayyanar K, Gump W, Bendel A, Nagib M, Bowers D, Weprin B, Bredlau AL, Gururangan S, Fuchs H, Cohen K, Jallo G, Dorris K, Handler M, Comito M, Dias M, Fangusaro JR, Goldman S, Tomita T, Alden T, DiPatri A, Gardner S, Karajannis M, Harter D, Gauvain K, Limbrick D, Leonard J, Geyer JR, Leary S, Browd S, Khatib Z, Ragheb J, Bhatia S, MacDonald T, Aguilera D, Brahma B, Manley P, Chi S, Mueller S, Banerjee A, Murray J, Nazemi K, Baird L, Robison N, Kiehna E, Krieger M, Sandler E, Aldana P, Wang J, Sood S, Neuberg D, Puligandla M, Greenspan L, Wright K, Prados M, Bandopadhayay P, Ligon K, Kieran M. PDCT-20. FEASIBILITY AND SAFETY OF SURGICAL BIOPSY FOR PATIENTS WITH DIPG: PRELIMINARY RESULTS FROM DIPG-BATS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.762] [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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Donson A, Griesinger A, Amani V, Witt D, Apps J, Grant G, Dudley R, Jackson E, Johnston J, Greenfield J, Naftel R, Limbrick D, Anderson RC, Niazi T, Handler M, Mulcahy-Levy J, Martinez-Barbera JP, Foreman N, Hankinson TC. IMMU-05. MOLECULAR ANALYSES DEMONSTRATE AN IMMUNOSUPPRESSIVE PHENOTYPE IN THE CYST AND SOLID TUMOR COMPARTMENTS OF ADAMANTINOMATOUS CRANIOPHARYNGIOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.116] [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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Gupta N, Goumnerova L, Ayyanar K, Gump W, Bendel A, Nagib M, Bowers D, Weprin B, Bredlau AL, Gururangan S, Fuchs H, Cohen K, Jallo G, Dorris K, Handler M, Comito M, Dias M, Fangusaro J, Goldman S, Tomita T, Alden T, DiPatri A, Gardner S, Karajannis M, Harter D, Gauvain K, Limbrick D, Leonard J, Geyer R, Leary S, Browd S, Khatib Z, Ragheb J, Bhatia S, MacDonald T, Aguilera D, Brahma B, Manley P, Chi S, Mueller S, Banerjee A, Murray J, Nazemi K, Baird L, Robison N, Kiehna E, Krieger M, Sandler E, Aldana P, Wang J, Sood S, Neuberg D, Puligandla M, Greenspan L, Wright K, Prados M, Bandopadhayay P, Ligon K, Kieran M. TRTH-23. FEASIBILITY AND SAFETY OF SURGICAL BIOPSY FOR PATIENTS WITH DIPG: PRELIMINARY RESULTS FROM DIPG-BATS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.234] [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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Harpster K, Yuan W, Mangano F, Limbrick D, Dodd J, Engsberg J, Powell S, Barnard H, Kadis D, Gauthier A, Darbin C, Weckherlin N. Tablet-Based Occupational Therapy Intervention for Children With Hydrocephalus. Am J Occup Ther 2016. [DOI: 10.5014/ajot.2016.70s1-po5048] [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: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/8/2016
Children with surgically treated congenital hydrocephalus (HCP) are at risk for long-term deficits in visual–spatial perception, visual attention, and visual–motor skills. This paper will review the implementation and effectiveness of an intensive, tablet-based intervention for children with HCP.
Primary Author and Speaker: Karen Harpster
Additional Authors and Speakers: Nicole Weckherlin
Contributing Authors: Weihong Yuan, Francesco Mangano, David Limbrick, Jon Dodd, Jack Engsberg, Stephanie Powell, Holly Barnard, Darren Kadis, Amanda Gauthier, Carolyn Darbin
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Gauvain K, Tran D, Rubin J, Shimony J, Campian J, Leuthardt E, Limbrick D. NS-14A PILOT STUDY OF USING MRI-GUIDED LASER HEAT ABLATION TO INDUCE DISRUPTION OF THE PERITUMORAL BLOOD BRAIN BARRIER TO ENHANCE DELIVERY AND EFFICACY OF TREATMENT OF PEDIATRIC BRAIN TUMORS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now078.14] [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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Whitehead WE, Riva-Cambrin J, Wellons JC, Kulkarni AV, Browd S, Limbrick D, Rozzelle C, Tamber MS, Simon TD, Shannon CN, Holubkov R, Oakes WJ, Luerssen TG, Walker ML, Drake JM, Kestle JRW. Factors associated with ventricular catheter movement and inaccurate catheter location: post hoc analysis of the hydrocephalus clinical research network ultrasound-guided shunt placement study. J Neurosurg Pediatr 2014; 14:173-8. [PMID: 24926971 DOI: 10.3171/2014.5.peds13481] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Shunt survival may improve when ventricular catheters are placed into the frontal horn or trigone of the lateral ventricle. However, techniques for accurate catheter placement have not been developed. The authors recently reported a prospective study designed to test the accuracy of catheter placement with the assistance of intraoperative ultrasound, but the results were poor (accurate placement in 59%). A major reason for the poor accurate placement rate was catheter movement that occurred between the time of the intraoperative ultrasound image and the first postoperative scan (33% of cases). The control group of non-ultrasound using surgeons also had a low rate of accurate placement (accurate placement in 49%). The authors conducted an exploratory post hoc analysis of patients in their ultrasound study to identify factors associated with either catheter movement or poor catheter placement so that improved surgical techniques for catheter insertion could be developed. METHODS The authors investigated the following risk factors for catheter movement and poor catheter placement: age, ventricular size, cortical mantle thickness, surgeon experience, surgeon experience with ultrasound prior to trial, shunt entry site, shunt hardware at entry site, ventricular catheter length, and use of an ultrasound probe guide for catheter insertion. Univariate analysis followed by multivariate logistic regression models were used to determine which factors were independent risk factors for either catheter movement or inaccurate catheter location. RESULTS In the univariate analyses, only age < 6 months was associated with catheter movement (p = 0.021); cortical mantle thickness < 1 cm was near-significant (p = 0.066). In a multivariate model, age remained significant after adjusting for cortical mantle thickness (OR 8.35, exact 95% CI 1.20-infinity). Univariate analyses of factors associated with inaccurate catheter placement showed that age < 6 months (p = 0.001) and a posterior shunt entry site (p = 0.021) were both associated with poor catheter placement. In a multivariate model, both age < 6 months and a posterior shunt entry site were independent risk factors for poor catheter placement (OR 4.54, 95% CI 1.80-11.42, and OR 2.59, 95% CI 1.14-5.89, respectively). CONCLUSIONS Catheter movement and inaccurate catheter placement are both more likely to occur in young patients (< 6 months). Inaccurate catheter placement is also more likely to occur in cases involving a posterior shunt entry site than those involving an anterior shunt entry site. Future clinical studies aimed at improving shunt placement techniques must consider the effects of young age and choice of entry site on catheter location.
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Affiliation(s)
- William E Whitehead
- Texas Children's Hospital, Houston, Baylor College of Medicine, Houston, Texas
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Srinivasakumar P, Limbrick D, Munro R, Mercer D, Rao R, Inder T, Mathur A. Posthemorrhagic ventricular dilatation-impact on early neurodevelopmental outcome. Am J Perinatol 2013; 30:207-14. [PMID: 22898993 DOI: 10.1055/s-0032-1323581] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study evaluates the impact of ventricular dilatation following severe (grades III or IV) intraventricular hemorrhage (IVH) in preterm neonates and the current practice of neurosurgical interventions in infants with posthemorrhagic ventricular dilatation (PHVD) and early neurodevelopmental outcome. STUDY DESIGN Premature neonates born at ≤34 weeks' gestational ages with severe IVH were identified retrospectively over a 5-year period (2005 to 2009). Standard measures of ventricular dilatation on head ultrasound (HUS) were recorded. The treatment of PHVD, timing of surgery including the type of temporizing neurosurgical procedure (TNP)-either a ventricular reservoir or a subgaleal shunt-and the subsequent need for ventriculoperitoneal (VP) shunt were evaluated. Patients were retrospectively stratified to an "early" versus "late" intervention group based on HUS measures. Early intervention was defined as TNP performed when the ventricular index (VI) was >97th percentile but <97th percentile + 4 mm. Late intervention was defined as TNP performed when VI was ≥97th percentile + 4 mm. Neurodevelopmental outcomes were evaluated at 18 to 24 months. Infants followed up for neurodevelopmental testing were stratified as group A (progressive PHVD with TNP), group B (PHVD without TNP), and group C (severe IVH without PHVD). RESULTS One hundred seventy-three preterm neonates with severe IVH were identified during the study period, of whom 139/173 (80%) developed PHVD. Of these, 54 (54/139, 39%) received TNP either early (4/54, 7%) or late (50/54, 93%). Of those who received TNP, 32/54 (59%) required subsequent VP shunt placement. Neurodevelopmental testing was available in 39/109 (36%) infants who survived to discharge. The mean ± standard deviation cognitive, motor, and language composite scores were 77 ± 14.8, 67 ± 15.2, 70 ± 13.8 for group A (n = 16/39), 90 ± 7.8, 84 ± 9.6, 82 ± 18.2 for group B (n = 12/39), and 95 ± 14.3, 86 ± 10.7, 94 ± 15.8 for group C (n = 11/39), respectively (p < 0.006 for group A versus group B and p < 0.004 for group A versus group C across all domains). Increasing ventricular dilatation was associated with adverse motor, cognitive, and language outcomes (p = 0.002) and neonates with progressive PHVD requiring a TNP were most adversely affected (p = 0.0006). There were no differences in any outcome measures between the two types of TNPs. Clinical and demographic characteristics of infants lost to follow-up were not significantly different than those available for follow-up. CONCLUSION Increasing ventricular size adversely affects neurodevelopmental outcome in infants with PHVD.
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Affiliation(s)
- Preethi Srinivasakumar
- Division of Newborn Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA.
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Kasasbeh A, Hwang EC, Steger-May K, Bandt SK, Oberhelman A, Limbrick D, Miller-Thomas MM, Shimony JS, Smyth MD. Association of magnetic resonance imaging identification of mesial temporal sclerosis with pathological diagnosis and surgical outcomes in children following epilepsy surgery. J Neurosurg Pediatr 2012; 9:552-61. [PMID: 22546035 DOI: 10.3171/2012.1.peds11447] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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] [Indexed: 11/06/2022]
Abstract
OBJECT Mesial temporal sclerosis (MTS) is widely recognized as a significant underlying cause of temporal lobe epilepsy. Magnetic resonance imaging is routinely used in the preoperative evaluation of children with epilepsy. The purpose of this study was to evaluate the prevalence, reliability, and prognostic value of MRI identification of MTS and MRI findings indicative of MTS in a series of patients who underwent resection of the medial temporal lobe for medically refractory epilepsy. METHODS The authors reviewed the medical records and preoperative MRI reports of 25 patients who had undergone medial temporal resections (anterior temporal lobectomy or functional hemispherotomy) for medically intractable epilepsy. The preoperative MRI studies were presented for blinded review by 2 neuroradiologists who independently evaluated the radiographs for selected MTS features and provided a final interpretation. To quantify interrater agreement and accuracy, the findings of the 2 blinded neuroradiologists, the nonblinded clinical preoperative radiology report, and the final pathology interpretation were compared. RESULTS The preoperative MRI studies revealed MTS in 6 patients (24%), and histopathological analysis verified MTS in 8 (32%) of 25 specimens. Six MRI features of MTS were specifically evaluated: 1) increased hippocampal signal intensity, 2) reduced hippocampal size, 3) atrophy of the ipsilateral hippocampal collateral white matter, 4) enlarged ipsilateral temporal horn, 5) reduced gray-white matter demarcation in the temporal lobe, and 6) decreased temporal lobe size. The most prevalent feature of MTS identified on MRI was a reduced hippocampal size, found in 11 of the MRI studies (44%). Analysis revealed moderate interrater agreement for MRI identification of MTS between the 2 blinded neuroradiologists and the nonblinded preoperative report (Cohen κ 0.40-0.59). Interrater agreement was highly variable for different MTS features indicative of MTS, ranging from poor to near perfect. Agreement was highest for increased hippocampal signal and decreased temporal lobe size and was consistently poor for reduced gray-white matter demarcation. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and proportion perfect agreement were highest for increased hippocampal signal and reduced hippocampal size. An MRI finding of MTS was not predictive of seizure outcome in this small series. CONCLUSIONS Mesial temporal sclerosis identification on brain MRI in children evaluated for medial temporal resections has a PPV of 55%-67% and an NPV of 79%-87%. Increased hippocampal signal and reduced hippocampal size were associated with high predictive values, while gray-white differentiation and an enlarged temporal horn were not predictive of MTS. Seizure outcome following medial temporal resections was not associated with MRI findings of MTS or MRI abnormalities indicative of MTS in this small sample size.
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Affiliation(s)
- Aimen Kasasbeh
- Department of Neuroscience, University of Arizona, Tucson, AZ 85719, USA.
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Abstract
OBJECT Intractable epilepsy is a significant burden on families and on the cognitive development and quality of life (QOL) of patients. Periinsular hemispherotomy (PIH) for medically intractable epilepsy can benefit patients who qualify for this procedure. The ideal hemispherotomy candidate has ipsilateral ictal and interictal epileptiform activity, unilateral MR imaging abnormalities, contralateral hemiplegia, and a normal contralateral hemisphere. However, certain patients present with a mixed picture of bilateral electroencephalography (EEG) findings and severe intractable epilepsy, prompting consideration of a more aggressive treatment approach. This report introduces the possibility of surgery for patients who normally would not meet criteria for this treatment modality. METHODS In this retrospective chart review, the authors report on 7 patients with bilateral seizure onset noted on routine or video-EEG monitoring. A QOL phone questionnaire, based on the Quality of Life in Childhood Epilepsy tool, was administered to a parent. The authors reviewed each patient's chart for surgical complications, changes in examination, QOL, limited neuropsychological outcomes, and seizure outcomes. They also investigated each chart for MR imaging and EEG findings as well as the patient's epilepsy clinic notes for seizure semiology and frequency. RESULTS All patients enjoyed a decrease in seizure frequency and a subjective increase in QOL after PIH. Five patients (71%) achieved Engel Class I or II seizure control. The mean follow-up was 3.64 years (2-5.3 years). One patient is now off all antiseizure medication. No patient had a decrement in Full Scale IQ on postsurgical testing, and 2 (28.5%) of 7 individuals had increased adaptive and social functioning. Postsurgical examination changes included hemiplegia and homonymous hemianopia. CONCLUSIONS Hemispherotomy in patients with intractable epilepsy is generally reserved for individuals with unilateral epileptiform abnormalities or lesions on MR imaging. Seven patients in this study benefited from surgery despite bilateral seizure onset with improvement in seizure control and overall QOL. Thus, bilateral ictal onset does not necessarily preclude consideration for hemispherotomy in selected patients with severe medically refractory epilepsy.
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Affiliation(s)
- Michael Anthony Ciliberto
- Departments of Developmental and Pediatric Neurology, Washington University, St. Louis, MO 63110, USA.
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Mansur D, Leonard J, Smyth M, Park T, Limbrick D, King A, Michalski J, Hollander A, Rubin J. 853 poster PEDIATRIC INTRACRANIAL EPENDYMOMA: OUTCOME AND PATTERNS OF FAILURE FOLLOWING POST-OPERATIVE RADIOTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70975-6] [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: 10/18/2022]
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Lipira A, Limbrick D, Haughey B, Custer P, Chicoine MR. Titanium mesh reconstruction to maintain scalp contour after temporalis musculofascial flap reconstruction of the floor of the middle cranial fossa: a technical note and report of two cases. Skull Base 2010; 19:303-9. [PMID: 20046599 DOI: 10.1055/s-0028-1114300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Temporalis musculofascial rotational flaps can provide excellent tissue for reconstruction of defects in the floor of the middle cranial fossa. This technique can, however, result in cosmetic deformity of the temporal fossa with an asymmetric contour of the head. We report a technique that uses titanium mesh and autologous abdominal adipose to maintain a normal scalp contour. CLINICAL PRESENTATION Two patients, one with a large middle cranial fossa and infratemporal schwannoma, and another with penetrating trauma secondary to a rifle accident, required surgical repair of defects of the floor of the middle cranial fossa. INTERVENTION The repair was achieved in both cases using a temporalis musculofascial rotational flap. Normal contour of the scalp was maintained with titanium mesh and autologous abdominal adipose reconstruction. CONCLUSION The temporalis musculofascial flap, combined with titanium mesh and autologous adipose reconstruction, provided excellent closure of defects of the floor of the middle cranial fossa while preserving normal cosmetic scalp contour.
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Affiliation(s)
- Angelo Lipira
- Departments of Neurosurgery, Otolaryngology and Ophthalmology, The Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital, Saint Louis, Missouri
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Kiehl EL, Stojadinovic S, Malinowski KT, Limbrick D, Jost SC, Garbow JR, Rubin JB, Deasy JO, Khullar D, Izaguirre EW, Parikh PJ, Low DA, Hope AJ. Feasibility of small animal cranial irradiation with the microRT system. Med Phys 2008; 35:4735-43. [PMID: 18975718 DOI: 10.1118/1.2977762] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To develop and validate methods for small-animal CNS radiotherapy using the microRT system. MATERIALS AND METHODS A custom head immobilizer was designed and built to integrate with a pre-existing microRT animal couch. The Delrin couch-immobilizer assembly, compatible with multiple imaging modalities (CT, microCT, microMR, microPET, microSPECT, optical), was first imaged via CT in order to verify the safety and reproducibility of the immobilization method. Once verified, the subject animals were CT-scanned while positioned within the couch-immobilizer assembly for treatment planning purposes. The resultant images were then imported into CERR, an in-house-developed research treatment planning system, and registered to the microRTP treatment planning space using rigid registration. The targeted brain was then contoured and conformal radiotherapy plans were constructed for two separate studies: (1) a whole-brain irradiation comprised of two lateral beams at the 90 degree and 270 degree microRT treatment positions and (2) a hemispheric (left-brain) irradiation comprised of a single A-P vertex beam at the 0 degree microRT treatment position. During treatment, subject animals (n=48) were positioned to the CERR-generated treatment coordinates using the three-axis microRT motor positioning system and were irradiated using a clinical Ir-192 high-dose-rate remote after-loading system. The radiation treatment course consisted of 5 Gy fractions, 3 days per week. 90% of the subjects received a total dose of 30 Gy and 10% received a dose of 60 Gy. RESULTS Image analysis verified the safety and reproducibility of the immobilizer. CT scans generated from repeated reloading and repositioning of the same subject animal in the couch-immobilizer assembly were fused to a baseline CT. The resultant analysis revealed a 0.09 mm average, center-of-mass translocation and negligible volumetric error in the contoured, murine brain. The experimental use of the head immobilizer added 0.1 mm to microRT spatial uncertainty along each axis. Overall, the total spatial uncertainty for the prescribed treatments was +/-0.3 mm in all three axes, a 0.2 mm functional improvement over the original version of microRT. Subject tolerance was good, with minimal observed side effects and a low procedure-induced mortality rate. Throughput was high, with average treatment times of 7.72 and 3.13 min/animal for the whole-brain and hemispheric plans, respectively (dependent on source strength). CONCLUSIONS The method described exhibits conformality more in line with the size differential between human and animal patients than provided by previous prevalent approaches. Using pretreatment imaging and microRT-specific treatment planning, our method can deliver an accurate, conformal dose distribution to the targeted murine brain (or a subregion of the brain) while minimizing excess dose to the surrounding tissue. Thus, preclinical animal studies assessing the radiotherapeutic response of both normal and malignant CNS tissue to complex dose distributions, which closer resemble human-type radiotherapy, are better enabled. The procedural and mechanistic framework for this method logically provides for future adaptation into other murine target organs or regions.
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Affiliation(s)
- Erich L Kiehl
- Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Schalk G, Kubánek J, Miller KJ, Anderson NR, Leuthardt EC, Ojemann JG, Limbrick D, Moran D, Gerhardt LA, Wolpaw JR. Decoding two-dimensional movement trajectories using electrocorticographic signals in humans. J Neural Eng 2007; 4:264-75. [PMID: 17873429 DOI: 10.1088/1741-2560/4/3/012] [Citation(s) in RCA: 305] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Signals from the brain could provide a non-muscular communication and control system, a brain-computer interface (BCI), for people who are severely paralyzed. A common BCI research strategy begins by decoding kinematic parameters from brain signals recorded during actual arm movement. It has been assumed that these parameters can be derived accurately only from signals recorded by intracortical microelectrodes, but the long-term stability of such electrodes is uncertain. The present study disproves this widespread assumption by showing in humans that kinematic parameters can also be decoded from signals recorded by subdural electrodes on the cortical surface (ECoG) with an accuracy comparable to that achieved in monkey studies using intracortical microelectrodes. A new ECoG feature labeled the local motor potential (LMP) provided the most information about movement. Furthermore, features displayed cosine tuning that has previously been described only for signals recorded within the brain. These results suggest that ECoG could be a more stable and less invasive alternative to intracortical electrodes for BCI systems, and could also prove useful in studies of motor function.
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Affiliation(s)
- G Schalk
- BCI R&D Progr, Wadsworth Ctr, NYS Department of Health, Albany, NY, USA.
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Pal S, Sun D, Limbrick D, Rafiq A, DeLorenzo RJ. Epileptogenesis induces long-term alterations in intracellular calcium release and sequestration mechanisms in the hippocampal neuronal culture model of epilepsy. Cell Calcium 2001; 30:285-96. [PMID: 11587552 DOI: 10.1054/ceca.2001.0236] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Calcium and calcium-dependent processes have been hypothesized to be involved in the induction of epilepsy. It has been shown that epileptic neurons have altered calcium homeostatic mechanisms following epileptogenesis in the hippocampal neuronal culture (HNC) and pilocarpine models of epilepsy. To investigate the mechanisms causing these alterations in [Ca2+]i homeostatic processes following epileptogenesis, we utilized the HNC model of in vitro 'epilepsy' which produces spontaneous recurrent epileptiform discharges (SREDs). Using [Ca2+]i imaging, studies were initiated to evaluate the mechanisms mediating these changes in [Ca2+]i homeostasis. 'Epileptic' neurons required much longer to restore a glutamate induced [Ca2+]i load to baseline levels than control neurons. Inhibition of Ca2+ entry through voltage and receptor gated Ca2+ channels and stretch activated Ca2+ channels had no effect on the prolonged glutamate induced increase in [Ca2+]i in epileptic neurons. Employing thapsigargin, an inhibitor of the sarco/endoplasmic reticulum calcium ATPase (SERCA), it was shown that thapsigargin inhibited sequestration of [Ca2+]i by SERCA was significantly decreased in 'epileptic' neurons. Using Ca2+ induced Ca2+ release (CICR) cell permeable inhibitors for the ryanodine receptor (dantrolene) and the IP3 receptor (2-amino-ethoxydiphenylborate, 2APB) mediated CICR, we demonstrated that CICR was significantly augmented in the 'epileptic' neurons, and determined that the IP3 receptor mediated CICR was the major release mechanism altered in epileptogenesis. These data indicate that both inhibition of SERCA and augmentation of CICR activity contribute to the alterations accounting for the impaired calcium homeostatic processes observed in 'epileptic' neurons. The results suggest that persistent changes in [Ca2+]i levels following epileptogenesis may contribute to the long-term plasticity changes manifested in epilepsy and that understanding the basic mechanisms mediating these changes may provide an insight into the development of novel therapeutic approaches to treat epilepsy and prevent or reverse epileptogenesis.
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Affiliation(s)
- S Pal
- Department of Neurology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0599, USA
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Churn SB, Limbrick D, Sombati S, DeLorenzo RJ. Excitotoxic activation of the NMDA receptor results in inhibition of calcium/calmodulin kinase II activity in cultured hippocampal neurons. J Neurosci 1995; 15:3200-14. [PMID: 7722657 PMCID: PMC6577768] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Neurotoxic effects of excitatory amino acids have been implicated in various neurological disorders, and have been utilized for excitotoxic models of delayed neuronal cell death. The excitotoxic glutamate-induced, delayed neuronal cell death also results in inhibition of calcium/calmodulin-dependent kinase II (CaM kinase II). In this report, we characterized the glutamate-induced inhibition of CaM kinase II in relation to loss of intracellular calcium regulation and delayed neuronal cell death. Glutamate (500 microM for 10 min), but not KCl (50 mM), exposure resulted in a significant inhibition of CaM kinase II activity. The inhibition of CaM kinase II activity was observed immediately following excitotoxic glutamate exposure and present at every time point measured. Glutamate-induced inhibition of kinase activity and delayed neuronal cell death was dependent upon both the activation of the NMDA glutamate receptor subtype and the presence of extracellular calcium. The relationship between inhibition of CaM kinase II activity and loss of intracellular calcium regulation was also examined. Experimental conditions which resulted in significant neuronal cell death and inhibition of CaM kinase II activity also resulted in a long-term loss of intracellular calcium regulation. Thus, inhibition of CaM kinase II activity occurred under experimental conditions which resulted in loss of neuronal viability and loss of neuronal calcium regulation. Since the glutamate-induced inhibition of CaM kinase II activity preceded neuronal cell death, the data support the hypothesis that inhibition of CaM kinase II activity may play a significant role in excitotoxicity-dependent, delayed neuronal cell death.
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Affiliation(s)
- S B Churn
- Department of Neurology, Medical College of Virginia, Richmond 23298, USA
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