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Akhter AS, Bankiewicz KS, Lonser RR. Real-Time Magnetic Resonance Imaging During Convective Gene Therapy Perfusion of the Brain. JAMA Surg 2024; 159:457-458. [PMID: 38198147 DOI: 10.1001/jamasurg.2023.3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
This article discusses use of intraoperative MRI in convective gene therapy perfusion.
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Affiliation(s)
- Asad S Akhter
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus
| | - Krzysztof S Bankiewicz
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus
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Shah VS, Dornbos D, Hoang NA, Cua S, Rodgers B, Pezzutti D, Duenas H, Eaton R, Kreatsoulas D, Elder JB, Prevedello DM, Lonser RR, Nimjee SM. Preoperative prescription opioid use as an independent predictor of 90-day mortality and adverse events in craniotomy and craniectomy patients. J Neurosurg 2024:1-6. [PMID: 38457788 DOI: 10.3171/2024.1.jns23615] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/04/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE A growing body of literature suggests that preoperative opioid exposure is an independent predictor of poor outcomes in surgical patients. No outcomes data exist on preoperative opioid use and craniotomies/craniectomies. The objective of this study was to determine the impact of preoperative opioid use on 90-day adverse events after craniotomy or craniectomy. METHODS A single-center retrospective cohort study of 2445 patients undergoing a craniotomy/craniectomy between January 1, 2013, and October 1, 2018, was conducted. Baseline demographics, pre- and postoperative opioid use (morphine milligram equivalents [MMEs]), and surgical metrics were recorded. Patients were categorized based on whether they took prescription opioids preoperatively, defined as within 1 month of surgery, or were opioid naive. The outcomes were mortality and adverse events 90 days after craniotomy/craniectomy. RESULTS Overall, 26.6% of patients composed the preoperative opioid group. The median daily MME intake among this group was 34.6 (IQR 14.1-90) MMEs. Lower employment rates (p < 0.001), uninsured status (p = 0.016), and intravenous drug use (p = 0.006) were associated with preoperative opioid use. Preoperative opioid use was associated with increased venous thromboembolism (p = 0.001), acute kidney injury (p = 0.002), acute respiratory failure (p < 0.001), myocardial infarction (p = 0.002), delirium (p < 0.001), and infection (p < 0.001). Preoperative opioid use was an independent predictor of overall 90-day adverse events (OR 1.643, 95% CI 1.289-2.095; p < 0.001) and 90-day mortality (OR 1.690, 95% CI 1.254-2.277; p < 0.001). CONCLUSIONS Preoperative opioid use was independently associated with 90-day postoperative adverse events and mortality. Opioid use increases vulnerability in craniotomy/craniectomy patients and necessitates close monitoring to improve outcomes.
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Affiliation(s)
- Varun S Shah
- 1College of Medicine, The Ohio State University, Columbus, Ohio
- 2Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - David Dornbos
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
- 4Department of Neurological Surgery, University of Tennessee Health Science Center and Semmes Murphey Clinic, Memphis, Tennessee
| | - Nguyen Alex Hoang
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Santino Cua
- 1College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brandon Rodgers
- 1College of Medicine, The Ohio State University, Columbus, Ohio
| | - Dante Pezzutti
- 1College of Medicine, The Ohio State University, Columbus, Ohio
| | - Helen Duenas
- 1College of Medicine, The Ohio State University, Columbus, Ohio
| | - Ryan Eaton
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Daniel Kreatsoulas
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - J Bradley Elder
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Daniel M Prevedello
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Russell R Lonser
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Shahid M Nimjee
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
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Kreatsoulas D, Damante M, Cua S, Lonser RR. Adjuvant convection-enhanced delivery for the treatment of brain tumors. J Neurooncol 2024; 166:243-255. [PMID: 38261143 PMCID: PMC10834622 DOI: 10.1007/s11060-023-04552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Malignant gliomas are a therapeutic challenge and remain nearly uniformly fatal. While new targeted chemotherapeutic agentsagainst malignant glioma have been developed in vitro, these putative therapeutics have not been translated into successful clinical treatments. The lack of clinical effectiveness can be the result of ineffective biologic strategies, heterogeneous tumor targets and/or the result of poortherapeutic distribution to malignant glioma cells using conventional nervous system delivery modalities (intravascular, cerebrospinal fluid and/orpolymer implantation), and/or ineffective biologic strategies. METHODS The authors performed a review of the literature for the terms "convection enhanced delivery", "glioblastoma", and "glioma". Selectclinical trials were summarized based on their various biological mechanisms and technological innovation, focusing on more recently publisheddata when possible. RESULTS We describe the properties, features and landmark clinical trials associated with convection-enhanced delivery for malignant gliomas.We also discuss future trends that will be vital to CED innovation and improvement. CONCLUSION Efficacy of CED for malignant glioma to date has been mixed, but improvements in technology and therapeutic agents arepromising.
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Affiliation(s)
- Daniel Kreatsoulas
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, N1019 Doan Hall, 410 W 10Th Avenue, Columbus, OH, 43210, USA.
| | - Mark Damante
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, N1019 Doan Hall, 410 W 10Th Avenue, Columbus, OH, 43210, USA
| | - Santino Cua
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, N1019 Doan Hall, 410 W 10Th Avenue, Columbus, OH, 43210, USA
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, N1019 Doan Hall, 410 W 10Th Avenue, Columbus, OH, 43210, USA
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Anderson MG, Anuar A, Tomei KL, Schwalb JM, Orrico KO, Sigounas D, Puffer RC, Bohl MA, Lonser RR, Martin JE. Survey of United States neurosurgeons on firearm injury prevention. J Neurosurg 2023:1-11. [PMID: 38134420 DOI: 10.3171/2023.11.jns231961] [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: 08/31/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Firearm-related injuries and deaths are an endemic problem in the US, posing a burden on the healthcare system with significant social and economic consequences. As front-line care providers for these patients, neurosurgeons are both knowledgeable about these injuries and credible messengers in the public discussion of ways to reduce firearm injuries. The purpose of this study was to explore US-based neurosurgeons' views and behaviors regarding firearms to understand and define a potential role for neurosurgical organizations in advocacy efforts to reduce firearm death and injuries. METHODS The authors conducted an anonymous survey of US neurosurgeons using the American Association of Neurological Surgeons (AANS) member database from April to June 2023. The 22-question survey included questions related to firearm ownership, personal views on firearms, and support for both general and policy-specific advocacy efforts to reduce firearm deaths and injuries. RESULTS The survey response rate was 20.7%, with 1568 of the 7587 members invited completing the survey. The survey completion rate was 93.4%, with 1465 of the 1568 surveys completed and included in this analysis. The majority of respondents were male (raw: 81.7%; weighted 81.1%), White (raw: 69.7%; weighted 70.2%), and older than 50 years (raw: 56.2%; weighted: 54%). Most respondents reported treating patients with firearm injuries (raw: 83.3%; weighted: 82%), 85.5% (weighted: 85.1%) had used a firearm, and 42.4% (weighted: 41.5%) reported owning a firearm. Overall, 78.8% (weighted: 78.7%) of respondents felt that organized neurosurgery should participate in advocacy efforts. When examining individual policies, those that restrict the acquisition of firearms garnered the support of at least 65% of respondents, while nonrestrictive policies were supported by more than 75% of respondents. Free-text responses provided insight into both motivations for and objections to organizational advocacy. CONCLUSIONS The majority of US-based neurosurgeons support involvement in advocacy efforts to reduce firearm deaths and injuries. Themes expressed by members both supporting and objecting to advocacy provide insight into approaches that could ensure broad support. Neurosurgical organizations such as the AANS and Congress of Neurological Surgeons may use the results of this survey to make informed decisions regarding involvement in advocacy efforts on behalf of their membership to lessen the burden of firearm injury in the US.
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Affiliation(s)
- Megan G Anderson
- 1Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut
- 2Research Operations and Development, Connecticut Children's, Hartford, Connecticut
| | - Amirul Anuar
- 2Research Operations and Development, Connecticut Children's, Hartford, Connecticut
| | - Krystal L Tomei
- 3Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jason M Schwalb
- 4Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan
| | - Katie O Orrico
- 5Washington Office, American Association of Neurological Surgeons/Congress of Neurosurgeons, Washington, DC
| | - Dimitri Sigounas
- 6Department of Neurosurgery, George Washington University, Washington, DC
| | - Ross C Puffer
- 7Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Michael A Bohl
- 8Carolina Neurosurgery & Spine Associates, Greensboro, North Carolina
| | - Russell R Lonser
- 9Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Jonathan E Martin
- 1Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut
- 10Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
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Kreatsoulas DC, Vignolles-Jeong J, Ambreen Y, Damante M, Akhter A, Lonser RR, Elder JB. Surgical Characteristics of Intracranial Biopsy Using a Frameless Stereotactic Robotic Platform: A Single-Center Experience. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00966. [PMID: 37976149 DOI: 10.1227/ons.0000000000000999] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cranial robotics are a burgeoning field of neurosurgery. To date, all cranial robotic systems described have been computerized, arm-based instruments that take up significant space in the operating room. The Medtronic Stealth Autoguide robot has a smaller operating room footprint and offers multiaxial, frame-based surgical targeting. The authors set out to define the surgical characteristics of a novel robotic platform for brain biopsy in a large patient cohort. METHODS Patients who underwent stereotactic biopsy using the Stealth Autoguide cranial robotic platform from July 2020 to March 2023 were included in this study. Clinical, surgical, and histological data were collected and analyzed. RESULTS Ninety-six consecutive patients (50 female, 46 male) were included. The mean age at biopsy was 53.7 ± 18.0 years. The mean target depth was 68.2 ± 15.3 mm. The biopsy diagnostic tissue acquisition rate was 100%. The mean time from incision to biopsy tissue acquisition was 15.4 ± 9.9 minutes. Target lesions were located throughout the brain: in the frontal lobe (n = 32, 33.3%), parietal lobe (n = 21, 21.9%), temporal lobe (n = 22, 22.9%), deep brain nuclei/thalamus (n = 13, 13.5%), cerebellum (n = 7, 7.3%), and brainstem (n = 1, 1.0%). Most cases were gliomas (n = 75, 78.2%). Patients were discharged home on postoperative day 0 or 1 in 62.5% of cases. A total of 7 patients developed postoperative complications (7.2%). CONCLUSION This cranial robotic platform can be used for efficient, safe, and accurate cranial biopsies that allow for reliable diagnosis of intracranial pathology in a minimally invasive setting.
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Affiliation(s)
- Daniel C Kreatsoulas
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Joshua Vignolles-Jeong
- The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yamenah Ambreen
- The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark Damante
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Asad Akhter
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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Lonser RR. Research in Neurological Surgery. Neurosurgery 2023; 93:245-246. [PMID: 37458430 DOI: 10.1227/neu.0000000000002466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Russell R Lonser
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
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Rocco MT, Akhter AS, Ehrlich DJ, Scott GC, Lungu C, Munjal V, Aquino A, Lonser RR, Fiandaca MS, Hallett M, Heiss JD, Bankiewicz KS. Long-term safety of MRI-guided administration of AAV2-GDNF and gadoteridol in the putamen of individuals with Parkinson's disease. Mol Ther 2023:S1525-0016(23)00207-1. [PMID: 37098347 PMCID: PMC10362408 DOI: 10.1016/j.ymthe.2023.04.009] [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: 04/27/2023] Open
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8
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Chittiboina P, Mandal D, Bugarini A, Asuzu DT, Mullaney D, Mastorakos P, Stoica S, Alvarez R, Scott G, Maric D, Elkahloun A, Zhuang Z, Chew EY, Yang C, Linehan M, Lonser RR. Proteostasis modulation in germline missense von Hippel Lindau disease. Clin Cancer Res 2023:725139. [PMID: 37018064 DOI: 10.1158/1078-0432.ccr-22-3651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/06/2023] [Accepted: 04/03/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE Missense mutated von Hippel Lindau (VHL) protein (pVHL) maintains intrinsic function but undergoes proteasomal degradation and tumor initiation/progression in VHL disease. Vorinostat can rescue missense mutated pVHL and arrest tumor growth in pre-clinical models. We asked if short-term oral vorinostat could rescue pVHL in central nervous system hemangioblastomas in germline missense VHL patients. EXPERIMENTAL DESIGN We administered oral vorinostat to seven subjects (aged 46.0±14.5 years) and then removed symptomatic hemangioblastomas surgically (clinicaltrials.gov identifier NCT02108002). RESULTS Vorinostat was tolerated without serious adverse events by all patients. pVHL expression was elevated in neoplastic stromal cells compared to untreated hemangioblastomas from same patients. We found transcriptional suppression of downstream HIF effectors. Mechanistically, vorinostat prevented Hsp90 recruitment to mutated pVHL in-vitro. The effects of vorinostat on the Hsp90-pVHL interaction, pVHL rescue, and transcriptional repression of downstream HIF effectors was independent of the location of the missense mutation on the VHL locus. We confirmed a neoplastic stromal cell-specific effect in suppression of pro-tumorigenic pathways with single nucleus transcriptomic profiling. CONCLUSIONS We found that oral vorinostat treatment in VHL patients with germline missense mutations has a potent biologic effect that warrants further clinical study. These results provide biologic evidence to support the use of proteostasis modulation for the treatment of syndromic solid tumors involving protein misfolding.
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Affiliation(s)
- Prashant Chittiboina
- National Institute of Neurological Disorders and Stroke, Bethesda, United States
| | - Debjani Mandal
- National Institute of Neurological Disorders and Stroke, Bethesda, United States
| | - Alejandro Bugarini
- National Institute of Neurological Disorders and Stroke, Bethesda, United States
| | - David T Asuzu
- National Institute of Neurological Disorders and Stroke, Bethesda, United States
| | - Dustin Mullaney
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, United States
| | | | - Stefan Stoica
- National Institute of Neurological Disorders and Stroke, Bethesda, United States
| | - Reinier Alvarez
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Gretchen Scott
- National Institute of Neurological Disorders and Stroke, Bethesda, United States
| | - Dragan Maric
- National Institutes of Health, Bethesda, MD, United States
| | | | | | - Emily Y Chew
- National Eye Institute, Bethesda, MD, United States
| | | | | | - Russell R Lonser
- National Institute of Neurological Disorders and Stroke, Columbus, Ohio, United States
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Srienc AI, Church S, Korn SJ, Lonser RR, Zipfel GJ. 418 Early Outcomes of the American Academy of Neurological Surgery Emerging Investigator Program in Promoting Neurosurgeon-Scientists. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_418] [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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Chittiboina P, Mandal D, Bugarini A, Mastorakos P, Stoica S, Boyle J, Alvarez R, Edwards NA, Scott G, Smith C, Maric D, Zhuang Z, Chew E, Yang C, Linehan M, Lonser RR. 375 Vorinostat for Missense Mutated Von Hippel Lindau Disease Associated Hemangioblastomas: A Pilot Study. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_375] [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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Zachariah MA, Cua S, Muhlestein WE, Otto BA, Carrau RL, Kirschner LS, Ghalib LM, Lonser RR, Hardesty DA, Prevedello DM. Intraoperative Predictor of Remission in Cushing Disease. Oper Neurosurg (Hagerstown) 2023; 24:460-467. [PMID: 36701661 DOI: 10.1227/ons.0000000000000560] [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: 01/18/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Cushing disease represents a challenge for neurosurgeons, with high recurrence rates reported. Characteristics associated with remission are incompletely understood; thus, an intraoperative predictor for outcome would be valuable for assessing resection of adrenocorticotropic hormone (ACTH) secreting tissue. OBJECTIVE To evaluate whether intraoperative ACTH measurement could predict outcome after surgery for Cushing disease. METHODS Retrospective cohort study of 55 consecutive encounters with Cushing disease who had peripheral plasma ACTH levels measured intraoperatively before, during, and after tumor resection. The primary outcome measure was remission, defined by either 2 negative 24-hour urine free cortisol or 2 negative midnight salivary cortisol measurements. A logistic regression machine learning model was generated using recursive feature elimination. RESULTS Fifty-five operative encounters, comprising 49 unique patients, had a mean follow-up of 2.73 years (±2.11 years) and a median follow-up of 2.07 years. Remission was achieved in 69.1% (n = 38) of all operations and in 78.0% (n = 32) of those without cavernous sinus invasion. The final ACTH level measured intraoperatively correctly predicted outcome (area under the curve = 0.766; P value = .002). The odds ratio of remission in patients with the lowest quartile vs highest quartile final intraoperative ACTH was 23.4 ( P value = .002). Logistic regression machine learning model resulted in incorporating postoperative day 1 morning cortisol, final intraoperative ACTH that predicted outcome with an average area under the curve of 0.80 ( P = .0027). CONCLUSION Intraoperative ACTH may predict outcome after surgery in Cushing disease; furthermore, investigation is warranted.
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Affiliation(s)
- Marcus A Zachariah
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Santino Cua
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Whitney E Muhlestein
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Bradley A Otto
- Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Lawrence S Kirschner
- Department of Endocrinology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Luma M Ghalib
- Department of Endocrinology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Russell R Lonser
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Douglas A Hardesty
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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12
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Rocco MT, Akhter AS, Ehrlich DJ, Scott GC, Lungu C, Munjal V, Aquino A, Lonser RR, Fiandaca MS, Hallett M, Heiss JD, Bankiewicz KS. Long-term safety of MRI-guided administration of AAV2-GDNF and gadoteridol in the putamen of individuals with Parkinson's disease. Mol Ther 2022; 30:3632-3638. [PMID: 35957524 PMCID: PMC9734022 DOI: 10.1016/j.ymthe.2022.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 02/16/2022] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
Direct putaminal infusion of adeno-associated virus vector (serotype 2) (AAV2) containing the human glial cell line-derived neurotrophic factor (GDNF) transgene was studied in a phase I clinical trial of participants with advanced Parkinson's disease (PD). Convection-enhanced delivery of AAV2-GDNF with a surrogate imaging tracer (gadoteridol) was used to track infusate distribution during real-time intraoperative magnetic resonance imaging (iMRI). Pre-, intra-, and serial postoperative (up to 5 years after infusion) MRI were analyzed in 13 participants with PD treated with bilateral putaminal co-infusions (52 infusions in total) of AAV2-GDNF and gadoteridol (infusion volume, 450 mL per putamen). Real-time iMRI confirmed infusion cannula placement, anatomic quantification of volumetric perfusion within the putamen, and direct visualization of off-target leakage or cannula reflux (which permitted corresponding infusion rate/cannula adjustments). Serial post-treatment MRI assessment (n = 13) demonstrated no evidence of cerebral parenchyma toxicity in the corresponding regions of AAV2-GDNF and gadoteridol co-infusion or surrounding regions over long-term follow-up. Direct confirmation of key intraoperative safety and efficacy parameters underscores the safety and tissue targeting value of real-time imaging with co-infused gadoteridol and putative therapeutic agents (i.e., AAV2-GDNF). This delivery-imaging platform enhances safety, permits delivery personalization, improves therapeutic distribution, and facilitates assessment of efficacy and dosing effect.
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Affiliation(s)
- Matthew T Rocco
- Department of Neurological Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Asad S Akhter
- Department of Neurological Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Debra J Ehrlich
- Parkinson's Disease Clinic, NINDS, National Institutes of Health Division of Clinical Research, Bethesda, MD 20896, USA
| | - Gretchen C Scott
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20896, USA
| | - Codrin Lungu
- Division of Clinical Research, NINDS, National Institutes of Health, Bethesda, MD 20896, USA
| | - Vikas Munjal
- Department of Neurological Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Anthony Aquino
- Department of Radiology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Russell R Lonser
- Department of Neurological Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Massimo S Fiandaca
- Asklepios BioPharmaceutical, Inc., 2447 North Star Road, Upper Arlington, OH 43221, USA
| | - Mark Hallett
- Division of Clinical Research, NINDS, National Institutes of Health, Bethesda, MD 20896, USA; Human Motor Control Section, Medical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20896, USA
| | - John D Heiss
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20896, USA
| | - Krystof S Bankiewicz
- Department of Neurological Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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Nazari MA, Rosenblum JS, Zhuang Z, Malik A, Lonser RR, Pacak K, Aronoff S. A 13-Year-Old Male With Left Eye Swelling. Pediatrics 2022; 150:189930. [PMID: 36353857 DOI: 10.1542/peds.2021-056037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/11/2022] Open
Abstract
A 13-year-old male presented with a 10-day history of left eye swelling and pain. These symptoms prompted presentation to the emergency department. He had no significant past medical history and no preceding fevers or chills. He was found on examination of the eyes and the orbit to have left supraorbital erythema, edema, and pain with upward and medial gaze. Examination of the globe, fundus, and visual fields were normal. His white blood cell count was 6.2 (x1000/mm3) with an erythrocyte sedimentation rate of 4 (mm/hr). Diagnostic endoscopic biopsy was performed. Here we present this case alongside clinical reasoning and diagnostic evaluation with relevant input from respective experts. This case discussion reviews the final diagnosis, as well as the corresponding evaluation and management. Diagnostic algorithms based on literature review and clinical experience are also included.
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Affiliation(s)
- Matthew A Nazari
- Department of Internal Medicine and Pediatrics, Georgetown University Hospital, Washington, District of Columbia.,Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | | | - Zhengping Zhuang
- Neuro-Oncology Branch, National Cancer Institute.,Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Archana Malik
- Department of Pediatric Diagnostic Radiology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Russell R Lonser
- Department of Neurologic Surgery, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Stephen Aronoff
- Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Section of Pediatric Infectious Diseases, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
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14
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Srienc AI, Church SC, Korn SJ, Lonser RR, Zipfel GJ. Early outcomes of the American Academy of Neurological Surgery Emerging Investigator Program in promoting neurosurgeon-scientists. J Neurosurg 2022; 138:287-292. [PMID: 35901692 DOI: 10.3171/2022.5.jns212846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Anja I Srienc
- 1Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Sophie C Church
- 1Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Stephen J Korn
- 2National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, Maryland; and
| | - Russell R Lonser
- 3Department of Neurological Surgery, The Ohio State University, Columbus, Ohio
| | - Gregory J Zipfel
- 1Department of Neurological Surgery, Washington University, St. Louis, Missouri
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15
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Mehta GU, Kim HJ, Gidley PW, Daniels AB, Miller ME, Lekovic GP, Butman JA, Lonser RR. Endolymphatic Sac Tumor Screening and Diagnosis in von Hippel-Lindau Disease: A Consensus Statement. Skull Base Surg 2022; 83:e225-e231. [DOI: 10.1055/s-0041-1725033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/01/2021] [Indexed: 10/21/2022]
Abstract
Abstract
Objective Endolymphatic sac tumors (ELSTs) are a frequent cause of hearing loss and other audiovestibular dysfunction in patients with von Hippel-Lindau disease (VHL). Unified screening recommendations for VHL patients have not been established. To develop consensus guidelines, the VHL Alliance formed an expert committee to define evidence-based clinical screening recommendations.
Patients and Methods Recommendations were formulated by using the Grading of Recommendations, Assessment, Development, and Evaluation framework after a comprehensive literature review.
Results Diagnosis of ELSTs in VHL requires a combination of clinical evaluation and imaging and audiometric findings. Audiovestibular signs/symptoms are often an early feature of small ELSTs, including those that are not visible on imaging. Diagnostic audiograms have the greatest sensitivity for the detection of ELST-associated sensorineural hearing loss and can help confirm clinically relevant lesions, including those that may not be radiographically evident. Magnetic resonance imaging (MRI) can be a more specific test for ELSTs in VHL particularly when supplemented with computed tomography imaging for the identification of small tumors. VHL patients between the ages 10 and 60 years carry high preponderance for ELST presentation.
Conclusion We recommend that clinical evaluation (yearly) and diagnostic audiograms (every other year) be the primary screening tools for ELSTs in VHL. We suggest that screening be performed between the ages 11 and 65 years or with the onset of audiovestibular signs/symptoms for synchronicity with other testing regimens in VHL. We recommend that baseline imaging (MRI of the internal auditory canals) can be performed between the ages of 15 and 20 years or after positive screening.
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Affiliation(s)
- Gautam U. Mehta
- Division of Neurosurgery, House Institute, Los Angeles, California, United States
| | - H. Jeffery Kim
- Neuro-Otology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, United States
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, District of Columbia, United States
| | - Paul W. Gidley
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States
| | - Anthony B. Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Mia E. Miller
- Division of Neurotology, House Institute, Los Angeles, California, United States
| | - Gregory P. Lekovic
- Division of Neurosurgery, House Institute, Los Angeles, California, United States
| | - John A. Butman
- Neuroradiology Section, Radiology and Imaging Sciences Department, The Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
| | - Russell R. Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
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16
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McGahan BG, Hatef J, Shaikhouni A, Leonard J, Grossbach AJ, Lonser RR, Powers CJ. Resident Night Float or 24-hour Call Hospital Coverage: Impact on Training, Patient Outcome, and Length of Stay. J Surg Educ 2022; 79:732-739. [PMID: 34866033 DOI: 10.1016/j.jsurg.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The impact of neurosurgical resident hospital coverage system, performed via a night float (12-hour shifts overnight) or a 24-hour call, on neurological surgery resident training and patient care is unknown. DESIGN Retrospective review comparing night float and 24-hour call coverage on trainee surgical experience, elective time, annual program surveys, patient outcomes, and length of stay. SETTING The Ohio State Wexner Medical Center Neurosurgery residency program, Columbus, Ohio. PARTICIPANTS The neurosurgical residents from 2016 to 2019. RESULTS Monthly cases performed by junior residents significantly increased after transitioning to a 24-hour call schedule (18 versus 30, p < 0.001). There were no differences for total cases among program graduates during this time (p = 0.7). Trainee elective time significantly increased after switching to 24-hour call coverage (18 versus 24 months after the transition; p = 0.004). Risk-adjusted mortality and length of stay indices were not different (0.5 versus 0.3, p = 0.1; 0.9 versus 0.9; p = 0.3). Program surveys had minimal change after the transition to 24-hour call. CONCLUSIONS Transitioning from a night float to a 24-hour call coverage system led to improved junior resident case volume and elective time without detrimental effect on patient-related outcomes.
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Affiliation(s)
- Ben G McGahan
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Jeffrey Hatef
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ammar Shaikhouni
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey Leonard
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Andrew J Grossbach
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Russell R Lonser
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ciaran J Powers
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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17
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Resnick DK, Lonser RR. Neurosurgery for Neurologists. Neurol Clin 2022. [DOI: 10.1016/s0733-8619(22)00029-9] [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: 10/18/2022]
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18
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Resnick DK, Lonser RR. Neurosurgery for Neurologists. Neurol Clin 2022; 40:xiii. [DOI: 10.1016/j.ncl.2021.11.014] [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: 10/18/2022]
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19
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Van Laar AD, Van Laar VS, San Sebastian W, Merola A, Bradley Elder J, Lonser RR, Bankiewicz KS. An Update on Gene Therapy Approaches for Parkinson's Disease: Restoration of Dopaminergic Function. J Parkinsons Dis 2021; 11:S173-S182. [PMID: 34366374 PMCID: PMC8543243 DOI: 10.3233/jpd-212724] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 12/04/2022]
Abstract
At present there is a significant unmet need for clinically available treatments for Parkinson’s disease (PD) patients to stably restore balance to dopamine network function, leaving patients with inadequate management of symptoms as the disease progresses. Gene therapy is an attractive approach to impart a durable effect on neuronal function through introduction of genetic material to reestablish dopamine levels and/or functionally recover dopaminergic signaling by improving neuronal health. Ongoing clinical gene therapy trials in PD are focused on enzymatic enhancement of dopamine production and/or the restoration of the nigrostriatal pathway to improve dopaminergic network function. In this review, we discuss data from current gene therapy trials for PD and recent advances in study design and surgical approaches.
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Affiliation(s)
- Amber D Van Laar
- Asklepios BioPharmaceutical, Inc., Columbus, OH, USA.,Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Victor S Van Laar
- Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, OH, USA
| | - Waldy San Sebastian
- Asklepios BioPharmaceutical, Inc., Columbus, OH, USA.,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Aristide Merola
- Department of Neurology, College of Medicine, the Ohio State University, Columbus, OH, USA
| | - J Bradley Elder
- Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, OH, USA
| | - Russell R Lonser
- Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, OH, USA
| | - Krystof S Bankiewicz
- Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, OH, USA.,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
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20
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Alvarez R, Mastorakos P, Hogan E, Scott G, Lonser RR, Wiley HE, Chew EY, Chittiboina P. Retrobulbar Hemangioblastomas in von Hippel-Lindau Disease: Clinical Course and Management. Neurosurgery 2021; 88:1012-1020. [PMID: 33442737 DOI: 10.1093/neuros/nyaa565] [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: 08/12/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Retrobulbar hemangioblastomas involving the optic apparatus in patients with von Hippel-Lindau disease (VHL) are rare, with only 25 reported cases in the literature. OBJECTIVE To analyze the natural history of retrobulbar hemangioblastomas in a large cohort of VHL patients in order to define presentation, progression, and management. METHODS Clinical history and imaging of 250 patients with VHL in an ongoing natural history trial and 1774 patients in a neurosurgical protocol were reviewed. The clinical course, magnetic resonance images, treatment, and outcomes were reviewed for all included patients. RESULTS A total of 18 patients with retrobulbar hemangioblastoma on surveillance magnetic resonance imaging met the inclusion criteria for this study. Of the 17 for whom clinical information was available, 10 patients presented with symptoms related to the hemangioblastoma, and 7 were asymptomatic. The mean tumor volume was larger for symptomatic (810.6 ± 545.5 mm3) compared to asymptomatic patients (307.6 ± 245.5 mm3; P < .05). A total of 5 of the symptomatic patients were treated surgically and all experienced improvement in their symptoms. All 3 symptomatic patients that did not undergo intervention had continued symptom progression. Long-term serial imaging on asymptomatic patients showed that these tumors can remain radiographically stable and asymptomatic for extended periods of time (101.43 ± 71 mo). CONCLUSION This study suggests that retrobulbar hemangioblastomas may remain stable and clinically asymptomatic for long durations. Recent growth and larger tumor volume were associated with symptom occurrence. Surgical treatment of symptomatic retrobulbar hemangioblastomas can be safe and may reverse the associated symptoms.
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Affiliation(s)
- Reinier Alvarez
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Florida International University Herbert Wertheim College of Medicine, Miami, Florida.,Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Panagiotis Mastorakos
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Elizabeth Hogan
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Department of Neurosurgery, George Washington University, Washington, District of Columbia
| | - Gretchen Scott
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Henry E Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland
| | - Prashant Chittiboina
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
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21
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Smith LGF, Chiocca EA, Zipfel GJ, Smith AGF, Groff MW, Haid RW, Lonser RR. Neurosurgery Research and Education Foundation funding conversion to National Institutes of Health funding. J Neurosurg 2021; 136:287-294. [PMID: 34116507 DOI: 10.3171/2020.11.jns203871] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Neurosurgery Research and Education Foundation (NREF) provides research support for in-training and early career neurosurgeon-scientists. To define the impact of this funding, the authors assessed the success of NREF awardees in obtaining subsequent National Institutes of Health (NIH) funding. METHODS NREF in-training (Research Fellowship [RF] for residents) and early career awards/awardees (Van Wagenen Fellowship [VW] and Young Clinician Investigator [YCI] award for neurosurgery faculty) were analyzed. NIH funding was defined by individual awardees using the NIH Research Portfolio Online Reporting tool (1985-2014). RESULTS Between 1985 and 2014, 207 unique awardees were supported by 218 NREF awards ($9.84 million [M] in funding), including 117 RF ($6.02 M), 32 VW ($1.68 M), and 69 YCI ($2.65 M) awards. Subspecialty funding included neuro-oncology (79 awards; 36% of RF, VW, and YCI awards), functional (53 awards; 24%), vascular (37 awards; 17%), spine (22 awards; 10%), pediatrics (18 awards; 8%), trauma/critical care (5 awards; 2%), and peripheral nerve (4 awards; 2%). These awardees went on to receive $353.90 M in NIH funding that resulted in an overall NREF/NIH funding ratio of 36.0:1 (in dollars). YCI awardees most frequently obtained later NIH funding (65%; $287.27 M), followed by VW (56%; $41.10 M) and RF (31%; $106.59 M) awardees. YCI awardees had the highest NREF/NIH funding ratio (108.6:1), followed by VW (24.4:1) and RF (17.7:1) awardees. Subspecialty awardees who went on to obtain NIH funding included vascular (19 awardees; 51% of vascular NREF awards), neuro-oncology (40 awardees; 51%), pediatrics (9 awardees; 50%), functional (25 awardees; 47%), peripheral nerve (1 awardees; 25%), trauma/critical care (2 awardees; 20%), and spine (2 awardees; 9%) awardees. Subspecialty NREF/NIH funding ratios were 56.2:1 for vascular, 53.0:1 for neuro-oncology, 47.6:1 for pediatrics, 34.1:1 for functional, 22.2:1 for trauma/critical care, 9.5:1 for peripheral nerve, and 0.4:1 for spine. Individuals with 2 NREF awards achieved a higher NREF/NIH funding ratio (83.3:1) compared to those with 1 award (29.1:1). CONCLUSIONS In-training and early career NREF grant awardees are an excellent investment, as a significant portion of these awardees go on to obtain NIH funding. Moreover, there is a potent multiplicative impact of NREF funding converted to NIH funding that is related to award type and subspecialty.
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Affiliation(s)
- Luke G F Smith
- 1Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - E Antonio Chiocca
- 2Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gregory J Zipfel
- 3Department of Neurological Surgery, Washington University, St. Louis, Missouri; and
| | - Adam G F Smith
- 1Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael W Groff
- 2Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Russell R Lonser
- 1Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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22
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Einstein EH, Bonda D, Hosseini H, Harel A, Palmer JD, Giglio P, Barve R, Gould M, Lonser RR, D'Amico RS. Large Adult Spinal Diffuse Midline Histone H3 Lysine27-to-Methionine-Mutant Glioma With Intramedullary and Extramedullary Components Presenting With Progressive Hydrocephalus: A Case Report Highlighting Unique Imaging Findings and Treatment. Cureus 2021; 13:e15333. [PMID: 34235012 PMCID: PMC8240764 DOI: 10.7759/cureus.15333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 11/26/2022] Open
Abstract
Diffuse midline glioma with histone H3 lysine27-to-methionine mutation (H3 K27M mutation) is a rare, aggressive tumor that is designated as World Health Organization (WHO) grade IV regardless of histologic features. Preoperative diagnosis remains challenging due to limited evidence regarding distinctive clinical and imaging characteristics. We describe the case of a young woman who presented with progressively worsening headaches due to communicating hydrocephalus. MR imaging with contrast of the cervical and thoracic spine revealed diffuse leptomeningeal enhancement with focal areas of intramedullary and subarachnoid T2 hyperintensity and enhancement, suggestive of a potential infectious process. Intraoperatively, no epidural pathology was identified, and with the differential diagnosis remaining broad, a second procedure was conducted involving intradural exploration and biopsy of a lesion. This was then identified as a diffuse midline glioma with H3 K27M mutation. The nonfocal clinical presentation in the setting of communicating hydrocephalus as well as the significant exophytic tumor growth and imaging findings made the initial diagnosis unique and challenging. This case, therefore, emphasizes the rare presentation of this tumor, and the need for further understanding of the clinical and imaging characteristics of this disease as well as the need for effective therapeutics.
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Affiliation(s)
- Evan H Einstein
- Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - David Bonda
- Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Hossein Hosseini
- Pathology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Asaff Harel
- Neurology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Joshua D Palmer
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, USA, Columbus, USA
| | - Pierre Giglio
- Neuro-oncology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Rahul Barve
- Neuro-oncology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Megan Gould
- Neuro-oncology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Russell R Lonser
- Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Randy S D'Amico
- Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
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23
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Casillo SM, Venkatesh A, Muthiah N, Agarwal N, Scott T, Romani R, Fernández LL, Aristizabal S, Ginalis EE, Ozair A, Bhat V, Faruqi A, Bajaj A, Sonkar AA, Ikeda DS, Chiocca EA, Lonser RR, Sutton TE, McGregor JM, Rea GL, Schunemann VA, Ngwenya LB, Marlin ES, Porensky PN, Shaikhouni A, Huntoon K, Dornbos D, Shaw AB, Powers CJ, Gluski JM, Culver LG, Goodwin AM, Ham S, Marupudi NI, Bhat DI, Berry KM, Wu EM, Wang MY. Biographies of international women leaders in neurosurgery. Neurosurg Focus 2021; 50:E19. [PMID: 33789227 DOI: 10.3171/2021.1.focus201096] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/06/2022]
Abstract
We received so many biographies of women neurosurgery leaders for this issue that only a selection could be condensed here. In all of them, the essence of a leader shines through. Many are included as "first" of their country or color or other achievement. All of them are included as outstanding-in clinical, academic, and organized neurosurgery. Two defining features are tenacity and service. When faced with shocking discrimination, or numbing indifference, they ignored it or fought valiantly. When choosing their life's work, they chose service, often of the most neglected-those with pain, trauma, and disability. These women inspire and point the way to a time when the term "women leaders" as an exception is unnecessary.-Katharine J. Drummond, MD, on behalf of this month's topic editors.
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Affiliation(s)
- Stephanie M Casillo
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anisha Venkatesh
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nallammai Muthiah
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nitin Agarwal
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Teresa Scott
- 2Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, Warwickshire
| | - Rossana Romani
- 3Department of Neurosurgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
| | - Laura L Fernández
- 4Faculty of Medicine, El Bosque University, Semillero Investigación Neurotrauma, Group of Investigation INUB-MEDITECH, Institute of Neuroscience and Neurosurgery, El Bosque University, Bogotá, Colombia
| | - Sarita Aristizabal
- 4Faculty of Medicine, El Bosque University, Semillero Investigación Neurotrauma, Group of Investigation INUB-MEDITECH, Institute of Neuroscience and Neurosurgery, El Bosque University, Bogotá, Colombia
| | - Elizabeth E Ginalis
- 5Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ahmad Ozair
- 6Faculty of Medicine, King George's Medical University, Lucknow
| | - Vivek Bhat
- 7Faculty of Medicine, St. John's Medical College, Bangalore
| | - Arjumand Faruqi
- 6Faculty of Medicine, King George's Medical University, Lucknow
| | - Ankur Bajaj
- 8Department of Neurosurgery, King George's Medical University, Lucknow
| | - Abhinav Arun Sonkar
- 9Department of General Surgery, King George's Medical University, Lucknow, India
| | - Daniel S Ikeda
- 10Department of Surgery, US Naval Hospital Okinawa, Japan
| | - E Antonio Chiocca
- 11Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Russell R Lonser
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Tracy E Sutton
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John M McGregor
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Gary L Rea
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Victoria A Schunemann
- 13Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Laura B Ngwenya
- 14Department of Neurosurgery and Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Ohio
| | - Evan S Marlin
- 15Department of Neurosurgery, St. Luke's University Hospital, Bethlehem, Pennsylvania
| | - Paul N Porensky
- 16Service of Neurosurgery, Naval Medical Center San Diego, California
| | - Ammar Shaikhouni
- 17Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Kristin Huntoon
- 18Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Dornbos
- 19Department of Neurosurgery, Semmes Murphey Clinic and University of Tennessee Health Science Center, Memphis, Tennessee
| | - Andrew B Shaw
- 20Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida
| | - Ciarán J Powers
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jacob M Gluski
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit
| | - Lauren G Culver
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit
| | - Alyssa M Goodwin
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit
| | - Steven Ham
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit.,22Department of Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan
| | - Neena I Marupudi
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit.,22Department of Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan
| | - Dhananjaya I Bhat
- 23Department of Neurosurgery, Aster RV Hospital, Bangalore, India; and
| | - Katherine M Berry
- 24Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eva M Wu
- 24Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael Y Wang
- 24Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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24
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Wang JL, Barth RF, Cavaliere R, Puduvalli VK, Giglio P, Lonser RR, Elder JB. Phase I trial of intracerebral convection-enhanced delivery of carboplatin for treatment of recurrent high-grade gliomas. PLoS One 2020; 15:e0244383. [PMID: 33373402 PMCID: PMC7771668 DOI: 10.1371/journal.pone.0244383] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022] Open
Abstract
Background Carboplatin is a potent cytoreductive agent for a variety of solid tumors. However, when delivered systemically, clinical efficacy for the treatment of high grade gliomas is poor due to limited penetration across the blood-brain barrier (BBB). Direct intracerebral (IC) convection-enhanced delivery (CED) of carboplatin has been used to bypass the BBB and successfully treat the F98 rat glioma. Based on these studies, we initiated a Phase I clinical trial. Objective This Phase I clinical trial was conducted to establish the maximum tolerated dose and define the toxicity profile of carboplatin delivered intracerebrally via convection enhanced delivery (CED) for patients with high grade glial neoplasms. Methods Cohorts of 3 patients with recurrent WHO grade III or IV gliomas were treated with escalating doses of CED carboplatin (1–4 μg in 54mL over 72 hours) delivered via catheters placed at the time of recurrent tumor resection. The primary outcome measure was determination of the maximum tolerated dose (MTD). Secondary outcome measures included overall survival (OS), progression-free survival (PFS), and radiographic correlation. Results A total of 10 patients have completed treatment with infusion doses of carboplatin of 1μg, 2μg, and 4μg. The total planned volume of infusion was 54mL for each patient. All patients had previously received surgery and chemoradiation. Histology at treatment include GBM (n = 9) and anaplastic oligodendroglioma (n = 1). Median KPS was 90 (range, 70 to 100) at time of treatment. Median PFS and OS were 2.1 and 9.6 months after completion of CED, respectively. A single adverse event possibly related to treatment was noted (generalized seizure). Conclusions IC CED of carboplatin as a potential therapy for recurrent malignant glioma is feasible and safe at doses up to 4μg in 54mL over 72 hours. Further studies are needed to determine the maximum tolerated dose and potential efficacy.
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Affiliation(s)
- Joshua L. Wang
- Department of Neurological Surgery, The Ohio State University College of Medicine Wexner Medical Center, Columbus, Ohio, United States of America
- * E-mail:
| | - Rolf F. Barth
- Department of Pathology, The Ohio State University College of Medicine Wexner Medical Center, Columbus, Ohio, United States of America
| | - Robert Cavaliere
- Division of Neuro-Oncology, Department of Neurology, The Ohio State University College of Medicine Wexner Medical Center, Columbus, Ohio, United States of America
| | - Vinay K. Puduvalli
- Division of Neuro-Oncology, Department of Neurology, The Ohio State University College of Medicine Wexner Medical Center, Columbus, Ohio, United States of America
| | - Pierre Giglio
- Division of Neuro-Oncology, Department of Neurology, The Ohio State University College of Medicine Wexner Medical Center, Columbus, Ohio, United States of America
| | - Russell R. Lonser
- Department of Neurological Surgery, The Ohio State University College of Medicine Wexner Medical Center, Columbus, Ohio, United States of America
| | - J. Bradley Elder
- Department of Neurological Surgery, The Ohio State University College of Medicine Wexner Medical Center, Columbus, Ohio, United States of America
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Tong AP, Pomeraniec IJ, Mastorakos P, Chittiboina P, Lonser RR, Zaghloul KA. Growth of Hemangioblastomas in von Hippel-Lindau Disease Demonstrates Power-law Scaling of Complex Systems. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_868] [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: 11/13/2022] Open
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Smith L, Rezaizadeh KP, Tennekoon M, Ojemann JA, Lonser RR, Korn SJ. Creation of a Comprehensive Training and Career Development Approach to Increase the Number of Neurosurgeons Supported by National Institutes of Health Funding. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_135] [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: 11/13/2022] Open
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Bankiewicz KS, Pasterski T, Kreatsoulas D, Onikijuk J, Mozgiel K, Munjal V, Elder JB, Lonser RR, Zabek M. Use of a novel ball-joint guide array for magnetic resonance imaging-guided cannula placement and convective delivery: technical note. J Neurosurg 2020:1-7. [PMID: 33096525 DOI: 10.3171/2020.6.jns201564] [Citation(s) in RCA: 4] [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: 04/30/2020] [Accepted: 06/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to assess the feasibility, accuracy, effectiveness, and safety of an MRI-compatible frameless stereotactic ball-joint guide array (BJGA) as a platform for cannula placement and convection-enhanced delivery (CED). METHODS The authors analyzed the clinical and imaging data from consecutive patients with aromatic l-amino acid decarboxylase (AADC) deficiency who underwent infusion of adeno-associated virus (AAV) containing the AADC gene (AAV2-AADC). RESULTS Eleven patients (7 females, 4 males) underwent bilateral MRI-guided BJGA cannula placement and CED of AAV2-AADC (22 brainstem infusions). The mean age at infusion was 10.5 ± 5.2 years (range 4-19 years). MRI allowed for accurate real-time planning, confirmed precise cannula placement after single-pass placement, and permitted on-the-fly adjustment. Overall, the mean bilateral depth to the target was 137.0 ± 5.2 mm (range 124.0-145.5 mm). The mean bilateral depth error was 0.9 ± 0.7 mm (range 0-2.2 mm), and the bilateral radial error was 0.9 ± 0.6 mm (range 0.1-2.3 mm). The bilateral absolute tip error was 1.4 ± 0.8 mm (range 0.4-3.0 mm). Target depth and absolute tip error were not correlated (Pearson product-moment correlation coefficient, r = 0.01). CONCLUSIONS Use of the BJGA is feasible, accurate, effective, and safe for cannula placement, infusion MRI monitoring, and cannula adjustment during CED. The low-profile universal applicability of the BJGA streamlines and facilitates MRI-guided CED.
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Affiliation(s)
- Krystof S Bankiewicz
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Tomasz Pasterski
- 2Department of Neurological Surgery, Centrum Medyczne Kształcenia Podyplomowego, Brodno Hospital, Warsaw, Poland
| | - Daniel Kreatsoulas
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Jakub Onikijuk
- 2Department of Neurological Surgery, Centrum Medyczne Kształcenia Podyplomowego, Brodno Hospital, Warsaw, Poland
| | - Krzysztof Mozgiel
- 2Department of Neurological Surgery, Centrum Medyczne Kształcenia Podyplomowego, Brodno Hospital, Warsaw, Poland
| | - Vikas Munjal
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - J Bradley Elder
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Russell R Lonser
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Mirosław Zabek
- 2Department of Neurological Surgery, Centrum Medyczne Kształcenia Podyplomowego, Brodno Hospital, Warsaw, Poland
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Wang MC, Boop FA, Kondziolka D, Resnick DK, Kalkanis SN, Koehnen E, Selden NR, Heilman CB, Valadka AB, Cockroft KM, Wilson JA, Ellenbogen RG, Asher AL, Byrne RW, Camarata PJ, Huang J, Knightly JJ, Levy EI, Lonser RR, Connolly ES, Meyer FB, Liau LM. Continuous improvement in patient safety and quality in neurological surgery: the American Board of Neurological Surgery in the past, present, and future. J Neurosurg 2020:1-7. [PMID: 33065539 DOI: 10.3171/2020.6.jns202066] [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: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
The American Board of Neurological Surgery (ABNS) was incorporated in 1940 in recognition of the need for detailed training in and special qualifications for the practice of neurological surgery and for self-regulation of quality and safety in the field. The ABNS believes it is the duty of neurosurgeons to place a patient's welfare and rights above all other considerations and to provide care with compassion, respect for human dignity, honesty, and integrity. At its inception, the ABNS was the 13th member board of the American Board of Medical Specialties (ABMS), which itself was founded in 1933. Today, the ABNS is one of the 24 member boards of the ABMS.To better serve public health and safety in a rapidly changing healthcare environment, the ABNS continues to evolve in order to elevate standards for the practice of neurological surgery. In connection with its activities, including initial certification, recognition of focused practice, and continuous certification, the ABNS actively seeks and incorporates input from the public and the physicians it serves. The ABNS board certification processes are designed to evaluate both real-life subspecialty neurosurgical practice and overall neurosurgical knowledge, since most neurosurgeons provide call coverage for hospitals and thus must be competent to care for the full spectrum of neurosurgery.The purpose of this report is to describe the history, current state, and anticipated future direction of ABNS certification in the US.
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Affiliation(s)
- Marjorie C Wang
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Frederick A Boop
- 2Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- 3Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Daniel K Resnick
- 4Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Steven N Kalkanis
- 5Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | | | - Nathan R Selden
- 7Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Carl B Heilman
- 8Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Alex B Valadka
- 9Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Kevin M Cockroft
- 10Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - John A Wilson
- 11Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Richard G Ellenbogen
- 12Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Anthony L Asher
- 13Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Richard W Byrne
- 14Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Paul J Camarata
- 15Department of Neurosurgery, University of Kansas, Kansas City, Kansas
| | - Judy Huang
- 16Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Elad I Levy
- 18Department of Neurosurgery, University at Buffalo, New York
| | - Russell R Lonser
- 19Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - E Sander Connolly
- 20Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Fredric B Meyer
- 21Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | - Linda M Liau
- 22Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Lonser RR, Smith LGF, Tennekoon M, Rezai-Zadeh KP, Ojemann JG, Korn SJ. Creation of a comprehensive training and career development approach to increase the number of neurosurgeons supported by National Institutes of Health funding. J Neurosurg 2020:1-9. [PMID: 32764178 DOI: 10.3171/2020.5.jns201008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/30/2020] [Accepted: 05/04/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To increase the number of independent National Institutes of Health (NIH)-funded neurosurgeons and to enhance neurosurgery research, the National Institute of Neurological Disorders and Stroke (NINDS) developed two national comprehensive programs (R25 [established 2009] for residents/fellows and K12 [2013] for early-career neurosurgical faculty) in consultation with neurosurgical leaders and academic departments to support in-training and early-career neurosurgeons. The authors assessed the effectiveness of these NINDS-initiated programs to increase the number of independent NIH-funded neurosurgeon-scientists and grow NIH neurosurgery research funding. METHODS NIH funding data for faculty and clinical department funding were derived from the NIH, academic departments, and Blue Ridge Institute of Medical Research databases from 2006 to 2019. RESULTS Between 2009 and 2019, the NINDS R25 funded 87 neurosurgical residents. Fifty-three (61%) have completed the award and training, and 39 (74%) are in academic practice. Compared to neurosurgeons who did not receive R25 funding, R25 awardees were twice as successful (64% vs 31%) in obtaining K-series awards and received the K-series award in a significantly shorter period of time after training (25.2 ± 10.1 months vs 53.9 ± 23.0 months; p < 0.004). Between 2013 and 2019, the NINDS K12 has supported 19 neurosurgeons. Thirteen (68%) have finished their K12 support and all (100%) have applied for federal funding. Eleven (85%) have obtained major individual NIH grant support. Since the establishment of these two programs, the number of unique neurosurgeons supported by either individual (R01 or DP-series) or collaborative (U- or P-series) NIH grants increased from 36 to 82 (a 2.3-fold increase). Overall, NIH funding to clinical neurological surgery departments between 2006 and 2019 increased from $66.9 million to $157.3 million (a 2.2-fold increase). CONCLUSIONS Targeted research education and career development programs initiated by the NINDS led to a rapid and dramatic increase in the number of NIH-funded neurosurgeon-scientists and total NIH neurosurgery department funding.
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Affiliation(s)
- Russell R Lonser
- 1Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Luke G F Smith
- 1Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Tennekoon
- 2Office of Training and Workforce Development, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
| | - Kavon P Rezai-Zadeh
- 2Office of Training and Workforce Development, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
| | - Jeffrey G Ojemann
- 3Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Stephen J Korn
- 2Office of Training and Workforce Development, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
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Lonser RR, Akhter AS, Zabek M, Elder JB, Bankiewicz KS. Direct convective delivery of adeno-associated virus gene therapy for treatment of neurological disorders. J Neurosurg 2020; 134:1751-1763. [PMID: 32915526 DOI: 10.3171/2020.4.jns20701] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 03/05/2020] [Accepted: 04/16/2020] [Indexed: 11/06/2022]
Abstract
Molecular biological insights have led to a fundamental understanding of the underlying genomic mechanisms of nervous system disease. These findings have resulted in the identification of therapeutic genes that can be packaged in viral capsids for the treatment of a variety of neurological conditions, including neurodegenerative, metabolic, and enzyme deficiency disorders. Recent data have demonstrated that gene-carrying viral vectors (most often adeno-associated viruses) can be effectively distributed by convection-enhanced delivery (CED) in a safe, reliable, targeted, and homogeneous manner across the blood-brain barrier. Critically, these vectors can be monitored using real-time MRI of a co-infused surrogate tracer to accurately predict vector distribution and transgene expression at the perfused site. The unique properties of CED of adeno-associated virus vectors allow for cell-specific transgene manipulation of the infused anatomical site and/or widespread interconnected sites via antero- and/or retrograde transport. The authors review the convective properties of viral vectors, associated technology, and clinical applications.
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Affiliation(s)
- Russell R Lonser
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Asad S Akhter
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Mirosław Zabek
- 2Department of Neurological Surgery, Bródno Hospital, Warsaw, Poland
| | - J Bradley Elder
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Krystof S Bankiewicz
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
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31
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Lonser RR, Zipfel GJ, Chiocca EA. National Institute of Neurological Disorders and Stroke: current funding status, opportunities, challenges, emerging scientific advances, and recommendations for neurosurgery. J Neurosurg 2020; 133:1-6. [PMID: 32619985 DOI: 10.3171/2020.4.jns201202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Russell R Lonser
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Gregory J Zipfel
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - E Antonio Chiocca
- 3Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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32
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Fiandaca MS, Lonser RR, Elder JB, Ząbek M, Bankiewicz KS. Advancing gene therapies, methods, and technologies for Parkinson’s Disease and other neurological disorders. Neurol Neurochir Pol 2020; 54:220-231. [DOI: 10.5603/pjnns.a2020.0046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 11/25/2022]
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Harrington BM, Gretschel A, Lombard C, Lonser RR, Vlok AJ. Complications, outcomes, and management strategies of non-missile penetrating head injuries. J Neurosurg 2020; 134:1658-1666. [PMID: 32559744 DOI: 10.3171/2020.4.jns20122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/13/2020] [Accepted: 04/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While high-velocity missile injury (gunshot) is associated with kinetic and thermal injuries, non-missile penetrating head injury (NMPHI) results in primary damage along the tract of the piercing object that can be associated with significant secondary complications. Despite the unique physical properties of NMPHI, factors associated with complications, expected outcomes, and optimal management have not been defined. In this study, the authors attempted to define those factors. METHODS Consecutive adult patients with NMPHI who presented to Tygerberg Academic Hospital (Cape Town, South Africa) in the period from August 1, 2011, through July 31, 2018, were enrolled in a prospective study using a defined treatment algorithm. Clinical, imaging, and laboratory data were analyzed. RESULTS One hundred ninety-two patients (185 males [96%], 7 females [4%]) with 192 NMPHIs were included in this analysis. The mean age at injury was 26.2 ± 1.1 years (range 18-58 years). Thirty-four patients (18%) presented with the weapon in situ. Seventy-one patients (37%) presented with a Glasgow Coma Scale (GCS) score of 15. Weapons included a knife (156 patients [81%]), screwdriver (18 [9%]), nail gun (1 [0.5%]), garden fork (1 [0.5%]), barbeque fork (1 [0.5%]), and unknown (15 [8%]). The most common wound locations were temporal (74 [39%]), frontal (65 [34%]), and parietal (30 [16%]). The most common secondary complications were vascular injury (37 patients [19%]) and infection (27 patients [14%]). Vascular injury was significantly associated with imaging evidence of deep subarachnoid hemorrhage and an injury tract crossing vascular territory (p ≤ 0.05). Infection was associated with delayed referral (> 24 hours), lack of prophylactic antibiotic administration, and weapon in situ (p ≤ 0.05). A poorer outcome was associated with a stab depth > 50 mm, a weapon removed by the assailant, vascular injury, and eloquent brain involvement (p ≤ 0.05). Nineteen patients (10%) died from their injuries. The Glasgow Outcome Scale (GOS) score was linearly related to the admission GCS score (p < 0.001). One hundred forty patients (73%) had a GOS score of 4 or better at discharge. CONCLUSIONS The most common NMPHI secondary complications are vascular injury and infection, which are associated with specific NMPHI imaging and clinical features. Identifying these features and using a systematic management paradigm can effectively treat the primary injury, as well as diagnose and manage NMPHI-related complications, leading to a good outcome in the majority of patients.
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Affiliation(s)
| | | | - Carl Lombard
- 2Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Western Cape, South Africa; and
| | - Russell R Lonser
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Adriaan J Vlok
- 1Division of Neurosurgery, University of Stellenbosch; and
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Heiss JD, Walbridge S, Argersinger DP, Hong CS, Ray-Chaudhury A, Lonser RR, Elias WJ, Zaghloul KA. Convection-Enhanced Delivery of Muscimol Into the Bilateral Subthalamic Nuclei of Nonhuman Primates. Neurosurgery 2020; 84:E420-E429. [PMID: 29931364 DOI: 10.1093/neuros/nyy279] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/02/2018] [Accepted: 05/30/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Muscimol is a gamma-aminobutyric acid receptor agonist that selectively and temporarily inhibits neurons. Local bolus injection of muscimol has been used experimentally to inhibit neuronal populations within discrete anatomical structures and discern their physiological function. OBJECTIVE To determine the safety and behavioral effects of convection-enhanced delivery of muscimol into the bilateral subthalamic nuclei (STN) of nonhuman primate rhesus macaques (NHPs). METHODS Six awake NHPs underwent co-infusion of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA), a surrogate magnetic resonance imaging (MRI) tracer, with increasing concentrations of muscimol for behavioral and histological assessment. Three other NHPs were co-infused with Gd-DTPA and 3H-muscimol into the STN to determine muscimol distribution by MRI and autoradiography. Two NHPs underwent microcatheter implantation without muscimol infusion for control comparison. RESULTS MRI revealed selective and complete perfusion of the bilateral STN in animals infused with Gd-DTPA and muscimol. No abnormal movements occurred at 0.125 mM. Muscimol doses between 0.25 and 4.4 mM resulted in transient, dose-dependent hyperkinesia. Muscimol (8.8 mM) resulted in severe bilateral dyskinesias, ballistic movements, and sedation. An 88.8 mM dose produced unresponsiveness in 1 animal. Infusion-related pathological abnormities or toxicity was not present on histological examination. MRI distribution of co-infused Gd-DTPA was similar to autoradiographic distribution of 3H-muscimol (Vd; R = 0.94). Mean Vd of infused animals was 37.9 mm3 ± 11.7 mm3 and mean Vd: Vi 7.6 ± 2.3. CONCLUSION Bilateral convection-enhanced delivery of muscimol into the primate STN resulted in dose-related hyperkinetic movements that resolved after stopping the infusion. Muscimol was not toxic to brain tissue. Gd-DTPA accurately tracked muscimol distribution.
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Affiliation(s)
- John D Heiss
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Stuart Walbridge
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Davis P Argersinger
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Christopher S Hong
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Abhik Ray-Chaudhury
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Russell R Lonser
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - W Jeffrey Elias
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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35
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Heiss JD, Jarvis K, Smith RK, Eskioglu E, Gierthmuehlen M, Patronas NJ, Butman JA, Argersinger DP, Lonser RR, Oldfield EH. Origin of Syrinx Fluid in Syringomyelia: A Physiological Study. Neurosurgery 2019; 84:457-468. [PMID: 29618081 DOI: 10.1093/neuros/nyy072] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/13/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The origin of syrinx fluid is controversial. OBJECTIVE To elucidate the mechanisms of syringomyelia associated with cerebrospinal fluid pathway obstruction and with intramedullary tumors, contrast transport from the spinal subarachnoid space (SAS) to syrinx was evaluated in syringomyelia patients. METHODS We prospectively studied patients with syringomyelia: 22 with Chiari I malformation and 16 with SAS obstruction-related syringomyelia before and 1 wk after surgery, and 9 with tumor-related syringomyelia before surgery only. Computed tomography-myelography quantified dye transport into the syrinx before and 0.5, 2, 4, 6, 8, 10, and 22 h after contrast injection by measuring contrast density in Hounsfield units (HU). RESULTS Before surgery, more contrast passed into the syrinx in Chiari I malformation-related syringomyelia and spinal obstruction-related syringomyelia than in tumor-related syringomyelia, as measured by (1) maximum syrinx HU, (2) area under the syrinx concentration-time curve (HU AUC), (3) ratio of syrinx HU to subarachnoid cerebrospinal fluid (CSF; SAS) HU, and (4) AUC syrinx/AUC SAS. More contrast (AUC) accumulated in the syrinx and subarachnoid space before than after surgery. CONCLUSION Transparenchymal bulk flow of CSF from the subarachnoid space to syrinx occurs in Chiari I malformation-related syringomyelia and spinal obstruction-related syringomyelia. Before surgery, more subarachnoid contrast entered syringes associated with CSF pathway obstruction than with tumor, consistent with syrinx fluid originating from the subarachnoid space in Chiari I malformation and spinal obstruction-related syringomyelia and not from the subarachnoid space in tumor-related syringomyelia. Decompressive surgery opened subarachnoid CSF pathways and reduced contrast entry into syringes associated with CSF pathway obstruction.
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Affiliation(s)
- John D Heiss
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland
| | - Katie Jarvis
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland
| | - René K Smith
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland
| | - Eric Eskioglu
- Novant Health Neurosurgery Specialists, Charlotte, North Carolina
| | - Mortimer Gierthmuehlen
- Department of Neurosurgery, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Nicholas J Patronas
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - John A Butman
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Davis P Argersinger
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland
| | - Russell R Lonser
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland
| | - Edward H Oldfield
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland
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Abstract
Importance von Hippel-Lindau (VHL) disease-associated central nervous system (CNS) lesions include hemangioblastomas and endolymphatic sac tumors (ELSTs), which are associated with significant neurological morbidity and mortality. Recent studies provide critical new biological, diagnostic, and management insights into these tumors. Observations Biological features, natural history, clinical findings, and management strategies of VHL disease-associated CNS tumors are reviewed. The VHL disease results from a germline mutation of the VHL gene (located on the short arm of chromosome 3), a tumor suppressor that encodes for the VHL protein. Whereas VHL disease is associated with visceral manifestations, CNS lesions are the most common source of morbidity and mortality. Craniospinal hemangioblastomas are almost entirely (99%) found in the cerebellum, brainstem, and spinal cord. These tumors arise from multipotent hemangioblasts. Peritumoral cysts frequently underlie the clinical findings associated with hemangioblastomas (>90% of symptomatic tumors). Prospective natural history studies demonstrate that CNS hemangioblastomas typically grow in a saltatory pattern. Due to this unpredictable growth pattern, surgical resection is reserved for symptomatic lesions, as many tumors do not become symptomatic. Recent studies indicate that VHL disease-associated ELSTs cause audiovestibular morbidity (hearing loss, tinnitus, and vertigo) via 3 mechanisms-otic capsule invasion, intralabyrinthine hemorrhage, and endolymphatic hydrops. Specialized magnetic resonance imaging techniques have been defined to elucidate each of these mechanisms, even when a tumor mass is not identified on imaging. Endolymphatic sac tumors cause audiovestibular morbidity unrelated to size or progression, and resection is now recommended at initial discovery of a tumor mass or a tumor-associated mechanism of morbidity. Conclusions and Relevance New insights into the development, pathobiological origin, natural history, and long-term outcomes of VHL disease-associated CNS tumors have redefined their management and treatment indications and potentially provide new targeted therapeutic strategies. Resection is reserved for symptomatic hemangioblastomas, but early resection of newly detected ELSTs is now recommended.
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Affiliation(s)
- David Dornbos
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - H Jeffrey Kim
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland.,Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, District of Columbia
| | - John A Butman
- Neuroradiology Section, Diagnostic Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus.,Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Elder JB, Sherman JH, Prevedello DM, Szerlip NJ, Spratt DE, Shaikhouni A, Mohyeldin A, Perez-Roman RJ, Buttrick SS, Ali SC, Komotar RJ, Todeschini A, Shahein M, Revuelta JM, Hardesty D, Carrau RL, Zada G, Giannotta S, Dornbos D, Lonser RR. Tumor. Oper Neurosurg (Hagerstown) 2019; 17:S119-S152. [PMID: 31099848 DOI: 10.1093/ons/opz100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Bradley Elder
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jonathan H Sherman
- Department of Neurosurgery, The George Washington University, Washington, District of Columbia
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | | | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Ammar Shaikhouni
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Ahmed Mohyeldin
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Roberto J Perez-Roman
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Simon S Buttrick
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Sheikh C Ali
- Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Alexandre Todeschini
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Mostafa Shahein
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Juan Manuel Revuelta
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Douglas Hardesty
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Gabriel Zada
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steven Giannotta
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - David Dornbos
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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Sudhakar V, Naidoo J, Samaranch L, Bringas JR, Lonser RR, Fiandaca MS, Bankiewicz KS. Infuse-as-you-go convective delivery to enhance coverage of elongated brain targets: technical note. J Neurosurg 2019; 133:1-8. [PMID: 31299656 DOI: 10.3171/2019.4.jns19826] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 03/26/2019] [Accepted: 04/29/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To develop and assess a convective delivery technique that enhances the effectiveness of drug delivery to nonspherical brain nuclei, the authors developed an occipital "infuse-as-you-go" approach to the putamen and compared it to the currently used transfrontal approach. METHODS Eleven nonhuman primates received a bilateral putamen injection of adeno-associated virus with 2 mM gadolinium-DTPA by real-time MR-guided convective perfusion via either a transfrontal (n = 5) or occipital infuse-as-you-go (n = 6) approach. RESULTS MRI provided contemporaneous assessment and monitoring of putaminal infusions for transfrontal (2 to 3 infusion deposits) and occipital infuse-as-you-go (stepwise infusions) putaminal approaches. The infuse-as-you-go technique was more efficient than the transfrontal approach (mean 35 ± 1.1 vs 88 ± 8.3 minutes [SEM; p < 0.001]). More effective perfusion of the postcommissural and total putamen was achieved with the infuse-as-you-go versus transfronatal approaches (100-µl infusion volumes; mean posterior commissural coverage 76.2% ± 5.0% vs 32.8% ± 2.9% [p < 0.001]; and mean total coverage 53.5% ± 3.0% vs 38.9% ± 2.3% [p < 0.01]). CONCLUSIONS The infuse-as-you-go approach, paralleling the longitudinal axis of the target structure, provides a more effective and efficient method for convective infusate coverage of elongated, irregularly shaped subcortical brain nuclei.
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Affiliation(s)
- Vivek Sudhakar
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Jerusha Naidoo
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Lluis Samaranch
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - John R Bringas
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Russell R Lonser
- 2Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Massimo S Fiandaca
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Krystof S Bankiewicz
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
- 2Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Mehta GU, Montgomery BK, Maggio DM, Chittiboina P, Oldfield EH, Lonser RR. Functional Outcome After Resection of Von Hippel-Lindau Disease-Associated Cauda Equina Hemangioblastomas: An Observational Cohort Study. Oper Neurosurg (Hagerstown) 2019; 13:435-440. [PMID: 28838111 DOI: 10.1093/ons/opx019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/24/2016] [Accepted: 01/28/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cauda equina hemangioblastomas in von Hippel-Lindau (VHL) disease can cause significant neurological signs and symptoms. Despite their associated morbidity, the management of these tumors remains incompletely defined. OBJECTIVE To determine optimal management, we analyzed the functional outcomes after resection of these tumors. METHODS VHL patients who underwent surgical resection of cauda equina hemangioblastomas at the National Institutes of Health and the University of Virginia were included. Clinical and radiological follow-up was performed at 6- to 12-month intervals after surgery. RESULTS Fifteen patients underwent 18 operations for 21 cauda equina hemangioblastomas (median follow-up 5.9 years). Patients often presented with multiple symptoms, including pain (67%), numbness (50%), urinary complaints (33%), and weakness (11%). Median preoperative tumor volume was 1.2 cm 3 . Four tumors at 3 operations were not resected due to a motor nerve root origin. Gross total resection was achieved in 14 surgeries (93% of operations when resection was attempted). New mild (non-function limiting) neurological symptoms were noted after 11 operations (61%), which most often (64%) resolved within 2 weeks of surgery. At 6-month follow-up, 15 patients (83%) were stable, 2 (11%) were improved, and 1 (6%) was worse. Histological analysis revealed that all tumors originated from within the involved nerve fascicle. CONCLUSIONS VHL-associated cauda equina hemangioblastomas have an intrafascicular origin and require interruption of the rootlet of origin for complete resection. Motor nerve root involvement may preclude complete resection but strategies including bony decompression and/or interruption of vascular supply may provide a therapeutic option. Nevertheless, most VHL patients with symptom-producing lesions improve with resection.
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Affiliation(s)
- Gautam U Mehta
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurosurgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Blake K Montgomery
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Dominic M Maggio
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurosurgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Prashant Chittiboina
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Edward H Oldfield
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurosurgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Russell R Lonser
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Pines AR, Alghoul MS, Hamade YJ, Sattur MG, Aoun RJN, Halasa TK, Krishna C, Zammar SG, El Tecle NE, El Ahmadieh TY, Aoun SG, Byrne RW, Harrop JS, Ragel BT, Resnick DK, Lonser RR, Selden NR, Bendok BR. Assessment of the Interrater Reliability of the Congress of Neurological Surgeons Microanastomosis Assessment Scale. Oper Neurosurg (Hagerstown) 2019; 13:108-112. [PMID: 28931262 DOI: 10.1227/neu.0000000000001403] [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: 11/24/2015] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The potential for simulation-based learning in neurosurgical training has led the Congress of Neurosurgical Surgeons to develop a series of simulation modules. The Northwestern Objective Microanastomosis Assessment Tool (NOMAT) was created as the corresponding assessment tool for the Congress of Neurosurgical Surgeons Microanastomosis Module. The face and construct validity of the NOMAT have been previously established. OBJECTIVE To further validate the NOMAT by determining its interrater reliability (IRR) between raters of varying levels of microsurgical expertise. METHODS The NOMAT was used to assess residents' performance in a microanastomosis simulation module in 2 settings: Northwestern University and the Society of Neurological Surgeons 2014 Boot Camp at the University of Indiana. At Northwestern University, participants were scored by 2 experienced microsurgeons. At the University of Indiana, participants were scored by 2 postdoctoral fellows and an experienced microsurgeon. The IRR of NOMAT was estimated by computing the intraclass correlation coefficient using SPSS v22.0 (IBM, Armonk, New York). RESULTS A total of 75 residents were assessed. At Northwestern University, 21 residents each performed microanastomosis on 2 model vessels of different sizes, one 3 mm and one 1 mm. At the University of Indiana, 54 residents performed a single microanastomosis procedure on 3-mm vessels. The intraclass correlation coefficient of the total NOMAT scores was 0.88 at Northwestern University and 0.78 at the University of Indiana. CONCLUSION This study indicates high IRR for the NOMAT. These results suggest that the use of raters with varying levels of expertise does not compromise the precision or validity of the scale. This allows for a wider adoption of the scale and, hence, a greater potential educational impact.
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Affiliation(s)
- Andrew R Pines
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Mohammed S Alghoul
- Departm-ent of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Youssef J Hamade
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Mithun G Sattur
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | | | - Tariq K Halasa
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
| | | | - Najib E El Tecle
- Department of Neurological Surgery, St. Louis University Hospital, St. Louis, Missouri
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | - Richard W Byrne
- Departm-ent of Neurological Surgery, Rush Univ-ersity Medical Center, Chicago, Illinois
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Brian T Ragel
- Departm-ent of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Daniel K Resnick
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Russell R Lonser
- Department of Neurological Surgery, Ohio State University, Columbus, Ohio
| | - Nathan R Selden
- Departm-ent of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
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Boyle J, Patronas NJ, Smirniotopoulos J, Herscovitch P, Dieckman W, Millo C, Maric D, Chatain GP, Hayes CP, Benzo S, Scott G, Edwards N, Ray Chaudhury A, Lodish MB, Sharma S, Nieman LK, Stratakis CA, Lonser RR, Chittiboina P. CRH stimulation improves 18F-FDG-PET detection of pituitary adenomas in Cushing's disease. Endocrine 2019; 65:155-165. [PMID: 31062234 DOI: 10.1007/s12020-019-01944-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/24/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE In MRI-negative cases Cushing's disease (CD), surgeons perform a more extensive exploration of the pituitary gland, with fewer instances of hormonal remission. 18F-fluoro-deoxy-glucose (18F-FDG) positron emission tomography (PET) has a limited role in detecting adenomas that cause CD (corticotropinomas). Our previous work demonstrated corticotropin-releasing hormone (CRH) stimulation leads to delayed, selective glucose uptake in corticotropinomas. Here, we prospectively evaluated the utility of CRH stimulation in improving 18F-FDG-PET detection of adenomas in CD. METHODS Subjects with a likely diagnosis of CD (n = 27, 20 females) each underwent two 18F-FDG-PET studies [without and with ovine-CRH (oCRH) stimulation] on a high-resolution PET platform. Standardized-uptake-values (SUV) in the sella were calculated. Two blinded neuroradiologists independently read 18F-FDG-PET images qualitatively. Adenomas were histopathologically confirmed, analyzed for mutations in the USP8 gene and for glycolytic pathway proteins. RESULTS The mean-SUV of adenomas was significantly increased from baseline (3.6 ± 1.5) with oCRH administration (3.9 ± 1.7; one-tailed p = 0.003). Neuroradiologists agreed that adenomas were visible on 21 scans, not visible on 26 scans (disagreed about 7, kappa = 0.7). oCRH-stimulation led to the detection of additional adenomas (n = 6) not visible on baseline-PET study. Of the MRI-negative adenomas (n = 5), two were detected on PET imaging (one only after oCRH-stimulation). USP8 mutations or glycolytic pathway proteins were not associated with SUV in corticotropinomas. CONCLUSIONS The results of the current study suggest that oCRH-stimulation may lead to increased 18F-FDG uptake, and increased rate of detection of corticotropinomas in CD. These results also suggest that some MRI invisible adenomas may be detectable by oCRH-stimulated FDG-PET imaging. CLINICAL TRIAL INFORMATION 18F-FDG-PET imaging with and without CRH stimulation was performed under the clinical trial NIH ID 12-N-0007 (clinicaltrials.gov identifier NCT01459237). The transsphenoidal surgeries and post-operative care was performed under the clinical trial NIH ID 03-N-0164 (clinicaltrials.gov identifier NCT00060541).
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Affiliation(s)
- Jacqueline Boyle
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA
- University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Nicholas J Patronas
- Diagnostic Radiology, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Peter Herscovitch
- Department of Positron Emission Tomography, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - William Dieckman
- Department of Positron Emission Tomography, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Corina Millo
- Department of Positron Emission Tomography, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Dragan Maric
- Flow Cytometry Core Facility, National Institute of Neurologic Diseases and Stroke, Bethesda, MD, USA
| | - Grégoire P Chatain
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | | | - Sarah Benzo
- Department of Neurosurgery, University of Colorado, Denver, CO, USA
| | - Gretchen Scott
- Department of Neurosurgery, University of Colorado, Denver, CO, USA
| | - Nancy Edwards
- Department of Neurosurgery, University of Colorado, Denver, CO, USA
| | | | - Maya B Lodish
- Section on Endocrinology and Genetics, Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Susmeeta Sharma
- Pituitary Endocrinology Section, MedStar Washington Hospital Center, Washington, DC, USA
| | - Lynnette K Nieman
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA
| | - Prashant Chittiboina
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA.
- Department of Neurosurgery, University of Colorado, Denver, CO, USA.
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Heiss JD, Lungu C, Hammoud DA, Herscovitch P, Ehrlich DJ, Argersinger DP, Sinharay S, Scott G, Wu T, Federoff HJ, Zaghloul KA, Hallett M, Lonser RR, Bankiewicz KS. Trial of magnetic resonance-guided putaminal gene therapy for advanced Parkinson's disease. Mov Disord 2019; 34:1073-1078. [PMID: 31145831 DOI: 10.1002/mds.27724] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 02/22/2019] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To investigate the safety and tolerability of convection-enhanced delivery of an adeno-associated virus, serotype-2 vector carrying glial cell line-derived neurotrophic factor into the bilateral putamina of PD patients. METHODS Thirteen adult patients with advanced PD underwent adeno-associated virus, serotype-2 vector carrying glial cell line-derived neurotrophic factor and gadoteridol (surrogate MRI tracer) coinfusion (450 μL/hemisphere) at escalating doses: 9 × 1010 vg (n = 6); 3 × 1011 vg (n = 6); and 9 × 1011 vg (n = 1). Intraoperative MRI monitored infusion distribution. Patients underwent UPDRS assessment and [18 F]FDOPA-PET scanning preoperatively and 6 and 18 months postoperatively. RESULTS Adeno-associated virus, serotype-2 vector carrying glial cell line-derived neurotrophic factor was tolerated without clinical or radiographic toxicity. Average putaminal coverage was 26%. UPDRS scores remained stable. Ten of thirteen and 12 of 13 patients had increased [18 F]FDOPA Kis at 6 and 18 months postinfusion (increase range: 5-274% and 8-130%; median, 36% and 54%), respectively. Ki differences between baseline and 6- and 18-month follow-up were statistically significant (P < 0.0002). CONCLUSION Adeno-associated virus, serotype-2 vector carrying glial cell line-derived neurotrophic factor infusion was safe and well tolerated. Increased [18 F]FDOPA uptake suggests a neurotrophic effect on dopaminergic neurons. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- John D Heiss
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Codrin Lungu
- Division of Clinical Research, and Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Dima A Hammoud
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter Herscovitch
- Positron Emission Tomography Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Debra J Ehrlich
- Parkinson's Disease Clinic, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Davis P Argersinger
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Sanhita Sinharay
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Gretchen Scott
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Tianxia Wu
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Howard J Federoff
- Department of Neurology, University of California-Irvine, Irvine, California, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Krystof S Bankiewicz
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Neurological Surgery, University of California-San Francisco, San Francisco, California, USA
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Elder JB, Huntoon K, Otero J, Kaya B, Hatef J, Eltobgy M, Lonser RR. Histologic findings associated with laser interstitial thermotherapy for glioblastoma multiforme. Diagn Pathol 2019; 14:19. [PMID: 30767775 PMCID: PMC6376796 DOI: 10.1186/s13000-019-0794-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 08/30/2018] [Accepted: 02/01/2019] [Indexed: 11/24/2022] Open
Abstract
Background Laser-interstitial thermal therapy (LITT) has been supported by some authors as an ablative treatment of glioblastoma multiforme (GBM). Although the effects of LITT have been modeled in vivo, the histologic effects in a clinical circumstance have not been described. We analyzed tissue from a patient who underwent LITT as primary treatment for GBM. Case presentation A 62-year-old male was diagnosed with a left temporal GBM and underwent LITT at an outside institution. Despite corticosteroid therapy, the patient was referred with increasing headache and acalculia associated with progressive peritumoral edema two weeks after LITT procedure. En bloc resection of the enhancing lesion and adjacent temporal lobe was performed with steroid-independent symptom resolution (follow-up, > 2 years). Histologic analysis revealed three distinct histologic zones concentrically radiating from the center of the treatment site. An acellular central region of necrosis (Zone 1) was surrounded by a rim of granulation tissue with macrophages (CD68) (Zone 2; mean thickness, 1.3 ± 0.3 mm [±S.D.]). Viable tumor cells (identified by Ki-67, p53 and Olig2 immunohistochemistry) were found (Zone 3) immediately adjacent to granulation tissue. The histologic volume of thermal tissue ablation/granulation was consistent with preoperative (pre-resection) magnetic resonance (MR)-imaging. Conclusion These findings are the first in vivo in humans to reveal that LITT causes a defined pattern of tissue necrosis, concentric destruction of tumor and tissue with viable tumor cells just beyond the zones of central necrosis and granulation. Furthermore, MR-imaging appears to be an accurate surrogate of tissue/tumor ablation in the early period (2 weeks) post-LITT treatment. Surgery is an effective strategy for patients with post-LITT swelling which does not respond to steroids.
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Affiliation(s)
- J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Doan 1047, Columbus, OH, 43210, USA
| | - Kristin Huntoon
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Doan 1047, Columbus, OH, 43210, USA.
| | - Jose Otero
- Division of Neuropathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Behiye Kaya
- Division of Neuropathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jeff Hatef
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Doan 1047, Columbus, OH, 43210, USA
| | - Mostafa Eltobgy
- Division of Neuropathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Doan 1047, Columbus, OH, 43210, USA
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Magdoom KN, Zeinomar A, Lonser RR, Sarntinoranont M, Mareci TH. Phase contrast MRI of creeping flows using stimulated echo. J Magn Reson 2019; 299:49-58. [PMID: 30579226 PMCID: PMC6402592 DOI: 10.1016/j.jmr.2018.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 05/30/2023]
Abstract
Creeping flows govern many important physiological phenomena such as elevated interstitial fluid flows in tumors, glymphatic flows in the brain, among other applications. However, few methods exist to measure such slow flows non-invasively in optically opaque biological tissues in vivo. Phase-contrast MRI is a velocimetry technique routinely used in the clinic to measure fast flows in biological tissues, such as blood and cerebrospinal fluid (CSF), in the order of cm/s. Use of this technique to encode slower flows is hampered by diffusion weighting and phase error introduced by gradient hardware imperfections. In this study, a new PC-MRI technique is developed using stimulated echo preparation to overcome these challenges. Flows as slow as 1 μm/s are measured and validated using controlled water flow through a pipe at 4.7 T. The error in measured flow rate obtained by integrating the measured velocity over the cross-sectional area of the pipe is less than 10%. The developed method was also able to capture slow natural convection flows appearing in liquids placed inside a horizontal bore magnet. Monitoring the 4D velocity vector field revealed that the natural convection flows decay exponentially with time. This method could be applied in future to study creeping flows, e.g. in tissue.
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Affiliation(s)
- Kulam Najmudeen Magdoom
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA.
| | - Ahmad Zeinomar
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL, USA
| | - Russell R Lonser
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Malisa Sarntinoranont
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, 1275 Center Drive, Biomedical Sciences Building, Gainesville, FL, USA
| | - Thomas H Mareci
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, 1275 Center Drive, Biomedical Sciences Building, Gainesville, FL, USA
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Heiss JD, Jamshidi A, Shah S, Martin S, Wolters PL, Argersinger DP, Warren KE, Lonser RR. Phase I trial of convection-enhanced delivery of IL13-Pseudomonas toxin in children with diffuse intrinsic pontine glioma. J Neurosurg Pediatr 2018; 23:333-342. [PMID: 30544335 PMCID: PMC7266009 DOI: 10.3171/2018.9.peds17225] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 04/28/2017] [Accepted: 09/12/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE In this clinical trial report, the authors analyze safety and infusion distribution of IL13-Pseudomonas exotoxin, an antitumor chimeric molecule, administered via intratumoral convection enhanced delivery (CED) in pediatric patients with diffuse intrinsic pontine glioma (DIPG). METHODS This was a Phase I single-institution, open-label, dose-escalation, safety and tolerability study of IL13-PE38QQR infused via single-catheter CED into 5 pediatric DIPG patients. IL13-PE38QQR was administered to regions of tumor selected by radiographic findings. Two escalating dose levels were evaluated: 0.125 µg/mL in cohort 1 and 0.25 µg/mL in cohort 2. Real-time MRI was performed during intratumoral infusions, and MRI and MR spectroscopy were performed before and after the infusions. Clinical evaluations, including parent-reported quality of life (QOL), were assessed at baseline and 4 weeks post-infusion. RESULTS Direct infusion of brainstem tumor with IL13-PE using the CED technique in patients with DIPG produced temporary arrest of disease progression in 2 of 5 patients, both of whom subsequently received a second infusion. All 5 patients showed signs of disease progression by 12 weeks after initial infusion. Two patients experienced transient cranial nerve deficits and lethargy after infusion, and these deficits resolved with corticosteroid treatment in both cases. No patient had radiographic evidence of acute or long-term treatment toxicity. Parent-reported QOL was consistent with medical outcomes. CONCLUSIONS Even though IL13-PE delivered by CED did not reach the entire MRI-defined tumor volume in any patient, short-term radiographic antitumor effects were observed in 2 of the 5 patients treated. The patients’ performance status did not improve. Drug delivery using multiple catheters may produce improved outcomes. Clinical trial registration no.: NCT00088061 (clinicaltrials.gov) ABBREVIATIONS CED = convection-enhanced delivery; DIPG = diffuse intrinsic pontine glioma; IL-13 = interleukin 13; IL13R = IL-13 receptor; IPI = Impact of Pediatric Illness; KPS = Karnofsky Performance Status; LPS = Lansky Performance Status; MRS = MR spectroscopy; NAA = n-acetyl aspartate; QOL = quality of life; Vd = volume of distribution; Vi = volume of infusion.
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Affiliation(s)
- John D. Heiss
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Aria Jamshidi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Smit Shah
- Rutgers University Robert Wood Johnson Medical School, Piscataway, New Jersey; and
| | | | | | - Davis P. Argersinger
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Katherine E. Warren
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Russell R. Lonser
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Nimjee SM, Lonser RR. Coagulation and Hematology in Neurological Surgery. Neurosurg Clin N Am 2018. [DOI: 10.1016/s1042-3680(18)30893-3] [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: 11/25/2022]
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Nimjee SM, Lonser RR. Coagulation and Hematology in Neurologic Surgery. Neurosurg Clin N Am 2018; 29:xiii-xiv. [PMID: 30223974 DOI: 10.1016/j.nec.2018.07.001] [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)
- Shahid M Nimjee
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, N-1014 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, N-1047 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
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Lu J, Montgomery BK, Chatain GP, Bugarini A, Zhang Q, Wang X, Edwards NA, Ray-Chaudhury A, Merrill MJ, Lonser RR, Chittiboina P. Corticotropin releasing hormone can selectively stimulate glucose uptake in corticotropinoma via glucose transporter 1. Mol Cell Endocrinol 2018; 470:105-114. [PMID: 28986303 PMCID: PMC5882598 DOI: 10.1016/j.mce.2017.10.003] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pre-operative detection of corticotropin (ACTH) secreting microadenomas causing Cushing's disease (CD) improves surgical outcomes. Current best magnetic resonance imaging fails to detect up to 40% of these microadenomas. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is specific, but not sensitive in detecting corticotropinomas. Theoretically, secretagogue stimulation with corticotropin releasing hormone (CRH) could improve detection of adenomas with 18F-FDG PET. Previous attempts with simultaneous CRH stimulation have failed to demonstrate increased 18F-FDG uptake in corticotropinomas. We hypothesized that CRH stimulation leads to a delayed elevation in glucose uptake in corticotropinomas. METHODS Clinical data was analyzed for efficacy of CRH in improving 18FDG-PET detection of corticotropinomas in CD. Glucose transporter 1 (GLUT1) immunoreactivity was performed on surgical specimens. Ex-vivo, viable cells from these tumors were tested for secretagogue effects (colorimetric glucose uptake), and for fate of intracellular glucose (glycolysis stress analysis). Validation of ex-vivo findings was performed with AtT-20 cells. RESULTS CRH increased glucose uptake in human-derived corticotroph tumor cells and AtT-20, but not in normal murine or human corticotrophs (p < 0.0001). Continuous and intermittent (1 h) CRH exposure increased glucose uptake in AtT-20 with maximal effect at 4 h (p = 0.001). Similarly, CRH and 8-Br-cAMP led to robust GLUT1 upregulation and increased membrane translocation at 2 h, while fasentin suppressed baseline (p < 0.0001) and CRH-mediated glucose uptake. Expectedly, intra-operatively collected corticotropinomas demonstrated GLUT1 overexpression. Lastly, human derived corticotroph tumor cells demonstrated increased glycolysis and low glucose oxidation. CONCLUSION Increased and delayed CRH-mediated glucose uptake differentially occurs in adenomatous corticotrophs. Delayed secretagogue-stimulated 18F-FDG PET could improve microadenoma detection.
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Affiliation(s)
- Jie Lu
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda MD
| | - Blake K. Montgomery
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD
- Department of Orthopedic Surgery, Stanford Medicine, Stanford, CA
| | - Grégoire P. Chatain
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda MD
| | - Alejandro Bugarini
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD
| | - Qi Zhang
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD
| | - Xiang Wang
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD
| | - Nancy A. Edwards
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD
| | - Abhik Ray-Chaudhury
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD
| | - Marsha J. Merrill
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD
| | - Russell R Lonser
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Prashant Chittiboina
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda MD
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD
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49
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Montaser AS, Revuelta Barbero JM, Todeschini A, Beer-Furlan A, Lonser RR, Carrau RL, Prevedello DM. Endoscopic endonasal pituitary gland hemi-transposition for resection of a dorsum sellae meningioma. Neurosurg Focus 2018; 43:V7. [PMID: 28967314 DOI: 10.3171/2017.10.focusvid.17344] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 69-year-old female with incidental diagnosis of a dorsum sellae meningioma had shown significant tumor growth after initial conservative management. The procedure started with a microscopic sublabial transsphenoidal approach to the sella and the suprasellar space. Due to limitations to a safe dissection and removal of the retrosellar component, the surgery was converted to a purely endoscopic endonasal approach with left hemi-transposition of the pituitary gland, followed by drilling of the dorsum sellae and removal of the left posterior clinoid process. A complete tumor resection was achieved, and a multilayer skull base reconstruction was performed without complications. The video can be found here: https://youtu.be/BEolyK-To_A .
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Affiliation(s)
- Alaa S Montaser
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio.,Department of Neurological Surgery, Ain Shams University, Cairo, Egypt
| | - Juan M Revuelta Barbero
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alexandre Todeschini
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - André Beer-Furlan
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; and
| | - Russell R Lonser
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Daniel M Prevedello
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
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Abstract
Pituitary adenomas are one of the most common primary central nervous system tumors and have an estimated prevalence of 17%. Approximately half of pituitary adenomas secrete distinct pituitary hormones (most often prolactin, growth hormone, or adrenocorticotropic hormone). While these tumors are histologically benign, they have potent endocrine effects that lead to significant morbidity and shortened lifespan. Because of their pathophysiologic endocrine secretion and anatomic location near critical neural/vascular structures, hormone-secreting pituitary adenomas require defined management paradigms that can include relief of mass effect and biochemical remission. Management of hormone-secreting pituitary adenomas involves a multidisciplinary approach that can incorporate surgical, medical, and/or radiation therapies. Early and effective treatment of hormone-secreting pituitary adenomas can reduce morbidity and mortality. Consequently, understanding clinical features as well as therapeutic options in the context of the specific biological features of each type of hormone-secreting pituitary adenoma is critical for optimal management.
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Affiliation(s)
- Gautam U Mehta
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Russell R Lonser
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.,Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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