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Azzam AY, Vaishnav D, Essibayi MA, Unda SR, Jabal MS, Liriano G, Fortunel A, Holland R, Khatri D, Haranhalli N, Altschul D. Prediction of delayed cerebral ischemia followed aneurysmal subarachnoid hemorrhage. A machine-learning based study. J Stroke Cerebrovasc Dis 2024; 33:107553. [PMID: 38340555 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/25/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Delayed Cerebral Ischemia (DCI) is a significant complication following aneurysmal subarachnoid hemorrhage (aSAH) that can lead to poor outcomes. Machine learning techniques have shown promise in predicting DCI and improving risk stratification. METHODS In this study, we aimed to develop machine learning models to predict the occurrence of DCI in patients with aSAH. Patient data, including various clinical variables and co-factors, were collected. Six different machine learning models, including logistic regression, multilayer perceptron, decision tree, random forest, gradient boosting machine, and extreme gradient boosting (XGB), were trained and evaluated using performance metrics such as accuracy, area under the curve (AUC), precision, recall, and F1 score. RESULTS After data augmentation, the random forest model demonstrated the best performance, with an AUC of 0.85. The multilayer perceptron neural network model achieved an accuracy of 0.93 and an F1 score of 0.85, making it the best performing model. The presence of positive clinical vasospasm was identified as the most important feature for predicting DCI. CONCLUSIONS Our study highlights the potential of machine learning models in predicting the occurrence of DCI in patients with aSAH. The multilayer perceptron model showed excellent performance, indicating its utility in risk stratification and clinical decision-making. However, further validation and refinement of the models are necessary to ensure their generalizability and applicability in real-world settings. Machine learning techniques have the potential to enhance patient care and improve outcomes in aSAH, but their implementation should be accompanied by careful evaluation and validation.
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Affiliation(s)
- Ahmed Y Azzam
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dhrumil Vaishnav
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Muhammed Amir Essibayi
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Santiago R Unda
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University NY, NY, USA
| | | | - Genesis Liriano
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adisson Fortunel
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan Holland
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Deepak Khatri
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neil Haranhalli
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Altschul
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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Vaishnav D, Essibayi MA, Toma A, Liriano G, Perkash RS, Stock A, Holland R, Dmytriw AA, Wolfe SQ, Al Kasab S, Spiotta A, Haranhalli N, Altschul DJ. Metal allergy and neurovascular stenting: A systematic review. Interv Neuroradiol 2024:15910199231226283. [PMID: 38225179 DOI: 10.1177/15910199231226283] [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: 01/17/2024] Open
Abstract
BACKGROUND Intracranial stents and flow diverters contain significant amounts of metals, notably nickel, which can cause allergic reactions in a considerable portion of the population. These allergic responses may lead to complications like in-stent stenosis (ISS) and TIA/Stroke in patients receiving stents or flow diverters for intracranial aneurysms. METHODS We conducted a systematic review of studies from inception until July 2023, which reported outcomes of patients with metal allergy undergoing neurovascular stenting. The skin patch test was used to group patients into those with positive, negative, or absent patch test results but with a known history of metal allergy. RESULTS Our review included seven studies with a total of 39 patients. Among them, 87% had a history of metal allergy before treatment. Most aneurysms (89%) were in the anterior circulation and the rest (11%) were in the posterior circulation. Skin patch tests were performed in 59% of patients, with 24% showing positive results and 33% negative. Incidental ISS was observed in 18% of patients, and the rate of TIA/Stroke was reported in 21%. The pooled rates of ISS and TIA/Stroke were higher in the first group (43% and 38%) compared to the second (18% and 9%) and third groups (15% and 15%), but these differences were not statistically significant. CONCLUSIONS The current neurosurgical literature does not provide a conclusive association between metal allergy and increased complications among patients undergoing neurovascular stenting. Further studies are necessary to gain a more comprehensive understanding of this topic.
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Affiliation(s)
- Dhrumil Vaishnav
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Muhammed Amir Essibayi
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aureliana Toma
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Genesis Liriano
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Raja Sandeep Perkash
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ariel Stock
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan Holland
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Alejandro Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Neil Haranhalli
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David J Altschul
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Buckner-Wolfson E, Jung G, Kim T, Fatemi R, Liriano G, Dalvi N, Behbahani M, Chin S, Martin A, Kobets A. A Case Report of Infant-Type Hemispheric Glioma with a Novel GAB1-ABL2 Kinase Fusion Treated with Dasatinib. Pediatr Neurosurg 2023; 59:27-34. [PMID: 38109857 DOI: 10.1159/000535842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Infant-type hemispheric glioma (IHG) is a rare form of cancer that affects newborns and infants. It is classified as a pediatric-type high-grade glioma and typically harbors receptor tyrosine kinase (RTK) gene fusions. Here, we present the finding of a novel gene fusion IHG treated with a targeted therapy that has yet to be implemented for any other IHG case to date. CASE PRESENTATION We report the case of a 12-month-old boy with IHG who presented with obstructive hydrocephalus due to a large mass in the right frontal lobe. The patient initially underwent mass resection, but subsequent imaging showed rapid interval progression of the residual tumor. Comprehensive molecular analysis of the tumor tissue revealed a novel GAB1-ABL2 gene fusion, and the patient was started on dasatinib, an ABL kinase inhibitor. Shortly after initiation of dasatinib treatment, there was a significant reduction in tumor size and enhancement, followed by stabilization of disease. DISCUSSION The patient's robust response to treatment suggests that dasatinib is an effective targeted therapy for IHG harboring a GAB1-ABL2 gene fusion. This finding may inform future investigations into the disease processes of IHG and help guide the diagnosis and treatment of IHG in the absence of previously identified gene fusions, improving clinical management of this vulnerable patient population.
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Affiliation(s)
- Emery Buckner-Wolfson
- Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Geena Jung
- Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Timothy Kim
- Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ryan Fatemi
- Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Genesis Liriano
- Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nagma Dalvi
- Department of Pediatric Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mandana Behbahani
- Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven Chin
- Department of Pathology, Montefiore Medical Center, Bronx, New York, USA
| | - Allison Martin
- Department of Pediatric Hematology, Oncology, and Cellular Therapy, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew Kobets
- Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
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Kim T, Jung G, Buckner-Wolfson E, Fatemi R, Liriano G, Tal A, Wang Y, Tepper O, Kobets A. Case Report: Treatment of the rare B-cell lymphoblastic lymphoma with scalp lesion using rotation flap. Front Oncol 2023; 13:1252512. [PMID: 37927459 PMCID: PMC10623147 DOI: 10.3389/fonc.2023.1252512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/30/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Leukemia is the most frequently occurring cancer in children, and lymphoblastic lymphoma (LBL) is a rare subtype. LBL are lymphoid neoplasms of B or T cell origin and are primarily treated with chemotherapy. Although cure rates among children are excellent, these patients must be monitored for relapse. Cutaneous lesions involving B-cell LBL (B-LBL) are extremely rare and here we present a patient with a worsening B-LBL scalp mass who required radical surgical excision. Case report A 6-year-old female patient with a history of a nontender scalp mass discovered at approximately 2-3 years of age was evaluated for resection of the nodule due to its size and treatment history. The patient was originally diagnosed with follicular lymphoma by punch biopsy; excision was successfully performed on this 4 cm lesion and upon examination of the skin biopsy did we get a diagnosis of B-LBL. Reconstruction of the scalp was done through the rotation flap method. The patient's scalp healed well, and adjuvant chemotherapy was continued. There has been no reoccurrence. Discussion Here we report the rarity of B-LBL cases involving extranodal involvement in the scalp. The most common reconstruction of scalp lesions has been using free flap from the anterolateral thigh (ALT) and latissimus dorsi (LD). Our case used the rotation flap, which has its functional and cosmetic benefits. The importance of monitoring this patient is emphasized due to the dangerous consequences of B-LBL relapse. Ultimately, our successful treatment and care of this rare case can be used as guidance for similar patients in the future.
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Affiliation(s)
- Timothy Kim
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Geena Jung
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Emery Buckner-Wolfson
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ryan Fatemi
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Genesis Liriano
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Adit Tal
- Department of Pediatric Hematology/Oncology, Montefiore Medical Center, Bronx, NY, United States
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Bronx, NY, United States
| | - Oren Tepper
- Department of Surgery (Plastic and Reconstructive Surgery), Montefiore Medical Center, Bronx, NY, United States
| | - Andrew Kobets
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
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Javed K, Ahmad S, Qin J, Mowrey W, Kadaba D, Liriano G, Fortunel A, Holland R, Khatri D, Haranhalli N, Altschul D. Higher Incidence of Unruptured Intracranial Aneurysms among Black and Hispanic Women on Screening MRA in Large Urban Populations. AJNR Am J Neuroradiol 2023; 44:574-579. [PMID: 37105681 PMCID: PMC10171375 DOI: 10.3174/ajnr.a7856] [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] [Received: 09/16/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms have a reported prevalence of 1%-2% in the general population. Currently, only patients with a strong family history or autosomal dominant polycystic kidney disease are screened for intracranial aneurysms using MRA. The purpose of this study was to determine whether there are other specific patient populations at risk that should be offered screening for intracranial aneurysms. MATERIALS AND METHODS This is a retrospective case-control study of adult patients who underwent a screening MRA of their brain at our comprehensive stroke center from 2011 to 2020. Patients with a history of a known brain aneurysm were excluded. Data were extracted on patient demographics and medical comorbidities. Bivariate analyses were performed, followed by multivariable logistic regression, to identify factors associated with a positive MRA screen for incidental aneurysms. RESULTS Of 24,397 patients eligible for this study, 2084 screened positive for a possible intracranial aneurysm. On bivariate analysis, significant differences were present in the following categories: age, sex, race and ethnicity, chronic constipation, and hyperlipidemia. On logistic regression analysis, older age (+10 years: OR = 10.01; 95% CI, 10.01-10.02; P = .001), female sex (OR = 1.37; 95% CI, 1.24-1.51; P = .001), non-Hispanic Black (OR = 1.19; 95% CI, 1.02-1.40; P = .031), and Hispanic ethnicity (OR = 1.35; 95% CI, 1.16-1.58; P = .001) versus non-Hispanic White remained significant when adjusted for other factors. CONCLUSIONS Targeted screening for high-risk elderly women of Black or Hispanic descent will yield higher positive findings for brain aneurysms, which may mitigate the risk of rupture. Whether this is a cost-effective approach has yet to be determined.
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Affiliation(s)
- K Javed
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - S Ahmad
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - J Qin
- Epidemiology & Population Health (J.Q., W.M.), Montefiore Medical Center, Bronx, New York
| | - W Mowrey
- Epidemiology & Population Health (J.Q., W.M.), Montefiore Medical Center, Bronx, New York
| | - D Kadaba
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - G Liriano
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - A Fortunel
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - R Holland
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - D Khatri
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - N Haranhalli
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - D Altschul
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
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