1
|
Eremiev A, Kurland DB, Cheung ATM, Cook D, Dastagirzada Y, Harter DH, Rodriguez-Olaverri J, Brockmeyer D, Pahys JM, Hedequist D, Oetgen M, Samdani AF, Anderson RCE. Association between structural rib autograft and the rate of arthrodesis in children undergoing occiput-C2 instrumentation and fusion. J Neurosurg Pediatr 2024:1-8. [PMID: 38518281 DOI: 10.3171/2024.1.peds23419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/11/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The purpose of this study was to identify factors associated with fusion success among pediatric patients undergoing occiput-C2 rigid instrumentation and fusion. METHODS The Pediatric Spine Study Group registry was queried to identify patients ≤ 21 years of age who underwent occiput-C2 posterior spinal rigid instrumentation and fusion and had a 2-year minimum clinical and radiographic (postoperative lateral cervical radiograph or CT scan) follow-up. Fusion failure was defined clinically if a patient underwent hardware revision surgery > 30 days after the index procedure or radiographically by the presence of hardware failure or screw haloing on the most recent follow-up imaging study. Univariate comparisons and multivariable logistic regression analyses were subsequently performed. RESULTS Seventy-six patients met inclusion criteria. The median age at surgery was 9 years (range 1.5-17.2 years), and 51% of the cohort was male. Overall, 75% of patients had syndromic (n = 41) or congenital (n = 15) etiologies, with the most frequent diagnoses of Down syndrome (28%), Chiari malformation (13%), and Klippel-Feil syndrome (12%). Data were available to determine if there was a fusion failure in 97% (74/76) of patients. Overall, 38% (28/74) of patients had fusion failure (95% CI 27%-50%). Univariate analysis demonstrated that use of a rigid cervical collar postoperatively (p = 0.04) and structural rib autograft (p = 0.02) were associated with successful fusion. Multivariable logistic regression analysis determined that patients who had rib autograft used in surgery had a 73% decrease in the odds of fusion failure (OR 0.27, 95% CI 0.09-0.82; p = 0.02). Age, etiology including Down syndrome, instrumentation type, unilateral instrumentation, use of recombinant human bone morphogenetic protein, and other variables did not influence the risk for fusion failure. CONCLUSIONS In this multicenter, multidisciplinary, international registry of children undergoing occiput-C2 instrumentation and fusion, fusion failure was seen in 38% of patients, a higher rate than previously reported in the literature. The authors' data suggest that postoperative immobilization in a rigid cervical collar may be beneficial, and the use of structural rib autograft should be considered, as rib autograft was associated with a 75% higher chance of successful fusion.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Douglas Brockmeyer
- 4Department of Pediatric Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah
| | | | - Daniel Hedequist
- 6Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Oetgen
- 7Division of Orthopedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC
| | - Amer F Samdani
- 8Neurosurgery, Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Richard C E Anderson
- Departments of1Neurological Surgery and
- 9NYU Neurosurgery Network, Ridgewood, New Jersey
| |
Collapse
|
2
|
Kurland DB, Lendhey M, Delavari N, Winfield J, Mahoney JM, Becske T, Shapiro M, Raz E, Pacione D, Bucklen BS, Frempong-Boadu AK. Percutaneous Juxtapedicular Cement Salvage of Failed Spinal Instrumentation? Institutional Experience and Cadaveric Biomechanical Study. Oper Neurosurg (Hagerstown) 2024; 26:38-45. [PMID: 37747337 DOI: 10.1227/ons.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/22/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Instrumented spinal fusion constructs sometimes fail because of fatigue loading, frequently necessitating open revision surgery. Favorable outcomes after percutaneous juxtapedicular cement salvage (perc-cement salvage) of failing instrumentation have been described; however, this approach is not widely known among spine surgeons , and its biomechanical properties have not been evaluated. We report our institutional experience with perc-cement salvage and investigate the relative biomechanical strength of this technique as compared with 3 other common open revision techniques. METHODS A retrospective chart review of patients who underwent perc-cement salvage was conducted. Biomechanical characterization of revision techniques was performed in a cadaveric model of critical pedicle screw failure. Three revision cohorts involved removal and replacement of hardware: (1) screw upsizing, (2) vertebroplasty, and (3) fenestrated screw with cement augmentation. These were compared with a cohort with perc-cement salvage performed using a juxtapedicular trajectory with the failed primary screw remaining engaged in the vertebral body. RESULTS Ten patients underwent perc-cement salvage from 2018 to 2022 to address screw haloing and/or endplate fracture threatening construct integrity. Pain palliation was reported by 8/10 patients. Open revision surgery was required in 4/10 patients, an average of 8.9 months after the salvage procedure (range 6.2-14.7 months). Only one revision was due to progressive hardware dislodgement. The remainder avoided open revision surgery through an average of 1.9 years of follow-up. In the cadaveric study, there were no significant differences in pedicle screw pullout strength among any of the revision cohorts. CONCLUSION Perc-cement salvage of failing instrumentation is reasonably efficacious. The technique is biomechanically noninferior to other revision strategies that require open surgery for removal and replacement of hardware. Open revision surgery may be avoided by perc-cement salvage in select cases.
Collapse
Affiliation(s)
- David B Kurland
- Department of Neurosurgery, New York University Langone Medical Center, New York , New York , USA
| | - Matin Lendhey
- Musculoskeletal Education and Research Center, Globus Medical Inc., Audubon , Pennsylvania , USA
| | - Nader Delavari
- Department of Neurosurgery, New York University Langone Medical Center, New York , New York , USA
| | - Jalen Winfield
- School of Biomedical Engineering, Drexel University, Philadelphia , Pennsylvania , USA
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, Globus Medical Inc., Audubon , Pennsylvania , USA
| | - Tibor Becske
- Departments of Neurology, University of North Carolina, Chapel Hill , North Carolina , USA
| | - Maksim Shapiro
- Department of Radiology, New York University Langone Medical Center, New York , New York , USA
| | - Eytan Raz
- Department of Radiology, New York University Langone Medical Center, New York , New York , USA
| | - Donato Pacione
- Department of Neurosurgery, New York University Langone Medical Center, New York , New York , USA
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, Globus Medical Inc., Audubon , Pennsylvania , USA
| | - Anthony K Frempong-Boadu
- Department of Neurosurgery, New York University Langone Medical Center, New York , New York , USA
| |
Collapse
|
3
|
Cheung ATM, Kurland DB, Neifert S, Mandelberg N, Nasir-Moin M, Laufer I, Pacione D, Lau D, Frempong-Boadu AK, Kondziolka D, Golfinos JG, Oermann EK. Developing an Automated Registry (Autoregistry) of Spine Surgery Using Natural Language Processing and Health System Scale Databases. Neurosurgery 2023; 93:1228-1234. [PMID: 37345933 DOI: 10.1227/neu.0000000000002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/25/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical registries are critical for modern surgery and underpin outcomes research, device monitoring, and trial development. However, existing approaches to registry construction are labor-intensive, costly, and prone to manual error. Natural language processing techniques combined with electronic health record (EHR) data sets can theoretically automate the construction and maintenance of registries. Our aim was to automate the generation of a spine surgery registry at an academic medical center using regular expression (regex) classifiers developed by neurosurgeons to combine domain expertise with interpretable algorithms. METHODS We used a Hadoop data lake consisting of all the information generated by an academic medical center. Using this database and structured query language queries, we retrieved every operative note written in the department of neurosurgery since our transition to EHR. Notes were parsed using regex classifiers and compared with a random subset of 100 manually reviewed notes. RESULTS A total of 31 502 operative cases were downloaded and processed using regex classifiers. The codebase required 5 days of development, 3 weeks of validation, and less than 1 hour for the software to generate the autoregistry. Regex classifiers had an average accuracy of 98.86% at identifying both spinal procedures and the relevant vertebral levels, and it correctly identified the entire list of defined surgical procedures in 89% of patients. We were able to identify patients who required additional operations within 30 days to monitor outcomes and quality metrics. CONCLUSION This study demonstrates the feasibility of automatically generating a spine registry using the EHR and an interpretable, customizable natural language processing algorithm which may reduce pitfalls associated with manual registry development and facilitate rapid clinical research.
Collapse
Affiliation(s)
| | - David B Kurland
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Sean Neifert
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | | | - Mustafa Nasir-Moin
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Ilya Laufer
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Darryl Lau
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | | | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Eric Karl Oermann
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
- Department of Radiology, NYU Langone Health, New York , New York , USA
- Center for Data Science, New York University, New York , New York , USA
| |
Collapse
|
4
|
Kurland DB, Cheung ATM, Kim NC, Ashayeri K, Hidalgo T, Frempong-Boadu A, Oermann EK, Kondziolka D. A Century of Evolution in Spine Surgery Publications: A Bibliometric Analysis of the Field From 1900 to 2023. Neurosurgery 2023; 93:1121-1143. [PMID: 37610208 DOI: 10.1227/neu.0000000000002648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Spine surgery has advanced in concert with our deeper understanding of its elements. Narrowly focused bibliometric analyses have been conducted previously, but never on the entire corpus of the field. Using big data and bibliometrics, we appraised the entire corpus of spine surgery publications to study the evolution of the specialty as a scholarly field since 1900. METHODS We queried Web of Science for all contents from 13 major publications dedicated to spine surgery. We next queried by topic [topic = (spine OR spinal OR vertebrae OR vertebral OR intervertebral OR disc OR disk)]; these results were filtered to include articles published by 49 other publications that were manually determined to contain pertinent articles. Articles, along with their metadata, were exported. Statistical and bibliometric analyses were performed using the Bibliometrix R package and various Python packages. RESULTS Eighty-five thousand five hundred articles from 62 journals and 134 707 unique authors were identified. The annual growth rate of publications was 2.78%, with a surge after 1980, concurrent with the growth of specialized journals. International coauthorship, absent before 1970, increased exponentially with the formation of influential spine study groups. Reference publication year spectroscopy allowed us to identify 200 articles that comprise the historical roots of modern spine surgery and each of its subdisciplines. We mapped the emergence of new topics and saw a recent lexical evolution toward outcomes- and patient-centric terms. Female and minority coauthorship has increased since 1990, but remains low, and disparities across major publications persist. CONCLUSION The field of spine surgery was borne from pioneering individuals who published their findings in a variety of journals. The renaissance of spine surgery has been powered by international collaboration and is increasingly outcomes focused. While spine surgery is gradually becoming more diverse, there is a clear need for further promotion and outreach to under-represented populations.
Collapse
Affiliation(s)
- David B Kurland
- Department of Neurological Surgery, New York University, New York , New York , USA
| | - Alexander T M Cheung
- Department of Neurological Surgery, New York University, New York , New York , USA
| | - Nora C Kim
- Department of Neurological Surgery, New York University, New York , New York , USA
| | - Kimberly Ashayeri
- Department of Neurological Surgery, New York University, New York , New York , USA
| | - Teresa Hidalgo
- Department of Neurological Surgery, New York University, New York , New York , USA
| | | | - Eric Karl Oermann
- Department of Neurological Surgery, New York University, New York , New York , USA
- Center for Data Science, New York University, New York , New York , USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, New York University, New York , New York , USA
| |
Collapse
|
5
|
Bi CL, Kurland DB, Ber R, Kondziolka D, Lau D, Pacione D, Frempong-Boadu A, Laufer I, Oermann EK. Digital Biomarkers and the Evolution of Spine Care Outcomes Measures: Smartphones and Wearables. Neurosurgery 2023; 93:745-754. [PMID: 37246874 DOI: 10.1227/neu.0000000000002519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/19/2023] [Indexed: 05/30/2023] Open
Abstract
Over the past generation, outcome measures in spine care have evolved from a reliance on clinician-reported assessment toward recognizing the importance of the patient's perspective and the wide incorporation of patient-reported outcomes (PROs). While patient-reported outcomes are now considered an integral component of outcomes assessments, they cannot wholly capture the state of a patient's functionality. There is a clear need for quantitative and objective patient-centered outcome measures. The pervasiveness of smartphones and wearable devices in modern society, which passively collect data related to health, has ushered in a new era of spine care outcome measurement. The patterns emerging from these data, so-called "digital biomarkers," can accurately describe characteristics of a patient's health, disease, or recovery state. Broadly, the spine care community has thus far concentrated on digital biomarkers related to mobility, although the researcher's toolkit is anticipated to expand in concert with advancements in technology. In this review of the nascent literature, we describe the evolution of spine care outcome measurements, outline how digital biomarkers can supplement current clinician-driven and patient-driven measures, appraise the present and future of the field in the modern era, as well as discuss present limitations and areas for further study, with a focus on smartphones (see Supplemental Digital Content , http://links.lww.com/NEU/D809 , for a similar appraisal of wearable devices).
Collapse
Affiliation(s)
- Christina L Bi
- Department of Neurological Surgery, New York University, New York , New York , USA
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Khan HA, Ber R, Neifert SN, Kurland DB, Laufer I, Kondziolka D, Chhabra A, Frempong-Boadu AK, Lau D. Carbon fiber-reinforced PEEK spinal implants for primary and metastatic spine tumors: a systematic review on implant complications and radiotherapy benefits. J Neurosurg Spine 2023; 39:534-547. [PMID: 37382293 DOI: 10.3171/2023.5.spine23106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/09/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE By minimizing imaging artifact and particle scatter, carbon fiber-reinforced polyetheretherketone (CF-PEEK) spinal implants are hypothesized to enhance radiotherapy (RT) planning/dosing and improve oncological outcomes. However, robust clinical studies comparing tumor surgery outcomes between CF-PEEK and traditional metallic implants are lacking. In this paper, the authors performed a systematic review of the literature with the aim to describe clinical outcomes in patients with spine tumors who received CF-PEEK implants, focusing on implant-related complications and oncological outcomes. METHODS A systematic review of the literature published between database inception and May 2022 was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The PubMed database was queried using the terms "carbon fiber" and "spine" or "spinal." The inclusion criteria were articles that described patients with CF-PEEK pedicle screw fixation and had a minimum of 5 patients. Case reports and phantom studies were excluded. RESULTS This review included 11 articles with 326 patients (237 with CF-PEEK-based implants and 89 with titanium-based implants). The mean follow-up period was 13.5 months, and most tumors were metastatic (67.1%). The rates of implant-related complications in the CF-PEEK and titanium groups were 7.8% and 4.7%, respectively. The rate of pedicle screw fracture was 1.7% in the CF-PEEK group and 2.4% in the titanium group. The rates of reoperation were 5.7% (with 60.0% because of implant failure or junctional kyphosis) and 4.8% (all because of implant failure or junctional kyphosis) in the CF-PEEK and titanium groups, respectively. When reported, 72.5% of patients received postoperative RT (41.0% stereotactic body RT, 30.8% fractionated RT, 25.6% proton, 2.6% carbon ion). Four articles suggested that implant artifact was reduced in the CF-PEEK group. Local recurrence occurred in 14.4% of CF-PEEK and 10.7% of titanium-implanted patients. CONCLUSIONS While CF-PEEK harbors similar implant failure rates to traditional metallic implants with reduced imaging artifact, it remains unclear whether CF-PEEK implants improve oncological outcomes. This study highlights the need for prospective, direct comparative clinical studies.
Collapse
Affiliation(s)
- Hammad A Khan
- 1Department of Neurosurgery, NYU Grossman School of Medicine, New York; and
| | - Roee Ber
- 1Department of Neurosurgery, NYU Grossman School of Medicine, New York; and
| | - Sean N Neifert
- 1Department of Neurosurgery, NYU Grossman School of Medicine, New York; and
| | - David B Kurland
- 1Department of Neurosurgery, NYU Grossman School of Medicine, New York; and
| | - Ilya Laufer
- 1Department of Neurosurgery, NYU Grossman School of Medicine, New York; and
| | - Douglas Kondziolka
- 1Department of Neurosurgery, NYU Grossman School of Medicine, New York; and
| | | | | | - Darryl Lau
- 1Department of Neurosurgery, NYU Grossman School of Medicine, New York; and
| |
Collapse
|
7
|
Kurland DB, Neifert S, Khan H, Lau D. Surgical management of Hirayama disease in a pediatric patient presenting with severe cervical kyphosis and focal myelopathy: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22544. [PMID: 37096817 PMCID: PMC10550675 DOI: 10.3171/case22544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/09/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Hirayama disease (HD) is a rare, nonfamilial neuromuscular disease causing cervical myelopathy and deformity, most commonly effecting pubertal Asian males. Patients whose nonoperative treatment fails and who cannot tolerate long-term cervical immobilization, experience relapse after arrest of symptoms, or present with severe features warrant surgical treatment. Here, the authors present an unusual case of HD that resulted in rapid progression of severe cervical kyphosis and discuss surgical management strategies. OBSERVATIONS A 15-year-old male presented with unprovoked neck pain, progressive chin-on-chest phenomenon, and cervical myelopathy. Imaging revealed a severe subaxial cervical kyphosis of 88° and severe spinal cord compression secondary to changes within the thecal sac, ligaments, and bony elements. He underwent a multistage surgery involving halo gravity traction, C3-6 anterior cervical discectomy and fusion, and C2 to T2 posterior instrumented fusion with C3-5 Smith-Petersen osteotomies. Cervical subaxial pedicle screws facilitated deformity correction through a cantilever technique. LESSONS HD is rare and often self-limited. For severe or refractory cases of HD, guidelines for surgical management have been suggested, with a variety of approaches deemed efficacious. This is the first case of a patient presenting with such severe cervical deformity; early diagnosis and recognition is the first step toward prompt, adequate management.
Collapse
|
8
|
Lau D, Kurland DB, Neifert SN, Wei-Hung Hwang S, Pahys J, Samdani AF. 670 Learning Curve Associated With Thoracoscopic Anterior Vertebral Body Tether for Idiopathic Scoliosis: Analysis of Three Independent Surgeons. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_670] [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: 03/18/2023] Open
|
9
|
Kurland DB, Lendhey M, Delavari N, Winfield J, Mahoney J, Bucklen B, Frempong-Boadu A. 437 Percutaneous Juxtapedicular Cement Salvage of Failed Pedicle Screws: A Cadaveric Biomechanical Study. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_437] [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: 03/18/2023] Open
|
10
|
Dastagirzada YM, Alexiades NG, Kurland DB, Anderson SN, Brockmeyer DL, Bumpass DB, Chatterjee S, Groves ML, Hankinson TC, Harter D, Hedequist D, Jea A, Leonard JR, Martin JE, Oetgen ME, Pahys J, Rozzelle C, Strahle JM, Thompson D, Yaszay B, Anderson RCE. Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi study. J Neurosurg Pediatr 2023; 31:32-42. [PMID: 36308472 DOI: 10.3171/2022.9.peds22319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/03/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical spine disorders in children are relatively uncommon; therefore, paradigms for surgical and nonsurgical clinical management are not well established. The purpose of this study was to bring together an international, multidisciplinary group of pediatric cervical spine experts to build consensus via a modified Delphi approach regarding the clinical management of children with cervical spine disorders and those undergoing cervical spine stabilization surgery. METHODS A modified Delphi method was used to identify consensus statements for the management of children with cervical spine disorders requiring stabilization. A survey of current practices, supplemented by a literature review, was electronically distributed to 17 neurosurgeons and orthopedic surgeons experienced with the clinical management of pediatric cervical spine disorders. Subsequently, 52 summary statements were formulated and distributed to the group. Statements that reached near consensus or that were of particular interest were then discussed during an in-person meeting to attain further consensus. Consensus was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). RESULTS Forty-five consensus-driven statements were identified, with all participants willing to incorporate them into their practice. For children with cervical spine disorders and/or stabilization, consensus statements were divided into the following categories: A) preoperative planning (12 statements); B) radiographic thresholds of instability (4); C) intraoperative/perioperative management (15); D) postoperative care (11); and E) nonoperative management (3). Several important statements reaching consensus included the following recommendations: 1) to obtain pre-positioning baseline signals with intraoperative neuromonitoring; 2) to use rigid instrumentation when technically feasible; 3) to provide postoperative external immobilization for 6-12 weeks with a rigid cervical collar rather than halo vest immobilization; and 4) to continue clinical postoperative follow-up at least until anatomical cervical spine maturity was reached. In addition, preoperative radiographic thresholds for instability that reached consensus included the following: 1) translational motion ≥ 5 mm at C1-2 (excluding patients with Down syndrome) or ≥ 4 mm in the subaxial spine; 2) dynamic angulation in the subaxial spine ≥ 10°; and 3) abnormal motion and T2 signal change on MRI seen at the same level. CONCLUSIONS In this study, the authors have demonstrated that a multidisciplinary, international group of pediatric cervical spine experts was able to reach consensus on 45 statements regarding the management of pediatric cervical spine disorders and stabilization. Further study is required to determine if implementation of these practices can lead to reduced complications and improved outcomes for children.
Collapse
Affiliation(s)
- Yosef M Dastagirzada
- 1Department of Neurological Surgery, New York University, Hassenfeld Children's Hospital, New York, New York
| | | | - David B Kurland
- 1Department of Neurological Surgery, New York University, Hassenfeld Children's Hospital, New York, New York
| | | | - Douglas L Brockmeyer
- 4Department of Pediatric Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah
| | - David B Bumpass
- 5Department of Orthopedic Surgery, University of Arkansas, Little Rock, Arkansas
| | | | - Mari L Groves
- 7Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd C Hankinson
- 8Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Harter
- 1Department of Neurological Surgery, New York University, Hassenfeld Children's Hospital, New York, New York
| | - Daniel Hedequist
- 9Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Jea
- 10Department of Neurological Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Jeffrey R Leonard
- 11Department of Neurosurgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jonathan E Martin
- 12Division of Pediatric Neurosurgery, Connecticut Children's, Hartford, Connecticut
| | - Matthew E Oetgen
- 13Division of Orthopedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC
| | - Joshua Pahys
- 14Department of Pediatric Orthopedic Surgery, Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Curtis Rozzelle
- 15Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Jennifer M Strahle
- 16Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Dominic Thompson
- 17Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom; and
| | - Burt Yaszay
- 18Department of Orthopedics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Richard C E Anderson
- 1Department of Neurological Surgery, New York University, Hassenfeld Children's Hospital, New York, New York
| |
Collapse
|
11
|
Dastagirzada YM, Kurland DB, Hankinson TC, Anderson RCE. Craniovertebral Junction Instability in the Setting of Chiari Malformation. Neurosurg Clin N Am 2023; 34:131-142. [DOI: 10.1016/j.nec.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
12
|
Kurland DB, Lau D, Dalle Ore CL, Haddad A, Deviren V, Ames CP. Combined retropleural thoracotomy and posterior spinal approach for thoracic dumbbell Schwannoma: Case series and review of the literature. J Clin Neurosci 2022; 106:173-179. [DOI: 10.1016/j.jocn.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
|
13
|
Benjamin CG, Dastagirzada Y, Bevilacqua J, Kurland DB, Fujita K, Sen C, Golfinos JG, Placantonakis DG, Jafar JJ, Lieberman S, Lebowitz R, Lewis A, Agrawal N, Pacione D. The Cost Effectiveness of Implementation of a Postoperative Endocrinopathy Management Protocol after Resection of Pituitary Adenomas. J Neurol Surg B Skull Base 2022; 83:618-625. [PMID: 36393880 PMCID: PMC9653289 DOI: 10.1055/s-0042-1750718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/23/2022] [Indexed: 10/17/2022] Open
Abstract
Purpose After developing a protocol for evaluating, diagnosing, and treating postoperative endocrinopathy both during the hospitalization and during the immediate discharge period following resection of pituitary adenomas, we sought to assess the impact of this protocol on quality outcomes. Methods An IRB-exempt, quality improvement initiated, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective comparison of a pre-and-post-protocol cohort of all patients undergoing endoscopic endonasal resection of pituitary adenomas at NYU Langone Medical Center from January 2013 to December 2018. Demographic characteristics of the patients and their tumors with their postoperative outcomes were recorded. Quality outcomes regarding number of laboratory studies sent, rate of diabetes insipidus, length of stay, and readmission rate were also recorded. Statistical analysis was performed between the pre- and post-protocol groups. Results There was a significant reduction in laboratory studies sent per patient (55.66 vs. 18.82, p <0.001). This corresponded with an overall cost reduction in laboratory studies of $255.95 per patient. There was a decrease in the overall number of patients treated with DDAVP (21.4% in the pre-protocol group vs. 8.9% in the post-protocol group, p = 0.04). All post-protocol patients requiring DDAVP at discharge were identified by 48 hours. There was no significant change in length of stay or need for hydrocortisone supplementation postoperatively between the two groups. Length of stay was driven mostly by need for reoperation during initial hospitalization. There was no significant change in the rate of 30-day readmission. Conclusion Implementation of a postoperative management protocol results in a more efficient diagnosis and management of endocrinopathy after pituitary adenoma surgery which translates to decreased cost.
Collapse
Affiliation(s)
- Carolina G. Benjamin
- Department of Neurosurgery, University of Miami, Miami, Florida, United States
- Address for correspondence Carolina Gesteira Benjamin, MD University of MiamiMiami, FL 33146United States
| | - Yosef Dastagirzada
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
| | - Julia Bevilacqua
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
| | - David B. Kurland
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
| | - Kevin Fujita
- Department of Neurosurgery, Yale Medical Center, New Haven, Connecticut, United States
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
| | - John G. Golfinos
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
| | | | - Jafar J. Jafar
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
| | - Seth Lieberman
- Department of Otolaryngology, NYU Langone Medical Center, New York, New York, United States
| | - Richard Lebowitz
- Department of Otolaryngology, NYU Langone Medical Center, New York, New York, United States
| | - Ariane Lewis
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
- Department of Neurology, NYU Langone Medical Center, New York, New York, United States
| | - Nidhi Agrawal
- Department of Endocrinology, NYU Langone Medical Center, New York, New York, United States
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
| |
Collapse
|
14
|
Liu DD, Kurland DB, Ali A, Golfinos JG, Nossek E, Riina HA. Pial brainstem artery arteriovenous malformation with flow-related intracanalicular aneurysm masquerading as vestibular schwannoma: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 4:CASE22208. [PMID: 36046703 PMCID: PMC9301348 DOI: 10.3171/case22208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Lesions of the internal auditory canal presenting with partial hearing loss are almost always vestibular schwannomas (VSs). Intracanalicular anterior inferior cerebellar artery (AICA) aneurysms are extremely rare but can mimic VS based on symptoms and imaging. The authors report the case of a flow-related intracanalicular AICA aneurysm from a pial brainstem arteriovenous malformation (AVM) masquerading as VS. OBSERVATIONS A 57-year-old male with partial left-sided hearing loss and an intracanalicular enhancing lesion was initially diagnosed with VS and managed conservatively at an outside institution with surveillance imaging over 3 years. When he was referred for VS follow-up, new imaging raised radiological suspicion for vascular pathology. Cerebral angiography revealed a small pial AVM located at the trigeminal root entry zone with an associated flow-related intracanalicular AICA aneurysm. The AVM was obliterated with open surgery, during which intraoperative angiography confirmed no AVM filling, preservation of the AICA, and no further aneurysm filling. LESSONS Intracanalicular AICA aneurysms and other lesions, including cavernous malformations, can mimic radiographic features of VS and present with hearing loss or facial weakness. Modern vascular neurosurgical techniques such as endovascular intervention and open surgery in a hybrid operating room allowed definitive management of both lesions without untoward morbidity.
Collapse
Affiliation(s)
- David D. Liu
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - David B. Kurland
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Aryan Ali
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - John G. Golfinos
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Erez Nossek
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Howard A. Riina
- Department of Neurosurgery, New York University Langone Health, New York, New York
| |
Collapse
|
15
|
Neifert SN, Khan HA, Kurland DB, Kim NC, Yohay K, Segal D, Samdani A, Hwang S, Lau D. Management and surgical outcomes of dystrophic scoliosis in neurofibromatosis type 1: a systematic review. Neurosurg Focus 2022; 52:E7. [DOI: 10.3171/2022.2.focus21790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Neurofibromatosis type 1 (NF1) dystrophic scoliosis is an early-onset, rapidly progressive multiplanar deformity. There are few studies on the surgical management of this patient population. Specifically, perioperative morbidity, instrument-related complications, and quality-of-life outcomes associated with surgical management have not been systematically evaluated. In this study, the authors aimed to perform a systematic review on the natural history, management options, and surgical outcomes in patients who underwent NF1 dystrophic scoliosis surgery.
METHODS
A PubMed search for articles with “neurofibromatosis” and either “dystrophic” or “scoliosis” in the title or abstract was performed. Articles with 10 or more patients undergoing surgery for NF1 dystrophic scoliosis were included. Data regarding indications, treatment details, morbidity, and outcomes were summarized and analyzed with descriptive statistics.
RESULTS
A total of 310 articles were identified, 48 of which were selected for full-text review; 30 studies describing 761 patients met the inclusion criteria. The mean age ranged from 7 to 22 years, and 99.7% of patients were younger than 18 years. The mean preoperative coronal Cobb angle was 75.2°, and the average correction achieved was 40.3°. The mean clinical follow-up in each study was at least 2 years (range 2.2–19 years). All patients underwent surgery with the intent of deformity correction. The scoliosis regions addressed were thoracic curves (69.6%) and thoracolumbar (11.1%) and lumbar (14.3%) regions. The authors reported on a variety of approaches: posterior-only, combined anterior-posterior, and growth-friendly surgery. For fixation techniques, 42.5% of patients were treated with hybrid constructs, 51.5% with pedicle screw–only constructs, and 6.0% with hook-based constructs. Only 0.9% of patients underwent a vertebral column resection. The nonneurological complication rate was 14.0%, primarily dural tears and wound infections. The immediate postoperative neurological deficit rate was 2.1%, and the permanent neurological deficit rate was 1.2%. Ultimately, 21.5% required revision surgery, most commonly for implant-related complications. Loss of correction in both the sagittal and coronal planes commonly occurred at follow-up. Five papers supplied validated patient-reported outcome measures, showing improvement in the mental health, self-image, and activity domains.
CONCLUSIONS
Data on the surgical outcomes of dystrophic scoliosis correction are heterogeneous and sparse. The perioperative complication rate appears to be high, although reported rates of neurological deficits appear to be lower than clinically observed and may be underreported. The incidence of implant-related failures requiring revision surgery is high. There is a great need for multicenter prospective studies of this complex type of deformity.
Collapse
Affiliation(s)
- Sean N. Neifert
- Department of Neurological Surgery, New York University, New York, New York
| | - Hammad A. Khan
- Department of Neurological Surgery, New York University, New York, New York
| | - David B. Kurland
- Department of Neurological Surgery, New York University, New York, New York
| | - Nora C. Kim
- Department of Neurological Surgery, New York University, New York, New York
| | - Kaleb Yohay
- Department of Neurology and Comprehensive Neurofibromatosis Center, New York University, New York, New York; and
| | - Devorah Segal
- Department of Neurology and Comprehensive Neurofibromatosis Center, New York University, New York, New York; and
| | - Amer Samdani
- Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Steven Hwang
- Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Darryl Lau
- Department of Neurological Surgery, New York University, New York, New York
| |
Collapse
|
16
|
Ber R, Valliani A, Liu A, Kurland DB, Pacione DR, Oermann EK. 825 Can Applying Machine Learning on Perioperative Team Communication Data Change the Way we Predict Case-time Duration? Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
17
|
Kurland DB, Mureb MC, Liu AH, Seidenstein AH, Stern E, Anderer EG. Yoga as an adjunctive treatment for nonoperative low-back pain. J Neurosurg Spine 2021:1-5. [PMID: 34653967 DOI: 10.3171/2021.6.spine2198] [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: 11/06/2022]
Affiliation(s)
- David B Kurland
- 1Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Monica C Mureb
- 2Department of Neurosurgery, New York Medical College, Valhalla, New York
| | - Albert H Liu
- 1Department of Neurosurgery, New York University Langone Health, New York, New York
| | | | | | - Erich G Anderer
- 1Department of Neurosurgery, New York University Langone Health, New York, New York
| |
Collapse
|
18
|
Rozman PA, Kurland DB, Golub D, Trang M, Rothstein A, Lewis A, Pacione D. Venous Duplex Ultrasound Surveillance in the Neurosurgical Population: A Single-Center Quality Improvement Initiative. World Neurosurg 2020; 144:e80-e86. [PMID: 32758655 DOI: 10.1016/j.wneu.2020.07.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) represents a significant source of morbidity and mortality in the inpatient population and is considered a leading preventable cause of death among inpatients. Neurosurgical inpatients are of particular interest because of the greater rates of immobility, steroid use, and potential consequences of postoperative hemorrhage. A consensus protocol for VTE screening in this population has not yet been developed, and institutional protocols vary widely. METHODS We performed a retrospective review of lower extremity venous duplex ultrasonography (VDUS) usage at our institution and applied this information to the development of a neurosurgery department protocol, with consideration of high-risk patient risk factors and indications for VDUS ordering. We then implemented this protocol, which consisted of preoperative screening of patients at high risk of VTE and limited postoperative surveillance, for a 6-month period and compared VDUS usage and VTE occurrence. RESULTS Preoperative VDUS screening before nonemergent neurosurgical procedures in high-risk patients with active cancer, an inability to ambulate, or a history of deep vein thrombosis (DVT) identified proximal DVTs that were then treated. Postoperative routine surveillance VDUS scans only diagnosed incidental isolated calf DVT for which no clinically relevant sequelae occurred. Overall, postoperative surveillance VDUS usage decreased significantly (66.9% vs. 13.5%; P = 0.001). CONCLUSIONS Our findings lend support to preoperative screening of high-risk patients and suggest that routine postoperative VDUS surveillance of asymptomatic patients is unnecessary.
Collapse
Affiliation(s)
- Peter A Rozman
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - David B Kurland
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Danielle Golub
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Myra Trang
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Aaron Rothstein
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Ariane Lewis
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA; Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
| |
Collapse
|
19
|
Karimy JK, Zhang J, Kurland DB, Theriault BC, Duran D, Furey CG, Gerzanich V, Simard JM, Kahle KT. 166 TLR-4-Regulated Cerebrospinal Fluid Hypersecretion in Post-Hemorrhagic Hydrocephalus. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx417.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
20
|
Karimy JK, Zhang J, Kurland DB, Theriault BC, Duran D, Stokum JA, Furey CG, Zhou X, Mansuri MS, Montejo J, Vera A, DiLuna ML, Delpire E, Alper SL, Gunel M, Gerzanich V, Medzhitov R, Simard JM, Kahle KT. Inflammation-dependent cerebrospinal fluid hypersecretion by the choroid plexus epithelium in posthemorrhagic hydrocephalus. Nat Med 2017; 23:997-1003. [PMID: 28692063 DOI: 10.1038/nm.4361] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 05/31/2017] [Indexed: 02/07/2023]
Abstract
The choroid plexus epithelium (CPE) secretes higher volumes of fluid (cerebrospinal fluid, CSF) than any other epithelium and simultaneously functions as the blood-CSF barrier to gate immune cell entry into the central nervous system. Posthemorrhagic hydrocephalus (PHH), an expansion of the cerebral ventricles due to CSF accumulation following intraventricular hemorrhage (IVH), is a common disease usually treated by suboptimal CSF shunting techniques. PHH is classically attributed to primary impairments in CSF reabsorption, but little experimental evidence supports this concept. In contrast, the potential contribution of CSF secretion to PHH has received little attention. In a rat model of PHH, we demonstrate that IVH causes a Toll-like receptor 4 (TLR4)- and NF-κB-dependent inflammatory response in the CPE that is associated with a ∼3-fold increase in bumetanide-sensitive CSF secretion. IVH-induced hypersecretion of CSF is mediated by TLR4-dependent activation of the Ste20-type stress kinase SPAK, which binds, phosphorylates, and stimulates the NKCC1 co-transporter at the CPE apical membrane. Genetic depletion of TLR4 or SPAK normalizes hyperactive CSF secretion rates and reduces PHH symptoms, as does treatment with drugs that antagonize TLR4-NF-κB signaling or the SPAK-NKCC1 co-transporter complex. These data uncover a previously unrecognized contribution of CSF hypersecretion to the pathogenesis of PHH, demonstrate a new role for TLRs in regulation of the internal brain milieu, and identify a kinase-regulated mechanism of CSF secretion that could be targeted by repurposed US Food and Drug Administration (FDA)-approved drugs to treat hydrocephalus.
Collapse
Affiliation(s)
- Jason K Karimy
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jinwei Zhang
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Hatherly Laboratory, Exeter, UK
| | - David B Kurland
- Department of Neurosurgery, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | | | - Daniel Duran
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jesse A Stokum
- Department of Neurosurgery, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | | | - Xu Zhou
- Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - M Shahid Mansuri
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julio Montejo
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alberto Vera
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael L DiLuna
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Eric Delpire
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Seth L Alper
- Division of Nephrology, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Murat Gunel
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Volodymyr Gerzanich
- Department of Neurosurgery, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Ruslan Medzhitov
- Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland, School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
- Department of Physiology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Mendelian Genomics, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
21
|
Abstract
Neurosurgeons increasingly use decompressive craniectomy (DC) in neurocritical care. In this review, the authors summarize the topic of DC for the neurointensivist. Following a brief overview of the procedure, the major indications for the procedure are described. This includes a review of the literature regarding well-established indications, such as infarction and traumatic brain injury, as well as lesser known indications, including intracerebral hemorrhage, ruptured cerebrovascular malformations, sinus thrombosis, and infection. Complications unique to DC, specifically syndrome of the trephined, hygroma, and hydrocephalus, also are reviewed with a discussion of their management, both in the immediate and the postoperative period.
Collapse
Affiliation(s)
- Erik G Hayman
- Departments of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David B Kurland
- Departments of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zachary Grunwald
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Sebastian Urday
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - J Marc Simard
- Departments of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
22
|
Kurland DB, Gerzanich V, Karimy JK, Woo SK, Vennekens R, Freichel M, Nilius B, Bryan J, Simard JM. The Sur1-Trpm4 channel regulates NOS2 transcription in TLR4-activated microglia. J Neuroinflammation 2016; 13:130. [PMID: 27246103 PMCID: PMC4888589 DOI: 10.1186/s12974-016-0599-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/24/2016] [Indexed: 12/12/2022] Open
Abstract
Background Harmful effects of activated microglia are due, in part, to the formation of peroxynitrite radicals, which is attributable to the upregulation of inducible nitric oxide (NO) synthase (NOS2). Because NOS2 expression is determined by Ca2+-sensitive calcineurin (CN) dephosphorylating nuclear factor of activated T cells (NFAT), and because Sur1-Trpm4 channels are crucial for regulating Ca2+ influx, we hypothesized that, in activated microglia, Sur1-Trpm4 channels play a central role in regulating CN/NFAT and downstream target genes such as Nos2. Methods We studied microglia in vivo and in primary culture from adult rats, and from wild type, Abcc8−/− and Trpm4−/− mice, and immortalized N9 microglia, following activation of Toll-like receptor 4 (TLR4) by lipopolysaccharide (LPS), using in situ hybridization, immunohistochemistry, co-immunoprecipitation, immunoblot, qPCR, patch clamp electrophysiology, calcium imaging, the Griess assay, and chromatin immunoprecipitation. Results In microglia in vivo and in vitro, LPS activation of TLR4 led to de novo upregulation of Sur1-Trpm4 channels and CN/NFAT-dependent upregulation of Nos2 mRNA, NOS2 protein, and NO. Pharmacological inhibition of Sur1 (glibenclamide), Trpm4 (9-phenanthrol), or gene silencing of Abcc8 or Trpm4 reduced Nos2 upregulation. Inhibiting Sur1-Trpm4 increased the intracellular calcium concentration ([Ca2+]i), as expected, but also decreased NFAT nuclear translocation. The increase in [Ca2+]i induced by inhibiting or silencing Sur1-Trpm4 resulted in phosphorylation of Ca2+/calmodulin protein kinase II and of CN, consistent with reduced nuclear translocation of NFAT. The regulation of NFAT by Sur1-Trpm4 was confirmed using chromatin immunoprecipitation. Conclusions Sur1-Trpm4 constitutes a novel mechanism by which TLR4-activated microglia regulate pro-inflammatory, Ca2+-sensitive gene expression, including Nos2.
Collapse
Affiliation(s)
- David B Kurland
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD, 21201-1595, USA. .,Neurosurgery Research Laboratories, 10 S. Pine St, Baltimore, MD, 21201-1595, USA.
| | - Volodymyr Gerzanich
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD, 21201-1595, USA
| | - Jason K Karimy
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD, 21201-1595, USA
| | - Seung Kyoon Woo
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD, 21201-1595, USA
| | - Rudi Vennekens
- Department Cell Molecular Medicine, Laboratory Ion Channel Research, Campus Gasthuisberg, Herestraat 49-Bus 802, Leuven, 3000, Belgium
| | - Marc Freichel
- Pharmakologisches Institut, Universität Heidelberg, Im Neuenheimer Feld 366, Heidelberg, 69120, Germany
| | - Bernd Nilius
- Department Cell Molecular Medicine, Laboratory Ion Channel Research, Campus Gasthuisberg, Herestraat 49-Bus 802, Leuven, 3000, Belgium
| | - Joseph Bryan
- Pacific Northwest Diabetes Research Institute, 720 Broadway, Seattle, WA, 98122, USA
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD, 21201-1595, USA. .,Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA. .,Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
23
|
Iqbal S, Hayman EG, Hong C, Stokum JA, Kurland DB, Gerzanich V, Simard JM. Inducible nitric oxide synthase (NOS-2) in subarachnoid hemorrhage: Regulatory mechanisms and therapeutic implications. Brain Circ 2016; 2:8-19. [PMID: 27774520 PMCID: PMC5074544 DOI: 10.4103/2394-8108.178541] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) typically carries a poor prognosis. Growing evidence indicates that overabundant production of nitric oxide (NO) may be responsible for a large part of the secondary injury that follows SAH. Although SAH modulates the activity of all three isoforms of nitric oxide synthase (NOS), the inducible isoform, NOS-2, accounts for a majority of NO-mediated secondary injuries after SAH. Here, we review the indispensable physiological roles of NO that must be preserved, even while attempting to downmodulate the pathophysiologic effects of NO that are induced by SAH. We examine the effects of SAH on the function of the various NOS isoforms, with a particular focus on the pathological effects of NOS-2 and on the mechanisms responsible for its transcriptional upregulation. Finally, we review interventions to block NOS-2 upregulation or to counteract its effects, with an emphasis on the potential therapeutic strategies to improve outcomes in patients afflicted with SAH. There is still much to be learned regarding the apparently maladaptive response of NOS-2 and its harmful product NO in SAH. However, the available evidence points to crucial effects that, on balance, are adverse, making the NOS-2/NO/peroxynitrite axis an attractive therapeutic target in SAH.
Collapse
Affiliation(s)
- Sana Iqbal
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Erik G Hayman
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Caron Hong
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Jesse A Stokum
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - David B Kurland
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Volodymyr Gerzanich
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - J Marc Simard
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA; Department of Pathology, School of Medicine, University of Maryland, Baltimore, Maryland, USA; Department of Physiology, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| |
Collapse
|
24
|
Kurland DB, Stokum J, Ivanov A, Gerzanich V, Simard JM. 159 Mitigating Microglial-Mediated Neuroinflammation. Neurosurgery 2015. [DOI: 10.1227/01.neu.0000467122.92580.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
25
|
Karimy JK, Kahle KT, Kurland DB, Yu E, Gerzanich V, Simard JM. A novel method to study cerebrospinal fluid dynamics in rats. J Neurosci Methods 2014; 241:78-84. [PMID: 25554415 DOI: 10.1016/j.jneumeth.2014.12.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/08/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) flow dynamics play critical roles in both the immature and adult brain, with implications for neurodevelopment and disease processes such as hydrocephalus and neurodegeneration. Remarkably, the only reported method to date for measuring CSF formation in laboratory rats is the indirect tracer dilution method (a.k.a., ventriculocisternal perfusion), which has limitations. NEW METHOD Anesthetized rats were mounted in a stereotaxic apparatus, both lateral ventricles were cannulated, and the Sylvian aqueduct was occluded. Fluid exited one ventricle at a rate equal to the rate of CSF formation plus the rate of infusion (if any) into the contralateral ventricle. Pharmacological agents infused at a constant known rate into the contralateral ventricle were tested for their effect on CSF formation in real-time. RESULTS The measured rate of CSF formation was increased by blockade of the Sylvian aqueduct but was not changed by increasing the outflow pressure (0-3cm of H2O). In male Wistar rats, CSF formation was age-dependent: 0.39±0.06, 0.74±0.05, 1.02±0.04 and 1.40±0.06μL/min at 8, 9, 10 and 12 weeks, respectively. CSF formation was reduced 57% by intraventricular infusion of the carbonic anhydrase inhibitor, acetazolamide. COMPARISON WITH EXISTING METHODS Tracer dilution methods do not permit ongoing real-time determination of the rate of CSF formation, are not readily amenable to pharmacological manipulations, and require critical assumptions. Direct measurement of CSF formation overcomes these limitations. CONCLUSIONS Direct measurement of CSF formation in rats is feasible. Our method should prove useful for studying CSF dynamics in normal physiology and disease models.
Collapse
Affiliation(s)
- Jason K Karimy
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kristopher T Kahle
- Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, United States; Department of Neurosurgery, Boston Children's Hospital, Boston, MA, United States
| | - David B Kurland
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Edward Yu
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Volodymyr Gerzanich
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, United States.
| |
Collapse
|
26
|
Stokum JA, Kurland DB, Gerzanich V, Simard JM. Mechanisms of astrocyte-mediated cerebral edema. Neurochem Res 2014; 40:317-28. [PMID: 24996934 DOI: 10.1007/s11064-014-1374-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/18/2014] [Accepted: 06/26/2014] [Indexed: 11/26/2022]
Abstract
Cerebral edema formation stems from disruption of blood brain barrier (BBB) integrity and occurs after injury to the CNS. Due to the restrictive skull, relatively small increases in brain volume can translate into impaired tissue perfusion and brain herniation. In excess, cerebral edema can be gravely harmful. Astrocytes are key participants in cerebral edema by virtue of their relationship with the cerebral vasculature, their unique compliment of solute and water transport proteins, and their general role in brain volume homeostasis. Following the discovery of aquaporins, passive conduits of water flow, aquaporin 4 (AQP4) was identified as the predominant astrocyte water channel. Normally, AQP4 is highly enriched at perivascular endfeet, the outermost layer of the BBB, whereas after injury, AQP4 expression disseminates to the entire astrocytic plasmalemma, a phenomenon termed dysregulation. Arguably, the most important role of AQP4 is to rapidly neutralize osmotic gradients generated by ionic transporters. In pathological conditions, AQP4 is believed to be intimately involved in the formation and clearance of cerebral edema. In this review, we discuss aquaporin function and localization in the BBB during health and injury, and we examine post-injury ionic events that modulate AQP4-dependent edema formation.
Collapse
Affiliation(s)
- Jesse A Stokum
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD, 21201-1595, USA
| | | | | | | |
Collapse
|
27
|
Tosun C, Koltz MT, Kurland DB, Ijaz H, Gurakar M, Schwartzbauer G, Coksaygan T, Ivanova S, Gerzanich V, Simard JM. The protective effect of glibenclamide in a model of hemorrhagic encephalopathy of prematurity. Brain Sci 2014; 3:215-38. [PMID: 23667741 PMCID: PMC3647482 DOI: 10.3390/brainsci3010215] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We studied a model of hemorrhagic encephalopathy of prematurity (EP) that closely recapitulates findings in humans with hemorrhagic EP. This model involves tandem insults of 20 min intrauterine ischemia (IUI) plus an episode of elevated venous pressure induced by intraperitoneal glycerol on post-natal day (P) 0. We examined Sur1 expression, which is upregulated after focal ischemia but has not been studied after brief global ischemia including IUI. We found that 20 min IUI resulted in robust upregulation of Sur1 in periventricular microvessels and tissues. We studied tandem insult pups from untreated or vehicle-treated dams (TI-CTR), and tandem insult pups from dams administered a low-dose, non-hypoglycemogenic infusion of the Sur1 blocker, glibenclamide, for 1 week after IUI (TI-GLIB). Compared to pups from the TI-CTR group, pups from the TI-GLIB group had significantly fewer and less severe hemorrhages on P1, performed significantly better on the beam walk and accelerating Rotarod on P35 and in tests of thigmotaxis and rapid learning on P35–49, and had significantly greater body and brain weights at P52. We conclude that low-dose glibenclamide administered to the mother at the end of pregnancy protects pups subjected to IUI from post-natal events of elevated venous pressure and its consequences.
Collapse
Affiliation(s)
- Cigdem Tosun
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (C.T.); (M.T.K.); (D.B.K.); (H.I.); (M.G.); (G.S.); (S.I.); (V.G.)
| | - Michael T. Koltz
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (C.T.); (M.T.K.); (D.B.K.); (H.I.); (M.G.); (G.S.); (S.I.); (V.G.)
| | - David B. Kurland
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (C.T.); (M.T.K.); (D.B.K.); (H.I.); (M.G.); (G.S.); (S.I.); (V.G.)
| | - Hina Ijaz
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (C.T.); (M.T.K.); (D.B.K.); (H.I.); (M.G.); (G.S.); (S.I.); (V.G.)
| | - Melda Gurakar
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (C.T.); (M.T.K.); (D.B.K.); (H.I.); (M.G.); (G.S.); (S.I.); (V.G.)
| | - Gary Schwartzbauer
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (C.T.); (M.T.K.); (D.B.K.); (H.I.); (M.G.); (G.S.); (S.I.); (V.G.)
| | - Turhan Coksaygan
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mail:
| | - Svetlana Ivanova
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (C.T.); (M.T.K.); (D.B.K.); (H.I.); (M.G.); (G.S.); (S.I.); (V.G.)
| | - Volodymyr Gerzanich
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (C.T.); (M.T.K.); (D.B.K.); (H.I.); (M.G.); (G.S.); (S.I.); (V.G.)
| | - J. Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (C.T.); (M.T.K.); (D.B.K.); (H.I.); (M.G.); (G.S.); (S.I.); (V.G.)
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mail:
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-410-328-0850; Fax: +1-410-328-0124
| |
Collapse
|
28
|
Hong CM, Tosun C, Kurland DB, Gerzanich V, Schreibman D, Simard JM. Biomarkers as outcome predictors in subarachnoid hemorrhage--a systematic review. Biomarkers 2014; 19:95-108. [PMID: 24499240 DOI: 10.3109/1354750x.2014.881418] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CONTEXT Subarachnoid hemorrhage (SAH) has a high fatality rate and many suffer from delayed neurological deficits. Biomarkers may aid in the identification of high-risk patients, guide treatment/management and improve outcome. OBJECTIVE The aim of this review was to summarize biomarkers of SAH associated with outcome. METHODS An electronic database query was completed, including an additional review of reference lists to include all potential human studies. RESULTS A total of 298 articles were identified; 112 were reviewed; 55 studies were included. CONCLUSION This review details biomarkers of SAH that correlate with outcome. It provides the basis for research investigating their possible translation into the management of SAH patients.
Collapse
Affiliation(s)
- Caron M Hong
- Department of Anesthesiology, Division of Critical Care Medicine
| | | | | | | | | | | |
Collapse
|
29
|
Kurland DB, Tosun C, Pampori A, Karimy JK, Caffes NM, Gerzanich V, Simard JM. Glibenclamide for the treatment of acute CNS injury. Pharmaceuticals (Basel) 2013; 6:1287-303. [PMID: 24275850 PMCID: PMC3817601 DOI: 10.3390/ph6101287] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/17/2013] [Accepted: 09/23/2013] [Indexed: 12/22/2022] Open
Abstract
First introduced into clinical practice in 1969, glibenclamide (US adopted name, glyburide) is known best for its use in the treatment of diabetes mellitus type 2, where it is used to promote the release of insulin by blocking pancreatic KATP [sulfonylurea receptor 1 (Sur1)-Kir6.2] channels. During the last decade, glibenclamide has received renewed attention due to its pleiotropic protective effects in acute CNS injury. Acting via inhibition of the recently characterized Sur1-Trpm4 channel (formerly, the Sur1-regulated NCCa-ATP channel) and, in some cases, via brain KATP channels, glibenclamide has been shown to be beneficial in several clinically relevant rodent models of ischemic and hemorrhagic stroke, traumatic brain injury, spinal cord injury, neonatal encephalopathy of prematurity, and metastatic brain tumor. Glibenclamide acts on microvessels to reduce edema formation and secondary hemorrhage, it inhibits necrotic cell death, it exerts potent anti-inflammatory effects and it promotes neurogenesis—all via inhibition of Sur1. Two clinical trials, one in TBI and one in stroke, currently are underway. These recent findings, which implicate Sur1 in a number of acute pathological conditions involving the CNS, present new opportunities to use glibenclamide, a well-known, safe pharmaceutical agent, for medical conditions that heretofore had few or no treatment options.
Collapse
Affiliation(s)
- David B. Kurland
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (D.B.K.); (C.T.); (A.P.); (J.K.K.); (N.M.C.); (V.G.)
| | - Cigdem Tosun
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (D.B.K.); (C.T.); (A.P.); (J.K.K.); (N.M.C.); (V.G.)
| | - Adam Pampori
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (D.B.K.); (C.T.); (A.P.); (J.K.K.); (N.M.C.); (V.G.)
| | - Jason K. Karimy
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (D.B.K.); (C.T.); (A.P.); (J.K.K.); (N.M.C.); (V.G.)
| | - Nicholas M. Caffes
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (D.B.K.); (C.T.); (A.P.); (J.K.K.); (N.M.C.); (V.G.)
| | - Volodymyr Gerzanich
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (D.B.K.); (C.T.); (A.P.); (J.K.K.); (N.M.C.); (V.G.)
| | - J. Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: (D.B.K.); (C.T.); (A.P.); (J.K.K.); (N.M.C.); (V.G.)
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-410-328-0850; Fax: +1-410-328-0124
| |
Collapse
|
30
|
Tosun C, Kurland DB, Mehta R, Castellani RJ, deJong JL, Kwon MS, Woo SK, Gerzanich V, Simard JM. Inhibition of the Sur1-Trpm4 channel reduces neuroinflammation and cognitive impairment in subarachnoid hemorrhage. Stroke 2013; 44:3522-8. [PMID: 24114458 DOI: 10.1161/strokeaha.113.002904] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Subarachnoid hemorrhage (SAH) can leave patients with memory impairments that may not recover fully. Molecular mechanisms are poorly understood, and no treatment is available. The sulfonylurea receptor 1-transient receptor potential melastatin 4 (Sur1-Trpm4) channel plays an important role in acute central nervous system injury. We evaluated upregulation of Sur1-Trpm4 in humans with SAH and, in rat models of SAH, we examined Sur1-Trpm4 upregulation, its role in barrier dysfunction and neuroinflammation, and its consequences on spatial learning. METHODS We used Förster resonance energy transfer to detect coassociated Sur1 and Trpm4 in human autopsy brains with SAH. We studied rat models of SAH involving filament puncture of the internal carotid artery or injection of blood into the subarachnoid space of the entorhinal cortex. In rats, we used Förster resonance energy transfer and coimmunoprecipitation to detect coassociated Sur1 and Trpm4, we measured immunoglobulin G extravasation and tumor necrosis α overexpression as measures of barrier dysfunction and neuroinflammation, and we assessed spatial learning and memory on days 7 to 19. RESULTS Sur1-Trpm4 channels were upregulated in humans and rats with SAH. In rats, inhibiting Sur1 using antisense or the selective Sur1 inhibitor glibenclamide reduced SAH-induced immunoglobulin G extravasation and tumor necrosis α overexpression. In models with entorhinal SAH, rats treated with glibenclamide for 7 days after SAH exhibited better platform search strategies and better performance on incremental and rapid spatial learning than vehicle-treated controls. CONCLUSIONS Sur1-Trpm4 channels are upregulated in humans and rats with SAH. Channel inhibition with glibenclamide may reduce neuroinflammation and the severity of cognitive deficits after SAH.
Collapse
Affiliation(s)
- Cigdem Tosun
- From the Departments of Neurosurgery (C.T., D.B.K., M.S.K., S.K.W., V.G., J.M.S.), Pathology (R.M., R.J.C., J.M.S.), and Physiology (J.M.S.), University of Maryland School of Medicine, Baltimore; and Department of Pathology, Western Michigan University School of Medicine, Kalamazoo, MI (J.L.d.J.)
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Kurland DB, Gerzanich V, Simard JM. 191 Heme Induces Microglial CXCL2 Release-A Mechanism of Neutrophil-Mediated Injury After Intracerebral Hemorrhage. Neurosurgery 2013. [DOI: 10.1227/01.neu.0000432781.74094.ab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
32
|
Simard JM, Tosun C, Ivanova S, Kurland DB, Hong C, Radecki L, Gisriel C, Mehta R, Schreibman D, Gerzanich V. Heparin reduces neuroinflammation and transsynaptic neuronal apoptosis in a model of subarachnoid hemorrhage. Transl Stroke Res 2012; 3:155-65. [PMID: 22707992 PMCID: PMC3372778 DOI: 10.1007/s12975-012-0166-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/27/2012] [Accepted: 03/29/2012] [Indexed: 01/01/2023]
Abstract
Subarachnoid hemorrhage (SAH) can lead to disabling motor, cognitive, and neuropsychological abnormalities. Part of the secondary injury to cerebral tissues associated with SAH is attributable to the neuroinflammatory response induced by blood. Heparin is a pleiotropic compound that reduces inflammatory responses in conditions outside the central nervous system. Using a model of SAH devoid of global insult, we evaluated the effect of delayed intravenous (IV) infusion of heparin, at a dose that does not produce therapeutic anticoagulation, on neuroinflammation, myelin preservation, and apoptosis. Adult male rats underwent bilateral stereotactic injections of autologous blood (50 μL) into the subarachnoid space of the entorhinal cortex. The rats were implanted with mini-osmotic pumps that delivered either vehicle or unfractionated heparin (10 U/kg/h IV) beginning 12 h after SAH. No mechanical or hemorrhagic injury was observed in the hippocampus. In vehicle controls assessed at 48 h, SAH was associated with robust neuroinflammation in the adjacent cortex [neutrophils, activated phagocytic microglia, nuclear factor-kappa B, tumor necrosis factor-alpha, and interleukin-1beta] and neurodegeneration (Fluoro-Jade C staining and loss of NeuN). In the hippocampus, a muted neuroinflammatory response was indicated by Iba1-positive, ED1-negative microglia exhibiting an activated morphology. The perforant pathway showed Fluoro-Jade C staining and demyelination, and granule cells of the dentate gyrus had pyknotic nuclei, labeled with Fluoro-Jade C and showed upregulation of cleaved caspase-3, consistent with transsynaptic apoptosis. Administration of heparin significantly reduced neuroinflammation, demyelination, and transsynaptic apoptosis. We conclude that delayed IV infusion of low-dose unfractionated heparin may attenuate adverse neuroinflammatory effects of SAH.
Collapse
Affiliation(s)
- J. Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD 21201-1595 USA
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD USA
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD USA
| | - Cigdem Tosun
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD 21201-1595 USA
| | - Svetlana Ivanova
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD 21201-1595 USA
| | - David B. Kurland
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD 21201-1595 USA
| | - Caron Hong
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD USA
| | - Leanne Radecki
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD 21201-1595 USA
| | - Carter Gisriel
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD 21201-1595 USA
| | - Rupal Mehta
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD USA
| | - David Schreibman
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD USA
| | - Volodymyr Gerzanich
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD 21201-1595 USA
| |
Collapse
|
33
|
Koltz MT, Tosun C, Kurland DB, Coksaygan T, Castellani RJ, Ivanova S, Gerzanich V, Simard JM. Tandem insults of prenatal ischemia plus postnatal raised intrathoracic pressure in a novel rat model of encephalopathy of prematurity. J Neurosurg Pediatr 2011; 8:628-39. [PMID: 22132923 PMCID: PMC3465975 DOI: 10.3171/2011.9.peds11174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Encephalopathy of prematurity (EP) is common in preterm, low birth weight infants who require postnatal mechanical ventilation. The worst types of EP are the hemorrhagic forms, including choroid plexus, germinal matrix, periventricular, and intraventricular hemorrhages. Survivors exhibit life-long cognitive, behavioral, and motor abnormalities. Available preclinical models do not fully recapitulate the salient features of hemorrhagic EP encountered in humans. In this study, the authors evaluated a novel model using rats that featured tandem insults of transient prenatal intrauterine ischemia (IUI) plus transient postnatal raised intrathoracic pressure (RIP). METHODS Timed-pregnant Wistar rats were anesthetized and underwent laparotomy on embryonic Day 19. Intrauterine ischemia was induced by clamping the uterine and ovarian vasculature for 20 minutes. Natural birth occurred on embryonic Day 22. Six hours after birth, the pups were subjected to an episode of RIP, induced by injecting glycerol (50%, 13 μl/g intraperitoneally). Control groups included naive, sham surgery, and IUI alone. Pathological, histological, and behavioral analyses were performed on pups up to postnatal Day 52. RESULTS Compared with controls, pups subjected to IUI+RIP exhibited significant increases in postnatal mortality and hemorrhages in the choroid plexus, germinal matrix, and periventricular tissues as well as intraventricularly. On postnatal Days 35-52, they exhibited significant abnormalities involving complex vestibulomotor function and rapid spatial learning. On postnatal Day 52, the brain and body mass were significantly reduced. CONCLUSIONS Tandem insults of IUI plus postnatal RIP recapitulate many features of the hemorrhagic forms of EP found in humans, suggesting that these insults in combination may play important roles in pathogenesis.
Collapse
Affiliation(s)
- Michael T. Koltz
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cigdem Tosun
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David B. Kurland
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Turhan Coksaygan
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rudolph J. Castellani
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Svetlana Ivanova
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Volodymyr Gerzanich
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - J. Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland,Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland,Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
34
|
Abstract
Lower and upper limb lengths and total height can be predicted by the multiplier method. The multiplier is a coefficient that corresponds to each age and gender. The coefficient for any age can be multiplied by the length at that age to give the length at skeletal maturity. Our purpose was to calculate foot length multipliers and determine whether they are independent of percentile, much like the multipliers for lower and upper limb lengths and total height. Foot length multipliers were calculated from 3 separate previously published databases of foot length in children. The multipliers were calculated by dividing foot length at maturity by foot length at each respective age for each percentile and for both genders. The multiplier values for each percentile group at each age were found to be relatively equivalent, with little variability (as was found for the validated multipliers for lower limb length and total height). Also, little variability was found among multipliers calculated from different databases. In addition, we compared foot length multipliers with lower limb, upper limb, and total height multipliers. Compared with lower limb (tibial and femoral) multipliers, the foot length multipliers were significantly different because the foot achieves a higher percentage of maturity length earlier than does the femur or tibia. Because prediction of limb length and limb length discrepancy can be achieved accurately by using the lower limb multiplier, it is also likely that the foot length multiplier can be used to predict foot length and foot length discrepancy at maturity.
Collapse
Affiliation(s)
- Bradley M Lamm
- Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, MD 21215, USA
| | | | | | | | | |
Collapse
|
35
|
Abstract
To date, the only way to predict adult height in achondroplastic dwarves has been to consult a growth chart. The purpose of this study was to ascertain whether the multiplier method of predicting adult height at skeletal maturity in healthy persons can be applied to persons with achondroplasia. Previous studies have shown that the multiplier method can be applied to lower limb length, upper limb length, total height, foot length, and foot height. It is therefore reasonable to suggest that the growth pattern for total height in achondroplastic dwarves might also be characterized by a multiplier. Total height multipliers for achondroplastic dwarves ("achondroplasia height multipliers") were calculated from two separate databases by dividing height at maturity by height at each respective age for both genders. Little variability was found among multipliers for each age and among multipliers calculated from different databases. Upper torso (sitting height) multipliers and lower limb multipliers were also derived for achondroplastic dwarves. Lower limb and total height growth rates were slower in achondroplastic dwarves compared with healthy persons. However, sitting height multipliers for achondroplastic dwarves were closely related to sitting height multipliers for healthy persons. Because these findings showed that the multiplier values were independent of population and percentile, the multiplier method may be a valid method for quickly predicting height at any age for achondroplastic dwarves.
Collapse
Affiliation(s)
- Dror Paley
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA.
| | | | | | | | | |
Collapse
|