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Di L, Eichberg DG, Jamshidi A, Shah AH, Luther E, Ivan ME, Komotar RJ, Gultekin S. Rapid Intraoperative Diagnosis of Gliomas Using Stimulated Raman Histology. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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102
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Eichberg DG, Komotar RJ, Ivan ME. Commentary: Microsurgical Transcranial Approach of 112 Paraoptic Meningiomas: A Single-Center Case Series. Oper Neurosurg (Hagerstown) 2020; 19:E557-E558. [PMID: 32710759 DOI: 10.1093/ons/opaa233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
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103
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Basil GW, Eichberg DG, Perez-Dickens M, Menendez I, Ivan ME, Urakov T, Komotar RJ, Wang MY, Levi AD. Differences Between Neurosurgical Subspecialties in Telehealth Adoption. World Neurosurg 2020; 146:e323-e327. [PMID: 33212275 PMCID: PMC9191889 DOI: 10.1016/j.wneu.2020.10.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The health care field has been faced with unprecedented challenges during the COVID 19 pandemic. One such challenge was the implementation of enhanced telehealth capabilities to ensure continuity of care. In this study, we aim to understand differences between subspecialties with regard to patient consent and satisfaction following telehealth implementation. METHODS A retrospective review of the electronic medical record was performed from March 2 to May 8, 2020 to evaluate surgical consents before and after telehealth implementation. Press Ganey survey results were also obtained both pre- and posttelehealth implementation and compared. RESULTS There was no significant difference in the percentage of new patients consented for surgery (after being seen via telehealth only) between the cranial and spine services. For procedures in which >10 patients were consented for surgery, the highest proportion of patients seen only via telehealth was for ventriculoperitoneal shunt placement/endoscopic third ventriculostomy for the cranial service, and lumbar laminectomy and microdiscectomy for the spine service. Additionally, the spine service experienced marked improvement in Press Ganey scores posttelehealth implementation with overall doctor ranking improving from the 29th to the 93rd percentile, and likelihood to recommend increasing from the 24th to the 94th percentile. CONCLUSIONS There were clear trends with regard to which pathologies and procedures were most amenable to telehealth visits, which suggests a potential roadmap for future clinic planning. Additionally, the notable improvement in spine patient satisfaction following the implementation of a telehealth program suggests the need for long-term process changes.
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Eichberg DG, Komotar RJ, Ivan ME. Commentary: Characterization of Magnetic Resonance Thermal Imaging Signal Artifact During Magnetic Resonance Guided Laser-Induced Thermal Therapy. Oper Neurosurg (Hagerstown) 2020; 19:E512-E513. [PMID: 32814960 DOI: 10.1093/ons/opaa255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/21/2020] [Indexed: 11/12/2022] Open
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105
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Ashraf O, Arzumanov G, Luther E, McMahon JT, Malcolm JG, Mansour S, Lee IY, Willie JT, Komotar RJ, Danish SF. Magnetic resonance-guided laser interstitial thermal therapy for posterior fossa neoplasms. J Neurooncol 2020; 149:533-542. [PMID: 33057919 DOI: 10.1007/s11060-020-03645-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Magnetic resonance-guided laser interstitial thermal therapy (LITT) has been increasingly used to treat a number of intracranial pathologies, though its use in the posterior fossa has been limited to a few small series. We performed a multi-institutional review of targets in the posterior fossa, reporting the efficacy and safety profile associated with laser ablation in this region of the brain. METHODS A retrospective review of patients undergoing LITT in the posterior fossa was performed from August 2010 to March 2020. Patient demographic information was collected alongside the operative parameters and patient outcomes. Reported outcomes included local control of the lesion, postoperative complications, hospital length of stay, and steroid requirements. RESULTS 58 patients across four institutions underwent LITT in the posterior fossa for 60 tumors. The median pre-ablation tumor volume was 2.24 cm3. 48 patients (50 tumors) were available for follow-up. An 84% (42/50) overall local control rate was achieved at 9.5 months median follow up. There were two procedural complications, including insertional hemorrhage and laser misplacement and 12/58 (21%) patients developed new neurological deficits. There was one procedure related death. The median length of hospital stay was 1 day, with 20.7% of patients requiring discharge to a rehabilitation facility. CONCLUSIONS LITT is an effective approach for treating pathology in the posterior fossa. The average target size is smaller than what has been reported in the supratentorial space. Care must be taken to prevent injury to surrounding structures given the close proximity of critical structures in this region.
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Eichberg DG, Komotar RJ, Ivan ME. Commentary: Left Modified Orbitozygomatic Approach for Clipping of Multilobulated Middle Cerebral Artery Bifurcation Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E387-E388. [PMID: 32678902 DOI: 10.1093/ons/opaa197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 11/12/2022] Open
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107
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Eichberg DG, Komotar RJ, Ivan ME. Commentary: Dissection of the Petrosal Presigmoid-Retrolabyrinthine Approach for the Petroclival Region on a Cadaver: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E400-E401. [PMID: 32453810 DOI: 10.1093/ons/opaa158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 11/14/2022] Open
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108
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Sprau AC, Figueroa JM, Komotar RJ, Jagid JR, Thaller SR. Letter: Guidelines for Non-Medical Field Personnel in Immediate Management of Craniofacial Baseball Injuries: The Neurosurgeon's Role. Neurosurgery 2020; 87:E533-E534. [PMID: 32674134 DOI: 10.1093/neuros/nyaa303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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109
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Eichberg DG, Epstein RH, Dexter F, Di L, Vadhan JD, Luther E, Komotar RJ. Building a Brain Tumor Practice: Objective Analysis of Referral Patterns and Implications for the Growth of a Subspecialty Surgical Program. Cureus 2020; 12:e10416. [PMID: 33062532 PMCID: PMC7550243 DOI: 10.7759/cureus.10416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction Growth of surgical caseload among specialties with a large contribution margin is an important financial objective for hospitals. In this study, we examined the diversity of referral patterns to a neurosurgeon over an eight-year interval and examined practice attributes related to surgical growth. Methods The electronic records of all patients undergoing an intracranial surgical procedure between August 2011 and August 2019 by an academic neurosurgeon were reviewed retrospectively. The Herfindahl-Hirschman index (HHI) was used to assess the distribution of referrals among community physicians who referred such patients; a value of HHI <0.15 indicates diversity. The yearly HHI trend was evaluated using meta-regression. Results The neurosurgeon's brain surgery caseload progressively increased on an annual basis from 1.4 to 12.5 cases per week between 2012 and 2018. Among the 1540 cases referred by 1775 different physicians, 78% were from three counties in southeast Florida and 8.1% from two counties in southwest Florida. The HHI declined between 2013 and 2018 by 0.023 per year (0.0046 standard error [SE], p = 0.0073) with the estimated value 0.0063 (0.0014 SE) < 0.15 in 2018 (p < 0.0001). The findings indicate that the base of referring physicians was highly diverse and that growth in caseload was accompanied by significantly less concentration of referrals. Conclusion Surgical growth in the neurosurgeon's practice resulted from a small number of referrals from many physicians, not from many referrals from a small number of physicians. Few physicians referred a sufficient number of patients to warrant attribution of the referral itself to personal knowledge of their patients' eventual outcomes. Rather, factors promoting timely access to patient care appear to have been the driving force for growth.
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Lu VM, Menendez I, Levi AD, Komotar RJ. Letter to the Editor: Lessons to Learn from the Coronavirus Disease 2019 (COVID-19) Pandemic for International Medical Graduate Applicants and United States Neurosurgery Residency Programs. World Neurosurg 2020; 141:571-572. [PMID: 32871735 PMCID: PMC7445004 DOI: 10.1016/j.wneu.2020.06.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
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Eichberg DG, Komotar RJ, Ivan ME. Commentary: Novel Diagnostic Methods and Posttreatment Clinical Phenotypes Among Intracranial Germ Cell Tumors. Neurosurgery 2020; 87:E308-E309. [PMID: 32348483 DOI: 10.1093/neuros/nyaa114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/14/2022] Open
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112
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Eichberg DG, Komotar RJ, Sur S. Commentary: Clipping of Complex Internal Cerebral Artery Terminus Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E292-E293. [PMID: 32453827 DOI: 10.1093/ons/opaa157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 11/12/2022] Open
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113
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Vadhan JD, Eichberg DG, Di L, Manzano G, Ivan M, Komotar RJ. Primary Low-Grade Astrocytoma of the Spine With Secondary Cerebral Metastasis: A Case Report and Comprehensive Review of the Literature. Cureus 2020; 12:e10030. [PMID: 32983723 PMCID: PMC7515806 DOI: 10.7759/cureus.10030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
An astrocytoma is a subclassification of glioma, with primary spinal manifestations accounting for less than 10% of all spinal cord tumors, with the majority encompassing low-grade features. It is even more uncommon for such lesions to demonstrate intracerebral metastasis. We report such an occurrence in a 39-year-old female who initially presented with an intramedullary and intradural mass from T10-L1, as well as secondary metastasis to the mesial right temporal lobe and cerebellum upon clinical follow-up. Surgical resection of the spine and subsequent temporal lobe biopsy confirmed high-grade glioma. Given the rarity and poor prognosis of spinal gliomas with cerebral metastasis, we also summarize all previously reported cases to date. We recommend that physicians maintain an index of suspicion for spinal gliomas in young patients with cord compression related symptoms outside the event of traumatic injury.
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Lu VM, Shah AH, Eichberg DG, Luther EM, Shah SS, Komotar RJ, Ivan ME. Utilizing systematic reviews and meta-analyses effectively to evaluate brain tumor biomarkers. Biomark Med 2020; 14:817-820. [PMID: 32799644 DOI: 10.2217/bmm-2020-0209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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115
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Eichberg DG, Sur S, Komotar RJ. Commentary: Surgical Clipping of an Unruptured Large Inferiorly Projecting Anterior Communicating Artery Aneurysm With Chiasmopathy: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E145-E146. [PMID: 32348500 DOI: 10.1093/ons/opaa112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 11/14/2022] Open
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Jamshidi AM, Eichberg DG, Gultekin S, Komotar RJ. Brain Metastasis From Bartholin Gland Carcinoma. World Neurosurg 2020; 143:280-284. [PMID: 32736128 DOI: 10.1016/j.wneu.2020.07.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Small cell neuroendocrine carcinoma of the Bartholin gland is an extremely uncommon gynecologic tumor. Brain metastasis from a malignant gynecologic lesion is rarely encountered and the prognosis for this type of metastasis is quite poor. CASE DESCRIPTION We report a case of a brain metastasis from a small cell neuroendocrine carcinoma of the Bartholin gland that was treated by surgical resection followed by whole-brain radiation therapy and review the literature. CONCLUSIONS Different treatment options, including resection, stereotactic radiosurgery, and whole-brain radiation therapy, as well as chemotherapy, are available and should each be considered on an individual basis.
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Shah AH, Mahavadi A, Di L, Sanjurjo A, Eichberg DG, Borowy V, Figueroa J, Luther E, de la Fuente MI, Semonche A, Ivan ME, Komotar RJ. Survival benefit of lobectomy for glioblastoma: moving towards radical supramaximal resection. J Neurooncol 2020; 148:501-508. [PMID: 32627128 DOI: 10.1007/s11060-020-03541-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Extent of resection remains a paramount prognostic factor for long-term outcomes for glioblastoma. As such, supramaximal resection or anatomic lobectomy have been offered for non-eloquent glioblastoma in an attempt to improve overall survival. Here, we conduct a propensity-matched analysis of patients with non-eloquent glioblastoma who underwent either lobectomy or gross total resection of lesion to investigate the efficacy of supramaximal resection of glioblastoma. METHODS Patients who underwent initial surgery for gross total resection or lobectomy for non-eloquent glioblastoma at our tertiary care referral center from 2010 to 2019 were included for this propensity-matched survival analysis. Propensity scores were generated with the following covariates: age, location, preoperative KPS, product of perpendicular maximal tumor diameters, and product of perpendicular FLAIR signal diameters. Inverse probability of treatment weighting (IPTW) with generated propensity scores was used to compare progression-free survival and overall survival. RESULTS Sixty-nine patients were identified who underwent initial resection of glioblastoma for non-eloquent glioblastoma from 2010 to 2019 (GTR = 37, lobectomy = 32). Using IPTW, overall survival (30.7 vs. 14.1 months) and progression-free survival (17.2 vs. 8.1 months were significantly higher in the lobectomy cohort compared to the GTR group (p < 0.001). There was no significant difference in pre-op or post-op KPS or complication rates between the two groups. CONCLUSION Our propensity-matched study suggests that lobectomy for non-eloquent glioblastoma confers an added survival benefit compared to GTR alone. For patients with non-eloquent glioblastoma, a supramaximal resection by means of an anatomic lobectomy should be considered as a primary surgical treatment in select patients if feasible.
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Daggubati LC, Eichberg DG, Ivan ME, Hanft S, Mansouri A, Komotar RJ, D'Amico RS, Zacharia BE. Telemedicine for Outpatient Neurosurgical Oncology Care: Lessons Learned for the Future During the COVID-19 Pandemic. World Neurosurg 2020; 139:e859-e863. [PMID: 32450309 PMCID: PMC7243783 DOI: 10.1016/j.wneu.2020.05.140] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The coronavirus 2019 (COVD-19) pandemic has drastically disrupted the delivery of neurosurgical care, especially for the already at-risk neuro-oncology population. The sudden change to clinic visits has rapidly spurned the implementation of telemedicine. A recommendation care paradigm of neuro-oncologic patients limited by telemedicine has not been reported. METHODS A summary of a multi-institution experience detailing the potential benefits, pitfalls, and the necessary considerations to outpatient care of neurosurgical oncology patients. RESULTS There are limitations and advantages to incorporating telemedicine into the outpatient care of neuro-oncology patients. Telemedicine-specific considerations for each step and stakeholder of the appointment (physician, patient, scheduling, previsit, imaging, and physical examination) are examined. CONCLUSIONS Telemedicine, pushed to prominence during this COVID-19 pandemic, is a powerful and possibly preferential tool for the future of outpatient neuro-oncologic care.
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Eichberg DG, Komotar RJ, Ivan ME. Commentary: Value of the Petromeatal Angle in Predicting Outcome of Translabyrinthine Resection of Vestibular Schwannomas. Oper Neurosurg (Hagerstown) 2020; 19:E93-E94. [PMID: 32348490 DOI: 10.1093/ons/opaa115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 11/14/2022] Open
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120
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Eichberg DG, Di L, Shah AH, Luther EM, Jackson C, Marenco-Hillembrand L, Chaichana KL, Ivan ME, Starke RM, Komotar RJ. Minimally invasive resection of intracranial lesions using tubular retractors: a large, multi-surgeon, multi-institutional series. J Neurooncol 2020; 149:35-44. [PMID: 32556805 DOI: 10.1007/s11060-020-03500-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/13/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Lesions located in subcortical areas are difficult to safely access. Tubular retractors have been increasingly used successfully with low complication profile to access lesions by minimizing brain retraction trauma and distributing pressure radially. Both binocular operative microscope and monocular exoscope are utilized for lesion visualization through tubular retractors. We present the largest multi-surgeon, multi-institutional series to determine the efficacy and safety profile of a transcortical-transtubular approach for intracranial lesion resections with both microscopic and exoscopic visualization. METHODS We reviewed a multi-surgeon, multi-institutional case series including transcortical-transtubular resection of intracranial lesions using either BrainPath (NICO, Indianapolis, Indiana) or ViewSite Brain Access System (VBAS, Vycor Medical, Boca Raton, Florida) tubular retractors (n = 113). RESULTS One hundred thirteen transtubular resections for intracranial lesions were performed. Patients presented with a diverse number of pathologies including 25 cavernous hemangiomas (21.2%), 15 colloid cysts (13.3%), 26 GBM (23.0%), two meningiomas (1.8%), 27 metastases (23.9%), 9 gliomas (7.9%) and 9 other lesions (7.9%). Mean lesion depth below the cortical surface was 4.4 cm, and mean lesion size was 2.7 cm. A gross total resection was achieved in 81 (71.7%) cases. Permanent complication rate was 4.4%. One patient (0.8%) experienced one early postoperative seizure (< 1 week postop). No patients experienced late seizures (> 1 week follow-up). Mean post-operative hospitalization length was 4.1 days. CONCLUSION Tubular retractors provide a minimally invasive operative corridor for resection of intracranial lesions. They provide an effective tool in the neurosurgical armamentarium to resect subcortical lesions with a low complication profile.
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Eichberg DG, Komotar RJ, Urakov TM. Commentary: Spinal Arteriovenous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E227-E228. [PMID: 32243536 DOI: 10.1093/ons/opaa063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/02/2020] [Indexed: 11/13/2022] Open
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Eichberg DG, Ivan ME, Komotar RJ. Commentary: Anatomical Variations in the Location of Veins Draining Into the Anterior Superior Sagittal Sinus: Implications for the Transbasal Approach. Oper Neurosurg (Hagerstown) 2020; 18:E205-E206. [PMID: 31848616 DOI: 10.1093/ons/opz367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/29/2019] [Indexed: 11/14/2022] Open
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Di L, Heath RN, Shah AH, Sanjurjo AD, Eichberg DG, Luther EM, de la Fuente MI, Komotar RJ, Ivan ME. Resection versus biopsy in the treatment of multifocal glioblastoma: a weighted survival analysis. J Neurooncol 2020; 148:155-164. [PMID: 32394325 DOI: 10.1007/s11060-020-03508-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECT Diffuse tumor invasion in multifocal/multicentric GBM (mGBM) often foreshadows poor survival outcome. The correlation between extent of resection in gliomas and patient outcome is well described. The objective of this study was to assess the effect of gross total resection compared to biopsy for mGBM on patient overall survival and progression free survival. METHODS Thirty-four patients with mGBM received either biopsy or resection of their largest enhancing lesion from 2011 to 2019. Relevant demographic, peri-operative, and radiographic data were collected. Tumor burden and extent of resection was assessed through measurement of pre-operative and post-operative contrast-enhancing volume. An adjusted Kaplan-Meier survival analysis was conducted using inverse probability of treatment weighting (IPTW) to account for the covariates of age, number of lesions, satellite tumor volume, total pre-operative tumor volume, degree of spread, and location. RESULTS Thirty-four patients were identified with sixteen (47.1%) and eighteen (52.9%) patients receiving resection and biopsy respectively. Patients receiving resection exhibited greater median overall survival but not progression free survival compared to biopsy on IPTW analysis (p = 0.026, p = 0.411). Greater than or equal to 85% extent of resection was significantly associated with increased median overall survival (p = 0.016). CONCLUSION Overall, our study suggests that resection of the largest contrast-enhancing lesion may provide a survival benefit. Our volumetric analysis suggests that a greater degree of resection results in improved survival. Employing IPTW analysis, we sought to control for selection bias in our retrospective analysis. Thus, aggressive surgical treatment of mGBM may offer improved outcomes. Further clinical trials are needed.
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Basil GW, Eichberg DG, Perez-Dickens M, Menendez I, Ivan ME, Urakov T, Komotar RJ, Wang MY, Levi AD. Letter: Implementation of a Neurosurgery Telehealth Program Amid the COVID-19 Crisis-Challenges, Lessons Learned, and a Way Forward. Neurosurgery 2020; 87:E260-E262. [PMID: 32385511 PMCID: PMC7239140 DOI: 10.1093/neuros/nyaa215] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Lu VM, O'Connor KP, Shah AH, Eichberg DG, Luther EM, Komotar RJ, Ivan ME. The prognostic significance of CDKN2A homozygous deletion in IDH-mutant lower-grade glioma and glioblastoma: a systematic review of the contemporary literature. J Neurooncol 2020; 148:221-229. [PMID: 32385699 DOI: 10.1007/s11060-020-03528-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The most recent cIMPACT-NOW update highlighted the homozygous deletion of the Cyclin Dependent Kinase Inhibitor 2A (CDKN2A) gene as a clinically important molecular alteration in IDH-mutant glioma. Correspondingly, we systematically reviewed the contemporary literature to affirm the contemporary stance of the literature on the prognostic significance of this alteration in this setting based on the current World Health Organization (WHO) Grade classification. METHODS A systematic search of seven electronic databases from inception to February 2020 was conducted following PRISMA guidelines. Articles were screened against pre-specified criteria to include lower-grade glioma (LGG, WHO Grade II/III) and glioblastoma (GBM, WHO Grade IV) separately. Progression free survival (PFS) and overall survival (OS) from Kaplan-Meier and multivariable analyses were outcomes of interest. RESULTS Nine institutional studies describing 2193 IDH-mutant gliomas satisfied criteria for evaluation, with 1756 (80%) LGG and 437 (20%) GBM. When reported, the proportion of CDKN2A homozygous deleted gliomas ranged from 9 to 43%, with a median incidence of 22%. For LGG, Kaplan-Meier analyses demonstrated shorter PFS in the presence of CDKN2A homozygous deletion in three studies (median values, 31 versus 91 months), and shorter OS in five studies (median values, 61 versus 154 months). For GBM, Kaplan-Meier analyses demonstrated shorter PFS in the presence of CDKN2A homozygous deletion in two studies (median values, 16 versus 30 months), and shorter OS in four studies (median values, 38 versus 86 months). By multivariable analyses, CDKN2A homozygous deletion was a predictor of significantly shorter PFS and OS in both LGG and GBM across all included studies. CONCLUSIONS The CDKN2A homozygous deletion is an important prognostic factor for survival outcomes of IDH-mutant glioma patients across multiple histologic WHO grades with specific molecular features likely dependent on IDH-mutant status. Greater understanding of how identifying this deletion can assist in the stratification of management for these tumors to optimize clinical course is required.
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