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Werner MT, Yeoh D, Fastenberg JH, Chaskes MB, Pollack AZ, Boockvar JA, Langer DJ, D’Amico RS, Ellis JA, Miles BA, Tong CCL. Reconstruction of the Anterior Skull Base Using the Nasoseptal Flap: A Review. Cancers (Basel) 2023; 16:169. [PMID: 38201596 PMCID: PMC10778443 DOI: 10.3390/cancers16010169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/17/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
The nasoseptal flap is a workhorse reconstructive option for anterior skull base defects during endonasal surgery. This paper highlights the versatility of the nasoseptal flap. After providing a brief historical perspective, this review will focus on the relevant primary literature published in the last ten years. We will touch upon new applications of the flap, how the flap has been modified to expand its reach and robustness, and some of the current limitations. We will conclude by discussing what the future holds for improving upon the design and use of the nasoseptal flap in anterior skull base reconstruction.
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Affiliation(s)
- Michael T. Werner
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Desmond Yeoh
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Judd H. Fastenberg
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Mark B. Chaskes
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Aron Z. Pollack
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - John A. Boockvar
- Department of Neurosurgery, Northwell Health System, New York, NY 11042, USA; (J.A.B.); (D.J.L.); (R.S.D.); (J.A.E.)
| | - David J. Langer
- Department of Neurosurgery, Northwell Health System, New York, NY 11042, USA; (J.A.B.); (D.J.L.); (R.S.D.); (J.A.E.)
| | - Randy S. D’Amico
- Department of Neurosurgery, Northwell Health System, New York, NY 11042, USA; (J.A.B.); (D.J.L.); (R.S.D.); (J.A.E.)
| | - Jason A. Ellis
- Department of Neurosurgery, Northwell Health System, New York, NY 11042, USA; (J.A.B.); (D.J.L.); (R.S.D.); (J.A.E.)
| | - Brett A. Miles
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Charles C. L. Tong
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
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San A, Rahman RK, Sanmugananthan P, Dubé MD, Panico N, Ariwodo O, Shah V, D’Amico RS. Health-Related Quality of Life Outcomes in Meningioma Patients Based upon Tumor Location and Treatment Modality: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4680. [PMID: 37835374 PMCID: PMC10571784 DOI: 10.3390/cancers15194680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Patients with meningiomas may have reduced health-related quality of life (HRQoL) due to postoperative neurological deficits, cognitive dysfunction, and psychosocial burden. Although advances in surgery and radiotherapy have improved progression-free survival rates, there is limited evidence regarding treatment outcomes on HRQoL. This review examines HRQoL outcomes based on tumor location and treatment modality. A systematic search in PubMed yielded 28 studies with 3167 patients. The mean age was 54.27 years and most patients were female (70.8%). Approximately 78% of meningiomas were located in the skull base (10.8% anterior, 23.3% middle, and 39.7% posterior fossae). Treatment modalities included craniotomy (73.6%), radiotherapy (11.4%), and endoscopic endonasal approach (EEA) (4.0%). The Karnofsky Performance Scale (KPS) was the most commonly utilized HRQoL instrument (27%). Preoperative KPS scores > 80 were associated with increased occurrence of postoperative neurological deficits. A significant difference was found between pre- and post-operative KPS scores for anterior/middle skull base meningiomas (SBMs) in comparison to posterior (SBMs) when treated with craniotomy. Post-craniotomy SF-36 scores were lower for posterior SBMs in comparison to those in the anterior and middle fossae. Risk factors for poor neurological outcomes include a high preoperative KPS score and patients with posterior SBMs may experience a greater burden in HRQoL.
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Affiliation(s)
- Ali San
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA
| | - Raphia K. Rahman
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, CA 92501, USA
| | | | | | - Nicholas Panico
- Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Ogechukwu Ariwodo
- Philadelphia College of Osteopathic Medicine, Moultrie, GA 31768, USA
| | - Vidur Shah
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA
| | - Randy S. D’Amico
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY 11030, USA;
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Barrington NM, Gupta N, Musmar B, Doyle D, Panico N, Godbole N, Reardon T, D’Amico RS. A Bibliometric Analysis of the Rise of ChatGPT in Medical Research. Med Sci (Basel) 2023; 11:61. [PMID: 37755165 PMCID: PMC10535733 DOI: 10.3390/medsci11030061] [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: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
The rapid emergence of publicly accessible artificial intelligence platforms such as large language models (LLMs) has led to an equally rapid increase in articles exploring their potential benefits and risks. We performed a bibliometric analysis of ChatGPT literature in medicine and science to better understand publication trends and knowledge gaps. Following title, abstract, and keyword searches of PubMed, Embase, Scopus, and Web of Science databases for ChatGPT articles published in the medical field, articles were screened for inclusion and exclusion criteria. Data were extracted from included articles, with citation counts obtained from PubMed and journal metrics obtained from Clarivate Journal Citation Reports. After screening, 267 articles were included in the study, most of which were editorials or correspondence with an average of 7.5 +/- 18.4 citations per publication. Published articles on ChatGPT were authored largely in the United States, India, and China. The topics discussed included use and accuracy of ChatGPT in research, medical education, and patient counseling. Among non-surgical specialties, radiology published the most ChatGPT-related articles, while plastic surgery published the most articles among surgical specialties. The average citation number among the top 20 most-cited articles was 60.1 +/- 35.3. Among journals with the most ChatGPT-related publications, there were on average 10 +/- 3.7 publications. Our results suggest that managing the inevitable ethical and safety issues that arise with the implementation of LLMs will require further research exploring the capabilities and accuracy of ChatGPT, to generate policies guiding the adoption of artificial intelligence in medicine and science.
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Affiliation(s)
- Nikki M. Barrington
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL 60064, USA
| | - Nithin Gupta
- School of Osteopathic Medicine, Campbell University, Lillington, NC 27546, USA
| | - Basel Musmar
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus P.O. Box 7, West Bank, Palestine
| | - David Doyle
- Central Michigan College of Medicine, Mount Pleasant, MI 48858, USA
| | - Nicholas Panico
- Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Nikhil Godbole
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Taylor Reardon
- Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Randy S. D’Amico
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY 10075, USA
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Tabor JK, Onoichenco A, Narayan V, Wernicke AG, D’Amico RS, Vojnic M. Brain metastasis screening in the molecular age. Neurooncol Adv 2023; 5:vdad080. [PMID: 37484759 PMCID: PMC10358433 DOI: 10.1093/noajnl/vdad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
The incidence of brain metastases (BM) amongst cancer patients has been increasing due to improvements in therapeutic options and an increase in overall survival. Molecular characterization of tumors has provided insights into the biology and oncogenic drivers of BM and molecular subtype-based screening. Though there are currently some screening and surveillance guidelines for BM, they remain limited. In this comprehensive review, we review and present epidemiological data on BM, their molecular characterization, and current screening guidelines. The molecular subtypes with the highest BM incidence are epithelial growth factor receptor-mutated non-small cell lung cancer (NSCLC), BRCA1, triple-negative (TN), and HER2+ breast cancers, and BRAF-mutated melanoma. Furthermore, BMs are more likely to present asymptomatically at diagnosis in oncogene-addicted NSCLC and BRAF-mutated melanoma. European screening standards recommend more frequent screening for oncogene-addicted NSCLC patients, and clinical trials are investigating screening for BM in hormone receptor+, HER2+, and TN breast cancers. However, more work is needed to determine optimal screening guidelines for other primary cancer molecular subtypes. With the advent of personalized medicine, molecular characterization of tumors has revolutionized the landscape of cancer treatment and prognostication. Incorporating molecular characterization into BM screening guidelines may allow physicians to better identify patients at high risk for BM development and improve patient outcomes.
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Affiliation(s)
| | | | - Vinayak Narayan
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - A Gabriella Wernicke
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Randy S D’Amico
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Morana Vojnic
- Corresponding Author: Morana Vojnic, MD, MBA, 210 East 64th Street, Floor 4, New York, NY 10065, USA ()
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5
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Shah HA, Mehta NH, Saleem MI, D’Amico RS. Connecting the connectome: A bibliometric investigation of the 50 most cited articles. Clin Neurol Neurosurg 2022; 223:107481. [DOI: 10.1016/j.clineuro.2022.107481] [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: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022]
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Shah HA, Leskinen S, Khilji H, Narayan V, Ben-Shalom N, D’Amico RS. Utility of 5-ALA for fluorescence-guided resection of brain metastases: a systematic review. J Neurooncol 2022; 160:669-675. [DOI: 10.1007/s11060-022-04188-0] [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: 10/09/2022] [Accepted: 11/01/2022] [Indexed: 11/14/2022]
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Immidisetti AV, Rosenberg AE, Katz J, Shlifer A, Ellis J, Ortiz RA, Boockvar JA, D’Amico RS, Langer DJ. BRAINterns 2.0: Durability of Webinar-Based Education and Social Media Beyond the Coronavirus Disease 2019 Pandemic. World Neurosurg 2022; 167:e79-e99. [PMID: 36028103 PMCID: PMC9398549 DOI: 10.1016/j.wneu.2022.07.146] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Webinars offer novel educational opportunities beyond those of traditional, in-person experiences. BRAINterns is an open-access webinar-based education platform created to replace opportunities lost during the coronavirus disease 2019 pandemic. This program previously showed the efficacy of webinars to expand access to careers in medicine, and in particular, neurosurgery. BRAINterns 2.0 was established to assess the durability of Web-based learning. METHODS A modified 4-week webinar series was held during July 2021. A retrospective exit survey was distributed to participants and responses analyzed. RESULTS A total of 16,045 people registered for BRAINterns 2.0, representing 103 countries. Survey responses were received from 3765 participants (23% response rate). New, first-time registrants comprised 66% of participants, with the rest being returning participants. A total of 342 students participated in a dedicated module delivered entirely in Spanish. Females represented 81% of respondents. Participants identified that desirable elements of the program were opportunities to hear from women (53%) and people of color (44%) in health care. Participants heard about the series through TikTok (n = 1251; 33%), Instagram (n = 1109; 29%), Facebook (n = 637; 17%), and word of mouth (n = 708; 19%) with assistance from an ambassador program. CONCLUSIONS Webinar-based education programs continue to be of interest to students in an increasingly digital world. Social media, and specifically the use of educational ambassadors, are effective to improve visibility of educational programs across a diverse population of students. Understanding the desires of participants is critical to building a successful online education platform.
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Affiliation(s)
- Amanda V. Immidisetti
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Ashley E. Rosenberg
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York, USA
| | - Joshua Katz
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Artur Shlifer
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York, USA
| | - Jason Ellis
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York, USA
| | - Rafael A. Ortiz
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York, USA
| | - John A. Boockvar
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York, USA
| | - Randy S. D’Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York, USA,To whom correspondence should be addressed: Randy S. D’Amico, M.D
| | - David J. Langer
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York, USA
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Olmsted ZT, Ryu B, Phayal G, Green R, Lo SF, Sciubba DM, Silverstein JW, D’Amico RS. D-wave intraoperative neuromonitoring for spinal tumor resection: a focused review. World Neurosurg X 2022; 17:100139. [PMID: 36217537 PMCID: PMC9547300 DOI: 10.1016/j.wnsx.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022] Open
Abstract
At present, surgical resection of primary intramedullary spinal cord tumors is the mainstay of treatment. However, given the dimensional constraints of the narrow spinal canal and dense organization of the ascending and descending tracts, intramedullary spinal cord tumor resection carries a significant risk of iatrogenic neurological injury. Intraoperative neurophysiological monitoring (IONM) and mapping techniques have been developed to evaluate the functional integrity of the essential neural pathways and optimize the surgical strategies. IONM can also inform on impending harm to at-risk structures and can correlate with postoperative functional recovery if damage has occurred. Direct waves (D-waves) will provide immediate feedback on the integrity of the lateral corticospinal tract. In the present review, we have provided an update on the utility of D-waves for spinal cord tumor resection. We have highlighted the neuroanatomical and neurophysiological insights from the use of D-wave monitoring, the technical considerations and limitations of the D-wave technique, and multimodal co-monitoring with motor-evoked potentials and somatosensory-evoked potentials. Together with motor-evoked potentials, D-waves can help to guide the extent of tumor resection and provide intraoperative warning signs and alarm criteria to direct the surgical strategy. D-waves can also serve as prognostic biomarkers for long-term recovery of postoperative motor function. We propose that the use of D-wave IONM can contribute key findings for clinical decision-making during spinal cord tumor resection.
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Doron O, D’Amico RS, Langer DJ. The Cranial Window: Opportunities for the Use of Bedside Ultrasound Facilitated by Sonolucent Implants in Neurosurgical Patients. World Neurosurg 2022; 165:142-144. [DOI: 10.1016/j.wneu.2022.05.084] [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: 11/15/2022]
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10
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Abrams M, Reichman N, Khatri D, Patel NV, D’Amico RS, Wong T, Fralin S, Li M, Symons M, Langer D, Filippi CG, Boockvar JA. Update on glioma biotechnology. Clin Neurol Neurosurg 2020; 195:106075. [DOI: 10.1016/j.clineuro.2020.106075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/28/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
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11
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D’Amico RS, Neira JA, Yun J, Alexiades NG, Banu M, Englander ZK, Kennedy BC, Ung TH, Rothrock RJ, Romanov A, Guo X, Zhao B, Sonabend AM, Canoll P, Bruce JN. Validation of an effective implantable pump-infusion system for chronic convection-enhanced delivery of intracerebral topotecan in a large animal model. J Neurosurg 2019; 133:1-10. [PMID: 31374547 PMCID: PMC7227320 DOI: 10.3171/2019.3.jns1963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/25/2019] [Accepted: 03/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracerebral convection-enhanced delivery (CED) has been limited to short durations due to a reliance on externalized catheters. Preclinical studies investigating topotecan (TPT) CED for glioma have suggested that prolonged infusion improves survival. Internalized pump-catheter systems may facilitate chronic infusion. The authors describe the safety and utility of long-term TPT CED in a porcine model and correlation of drug distribution through coinfusion of gadolinium. METHODS Fully internalized CED pump-catheter systems were implanted in 12 pigs. Infusion algorithms featuring variable infusion schedules, flow rates, and concentrations of a mixture of TPT and gadolinium were characterized over increasing intervals from 4 to 32 days. Therapy distribution was measured using gadolinium signal on MRI as a surrogate. A 9-point neurobehavioral scale (NBS) was used to identify side effects. RESULTS All animals tolerated infusion without serious adverse events. The average NBS score was 8.99. The average maximum volume of distribution (Vdmax) in chronically infused animals was 11.30 mL and represented 32.73% of the ipsilateral cerebral hemispheric volume. Vdmax was achieved early during infusions and remained relatively stable despite a slight decline as the infusion reached steady state. Novel tissue TPT concentrations measured by liquid chromatography mass spectroscopy correlated with gadolinium signal intensity on MRI (p = 0.0078). CONCLUSIONS Prolonged TPT-gadolinium CED via an internalized system is safe and well tolerated and can achieve a large Vdmax, as well as maintain a stable Vd for up to 32 days. Gadolinium provides an identifiable surrogate for measuring drug distribution. Extended CED is potentially a broadly applicable and safe therapeutic option in select patients.
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Affiliation(s)
- Randy S. D’Amico
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Justin A. Neira
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Jonathan Yun
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Nikita G. Alexiades
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Matei Banu
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Zachary K. Englander
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Benjamin C. Kennedy
- Division of Neurosurgery, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy H. Ung
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Robert J. Rothrock
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Alexander Romanov
- Institute of Comparative Medicine, Columbia University Medical Center, New York, New York
| | - Xiaotao Guo
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Adam M. Sonabend
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Peter Canoll
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Jeffrey N. Bruce
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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D’Amico RS, Englander ZK, Canoll P, Bruce JN. Extent of Resection in Glioma–A Review of the Cutting Edge. World Neurosurg 2017; 103:538-549. [DOI: 10.1016/j.wneu.2017.04.041] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 11/29/2022]
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13
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Bowden SG, Neira JA, Gill BJA, Ung TH, Englander ZK, Zanazzi G, Chang PD, Samanamud J, Grinband J, Sheth SA, McKhann GM, Sisti MB, Canoll P, D’Amico RS, Bruce JN. Sodium Fluorescein Facilitates Guided Sampling of Diagnostic Tumor Tissue in Nonenhancing Gliomas. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx271] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Accurate tissue sampling in nonenhancing (NE) gliomas is a unique surgical challenge due to their intratumoral histological heterogeneity and absence of contrast enhancement as a guide for intraoperative stereotactic guidance. Instead, T2/fluid-attenuated inversion-recovery (FLAIR) hyperintensity on MRI is commonly used as an imaging surrogate for pathological tissue, but sampling from this region can yield nondiagnostic or underdiagnostic brain tissue. Sodium fluorescein is an intraoperative fluorescent dye that has a high predictive value for tumor identification in areas of contrast enhancement and NE in glioblastomas. However, the underlying histopathological alterations in fluorescent regions of NE gliomas remain undefined.
OBJECTIVE
To evaluate whether fluorescein can identify diagnostic tissue and differentiate regions with higher malignant potential during surgery for NE gliomas, thus improving sampling accuracy.
METHODS
Thirteen patients who presented with NE, T2/FLAIR hyperintense lesions suspicious for glioma received fluorescein (10%, 3 mg/kg intravenously) during surgical resection.
RESULTS
Patchy fluorescence was identified within the T2/FLAIR hyperintense area in 10 of 13 (77%) patients. Samples taken from fluorescent regions were more likely to demonstrate diagnostic glioma tissue and cytologic atypia (P < .05). Fluorescein demonstrated a 95% positive predictive value for the presence of diagnostic tissue. Samples from areas of fluorescence also demonstrated greater total cell density and higher Ki-67 labeling than nonfluorescent biopsies (P < .05).
CONCLUSION
Fluorescence in NE gliomas is highly predictive of diagnostic tumor tissue and regions of higher cell density and proliferative activity.
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Affiliation(s)
- Stephen G Bowden
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Justin A Neira
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Brian J A Gill
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Timothy H Ung
- Department of Neurological Surgery, University of Colorado, Aurora, Colorado
| | - Zachary K Englander
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
| | - George Zanazzi
- Department of Pathology and Cell Biology, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Peter D Chang
- Department of Radiology, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Jorge Samanamud
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Jack Grinband
- Department of Radiology, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Sameer A Sheth
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Guy M McKhann
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Michael B Sisti
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Peter Canoll
- Department of Pathology and Cell Biology, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Randy S D’Amico
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
| | - Jeffrey N Bruce
- Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York
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