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Punchak MA, Bond KM, Wathen CA, Hollawell ML, Zhao C, Sarris C, Flanders TM, Madsen PJ, Tucker AM, Heuer GG. Use of a machine learning algorithm with a focus on spinopelvic parameters to predict development of symptomatic tethered cord after initial untethering surgery. J Neurosurg Pediatr 2024; 33:405-410. [PMID: 38428005 DOI: 10.3171/2023.11.peds23278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/01/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Among patients with a history of prior lipomyelomeningocele repair, an association between increased lumbosacral angle (LSA) and cord retethering has been described. The authors sought to build a predictive algorithm to determine which complex tethered cord patients will develop the symptoms of spinal cord retethering after initial surgical repair with a focus on spinopelvic parameters. METHODS An electronic medical record database was reviewed to identify patients with complex tethered cord (e.g., lipomyelomeningocele, lipomyeloschisis, myelocystocele) who underwent detethering before 12 months of age between January 1, 2008, and June 30, 2022. Descriptive statistics were used to characterize the patient population. The Caret package in R was used to develop a machine learning model that predicted symptom development by using spinopelvic parameters. RESULTS A total of 72 patients were identified (28/72 [38.9%] were male). The most commonly observed dysraphism was lipomyelomeningocele (41/72 [56.9%]). The mean ± SD age at index MRI was 2.1 ± 2.2 months, at which time 87.5% of patients (63/72) were asymptomatic. The mean ± SD lumbar lordosis at the time of index MRI was 23.8° ± 11.1°, LSA was 36.5° ± 12.3°, sacral inclination was 30.4° ± 11.3°, and sacral slope was 23.0° ± 10.5°. Overall, 39.6% (25/63) of previously asymptomatic patients developed new symptoms during the mean ± SD follow-up period of 44.9 ± 47.2 months. In the recursive partitioning model, patients whose LSA increased at a rate ≥ 5.84°/year remained asymptomatic, whereas those with slower rates of LSA change experienced neurological decline (sensitivity 77.5%, specificity 84.9%, positive predictive value 88.9%, and negative predictive value 70.9%). CONCLUSIONS This is the first study to build a machine learning algorithm to predict symptom development of spinal cord retethering after initial surgical repair. The authors found that, after initial surgery, patients who demonstrate a slower rate of LSA change per year may be at risk of developing neurological symptoms.
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Affiliation(s)
- Maria A Punchak
- 1Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and
| | - Kamila M Bond
- 1Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and
| | - Connor A Wathen
- 1Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and
| | - Madison L Hollawell
- 2Division of Neurosurgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chao Zhao
- 2Division of Neurosurgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina Sarris
- 2Division of Neurosurgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tracy M Flanders
- 1Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and
- 2Division of Neurosurgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Peter J Madsen
- 1Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and
- 2Division of Neurosurgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander M Tucker
- 1Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and
- 2Division of Neurosurgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gregory G Heuer
- 1Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and
- 2Division of Neurosurgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Punchak MA, Sarris C, Xu E, Flanders TM, Lang SS, Swanson JW, Taylor JA, Heuer GG. Craniosynostosis in primary metabolic bone disorders: a single-institution experience. Childs Nerv Syst 2023; 39:3583-3588. [PMID: 37420034 DOI: 10.1007/s00381-023-06059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE The incidence of metabolic bone diseases in pediatric neurosurgical patients is rare. We examined our institutional experience of metabolic bone diseases along with a review of the literature in an effort to understand management for this rare entity. METHODS Retrospective review of the electronic medical record database was performed to identify patients with primary metabolic bone disorders who underwent craniosynostosis surgery between 2011 and 2022 at a quaternary referral pediatric hospital. Literature review was conducted for primary metabolic bone disorders associated with craniosynostosis. RESULTS Ten patients were identified, 6 of whom were male. The most common bone disorders were hypophosphatemic rickets (n = 2) and pseudohypoparathyroidism (n = 2). The median age at diagnosis of metabolic bone disorder was 2.02 years (IQR: 0.11-4.26), 2.52 years (IQR: 1.24-3.14) at craniosynostosis diagnosis, and 2.65 years (IQR: 0.91-3.58) at the time of surgery. Sagittal suture was most commonly fused (n = 4), followed by multi-suture craniosynostosis (n = 3). Other imaging findings included Chiari (n = 1), hydrocephalus (n = 1), and concurrent Chiari and hydrocephalus (n = 1). All patients underwent surgery for craniosynostosis, with the most common operation being bifronto-orbital advancement (n = 4). A total of 5 patients underwent reoperation, 3 of which were planned second-stage surgeries and 2 of whom had craniosynostosis recurrence. CONCLUSIONS We advocate screening for suture abnormalities in children with primary metabolic bone disorders. While cranial vault remodeling is not associated with a high rate of postoperative complications in this patient cohort, craniosynostosis recurrences may occur, and parental counseling is recommended.
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Affiliation(s)
- Maria A Punchak
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, 19146, USA.
| | - Christina Sarris
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emily Xu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tracy M Flanders
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, 19146, USA
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shih-Shan Lang
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, 19146, USA
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory G Heuer
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, 19146, USA
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Abstract
Convexity meningiomas are among the most common extra-axial tumors encountered in neurosurgery. Advances in diagnostic imaging, intraoperative technology, and nonsurgical treatment modalities have changed the face of neurosurgical oncology. In this chapter we describe the modern neurosurgeon's approach to convexity meningiomas in terms of diagnosis, treatment, and follow-up care.
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Affiliation(s)
- Christina Sarris
- Department of Neurological Surgery, Barrow Brain Tumor Research Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Nader Sanai
- Department of Neurological Surgery, Barrow Brain Tumor Research Center, Barrow Neurological Institute, Phoenix, AZ, United States.
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Mooney M, Bohl M, Sarris C, Jahnke H, White W, Little A. Sodium and Water Regulation after Pituitary Surgery: Results of a Prospective Pilot Study of Early Postoperative Water Load. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Michael Mooney
- Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Michael Bohl
- Barrow Neurological Institute, Phoenix, Arizona, United States
| | | | - Heidi Jahnke
- Barrow Neurological Institute, Phoenix, Arizona, United States
| | - William White
- Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Andrew Little
- Barrow Neurological Institute, Phoenix, Arizona, United States
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Mooney M, Sarris C, Hendricks B, Porter R, Spetzler R, Almefty K. Long-Term Facial Nerve Outcomes Following Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michael Mooney
- Barrow Neurological Institute, Phoenix, Arizona, United States
| | | | | | - Randall Porter
- Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Robert Spetzler
- Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Kaith Almefty
- Barrow Neurological Institute, Phoenix, Arizona, United States
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Nwagwu CD, Sarris C, Tao YX, Mammis A. Biomarkers for Chronic Neuropathic Pain and their Potential Application in Spinal Cord Stimulation: A Review. Transl Perioper Pain Med 2016; 1:33-38. [PMID: 28480314 PMCID: PMC5415348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This review was focused on understanding which substances inside the human body increase and decrease with increasing neuropathic pain. We reviewed various studies, and saw correlations between neuropathic pain and components of the immune system (this system defends the body against diseases and infections). Our findings will especially be useful for understanding ways to reduce or eliminate the discomfort, chronic neuropathic pain brings with it. Spinal cord stimulation (SCS) procedure is one of the few fairly efficient remedial treatments for pain. A follow-up study will apply our findings from this review to SCS, in order to understand the mechanism, and further optimize efficaciousness.
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Affiliation(s)
- Chibueze D. Nwagwu
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Yuan-Xiang Tao
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Antonios Mammis
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Agarwal N, Sarris C, Hansberry DR, Lin MJ, Barrese JC, Prestigiacomo CJ. Quality of patient education materials for rehabilitation after neurological surgery. NeuroRehabilitation 2013; 32:817-21. [DOI: 10.3233/nre-130905] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
| | - Christina Sarris
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
| | - David R. Hansberry
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
| | - Matthew J. Lin
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
| | - James C. Barrese
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
| | - Charles J. Prestigiacomo
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
- Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
- Department of Neurology and Neuroscience, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Antonadou D, Sarris C, Pulizzi M, Throuvalas N. 387Evaluation of the efficacy and safety of GM-CSF in the prophylaxis of oral mucositis in patients with head & neck cancer treated with radiotherapy. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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