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Carlson AP, Slot EMH, van Doormaal TPC, Voormolen EHJ, Dankbaar JW, Depauw P, Brouwers B, Germans MR, Baert E, Vandersteene J, Freyschlag CF, Freyschlag J, Thomé C, Zenga F, Penner F, Abdulazim A, Sabel M, Rapp M, Beez T, Zuccarello M, Sauvageau E, Abdullah K, Welch B, Langer D, Ellis J, Dehdashti A, VanGompel J, Bendok B, Chaichana K, Liu J, Dogan A, Lim MK, Hayden MG. Evaluate the safety and efficacy of dura sealant patch in reducing cerebrospinal fluid leakage following elective cranial surgery (ENCASE II): study protocol for a randomized, two-arm, multicenter trial. Trials 2022; 23:581. [PMID: 35858894 PMCID: PMC9297260 DOI: 10.1186/s13063-022-06490-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage is a frequent and challenging complication in neurosurgery, especially in the posterior fossa, with a prevalence of 8%. It is associated with substantial morbidity and increased healthcare costs. A novel dural sealant patch (LIQOSEAL) was developed for watertight dural closure. The objective of this study is to clinically assess the safety and effectiveness of LIQOSEAL as a means of reducing intra- as well as postoperative CSF leakage in patients undergoing elective posterior fossa intradural surgery with a dural closure procedure compared to the best currently available dural sealants. METHODS We will conduct a two-arm, randomized controlled, multicenter study with a 90-day follow-up. A total of 228 patients will be enrolled in 19 sites, of which 114 will receive LIQOSEAL and 114 an FDA-approved PEG sealant. The composite primary endpoint is defined as intraoperative CSF leakage at PEEP 20 cm H2O, percutaneous CSF leakage within 90 days of, wound infection within 90 days of or pseudomeningocele of more than 20cc on MRI or requiring intervention. We hypothesize that the primary endpoint will not be reached by more than 10 patients (9%) in the investigational arm, which will demonstrate non-inferiority of LIQOSEAL compared to control. DISCUSSION This trial will evaluate whether LIQOSEAL is non-inferior to control as a means of reducing CSF leakage and safety TRIAL REGISTRATION: ClinicalTrials.gov NCT04086550 . Registered on 11 September 2019.
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Affiliation(s)
- Andrew P Carlson
- Department of Neurosurgery, University of New Mexico, 1 UNM, Albuquerque, NM, 87131, USA.
| | - Emma M H Slot
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Translational Neuroscience, University Medical Center Utrecht, Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Tristan P C van Doormaal
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Translational Neuroscience, University Medical Center Utrecht, Brain Center, Utrecht University, Utrecht, The Netherlands.,Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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Brown H, Chen R, Cooks R, Garcia D, Chaichana K, Quinones-Hinojosa A, Jentoft M, Middlebrooks E. Intraoperative Assessment of IDH Mutation Status and Tumor Invasioni in Glioma. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Maximizing surgical resection in gliomas, while avoiding compromising non-infiltrated tissue, is associated with survival benefit. Current methodologies are suboptimal in providing rapid, intraoperative molecular characterization of tissue. We address this unmet need by using desorption electrospray ionization mass spectrometry (DESI-MS) for the intraoperative molecular assessment of gliomas.
Methods/Case Report
This prospective study uses intraoperative DESI-MS analysis of fresh tissue to evaluate IDH mutations via 2-hydroxyglutarate intensity and TCP via measurement of N-acetylaspartic acid (NAA) intensity and characteristic lipid profiles in less than three minutes. Blinded review of the tissue smears by a neuropathologist is used to validate IDH mutation status and TCP estimates.
Results (if a Case Study enter NA)
Presently, 529 biopsies from 85 enrolled patients have been collected and analyzed at two institutions. TCP assessment based on NAA intensity in 203 biopsies at the first institution yielded sensitivity, specificity, and accuracy values of 91, 76, and 83%, whereas TCP estimates via characteristic lipid profiles yielded 76, 85, and 81%, respectively. Assessment of IDH mutation status of 71 core biopsies yielded sensitivity, specificity, and accuracy values of 89, 100, and 94%. Ongoing validation of the methodology is being performed at a second institution, where we have collected 282 biopsies from 36 patients. IDH mutation assessment of the first 15 patients indicate 100% sensitivity, specificity, and accuracy.
Conclusion
This study represents the first and largest study using DESI-MS for the intraoperative evaluation of IDH status and TCP measurement in gliomas. Prospectively, we propose to modify our DESI-MS system to allow estimation of IDH mutation status and TCP in surgical cavities without the need for a biopsy by placing a surgical material along the margin and transferring material from the blot to a microscope slide prior to DESI-MS analysis. We envision molecular analysis by DESI-MS as a complementary technique to histopathology capable of providing additional clinical information in near real-time.
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Affiliation(s)
- H Brown
- Chemistry, Purdue University, West Lafayette, Indiana, UNITED STATES
| | - R Chen
- Chemistry, Purdue University, West Lafayette, Indiana, UNITED STATES
| | - R Cooks
- Chemistry, Purdue University, West Lafayette, Indiana, UNITED STATES
| | - D Garcia
- Neurosurgery, Mayo Clinic, Jacksonville, Florida, UNITED STATES
| | - K Chaichana
- Neurosurgery, Mayo Clinic, Jacksonville, Florida, UNITED STATES
| | | | - M Jentoft
- Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, UNITED STATES
| | - E Middlebrooks
- Radiology, Mayo Clinic, Jacksonville, Florida, UNITED STATES
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Chambless LB, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC, Zhou T, Meng X, Xu B, Wei S, Chen X, De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS, Gonzalez JDSR, Alberto OV, Patricia HM, Chaichana K, Pendleton C, Chambless L, Nathan J, Camara-Quintana J, Li G, Harsh G, Thompson R, Lim M, Quinones-Hinojosa A, Oppenlander ME, Wolf A, Porter R, Nakaji P, Smith KA, Spetzler RF, Sanai N, Kim JH, Clark AJ, Jahangiri A, Sughrue ME, McDermott MW, Aghi MK, Chen C, Kasper E, Warnke P, Park CK, Lee SH, Song SW, Kim JW, Kim TM, Yamaguchi F, Omura T, Ten H, Ishii Y, Kojima T, Takahashi H, Teramoto A, Pereira EA, Livermore J, Ansorge O, Bojanic S, Meng X, Xu B, Chen X, Wei S, Zhou T, Tong H, Yu X, Zhou D, Hou Y, Zhou Z, Zhang J, Fabiano AJ, Rigual N, Munich S, Fenstermaker RA, Chen X, Meng X, Zhang J, Wang F, Zhao Y, Xu BN, Kim EH, Oh MC, Lee EJ, Kim SH, Kim YH, Kim CY, Kim YH, Han JH, Park CK, Kim SK, Paek SH, Wang KC, Kim DG, Jung HW, Chen X, Meng X, Wang F, Zhao Y, Xu BN, Krex D, Lindner C, Juratli T, Raue C, Schackert G, Valdes PA, Kim A, Leblond F, Conde OM, Harris BT, Paulsen KD, Wilson BC, Roberts DW, Krex D, Juratli T, Lindner C, Raue C, Schackert G, Occhiogrosso G, Cascardi P, Blagia M, De Tommasi A, Gelinas-Phaneuf N, Choudhury N, Al-Habib A, Cabral A, Nadeau E, Vincent M, Pazos V, Debergue P, DiRaddo R, Del Maestro RF, Guha-Thakurta N, Prabhu SS, Schulder M, Zavarella S, Nardi D, Schaffer S, Ruge MI, Grau S, Fuetsch M, Kickingereder P, Hamisch C, Treuer H, Voges J, Sturm V, Choy W, Yew A, Spasic M, Nagasawa D, Kim W, Yang I, Quigley MR, Hobbs J, Bhatia S, Cohen ZR, Shimon I, Hadani M, Carapella CM, Oppido PA, Vidiri A, Telera S, Pompili A, Villani V, Fabi A, Pace A, Cahill D, Wang M, Won M, Aldape K, Maywald R, Hegi M, Mehta M, Gilbert M, Sulman E, Vogelbaum M, Narayana A, Kunnakkat SD, Parker E, Gruber D, Gruber M, Knopp E, Zagzag D, Golfinos J, Dziurzynski K, Blas-Boria D, Suki D, Cahill D, Prabhu S, Puduvalli V, Levine N, Bloch O, Han SJ, Kaur G, Aghi MK, McDermott MW, Berger MS, Parsa AT, Quigley MR, Fukui O, Chew B, Bhatia S, DePowell JJ, Sanders-Taylor C, Guarnaschelli J, McPherson C, Sheth SA, Snuderl M, Kwon CS, Wirth D, Yaroslavsky A, Curry WT, Vogelbaum MA, Wang M, Hadjipanayis CG, Won M, Mehta MP, Gilbert MR, Megyesi JF, Macdonald D, Wang B, Pierre GHS, Hoover JM, Goerss SJ, Kaufmann TJ, Meyer FB, Parney IF, Guthikonda B, Thakur J, Khan I, Ahmed O, Shorter C, Wilson J, Welsh J, Cuellar H, Jeroudi M. SURGICAL THERAPIES. Neuro Oncol 2011; 13:iii154-iii163. [PMCID: PMC3222965 DOI: 10.1093/neuonc/nor164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023] Open
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