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Pernik MN, Hicks WH, Akbik OS, Nguyen ML, Luu I, Traylor JI, Deme PR, Dosselman LJ, Hall K, Wingfield SA, Aoun SG, Bagley CA. Response to the Letter to the Editor on "Psoas Muscle Index as a Predictor of Perioperative Outcomes in Geriatric Patients Undergoing Spine Surgery". Global Spine J 2024; 14:1450-1451. [PMID: 37939318 DOI: 10.1177/21925682231214658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Affiliation(s)
- Mark N Pernik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - William H Hicks
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Omar S Akbik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Madelina L Nguyen
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Ivan Luu
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Jeffrey I Traylor
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Palvasha R Deme
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Luke J Dosselman
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Kristen Hall
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Sarah A Wingfield
- Geriatrics Division, Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX, USA
| | - Salah G Aoun
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
- Department of Orthopedic Surgery, UT Southwestern Medical School, Dallas, TX, USA
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Traylor JI, Venkatesh P, Fabiano AS, Beach C, de Oliveira Sillero R. Clip Ligation of a Recurrent Middle Cerebral Artery Aneurysm After Treatment With Woven EndoBridge: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:229. [PMID: 37729624 DOI: 10.1227/ons.0000000000000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Jeffrey I Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas , Texas , USA
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Hicks WH, Gattie LC, Traylor JI, Davar D, Najjar YG, Richardson DO TE, McBrayer SK, Abdullah KG. Matched three-dimensional organoids and two-dimensional cell lines of melanoma brain metastases mirror response to targeted molecular therapy. bioRxiv 2024:2024.01.18.576318. [PMID: 38328251 PMCID: PMC10849477 DOI: 10.1101/2024.01.18.576318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Purpose Despite significant advances in the treatment paradigm for patients with metastatic melanoma, melanoma brain metastasis (MBM) continues to represent a significant treatment challenge. The study of MBM is limited, in part, by shortcomings in existing preclinical models. Surgically eXplanted Organoids (SXOs) are ex vivo, three-dimensional cultures prepared from primary tissue samples with minimal processing that recapitulate genotypic and phenotypic features of parent tumors and are grown without artificial extracellular scaffolding. We aimed to develop the first matched patient-derived SXO and cell line models of MBM to investigate responses to targeted therapy. Methods MBM SXOs were created by a novel protocol incorporating techniques for establishing glioma and cutaneous melanoma organoids. A BRAFV600K-mutant and BRAF-wildtype MBM sample were collected directly from the operating room for downstream experiments. Organoids were cultured in an optimized culture medium without an artificial extracellular scaffold. Concurrently, matched patient-derived cell lines were created. Drug screens were conducted to assess treatment response in SXOs and cell lines. Results Organoid growth was observed within 3-4 weeks, and MBM SXOs retained histological features of the parent tissue, including pleomorphic epithelioid cells with abundant cytoplasm, large nuclei, focal melanin accumulation, and strong SOX10 positivity. After sufficient growth, organoids could be manually parcellated to increase the number of replicates. Matched SXOs and cell lines demonstrated sensitivity to BRAF and MEK inhibitors. Conclusion Here, we describe the creation of a scaffold-free organoid model of MBM. Further study using SXOs may improve the translational relevance of preclinical studies and enable the study of the metastatic melanoma tumor microenvironment.
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Affiliation(s)
- William H. Hicks
- Department of Neurosurgery, University of Pittsburgh School of Medicine, 200 Lothrop St, Pittsburgh, PA, 15213, USA
- Hillman Comprehensive Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Lauren C. Gattie
- Department of Neurosurgery, University of Pittsburgh School of Medicine, 200 Lothrop St, Pittsburgh, PA, 15213, USA
- Hillman Comprehensive Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Jeffrey I Traylor
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, Dallas, TX, 75235, USA
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Diwakar Davar
- Hillman Comprehensive Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Yana G. Najjar
- Hillman Comprehensive Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Timothy E. Richardson DO
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, 11029, USA
| | - Samuel K. McBrayer
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, Dallas, TX, 75235, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Kalil G. Abdullah
- Department of Neurosurgery, University of Pittsburgh School of Medicine, 200 Lothrop St, Pittsburgh, PA, 15213, USA
- Hillman Comprehensive Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
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Pernik MN, Hicks WH, Akbik OS, Nguyen ML, Luu I, Traylor JI, Deme PR, Dosselman LJ, Hall K, Wingfield SA, Aoun SG, Bagley CA. Psoas Muscle Index as a Predictor of Perioperative Outcomes in Geriatric Patients Undergoing Spine Surgery. Global Spine J 2023; 13:2016-2024. [PMID: 35034500 PMCID: PMC10556882 DOI: 10.1177/21925682211072626] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN Single-center retrospective study. OBJECTIVE The objective of this study was to evaluate the association of psoas muscle mass defined sarcopenia with perioperative outcomes in geriatric patients undergoing elective spine surgery. METHODS We included geriatric patients undergoing thoracolumbar spinal surgery. Total psoas surface area (TPA) was measured on preoperative axial computerized tomography or magnetic resonance imaging at the L3 vertebra and normalized to the L3 vertebral body area. Patients were divided into quartiles by normalized TPA, and the fourth quartile (Q4) was compared to quartiles 1-3 (Q1-3). Outcomes included perioperative transfusions, length of stay (LOS), delirium, pseudoarthrosis, readmission, discharge disposition, revision surgery, and mortality. RESULTS Of the patients who met inclusion criteria (n = 196), the average age was 73.4 y, with 48 patients in Q4 and 148 patients in Q1-3. Q4 normalized TPA cut-off was <1.05. Differences in Q4 preoperative characteristics included significantly lower body mass index, baseline creatinine, and a greater proportion of females (Table 1). Q4 patients received significantly more postoperative red blood cell and platelet transfusions and had longer ICU LOS (P < .05; Table 2). There was no difference in intraoperative transfusion volumes, delirium, initiation of walking, discharge disposition, readmission, pseudoarthrosis, or revision surgery (Tables 2 and 3). Mortality during follow-up was higher in Q4 but was not statistically significant (P = .075). CONCLUSION Preoperative TPA in geriatric patients undergoing elective spine surgery is associated with increased need for intensive care and postoperative blood transfusion. Preoperative normalized TPA is a convenient measurement and could be included in geriatric preoperative risk assessment algorithms.
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Affiliation(s)
- Mark N. Pernik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - William H. Hicks
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Omar S. Akbik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Madelina L. Nguyen
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Ivan Luu
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Palvasha R. Deme
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Luke J. Dosselman
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Kristen Hall
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Sarah A. Wingfield
- Department of Internal Medicine, Geriatrics Division, UT Southwestern Medical School, Dallas, TX, USA
| | - Salah G. Aoun
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Carlos A. Bagley
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
- Department of Orthopedic Surgery, UT Southwestern Medical School, Dallas, TX, USA
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Traylor JI, Plitt AR, Hicks WH, Mian TM, Mickey BE, Barnett SL. Evaluating risk of recurrence in patients with meningioma. J Neurosurg 2023; 138:621-628. [PMID: 36866795 DOI: 10.3171/2022.6.jns221162] [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: 05/18/2022] [Accepted: 06/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meningioma prognostication and treatment continues to evolve with an increasing understanding of tumor biology. In this study, the authors aimed to test conventional predictors of meningioma recurrence, histopathology variables for which there exists some controversy (brain invasion), as well as a novel molecular-based location paradigm. METHODS This is a retrospective study of a consecutive series of patients with WHO grade I-III meningioma resected at The University of Texas Southwestern Medical Center between 1994 and 2015. Time to meningioma recurrence (i.e., recurrence-free survival [RFS]) was the primary endpoint measured. Kaplan-Meier curves were constructed and compared using log-rank tests. Cox univariate and multivariate analyses were performed to identify predictors of RFS. RESULTS A total of 703 consecutive patients with meningioma underwent resection at The University of Texas Southwestern Medical Center between the years 1994 and 2015. A total of 158 patients were excluded for insufficient follow-up (< 3 months). The median age of the cohort was 55 years (range 16-88 years) and 69.5% (n = 379) were female. The median follow-up was 48 months (range 3-289 months). There was not a significantly increased risk of recurrence in patients with evidence of brain invasion, in patients with otherwise WHO grade I meningioma (Cox univariate HR 0.92, 95% CI 0.44-1.91, p = 0.82, power 4.4%). Adjuvant radiosurgery to subtotally resected WHO grade I meningiomas did not prolong the time to recurrence (n = 52, Cox univariate HR 0.21, 95% CI 0.03-1.61, p = 0.13, power 71.6%). Location (midline skull base, lateral skull base, and paravenous) was significantly associated with RFS (p < 0.01, log-rank test). In patients with high-grade meningiomas (WHO grade II or III), location was predictive of RFS (p = 0.03, log-rank test), with paravenous meningiomas exhibiting the highest rates of recurrence. Location was not significant on multivariate analysis. CONCLUSIONS The data suggest that brain invasion does not increase the risk of recurrence in otherwise WHO grade I meningioma. Adjuvant radiosurgery to subtotally resected WHO grade I meningiomas did not prolong the time to recurrence. Location categorized by distinct molecular signatures did not predict RFS in a multivariate model. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Jeffrey I. Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aaron R. Plitt
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - William H. Hicks
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tabarak M. Mian
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bruce E. Mickey
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samuel L. Barnett
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
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Caruso JP, Kafka BR, Traylor JI, Wilson RA, El Ahmadieh T, Nassif RB, Caldwell C, Palmisciano P, Al Tamimi M, Olson DM, Dahdaleh NS, Bagley CA, Aoun SG. Applying 3-Dimensional Printing and Modeling for Preoperative Reconstruction and Instrumentation Placement Planning in Complex Deformity Surgery. Oper Neurosurg (Hagerstown) 2022; 23:514-522. [DOI: 10.1227/ons.0000000000000409] [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: 03/03/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
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Muir M, Traylor JI, Gadot R, Patel R, Prabhu SS. Repeat laser interstitial thermal therapy for recurrent primary and metastatic intracranial tumors. Surg Neurol Int 2022; 13:311. [PMID: 35928321 PMCID: PMC9345120 DOI: 10.25259/sni_418_2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Repeat craniotomy in patients with primary and metastatic brain tumors carries significant morbidity and can delay adjuvant treatments. Repeat laser interstitial thermal therapy (LITT) for recurrent disease has been described and could benefit patients with limited cytoreductive options. We aim to describe the indications, safety, and efficacy of repeat LITT for recurrent primary and metastatic intracranial tumors. Methods: Patients undergoing repeat ablations for the same lesion were included in the study. We retrospectively analyzed 13 patients treated with 29 total LITT ablations. Results: Eleven patients were treated for glioblastoma (GBM), while two had brain metastases. Eleven patients had LITT performed only 2 times, while three patients underwent three total iterations of LITT for disease recurrence. Median length of stay after the 1st ablation was 2 days, while the median length of stay after the 2nd ablation was 1 day. The median time to resuming adjuvant treatments after the 1st LITT was 11 days. The median time to resuming adjuvant treatments after the 2nd LITT was 28 days. Four patients after the 1st and 2nd LITT sustained deficits persisting through 30-day follow-up. The median progression-free survival among the GBM patients from the first ablation was 6.0 months, 3.2 months from the 2nd ablation, and 2.1 months from the 3rd ablation. Conclusion: Recurrent tumors, especially GBM, can be safely treated using repeat LITT when surgery cannot be effectively performed. Our results indicate that patients tolerate the procedure well and have a meaningful survival given the salvage nature of the procedure.
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Affiliation(s)
- Matthew Muir
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, United States
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, UT Southwestern, Dallas, United States
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Rajan Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Sujit S. Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, United States
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Bird CE, Traylor JI, Johnson ZD, Kim J, Raisanen J, Welch BG, Abdullah KG. Surgical Management of a Massive Frontal Bone Hemangioma: Case Report. J Neurol Surg Rep 2022; 83:e72-e76. [PMID: 35832685 PMCID: PMC9272017 DOI: 10.1055/s-0042-1750366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Abstract
Intraosseous hemangiomas are rare, benign tumors that can arise from the calvarium. These lesions often invade the outer table of the skull, but typically spare the inner table and intracranial structures. En bloc surgical resection is the standard treatment for intraosseous hemangiomas. However, a piecemeal resection may be required to safely remove the tumor in cases involving the inner table to protect the underlying brain parenchyma and vascular structures. Proper reconstruction is critical to optimize the cosmetic outcome, and a staged procedure allowing implantation of a custom-made implant can be considered for large lesions involving the forehead. We present a case of a patient with a large frontal intraosseous hemangioma with intradural involvement to highlight the surgical nuances of resection and review the existing literature regarding optimal management of these patients.
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Affiliation(s)
- Cylaina E Bird
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jeffrey I Traylor
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Zachary D Johnson
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jun Kim
- Department of Neurosurgery, Westmead Hospital, Westmead, Sydney, Australia
| | - Jack Raisanen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Babu G Welch
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kalil G Abdullah
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Muir M, Prinsloo S, Traylor JI, Patel R, Ene C, Tummala S, Prabhu SS. Transcranial magnetic stimulation tractography and the facilitation of gross total resection in a patient with a motor eloquent glioblastoma: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE22128. [PMCID: PMC9379643 DOI: 10.3171/case22128] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
In patients with perieloquent tumors, neurosurgeons must use a variety of techniques to maximize survival while minimizing postoperative neurological morbidity. Recent publications have shown that conventional anatomical features may not always predict postoperative deficits. Additionally, scientific conceptualizations of complex brain function have shifted toward more dynamic, neuroplastic theories instead of traditional static, localizationist models. Functional imaging techniques have emerged as potential tools to incorporate these advances into modern neurosurgical care. In this case report, we describe our observations using preoperative transcranial magnetic stimulation data combined with tractography to guide a nontraditional surgical approach in a patient with a motor eloquent glioblastoma.
OBSERVATIONS
The authors detail the use of preoperative functional and structural imaging to perform a gross total resection despite tumor infiltration of conventionally eloquent anatomical structures. The authors resected the precentral gyrus, specifically the paracentral lobule, localized using intraoperative mapping techniques. The patient demonstrated mild transient postoperative weakness and made a full neurological recovery by discharge 1 week later.
LESSONS
Preoperative functional and structural imaging has potential to not only optimize patient selection and surgical planning, but also facilitate important intraoperative decisions. Innovative preoperative imaging techniques should be optimized and used to identify safely resectable structures.
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Affiliation(s)
- Matthew Muir
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajan Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; and
| | - Sujit S. Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Hicks WH, Bird CE, Gattie LC, Shami ME, Traylor JI, Shi DD, McBrayer SK, Abdullah KG. Creation and Development of Patient-Derived Organoids for Therapeutic Screening in Solid Cancer. Curr Stem Cell Rep 2022. [DOI: 10.1007/s40778-022-00211-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Muir M, Prinsloo S, Traylor JI, Bastos D, Prabhu SS. 512 TMS Seeded DTI Tractography Provides Superior Identification of Eloquent Cortex Compared to Anatomic Seeded Tractography. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Pernik MN, Montgomery EY, Isa S, Sundarrajan C, Caruso JP, Traylor JI, Liu Y, Garzon-Muvdi T. The natural history of non-functioning pituitary adenomas: A meta-analysis of conservatively managed tumors. J Clin Neurosci 2021; 95:134-141. [PMID: 34929637 DOI: 10.1016/j.jocn.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/13/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Non-functioning pituitary adenomas (NFPA) are often discovered incidentally. The natural history of NFPA is not well understood, obfuscating evidence-based management decisions. Meta-data of radiographically followed NFPA may help guide conservative versus operative treatment of these tumors. METHODS We searched PubMed, Medline, Embase, and Ovid for studies with NFPA managed nonoperatively with radiographic follow-up. Studies on postoperative outcomes after NFPA resection and studies that did not delineate NFPA data from functional pituitary lesions were excluded. NFPA were divided into micro- and macroadenomas based on size at presentation. We performed a meta-analysis of aggregate data for length of follow-up, change in tumor size, rate of apoplexy, and need for resection during follow-up. RESULTS Our database search yielded 1787 articles, of which 19 were included for final analysis. The studies included 1057 patients with NFPA followed radiographically. Macroadenomas were significantly more likely to undergo growth (34% vs. 12%; p < 0.01) or apoplexy (5% vs. < 1%; p = 0.01) compared to microadenomas. Resection was performed in 11% of all NFPA patients during follow-up regardless of size at presentation. Meta-regression showed that surgery during follow-up was associated with macroadenomas and negatively associated with microadenomas that decreased in size. CONCLUSION Low-quality evidence suggests that NFPA classified as macroadenomas have an increased rate of growth and apoplexy during follow-up compared to microadenomas. A significant minority of all NFPA patients ultimately underwent surgery. In select patients, nonoperative management may be the appropriate strategy for NFPA. Macroadenomas may require closer follow-up.
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Affiliation(s)
- Mark N Pernik
- UT Southwestern Medical School, Department of Neurological Surgery, Dallas, TX, USA
| | - Eric Y Montgomery
- UT Southwestern Medical School, Department of Neurological Surgery, Dallas, TX, USA
| | - Samya Isa
- UT Southwestern Medical School, Department of Neurological Surgery, Dallas, TX, USA
| | | | - James P Caruso
- UT Southwestern Medical School, Department of Neurological Surgery, Dallas, TX, USA
| | - Jeffrey I Traylor
- UT Southwestern Medical School, Department of Neurological Surgery, Dallas, TX, USA
| | - Yulun Liu
- UT Southwestern Medical School, Department of Population and Data Sciences, Dallas, TX, USA
| | - Tomas Garzon-Muvdi
- UT Southwestern Medical School, Department of Neurological Surgery, Dallas, TX, USA.
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Traylor JI, Sheppard HE, Ravikumar V, Breshears J, Raza SM, Lin CY, Patel SR, DeMonte F. Computational Drug Repositioning Identifies Potentially Active Therapies for Chordoma. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa398_s099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nyancho D, Atem FD, Venkatachalam AM, Barnes A, Hill M, Traylor JI, Stutzman SE, Bedros N, Aiyagari V, Aoun SG. Anisocoria Correlates With Injury Severity and Outcomes After Blunt Traumatic Brain Injury. J Neurosci Nurs 2021; 53:251-255. [PMID: 34620803 DOI: 10.1097/jnn.0000000000000613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: Automated infrared pupillometry (AIP) has been shown to be helpful in the setting of aneurysmal subarachnoid hemorrhage and stroke as an indicator of imminent irreversible brain injury. We postulated that the early detection of pupillary dysfunction after light stimulation using AIP may be useful in patients with traumatic brain injury (TBI). METHODS: We performed a retrospective review of the Establishing Normative Data for Pupillometer Assessment in Neuroscience Intensive Care database, a prospectively populated multicenter registry of patients who had AIP measurements taken during their intensive care unit admission. The primary eligibility criterion was a diagnosis of blunt TBI. Ordinal logistic modeling was used to explore the association between anisocoria and daily Glasgow Coma Scale scores and discharge modified Rankin Scale scores from the intensive care unit and from the hospital. RESULTS: Among 118 subjects in the who met inclusion, there were 6187 pupillometer readings. Of these, anisocoria in ambient light was present in 12.8%, and that after light stimulation was present in 9.8%. Anisocoria after light stimulation was associated with worse injury severity (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.14-0.46]), lower discharge Glasgow Coma Scale scores (OR, 0.28 [95% CI, 0.17-0.45]), and lower discharge modified Rankin Scale scores (OR, 0.28 [95% CI, 0.17-0.47]). Anisocoria in ambient light showed a similar but weaker association. CONCLUSION: Anisocoria correlates with injury severity and with patient outcomes after blunt TBI. Anisocoria after light stimulation seems to be a stronger predictor than does anisocoria in ambient light. These findings represent continued efforts to understand pupillary changes in the setting of TBI.
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Muir M, Patel R, Traylor JI, de Almeida Bastos DC, Kamiya C, Li J, Rao G, Prabhu SS. Laser interstitial thermal therapy for newly diagnosed glioblastoma. Lasers Med Sci 2021; 37:1811-1820. [PMID: 34687390 DOI: 10.1007/s10103-021-03435-6] [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: 01/29/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022]
Abstract
Gliomas are the most frequent primary brain tumor in adults. Patients with glioblastoma (GBM) tumors deemed inoperable with open surgical techniques and treated only with chemo/radiation have a median overall survival of less than 9 months. Laser interstitial thermal therapy (LITT) has emerged as a cytoreductive alternative to surgery for these patients. The present study describes the outcomes of twenty patients with newly diagnosed, IDH wild-type glioblastoma treated with LITT. We retrospectively reviewed patients with newly diagnosed, unresectable GBM who underwent LITT at our institution. Progression-free survival (PFS) was the primary endpoint measured in our study, defined as time from LITT to disease progression. Results Twenty patients were identified with newly diagnosed, inoperable GBM lesions who underwent LITT. The overall median PFS was 4 months (95% CI = 2 - N/A, upper limit not reached). The median progression-free survival (PFS) for patients with less than 1 cm 3 residual tumor (gross total ablation, GTA) was 7 months (95% CI = 6 - N/A, upper limit not reached), compared to 2 months (95% CI = 1 - upper limit not reached) for patients with a lower GTA (p = .0019). The median overall survival was 11 months (95% CI = 6 - upper limit not reached). Preoperative Karnofsky performance score (KPS) less than or equal to 80 and deep-seated tumor location were significantly associated with decreased PFS (HR, .18, p = .03; HR, .08, p = .03, respectively). At the end of 1 month, only 4 patients (20%) experienced persistent motor deficits. LITT is a safe and effective treatment for patients with unresectable, untreated GBM with rates of survival and local recurrence comparable to patients with surgically accessible lesions treated with conventional resection. Careful patient selection is needed to determine if GTA is attainable.
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Affiliation(s)
- Matthew Muir
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA.
| | - Rajan Patel
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
| | - Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
| | - Dhiego Chaves de Almeida Bastos
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
| | - Carlos Kamiya
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
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16
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Bird CE, Traylor JI, Thomas J, Caruso JP, Kafka B, Rosado F, Blackburn KM, Hatanpaa KJ, Abdullah KG. Primary peripheral T-cell central nervous system lymphoma. Surg Neurol Int 2021; 12:465. [PMID: 34621580 PMCID: PMC8492444 DOI: 10.25259/sni_224_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/07/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary peripheral T-cell central nervous system lymphoma (PCNSL) is a rare, aggressive tumor that arises in the craniospinal axis and has an increased risk in individuals who are immunocompromised. This lesion often mimics other benign and malignant processes on radiographic imaging, leading to misdiagnosis and delays in treatment. We present a case of a patient with a history of Sjögren's syndrome and progressive neurologic symptoms who underwent craniotomy for diagnosis. CASE DESCRIPTION A 61-year-old woman with a history of Sjögren's syndrome, progressive aphasia, left facial droop, and right-sided paresthesias for 4 months presented for evaluation and management. An enhancing, infiltrative lesion in the left frontal lobe with underlying vasogenic edema was appreciated and suggestive of a primary or metastatic neoplasm. The patient underwent an open biopsy for further evaluation of the lesion. Extensive histopathologic evaluation revealed a diagnosis of T-cell PCNSL. The patient was started on induction methotrexate and temozolomide followed by consolidative radiotherapy. CONCLUSION Autoimmune conditions are a risk factor for T-cell PCNSL development. T-cell PCNSL has radiographic and gross histologic features that are consistent with a broad differential, including gliomas and inflammatory processes. Prompt diagnosis and extensive histopathological evaluation is essential to ensure appropriate treatment.
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Affiliation(s)
- Cylaina E. Bird
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jenna Thomas
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - James P. Caruso
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Benjamin Kafka
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Flavia Rosado
- Department of Pathology The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kyle M. Blackburn
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kimmo J. Hatanpaa
- Department of Pathology The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kalil G. Abdullah
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
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17
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Traylor JI, Lega B. Commentary: Feasibility and Morbidity of Magnetic Resonance Imaging-Guided Stereotactic Laser Ablation of Deep Cerebral Cavernous Malformations: A Report of 4 Cases. Neurosurgery 2021; 89:E211-E212. [PMID: 34352886 DOI: 10.1093/neuros/nyab287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jeffrey I Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bradley Lega
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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18
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Traylor JI, El Ahmadieh TY, Bedros NM, Al Adli N, Stutzman SE, Venkatachalam AM, Pernik MN, Collum CM, Douglas PM, Aiyagari V, Bagley CA, Olson DM, Aoun SG. Quantitative pupillometry in patients with traumatic brain injury and loss of consciousness: A prospective pilot study. J Clin Neurosci 2021; 91:88-92. [PMID: 34373065 DOI: 10.1016/j.jocn.2021.06.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Loss of consciousness (LOC) is a hallmark feature in Traumatic Brain Injury (TBI), and a strong predictor of outcomes after TBI. The aim of this study was to describe associations between quantitative infrared pupillometry values and LOC, intracranial hypertension, and functional outcomes in patients with TBI. METHODS We conducted a prospective study of patients evaluated at a Level 1 trauma center between November 2019 and February 2020. Pupillometry values including the Neurological Pupil Index (NPi), constriction velocity (CV), and dilation velocity (DV) were obtained. RESULTS Thirty-six consecutive TBI patients were enrolled. The median (range) age was 48 (range 21-86) years. The mean Glasgow Coma Scale score on arrival was 11.8 (SD = 4.0). DV trichotomized as low (<0.5 mm/s), moderate (0.5-1.0 mm/s), or high (>1.0 mm/s) was significantly associated with LOC (P = .02), and the need for emergent intervention (P < .01). No significant association was observed between LOC and NPi (P = .16); nor between LOC and CV (P = .07). CONCLUSIONS Our data suggests that DV, as a discrete variable, is associated with LOC in TBI. Further investigation of the relationship between discrete pupillometric variables and NPi may be valuable to understand the clinical significance of the pupillary light reflex findings in acute TBI.
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Affiliation(s)
- Jeffrey I Traylor
- UT Southwestern Medical Center, Department of Neurological Surgery, USA
| | | | - Nicole M Bedros
- Baylor University Medical Center, Division of Trauma, Department of Surgery, USA
| | - Nadeem Al Adli
- UT Southwestern Medical Center, Department of Neurological Surgery, USA
| | | | | | - Mark N Pernik
- UT Southwestern Medical Center, Department of Neurological Surgery, USA
| | - C Munro Collum
- UT Southwestern Medical Center, O'Donnell Brain Institute, USA
| | - Peter M Douglas
- Department of Molecular Biology, USA; Hamon Center for Regenerative Science and Medicine, USA
| | - Venkatesh Aiyagari
- UT Southwestern Medical Center, Department of Neurology, USA; UT Southwestern Medical Center, Department of Neuro-Critical Care, USA
| | - Carlos A Bagley
- UT Southwestern Medical Center, Department of Neurological Surgery, USA
| | - DaiWai M Olson
- UT Southwestern Medical Center, Department of Neurology, USA; UT Southwestern Medical Center, Department of Neuro-Critical Care, USA
| | - Salah G Aoun
- UT Southwestern Medical Center, Department of Neurological Surgery, USA.
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19
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Pernik MN, Traylor JI, El Ahmadieh TY, Bagley CA, Aoun SG. Commentary: Machine Learning-Driven Metabolomic Evaluation of Cerebrospinal Fluid: Insights Into Poor Outcomes After Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2021; 88:E410-E411. [PMID: 33556179 DOI: 10.1093/neuros/nyaa595] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark N Pernik
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey I Traylor
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | - Carlos A Bagley
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas.,Department of Orthopedic Surgery, University of Texas Southwestern, Dallas, Texas
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
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20
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Traylor JI, Pernik MN, Plitt AR, Lim M, Garzon-Muvdi T. Immunotherapy for Chordoma and Chondrosarcoma: Current Evidence. Cancers (Basel) 2021; 13:2408. [PMID: 34067530 PMCID: PMC8156915 DOI: 10.3390/cancers13102408] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 04/07/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/21/2022] Open
Abstract
Chordomas and chondrosarcomas are rare but devastating neoplasms that are characterized by chemoradiation resistance. For both tumors, surgical resection is the cornerstone of management. Immunotherapy agents are increasingly improving outcomes in multiple cancer subtypes and are being explored in chordoma and chondrosarcoma alike. In chordoma, brachyury has been identified as a prominent biomarker and potential molecular immunotherapy target as well as PD-1 inhibition. While studies on immunotherapy in chondrosarcoma are sparse, there is emerging evidence and ongoing clinical trials for PD-1 as well as IDH inhibitors. This review highlights potential biomarkers and targets for immunotherapy in chordoma and chondrosarcoma, as well as current clinical evidence and ongoing trials.
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Affiliation(s)
- Jeffrey I. Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.); (A.R.P.)
| | - Mark N. Pernik
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.); (A.R.P.)
| | - Aaron R. Plitt
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.); (A.R.P.)
| | - Michael Lim
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA 94305, USA;
| | - Tomas Garzon-Muvdi
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.); (A.R.P.)
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21
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Pernik MN, Bird CE, Traylor JI, Shi DD, Richardson TE, McBrayer SK, Abdullah KG. Patient-Derived Cancer Organoids for Precision Oncology Treatment. J Pers Med 2021; 11:423. [PMID: 34067714 PMCID: PMC8156513 DOI: 10.3390/jpm11050423] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022] Open
Abstract
The emergence of three-dimensional human organoids has opened the door for the development of patient-derived cancer organoid (PDO) models, which closely recapitulate parental tumor tissue. The mainstays of preclinical cancer modeling include in vitro cell lines and patient-derived xenografts, but these models lack the cellular heterogeneity seen in human tumors. Moreover, xenograft establishment is resource and time intensive, rendering these models difficult to use to inform clinical trials and decisions. PDOs, however, can be created efficiently and retain tumor-specific properties such as cellular heterogeneity, cell-cell and cell-stroma interactions, the tumor microenvironment, and therapeutic responsiveness. PDO models and drug-screening protocols have been described for several solid tumors and, more recently, for gliomas. Since PDOs can be developed in clinically relevant time frames and share many characteristics of parent tumors, they may enhance the ability to provide precision oncologic care for patients. This review explores the current literature on cancer organoids, highlighting the history of PDO development, organoid models of glioma, and potential clinical applications of PDOs.
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Affiliation(s)
- Mark N. Pernik
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (M.N.P.); (C.E.B.); (J.I.T.)
| | - Cylaina E. Bird
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (M.N.P.); (C.E.B.); (J.I.T.)
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (M.N.P.); (C.E.B.); (J.I.T.)
| | - Diana D. Shi
- Department of Radiation Oncology, Harvard Medical School, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Timothy E. Richardson
- Biggs Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
| | - Samuel K. McBrayer
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Kalil G. Abdullah
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (M.N.P.); (C.E.B.); (J.I.T.)
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- O’Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
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22
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Traylor JI, Christiano LD, Esmaeli B, Hanasono MM, Yu P, Suki D, Zhang W, Raza SM, Hanna EY, DeMonte F. Outcomes of orbital exenteration for craniofacial lesions. Cancer 2021; 127:2465-2475. [PMID: 33799313 DOI: 10.1002/cncr.33526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Orbital exenteration (OE) is an ablative procedure used in the management of malignancies of the orbit of either primary or secondary origin. Publications evaluating this procedure have suffered from small patient numbers, heterogeneity of pathologies, and poor patient follow-up. The purpose of this study was to assess patient outcomes in a large cohort of patients undergoing OE at a tertiary cancer center. METHODS A retrospective review was conducted of 180 consecutive patients who underwent OE at the authors' institution. Overall survival (OS) was the primary end point measured in the study. Time to locoregional recurrence (progression-free survival [PFS]) and disease-free survival were secondary end points. RESULTS Between the years 1993 and 2011, 180 consecutive patients received OE for craniofacial malignancy at the authors' institution. The median follow-up for the cohort was 9.7 years (116 months). The median OS was 73 months, and the median PFS was 96 months. The presence of perineural invasion was associated with shorter OS (P = .01) and PFS (P < .01). Magnetic resonance imaging was predictive of perineural invasion (P < .01). Positive margins were associated with shorter PFS than negative margins (P < .01) but with no change in OS (P = .15). The overall complication rate was 15%. The major complication rate (Clavien-Dindo 3b or greater) was 2.8% (n = 5), and there was 1 death observed (0.6%). CONCLUSIONS Used judiciously in the setting of a multidisciplinary management plan, OE for tumor control is a safe therapy. LAY SUMMARY Between the years 1993 and 2011, 180 consecutive patients received orbital exenteration for craniofacial malignancy at the MD Anderson Cancer Center. The median follow-up for the cohort was 9.7 years. The presence of perineural invasion was associated with shorter overall survival (P = .01) and progression-free survival (P < .01). Magnetic resonance imaging was predictive of perineural invasion (P < .01). Positive margins were associated with shorter progression-free survival than negative margins (P < .01). The overall complication rate was 15%. The major complication rate (Clavien-Dindo 3b or greater) was 2.8% (n = 5).
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Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lana D Christiano
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bita Esmaeli
- Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew M Hanasono
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peirong Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dima Suki
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wen Zhang
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Shaan M Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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23
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Hicks WH, Bird CE, Traylor JI, Shi DD, El Ahmadieh TY, Richardson TE, McBrayer SK, Abdullah KG. Contemporary Mouse Models in Glioma Research. Cells 2021; 10:cells10030712. [PMID: 33806933 PMCID: PMC8004772 DOI: 10.3390/cells10030712] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/20/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023] Open
Abstract
Despite advances in understanding of the molecular pathogenesis of glioma, outcomes remain dismal. Developing successful treatments for glioma requires faithful in vivo disease modeling and rigorous preclinical testing. Murine models, including xenograft, syngeneic, and genetically engineered models, are used to study glioma-genesis, identify methods of tumor progression, and test novel treatment strategies. Since the discovery of highly recurrent isocitrate dehydrogenase (IDH) mutations in lower-grade gliomas, there is increasing emphasis on effective modeling of IDH mutant brain tumors. Improvements in preclinical models that capture the phenotypic and molecular heterogeneity of gliomas are critical for the development of effective new therapies. Herein, we explore the current status, advancements, and challenges with contemporary murine glioma models.
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Affiliation(s)
- William H. Hicks
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (W.H.H.); (C.E.B.); (J.I.T.); (T.Y.E.A.)
| | - Cylaina E. Bird
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (W.H.H.); (C.E.B.); (J.I.T.); (T.Y.E.A.)
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (W.H.H.); (C.E.B.); (J.I.T.); (T.Y.E.A.)
| | - Diana D. Shi
- Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA;
| | - Tarek Y. El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (W.H.H.); (C.E.B.); (J.I.T.); (T.Y.E.A.)
| | - Timothy E. Richardson
- Department of Pathology, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX 75229, USA;
| | - Samuel K. McBrayer
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Harrold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Correspondence: (S.K.M.); (K.G.A.)
| | - Kalil G. Abdullah
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (W.H.H.); (C.E.B.); (J.I.T.); (T.Y.E.A.)
- Harrold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Correspondence: (S.K.M.); (K.G.A.)
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24
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Traylor JI, Patel R, Muir M, de Almeida Bastos DC, Ravikumar V, Kamiya-Matsuoka C, Rao G, Thomas JG, Kew Y, Prabhu SS. Laser Interstitial Thermal Therapy for Glioblastoma: A Single-Center Experience. World Neurosurg 2021; 149:e244-e252. [PMID: 33610872 DOI: 10.1016/j.wneu.2021.02.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surgical resection has been shown to prolong survival in patients with glioblastoma multiforme (GBM), although this benefit has not been demonstrated for reoperation following tumor recurrence. Laser interstitial thermal therapy (LITT) is a minimally invasive ablation technique that has been shown to effectively reduce tumor burden in some patients with intracranial malignancy. The aim of this study was to describe the safety and efficacy of LITT for recurrent and newly diagnosed GBM at a large tertiary referral center. METHODS Patients with GBM receiving LITT were retrospectively analyzed. Overall survival from the time of LITT was the primary end point measured. RESULTS There were 69 patients identified for inclusion in this study. The median age of the cohort was 56 years (range, 15-77 years). Median tumor volume was 10.4 cm3 (range, 1.0-64.0 cm3). A Kaplan-Meier estimate of median overall survival for the series from the time of LITT was 12 months (95% confidence interval 8-16 months). Median progression-free survival for the cohort from LITT was 4 months (95% confidence interval 3-7 months). Adjuvant chemotherapy significantly prolonged progression-free survival and overall survival (P < 0.01 for both) in the cohort. Gross total ablation was not significantly associated with progression-free survival (P = 0.09). CONCLUSIONS LITT can safely reduce intracranial tumor burden in patients with GBM who have exhausted other adjuvant therapies or are poor candidates for conventional resection techniques.
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Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rajan Patel
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Visweswaran Ravikumar
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan G Thomas
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yvonne Kew
- Department of Neurology, Baylor St. Luke's Medical Center, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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25
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Traylor JI, Pernik MN, Sternisha AC, McBrayer SK, Abdullah KG. Molecular and Metabolic Mechanisms Underlying Selective 5-Aminolevulinic Acid-Induced Fluorescence in Gliomas. Cancers (Basel) 2021; 13:cancers13030580. [PMID: 33540759 PMCID: PMC7867275 DOI: 10.3390/cancers13030580] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary 5-aminolevulinic acid (5-ALA) is a medication that produces fluorescence in certain cancers, which enables surgeons to visualize tumor margins during surgery. Gliomas are brain tumors that can be difficult to fully resect due to their infiltrative nature. In this review we explored what is known about the mechanism of 5-ALA, recent discoveries that increase our understanding of that mechanism, and potential targets to increase fluorescence in lower grade gliomas. Abstract 5-aminolevulinic acid (5-ALA) is a porphyrin precursor in the heme synthesis pathway. When supplied exogenously, certain cancers consume 5-ALA and convert it to the fluorogenic metabolite protoporphyrin IX (PpIX), causing tumor-specific tissue fluorescence. Preoperative administration of 5-ALA is used to aid neurosurgical resection of high-grade gliomas such as glioblastoma, allowing for increased extent of resection and progression free survival for these patients. A subset of gliomas, especially low-grade tumors, do not accumulate PpIX intracellularly or readily fluoresce upon 5-ALA administration, making gross total resection difficult to achieve in diffuse lesions. We review existing literature on 5-ALA metabolism and PpIX accumulation to explore potential mechanisms of 5-ALA-induced glioma tissue fluorescence. Targeting the heme synthesis pathway and understanding its dysregulation in malignant tissues could aid the development of adjunct therapies to increase intraoperative fluorescence after 5-ALA treatment.
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Affiliation(s)
- Jeffrey I. Traylor
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.)
| | - Mark N. Pernik
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.)
| | - Alex C. Sternisha
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Samuel K. McBrayer
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
- Correspondence: (S.K.M.); (K.G.A.); Tel.: +1-(214)-648-3730 (S.K.M.); +1-(214)-645-2300 (K.G.A.)
| | - Kalil G. Abdullah
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.)
- Correspondence: (S.K.M.); (K.G.A.); Tel.: +1-(214)-648-3730 (S.K.M.); +1-(214)-645-2300 (K.G.A.)
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Traylor JI, Sheppard HE, Ravikumar V, Breshears J, Raza SM, Lin CY, Patel SR, DeMonte F. Computational Drug Repositioning Identifies Potentially Active Therapies for Chordoma. Neurosurgery 2021; 88:428-436. [PMID: 33017025 PMCID: PMC7803434 DOI: 10.1093/neuros/nyaa398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/28/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chordomas are aggressive bone tumors that often recur despite maximal resection and adjuvant radiation. To date there are no Food and Drug Administration (FDA)-approved chemotherapies. Computational drug repositioning is an expanding approach to identify pharmacotherapies for clinical trials. OBJECTIVE To identify FDA-approved compounds for repurposing in chordoma. METHODS Previously identified highly differentially expressed genes from chordoma tissue samples at our institution were compared with pharmacogenomic interactions in the Comparative Toxicogenomics Database (CTD) using ksRepo, a drug-repositioning platform. Compounds selected by ksRepo were then validated in CH22 and UM-Chor1 human chordoma cells in Vitro. RESULTS A total of 13 chemical compounds were identified in silico from the CTD, and 6 were selected for preclinical validation in human chordoma cell lines based on their clinical relevance. Of these, 3 identified drugs are FDA-approved chemotherapies for other malignancies (cisplatin, cytarabine, and lucanthone). Cytarabine, a deoxyribonucleic acid polymerase inhibitor approved for the treatment of various leukemias, exhibited a significant concentration-dependent effect against CH22 and UM-Chor1 cells when compared to positive (THZ1) and negative (venetoclax) controls. Tretinoin exhibited a significant concentration-dependent cytotoxic effect in CH22, sacral chordoma-derived cell lines but to a much lesser extent in UM-Chor1, a cell line derived from skull base chordoma. CONCLUSION Cytarabine administration reduces the viability of human chordoma cells. The equally effective reduction in viability seen with tretinoin seems to be cell line dependent. Based on our findings, we recommend the evaluation of cytarabine and tretinoin in an expanded set of human chordoma cell lines and animal models.
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Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hadley E Sheppard
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Visweswaran Ravikumar
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan Breshears
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shaan M Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles Y Lin
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Kronos Bio, Cambridge, Massachusetts
| | - Shreyaskumar R Patel
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Bastos DCA, Vega RA, Traylor JI, Ghia AJ, Li J, Oro M, Bishop AJ, Yeboa DN, Amini B, Kumar VA, Rao G, Rhines LD, Tatsui CE. Spinal laser interstitial thermal therapy: single-center experience and outcomes in the first 120 cases. J Neurosurg Spine 2020:1-10. [PMID: 33307530 DOI: 10.3171/2020.7.spine20661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors. METHODS The electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications. RESULTS There were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non-small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine. CONCLUSIONS sLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.
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Affiliation(s)
| | - Rafael A Vega
- 4Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Behrang Amini
- 3Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Vinodh A Kumar
- 3Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
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Stumpo V, Latour K, Traylor JI, Staartjes VE, Giordano M, Caccavella VM, Olivi A, Ricciardi L, Signorelli F. Medical Student Interest and Recruitment in Neurosurgery. World Neurosurg 2020; 141:448-454.e6. [DOI: 10.1016/j.wneu.2020.04.248] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
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Abstract
Importance: In today’s climate of high healthcare costs and limited research resources, much attention has been given to inefficiency in research. Open access to research data has been proposed as a way to pool resources and make the most of research funding while also promoting transparency and scientific rigor. Objective: The clinical neurosciences stand to benefit greatly from the potential opportunities afforded by open data, and we sought to evaluate the current state of publicly available research findings and data sharing policies within the clinical neurosciences. Design: The Clarivate Analytics Web of Science journal citation reports for 2017 were used to sort journals in the category ‘Clinical Neurosciences’ by impact factor. The top 50 journals were selected and reviewed, but data was only collected from journals focused on original research (42/50). For each journal we reviewed the 10 most recent original research articles for 2016, 2017, and 2018 as designated by Scopus. Results: A data sharing policy existed for 60% (25/42) of the journals reviewed. Of the articles studied 41% (517/1255) contained source data, and the amount of articles with available source data increased from 2016 to 2018. Of all the articles reviewed, 49.4% (620/1255) were open access. Overall, 6.9% (87/1255) of articles had their source data accessible outside of the manuscript (e.g. registries, databases, etc.) and 8.9% (112/1255) addressed the availability of their source data within the publication itself. The availability of source data outside the manuscript and in-article discussion of source data availability both increased from 2016 to 2018. Only 3.9% (49/1255) of articles reviewed reported negative results for their primary outcome, and 7.6% (95/1255) of the articles could not be defined as primarily reporting positive or negative findings (characterization studies, census reporting, etc.). The distribution of negative versus positive results reported showed no significant trend over the years studied. Conclusion and Relevance: Our results demonstrate an opportunity for increased data sharing in neuroscience original research. These findings also suggest a trend towards increased adoption of open data sharing policies among journals and increased availability of unprocessed data in publications. This can increase the quality and speed at which new research is developed in the clinical neurosciences.
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Affiliation(s)
- Keith A Hanson
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Nyle Almeida
- Department of Neurosurgery, University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Jeffrey I Traylor
- Department of Neurosurgery, University of Texas at Austin Dell Medical School, Austin, USA
| | - Dayal Rajagopalan
- Department of Neurosurgery, University of Texas at Austin Dell Medical School, Austin, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
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Vega RA, Traylor JI, Habib A, Rhines LD, Tatsui CE, Rao G. Minimally Invasive Separation Surgery for Metastases in the Vertebral Column: A Technical Report. Oper Neurosurg (Hagerstown) 2020; 18:606-613. [PMID: 31529099 DOI: 10.1093/ons/opz233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/31/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Epidural spinal cord compression (ESCC) is a common and severe cause of morbidity in cancer patients. Minimally invasive surgical techniques may be utilized to preserve neurological function and permit the use of radiation to maximize local control. Minimally invasive techniques are associated with lower morbidity. OBJECTIVE To describe a novel, minimally invasive operative technique for the management of metastatic ESCC. METHODS A minimally invasive approach was used to cannulate the pedicles of the thoracic vertebrae, which were then held in place by Kirschner wires (K-wires). Following open decompression of the spinal cord, cannulated screws were placed percutaneously with stereotactic guidance through the pedicles followed by cement induction. Stereotactic radiosurgery is performed in the postoperative period for residual metastatic disease in the vertebral body. RESULTS The minimally invasive technique used in this case reduced tissue damage and optimized subsequent recovery without compromising the quality of decompression or the extent of metastatic tumor resection. Development of more minimally invasive techniques for the management of metastatic ESCC has the potential to facilitate healing and preserve quality of life in patients with systemic malignancy. CONCLUSION ESCC from vertebral metastases poses a challenge to treat in the context of minimizing potential risks to preserve quality of life. Percutaneous pedicle screw fixation with cement augmentation provides a minimally invasive alternative for definitive treatment of these patients.
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Affiliation(s)
- Rafael A Vega
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmed Habib
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laurence D Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Claudio E Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Vega RA, Traylor JI, Patel R, Muir M, Bastos DC, Prabhu SS. Combined Surgical Resection and Laser Interstitial Thermal Therapy for Glioblastoma: Technical Note. J Neurol Surg A Cent Eur Neurosurg 2020; 81:348-354. [DOI: 10.1055/s-0040-1709163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background Glioblastoma multiforme (GBM) is an aggressive intracranial malignancy that confers a poor prognosis despite maximum surgical resection and chemoradiotherapy. Survival decreases further with deep-seated lesions. Laser interstitial thermal therapy (LITT) is an emerging minimally invasive technique for tumor ablation shown to reduce tumor burden effectively, particularly in deep-seated locations less amenable to gross total resection. We describe our initial technical experience of using the combination of LITT followed by surgical resection in patients with GBMs that exhibit both an easily accessible and deep-seated component.
Materials and Methods Patients with GBM who received concurrent LITT and surgical resection at our institution were identified. Patient demographic and clinical information was procured from the University of Texas MD Anderson Cancer Center electronic medical record along with preoperative, postoperative, and 1-month follow-up magnetic resonance imaging (MRI).
Results Four patients (n = 2 male, n = 2 female) with IDH-wild type GBM who received combined LITT and surgical resection were identified and analyzed retrospectively. All patients received chemoradiotherapy before presentation. All but one patient (75%) received resection before presentation. Median age was 54 years (range: 44–56 years). Median length of hospital stay was 6.5 days (range: 2–47 days). Median extent of combined ablation/resection was 90.4%. One of the four patients experienced complications in the perioperative or immediate follow-up periods. Local recurrence was observed in one patient during the follow-up period.
Conclusion Malignant gliomas in deep-seated locations or in close proximity to white matter structures are challenging to manage. LITT followed by surgical resection may provide an alternative for tumor debulking that minimizes potential morbidities and extent of residual tumor. Further studies comparing this approach with standard resection techniques are warranted.
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Affiliation(s)
- Rafael A. Vega
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Jeffrey I. Traylor
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Rajan Patel
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Matthew Muir
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Dheigo C.A. Bastos
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Sujit S. Prabhu
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Traylor JI, Patel R, Habib A, Muir M, de Almeida Bastos DC, Rao G, Prabhu SS. Laser Interstitial Thermal Therapy to the Posterior Fossa: Challenges and Nuances. World Neurosurg 2019; 132:e124-e132. [DOI: 10.1016/j.wneu.2019.08.242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022]
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Traylor JI, Patel R, Muir M, Habib A, Bastos DCDA, Rao G, Prabhu SS. Laser Interstitial Thermal Therapy to the Posterior Fossa: Challenges and Nuances. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION
Posterior fossa tumors are rare in adults and pose a challenge to treat due to the bony contour of the posterior fossa, complex anatomical structures including deep venous sinuses, and the proximity of the fourth ventricle and brain stem. We describe our experience with laser interstitial thermal therapy (LITT) for the management of brain metastases and radiation necrosis of the posterior fossa.
METHODS
We retrospectively analyzed 13 patients with metastases and radiation necrosis of the posterior fossa managed with LITT. Patient data were extracted from the electronic medical record along with magnetic resonance images (MRI) preoperatively, immediately postoperatively, and at each follow-up.
RESULTS
Thirteen patients with histopathologically confirmed radiation necrosis (n = 5) and metastases (n = 8) of the posterior fossa underwent LITT. The median preoperative tumor and postoperative ablation cavity volume was 4.66 and 6.29 cm3, respectively. The median volume of the ablation cavity decreased to 2.90 cm3 at 9-mo follow-up. The median volume of peritumoral edema was 12.25 cm3, which fell to a median 5.77 cm3 at 1-mo follow-up. Median progression-free survival was 7 mo (range 3-14 mo) from LITT. The mean overall survival (OS) was 40 months (range 2-49 mo). There were no intraoperative complications. One patient experienced palsy of the seventh and eighth cranial nerves on follow-up, attributable to LITT. Two patients received 2 LITT treatments for their respective lesions.
CONCLUSION
Lesions of the posterior fossa are challenging to treat given their proximity to the dura and venous sinuses. We demonstrate that LITT ablation may be a safe and feasible option for metastases and radiation necrosis of the posterior fossa. Larger studies are needed to confirm the efficacy of this approach.
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Traylor JI, Bastos DCA, Fuentes D, Muir M, Patel R, Kumar VA, Stafford RJ, Rao G, Prabhu SS. Dynamic Contrast-Enhanced MRI in Patients with Brain Metastases Undergoing Laser Interstitial Thermal Therapy: A Pilot Study. AJNR Am J Neuroradiol 2019; 40:1451-1457. [PMID: 31371353 DOI: 10.3174/ajnr.a6144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/19/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Tumor recurrence is difficult to predict in patients receiving laser ablation for intracranial malignancy. We assessed the efficacy of the initial area under the time-to-signal intensity curve at 60 seconds (iAUC60) from dynamic contrast-enhanced MR imaging in predicting progression-free survival in patients with brain metastases following laser interstitial thermal therapy. MATERIALS AND METHODS The study population was a consecutive series of patients undergoing laser interstitial thermal therapy for brain metastases. Patient demographics including age, sex, tumor histology, and Karnofsky Performance Scale were collected prospectively. Preoperative, postoperative, and 1-month follow-up dynamic contrast-enhanced MRIs were analyzed. Values of iAUC60 were computed using a trapezoidal rule applied to the time history of contrast uptake over the first 60 seconds postenhancement. The change in iAUC60 (ΔiAUC60) was calculated by taking the difference between the values of iAUC60 from 2 time points. Pearson correlation coefficients were calculated between progression-free survival, defined as the time from laser interstitial thermal therapy to tumor recurrence, and iAUC60 or ΔiAUC60 values. RESULTS Thirty-three cases of laser interstitial thermal therapy for 32 brain metastases in a cohort of 27 patients were prospectively analyzed. A significant relationship was observed between the values of iAUC60 from postoperative dynamic contrast-enhanced MR imaging and progression-free survival with Pearson correlation (P = .03) and Cox univariate analysis (P = .01). The relationship between preoperative and 1-month follow-up dynamic contrast-enhanced MR imaging was not significantly correlated with progression-free survival. Similarly, no statistically significant relationship was observed with ΔiAUC60 and progression-free survival between any time points. CONCLUSIONS Progression-free survival is difficult to predict in patients undergoing laser interstitial thermal therapy for brain metastases due to confounding with posttreatment change. iAUC60 extracted from postoperative dynamic contrast-enhanced MR imaging shows promise for accurately prognosticating patients following this operative therapy.
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Affiliation(s)
- J I Traylor
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - D C A Bastos
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | | | - M Muir
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - R Patel
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - V A Kumar
- Diagnostic Radiology (V.A.K.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - G Rao
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - S S Prabhu
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
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Traylor JI, Satarasinghe P, Kuo JS. Neoantigen-Targeting Vaccine Promotes T-Cell Response in Glioblastoma. Neurosurgery 2019; 85:E207-E209. [PMID: 31304540 DOI: 10.1093/neuros/nyz164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery Mulva Clinic for the Neurosciences Dell Medical School The University of Texas at Austin Austin, Texas
| | - Praveen Satarasinghe
- Department of Neurosurgery Mulva Clinic for the Neurosciences Dell Medical School The University of Texas at Austin Austin, Texas
| | - John S Kuo
- Department of Neurosurgery Mulva Clinic for the Neurosciences Dell Medical School The University of Texas at Austin Austin, Texas
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Traylor JI, Habib A, Patel R, Muir M, Gadot R, Briere T, Yeboa DN, Li J, Rao G. Fractionated stereotactic radiotherapy for local control of resected brain metastases. J Neurooncol 2019; 144:343-350. [PMID: 31313060 DOI: 10.1007/s11060-019-03233-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/26/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Postoperative stereotactic radiosurgery (SRS) has been shown to establish local control in patients with resected brain metastases, yet its efficacy may be limited, particularly for resected lesions with large post-operative resection cavities. We describe the efficacy of postoperative fractionated stereotactic radiotherapy (FSRT) for local control in patients who have undergone resection for brain metastases. METHODS In this retrospective cohort study, we analyzed patients who received FSRT for resected brain metastases in 3 or 5 fractions. Time to local recurrence was the primary endpoint in this study. RESULTS Sixty-seven patients (n = 29 female, n = 38 male) met study criteria for review. The median age of the cohort was 62 years (range 18-79 years). Median preoperative tumor volume was 11.1 cm3 (range 0.4-77.0 cm3). The rate of local control was 91.0% at 6 months, 85.1% at 12 months, and 85.1% at 18 months. Estimates of freedom from local recurrence at 6 and 12 months were 90.9% and 84.3%, respectively. Higher biologically equivalent doses (BED10) were found to be predictive of longer freedom from local recurrence on univariate and multivariable analysis. Larger cavity volumes were found to correspond to longer time to local recurrence on univariate and multivariable analysis. CONCLUSION Our results suggest that postoperative FSRT may be an effective method for providing local control to the surgical bed in patients with resected brain metastases, particularly for larger tumors not amenable to conventional, single-fraction SRS. Additional prospective studies are needed to confirm these findings.
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Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed Habib
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajan Patel
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ron Gadot
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 853, Houston, TX, 77030-4009, USA.
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Patel R, Traylor JI, Latha K, Heimberger AB, Li S, Rao G. Fibrinogen-like protein 2: a potential molecular target for glioblastoma treatment. Expert Opin Ther Targets 2019; 23:647-649. [PMID: 31167575 DOI: 10.1080/14728222.2019.1628220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Rajan Patel
- a Department of Neurosurgery , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jeffrey I Traylor
- a Department of Neurosurgery , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Khatri Latha
- a Department of Neurosurgery , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Amy B Heimberger
- a Department of Neurosurgery , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Shulin Li
- b Department of Pediatrics-Research , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Ganesh Rao
- a Department of Neurosurgery , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Traylor JI, Johnson GS, Ashour R, Ghafoori P, Buchanan RJ. Volume-Staged CyberKnife Stereotactic Radiosurgery for Treatment of Drug-Resistant Epilepsy for a Spetzler-Martin Grade V Arteriovenous Malformation: A Case Report and Review of the Literature. World Neurosurg 2019; 125:329-332. [PMID: 30797935 DOI: 10.1016/j.wneu.2019.01.296] [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: 12/26/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Evidence to support the use of stereotactic radiosurgery (SRS) in the treatment of epilepsy secondary to cerebral arteriovenous malformations (AVMs) is emerging. However, these studies have not clearly demonstrated the use of SRS in the treatment of drug-resistant epilepsy (DRE) in high Spetzler-Martin grade (IV-V) AVMs. CASE DESCRIPTION We present a 48-year-old woman with DRE secondary to a Spetzler-Martin grade V cerebral AVM. She was treated with volume-staged SRS (VS-SRS) and achieved near-complete resolution of her seizures with incomplete obliteration of the AVM. Six years after treatment, she has experienced no serious complications. CONCLUSIONS VS-SRS successfully controlled seizures (Engel Outcome Measure of 1A) in a patient with intractable, DRE secondary to a high-grade cerebral AVM.
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Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery, Dell Medical School, The University of Texas, Austin, Texas, USA.
| | - Garrett S Johnson
- Department of Neurosurgery, Dell Medical School, The University of Texas, Austin, Texas, USA
| | - Ramsey Ashour
- Department of Neurosurgery, Dell Medical School, The University of Texas, Austin, Texas, USA
| | - Paiman Ghafoori
- Department of Women's Health, Dell Medical School, The University of Texas, Austin, Texas, USA
| | - Robert J Buchanan
- Department of Neurosurgery, Dell Medical School, The University of Texas, Austin, Texas, USA
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Traylor JI, Kuo JS. "Liquid Biopsy" of Circulating Tumor DNA Characterizes Treatment Response in Pediatric Patients Diffuse Midline Glioma. Neurosurgery 2019; 85:E167-E168. [PMID: 30793197 DOI: 10.1093/neuros/nyz029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery Dell Medical School The University of Texas at Austin Austin, Texas
| | - John S Kuo
- Department of Neurosurgery Dell Medical School The University of Texas at Austin Austin, Texas
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Ziu M, Traylor JI, Paxman J, Goodgame BW. Stereotactic Vertebroplasty for Spinal Metastases with Multilevel Bilateral Pedicle Fractures: A Technical Note. Cureus 2019; 11:e4123. [PMID: 31037237 PMCID: PMC6478491 DOI: 10.7759/cureus.4123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Vertebral compression fractures (VCFs) represent a significant cause of disability and primarily result from either underlying vertebral body neoplasms or osteoporosis. Vertebroplasty (VP) is a procedure commonly utilized to repair pathologic VCFs in order to manage pain and reinstate vertebral body height. However, there is a paucity of literature on how to manage painful multilevel VCFs with concomitant bilateral pedicle fractures. We describe a patient with a primary prostatic carcinoma and VCFs of the third and fourth lumbar vertebrae (L3 and L4, respectively) with concomitant bilateral pedicle fractures secondary to metastatic disease. Due to the degree of damage to the L3 and L4 vertebral bodies and pedicles, a VP performed via a percutaneous approach was deemed to be too high risk. VP for L3 and L4 was instead performed by utilizing stereotactic spine navigation and an intraoperative O-arm (Medtronic Corporation, Minneapolis, Minnesota). Our result indicates a potential role for stereotactic spine navigation in vertebroplasty for complex pathologic VCFs.
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Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery Dell Medical School The University of Texas at Austin Austin, Texas
| | - John S Kuo
- Department of Neurosurgery Dell Medical School The University of Texas at Austin Austin, Texas
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Traylor JI, Kuo JS. Delta-24-RGD Adenoviral Therapy Directs Oncolytic and Immune-Mediated Anti-Tumor Effects in Recurrent Malignant Glioma Patients. Neurosurgery 2018; 84:E11-E12. [DOI: 10.1093/neuros/nyy504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - John S Kuo
- Dell Medical School The University of Texas at Austin Austin, Texas
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43
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Ziu M, Traylor JI, Paxman J, Gorrebeeck A, Fortes DL. Utilizing Stereotactic Spine Navigation for Posterior Partial Vertebrectomy in an En Bloc Resection of a Superior Pulmonary Sulcus Tumor Invading the Thoracic Vertebrae: A Technical Note. Cureus 2018; 10:e3303. [PMID: 30456002 PMCID: PMC6239614 DOI: 10.7759/cureus.3303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Prior to the development of en bloc techniques, vertebral invasion by non-small cell lung cancer (NSCLC) had been considered a relative contraindication to surgical intervention. However, reports in the literature have demonstrated increased progression-free survival with the use of neoadjuvant chemotherapy followed by anterior en bloc resection of the residual tumor. Stereotactic spine navigation has been shown to improve accuracy during complex vertebral osteotomies, improving patient outcomes. We report a 53-year-old woman with an NSCLC in the left upper lobe, a periosteum attachment of the second and third thoracic vertebrae (T2 and T3, respectively), and an infiltration of the corresponding nerve roots. We describe a surgical approach for the resection of NSCLC with vertebral infiltration utilizing stereotactic spine navigation and intraoperative computed tomography (CT) (O-Arm, Medtronic, Minneapolis, Minnesota, US) for a posterior approach laminectomy, osteotomy, and partial vertebrectomy, followed by trans-thoracic en bloc resection of a superior pulmonary sulcus tumor with nerve root infiltration. Posterior approach vertebral osteotomy and en bloc resection for superior sulcus NSCLC infiltrating the vertebrae utilizing stereotactic spine navigation and intraoperative CT (O-Arm) is a viable alternative to the traditional anterior approach.
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Affiliation(s)
- Mateo Ziu
- Department of Surgery & Perioperative Care, The University of Texas at Austin, Dell Medical School, Austin, USA
| | - Jeffrey I Traylor
- Medical Student, The University of Texas at Austin, Dell Medical School, Austin, USA
| | - Jason Paxman
- Medical Student, The University of Texas at Austin, Dell Medical School, Austin, USA
| | - Allison Gorrebeeck
- Department of Internal Medicine, Dell Seton Medical Center at The University of Texas, Austin, USA
| | - Daniel L Fortes
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, USA
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Ziu M, Traylor JI. Temozolomide—the jack of all gliomas? Reviewing the interim results of the CATNON trial for 1p/19q non-co-deleted anaplastic glioma. Transl Cancer Res 2018. [DOI: 10.21037/tcr.2018.03.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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