1
|
Garcia CA, Bhargav AG, Brooks M, Suárez-Meade P, Mondal SK, Zarco N, ReFaey K, Jentoft M, Middlebrooks EH, Snuderl M, Carrano A, Guerrero-Cazares H, Schiapparelli P, Sarabia-Estrada R, Quiñones-Hinojosa A. Functional Characterization of Brain Tumor-Initiating Cells and Establishment of GBM Preclinical Models that Incorporate Heterogeneity, Therapy, and Sex Differences. Mol Cancer Ther 2021; 20:2585-2597. [PMID: 34465594 PMCID: PMC8687628 DOI: 10.1158/1535-7163.mct-20-0547] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 07/12/2020] [Revised: 03/09/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
Glioblastoma (GBM) is the most common primary brain cancer in adults where tumor cell heterogeneity and sex differences influence clinical outcomes. Here, we functionally characterize three male and three female patient-derived GBM cell lines, identify protumorigenic BTICs, and create novel male and female preclinical models of GBM. Cell lines were evaluated on the following features: proliferation, stemness, migration, tumorigenesis, clinical characteristics, and sensitivity to radiation, TMZ, rhTNFSF10 (rhTRAIL), and rhBMP4 All cell lines were classified as GBM according to epigenetic subtyping, were heterogenous and functionally distinct from one another, and re-capitulated features of the original patient tumor. In establishing male and female preclinical models, it was found that two male-derived GBM cell lines (QNS108 and QNS120) and one female-derived GBM cell line (QNS315) grew at a faster rate in female mice brains. One male-derived GBM cell line (QNS108) decreased survival in female mice in comparison with male mice. However, no survival differences were observed for mice injected with a female-derived cell line (QNS315). In summary, a panel of six GBM patient-derived cell lines were functionally characterized, and it was shown that BTIC lines can be used to construct sex-specific models with differential phenotypes for additional studies.
Collapse
Affiliation(s)
- Cesar A Garcia
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Brain Tumor Stem Cell Laboratory, Mayo Clinic, Jacksonville, Florida
| | - Adip G Bhargav
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Brain Tumor Stem Cell Laboratory, Mayo Clinic, Jacksonville, Florida
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mieu Brooks
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Brain Tumor Stem Cell Laboratory, Mayo Clinic, Jacksonville, Florida
| | - Paola Suárez-Meade
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Brain Tumor Stem Cell Laboratory, Mayo Clinic, Jacksonville, Florida
| | - Sujan K Mondal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Brain Tumor Stem Cell Laboratory, Mayo Clinic, Jacksonville, Florida
| | - Natanael Zarco
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Neurogenesis and Brain Tumors Laboratory, Mayo Clinic, Jacksonville, Florida
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - Mark Jentoft
- Department of Pathology, Mayo Clinic, Jacksonville, Florida
| | - Erik H Middlebrooks
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York, New York
| | - Anna Carrano
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Neurogenesis and Brain Tumors Laboratory, Mayo Clinic, Jacksonville, Florida
| | - Hugo Guerrero-Cazares
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Neurogenesis and Brain Tumors Laboratory, Mayo Clinic, Jacksonville, Florida
| | - Paula Schiapparelli
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Brain Tumor Stem Cell Laboratory, Mayo Clinic, Jacksonville, Florida
| | - Rachel Sarabia-Estrada
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- Brain Tumor Stem Cell Laboratory, Mayo Clinic, Jacksonville, Florida
| | - Alfredo Quiñones-Hinojosa
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida.
- Brain Tumor Stem Cell Laboratory, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
2
|
Karadag A, Kirgiz PG, Bozkurt B, Kucukyuruk B, ReFaey K, Middlebrooks EH, Senoglu M, Tanriover N. The benefits of inferolateral transtubercular route on intradural surgical exposure using the endoscopic endonasal transclival approach. Acta Neurochir (Wien) 2021; 163:2141-2154. [PMID: 33847826 DOI: 10.1007/s00701-021-04835-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical access to the ventral pontomedullary junction (PMJ) can be achieved through various corridors depending on the location and extension of the lesion. The jugular tubercle (JT), a surgically challenging obstacle to access the PMJ, typically needs to be addressed in transcranial exposures. We describe the endoscopic endonasal transclival approach (EETCA) and its inferolateral transtubercular extension to assess the intradural surgical field gained through JT removal. We also complement the dissections with an illustrative case. METHODS EETCA was surgically simulated, and the anatomical landmarks were assessed in eight cadaveric heads. Microsurgical dissections were additionally performed along the endoscopic surgical path. Lastly, we present an intraoperative video of the trans-JT approach in a patient with lower clival chordoma. RESULTS The EETCA allowed adequate extracranial visualization and removal of the JT. The surgical bony window-obtained along the clivus and centered at the JT via the EETCA-measured 11 × 9 × 7 mm. Removal of the JT provided an improved intradural field within the lower third of the cerebellopontine cistern to expose an area bordered by the cranial nerves VII/VIII and flocculus superior and anterior margin of the lateral recess of the fourth ventricle and cranial nerves IX-XI inferiorly, centered on the foramen of Luschka. CONCLUSIONS Removal of the JT via EETCA improves exposure along the lower third of the cerebellopontine and upper cerebellomedullary cisterns. The inferolateral transtubercular extension of the EETCA provides access to the lateral recess of the fourth ventricle, in combination with the ventral midline pontomedullary region.
Collapse
|
3
|
ReFaey K, Freeman WD, Tripathi S, Guerrero-Cazares H, Eatz TA, Meschia JF, Carter RE, Petrucelli L, Meyer FB, Quinones-Hinojosa A. NIH funding trends for neurosurgeon-scientists from 1993-2017: Biomedical workforce implications for neurooncology. J Neurooncol 2021; 154:51-62. [PMID: 34232472 PMCID: PMC8684039 DOI: 10.1007/s11060-021-03797-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/16/2021] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Neurosurgeons represent 0.5% of all physicians and currently face a high burden of disease. Physician-scientists are essential to advance the mission of National Academies of Science (NAS) and National Institutes of Health (NIH) through discovery and bench to bedside translation. We investigated trends in NIH neurosurgeon-scientist funding over time as an indicator of physician-scientist workforce training. METHODS We used NIH Research Portfolio Online Reporting Tools (RePORTER) to extract grants to neurosurgery departments and neurosurgeons from 1993 to 2017. Manual extraction of each individual grant awardee was conducted. RESULTS After adjusting for U.S. inflation (base year: 1993), NIH funding to neurosurgery departments increased yearly (P < 0.00001). However, neurosurgeon-scientists received significantly less NIH funding compared to scientists (including basic scientists and research only neurosurgeons) (P = 0.09). The ratio of neurosurgeon-scientists to scientists receiving grants was significantly reduced (P = 0.002). Interestingly, the percentage of oncology-related neurosurgery grants significantly increased throughout the study period (P = 0.002). The average number of grants per neurosurgeon-scientists showed an upward trend (P < 0.001); however, the average number of grants for early-career neurosurgeon-scientists, showed a significant downward trend (P = 0.05). CONCLUSION Over the past 23 years, despite the overall increasing trends in the number of NIH grants awarded to neurosurgery departments overall, the proportion of neurosurgeon-scientists that were awarded NIH grants compared to scientists demonstrates a declining trend. This observed shift is disproportionate in the number of NIH grants awarded to senior level compared to early-career neurosurgeon-scientists, with more funding allocated towards neurosurgical-oncology-related grants.
Collapse
Affiliation(s)
- Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - William D Freeman
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Shashwat Tripathi
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Tiffany A Eatz
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - James F Meschia
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Alfredo Quinones-Hinojosa
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA. .,Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA.
| |
Collapse
|
4
|
ReFaey K, Tripathi S, Grewal SS, Bhargav AG, Quinones DJ, Chaichana KL, Antwi SO, Cooper LT, Meyer FB, Dronca RS, Diasio RB, Quinones-Hinojosa A. Cancer Mortality Rates Increasing vs Cardiovascular Disease Mortality Decreasing in the World: Future Implications. Mayo Clin Proc Innov Qual Outcomes 2021; 5:645-653. [PMID: 34195556 PMCID: PMC8240359 DOI: 10.1016/j.mayocpiqo.2021.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To highlight the current global trends in mortality for cardiovascular disease and cancer. METHODS The World Health Organization and the World Bank DataBank databases were used to analyze mortality rates for cancer and cardiovascular disease by calculating age-standardized mortality rates (ASRs) from 2000 to 2015 for high-income, upper-middle-income, and lower-middle-income countries. Data for cancer mortality and population for 43 countries representing 5 of the 7 continents (except Australia and Antarctica) were analyzed. RESULTS From 2000 to 2015, there was an increase in the ASR for cancer for both men and women irrespective of a country's income status, representing an overall 7% increase in cancer ASR (Pearson r, +0.99; P<.00001). We report a higher ASR for cancer in high-income countries than in upper-middle-income and lower-middle-income countries specifically; high-income countries saw a 3% increase in cancer ASR vs +31% for upper-middle-income and +19% for lower-middle-income countries (P<.01). There has been a decrease in the ASR for cardiovascular disease for the 15 years analyzed (P<.00001). In addition, high-income countries had a higher ASR for cardiovascular disease than upper-middle-income countries during the 15-year period (P<.05). CONCLUSION We suspect that because of early detection and targeted interventions, cardiovascular disease mortality rates have decreased during the past decade. On the basis of our results, cancer mortality rates continue to rise, with the projection of surpassing cardiovascular disease mortality rates in the near future.
Collapse
Affiliation(s)
- Karim ReFaey
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, FL
- National Center for Adaptive Neurotechnologies, Albany, NY
| | - Shashwat Tripathi
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, FL
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Adip G. Bhargav
- Neurologic Surgery Department, Mayo Clinic, Rochester, MN
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN
| | | | - Kaisorn L. Chaichana
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, FL
- Otolaryngology–Head and Neck Surgery (ENT) Department, Mayo Clinic, Jacksonville, FL
| | - Samuel O. Antwi
- Department of Health Sciences Research and Epidemiology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | - Alfredo Quinones-Hinojosa
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, FL
- Otolaryngology–Head and Neck Surgery (ENT) Department, Mayo Clinic, Jacksonville, FL
- Molecular Neuroscience Department, Mayo Clinic, Jacksonville, FL
- Cancer Biology Department, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
5
|
Bojaxhi E, Louie C, ReFaey K, Gruenbaum SE, Leone BJ, Bechtel P, Barbosa MP, Chaichana KL, Quinones-Hinojosa A. Reduced Pain and Opioid Use in the Early Postoperative Period in Patients Undergoing a Frontotemporal Craniotomy under Regional vs General Anesthesia. World Neurosurg 2021; 150:e31-e37. [PMID: 33684585 DOI: 10.1016/j.wneu.2021.02.009] [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: 09/24/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study compares the postsurgical course of frontotemporal craniotomies conducted "awake" under regional anesthesia (RA) versus "asleep" under general anesthesia (GA) to investigate postoperative recovery, pain, opioid use, and anesthesia-related side effects. METHODS We retrospectively reviewed craniotomies for supratentorial, intra-axial tumors with frontotemporal exposure. Chronic opioid use and emergent cases were excluded. Primary outcomes included pain scores on a 0-10 numerical rating scale, opioid use as oral morphine milligram equivalence, first time to opioid use, nausea, and sedation on the Richmond Agitation and Sedation Scale (RASS). Secondary outcomes included postoperative seizures, Karnofsky Performance Scale (KPS) status, and hospital length of stay (LOS). RESULTS A total of 91 patients met inclusion criteria: 56 underwent a craniotomy under RA versus 35 under GA. Demographics and operative characteristics were similar between cohorts. A significant reduction in both postoperative pain and opioid use was observed among RA versus GA (first postoperative pain score 2 vs. 5, P < 0.01; postoperative day [POD] 0 median pain score 2.5 vs. 4, P < 0.01; POD 0 mean opioid in mg 14.49 vs. 24.43, P < 0.01). The time until patients requested opioids for pain after surgery was prolonged for RA versus GA [mean 7.23 vs. 3.42 hours, P < 0.01). Somnolence (RASS < 0) on POD 0 was significantly reduced among RA versus GA, with 23% versus 43%. Both cohorts had equivocal postsurgical outcomes such as seizures, KPS, and hospital LOS. CONCLUSIONS Frontotemporal craniotomy under RA during awake craniotomies provides better pain control, a reduction in opioid use, and less somnolence in the early postoperative period.
Collapse
Affiliation(s)
- Elird Bojaxhi
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA.
| | - Christopher Louie
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Surgery, University of California, San Diego, California, USA
| | - Karim ReFaey
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Shaun E Gruenbaum
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bruce J Leone
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Perry Bechtel
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Maria P Barbosa
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | |
Collapse
|
6
|
Rivera Perla KM, Tang OY, Durfey S, ReFaey K, Vivas-Buitrago TG, Parney IF, Toms SA, Quinones-Hinojosa A. Low Socioeconomic Status Predicts Decreased Access to Post-Operative Treatment After Glioblastoma Resection. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
7
|
Ramos-Fresnedo A, Domingo RA, ReFaey K, Gassie K, Clifton W, Grewal SS, Chen SG, Chaichana KL, Quiñones-Hinojosa A. Neurosurgical Interactive Teaching Series: Multidisciplinary Educational Approach. World Neurosurg 2020; 144:e766-e773. [PMID: 32956889 PMCID: PMC7500337 DOI: 10.1016/j.wneu.2020.09.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The goal of this manuscript is to investigate the effects of a multidisciplinary multinational web-based teaching conference on trainee education, research, and patient care. METHODS We present the structure, case selection, and presentation of our educational lectures. We retrospectively reviewed our database to gather data on the number of presentations, type of presentation, and the pathology diagnosis from November 11, 2016 until February 28, 2020. To investigate attendee satisfaction, we analyzed our yearly continuing medical education evaluation survey results to report the impact that this series may have had on our attendees. We assigned a numeric value to the answers, and the mean overall scores were compared through an analysis of variance. Further analysis on specific questions was performed with a Fisher exact test. RESULTS We have hosted 150 lectures, in which we have presented 208 neurosurgical cases corresponding to 133 general session, 59 pituitary, and 16 spine cases, as well as 28 distinct lectures by guest speakers from institutions across the globe. We received 61 responses to our yearly continuing medical education evaluations over the course of 3 years. On these evaluations, we have maintained an excellent overall rating from 2017-2019 (two-sided P > 0.05) and received significantly less suggestions to improve the series comparing 2017 with 2019 (two-sided, P= 0.04). CONCLUSIONS As the world of medicine is constantly changing, we are in need of developing new tools to enhance our ability to relay knowledge through accredited and validated methods onto physicians in training, such as the implementation of structured, multidisciplinary, case-based lectures as presented in this manuscript.
Collapse
Affiliation(s)
| | | | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kelly Gassie
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - William Clifton
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Selby G Chen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | | |
Collapse
|
8
|
Wong BS, Shah SR, Yankaskas CL, Bajpai VK, Wu PH, Chin D, Ifemembi B, ReFaey K, Schiapparelli P, Zheng X, Martin SS, Fan CM, Quiñones-Hinojosa A, Konstantopoulos K. A microfluidic cell-migration assay for the prediction of progression-free survival and recurrence time of patients with glioblastoma. Nat Biomed Eng 2020; 5:26-40. [PMID: 32989283 PMCID: PMC7855796 DOI: 10.1038/s41551-020-00621-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 02/25/2019] [Accepted: 09/01/2020] [Indexed: 01/22/2023]
Abstract
Clinical scores, molecular markers and cellular phenotypes have been used to predict the clinical outcomes of patients with glioblastoma. However, their clinical use has been hampered by confounders such as patient co-morbidities, by the tumoral heterogeneity of molecular and cellular markers, and by the complexity and cost of high-throughput single-cell analysis. Here, we show that a microfluidic assay for the quantification of cell migration and proliferation can categorize patients with glioblastoma according to progression-free survival. We quantified with a composite score the ability of primary glioblastoma cells to proliferate (via the protein biomarker Ki-67) and to squeeze through microfluidic channels, mimicking aspects of the tight perivascular conduits and white-matter tracts in brain parenchyma. The assay retrospectively categorized 28 patients according to progression-free survival (short-term or long-term) with an accuracy of 86%, predicted time to recurrence and correctly categorized five additional patients on the basis of survival prospectively. RNA sequencing of the highly motile cells revealed differentially expressed genes that correlated with poor prognosis. Our findings suggest that cell-migration and proliferation levels can predict patient-specific clinical outcomes.
Collapse
Affiliation(s)
- Bin Sheng Wong
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA.,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA
| | - Sagar R Shah
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Christopher L Yankaskas
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA.,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA
| | - Vivek K Bajpai
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Pei-Hsun Wu
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA.,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA
| | - Deborah Chin
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Brent Ifemembi
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA.,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Xiaobin Zheng
- Department of Embryology, Carnegie Institution for Science, Baltimore, MD, USA
| | - Stuart S Martin
- Marlene and Stewart Greenebaum National Cancer Institute Comprehensive Cancer Center, Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chen-Ming Fan
- Department of Embryology, Carnegie Institution for Science, Baltimore, MD, USA
| | | | - Konstantinos Konstantopoulos
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA. .,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA. .,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Oncology, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
9
|
Al-Kharboosh R, ReFaey K, Lara-Velazquez M, Grewal SS, Imitola J, Quiñones-Hinojosa A. Inflammatory Mediators in Glioma Microenvironment Play a Dual Role in Gliomagenesis and Mesenchymal Stem Cell Homing: Implication for Cellular Therapy. Mayo Clin Proc Innov Qual Outcomes 2020; 4:443-459. [PMID: 32793872 PMCID: PMC7411162 DOI: 10.1016/j.mayocpiqo.2020.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Glioblastoma is the most aggressive malignant primary brain tumor, with a dismal prognosis and a devastating overall survival. Despite aggressive surgical resection and adjuvant treatment, average survival remains approximately 14.6 months. The brain tumor microenvironment is heterogeneous, comprising multiple populations of tumor, stromal, and immune cells. Tumor cells evade the immune system by suppressing several immune functions to enable survival. Gliomas release immunosuppressive and tumor-supportive soluble factors into the microenvironment, leading to accelerated cancer proliferation, invasion, and immune escape. Mesenchymal stem cells (MSCs) isolated from bone marrow, adipose tissue, or umbilical cord are a promising tool for cell-based therapies. One crucial mechanism mediating the therapeutic outcomes often seen in MSC application is their tropism to sites of injury. Furthermore, MSCs interact with host immune cells to regulate the inflammatory response, and data points to the possibility of using MSCs to achieve immunomodulation in solid tumors. Interleukin 1β, interleukin 6, tumor necrosis factor α, transforming growth factor β, and stromal cell-derived factor 1 are notably up-regulated in glioblastoma and dually promote immune and MSC trafficking. Mesenchymal stem cells have widely been regarded as hypoimmunogenic, enabling this cell-based administration across major histocompatibility barriers. In this review, we will highlight (1) the bidirectional communication of glioma cells and tumor-associated immune cells, (2) the inflammatory mediators enabling leukocytes and transplantable MSC migration, and (3) review preclinical and human clinical trials using MSCs as delivery vehicles. Mesenchymal stem cells possess innate abilities to migrate great distances, cross the blood-brain barrier, and communicate with surrounding cells, all of which make them desirable "Trojan horses" for brain cancer therapy.
Collapse
Key Words
- 5-FC, 5-fluorocytosine
- AMSC, adipose tissue–derived mesenchymal stem cell
- BBB, blood-brain barrier
- BMSC, bone marrow–derived mesenchymal stem cell
- CED, convection-enhanced delivery
- DC, dendritic cell
- EGFRvIII, EGFR variant III
- GBM, glioblastoma
- GSC, glioma stem cell
- IFN, interferon
- IL, interleukin
- MDSC, myeloid-derived suppressor cell
- MHC, major histocompatibility complex
- MSC, mesenchymal stem cell
- NSC, neural stem cell
- TAM, tumor-associated macrophage
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- UC-MSC, umbilical cord MSC
Collapse
Affiliation(s)
- Rawan Al-Kharboosh
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL.,Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences (Neuroscience Track), Regenerative Sciences Training Program, Mayo Clinic, Rochester, MN
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL
| | - Montserrat Lara-Velazquez
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL.,Plan of Combined Studies in Medicine (MD/PhD), National Autonomous University of Mexico, Mexico City
| | | | - Jaime Imitola
- Department of Neurology Research, Division of Multiple Sclerosis and Translational Neuroimmunology, UConn School of Medicine, Farmington, CT
| | | |
Collapse
|
10
|
Abstract
Sports-related concussion has been examined extensively in collision sports such as football and hockey. However, historically, lower-risk contact sports such as soccer have only more recently garnered increased attention. Here, we review articles examining the epidemiology, injury mechanisms, sex differences, as well as the neurochemical, neurostructural and neurocognitive changes associated with soccer-related concussion. From 436 titles and abstracts, 121 full texts were reviewed with a total of 64 articles identified for inclusion. Concussion rates are higher during competitions and in female athletes with purposeful heading rarely resulting in concussion. Given a lack of high-level studies examining sports-related concussion in soccer, clinicians and scientists must focus research efforts on large-scale data gathering and development of improved technologies to better detect and understand concussion.
Collapse
Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Mitchell Self
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| |
Collapse
|
11
|
ReFaey K, Tripathi S, Bhargav AG, Grewal SS, Middlebrooks EH, Sabsevitz DS, Jentoft M, Brunner P, Wu A, Tatum WO, Ritaccio A, Chaichana KL, Quinones-Hinojosa A. Potential differences between monolingual and bilingual patients in approach and outcome after awake brain surgery. J Neurooncol 2020; 148:587-598. [PMID: 32524393 DOI: 10.1007/s11060-020-03554-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/04/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION 20.8% of the United States population and 67% of the European population speak two or more languages. Intraoperative different languages, mapping, and localization are crucial. This investigation aims to address three questions between BL and ML patients: (1) Are there differences in complications (i.e. seizures) and DECS techniques during intra-operative brain mapping? (2) Is EOR different? and (3) Are there differences in the recovery pattern post-surgery? METHODS Data from 56 patients that underwent left-sided awake craniotomy for tumors infiltrating possible dominant hemisphere language areas from September 2016 to June 2019 were identified and analyzed in this study; 14 BL and 42 ML control patients. Patient demographics, education level, and the age of language acquisition were documented and evaluated. fMRI was performed on all participants. RESULTS 0 (0%) BL and 3 (7%) ML experienced intraoperative seizures (P = 0.73). BL patients received a higher direct DECS current in comparison to the ML patients (average = 4.7, 3.8, respectively, P = 0.03). The extent of resection was higher in ML patients in comparison to the BL patients (80.9 vs. 64.8, respectively, P = 0.04). The post-operative KPS scores were higher in BL patients in comparison to ML patients (84.3, 77.4, respectively, P = 0.03). BL showed lower drop in post-operative KPS in comparison to ML patients (- 4.3, - 8.7, respectively, P = 0.03). CONCLUSION We show that BL patients have a lower incidence of intra-operative seizures, lower EOR, higher post-operative KPS and tolerate higher DECS current, in comparison to ML patients.
Collapse
Affiliation(s)
- Karim ReFaey
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Shashwat Tripathi
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Mathematics, University of Texas at Austin, Austin, TX, USA
| | - Adip G Bhargav
- Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Sanjeet S Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - David S Sabsevitz
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Mark Jentoft
- Department of Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Peter Brunner
- Albany Medical College, Albany, NY, USA.,National Center for Adaptive Neurotechnologies, Albany, NY, USA
| | - Adela Wu
- Department of Neurologic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | - Alfredo Quinones-Hinojosa
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA. .,Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, FloridaJacksonville, FL, 32224, USA.
| |
Collapse
|
12
|
Tripathi S, ReFaey K, Stein R, Calhoun BJ, Despart AN, Brantley MC, Grewal SS, Quinones-Hinojosa A, Wharen RE. The reliability of Deep Brain Stimulation YouTube videos. J Clin Neurosci 2020; 74:202-204. [PMID: 32094069 DOI: 10.1016/j.jocn.2020.02.015] [Citation(s) in RCA: 5] [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: 12/03/2019] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Deep Brain Stimulation (DBS) was approved by the FDA in the 1990s and is used to treat a variety of movement disorders. Patients are increasingly turning to the internet for information regarding their ailments. In this study, we aim to evaluate the accuracy and reliability of information presented in DBS-related YouTube videos. METHODS Using the "Relevance-Based Ranking" strategy for analysis we assessed the first 3 pages of YouTube for each of the following keywords: "Deep Brain Stimulation", "DBS", "DBS for Parkinson's disease", "DBS for essential tremor", and "DBS for movement disorders". Four independent healthcare personnel evaluated the videos' education quality and informational material using the validated DISCERN tool. RESULTS Our study found that only 24% of the 42 published videos analyzed scored above a 3 on the DISCERN scoring scale (considered a "good" video). The search term "Deep Brain Stimulation" had the highest percentage of good videos (DISCERN > 3) (32%). We also found that the duration of videos was longer for the "good" videos (Good = 25.6 min vs Unhelpful = 3.0 min, P = 0.01). CONCLUSION YouTube is one of the largest video platforms; the uploaded videos lack reliability and institutional oversight by the experts. We believe that medical institutions should explore this way of communicating to patients by publishing evidence-based and informative videos on diseases and their management. As it is imperative that the medical field advance to combat medical misinformation.
Collapse
Affiliation(s)
- Shashwat Tripathi
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA; Department of Mathematics, University of Texas at Austin, Austin, TX, USA
| | - Karim ReFaey
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Rachel Stein
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Breanna J Calhoun
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Megan C Brantley
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Sanjeet S Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Robert E Wharen
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| |
Collapse
|
13
|
Tatum WO, McKay JH, ReFaey K, Feyissa AM, Ryan D, Ritaccio A, Middlebrooks E, Yelvington K, Roth G, Acton E, Grewal S, Chaichana K, Quinones-Hinojosa A. Detection of after-discharges during intraoperative functional brain mapping in awake brain tumor surgery using a novel high-density circular grid. Clin Neurophysiol 2020; 131:828-835. [PMID: 32066101 DOI: 10.1016/j.clinph.2019.12.416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/23/2019] [Revised: 11/21/2019] [Accepted: 12/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate intraoperative use of a novel high-density circular grid in detecting after-discharges (AD) on electrocorticography (ECoG) during functional brain mapping (FBM). METHODS FBM during glioma surgery (10/2016 to 5/2019) recorded ADs using a 22-channel circular grid compared to conventional strip electrodes. ADs were analyzed for detection, duration, amplitude, morphology, histology, direction, and clinical signs. RESULTS Thirty-two patients (mean age 54.2 years; r = 30-75) with glioma (WHO grade II-IV; 20 grade IV) had surgery. ADs during FBM were more likely in patients with wild-type as opposed to IDH-1 mutants (p < 0.0001) using more contacts compared with linear strip electrodes (p = 0.0001). More sensors tended to be involved in ADs detected by the circular grid vs strips (6.61 vs 3.43; p = 0.16) at lower stimulus intensity (3.14 mA vs 4.13 mA; p = 0.09). No difference in the number of cortical stimulations before resection was present (38.9 mA vs 47.9 mA; p = 0.26). ADs longer than 10 seconds were 32.5 seconds (circular grid) vs 58.4 (strips) (p = 0.12). CONCLUSIONS High-density circular grids detect ADs in 360 degrees during FBM for glioma resection. Provocation of ADs was more likely in patients with wild-type than IDH-1 mutation. SIGNIFICANCE Circular grids offer high-resolution ECoG during intraoperative FBM for detection of ADs.
Collapse
Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | - Jake H McKay
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Dan Ryan
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Kirsten Yelvington
- Department of Clinical Neurophysiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Emily Acton
- University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjeet Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | |
Collapse
|
14
|
Clifton W, Nottmeier E, ReFaey K, Damon A, Vlasak A, Tubbs RS, Clifton CL, Pichelmann M. Ex vivo virtual and 3D printing methods for evaluating an anatomy‐based spinal instrumentation technique for the 12th thoracic vertebra. Clin Anat 2020; 33:458-467. [DOI: 10.1002/ca.23562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 12/28/2022]
Affiliation(s)
- William Clifton
- Department of Neurological SurgeryMayo Clinic Florida Jacksonville Florida
| | - Eric Nottmeier
- Department of Neurological SurgeryMayo Clinic Florida Jacksonville Florida
| | - Karim ReFaey
- Department of Neurological SurgeryMayo Clinic Florida Jacksonville Florida
| | - Aaron Damon
- Department of EducationMayo Clinic Florida Jacksonville Florida
| | - Alexander Vlasak
- Department of Neurological SurgeryMayo Clinic Florida Jacksonville Florida
| | - R. Shane Tubbs
- Department of Neurosurgery and Structural and Cellular BiologyTulane University School of Medicine New Orleans Louisiana
| | | | - Mark Pichelmann
- Department of NeurosurgeryMayo Clinic Health Systems Eau Claire Wisconsin
| |
Collapse
|
15
|
Eseonu CI, ReFaey K, Pamias-Portalatin E, Asensio J, Garcia O, Boahene KD, Quiñones-Hinojosa A. Three-Hand Endoscopic Endonasal Transsphenoidal Surgery: Experience With an Anatomy-Preserving Mononostril Approach Technique. Oper Neurosurg (Hagerstown) 2019; 14:158-165. [PMID: 29351688 DOI: 10.1093/ons/opx110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/11/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Variations on the endoscopic transsphenoidal approach present unique surgical techniques that have unique effects on surgical outcomes, extent of resection (EOR), and anatomical complications. OBJECTIVE To analyze the learning curve and perioperative outcomes of the 3-hand endoscopic endonasal mononostril transsphenoidal technique. METHODS Prospective case series and retrospective data analysis of patients who were treated with the 3-hand transsphenoidal technique between January 2007 and May 2015 by a single neurosurgeon. Patient characteristics, preoperative presentation, tumor characteristics, operative times, learning curve, and postoperative outcomes were analyzed. Volumetric EOR was evaluated, and a logistic regression analysis was used to assess predictors of EOR. RESULTS Two hundred seventy-five patients underwent an endoscopic transsphenoidal surgery using the 3-hand technique. One hundred eighteen patients in the early group had surgery between 2007 and 2010, while 157 patients in the late group had surgery between 2011 and 2015. Operative time was significantly shorter in the late group (161.6 min) compared to the early group (211.3 min, P = .001). Both cohorts had similar EOR (early group 84.6% vs late group 85.5%, P = .846) and postoperative outcomes. The learning curve showed that it took 54 cases to achieve operative proficiency with the 3-handed technique. Multivariate modeling suggested that prior resections and preoperative tumor size are important predictors for EOR. CONCLUSION We describe a 3-hand, mononostril endoscopic transsphenoidal technique performed by a single neurosurgeon that has minimal anatomic distortion and postoperative complications. During the learning curve of this technique, operative time can significantly decrease, while EOR, postoperative outcomes, and complications are not jeopardized.
Collapse
Affiliation(s)
- Chikezie I Eseonu
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Karim ReFaey
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Eva Pamias-Portalatin
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Javier Asensio
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Oscar Garcia
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Kofi D Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Alfredo Quiñones-Hinojosa
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
16
|
ReFaey K, Grewal SS, Segura-Duran I, Thomas M, Wharen RE. Video-Assisted Bilateral Thoracoscopic Sympathotomy for Palmar Hyperhidrosis. World Neurosurg 2019; 132:333. [PMID: 31525484 DOI: 10.1016/j.wneu.2019.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
Abstract
In this video, we demonstrate a case of a 21-year-old right-handed man who presented with palmar hyperhidrosis. His symptoms started at the age of 4 years and progressively worsened throughout his life. Multiple medical treatments were used without significant benefit. His symptoms worsened to the limit that it affected his work and lifestyle. The patient was taken to the operating room in a supine position with both arms abducted 90°. The right and left chest were prepped and draped in a sterile fashion. The skin incision was done on the left side first, the left lung was isolated, and two 5-mm thoracoports were placed in the sixth and third intercostal spaces, respectively. Carbon dioxide insufflation was used to a pressure of 6 mm Hg for exposure. The chest was visualized, and the sympathetic chain was identified. Ribs were counted and then cautery at a low setting was used. The sympathetic chain was transected at the level of the head of the second rib. Accessory nerves of Kuntz were identified and resected. Carbon dioxide was then evacuated from the left chest using a bronchial tube exchanger and Valsalva maneuver. The lung was completely reinflated and skin was closed in a normal fashion. The same procedure was repeated on the right side. A chest radiograph was obtained intraoperatively, and no pneumothorax was observed. At the end of the procedure, both upper extremity temperature probes showed a significant increase from baseline. Informed patient consent was obtained.
Collapse
Affiliation(s)
- Karim ReFaey
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sanjeet S Grewal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Ivan Segura-Duran
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Mathew Thomas
- Department of Thoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Robert E Wharen
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
| |
Collapse
|
17
|
Garcia CA, Bhargav AG, Mondal SK, ReFaey K, Zarco N, Schiapparelli P, Sarabia-Estrada R, Guerrero-Cazares H, Quiñones-Hinojosa A. Functional Characterization of Brain Tumor-Initiating Cells: Implications for Preclinical Models and Drug Development. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
18
|
ReFaey K, Tripathi S, Freeman WD, Guerrero-Cazares H, Meschia J, Petrucelli L, Meyer FB, Quinones-Hinojosa A. The Neurosurgeon-Scientists National Institutes of Health Funding Trends. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_715] [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: 11/14/2022] Open
|
19
|
Tatum WO, Feyissa AM, ReFaey K, Grewal SS, Alvi MA, Castro-Apolo R, Roth G, Segura-Duran I, Mahato D, Ruiz-Garcia H, Pamias-Portalatin E, Yelvington K, Chaichana K, Bechtle P, Quinones-Hinojosa A. Periodic focal epileptiform discharges. Clin Neurophysiol 2019; 130:1320-1328. [DOI: 10.1016/j.clinph.2019.04.718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/30/2019] [Accepted: 04/22/2019] [Indexed: 11/16/2022]
|
20
|
ReFaey K, Chaichana KL, Feyissa AM, Vivas-Buitrago T, Brinkmann BH, Middlebrooks EH, McKay JH, Lankford DJ, Tripathi S, Bojaxhi E, Roth GE, Tatum WO, Quiñones-Hinojosa A. A 360° electronic device for recording high-resolution intraoperative electrocorticography of the brain during awake craniotomy. J Neurosurg 2019; 133:443-450. [PMID: 31277069 DOI: 10.3171/2019.4.jns19261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy is common among patients with supratentorial brain tumors; approximately 40%-70% of patients with glioma develop brain tumor-related epilepsy (BTRE). Intraoperative localization of the epileptogenic zone during surgical tumor resection (real-time data) may improve intervention techniques in patients with lesional epilepsy, including BTRE. Accurate localization of the epileptogenic signals requires electrodes with high-density spatial organization that must be placed on the cortical surface during surgery. The authors investigated a 360° high-density ring-shaped cortical electrode assembly device, called the "circular grid," that allows for simultaneous tumor resection and real-time electrophysiology data recording from the brain surface. METHODS The authors collected data from 99 patients who underwent awake craniotomy from January 2008 to December 2018 (29 patients with the circular grid and 70 patients with strip electrodes), of whom 50 patients were matched-pair analyzed (25 patients with the circular grid and 25 patients with strip electrodes). Multiple variables were then retrospectively assessed to determine if utilization of this device provides more accurate real-time data and improves patient outcomes. RESULTS Matched-pair analysis showed higher extent of resection (p = 0.03) and a shorter transient motor recovery period during the hospitalization course (by approximately 6.6 days, p ≤ 0.05) in the circular grid patients. Postoperative versus preoperative Karnofsky Performance Scale (KPS) score difference/drop was greater for the strip electrode patients (p = 0.007). No significant difference in postoperative seizures between the 2 groups was present (p = 0.80). CONCLUSIONS The circular grid is a safe, feasible tool that grants direct access to the cortical surgical surface for tissue resection while simultaneously monitoring electrical activity. Application of the circular grid to different brain pathologies may improve intraoperative epileptogenic detection accuracy and functional outcomes, while decreasing postoperative complications.
Collapse
Affiliation(s)
| | | | | | | | - Benjamin H Brinkmann
- Departments of3Neurology and
- 4Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Shashwat Tripathi
- 6Department of Mathematics, University of Texas at Austin, Austin, Texas; and
| | - Elird Bojaxhi
- 7Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida
| | | | | | | |
Collapse
|
21
|
Abstract
Ancient Egyptian civilization is one of the oldest cultures in human history. Ancient Egyptians are well-known for pioneering the fields of art, medicine, and the documentation of discoveries as mythological tales. The Egyptians mastered the integration of anatomy and mythology into artistic symbols and figures. The mythology of Isis, Osiris, and Horus is arguably one of the most recognized mythologies in ancient Egypt. The Eye of Horus was used as a sign of prosperity and protection, derived from the myth of Isis and Osiris. This symbol has an astonishing connection between neuroanatomical structure and function. Artistically, the Eye is comprised of six different parts. From the mythological standpoint, each part of the Eye is considered to be an individual symbol. Additionally, parts of the Eye represent terms in the series 1/2, 1/4, 1/8, 1/16, and 1/32; when this image is superimposed upon a sagittal image of the human brain, it appears that each part corresponds to the anatomic location of a particular human sensorium. In this manuscript, we highlight the possible scientific speculation of the ingenuity of ancient Egyptians’ remarkable insight into human anatomy and physiology.
Collapse
|
22
|
Feyissa AM, Worrell GA, Tatum WO, Chaichana KL, Jentoft ME, Guerrero Cazares H, Ertekin-Taner N, Rosenfeld SS, ReFaey K, Quinones-Hinojosa A. Potential influence of IDH1 mutation and MGMT gene promoter methylation on glioma-related preoperative seizures and postoperative seizure control. Seizure 2019; 69:283-289. [PMID: 31141785 DOI: 10.1016/j.seizure.2019.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 03/09/2019] [Revised: 04/21/2019] [Accepted: 05/20/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To examine the occurrence of glioma-related preoperative seizures (GPS) and post-operative seizure control (PSC) with respect to patients characteristics including five commonly tested tumor molecular markers (TMMs). METHODS A single-center retrospective cohort study of patients with glioma evaluated at the Mayo Clinic, Florida between 2016 and 2018. RESULTS 68 adult patients (mean age = 51-years, 45-males) were included. 46 patients had GPS. 57 patients underwent intra-operative electrocorticography during awake craniotomy-assisted glioma resection. All patients underwent glioma resection (53, gross-total resection) with histologies of pilocytic astrocytoma (n = 2), diffuse astrocytoma (n = 4), oligodendroglioma (n = 14), anaplastic astrocytoma (n = 16), anaplastic oligodendroglioma (n = 1), and glioblastoma (n = 31). 31 (67%) patients had PSC (median follow-up = 14.5 months; IQR = 7-16.5 months). IDH1 mutation (IDH1mut) was present in 32, ARTX retention in 53, MGMT gene promotor methylation in 15, 1p/19q co-deletion in 15, and over-expression of p53 in 19 patients. Patients with IDH1mut were more likely to have GPS (p = 0.037) and PSC (p = 0.035) compared to patients with IDH1 wild-type. Patients with MGMT gene promoter methylation were also likely to have PSC (p = 0.032). GPS or PSC did not differ by age, sex, extent of surgery, glioma grade, location, and histopathological subtype, p53 expression, ARTX retention, or 1p/19q co-deletion status. CONCLUSIONS GPS and PSC may be associated with IDH1 mutation and MGMT gene promoter methylation status but not other glioma characteristics including tumor grade, location, or histopathology. Prospective studies with larger sample size are needed to clarify the exact mechanisms of GPS and PSC by the various TMMs to identify new treatment targets.
Collapse
Affiliation(s)
- Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Gregory A Worrell
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - William O Tatum
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Kaisorn L Chaichana
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Mark E Jentoft
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Hugo Guerrero Cazares
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Nileufer Ertekin-Taner
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Steven S Rosenfeld
- Department of Hematology/Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Karim ReFaey
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | | |
Collapse
|
23
|
Mikula AL, ReFaey K, Grewal SS, Britton JW, Van Gompel JJ. Medial Temporal Encephalocele and Medically Intractable Epilepsy: A Tailored Inferior Temporal Lobectomy and Case Report. Oper Neurosurg (Hagerstown) 2019; 18:E19-E22. [DOI: 10.1093/ons/opz098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/13/2019] [Indexed: 11/12/2022] Open
Abstract
AbstractBACKGROUND AND IMPORTANCETemporal lobe encephaloceles are increasingly recognized as a potential cause of medically refractory epilepsy and surgical treatment has proven effective. Resection of the encephalocele and associated cortex is often sufficient to provide seizure control. However, it is difficult to determine the extent of adjacent temporal lobe that should be resected. We present a case report and our technique of a tailored inferior temporal pole resection.CLINICAL PRESENTATIONA 32-yr-old man with an 11-yr history of medically refractory epilepsy. Prolonged electroencephalography (EEG) revealed frequent left and rare right frontotemporal sharp waves. Numerous seizures were captured with EEG, all of which originated from the left temporal region. Statistical parametric mapping (SPM) subtraction ictal–interictal SPECT coregistered with magnetic resonance imaging (MRI) (SISCOM) demonstrated ictal hyperperfusion in the anterior left temporal lobe. MRI showed 2 encephaloceles in the left anterior temporal lobe with the accompanying bony defects in the floor of the middle cranial fossa apparent on the computed tomography scan. The patient underwent left temporal craniotomy with intraoperative electrocorticography, resection of the encephaloceles, and a tailored inferior temporal lobectomy (IFTL) and repair of the middle fossa defects. At 7 mo follow up he reported seizure-freedom since surgery.CONCLUSIONResection of temporal encephalocele and adjacent cortex is safe and effective procedure for select patients with medically refractory epilepsy. This video demonstrates our technique which provides a more standardized approach to the resection.
Collapse
Affiliation(s)
- Anthony L Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karim ReFaey
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Sanjeet S Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | | | | |
Collapse
|
24
|
ReFaey K, Tripathi S, Bohnen AM, Waddle MR, Peterson J, Vazquez-Ramos C, Bondoc CM, Quiñones-Hinojosa A, Trifiletti DM. The Reliability of YouTube Videos Describing Stereotactic Radiosurgery: A Call for Action. World Neurosurg 2019; 125:e398-e402. [DOI: 10.1016/j.wneu.2019.01.086] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 12/27/2022]
|
25
|
ReFaey K, Clifton W, Quinones GC, Tripathi S, Quiñones-Hinojosa A. Mysterious Civilizations: Is There a Connection between Medicine and Architecture in Ancient Egypt and Peru? Cureus 2019; 11:e4576. [PMID: 31281759 PMCID: PMC6605966 DOI: 10.7759/cureus.4576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The ancient Egyptian and Peruvian Civilizations are two of the earliest cultures in human history. Through medical and architectural similarities, we wish to show a possible connection between these two cultures. A literature search was conducted by searching the database of Medline, National Geographic magazine, history books, and Google Scholar using the search terms: neurosurgery, pyramids, pyramidal architectures, ancient Egypt, ancient Peru, the connection between ancient Egypt and Peru. Both the ancient Egyptian and Peruvian Civilizations are well-known for their pioneering work in medicine and architecture; their accomplishments in these areas have been well-documented in the walls of uncovered tombs and discovered papyrus. Both these cultures also firmly believed in an afterlife and built pyramids to serve as tombs and homes for royalty in the afterlife. The sloping sides of the pyramids were inclined to signify the emergence of the physical body from Earth towards the Sun. Both civilizations independently pioneered the art of neurosurgery with different techniques and approaches. In this paper, we discuss the potential links between both civilizations. We recognize and appreciate the brilliance of these ancient cultures in mastering the medicinal and architectural sciences.
Collapse
|
26
|
ReFaey K, Tripathi S, Yoon JW, Justice J, Kerezoudis P, Parney IF, Bendok BR, Chaichana KL, Quiñones-Hinojosa A. The reliability of YouTube videos in patients education for Glioblastoma Treatment. J Clin Neurosci 2018; 55:1-4. [DOI: 10.1016/j.jocn.2018.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/08/2018] [Indexed: 11/28/2022]
|
27
|
Tatum WO, Feyissa A, ReFaey K, Segura I, Vivas-Buitrago T, Mahato D, Ruiz-Garcia H, Mari-Acevedo JA, Pamias E, Castro R, Quinones-Hinojosa A. T11. Epileptiform discharges on high-density electrocorticography during awake craniotomy. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
28
|
Eseonu CI, Rincon-Torroella J, ReFaey K, Lee YM, Nangiana J, Vivas-Buitrago T, Quiñones-Hinojosa A. Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas: Evaluating Perioperative Complications and Extent of Resection. Neurosurgery 2018; 81:481-489. [PMID: 28327900 DOI: 10.1093/neuros/nyx023] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [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: 07/06/2016] [Accepted: 09/07/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A craniotomy with direct cortical/subcortical stimulation either awake or under general anesthesia (GA) present 2 approaches for removing eloquent region tumors. With a reported higher prevalence of intraoperative seizures occurring during awake resections of perirolandic lesions, oftentimes, surgery under GA is chosen for these lesions. OBJECTIVE To evaluate a single-surgeon's experience with awake craniotomies (AC) vs surgery under GA for resecting perirolandic, eloquent, motor-region gliomas. METHODS Between 2005 and 2015, a retrospective analysis of 27 patients with perirolandic, eloquent, motor-area gliomas that underwent an AC were case-control matched with 31 patients who underwent surgery under GA for gliomas in the same location. All patients underwent direct brain stimulation with neuromonitoring and perioperative risk factors, extent of resection, complications, and discharge status were assessed. RESULTS The postoperative Karnofsky Performance Score (KPS) was significantly lower for the GA patients at 81.1 compared to the AC patients at 93.3 ( P = .040). The extent of resection for GA patients was 79.6% while the AC patients had an 86.3% resection ( P = .136). There were significantly more 100% total resections in the AC patients 25.9% compared to the GA group (6.5%; P = .041). Patients in the GA group had a longer mean length of hospitalization of 7.9 days compared to the AC group at 4.2 days ( P = .049). CONCLUSION We show that AC can be performed with more frequent total resections, better postoperative KPS, shorter hospitalizations, as well as similar perioperative complication rates compared to surgery under GA for perirolandic, eloquent motor-region glioma.
Collapse
Affiliation(s)
- Chikezie I Eseonu
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Jordina Rincon-Torroella
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Karim ReFaey
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Young M Lee
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Jasvinder Nangiana
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Tito Vivas-Buitrago
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Alfredo Quiñones-Hinojosa
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
29
|
Feyissa AM, Worrell GA, Tatum WO, Mahato D, Brinkmann BH, Rosenfeld SS, ReFaey K, Bechtle PS, Quinones-Hinojosa A. High-frequency oscillations in awake patients undergoing brain tumor-related epilepsy surgery. Neurology 2018; 90:e1119-e1125. [PMID: 29490917 DOI: 10.1212/wnl.0000000000005216] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/22/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine the relationship between high-frequency oscillations (HFOs) and the presence of preoperative seizures, World Health Organization tumor grade, and isocitrate dehydrogenase 1 (IDH1) mutational status in gliomas. METHODS We retrospectively studied intraoperative electrocorticography recorded in 16 patients with brain tumor (12 presenting with seizures) who underwent awake craniotomy and surgical resection between September 2016 and June 2017. The number and distribution of HFOs were determined and quantified visually and with an automated HFO detector. RESULTS Five patients had low-grade (1 with grade I and 4 with grade II) and 11 had high-grade (6 with grade III and 5 with grade IV) brain tumors. An IDH1 mutation was found in 6 patients. Patients with a history of preoperative seizures were more likely to have HFOs than those without preoperative seizures (9 of 12 vs 0 of 4, p = 0.02). The rate of HFOs was higher in patients with IDH1 mutant (mean 7.2 per minute) than IDH wild-type (mean 2.3 per minute) genotype (p = 0.03). CONCLUSIONS HFOs are common in brain tumor-related epilepsy, and HFO rate may be a useful measure of epileptogenicity in gliomas. Our findings further support the notion that IDH1 mutant genotype is more epileptogenic than IDH1 wild-type genotype gliomas.
Collapse
Affiliation(s)
- Anteneh M Feyissa
- From the Departments of Neurology (A.M.F., W.O.T.), Neurological Surgery (D.M., K.R., A.Q.-H.), Hematology/Oncology (S.S.R.), and Anesthesiology (P.S.B.), Mayo Clinic, Jacksonville, FL; and Departments of Neurology (G.A.W., B.H.B.) and Physiology and Biomedical Engineering (G.A.W., B.H.B.), Mayo Clinic, Rochester, MN.
| | - Gregory A Worrell
- From the Departments of Neurology (A.M.F., W.O.T.), Neurological Surgery (D.M., K.R., A.Q.-H.), Hematology/Oncology (S.S.R.), and Anesthesiology (P.S.B.), Mayo Clinic, Jacksonville, FL; and Departments of Neurology (G.A.W., B.H.B.) and Physiology and Biomedical Engineering (G.A.W., B.H.B.), Mayo Clinic, Rochester, MN
| | - William O Tatum
- From the Departments of Neurology (A.M.F., W.O.T.), Neurological Surgery (D.M., K.R., A.Q.-H.), Hematology/Oncology (S.S.R.), and Anesthesiology (P.S.B.), Mayo Clinic, Jacksonville, FL; and Departments of Neurology (G.A.W., B.H.B.) and Physiology and Biomedical Engineering (G.A.W., B.H.B.), Mayo Clinic, Rochester, MN
| | - Deependra Mahato
- From the Departments of Neurology (A.M.F., W.O.T.), Neurological Surgery (D.M., K.R., A.Q.-H.), Hematology/Oncology (S.S.R.), and Anesthesiology (P.S.B.), Mayo Clinic, Jacksonville, FL; and Departments of Neurology (G.A.W., B.H.B.) and Physiology and Biomedical Engineering (G.A.W., B.H.B.), Mayo Clinic, Rochester, MN
| | - Benjamin H Brinkmann
- From the Departments of Neurology (A.M.F., W.O.T.), Neurological Surgery (D.M., K.R., A.Q.-H.), Hematology/Oncology (S.S.R.), and Anesthesiology (P.S.B.), Mayo Clinic, Jacksonville, FL; and Departments of Neurology (G.A.W., B.H.B.) and Physiology and Biomedical Engineering (G.A.W., B.H.B.), Mayo Clinic, Rochester, MN
| | - Steven S Rosenfeld
- From the Departments of Neurology (A.M.F., W.O.T.), Neurological Surgery (D.M., K.R., A.Q.-H.), Hematology/Oncology (S.S.R.), and Anesthesiology (P.S.B.), Mayo Clinic, Jacksonville, FL; and Departments of Neurology (G.A.W., B.H.B.) and Physiology and Biomedical Engineering (G.A.W., B.H.B.), Mayo Clinic, Rochester, MN
| | - Karim ReFaey
- From the Departments of Neurology (A.M.F., W.O.T.), Neurological Surgery (D.M., K.R., A.Q.-H.), Hematology/Oncology (S.S.R.), and Anesthesiology (P.S.B.), Mayo Clinic, Jacksonville, FL; and Departments of Neurology (G.A.W., B.H.B.) and Physiology and Biomedical Engineering (G.A.W., B.H.B.), Mayo Clinic, Rochester, MN
| | - Perry S Bechtle
- From the Departments of Neurology (A.M.F., W.O.T.), Neurological Surgery (D.M., K.R., A.Q.-H.), Hematology/Oncology (S.S.R.), and Anesthesiology (P.S.B.), Mayo Clinic, Jacksonville, FL; and Departments of Neurology (G.A.W., B.H.B.) and Physiology and Biomedical Engineering (G.A.W., B.H.B.), Mayo Clinic, Rochester, MN
| | - Alfredo Quinones-Hinojosa
- From the Departments of Neurology (A.M.F., W.O.T.), Neurological Surgery (D.M., K.R., A.Q.-H.), Hematology/Oncology (S.S.R.), and Anesthesiology (P.S.B.), Mayo Clinic, Jacksonville, FL; and Departments of Neurology (G.A.W., B.H.B.) and Physiology and Biomedical Engineering (G.A.W., B.H.B.), Mayo Clinic, Rochester, MN
| |
Collapse
|
30
|
Eseonu CI, Rincon-Torroella J, Lee YM, ReFaey K, Tripathi P, Quinones-Hinojosa A. Intraoperative Seizures in Awake Craniotomy for Perirolandic Glioma Resections That Undergo Cortical Mapping. J Neurol Surg A Cent Eur Neurosurg 2018; 79:239-246. [PMID: 29346829 DOI: 10.1055/s-0037-1617759] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Perirolandic motor area gliomas present invasive eloquent region tumors within the precentral gyrus that are difficult to resect without causing neurologic deficits. STUDY AIMS This study evaluates the role of awake craniotomy and motor mapping on neurologic outcome and extent of resection (EOR) of tumor in the perirolandic motor region. It also analyzes preoperative risk factors for intraoperative seizures. METHODS We evaluated 57 patients who underwent an awake craniotomy for a perirolandic motor area eloquent region glioma. Patients who had positive mapping (PM) or intraoperative identification of motor regions in the cortex using direct cortical stimulation were compared with patients with no positive motor mapping following direct cortical stimulation and negative mapping (NM). Preoperative risks, intraoperative seizures, perioperative outcomes, tumor characteristics, and EOR were also compared. A logistic regression model was used to evaluate the predictors for intraoperative seizures in this patient cohort. RESULTS Overall, 33 patients were in the PM cohort; 24 were in the NM cohort. Our study showed an 8.8% incidence of intraoperative seizures during cortical and subcortical mapping for awake craniotomies in the perirolandic motor area, none of which aborted the case. PM patients had significantly more intraoperative and postoperative seizures (15.5% and 30.3%, respectively) compared with the NM patients (0% and 8.3%, respectively; p = 0.046 and 0.044). New transient postoperative motor deficits were found more often in the PM group (51.5%) versus the NM group (12.5%; p = 0.002). A univariate logistic regression showed that PM (odds ratio [OR]: 1.16; 95% confidence interval [CI], 1.01-1.34; p = 0.035) and preoperative tumor volume (OR: 0.998; 95% CI, 0.996-0.999; p = 0.049) were significant predictors for intraoperative seizures in patients with perirolandic gliomas. CONCLUSION Awake craniotomies in the perirolandic motor region can be safely performed with a similar incidence of intraoperative seizures as reported for the language cortex. PM in this region may increase the likelihood of perioperative seizures or motor deficits compared with NM. Craniotomies that minimize cortical exposure for perirolandic gliomas that may not localize motor regions can still allow for extensive tumor resection with a good postoperative outcome.
Collapse
Affiliation(s)
| | | | - Young M Lee
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Karim ReFaey
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States.,Department of Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, United States
| | - Punita Tripathi
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Alfredo Quinones-Hinojosa
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States.,Department of Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, United States
| |
Collapse
|
31
|
Akinduro OO, Mbabuike N, ReFaey K, Yoon JW, Clifton WE, Brown B, Wharen RE, Quinones-Hinojosa A, Tawk RG. Microsphere Embolization of Hypervascular Posterior Fossa Tumors. World Neurosurg 2018; 109:182-187. [DOI: 10.1016/j.wneu.2017.09.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/16/2022]
|
32
|
Eseonu C, ReFaey K, Raghuraman G, Quiñones-Hinojosa A. 378 Analysis of Molecular Markers and Volumetric Extent of Resection on Survival for Insular Gliomas. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx417.378] [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
|
33
|
Eseonu CI, ReFaey K, Garcia O, Salvatori R, Quinones-Hinojosa A. Comparative Cost Analysis of Endoscopic versus Microscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas. J Neurol Surg B Skull Base 2017; 79:131-138. [PMID: 29868317 DOI: 10.1055/s-0037-1604484] [Citation(s) in RCA: 7] [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: 02/06/2017] [Accepted: 06/17/2017] [Indexed: 12/14/2022] Open
Abstract
Objective This study presents a comparative analysis of cost efficacy between the microscopic and endoscopic transsphenoidal approaches, evaluating neurological outcome, extent of resection (EOR), and inpatient hospital costs. Design This study was a retrospective chart review. Setting This study was conducted at a tertiary care center. Participants The study group consisted of 68 patients with transsphenoidal surgeries between January 2007 and January 2014. Main Outcome Measures Two-sample t -tests and Pearson's chi-square test evaluated inpatient costs, quality-adjusted life years (QALYs), volumetric EOR, and neurological outcomes. Results Total inpatient costs per patient was $22,853 in the microscopic group and less ($19,736) in the endoscopic group ( p = 0.049). Operating room costs were $5,974 in the microscopic group and lower in the endoscopic group ($5,045; p = 0.038). Operative time was 203.6 minutes in the microscopic group and 166.3 minutes in the endoscopic group ( p = 0.032). The QALY score, length of hospital stay, and postoperative outcomes were found to be similar between the two cohorts. Multivariate linear regression modeling suggested that length of stay ( p < 0.001) and operative time ( p = 0.008) were important factors that influenced total inpatient costs following transsphenoidal surgery. Conclusion This study shows that transsphenoidal surgery is more cost effective with the endoscopic approach than with the microscopic approach and depends on efficiency in the operating room as well as reduction in the length of hospitalization.
Collapse
Affiliation(s)
| | - Karim ReFaey
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Oscar Garcia
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Roberto Salvatori
- Department of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States
| | - Alfredo Quinones-Hinojosa
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
| |
Collapse
|
34
|
Yoon JW, Chen RE, ReFaey K, Diaz RJ, Reimer R, Komotar RJ, Quinones-Hinojosa A, Brown BL, Wharen RE. Technical feasibility and safety of image-guided parieto-occipital ventricular catheter placement with the assistance of a wearable head-up display. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1836] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/25/2017] [Accepted: 04/11/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Jang W. Yoon
- Department of Neurological Surgery; Mayo Clinic Florida; Jacksonville Florida USA
| | - Robert E. Chen
- Emory University School of Medicine; Atlanta Georgia USA
- Georgia Institute of Technology; Atlanta Georgia USA
| | - Karim ReFaey
- Department of Neurological Surgery; Mayo Clinic Florida; Jacksonville Florida USA
| | - Roberto J. Diaz
- Department of Neurosurgery and Neurology, Montreal Neurological Institute and Hospital; McGill University; Montreal, QC Canada
| | - Ronald Reimer
- Department of Neurological Surgery; Mayo Clinic Florida; Jacksonville Florida USA
| | - Ricardo J. Komotar
- Department of Neurological Surgery; University of Miami Miller School of Medicine, University of Miami Hospital, University of Miami Brain Tumor Initiative; Miami Florida USA
| | | | - Benjamin L. Brown
- Department of Neurological Surgery; Mayo Clinic Florida; Jacksonville Florida USA
| | - Robert E. Wharen
- Department of Neurological Surgery; Mayo Clinic Florida; Jacksonville Florida USA
| |
Collapse
|
35
|
Eseonu CI, Eguia F, ReFaey K, Garcia O, Rodriguez FJ, Chaichana K, Quinones-Hinojosa A. Comparative volumetric analysis of the extent of resection of molecularly and histologically distinct low grade gliomas and its role on survival. J Neurooncol 2017; 134:65-74. [PMID: 28527004 DOI: 10.1007/s11060-017-2486-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 11/22/2016] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
The authors investigate the role of extent of resection (EOR) and genetic markers on patient outcome and survival for LGGs. We conducted a retrospective cohort between 2005 and 2015, of 109 adult patients who underwent surgery for a LGG by a single surgeon. Volumetric computations of MRI studies were conducted to evaluate the EOR, and genetic markers (IDH1, 1p/19q co-deletion, and p53) were assessed and their effects on survival and neurological outcome were evaluated. The median EOR was 88.1%. Permanent postoperative neurological deficits were seen in 4.6% of patients. EOR was a significant predictor for both overall survival (OS) (hazard ratio [HR] = 0.979, 95% CI 0.961-0.980, p = 0.029) and progression free survival (PFS) (HR = 0.982, 95% CI 0.968-0.997, p = 0.018). Malignant progression free survival (MPFS) was predicted by the 1p/19q co-deletion (HR = 0.148, 95% CI 0.019-1.148, p = 0.048). Patients with EOR of 100% had a significantly better OS than EOR less than 90% (p = 0.038). Patients with an EOR of at least 76% had a better OS than EOR less than 76% (p = 0.025). Patients with an EOR of at least 71% had a better PFS than EOR less than 71% (p = 0.030). Preoperative tumor volume was found to have significant association with EOR (R2 = 0.049, p = 0.031). Increased EOR is associated with improved OS and PFS survival outcomes, while 1p/19q co-deletion provides improved MPFS. Understanding both surgical resections and molecular markers of the tumor are important for effective management of LGG patients.
Collapse
Affiliation(s)
- Chikezie I Eseonu
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | - Francisco Eguia
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | - Karim ReFaey
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | - Oscar Garcia
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | | | - Kaisorn Chaichana
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | - Alfredo Quinones-Hinojosa
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA. .,Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, Florida, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA.
| |
Collapse
|
36
|
Eseonu CI, Rincon-Torroella J, ReFaey K, Quiñones-Hinojosa A. The Cost of Brain Surgery: Awake vs Asleep Craniotomy for Perirolandic Region Tumors. Neurosurgery 2017; 81:307-314. [DOI: 10.1093/neuros/nyx022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 02/15/2017] [Indexed: 11/14/2022] Open
|
37
|
Eseonu C, ReFaey K, Garcia O, Quinones-Hinojosa A. Comparative Cost Analysis of Endoscopic versus Microscopic Transsphenoidal Surgery for Pituitary Adenomas. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chikezie Eseonu
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Karim ReFaey
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Oscar Garcia
- Johns Hopkins University, Baltimore, Maryland, United States
| | | |
Collapse
|
38
|
Eseonu C, ReFaey K, Garcia O, Wand G, Salvatori R, Quinones-Hinojosa A. Microscopic versus Endoscopic Transsphenoidal Surgery for Pituitary Adenomas: Comparative Outcomes Analysis during the Transition of Methods of a Single Surgeon. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chikezie Eseonu
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Karim ReFaey
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Oscar Garcia
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Gary Wand
- Johns Hopkins University, Baltimore, Maryland, United States
| | | | | |
Collapse
|
39
|
Eseonu CI, ReFaey K, Rincon-Torroella J, Garcia O, Wand GS, Salvatori R, Quinones-Hinojosa A. Endoscopic Versus Microscopic Transsphenoidal Approach for Pituitary Adenomas: Comparison of Outcomes During the Transition of Methods of a Single Surgeon. World Neurosurg 2016; 97:317-325. [PMID: 27742515 DOI: 10.1016/j.wneu.2016.09.120] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 08/04/2016] [Revised: 09/25/2016] [Accepted: 09/29/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The transition from microscopic to fully endoscopic transsphenoidal surgery requires a surgeon to assess how the change in technique will affect the extent of tumor resection (EOR), outcomes, and complications. We compared a single surgeon's experience transitioning from one technique to the other and examined the operative outcomes and EOR between microscopic versus endoscopic transsphenoidal surgery. METHODS Retrospective data analysis of adult patients who were treated surgically for a pituitary adenoma between August 2005 and May 2015 by a single neurosurgeon, who was originally trained and practiced in the microscopic transsphenoidal approach. Patient demographics, perioperative conditions, tumor characteristics, operative times, volumetric EOR, postoperative outcome, and the endoscopic learning curve were evaluated. RESULTS One hundred and nine patients underwent microscopic transsphenoidal surgery and 275 patients underwent a fully endoscopic approach. The patient characteristics were similar in the 2 groups. Operative room time was significantly shorter in the endoscopic group than in the microscopic group (180.2 vs. 215.6 minutes; P < 0.001). The endoscopic and microscopic groups had similar volumetric EOR (85.1% vs. 82.8%; P = 0.371) as well as residual tumor volume (1.06 cm3 vs. 1.15 cm3; P = 0.765). The mean length of hospital stay was 2.4 days in the endoscopic group and 3.2 days in the microscopic group (P = 0.03). CONCLUSIONS During the transition from the microscopic to the endoscopic approach, similar surgical outcomes and EOR were achieved in the 2 cohorts. In our experience, the endoscopic approach offers the advantage of shorter operative times and lengths of hospital stays after the surgeon has developed more experience with the technique.
Collapse
Affiliation(s)
- Chikezie I Eseonu
- Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karim ReFaey
- Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jordina Rincon-Torroella
- Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA
| | - Oscar Garcia
- Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gary S Wand
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alfredo Quinones-Hinojosa
- Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA.
| |
Collapse
|
40
|
Eseonu CI, ReFaey K, Geocadin RG, Quinones-Hinojosa A. Postoperative Cerebral Vasospasm Following Transsphenoidal Pituitary Adenoma Surgery. World Neurosurg 2016; 92:7-14. [PMID: 27155378 DOI: 10.1016/j.wneu.2016.04.099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 03/14/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Cerebral vasospasm following a transsphenoidal resection of a pituitary adenoma is a devastating occurrence that can lead to delayed cerebral ischemia and poor neurologic outcome if not diagnosed and treated in a timely manner. The etiology of this condition is not well understood but can lead to significant arterial vasospasm that causes severe ischemic insults. In this paper, we identify common presenting symptoms and essential management strategies to treat this harmful disease. METHODS A retrospective case report and literature review of presentation, treatment, and outcome of cerebral vasospasm following transsphenoidal surgery. RESULTS We present 1 case and review 12 known cases in the literature on vasospasm following transsphenoidal surgery. Mean age was 48 (±13.8) years. There were 46.2% male patients. Factors associated with vasospasm, such as cerebral spinal fluid leaks following surgery, were seen in 38.5% of cases, and postoperative subarachnoid hemorrhage (SAH) was seen in 84.6% of cases. Hemiparesis was the presenting symptom of delayed cerebral ischemia in 61.5% of cases. For management, maintaining at least a euvolemic volume status was used in 76.9%, induced hypertension was used in 61.5%, and nimodipine was administered in 46.2% of cases. Patients returned to their neurologic baseline in 61.5% of cases, had new permanent deficits in 7.7% of cases, and died in 30.8% of cases. CONCLUSION Cerebral vasospasm following transsphenoidal surgery is a dangerous disease that can lead to a high likelihood of mortality if not identified and treated. Early postoperative events, such as peritumoral subarachnoid hemorrhage and hemiparesis, may be factors associated with post-transsphenoidal surgery vasospasm. Effective treatment options used in patients that regained complete neurologic recovery were by inducing hypertension, maintaining euvolemia, and administering nimodipine.
Collapse
Affiliation(s)
- Chikezie I Eseonu
- Department of Neurological Surgery and Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karim ReFaey
- Department of Neurological Surgery and Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Romergryko G Geocadin
- Division of Neuroscience Critical Care, Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alfredo Quinones-Hinojosa
- Department of Neurological Surgery and Oncology, Johns Hopkins University, Baltimore, Maryland, USA.
| |
Collapse
|