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Sabahi M, Yousefi O, Kehoe L, Sasannia S, Gerndt C, Adada B, Borghei-Razavi H, Shahlaie K, Palmisciano P. Correlation Between Pituitary Adenoma Surgery and Anxiety Disorder: Systematic Review and Meta-Analysis. World Neurosurg 2024:S1878-8750(24)00728-9. [PMID: 38697260 DOI: 10.1016/j.wneu.2024.04.154] [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: 03/29/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE This study aims to evaluate the impact of surgical intervention on anxiety levels in patients with various types of pituitary adenoma (PA). METHOD A systematic review was conducted following PRISMA guidelines until October 2022, searching Embase, PubMed, Web of Sciences, and Scopus. RESULTS A total of 32 studies were included, encompassing 2681 patients with the mean age of 53.33 ± 6.48 years (43.4% male). Among all subtypes, 664 diagnosed with Cushing's disease (25.8%), 612 with acromegaly (23.8%), 282 with prolactinoma (10.9%), and 969 with non-functional PAs (37.6%). Pituitary insufficiency was the most common complications. Considering therapeutic modalities, 515 patients (29.8%) underwent endoscopic trans-sphenoidal surgery, while 222 (12.9%) underwent microscopic trans-sphenoidal surgery. The type of trans-sphenoidal surgery was not specified in 977 (56.6%) patients. A total of 17 studies including 1510 patients which mostly assessed anxiety using the Hospital Anxiety and Depression Scale (HADS) and Zung Self-Rating Anxiety Scale (SAS) were included in the meta-analysis. Pre-operative evaluation using HADS questionnaire showed a pooled score of 8.27 (95%CI 4.54-12.01), while post-operative evaluation yielded a pooled score of 6.49 (95%CI 5.35-7.63), indicating no significant difference. Pre-operative SAS assessment resulted in a pooled score of 50.43 (95%CI 37.40-63.45), with post-operative pooled score of 55.91 (95%CI 49.40-62.41), showing no significant difference. CONCLUSIONS Our analysis revealed no significant difference in anxiety scores pre- and post-operatively. While our findings suggest stability in anxiety levels following surgical intervention, it is imperative to recognize the limitations of the current evidence base. The observed lack of consensus may be influenced by factors such as the heterogeneous nature of the patient population, variations in the characteristics of pituitary adenomas, diverse therapeutic approaches, and potential confounding variables such as pre-existing mental health conditions and coping mechanisms. Further research is warranted to elucidate the nuanced relationship between surgical intervention for PA and anxiety outcomes, considering these complex interactions and employing rigorous methodologies to address potential sources of bias.
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Affiliation(s)
- Mohammadmahdi Sabahi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Omid Yousefi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laura Kehoe
- School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin 2, Ireland
| | - Sarvin Sasannia
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA; Departments of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clayton Gerndt
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Badih Adada
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Paolo Palmisciano
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA.
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Card NS, Wairagkar M, Iacobacci C, Hou X, Singer-Clark T, Willett FR, Kunz EM, Fan C, Vahdati Nia M, Deo DR, Srinivasan A, Choi EY, Glasser MF, Hochberg LR, Henderson JM, Shahlaie K, Brandman DM, Stavisky SD. An accurate and rapidly calibrating speech neuroprosthesis. medRxiv 2024:2023.12.26.23300110. [PMID: 38645254 PMCID: PMC11030484 DOI: 10.1101/2023.12.26.23300110] [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] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Brain-computer interfaces can enable rapid, intuitive communication for people with paralysis by transforming the cortical activity associated with attempted speech into text on a computer screen. Despite recent advances, communication with brain-computer interfaces has been restricted by extensive training data requirements and inaccurate word output. A man in his 40's with ALS with tetraparesis and severe dysarthria (ALSFRS-R = 23) was enrolled into the BrainGate2 clinical trial. He underwent surgical implantation of four microelectrode arrays into his left precentral gyrus, which recorded neural activity from 256 intracortical electrodes. We report a speech neuroprosthesis that decoded his neural activity as he attempted to speak in both prompted and unstructured conversational settings. Decoded words were displayed on a screen, then vocalized using text-to-speech software designed to sound like his pre-ALS voice. On the first day of system use, following 30 minutes of attempted speech training data, the neuroprosthesis achieved 99.6% accuracy with a 50-word vocabulary. On the second day, the size of the possible output vocabulary increased to 125,000 words, and, after 1.4 additional hours of training data, the neuroprosthesis achieved 90.2% accuracy. With further training data, the neuroprosthesis sustained 97.5% accuracy beyond eight months after surgical implantation. The participant has used the neuroprosthesis to communicate in self-paced conversations for over 248 hours. In an individual with ALS and severe dysarthria, an intracortical speech neuroprosthesis reached a level of performance suitable to restore naturalistic communication after a brief training period.
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Lui A, Do T, Alzayat O, Yu N, Phyu S, Santuya HJ, Liang B, Kailash V, Liu D, Inslicht SS, Shahlaie K, Liu D. Tumor Suppressor MicroRNAs in Clinical and Preclinical Trials for Neurological Disorders. Pharmaceuticals (Basel) 2024; 17:426. [PMID: 38675388 PMCID: PMC11054060 DOI: 10.3390/ph17040426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
Cancers and neurological disorders are two major types of diseases in humans. We developed the concept called the "Aberrant Cell Cycle Disease (ACCD)" due to the accumulating evidence that shows that two different diseases share the common mechanism of aberrant cell cycle re-entry. The aberrant cell cycle re-entry is manifested as kinase/oncoprotein activation and tumor suppressor (TS) inactivation, which are associated with both tumor growth in cancers and neuronal death in neurological disorders. Therefore, some cancer therapies (e.g., kinase/oncogene inhibition and TS elevation) can be leveraged for neurological treatments. MicroRNA (miR/miRNA) provides a new style of drug-target binding. For example, a single tumor suppressor miRNA (TS-miR/miRNA) can bind to and decrease tens of target kinases/oncogenes, producing much more robust efficacy to block cell cycle re-entry than inhibiting a single kinase/oncogene. In this review, we summarize the miRNAs that are altered in both cancers and neurological disorders, with an emphasis on miRNA drugs that have entered into clinical trials for neurological treatment.
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Affiliation(s)
- Austin Lui
- Department of Neurology, University of California at Davis, Davis, CA 95616, USA; (A.L.); (V.K.)
| | - Timothy Do
- Department of Neurology, University of California at Davis, Davis, CA 95616, USA; (A.L.); (V.K.)
| | - Omar Alzayat
- Department of Neurology, University of California at Davis, Davis, CA 95616, USA; (A.L.); (V.K.)
| | - Nina Yu
- Department of Neurology, University of California at Davis, Davis, CA 95616, USA; (A.L.); (V.K.)
| | - Su Phyu
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Hillary Joy Santuya
- Department of Neurology, University of California at Davis, Davis, CA 95616, USA; (A.L.); (V.K.)
| | - Benjamin Liang
- Department of Neurology, University of California at Davis, Davis, CA 95616, USA; (A.L.); (V.K.)
| | - Vidur Kailash
- Department of Neurology, University of California at Davis, Davis, CA 95616, USA; (A.L.); (V.K.)
| | - Dewey Liu
- Department of Neurology, University of California at Davis, Davis, CA 95616, USA; (A.L.); (V.K.)
| | - Sabra S. Inslicht
- Department of Psychiatry and Behavioral Sciences, University of California at San Francisco, San Francisco, CA 94143, USA
- San Francisco VA Health Care System, San Francisco, CA 94121, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California at Davis, Davis, CA 95616, USA
| | - DaZhi Liu
- Department of Neurology, University of California at Davis, Davis, CA 95616, USA; (A.L.); (V.K.)
- Mirnova Therapeutics Inc., Davis, CA 95618, USA
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Nguyen PT, Chang J, Shahlaie K, Raslan O, Ozturk A, Bobinski M, Assadsangabi R. Skull base infections, their complications, and management. Neuroradiol J 2024; 37:6-16. [PMID: 36382775 PMCID: PMC10863568 DOI: 10.1177/19714009221140540] [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] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Our review aims to summarize the current literature on skull base infections (SBIs) and retrospectively analyze any such cases encountered at our institution. DESIGN A literature search was conducted using online databases PubMed, MEDLINE, and ResearchGate with the terms "skull base osteomyelitis," "temporal bone osteomyelitis," "skull base infections," "necrotizing otitis media," and "SBO". References from the resulting manuscripts were reviewed for relevant articles. A search of our electronic health records using the same key terms was also performed to identify patients with a tissue biopsy-confirmed diagnosis of skull base infections. Patients with an indeterminate diagnosis or inaccessible/poor imaging were excluded. SETTING A level one trauma and major tertiary academic medical center. PARTICIPANTS All patients treated at the University of California Davis Health System with a confirmed diagnosis of skull base infections from January 2005 to November 2020. MAIN OUTCOME MEASURES Imaging results, symptoms, treatment, morbidity, and mortality. RESULTS Our literature search yielded 59 articles ranging from 1982 to 2021. A retrospective search of our electronic health records identified two cases of skull base infections. CONCLUSION Skull base infections have no pathognomonic findings. A multimodal approach with computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine is necessary to characterize the disease process in addition to a biopsy for definitive diagnosis. Other diagnoses can mimic SBI on imaging, such as nasopharyngeal carcinoma and inflammatory pseudotumor. Culture-guided antimicrobial treatment and surgery are mainstay therapies. Other adjuvant strategies currently lack the robust evidence necessary to characterize their risks and benefits.
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Affiliation(s)
- Phat Tan Nguyen
- Internal Medicine, Kaiser Permanente San Francisco, San Francisco, CA, USA
| | - Jennifer Chang
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Osama Raslan
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Arzu Ozturk
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Matthew Bobinski
- Internal Medicine, Kaiser Permanente San Francisco, San Francisco, CA, USA
| | - Reza Assadsangabi
- Department of Radiology, Keck School of Medicine of USC University of Southern California, Sacramento, CA, USA
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Lechpammer M, Todd A, Tang V, Morningstar T, Borowsky A, Shahlaie K, Kintner JA, McPherson JD, Bishop JW, Fereidouni F, Harmany ZT, Coley N, Zagzag D, Wong JWH, Tao J, Hesson LB, Burnett L, Levenson R. Neuropathological Applications of Microscopy with Ultraviolet Surface Excitation (MUSE): A Concordance Study of Human Primary and Metastatic Brain Tumors. Brain Sci 2024; 14:108. [PMID: 38275528 PMCID: PMC10813539 DOI: 10.3390/brainsci14010108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Whereas traditional histology and light microscopy require multiple steps of formalin fixation, paraffin embedding, and sectioning to generate images for pathologic diagnosis, Microscopy using Ultraviolet Surface Excitation (MUSE) operates through UV excitation on the cut surface of tissue, generating images of high resolution without the need to fix or section tissue and allowing for potential use for downstream molecular tests. Here, we present the first study of the use and suitability of MUSE microscopy for neuropathological samples. MUSE images were generated from surgical biopsy samples of primary and metastatic brain tumor biopsy samples (n = 27), and blinded assessments of diagnoses, tumor grades, and cellular features were compared to corresponding hematoxylin and eosin (H&E) images. A set of MUSE-treated samples subsequently underwent exome and targeted sequencing, and quality metrics were compared to those from fresh frozen specimens. Diagnostic accuracy was relatively high, and DNA and RNA integrity appeared to be preserved for this cohort. This suggests that MUSE may be a reliable method of generating high-quality diagnostic-grade histologic images for neuropathology on a rapid and sample-sparing basis and for subsequent molecular analysis of DNA and RNA.
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Affiliation(s)
- Mirna Lechpammer
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
- Department of Biochemistry and Molecular Pharmacology, New York University Langone Medical Center, New York, NY 10016, USA
- Pathology and Laboratory Operations, Foundation Medicine, Inc., Cambridge, MA 02141, USA
| | - Austin Todd
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
| | - Vivian Tang
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
| | - Taryn Morningstar
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
| | - Alexander Borowsky
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
| | - Kiarash Shahlaie
- Department of Neurosurgery, University of California Davis Health, Sacramento, CA 95817, USA;
| | - John A. Kintner
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
| | - John D. McPherson
- Department of Biochemistry and Molecular Medicine, University of California Davis Health, Sacramento, CA 95817, USA;
| | - John W. Bishop
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
| | - Farzad Fereidouni
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
| | - Zachary T. Harmany
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
| | - Nicholas Coley
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
| | - David Zagzag
- Departments of Pathology and Neurosurgery, New York University Langone Medical Center, New York, NY 10016, USA;
| | - Jason W. H. Wong
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China;
| | - Jiang Tao
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst NSW 2010, Australia; (J.T.); (L.B.H.); (L.B.)
- School of Clinical Medicine, University of New South Wales Sydney, St Vincent’s Healthcare Clinical Campus, Darlinghurst NSW 2010, Australia
| | - Luke B. Hesson
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst NSW 2010, Australia; (J.T.); (L.B.H.); (L.B.)
- Department of Molecular Genetics, Douglass Hanly Moir Pathology, Macquarie Park NSW 2113, Australia
- School of Clinical Medicine, University of New South Wales Sydney, Randwick NSW 2052, Australia
| | - Leslie Burnett
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst NSW 2010, Australia; (J.T.); (L.B.H.); (L.B.)
- School of Clinical Medicine, University of New South Wales Sydney, St Vincent’s Healthcare Clinical Campus, Darlinghurst NSW 2010, Australia
| | - Richard Levenson
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.T.); (V.T.); (T.M.); (A.B.); (J.A.K.); (J.W.B.); (F.F.); (Z.T.H.); (N.C.); (R.L.)
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Yu N, Raslan OA, Lee HS, Theeler BJ, Raafat TA, Fragoso R, Shahlaie K, Aboud O. Promising response to vemurafenib and cobimetinib treatment for BRAF V600E mutated craniopharyngioma: a case report and literature review. CNS Oncol 2024; 13:CNS106. [PMID: 38348829 DOI: 10.2217/cns-2023-0018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Craniopharyngiomas are tumors that arise from the remnants of Rathke's pouch along the nasopharynx to the diencephalon. Current standard of care includes maximal surgical resection versus adjuvant radiation if a maximal resection is unfeasible. Pharmacological therapy with MAPK targeted agents is an emerging therapeutic option for tumors with BRAF V600E mutations. We report a 45-year-old male with a strictly third ventricle papillary craniopharyngioma with a BRAF V600E mutation. After initial surgery with subtotal resection, the patient demonstrated durable response to targeted BRAF and MEK inhibitor therapy with vemurafenib and cobimetinib. Our report suggests that targeted therapy may reduce the need for radiation and impact surgical interventions in select cases.
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Affiliation(s)
- Nina Yu
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Osama A Raslan
- Department of Radiology, Division of Neuroradiology, University of California Davis, Sacramento, CA 95817, USA
| | - Han Sung Lee
- Department of Pathology, University of California Davis, Sacramento, CA 95817, USA
| | - Brett J Theeler
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Tarek A Raafat
- Department of Radiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ruben Fragoso
- Department of Radiation Oncology, University of California, Davis, Sacramento, CA 95817, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | - Orwa Aboud
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
- Department of Neurology, University of California, Davis, Sacramento, CA 95817, USA
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
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Ernst LD, Raslan AM, Wabulya A, Shin HW, Cash SS, Yang JC, Sagi V, King-Stephens D, Damisah EC, Ramos A, Hussain B, Toprani S, Brandman DM, Shahlaie K, Kanth K, Arain A, Peters A, Rolston JD, Berns M, Patel SI, Uysal U. Responsive neurostimulation as a treatment for super-refractory focal status epilepticus: a systematic review and case series. J Neurosurg 2024; 140:201-209. [PMID: 37329518 DOI: 10.3171/2023.4.jns23367] [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: 02/16/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Super-refractory status epilepticus (SRSE) has high rates of morbidity and mortality. Few published studies have investigated neurostimulation treatment options in the setting of SRSE. This systematic literature review and series of 10 cases investigated the safety and efficacy of implanting and activating the responsive neurostimulation (RNS) system acutely during SRSE and discusses the rationale for lead placement and selection of stimulation parameters. METHODS Through a literature search (of databases and American Epilepsy Society abstracts that were last searched on March 1, 2023) and direct contact with the manufacturer of the RNS system, 10 total cases were identified that utilized RNS acutely during SE (9 SRSE cases and 1 case of refractory SE [RSE]). Nine centers obtained IRB approval for retrospective chart review and completed data collection forms. A tenth case had published data from a case report that were referenced in this study. Data from the collection forms and the published case report were compiled in Excel. RESULTS All 10 cases presented with focal SE: 9 with SRSE and 1 with RSE. Etiology varied from known lesion (focal cortical dysplasia in 7 cases and recurrent meningioma in 1) to unknown (2 cases, with 1 presenting with new-onset refractory focal SE [NORSE]). Seven of 10 cases exited SRSE after RNS placement and activation, with a time frame ranging from 1 to 27 days. Two patients died of complications due to ongoing SRSE. Another patient's SE never resolved but was subclinical. One of 10 cases had a device-related significant adverse event (trace hemorrhage), which did not require intervention. There was 1 reported recurrence of SE after discharge among the cases in which SRSE resolved up to the defined endpoint. CONCLUSIONS This case series offers preliminary evidence that RNS is a safe and potentially effective treatment option for SRSE in patients with 1-2 well-defined seizure-onset zone(s) who meet the eligibility criteria for RNS. The unique features of RNS offer multiple benefits in the SRSE setting, including real-time electrocorticography to supplement scalp EEG for monitoring SRSE progress and response to treatment, as well as numerous stimulation options. Further research is indicated to investigate the optimal stimulation settings in this unique clinical scenario.
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Affiliation(s)
| | - Ahmed M Raslan
- 2Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Angela Wabulya
- 3Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Hae Won Shin
- 4Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Sydney S Cash
- 5Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jimmy C Yang
- 6Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vishwanath Sagi
- 7Department of Neurology, University of Louisville, Kentucky
| | | | | | - Alexander Ramos
- 10Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland
| | | | | | - David M Brandman
- 12Neurological Surgery, University of California, Davis, California
| | - Kiarash Shahlaie
- 12Neurological Surgery, University of California, Davis, California
| | | | - Amir Arain
- 13Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Angela Peters
- 13Department of Neurology, University of Utah, Salt Lake City, Utah
| | - John D Rolston
- 14Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Meaghan Berns
- 15Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | - Sima I Patel
- 15Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | - Utku Uysal
- 16Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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Do T, Wang JK, Steele T, Strong EB, Shahlaie K, Liu YA. Neuro-ophthalmic features of patients with spontaneous cerebrospinal fluid leaks. Med Hypothesis Discov Innov Ophthalmol 2023; 12:106-114. [PMID: 38476573 PMCID: PMC10926311 DOI: 10.51329/mehdiophthal1476] [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] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/29/2023] [Indexed: 03/14/2024]
Abstract
Background Increased intracranial pressure is a potential cause of spontaneous cerebrospinal fluid (sCSF) leak. Associated neuro-ophthalmic features have not been well studied, particularly relationships with idiopathic intracranial hypertension (IIH). We hypothesized that neuro-ophthalmic features routinely used in evaluations for IIH can be useful in the investigation of a causal relationship between IIH and sCSF leak. We reviewed the neuro-ophthalmic examination and office-based ophthalmic imaging data of all consecutive patients with sCSF leaks and at least one repair to investigate the clinical and neuro-ophthalmic features of increased intracranial pressure. Methods We conducted a retrospective longitudinal study at a single institution by querying the electronic medical record system for CSF leak Current Procedural Terminology (CPT) codes (G96.00 and G96.01) from June 1, 2019, to July 31, 2022. For patients with a confirmed diagnosis of sCSF leak, demographic information, eye examination results, and ophthalmic imaging details for both eyes were collected. Results A total of 189 patients with CSF leaks were identified through CPT coding; 159 had iatrogenic or traumatic CSF leaks, and 30 individuals (3 male, 27 female) had confirmed sCSF leaks. The mean age of patients with sCSF leaks was 46 years (range: 29 - 81), with a mean body mass index of 35.2 kg/m2 (range: 18.2 - 54.1). Only 11 of 30 underwent eye examinations (8 before surgical repair and 10 after). The mean pre-repair and post-repair best-corrected visual acuity were 20/30 (range: 20/20 - 20/55) and 20/25 (range: 20/20 - 20/40), respectively (P = 0.188). The mean retinal nerve fiber layer thickness was 99 µm (range: 96 - 104) pre-repair and 97 µm (range: 84 - 103) post-repair (P = 0.195). The mean ganglion cell complex thickness was 84 µm (range: 72 - 94) pre-repair and 82 µm (range: 71 - 94) post-repair (P = 0.500). Humphrey visual field average mean deviation was -5.1 (range: -12.4 - -1.8) pre-repair and -1.0 (range: -10.1 - 2.1) post-repair (P = 0.063). Conclusions Serial neuro-ophthalmic examinations are recommended for patients with sCSF leaks to screen for signs of current or prior increased intracranial pressure. Larger studies are required to clarify the longitudinal changes in neuro-ophthalmic features, to investigate the incidence of IIH in cases of sCSF leak development or recurrence after surgical repair, and to explore potential causal relationships to guide post-repair management and prevent recurrent leaks. A multicenter consortium is also suggested to develop a standard clinical protocol for comprehensive management of sCSF leaks.
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Affiliation(s)
- Timothy Do
- School of Medicine, University of California, Davis, USA
| | - Jui-Kai Wang
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Health System, Iowa, USA
| | - Toby Steele
- Department of Otorhinolaryngology, University of California, Davis, USA
| | - E. Bradley Strong
- Department of Otorhinolaryngology, University of California, Davis, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, USA
| | - Yin Allison Liu
- Department of Neurological Surgery, University of California, Davis, USA
- Department of Ophthalmology, University of California, Davis, USA
- Department of Neurology, University of California, Davis, USA
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9
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Yu N, Hoch JS, Martin AR, Shahlaie K. Trends in successfully matched neurosurgery residency applicants. J Neurosurg 2023; 139:1456-1462. [PMID: 37086164 DOI: 10.3171/2023.3.jns222397] [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: 10/20/2022] [Accepted: 03/06/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The United States Medical Licensing Examination (USMLE) Step 1 recently transitioned to a pass/fail outcome, renewing interest in how programs select neurosurgical residents. This study investigates the association between match status and key academic metrics over time. METHODS Data are from the National Resident Matching Program from 2009 to 2022 for matched and unmatched US allopathic (MD) seniors. Investigated metrics included the mean number of contiguous ranks; mean number of distinct specialties ranked; mean USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores; mean number of abstracts, presentations, and publications; mean number of research, work, and volunteer experiences; Alpha Omega Alpha status; attendance at a top 40 NIH-funded institution; PhD degree; and other degree. Multiple linear regression without an interaction term was used to evaluate how these have varied between the two groups during the study period and whether there is a difference between unmatched and matched MD seniors applying for a neurosurgical residency. Multiple linear regression with an interaction term was then used to test whether the difference in variables between the two groups changed over time. RESULTS Regardless of match status, MD senior neurosurgical residency applicants exhibited an increase in USMLE Step 1 and 2 scores; average research experiences; abstracts, presentations, and publications; and work and volunteer experiences (p < 0.001). The percentage of applicants from a top 40 NIH-funded school decreased (p = 0.018), and the percentage who held an additional degree increased (p = 0.007). Between groups, there were significant differences in all categories except work experiences and other degree obtained. Over time, the difference between USMLE Step 2 scores between matched and unmatched seniors diminished (p = 0.027); in contrast, the difference in abstracts, presentations, and publications between the two groups increased over time (p < 0.001). CONCLUSIONS From 2009 to 2022, neurosurgical residency applicants grew in their achievements across many metrics. In the advent of Step 1 becoming pass/fail, this study suggests that Step 2 is not viewed by programs as an adequate replacement. However, the Step 1 grading transition may serve as an opportunity for other factors to be considered that may better predict success in neurosurgical residency.
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Affiliation(s)
- Nina Yu
- 1University of California, Davis, School of Medicine, Sacramento
| | - Jeffrey S Hoch
- 2Department of Public Health Sciences, Division of Health Policy and Management, Center for Healthcare Policy and Research, University of California, Davis, School of Medicine, Sacramento
| | - Allan R Martin
- 3Department of Neurological Surgery, University of California, Davis, Medical Center, Sacramento, California
| | - Kiarash Shahlaie
- 3Department of Neurological Surgery, University of California, Davis, Medical Center, Sacramento, California
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Robinow ZM, Peterson C, Riestenberg R, Waldau B, Yu N, Shahlaie K. Cosmetic Outcomes of Supraorbital Keyhole Craniotomy Via Eyebrow Incision: A Systematic Review and Meta-Analysis. J Neurol Surg B Skull Base 2023; 84:470-498. [PMID: 37671300 PMCID: PMC10477017 DOI: 10.1055/s-0042-1755575] [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: 06/01/2022] [Accepted: 07/08/2022] [Indexed: 10/14/2022] Open
Abstract
Background Supraorbital eyebrow craniotomy is a minimally invasive alternative to a frontotemporal craniotomy and is often used for tumor and vascular pathologies. The purpose of this study was to investigate how patient cosmetic outcomes are affected by technique variations of this approach. Methods PubMed, Embase, and Scopus databases were systematically searched, and results were reported according to PRISMA guidelines. For the meta-analysis portion, the DerSimonian-Laird random effects model was used, and the primary end points were patient satisfaction and percentage of permanent cosmetic complications. Results A total of 2,629 manuscripts were identified. Of those, 124 studies (8,241 surgical cases) met the inclusion criteria. Overall, 93.04 ± 11.93% of patients reported favorable cosmetic outcome following supraorbital craniotomy, and mean number of cases with permanent cosmetic complications was 6.62 ± 12.53%. We found that vascular cases are associated with more favorable cosmetic outcomes than tumor cases ( p = 0.0001). Addition of orbital osteotomy or use of a drain is associated with adverse cosmetic outcomes ( p = 0.001 and p = 0.0001, respectively). The location of incision, size of craniotomy, utilization of an endoscope, method of cranial reconstruction, skin closure, use of antibiotics, and addition of pressure dressing did not significantly impact cosmetic outcomes ( p > 0.05 for all). Conclusions Supraorbital craniotomy is a minimally invasive technique associated with generally high favorable cosmetic outcomes. While certain techniques used in supraorbital keyhole approach do not pose significant cosmetic risks, utilization of an orbital osteotomy and the addition of a drain correlate with unfavorable cosmetic outcomes.
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Affiliation(s)
- Zoe M. Robinow
- California Northstate University College of Medicine, Elk Grove, California, United States
| | - Catherine Peterson
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Robert Riestenberg
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Ben Waldau
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Nina Yu
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
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11
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Ghaffari-Rafi A, Choi SY, Leon-Rojas J, Shahlaie K. Predictors of Multi-Vessel Identification, Outcome, and Optimal Surgical Timing for Microvascular Decompression in Hemifacial Spasm. Clin Neurol Neurosurg 2023; 233:107841. [PMID: 37544024 DOI: 10.1016/j.clineuro.2023.107841] [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: 05/13/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES AND BACKGROUND Hemifacial spasm (HFS) is a disabling condition that imposes significant burden upon patients. Microvascular decompression (MVD) surgery is the most effective and long-lasting treatment for HFS, but outcomes following this surgery may vary based on a variety of clinical and operative factors. A more thorough understanding of the variables that impact patient outcome after MVD surgery is needed. METHODS A systematic review and meta-analysis of Medline, Embase, and Central was conducted (n = 2108 screened; n = 86 included) with the goal of determining the impact of the following variables on outcome: duration of disease, geographic location, intraoperative use of an endoscope, and intraoperative finding of single versus multi-vessel neurovascular compression. RESULTS Most cases of hemifacial spasm occur on the left side (53.9%, p < 0.001) and are more common in women than men (66.5% versus 33.5%, p < 0.0001). The offending vessel frequencies were: 40.8% anterior inferior cerebellar artery [AICA], 24.9% posterior inferior cerebellar artery [PICA], 17.2% multiple vessels, and 4.7% vertebral artery [VA]. Multiple vessel combinations involved: 26.5% PICA + AICA, 24.6% PICA + VA, 23.1% AICA + VA, and 4.7% AICA + PICA + VA. Relative to the Americas, AICA was less frequent in Europe (p = 0.005), while PICA more frequent in Europe (p = 0.009) and Asia (p < 0.0001). With endoscope assistance, frequency of multiple vessels identified was 31.7% (versus 14.7% with non-endoscopic, p = 0.005), and 27.4% for AICA (43.5% with non-endoscopic, p = 0.003). Spasm improvement was 94.1% near discharge and 96.0% at maximum follow-up. Complications occurred in 16.5% of cases, with spasm recurrence in 2.4%. Greatest frequency of spasm improvement (p < 0.0001) and lowest spasm recurrence rates (p = 0.0005) were reported in series from Asia. For every additional month of pre-operative spasm, the effect size of post-operative improvement decreased (p = 0.04). With every subsequent postoperative month, the effect size of spasm improvement increased (p = 0.0497). The frequency of spasm improvement was significantly higher in series published after 2005 (94.4% versus 97.4%, p = 0.005). CONCLUSION Clinical outcomes following MVD for HFS have improved since 2005. Consideration should be given to earlier operation (shorter disease duration) and use of an endoscope may increase detection of multiple offending vessels. Further studies are needed to understand regional differences in culprit vessel incidence and surgical outcomes in the Americas, Europe, and Asia.
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Affiliation(s)
- Arash Ghaffari-Rafi
- University of California, Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA; University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA.
| | - So Yung Choi
- University of Hawai'i at Mānoa, John A. Burns School of Medicine, Department of Quantitative Health Sciences, Biostatistics Core Facility, Honolulu, HI, USA
| | - Jose Leon-Rojas
- Universidad de las Americas, Escuela de Medicina, Quito, Ecuador; University College London, Queen Square Institute of Neurology, London, England, UK
| | - Kiarash Shahlaie
- University of California, Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA.
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12
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Tang SJ, Mor S, Fine J, Shahlaie K. 804 The Association Between Hyperoxia after TBI and Degree of Disability in Pediatric Patients. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_804] [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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13
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Jude MB, Izadi A, Shahlaie K, Gurkoff GG. 333 Intraventricular Ziconotide Improves Cognitive Outcomes following Lateral Fluid Percussion Injury in a Rat Model. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_333] [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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14
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Scurfield AK, Wilson MD, Gurkoff G, Martin R, Shahlaie K. Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage. Neurocrit Care 2023; 38:149-157. [PMID: 36050537 PMCID: PMC9957945 DOI: 10.1007/s12028-022-01587-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/08/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The presence of traumatic intraventricular hemorrhage (tIVH) following traumatic brain injury (TBI) is associated with worse neurological outcome. The mechanisms by which patients with tIVH have worse outcome are not fully understood and research is ongoing, but foundational studies that explore prognostic factors within tIVH populations are also lacking. This study aimed to further identify and characterize demographic and clinical variables within a subset of patients with TBI and tIVH that may be implicated in tIVH outcome. METHODS In this observational study, we reviewed a large prospective TBI database to determine variables present on admission that predicted neurological outcome 6 months after injury. A review of 7,129 patients revealed 211 patients with tIVH on admission and 6-month outcome data. Hypothesized risk factors were tested in univariate analyses with significant variables (p < 0.05) included in logistic and linear regression models. Following the addition of either the Rotterdam computed tomography or Glasgow Coma Scale (GCS) score, we employed a backward selection process to determine significant variables in each multivariate model. RESULTS Our study found that that hypotension (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.13-0.94, p = 0.04) and the hemoglobin level (OR = 1.33, 95% CI = 1.09-1.63, p = 0.006) were significant predictors in the Rotterdam model, whereas only the hemoglobin level (OR = 1.29, 95% CI = 1.06-1.56, p = 0.01) was a significant predictor in the GCS model. CONCLUSIONS This study represents one of the largest investigations into prognostic factors for patients with tIVH and demonstrates that admission hemoglobin level and hypotension are associated with outcomes in this patient population. These findings add value to established prognostic scales, could inform future predictive modeling studies, and may provide potential direction in early medical management of patients with tIVH.
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Affiliation(s)
- Abby K Scurfield
- Frank H. Netter M.D. School of Medicine, Quinnipiac University, 830 Orange Street, New Haven, CT, 06511, USA
| | - Machelle D Wilson
- Division of Biostatistics, Department of Public Health Sciences, Davis Clinical and Translational Science Center, University of California, 2921 Stockton Blvd., Suite 1400, Sacramento, CA, 95817, USA
| | - Gene Gurkoff
- Department of Neurological Surgery, University of California, 4860 Y Street, Suite 3740,, 95817, Davis, Sacramento, CA, USA
| | - Ryan Martin
- Department of Neurological Surgery, University of California, 4860 Y Street, Suite 3740,, 95817, Davis, Sacramento, CA, USA
- Department of Neurology, University of California, 4860 Y Street, Suite 3740,, Davis, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, 4860 Y Street, Suite 3740,, 95817, Davis, Sacramento, CA, USA.
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15
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Robinow ZM, Peterson C, Waldau B, Shahlaie K. In Reply to the Letter to the Editor Regarding "Supraorbital Keyhole Craniotomy via Eyebrow Incision: A Systematic Review and Meta-Analysis". World Neurosurg 2022; 166:301. [PMID: 36192857 DOI: 10.1016/j.wneu.2022.07.100] [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] [Received: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Zoe M Robinow
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Catherine Peterson
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
| | - Ben Waldau
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA.
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16
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Far R, Saez I, Sardo A, Ovruchesky E, Sperry L, Zhang L, Shahlaie K, Girgis F. Subthalamic nucleus deep brain stimulation programming settings do not correlate with Parkinson's disease severity. Acta Neurochir (Wien) 2022; 164:2271-2278. [PMID: 35751700 DOI: 10.1007/s00701-022-05279-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD). While the success of DBS is dependent on careful patient selection and accurate lead placement, programming parameters play a pivotal role in tailoring therapy on the individual level. Various algorithms have been developed to streamline the initial programming process, but the relationship between pre-operative patient characteristics and post-operative device settings is unclear. In this study, we investigated how PD severity correlates with DBS settings. METHODS We conducted a retrospective review of PD patients who underwent DBS of the subthalamic nucleus at one US tertiary care center between 2014 and 2018. Pre-operative patient characteristics and post-operative programming data at various intervals were collected. Disease severity was measured using the Unified Parkinson's Disease Rating Scale score (UPDRS) as well as levodopa equivalent dose (LED). Correlation analyses were conducted looking for associations between pre-operative disease severity and post-operative programming parameters. RESULTS Fifty-six patients were analyzed. There was no correlation between disease severity and any of the corresponding programming parameters. Pre-operative UPDRS scores on medication were similar to post-operative scores with DBS. Settings of amplitude, frequency, and pulse width increased significantly from 1 to 6 months post-operatively. Stimulation volume, inferred by the distance between contacts used, also increased significantly over time. CONCLUSIONS Interestingly, we found that patients with more advanced disease responded to electrical stimulation similarly to patients with less advanced disease. These data provide foundational knowledge of DBS programming parameters used in a single cohort of PD patients over time.
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Affiliation(s)
- Rena Far
- Department of Clinical Neurosciences, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - Ignacio Saez
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
| | - Angela Sardo
- School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Eric Ovruchesky
- School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Laura Sperry
- Department of Neurology, University of California Davis, Sacramento, CA, USA
| | - Lin Zhang
- Department of Neurology, University of California Davis, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
| | - Fady Girgis
- Department of Clinical Neurosciences, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
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17
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Gill AS, Biggs PC, Hagwood G, Beliveau AM, Shahlaie K, Strong EB, Steele TO. Health Literacy and Web-Based Audiovisual Multimedia in Pituitary and Endoscopic Skull Base Surgery. Skull Base Surg 2022; 83:e401-e409. [DOI: 10.1055/s-0041-1729979] [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: 07/07/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
Abstract
Introduction The internet presents a rich milieu of multimedia options relating to pituitary and endoscopic skull base surgery (ESBS). Misinformation can create discordance between patient and provider expectations. The purpose of this study is to analyze the understandability and actionability of available ESBS and pituitary surgery audiovisual information on YouTube and Google.
Methods The top 50 videos generated by searching “pituitary surgery/transsphenoidal surgery” and “endoscopic skull base surgery” in both YouTube and Google were sorted by relevance. Two independent reviewers evaluated each for understandability and actionability based on the Patient Education Materials Assessment Tool for audiovisual material (PEMAT-A/V). Source, authorship, audience, and education/advertisement variables were collected. Chi-square test followed by univariate and multivariate regression analyses assessed the association between these variables and quality.
Results A total of 85 videos (52 YouTube and 33 Google) met inclusion criteria for analysis. There was no significant difference in the presence of the aforementioned variables between YouTube and Google (p < 0.05). Also, 72% of videos targeted patients and 28% targeted surgeons. Academic institutions uploaded 58% of videos. Surgeon-targeted videos were more educational (p = 0.01) and patient-targeted videos involved more advertisement (p = 0.01). Understandability and actionability scores were below the 70% threshold for both YouTube (65 ± 15, 38 ± 33, p = 0.65) and Google (66 ± 12, 38 ± 26, p = 0.94). Patient-targeted videos (p = 0.002) were more understandable, while surgeon- (p < 0.001) and education-focused videos (p < 0.001) were more actionable.
Conclusion Understandability and actionability of YouTube and Google audiovisual patient information on ESBS and pituitary surgery is poor. Consideration should be given to the formation of a standardized patient information resource.
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Affiliation(s)
- Amarbir S. Gill
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Philip C. Biggs
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Garrett Hagwood
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Angela M. Beliveau
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - E. B. Strong
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Toby O. Steele
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
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18
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Riestenberg RA, Sherman AE, Clark AJS, Shahlaie K, Zwienenberg M, Alden T, Bandt SK. Patient-Specific Characteristics Associated with Favorable Response to Vagus Nerve Stimulation. World Neurosurg 2022; 161:e608-e624. [PMID: 35202878 DOI: 10.1016/j.wneu.2022.02.055] [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: 11/02/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The expansion in treatments for medically refractory epilepsy heightens the importance of identifying patients who are likely to benefit from vagus nerve stimulation (VNS). Here, we identify predictors with a positive VNS response. METHODS We present a retrospective analysis of 158 patients with medically refractory epilepsy. Patients were categorized as VNS responders or nonresponders. Baseline characteristics and time to VNS response were recorded. Univariate and multivariate Cox regression were used to identify predictors of response. Recursive partitioning analysis was used to identify likely VNS responders. RESULTS Eighty-nine (56.3%) patients achieved ≥50% seizure frequency reduction. Left-hand dominance (hazard ratio [HR] 1.703, P = 0.038), age at epilepsy onset ≥15 years (HR 2.029, P = 0.005), duration of epilepsy ≥8 years (HR 1.968, P = 0.007) and age at implantation ≥35 years (HR 1.809, P = 0.020), and baseline seizure frequency <5/month (HR 1.569, P = 0.044) were significant univariate predictors of VNS response. Following multivariate Cox regression, left-hand dominance, age at epilepsy onset ≥15 years, and duration of epilepsy ≥8 years remained significant. With recursive partitioning analysis, patients with either age at epilepsy onset ≥15 years, left-hand dominance, or baseline seizure frequency <5/month were stratified into Group A and had a 73.9% responder rate; the remaining patients stratified into Group B had a 43.8% responder rate. CONCLUSIONS Patients with age at epilepsy onset ≥15 years, left-hand dominance, or baseline seizure frequency <5/month are ideal candidates for VNS.
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Affiliation(s)
- Robert A Riestenberg
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA.
| | - Alain E Sherman
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Austin J S Clark
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Marike Zwienenberg
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Tord Alden
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - S Kathleen Bandt
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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19
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Lubomirsky B, Jenner ZB, Jude MB, Shahlaie K, Assadsangabi R, Ivanovic V. Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches. Neuroradiol J 2021; 35:269-283. [PMID: 34856828 DOI: 10.1177/19714009211055195] [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] [Indexed: 12/12/2022] Open
Abstract
The sellar, suprasellar, and parasellar space contain a vast array of pathologies, including neoplastic, congenital, vascular, inflammatory, and infectious etiologies. Symptoms, if present, include a combination of headache, eye pain, ophthalmoplegia, visual field deficits, cranial neuropathy, and endocrine manifestations. A special focus is paid to key features on CT and MRI that can help in differentiating different pathologies. While most lesions ultimately require histopathologic evaluation, expert knowledge of skull base anatomy in combination with awareness of key imaging features can be useful in limiting the differential diagnosis and guiding management. Surgical techniques, including endoscopic endonasal and transcranial neurosurgical approaches are described in detail.
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Affiliation(s)
- Bryan Lubomirsky
- Department of Radiology, Section of Neuroradiology, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Zachary B Jenner
- Department of Radiology, Diagnostic and Interventional Radiology Residency, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Morgan B Jude
- School of Medicine, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Reza Assadsangabi
- Department of Radiology, Section of Neuroradiology, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Vladimir Ivanovic
- Department of Radiology, Section of Neuroradiology, 21772University of California Davis Medical Center, Sacramento, CA, USA
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20
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Izadi A, Schedlbauer A, Ondek K, Disse G, Ekstrom AD, Cowen SL, Shahlaie K, Gurkoff GG. Early Intervention via Stimulation of the Medial Septal Nucleus Improves Cognition and Alters Markers of Epileptogenesis in Pilocarpine-Induced Epilepsy. Front Neurol 2021; 12:708957. [PMID: 34557145 PMCID: PMC8452867 DOI: 10.3389/fneur.2021.708957] [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: 05/13/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Over one-third of patients with temporal lobe epilepsy are refractory to medication. In addition, anti-epileptic drugs often exacerbate cognitive comorbidities. Neuromodulation is an FDA treatment for refractory epilepsy, but patients often wait >20 years for a surgical referral for resection or neuromodulation. Using a rodent model, we test the hypothesis that 2 weeks of theta stimulation of the medial septum acutely following exposure to pilocarpine will alter the course of epileptogenesis resulting in persistent behavioral improvements. Electrodes were implanted in the medial septum, dorsal and ventral hippocampus, and the pre-frontal cortex of pilocarpine-treated rats. Rats received 30 min/day of 7.7 Hz or theta burst frequency on days 4-16 post-pilocarpine, prior to the development of spontaneous seizures. Seizure threshold, spikes, and oscillatory activity, as well as spatial and object-based learning, were assessed in the weeks following stimulation. Non-stimulated pilocarpine animals exhibited significantly decreased seizure threshold, increased spikes, and cognitive impairments as compared to vehicle controls. Furthermore, decreased ventral hippocampal power (6-10 Hz) correlated with both the development of spikes and impaired cognition. Measures of spikes, seizure threshold, and cognitive performance in both acute 7.7 Hz and theta burst stimulated animals were statistically similar to vehicle controls when tested during the chronic phase of epilepsy, weeks after stimulation was terminated. These data indicate that modulation of the septohippocampal circuit early after pilocarpine treatment alters the progression of epileptic activity, resulting in elevated seizure thresholds, fewer spikes, and improved cognitive outcome. Results from this study support that septal theta stimulation has the potential to serve in combination or as an alternative to high frequency thalamic stimulation in refractory cases and that further research into early intervention is critical.
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Affiliation(s)
- Ali Izadi
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Amber Schedlbauer
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States
| | - Katelynn Ondek
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Gregory Disse
- Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Arne D Ekstrom
- Department of Psychology, University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Stephen L Cowen
- Department of Psychology, University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
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21
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Reddy RK, Gill AS, Hwang J, Wilson MD, Shahlaie K, Harsh GR, Strong EB, Steele TO. Surgeon education through a surgical cost feedback system reduces supply cost in endoscopic skull base surgery. J Neurosurg 2021; 136:422-430. [PMID: 34388725 DOI: 10.3171/2021.2.jns203208] [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: 08/20/2020] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A large proportion of healthcare expense is operating room (OR) costs. As a means of cost mitigation, several institutions have implemented surgeon education programs to bring awareness about supply costs. This study evaluates the impact of a surgical cost feedback system (surgical receipt) on the supply costs of endoscopic skull base surgery (ESBS) procedures. METHODS The supply costs of each ESBS surgical case were prospectively collected and analyzed before and after the implementation of a nonincentivized, automated, and itemized weekly surgical receipt system between January 2017 and December 2019. Supply cost data collected 15 months prior to intervention were compared with cost data 21 months after implementation of the surgical receipt system. Demographics, surgical details, and OR time were collected retrospectively. RESULTS Of 105 ESBS procedures analyzed, 36 preceded and 69 followed implementation of cost feedback. There were no significant differences in patient age (p = 0.064), sex (p = 0.489), surgical indication (p = 0.389), or OR anesthesia time (p = 0.51) for patients treated before and after implementation. The mean surgical supply cost decreased from $3824.41 to $3010.35 (p = 0.002) after implementation of receipt feedback. Usage of dural sealants (p = 0.043), microfibrillar collagen hemostat (p = 0.007), and oxidized regenerated cellulose hemostat (p < 0.0001) and reconstructive technique (p = 0.031) significantly affected cost. Mediation analysis confirmed that the overall cost reduction was predominantly driven by reduced use of dural sealant; this cost saving exceeded the incremental cost of greater use of packing materials such as microfibrillar collagen hemostat. CONCLUSIONS Education of surgeons regarding surgical supply costs by a surgical receipt feedback system can reduce the supply cost per case of ESBS operations.
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Affiliation(s)
- Renuka K Reddy
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento
| | - Amarbir S Gill
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento
| | - Joshua Hwang
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento
| | - Machelle D Wilson
- 3Department of Public Health Sciences/Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento; and
| | - Kiarash Shahlaie
- 2University of California Davis Department of Neurological Surgery, Sacramento
| | - Griffith R Harsh
- 2University of California Davis Department of Neurological Surgery, Sacramento
| | - E Bradley Strong
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento
| | - Toby O Steele
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento.,4VA Northern California Healthcare System, Sacramento, California
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22
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Lee D, Omofoye OA, Karnati T, Graff JP, Shahlaie K. Intracranial myeloid sarcoma presentation in distant acute myeloid leukemia remission. J Clin Neurosci 2021; 89:158-160. [PMID: 34119261 DOI: 10.1016/j.jocn.2021.05.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/10/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022]
Abstract
Intracranial myeloid sarcoma (IMS) is a rare central nervous system manifestation of hematopoietic neoplasms of myeloid origin. We report the first case of IMS treatment with an isocitrate dehydrogenase-2 (IDH-2) inhibitor, Enasidenib, following surgical resection, whole-brain radiation, and consolidation Etoposide/Cytarabine therapy. A 42-year-old female was diagnosed with IMS after a 10-year remission of her acute myeloid leukemia (AML). She underwent surgical debulking and had postoperative resolution of her visual symptoms. She received adjuvant radiation and medical management, and continues to show no evidence of recurrence or progression at 17 months postoperatively. This case is notable for an isolated IMS presentation in a patient with a very distant history of AML remission, and without evidence of concurrent bone marrow relapse. The goals of neurosurgical intervention should be symptomatic relief of mass effect and pathological diagnosis, due to the sensitivity of IMS to adjuvant radiation and medical management such as IDH-2 inhibitors.
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Affiliation(s)
- Dennis Lee
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
| | - Oluwaseun A Omofoye
- Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Tejas Karnati
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA.
| | - John Paul Graff
- Department of Pathology, University of California Davis, Sacramento, CA, USA.
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA.
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23
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Clark AJ, Samuel R, Saez I, Kennedy J, Seyal M, Shahlaie K, Girgis F. The impact of sub specialization within functional neurosurgery on patient outcomes in a comprehensive epilepsy center. Clin Neurol Neurosurg 2021; 205:106636. [PMID: 33984798 DOI: 10.1016/j.clineuro.2021.106636] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/19/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND One in three patients with epilepsy are medication-refractory and may benefit from investigations and operative treatment at a comprehensive epilepsy center. However, while these centers have capabilities for advanced seizure monitoring and surgical intervention, they are not required to have a functional neurosurgeon who is primarily focused in epilepsy surgery. Therefore, the objective of this study is to determine the impact of having a sub-specialized, epilepsy-focused functional neurosurgeon on patient outcomes. METHODS We conducted a retrospective chart review for all patients who underwent surgical intervention for medically refractory epilepsy at a Level 4 comprehensive Epilepsy Center from 2008 through 2019. Data was divided into two groups: group 1 comprised patients who had surgery before the hiring of a dedicated epilepsy-focused functional neurosurgeon in 2016, and group 2 was afterwards. We compared surgical procedures, significant complications, and seizure outcomes. RESULTS A total of 101 patients underwent 105 operations (52 in group 1 and 53 in group 2), not including intracranial EEG insertion. Compared to group 1, group 2 had more surgeries performed per year (15.1 vs. 6.5), and a significantly lower Engel score at last follow-up (1.78 vs. 2.57; p < 0.001). There was no difference in percentage of cases undergoing iEEG, and no difference in complication rates. CONCLUSIONS In this series, the hiring of a sub-specialized functional neurosurgeon dedicated to epilepsy surgery in a comprehensive epilepsy center was associated with an increase in surgical volume and improved seizure outcomes.
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Affiliation(s)
- Austin Js Clark
- School of Medicine, University of California Davis, Sacramento, CA 95817, United States; Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, United States.
| | - Rikki Samuel
- School of Medicine, University of California Davis, Sacramento, CA 95817, United States
| | - Ignacio Saez
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, United States; Center for Neuroscience, University of California Davis, Davis, CA 95618, United States
| | - Jeffrey Kennedy
- Department of Neurology, University of California Davis, Sacramento, CA 95817, United States
| | - Masud Seyal
- Department of Neurology, University of California Davis, Sacramento, CA 95817, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, United States; Center for Neuroscience, University of California Davis, Davis, CA 95618, United States
| | - Fady Girgis
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada T2N 1N4
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24
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Lee D, Omofoye OA, Nuño MA, Riestenberg RA, Shahlaie K. Treatment Outcomes of Intracranial Myeloid Sarcomas: A Meta-Analysis. World Neurosurg 2021; 148:29-37. [PMID: 33444829 DOI: 10.1016/j.wneu.2021.01.004] [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: 09/27/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Intracranial myeloid sarcomas (IMS) are rare central nervous system manifestations of malignant hematopoietic neoplasms of myeloid origin such as acute myeloid leukemia and chronic myeloid leukemia. Reported cases in the literature are limited to primarily case reports. We present a systematic review of this rare central nervous system tumor, characterizing the clinical presentation, tumor location, histopathology, and available treatment modalities. We correlate these variables with mortality, recurrence, and complications to suggest optimal management strategies for IMS. METHODS A systematic literature search was performed across Ovid MEDLINE, Scopus, and Embase using 14 search terms in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This systematic review examines variables such as patient age, tumor location, size, presenting symptoms, treatment modality, extent of resection, and mortality. We performed descriptive analyses to identify bivariate associations between patient characteristics, treatment, and outcomes. RESULTS The mean age at diagnosis was 34.8 years, and the most common etiology was acute myeloid leukemia (68.8%). The most common presenting symptoms were headache (45.5%), vision complaints (27.3%), and weakness/motor symptoms (21.2%). IMS were most commonly located in the temporal lobe (10.1%), cerebellum (10.1%), or falcine/parasagittal (10.1%) region. Patients who received radiotherapy (P < 0.001) or chemotherapy (P < 0.001) had lower rates of mortality versus those who did not. Surgical treatment and extent of resection were not significantly associated with mortality (P > 0.05). CONCLUSION The use of adjuvant radiotherapy or chemotherapy for IMS significantly reduces mortality, confirming IMS as a cranial manifestation of a systemic disease. Although surgical treatment is indicated for histopathologic diagnosis and to relieve mass effect, the extent of resection does not predict overall survival.
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Affiliation(s)
- Dennis Lee
- Department of Neurological Surgery, University of California, Davis, California, USA; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Oluwaseun A Omofoye
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Miriam A Nuño
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, California, USA
| | - Robert A Riestenberg
- Department of Neurological Surgery, University of California, Davis, California, USA; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, California, USA.
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25
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Ondek K, Pevzner A, Tercovich K, Schedlbauer AM, Izadi A, Ekstrom AD, Cowen SL, Shahlaie K, Gurkoff GG. Recovery of Theta Frequency Oscillations in Rats Following Lateral Fluid Percussion Corresponds With a Mild Cognitive Phenotype. Front Neurol 2020; 11:600171. [PMID: 33343499 PMCID: PMC7746872 DOI: 10.3389/fneur.2020.600171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/28/2020] [Accepted: 10/21/2020] [Indexed: 01/31/2023] Open
Abstract
Whether from a fall, sports concussion, or even combat injury, there is a critical need to identify when an individual is able to return to play or work following traumatic brain injury (TBI). Electroencephalogram (EEG) and local field potentials (LFP) represent potential tools to monitor circuit-level abnormalities related to learning and memory: specifically, theta oscillations can be readily observed and play a critical role in cognition. Following moderate traumatic brain injury in the rat, lasting changes in theta oscillations coincide with deficits in spatial learning. We hypothesized, therefore, that theta oscillations can be used as an objective biomarker of recovery, with a return of oscillatory activity corresponding with improved spatial learning. In the current study, LFP were recorded from dorsal hippocampus and anterior cingulate in awake, behaving adult Sprague Dawley rats in both a novel environment on post-injury days 3 and 7, and Barnes maze spatial navigation on post-injury days 8–11. Theta oscillations, as measured by power, theta-delta ratio, peak theta frequency, and phase coherence, were significantly altered on day 3, but had largely recovered by day 7 post-injury. Injured rats had a mild behavioral phenotype and were not different from shams on the Barnes maze, as measured by escape latency. Injured rats did use suboptimal search strategies. Combined with our previous findings that demonstrated a correlation between persistent alterations in theta oscillations and spatial learning deficits, these new data suggest that neural oscillations, and particularly theta oscillations, have potential as a biomarker to monitor recovery of brain function following TBI. Specifically, we now demonstrate that oscillations are depressed following injury, but as oscillations recover, so does behavior.
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Affiliation(s)
- Katelynn Ondek
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Aleksandr Pevzner
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
| | - Kayleen Tercovich
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Amber M Schedlbauer
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Ali Izadi
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Arne D Ekstrom
- Department of Psychology, The University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, The University of Arizona, Tucson, AZ, United States
| | - Stephen L Cowen
- Department of Psychology, The University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, The University of Arizona, Tucson, AZ, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
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26
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Reddy RK, Gill A, Hwang J, Shahlaie K, Harsh GR, Strong EB, Steele T. The Impact of a Surgical Receipt Cost Feedback System on Operating Room Supply Expense in Endoscopic Skull Base Surgery. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Girgis F, Ovruchesky E, Kennedy J, Seyal M, Shahlaie K, Saez I. Superior accuracy and precision of SEEG electrode insertion with frame-based vs. frameless stereotaxy methods. Acta Neurochir (Wien) 2020; 162:2527-2532. [PMID: 32458403 DOI: 10.1007/s00701-020-04427-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/21/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stereotactic electroencephalography (SEEG) has largely become the preferred method for intracranial seizure localization in epileptic patients due to its low morbidity and minimally invasive approach. While robotic placement is gaining popularity, many centers continue to use manual frame-based and frameless methods for electrode insertion. However, it is unclear how these methods compare in regard to accuracy, precision, and safety. Here, we aim to compare frame-based insertion using a CRW frame (Integra®) and frameless insertion using the StealthStation™ S7 (Medtronic®) navigation system for common temporal SEEG targets. METHODS We retrospectively examined electrode targets in SEEG patients that were implanted with either frame-based or frameless methods at a level 4 epilepsy center. We focused on two commonly used targets: amygdala and hippocampal head. Stealth station software was used to merge pre-operative MR with post-operative CT images for each patient, and coordinates for each electrode tip were calculated in relation to the midcommissural point. These were compared to predetermined ideal coordinates in regard to error and directional bias. RESULTS A total of 81 SEEG electrodes were identified in 23 patients (40 amygdala and 41 hippocampal head). Eight of 45 electrodes (18%) placed with the frameless technique and 0 of 36 electrodes (0%) placed with the frame-based technique missed their target and were not clinically useful. The average Euclidean distance comparing actual to ideal electrode tip coordinates for frameless vs. frame-based techniques was 11.0 mm vs. 7.1 mm (p < 0.001) for the amygdala and 12.4 mm vs. 8.5 mm (p < 0.001) for the hippocampal head, respectively. There were no hemorrhages or clinical complications in either group. CONCLUSIONS Based on this series, frame-based SEEG insertion is significantly more accurate and precise and results in more clinically useful electrode contacts, compared to frameless insertion using a navigation guidance system. This has important implications for centers not currently using robotic insertion.
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Affiliation(s)
- Fady Girgis
- Department of Neurosurgery, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA.
| | - Eric Ovruchesky
- Department of Neurosurgery, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
| | - Jeffrey Kennedy
- Department of Neurology, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
| | - Masud Seyal
- Department of Neurology, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
| | - Kiarash Shahlaie
- Department of Neurosurgery, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
| | - Ignacio Saez
- Department of Neurosurgery, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
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28
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Affiliation(s)
- Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California
| | - Griffith R. Harsh
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California
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29
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Park K, Kanth K, Bajwa S, Girgis F, Shahlaie K, Seyal M. Seizure-related apneas have an inconsistent linkage to amygdala seizure spread. Epilepsia 2020; 61:1253-1260. [PMID: 32391925 DOI: 10.1111/epi.16518] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/03/2019] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) is a frequent cause of death in epilepsy. Respiratory dysfunction is implicated as a critical factor in SUDEP pathophysiology. Human studies have shown that electrical stimulation of the amygdala resulted in apnea, indicating that the amygdala has a role in respiration control. Unilateral amygdala stimulation resulted in immediate onset of respiratory dysfunction occurring only during nose breathing. In small numbers of patients, some but not all spontaneous seizures resulted in apnea occurring shortly after seizure spread to the amygdala. With this study we aimed to determine whether seizure onset or spread to the amygdala was necessary and sufficient to cause apnea. METHODS We investigated the temporal relationship between apnea/hypopnea (AH) onset and initial seizure involvement within the amygdala in patients with implanted depth electrodes. RESULTS Data from 17 patients (11 female) with 47 seizures were analyzed. With seven seizures (three patients), AH preceded amygdala seizure involvement by 2 to 55 seconds. There was no AH with four seizures (three patients) that involved the amygdala. With eight seizures (four patients) AH occurred within 2 seconds following amygdala seizure onset. With 28 seizures, AH started >2 seconds after amygdala seizure onset (range 3-158 seconds). Following seizure onset, there was a significant difference between AH onset time and amygdala seizure onset (P < .001). The mean ± standard deviation (SD) AH onset was 27.8 ± 41.06 seconds, and the mean time to amygdala involvement was 8.83 ± 20.19 seconds. SIGNIFICANCE There is a wide range of AH onset times relative to amygdala seizure involvement. With some seizures, amygdala seizure involvement occurs without AH. With other seizures, AH precedes amygdala seizures, suggesting that, with spontaneous seizures, involvement of the amygdala may not be crucial to induction of AH with all seizures. Other pathophysiology impacting brainstem respiratory networks may be of greater relevance to seizure-triggered apneas.
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Affiliation(s)
- Katherine Park
- Department of Neurology, University of California, Davis, California
| | - Kiran Kanth
- Department of Neurology, University of California, Davis, California
| | - Sami Bajwa
- Department of Neurology, University of California, Davis, California
| | - Fady Girgis
- Department of Neurological Surgery, University of California, Davis, California
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, California
| | - Masud Seyal
- Department of Neurology, University of California, Davis, California
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30
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Riestenberg RA, Omofoye OA, Lee D, Shahlaie K. Subarachnoid fat dissemination secondary to intrathecal pump. J Clin Neurosci 2020; 78:416-417. [PMID: 32362469 DOI: 10.1016/j.jocn.2020.04.120] [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: 03/16/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
Implantable intrathecal infusion pumps (ITPs) are an effective pain management modality for patients who have failed non-operative options. We present the first report of asymptomatic intracranial subarachnoid fat dissemination secondary to an ITP. A 39-year-old who underwent implantation of an ITP for intractable pelvic pain developed altered mental status. CT and MRI revealed subarachnoid fat deposition without evidence of a dermoid or epidermoid cyst. She returned to her baseline mental status with her symptoms attributed to delirium. The rare possibility of subarachnoid fat dissemination following transdural spinal procedures should be considered as a potential complication of ITPs. Although fat may persist in the subarachnoid space for years, asymptomatic patients can be safely managed with observation alone.
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Affiliation(s)
- Robert A Riestenberg
- Northwestern University, Feinberg School of Medicine, 420 E Superior Street, Chicago, IL 60611, USA; University of California, Davis, Department of Neurological Surgery, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA.
| | - Oluwaseun A Omofoye
- University of California, Davis, Department of Neurological Surgery, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA.
| | - Dennis Lee
- University of California, Davis, Department of Neurological Surgery, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA; Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064, USA.
| | - Kiarash Shahlaie
- University of California, Davis, Department of Neurological Surgery, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA.
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31
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Garza N, Toussi A, Wilson M, Shahlaie K, Martin R. The Increasing Age of TBI Patients at a Single Level 1 Trauma Center and the Discordance Between GCS and CT Rotterdam Scores in the Elderly. Front Neurol 2020; 11:112. [PMID: 32153493 PMCID: PMC7045038 DOI: 10.3389/fneur.2020.00112] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 10/04/2019] [Accepted: 01/31/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction: Traumatic brain injury (TBI) is frequently encountered in geriatric patients, but there is a paucity of data describing TBI in the elderly. Here, we show the age of patients with TBI is increasing at our medical center and discuss the relationship between age and injury severity with patient outcomes. Methods: This is a retrospective analysis of 3,179 adult patients with TBI treated at the University of California, Davis Level 1 Trauma Center between 2009 and 2016. Age, Glasgow Coma Scale (GCS), and CT Rotterdam Scores were recorded. Age was analyzed as both a continuous and categorical variable (18-34, 35-50, 51-65, >65 years-old). Extended Glasgow Outcome Scale was obtained at 3 and 6 months and dichotomized into favorable and unfavorable outcomes. Multivariable general linear regression models, chi-square, logistic regression analyses and ANOVA were used for statistical analyses; a p < 0.05 was considered significant. Results: The mean age of patients was 52.2 ± 21.9 years with a male predominance (69%). There was a significant trend (p = 0.002) toward an increase in mean age each year, increasing by 4.4 years (p = 0.008) over the course of the analysis. Older patients had a higher mean GCS compared to younger patients with the same CT Rotterdam Score (p = 0.027), this becoming more pronounced with worse CT Rotterdam Scores. The >65 group had a 4-fold increased risk for unfavorable outcome when compared to the 18-34 group, this effect being most pronounced after mild TBI. Conclusions: The mean age of TBI patients is increasing at our trauma center. The largest disparity in outcomes across age was seen in patients with a mild GCS and low CT Rotterdam Scores, suggesting that these markers of injury severity may underestimate the severity of injury in the elderly population. This information highlights the need for clinical trials and validation of outcome markers in geriatric TBI.
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Affiliation(s)
- Nicholas Garza
- School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Atrin Toussi
- School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Machelle Wilson
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Sacramento, CA, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States
| | - Ryan Martin
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Department of Neurology, University of California, Davis, Sacramento, CA, United States
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32
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Karnati T, Shahlaie K. Book Review. Neurosurgery 2020. [DOI: 10.1093/neuros/nyz429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Goodarzi A, Toussi A, Garza N, Lechpammer M, Brodie H, Diaz RC, Shahlaie K. Internal Acoustic Canal Stenosis Due to Hyperostosis. J Neurol Surg B Skull Base 2019; 81:216-222. [PMID: 32499994 DOI: 10.1055/s-0039-1685530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/08/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022] Open
Abstract
Background Exostoses and osteomas are benign, insidious lesions of the bone involving the internal acoustic canal (IAC). We present two cases of IAC exostoses managed with surgical decompression and review the clinical outcomes of previously reported cases in the literature. Methods A comprehensive search was conducted using PubMed Central, Web of Science Core Collection, and Google Scholar databases to identify previous reports of IAC exostoses and osteomas. A total of 26 reported cases were identified, and patient presenting symptoms, management strategies, and response to surgery was obtained when available. Results Of the 13 patients who underwent surgical decompression, 8 patients had resolution of vertigo symptoms, 10 patients had improvement of tinnitus symptoms, and all patients maintained some level of serviceable hearing. Conclusion IAC exostoses and osteomas are rare lesions that lead to insidious onset of debilitating symptoms from vestibulocochlear nerve dysfunction. Although the role of surgical decompression remains unclear, it appears that patients presenting with vertigo have more favorable response to surgical decompression as compared with those presenting with tinnitus and sensorineural hearing loss.
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Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Atrin Toussi
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Nicholas Garza
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Mirna Lechpammer
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States.,Department of Pathology, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Hilary Brodie
- Department of Otolaryngology/Head and Neck Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Rodney C Diaz
- Department of Otolaryngology/Head and Neck Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
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Greenan K, Taylor SL, Fulkerson D, Shahlaie K, Gerndt C, Krueger EM, Zwienenberg M. Selection of children with ultra-severe traumatic brain injury for neurosurgical intervention. J Neurosurg Pediatr 2019; 23:670-679. [PMID: 30952132 DOI: 10.3171/2019.1.peds18293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 01/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A recent retrospective study of severe traumatic brain injury (TBI) in pediatric patients showed similar outcomes in those with a Glasgow Coma Scale (GCS) score of 3 and those with a score of 4 and reported a favorable long-term outcome in 11.9% of patients. Using decision tree analysis, authors of that study provided criteria to identify patients with a potentially favorable outcome. The authors of the present study sought to validate the previously described decision tree and further inform understanding of the outcomes of children with a GCS score 3 or 4 by using data from multiple institutions and machine learning methods to identify important predictors of outcome. METHODS Clinical, radiographic, and outcome data on pediatric TBI patients (age < 18 years) were prospectively collected as part of an institutional TBI registry. Patients with a GCS score of 3 or 4 were selected, and the previously published prediction model was evaluated using this data set. Next, a combined data set that included data from two institutions was used to create a new, more statistically robust model using binomial recursive partitioning to create a decision tree. RESULTS Forty-five patients from the institutional TBI registry were included in the present study, as were 67 patients from the previously published data set, for a total of 112 patients in the combined analysis. The previously published prediction model for survival was externally validated and performed only modestly (AUC 0.68, 95% CI 0.47, 0.89). In the combined data set, pupillary response and age were the only predictors retained in the decision tree. Ninety-six percent of patients with bilaterally nonreactive pupils had a poor outcome. If the pupillary response was normal in at least one eye, the outcome subsequently depended on age: 72% of children between 5 months and 6 years old had a favorable outcome, whereas 100% of children younger than 5 months old and 77% of those older than 6 years had poor outcomes. The overall accuracy of the combined prediction model was 90.2% with a sensitivity of 68.4% and specificity of 93.6%. CONCLUSIONS A previously published survival model for severe TBI in children with a low GCS score was externally validated. With a larger data set, however, a simplified and more robust model was developed, and the variables most predictive of outcome were age and pupillary response.
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Affiliation(s)
- Krista Greenan
- 1Department of Neurological Surgery, University of California, Davis.,3Department of Pediatric Neurosurgery, University of Colorado, Aurora, Colorado; and
| | - Sandra L Taylor
- 2Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, California
| | - Daniel Fulkerson
- 4Department of Neurological Surgery, Goodman Campbell Brain and Spine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - Kiarash Shahlaie
- 1Department of Neurological Surgery, University of California, Davis
| | - Clayton Gerndt
- 1Department of Neurological Surgery, University of California, Davis
| | - Evan M Krueger
- 3Department of Pediatric Neurosurgery, University of Colorado, Aurora, Colorado; and
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Moxon KA, Shahlaie K, Girgis F, Saez I, Kennedy J, Gurkoff GG. From adagio to allegretto: The changing tempo of theta frequencies in epilepsy and its relation to interneuron function. Neurobiol Dis 2019; 129:169-181. [PMID: 30798003 DOI: 10.1016/j.nbd.2019.02.009] [Citation(s) in RCA: 5] [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: 11/20/2018] [Revised: 02/06/2019] [Accepted: 02/20/2019] [Indexed: 12/29/2022] Open
Abstract
Despite decades of research, our understanding of epilepsy, including how seizures are generated and propagate, is incomplete. However, there is growing recognition that epilepsy is more than just the occurrence of seizures, with patients often experiencing comorbid deficits in cognition that are poorly understood. In addition, the available therapies for treatment of epilepsy, from pharmaceutical treatment to surgical resection and seizure prevention devices, often exacerbate deficits in cognitive function. In this review, we discuss the hypothesis that seizure generation and cognitive deficits have a similar pathological source characterized by, but not limited to, deficits in theta oscillations and their influence on interneurons. We present a new framework that describes oscillatory states in epilepsy as alternating between hyper- and hypo-synchrony rather than solely the spontaneous transition to hyper-excitability characterized by the seizures. This framework suggests that as neural oscillations, specifically in the theta range, vary their tempo from a slowed almost adagio tempo during interictal periods to faster, more rhythmic allegretto tempo preictally, they impact the function of interneurons, modulating their ability to control seizures and their role in cognitive processing. This slow wave oscillatory framework may help explain why current therapies that work to reduce hyper-excitability do not completely eliminate seizures and often lead to exacerbated cognitive deficits.
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Affiliation(s)
- Karen A Moxon
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, United States of America.
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, United States of America; Center for Neuroscience, University of California Davis, Davis, CA 95618, United States of America
| | - Fady Girgis
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, United States of America
| | - Ignacio Saez
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, United States of America; Center for Neuroscience, University of California Davis, Davis, CA 95618, United States of America
| | - Jeffrey Kennedy
- Department of Neurology, University of California Davis, Sacramento, CA 95817, United States of America
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, United States of America; Center for Neuroscience, University of California Davis, Davis, CA 95618, United States of America
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Izadi A, Pevzner A, Lee DJ, Ekstrom AD, Shahlaie K, Gurkoff GG. Medial septal stimulation increases seizure threshold and improves cognition in epileptic rats. Brain Stimul 2019; 12:735-742. [PMID: 30733144 DOI: 10.1016/j.brs.2019.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 07/03/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Temporal lobe epilepsy is most prevalent among focal epilepsies, and nearly one-third of patients are refractory to pharmacological intervention. Persistent cognitive and neurobehavioral comorbidities also occur due to the recurrent nature of seizures and medication-related side effects. HYPOTHESIS Electrical neuromodulation is an effective strategy to reduce seizures both in animal models and clinically, but its efficacy to modulate cognition remains unclear. We hypothesized that theta frequency stimulation of the medial septum would increase septohippocampal oscillations, increase seizure threshold, and improve spatial learning in a rat model of pilocarpine-induced epilepsy. METHODS Sham and pilocarpine rats were implanted with electrodes in the medial septum, hippocampus and prefrontal cortex. EEG was assessed days prior to and following stimulation. Sham and pilocarpine-treated rats received either no stimulation, continuous (throughout each behavior), or pre-task (one minute prior to each behavior) 7.7 Hz septal stimulation during the Barnes maze spatial navigation test and also during assessment of flurothyl-induced seizures. RESULTS Both continuous and pre-task stimulation prevented epilepsy-associated reductions in theta oscillations over time. Additionally, both stimulation paradigms significantly improved spatial navigation in the Barnes maze, reducing latency and improving search strategy. Moreover, stimulation led to significant increases in seizure threshold in pilocarpine-treated rats. There was no evidence of cognitive enhancement or increased seizure threshold in stimulated sham rats. CONCLUSION These findings have profound implications as theta stimulation of the septum represents a single frequency and target that has the potential to both improve cognition and reduce seizures for patients with refractory epilepsy.
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Affiliation(s)
- Ali Izadi
- Department of Neurological Surgery, University of California, Davis, USA; Center for Neuroscience, University of California, Davis, USA
| | - Aleksandr Pevzner
- Department of Neurological Surgery, University of California, Davis, USA
| | - Darrin J Lee
- Department of Neurological Surgery, University of California, Davis, USA
| | - Arne D Ekstrom
- Center for Neuroscience, University of California, Davis, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, USA; Center for Neuroscience, University of California, Davis, USA
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California, Davis, USA; Center for Neuroscience, University of California, Davis, USA.
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Izadi A, Ondek K, Schedlbauer A, Keselman I, Shahlaie K, Gurkoff G. Clinically indicated electrical stimulation strategies to treat patients with medically refractory epilepsy. Epilepsia Open 2018; 3:198-209. [PMID: 30564779 PMCID: PMC6293066 DOI: 10.1002/epi4.12276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 12/25/2022] Open
Abstract
Focal epilepsies represent approximately half of all diagnoses, and more than one-third of these patients are refractory to pharmacologic treatment. Although resection can result in seizure freedom, many patients do not meet surgical criteria, as seizures may be multifocal in origin or have a focus in an eloquent region of the brain. For these individuals, several U.S. Food and Drug Administration (FDA)-approved electrical stimulation paradigms serve as alternative options, including vagus nerve stimulation, responsive neurostimulation, and stimulation of the anterior nucleus of the thalamus. All of these are safe, flexible, and lead to progressive seizure control over time when used as an adjunctive therapy to antiepileptic drugs. Focal epilepsies frequently involve significant comorbidities such as cognitive decline. Similar to antiepilepsy medications and surgical resection, current stimulation targets and parameters have yet to address cognitive impairments directly, with patients reporting persistent comorbidities associated with focal epilepsy despite a significant reduction in the number of their seizures. Although low-frequency theta oscillations of the septohippocampal network are critical for modulating cellular activity and, in turn, cognitive processing, the coordination of neural excitability is also imperative for preventing seizures. In this review, we summarize current FDA-approved electrical stimulation paradigms and propose that theta oscillations of the medial septal nucleus represent a novel neuromodulation target for concurrent seizure reduction and cognitive improvement in epilepsy. Ultimately, further advancements in clinical neurostimulation strategies will allow for the efficient treatment of both seizures and comorbidities, thereby improving overall quality of life for patients with epilepsy.
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Affiliation(s)
- Ali Izadi
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.
| | - Katelynn Ondek
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.,Center for NeuroscienceUniversity of CaliforniaDavisCalifornia,U.S.A.
| | - Amber Schedlbauer
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.
| | - Inna Keselman
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.,Department of NeurologyUniversity of CaliforniaDavisCaliforniaU.S.A.
| | - Kiarash Shahlaie
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.,Center for NeuroscienceUniversity of CaliforniaDavisCalifornia,U.S.A.
| | - Gene Gurkoff
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.,Center for NeuroscienceUniversity of CaliforniaDavisCalifornia,U.S.A.
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Lechpammer M, Rabow Z, Morningstar T, Gagner JP, Shahlaie K, Girgis F, Green R, Nudler E, Zagzag D. CBMT-21. ALTERATIONS OF CYSTEINE METABOLISM IN GENETIC VARIANTS OF HIGH GRADE GLIOMAS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mirna Lechpammer
- University of California Davis, Department of Pathology and Laboratory Medicine, Sacramento, CA, USA
| | - Zachary Rabow
- University of California Davis, Department of Pathology and Laboratory Medicine, Sacramento, CA, USA
| | - Taryn Morningstar
- University of California Davis, Department of Pathology and Laboratory Medicine, Sacramento, CA, USA
| | | | - Kiarash Shahlaie
- University of California Davis, Department of Neurosurgery, Sacramento, CA, USA
| | - Fady Girgis
- University of California Davis, Department of Neurosurgery, Sacramento, CA, USA
| | - Ralph Green
- University of California Davis, Department of Pathology and Laboratory Medicine, Sacramento, CA, USA
| | - Evgeny Nudler
- New York University School of Medicine, Department of Biochemistry, New York, CA, USA
| | - David Zagzag
- Langone Hospital, Department of Pathology, Division of Neuropathology, NYC, NY, USA
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Mathes LM, Girgis F, Shahlaie K, Kennedy JD, Seyal M, Keselman I. T03. Responsive Neurostimulation Device (RNS) vs. Multiple Hippocampal Transections (MHT) as treatments for refractory Temporal Lobe Epilepsy (TLE) – Outcomes from a single center, the University of California, Davis Medical Center (UCDMC). Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.004] [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: 10/16/2022]
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40
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Noblett DA, Chang J, Toussi A, Dublin A, Shahlaie K. Hemangioma of the Cavernous Sinus: A Case Series. J Neurol Surg Rep 2018; 79:e26-e30. [PMID: 29707473 PMCID: PMC5919774 DOI: 10.1055/s-0038-1641731] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/02/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction Cavernous sinus hemangiomas (CSHs) are rare, vascular, extra-axial tumors that are diagnosed with a combination of imaging and biopsy. We describe the clinical presentations, imaging findings, and management of two male patients with CSHs. Case Report Case 1 describes a 57-year-old man who presented with vision changes and cranial nerve palsies. Initial imaging and surgical biopsy were nondiagnostic. Follow-up Tc-99m tagged red blood cell (RBC) imaging supported CSH diagnosis. He was treated with surgical resection and radiotherapy. Case 2 describes a 57-year-old man who presented with chronic headache. Imaging findings were suggestive of CSH. He underwent endoscopic endonasal surgical resection and a final diagnosis of CSH was made via biopsy. Discussion CSHs often present with headache, vision changes, and cranial nerve palsies. Characteristic findings of a T2 hyperintense lesion with homogeneous contrast enhancement has been described in the literature. There is also a role for tagged RBC imaging studies in the setting of nondiagnostic imaging and biopsy. Surgical resection can be difficult due to tumor vascularity and encasement of internal carotid arteries. Stereotactic radiosurgery and adjuvant radiotherapy can play a role in the treatment of patients who have inoperable lesions or subtotal resections.
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Affiliation(s)
- Dylan A Noblett
- Departments of Radiology, University of California, Davis Medical Center, Sacramento, California, United States
| | - Jennifer Chang
- Departments of Radiology, University of California, Davis Medical Center, Sacramento, California, United States
| | - Atrin Toussi
- Departments of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
| | - Arthur Dublin
- Departments of Radiology, University of California, Davis Medical Center, Sacramento, California, United States
| | - Kiarash Shahlaie
- Departments of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
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41
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Strong EB, Scangos K, Mefford A, Lee D, Shahlaie K. Effect of Short‐Term Theta Frequency Stimulation of the Vagus Nerve on Cognition among Patients with Refractory Epilepsy: A Pilot Study. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.lb448] [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]
Affiliation(s)
- E. Brandon Strong
- Neurological SurgeryUniversity of CaliforniaDavisSacramentoCA
- Biological SciencesCalifornia Polytechnic State UniversitySan Luis ObispoCA
| | - Katherine Scangos
- Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisSacramentoCA
| | - Anthony Mefford
- Neurological SurgeryUniversity of CaliforniaDavisSacramentoCA
| | - Darrin Lee
- Neurological SurgeryUniversity of CaliforniaDavisSacramentoCA
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Scangos KW, Carter CS, Gurkoff G, Zhang L, Shahlaie K. A pilot study of subthalamic theta frequency deep brain stimulation for cognitive dysfunction in Parkinson's disease. Brain Stimul 2018; 11:456-458. [DOI: 10.1016/j.brs.2017.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/19/2017] [Indexed: 11/29/2022] Open
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Goodarzi A, Ahmadpour A, Toussi A, Shahlaie K. A Multilayered Technique for Repair of the Suboccipital Retrosigmoid Craniotomy. J Neurol Surg B Skull Base 2018; 79:508-514. [PMID: 30210980 DOI: 10.1055/s-0038-1625976] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/02/2017] [Indexed: 10/17/2022] Open
Abstract
Objective Our primary objective was to retrospectively review our single institution experience using an anatomic multilayered repair of the retrosigmoid suboccipital craniotomy. Our secondary objective was to review the existing body of literature on the repair of this craniotomy and compare our outcomes to previous results. Design Retrospective review of 25 consecutive patients undergoing repair for the retrosigmoid craniotomy. Setting University of California Davis Medical Center (2010-2016). Participants A total of 25 consecutive patients who underwent retrosigmoid craniotomy and repair. Exclusion criteria included patients who were under the age of 18 years. Main Outcome Measures Main outcomes included incidence of postoperative headache, cerebrospinal fluid leak, and wound infections. Results Postoperative headache was reported in two patients in this series (8%). None of the patients in the series developed cerebrospinal fluid leak or wound infections. Mean follow-up period was 16 months. Conclusion Our multilayered anatomic repair after retrosigmoid suboccipital craniotomy results in favorable clinical results and may help reduce the risks associated with this operation.
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Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Arjang Ahmadpour
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Atrin Toussi
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
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Nishijima DK, Gaona SD, Waechter T, Maloney R, Blitz A, Elms AR, Farrales RD, Montoya J, Bair T, Howard C, Gilbert M, Trajano RP, Hatchel KM, Faul M, Bell JM, Coronado VC, Vinson DR, Ballard DW, Tancredi DJ, Garzon H, Mackey KE, Shahlaie K, Holmes JF. The Incidence of Traumatic Intracranial Hemorrhage in Head-Injured Older Adults Transported by EMS with and without Anticoagulant or Antiplatelet Use. J Neurotrauma 2018; 35:750-759. [PMID: 29108469 DOI: 10.1089/neu.2017.5232] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Field triage guidelines recommend transport of head-injured patients on anticoagulants or antiplatelets to a higher-level trauma center based on studies suggesting a high incidence of traumatic intracranial hemorrhage (tICH). We compared the incidence of tICH in older adults transported by emergency medical services (EMS) with and without anticoagulation or antiplatelet use and evaluated the accuracies of different sets of field triage criteria to identify tICH. This was a prospective, observational study at five EMS agencies and 11 hospitals. Older adults (≥55 years) with head trauma and transported by EMS from August 2015 to September 2016 were eligible. EMS providers completed standardized data forms and patients were followed through emergency department (ED) or hospital discharge. We enrolled 1304 patients; 1147 (88%) received a cranial computed tomography (CT) scan and were eligible for analysis. Four hundred thirty-four (33%) patients had anticoagulant or antiplatelet use and 112 (10%) had tICH. The incidence of tICH in patients with (11%, 95% confidence interval [CI] 8%-14%) and without (9%, 95% CI 7%-11%) anticoagulant or antiplatelet use was similar. Anticoagulant or antiplatelet use was not predictive of tICH on adjusted analysis. Steps 1-3 criteria alone were not sensitive in identifying tICH (27%), whereas the addition of anticoagulant or antiplatelet criterion improved sensitivity (63%). Other derived sets of triage criteria were highly sensitive (>98%) but poorly specific (<11%). The incidence of tICH was similar between patients with and without anticoagulant or antiplatelet use. Use of anticoagulant or antiplatelet medications was not a risk factor for tICH. We were unable to identify a set of triage criteria that was accurate for trauma center need.
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Affiliation(s)
- Daniel K Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Samuel D Gaona
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Trent Waechter
- City of Sacramento Fire Department, Sacramento, California
| | - Ric Maloney
- Sacramento Metropolitan Fire Department, Sacramento, California
| | - Adam Blitz
- American Medical Response, Sacramento, California
| | - Andrew R Elms
- Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | | | | | - Troy Bair
- Cosumnes Community Services District Fire Department, Elk Grove, California
| | | | - Megan Gilbert
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Renee P Trajano
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Kaela M Hatchel
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Mark Faul
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeneita M Bell
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Victor C Coronado
- Centers for Disease Control and Prevention, Atlanta, Georgia.,Bridge to Heath, Atlanta, Georgia
| | - David R Vinson
- Kaiser Permanente Division of Research, Oakland, California.,Kaiser Permanente Sacramento Medical Center, Sacramento, California
| | - Dustin W Ballard
- Kaiser Permanente Division of Research, Oakland, California.,Kaiser Permanente San Rafael Medical Center, San Rafael, California
| | - Daniel J Tancredi
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Hernando Garzon
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Kevin E Mackey
- Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Kiarash Shahlaie
- Department of Neurological Surgery, UC Davis School of Medicine, Sacramento, California
| | - James F Holmes
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
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Toussi A, Noblett D, Lechpammer M, Chang J, Shahlaie K. Cavernous Sinus Hemangioma: Case Report and Review. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633817] [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: 10/28/2022]
Affiliation(s)
- Atrin Toussi
- Department of Neurological Surgery, University of California, Davis, California, United States
| | - Dylan Noblett
- Department of Radiology, University of California, Davis, California, United States
| | - Mirna Lechpammer
- Department of Pathology, University of California, Davis, California, United States
| | - Jennifer Chang
- Department of Radiology, University of California, Davis, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, California, United States
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46
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Goodarzi A, Ahmadpour A, Toussi A, Shahlaie K. A Multilayered Technique for the Repair of a Suboccipital Retrosigmoid Craniotomy. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633802] [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: 10/28/2022]
Affiliation(s)
- Amir Goodarzi
- University of California, Davis, Davis, California, United States
| | | | - Atrin Toussi
- University of California, Davis, Davis, California, United States
| | - Kiarash Shahlaie
- University of California, Davis, Davis, California, United States
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47
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Kolarik BS, Baer T, Shahlaie K, Yonelinas AP, Ekstrom AD. Close but no cigar: Spatial precision deficits following medial temporal lobe lesions provide novel insight into theoretical models of navigation and memory. Hippocampus 2018; 28:31-41. [PMID: 28888032 PMCID: PMC5747326 DOI: 10.1002/hipo.22801] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/25/2017] [Accepted: 09/07/2017] [Indexed: 12/23/2022]
Abstract
Increasing evidence suggests that the human hippocampus contributes to a range of different behaviors, including episodic memory, language, short-term memory, and navigation. A novel theoretical framework, the Precision and Binding Model, accounts for these phenomenon by describing a role for the hippocampus in high-resolution, complex binding. Other theories like Cognitive Map Theory, in contrast, predict a specific role for the hippocampus in allocentric navigation, while Declarative Memory Theory predicts a specific role in delay-dependent conscious memory. Navigation provides a unique venue for testing these predictions, with past results from research with humans providing inconsistent findings regarding the role of the human hippocampus in spatial navigation. Here, we tested five patients with lesions primarily restricted to the hippocampus and those extending out into the surrounding medial temporal lobe cortex on a virtual water maze task. Consistent with the Precision and Binding Model, we found partially intact allocentric memory in all patients, with impairments in the spatial precision of their searches for a hidden target. We found similar impairments at both immediate and delayed testing. Our findings are consistent with the Precision and Binding Model of hippocampal function, arguing for its role across domains in high-resolution, complex binding. SIGNIFICANCE STATEMENT Remembering goal locations in one's environment is a critical skill for survival. How this information is represented in the brain is still not fully understood, but is believed to rely in some capacity on structures in the medial temporal lobe. Contradictory findings from studies of both humans and animals have been difficult to reconcile with regard to the role of the MTL, specifically the hippocampus. By assessing impairments observed during navigation to a goal in patients with medial temporal lobe damage we can better understand the role these structures play in such behavior. Utilizing virtual reality and novel analysis techniques, we have more precisely assessed the impact that medial temporal lobe damage has on spatial memory and navigation.
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Affiliation(s)
- Branden S Kolarik
- Department of Psychology, University of California, Davis, Davis, California, 95618
- Center for Neuroscience, University of California, Davis, Davis, California, 95618
| | - Trevor Baer
- Department of Psychology, University of California, Davis, Davis, California, 95618
- Center for Neuroscience, University of California, Davis, Davis, California, 95618
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, 95817
| | - Andrew P Yonelinas
- Department of Psychology, University of California, Davis, Davis, California, 95618
- Center for Neuroscience, University of California, Davis, Davis, California, 95618
| | - Arne D Ekstrom
- Department of Psychology, University of California, Davis, Davis, California, 95618
- Center for Neuroscience, University of California, Davis, Davis, California, 95618
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Lechpammer M, Shahlaie K, Girgis F, Gonzales H, Bishop J, Nudler E, Zagzag D. CMET-46. EXPRESSION OF HYDROGEN SULFIDE (H2S) PRODUCING ENZYMES IN METASTATIC BRAIN TUMORS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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49
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Goodarzi A, Toussi A, Lechpammer M, Lee D, Shahlaie K. Intradural Chordoma of Cerebellopontine Angle: Case Report and Review. World Neurosurg 2017; 107:1052.e11-1052.e16. [PMID: 28866065 DOI: 10.1016/j.wneu.2017.08.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/30/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chordomas are rare, notochord-derived neoplasms. Of these tumors, intradural chordomas are exceedingly rare. Most occur within the prepontine, parasellar, or other midline intradural locations. An intradural chordoma arising from the cerebellopontine angle has not been described previously. CASE REPORT We describe the first case of an intradural chordoma originating from the left cerebellopontine angle resected over the course of 2 operations. CONCLUSIONS Intradural chordomas are rare and can arise anywhere in the posterior fossa. Lack of bony involvement on computed tomography and magnetic resonance imaging are indicative of this pathology when there is also a lack of markers indicating the presence of more common cerebellopontine angle tumors. Treatment goals should include gross total resection and possible radiation therapy.
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Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Atrin Toussi
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Mirna Lechpammer
- Department of Pathology, University of California, Davis, California, USA
| | - Darrin Lee
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, California, USA.
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50
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Yuan M, Sperry L, Malhado‐Chang N, Duffy A, Wheelock V, Farias S, O'Connor K, Olichney J, Shahlaie K, Zhang L. Atypical antipsychotic therapy in Parkinson's disease psychosis: A retrospective study. Brain Behav 2017. [PMID: 28638698 PMCID: PMC5474696 DOI: 10.1002/brb3.639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Parkinson's disease psychosis (PDP) is a frequent complication of idiopathic Parkinson's disease (iPD) with significant impact on quality of life and association with poorer outcomes. Atypical antipsychotic drugs (APDs) are often used for the treatment of PDP; however, their use is often complicated by adverse drug reactions (ADRs). In this study, we present patients with PDP who were treated with the most commonly used atypical antipsychotic agents and review their respective ADRs. METHODS A retrospective study was carried out to include a total of 45 patients with iPD who visited a movement disorders clinic between 2006 and 2015. All PDP patients treated with atypical APDs were included in the analysis for their specific ADRs. RESULTS Forty-five iPD patients (mean age of onset: 62.67 ± 9.86 years) were included, of those 10 patients had psychosis (mean age of onset: 76.80 ± 4.61 years). Of the 45 patients, 22.2% were found to have psychotic symptoms, of whom 70% had hallucinations, 20% had delusions, and 10% illusions. Seventy percent of psychotic symptoms occurred after ten or more years from diagnosis of iPD. PDP patients were treated with quetiapine, olanzapine, and risperidone separately or in combination, all of which were found to have certain ADRs. LIMITATIONS This study was limited by its retrospective study design and small sample size and with likely selection bias. CONCLUSIONS The prevalence of PDP is relatively high in older patients with iPD. The uses of the currently available atypical APDs in this patient population are often complicated by ADRs. The selective 5-HT 2A inverse agonist, pimavanserin, could be a better alternative in the treatment of PDP.
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Affiliation(s)
- Mei Yuan
- Department of NeurologyThe Second Affiliated HospitalUniversity Of South ChinaHengyangHunanChina
- Department of NeurologyUC Davis Medical CenterSacramentoCAUSA
| | - Laura Sperry
- Department of NeurologyUC Davis Medical CenterSacramentoCAUSA
| | | | - Alexandra Duffy
- Department of NeurologyUC Davis Medical CenterSacramentoCAUSA
| | - Vicki Wheelock
- Department of NeurologyUC Davis Medical CenterSacramentoCAUSA
| | - Sarah Farias
- Department of NeurologyUC Davis Medical CenterSacramentoCAUSA
| | - Kevin O'Connor
- Center for Neuroscience and Department of Neurobiology, Physiology and BehaviorUC Davis Medical CenterUC DavisSacramentoCAUSA
| | - John Olichney
- Center for Neuroscience and Department of Neurobiology, Physiology and BehaviorUC Davis Medical CenterUC DavisSacramentoCAUSA
| | - Kiarash Shahlaie
- Department of Neurologic SurgeryUC Davis Medical CenterSacramentoCAUSA
| | - Lin Zhang
- Department of NeurologyUC Davis Medical CenterSacramentoCAUSA
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