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Taslimi S, Brogly SB, Li W, Rodger J, Kasper EM, Cook DJ, Levy R. Effect of neurosurgical residency programs on neurosurgical patient outcomes in a single health care system: a cohort study. Can J Surg 2024; 67:E188-E197. [PMID: 38692681 PMCID: PMC11068422 DOI: 10.1503/cjs.008522] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The evidence on the benefits and drawbacks of involving neurosurgical residents in the care of patients who undergo neurosurgical procedures is heterogeneous. We assessed the effect of neurosurgical residency programs on the outcomes of such patients in a large single-payer public health care system. METHODS Ten population-based cohorts of adult patients in Ontario who received neurosurgical care from 2013 to 2017 were identified on the basis of procedural codes, and the cohorts were followed in administrative health data sources. Patient outcomes by the status of the treating hospital (with or without a neurosurgical residency program) within each cohort were compared with models adjusted for a priori confounders and with adjusted multilevel models (MLMs) to also account for hospital-level factors. RESULTS A total of 46 608 neurosurgical procedures were included. Operative time was 8%-30% longer in hospitals with neurosurgical residency programs in 9 out of 10 cohorts. Thirty-day mortality was lower in hospitals with neurosurgical residency programs for aneurysm repair (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.20-0.44), cerebrospinal fluid shunting (OR 0.52, 95% CI 0.34-0.79), intracerebral hemorrhage evacuation (OR 0.66, 95% CI 0.52-0.84), and posterior lumbar decompression (OR 0.32, 95% CI 0.15-0.65) in adjusted models. The mortality rates remained significantly different only for aneurysm repair (OR 0.19, 95% CI 0.05-0.69) and cerebrospinal shunting (OR 0.42, 95% CI 0.21-0.85) in MLMs. Length of stay was mostly shorter in hospitals with neurosurgical residents, but this finding did not persist in MLMs. Thirty-day reoperation rates did not differ between hospital types in MLMs. For 30-day readmission rates, only extracerebral hematoma decompression was significant in MLMs (OR 1.41, 95% CI 1.07-1.87). CONCLUSION Hospitals with neurosurgical residents had longer operative times with similar to better outcomes. Most, but not all, of the differences between hospitals with and without residency programs were explained by hospital-level variables rather than direct effects of residents.
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Affiliation(s)
- Shervin Taslimi
- From the Division of Neurosurgery, Department of Surgery, Kingston General Hospital, Kingston, Ont. (Taslimi, Cook, Levy); the Department of Surgery, Queen's University, Kingston, Ont. (Brogly); ICES Queen's, Kingston, Ont. (Li); the Faculty of Medicine, University of British Columbia, Kelowna, B.C. (Rodger); the Department of Life Sciences, Queen's University, Kingston, Ont. (Rodger); and the Department of Neurosurgery, McMaster University, Hamilton, Ont. (Kasper).
| | - Susan B Brogly
- From the Division of Neurosurgery, Department of Surgery, Kingston General Hospital, Kingston, Ont. (Taslimi, Cook, Levy); the Department of Surgery, Queen's University, Kingston, Ont. (Brogly); ICES Queen's, Kingston, Ont. (Li); the Faculty of Medicine, University of British Columbia, Kelowna, B.C. (Rodger); the Department of Life Sciences, Queen's University, Kingston, Ont. (Rodger); and the Department of Neurosurgery, McMaster University, Hamilton, Ont. (Kasper)
| | - Wenbin Li
- From the Division of Neurosurgery, Department of Surgery, Kingston General Hospital, Kingston, Ont. (Taslimi, Cook, Levy); the Department of Surgery, Queen's University, Kingston, Ont. (Brogly); ICES Queen's, Kingston, Ont. (Li); the Faculty of Medicine, University of British Columbia, Kelowna, B.C. (Rodger); the Department of Life Sciences, Queen's University, Kingston, Ont. (Rodger); and the Department of Neurosurgery, McMaster University, Hamilton, Ont. (Kasper)
| | - Jillian Rodger
- From the Division of Neurosurgery, Department of Surgery, Kingston General Hospital, Kingston, Ont. (Taslimi, Cook, Levy); the Department of Surgery, Queen's University, Kingston, Ont. (Brogly); ICES Queen's, Kingston, Ont. (Li); the Faculty of Medicine, University of British Columbia, Kelowna, B.C. (Rodger); the Department of Life Sciences, Queen's University, Kingston, Ont. (Rodger); and the Department of Neurosurgery, McMaster University, Hamilton, Ont. (Kasper)
| | - Ekkehard M Kasper
- From the Division of Neurosurgery, Department of Surgery, Kingston General Hospital, Kingston, Ont. (Taslimi, Cook, Levy); the Department of Surgery, Queen's University, Kingston, Ont. (Brogly); ICES Queen's, Kingston, Ont. (Li); the Faculty of Medicine, University of British Columbia, Kelowna, B.C. (Rodger); the Department of Life Sciences, Queen's University, Kingston, Ont. (Rodger); and the Department of Neurosurgery, McMaster University, Hamilton, Ont. (Kasper)
| | - Douglas J Cook
- From the Division of Neurosurgery, Department of Surgery, Kingston General Hospital, Kingston, Ont. (Taslimi, Cook, Levy); the Department of Surgery, Queen's University, Kingston, Ont. (Brogly); ICES Queen's, Kingston, Ont. (Li); the Faculty of Medicine, University of British Columbia, Kelowna, B.C. (Rodger); the Department of Life Sciences, Queen's University, Kingston, Ont. (Rodger); and the Department of Neurosurgery, McMaster University, Hamilton, Ont. (Kasper)
| | - Ron Levy
- From the Division of Neurosurgery, Department of Surgery, Kingston General Hospital, Kingston, Ont. (Taslimi, Cook, Levy); the Department of Surgery, Queen's University, Kingston, Ont. (Brogly); ICES Queen's, Kingston, Ont. (Li); the Faculty of Medicine, University of British Columbia, Kelowna, B.C. (Rodger); the Department of Life Sciences, Queen's University, Kingston, Ont. (Rodger); and the Department of Neurosurgery, McMaster University, Hamilton, Ont. (Kasper)
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Power RG, Lam FC, Whitton AC, Sharma S, Kasper EM. Surgical Management of Meningiomas Involving the Torcula, Transverse Sinus, and Jugular Bulb: A Technical Note and Review of the Literature. J Neurol Surg Rep 2023; 84:e92-e102. [PMID: 37635841 PMCID: PMC10457152 DOI: 10.1055/s-0043-1772201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 01/26/2023] [Indexed: 08/29/2023] Open
Abstract
Meningiomas that invade the confluens sinuum are rare and require extensive preoperative planning. Here, we describe the surgical and radio-oncological management of an aggressive large occipital meningioma invading the superior sagittal sinus, torcula, right and left transverse sinus down to the level of the jugular bulb in a 21-year-old female patient. Details of the surgical approach are presented to highlight the planned staged resection of this tumor at the level of the torcula to initially debulk the lesion while preserving venous outflow through the patent's sinus. Once the tumor fully occluded the confluens, a second-stage en bloc resection ensued. Postsurgical adjuvant radiation therapy was delivered via fractionated external beam therapy which has provided local control of the tumor since. This case is being discussed in the context of the pertinent literature to demonstrate the highly complex interdisciplinary and staged management of partially intravascular meningiomas involving the major venous sinuses.
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Affiliation(s)
- Robert G. Power
- Division of Neurosurgery, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Fred C. Lam
- Division of Neurosurgery, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anthony C. Whitton
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Sunjay Sharma
- Division of Neurosurgery, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ekkehard M. Kasper
- Division of Neurosurgery, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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Kasper EM, Mirza FA, Kaya S, Walker R, Starnoni D, Daniel RT, Nair R, Lam FC. Surgical Morbidity in Relation to the Surgical Approach for Olfactory Groove Meningiomas-A Pooled Analysis of 1016 Patients and Proposal of a New Reporting System. Brain Sci 2023; 13:896. [PMID: 37371375 DOI: 10.3390/brainsci13060896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Background: There is currently no consensus in the field regarding whether a frontal or lateral approach is superior for microsurgical resection of olfactory groove meningiomas (OGM). Due to the lack of uniformity in classifying lesions and inherent differences in reporting outcomes after varying operative approaches, the best practice for approaching these lesions is yet to be determined. Objective: This study aimed to assess various surgical approaches undertaken for OGMs, investigate procedural aspects influencing the extent of resection, and analyze the respective complication rate associated with each approach. We performed a comprehensive literature review of presenting signs and symptoms in OGM patients, their surgical management, and the reported surgical outcomes. To address the lack of uniform data reporting across studies and to take more recent translational studies into account, we developed a new classification system for OGMs that can remedy the existing deficiencies in comparability of reporting. Methods: We conducted a PRISMA-guided literature search for surgical reports on OGMs published in the MRI era using broad search terms such as 'olfactory groove meningioma' and 'surgery', which yielded 20,672 results. After title screening and removal of duplicates, we assessed 871 studies on the specific surgical management of olfactory groove meningiomas. Following the application of exclusion criteria and abstract screening, a set of 27 studies was chosen for the final analysis of a pooled cohort of these reported patient outcomes. Results: The final twenty-seven studies included in our in-depth analysis identified a total of 1016 individual patients who underwent open microsurgical resection of OGMs. The approaches used included: pterional/unilateral, bifrontal with variations, and anterior interhemispheric approaches. Across all studies, gross total resection (Simpson Grades I or II) was achieved in 91.4% of cases, and subtotal resection (Grades III and IV) was reported in 8.6% of cases. A cumulative twenty-seven percent of surgical OGM patients sustained some form of complications. Minor issues accounted for 22.2% (CSF leak, seizures, infection, transient cranial nerve palsies, hydrocephalus), whereas major issues comprised 4.7% (hemorrhage, ischemic infarct, malignant cerebral edema). We then examined the correlation between these complications and the surgical approach chosen. Among pooled cohort of 426 patients who underwent unilateral approaches, 14% experienced minor complications, and 2.1% experienced major complications. For the mixed cohort of 410 patients who underwent bifrontal approaches, 24.6% experienced minor complications, and 7% experienced major complications. Conclusions: Unilateral approaches appear to have lower complication rates for the resection of OGMs compared to bilateral approaches. However, the extent of resection is not uniformly reported, making it difficult to identify differences. The use of an improved preoperative classification and scoring system can help establish a more coherent system to select the most suitable approach and to uniformly report surgical outcomes, such as EOR and complication rates specific to a given OGM and its surgical approach.
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Affiliation(s)
- Ekkehard M Kasper
- Department of Neurosurgery, St. Elizabeth's Medical Center, Brighton, MA 02135, USA
- Dana Farber Cancer Institute, Boston, MA 02215, USA
- Boston University School of Medicine, Boston, MA 02118, USA
- Division of Neurosurgery, Hamilton General Hospital, McMaster University Faculty of Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Farhan A Mirza
- Department of Neurosurgery, University of Kentucky, Lexington, KY 40536, USA
| | - Serdar Kaya
- Department of Neurosurgery, St. Elizabeth's Medical Center, Brighton, MA 02135, USA
- Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Robert Walker
- Department of Neurosurgery, St. Elizabeth's Medical Center, Brighton, MA 02135, USA
- Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Daniele Starnoni
- Neurosurgery Service, Centre Hospitalier Universitaire Vaudois/University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Roy T Daniel
- Neurosurgery Service, Centre Hospitalier Universitaire Vaudois/University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Ramesh Nair
- Neurosurgery Service, Charing Cross Hospital, Imperial College London, London W6 8RF, UK
| | - Fred C Lam
- Department of Neurosurgery, St. Elizabeth's Medical Center, Brighton, MA 02135, USA
- Dana Farber Cancer Institute, Boston, MA 02215, USA
- Boston University School of Medicine, Boston, MA 02118, USA
- Harvey Cushing Neuro-Oncology Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Nong Y, Stoppel DC, Johnson MA, Boillot M, Todorovic J, Shen J, Zhou X, Nadler MJ, Rodriguez C, Huo Y, Nagakura I, Kasper EM, Anderson MP. UBE3A and transsynaptic complex NRXN1-CBLN1-GluD1 in a hypothalamic VMHvl-arcuate feedback circuit regulates aggression. bioRxiv 2023:2023.02.28.530462. [PMID: 36909588 PMCID: PMC10002692 DOI: 10.1101/2023.02.28.530462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
The circuit origins of aggression in autism spectrum disorder remain undefined. Here we report Tac1-expressing glutamatergic neurons in ventrolateral division of ventromedial hypothalamus (VMHvl) drive intermale aggression. Aggression is increased due to increases of Ube3a gene dosage in the VMHvl neurons when modeling autism due to maternal 15q11-13 triplication. Targeted deletion of increased Ube3a copies in VMHvl reverses the elevated aggression adult mice. VMHvl neurons form excitatory synapses onto hypothalamic arcuate nucleus AgRP/NPY neurons through a NRXN1-CBLN1-GluD1 transsynaptic complex and UBE3A impairs this synapse by decreasing Cbln1 gene expression. Exciting AgRP/NPY arcuate neurons leads to feedback inhibition of VMHvl neurons and inhibits aggression. Asymptomatic increases of UBE3A synergize with a heterozygous deficiency of presynaptic Nrxn1 or postsynaptic Grid1 (both ASD genes) to increase aggression. Targeted deletions of Grid1 in arcuate AgRP neurons impairs the VMHvl to AgRP/NPY neuron excitatory synapses while increasing aggression. Chemogenetic/optogenetic activation of arcuate AgRP/NPY neurons inhibits VMHvl neurons and represses aggression. These data reveal that multiple autism genes converge to regulate the VMHvl-arcuate AgRP/NPY glutamatergic synapse. The hypothalamic circuitry implicated by these data suggest impaired excitation of AgRP/NPY feedback inhibitory neurons may explain the increased aggression behavior found in genetic forms of autism.
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Affiliation(s)
- Yi Nong
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Regeneron 777 Old Saw Mill River Road Tarrytown, NY 10591, USA
| | - David C. Stoppel
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Program in Neuroscience, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Mark A. Johnson
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Morgane Boillot
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Jelena Todorovic
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Jason Shen
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Xinyu Zhou
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Monica J.S. Nadler
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Carrie Rodriguez
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Yuda Huo
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Regeneron 777 Old Saw Mill River Road Tarrytown, NY 10591, USA
| | - Ikue Nagakura
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Ekkehard M. Kasper
- Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Matthew P. Anderson
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
- Boston Children’s Hospital Intellectual and Developmental Disabilities Research Center, 300 Longwood Avenue, Boston, MA 02115, USA
- Program in Neuroscience, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
- Regeneron 777 Old Saw Mill River Road Tarrytown, NY 10591, USA
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Christ SM, Farhadi DS, Junzhao S, Mahadevan A, Thormann M, Lam FC, Yu X, Kasper EM. Efficacy and Safety of Primary Stereotactic Radiosurgery in Patients With Intraventricular Meningiomas. Adv Radiat Oncol 2023; 8:101098. [PMID: 36407683 PMCID: PMC9666502 DOI: 10.1016/j.adro.2022.101098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Primary stereotactic radiosurgery for intraventricular meningiomas remains controversial owing to the potential for life-threatening peritumoral edema and lack of long-term follow-up data. We review the literature and present the largest series to assess efficacy and safety of primary stereotactic radiosurgery. Methods and Materials A systematic review of the literature for primary stereotactic radiosurgery for intraventricular meningiomas was conducted. The retrospective series presented here comprised 33 patients who received primary stereotactic radiosurgery between 1999 and 2015 for a radiologically detected intraventricular meningioma. Demographic, diagnostic, and therapeutic data were extracted from medical records, imaging, and treatment-planning systems. Both standalone and pooled analysis were performed. Results The mean patient age was 53 years, and 24 patients (73%) were female. The median Karnofsky performance status pretreatment was 80 (range, 60-100). The majority of lesions were located in the lateral ventricles (n = 32; 97%). The mean tumor volume was 8.7 cm3 (range, 0.6-44.55 cm3). The mean delivered dose was 1390.9 cGy. Complete imaging follow-up data were available for 21 patients (64%). Of those, 14 (67%) showed partial or marginal response, 7 (33%) had stable disease, and no patient progressed per Response Assessment in Neuro-Oncology criteria. On last follow-up, 32 patients (97%) had significant improvement in performance status and a decrease in pretreatment symptoms. No high-grade Common Terminology Criteria for Adverse Events (version 5.0) toxicity was observed with the dose range employed. Conclusions Primary stereotactic radiosurgery for intraventricular meningiomas shows excellent treatment efficacy and low toxicity in patients with a long follow-up period. The best therapeutic algorithm remains to be established leveraging further clinical investigation.
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Agolia JP, Kasper EM. Wrong-Level Spine Surgery: Introduction of a Protocol for Avoidance of This Complication. Acta Neurochir Suppl 2023; 130:179-184. [PMID: 37548737 DOI: 10.1007/978-3-030-12887-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Wrong-level spine surgery, in which an operation is performed at a vertebral level different from the intended one, is a rare but serious complication with wide-ranging medical and legal effects. Although many protocols have been developed to prevent such a serious unfavorable event, the problem has not yet been eliminated. Research into the effectiveness of strategies to prevent wrong-level spine surgery is lacking. Herein, we describe a case of 44-year-old woman presented with neck pain and bilateral upper extremity weakness and numbness. Magnetic resonance imaging showed C5/6 and C6/7 disc herniations with spinal cord compression. The patient underwent anterior cervical discectomy and fusion; however, at the conclusion of the surgery, intraoperative radiographs showed that it was accomplished at C4/5 and C5/6-one level above the intended level. On the basis of this case and similar ones, a new protocol was developed that included implementation of a Spine Level Safety Checklist to document the reference point, the landmark, and the level of exposure that is marked on the intraoperative radiograph. Since implementation of this protocol, the incidence of wrong-level spine surgery at the senior author's institution has decreased from 4/7000 to 0/11,200. Adoption of this protocol by other centers is thus recommended to reduce the incidence of such complication.
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Affiliation(s)
| | - Ekkehard M Kasper
- DeGroote School of Medicine, McMaster University, Faculty of Health Sciences, Hamilton General Hospital, Hamilton, ON, Canada.
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Al Fauzi A, Apriawan T, Ranuh IGMAR, Christi AY, Bajamal AH, Turchan A, Agus Subagio E, Suroto NS, Santoso B, Dachlan EG, Utomo B, Kasper EM. Traumatic brain injury in pregnancy: A systematic review of epidemiology, management, and outcome. J Clin Neurosci 2023; 107:106-117. [PMID: 36527810 DOI: 10.1016/j.jocn.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) during pregnancy is an extremely rare condition in our neurosurgical emergency practices. Studies on the epidemiology and management of TBI in pregnancy are limited to case reports or serial case reports. There is no specific guidelines of management of TBI in pregnancy yet. METHODS The authors performed a structured search of all published articles on TBI in pregnancy from 1990 to 2020. We restricted search for papers in English and Bahasa. RESULTS The literature search yielded 22 articles with total 43 patients. We distinguished C-section based on its timing according to the neurosurgical treatment into primary (simultaneous or prior to neurosurgery) and secondary group (delayed C-section). The mean GOS value in primary C-section is better compared to secondary C-section in severe TBI group (3.57 ± 1.47 vs 3.0 ± 1.27, respectively) consistently in the moderate TBI group (4.33 ± 1.11 vs 3.62 ± 1.47, respectively). The fetal death rate in primary C-section is lower compared to secondary C-section in severe TBI group (14.2 % vs 33.3 %, respectively), contrary, in moderate TBI group (16.7 % vs 12.5 %, respectively). CONCLUSIONS Care of pregnant patients with TBI often requires multidisciplinary approach to optimize treatment strategy on a case-by-case basis in light of prior experience across different center. We propose management guideline for head injury in pregnancy.
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Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Tedy Apriawan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - I G M Aswin R Ranuh
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ayu Yoniko Christi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eko Agus Subagio
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nur Setiawan Suroto
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Santoso
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Utomo
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ekkehard M Kasper
- Department of Neurosurgery, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
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Riggs J, Ahn H, Longmoore H, Jardim P, Kim MJ, Kasper EM, Han J, Lam FC. Addressing disparities in delivery of cancer care for patients with melanoma brain metastases-Not just a simple case of rurality. Neurooncol Adv 2023; 5:vdad113. [PMID: 37860268 PMCID: PMC10584078 DOI: 10.1093/noajnl/vdad113] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Affiliation(s)
- Joseph Riggs
- Rural Health Scholarly Concentration, Indiana University School of Medicine, Terre Haute, Indiana, USA
| | - Hyejeong Ahn
- Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hailee Longmoore
- Faculty of Science, Clemson University, Clemson, South Carolina, USA
| | - Pedro Jardim
- Faculty of Science, Providence College, Providence, Rhode Island, USA
| | - Min J Kim
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ekkehard M Kasper
- Department of Neurosurgery, Saint Elizabeth’s Medical Center, Brighton, Massachusetts, USA
- Faculty of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jiali Han
- Department of Epidemiology, Richard M Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Fred C Lam
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Neurosurgery, Saint Elizabeth’s Medical Center, Brighton, Massachusetts, USA
- Faculty of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
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Kasper BS, Thomas C, Albers A, Kasper EM, Sandhoff K. From amaurotic idiocy to biochemically defined lipid storage diseases: the first identification of GM1-Gangliosidosis. Free Neuropathol 2023; 4:4-12. [PMID: 37577107 PMCID: PMC10413987 DOI: 10.17879/freeneuropathology-2023-4845] [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] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/15/2023] [Indexed: 08/15/2023]
Abstract
On February 23rd 1936, a boy-child ("Kn") died in an asylum near Munich after years of severe congenital disease, which had profoundly impaired his development leading to inability to walk, talk and see as well as to severe epilepsy. While a diagnosis of "Little's disease" was made during life, his postmortem brain investigation at Munich neuropathology ("Deutsche Forschungsanstalt für Psychiatrie") revealed the diagnosis of "amaurotic idiocy" (AI). AI, as exemplified by Tay-Sachs-Disease (TSD), back then was not yet understood as a specific inborn error of metabolism encompassing several disease entities. Many neuropathological studies were performed on AI, but the underlying processes could only be revealed by new scientific techniques such as biochemical analysis of nervous tissue, deciphering AI as nervous system lipid storage diseases, e.g. GM2-gangliosidosis. In 1963, Sandhoff & Jatzkewitz published an article on a "biochemically special form of AI" reporting striking differences when comparing their biochemical observations of hallmark features of TSD to tissue composition in a single case: the boy Kn. This was the first description of "GM1-Gangliosidosis", later understood as resulting from genetically determined deficiency in beta-galactosidase. Here we present illustrative materials from this historic patient, including selected diagnostic slides from the case "Kn" in virtual microscopy, original records and other illustrative material available. Finally, we present results from genetic analysis performed on archived tissue proving beta-galactosidase-gene mutation, verifying the 1963 interpretation as correct. This synopsis shall give a first-hand impression of this milestone finding in neuropathology. Original paper: On a biochemically special form of infantile amaurotic idiocy. Jatzkewitz H., Sandhoff K., Biochim. Biophys. Acta 1963; 70; 354-356. See supplement 1.
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Affiliation(s)
- Burkhard S Kasper
- Friedrich-Alexander-Universität Erlangen-Nuremberg, University Hospital, Dept. Neurology; Erlangen, Germany
| | - Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Anne Albers
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Ekkehard M Kasper
- Division of Neurosurgery, Hamilton Health Sciences, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Konrad Sandhoff
- LIMES Institute, Membrane Biology & Biochemistry Unit, Bonn University, Bonn, Germany
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10
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Lam FC, Tsedev U, Kasper EM, Belcher AM. Forging the Frontiers of Image-Guided Neurosurgery—The Emerging Uses of Theranostics in Neurosurgical Oncology. Front Bioeng Biotechnol 2022; 10:857093. [PMID: 35903794 PMCID: PMC9315239 DOI: 10.3389/fbioe.2022.857093] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fred C. Lam
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- Division of Neurosurgery, Saint Elizabeth’s Medical Center, Brighton, MA, United States
- *Correspondence: Fred C. Lam,
| | - Uyanga Tsedev
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ekkehard M. Kasper
- Division of Neurosurgery, Saint Elizabeth’s Medical Center, Brighton, MA, United States
| | - Angela M. Belcher
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
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11
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Faiz K, Lam FC, Chen J, Kasper EM, Salehi F. The Emerging Applications of Nanotechnology in Neuroimaging: A Comprehensive Review. Front Bioeng Biotechnol 2022; 10:855195. [PMID: 35875504 PMCID: PMC9297121 DOI: 10.3389/fbioe.2022.855195] [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] [Received: 01/14/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022] Open
Abstract
Neuroimaging modalities such as computer tomography and magnetic resonance imaging have greatly improved in their ability to achieve higher spatial resolution of neurovascular and soft tissue neuroanatomy, allowing for increased accuracy in the diagnosis of neurological conditions. However, the use of conventional contrast agents that have short tissue retention time and associated renal toxicities, or expensive radioisotope tracers that are not widely available, continue to limit the sensitivity of these imaging modalities. Nanoparticles can potentially address these shortcomings by enhancing tissue retention and improving signal intensity in the brain and neural axis. In this review, we discuss the use of different types of nanotechnology to improve the detection, diagnosis, and treatment of a wide range of neurological diseases.
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Affiliation(s)
- Khunza Faiz
- Department of Radiology, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Fred C. Lam
- Koch Institute for Integrative Cancer Research at MIT, Cambridge, MA, United States
- Division of Neurosurgery, Saint Elizabeth Medical Center, Brighton, MA, United States
- *Correspondence: Fred C. Lam, ; Ekkehard M. Kasper, ; Fateme Salehi,
| | - Jay Chen
- Department of Radiology, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Ekkehard M. Kasper
- Division of Neurosurgery, Saint Elizabeth Medical Center, Brighton, MA, United States
- *Correspondence: Fred C. Lam, ; Ekkehard M. Kasper, ; Fateme Salehi,
| | - Fateme Salehi
- Department of Radiology, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
- *Correspondence: Fred C. Lam, ; Ekkehard M. Kasper, ; Fateme Salehi,
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12
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Lam FC, Salehi F, Kasper EM. Integrating Nanotechnology in Neurosurgery, Neuroradiology, and Neuro-Oncology Practice-The Clinicians' Perspective. Front Bioeng Biotechnol 2022; 10:801822. [PMID: 35223783 PMCID: PMC8864069 DOI: 10.3389/fbioe.2022.801822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Affiliation(s)
- Fred C Lam
- Division of Neurosurgery, Hamilton Health Sciences, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Fateme Salehi
- Department of Radiology, Hamilton Health Sciences, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Ekkehard M Kasper
- Division of Neurosurgery, Hamilton Health Sciences, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
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13
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Uhlmann EJ, Rabinovsky R, Varma H, El Fatimy R, Kasper EM, Moore JM, Vega RA, Thomas AJ, Alterman RL, Stippler M, Anderson MP, Uhlmann EN, Kipper FC, Krichevsky AM. Tumor-Derived Cell Culture Model for the Investigation of Meningioma Biology. J Neuropathol Exp Neurol 2021; 80:1117-1124. [PMID: 34850056 PMCID: PMC8716066 DOI: 10.1093/jnen/nlab111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Meningioma is the most common primary central nervous system tumor. Although mostly nonmalignant, meningioma can cause serious complications by mass effect and vasogenic edema. While surgery and radiation improve outcomes, not all cases can be treated due to eloquent location. Presently no medical treatment is available to slow meningioma growth owing to incomplete understanding of the underlying pathology, which in turn is due to the lack of high-fidelity tissue culture and animal models. We propose a simple and rapid method for the establishment of meningioma tumor-derived primary cultures. These cells can be maintained in culture for a limited time in serum-free media as spheres and form adherent cultures in the presence of 4% fetal calf serum. Many of the tissue samples show expression of the lineage marker PDG2S, which is typically retained in matched cultured cells, suggesting the presence of cells of arachnoid origin. Furthermore, nonarachnoid cells including vascular endothelial cells are also present in the cultures in addition to arachnoid cells, potentially providing a more accurate tumor cell microenvironment, and thus making the model more relevant for meningioma research and high-throughput drug screening.
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Affiliation(s)
- Erik J Uhlmann
- From the Department of Neurology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rosalia Rabinovsky
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hemant Varma
- Department of Pathology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rachid El Fatimy
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ekkehard M Kasper
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Justin M Moore
- Department of Neurosurgery, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rafael A Vega
- Department of Neurosurgery, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald L Alterman
- Department of Neurosurgery, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Martina Stippler
- Department of Neurosurgery, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew P Anderson
- Department of Pathology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Erik N Uhlmann
- Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada.,Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Franciela C Kipper
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Krichevsky
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Yu X, Christ SM, Liu R, Wang Y, Hu C, Feng B, Mahadevan A, Kasper EM. Evaluation of Long-Term Outcomes and Toxicity After Stereotactic Phosphorus-32-Based Intracavitary Brachytherapy in Patients With Cystic Craniopharyngioma. Int J Radiat Oncol Biol Phys 2021; 111:773-784. [PMID: 34058257 DOI: 10.1016/j.ijrobp.2021.05.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/03/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Interstitial brachytherapy based on phosphorus-32 (P-32) has an established role as a minimally invasive treatment modality for patients with cystic craniopharyngioma. However, reporting on long-term outcomes with toxicity profiles for large cohorts is lacking in the literature. The purpose of this study is therefore to evaluate the long-term visual, endocrinal, and neurocognitive functions in what is the largest patient series having received this treatment to date. METHODS AND MATERIALS We retrospectively evaluated 90 patients with cystic craniopharyngiomas who were treated with stereotactic intracavitary brachytherapy between 1998 and 2010. Colloidal activity of injected radioisotope P-32 was based on an even distribution within the tumor. After treatment, patients were followed-up for a minimum of 5 years and over a mean of 121 months (60-192 months) to assess radiographic and clinical responses. RESULTS The 90 patients included in our study cohort underwent a total of 108 stereotactic surgical procedures for 129 craniopharyngioma-related cysts. Of the included tumors, 65 (72.2%) were associated with a single cyst, 15 (16.7%) were associated with 2 cysts, and 10 (11.1%) tumors had developed septations with 3 to 4 cysts. Stereotactic cyst puncture and content aspiration were used to drain a mean cyst fluid volume of 21.4 mL (1.0-55.0 mL). Each cyst was then instilled for interstitial brachytherapy with colloidal P-32 solution. Based on radiographic follow-up assessments, 56 cysts (43.4%) showed resolution and/or nonrecurrence, which was classified as a complete response to treatment; 47 cysts (36.4%) showed a partial response; and 5 cysts (3.9%) displayed a stable appearance. Treatment resulted in immediate and clinically significant vision improvement in 54 of 63 (86%) symptomatic patients, and this improvement was maintained. Progression-free survival rates at 5 and 10 years were 95.5% and 84.4%, respectively. CONCLUSIONS P-32-based interstitial brachytherapy can play an effective role in managing patients with cystic craniopharyngiomas. It can be considered a valid alternative to surgery in select patients with a favorable toxicity profile and long-term clinical outcomes.
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Affiliation(s)
- Xin Yu
- Department of Neurosurgery, People's Liberation Army General Hospital, Beijing, China
| | - Sebastian M Christ
- Department of Radiation Oncology with Competence Center for Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Rui Liu
- Department of Neurosurgery, People's Liberation Army General Hospital, Beijing, China
| | - Yaming Wang
- Department of Neurosurgery, People's Liberation Army General Hospital, Beijing, China
| | - Chenhao Hu
- Department of Neurosurgery, People's Liberation Army General Hospital, Beijing, China
| | - Bo Feng
- Department of Biostatistics, PLA General Hospital, Beijing, China
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Health Care, Danville, Pennsylvania
| | - Ekkehard M Kasper
- Department of Radiation Oncology, Geisinger Health Care, Danville, Pennsylvania; Division of Neurosurgery, McMaster University and Hamilton General Hospital, Hamilton, Ontario, Canada.
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15
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Ellenbogen Y, Power RG, Martyniuk A, Engels PT, Sharma SV, Kasper EM. Pharmacoprophylaxis for Venous Thromboembolism in Spinal Surgery: A Systematic Review and Meta-analysis. World Neurosurg 2021; 150:e144-e154. [PMID: 33684581 DOI: 10.1016/j.wneu.2021.02.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Venous thromboembolism (VTE) is a significant contributor to postoperative morbidity and mortality. Prophylactic regimens for VTE involve mechanical prophylaxis and pharmacoprophylaxis. This systematic review and meta-analysis aimed to determine the efficacy and safety of pharmacoprophylaxis in comparison with any nonpharmacoprophylaxis regimen for the prevention of postoperative VTE in patients undergoing spinal surgery. METHODS MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and ICRCTN were searched for comparative studies including both pharmacoprophylaxis and nonpharmacoprophylaxis post spinal surgery. The primary outcome was the incidence of VTE within the postoperative hospitalized period. Secondary outcomes included the incidence of spinal epidural hematoma, significant bleeding events, and other adverse events associated with VTE. The data was pooled using random-effects models of meta-analysis and relative risk (RR) was calculated. RESULTS Four retrospective and 3 randomized controlled trials representing a total of 8373 patients were included. Overall, there was a significant decrease in postoperative deep venous thrombosis with pharmacoprophylaxis versus nonpharmacoprophylaxis (RR 0.42, 95% confidence interval 0.21-0.86, P = 0.02, I2 = 0%); however, there were no significant differences between the groups in the incidences of VTE (RR 0.31, 95% confidence interval 0.12-0.81, P = 0.02, I2 = 0%). The incidences of spinal epidural hematoma and significant bleeding events were rare and comparable in both groups. CONCLUSIONS This systematic review and meta-analysis found a potential benefit with pharmacoprophylaxis post spinal surgery in the prevention of deep venous thrombosis. However, there is a need for future randomized controlled trials to investigate the efficacy and safety of pharmacoprophylaxis in spinal surgery across various spinal procedures.
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Affiliation(s)
- Yosef Ellenbogen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert G Power
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Martyniuk
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul T Engels
- Department of Critical Care, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sunjay V Sharma
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Ekkehard M Kasper
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
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16
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Kasper EM, Çaksen H. Closing the Gap between Pediatric and Adult Care: Establishing Proper Transition Care. Journal of Pediatric Neurology 2020. [DOI: 10.1055/s-0040-1715502] [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: 10/23/2022]
Affiliation(s)
- Ekkehard M. Kasper
- Division of Neurosurgery, Faculty of Health Sciences at McMaster University, Hamilton, Ontario, Canada
| | - Hüseyin Çaksen
- Division of Pediatric Neurology and Genetics, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
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17
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Lam FCL, Kasper EM, Mahadevan A. Management and Surveillance of Short- and Long-Term Sequelae of Radiation Therapy for the Treatment of Pediatric Brain Tumors. Journal of Pediatric Neurology 2020. [DOI: 10.1055/s-0040-1715501] [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: 10/23/2022]
Abstract
AbstractRadiation therapy (RT) is a mainstay for the treatment of pediatric brain tumors. As improvements in and sophistication of this modality continue to increase the survival of patients, the long-term sequelae of RT pose significant challenges in the clinical management of this patient population as they transition into adulthood. In this special edition, we review the short- and long-term effects of RT for the treatment of pediatric brain tumors and the necessary surveillance required for follow-up.
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Affiliation(s)
- Fred Chiu-Lai Lam
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Ekkehard M Kasper
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Anand Mahadevan
- Division of Radiation Oncology, Geisinger Health, Danville, Pennsylvania, United States
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18
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Graf W, Kasper BS, Sharma S, Kasper EM. Lost in Transition: The Long and Winding Road Toward Epilepsy Surgery—An Analysis of Obstacles Prior to Surgery and Call for Orchestrated Health Care Efforts in Epilepsy. Journal of Pediatric Neurology 2020. [DOI: 10.1055/s-0040-1715503] [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: 10/23/2022]
Abstract
AbstractDifficult-to-treat epilepsy is defined as ongoing seizures despite adequate pharmacological treatment. This condition is affecting a significant percentage of epilepsy patients and is estimated to be as high as one-third of all patients. Epilepsy surgery, targeting the removal of the key parts of cerebral convolutions responsible for seizure generation and often including a structural lesion, can be a very successful approach. However, this necessitates careful patient selection by comprehensive investigations, proving the localization of the epileptogenic zone as well as measures to make such surgeries safe. With careful selection as a prerequisite, the percentage of patients achieving seizure freedom by neurosurgical intervention is high, approximating two-thirds of all epilepsy surgeries performed. In contrast, the average duration of a patient's pharmacoresistant focal epilepsy prior to surgery anywhere around the globe is around 20 years. Given that typical patients are ∼30 to 40 years of age at the time of surgery, many patients have been living with chronic seizures since childhood or adolescence. This means that most of these patients have been going through several stages of medical care for years or even decades, both as children and adults, without ever being fully investigated and/or selected for surgery which is concerning. Yet, there is no set standard for a timeline leading toward successful surgery in epilepsy. It is obvious that the average transit period from the moment of first seizure manifestation until the day of successful surgery takes much too long. This is the reason why we see these patients lost in transition.
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Affiliation(s)
- Wolfgang Graf
- Department of Neurology, Epilepsy Center, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Burkhard S. Kasper
- Department of Neurology, Epilepsy Center, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sunjay Sharma
- Division of Neurosurgery, McMaster University, Hamilton, Canada
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Krause M, Merkenschlager A, Mahr CV, Bernhard MK, Kasper EM, Weißer M, Wachowiak R. Long-Term Surveillance and Life-Time Care for Pediatric Patients Suffering from Hydrocephalus. Journal of Pediatric Neurology 2020. [DOI: 10.1055/s-0040-1715497] [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: 10/23/2022]
Abstract
AbstractEven though shunt surgery has been an established and widely accepted treatment for congenital hydrocephalus for five decades, long-term follow-up and functional outcome data are scarce. Based on our experience, we advocate a very rigid follow-up regimen throughout life for every hydrocephalus patient encountered with individual screening intervals not longer than 1 year in childhood and adolescence and surveillance intervals of 2 years in adulthood. A continuous treatment of the patients at the primary institution that performed hydrocephalus surgery provides an optimal setting to be prepared for the detection of adverse events of shunt malfunctioning. However, some patients may still encounter catastrophic events resulting in persistent deficits or death.
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Affiliation(s)
- Matthias Krause
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | | | | | | | - Ekkehard M. Kasper
- Division of Neurosurgery, Hamilton General Hospital, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Margit Weißer
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Robin Wachowiak
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
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20
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Jinadasa SP, Ruan QZ, Bayoumi AB, Sharma SV, Boone MD, Malik R, Chen CC, Kasper EM. Hemorrhagic Complications of Invasive Intracranial Pressure Monitor Placement in Acute Liver Failure: Outcomes of a Single-Center Protocol and Comprehensive Literature Review. Neurocrit Care 2020; 35:87-102. [PMID: 33205356 DOI: 10.1007/s12028-020-01143-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/27/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Elevated intracranial pressure due to cerebral edema is associated with very poor survival in patients with acute liver failure (ALF). Placing an intracranial pressure monitor (ICPm) aids in management of intracranial hypertension, but is associated with potentially fatal hemorrhagic complications related to the severe coagulopathy associated with ALF. METHODS An institutional Acute Liver Failure Clinical Protocol (ALF-CP) was created to correct ALF coagulopathy prior to placing parenchymal ICP monitoring bolts. We aimed to investigate the frequency, severity, and clinical significance of hemorrhagic complications associated with ICPm bolt placement in the setting of an ALF-CP. All assessed patients were managed with the ALF-CP and had rigorous radiologic follow-up allowing assessment of the occurrence and chronology of hemorrhagic complications. We also aimed to compare our outcomes to other studies that were identified through a comprehensive review of the literature. RESULTS Fourteen ALF patients were included in our analysis. There was no symptomatic hemorrhage after ICP monitor placement though four patients were found to have minor intraparenchymal asymptomatic hemorrhages after liver transplant when the ICP monitor had been removed, making the rate of radiographically identified clinically asymptomatic hemorrhage 28.6%. These results compare favorably to those found in a comprehensive review of the literature which revealed rates as high as 17.5% for symptomatic hemorrhages and 30.4% for asymptomatic hemorrhage. CONCLUSION This study suggests that an intraparenchymal ICPm can be placed safely in tertiary referral centers which utilize a protocol such as the ALF-CP that aggressively corrects coagulopathy. The ALF-CP led to advantageous outcomes for ICPm placement with a 0% rate of symptomatic and low rate of asymptomatic hemorrhagic complications, which compares well to results reported in other series. A strict ICPm placement protocol in this setting facilitates management of ALF patients with cerebral edema during the wait time to transplantation or spontaneous recovery.
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Affiliation(s)
- Sayuri P Jinadasa
- Department of General Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Qing Zhao Ruan
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ahmed B Bayoumi
- Division of Neurosurgery, McMaster University/Hamilton Health Sciences, 237, Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - Sunjay V Sharma
- Division of Neurosurgery, McMaster University/Hamilton Health Sciences, 237, Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - M Dustin Boone
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Raza Malik
- Department of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, McMaster University/Hamilton Health Sciences, 237, Barton Street East, Hamilton, ON, L8L 2X2, Canada.
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Lam FC, Kong YW, Huang Q, Vu Han TL, Maffa AD, Kasper EM, Yaffe MB. BRD4 prevents the accumulation of R-loops and protects against transcription-replication collision events and DNA damage. Nat Commun 2020; 11:4083. [PMID: 32796829 PMCID: PMC7428008 DOI: 10.1038/s41467-020-17503-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [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: 01/03/2018] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
Proper chromatin function and maintenance of genomic stability depends on spatiotemporal coordination between the transcription and replication machinery. Loss of this coordination can lead to DNA damage from increased transcription-replication collision events. We report that deregulated transcription following BRD4 loss in cancer cells leads to the accumulation of RNA:DNA hybrids (R-loops) and collisions with the replication machinery causing replication stress and DNA damage. Whole genome BRD4 and γH2AX ChIP-Seq with R-loop IP qPCR reveals that BRD4 inhibition leads to accumulation of R-loops and DNA damage at a subset of known BDR4, JMJD6, and CHD4 co-regulated genes. Interference with BRD4 function causes transcriptional downregulation of the DNA damage response protein TopBP1, resulting in failure to activate the ATR-Chk1 pathway despite increased replication stress, leading to apoptotic cell death in S-phase and mitotic catastrophe. These findings demonstrate that inhibition of BRD4 induces transcription-replication conflicts, DNA damage, and cell death in oncogenic cells.
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Affiliation(s)
- Fred C Lam
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA, 02139, USA.
- Center for Precision Cancer Medicine, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA, 02139, USA.
- Faculty of Health Sciences, Division of Neurosurgery, Hamilton General Hospital, McMaster University, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada.
| | - Yi Wen Kong
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA, 02139, USA
- Center for Precision Cancer Medicine, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA, 02139, USA
| | - Qiuying Huang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA, 02139, USA
| | - Tu-Lan Vu Han
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA, 02139, USA
| | - Amanda D Maffa
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA, 02139, USA
| | - Ekkehard M Kasper
- Faculty of Health Sciences, Division of Neurosurgery, Hamilton General Hospital, McMaster University, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | - Michael B Yaffe
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA, 02139, USA.
- Center for Precision Cancer Medicine, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA, 02139, USA.
- Departments of Biology and Bioengineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
- Beth Israel Deaconess Medical Center, Department of Surgery, Harvard Medical School, Boston, MA, 02215, USA.
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Kasper EM, Mathiesen TI, Demetriades A. Clinical Chiari syndrome or anatomical Chiari malformation? A conundrum revisited. Acta Neurochir (Wien) 2020; 162:1527-1528. [PMID: 31863299 DOI: 10.1007/s00701-019-04175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
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Kasper EM, Mathiesen TI, Demetriades AK. Correction to: Clinical Chiari syndrome or anatomical Chiari malformation? A conundrum revisited. Acta Neurochir (Wien) 2020; 162:1529. [PMID: 32430636 DOI: 10.1007/s00701-020-04389-4] [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: 10/24/2022]
Abstract
An incorrect set of affiliations for two authors (Tiit Illimar Mathiesen and Andreas K. Demetriades).
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Affiliation(s)
- Ekkehard M Kasper
- Division of Neurosurgery, McMaster University Faculty of Health, Sciences and Hamilton Health Sciences Corporation, 237 Barton, Street East, Hamilton, ON, L8L 2X2, Canada.
| | - Tiit Illimar Mathiesen
- Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, 2300, Copenhagen, Denmark.,Department of Clinical Neuroscience, Karolinska Institutet, 171 76, Stockholm, Sweden
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Sastry R, Sufianov R, Laviv Y, Young BC, Rojas R, Bhadelia R, Boone MD, Kasper EM. Chiari I malformation and pregnancy: a comprehensive review of the literature to address common questions and to guide management. Acta Neurochir (Wien) 2020; 162:1565-1573. [PMID: 32306160 DOI: 10.1007/s00701-020-04308-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal management of Chiari I malformation during pregnancy remains uncertain. Labor contractions, which increase intracranial pressure, and neuraxial anesthesia both carry the theoretical risk of brainstem herniation given the altered CSF dynamics inherent to the condition. Mode of delivery and planned anesthesia, therefore, require forethought to avoid potentially life-threatening complications. Since the assumed potential risks are significant, we seek to systematically review published literature regarding Chiari I malformation in pregnancy and, therefore, to establish a best practice recommendation based on available evidence. METHODS The English-language literature was systematically reviewed from 1991 to 2018 according to PRISMA guidelines to assess all pregnancies reported in patients with Chiari I malformation. After analysis, a total of 34 patients and 35 deliveries were included in this investigation. Additionally, a single case from our institutional experience is presented for illustrative purposes but not included in the statistical analysis. RESULTS No instances of brain herniation during pregnancy in patients with Chiari I malformation were reported. Cesarean deliveries (51%) and vaginal deliveries (49%) under neuraxial blockade and general anesthesia were both reported as safe and suitable modes of delivery. Across all publications, only one patient experienced a worsening of neurologic symptoms, which was only later discovered to be the result of a previously undiagnosed Chiari I malformation. Several patients underwent decompressive suboccipital craniectomy to treat the Chiari I malformation during the preconception period (31%), during pregnancy (3%), and after birth (6%). Specific data regarding maternal management were not reported for a large number (21) of these patients (60%). Aside from one abortion in our own institutional experience, there was no report of any therapeutic abortion or of adverse fetal outcome. CONCLUSIONS Although devastating maternal complications are frequently feared, very few adverse outcomes have ever been reported in pregnant patients with a Chiari I malformation. The available evidence is, however, rather limited. Based on our survey of available data, we recommend vaginal delivery under neuraxial blockade for truly asymptomatic patients. Furthermore, based on our own experience and physiological conceptual considerations, we recommend limiting maternal Valsalva efforts either via Cesarean delivery under regional or general anesthesia or by choosing assisted vaginal delivery under neuraxial blockade. There is no compelling reason to offer suboccipital decompression for Chiari I malformation during pregnancy. For patients with significant neurologic symptoms prior to conception, decompression prior to pregnancy should be considered.
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Affiliation(s)
- Rahul Sastry
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Rinat Sufianov
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yosef Laviv
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Brett C Young
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rafael Rojas
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rafeeque Bhadelia
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Myles D Boone
- Department of Anesthesia, Pain and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ekkehard M Kasper
- Department of Surgery, Division of Neurosurgery, DeGroote Medical School, McMaster University, Hamilton, ON, Canada.
- Hamilton General Hospital, 237, Barton Street East, Hamilton, ON, L8L 2X2, Canada.
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Liu J, Rojas R, Lam FC, Mirza FA, Mahadevan A, Kasper EM. Indications, feasibility, safety, and efficacy of CyberKnife radiotherapy for the treatment of olfactory groove meningiomas: a single institutional retrospective series. Radiat Oncol 2020; 15:63. [PMID: 32164781 PMCID: PMC7069021 DOI: 10.1186/s13014-020-01506-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose To assess the safety and efficacy of CyberKnife® radiotherapy (CKRT) for the treatment of olfactory groove meningiomas (OGMs). Methods A retrospective review was performed of 13 patients with OGM treated with CKRT from September 2005 to May 2018 at our institution. Nine patients were treated primarily with CKRT, 3 for residual disease following resection, and 1 for disease recurrence. Results Five patients were treated with stereotactic radiosurgery (SRS), 6 with hypofractionated stereotactic radiotherapy (HSRT), and 2 with fractionated stereotactic radiotherapy (FSRT). The median tumor volume was 8.12 cm3. The median prescribed dose was 14.8 Gy for SRS, 27.3 Gy for HSRT, and 50.2 Gy for FSRT. The median maximal dose delivered was 32.27 Gy. Median post treatment follow-up was 48 months. Twelve of 13 patients yielded a 100% regional control rate with a median tumor volume reduction of 31.7%. Six of the 12 patients had reduced tumor volumes while the other 6 had no changes. The thirteenth patient had significant radiation-induced edema requiring surgical decompression. Twelve patients were alive and neurologically stable at the time of the review. One patient died from pneumonia unrelated to his CKRT treatment. Conclusions CKRT appears to be safe and effective for the treatment of OGMs.
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Affiliation(s)
- Jianmin Liu
- Department of Neurosurgery, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Rafael Rojas
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fred C Lam
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, McMaster University Faculty of Health Sciences, 237 Barton Street East, Hamilton, ON, L2L 8X8, Canada
| | - Farhan A Mirza
- Division of Neurosurgery, Kentucky Neuroscience Institute, University of Kentucky, Lexington, KT, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Medical Group, Danville, PA, USA
| | - Ekkehard M Kasper
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. .,Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, McMaster University Faculty of Health Sciences, 237 Barton Street East, Hamilton, ON, L2L 8X8, Canada.
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Motiei-Langroudi R, Alterman RL, Stippler M, Phan K, Alturki AY, Papavassiliou E, Kasper EM, Arle J, Ogilvy CS, Thomas AJ. Factors influencing the presence of hemiparesis in chronic subdural hematoma. J Neurosurg 2020; 131:1926-1930. [PMID: 30641839 DOI: 10.3171/2018.8.jns18579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 08/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) has a variety of clinical presentations, including hemiparesis. Hemiparesis is of the utmost importance because it is one of the major indications for surgical intervention and influences outcome. In the current study, the authors intended to identify factors influencing the presence of hemiparesis in CSDH patients and to determine the threshold value of hematoma thickness and midline shift for development of hemiparesis. METHODS The authors retrospectively reviewed 325 patients (266 with unilateral and 59 with bilateral hematomas) with CSDH who underwent surgical evacuation, regardless of presence or absence of hemiparesis. RESULTS In univariate analysis, hematoma loculation, age, hematoma maximal thickness, and midline shift were significantly associated with hemiparesis. Moreover, patients with unilateral hematomas had a higher rate of hemiparesis than patients with bilateral hematomas. Sex, trauma history, anticoagulant and antiplatelet drug use, presence of comorbidities, Glasgow Coma Scale score, hematoma density characteristics on CT scan, and hematoma signal intensity on T1- and T2-weighted MRI were not associated with hemiparesis. In multivariate analysis, the presence of loculation and hematoma laterality (unilateral vs bilateral) influenced hemiparesis. For unilateral hematomas, maximal hematoma thickness of 19.8 mm and midline shift of 6.4 mm were associated with a 50% probability of hemiparesis. For bilateral hematomas, 29.0 mm of maximal hematoma thickness and 6.8 mm of shift were associated with a 50% probability of hemiparesis. CONCLUSIONS Presence of loculations, unilateral hematomas, older patient age, hematoma maximal thickness, and midline shift were associated with a higher rate of hemiparesis in CSDH patients. Moreover, 19.8 mm of hematoma thickness and 6.4 mm of midline shift were associated with a 50% probability of hemiparesis in patients with unilateral hematomas.
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Affiliation(s)
- Rouzbeh Motiei-Langroudi
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,2Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ron L Alterman
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Martina Stippler
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kevin Phan
- 3University of Sydney Westmead Clinical School, Westmead, New South Wales, Australia
| | - Abdulrahman Y Alturki
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,4Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; and
| | - Efstathios Papavassiliou
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ekkehard M Kasper
- 5Division of Neurosurgery, Hamilton General Hospital, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jeffrey Arle
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Motiei-Langroudi R, Stippler M, Shi S, Adeeb N, Gupta R, Griessenauer CJ, Papavassiliou E, Kasper EM, Arle J, Alterman RL, Ogilvy CS, Thomas AJ. Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation. J Neurosurg 2019; 129:1143-1150. [PMID: 29243977 DOI: 10.3171/2017.6.jns17130] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/05/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEChronic subdural hematoma (CSDH) is commonly encountered in neurosurgical practice. However, surgical evacuation remains complicated by a high rate of reoperation. The optimal surgical approach to reduce the reoperation rate has not been determined. In the current study, the authors evaluated the prognostic value of clinical and radiographic factors to predict reoperation in the context of CSDH.METHODSA retrospective review of 325 CSDH patients admitted to an academic medical center in the United States, between 2006 and 2016, was performed. Clinical and radiographic factors predictive of the need for CSDH reoperation were identified on univariable and multivariable analyses.RESULTSUnivariable analysis showed that warfarin use, clopidogrel use, mixed hypo- and isointensity on T1-weighted MRI, greater preoperative midline shift, larger hematoma/fluid residual on first postoperative day CT, lesser decrease in hematoma size after surgery, use of monitored anesthesia care (MAC), and lack of intraoperative irrigation correlated with a significantly higher rate of reoperation. Multivariable analysis, however, showed that only the presence of loculation, clopidogrel or warfarin use, and percent of hematoma change after surgery significantly predicted the need for reoperation. Our results showed that 0% (no reduction), 50%, and 100% hematoma maximum thickness change (complete resolution of hematoma after surgery) were associated with a 41%, 6%, and < 1% rate of reoperation, respectively. The use of drains, either large diameter or small caliber, did not have any effect on the likelihood of reoperation.CONCLUSIONSAmong many factors, clopidogrel or warfarin use, hematoma loculation on preoperative CT, and the amount of hematoma evacuation on the first postoperative CT were the strongest predictors of reoperation.
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de Almeida CC, Boone MD, Laviv Y, Kasper BS, Chen CC, Kasper EM. The Utility of Routine Intensive Care Admission for Patients Undergoing Intracranial Neurosurgical Procedures: A Systematic Review. Neurocrit Care 2019; 28:35-42. [PMID: 28808901 DOI: 10.1007/s12028-017-0433-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients who have undergone intracranial neurosurgical procedures have traditionally been admitted to an intensive care unit (ICU) for close postoperative neurological observation. The purpose of this study was to systematically review the evidence for routine ICU admission in patients undergoing intracranial neurosurgical procedures and to evaluate the safety of alternative postoperative pathways. METHODS We were interested in identifying studies that examined selected patients who presented for elective, non-emergent intracranial surgery whose postoperative outcomes were compared as a function of ICU versus non-ICU admission. A systematic review was performed in July 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist of the Medline database. The search strategy was created based on the following key words: "craniotomy," "neurosurgical procedure," and "intensive care unit." RESULTS The nine articles that satisfied the inclusion criteria yielded a total of 2227 patients. Of these patients, 879 were observed in a non-ICU setting. The most frequent diagnoses were supratentorial brain tumors, followed by patients with cerebrovascular diseases and infratentorial brain tumors. Three percent (30/879) of the patients originally assigned to floor or intermediate care status were transferred to the ICU. The most frequently observed neurological complications leading to ICU transfer were delayed postoperative neurological recovery, seizures, worsening of neurological deficits, hemiparesis, and cranial nerves deficits. CONCLUSION Our systematic review demonstrates that routine postoperative ICU admission may not benefit carefully selected patients who have undergone elective intracranial neurosurgical procedures. In addition, limiting routine ICU admission may result in significant cost savings.
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Affiliation(s)
- Cesar Cimonari de Almeida
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Lowry Medical Building 3B, 02215, Boston, MA, USA
| | - M Dustin Boone
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Yosef Laviv
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Lowry Medical Building 3B, 02215, Boston, MA, USA
| | | | - Clark C Chen
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Ekkehard M Kasper
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Lowry Medical Building 3B, 02215, Boston, MA, USA
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Nigim F, Kiyokawa J, Gurtner A, Kawamura Y, Hua L, Kasper EM, Brastianos PK, Cahill DP, Rabkin SD, Martuza RL, Carbonell WS, Wakimoto H. A Monoclonal Antibody Against β1 Integrin Inhibits Proliferation and Increases Survival in an Orthotopic Model of High-Grade Meningioma. Target Oncol 2019; 14:479-489. [DOI: 10.1007/s11523-019-00654-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lu VM, Phan K, Rao PJ, Sharma SV, Kasper EM. Dabigatran reversal by idarucizumab in the setting of intracranial hemorrhage: A systematic review of the literature. Clin Neurol Neurosurg 2019; 181:76-81. [DOI: 10.1016/j.clineuro.2019.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 12/20/2022]
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Curiel D, Medin C, Kamali P, Ibrahim AM, Paul MA, Schermerhorn ML, Kasper EM, Lin SJ. Disparate Complication Rates by Race after Vestibular Schwannoma Excision. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.401] [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: 10/28/2022]
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Sullivan JC, Goldsmith J, Rojas R, Varma H, Kasper EM. Intracranial Dural Parafalcine Chondroma: Case Report and Systematic Review of the Literature. World Neurosurg 2018; 122:1-7. [PMID: 30273721 DOI: 10.1016/j.wneu.2018.09.169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/10/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
Intracranial chondromas are rare, benign neoplasms representing only 0.2%-0.3% of neoplastic intracranial lesions. They commonly originate from the skull base but can infrequently arise from the falx, convexity dura, or ventricular ependyma. Diagnosis requires histopathologic confirmation, as patients present with nonspecific symptoms related to mass effect, and imaging characteristics often resemble meningiomas, oligodendrogliomas, and vascular malformations. We describe the case of a patient harboring a parafalcine dural chondroma that was discovered incidentally and was managed surgically at our institution. We also provide a systematic review of the literature to elucidate incidence, origin, imaging findings, surgical management approaches, and prognosis of this rare tumor.
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Affiliation(s)
- Jensyn Cone Sullivan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Goldsmith
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rafael Rojas
- Division of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Hemant Varma
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ekkehard M Kasper
- Division of Neurosurgery, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
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Motiei-Langroudi R, Thomas AJ, Ascanio L, Alturki A, Papavassiliou E, Kasper EM, Arle J, Alterman RL, Ogilvy CS, Stippler M. Factors Predicting the Need for Surgery of the Opposite Side After Unilateral Evacuation of Bilateral Chronic Subdural Hematomas. Neurosurgery 2018; 85:648-655. [DOI: 10.1093/neuros/nyy432] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Patients with bilateral chronic subdural hematoma (bCSDH) undergo unilateral evacuation for the large or symptomatic side because the contralateral hematoma is either small or asymptomatic. However, the contralateral hematoma may subsequently grow and require evacuation.
OBJECTIVE
To characterize factors that predict contralateral hematoma growth and need for evacuation.
METHODS
A retrospective study on 128 surgically treated bCSDHs.
RESULTS
Fifty-one and 77 were bilaterally and unilaterally evacuated, respectively. Glasgow Coma Scale was lower and midline shift was higher in those evacuated unilaterally compared to those evacuated bilaterally. Hematoma size was a significant determinant of decision for unilateral vs bilateral evacuation. The contralateral side needed evacuation at a later stage in 7 cases (9.1%). There was no significant difference in terms of reoperation rate between those evacuated unilaterally and bilaterally. Greater contralateral hematoma thickness on the first postoperative day computed tomography (CT) and more postoperative midline shift reversal had higher rates of operation in the opposite side. There was no difference between the daily pace of hematoma decrease in the operated and nonoperated sides (0.7% decrease per day vs 0.9% for the operated and nonoperated sides, respectively).
CONCLUSION
Results of this study show that most bCSDHs evacuated unilaterally do not experience growth in the nonoperated side and unilateral evacuation results in hematoma resolution for both sides in most cases. Hematoma thickness on the opposite side on the first postoperative day CT and amount of midline shift reversal after surgery are the most important factors predicting the need for surgery on the opposite side.
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Affiliation(s)
- Rouzbeh Motiei-Langroudi
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Luis Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Abdulrahman Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Efstathios Papavassiliou
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ekkehard M Kasper
- Division of Neurosurgery, Hamilton General Hospital, McMaster University, Hamilton ON, Canada
| | - Jeffrey Arle
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ronnie L Alterman
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Martina Stippler
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Nigim F, Wakimoto H, Kasper EM, Ackermans L, Temel Y. Emerging Medical Treatments for Meningioma in the Molecular Era. Biomedicines 2018; 6:biomedicines6030086. [PMID: 30082628 PMCID: PMC6165537 DOI: 10.3390/biomedicines6030086] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 12/19/2022] Open
Abstract
Meningiomas are the most common type of primary central nervous system tumors. Approximately, 80% of meningiomas are classified by the World Health Organization (WHO) as grade I, and 20% of these tumors are grade II and III, considered high-grade meningiomas (HGMs). Clinical control of HGMs, as well as meningiomas that relapse after surgery, and radiation therapy is difficult, and novel therapeutic approaches are necessary. However, traditional chemotherapies, interferons, hormonal therapies, and other targeted therapies have so far failed to provide clinical benefit. During the last several years, next generation sequencing has dissected the genetic heterogeneity of meningioma and enriched our knowledge about distinct oncogenic pathways driving different subtypes of meningiomas, opening up a door to new personalized targeted therapies. Molecular classification of meningioma allows a new design of clinical trials that assign patients to corresponding targeted agents based on the tumor genetic subtypes. In this review, we will shed light on emerging medical treatments of meningiomas with a particular focus on the new targets identified with genomic sequencing that have led to clinical trials testing novel compounds. Moreover, we present recent development of patient-derived preclinical models that provide platforms for assessing targeted therapies as well as strategies with novel mechanism of action such as oncolytic viruses.
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Affiliation(s)
- Fares Nigim
- Brain Tumor Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Hiroaki Wakimoto
- Brain Tumor Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Ekkehard M Kasper
- Department of Neurosurgery, McMaster University, Hamilton, ON 8L8 2X2, Canada.
| | - Linda Ackermans
- Department of Neurosurgery and Neuroscience, Maastricht University Medical Center, 6229 HY Maastricht, The Netherlands.
| | - Yasin Temel
- Department of Neurosurgery and Neuroscience, Maastricht University Medical Center, 6229 HY Maastricht, The Netherlands.
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Laviv Y, Bayoumi A, Mahadevan A, Young B, Boone M, Kasper EM. Meningiomas in pregnancy: timing of surgery and clinical outcomes as observed in 104 cases and establishment of a best management strategy. Acta Neurochir (Wien) 2018; 160:1521-1529. [PMID: 28326464 DOI: 10.1007/s00701-017-3146-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/07/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a strong correlation between the level of circulating female sex hormones and the parturient growth of meningiomas. As a result, rapid changes in meningioma size occur during pregnancy, putting both the mother and fetus at risk. Large, symptomatic meningiomas require surgical resection, regardless of the status of pregnancy. However, the preferred timing of such complex intervention is a matter of debate. The rarity of this clinical scenario and the absence of prospective trials make it difficult to reach evidence-based conclusions. The aim of this study was to create evidence-based management guidelines for timing of surgery for pregnancy-related intracranial meningiomas. METHOD The English literature from 1990 to 2016 was systematically reviewed according to PRISMA guidelines for all surgical cases of pregnancy-related intracranial meningiomas. Cases were divided into two groups: patients who have had surgery during pregnancy and delivered thereafter (group A) and patients who delivered first (group B). Groups were compared for demographic, clinical and radiological features, as well as for neurosurgical, obstetrical and neonatological outcomes. Statistical analysis was performed to assess differences. RESULTS A total of 104 surgical cases were identified and reviewed, of which 86 were suitable for comparison and statistical analysis. Thirty-five patients (40%) underwent craniotomy for resection during pregnancy or at delivery (group A) and 51 patients (60%) underwent surgery after delivery (group B). Groups showed no significant differences in characteristics such as age at diagnosis, number of gestations, presenting symptoms, tumor site and tumor size. Despite a comparable distribution over the gestational trimesters, group A had significantly more patients diagnosed prior to the 27th gestational week (46 vs 17.5%, p = 0.0075). Group A was also associated with a significantly higher rate of both emergent craniotomies (40 vs 19.6%, p = 0.0048) and emergent Caesarian deliveries (47 vs 17.8%, p = 0.00481). The time from diagnosis to surgery was significantly longer in group B (11 weeks vs 1 week in group A, p = 0.0013). The rate of premature delivery was high but similar in both groups (∼70%). Risks of maternal mortality or fetal mortality were associated with group A (odds ratio = 14.7), but did not reach statistical significance. CONCLUSIONS While surgical resection of meningioma during pregnancy may be associated with increased maternal and fetal mortalities, the overall neurosurgical, obstetrical and neonatological outcomes, as well as many clinical characteristics, are similar to patients undergoing resection postpartum. We believe that fetal survival chances have a significant impact on decision-making, as patients diagnosed at a later stage in pregnancy (≥27th week of gestation) were more likely to undergo delivery first. This complicated clinical scenario requires the close cooperation of multiple disciplines. While the mother's health and well-being should always be paramount in guiding management, we hope that the overall good outcomes observed by this systematic review will encourage colleagues to aim for term pregnancies whenever possible in order to reduce prematurity-related problems.
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Affiliation(s)
- Yosef Laviv
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ahmed Bayoumi
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Anand Mahadevan
- Department of Radiation Oncology, Department of Radiology/Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Brett Young
- Department of Obstetrics and Fetal Maternal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Myles Boone
- Department of Anesthesia, Pain and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ekkehard M Kasper
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Abstract
The meningo-orbital band (MOB) is a dural fold which runs along the lateral border of the superior orbital fissure and contains few small dural veins and the orbitomeningeal artery. MOB detachment is relatively easy to understand step-wise procedure, provides a wider exposure, and better orientation thus facilitating relatively easy approach to paraclinoid and cavernous sinus region. The present microsurgical technique helps to preserve the true cavernous membrane and thereby providing almost bloodless dissection of the cavernous sinus. The same technique can be used to uncover the anterior clinoid process laterally, posteriorly, superiorly, and also in the inferolateral region thereby decreasing the risk and time of clinoidectomy.
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Affiliation(s)
- Iype Cherian
- Department of Neurosurgery, College of Medical sciences, Bharatpur, Chitwan, Nepal
| | - Ekkehard M Kasper
- Department of Neurosurgery, Harvard Medical School and Director of Neurosurgical Oncology at BIDMC, Boston/MA, USA
| | - Amit Agarwal
- Department of Neurosurgery, Narayana Medical College and Hospital, Chintareddypalem, Nellore, Andhra Pradesh, India
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Bezuidenhout AF, Khatami D, Heilman CB, Kasper EM, Patz S, Madan N, Zhao Y, Bhadelia RA. Relationship between Cough-Associated Changes in CSF Flow and Disease Severity in Chiari I Malformation: An Exploratory Study Using Real-Time MRI. AJNR Am J Neuroradiol 2018; 39:1267-1272. [PMID: 29748208 DOI: 10.3174/ajnr.a5670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/21/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Currently no quantitative objective test exists to determine disease severity in a patient with Chiari I malformation. Our aim was to correlate disease severity in symptomatic patients with Chiari I malformation with cough-associated changes in CSF flow as measured with real-time MR imaging. MATERIALS AND METHODS Thirteen symptomatic patients with Chiari I malformation (tonsillar herniation of ≥5 mm) were prospectively studied. A real-time, flow-sensitized pencil-beam MR imaging scan was used to measure CSF stroke volume during rest and immediately following coughing and relaxation periods (total scan time, 90 seconds). Multiple posterior fossa and craniocervical anatomic measurements were also obtained. Patients were classified into 2 groups by neurosurgeons blinded to MR imaging measurements: 1) nonspecific Chiari I malformation (5/13)-Chiari I malformation with nonspecific symptoms like non-cough-related or mild occasional cough-related headache, neck pain, dizziness, paresthesias, and/or trouble swallowing; 2) specific Chiari I malformation (8/13)-patients with Chiari I malformation with specific symptoms and/or objective findings like severe cough-related headache, myelopathy, syringomyelia, and muscle atrophy. The Spearman correlation was used to determine correlations between MR imaging measurements and disease severity, and both groups were also compared using a Mann-Whitney U test. RESULTS There was a significant negative correlation between the percentage change in CSF stroke volume (resting to postcoughing) and Chiari I malformation disease severity (R = 0.59; P = .03). Mann-Whitney comparisons showed the percentage change in CSF stroke volume (resting to postcoughing) to be significantly different between patient groups (P = .04). No other CSF flow measurement or anatomic measure was significantly different between the groups. CONCLUSIONS Our exploratory study suggests that assessment of CSF flow response to a coughing challenge has the potential to become a valuable objective noninvasive test for clinical assessment of disease severity in patients with Chiari I malformation.
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Affiliation(s)
| | - D Khatami
- From the Departments of Radiology (A.F.B., D.K., R.A.B.)
| | | | - E M Kasper
- Neurosurgery (E.M.K.), Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - S Patz
- Department of Radiology (S.P.), Brigham and Woman's Hospital, Boston, Massachusetts
| | - N Madan
- Radiology (N.M.), Tufts Medical Center, Boston, Massachusetts
| | - Y Zhao
- Philips Healthcare (Y.Z.), Boston, Massachusetts
| | - R A Bhadelia
- From the Departments of Radiology (A.F.B., D.K., R.A.B.)
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Salem MM, Alturki AY, Fusco MR, Thomas AJ, Carter BS, Chen CC, Kasper EM. Carotid artery stenting vs. carotid endarterectomy in the management of carotid artery stenosis: Lessons learned from randomized controlled trials. Surg Neurol Int 2018; 9:85. [PMID: 29740506 PMCID: PMC5926211 DOI: 10.4103/sni.sni_400_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/28/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Carotid artery stenosis, both symptomatic and asymptomatic, has been well studied with several multicenter randomized trials. The superiority of carotid endarterectomy (CEA) to medical therapy alone in both symptomatic and asymptomatic carotid artery stenosis has been well established in previous trials in the 1990s. The consequent era of endovascular carotid artery stenting (CAS) has offered another option for treating carotid artery stenosis. A series of randomized trials have now been conducted to compare CEA and CAS in the treatment of carotid artery disease. The large number of similar trials has created some confusion due to inconsistent results. Here, the authors review the trials that compare CEA and CAS in the management of carotid artery stenosis. Methods: The PubMed database was searched systematically for randomized controlled trials published in English that compared CEA and CAS. Only human studies on adult patients were assessed. The references of identified articles were reviewed for additional manuscripts to be included if inclusion criteria were met. The following terms were used during search: carotid stenosis, endarterectomy, stenting. Retrospective or single-center studies were excluded from the review. Results: Thirteen reports of seven large-scale prospective multicenter studies, comparing both interventions for symptomatic or asymptomatic extracranial carotid artery stenosis, were identified. Conclusions: While the superiority of intervention to medical management for symptomatic patients has been well established in the literatures, careful selection of asymptomatic patients for intervention should be undertaken and only be pursued after institution of appropriate medical therapy until further reports on trials comparing medical therapy to intervention in this patient group are available.
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Affiliation(s)
- Mohamed M Salem
- Division of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Abdulrahman Y Alturki
- Division of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, National Neuroscience Institute, Riyadh, Saudi Arabia
| | - Matthew R Fusco
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ajith J Thomas
- Division of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Bob S Carter
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Bezuidenhout AF, Kasper EM, Baledent O, Rojas R, Bhadelia RA. Relationship between pineal cyst size and aqueductal CSF flow measured by phase contrast MRI. J Neurosurg Sci 2018; 65:63-68. [PMID: 29480683 DOI: 10.23736/s0390-5616.18.04258-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most patients with pineal cysts referred for neurosurgical consultation have no specific symptoms or objective findings except for pineal cyst size to help in management decisions. Our purpose was to assess the relationship between pineal cyst size and aqueductal CSF flow using PC-MRI. METHODS Eleven adult patients with pineal cysts (>1 cm) referred for neurosurgical consultations were included. Cyst volume was calculated using 3D T1 images. Phase contrast magnetic resonance imaging (PC-MRI) in axial plane with velocity encoding of 5 cm/sec was used to quantitatively assess CSF flow through the cerebral aqueduct to determine the aqueductal stroke volume, which was then correlated to cyst size using Pearson's correlation. Pineal cysts were grouped by size into small (6/11) and large (5/11) using the median value to compare aqueductal stroke volume using Mann-Whitney test. RESULTS Patients were 39±13 years (mean±SD) of age, and 10/11 (91%) were female. There was significant negative correlation between cyst volume and aqueductal stroke volume (r=0.74; P=0.009). Volume of small cysts (4954±2157 mm3) was significantly different compared to large cysts (13,752±3738 mm3; P=0.008). The aqueductal stroke volume of patients harboring large cysts 33±8 μL/cardiac cycle was significantly lower than that of patients with small cysts 96±29 μL/cardiac cycle (P=0.008). CONCLUSIONS Aqueductal CSF flow appears to decrease with increasing pineal cyst size. Our preliminary results provide first evidence that even in the absence of objective neurological findings or hydrocephalus; larger pineal cysts already display decreased CSF flow through the cerebral aqueduct.
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Affiliation(s)
| | - Ekkehard M Kasper
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Olivier Baledent
- Department of Imaging and Biophysics, Amiens-Picardy Nord University Hospital, Amiens, France
| | - Rafael Rojas
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rafeeque A Bhadelia
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Bayoumi AB, Efe IE, Berk S, Kasper EM, Toktas ZO, Konya D. Posterior Rigid Instrumentation of C7: Surgical Considerations and Biomechanics at the Cervicothoracic Junction. A Review of the Literature. World Neurosurg 2017; 111:216-226. [PMID: 29253696 DOI: 10.1016/j.wneu.2017.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The cervicothoracic junction is a challenging anatomic transition in spine surgery. It is commonly affected by different types of diseases that may significantly impair stability in this region. The seventh cervical vertebra (C7) is an atypical cervical vertebra with unique anatomic features compared to subaxial cervical spine (C3 to C6). C7 has relatively broader laminae, larger pedicles, smaller lateral masses, and a long nonbifid spinous process. These features allow a variety of surgical methods for performing posterior rigid instrumentation in the form of different types of screws, such as lateral mass screws, pedicle screws, transfacet screws, and intralaminar screws. Many biomechanical studies on cadavers have evaluated and compared different types of implants at C7. METHODS We reviewed PubMed/Medline by using specific combinations of keywords to summarize previously published articles that examined C7 posterior rigid instrumentation thoroughly in an experimental fashion on patients or cadavers with additional descriptive radiologic parameters for evaluation of the optimum surgical technique for each type. RESULTS A total of 44 articles were reported, including 22 articles that discussed anatomic considerations (entry points, sagittal and axial trajectories, and features of screws) and another 22 articles that discussed the relevant biomechanical testing at this transitional region if C7 was directly involved in terms of receiving posterior rigid implants. CONCLUSIONS C7 can accommodate different types of screws, which can provide additional benefits and risks based on availability of bony purchase, awareness of surgical technique, biomechanics, and anatomic considerations.
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Affiliation(s)
- Ahmed B Bayoumi
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey.
| | - Ibrahim E Efe
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey; Department of Neurosurgery, Charite-University Medicine Berlin, Berlin, Germany
| | - Selim Berk
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Zafer Orkun Toktas
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Deniz Konya
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
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Sufianov AA, Kasper EM, Sufianov RA. An optimized technique of endoscopic third ventriculocisternostomy (ETV) for children with occlusive hydrocephalus. Neurosurg Rev 2017; 41:851-859. [PMID: 29230595 DOI: 10.1007/s10143-017-0934-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 09/27/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
In this article, we present an optimized minimally invasive technique of ETV for children with occlusive hydrocephalus. The study comprises of 64 consecutive pediatric cases (34 boys and 30 girls aged from 1 month to 5 years) of occlusive hydrocephalus from various etiologies, which were treated with a modified technique of ETV. Mean clinical follow-up period after ETV was 24.2 ± 3.8 months. Application of the new technique made it possible to significantly reduce the length of the soft tissue incision for access, and the use of upgraded instruments allowed to perform a twist drill hole in the skull to less than half a usual size. Access to the brain and lateral ventricle was performed by blunt trephination of the dura without the need for significant corticectomy or coagulation, and yielded minimal damage to the brain, which is very important in patients of young age. Continued endoscopic control during the approach down to the lateral ventricle increases safety and decreases risk of injury, and can be performed in cases of pathologies affecting the anatomical relationships of the lateral and third ventricle. Mortality in our cohort was 0%, and there were no postoperative neurological, endocrinological, or infectious complications. Patency rates of the first ETV performed was 78%, with the remaining patients requiring additional surgical procedures for complicated settings. This new technique of minimally invasive ETV placement in pediatric patients is an effective and safe method to treat occlusive hydrocephalus and can be recommended for extensive clinical use.
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Affiliation(s)
- Albert Akramovich Sufianov
- Federal State-Financed Institution "Federal Centre of Neurosurgery" of Ministry of Health of the Russian Federation (city of Tyumen), Ul. 4 km. Chervishevskogo trakta, 5, Tyumen, 625032, Russia. .,I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya st, Moscow, 119991, Russia.
| | - Ekkehard M Kasper
- Department of Neurosurgery, Harvard Medical School, A-111, 25 Shattuck Street, Boston, 02115, MA, USA.,Division of Neurosurgery, Beth Israel Deaconess Medical Center, 110, Francis Street - Suite 3B, Boston, MA, 02215, USA
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Bayoumi AB, Laviv Y, Karaali CN, Ertilav K, Kepoglu U, Toktas ZO, Konya D, Kasper EM. Spinal meningiomas: 61 cases with predictors of early postoperative surgical outcomes. J Neurosurg Sci 2017; 64:446-451. [PMID: 29115099 DOI: 10.23736/s0390-5616.17.04102-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Spinal meningiomas are benign, well-circumscribed and slowly-growing intradural tumors that compress the spinal cord. Hereby, a retrospective review of 61 spinal meningioma cases evaluated in terms of demographic, clinical, pathological and radiological features to predict the early postoperative functional outcomes. METHODS Patients' records and MRI images of all the histologically confirmed spinal meningioma cases that underwent surgical resection at two university hospitals from January 2005 to June 2016 were retrospectively reviewed. Demographic data, clinical findings, radiological features and pathology reports were reviewed. Univariate and multivariate logistic regression analyses were used to evaluate the impact of each factor on the early 3-month post-surgical functional outcome. A receiver operating characteristic (ROC) curve was used to predict the power of the model. RESULTS Sixty-one cases of spinal meningiomas were operated: 13 males (21%) and 48 females (79%). Mean age was 60.5 years and ranged from 24 to 92 years. Patients presented with back pain (57%), motor deficits (47.5%), sensory deficits (18%) and sphincteric dysfunction (11.5%). One case (1.6%) showed an additional extradural growth. There were 40 thoracic, nine cervical, five cervicothoracic, five thoracolumbar, and two lumbar cases. Only four cases (6.6%) showed atypical pathological features (WHO grade II). At 3-month follow-up, 46 patients (75.4%) had either functionally improved or remained stable. Fifteen patients (24.6%) had "worse" functional outcome. Three variables showed statistically significant odds ratio for improved outcomes (OR): pre-surgical motor deficit (OR=5; P=0.005); presurgical sensory disturbance (OR=3.5; P=0.026); pre-surgical myelopathy (OR=3.5; P=0.026). Multivariate analysis showed increased OR for cross-sectional ratio, pre-surgical myelopathy, pre-surgical radiculopathy and non-cervical location of tumor (1.59, 3.46, 3.2, 1.63/3.56, respectively). Although none has reached statistical significance (P>0.05), the receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.74. CONCLUSIONS The independent predictors of the early postoperative functional outcomes of spinal meningioma resections may include pre-surgical motor deficit, sensory deficit and myelopathy.
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Affiliation(s)
- Ahmed B Bayoumi
- Department of Neurosurgery, Medical Park of Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Yosef Laviv
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ceren N Karaali
- Department of Neurosurgery, Medical Park of Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Kemal Ertilav
- Department of Neurosurgery, Suleyman Demirel University, Isparta, Turkey
| | - Umit Kepoglu
- Department of Neurosurgery, Medical Park of Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Zafer O Toktas
- Department of Neurosurgery, Medical Park of Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Deniz Konya
- Department of Neurosurgery, Medical Park of Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA -
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Abstract
Ependymomas of the posterior fossa in adults are relatively rare, represent less than 1% of adult intracranial gliomas. Most of the cases are WHO grade II. Due to their rarity, there are no randomized studies regarding the best management of these tumors. It seems that surgical resection has a major role in their management. Unlike the scenario in children, these tumors can be cured by gross total resection without adjuvant therapy in the majority of cases. Hence, knowing the different surgical approaches, with their pros and cons, is important in order to offer the patient the best treatment. In this paper, we review the current literature on surgery for ependymomas of the posterior fossa in adults, and the advantages and risks of the principal surgical approaches, namely the telo-velar and the transvermian, are discussed.
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Affiliation(s)
- Yosef Laviv
- Department of Neurosurgery, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel -
| | - Isabelle M Germano
- Department of Neurosurgery, The Mount Sinai Medical Center, New York, NY, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ekkehard M Kasper
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Abstract
The purpose of this paper was to introduce and review the characteristic imaging features of ependymal neoplasms through a comprehensive case-based approach. Illustrated cases highlight both common and uncommon manifestations of central nervous system-ependymomas. The combination of imaging features, location of the tumor, and patient's demographics often allow the suggestion of ependymoma as a lead entity in the differential diagnosis. However, significant overlap exists between the radiologic characteristics of ependymomas and those of other tumors commonly encountered in the same locations, which can pose a challenge for a definitive diagnosis based on imaging alone.
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Affiliation(s)
- David Khatami
- Section of Neuroradiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA -
| | - Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rafeeque Bhadelia
- Section of Neuroradiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rafael Rojas
- Section of Neuroradiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Germano IM, Kasper EM. The changing landscape of ependymomas: diagnostic and treatment approaches. J Neurosurg Sci 2017; 62:36-37. [PMID: 28945056 DOI: 10.23736/s0390-5616.17.04217-5] [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: 11/08/2022]
Affiliation(s)
- Isabelle M Germano
- Department of Neurosurgery, ICAHN School of Medicine at Mount Sinai, New York, NY, USA -
| | - Ekkehard M Kasper
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Kasper EM, Ippen FM, Maragkos GA, Anderson MP, Rojas R, Mahadevan A. Tanycytic ependymoma of the brain stem, presentations of rare cystic disease variants and review of literature. J Neurosurg Sci 2017; 62:78-88. [PMID: 28884561 DOI: 10.23736/s0390-5616.17.04194-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of this paper was to systematically review the evidence linking Propionibacterium acnes (P. acnes) with the develop Tanycytic ependymoma (tcE) is a rare variant of ependymoma and management guidelines for patients with this disease are not established. EVIDENCE ACQUISITION We performed a systematic search on Pubmed complimented by hand-searching citation lists to identify patients with pathologically confirmed tcE. Signs and symptoms, radiological and specific pathological findings as well as reported treatment modalities and outcomes were recorded and analyzed. EVIDENCE SYNTHESIS Fifty-one studies involving a total of 77 patients were identified and included in this review. Most cases of tcEs occurred in the spinal cord (50.6%), followed by lesions located in upper intracranial sites (36.4%) and only a few at the cervicomedullary junction (3.9%). Female to male ratio was calculated as about 1:1.5, with a mean age at diagnosis of approximately 36.1±18 years. Complete resection of the tumor without further additional therapy was the treatment of choice in most cases (63.6%), radiotherapy was considered in 10 cases (13.0%). In 18 reported cases of tcE (23.4%), the treatment was not documented. Defined follow-up periods for patients with tcE were only documented in 44 cases (57.1%), the mean follow-up was 22.3 months. 36 cases (46.8%) had no recurrence of tumor after treatment (26 months mean follow-up). CONCLUSIONS This comprehensive review on tcEs supports surgery as the initial treatment modality of choice. Radiotherapy can be considered when total gross resection cannot be achieved and allows for prolonged progression-free survival. Given the benign nature of this subtype of ependymoma, aggressive treatment such as chemotherapy is usually not indicated.
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Affiliation(s)
- Ekkehard M Kasper
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA -
| | - Franziska M Ippen
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Georgios A Maragkos
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Matthew P Anderson
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Rafael Rojas
- Division of Neuroradiology, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Bayoumi AB, Chen JX, Swiatek PR, Laviv Y, Kasper EM. Primary Pituitary Fibrosarcoma with Previous Adenoma. World Neurosurg 2017; 105:1032.e7-1032.e11. [DOI: 10.1016/j.wneu.2017.05.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
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Laviv Y, Neto S, Kasper EM. Management of quadrigeminal arachnoid cyst associated with obstructive hydrocephalus: report on stereotactic ventricular - cystic stenting. Br J Neurosurg 2017. [PMID: 28643523 DOI: 10.1080/02688697.2017.1344618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Quadrigeminal arachnoid cysts (QAC) are usually accompanied by a symptomatic obstructive hydrocephalus. Several endoscopic and surgical treatments exist; however, the critical location of these cysts further complicates treatment and usually more than one procedure is required. In this report, a 31 year old female with QAC and associated obstructive hydrocephalus was successfully treated with stereotactic placement of a permanent ventricular - cystic stent (intraventricualr - cystic catheterization) in single - session. Intraventricular - cystic stenting provides a long lasting communication between these two compartments, allowing persistent "physiologic" solution to this challenging condition.
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Affiliation(s)
- Yosef Laviv
- a Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Sergio Neto
- b Division of Neurosurgery, University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Ekkehard M Kasper
- a Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
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49
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Kasper BS, Dörfler A, Di Donato N, Kasper EM, Wieczorek D, Hoyer J, Zweier C. Central nervous system anomalies in two females with Borjeson-Forssman-Lehmann syndrome. Epilepsy Behav 2017; 69:104-109. [PMID: 28237832 DOI: 10.1016/j.yebeh.2017.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 02/07/2023]
Abstract
Borjeson-Forssman-Lehmann syndrome (BFLS) is a rare disorder caused by mutations in the PHF6 gene. It manifests as syndromic X-linked recessive intellectual disability (ID) in males and as sporadic ID due to de novo mutations in females. Clinical features include variable ID and a range of somatic manifestations constituting a distinct phenotype in both males and females, respectively, including seizures in a few. Central nervous system (CNS) imaging data are largely unavailable for BFLS. Here we report on CNS MRI findings from two female individuals with BFLS due to a de novo duplication in PHF6 who presented with typical BFLS and epilepsy. Brain findings encompass an intriguing combination of structural abnormalities including a simplified gyral pattern and aspects resembling subcortical band heterotopia as signs of malformation of cortical development (MCD). This finding is of note, since PHF6 has been suggested to play pivotal roles in CNS development including neuronal migration.
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Affiliation(s)
- Burkhard S Kasper
- Epilepsy Center, Dept. Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany.
| | - Arnd Dörfler
- Dept. Neuroradiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen, Germany
| | - Nataliya Di Donato
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany
| | - Ekkehard M Kasper
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Dagmar Wieczorek
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany; Institut für Humangenetik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Juliane Hoyer
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christiane Zweier
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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50
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Krishnan V, Stoppel DC, Nong Y, Johnson MA, Nadler MJS, Ozkaynak E, Teng BL, Nagakura I, Mohammad F, Silva MA, Peterson S, Cruz TJ, Kasper EM, Arnaout R, Anderson MP. Autism gene Ube3a and seizures impair sociability by repressing VTA Cbln1. Nature 2017; 543:507-512. [PMID: 28297715 PMCID: PMC5364052 DOI: 10.1038/nature21678] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/27/2017] [Indexed: 12/18/2022]
Abstract
Maternally inherited 15q11-13 chromosomal triplications cause a frequent and highly penetrant autism linked to increased gene dosages of UBE3A, which both possesses ubiquitin-ligase and transcriptional co-regulatory functions. Here, using in vivo mouse genetics, we show that increasing UBE3A in the nucleus down-regulates glutamatergic synapse organizer cerebellin-1 (Cbln1) that is needed for sociability in mice. Epileptic seizures also repress Cbln1 and are found to expose sociability impairments in mice with asymptomatic increases of UBE3A. This Ube3a-seizure synergy maps to glutamate neurons of the midbrain ventral tegmental area (VTA) where Cbln1 deletions impair sociability and weaken glutamatergic transmission. We provide preclinical evidence that viral-vector-based chemogenetic activations of, or Cbln1 restorations in VTA glutamatergic neurons rescues sociability deficits induced by Ube3a and/or seizures. Our results suggest a gene × seizure interaction in VTA glutamatergic neurons that impairs sociability by downregulating Cbln1, a key node in the expanding protein interaction network of autism genes.
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Affiliation(s)
- Vaishnav Krishnan
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - David C Stoppel
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Program in Neuroscience, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts 02115, USA
| | - Yi Nong
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Mark A Johnson
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Monica J S Nadler
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Ekim Ozkaynak
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Brian L Teng
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Ikue Nagakura
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Fahim Mohammad
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Michael A Silva
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Sally Peterson
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Tristan J Cruz
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Ekkehard M Kasper
- Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Ramy Arnaout
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Division of Clinical Informatics, Department of Internal Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA.,Department of Systems Biology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Matthew P Anderson
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02115, USA.,Program in Neuroscience, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts 02115, USA.,Boston Children's Hospital Intellectual and Developmental Disabilities Research Center, 300 Longwood Avenue, Boston, Massachusetts 02115, USA
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