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Bennett KH, Khor BY, Hughes S, Patel AJ. A multi-lesional analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a single-centre analysis. Clin Radiol 2024; 79:413-419. [PMID: 38378386 DOI: 10.1016/j.crad.2024.01.036] [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: 05/06/2023] [Revised: 11/10/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
AIM To conduct a multi-lesional computed tomography (CT) analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) patients to determine volumetric changes in lesions over 5 years. MATERIALS AND METHODS A retrospective case-note review was undertaken to identify 16 patients with histological and radiological features of DIPNECH between 2012-2021. Area and volume were calculated for 17 sets of lesions identified on high-resolution CT. Clinical data were extracted from electronic patient records, which included demographic data, outpatient clinic letters, histology reports, and imaging reports. RESULTS One hundred and twenty-eight lesions were identified in 16 patients (one male, 15 female) and followed-up annually over a median 1,985 days (range 1,450-2,290). At year 1 follow-up, lesion area ranged from 1-48 mm2, and lesion volume ranged from 8-18,380 mm3; lesion area ranged from 1-45mm2 and lesion volume ranged from 11-17,800 mm3 and year 5. Half (8/16) of the patients had concomitant typical carcinoid tumours and one patient had an atypical carcinoid tumour. No statistically significant correlation (p<0.05) was found between lesion cross-sectional area or volume and duration of follow-up (years and days). No metastatic spread was observed at the time of analysis. CONCLUSIONS No significant increase was observed in the size of over 100 lesions in patients with DIPNECH over a 5-year period and no metastasis occurred during the study period affirming the relatively indolent course of the disease.
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Affiliation(s)
- K H Bennett
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - B Y Khor
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - S Hughes
- Department of Nuclear Medicine and Radiology, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - A J Patel
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK; Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Reyes G, Patel AJ. In Reply: Firearm-Related Traumatic Brain Injuries in Adults: A Scoping Review. Neurosurgery 2024:00006123-990000000-01144. [PMID: 38661376 DOI: 10.1227/neu.0000000000002969] [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] [Received: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Gabriel Reyes
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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Ng PR, Yearley AG, Eatz TA, Ajmera S, West T, Razak SS, Lazaro T, Urakov T, Jones PS, Coumans JV, Stapleton CJ, Shankar G, Chen HI, Komotar RJ, Patel AJ, Nahed BV. Neurological Surgery Residency Programs in the United States: A National Cross-Sectional Survey. Neurosurgery 2024; 94:529-537. [PMID: 37795983 DOI: 10.1227/neu.0000000000002703] [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: 03/30/2023] [Accepted: 08/04/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education has approved 117 neurological surgery residency programs which develop and educate neurosurgical trainees. We present the current landscape of neurosurgical training in the United States by examining multiple aspects of neurological surgery residencies in the 2022-2023 academic year and investigate the impact of program structure on resident academic productivity. METHODS Demographic data were collected from publicly available websites and reports from the National Resident Match Program. A 34-question survey was circulated by e-mail to program directors to assess multiple features of neurological surgery residency programs, including curricular structure, fellowship availability, recent program changes, graduation requirements, and resources supporting career development. Mean resident productivity by program was collected from the literature. RESULTS Across all 117 programs, there was a median of 2.0 (range 1.0-4.0) resident positions per year and 1.0 (range 0.0-2.0) research/elective years. Programs offered a median of 1.0 (range 0.0-7.0) Committee on Advanced Subspecialty Training-accredited fellowships, with endovascular fellowships being most frequently offered (53.8%). The survey response rate was 75/117 (64.1%). Of survey respondents, the median number of clinical sites was 3.0 (range 1.0-6.0). Almost half of programs surveyed (46.7%) reported funding mechanisms for residents, including R25, T32, and other in-house grants. Residents received a median academic stipend of $1000 (range $0-$10 000) per year. Nearly all programs (93.3%) supported wellness activities for residents, which most frequently occurred quarterly (46.7%). Annual academic stipend size was the only significant predictor of resident academic productivity (R 2 = 0.17, P = .002). CONCLUSION Neurological surgery residency programs successfully train the next generation of neurosurgeons focusing on education, clinical training, case numbers, and milestones. These programs offer trainees the chance to tailor their career trajectories within residency, creating a rewarding and personalized experience that aligns with their career aspirations.
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Affiliation(s)
- Patrick R Ng
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Alexander G Yearley
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Tiffany A Eatz
- Department of Neurological Surgery, University of Miami, Miami , Florida , USA
| | - Sonia Ajmera
- Department of Neurological Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia , Pennsylvania , USA
| | - Timothy West
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Shahaan S Razak
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Tyler Lazaro
- Department of Neurological Surgery, Baylor College of Medicine, Houston , Texas , USA
| | - Timur Urakov
- Department of Neurological Surgery, University of Miami, Miami , Florida , USA
| | - Pamela S Jones
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Jean-Valery Coumans
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Christopher J Stapleton
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Ganesh Shankar
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - H Isaac Chen
- Department of Neurological Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia , Pennsylvania , USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami , Florida , USA
| | - Akash J Patel
- Department of Neurological Surgery, Baylor College of Medicine, Houston , Texas , USA
| | - Brian V Nahed
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
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4
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Harmanci AS, Boudreau B, Lau S, Hosseingholi Nouri S, Mandel JJ, Lu HC, Harmanci AO, Klisch TJ, Levine JM, Patel AJ. Aggressive human MenG C meningiomas have a molecular counterpart in canines. Acta Neuropathol 2024; 147:42. [PMID: 38376654 DOI: 10.1007/s00401-024-02692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Akdes S Harmanci
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Center for Cancer Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Beth Boudreau
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Sean Lau
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Jacob J Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Hsiang-Chih Lu
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Arif O Harmanci
- Center for Secure Artificial Intelligence For hEalthcare (SAFE), Center for Precision Health, D. Bradley McWilliams School of Biomedical Informatics, University of Texas Health Science Center Houston, Houston, TX, USA
| | - Tiemo J Klisch
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA.
| | - Jonathan M Levine
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- Center for Cancer Neuroscience, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA.
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
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5
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Reyes G, Gadot R, Ouellette L, Nouri SH, Gopinath SP, Patel AJ. Firearm-Related Traumatic Brain Injuries in Adults: A Scoping Review. Neurosurgery 2024; 94:229-239. [PMID: 37878414 DOI: 10.1227/neu.0000000000002734] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Firearm-related traumatic brain injury (TBI) has emerged as a significant public health issue in the United States, coinciding with a rapid increase in gun-related deaths. This scoping review aims to update our understanding of firearm-related TBI in adult populations. METHODS A comprehensive search of 6 online databases yielded 22 studies that met the inclusion criteria. The reviewed studies predominantly focused on young adult men who were victims of assault, although other vulnerable populations were also affected. RESULTS Key factors in evaluating patients with firearm-related TBI included low Glasgow Coma Scale scores, central nervous system involvement, hypotension, and coagulopathies at presentation. Poor outcomes in firearm-related TBIs were influenced by various factors, including the location and trajectory of the gunshot wound, hypercoagulability, hemodynamic instability, insurance status, and specific clinical findings at hospital admission. CONCLUSION Proposed interventions aimed to reduce the incidence and mortality of penetrating TBIs, including medical interventions such as coagulopathy reversal and changes to prehospital stabilization procedures. However, further research is needed to demonstrate the effectiveness of these interventions. The findings of this scoping review hope to inform future policy research, advocacy efforts, and the training of neurosurgeons and other treating clinicians in the management of firearm-related TBI.
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Affiliation(s)
- Gabriel Reyes
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
| | | | - Shervin H Nouri
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
| | - Shankar P Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston , Texas , USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
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6
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Mirian C, Jensen LR, Juratli TA, Maier AD, Torp SH, Shih HA, Morshed RA, Young JS, Magill ST, Bertero L, Stummer W, Spille DC, Brokinkel B, Oya S, Miyawaki S, Saito N, Proescholdt M, Kuroi Y, Gousias K, Simon M, Moliterno J, Prat-Acin R, Goutagny S, Prabhu VC, Tsiang JT, Wach J, Güresir E, Yamamoto J, Kim YZ, Lee JH, Koshy M, Perumal K, Baskaya MK, Cannon DM, Shrieve DC, Suh CO, Chang JH, Kamenova M, Straumann S, Soleman J, Eyüpoglu IY, Catalan T, Lui A, Theodosopoulos PV, McDermott MW, Wang F, Guo F, Góes P, de Paiva Neto MA, Jamshidi A, Komotar R, Ivan M, Luther E, Souhami L, Guiot MC, Csonka T, Endo T, Barrett OC, Jensen R, Gupta T, Patel AJ, Klisch TJ, Kim JW, Maiuri F, Barresi V, Tabernero MD, Skyrman S, Broechner A, Bach MJ, Law I, Scheie D, Kristensen BW, Munch TN, Meling T, Fugleholm K, Blanche P, Mathiesen T. The importance of considering competing risks in recurrence analysis of intracranial meningioma. J Neurooncol 2024; 166:503-511. [PMID: 38336917 PMCID: PMC10876814 DOI: 10.1007/s11060-024-04572-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The risk of recurrence is overestimated by the Kaplan-Meier method when competing events, such as death without recurrence, are present. Such overestimation can be avoided by using the Aalen-Johansen method, which is a direct extension of Kaplan-Meier that accounts for competing events. Meningiomas commonly occur in older individuals and have slow-growing properties, thereby warranting competing risk analysis. The extent to which competing events are considered in meningioma literature is unknown, and the consequences of using incorrect methodologies in meningioma recurrence risk analysis have not been investigated. METHODS We surveyed articles indexed on PubMed since 2020 to assess the usage of competing risk analysis in recent meningioma literature. To compare recurrence risk estimates obtained through Kaplan-Meier and Aalen-Johansen methods, we applied our international database comprising ~ 8,000 patients with a primary meningioma collected from 42 institutions. RESULTS Of 513 articles, 169 were eligible for full-text screening. There were 6,537 eligible cases from our PERNS database. The discrepancy between the results obtained by Kaplan-Meier and Aalen-Johansen was negligible among low-grade lesions and younger individuals. The discrepancy increased substantially in the patient groups associated with higher rates of competing events (older patients with high-grade lesions). CONCLUSION The importance of considering competing events in recurrence risk analysis is poorly recognized as only 6% of the studies we surveyed employed Aalen-Johansen analyses. Consequently, most of the previous literature has overestimated the risk of recurrence. The overestimation was negligible for studies involving low-grade lesions in younger individuals; however, overestimation might have been substantial for studies on high-grade lesions.
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Affiliation(s)
- Christian Mirian
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lasse Rehné Jensen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tareq A Juratli
- Department of Neurosurgery, Division of Neuro-Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
- Department of Neurosurgery, Laboratory of Translational Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Andrea Daniela Maier
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
| | - Sverre H Torp
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian, University of Science and Technology (NTNU), Laboratory Centre, St. Olavs Hospital, NO-7491, Trondheim, Norway
- Department of Pathology, Laboratory Centre, St. Olavs Hospital, NO-7030, Trondheim, Norway
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramin A Morshed
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jacob S Young
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Stephen T Magill
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Illinois, USA
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University and Città Della Salute E Della Scienza University Hospital of Turin, Turin, Italy
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | | | - Benjamin Brokinkel
- Department of Neurosurgery, University of Münster, Münster, Germany
- Institute for Neuropathology, University of Münster, Münster, Germany
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center/University, Saitama, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Martin Proescholdt
- Department of Neurosurgery, University Regensburg Medical Center, Regensburg, Germany
| | - Yasuhiro Kuroi
- Department of Neurosurgery, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Matthias Simon
- Department of Neurosurgery, Bethel Clinic University of Bielefeld Medical Center, Bielefeld, Germany
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine Yale New Haven Hospital, Smilow Cancer Hospital, New Haven, USA
| | | | - Stéphane Goutagny
- Department of Neurosurgery, Université Paris Cité, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Vikram C Prabhu
- Department of Neurological Surgery, Loyola University Medical Center, Stritch School of Medicine, Illinois, USA
| | - John T Tsiang
- Department of Neurological Surgery, Loyola University Medical Center, Stritch School of Medicine, Illinois, USA
| | - Johannes Wach
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Matthew Koshy
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Illinois, USA
| | - Karthikeyan Perumal
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mustafa K Baskaya
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Donald M Cannon
- Department of Radiation Oncology Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dennis C Shrieve
- Department of Radiation Oncology Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Maria Kamenova
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Sven Straumann
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Ilker Y Eyüpoglu
- Department of Neurosurgery, Division of Neuro-Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Tony Catalan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Austin Lui
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Philip V Theodosopoulos
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael W McDermott
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Division of Neurosurgery, Miami Neuroscience Institute, Miami, FL, USA
| | - Fang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Pedro Góes
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | | | - Aria Jamshidi
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Michael Ivan
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Evan Luther
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Luis Souhami
- Division of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | | | - Tamás Csonka
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Toshiki Endo
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Tohoku, Japan
| | | | - Randy Jensen
- Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Tejpal Gupta
- Department of Radiation Oncology ACTREC, Tata Memorial Centre, HBNI Kharghar, Navi Mumbai, 410210, India
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX , USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX , USA
| | - Tiemo J Klisch
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX , USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Francesco Maiuri
- Department of Neurosurgery, University of Naples Federico II, Naples, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - María Dolores Tabernero
- Instituto de Investigación Biomédica de Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Simon Skyrman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Broechner
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
| | - Bjarne Winther Kristensen
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
- Department of Clinical Medicine and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Tina Nørgaard Munch
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Torstein Meling
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Neurological Surgery, Istituto Nazionale Neurologico "C.Besta", Milan, Italy
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paul Blanche
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tiit Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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7
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Barrett TF, Patel B, Khan SM, Mullins RDZ, Yim AKY, Pugazenthi S, Mahlokozera T, Zipfel GJ, Herzog JA, Chicoine MR, Wick CC, Durakovic N, Osbun JW, Shew M, Sweeney AD, Patel AJ, Buchman CA, Petti AA, Puram SV, Kim AH. Single-cell multi-omic analysis of the vestibular schwannoma ecosystem uncovers a nerve injury-like state. Nat Commun 2024; 15:478. [PMID: 38216553 PMCID: PMC10786875 DOI: 10.1038/s41467-023-42762-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 10/10/2023] [Indexed: 01/14/2024] Open
Abstract
Vestibular schwannomas (VS) are benign tumors that lead to significant neurologic and otologic morbidity. How VS heterogeneity and the tumor microenvironment (TME) contribute to VS pathogenesis remains poorly understood. In this study, we perform scRNA-seq on 15 VS, with paired scATAC-seq (n = 6) and exome sequencing (n = 12). We identify diverse Schwann cell (SC), stromal, and immune populations in the VS TME and find that repair-like and MHC-II antigen-presenting SCs are associated with myeloid cell infiltrate, implicating a nerve injury-like process. Deconvolution analysis of RNA-expression data from 175 tumors reveals Injury-like tumors are associated with larger tumor size, and scATAC-seq identifies transcription factors associated with nerve repair SCs from Injury-like tumors. Ligand-receptor analysis and in vitro experiments suggest that Injury-like VS-SCs recruit myeloid cells via CSF1 signaling. Our study indicates that Injury-like SCs may cause tumor growth via myeloid cell recruitment and identifies molecular pathways that may be therapeutically targeted.
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Affiliation(s)
- Thomas F Barrett
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Bhuvic Patel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Saad M Khan
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Brain Tumor Immunology and Immunotherapy Program, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Riley D Z Mullins
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Aldrin K Y Yim
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Sangami Pugazenthi
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Tatenda Mahlokozera
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Brain Tumor Center, Washington University School of Medicine/Siteman Cancer Center, St. Louis, MO, USA
| | - Jacques A Herzog
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Brain Tumor Center, Washington University School of Medicine/Siteman Cancer Center, St. Louis, MO, USA
| | - Michael R Chicoine
- Department of Neurological Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Brain Tumor Center, Washington University School of Medicine/Siteman Cancer Center, St. Louis, MO, USA
| | - Nedim Durakovic
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Brain Tumor Center, Washington University School of Medicine/Siteman Cancer Center, St. Louis, MO, USA
| | - Joshua W Osbun
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Shew
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Brain Tumor Center, Washington University School of Medicine/Siteman Cancer Center, St. Louis, MO, USA
| | - Alex D Sweeney
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Akash J Patel
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Brain Tumor Center, Washington University School of Medicine/Siteman Cancer Center, St. Louis, MO, USA
| | - Allegra A Petti
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Brain Tumor Immunology and Immunotherapy Program, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA.
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
- Brain Tumor Center, Washington University School of Medicine/Siteman Cancer Center, St. Louis, MO, USA.
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8
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Boop S, Gibson A, Pedersen K, Coppel D, Durfy S, Patel AJ, Lee A, Ravanpay A. Virtual Interviews in Neurosurgery Resident Selection: A Follow-up Report. World Neurosurg 2024; 181:e154-e162. [PMID: 37739171 DOI: 10.1016/j.wneu.2023.09.051] [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: 07/10/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND The 2021 U.S. neurosurgery residency match interviews were conducted virtually; we surveyed applicants and interviewers to determine satisfaction with that virtual interview process. Subsequently, we conducted a follow-up survey to determine satisfaction with the virtual interview process after the residency match for faculty interviewers and 2022 interns. METHODS A 22-question online faculty survey was sent to 116 U.S. neurosurgery training programs. A 26-question survey was sent to these programs for distribution to their intern classes. Data were analyzed quantitatively, including mean Likert score. Open-ended questionnaire responses were reviewed to identify themes. RESULTS Overall, 32 interns representing 20 programs and 73 faculty representing 62 programs responded. Most respondents agreed that virtual interviews were more convenient (86% faculty, 90% interns) and cost-effective (100% interns) than in-person interviews. Faculty respondents agreed or strongly agreed that virtual interviews were effective to evaluate applicants' competence as residents (44%); fewer faculty agreed or strongly agreed that virtual interviews were an effective way to evaluate candidates' fit in the program (27%). For interns, 44% agreed or strongly agreed that virtual interviews gave them a good sense of the program faculty; 75% agreed or strongly agreed they were satisfied with the process related to where they matched. CONCLUSIONS Virtual interviews offer an advantage in terms of time and cost but potentially at the expense of adequate faculty assessment of candidates' "fit" within a program's culture. Despite this, interns undergoing an all-virtual interview process report high satisfaction with the results of the residency match.
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Affiliation(s)
- Scott Boop
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Alec Gibson
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Kyle Pedersen
- School of Engineering, Santa Clara University, Santa Clara, California, USA
| | - David Coppel
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA; Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA
| | - Amy Lee
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ali Ravanpay
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosurgery, Puget Sound Veterans Affairs Hospital, Seattle, Washington, USA.
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9
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Chen WC, Choudhury A, Youngblood MW, Polley MYC, Lucas CHG, Mirchia K, Maas SLN, Suwala AK, Won M, Bayley JC, Harmanci AS, Harmanci AO, Klisch TJ, Nguyen MP, Vasudevan HN, McCortney K, Yu TJ, Bhave V, Lam TC, Pu JKS, Li LF, Leung GKK, Chan JW, Perlow HK, Palmer JD, Haberler C, Berghoff AS, Preusser M, Nicolaides TP, Mawrin C, Agnihotri S, Resnick A, Rood BR, Chew J, Young JS, Boreta L, Braunstein SE, Schulte J, Butowski N, Santagata S, Spetzler D, Bush NAO, Villanueva-Meyer JE, Chandler JP, Solomon DA, Rogers CL, Pugh SL, Mehta MP, Sneed PK, Berger MS, Horbinski CM, McDermott MW, Perry A, Bi WL, Patel AJ, Sahm F, Magill ST, Raleigh DR. Targeted gene expression profiling predicts meningioma outcomes and radiotherapy responses. Nat Med 2023; 29:3067-3076. [PMID: 37944590 PMCID: PMC11073469 DOI: 10.1038/s41591-023-02586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/11/2023] [Indexed: 11/12/2023]
Abstract
Surgery is the mainstay of treatment for meningioma, the most common primary intracranial tumor, but improvements in meningioma risk stratification are needed and indications for postoperative radiotherapy are controversial. Here we develop a targeted gene expression biomarker that predicts meningioma outcomes and radiotherapy responses. Using a discovery cohort of 173 meningiomas, we developed a 34-gene expression risk score and performed clinical and analytical validation of this biomarker on independent meningiomas from 12 institutions across 3 continents (N = 1,856), including 103 meningiomas from a prospective clinical trial. The gene expression biomarker improved discrimination of outcomes compared with all other systems tested (N = 9) in the clinical validation cohort for local recurrence (5-year area under the curve (AUC) 0.81) and overall survival (5-year AUC 0.80). The increase in AUC compared with the standard of care, World Health Organization 2021 grade, was 0.11 for local recurrence (95% confidence interval 0.07 to 0.17, P < 0.001). The gene expression biomarker identified meningiomas benefiting from postoperative radiotherapy (hazard ratio 0.54, 95% confidence interval 0.37 to 0.78, P = 0.0001) and suggested postoperative management could be refined for 29.8% of patients. In sum, our results identify a targeted gene expression biomarker that improves discrimination of meningioma outcomes, including prediction of postoperative radiotherapy responses.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.
| | - Abrar Choudhury
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
- Medical Scientist Training Program, University of California San Francisco, San Francisco, CA, USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Mei-Yin C Polley
- NRG Statistics and Data Management Center, NRG Oncology, Philadelphia, PA, USA
| | | | - Kanish Mirchia
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Sybren L N Maas
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Abigail K Suwala
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Minhee Won
- NRG Statistics and Data Management Center, NRG Oncology, Philadelphia, PA, USA
| | - James C Bayley
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Akdes S Harmanci
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Arif O Harmanci
- Center for Secure Artificial Intelligence for Healthcare, Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center, Houston, TX, USA
| | - Tiemo J Klisch
- Department of Molecular and Human Genetics, Baylor College of Medicine, and Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Minh P Nguyen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Harish N Vasudevan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen McCortney
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Theresa J Yu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Varun Bhave
- Department of Neurosurgery, Brigham and Women's Hospital, and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tai-Chung Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, China
| | - Jenny Kan-Suen Pu
- Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Pokfulam, China
| | - Lai-Fung Li
- Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Pokfulam, China
| | - Gilberto Ka-Kit Leung
- Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Pokfulam, China
| | - Jason W Chan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Haley K Perlow
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Christian Mawrin
- Department of Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Sameer Agnihotri
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam Resnick
- Department of Neurological Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian R Rood
- Brain Tumor Institute, Children's National Hospital, Washington, DC, USA
| | - Jessica Chew
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Jacob S Young
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Lauren Boreta
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Schulte
- Neurosciences Department, University of California San Diego, La Jolla, CA, USA
| | - Nicholas Butowski
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Nancy Ann Oberheim Bush
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Javier E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - James P Chandler
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - David A Solomon
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - C Leland Rogers
- NRG Statistics and Data Management Center, NRG Oncology, Philadelphia, PA, USA
| | - Stephanie L Pugh
- NRG Statistics and Data Management Center, NRG Oncology, Philadelphia, PA, USA
| | - Minesh P Mehta
- NRG Statistics and Data Management Center, NRG Oncology, Philadelphia, PA, USA
- Miami Neuroscience Institute, Baptist Health, Miami, FL, USA
| | - Penny K Sneed
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Craig M Horbinski
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
- Department of Pathology, Northwestern University, Chicago, IL, USA
| | | | - Arie Perry
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Akash J Patel
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA.
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.
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10
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McDonald MF, Prather LL, Helfer CR, Ludmir EB, Echeverria AE, Yust-Katz S, Patel AJ, Deneen B, Rao G, Jalali A, Dhar SU, Amos CI, Mandel JJ. Prevalence of pathogenic germline variants in adult-type diffuse glioma. Neurooncol Pract 2023; 10:482-490. [PMID: 37720399 PMCID: PMC10502787 DOI: 10.1093/nop/npad033] [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] [Indexed: 09/19/2023] Open
Abstract
Background No consensus germline testing guidelines currently exist for glioma patients, so the prevalence of germline pathogenic variants remains unknown. This study aims to determine the prevalence and type of pathogenic germline variants in adult glioma. Methods A retrospective review at a single institution with paired tumor/normal sequencing from August 2018-April 2022 was performed and corresponding clinical data were collected. Results We identified 152 glioma patients of which 15 (9.8%) had pathogenic germline variants. Pathogenic germline variants were seen in 11/84 (13.1%) of Glioblastoma, IDH wild type; 3/42 (7.1%) of Astrocytoma, IDH mutant; and 1/26 (3.8%) of Oligodendroglioma, IDH mutant, and 1p/19q co-deleted patients. Pathogenic variants in BRCA2, MUTYH, and CHEK2 were most common (3/15, 20% each). BRCA1 variants occurred in 2/15 (13%) patients, with variants in NF1, ATM, MSH2, and MSH3 occurring in one patient (7%) each. Prior cancer diagnosis was found in 5/15 patients (33%). Second-hit somatic variants were seen in 3/15 patients (20%) in NF1, MUTYH, and MSH2. Referral to genetics was performed in 6/15 (40%) patients with pathogenic germline variants. 14/15 (93%) of patients discovered their pathogenic variant as a result of their paired glioma sequencing. Conclusions These findings suggest a possible overlooked opportunity for determination of hereditary cancer syndromes with impact on surveillance as well as potential broader treatment options. Further studies that can determine the role of variants in gliomagenesis and confirm the occurrence and types of pathogenic germline variants in patients with IDH wild type compared to IDH mutant tumors are necessary.
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Affiliation(s)
- Malcolm F McDonald
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas, USA
| | - Lyndsey L Prather
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Cassandra R Helfer
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Ethan B Ludmir
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Alfredo E Echeverria
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
| | - Benjamin Deneen
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ganesh Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ali Jalali
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Shweta U Dhar
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Chris I Amos
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Jacob J Mandel
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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11
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Rasband JM, Alfattal R, Patel AJ, Fuller GN, Perry A, Lu HC. Cavernous sinus hemangioma: Histopathological spectrum of 8 cases. J Neuropathol Exp Neurol 2023; 82:884-886. [PMID: 37487571 DOI: 10.1093/jnen/nlad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Affiliation(s)
- Joshua M Rasband
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Rasha Alfattal
- Department of Pathology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Gregory N Fuller
- Section of Neuropathology, Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Hsiang-Chih Lu
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
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12
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Zhang H, Du Y, Qi L, Xiao S, Braun FK, Kogiso M, Huang Y, Huang F, Abdallah A, Suarez M, Karthick S, Ahmed NM, Salsman VS, Baxter PA, Su JM, Brat DJ, Hellenbeck PL, Teo WY, Patel AJ, Li XN. Targeting GBM with an Oncolytic Picornavirus SVV-001 alone and in combination with fractionated Radiation in a Novel Panel of Orthotopic PDX models. J Transl Med 2023; 21:444. [PMID: 37415222 PMCID: PMC10324131 DOI: 10.1186/s12967-023-04237-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Animal models representing different molecular subtypes of glioblastoma multiforme (GBM) is desired for developing new therapies. SVV-001 is an oncolytic virus selectively targeting cancer cells. It's capacity of passing through the blood brain barrier makes is an attractive novel approach for GBM. MATERIALS AND METHODS 23 patient tumor samples were implanted into the brains of NOD/SCID mice (1 × 105 cells/mouse). Tumor histology, gene expression (RNAseq), and growth rate of the developed patient-derived orthotopic xenograft (PDOX) models were compared with the originating patient tumors during serial subtransplantations. Anti-tumor activities of SVV-001 were examined in vivo; and therapeutic efficacy validated in vivo via single i.v. injection (1 × 1011 viral particle) with or without fractionated (2 Gy/day x 5 days) radiation followed by analysis of animal survival times, viral infection, and DNA damage. RESULTS PDOX formation was confirmed in 17/23 (73.9%) GBMs while maintaining key histopathological features and diffuse invasion of the patient tumors. Using differentially expressed genes, we subclassified PDOX models into proneural, classic and mesenchymal groups. Animal survival times were inversely correlated with the implanted tumor cells. SVV-001 was active in vitro by killing primary monolayer culture (4/13 models), 3D neurospheres (7/13 models) and glioma stem cells. In 2/2 models, SVV-001 infected PDOX cells in vivo without harming normal brain cells and significantly prolonged survival times in 2/2 models. When combined with radiation, SVV-001 enhanced DNA damages and further prolonged animal survival times. CONCLUSION A panel of 17 clinically relevant and molecularly annotated PDOX modes of GBM is developed, and SVV-001 exhibited strong anti-tumor activities in vitro and in vivo.
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Affiliation(s)
- Huiyuan Zhang
- Texas Children's Cancer Center, Houston, TX, USA
- Laboratory of Molecular Neuro-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Yuchen Du
- Texas Children's Cancer Center, Houston, TX, USA
- Laboratory of Molecular Neuro-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
- Department of Pharmacology, School of Medicine, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Lin Qi
- Texas Children's Cancer Center, Houston, TX, USA
- Laboratory of Molecular Neuro-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Sophie Xiao
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Frank K Braun
- Texas Children's Cancer Center, Houston, TX, USA
- Laboratory of Molecular Neuro-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Mari Kogiso
- Texas Children's Cancer Center, Houston, TX, USA
- Laboratory of Molecular Neuro-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Yulun Huang
- Texas Children's Cancer Center, Houston, TX, USA
- Laboratory of Molecular Neuro-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Neurosurgery, Dushou Lake Hospital, Soochow University Medical School, Suzhou, Jiangsu, China
| | - Frank Huang
- Division of Experimental Hematology and Cancer Biology, Brain Tumor Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Aalaa Abdallah
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Milagros Suarez
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Sekar Karthick
- Pediatric Brain Tumor Research Office, Cancer and Stem Cell Biology Program, SingHealth Duke-NUS Academic Medical Center, Humphrey Oei Institute of Cancer Research, National Cancer Center Singapore, Duke-NUS Medical School, 169610, Singapore, Singapore
| | | | | | - Patricia A Baxter
- Texas Children's Cancer Center, Houston, TX, USA
- Laboratory of Molecular Neuro-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jack M Su
- Texas Children's Cancer Center, Houston, TX, USA
- Laboratory of Molecular Neuro-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Daniel J Brat
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Wan-Yee Teo
- Texas Children's Cancer Center, Houston, TX, USA
- Pediatric Brain Tumor Research Office, Cancer and Stem Cell Biology Program, SingHealth Duke-NUS Academic Medical Center, Humphrey Oei Institute of Cancer Research, National Cancer Center Singapore, Duke-NUS Medical School, 169610, Singapore, Singapore
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA.
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
- Dan Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA.
| | - Xiao-Nan Li
- Texas Children's Cancer Center, Houston, TX, USA.
- Laboratory of Molecular Neuro-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA.
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA.
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, 60611, USA.
- Program of Precision Medicine PDOX Modeling of Pediatric Tumors, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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13
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Khan AB, Patel R, McDonald MF, Goethe E, English C, Gadot R, Shetty A, Nouri SH, Harmanci AO, Harmanci AS, Klisch TJ, Patel AJ. Integrated clinical genomic analysis reveals xenobiotic metabolic genes are downregulated in meningiomas of current smokers. J Neurooncol 2023:10.1007/s11060-023-04359-7. [PMID: 37318677 DOI: 10.1007/s11060-023-04359-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Meningiomas are the most common primary intracranial tumor. Recently, various genetic classification systems for meningioma have been described. We sought to identify clinical drivers of different molecular changes in meningioma. As such, clinical and genomic consequences of smoking in patients with meningiomas remain unexplored. METHODS 88 tumor samples were analyzed in this study. Whole exome sequencing (WES) was used to assess somatic mutation burden. RNA sequencing data was used to identify differentially expressed genes (DEG) and genes sets (GSEA). RESULTS Fifty-seven patients had no history of smoking, twenty-two were past smokers, and nine were current smokers. The clinical data showed no major differences in natural history across smoking status. WES revealed absence of AKT1 mutation rate in current or past smokers compared to non-smokers (p = 0.046). Current smokers had increased mutation rate in NOTCH2 compared to past and never smokers (p < 0.05). Mutational signature from current and past smokers showed disrupted DNA mismatch repair (cosine-similarity = 0.759 and 0.783). DEG analysis revealed the xenobiotic metabolic genes UGT2A1 and UGT2A2 were both significantly downregulated in current smokers compared to past (Log2FC = - 3.97, padj = 0.0347 and Log2FC = - 4.18, padj = 0.0304) and never smokers (Log2FC = - 3.86, padj = 0.0235 and Log2FC = - 4.20, padj = 0.0149). GSEA analysis of current smokers showed downregulation of xenobiotic metabolism and enrichment for G2M checkpoint, E2F targets, and mitotic spindle compared to past and never smokers (FDR < 25% each). CONCLUSION In this study, we conducted a comparative analysis of meningioma patients based on their smoking history, examining both their clinical trajectories and molecular changes. Meningiomas from current smokers were more likely to harbor NOTCH2 mutations, and AKT1 mutations were absent in current or past smokers. Moreover, both current and past smokers exhibited a mutational signature associated with DNA mismatch repair. Meningiomas from current smokers demonstrate downregulation of xenobiotic metabolic enzymes UGT2A1 and UGT2A2, which are downregulated in other smoking related cancers. Furthermore, current smokers exhibited downregulation xenobiotic metabolic gene sets, as well as enrichment in gene sets related to mitotic spindle, E2F targets, and G2M checkpoint, which are hallmark pathways involved in cell division and DNA replication control. In aggregate, our results demonstrate novel alterations in meningioma molecular biology in response to systemic carcinogens.
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Affiliation(s)
- A Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | - Rajan Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | - Malcolm F McDonald
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
- Medical Scientist Training Program, Baylor College of Medicine, Houston, USA
| | - Eric Goethe
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | - Collin English
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | - Arya Shetty
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | | | - Arif O Harmanci
- School of Biomedical Informatics, University of Texas Health Science Center Houston, Houston, USA
| | - Akdes S Harmanci
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | - Tiemo J Klisch
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA.
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, USA.
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, USA.
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You P, Lovin BD, Patel AJ, Hosek KE, Peng A, Sweeney AD. Quality of Life After Modified Rambo Ear Canal Closure in Pediatric and Adult Patients. Otolaryngol Head Neck Surg 2023; 168:814-820. [PMID: 35414323 DOI: 10.1177/01945998221093529] [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: 01/31/2022] [Accepted: 03/19/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present the surgical and quality of life (QOL) outcomes of patients who underwent blind sac closure of the external auditory canal (EAC) via a modified Rambo approach. STUDY DESIGN Retrospective case review. SETTING Tertiary academic referral center. METHODS All patients who underwent EAC closure with a modified Rambo approach between 2015 and 2021 were evaluated. Complication rates, QOL estimations from a validated survey, and subjective cosmetic reports were analyzed. RESULTS Thirty-five ears were closed in 31 patients. The most common indication for surgery was related to cochlear implantation and cochlear malformation or cholesteatoma (31.4%). No case involved an immediate complication requiring revision surgery, and 4 ears (11.4%) were suspected of having cholesteatoma within the surgical cavity at a mean 28.6-month follow-up. Adults (≥18 years) had significantly higher QOL scores than children in the medical resource subscale of the Chronic Ear Survey (P < .01), and patients undergoing concurrent EAC closure and skull base tumor removal scored higher than others (P = .04). Females reported higher cosmetic scores than males (P = .04). QOL and cosmetic scores compared favorably to previously published data involving the management of otologic disease. CONCLUSIONS Ear canal closure can be a useful technique for select adult and pediatric patients. Patient and surgeon concerns regarding QOL and cosmesis in ear canal closure should be explored prior to employing this surgical technique, though the present data suggest that the modified Rambo approach to closure is generally associated with reasonable outcomes in both areas.
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Affiliation(s)
- Peng You
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Akash J Patel
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Kathleen E Hosek
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Angela Peng
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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15
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Khan AB, English CW, Chen WC, Athukuri P, Bayley JC, Brandt VL, Shetty A, Hadley CC, Choudhury A, Lu HC, Harmanci AO, Harmanci AS, Magill ST, Raleigh DR, Klisch TJ, Patel AJ. Even heterozygous loss of CDKN2A/B greatly accelerates recurrence in aggressive meningioma. Acta Neuropathol 2023; 145:501-503. [PMID: 36729132 DOI: 10.1007/s00401-023-02543-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Affiliation(s)
- A Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Collin W English
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Prazwal Athukuri
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - James C Bayley
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Vicky L Brandt
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Arya Shetty
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Caroline C Hadley
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Abrar Choudhury
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Hsiang-Chih Lu
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Arif O Harmanci
- Center for Secure Artificial Intelligence For hEalthcare (SAFE), Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center Houston, Houston, TX, USA
| | - Akdes S Harmanci
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Tiemo J Klisch
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA.
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA.
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
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Gadot R, Khan B, Katlowitz K, Gupta M, Bayley J, Klisch T, Patel AJ. 455 Radiographic Features Predict Genomic Subtype in Meningioma. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_455] [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
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17
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Choudhury A, Chen WC, Lucas CHG, Bayley JC, Harmanci AS, Maas SLN, Santagata S, Klisch T, Perry A, Bi WL, Sahm F, Patel AJ, Magill ST, Raleigh DR. Hypermitotic meningiomas harbor DNA methylation subgroups with distinct biological and clinical features. Neuro Oncol 2023; 25:520-530. [PMID: 36227281 PMCID: PMC10013643 DOI: 10.1093/neuonc/noac224] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Meningiomas, the most common primary intracranial tumors, can be separated into 3 DNA methylation groups with distinct biological drivers, clinical outcomes, and therapeutic vulnerabilities. Alternative meningioma grouping schemes using copy number variants, gene expression profiles, somatic short variants, or integrated molecular models have been proposed. These data suggest meningioma DNA methylation groups may harbor subgroups unifying contrasting theories of meningioma biology. METHODS A total of 565 meningioma DNA methylation profiles from patients with comprehensive clinical follow-up at independent discovery (n = 200) or validation (n = 365) institutions were reanalyzed and classified into Merlin-intact, Immune-enriched, or Hypermitotic DNA methylation groups. RNA sequencing from the discovery (n = 200) or validation (n = 302) cohort were analyzed in the context of DNA methylation groups to identify subgroups. Biological features and clinical outcomes were analyzed across meningioma grouping schemes. RESULTS RNA sequencing revealed differential enrichment of FOXM1 target genes across two subgroups of Hypermitotic meningiomas. Differential expression and ontology analyses showed the subgroup of Hypermitotic meningiomas without FOXM1 target gene enrichment was distinguished by gene expression programs driving macromolecular metabolism. Analysis of genetic, epigenetic, gene expression, or cellular features revealed Hypermitotic meningioma subgroups were concordant with Proliferative or Hypermetabolic meningiomas, which were previously reported alongside Merlin-intact and Immune-enriched tumors using an integrated molecular model. The addition of DNA methylation subgroups to clinical models refined the prediction of postoperative outcomes compared to the addition of DNA methylation groups. CONCLUSIONS Meningiomas can be separated into three DNA methylation groups and Hypermitotic meningiomas can be subdivided into Proliferative and Hypermetabolic subgroups, each with distinct biological and clinical features.
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Affiliation(s)
- Abrar Choudhury
- Departments of Radiation Oncology and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - William C Chen
- Departments of Radiation Oncology and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Calixto-Hope G Lucas
- Departments of Radiation Oncology and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - James C Bayley
- Department of Neurosurgery, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX, USA
| | - Akdes S Harmanci
- Department of Neurosurgery, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX, USA
| | - Sybren L N Maas
- Departments of Pathology, Leiden University Medical Center, Leiden, and Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sandro Santagata
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tiemo Klisch
- Department of Molecular and Human Genetics, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX, USA
| | - Arie Perry
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Wenya Linda Bi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - David R Raleigh
- Departments of Radiation Oncology and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
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18
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Shahbandi A, Shah DS, Hadley CC, Patel AJ. The Role of Pharmacotherapy in Treatment of Meningioma: A Systematic Review. Cancers (Basel) 2023; 15:483. [PMID: 36672431 PMCID: PMC9856307 DOI: 10.3390/cancers15020483] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
The safety and efficacy of various pharmacotherapeutic regimens on refractory meningiomas have been the focus of investigations. We present a comprehensive review of the previous efforts and the current state of ongoing clinical trials. A PRISMA-compliant review of the MEDLINE and ClinicalTrial.gov databases of the National Library of Medicine were performed. The primary outcomes of interest for included articles were radiographic response, overall survival, progression-free survival, six-month progression-free survival, and adverse events. Overall, 34 completed trials and 27 ongoing clinical trials were eligible. Six-month progression-free survival was reported in 6-100% of patients in the completed studies. Hematological disorders were the most common adverse events. Of the ongoing clinical trials identified, nine studies are phase I clinical trials, eleven are phase II trials, two are phase I and II trials, one is phase II and III, and two trials do not have a designated phase. Currently, there is no effective chemotherapy for refractory or recurrent meningiomas. Several promising targeted agents have been developed and are currently being investigated in the hope of identifying novel therapeutic strategies for the treatment of this pathology.
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Affiliation(s)
- Ataollah Shahbandi
- Department of Neurological Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Darsh S. Shah
- Department of Neurological Surgery, Dell Medical School, Austin, TX 78712, USA
| | - Caroline C. Hadley
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Akash J. Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX 77030, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX 77030, USA
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19
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Harmanci A, Harmanci AS, Klisch TJ, Patel AJ. XCVATR: detection and characterization of variant impact on the Embeddings of single -cell and bulk RNA-sequencing samples. BMC Genomics 2022; 23:841. [PMID: 36539717 PMCID: PMC9764736 DOI: 10.1186/s12864-022-09004-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND RNA-sequencing has become a standard tool for analyzing gene activity in bulk samples and at the single-cell level. By increasing sample sizes and cell counts, this technique can uncover substantial information about cellular transcriptional states. Beyond quantification of gene expression, RNA-seq can be used for detecting variants, including single nucleotide polymorphisms, small insertions/deletions, and larger variants, such as copy number variants. Notably, joint analysis of variants with cellular transcriptional states may provide insights into the impact of mutations, especially for complex and heterogeneous samples. However, this analysis is often challenging due to a prohibitively high number of variants and cells, which are difficult to summarize and visualize. Further, there is a dearth of methods that assess and summarize the association between detected variants and cellular transcriptional states. RESULTS Here, we introduce XCVATR (eXpressed Clusters of Variant Alleles in Transcriptome pRofiles), a method that identifies variants and detects local enrichment of expressed variants within embedding of samples and cells in single-cell and bulk RNA-seq datasets. XCVATR visualizes local "clumps" of small and large-scale variants and searches for patterns of association between each variant and cellular states, as described by the coordinates of cell embedding, which can be computed independently using any type of distance metrics, such as principal component analysis or t-distributed stochastic neighbor embedding. Through simulations and analysis of real datasets, we demonstrate that XCVATR can detect enrichment of expressed variants and provide insight into the transcriptional states of cells and samples. We next sequenced 2 new single cell RNA-seq tumor samples and applied XCVATR. XCVATR revealed subtle differences in CNV impact on tumors. CONCLUSIONS XCVATR is publicly available to download from https://github.com/harmancilab/XCVATR .
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Affiliation(s)
- Arif Harmanci
- grid.267308.80000 0000 9206 2401University of Texas Health Science Center, School of Biomedical Informatics, Center for Secure Artificial intelligence For hEalthcare (SAFE), Center for Precision Health, Houston, USA
| | - Akdes Serin Harmanci
- grid.39382.330000 0001 2160 926XDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX 77030 USA
| | - Tiemo J. Klisch
- grid.416975.80000 0001 2200 2638Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX 77030 USA ,grid.39382.330000 0001 2160 926XDepartment of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030 USA
| | - Akash J. Patel
- grid.39382.330000 0001 2160 926XDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX 77030 USA ,grid.416975.80000 0001 2200 2638Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX 77030 USA ,grid.39382.330000 0001 2160 926XDepartment of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, TX 77030 USA
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20
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McDonald MF, Athukuri P, Anand A, Gopakumar S, Jalali A, Patel AJ, Rao G, Goodman JC, Lu HC, Mandel JJ. Varied histomorphology and clinical outcomes of FGFR3-TACC3 fusion gliomas. Neurosurg Focus 2022; 53:E16. [PMID: 36455273 DOI: 10.3171/2022.9.focus22420] [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: 07/31/2022] [Accepted: 09/23/2022] [Indexed: 12/04/2022]
Abstract
Targeted therapies for driver gene fusions in cancers have yielded substantial improvements in care. Here, the authors outline a case series of 6 patients with FGFR3-TACC3 fusion in primary brain tumors ranging from polymorphous low-grade neuroepithelial tumor of the young to papillary glioneuronal tumors and glioblastoma (GBM). Previous studies indicated the FGFR3-TACC3 fusion provides survival benefit to GBM patients. Consistent with this, 2 patients with GBM had unexpectedly good outcomes and survived for 5 and 7 years, respectively. In contrast, 2 patients with initially lower graded tumors survived only 3 years and 1 year, respectively. One patient received erdafitinib, a targeted FGFR inhibitor, for 3 months at late disease recurrence and no response was seen. There were varied histomorphological features, including many cases that lacked the characteristic FGFR3-TACC3 pathology. The findings of this cohort suggest that molecular testing is justified, even for glioma cases lacking classic histopathological signatures. Currently, FGFR3-TACC3 fusion gliomas are often classified on the basis of histopathological features. However, further research is needed to examine whether IDH1/2-wild-type tumors with FGFR3-TACC3 fusion should be classified as a subtype on the basis of this molecular fusion. Because patients with IDH1/2-wild-type GBM with FGFR3-TACC3 fusion have improved survival, routine molecular testing for this mutation in patients enrolled in clinical trials and subsequent stratification may be warranted.
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Affiliation(s)
- Malcolm F McDonald
- 1Department of Neurosurgery, Baylor College of Medicine, Houston.,2Medical Scientist Training Program, Baylor College of Medicine, Houston
| | - Prazwal Athukuri
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Adrish Anand
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | | | - Ali Jalali
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Ganesh Rao
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - J Clay Goodman
- 3Department of Pathology, Baylor College of Medicine, Houston; and
| | - Hsiang-Chih Lu
- 3Department of Pathology, Baylor College of Medicine, Houston; and
| | - Jacob J Mandel
- 4Department of Neurology, Baylor College of Medicine, Houston, Texas
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21
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Reddy S, Flores A, Lee S, Shetty A, Shah D, Heck KA, Jalali A, Mandel JJ, Patel AJ. EWSR1-PATZ1 Fusion Gene in Ependymoma: A Report of Two Adult Cases and Systematic Review of Literature. JCO Precis Oncol 2022; 6:e2200312. [PMID: 36480780 DOI: 10.1200/po.22.00312] [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: 12/13/2022] Open
Affiliation(s)
- Sandesh Reddy
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX
| | - Alex Flores
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX
| | - Sungho Lee
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX
| | - Arya Shetty
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX
| | - Darsh Shah
- Department of Neurological Surgery, Dell Medical School, Austin, TX
| | - Kent A Heck
- Department of Pathology, Baylor College of Medicine, Houston, TX
| | - Ali Jalali
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX
| | - Jacob J Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Akash J Patel
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX.,Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX
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22
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Ehrlich AM, Larkin MB, English CW, Shetty A, Gupta M, Nouri SH, Lu HC, Mandel JJ, Patel AJ. Protracted course of chemical meningitis following posterior fossa epidermoid cyst excision – A case report. Surg Neurol Int 2022; 13:544. [DOI: 10.25259/sni_852_2022] [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: 09/14/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background:
Chemical meningitis, a subtype of aseptic meningitis, as a complication of posterior fossa surgery is not a rare complication. However, the description of a severe protracted course following the surgical resection of an epidermoid cyst has not been described in the current literature. Chemical meningitis is thought to be associated with a hyperreactive inflammatory response, mediated in part by interleukin (IL)-10, IL-1β, and tumor necrosis factor-α, to the postoperative keratin debris from the spontaneous leakage or surgical release of epidermoid contents into subarachnoid spaces, which ultimately can result in patient symptoms of meningitis and hydrocephalus. Often, this remains mild and the recommended management includes a short course administration of corticosteroids.
Case Description:
The authors report such a case in a patient who underwent a redoresection for a fourth ventricular epidermoid cyst. Postoperatively, the patient returned several times with symptoms of meningitis and hydrocephalus requiring multiple hospitalizations in the ensuing months. The patient required emergent cerebrospinal fluid diversion, further posterior fossa exploration and an extended high-dose corticosteroid treatment regimen.
Conclusion:
The authors summarize the current understanding of the biochemical processes involved for the rare presentation of postoperative chemical meningitis.
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Affiliation(s)
- Adin M. Ehrlich
- School of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | | | | | - Arya Shetty
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Mayuri Gupta
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | | | - Hsiang-Chih Lu
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, United States
| | - Jacob J. Mandel
- Department of Neurology, Baylor College of Medicine, Houston, Texas, United States
| | - Akash J. Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
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23
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Lazaro TT, Katlowitz KA, Karas PJ, Srinivasan VM, Walls E, Collier G, Raza SM, Curry DJ, Ropper AE, Fuentes A, Gopinath SP, Rao G, Patel AJ. The impact of a night float system on operative experience in neurosurgery residency. J Neurosurg 2022; 138:1117-1123. [PMID: 36087325 DOI: 10.3171/2022.4.jns212612] [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: 11/12/2021] [Accepted: 04/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Since the Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour restrictions in 2003, many residency programs have adopted a night float system to comply with time constraints. However, some surgical subspecialities have been concerned that use of a night float system deprives residents of operative experience. In this study, the authors describe their training program's transition to a night float system and its impact on resident operative experience. METHODS The authors conducted a single-program study of resident surgical case volume before and after implementing the night float system at 3 of their 5 hospitals from 2014 to 2020. The authors obtained surgical case numbers from the ACGME case log database. RESULTS Junior residents received a concentrated educational experience, whereas senior residents saw a significant decrease from 112 calls/year to 17. Logged cases significantly increased after implementation of the night float system (8846 vs 10,547, p = 0.04), whereas cases at non-night float hospitals remained the same. This increase was concurrent with an increase in hospital cases. This difference was mainly driven by senior resident cases (p = 0.010), as junior and chief residents did not show significant differences in logged cases (p > 0.40). Lead resident cases increased significantly after implementation of the night float system (6852 vs 8860, p = 0.04). When normalized for increased hospital cases, resident case increases were not statistically significant. CONCLUSIONS Transitioning to a night float call system at the authors' institution increased overall resident operative cases, particularly for lead resident surgeons. Based on the results of this study, the authors recommend the use of a night float call system to consolidate night calls, which increases junior resident-level educational opportunities and senior resident cases.
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Affiliation(s)
- Tyler T Lazaro
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Patrick J Karas
- 3Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| | - Visish M Srinivasan
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Gina Collier
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Shaan M Raza
- 5University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel J Curry
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Alfonso Fuentes
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Ganesh Rao
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.,6Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas; and.,7Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Shah DS, Sharma H, Patel P, Shetty A, English CW, Goodman JC, Viswanathan A, Patel AJ. Recurrent liponeurocytoma: A case report and systematic review of the literature. Surg Neurol Int 2022; 13:395. [PMID: 36128091 PMCID: PMC9479547 DOI: 10.25259/sni_513_2022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Liponeurocytomas are rare neurocytic neoplasms that most often arise in the posterior fossa and affect individuals in the third and fifth decades of life. Most reported cases of this unique tumor in the literature have described a favorable clinical prognosis without recurrence. However, increasing reports of recurrent cases prompted the World Health Organization, in 2016, to recategorize the tumor from Grade I to the less favorable Grade II classification. We conducted a systematic review to identify recurrent cases of this unique tumor and to summarize differences between the primary and recurrent cases of liponeurocytoma. Methods: A systematic review exploring recurrent liponeurocytoma cases was conducted by searching the PubMed, Google Scholar, and Scopus databases for articles in English. Abstracts from articles were read and selected for full-text review according to a priori criteria. Relevant full-text articles were analyzed for symptoms, imaging, location, histological, pathological, treatment, and recurrence-free time between the primary and recurrent cases. Results: Of 4392 articles, 15 articles accounting for 18 patients were included (level of evidence: IV) in the study. Recurrence-free time decreased from an average of 82 months between the primary tumor resection to first recurrence to 31.3 months between the first and second recurrence. Recurrent tumors demonstrated increased pleomorphic neural cells, necrosis, vascular proliferation, and MIB-1 index when compared to the primary tumor. Several cases also demonstrated decreased lipidizing components when compared to the primary tumor, further indicating increased dedifferentiation. The primary treatment for this tumor was surgical resection with occasional adjunctive radiotherapy. Conclusion: Recurrent cases of liponeurocytoma have features of increased malignant proliferation compared to the primary cases. The standard treatment for these primary and recurrent tumors is gross total resection. The role of adjunctive radiotherapy remains a matter of debate.
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Affiliation(s)
- Darsh S. Shah
- Department of Neurosurgery, Dell Medical School, Austin,
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital,
- Department of Neurosurgery, Baylor College of Medicine, Houston,
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston,
| | - Prem Patel
- Department of Neurosurgery, University of Texas Southwestern, Dallas,
| | - Arya Shetty
- Department of Neurosurgery, Baylor College of Medicine, Houston,
| | - Collin William English
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital,
- Department of Neurosurgery, Baylor College of Medicine, Houston,
| | | | | | - Akash J. Patel
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital,
- Department of Neurosurgery, Baylor College of Medicine, Houston,
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
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25
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Shi J, Ayeni T, Gallagher KK, Patel AJ, Jalali A, Hernandez DJ, Haskins AD, Sandulache VC, Sturgis EM, Huang AT. Reconstructive Outcomes of Multilayered Closure of Large Skull Base Dural Defects Following Open Anterior Craniofacial Resection. Skull Base Surg 2022; 83:359-366. [DOI: 10.1055/s-0041-1722899] [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: 08/21/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Introduction Standardized reconstruction protocols for large open anterior skull base defects with dural resection are not well described. Here we report the outcomes and technique of a multilayered reconstructive algorithm utilizing local tissue, dural graft matrix, and microvascular free tissue transfer (MVFTT) for reconstruction of these deformities.
Design This study is a retrospective review.
Results Eleven patients (82% males) met inclusion criteria, with five (45%) having concurrent orbital exenteration and eight (73%) requiring maxillectomy. All patients required dural resection with or without intracranial tumor resection, with the average dural defect being 36.0 ± 25.9 cm2. Dural graft matrices and pericranial flaps were used for primary reconstruction of the dural defects, which were then reinforced with free fascia or muscle overlay by means of MVFTT. Eight (73%) patients underwent anterolateral thigh MVFTT, with the radial forearm, fibula, and vastus lateralis comprising the remainder. Average total surgical time of tumor resection and reconstruction was 14.9 ± 3.8 hours, with median length of hospitalization being 10 days (IQR: 9.5, 14). Continuous cerebrospinal fluid drainage through a lumber drain was utilized in 10 (91%) patients perioperatively, with an average length of indwelling drain of 5 days. Postoperative complications occurred in two (18%) patients who developed asymptomatic pneumocephalus that resolved with high-flow oxygen therapy.
Conclusion A standardized multilayered closure technique of dural graft matrix, pericranial flap, and MVFTT overlay in the reconstruction of large open anterior craniofacial dural defects can assist the reconstructive team in approaching these complex deformities and may help prevent postoperative complications.
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Affiliation(s)
- Justin Shi
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Tokunbo Ayeni
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Kathleen Kelly Gallagher
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Akash J. Patel
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, United States
| | - Ali Jalali
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - David J. Hernandez
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Angela D. Haskins
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Vlad C. Sandulache
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Erich M. Sturgis
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Andrew T. Huang
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
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Gadot R, Khan AB, Patel R, Goethe E, Shetty A, Hadley CC, V JCB, Harmanci AS, Klisch TJ, Yoshor D, Sheth SA, Patel AJ. Predictors of postoperative seizure outcome in supratentorial meningioma. J Neurosurg 2022; 137:515-524. [PMID: 35099915 DOI: 10.3171/2021.9.jns211738] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/14/2021] [Accepted: 09/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meningiomas are the most common primary intracranial tumor. Seizures are common sequelae of meningioma development. Meningioma patients with seizures can be effectively treated with resection, with reports of seizure freedom of 60%-90%. Still, many patients manifest persistent epilepsy. Determining factors associated with worsened seizure outcomes remains critical in improving the quality of life for these patients. The authors sought to identify clinical, radiological, and histological factors associated with worse seizure outcomes in patients with supratentorial meningioma and preoperative seizures. METHODS The authors retrospectively reviewed the charts of 384 patients who underwent meningioma resection from 2008 to 2020. The charts of patients with a documented history of preoperative seizures were further reviewed for clinical, radiological, operative, perioperative, histological, and postoperative factors associated with seizures. Engel class at last follow-up was retrospectively assigned by the authors and further grouped into favorable (class I) and worse (class II-IV) outcomes. Factors were subsequently compared by group using comparative statistics. Univariable and multivariable regression models were utilized to identify independent predictors of worse seizure outcome. RESULTS Fifty-nine patients (15.4%) were found to have preoperative seizures, of whom 57 had sufficient postoperative data to determine Engel class outcome. Forty-two patients (74%) had Engel class I outcomes. The median follow-up was 17 months. Distinct margins on preoperative imaging (p = 0.012), Simpson grade I resection (p = 0.004), postresection ischemia (p = 0.019), WHO grade (p = 0.019), and recurrent disease (p = 0.015) were found to be the strongest predictors of Engel class outcome in univariable logistic regression. MIB-1 index (p = 0.001) and residual volume (p = 0.014) at last follow-up were found to be the strongest predictors of Engel class outcome in univariable generalized linear regression. Postresection ischemia (p = 0.012), WHO grade (p = 0.022), recurrent disease (p = 0.038), and MIB-1 index (p = 0.002) were found to be the strongest independent predictors of Engel class outcomes in multivariable analysis. CONCLUSIONS Postresection ischemia, higher WHO grade, elevated MIB-1 index, and disease recurrence independently predict postresection seizure persistence in patients with supratentorial meningioma. Further understanding of the etiology of these markers may aid in elucidation of this complex disease process and guide management to prevent worse outcomes.
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Affiliation(s)
- Ron Gadot
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - A Basit Khan
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Rajan Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Eric Goethe
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Arya Shetty
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | | | - James C Bayley V
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Akdes S Harmanci
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Tiemo J Klisch
- 2Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
| | - Daniel Yoshor
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Sameer A Sheth
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
- 2Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
- 4Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Abstract
Brain metastases are the most common intracranial tumors and are increasing in incidence as overall cancer survival improves. Diagnosis of brain metastases involves both clinical examination and magnetic resonance imaging. Treatment may involve a combination of surgery, radiotherapy, and systemic medical therapy depending on the patient’s neurologic status, performance status, and overall oncologic burden. Advances in these domains have substantially impacted the management of brain metastases and improved performance status and survival for some patients. Indications for surgery have expanded with improved patient selection, imaging, and intraoperative monitoring. Robust evidence supports the use of whole brain radiotherapy and stereotactic radiosurgery, for both standalone and adjuvant indications, in almost all patients. Lastly, while systemic medical therapy has historically provided little benefit, modern immunotherapeutic agents have demonstrated promise. Current investigation seeks to determine the utility of neoadjuvant radiotherapy and laser interstitial thermal therapy, which have shown benefit in limited studies to date. This article provides a review of the epidemiology, pathology, diagnosis, and treatment of brain metastases and the corresponding supporting evidence.
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Affiliation(s)
- Alex W Brenner
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
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Athukuri P, Khan AB, Gadot R, Haque M, Lee S, Gallagher KK, Mims MP, Rivero GA, Barbieri A, Patel AJ, Jalali A. Myeloid sarcoma of the skull base: A case report and systematic literature review. Surg Neurol Int 2022; 13:220. [PMID: 35673665 PMCID: PMC9168333 DOI: 10.25259/sni_255_2022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Myeloid sarcoma (MS), or chloroma, is a rare extramedullary malignant tumor that consists of undifferentiated granulocytic cells, and it is most commonly associated with acute myeloid leukemia (AML). Intracranial MS accounts for 0.4% of MS cases, and involvement of the skull base and visual dysfunction is rarely reported. However, the optimal treatment and response to treatment of skull base MS in the presence of visual symptoms is unknown. Case Description: A 30-year-old male with a history of AML presented with rapidly progressive vision loss and a sellar and parasellar mass with bilateral cavernous sinus and optic nerve encasement. The patient underwent endoscopic endonasal transsphenoidal biopsy revealing intracranial MS. He was treated postoperatively with high-dose intravenous and intrathecal cytarabine and had complete restoration of his vision by postoperative day 11. A systematic review of the literature identified six cases of skull base MS, five of whom presenting with visual symptoms. All patients underwent systemic chemotherapy with cytarabine and/or cyclophosphamide, with infrequent use of intrathecal chemotherapy or radiation. Those with reported visual outcomes were diagnosed 4 months or longer after symptom onset and demonstrated no visual improvement with treatment. Conclusion: Skull base MS is a rare disease entity with a high prevalence of visual dysfunction. Our patient’s complete disappearance of intracranial disease and resolution of visual symptoms with systemic and intrathecal chemotherapy highlight the importance of timely diagnosis and appropriate treatment without a need for direct surgical decompression.
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Affiliation(s)
- Prazwal Athukuri
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - A Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Monira Haque
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Sungho Lee
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - K Kelly Gallagher
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Martha P Mims
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Gustavo A Rivero
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Andreia Barbieri
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Ali Jalali
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
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Mohamed S, Patel AJ, Mazhar K, Osman A, Balacumaraswami L, Ridley P. Native pulmonary valve endocarditis requiring pulmonary valve replacement in adulthood: a case series. J Surg Case Rep 2022; 2022:rjac137. [PMID: 35444791 PMCID: PMC9015772 DOI: 10.1093/jscr/rjac137] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Native pulmonary valve endocarditis is a rare phenomenon as native valve endocarditis tends to typically affect the left sided heart valves. However, the right-sided heart valves can be affected in patients with a history of intravenous drug use, whereby the tricuspid valve is most commonly affected. We present two cases who were diagnosed with native pulmonary valve endocarditis in the absence of congenital heart disease. In the first case, the native pulmonary valve endocarditis was probably a derivative of compounding factors of an enlarged underlying pulmonary artery and staphylococcal bacteraemia. In the second case, a common causal organism of native valve endocarditis following dental treatment and the resultant echocardiography findings was of significant interest. In summary, native pulmonary valve endocarditis is relatively rare complication in the adult population, especially in the absence of congenital heart disease.
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Affiliation(s)
- S Mohamed
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
| | - A J Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - K Mazhar
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
| | - A Osman
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
| | - L Balacumaraswami
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
| | - P Ridley
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
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Snyder R, Lee S, Heck K, Mandel JJ, Patel AJ, Jalali A. Hemorrhagic cavum vergae colloid cyst: A presentation of anterograde amnesia without hydrocephalus. Surg Neurol Int 2022; 13:148. [PMID: 35509582 PMCID: PMC9062956 DOI: 10.25259/sni_886_2021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Colloid cysts characteristically arise from the roof of the third ventricle near the foramen of Monro, causing symptoms from obstructive hydrocephalus. However, atypical locations have been reported with various clinical presentations, growth patterns, and displacement of surrounding anatomic structures. Case Description: Here, we describe the interesting case of a patient with a large hemorrhagic cavum vergae colloid cyst presenting with anterograde amnesia soon after starting antiplatelet therapy. The patient did not have hydrocephalus on presentation and his amnesia persisted after complete removal of the hemorrhagic mass through transcallosal interforniceal approach. Conclusion: To the best of our knowledge, this is the only reported instance of a colloid cyst presenting with amnesia in the absence of hydrocephalus. Pathophysiology as well as diagnostic and management strategies of hemorrhagic colloid cysts are discussed.
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Affiliation(s)
- Rita Snyder
- Departments of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
| | - Sungho Lee
- Departments of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
| | - Kent Heck
- Pathology, Baylor College of Medicine, Houston, Texas, United States,
| | - Jacob J. Mandel
- Neurology, Baylor College of Medicine, Houston, Texas, United States
| | - Akash J. Patel
- Departments of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
| | - Ali Jalali
- Departments of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
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Gadot R, Anand A, Lovin BD, Sweeney AD, Patel AJ. Predicting surgical decision-making in vestibular schwannoma using tree-based machine learning. Neurosurg Focus 2022; 52:E8. [DOI: 10.3171/2022.1.focus21708] [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: 11/22/2021] [Accepted: 01/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Vestibular schwannomas (VSs) are the most common neoplasm of the cerebellopontine angle in adults. Though these lesions are generally slow growing, their growth patterns and associated symptoms can be unpredictable, which may complicate the decision to pursue conservative management versus active intervention. Additionally, surgical decision-making can be controversial because of limited high-quality evidence and multiple quality-of-life considerations. Machine learning (ML) is a powerful tool that utilizes data sets to essentialize multidimensional clinical processes. In this study, the authors trained multiple tree-based ML algorithms to predict the decision for active treatment versus MRI surveillance of VS in a single institutional cohort. In doing so, they sought to assess which preoperative variables carried the most weight in driving the decision for intervention and could be used to guide future surgical decision-making through an evidence-based approach.
METHODS
The authors reviewed the records of patients who had undergone evaluation by neurosurgery and otolaryngology with subsequent active treatment (resection or radiation) for unilateral VS in the period from 2009 to 2021, as well as those of patients who had been evaluated for VS and were managed conservatively throughout 2021. Clinical presentation, radiographic data, and management plans were abstracted from each patient record from the time of first evaluation until the last follow-up or surgery. Each encounter with the patient was treated as an instance involving a management decision that depended on demographics, symptoms, and tumor profile. Decision tree and random forest classifiers were trained and tested to predict the decision for treatment versus imaging surveillance on the basis of unseen data using an 80/20 pseudorandom split. Predictor variables were tuned to maximize performance based on lowest Gini impurity indices. Model performance was optimized using fivefold cross-validation.
RESULTS
One hundred twenty-four patients with 198 rendered decisions concerning management were included in the study. In the decision tree analysis, only a maximum tumor dimension threshold of 1.6 cm and progressive symptoms were required to predict the decision for treatment with 85% accuracy. Optimizing maximum dimension thresholds and including age at presentation boosted accuracy to 88%. Random forest analysis (n = 500 trees) predicted the decision for treatment with 80% accuracy. Factors with the highest variable importance based on multiple measures of importance, including mean minimal conditional depth and largest Gini impurity reduction, were maximum tumor dimension, age at presentation, Koos grade, and progressive symptoms at presentation.
CONCLUSIONS
Tree-based ML was used to predict which factors drive the decision for active treatment of VS with 80%–88% accuracy. The most important factors were maximum tumor dimension, age at presentation, Koos grade, and progressive symptoms. These results can assist in surgical decision-making and patient counseling. They also demonstrate the power of ML algorithms in extracting useful insights from limited data sets.
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Affiliation(s)
- Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine
| | - Benjamin D. Lovin
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston; and
| | - Alex D. Sweeney
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston; and
| | - Akash J. Patel
- Department of Neurosurgery, Baylor College of Medicine
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas
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Lazaro T, Katlowitz K, Karas PJ, Srinivasan VM, Rao G, Patel AJ. 828 The Impact of a Night Float System on Neurosurgery Resident Operative Experience. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_828] [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
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Karas PJ, Gopakumar S, Lazaro TT, Lee S, Khan AB, Hadley CC, Patel AJ. 3D Modeling in Virtual Reality for Resection of a Pineal Region Falcotentorial Meningioma. World Neurosurg 2022; 161:110. [PMID: 35202874 DOI: 10.1016/j.wneu.2022.02.058] [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: 10/24/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
We present a parietal interhemispheric approach to resect a pineal region falcotentorial meningioma. 3D modeling was utilized to visualize and plan the surgical approach in virtual reality. A 78-year-old woman was incidentally found to have a slow-growing falcotentorial meningioma. The tumor was first treated with stereotactic radiosurgery, but the patient had progressive confusion, memory issues, and bilateral temporal field cuts with interval expansion of the tumor and significantly increased peri-tumoral vasogenic edema on MRI. After recommending tumor resection, the patient consented to surgery and underwent resection via a posterior interhemispheric subsplenial approach. Using a 3D model in virtual reality, we discuss the advantages and disadvantages of various classical approaches to the pineal region for resection of this tumor.1,2,3 Falcotentorial meningiomas often displace the deep veins inferiorly, making an interhemispheric approach more favorable.4,5,6 Pre-operative visualization of critical deep venous structures with the 3D model was a valuable adjunct to MRI for achieving safe resection. We depict key steps of the surgical planning process using virtual reality and demonstrate how simulation can be used to evaluate risks and benefits of different surgical corridors. A small rim of residual tumor adherent to the deep cerebral veins was intentionally left behind in order to minimize risk of morbidity to the patient.7 At one month follow-up, the patient's cognition had returned to baseline and her vision had significantly improved. Ultimately, surgical planning using virtual reality promotes both neurosurgical education and patient safety through clear visualization and understanding of different surgical approaches.
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Affiliation(s)
- Patrick J Karas
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Tyler T Lazaro
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sungho Lee
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - A Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Caroline C Hadley
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA.
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Bayley JC, Hadley CC, Harmanci AO, Harmanci AS, Klisch TJ, Patel AJ. Multiple approaches converge on three biological subtypes of meningioma and extract new insights from published studies. Sci Adv 2022; 8:eabm6247. [PMID: 35108039 DOI: 10.1126/sciadv.abm6247] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
One-fifth of meningiomas classified as benign by World Health Organization (WHO) histopathological grading will behave malignantly. To better diagnose these tumors, several groups turned to DNA methylation, whereas we combined RNA-sequencing (RNA-seq) and cytogenetics. Both approaches were more accurate than histopathology in identifying aggressive tumors, but whether they revealed similar tumor types was unclear. We therefore performed unbiased DNA methylation, RNA-seq, and cytogenetic profiling on 110 primary meningiomas WHO grade I and II). Each technique distinguished the same three groups (two benign and one malignant) as our previous molecular classification; integrating these methods into one classifier further improved accuracy. Computational modeling revealed strong correlations between transcription and cytogenetic changes, particularly loss of chromosome 1p, in malignant tumors. Applying our classifier to data from previous studies also resolved certain anomalies entailed by grouping tumors by WHO grade. Accurate classification will therefore elucidate meningioma biology as well as improve diagnosis and prognosis.
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Affiliation(s)
- James C Bayley
- Department of Neurosurgery, Baylor College of Medicine, Houston , TX 77030, USA
| | - Caroline C Hadley
- Department of Neurosurgery, Baylor College of Medicine, Houston , TX 77030, USA
| | - Arif O Harmanci
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center , Houston , TX 77030, USA
| | - Akdes S Harmanci
- Department of Neurosurgery, Baylor College of Medicine, Houston , TX 77030, USA
| | - Tiemo J Klisch
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston , TX 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston , TX 77030, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston , TX 77030, USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston , TX 77030, USA
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Jackson HN, Hadley CC, Khan AB, Gadot R, Bayley JC, Shetty A, Mandel J, Jalali A, Gallagher KK, Sweeney AD, Harmanci AO, Harmanci AS, Klisch T, Gopinath SP, Rao G, Yoshor D, Patel AJ. Racial and Socioeconomic Disparities in Patients With Meningioma: A Retrospective Cohort Study. Neurosurgery 2022; 90:114-123. [PMID: 34982878 PMCID: PMC9514723 DOI: 10.1227/neu.0000000000001751] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors. OBJECTIVE To determine factors that contribute to different clinical outcomes in racial populations. METHODS We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and histopathological differences. RESULTS Minority patients were more likely to present through the emergency department than an outpatient clinic (P < .0001). They were more likely to present with more advanced clinical symptoms with lower Karnofsky Performance scores, more frequently had peritumoral edema (P = .0031), and experienced longer postoperative stays in the hospital (P = .0053), and African-American patients had higher hospitalization costs (P = .046) and were more likely to be publicly insured. Extent of resection was an independent predictor of recurrence freedom (P = .039). Presentation in clinic setting trended toward an association with recurrence-free survival (P = .055). We observed no significant difference in gross total resection rates, postoperative recurrence, or recurrence-free survival. CONCLUSION Minority patients are more likely to present with severe symptoms, require longer perioperative hospitalization, and generate higher hospitalization costs. This may be due to socioeconomic factors that affect access to health care. Targeting barriers to access, especially to subspecialty care, may facilitate more appropriate and timely diagnosis, thereby improving patient care and outcomes.
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Affiliation(s)
- Hudin N Jackson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Caroline C Hadley
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - A Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - James C Bayley
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Arya Shetty
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Ali Jalali
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - K Kelly Gallagher
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Otolaryngology, Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Alex D Sweeney
- Department of Otolaryngology, Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Arif O Harmanci
- Center for Computational Systems Medicine, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Akdes S Harmanci
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Tiemo Klisch
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Jan and Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA
| | - Shankar P Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ganesh Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel Yoshor
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Otolaryngology, Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.,Jan and Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA
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Gadot R, Khan AB, Patel R, Goethe E, Shetty A, Hadley CC, V JCB, Harmanci AS, Klisch TJ, Yoshor D, Sheth SA, Patel AJ. Predictors of postoperative seizure outcome in supratentorial meningioma. J Neurosurg 2021; 1:1-10. [PMID: 35099915 DOI: 10.1016/j.bas.2021.100580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/14/2021] [Accepted: 09/01/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Meningiomas are the most common primary intracranial tumor. Seizures are common sequelae of meningioma development. Meningioma patients with seizures can be effectively treated with resection, with reports of seizure freedom of 60%-90%. Still, many patients manifest persistent epilepsy. Determining factors associated with worsened seizure outcomes remains critical in improving the quality of life for these patients. The authors sought to identify clinical, radiological, and histological factors associated with worse seizure outcomes in patients with supratentorial meningioma and preoperative seizures. METHODS The authors retrospectively reviewed the charts of 384 patients who underwent meningioma resection from 2008 to 2020. The charts of patients with a documented history of preoperative seizures were further reviewed for clinical, radiological, operative, perioperative, histological, and postoperative factors associated with seizures. Engel class at last follow-up was retrospectively assigned by the authors and further grouped into favorable (class I) and worse (class II-IV) outcomes. Factors were subsequently compared by group using comparative statistics. Univariable and multivariable regression models were utilized to identify independent predictors of worse seizure outcome. RESULTS Fifty-nine patients (15.4%) were found to have preoperative seizures, of whom 57 had sufficient postoperative data to determine Engel class outcome. Forty-two patients (74%) had Engel class I outcomes. The median follow-up was 17 months. Distinct margins on preoperative imaging (p = 0.012), Simpson grade I resection (p = 0.004), postresection ischemia (p = 0.019), WHO grade (p = 0.019), and recurrent disease (p = 0.015) were found to be the strongest predictors of Engel class outcome in univariable logistic regression. MIB-1 index (p = 0.001) and residual volume (p = 0.014) at last follow-up were found to be the strongest predictors of Engel class outcome in univariable generalized linear regression. Postresection ischemia (p = 0.012), WHO grade (p = 0.022), recurrent disease (p = 0.038), and MIB-1 index (p = 0.002) were found to be the strongest independent predictors of Engel class outcomes in multivariable analysis. CONCLUSIONS Postresection ischemia, higher WHO grade, elevated MIB-1 index, and disease recurrence independently predict postresection seizure persistence in patients with supratentorial meningioma. Further understanding of the etiology of these markers may aid in elucidation of this complex disease process and guide management to prevent worse outcomes.
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Affiliation(s)
- Ron Gadot
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - A Basit Khan
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Rajan Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Eric Goethe
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Arya Shetty
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | | | - James C Bayley V
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Akdes S Harmanci
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Tiemo J Klisch
- 2Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
| | - Daniel Yoshor
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Sameer A Sheth
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
- 2Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
- 4Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Goethe EA, Hartford J, Foroozan R, Patel AJ. Oscillopsia following orbitotomy for intracranial tumor resection. Surg Neurol Int 2021; 12:459. [PMID: 34621574 PMCID: PMC8492429 DOI: 10.25259/sni_498_2021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/15/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Oscillopsia is a visual phenomenon in which an individual perceives that their environment is moving when it is in fact stationary. In this report, we describe two patients with pulsatile oscillopsia following orbitocranial approaches for skull base meningioma resection. Case Description: Two patients, both 42-year-old women, underwent orbitocranial approaches for resection of a right sphenoid wing (Patient 1) and left cavernous sinus (Patient 2) meningioma. Patient 1 underwent uncomplicated resection and was discharged home without neurologic or visual complaints; she presented 8 days later with pulsatile oscillopsia. This was managed expectantly, and MRA revealed no evidence of vascular pathology. She has not required intervention as of most recent follow-up. Patient 2 developed trochlear and trigeminal nerve palsies following resection and developed pulsatile oscillopsia 4 months postoperatively. After patching and corrective lens application, the patient’s symptoms had improved by 26 months postoperatively. Conclusion: Oscillopsia is a potential complication following skull base tumor resection about which patients should be aware. Patients may improve with conservative management alone, although the literature describes repair of orbital defects for ocular pulsations in traumatic and with some developmental conditions.
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Affiliation(s)
- Eric A Goethe
- Department of Neurosurgery Baylor College of Medicine, Houston, Texas, United States
| | - Juliet Hartford
- Department of Opthalmology, Baylor College of Medicine, Houston, Texas, United States
| | - Rod Foroozan
- Department of Opthalmology, Baylor College of Medicine, Houston, Texas, United States
| | - Akash J Patel
- Department of Neurosurgery Baylor College of Medicine, Houston, Texas, United States
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Mohanty A, Caldwell DJ, Hadley CC, Gibson A, Ravanpay A, Patel AJ. Virtual Interviews in Neurosurgery Resident Selection-A Work in Progress. World Neurosurg 2021; 155:e412-e417. [PMID: 34428584 DOI: 10.1016/j.wneu.2021.08.074] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Due to the COVID-19 pandemic, the ACGME recommended all interviews for the 2021 residency application cycle be held virtually. Because this is major shift from neurosurgical interviews in past years, this study aims to evaluate both applicant and interviewer satisfaction of conducting interviews virtually. METHODS For faculty, an 11-question online survey was sent to 116 United States neurosurgery training programs. A 14-question online survey was sent to 255 neurosurgery applicants. The resulting data were analyzed qualitatively and quantitatively. RESULTS From applicants, 118 responses were received. From faculty, 171 individual responses were received. Thirty-five percent (34.7%) of applicants agreed that they were satisfied with the virtual interview process as a whole. Although 44.5% of faculty disagreed with the statement "I would like to replace in-person interviews with virtual interviews in the future", 57.3% of faculty agreed that they were likely to implement virtual interviews in the future. CONCLUSIONS Some things might be better assessed through in-person interviews, but there are clear benefits to virtual interviews. Future iterations of the interview process, incorporating virtual interviews, might help determine how and in which situations virtual interviews can be utilized in future residency application cycles.
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Affiliation(s)
- Alina Mohanty
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - David J Caldwell
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Caroline C Hadley
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Alec Gibson
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Ali Ravanpay
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA; Puget Sound Veterans Hospital, Seattle, Washington, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA; Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA.
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Mandel JJ, Youssef M, Yust-Katz S, Patel AJ, Jalali A, Li Z, Wu J, Ludmir EB, de Groot JF. IDH mutation status and the development of venous thromboembolism in astrocytoma patients. J Neurol Sci 2021; 427:117538. [PMID: 34146775 DOI: 10.1016/j.jns.2021.117538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/19/2021] [Revised: 05/21/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a very common adverse event for astrocytoma patients, but validation of proposed risk biomarkers has been elusive. We examine whether the status of the isocitrate dehydrogenase (IDH) gene is a risk factor for the development of venous thromboembolism (VTE) in astrocytoma patients. METHODS We conducted a retrospective chart review of 282 astrocytoma patients enrolled in the PROACTIVE (Prospective Assessment of Correlative Biomarker) study at MD Anderson Cancer Center (MDACC) from 9/1/2000 until 12/31/2013. RESULTS We identified 282 astrocytoma patients consisting of 49 IDH mutant astrocytomas and 233 IDH wildtype astrocytomas. Glioblastoma was the initial histopathologic diagnosis in 30 (61.2%) of the IDH mutated astrocytomas compared to 227(97.4%) of the IDH wild type astrocytomas. VTE was identified in 52 (18.4%) of patients. VTE was diagnosed in 7 (14.3%) of the IDH mutated astrocytomas compared to 45(19.3%) of the IDH wild type astrocytoma s (p = 0.4094). Median time to VTE from diagnosis was 2.71 months. Median time to VTE from diagnosis was 2.6 months for IDH mutated astrocytomas compared to 3.06 months for the IDH wild type astrocytomas (p = 0.8663). CONCLUSIONS IDH gene status did not appear as a significant risk factor for the development of venous thromboembolism (VTE) in our cohort of astrocytoma patients. Further research into potential biomarkers for VTE may be warranted.
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Affiliation(s)
- Jacob J Mandel
- Baylor College of Medicine, Department of Neurology and Neurosurgery, One Baylor Plaza, MS NB302, Houston, TX 77030, United States of America
| | | | - Shlomit Yust-Katz
- Rabin Medical Center, Department of Neurosurgery, 39 Jabotinski St, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Akash J Patel
- Baylor College of Medicine, Department of Neurology and Neurosurgery, One Baylor Plaza, MS NB302, Houston, TX 77030, United States of America
| | - Ali Jalali
- Baylor College of Medicine, Department of Neurology and Neurosurgery, One Baylor Plaza, MS NB302, Houston, TX 77030, United States of America
| | - Ziyi Li
- The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Unit 1409, P. O. Box 301402, Houston, TX 77230-1402, United States of America
| | - Jimin Wu
- The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Unit 1409, P. O. Box 301402, Houston, TX 77230-1402, United States of America
| | - Ethan B Ludmir
- The University of Texas MD Anderson Cancer Center, Division of Radiation Oncology - Unit 1422, 1400 Pressler St., FCT6.5000, Houston, TX 77030, United States of America
| | - John F de Groot
- The University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, Unit 431, 1515 Holcombe Blvd, Houston, TX 77030-4009, United States of America.
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Cotton PC, Srinivasan V, Lazaro T, Raper D, Kan P, Patel AJ, Burkhardt JK. Comparison of Simultaneous Bilateral Internal Carotid Artery (ICA) 3-Dimensional Rotational Venography (3D-RV) versus Separate Bilateral ICA 3D-RV and Postprocessing 3D-3D Fusion. World Neurosurg 2021; 152:e201-e204. [PMID: 34052454 DOI: 10.1016/j.wneu.2021.05.063] [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: 03/31/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preoperative venogram of the superior sagittal sinus (SSS) is helpful to plan the surgical resection strategy in patients with parasagittal meningiomas invading the SSS. METHODS Catheter 3-dimensional rotational venography (3D-RV) allows for SSS patency assessment and detection of alternative venous cortical drainage routes in patients with contraindication for magnet resonance venography. It is unknown if separate bilateral internal carotid artery 3D-RV followed by postprocessing 3D-3D fusion (technique 1) achieves the same imaging results as simultaneous bilateral internal carotid artery 3D-RV without postprocessing fusion (technique 2) needed. RESULTS In this report we were able to confirm in 2 patients that both techniques achieve comparable imaging quality with similar amount of contrast use. CONCLUSIONS Although technique 2 requires less radiation, technique 1 is favored due to the need for only 1 vessel access site and catheter with reduced risk for access site and ischemic complications.
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Affiliation(s)
- Patrick C Cotton
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
| | - Visish Srinivasan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Tyler Lazaro
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel Raper
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Nduom EK, Gephart MH, Chheda MG, Suva ML, Amankulor N, Battiste JD, Campian JL, Dacey RG, Das S, Fecci PE, Hadjipanayis CG, Hoang KB, Jalali A, Orringer D, Patel AJ, Placantonakis D, Rodriguez A, Yang I, Yu JS, Zipfel GJ, Dunn GP, Leuthardt EC, Kim AH. Re-evaluating Biopsy for Recurrent Glioblastoma: A Position Statement by the Christopher Davidson Forum Investigators. Neurosurgery 2021; 89:129-132. [PMID: 33862619 DOI: 10.1093/neuros/nyab063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 11/15/2022] Open
Abstract
Patients with glioblastoma (GBM) need bold new approaches to their treatment, yet progress has been hindered by a relative inability to dynamically track treatment response, mechanisms of resistance, evolution of targetable mutations, and changes in mutational burden. We are writing on behalf of a multidisciplinary group of academic neuro-oncology professionals who met at the collaborative Christopher Davidson Forum at Washington University in St Louis in the fall of 2019. We propose a dramatic but necessary change to the routine management of patients with GBM to advance the field: to routinely biopsy recurrent GBM at the time of presumed recurrence. Data derived from these samples will identify true recurrence vs treatment effect, avoid treatments with little chance of success, enable clinical trial access, and aid in the scientific advancement of our understanding of GBM.
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Affiliation(s)
- Edjah K Nduom
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Melanie Hayden Gephart
- Department of Neurological Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Milan G Chheda
- Departments of Medicine and Neurology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Mario L Suva
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Nduka Amankulor
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James D Battiste
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jian L Campian
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ralph G Dacey
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sunit Das
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Kimberly B Hoang
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali Jalali
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel Orringer
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Analiz Rodriguez
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Isaac Yang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer S Yu
- Department of Radiation Oncology and Cancer Biology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Greg J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Gavin P Dunn
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Mohamed S, Mazhar K, Patel AJ, Jeeji R, Ridley P, Balacumaraswami L. Off-pump external pericardial patch repair for post-infarct left ventricular free wall rupture: a case series. J Surg Case Rep 2021; 2021:rjab073. [PMID: 33758654 PMCID: PMC7963454 DOI: 10.1093/jscr/rjab073] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
We describe an off-pump surgical approach to this challenging condition supported by our results from a case series, which would add to existing literature in the management of this life-threatening complication. We identified seven patients who underwent surgical intervention for left ventricular (LV) free wall rupture at our institution. They were all diagnosed to have cardiac tamponade secondary to free wall rupture of the LV in the presence of acute myocardial infarction. The surgical technique comprised of utilizing an external pericardial patch which was secured using surgical biological glues (fibrin-based sealants or gelatin hydrogels). The 30-day mortality, 1-year survival and 2-year survival were 57, 42 and 42%, respectively. Advanced age, female gender and use of cardiopulmonary bypass were characteristics that were not significantly associated with survival. We advocate the use of an off-pump external pericardial patch repair strategy as a ‘bridge to recovery’ in this extremely high-risk group of patients.
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Affiliation(s)
- S Mohamed
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - K Mazhar
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - A J Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - R Jeeji
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - P Ridley
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - L Balacumaraswami
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
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Rumalla K, Srinivasan VM, Gaddis M, Kvint S, Patel AJ, Kan P, Lawton MT, Burkhardt JK. Cavernous Malformation Surgery in the United States: Validation of a Novel International Classification of Disease, 10th Edition, Clinical Modification Code Search Algorithm and Volume-Driven Surgical Outcomes. World Neurosurg 2021; 150:e66-e73. [PMID: 33640531 DOI: 10.1016/j.wneu.2021.02.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/06/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The surgical decision-making process for cavernous malformation (CM) must weigh the risks of surgery against the burden of patient symptoms/hemorrhage and anticipated natural history. Here, we sought to internally validate an International Classification of Disease (ICD)-10 search algorithm for CM surgery to use to analyze a nationwide administrative database. METHODS Institutional records were accessed to test the validity of a novel ICD-10 search algorithm for CM surgery. The algorithm identified patients with positive predictive value (92%), specificity (100%), and sensitivity of 55%. The algorithm was applied to extract our target population from the Nationwide Readmissions Database. Univariate and multivariable analyses were used to identify factors influencing patient outcomes. RESULTS We identified 1235 operations for supratentorial (87%) or infratentorial (13%) CM surgery from the Nationwide Readmissions Database (2016-2017). The overall rate of adverse disposition and 30-day readmission were 19.7% and 7.5%, respectively. The rate of adverse disposition was significantly higher for infratentorial (vs. supratentorial cases) (34.3% vs. 17.6%, P = 0.001) and brainstem (vs. cerebellar) cases (55% vs. 28%, P = 0.03). Hospital case-volume percentile was associated with decreasing rates of adverse disposition (1-74th: 22%, 75th: 16%, 90th: 13%, 95th: 7%). Treatment at HVCs was also associated with shorter average length of stay (4.6 vs. 7.3 days, P < 0.001) without significant changes to average cost of hospitalization (P = 0.60). CONCLUSIONS Our ICD-10 coding algorithm reliably identifies CM surgery with minimal false positives. Outcomes were influenced by patient age, clinical presentation, location of CM, and experience of institution. Centralization of care may improve outcomes and warrants further investigation.
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Affiliation(s)
- Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA; Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Monica Gaddis
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Svetlana Kvint
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA; Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
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Srinivasan VM, Hadley CC, Patel AJ, Ehni BL, Weiner HL, Rao G, Lang FF, Sawaya RE, Yoshor D. The history of neurosurgery at Baylor College of Medicine. J Neurosurg 2021; 135:1259-1269. [PMID: 33607618 DOI: 10.3171/2020.7.jns201196] [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: 04/12/2020] [Accepted: 07/16/2020] [Indexed: 11/06/2022]
Abstract
The development of neurosurgery at Baylor College of Medicine began with the medical school's relocation to the new Texas Medical Center in Houston in 1943. An academic service was organized in 1949 as a section of neurosurgery within Baylor's Department of Surgery. Soon the practice, led by Dr. George Ehni, evolved to include clinical services at Methodist, Jefferson Davis (forerunner of Ben Taub), Texas Children's, the Veterans Affairs, and the University of Texas MD Anderson Cancer Center hospitals. A neurosurgery residency program was established in 1954. As the clinical practice expanded, neurosurgery was upgraded from a section to a division and then to a department. It has been led by four chiefs/chairs over the past 60 years-Dr. George Ehni (1959-1979), Dr. Robert Grossman (1980-2004), Dr. Raymond Sawaya (2005-2014), and Dr. Daniel Yoshor (2015-2020). Since the 1950s, the department has drawn strength from its robust residency program, its research base in the medical school, and its five major hospital affiliates, which have largely remained unchanged (with the exception of Baylor St. Luke's Medical Center replacing Methodist in 2004). The recent expansion of the residency program to 25 accredited positions and the growing strength of relationships with the "Baylor five" hospitals affiliated with Baylor College of Medicine portend a bright future.
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Affiliation(s)
| | | | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine
| | - Bruce L Ehni
- 1Department of Neurosurgery, Baylor College of Medicine
| | - Howard L Weiner
- 1Department of Neurosurgery, Baylor College of Medicine.,2Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine; and
| | - Ganesh Rao
- 1Department of Neurosurgery, Baylor College of Medicine.,3Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frederick F Lang
- 1Department of Neurosurgery, Baylor College of Medicine.,3Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Raymond E Sawaya
- 1Department of Neurosurgery, Baylor College of Medicine.,3Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel Yoshor
- 1Department of Neurosurgery, Baylor College of Medicine
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Gopakumar S, Srinivasan VM, Hadley CC, Anand A, Daou M, Karas PJ, Mandel J, Gopinath SP, Patel AJ. Intracranial Solitary Fibrous Tumor of the Skull Base: 2 Cases and Systematic Review of the Literature. World Neurosurg 2021; 149:e345-e359. [PMID: 33609763 DOI: 10.1016/j.wneu.2021.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/04/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intracranial solitary fibrous tumors (ISFTs) are rare neoplasms of mesenchymal origin that originate from the meninges. ISFTs of the skull base can be challenging to treat, as resection can be complicated by skull base anatomy. We present 2 cases of ISFT, the first manifesting with compressive cranial neuropathy from Meckel cave involvement and the second a posterior fossa lesion causing symptomatic hydrocephalus. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed database was queried with title/abstract keywords "intracranial," "solitary fibrous tumor," "hemangiopericytoma," "SFT," and "HPC." Search results were reviewed to exclude cases not involving the skull base. References from all selected articles were reviewed for potential additional cases. Patient demographic and clinical data from 58 identified skull base cases were collected for qualitative synthesis. RESULTS Visual disturbances were the most common presenting symptom (30 cases, 52%) followed by headache (22 cases, 38%). The most common site of involvement was the sellar/parasellar region (18 cases, 31%) followed by middle fossa/temporal bone (14 cases, 24%). Resection was performed in 55 cases; gross total resection was reported in 26 cases (45%) and subtotal resection was reported in 21 cases (36%). Tumor recurrence was documented in 15 cases (26%) with median and mean follow-up periods of 16 and 29.9 months, respectively. CONCLUSIONS We discuss presentation, imaging, histopathology, and management considerations for ISFTs while highlighting the potentially complex nature of skull base lesions and need for multidisciplinary approach to treatment.
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Affiliation(s)
| | | | - Caroline C Hadley
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Marc Daou
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick J Karas
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Shankar P Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA; Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA.
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Gopakumar S, Srinivasan VM, Sharma H, Cherian J, Patel AJ. Fully Endoscopic Resection of an Epidermoid Cyst of the Cerebellopontine Angle: Bilateral Resection via a Unilateral Approach. Oper Neurosurg (Hagerstown) 2021; 20:E152-E155. [PMID: 32970119 DOI: 10.1093/ons/opaa291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/15/2020] [Accepted: 07/05/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Epidermoid cysts are rare, benign intracranial neoplasms that typically arise at the cerebellopontine angle (CPA) and can be extensive lesions that intricately involve many critical neurovascular structures. We describe the case of a patient who presents with the classic picture of CPA epidermoid cyst and describe the value of the 4K endoscope for resection, which is illustrated in our accompanying surgical video. CLINICAL PRESENTATION The patient presents with headache, nausea, and vomiting accompanied by dizziness and balance issues. Radiographic imaging demonstrated a large lesion highly consistent with epidermoid cyst which involved the left CPA, encircled the basilar artery, and extended to the opposite side. Surgery was planned with a small left-sided retrosigmoid craniotomy with use of a 2-dimensional 4K endoscope to aid in resection, particularly of the contralateral side. This approach was successful with gross total resection apparent at 14-mo follow-up. CONCLUSION We describe the use of a fully endoscopic technique from a unilateral approach for resection of a lesion that extended in the CPA bilaterally. Additionally, we highlight the relevant neuroanatomical and neurovascular structures in this highly critical intracranial region which is well-visualized through endoscopy in the associated surgical video.
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Affiliation(s)
| | | | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
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Mohanty A, Srinivasan VM, Burkhardt JK, Johnson J, Patel AJ, Sheth SA, Viswanathan A, Yoshor D, Kan P. Ambulatory neurosurgery in the COVID-19 era: patient and provider satisfaction with telemedicine. Neurosurg Focus 2020; 49:E13. [PMID: 33260126 DOI: 10.3171/2020.9.focus20596] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 06/30/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Telemedicine has rapidly expanded in the recent years as technologies have afforded healthcare practitioners the ability to diagnose and treat patients remotely. Due to the COVID-19 pandemic, nonessential clinical visits were greatly limited, and much of the outpatient neurosurgical practice at the authors' institution was shifted quickly to telehealth. Although there are prior data suggesting that the use of telemedicine is satisfactory in other surgical fields, data in neurosurgery are limited. This study aimed to investigate both patient and provider satisfaction with telemedicine and its strengths and limitations in outpatient neurosurgery visits. METHODS This quality improvement study was designed to analyze provider and patient satisfaction with telemedicine consultations in an outpatient neurosurgery clinic setting at a tertiary care, large-volume, academic center. The authors designed an 11-question survey for neurosurgical providers and a 13-question survey for patients using both closed 5-point Likert scale responses and multiple choice responses. The questionnaires were administered to patients and providers during the period when the clinic restricted in-person visits. At the conclusion of the study, the overall data were analyzed qualitatively and quantitatively. RESULTS During the study period, 607 surveys were sent out to patients seen by telehealth at the authors' academic center, and 122 responses were received. For the provider survey, 85 surveys were sent out to providers at the authors' center and other academic centers, and 40 surveys were received. Ninety-two percent of patients agreed or strongly agreed that they were satisfied with that particular telehealth visit. Eighty-eight percent of patients agreed that their telehealth visit was more convenient for them than an in-person visit, but only 36% of patients stated they would like their future visits to be telehealth. Sixty-three percent of providers agreed that telehealth visits were more convenient for them than in-person visits, and 85% of responding providers stated that they wished to incorporate telehealth into their future practice. CONCLUSIONS Although the authors' transition to telehealth was both rapid and unexpected, most providers and patients reported positive experiences with their telemedicine visits and found telemedicine to be an effective form of ambulatory neurosurgical care. Not all patients preferred telemedicine visits over in-person visits, but the high satisfaction with telemedicine by both providers and patients is promising to the future expansion of telehealth in ambulatory neurosurgery.
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Affiliation(s)
- Alina Mohanty
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | | | | | - Jeremiah Johnson
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Sameer A Sheth
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | | | - Daniel Yoshor
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Peter Kan
- 2Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
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Khan AB, Gadot R, Shetty A, Bayley J, Hadley C, Cardenas M, Jalali A, Harmanci A, Harmanci A, Wheeler D, Klisch T, Patel AJ. Identification of Novel Fusion Transcripts in Meningioma. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_852] [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: 11/12/2022] Open
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Lazaro T, Srinivasan VM, Rahman M, Asthagiri A, Barkhoudarian G, Chambless LB, Kan P, Rao G, Nahed BV, Patel AJ. Virtual education in neurosurgery during the COVID-19 pandemic. Neurosurg Focus 2020; 49:E17. [DOI: 10.3171/2020.9.focus20672] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVENeurosurgical education in the US has changed significantly as a consequence of the novel coronavirus (COVID-19) pandemic. Institutional social distancing requirements have resulted in many neurosurgical programs utilizing video conferencing for educational activities. However, it is unclear how or if these practices should continue after the pandemic. The objective of this study was to characterize virtual education in neurosurgery and understand how it should be utilized after COVID-19.METHODSA 24-question, 3-part online survey was administered anonymously to all 117 US neurosurgical residency programs from May 15, 2020, to June 15, 2020. Questions pertained to the current use of virtual conferencing, preferences over traditional conferences, and future inclinations. The Likert scale (1 = strongly disagree, 3 = neutral, 5 = strongly agree) was used. Comparisons were calculated using the Mann-Whitney U-test. Statistical significance was set at 0.05.RESULTSOne-hundred eight responses were recorded. Overall, 38 respondents (35.2%) were attendings and 70 (64.8%) were trainees. Forty-one respondents (38.0%) indicated attending 5–6 conferences per week and 70 (64.8%) attend national virtual conferences. When considering different conference types, there was no overall preference (scores < 3) for virtual conferences over traditional conferences. In regard to future use, respondents strongly agreed that they would continue the practice at some capacity after the pandemic (median score 5). Overall, respondents agreed that virtual conferences would partially replace traditional conferences (median score 4), whereas they strongly disagreed with the complete replacement of traditional conferences (median score 1). The most common choices for the partial replacement of tradition conferences were case conferences (59/108, 55%) and board preparation (64/108, 59%). Lastly, there was a significant difference in scores for continued use of virtual conferencing in those who attend nationally sponsored conferences (median score 5, n = 70) and those who do not (median score 4, n = 38; U = 1762.50, z = 2.97, r = 0.29, p = 0.003).CONCLUSIONSVirtual conferences will likely remain an integral part of neurosurgical education after the COVID-19 pandemic has abated. Across the country, residents and faculty report a preference for continued use of virtual conferencing, especially virtual case conferences and board preparation. Some traditional conferences may even be replaced with virtual conferences, in particular those that are more didactic. Furthermore, nationally sponsored virtual conferences have a positive effect on the preferences for continued use of virtual conferences.
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Affiliation(s)
| | | | - Maryam Rahman
- 3University of Florida College of Medicine, Gainesville, Florida
| | - Ashok Asthagiri
- 4John Wayne Cancer Institute at Providence Saint John’s Health Center, Santa Monica, California
| | | | - Lola B. Chambless
- 6Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Peter Kan
- 7Department of Neurosurgery, University of Texas Medical Branch School of Medicine, Houston, Texas
| | | | - Brian V. Nahed
- 8Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts; and
| | - Akash J. Patel
- Departments of 1Neurosurgery and
- 2Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- 9Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas
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Choi JS, Yu J, Lovin BD, Chapel AC, Patel AJ, Gallagher KK. Effects of Preoperative Embolization on Juvenile Nasopharyngeal Angiofibroma Surgical Outcomes: A Study of the Kids' Inpatient Database. Skull Base Surg 2020; 83:76-81. [DOI: 10.1055/s-0040-1716676] [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: 04/02/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Abstract
Objectives The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database.
Methods The health care cost and utilization project Kids' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients.
Results A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day (p = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p = 0.041). Patients receiving PVE were charged an additional $35,600 (p < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing.
Conclusion PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread.
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Affiliation(s)
- Jonathan S. Choi
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Justin Yu
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Benjamin D. Lovin
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Alyssa C. Chapel
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Akash J. Patel
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - K. Kelly Gallagher
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
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