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Castillo J, Soufi K, Zhou J, Kulubya E, Javidan Y, Ebinu JO. Minimally Invasive Techniques in the Surgical Management of Traumatic Pediatric Thoracolumbar Fractures. World Neurosurg 2024; 182:e292-e300. [PMID: 38008163 DOI: 10.1016/j.wneu.2023.11.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Thoracolumbar (TL) fractures are uncommon in children. While surgical treatment is recommended for unstable TL fractures, there is no consensus on appropriate surgical treatment. We present a case series of pediatric patients with traumatic TL fractures treated with minimally invasive techniques. We discuss our early experience and technical challenges with navigation and robotic-assisted fixation. METHODS A retrospective review of a prospectively maintained trauma database from February 2018 to February 2023 of all pediatric patients (<18 years old) undergoing percutaneous fixation for unstable TL fractures was performed. Minimally invasive techniques included fluoroscopy and/or navigation-guided or robotic-assisted surgery. Clinical course, radiographic findings, and technical challenges were reviewed. RESULTS A cohort of 12 patients (age range, 4-17 years) with 6 (50%) Chance fractures, 2 (16%) pars fractures, 2 (16%) pedicle fracture, 1 (8%) burst fracture, and 1 (8%) other fracture were identified. Nine patients had fractures involving the lumbar spine, and the remaining 3 had thoracic fractures. In all cases, percutaneous pedicle screws were placed above and below the fracture with the use of neuronavigation or robotic-assisted navigation (n = 2). Blood loss was <30 mL for single-level fractures and instrumented fusion. Two patients had hardware-related complications. At follow-up (mean 9.67 months after surgery), patients were doing well clinically, and most imaging showed stable alignment. CONCLUSIONS Our early experience shows that short segment instrumentation through a minimally invasive approach is a safe and effective surgical option for young pediatric patients with good clinical outcomes and favorable radiographic postoperative finding.
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Affiliation(s)
- Jose Castillo
- Department of Neurological Surgery, University of California, Sacramento, California, USA
| | - Khadija Soufi
- Department of Neurological Surgery, University of California, Sacramento, California, USA
| | - James Zhou
- Department of Neurological Surgery, University of California, Sacramento, California, USA
| | - Edwin Kulubya
- Department of Neurological Surgery, University of California, Sacramento, California, USA
| | - Yashar Javidan
- Department of Orthopedic Surgery, University of California, Sacramento, California, USA
| | - Julius O Ebinu
- Department of Surgery, Division of Neurosurgery, Queen's University, Kingston, Ontario, Canada.
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Castillo JA, Soufi K, Rodriguez F, Ebinu JO. Intraoperative Ultrasound: Real-Time Surgical Adjunct for Complete Resection of Spinal Arachnoid Webs. World Neurosurg 2023; 179:143. [PMID: 37619841 DOI: 10.1016/j.wneu.2023.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
Spinal arachnoid webs are abnormal formations of arachnoid membranes that reside in the arachnoid space. Clinically, they may present as an incidental finding or in patients with progressively worsening myelopathy. Early detection and surgical intervention are recommended in patients with progressive symptoms. Several methods have been described for the surgical treatment of these web formations.1-4 The success of surgery and the ability to prevent recurrence is dependent on complete surgical resection of these lesions, which in some cases can appear complex and intricate in nature. A few reports have highlighted the use of intraoperative ultrasound to localize the lesion; however, none have highlighted its value in establishing successful web resection and restoration of normal cerebrospinal fluid flow.3,4 Herein, we demonstrate the use of intraoperative ultrasound as an effective adjunct to assessing and establishing complete resection of arachnoid webs. We illustrate how intraoperative ultrasound allows for real-time, direct visualization of arachnoid lysis with restoration of normal cerebrospinal fluid flow (Video 1). Our patient was symptomatic for 12 months with rapid progression of myelopathic symptoms in the 3 months before presentation. Following surgery, she remained asymptomatic at 4-year follow-up with no reoccurrence at 24-month magnetic resonance imaging. Intraoperative ultrasound is a useful adjunct to successfully performing dorsal arachnoid web surgery and ensuring improved surgical outcomes through complete web resection and decompression of the spinal cord.
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Affiliation(s)
- Jose A Castillo
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
| | - Khadija Soufi
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
| | - Freddie Rodriguez
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
| | - Julius O Ebinu
- Division of Neurosurgery, Department of Surgery, Queens University, Kingston, Ontario, Canada.
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Bakr O, Soufi K, Jones Q, Bautista B, Van B, Booze Z, Martin AR, Klineberg EO, Le H, Ebinu JO, Kim KD, Javidan Y, Roberto RF. Laminoplasty versus laminectomy with fusion for treating multilevel degenerative cervical myelopathy. N Am Spine Soc J 2023; 15:100232. [PMID: 37416091 PMCID: PMC10320595 DOI: 10.1016/j.xnsj.2023.100232] [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] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/08/2023]
Abstract
Background Laminectomy with fusion (LF) and laminoplasty (LP) are common posterior decompression procedures used to treat multilevel degenerative cervical myelopathy (DCM). There is debate on their relative efficacy and safety for treatment of DCM. The goal of this study is to examine outcomes and costs of LF and LP procedures for DCM. Methods This is a retrospective review of adult patients (<18) at a single center who underwent elective LP and LF of at least 3 levels from C3-C7. Outcome measures included operative characteristics, inpatient mobility status, length of stay, complications, revision surgery, VAS neck pain scores, and changes in radiographic alignment. Oral opioid analgesic needs and hospital cost comparison were also assessed. Results LP cohort (n=76) and LF cohort (n=59) reported no difference in neck pain at baseline, 1, 6, 12, and 24 months postoperatively (p>.05). Patients were successfully weaned off opioids at similar rates (LF: 88%, LP: 86%). Fixed and variable costs respectively with LF cases hospital were higher, 15.7% and 25.7% compared to LP cases (p=.03 and p<.001). LF has a longer length of stay (4.2 vs. 3.1 days, p=.001). Wound-related complications were 5 times more likely after LF (13.6% vs. 5.9%, RR: 5.15) and C5 palsy rates were similar across the groups (LF: 11.9% LP: 5.6% RR: 1.8). Ground-level falls requiring an emergency department visit were more likely after LF (11.9% vs. 2.6%, p=.04). Conclusions When treating multilevel DCM, LP has similar rates of new or increasing axial neck pain compared to LF. LF was associated with greater hospital costs, length of stay, and complications compared to LP. LP may in fact be a less morbid and more cost-effective alternative to LF for patients without cervical deformity.
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Affiliation(s)
- Oussama Bakr
- School of Medicine, University of California, Davis, CA, USA
| | - Khadija Soufi
- School of Medicine, University of California, Davis, CA, USA
| | - Quincy Jones
- School of Medicine, University of California, Davis, CA, USA
| | - Barry Bautista
- School of Medicine, University of California, Davis, CA, USA
| | - Benjamin Van
- School of Medicine, University of California, Davis, CA, USA
| | - Zachary Booze
- School of Medicine, University of California, Davis, CA, USA
| | - Allan R. Martin
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | - Eric O. Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | - Hai Le
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | - Julius O. Ebinu
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | - Kee D. Kim
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | - Yashar Javidan
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | - Rolando F. Roberto
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA 95817, USA
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Castillo J, Soufi K, Rodriguez F, Ebinu JO. Traumatic bilateral lumbosacral facet dislocation without fracture: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23261. [PMID: 37458364 PMCID: PMC10555645 DOI: 10.3171/case23261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Traumatic bilateral lumbosacral facet dislocations without fractures are extremely rare. Only 7 cases have been documented since the first description by Watson-Jones in 1974. Although various treatment strategies have been reported, no consensus has been reached regarding the best surgical approach. OBSERVATIONS A 35-year-old female presented for medical attention following a high-speed motor vehicle collision. She sustained multiple injuries, including an abdominal aortic injury requiring emergent thoracic endovascular aortic repair. She was found to have bilateral lumbosacral dislocation without fracture (L5-S1) and was noted to be neurologically intact. Once medically stabilized, the patient was taken to the operating room for minimally invasive reduction and stabilization of her lumbosacral spine. Postoperatively, the patient was neurologically intact and remained stable with no deficits and appropriate lumbosacral alignment throughout her 2-year follow-up. LESSONS The authors report a minimally invasive approach to the management of bilateral lumbosacral facet dislocation without fracture. Although conventional open approaches have been described previously, consideration should be given to minimally invasive strategies in select patients to facilitate their rehabilitative postoperative course.
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Soufi KH, Castillo JA, Rogdriguez FY, DeMesa CJ, Ebinu JO. Potential Role for Stem Cell Regenerative Therapy as a Treatment for Degenerative Disc Disease and Low Back Pain: A Systematic Review. Int J Mol Sci 2023; 24:ijms24108893. [PMID: 37240236 DOI: 10.3390/ijms24108893] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 04/01/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Back pain is the single leading cause of disability worldwide. Despite the prevalence and morbidity of lower back pain, we still lack a gold-standard treatment that restores the physiological function of degenerated intervertebral discs. Recently, stem cells have emerged as a promising strategy for regenerative therapy for degenerative disc disease. In this study, we review the etiology, pathogenesis, and developing treatment strategies for disc degeneration in low back pain with a focus on regenerative stem cell therapies. A systematic search of PubMed/MEDLINE/Embase/Clinical Trials.gov databases was conducted for all human subject abstracts or studies. There was a total of 10 abstracts and 11 clinical studies (1 RCT) that met the inclusion criteria. The molecular mechanism, approach, and progress of the different stem cell strategies in all studies are discussed, including allogenic bone marrow, allogenic discogenic cells, autologous bone marrow, adipose mesenchymal stem cells (MSCs), human umbilical cord MSC, adult juvenile chondrocytes, autologous disc derived chondrocytes, and withdrawn studies. Clinical success with animal model studies is promising; however, the clinical outcomes of stem cell regenerative therapy remain poorly understood. In this systematic review, we found no evidence to support its use in humans. Further studies on efficacy, safety, and optimal patient selection will establish whether this becomes a viable, non-invasive therapeutic option for back pain.
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Affiliation(s)
- Khadija H Soufi
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, USA
| | - Jose A Castillo
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, USA
| | - Freddie Y Rogdriguez
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, USA
| | - Charles J DeMesa
- Department of Anesthesia and Pain Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Julius O Ebinu
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, USA
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Moskalik AD, Castillo JA, Soufi K, Perez T, Kercher M, Karnati T, Goodrich D, Kim K, Ebinu JO, Martin AR. 493 One and Two-Level Robotic MIS TLIF With Expandable Implants Demonstrates a Favorable Safety Profile and Improved Alignment Parameters. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_493] [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: 03/18/2023] Open
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Nandakumar B, Blumenthal GH, Disse GD, Desmond PC, Ebinu JO, Ricard J, Bethea JR, Moxon KA. Exercise therapy guides cortical reorganization after midthoracic spinal contusion to enhance control of lower thoracic muscles, supporting functional recovery. Exp Neurol 2023; 364:114394. [PMID: 37001630 DOI: 10.1016/j.expneurol.2023.114394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
Postural control is critical for locomotion, allowing for gait changes, obstacle avoidance and navigation of rough terrain. A major problem after spinal cord injury (SCI) is regaining the control of balance to prevent falls and further injury. While the circuits for locomotor pattern generation reside in the spinal cord, postural control consists of multiple, complex networks that interact at the spinal, brainstem and cortical levels. After complete SCI, cortical reorganization establishes novel control of trunk musculature that is required for weight-supported stepping. In this study, we examined the impact of exercise therapy on cortical reorganization in the more clinically relevant models of both moderate and severe midthoracic contusion injury in the rat. Results demonstrate that both spontaneous recovery and therapy induced recovery of weight-supported stepping utilize cortical reorganization. Moreover, exercise therapy further improves outcome by enhancing cortical control of lower thoracic muscles enabling improvements in interlimb coordination associated with improved balance that increases weight-supported stepping. The outcome of this study suggest that cortical control of posture is key to functional improvement in locomotion. This information can be used to improve the timing and type of therapy after SCI by considering changes along the entire neural axis.
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Lee ET, Ebinu JO. Multivariate computational linguistic analysis for early detection of cognitive impairment. Alzheimers Dement 2021. [DOI: 10.1002/alz.057876] [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: 11/11/2022]
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Pham N, Ebinu JO, Karnati T, Hacein-Bey L. Neuroimaging findings and pathophysiology of dorsal spinal arachnoid webs: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE2142. [PMID: 35855021 PMCID: PMC9245846 DOI: 10.3171/case2142] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spinal arachnoid webs are uncommon and difficult to diagnose, especially because causative intradural transverse bands of arachnoid tissue are radiographically occult. Left untreated, arachnoid webs may cause progressive, debilitating, and permanent neurological dysfunction. Conversely, more than 90% of patients may experience rapid neurological recovery after resection, even with a prolonged duration of presenting symptoms. Indirect imaging signs such as spinal cord indentation and compression with cerebrospinal fluid (CSF) flow alteration provide crucial diagnostic clues that are critical in guiding appropriate management of such patients. OBSERVATIONS The authors reported a patient with no significant medical history who presented with back pain, progressive lower extremity weakness, gait ataxia, and bowel and bladder incontinence. They discussed multimodality imaging for determining the presence of arachnoid webs, including magnetic resonance imaging, phase-contrast CSF flow study, computed tomography myelography, and intraoperative ultrasound. They also discussed the detailed anatomy of the spinal subarachnoid space and a plausible pathophysiological mechanism for dorsal arachnoid webs. LESSONS The authors report on a patient who underwent comprehensive imaging evaluation detailing the arachnoid web and whose subsequent anatomical localization and surgical treatment resulted in a full neurological recovery.
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Affiliation(s)
- Nancy Pham
- Department of Radiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California; and
| | | | | | - Lotfi Hacein-Bey
- Radiology, University of California, Davis, School of Medicine, Sacramento, California
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Ebinu JO, Ramanathan D, Kurtz SM, Lawandy S, Kim KD. Periprosthetic Osteolysis in Cervical Total Disc Arthroplasty: A Single Institutional Experience. Neurosurgery Open 2021. [DOI: 10.1093/neuopn/okab013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
ABSTRACT
BACKGROUND
Cervical disc arthroplasty (CDA) affords an excellent alternative to cervical fusion for the treatment of symptomatic patients with degenerative disc disease. As more surgeons perform CDAs, an understanding of the complications associated with this technique is crucial. Periprosthetic osteolysis (PO) is a rare potential complication associated with CDA.
OBJECTIVE
To highlight potential complications associated with CDA.
METHODS
A retrospective chart review of patients who underwent CDA at our institution was performed. Patient outcomes and relevant clinical and radiographical data were analyzed in addition to associated complications. Explanted devices were subjected to macroscopic and microscopic analyses.
RESULTS
A total of 88 patients were included: 68 patients underwent 1-level CDA and 20 patients had 2-level CDA. Implants used in this series included Mobi-C (Zimmer Biomet), Prestige LP (Medtronic), Secure C (Globus), Advent (Orthofix), and ProDisc C (DePuy). One patient demonstrated symptoms of myeloradiculopathy that correlated with radiographical periprosthetic osteolysis and required surgical intervention in the form of disc explantation, corpectomy, and cervical instrumented fusion. Device retrieval analysis demonstrated evidence of elevated oxidation levels and increased wear in the presence of high concentrations of metal ions and debris in the surrounding tissue. The tissue did not exhibit any immune response, infection, or acute inflammation.
CONCLUSION
PO is a potential complication of CDA that occurs irrespective of the type of implant used. We describe its occurrence and management and highlight the importance of being aware of this understated phenomenon.
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Affiliation(s)
- Julius O Ebinu
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Dinesh Ramanathan
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Steven M Kurtz
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Shokry Lawandy
- School of Medicine, California University of Science and Medicine, Riverside, California, USA
| | - Kee D Kim
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
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Ebinu JO, Lwu S, Monsalves E, Arayee M, Chung C, Laperriere NJ, Kulkarni AV, Goetz P, Zadeh G. Gamma knife radiosurgery for the treatment of cystic cerebral metastases. Int J Radiat Oncol Biol Phys 2012; 85:667-71. [PMID: 22885145 DOI: 10.1016/j.ijrobp.2012.06.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/19/2012] [Accepted: 06/20/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the role of Gamma Knife radiosurgery (GKRS) in the treatment of nonsurgical cystic brain metastasis, and to determine predictors of response to GKRS. METHODS We reviewed a prospectively maintained database of brain metastases patients treated at our institution between 2006 and 2010. All lesions with a cystic component were identified, and volumetric analysis was done to measure percentage of cystic volume on day of treatment and consecutive follow-up MRI scans. Clinical, radiologic, and dosimetry parameters were reviewed to establish the overall response of cystic metastases to GKRS as well as identify potential predictive factors of response. RESULTS A total of 111 lesions in 73 patients were analyzed; 57% of lesions received prior whole-brain radiation therapy (WBRT). Lung carcinoma was the primary cancer in 51% of patients, 10% breast, 10% colorectal, 4% melanoma, and 26% other. Fifty-seven percent of the patients were recursive partitioning analysis class 1, the remainder class 2. Mean target volume was 3.3 mL (range, 0.1-23 mL). Median prescription dose was 21 Gy (range, 15-24 Gy). Local control rates were 91%, 63%, and 37% at 6, 12, and 18 months, respectively. Local control was improved in lung primary and worse in patients with prior WBRT (univariate). Only lung primary predicted local control in multivariate analysis, whereas age and tumor volume did not. Lesions with a large cystic component did not show a poorer response compared with those with a small cystic component. CONCLUSIONS This study supports the use of GKRS in the management of nonsurgical cystic metastases, despite a traditionally perceived poorer response. Our local control rates are comparable to a matched cohort of noncystic brain metastases, and therefore the presence of a large cystic component should not deter the use of GKRS. Predictors of response included tumor subtype. Prior WBRT decreased effectiveness of SRS for local control rates.
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Affiliation(s)
- Julius O Ebinu
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
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Abstract
Glomus tumors of the sellar region are exceedingly rare with only two reported cases in the literature. A case of a sellar glomangioma in a 72-year-old man is described. The tumor had the radiographic and gross appearance of a pituitary adenoma. Microscopically, the tumor was composed of epithelioid cells surrounding prominent small vascular channels. The tumor cells had indistinct cell borders and monotonous nuclei. Histological and immunohistochemical analysis identified the sellar tumor as a glomangioma. Here, we report the clinicopathological features of a third case of a sellar glomus tumor and review the literature.
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Affiliation(s)
- Julius O Ebinu
- Department of Surgery, Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, ON, M5T 2S8, Canada
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13
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Goetz P, Ebinu JO, Roberge D, Zadeh G. Current standards in the management of cerebral metastases. Int J Surg Oncol 2011; 2012:493426. [PMID: 22312540 PMCID: PMC3263704 DOI: 10.1155/2012/493426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 06/01/2011] [Revised: 09/18/2011] [Accepted: 09/28/2011] [Indexed: 12/15/2022] Open
Abstract
The last 30 years have seen major changes in attitude toward patients with cerebral metastases. This paper aims to outline the major landmarks in this transition and the therapeutic strategies currently used. The controversies surrounding control of brain disease are discussed, and two emerging management trends are reviewed: tumor bed radiosurgery and salvage radiation.
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Affiliation(s)
- Pablo Goetz
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst, Toronto, ON, Canada M5T 2S8
| | - Julius O. Ebinu
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst, Toronto, ON, Canada M5T 2S8
| | - David Roberge
- Département de Radio-Oncologie, Hôpital Notre Dame, Université de Montréal, Montréal, QC, Canada H3C 3J7
| | - Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst, Toronto, ON, Canada M5T 2S8
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Ebinu JO, Matouk CC, Wallace MC, Terbrugge KG, Krings T. Hydrocephalus secondary to hydrodynamic disequilibrium in an adult patient with a choroidal-type arteriovenous malformation. Interv Neuroradiol 2011; 17:212-6. [PMID: 21696661 DOI: 10.1177/159101991101700212] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 02/01/2011] [Indexed: 11/15/2022] Open
Abstract
We describe an adult patient with an unruptured choroidal-type arteriovenous malformation (AVM) associated with progressive hydrocephalus. There was no evidence of mechanical obstruction of the ventricular system by the AVM nidus itself or a draining vein. However significant reflux into periventricular and transmedullary veins was demonstrated. Following partial targeted embolization of the AVM, no further reflux was observed, the patient's clinical deficits resolved, and the hydrocephalus improved. We suggest a hydrodynamic disorder as a potential pathomechanism of hydrocephalus in this adult patient with an unruptured AVM.
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Affiliation(s)
- J O Ebinu
- Departments of Surgery and Medical Imaging, The University of Toronto Brain Vascular Malformation Study Group, The Toronto Hospital, Western Division, ON, Canada
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15
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Ebinu JO. P2-295 Formation of an apo E-IDE-Aβ complex that regulates Aβ degradation. Neurobiol Aging 2004. [DOI: 10.1016/s0197-4580(04)81040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
The generation of nuclear signaling proteins by regulated intramembrane proteolysis (RIP) is a new paradigm of signal transduction. Mammalian proteins that are processed by RIP include SREBP-1, Notch-1, amyloid precursor protein (APP), and ErbB-4. Intramembranous gamma-secretase cleavage of APP plays a central role in Alzheimer's disease by generating the amyloid beta protein. An intriguing possibility is that the cognate C-terminal fragment generated by gamma-secretase cleavage could also play a role through the regulation of nuclear signaling events. Thus, RIP may contribute to both brain development and degeneration and may provide unexpected diversity to the signaling repertoire of a cell.
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Affiliation(s)
- Julius O Ebinu
- Department of Neurology, Harvard Medical School and, Division of Neuroscience, The Children's Hospital, Enders 260, 300 Longwood Avenue, 02115, Boston, MA 02115, USA
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Dower NA, Stang SL, Bottorff DA, Ebinu JO, Dickie P, Ostergaard HL, Stone JC. RasGRP is essential for mouse thymocyte differentiation and TCR signaling. Nat Immunol 2000; 1:317-21. [PMID: 11017103 DOI: 10.1038/79766] [Citation(s) in RCA: 298] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Ras signaling pathway plays a critical role in thymopoiesis and T cell activation, but the mechanism of Ras regulation is controversial. At least one mode of Ras regulation in T cells involves the messenger diacylglycerol (DAG). RasGRP, a Ras activator with a DAG-binding C1 domain, is expressed in T cells and thymocytes. Here we show that thymi of RasGRP-null mutant mice have approximately normal numbers of immature thymocytes but a marked deficiency of mature, single-positive (CD4+CD8- and CD4-CD8+) thymocytes. In Ras signaling and proliferation assays, mutant thymocytes showed a complete lack of response to DAG analogs or T cell receptor (TCR) stimulation by antibodies. Thus, TCR and DAG are linked through RasGRP to Ras signaling.
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Affiliation(s)
- N A Dower
- Department of Pediatrics, University of Alberta, Edmonton Alberta, Canada, T6G 2H7
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Ebinu JO, Stang SL, Teixeira C, Bottorff DA, Hooton J, Blumberg PM, Barry M, Bleakley RC, Ostergaard HL, Stone JC. RasGRP links T-cell receptor signaling to Ras. Blood 2000; 95:3199-203. [PMID: 10807788] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Stimulation of the T-cell receptor (TCR) alters a number of intracellular signaling pathways including one that involves protein tyrosine kinases, phospholipase C-gamma1 (PLC-gamma1), diacylglycerol (DAG), and calcium messengers. By a divergent pathway, TCR-stimulated protein tyrosine kinase activity is thought to result independently in recruitment of the Ras activator Sos to the plasma membrane, leading to Ras activation. Here we show that RasGRP, a Ras activator that contains calcium-binding EF hands and a DAG-binding domain, is expressed in T cells. A PLC-gamma1 inhibitor diminished activation of Ras following TCR stimulation. Membranes from TCR-stimulated Jurkat T cells exhibited increased RasGRP and increased Ras-guanyl nucleotide association activity that was inhibited by antibodies directed against RasGRP. Overexpression of RasGRP in T cells enhanced TCR-Ras-Erk signaling and augmented interleukin-2 secretion in response to calcium ionophore plus DAG analogues phorbol ester myristate or bryostatin-1. Thus, RasGRP links TCR and PLC-gamma1 to Ras-Erk signaling, a pathway amenable to pharmacologic manipulation.
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Affiliation(s)
- J O Ebinu
- Departments of Biochemistry and Immunobiology, University of Alberta, Edmonton, Canada
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Ebinu JO, Bottorff DA, Chan EY, Stang SL, Dunn RJ, Stone JC. RasGRP, a Ras guanyl nucleotide- releasing protein with calcium- and diacylglycerol-binding motifs. Science 1998; 280:1082-6. [PMID: 9582122 DOI: 10.1126/science.280.5366.1082] [Citation(s) in RCA: 526] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
RasGRP, a guanyl nucleotide-releasing protein for the small guanosine triphosphatase Ras, was characterized. Besides the catalytic domain, RasGRP has an atypical pair of "EF hands" that bind calcium and a diacylglycerol (DAG)-binding domain. RasGRP activated Ras and caused transformation in fibroblasts. A DAG analog caused sustained activation of Ras-Erk signaling and changes in cell morphology. Signaling was associated with partitioning of RasGRP protein into the membrane fraction. Sustained ligand-induced signaling and membrane partitioning were absent when the DAG-binding domain was deleted. RasGRP is expressed in the nervous system, where it may couple changes in DAG and possibly calcium concentrations to Ras activation.
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Affiliation(s)
- J O Ebinu
- Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada T6G 2H7
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