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Fairclough S, Chumas P, Goodden J, Maguire M, Mathew RK. Motor seizures confer overall survival benefit in who grade 2 glioma. Epilepsia 2024. [PMID: 38506645 DOI: 10.1111/epi.17956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The prevalence of epilepsy in World Health Organization (WHO) grade 2 glioma is high, with seizures being the presenting symptom in 60%-90%. We explore the epidemiology of seizures in this patient population in a regional neurosurgical center. METHODS Electronic health records of patients with histologically-proven WHO grade 2 glioma (n = 228) were reviewed between 1997 and 2021, with data collected including patient demographics, epilepsy prevalence, and seizure semiology. The influence of seizure type on overall survival was calculated using a Cox proportional hazards model. RESULTS Overall, 197 of 228 patients (86.4%) were diagnosed with epilepsy-either at presentation or during the course of their disease. Male patients were more likely than female patients to be diagnosed with epilepsy (91.1% vs 77.1%, p = .003) and, in those with epilepsy, more likely to experience at least one focal to bilateral tonic-clonic seizure (69.4% vs 54.1%, p = .05). Patients with left-sided tumors were twice as likely to have experienced a focal to bilateral tonic-clonic seizure (p = .02, odds ratio [OR] = .47). Predominantly experiencing seizures with motor activity appeared to confer better overall survival, with a 65% decrease in the risk of death 10 years post diagnosis (hazard ratio [HR] = .35, p = .02). This is despite accounting for previously described prognostic markers including tumor histology/genetics, time from diagnosis to surgery, and the extent of tumor resection. SIGNIFICANCE Motor seizure activity is a frequent feature in WHO grade 2 glioma and appears to confer a survival benefit regardless of histology or surgical factors. Seizures due to dominant hemisphere tumors may be more likely to propagate and cause bilateral tonic-clonic activity.
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Affiliation(s)
- Sam Fairclough
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - John Goodden
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - Melissa Maguire
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Ryan K Mathew
- School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
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Ramakrishnan PK, Saeed F, Thomson S, Corns R, Mathew RK, Sivakumar G. Awake craniotomy for high-grade gliomas - a prospective cohort study in a UK tertiary-centre. Surgeon 2024; 22:e3-e12. [PMID: 38008681 DOI: 10.1016/j.surge.2023.11.002] [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: 08/29/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Studies from the UK reporting on awake craniotomy (AC) include a heterogenous group of patients which limit the evaluation of the true impact of AC in high-grade glioma (HGG) patients. This study aims to report solely the experience and outcomes of AC for HGG surgery from our centre. METHODS A prospective review of all patients who underwent AC for HGG from 2013 to 2019 were performed. Data on patient characteristics including but not limited to demographics, pre- and post-operative Karnofsky performance status (KPS), tumour location and volume, type of surgery, extent of resection (EOR), tumour histopathology, intra- and post-operative complications, morbidity, mortality, disease recurrence, progression-free survival (PFS) and overall survival (OS) from the time of surgery were collected. RESULTS Fifteen patients (6 males; 9 females; 17 surgeries) underwent AC for HGG (median age = 55 years). Two patients underwent repeat surgeries due to disease recurrence. Median pre- and post-operative KPS score was 90 (range:80-100) and 90 (range:60-100), respectively. The EOR ranges from 60 to 100 % with a minimum of 80 % achieved in 81.3 % cases. Post-operative complications include focal seizures (17.6 %), transient aphasia/dysphasia (17.6 %), permanent motor deficit (11.8 %), transient motor deficit (5.9 %) and transient sensory disturbance (5.9 %). There were no surgery-related mortality or post-operative infection. The median PFS and OS were 13 (95%CI 5-78) and 30 (95%CI 21-78) months, respectively. CONCLUSION This is the first study in the UK to solely report outcomes of AC for HGG surgery. Our data demonstrates that AC for HGG in eloquent region is safe, feasible and provides comparable outcomes to those reported in the literature.
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Affiliation(s)
- Piravin Kumar Ramakrishnan
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Fozia Saeed
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Simon Thomson
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Robert Corns
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Ryan K Mathew
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom; School of Medicine, University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom.
| | - Gnanamurthy Sivakumar
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom.
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Wahba AJ, Cromwell DA, Hutchinson PJ, Mathew RK, Phillips N. Assessing national patterns and outcomes of pituitary surgery: is hospital administrative data good enough? Br J Neurosurg 2023; 37:1135-1142. [PMID: 36727284 DOI: 10.1080/02688697.2023.2170982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Patterns of surgical care, outcomes, and quality of care can be assessed using hospital administrative databases but this requires accurate and complete data. The aim of this study was to explore whether the quality of hospital administrative data was sufficient to assess pituitary surgery practice in England. METHODS The study analysed Hospital Episode Statistics (HES) data from April 2013 to March 2018 on all adult patients undergoing pituitary surgery in England. A series of data quality indicators examined the attribution of cases to consultants, the coding of sellar and parasellar lesions, associated endocrine and visual disorders, and surgical procedures. Differences in data quality over time and between neurosurgical units were examined. RESULTS A total of 5613 records describing pituitary procedures were identified. Overall, 97.3% had a diagnostic code for the tumour or lesion treated, with 29.7% (n = 1669) and 17.8% (n = 1000) describing endocrine and visual disorders, respectively. There was a significant reduction from the first to the fifth year in records that only contained a pituitary tumour code (63.7%-47.0%, p < .001). The use of procedure codes that attracted the highest tariff increased over time (66.4%-82.4%, p < .001). Patterns of coding varied widely between the 24 neurosurgical units. CONCLUSION The quality of HES data on pituitary surgery has improved over time but there is wide variation in the quality of data between neurosurgical units. Research studies and quality improvement programmes using these data need to check it is of sufficient quality to not invalidate their results.
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Affiliation(s)
- Adam J Wahba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Research, Royal College of Surgeons of England, London, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Phillips
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Currie S, Fatania K, Frood R, Whitehead R, Start J, Lee MT, McDonald B, Rankeillor K, Roberts P, Chakrabarty A, Mathew RK, Murray L, Short S, Scarsbrook A. Imaging Spectrum of the Developing Glioblastoma: A Cross-Sectional Observation Study. Curr Oncol 2023; 30:6682-6698. [PMID: 37504350 PMCID: PMC10378288 DOI: 10.3390/curroncol30070490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Glioblastoma (GBM) has the typical radiological appearance (TRA) of a centrally necrotic, peripherally enhancing tumor with surrounding edema. The objective of this study was to determine whether the developing GBM displays a spectrum of imaging changes detectable on routine clinical imaging prior to TRA GBM. Patients with pre-operative imaging diagnosed with GBM (1 January 2014-31 March 2022) were identified from a neuroscience center. The imaging was reviewed by an experienced neuroradiologist. Imaging patterns preceding TRA GBM were analyzed. A total of 76 out of 555 (14%) patients had imaging preceding TRA GBM, 57 had solitary lesions, and 19 had multiple lesions (total = 84 lesions). Here, 83% of the lesions had cortical or cortical/subcortical locations. The earliest imaging features for 84 lesions were T2 hyperintensity/CT low density (n = 18), CT hyperdensity (n = 51), and T2 iso-intensity (n = 15). Lesions initially showing T2 hyperintensity/CT low density later showed T2 iso-intensity. When CT and MRI were available, all CT hyperdense lesions showed T2 iso-intensity, reduced diffusivity, and the following enhancement patterns: nodular 35%, solid 29%, none 26%, and patchy peripheral 10%. The mean time to develop TRA GBM from T2 hyperintensity was 140 days and from CT hyperdensity was 69 days. This research suggests that the developing GBM shows a spectrum of imaging features, progressing through T2 hyperintensity to CT hyperdensity, T2 iso-intensity, reduced diffusivity, and variable enhancement to TRA GBM. Red flags for non-TRA GBM lesions are cortical/subcortical CT hyperdense/T2 iso-intense/low ADC. Future research correlating this imaging spectrum with pathophysiology may provide insight into GBM growth patterns.
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Affiliation(s)
- Stuart Currie
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Floor B, Clarendon Wing, Great George Street, Leeds LS1 3EX, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9TJ, UK; (L.M.); (S.S.); (A.S.)
| | - Kavi Fatania
- Radiology Academy, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Floor B, Clarendon Wing, Great George Street, Leeds LS1 3EX, UK; (K.F.); (R.F.); (R.W.); (J.S.); (M.-T.L.)
| | - Russell Frood
- Radiology Academy, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Floor B, Clarendon Wing, Great George Street, Leeds LS1 3EX, UK; (K.F.); (R.F.); (R.W.); (J.S.); (M.-T.L.)
| | - Ruth Whitehead
- Radiology Academy, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Floor B, Clarendon Wing, Great George Street, Leeds LS1 3EX, UK; (K.F.); (R.F.); (R.W.); (J.S.); (M.-T.L.)
| | - Joanna Start
- Radiology Academy, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Floor B, Clarendon Wing, Great George Street, Leeds LS1 3EX, UK; (K.F.); (R.F.); (R.W.); (J.S.); (M.-T.L.)
| | - Ming-Te Lee
- Radiology Academy, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Floor B, Clarendon Wing, Great George Street, Leeds LS1 3EX, UK; (K.F.); (R.F.); (R.W.); (J.S.); (M.-T.L.)
| | - Benjamin McDonald
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7TF, UK; (B.M.); (K.R.); (P.R.); (A.C.)
| | - Kate Rankeillor
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7TF, UK; (B.M.); (K.R.); (P.R.); (A.C.)
| | - Paul Roberts
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7TF, UK; (B.M.); (K.R.); (P.R.); (A.C.)
| | - Aruna Chakrabarty
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7TF, UK; (B.M.); (K.R.); (P.R.); (A.C.)
| | - Ryan K. Mathew
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Floor G, Jubilee Wing, Great George Street, Leeds LS1 3EX, UK
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Louise Murray
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9TJ, UK; (L.M.); (S.S.); (A.S.)
- Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7TF, UK
| | - Susan Short
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9TJ, UK; (L.M.); (S.S.); (A.S.)
- Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7TF, UK
| | - Andrew Scarsbrook
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9TJ, UK; (L.M.); (S.S.); (A.S.)
- Department of Radiology, Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James’s University Hospital, Leeds LS9 7TF, UK
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Wahba AJ, Phillips N, Mathew RK, Hutchinson PJ, Helmy A, Cromwell DA. Benchmarking short-term postoperative mortality across neurosurgery units: is hospital administrative data good enough for risk-adjustment? Acta Neurochir (Wien) 2023:10.1007/s00701-023-05623-5. [PMID: 37243824 DOI: 10.1007/s00701-023-05623-5] [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: 10/19/2022] [Accepted: 05/02/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Surgical mortality indicators should be risk-adjusted when evaluating the performance of organisations. This study evaluated the performance of risk-adjustment models that used English hospital administrative data for 30-day mortality after neurosurgery. METHODS This retrospective cohort study used Hospital Episode Statistics (HES) data from 1 April 2013 to 31 March 2018. Organisational-level 30-day mortality was calculated for selected subspecialties (neuro-oncology, neurovascular and trauma neurosurgery) and the overall cohort. Risk adjustment models were developed using multivariable logistic regression and incorporated various patient variables: age, sex, admission method, social deprivation, comorbidity and frailty indices. Performance was assessed in terms of discrimination and calibration. RESULTS The cohort included 49,044 patients. Overall, 30-day mortality rate was 4.9%, with unadjusted organisational rates ranging from 3.2 to 9.3%. The variables in the best performing models varied for the subspecialties; for trauma neurosurgery, a model that included deprivation and frailty had the best calibration, while for neuro-oncology a model with these variables plus comorbidity performed best. For neurovascular surgery, a simple model of age, sex and admission method performed best. Levels of discrimination varied for the subspecialties (range: 0.583 for trauma and 0.740 for neurovascular). The models were generally well calibrated. Application of the models to the organisation figures produced an average (median) absolute change in mortality of 0.33% (interquartile range (IQR) 0.15-0.72) for the overall cohort model. Median changes for the subspecialty models were 0.29% (neuro-oncology, IQR 0.15-0.42), 0.40% (neurovascular, IQR 0.24-0.78) and 0.49% (trauma neurosurgery, IQR 0.23-1.68). CONCLUSIONS Reasonable risk-adjustment models for 30-day mortality after neurosurgery procedures were possible using variables from HES, although the models for trauma neurosurgery performed less well. Including a measure of frailty often improved model performance.
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Affiliation(s)
- Adam J Wahba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK.
- Leeds Institute of Medical Research, School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK.
| | - Nick Phillips
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research, School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Peter J Hutchinson
- Department of Research, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Adel Helmy
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Islim AI, Millward CP, Mills SJ, Fountain DM, Zakaria R, Pathmanaban ON, Mathew RK, Santarius T, Jenkinson MD. The management of incidental meningioma: An unresolved clinical conundrum. Neurooncol Adv 2023; 5:i26-i34. [PMID: 37287572 PMCID: PMC10243855 DOI: 10.1093/noajnl/vdac109] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
The widespread availability and use of brain magnetic resonance imaging and computed tomography has led to an increase in the frequency of incidental meningioma diagnoses. Most incidental meningioma are small, demonstrate indolent behavior during follow-up, and do not require intervention. Occasionally, meningioma growth causes neurological deficits or seizures prompting surgical or radiation treatment. They may cause anxiety to the patient and present a management dilemma for the clinician. The questions for both patient and clinician are "will the meningioma grow and cause symptoms such that it will require treatment within my lifetime?" and "will deferment of treatment result in greater treatment-related risks and lower chance of cure?." International consensus guidelines recommend regular imaging and clinical follow-up, but the duration is not specified. Upfront treatment with surgery or stereotactic radiosurgery/radiotherapy may be recommended but this is potentially an overtreatment, and its benefits must be balanced against the risk of related adverse events. Ideally, treatment should be stratified based on patient and tumor characteristics, but this is presently hindered by low-quality supporting evidence. This review discusses risk factors for meningioma growth, proposed management strategies, and ongoing research in the field.
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Affiliation(s)
- Abdurrahman I Islim
- Corresponding Author: Abdurrahman I. Islim, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Stott Lane, Manchester, M6 8HD, UK ()
| | - Christopher P Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel M Fountain
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Omar N Pathmanaban
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ryan K Mathew
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge, UK
- Division of Neurosurgery, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
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Schramm MWJ, Currie S, Lee MT, Livermore LJ, Solanki SP, Mathew RK, Wurdak H, Lorger M, Twelves C, Short SC, Chakrabarty A, Chumas P. Do animal models of brain tumors replicate human peritumoral edema? a systematic literature search. J Neurooncol 2023; 161:451-467. [PMID: 36757526 PMCID: PMC9992038 DOI: 10.1007/s11060-023-04246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Brain tumors cause morbidity and mortality in part through peritumoral brain edema. The current main treatment for peritumoral brain edema are corticosteroids. Due to the increased recognition of their side-effect profile, there is growing interest in finding alternatives to steroids but there is little formal study of animal models of peritumoral brain edema. This study aims to summarize the available literature. METHODS A systematic search was undertaken of 5 literature databases (Medline, Embase, CINAHL, PubMed and the Cochrane Library). The generic strategy was to search for various terms associated with "brain tumors", "brain edema" and "animal models". RESULTS We identified 603 reports, of which 112 were identified as relevant for full text analysis that studied 114 peritumoral brain edema animal models. We found significant heterogeneity in the species and strain of tumor-bearing animals, tumor implantation method and edema assessment. Most models did not produce appreciable brain edema and did not test for observable manifestations thereof. CONCLUSION No animal model currently exists that enable the investigation of novel candidates for the treatment of peritumoral brain edema. With current interest in alternative treatments for peritumoral brain edema, there is an unmet need for clinically relevant animal models.
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Affiliation(s)
- Moritz W J Schramm
- School of Medicine, University of Leeds, Leeds, UK.
- Department of Neurosurgery, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UK.
| | - Stuart Currie
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Ming-Te Lee
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Laurent J Livermore
- Department of Neurosurgery, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UK
| | | | - Ryan K Mathew
- School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UK
| | - Heiko Wurdak
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Chris Twelves
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Susan C Short
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Paul Chumas
- Department of Neurosurgery, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UK
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Bautista M, Burger R, Anderson IA, Mathew RK. ASPECT Score and Its Application to Vasospasm in Aneurysmal Subarachnoid Haemorrhage: a Case-Control Study. Transl Stroke Res 2023; 14:94-99. [PMID: 35943718 PMCID: PMC9873732 DOI: 10.1007/s12975-022-01073-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 01/31/2023]
Abstract
Delayed cerebral ischaemia (DCI) is a significant complication of aneurysmal subarachnoid haemorrhage (aSAH) and is strongly associated with poorer outcome. The Alberta Stroke Program Early Computer Tomography (ASPECT) score is an established scoring tool, used in acute ischaemic stroke, to quantify early ischaemic changes on CT head scans. We aim to identify if ASPECT scoring correlates with functional outcome in DCI following aSAH. Retrospective case-control study. Inclusion criteria: admission to the Department of Neurosurgery at Leeds Teaching Hospitals NHS Trust (a tertiary neurosurgical centre in the United Kingdom) between 2014 and 2018, with a diagnosis of anterior circulation aneurysmal subarachnoid haemorrhage; as confirmed by initial CT scan and subsequent CT angiography or catheter digital subtraction angiography. Cases were those who developed DCI (n = 43) and controls were randomly selected from those who did not develop DCI (n = 46) but otherwise met the same inclusion criteria. The primary outcome measure was Glasgow Outcome Score (GOS): assessed at discharge and 3 months. ASPECT scores were calculated from non-contrast CT head scans by three researchers blinded to each other and clinical outcome. Spearman's rank correlation was used to calculate correlation between ASPECT scores and GOS. ASPECT score positively correlated with GOS in the cases both at discharge (Spearman rho 0.436, p = 0.003) and at 3 months (Spearman rho 0.431, p = 0.004). When corrected for Fisher grading, the adjusted odds ratio of having a high GOS with a low ASPECT score at discharge was OR 0.74 (95% CI 0.61-0.94, p = 0.003), and 3 months OR 0.73 (95% CI 0.59-0.91, p = 0.005). ASPECT score significantly correlates with clinical outcome in DCI post aSAH, even after correcting for Fisher grade. ASPECT scoring may identify patients at risk of poor outcome following DCI and represents a quick and reliable tool that aids in clinical decision-making and prognostication.
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Affiliation(s)
- Melissa Bautista
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, G Floor, Leeds General Infirmary, Jubilee Wing Great George Street, Leeds, LS1 3EX UK
| | - Rebecca Burger
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, G Floor, Leeds General Infirmary, Jubilee Wing Great George Street, Leeds, LS1 3EX UK
| | - Ian A. Anderson
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, G Floor, Leeds General Infirmary, Jubilee Wing Great George Street, Leeds, LS1 3EX UK ,School of Medicine, Clinical Sciences Building, Leeds Institute of Medical Research at St James’s, University of Leeds, Room 7.6, Leeds, LS9 7TF UK
| | - Ryan K. Mathew
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, G Floor, Leeds General Infirmary, Jubilee Wing Great George Street, Leeds, LS1 3EX UK ,School of Medicine, Clinical Sciences Building, Leeds Institute of Medical Research at St James’s, University of Leeds, Room 7.6, Leeds, LS9 7TF UK
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Wahba AJ, Cromwell DA, Hutchinson PJ, Mathew RK, Phillips N. Mortality as an indicator of quality of neurosurgical care in England: a retrospective cohort study. BMJ Open 2022; 12:e067409. [PMID: 36332948 PMCID: PMC9639111 DOI: 10.1136/bmjopen-2022-067409] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Postoperative mortality is a widely used quality indicator, but it may be unreliable when procedure numbers and/or mortality rates are low, due to insufficient statistical power. The objective was to investigate the statistical validity of postoperative 30-day mortality as a quality metric for neurosurgical practice across healthcare providers. DESIGN Retrospective cohort study. SETTING Hospital Episode Statistics data from all neurosurgical units in England. PARTICIPANTS Patients who underwent neurosurgical procedures between April 2013 and March 2018. Procedures were grouped using the National Neurosurgical Audit Programme classification. OUTCOMES MEASURED National 30-day postoperative mortality rates were calculated for elective and non-elective neurosurgical procedural groups. The study estimated the proportion of neurosurgeons and NHS trusts in England that performed sufficient procedures in 3-year and 5-year periods to detect unusual performance (defined as double the national rate of mortality). The actual difference in mortality rates that could be reliably detected based on procedure volumes of neurosurgeons and units over a 5-year period was modelled. RESULTS The 30-day mortality rates for all elective and non-elective procedures were 0.4% and 6.1%, respectively. Only one neurosurgeon in England achieved the minimum sample size (n=2402) of elective cases in 5 years needed to detect if their mortality rate was double the national average. All neurosurgical units achieved the minimum sample sizes for both elective (n=2402) and non-elective (n=149) procedures. In several neurosurgical subspecialties, approximately 80% of units (or more) achieved the minimum sample sizes needed to detect if their mortality rate was double the national rate, including elective neuro-oncology (baseline mortality rate=2.3%), non-elective neuro-oncology (rate=5.7%), neurovascular (rate=6.7%) and trauma (rate=11%). CONCLUSION Postoperative mortality lacks statistical power as a measure of individual neurosurgeon performance. Neurosurgical units in England performed sufficient procedure numbers overall and in several subspecialty areas to support the use of mortality as a quality indicator.
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Affiliation(s)
- Adam J Wahba
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter J Hutchinson
- Academic Neurosurgery, University of Cambridge, Cambridge, UK
- Clinical Research, Royal College of Surgeons, London, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Phillips
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Clinical Lead for Cranial Neurosurgery, Getting It Right First Time (GIRFT), London, UK
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10
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Gillespie CS, Bligh ER, Poon MTC, Solomou G, Islim AI, Mustafa MA, Rominiyi O, Williams ST, Kalra N, Mathew RK, Booth TC, Thompson G, Brennan PM, Jenkinson MD. Imaging timing after glioblastoma surgery (INTERVAL-GB): protocol for a UK and Ireland, multicentre retrospective cohort study. BMJ Open 2022; 12:e063043. [PMID: 36100297 PMCID: PMC9472166 DOI: 10.1136/bmjopen-2022-063043] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Glioblastoma is the most common malignant primary brain tumour with a median overall survival of 12-15 months (range 6-17 months), even with maximal treatment involving debulking neurosurgery and adjuvant concomitant chemoradiotherapy. The use of postoperative imaging to detect progression is of high importance to clinicians and patients, but currently, the optimal follow-up schedule is yet to be defined. It is also unclear how adhering to National Institute for Health and Care Excellence (NICE) guidelines-which are based on general consensus rather than evidence-affects patient outcomes such as progression-free and overall survival. The primary aim of this study is to assess MRI monitoring practice after surgery for glioblastoma, and to evaluate its association with patient outcomes. METHODS AND ANALYSIS ImagiNg Timing aftER surgery for glioblastoma: an eVALuation of practice in Great Britain and Ireland is a retrospective multicentre study that will include 450 patients with an operated glioblastoma, treated with any adjuvant therapy regimen in the UK and Ireland. Adult patients ≥18 years diagnosed with glioblastoma and undergoing surgery between 1 August 2018 and 1 February 2019 will be included. Clinical and radiological scanning data will be collected until the date of death or date of last known follow-up. Anonymised data will be uploaded to an online Castor database. Adherence to NICE guidelines and the effect of being concordant with NICE guidelines will be identified using descriptive statistics and Kaplan-Meier survival analysis. ETHICS AND DISSEMINATION Each participating centre is required to gain local institutional approval for data collection and sharing. Formal ethical approval is not required since this is a service evaluation. Results of the study will be reported through peer-reviewed presentations and articles, and will be disseminated to participating centres, patients and the public.
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Affiliation(s)
- Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emily R Bligh
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
| | - Michael T C Poon
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Georgios Solomou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mohammad A Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ola Rominiyi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Sophie T Williams
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Neeraj Kalra
- Department of Neurosurgery, Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ryan K Mathew
- Department of Neurosurgery, Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Thomas C Booth
- Department of Neuroradiology, King's College Hospital, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Gerard Thompson
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Edinburgh Neuro-oncology Translational Imaging Research (ENTIRe), Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
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11
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Lam K, Abràmoff MD, Balibrea JM, Bishop SM, Brady RR, Callcut RA, Chand M, Collins JW, Diener MK, Eisenmann M, Fermont K, Neto MG, Hager GD, Hinchliffe RJ, Horgan A, Jannin P, Langerman A, Logishetty K, Mahadik A, Maier-Hein L, Antona EM, Mascagni P, Mathew RK, Müller-Stich BP, Neumuth T, Nickel F, Park A, Pellino G, Rudzicz F, Shah S, Slack M, Smith MJ, Soomro N, Speidel S, Stoyanov D, Tilney HS, Wagner M, Darzi A, Kinross JM, Purkayastha S. A Delphi consensus statement for digital surgery. NPJ Digit Med 2022; 5:100. [PMID: 35854145 PMCID: PMC9296639 DOI: 10.1038/s41746-022-00641-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/24/2022] [Indexed: 12/13/2022] Open
Abstract
The use of digital technology is increasing rapidly across surgical specialities, yet there is no consensus for the term ‘digital surgery’. This is critical as digital health technologies present technical, governance, and legal challenges which are unique to the surgeon and surgical patient. We aim to define the term digital surgery and the ethical issues surrounding its clinical application, and to identify barriers and research goals for future practice. 38 international experts, across the fields of surgery, AI, industry, law, ethics and policy, participated in a four-round Delphi exercise. Issues were generated by an expert panel and public panel through a scoping questionnaire around key themes identified from the literature and voted upon in two subsequent questionnaire rounds. Consensus was defined if >70% of the panel deemed the statement important and <30% unimportant. A final online meeting was held to discuss consensus statements. The definition of digital surgery as the use of technology for the enhancement of preoperative planning, surgical performance, therapeutic support, or training, to improve outcomes and reduce harm achieved 100% consensus agreement. We highlight key ethical issues concerning data, privacy, confidentiality and public trust, consent, law, litigation and liability, and commercial partnerships within digital surgery and identify barriers and research goals for future practice. Developers and users of digital surgery must not only have an awareness of the ethical issues surrounding digital applications in healthcare, but also the ethical considerations unique to digital surgery. Future research into these issues must involve all digital surgery stakeholders including patients.
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Affiliation(s)
- Kyle Lam
- Department of Surgery and Cancer, Imperial College, London, UK.,Institute of Global Health Innovation, Imperial College London, London, UK
| | - Michael D Abràmoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.,Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - José M Balibrea
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | | | - Richard R Brady
- Newcastle Centre for Bowel Disease Research Hub, Newcastle University, Newcastle, UK.,Department of Colorectal Surgery, Newcastle Hospitals, Newcastle, UK
| | | | - Manish Chand
- Department of Surgery and Interventional Sciences, University College London, London, UK
| | - Justin W Collins
- CMR Surgical Limited, Cambridge, UK.,Department of Surgery and Interventional Sciences, University College London, London, UK
| | - Markus K Diener
- Department of General and Visceral Surgery, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Matthias Eisenmann
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kelly Fermont
- Solicitor of the Senior Courts of England and Wales, Independent Researcher, Bristol, UK
| | - Manoel Galvao Neto
- Endovitta Institute, Sao Paulo, Brazil.,FMABC Medical School, Santo Andre, Brazil
| | - Gregory D Hager
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, USA.,Department of Computer Science, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Alan Horgan
- Department of Colorectal Surgery, Newcastle Hospitals, Newcastle, UK
| | - Pierre Jannin
- LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Alexander Langerman
- Otolaryngology, Head & Neck Surgery and Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | - Lena Maier-Hein
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany.,LKSK Institute of St. Michael's Hospital, Toronto, ON, Canada
| | | | - Pietro Mascagni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,ICube, University of Strasbourg, Strasbourg, France
| | - Ryan K Mathew
- School of Medicine, University of Leeds, Leeds, UK.,Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Adrian Park
- Department of Surgery, Anne Arundel Medical Center, School of Medicine, Johns Hopkins University, Annapolis, MD, USA
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Frank Rudzicz
- Department of Computer Science, University of Toronto, Toronto, ON, Canada.,Vector Institute for Artificial Intelligence, Toronto, ON, Canada.,Unity Health Toronto, Toronto, ON, Canada.,Surgical Safety Technologies Inc, Toronto, ON, Canada
| | - Sam Shah
- Faculty of Future Health, College of Medicine and Dentistry, Ulster University, Birmingham, UK
| | - Mark Slack
- CMR Surgical Limited, Cambridge, UK.,Department of Urogynaecology, Addenbrooke's Hospital, Cambridge, UK.,University of Cambridge, Cambridge, UK
| | - Myles J Smith
- The Royal Marsden Hospital, London, UK.,Institute of Cancer Research, London, UK
| | - Naeem Soomro
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stefanie Speidel
- Division of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, Dresden, Germany
| | - Danail Stoyanov
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Henry S Tilney
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Martin Wagner
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College, London, UK.,Institute of Global Health Innovation, Imperial College London, London, UK
| | - James M Kinross
- Department of Surgery and Cancer, Imperial College, London, UK.
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12
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Bolton WS, Gharial PK, Akhunbay-Fudge C, Chumas P, Mathew RK, Anderson IA. Day 2 neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for prediction of delayed cerebral ischemia in subarachnoid hemorrhage. Neurosurg Focus 2022; 52:E4. [DOI: 10.3171/2021.12.focus21642] [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: 10/27/2021] [Accepted: 12/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Recent evidence has suggested that an admission neutrophil-to-lymphocyte ratio (NLR) of ≥ 5.9 predicts delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH). The primary aims of this study were to assess reproducibility and to ascertain the predictive ability of NLR on subsequent days postictus. Secondary aims included identification of additional inflammatory markers.
METHODS
A single-center, retrospective study of all patients aged ≥ 18 years with aSAH between May 2014 and July 2018 was performed. Patient characteristics, DCI incidence, operative features, and outcomes (on discharge and at 3 months postictus) were recorded. C-reactive protein (CRP) and full blood count differentials were recorded on admission and through day 8 postictus or at discharge. In total, 403 patients were included in the final analysis.
RESULTS
Ninety-six patients (23.8%) developed DCI with a median time from ictus of 6 days (IQR 3.25–8 days). A platelet-to-lymphocyte ratio (PLR) cutoff ≥ 157 and CRP cutoff ≥ 27 was used in our cohort. In a multiple binary logistic regression model, after controlling for known DCI predictors, day 2 NLR ≥ 5.9 (OR 2.194, 95% CI 1.099–4.372; p = 0.026), day 1 PLR ≥ 157 (OR 2.398, 95% CI 1.1072–5.361; p = 0.033), day 2 PLR ≥ 157 (OR 2.676, 95% CI 1.344–5.329; p = 0.005), and CRP ≥ 27 on days 3, 4, and 5 were predictive of DCI.
CONCLUSIONS
The results of this study have confirmed the association between NLR and DCI and have demonstrated the predictive potential of PLR and CRP, suggesting that NLR and PLR at day 2, and CRP from day 3 onward, may be better predictors of DCI than those measurements at the time of ictus.
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Affiliation(s)
- William S. Bolton
- Leeds Institute of Medical Research at St. James’s, School of Medicine, University of Leeds; and
- Department of Neurosurgery, Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Parjeet Kaur Gharial
- Department of Neurosurgery, Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Christopher Akhunbay-Fudge
- Department of Neurosurgery, Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Paul Chumas
- Department of Neurosurgery, Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ryan K. Mathew
- Leeds Institute of Medical Research at St. James’s, School of Medicine, University of Leeds; and
- Department of Neurosurgery, Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ian A. Anderson
- Department of Neurosurgery, Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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13
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Wahba AJ, Cromwell DA, Hutchinson PJ, Mathew RK, Phillips N. Patterns and outcomes of neurosurgery in England over a five-year period: A national retrospective cohort study. Int J Surg 2022; 99:106256. [PMID: 35150923 DOI: 10.1016/j.ijsu.2022.106256] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neurosurgical practice has seen major changes over several decades. There are no recent evaluations of national neurosurgical practice. The aim of this observational study was to describe neurosurgical practice in England and to use outcomes to assess and benchmark the quality of care in neurosurgery. MATERIAL AND METHODS This national retrospective cohort study analysed Hospital Episode Statistics (HES) data from April 2013 to March 2018 for all adult admissions with a specialty code for neurosurgery. The epidemiology of patients and RCS Charlson comorbidities were derived and procedure incidence rates per 100,000 person-years calculated. Post-operative outcomes for elective and non-elective patients included: median length of stay, the proportion of patients requiring additional inpatient neurosurgical procedures, the proportion of patients discharged to their usual address, and in-hospital mortality rates. RESULTS During the 5-year study period, there were 371,418 admissions to neurosurgery. The proportion of admissions involving a neurosurgical procedure was 77.3% (n = 287,077). Of these, 45% were for cranial surgery and 37% for spinal. Overall, 68.3% were elective procedures. The incidence rates of most procedures were low (<20 per 100,000 person-years). Following elective neurosurgical procedures, in-hospital mortality rates for cranial and spinal surgery were 0.5% (95% CI, 0.5-0.6) and 0.1% (95% CI, 0.04-0.1), respectively. After non-elective neurosurgery, mortality rates were 7.4% (95% CI, 7.2-7.6) and 1.3% (95% CI, 1.2-1.5) for cranial and spinal surgery, respectively. Approximately 1 in 4 patients had additional procedures following non-elective cranial surgery (24%; 95% CI, 23.6-24.3). Outcomes were highly variable across different subspecialty areas. CONCLUSIONS The incidence rates of neurosurgical procedures are low within England, and neurosurgical units have a high volume of non-surgical admissions. In-hospital mortality rates after elective neurosurgery are low but there may be opportunities for quality improvement programmes to improve outcomes for non-elective surgery as well as ensuring equitable access to treatment.
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Affiliation(s)
- Adam J Wahba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK Vice President, Society of British Neurological Surgeons, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
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14
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Islim AI, Millward CP, Piper RJ, Fountain DM, Mehta S, Kolamunnage-Dona R, Ali U, Koszdin SD, Georgious T, Mills SJ, Brodbelt AR, Mathew RK, Santarius T, Jenkinson MD. External validation and recalibration of an incidental meningioma prognostic model - IMPACT: protocol for an international multicentre retrospective cohort study. BMJ Open 2022; 12:e052705. [PMID: 35042706 PMCID: PMC8768908 DOI: 10.1136/bmjopen-2021-052705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Due to the increased use of CT and MRI, the prevalence of incidental findings on brain scans is increasing. Meningioma, the most common primary brain tumour, is a frequently encountered incidental finding, with an estimated prevalence of 3/1000. The management of incidental meningioma varies widely with active clinical-radiological monitoring being the most accepted method by clinicians. Duration of monitoring and time intervals for assessment, however, are not well defined. To this end, we have recently developed a statistical model of progression risk based on single-centre retrospective data. The model Incidental Meningioma: Prognostic Analysis Using Patient Comorbidity and MRI Tests (IMPACT) employs baseline clinical and imaging features to categorise the patient with an incidental meningioma into one of three risk groups: low, medium and high risk with a proposed active monitoring strategy based on the risk and temporal trajectory of progression, accounting for actuarial life expectancy. The primary aim of this study is to assess the external validity of this model. METHODS AND ANALYSIS IMPACT is a retrospective multicentre study which will aim to include 1500 patients with an incidental intracranial meningioma, powered to detect a 10% progression risk. Adult patients ≥16 years diagnosed with an incidental meningioma between 1 January 2009 and 31 December 2010 will be included. Clinical and radiological data will be collected longitudinally until the patient reaches one of the study endpoints: intervention (surgery, stereotactic radiosurgery or fractionated radiotherapy), mortality or last date of follow-up. Data will be uploaded to an online Research Electronic Data Capture database with no unique identifiers. External validity of IMPACT will be tested using established statistical methods. ETHICS AND DISSEMINATION Local institutional approval at each participating centre will be required. Results of the study will be reported through peer-reviewed articles and conferences and disseminated to participating centres, patients and the public using social media.
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Affiliation(s)
- Abdurrahman I Islim
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher P Millward
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Shaveta Mehta
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - Ruwanthi Kolamunnage-Dona
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Usama Ali
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research at St James's, University of Leeds School of Medicine, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
- Division of Neurosurgery, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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15
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Burger R, Bolton WS, Mathew RK. Challenges and opportunities in academic neurosurgery. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34726938 DOI: 10.12968/hmed.2021.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical academia aims to bridge the gap between clinicians and scientists, by combining academic activity with clinical practice. The term 'clinical academics' generally refers to clinicians who have protected time within their job plans for undertaking academic activities. Engagement with academic activity by trainees is not only essential to fulfil necessary curriculum competencies, but also allows them to explore areas of interest outside of clinical practice and develop advanced academic skills. This article provides an overview of different routes into academic neurosurgery, and discusses the advantages and difficulties in pursuing this career path. It also covers the differences between postgraduate research degrees and explores the different job plan models available at consultant level. Academic neurosurgery is a rewarding career and opportunities should be made available to those who wish to explore it further. Developing academic careers may have a positive impact on wider workforce planning strategies and improve the delivery of high-quality evidence-based neurosurgical care.
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Affiliation(s)
- R Burger
- Department of Neurosurgery, King's College Hospital, London, UK
| | - W S Bolton
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK.,Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - R K Mathew
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK.,Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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16
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Mathew RK, Mushtaq F. Three principles for the progress of immersive technologies in healthcare training and education. BMJ Simul Technol Enhanc Learn 2021; 7:459-460. [PMID: 35515725 PMCID: PMC8936968 DOI: 10.1136/bmjstel-2021-000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/20/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Ryan K Mathew
- School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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17
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Newham G, Mathew RK, Wurdak H, Evans SD, Ong ZY. Polyelectrolyte complex templated synthesis of monodisperse, sub-100 nm porous silica nanoparticles for cancer targeted and stimuli-responsive drug delivery. J Colloid Interface Sci 2020; 584:669-683. [PMID: 33223243 DOI: 10.1016/j.jcis.2020.10.133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/30/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022]
Abstract
Porous silica nanoparticles (PSiNPs) have long attracted interest in drug delivery research. However, conventional synthesis methods for sub-100 nm, functionalised PSiNPs typically give poor monodispersity, reproducibility, or involve complex synthetic protocols. We report a facile, reproducible, and cost-effective one-pot method for the synthesis of cancer targeting and pH responsive PSiNPs in this size range, without the need for post-synthetic modification. This was achieved by using monodisperse l-arginine (Arg)/ poly(acrylic acid) (PAA) polyelectrolyte complexes (PECs) as soft templates for silane hydrolysis and condensation. Highly uniform PSiNPs with tunable size control between 42 and 178 nm and disordered pore structure (1.1-2.7 nm) were obtained. Both PAA and Arg were retained within the PSiNPs, which enabled a high doxorubicin hydrochloride (Dox) loading capacity (22% w/w) and a 4-fold increase in drug release under weakly acidic pH compared to physiological pH. The surface presentation of Arg conferred significantly higher intracellular accumulation of Arg/PAA-PSiNPs in patient-derived glioblastoma cells compared to non-tumorigenic neural progenitor cells, which effectively translated to lower IC50 values for Dox-loaded Arg/PAA-PSiNPs than non-functionalised PSiNPs. This work brings forward new insights for the development of monodisperse PSiNPs with highly desirable built-in functionalities for biomedical applications.
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Affiliation(s)
- George Newham
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research at St. James's, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, UK
| | - Heiko Wurdak
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
| | - Stephen D Evans
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
| | - Zhan Yuin Ong
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK; Leeds Institute of Medical Research at St. James's, School of Medicine, University of Leeds, Leeds LS2 9JT, UK.
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18
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Price SJ, Joannides A, Plaha P, Afshari FT, Albanese E, Barua NU, Chan HW, Critchley G, Flannery T, Fountain DM, Mathew RK, Piper RJ, Poon MT, Rajaraman C, Rominiyi O, Smith S, Solomou G, Solth A, Surash S, Wykes V, Watts C, Bulbeck H, Hutchinson P, Jenkinson MD. Impact of COVID-19 pandemic on surgical neuro-oncology multi-disciplinary team decision making: a national survey (COVID-CNSMDT Study). BMJ Open 2020; 10:e040898. [PMID: 32801210 PMCID: PMC7430412 DOI: 10.1136/bmjopen-2020-040898] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Pressures on healthcare systems due to COVID-19 has impacted patients without COVID-19 with surgery disproportionally affected. This study aims to understand the impact on the initial management of patients with brain tumours by measuring changes to normal multidisciplinary team (MDT) decision making. DESIGN A prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020. SETTING Regional neurosurgical units outside London (as the pandemic was more advanced at time of study). PARTICIPANTS Representatives from all units were invited to collect data on new patients discussed at their MDT meetings during the study period. Each unit decided if management decision for each patient had changed due to COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures included number of patients where the decision to undergo surgery changed compared with standard management usually offered by that MDT. Secondary outcome measures included changes in surgical extent, numbers referred to MDT, number of patients denied surgery not receiving any treatment and reasons for any variation across the UK. RESULTS 18 units (75%) provided information from 80 MDT meetings that discussed 1221 patients. 10.7% of patients had their management changed-the majority (68%) did not undergo surgery and more than half of this group not undergoing surgery had no active treatment. There was marked variation across the UK (0%-28% change in management). Units that did not change management could maintain capacity with dedicated oncology lists. Low volume units were less affected. CONCLUSION COVID-19 has had an impact on patients requiring surgery for malignant brain tumours, with patients receiving different treatments-most commonly not receiving surgery or any treatment at all. The variations show dedicated cancer operating lists may mitigate these pressures. STUDY REGISTRATION This study was registered with the Royal College of Surgeons of England's COVID-19 Research Group (https://www.rcseng.ac.uk/coronavirus/rcs-covid-research-group/).
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Affiliation(s)
- Stephen John Price
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Alexis Joannides
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Fardad Taghizadeh Afshari
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
| | - Erminia Albanese
- Department of Neurosurgery, University Hospitals of North Midlands National Health Service Trust, Stoke-on-Trent, Staffordshire, UK
| | - Neil U Barua
- Department of Neurosurgery, North Bristol National Health Service Trust, Bristol, UK
| | - Huan Wee Chan
- Department of Neurosurgery, University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - Giles Critchley
- Department of Neurosurgery, Brighton and Sussex University Hospitals National Health Service Trust, Brighton, UK
| | - Thomas Flannery
- Department of Neurosurgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal National Health Service Foundation Trust, Salford, UK
| | - Ryan K Mathew
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | | | - Chittoor Rajaraman
- Department of Neurosurgery, Hull Royal Infirmary, Hull, Kingston upon Hull, UK
| | - Ola Rominiyi
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Stuart Smith
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Georgios Solomou
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Solth
- Department of Neurosurgery, Ninewells Hospital, Dundee, UK
| | - Surash Surash
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Victoria Wykes
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Colin Watts
- Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
| | | | - Peter Hutchinson
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre National Health Service Foundation Trust, Liverpool, UK
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19
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Andreou T, Rippaus N, Wronski K, Williams J, Taggart D, Cherqui S, Sunderland A, Kartika YD, Egnuni T, Brownlie RJ, Mathew RK, Holmen SL, Fife C, Droop A, Lorger M. Hematopoietic Stem Cell Gene Therapy for Brain Metastases Using Myeloid Cell-Specific Gene Promoters. J Natl Cancer Inst 2020; 112:617-627. [PMID: 31501884 PMCID: PMC7301153 DOI: 10.1093/jnci/djz181] [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: 09/17/2018] [Revised: 07/16/2019] [Accepted: 09/04/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Brain metastases (BrM) develop in 20-40% of cancer patients and represent an unmet clinical need. Limited access of drugs into the brain because of the blood-brain barrier is at least partially responsible for therapeutic failure, necessitating improved drug delivery systems. METHODS Green fluorescent protein (GFP)-transduced murine and nontransduced human hematopoietic stem cells (HSCs) were administered into mice (n = 10 and 3). The HSC progeny in mouse BrM and in patient-derived BrM tissue (n = 6) was characterized by flow cytometry and immunofluorescence. Promoters driving gene expression, specifically within the BrM-infiltrating HSC progeny, were identified through differential gene-expression analysis and subsequent validation of a series of promoter-green fluorescent protein-reporter constructs in mice (n = 5). One of the promoters was used to deliver tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) to BrM in mice (n = 17/21 for TRAIL vs control group). RESULTS HSC progeny (consisting mostly of macrophages) efficiently homed to macrometastases (mean [SD] = 37.6% [7.2%] of all infiltrating cells for murine HSC progeny; 27.9% mean [SD] = 27.9% [4.9%] of infiltrating CD45+ hematopoietic cells for human HSC progeny) and micrometastases in mice (19.3-53.3% of all macrophages for murine HSCs). Macrophages were also abundant in patient-derived BrM tissue (mean [SD] = 8.8% [7.8%]). Collectively, this provided a rationale to optimize the delivery of gene therapy to BrM within myeloid cells. MMP14 promoter emerged as the strongest promoter construct capable of limiting gene expression to BrM-infiltrating myeloid cells in mice. TRAIL delivered under MMP14 promoter statistically significantly prolonged survival in mice (mean [SD] = 19.0 [3.4] vs mean [SD] = 15.0 [2.0] days for TRAIL vs control group; two-sided P = .006), demonstrating therapeutic and translational potential of our approach. CONCLUSIONS Our study establishes HSC gene therapy using a myeloid cell-specific promoter as a new strategy to target BrM. This approach, with strong translational value, has potential to overcome the blood-brain barrier, target micrometastases, and control multifocal lesions.
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Affiliation(s)
| | - Nora Rippaus
- School of Medicine, University of Leeds, Leeds, UK
| | | | | | | | | | | | | | - Teklu Egnuni
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Ryan K Mathew
- School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sheri L Holmen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Alastair Droop
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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20
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Islim AI, Millward CP, Martin-McGill KJ, Kolamunnage-Dona R, Santarius T, Mathew RK, Haylock BJ, Mills SJ, Brodbelt AR, Jenkinson MD. Clinical studies of incidental intracranial meningiomas-towards high-quality evidence-based practice. Acta Neurochir (Wien) 2020; 162:673-674. [PMID: 31938821 DOI: 10.1007/s00701-020-04214-y] [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] [Received: 11/21/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
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21
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da Silva B, Irving BK, Polson ES, Droop A, Griffiths HBS, Mathew RK, Stead LF, Marrison J, Williams C, Williams J, Short SC, Scarcia M, O'Toole PJ, Allison SJ, Mavria G, Wurdak H. Chemically induced neurite-like outgrowth reveals a multicellular network function in patient-derived glioblastoma cells. J Cell Sci 2019; 132:jcs.228452. [PMID: 31515278 DOI: 10.1242/jcs.228452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 09/02/2019] [Indexed: 12/22/2022] Open
Abstract
Tumor stem cells and malignant multicellular networks have been separately implicated in the therapeutic resistance of glioblastoma multiforme (GBM), the most aggressive type of brain cancer in adults. Here, we show that small-molecule inhibition of RHO-associated serine/threonine kinase proteins (ROCKi) significantly promoted the outgrowth of neurite-like cell projections in cultures of heterogeneous patient-derived GBM stem-like cells. These projections formed de novo-induced cellular network (iNet) 'webs', which regressed after withdrawal of ROCKi. Connected cells within the iNet web exhibited long range Ca2+ signal transmission, and significant lysosomal and mitochondrial trafficking. In contrast to their less-connected vehicle control counterparts, iNet cells remained viable and proliferative after high-dose radiation. These findings demonstrate a link between ROCKi-regulated cell projection dynamics and the formation of radiation-resistant multicellular networks. Our study identifies means to reversibly induce iNet webs ex vivo, and may thereby accelerate future studies into the biology of GBM cellular networks.
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Affiliation(s)
| | | | - Euan S Polson
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Alastair Droop
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - Hollie B S Griffiths
- School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Ryan K Mathew
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
- Department of Neurosurgery, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Lucy F Stead
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Joanne Marrison
- Department of Biology, University of York, York, YO10 5DD, UK
| | - Courtney Williams
- School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | | | - Susan C Short
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Peter J O'Toole
- Department of Biology, University of York, York, YO10 5DD, UK
| | - Simon J Allison
- School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Georgia Mavria
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Heiko Wurdak
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
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22
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Polson ES, Kuchler VB, Abbosh C, Ross EM, Mathew RK, Beard HA, da Silva B, Holding AN, Ballereau S, Chuntharpursat-Bon E, Williams J, Griffiths HBS, Shao H, Patel A, Davies AJ, Droop A, Chumas P, Short SC, Lorger M, Gestwicki JE, Roberts LD, Bon RS, Allison SJ, Zhu S, Markowetz F, Wurdak H. KHS101 disrupts energy metabolism in human glioblastoma cells and reduces tumor growth in mice. Sci Transl Med 2018; 10:eaar2718. [PMID: 30111643 DOI: 10.1126/scitranslmed.aar2718] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/24/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022]
Abstract
Pharmacological inhibition of uncontrolled cell growth with small-molecule inhibitors is a potential strategy for treating glioblastoma multiforme (GBM), the most malignant primary brain cancer. We showed that the synthetic small-molecule KHS101 promoted tumor cell death in diverse GBM cell models, independent of their tumor subtype, and without affecting the viability of noncancerous brain cell lines. KHS101 exerted cytotoxic effects by disrupting the mitochondrial chaperone heat shock protein family D member 1 (HSPD1). In GBM cells, KHS101 promoted aggregation of proteins regulating mitochondrial integrity and energy metabolism. Mitochondrial bioenergetic capacity and glycolytic activity were selectively impaired in KHS101-treated GBM cells. In two intracranial patient-derived xenograft tumor models in mice, systemic administration of KHS101 reduced tumor growth and increased survival without discernible side effects. These findings suggest that targeting of HSPD1-dependent metabolic pathways might be an effective strategy for treating GBM.
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Affiliation(s)
- Euan S Polson
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | | | | | - Edith M Ross
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, UK
| | - Ryan K Mathew
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- Department of Neurosurgery, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Hester A Beard
- School of Chemistry, University of Leeds, Leeds LS2 9JT, UK
| | | | - Andrew N Holding
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, UK
| | - Stephane Ballereau
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, UK
| | | | | | - Hollie B S Griffiths
- School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Hao Shao
- Department of Pharmaceutical Chemistry and the Institute for Neurodegenerative Disease, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94158, USA
| | - Anjana Patel
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Adam J Davies
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Alastair Droop
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Susan C Short
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Mihaela Lorger
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Jason E Gestwicki
- Department of Pharmaceutical Chemistry and the Institute for Neurodegenerative Disease, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94158, USA
| | - Lee D Roberts
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Robin S Bon
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- School of Chemistry, University of Leeds, Leeds LS2 9JT, UK
| | - Simon J Allison
- School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Shoutian Zhu
- California Institute for Biomedical Research, 11119 North Torrey Pines Road, Suite 100, La Jolla, CA 92037, USA
| | - Florian Markowetz
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, UK
| | - Heiko Wurdak
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK.
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23
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Mathew RK, Rutka JT. Diffuse Intrinsic Pontine Glioma : Clinical Features, Molecular Genetics, and Novel Targeted Therapeutics. J Korean Neurosurg Soc 2018; 61:343-351. [PMID: 29742880 PMCID: PMC5957322 DOI: 10.3340/jkns.2018.0008] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 01/06/2018] [Accepted: 01/21/2018] [Indexed: 12/18/2022] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a deadly paediatric brain cancer. Transient response to radiation, ineffective chemotherapeutic agents and aggressive biology result in rapid progression of symptoms and a dismal prognosis. Increased availability of tumour tissue has enabled the identification of histone gene aberrations, genetic driver mutations and methylation changes, which have resulted in molecular and phenotypic subgrouping. However, many of the underlying mechanisms of DIPG oncogenesis remain unexplained. It is hoped that more representative in vitro and preclinical models–using both xenografted material and genetically engineered mice–will enable the development of novel chemotherapeutic agents and strategies for targeted drug delivery. This review provides a clinical overview of DIPG, the barriers to progress in developing effective treatment, updates on drug development and preclinical models, and an introduction to new technologies aimed at enhancing drug delivery.
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Affiliation(s)
- Ryan K Mathew
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada.,Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.,Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - James T Rutka
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
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24
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da Silva B, Mathew RK, Polson ES, Williams J, Wurdak H. Spontaneous Glioblastoma Spheroid Infiltration of Early-Stage Cerebral Organoids Models Brain Tumor Invasion. SLAS Discov 2018. [PMID: 29543559 DOI: 10.1177/2472555218764623] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Organoid methodology provides a platform for the ex vivo investigation of the cellular and molecular mechanisms underlying brain development and disease. The high-grade brain tumor glioblastoma multiforme (GBM) is considered a cancer of unmet clinical need, in part due to GBM cell infiltration into healthy brain parenchyma, making complete surgical resection improbable. Modeling the process of GBM invasion in real time is challenging as it requires both tumor and neural tissue compartments. Here, we demonstrate that human GBM spheroids possess the ability to spontaneously infiltrate early-stage cerebral organoids (eCOs). The resulting formation of hybrid organoids demonstrated an invasive tumor phenotype that was distinct from noncancerous adult neural progenitor (NP) spheroid incorporation into eCOs. These findings provide a basis for the modeling and quantification of the GBM infiltration process using a stem-cell-based organoid approach, and may be used for the identification of anti-GBM invasion strategies.
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Affiliation(s)
- Bárbara da Silva
- 1 Stem Cells and Brain Tumour Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Ryan K Mathew
- 1 Stem Cells and Brain Tumour Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.,2 Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Euan S Polson
- 1 Stem Cells and Brain Tumour Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Jennifer Williams
- 1 Stem Cells and Brain Tumour Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Heiko Wurdak
- 1 Stem Cells and Brain Tumour Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
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25
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Samson A, Scott KJ, Taggart D, West EJ, Wilson E, Nuovo GJ, Thomson S, Corns R, Mathew RK, Fuller MJ, Kottke TJ, Thompson JM, Ilett EJ, Cockle JV, van Hille P, Sivakumar G, Polson ES, Turnbull SJ, Appleton ES, Migneco G, Rose AS, Coffey MC, Beirne DA, Collinson FJ, Ralph C, Alan Anthoney D, Twelves CJ, Furness AJ, Quezada SA, Wurdak H, Errington-Mais F, Pandha H, Harrington KJ, Selby PJ, Vile RG, Griffin SD, Stead LF, Short SC, Melcher AA. Intravenous delivery of oncolytic reovirus to brain tumor patients immunologically primes for subsequent checkpoint blockade. Sci Transl Med 2018; 10:eaam7577. [PMID: 29298869 PMCID: PMC6276984 DOI: 10.1126/scitranslmed.aam7577] [Citation(s) in RCA: 258] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 09/08/2017] [Accepted: 11/27/2017] [Indexed: 12/23/2022]
Abstract
Immune checkpoint inhibitors, including those targeting programmed cell death protein 1 (PD-1), are reshaping cancer therapeutic strategies. Evidence suggests, however, that tumor response and patient survival are determined by tumor programmed death ligand 1 (PD-L1) expression. We hypothesized that preconditioning of the tumor immune microenvironment using targeted, virus-mediated interferon (IFN) stimulation would up-regulate tumor PD-L1 protein expression and increase cytotoxic T cell infiltration, improving the efficacy of subsequent checkpoint blockade. Oncolytic viruses (OVs) represent a promising form of cancer immunotherapy. For brain tumors, almost all studies to date have used direct intralesional injection of OV, because of the largely untested belief that intravenous administration will not deliver virus to this site. We show, in a window-of-opportunity clinical study, that intravenous infusion of oncolytic human Orthoreovirus (referred to herein as reovirus) leads to infection of tumor cells subsequently resected as part of standard clinical care, both in high-grade glioma and in brain metastases, and increases cytotoxic T cell tumor infiltration relative to patients not treated with virus. We further show that reovirus up-regulates IFN-regulated gene expression, as well as the PD-1/PD-L1 axis in tumors, via an IFN-mediated mechanism. Finally, we show that addition of PD-1 blockade to reovirus enhances systemic therapy in a preclinical glioma model. These results support the development of combined systemic immunovirotherapy strategies for the treatment of both primary and secondary tumors in the brain.
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Affiliation(s)
- Adel Samson
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK.
| | - Karen J Scott
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - David Taggart
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Emma J West
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Erica Wilson
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Gerard J Nuovo
- Ohio State University, Comprehensive Cancer Centre, Columbus, OH 43210, USA
| | - Simon Thomson
- Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Robert Corns
- Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Ryan K Mathew
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Martin J Fuller
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | | | - Jill M Thompson
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Elizabeth J Ilett
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Julia V Cockle
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Philip van Hille
- Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Gnanamurthy Sivakumar
- Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Euan S Polson
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Samantha J Turnbull
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Elizabeth S Appleton
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Gemma Migneco
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Ailsa S Rose
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | | | - Deborah A Beirne
- Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Fiona J Collinson
- Leeds Institute of Clinical Trials Research, Faculty of Medicine and Health, University of Leeds, Leeds, West Yorkshire LS2 9JT, UK
| | - Christy Ralph
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - D Alan Anthoney
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Christopher J Twelves
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | | | | | - Heiko Wurdak
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Fiona Errington-Mais
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | | | | | - Peter J Selby
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Richard G Vile
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Stephen D Griffin
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Lucy F Stead
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Susan C Short
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK.
| | - Alan A Melcher
- Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
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Abstract
Spinal glioblastoma multiforme (GBM) is uncommon, and its diagnosis may be challenging. This is especially true in the elderly population. Best management strategy remains to be defined. The purpose of this report is to document this rare condition, increase awareness (as a potential differential diagnosis) and propose treatment options in the elderly; a review of the relevant literature is included. A biopsy may be beneficial in given circumstances as cervical spinal GBM carries a better prognosis compared with intramedullary metastasis.
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Affiliation(s)
- Dmitri Shastin
- Department of Neurosurgery, Cardiff University, University Hospital of Wales, Cardiff, UK
| | - Ryan K Mathew
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - Azzam Ismail
- Department of Pathology, Leeds Teaching Hospitals, Leeds, UK
| | - Gerry Towns
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
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Affiliation(s)
- R K Mathew
- Cancer Research UK Clinical Research Fellow, Department of Neurosurgery, Leeds General Infirmary, Leeds LS1 3EX, and Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds
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Soon WC, Mathew RK, Timothy J. Comparison of vertebroplasty using directional versus straight needle. Acta Radiol Open 2015; 4:2047981615569268. [PMID: 25815210 PMCID: PMC4372567 DOI: 10.1177/2047981615569268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/21/2014] [Accepted: 01/05/2015] [Indexed: 12/04/2022] Open
Abstract
Background Percutaneous vertebroplasty is a minimally invasive procedure that can be performed to treat pain and immobility associated with vertebral compression fractures. Previous studies have shown that a single injection can achieve adequate fill across the midline of the vertebral body. Purpose To compare the radiological outcomes of using a novel steerable needle with using a conventional, straight needle in unipedicular vertebroplasty. Material and Methods Data were collected from 19 patients who were operated at our institute between 1 September 2010 and 31 March 2011. Outcomes were measured in terms of radiological evidence of midline crossing of cement. The available pre- and postoperative pain scores and complications were reviewed. Student’s t-test was used to compare mean cement projection across the midline in both groups with P < 0.05 considered to be statistically significant Results Mean fill across the midline was significantly greater with the steerable needle (58%) compared with the straight needle (35%) (P = 0.046). Cement leakage was higher with the steerable needle (44% versus 30%); however no clinical complications were reported in either group. Conclusion Percutaneous vertebroplasty using a directional needle is an excellent example of advancement and refinement in spinal surgery without increased clinical risk. Our results indicate that the novel technique can potentially provide better radiological outcomes when compared with a straight needle. A larger, randomized multicenter prospective trial would be valuable in confirming these findings.
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Affiliation(s)
- Wai Cheong Soon
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Ryan K Mathew
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Jake Timothy
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
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29
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Upton-Rice MN, Cudkowicz ME, Warren L, Mathew RK, Ren JM, Finklestein SP, Brown RH. Basic fibroblast growth factor does not prolong survival in a transgenic model of familial amyotrophic lateral sclerosis. Ann Neurol 1999; 46:934. [PMID: 10589551 DOI: 10.1002/1531-8249(199912)46:6<934::aid-ana21>3.0.co;2-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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30
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Upton-Rice MN, Cudkowicz ME, Mathew RK, Reif D, Brown RH. Administration of nitric oxide synthase inhibitors does not alter disease course of amyotrophic lateral sclerosis SOD1 mutant transgenic mice. Ann Neurol 1999; 45:413-4. [PMID: 10072062 DOI: 10.1002/1531-8249(199903)45:3<413::aid-ana24>3.0.co;2-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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31
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Murali R, Ganesh A, Jesudason M, Mathew RK, Date A. Surat'94: was it melioidosis?--interesting observations from the first case of imported melioidosis in India. J Assoc Physicians India 1996; 44:218-9. [PMID: 9251327] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R Murali
- Dept. of Medicine III, Christian Medical College and Hospital-Vellore, Tamilnadu, S. India
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