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Hang G, Gong Y, Xie H, Xie T. A novel lateral myelotomy approach for the treatment of lateral or ventrolateral spinal gliomas. Acta Neurochir (Wien) 2024; 166:237. [PMID: 38809310 DOI: 10.1007/s00701-024-06139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To describe a novel surgical approach in which myelotomy was performed lateral to the dorsal root entry zone (LDREZ), for the treatment of lateral or ventrolateral spinal intramedullary glioma. METHODS This study reviewed six patients with lateral or ventrolateral spinal intramedullary glioma who received surgical treatments by using myelotomy technique of LDREZ approach. The patient's clinical characteristics, magnetic resonance imaging (MRI) results, and follow-up outcomes were analyzed. The neurological function of patients before and after operation was assessed based on the Frankel scale system. The anatomical feasibility, surgical techniques, advantages and disadvantages of LDREZ approach were analyzed. RESULTS Myelotomy technique of LDREZ approach was employed in all 6 patients. Gross total resections were achieved in 4 patients, and 2 patients with astrocytoma (case 2, 6) underwent partial removal. The perioperative recovery was all smooth and all the patients were discharged on schedule. All the patients who suffered from neuropathic pain were relieved. After surgery, neurological function remained unchanged in 3 patients. 2 patients improved from Frankel grade B to C, and 1 patient deteriorated from Frankel grade D to C immediately after surgery and returned to Frankel grade D at 3 months follow-up. Regarding to the poor prognosis of high-grade glioma, the two cases with WHO IV glioma didn't achieve long survival. CONCLUSION LDREZ approach is feasible and safe for the surgical removal of lateral or ventrolateral spinal gliomas. This approach can provide a direct pathway to lateral or ventrolateral spinal gliomas with minimal damage to normal spinal cord.
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Affiliation(s)
- Gai Hang
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Yukang Gong
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Hang Xie
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Tianhao Xie
- Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, Wuhan, China.
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Albalkhi I, Shafqat A, Bin-Alamer O, Abou Al-Shaar AR, Mallela AN, Fernández-de Thomas RJ, Zinn PO, Gerszten PC, Hadjipanayis CG, Abou-Al-Shaar H. Fluorescence-guided resection of intradural spinal tumors: a systematic review and meta-analysis. Neurosurg Rev 2023; 47:10. [PMID: 38085385 DOI: 10.1007/s10143-023-02230-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023]
Abstract
Intradural spinal tumors present significant challenges due to involvement of critical motor and sensory tracts. Achieving maximal resection while preserving functional tissue is therefore crucial. Fluorescence-guided surgery aims to improve resection accuracy and is well studied for brain tumors, but its efficacy has not been fully assessed for spinal tumors. This meta-analysis aims to delineate the efficacy of fluorescence guidance in intradural spinal tumor resection. The authors performed a systematic review in four databases. We included studies that have utilized fluorescence agents, 5-aminolevulinic acid (5-ALA) or sodium fluorescein, for the resection of intradural spinal tumors. A meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 12 studies involving 552 patients undergoing fluorescence-guided intradural spinal tumor resection were included. Meningiomas demonstrated a 98% fluorescence rate and were associated with a homogenous florescence pattern; however, astrocytomas had variable fluorescence rate with pooled proportion of 70%. There was no significant difference in gross total resection (GTR) rates between fluorescein and 5-ALA (94% vs 84%, p = .22). Pre-operative contrast enhancement was significantly associated with intraoperative fluorescence with fluorescein. Intramedullary tumors with positive intraoperative fluorescence were significantly associated with higher GTR rates (96% vs 73%, p = .03). Utilizing fluorescence guidance during intradural spinal tumor resection holds promise of improving intraoperative visualization for specific intradural spinal tumors. Meningiomas and ependymomas have the highest fluorescence rates especially with sodium fluorescein; on the other hand, astrocytomas have variable fluorescence rates with no superiority of either agent. Positive fluorescence of intramedullary tumors is associated with a higher degree of resection.
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Affiliation(s)
- Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Pascal O Zinn
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Shimony N, Fehnel K, Abbott IR, Jallo GI. The evolution of spinal cord surgery: history, people, instruments, and results. Childs Nerv Syst 2023; 39:2687-2700. [PMID: 37658937 DOI: 10.1007/s00381-023-06128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/12/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Spinal cord surgery has and always will be a challenging operation with satisfying results, but also with potentially devastating results. Over the last century, there has been an evolution in the way we perceive and conduct spinal cord surgery. The phenomenal evolution in technology from the very first x-ray pictures helps to localize the spinal pathology through the use of high-resolution MRI and ultrasonography that allows for high precision surgery with relatively minimal exposure. METHODS The advancements in the surgical technique and the utilization of neuromonitoring allow for maximal safe resection of these delicate and intricate tumors. We also are beginning to understand the biology of spinal cord tumors and vascular lesions, as in the recent 2021 WHO classification which identifies specific entities such as spinal ependymomas, MYCN-amplified, as separate entity from the other subtypes of ependymomas. Surgeons have also accepted the importance of maximal safe resection for most of the spinal cord pathologies rather than just performing biopsy and adjuvant treatment. CONCLUSION There have been significant advances since the first resection of an intramedullary tumor including diagnosis, imaging, and surgical technique for children. These advances have improved the prognosis and outcome in these children.
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Affiliation(s)
- Nir Shimony
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
- Semmes-Murphey Clinic, Memphis, TN, USA
| | - Katie Fehnel
- Department of Neurological Surgery, Harvard Medical School, Boston, MA, USA
- Department of Neurological Surgery, Dana Farber Institute, Boston Children's Hospital, Boston, MA, USA
| | - I Rick Abbott
- Division of Pediatric Neurosurgery, Albert Einstein College of Medicine, New York, NY, USA
| | - George I Jallo
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, 600 5Th Street South, St Petersburg, FL, 33701, USA.
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Muto J, Murata H, Shigekawa S, Mitsuhara T, Umebayashi D, Kanematsu R, Joko M, Inoue T, Inoue T, Endo T, Hirose Y. Clinical Characteristics and Long-term Outcomes of Spinal Pilocytic Astrocytomas: A Multicenter Retrospective Study by the Neurospinal Society of Japan. Neurospine 2023; 20:774-782. [PMID: 37798969 PMCID: PMC10562249 DOI: 10.14245/ns.2346450.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE The characteristics, imaging features, long-term surgical outcomes, and recurrence rates of primary spinal pilocytic astrocytomas (PAs) have not been clarified owing to their rarity and limited reports. Thus, this study aimed to analyze the clinical presentation, radiological features, pathological findings, and long-term outcomes of spinal PAs. METHODS Eighteen patients with spinal PAs who were surgically treated between 2009 and 2020 at 58 institutions were included in this retrospective multicenter study. Patient data, including demographics, radiographic features, treatment modalities, and long-term outcomes, were evaluated. RESULTS Among the 18 consecutive patients identified, 11 were women and 7 were men; the mean age at presentation was 31 years (3-73 years). Most PAs were located eccentrically, were solid or heterogeneous in appearance (cystic and solid), and had unclear margins. Gross total resection (GTR), subtotal resection (STR), partial resection (PR), and biopsy were performed in 28%, 33%, 33%, and 5% of cases, respectively. During a follow-up period of 65 ± 49 months, 4 patients developed a recurrence; however, the recurrence-free survival did not differ significantly between the GTR and non-GTR (STR, PR, and biopsy) groups. CONCLUSION Primary spinal PAs are rare and present as eccentric and intermixed cystic and solid intramedullary cervical tumors. The imaging features of spinal PAs are nonspecific, and a definitive diagnosis requires pathological support. Surgical resection with prevention of neurological deterioration can serve as the first-line treatment; however, the resection rate does not affect recurrence-free survival. Investigation of relevant molecular biomarkers is required to elucidate the regrowth risk and prognostic factors.
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Affiliation(s)
- Jun Muto
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Hidetoshi Murata
- Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama, Japan
| | | | | | - Daisuke Umebayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Kanematsu
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Masahiro Joko
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Tatsushi Inoue
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Tomoo Inoue
- Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku Medical and Phamaceutical University, Sendai, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - for the Investigators of Intramedullary Spinal Cord Tumors in the Neurospinal Society of Japan
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
- Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama, Japan
- Department of Neurosurgery, Ehime University, Ehime, Japan
- Department of Neurosurgery, Hiroshima University, Hiroshima, Japan
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
- Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Japan
- Department of Neurosurgery, Tohoku Medical and Phamaceutical University, Sendai, Japan
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Ung TH, Meola A, Chang SD. Metastatic Lesions of the Brain and Spine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:545-564. [PMID: 37452953 DOI: 10.1007/978-3-031-23705-8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Brain and spinal metastases are common in cancer patients and are associated with significant morbidity and mortality. Continued advancement in the systemic care of cancer has increased the life expectancy of patients, and consequently, the incidence of brain and spine metastasis has increased. There has been an increase in the understanding of oncogenic mutations, and research has also demonstrated spatial and temporal mutations in patients that may drive overall treatment resistance and failure. Combinatory treatments with radiation, surgery, and newer systemic therapies have continued to increase the life expectancy of patients with brain and spine metastases. Given the overall complexity of brain and spine metastases, this chapter aims to give a comprehensive overview and cover important topics concerning brain and spine metastases. This will include the molecular, genetic, radiographic, surgical, and non-surgical treatments of brain and spinal metastases.
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Affiliation(s)
- Timothy H Ung
- Center for Academic Medicine, Department of Neurosurgery, MC: 5327, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Antonio Meola
- Center for Academic Medicine, Department of Neurosurgery, MC: 5327, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Steven D Chang
- Center for Academic Medicine, Department of Neurosurgery, MC: 5327, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
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Antkowiak L, Putz M, Sordyl R, Pokora S, Mandera M. Predictive Value of Motor Evoked Potentials in the Resection of Intradural Extramedullary Spinal Tumors in Children. J Clin Med 2022; 12:jcm12010041. [PMID: 36614841 PMCID: PMC9821272 DOI: 10.3390/jcm12010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/04/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This study aimed to evaluate the predictive value of motor evoked potentials (MEP) in the resection of pediatric intradural extramedullary (IDEM) tumors. Additionally, we aimed to assess the impact of MEP alerts on the extent of tumor resection. Medical records of pediatric patients who underwent resection of IDEM tumors with the assistance of MEP between March 2011 and October 2020 were reviewed. The occurrence of postoperative motor deficits was correlated with intraoperative MEP alerts. Sixteen patients were included. MEP alerts appeared in 2 patients (12.5%), being reflective of new postoperative motor deficits. Among the remaining 14 patients without any intraoperative MEP alerts, no motor decline was found. Accordingly, MEP significantly predicted postoperative motor deficits, reaching sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100% (p < 0.001). In the absence of MEP alerts, 11 out of 14 patients (78.6%) underwent GTR, while no patient with intraoperative IONM alerts underwent GTR (p = 0.025). Although MEP alerts limit the extent of tumor resection, the high sensitivity and PPV of MEP underline its importance in avoiding iatrogenic motor deficits. Concurrently, high specificity and NPV ensure safer tumor excision. Therefore, MEP can reliably support surgical decisions in pediatric patients with IDEM tumors.
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Yuan C, Guan J, Du Y, Fang Z, Wang X, Yao Q, Zhang C, Liu Z, Wang K, Duan W, Wang X, Wang Z, Wu H, Jian F. Neurological deterioration after posterior fossa decompression for adult syringomyelia: Proposal for a summarized treatment algorithm. Front Surg 2022; 9:968906. [PMID: 36189393 PMCID: PMC9520238 DOI: 10.3389/fsurg.2022.968906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with syringomyelia who present with new neurological symptoms after posterior fossa decompression (PFD) are not uncommon. However, systematic reports on different pathologies are few in the literature.ObjectiveThe purpose of this study was to summarize our experience for failed PFD.MethodsBetween January 2015 and December 2019, 85 consecutive failed PFD patients were identified. The neurological courses were summarized with Klekamp J (KJ) or mJOA score system for all patients. Long-term results were summarized with Kaplan-Meier method.ResultsTwenty-eight consecutive patients underwent FMDD (Foramen magnum and foramen of Magendie dredging) (Group I), extradural PFD and manipulation of tonsil was significantly associated with lower failure rates. Twenty patients underwent craniocervical fixation (Group II), nine underwent local spinal segment decompression (Group III), six underwent CSF diversion procedures, and one were treated for persistent pain by radiofrequency. Neuropathic pain was most significantly improved in Group I while swallowing improved in Group II within 1 year after the surgery. In the long term, late postoperative deterioration-free possibility in Group II was better than in Group I. All patients in Group III improved (P = 0.0088). Six cases of CSF diversion procedures were relieved in a short time. Pain in one patient persisted after PFD, and trial of radiofrequency failed.ConclusionNot only does the recurrent cerebrospinal fluid flow obstruct the foramen magnum, but also spinal pathologies and craniocervical instabilities may occur. This study provides the largest summarized clinical experience that may assist surgeons with different therapeutic decisions for failed PFD.
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Affiliation(s)
- Chenghua Yuan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Yueqi Du
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Zeyu Fang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Xinyu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Qingyu Yao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Can Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Kai Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Xingwen Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Zuowei Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- Correspondence: Fengzeng Jian
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Tarabay B, Gennari A, Boubez G, Wang Z, Shedid D, Yuh SJ. Minimally Invasive Approach for Complete Resection of a Cervical Intramedullary Tumor via a Dorsal Root Entry Zone Using Fixed Tubular Retractor. Cureus 2022; 14:e28457. [PMID: 36185933 PMCID: PMC9514149 DOI: 10.7759/cureus.28457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/05/2022] Open
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Chatain GP, Kortz MW, Serva S, Shrestha K, Hosokawa P, Ung TH, Finn M. Long-term Neurologic Outcome After Spinal Ependymoma Resection With Multimodal Intraoperative Electrophysiological Recording: Cohort Study and Review of the Literature. Neurospine 2022; 19:118-132. [PMID: 35378586 PMCID: PMC8987544 DOI: 10.14245/ns.2143200.600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/06/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate how multimodal intraoperative neuromonitoring (IONM) changes during spinal ependymoma (SE) resection correlate with long-term neuro-functional outcomes.
Methods A retrospective analysis of patients aged 18 years or older who underwent surgical resection for SE over a 10-year period was conducted. IONM changes were defined as sustained transcranial motor evoked potential (TcMEP) and/or somatosensory evoked potential (SSEP) signal decrease of 50% or greater from baseline. Primary endpoints were postoperative modified McCormick Neurologic Scale (MNS) scores at postoperative day (POD) < 2, 6 weeks, 1 year, and 2 years. Univariate and multivariate analyses were performed. Results Twenty-nine patients were identified. Average age was 44.2±15.4 years. Sixteen (55.2%) were male and 13 (44.8%) were female. Tumor location was 10 cervical-predominant (34.5%), 13 thoracic-predominant (44.8%), and 6 lumbar/conus-predominant (20.7%). A majority (69.0%) were World Health Organization grade 2 tumors. Twentyfour patients (82.8%) achieved gross total resection. Thirteen patients (44.8%) had a sustained documented IONM signal change and 10 (34.5%) had a TcMEP change with or without derangement in SSEP. At POD < 2, 6 weeks, 1 year, and 2 years, MNS was significantly higher for those when analyzing subgroups with either any sustained IONM or TcMEP±SSEP signal attenuation > 50% below baseline (all p<0.05).
Conclusion Sustained IONM derangements > 50% below baseline, particularly for TcMEP, are significantly associated with higher MNS postoperatively out to 2 years. Intraoperative and postoperative management of these patients warrant special consideration to limit neurologic morbidity.
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Affiliation(s)
- Grégoire P. Chatain
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
- Corresponding Author Grégoire P. Chatain https://orcid.org/0000-0002-7770-3009 Department of Neurosurgery, University of Colorado School of Medicine, 12605 E 16th Ave, Aurora, CO 80045, USA
| | - Michael W. Kortz
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephanie Serva
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Keshari Shrestha
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Patrick Hosokawa
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
| | - Timothy H. Ung
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael Finn
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
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Menon G, Srinivasan S, Nair R, Hegde A, Nair S. Spinal intramedullary tumors. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_263_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Zhang M, Wang E, Yecies D, Tam LT, Han M, Toescu S, Wright JN, Altinmakas E, Chen E, Radmanesh A, Nemelka J, Oztekin O, Wagner MW, Lober RM, Ertl-Wagner B, Ho CY, Mankad K, Vitanza NA, Cheshier SH, Jacques TS, Fisher PG, Aquilina K, Said M, Jaju A, Pfister S, Taylor MD, Grant GA, Mattonen S, Ramaswamy V, Yeom KW. Radiomic Signatures of Posterior Fossa Ependymoma: Molecular Subgroups and Risk Profiles. Neuro Oncol 2021; 24:986-994. [PMID: 34850171 DOI: 10.1093/neuonc/noab272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The risk profile for posterior fossa ependymoma (EP) depends on surgical and molecular status [Group A (PFA) versus Group B (PFB)]. While subtotal tumor resection is known to confer worse prognosis, MRI-based EP risk-profiling is unexplored. We aimed to apply machine learning strategies to link MRI-based biomarkers of high-risk EP and also to distinguish PFA from PFB. METHODS We extracted 1800 quantitative features from presurgical T2-weighted (T2-MRI) and gadolinium-enhanced T1-weighted (T1-MRI) imaging of 157 EP patients. We implemented nested cross-validation to identify features for risk score calculations and apply a Cox model for survival analysis. We conducted additional feature selection for PFA versus PFB and examined performance across three candidate classifiers. RESULTS For all EP patients with GTR, we identified four T2-MRI-based features and stratified patients into high- and low-risk groups, with 5-year overall survival rates of 62% and 100%, respectively (p < 0.0001). Among presumed PFA patients with GTR, four T1-MRI and five T2-MRI features predicted divergence of high- and low-risk groups, with 5-year overall survival rates of 62.7% and 96.7%, respectively (p = 0.002). T1-MRI-based features showed the best performance distinguishing PFA from PFB with an AUC of 0.86. CONCLUSIONS We present machine learning strategies to identify MRI phenotypes that distinguish PFA from PFB, as well as high- and low-risk PFA. We also describe quantitative image predictors of aggressive EP tumors that might assist risk-profiling after surgery. Future studies could examine translating radiomics as an adjunct to EP risk assessment when considering therapy strategies or trial candidacy.
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Affiliation(s)
- Michael Zhang
- Department of Neurosurgery, Stanford Hospital and Clinics, Stanford, CA, USA.,Department of Radiology, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Edward Wang
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Derek Yecies
- Department of Neurosurgery, Stanford Hospital and Clinics, Stanford, CA, USA.,Department of Radiology, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Lydia T Tam
- Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Michelle Han
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sebastian Toescu
- Department of Neurosurgery, Great Ormond Street Institute of Child Health, London, UK
| | - Jason N Wright
- Department of Radiology, Seattle Children's Hospital, and Harborview Medical Center, Seattle, WA, USA
| | - Emre Altinmakas
- Department of Radiology, Koç University School of Medicine, Istanbul, Turkey
| | - Eric Chen
- Department of Clinical Radiology & Imaging Sciences, Riley Children's Hospital, Indianapolis, IA, USA
| | - Alireza Radmanesh
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Jordan Nemelka
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Huntsman Cancer Institute, University of Utah School of Medicine, Intermountain Healthcare Primary Children's Hospital, Salt Lake City, UT, USA
| | - Ozgur Oztekin
- Department of Neuroradiology, Cigli Education and Research Hospital, and Tepecik Education and Research Hospital, Izmir, Turkey
| | - Matthias W Wagner
- Department of Diagnostic Imaging, The Hospital for Sick Children, ON, Canada
| | - Robert M Lober
- Division of Neurosurgery, Dayton Children's Hospital, Dayton, OH, USA
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, The Hospital for Sick Children, ON, Canada
| | - Chang Y Ho
- Department of Clinical Radiology & Imaging Sciences, Riley Children's Hospital, Indianapolis, IA, USA
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Institute of Child Health, London, UK
| | - Nicholas A Vitanza
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, Seattle WA, USA
| | - Samuel H Cheshier
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Huntsman Cancer Institute, University of Utah School of Medicine, Intermountain Healthcare Primary Children's Hospital, Salt Lake City, UT, USA
| | - Tom S Jacques
- Department of Developmental Biology & Cancer, University College London Great Ormond Street Institute of Child Health, and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paul G Fisher
- Department of Neurology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Institute of Child Health, London, UK
| | - Mourad Said
- Radiology Department Centre International Carthage Médicale, Monastir, Tunisia
| | - Alok Jaju
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Stefan Pfister
- Department of Pediatrics, Hopp Children' Cancer Center, Heidelberg, Germany
| | - Michael D Taylor
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gerald A Grant
- Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Sarah Mattonen
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Programme in Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Kristen W Yeom
- Department of Radiology, Lucile Packard Children's Hospital, Stanford, CA, USA
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12
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Jankovic D, Hanissian A, Rotim K, Splavski B, Arnautovic KI. Novel Clinical Insights into Spinal Hemangioblastoma in Adults: A Systematic Review. World Neurosurg 2021; 158:1-10. [PMID: 34687932 DOI: 10.1016/j.wneu.2021.10.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hemangioblastomas (HBs) are well-vascularized, benign central nervous system tumors and the third most common primary spinal cord tumor after astrocytoma/ependymoma, occurring sporadically or as a part of autosomal dominant von Hippel-Lindau disease, in which tumors are often multiple and prone to relapse. Spinal HBs are commonly located in the cervical cord and associated with a syrinx formation. Owing to location and growth trends, they may cause significant neurological deficit, impairing quality of life. We conducted a systematic review to understand better clinical insights into spinal HB in adults and compare spinal HB versus posterior cranial fossa HB. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for conducting systematic reviews, we reviewed the English-language literature on adult spinal HB in the MEDLINE/PubMed database over the last 40 years. RESULTS We reviewed 237 articles on adult spinal HB and analyzed national and continental distribution, clinical symptoms, tumor location and presence of syringomyelia, treatment strategies and postoperative complications, histology and immunochemistry, and treatment outcomes. We compared individual characteristics in sporadic and von Hippel-Lindau disease spinal HBs. Finally, we compared features of posterior cranial fossa and spinal HBs. CONCLUSIONS Spinal cord HBs most commonly have a dorsal intramedullary location. Total surgical tumor resection is the first treatment option; preoperative embolization may be performed to reduce intraoperative bleeding and surgical time. HBs located in the spine have decreased mortality and rate of infection, but increased rates of cardiopulmonary complications compared with HBs in the posterior cranial fossa.
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Affiliation(s)
- Dragan Jankovic
- Department of Neurosurgery, University Medical Centre of Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | - Kresimir Rotim
- Department of Neurosurgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; J.J. Strossmayer University of Osijek Faculty of Medicine, Osijek, Croatia; University of Applied Health Sciences, Zagreb, Croatia
| | - Bruno Splavski
- Department of Neurosurgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; J.J. Strossmayer University of Osijek Faculty of Medicine, Osijek, Croatia; University of Applied Health Sciences, Zagreb, Croatia; J.J. Strossmayer University of Osijek Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Kenan I Arnautovic
- Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
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13
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Yang C, Sun J, Xie J, Ma C, Liu B, Wang T, Chen X, Wu J, Wu H, Zheng M, Chang Q, Yang J. Multisegmental versus monosegmental intramedullary spinal cord ependymomas: perioperative neurological functions and surgical outcomes. Neurosurg Rev 2021; 45:553-560. [PMID: 33988802 DOI: 10.1007/s10143-021-01567-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/09/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
Multiple factors, such as tumor size, lateralization, tumor location, accompanying syringomyelia, and regional spinal cord atrophy, may affect the resectability and clinical prognosis of intramedullary spinal cord ependymomas. However, whether long-segmental involvement of the spinal cord may impair functional outcomes remains unclear. This study was aimed to compare perioperative neurological functions and long-term surgical outcomes between multisegmental ependymomas and their monosegmental counterparts. A total of 62 patients with intramedullary spinal cord ependymoma (WHO grade II) were enrolled, and all of them underwent surgical resection. The patients were classified into the multisegmental group (n = 43) and the monosegmental group (n = 19). Perioperative and long-term (average follow-up period, 47.3 ± 21.4 months) neurological functions were evaluated using the modified McCormick (mMC) scale and the modified Japanese Orthopaedic Association (mJOA) scoring system. Preoperative neurological functions in the multisegmental group were significantly worse than those in the monosegmental group (P < 0.05). However, postoperative short-term neurological functions, as well as long-term functional outcomes, were similar between the two groups (P > 0.05). Logistic regression analysis showed that preoperative mMC and mJOA scores were significantly correlated with neurological improvement during the follow-up period (P < 0.05). Multisegmental involvement of the spinal cord is associated with worse neurological functions in patients with intramedullary spinal cord ependymoma, while the long-term prognosis is not affected. The preoperative neurological status of the patient is the only predictor of long-term functional improvement.
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Affiliation(s)
- Chenlong Yang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China.,North America Medical Education Foundation, Union City, CA, USA
| | - Jianjun Sun
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China.
| | - Jingcheng Xie
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Changcheng Ma
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Bin Liu
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Xiaodong Chen
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Jian Wu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Haibo Wu
- Department of Neuroradiology, Peking University Third Hospital, Peking University, Beijing, China
| | - Mei Zheng
- Department of Neurology, Peking University Third Hospital, Peking University, Beijing, China
| | - Qing Chang
- Department of Pathology, Peking University Third Hospital, Peking University, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China.
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14
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Kimchi G, Knoller N, Korn A, Eyal-Mazuz Y, Sapir Y, Peled A, Harel R. Delayed variations in the diagnostic accuracy of intraoperative neuromonitoring in the resection of intramedullary spinal cord tumors. Neurosurg Focus 2021; 50:E21. [PMID: 33932929 DOI: 10.3171/2021.2.focus201084] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of intraoperative neuromonitoring (IONM) has become an imperative adjunct to the resection of intramedullary spinal cord tumors (IMSCTs). While the diagnostic utility of IONM during the immediate postoperative period has been previously studied, its long-term diagnostic accuracy has seldom been thoroughly assessed. The aim of this study was to evaluate long-term variations in the diagnostic accuracy of transcranial motor evoked potentials (tcMEPs), somatosensory evoked potentials (SSEPs), and D-wave recordings during IMSCT excision. METHODS The authors performed a retrospective evaluation of imaging studies, patient charts, operative reports, and IONM recordings of patients who were operated on for gross-total or subtotal resection of IMSCTs at a single institution between 2012 and 2018. Variations in the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for postoperative functional outcome (McCormick Scale) were analyzed at postoperative day 1 (POD1), 6 weeks postoperatively (PO-6 weeks), and at the latest follow-up. RESULTS Overall, 28 patients were included. The mean length of follow-up was 19 ± 23.4 months. Persistent motor attenuations occurred in 71.4% of the cohort. MEP was the most sensitive modality (78.6%, 87.5%, and 85.7% sensitivity at POD1, PO-6 weeks, and last follow-up, respectively). The specificity of the D-wave was the most consistent over time (100%, 83.35%, and 90% specificity at the aforementioned time points). The PPV of motor recordings decreased over time (58% vs 33% and 100% vs 0 for tcMEP and D-wave at POD1 and last follow-up, respectively), while their NPV consistently increased (67% vs 89% and 70% vs 100% for tcMEP and D-wave at POD1 and last follow-up, respectively). CONCLUSIONS The diagnostic accuracy of IONM in the resection of IMSCTs varies during the postoperative period. The decrease in the PPV of motor recordings over time suggests that this method is more predictive of short-term rather than long-term neurological deficits. The increasing NPV of motor recordings indicates a higher diagnostic accuracy in the identification of patients who preserve neurological function, albeit with an increased proportion of false-negative alarms for the immediate postoperative period. These variations should be considered in the surgical decision-making process when weighing the risk of resection-associated neurological injury against the implications of incomplete tumor resection.
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Affiliation(s)
- Gil Kimchi
- 1Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv; and
| | - Nachshon Knoller
- 1Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv; and
| | - Akiva Korn
- 2Surgical Monitoring Services Ltd., Beit Shemesh, Israel
| | | | - Yechiam Sapir
- 2Surgical Monitoring Services Ltd., Beit Shemesh, Israel
| | - Anton Peled
- 1Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv; and
| | - Ran Harel
- 1Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv; and
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15
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Snyder MH, Ampie L, DiDomenico JD, Asthagiri AR. Bevacizumab as a surgery-sparing agent for spinal ependymoma in patients with neurofibromatosis type II: Systematic review and case. J Clin Neurosci 2021; 86:79-84. [PMID: 33775351 DOI: 10.1016/j.jocn.2021.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/27/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Abstract
Neurofibromatosis type 2 (NF2) is a rare, hereditary tumor syndrome, often requiring repeated surgeries for multiple lesions with significant cumulative morbidity. As such, non-operative management should be considered when possible for this patient population. The aim of this study is to provide a systematic review of the literature regarding this treatment strategy. A descriptive case of a patient in whom bevacizumab treatments enabled over 15 years of surgical postponement for a symptomatic spinal cord ependymoma is also provided. Evidence suggests that bevacizumab is a reasonable surgery-deferring option for cystic lesions, and it may be especially useful in NF2 patients to reduce cumulative morbidity.
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Affiliation(s)
- M Harrison Snyder
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Leonel Ampie
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA; Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
| | - Joseph D DiDomenico
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ashok R Asthagiri
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
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16
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Toll BJ, Pahys JM, Yezdani SG, Samdani AF, Hwang SW. Novel Use of Subcostal Polyethylene Bands to Manage Tumor-Related Scoliosis Requiring Serial Imaging: A Case Report. JBJS Case Connect 2021; 10:e0351. [PMID: 32224656 DOI: 10.2106/jbjs.cc.19.00351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 16-year-old male patient with severe kyphoscoliosis, paraplegia, and neurogenic bowel/bladder caused by a juvenile pilocytic astrocytoma was treated surgically using a hybrid fusion construct with polyethylene bands after neoplasm resection. Owing to the necessity of serial postoperative magnetic resonance imaging studies to evaluate the recurrence of pathology and known effect of metal artifact from spinal instrumentation, preservation of radiographic resolution was critical. CONCLUSION We describe the novel utility of polyethylene bands placed around the ribs as a safe and effective form of hybrid construct for reducing radiographic metal artifact in spinal deformity cases requiring serial imaging.
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Affiliation(s)
- Brandon J Toll
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Joshua M Pahys
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Samir G Yezdani
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Amer F Samdani
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Steven W Hwang
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
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17
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Martinelli C, Gabriele F, Manai F, Ciccone R, Novara F, Sauta E, Bellazzi R, Patane M, Moroni I, Paterra R, Comincini S. The Search for Molecular Markers in a Gene-Orphan Case Study of a Pediatric Spinal Cord Pilocytic Astrocytoma. Cancer Genomics Proteomics 2020; 17:117-130. [PMID: 32108034 DOI: 10.21873/cgp.20172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/AIM We herein presented a case of pediatric spinal cord pilocytic astrocytoma diagnosed on the basis of histopathological and clinical findings. MATERIALS AND METHODS Given the paucity of data on genetic features for this tumor, we performed exome, array CGH and RNA sequencing analysis from nucleic acids isolated from a unique and not repeatable very small amount of a formalin-fixed, paraffin-embedded (FFPE) specimen. RESULTS DNA mutation analysis, comparing tumor and normal lymphocyte peripheral DNA, evidenced few tumor-specific single nucleotide variants in DEFB119, MUC5B, NUDT1, LTBP3 and CPSF3L genes. Differently, tumor DNA was not characterized by for the main pilocytic astrocytoma gene variations, including BRAFV600E. An inframe trinucleotides insertion involving DLX6 or lnc DLX6-AS1 genes was scored in 44.9% of sequenced reads; the temporal profile of this variation on the expression of DLX-AS1 was investigated in patient's urine-derived exosomes, reporting no significant variation in the one-year molecular follow-up. Array CGH identified a tumor microdeletion at the 6q25.3 chromosomal region, spanning 1,01 Mb and comprising ZDHHC14, SNX9, TULP4 and SYTL3 genes. The expression of these genes did not change in urine-derived exosomes during the one-year investigation period. Finally, RNAseq did not reveal any of the common pilocytic BRAF-KIAA1549 genes fusion events. CONCLUSION To our knowledge, the present report is one of the first described gene-orphan case studies of a pediatric spinal cord pilocytic astrocytoma.
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Affiliation(s)
| | - Fabio Gabriele
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Federico Manai
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Roberto Ciccone
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Microgenomics Laboratory, Pavia, Italy
| | | | - Elisabetta Sauta
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Monica Patane
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Moroni
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rosina Paterra
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sergio Comincini
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
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18
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Liu EK, Silverman JS, Sulman EP. Stereotactic Radiation for Treating Primary and Metastatic Neoplasms of the Spinal Cord. Front Oncol 2020; 10:907. [PMID: 32582555 PMCID: PMC7295942 DOI: 10.3389/fonc.2020.00907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
Stereotactic radiation treatment can be used to treat spinal cord neoplasms in patients with either unresectable lesions or residual disease after surgical resection. While treatment guidelines have been suggested for epidural lesions, the utility of stereotactic radiation for intradural and intramedullary malignancies is still debated. Prior reports have suggested that stereotactic radiation approaches can be used for effective tumor control and symptom management. Treatment-related toxicity has been documented in rare subsets of patients, though the incidences of injury are not directly correlated with higher radiation doses. Further studies are needed to assess the factors that influence the risk of radiation-induced myelopathy when treating spinal cord neoplasms with stereotactic radiation, which can include, but may not be limited to, maximum dose, dose-fractionation, irradiated volume, tumor location, histology and treatment history. This review will discuss evidence for current treatment approaches.
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Affiliation(s)
- Elisa K Liu
- Departments of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, United States
| | - Joshua S Silverman
- Departments of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, United States.,Departments of Neurosurgery, NYU Grossman School of Medicine, New York, NY, United States
| | - Erik P Sulman
- Departments of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, United States.,Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, United States
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19
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Han B, Wu D, Jia W, Lin S, Xu Y. Intraoperative Ultrasound and Contrast-Enhanced Ultrasound in Surgical Treatment of Intramedullary Spinal Tumors. World Neurosurg 2020; 137:e570-e576. [DOI: 10.1016/j.wneu.2020.02.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/30/2022]
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20
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Yanke AB, Miller MA, Fulkerson CV, Bohn K, Bentley RT. Remission after complete excision of an intramedullary hemangioma with an identifiable tumor plane in a dog. Vet Surg 2019; 48:1507-1513. [PMID: 31179565 DOI: 10.1111/vsu.13238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/04/2019] [Accepted: 04/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the use of an identifiable tumor plane (ITP) during myelotomy to excise an intramedullary hemangioma in a dog and report the outcome. STUDY DESIGN Case report. ANIMALS One 5.5-year-old 42.9-kg spayed female Leonberger dog. METHODS Clinical signs included progressive proprioceptive deficits of both pelvic limbs. Magnetic resonance imaging was consistent with a dorsal intramedullary mass at L3-L4. A laminectomy of the third and fourth lumbar vertebrae provided access for dorsal myelotomy. A clear surgical ITP was identified between the intramedullary mass and the spinal cord facilitating complete surgical resection. RESULTS Histopathological examination was consistent with a hemangioma. Postoperative MRI was consistent with complete excision of the mass. No evidence of recurrence was found by MRI at 3 months and at 22 months after surgery. Mild proprioceptive deficits persisted in the right pelvic limb. CONCLUSION A clear ITP was present, and gross-total resection (GTR) was achieved without significant morbidity. Persistent clinical remission resulted from surgery as the sole therapy. CLINICAL SIGNIFICANCE For an intramedullary tumor, GTR is the absence of visible tumor on intraoperative inspection combined with the absence of intramedullary contrast enhancement on postoperative MRI. When an ITP is present, GTR and resultant long-term remission may be more likely.
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Affiliation(s)
- Amy B Yanke
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana.,Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Margaret A Miller
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Caroline V Fulkerson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Kendra Bohn
- Neurology Service, Pittsburgh Veterinary Specialty & Emergency Center, Pittsburgh, Pennsylvania
| | - R Timothy Bentley
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
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21
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Primary spinal pilocytic astrocytoma: clinical study with long-term follow-up in 16 patients and a literature review. Neurosurg Rev 2019; 43:719-727. [PMID: 31098788 DOI: 10.1007/s10143-019-01109-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/09/2019] [Accepted: 04/25/2019] [Indexed: 02/05/2023]
Abstract
Primary pilocytic astrocytoma (PA) of the spine is extremely rare and most published case series only include only a few patients. We attempted to explore the clinical features, radiological findings, and treatment outcomes of patients with spinal PA. Sixteen spinal PA patients who were surgically treated in our hospital between April 2008 and June 2018 were included in this retrospective study. An integrative analysis was performed regarding spinal PA patients by extracting from published studies on PubMed. The 16 patients with spinal PA included eight male and eight female patients with a mean age of 29.1 years. Ten cases (62.5%) had masses located in the cervical segments, five (31.3%) had masses in the thoracic segments, and one (6.2%) had masses in the sacral canal. All the patients were treated surgically with 13 gross total resections (GTRs, 81.3%) and three subtotal resections (STRs). The mean follow-up period was 40.4 months. These tumors accounted for a recurrence rate of 37.5% (6 of 16 patients) and no death during the follow-up periods. The influencing factors of recurrence were mainly STR, gene mutation (NF-1 and H2-K27M), and the number of segments involved. The mean recurrence-free survival duration was 19 months. The imaging features of spinal PA are heterogeneous, and the definitive diagnosis requires pathological support. GTR is the standard therapy for spinal PAs, although patients with GTR are still likely to relapse. The regular spinal magnetic resonance imaging follow-ups are required regardless of the resection status. Reoperation is feasible for patients with recurrence.
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Cachia D, Johnson DR, Kaufmann TJ, Lowe S, Andersen S, Olar A, Cooper SL, Frankel BM, Gilbert MR. Case-based review: ependymomas in adults. Neurooncol Pract 2018; 5:142-153. [PMID: 31386035 DOI: 10.1093/nop/npy026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Ependymomas are rare primary central nervous system (CNS) tumors in adults. They occur most commonly in the spinal cord, and have classically been graded histologically into World Health Organization (WHO) grades I, II, or III based on the level of anaplasia. Recent data are showing that genetic heterogeneity occurs within the same histological subgroup and that ependymomas arising from different CNS locations have different molecular signatures. This has renewed interest in developing targeting therapies based on molecular profiles especially given the variable outcomes with radiation and the poor results with cytotoxic agents. In this paper, we present the case of a 46-year-old woman with a classic presentation of spinal cord ependymoma and discuss the current histopathological and molecular classification for ependymomas as well as current guidelines for patient management.
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Affiliation(s)
- David Cachia
- Department of Neuro-surgery, Medical University of South Carolina, Charleston, USA
| | - Derek R Johnson
- Department of Neurology and Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stephen Lowe
- Department of Neuro-surgery, Medical University of South Carolina, Charleston, USA
| | - Samuel Andersen
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, USA
| | - Adriana Olar
- Department of Neuro-surgery, Medical University of South Carolina, Charleston, USA.,Department of Pathology and Laboratory Medicine and Neurosurgery, Medical University of South Carolina, Charleston, USA
| | - Samuel Lewis Cooper
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, USA
| | - Bruce M Frankel
- Department of Neuro-surgery, Medical University of South Carolina, Charleston, USA
| | - Mark R Gilbert
- Department of Neuro-Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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