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Kameda-Smith M, Biswas A, D'Arco F, Thompson D. Os odontoideum and craniovertebral junction instability secondary to dystonia: case series and review of the literature. Eur Spine J 2024; 33:1164-1170. [PMID: 37994987 DOI: 10.1007/s00586-023-08044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/24/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Os odontoideum refers to a rounded ossicle detached from a hypoplastic odontoid process at the body of the axis. The aetiology has been debated and believed to be either congenital or acquired (resulting from trauma). Os odontoideum results in incompetence of the transverse ligament and thus predisposes to atlantoaxial instability and spinal cord injury. METHODS/RESULTS Three cases of children with severe dystonic cerebral palsy presenting with myelopathic deterioration secondary to atlantoaxial instability due to os odontoideum are presented. This observation supports the hypothesis of os odontoideum being an acquired phenomenon, secondary to chronic excessive movement with damage to the developing odontoid process. CONCLUSION In children with cerebral palsy and dystonia, pre-existing motor deficits may conceal an evolving myelopathy and result in delayed diagnosis of clinically significant atlantoaxial subluxation.
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Affiliation(s)
- Michelle Kameda-Smith
- Great Ormond Street Hospital for Sick Children, London, England
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, England
| | - Asthik Biswas
- Great Ormond Street Hospital for Sick Children, London, England
- Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children, London, England
| | - Felice D'Arco
- Great Ormond Street Hospital for Sick Children, London, England
- Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children, London, England
| | - Dominic Thompson
- Great Ormond Street Hospital for Sick Children, London, England.
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, England.
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2
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Kisiel M, Bass VM, Fong C, Graham AK, Yahya S, Eichorn FC, Lannon M, Kameda-Smith M, Reddy KKV, Lu JQ. Clinicopathologic characteristics of Nocardia brain abscesses: Necrotic and non-necrotic foci of various stages. J Neurol Sci 2024; 456:122850. [PMID: 38142539 DOI: 10.1016/j.jns.2023.122850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
Nocardia brain abscesses are rare bacterial infections associated with a high mortality rate, and their preoperative diagnosis can be difficult for various reasons including a nonspecific clinical presentation. While late-stage nocardial brain abscesses may be radiologically characteristic, early-stage lesions are nonspecific and indistinguishable from another inflammatory/infectious process and other mimics. Despite the paucity of previous histopathological descriptions, histopathological examination is critical for the identification of the pathogen, lesion stage(s), and possible coexisting pathology. In this study, we examined the clinical, radiological and histopathological features of 10 patients with brain nocardiosis. Microscopic findings were analysed in correlation with clinical and radiological features in 9 patients, which revealed that brain nocardiosis was characterized by numerous necrotic and non-necrotic foci of various stages (I-IV) along with Nocardia identification, as well as the leptomeningeal involvement in most cases, and co-infection of brain nocardiosis with toxoplasmosis in 2 patients. The imaging features were characteristic with a multilobulated/bilobed ring-enhancing appearance in 8 patients including 2 patients with multiple lobulated and non-lobulated lesions and 1 patient showing the progression from a non-lobulated to lobulated lesion. These findings suggest that nocardial brain abscesses particularly at late-stages share common characteristics. Nevertheless, given the complex pathologic features, including possible co-infection by other pathogens, nocardial brain abscesses remain a therapeutic challenge.
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Affiliation(s)
- Marta Kisiel
- Department of Pathology and Molecular Medicine, Canada
| | | | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Sultan Yahya
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, Canada.
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3
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Kameda-Smith M, Tahir MZ, Kumar A, Thompson D, Pang D. Limited exposure to preserve stability and achieve complete excision of limited dorsal myeloschisis - the "Skip-Hop Laminectomy" technique: a technical note. Childs Nerv Syst 2024; 40:213-218. [PMID: 37428253 DOI: 10.1007/s00381-023-06069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The fibroneural stalk of an LDM has variable thickness, complexity, and length, which can span 5 to 6 vertebral segments from its skin attachment to its "merge point" with the dorsal spinal cord. Therefore, complete resection may require extensive multi-level laminotomies. In this technical note, a modification of the procedure is presented that avoids long segment laminectomies while ensuring complete excision of long LDM stalks. RESULTS An illustrative case of resection of LDM is presented using skip laminectomies. The technique ensures complete removal of the stalk, thus reducing the risk of future intradural dermoid development, while at the same time minimizes the risk for delayed kyphotic deformity. CONCLUSIONS A technique of "skip-hop" proximal and distal short segment laminectomies in cases of LDM optimizes the objectives of complete stalk resection with preservation of spinal integrity.
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Affiliation(s)
- Michelle Kameda-Smith
- Great Ormond Street Hospital for Children, London, England
- Department of Paediatric Neurosurgery, London, England
| | - M Zubair Tahir
- Great Ormond Street Hospital for Children, London, England
- Department of Paediatric Neurosurgery, London, England
| | - Atul Kumar
- Department of Histopathology, London, England
| | - Dominic Thompson
- Great Ormond Street Hospital for Children, London, England
- Department of Paediatric Neurosurgery, London, England
| | - Dachling Pang
- Great Ormond Street Hospital for Children, London, England.
- Department of Paediatric Neurosurgery, London, England.
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4
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Hutton D, Kameda-Smith M, Afshari FT, Elawadly A, Hogg F, Mehta S, Samarasekara J, Aquilina K, Jeelani NUO, Tahir MZ, Thompson D, Tisdall MM, Silva AHD, Hatcher J, James G. Intracranial invasive group A streptococcus: a neurosurgical emergency in children. J Neurosurg Pediatr 2023; 32:478-487. [PMID: 37439477 DOI: 10.3171/2023.5.peds23109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/16/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Invasive group A streptococcus (iGAS) infections are associated with a high rate of morbidity and mortality. CNS involvement is rare, with iGAS accounting for only 0.2%-1% of all childhood bacterial meningitis. In 2022, a significant increase in scarlet fever and iGAS was reported globally with a displacement of serotype, causing a predominance of the emm1.0 subtype. Here, the authors report on iGAS-related suppurative intracranial complications requiring neurosurgical intervention and prolonged antibiotic therapy. METHODS The authors performed a retrospective chart review of consecutive cases of confirmed GAS in pediatric neurosurgical patients. RESULTS Five children with a median age of 9 years were treated for intracranial complications of GAS infection over a 2-month period between November 2022 and December 2022. All patients had preceding illnesses, including chicken pox and upper respiratory tract infections. Infections included subdural empyema with associated encephalitis (n = 2), extradural empyema (n = 1), intracranial abscess (n = 1), and diffuse global meningoencephalitis (n = 1). Streptococcus pyogenes was cultured from 4 children, and 2 were of the emm1.0 subtype. Antimicrobial therapy in all patients included a third-generation cephalosporin but varied in adjunctive therapy, often including a toxin synthesis inhibitor antibiotic such as clindamycin. Neurological outcomes varied; 3 patients returned to near neurological baseline, 1 had significant residual neurological deficits, and 1 patient died. CONCLUSIONS Despite the worldwide increased incidence, intracranial complications remain rarely reported resulting in a lack of awareness of iGAS-related intracranial disease. Awareness of intracranial complications of iGAS and prompt referral to a pediatric neurology/neurosurgical center is crucial to optimize neurological outcomes.
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Affiliation(s)
- Dana Hutton
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 2School of Medicine, University of Dundee
| | | | - Fardad T Afshari
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - Ahmed Elawadly
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - Florence Hogg
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - Samir Mehta
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - James Samarasekara
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - Kristian Aquilina
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - Noor Ul Owase Jeelani
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - M Zubair Tahir
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - Dominic Thompson
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - Martin M Tisdall
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - Adikarige Haritha Dulanka Silva
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - James Hatcher
- 3Great Ormond Street Institute of Child Health, University College London; and
- 4Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital, London, United Kingdom
| | - Greg James
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
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5
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Maclean MA, Touchette CJ, Duda T, Almojuela A, Bergeron D, Kameda-Smith M, Persad ARL, Sader N, Alant J, Christie SD. Work-up and Management of Asymptomatic Extracranial Traumatic Vertebral Artery Injury. Can J Neurol Sci 2023; 50:662-672. [PMID: 36017734 DOI: 10.1017/cjn.2022.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Non-penetrating head and neck trauma is associated with extracranial traumatic vertebral artery injury (eTVAI) in approximately 1-2% of cases. Most patients are initially asymptomatic but have an increased risk for delayed stroke and mortality. Limited evidence is available to guide the management of asymptomatic eTVAI. As such, we sought to investigate national practice patterns regarding screening, treatment, and follow-up domains. METHODS A cross-sectional, electronic survey was distributed to members of the Canadian Neurosurgical Society and Canadian Spine Society. We presented two cases of asymptomatic eTVAI, stratified by injury mechanism, fracture type, and angiographic findings. Screening questions were answered prior to presentation of angiographic findings. Survey responses were analyzed using descriptive statistics. RESULTS One hundred-eight of 232 (46%) participants, representing 20 academic institutions, completed the survey. Case 1: 78% of respondents would screen for eTVAI with computed topography angiography (CTA) (97%), immediately (88%). The majority of respondents (97%) would treat with aspirin (89%) for 3-6 months (46%). Respondents would follow up clinically (89%) or radiographically (75%), every 1-3 months. Case 2: 73% of respondents would screen with CTA (96%), immediately (88%). Most respondents (94%) would treat with aspirin (50%) for 3-6 months (35%). Thirty-six percent of respondents would utilize endovascular therapy. Respondents would follow up clinically (97%) or radiographically (89%), every 1-3 months. CONCLUSION This survey of Canadian practice patterns highlights consistency in the approach to screening, treatment, and follow-up of asymptomatic eTVAI. These findings are relevant to neurosurgeons, spinal surgeons, stroke neurologists, and neuro-interventionalists.
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Affiliation(s)
- Mark A Maclean
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Charles J Touchette
- Division of Neurosurgery, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Taylor Duda
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Alysa Almojuela
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Bergeron
- Division of Neurosurgery, Universite de Montreal, Montreal, Quebec, Canada
| | - Michelle Kameda-Smith
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Amit R L Persad
- Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nicholas Sader
- Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Jacob Alant
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sean D Christie
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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6
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Kameda-Smith M, James G, Seunarine K, Rennie A, Robertson F, Silva AHD. Paediatric subarachnoid haemorrhage and severe vasospasm secondary to traumatic pseudoaneurysm of a fenestrated vertebral artery: a case report and review of the literature. Childs Nerv Syst 2023; 39:2187-2193. [PMID: 37162521 PMCID: PMC10390618 DOI: 10.1007/s00381-023-05894-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/20/2023] [Indexed: 05/11/2023]
Abstract
Paediatric intracranial aneurysms are rare entities accounting for less than 5% of all age intracranial aneurysms. Traumatic aneurysms are more common in children and have an association with anatomical variations such as arterial fenestrations. Here, we present a case of a child initially presenting with traumatic subarachnoid haemorrhage who returned to baseline and was discharged home only to return within 2 weeks with diffuse subarachnoid and intraventricular re-haemorrhage. A dissecting aneurysm of a duplicated (fenestrated) V4 vertebral artery segment was identified as a rare cause of rebleeding. We describe a course complicated by severe vasospasm delaying aneurysm detection and treatment. Dissecting aneurysms in children should be considered in all cases of delayed post-traumatic cranial rebleeding, particularly where there is anomalous arterial anatomy.
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Affiliation(s)
- Michelle Kameda-Smith
- Great Ormond Street Hospital for Sick Children, London, England
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, England
| | - Greg James
- Great Ormond Street Hospital for Sick Children, London, England
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, England
| | - Kiran Seunarine
- Great Ormond Street Hospital for Sick Children, London, England
- Department of Radiology, Physics Group, London, England
| | - Adam Rennie
- Great Ormond Street Hospital for Sick Children, London, England
- Paediatric Interventional Neuroradiology, London, England
| | - Fergus Robertson
- Great Ormond Street Hospital for Sick Children, London, England
- Paediatric Interventional Neuroradiology, London, England
| | - Adikarige Haritha Dulanka Silva
- Great Ormond Street Hospital for Sick Children, London, England.
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, England.
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7
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Sidhu K, Kim D, Lebel D, Alshammari A, Photopoulos G, Duarte MP, Provost M, Nielsen C, Oitment C, Cowley R, Dumas E, Dea N, Versteeg A, Eltit F, Rampersaud YR, Dandurand C, Grassner L, Alduwaisan A, Kennedy C, Christie S, Toobaie A, Algarni N, El-Mughayyar D, Pahuta M, Grassner L, Pelletier-Roy R, Bak AB, Singh S, Abbas A, Abbas A, Abbas A, Ajisebutu A, Aldahamsheh O, Martin S, Baron N, Basiratzadeh S, Beresford-Cleary N, Good C, Thomson A, Bhatt F, Bhatt F, Good C, Thomson A, Blake N, Briand MM, Shah V, Chen T, Cherry A, Rocos B, Cherry A, Chua R, Chua R, Cotter T, Coyle MJ, Dandurand C, Dandurand C, Dandurand C, Dauphinee E, Dionne A, El Bojairami I, Duarte MP, Duarte MP, Elahi MT, Ellingwood N, Ells B, Fallah N, Fernandes R, Fernandes R, Fleury C, Flórez-Jiménez S, Li P, Gennari A, Georgiopoulos M, Greene R, Yu C, Werthmann N, Hakimjavadi R, Hakimjavadi R, Heard B, Hutchison C, Kemna C, Kennedy C, Laflamme M, Laskin J, MacLean M, Mac-Thiong JM, Manson N, Manson N, Manson N, Urquhart J, Kuepper E, Pahuta M, Pahuta M, Parker E, Persad A, Phan K, Rachevitz M, Ridha B, Dhaliwal P, Sakoto S, Sarraj M, Sarraj M, Hache P, Singh S, Slosar P, Sun M, Sundararajan K, Sundararajan K, Thornley P, Thornley P, Thornley P, Thornley P, Thorogood N, Toobaie A, Belhouari S, Olotu O, Du JT, Saleh I, Varga A, Varshney V, Versteeg A, Visnjevac O, Wang Z, Wasim A, Wasim A, Wu J, Filezio M, Singh V, Ferri-de-Barros F, Dermott J, Lebel D, Machida M, Bath N, Levin D, Campbell F, Koyle M, Isaac L, Ruskin D, Brennenstuh S, Stinson J, Navarro-Ramirez R, Rabau O, Ouellet JA, Hurry J, Brooks J, Fitzgerald R, Louer C, Murphy J, Shaw KA, Smit K, El-Hawary R, Joncas J, Parent S, Duval M, Chèmaly O, Brassard F, Mac-Thiong JM, Barchi S, Labelle H, Beauséjour M, Ishimo MC, Joncas J, Labelle H, Le May S, Lewis L, Arnold K, Oitment C, Jentzsch T, Lewis S, Rienmuller A, Jentzsch T, Yashuv HS, Martin A, Nielsen C, Berven S, Ludwig T, Coyle M, Asmussen M, Edwards B, Nicholls F, Bigney E, Fleury C, El-Mughayyar D, Cherry A, Vanderwint A, Richardson E, Kerr J, McPhee R, Abraham E, Manson N, Attabib N, Small C, Couture J, Goulet J, Bédard S, Lebel K, LaRue B, Investigators CSORN, Gal R, Verlaan JJ, Charest-Morin R, Fisher CG, Wessels H, Verkooijen L, Ng T, Gokaslan Z, Fisher C, Dea N, Charest-Morin R, Urquhart J, Glennie A, Fisher C, Bailey C, Mcintosh G, Fisher C, Paquet J, Abraham E, Bailey C, Weber M, Johnson M, Nataraj A, Glennie A, Attabib N, Kelly A, Hall H, Rampersaud R, Manson N, Phan P, Thomas K, Dea N, Thomé C, Kögl N, Vo AK, Kramer JLK, Petr O, Visva S, Phan K, Nguyen-Luu T, Stratton A, Kingwell S, Wai E, Phan P, Puskas D, Pahuta M, Marion T, Greene R, Kehler S, Rockwood K, Urquhart J, Thornley P, Rasoulinejad P, Glennie A, Rampersaud R, Manson N, Abraham E, Fisher C, Charest-Morin R, Paquette S, Gélinas-Phaneuf N, Thomas K, Dea N, Dvorak M, Kwon B, Street J, Ailon T, Christie S, Bailey C, McIntosh G, Dea N, Charest-Morin R, Adams T, Bigney E, Cunningham E, Richardson E, Vandewint A, Attabib N, Abraham E, Manson N, Small C, LeRoux A, Kolyvas G, Investigators CSORN, Hebert J, Jiang E, Fisk F, Taliaferro K, Stukas S, Cooper J, Gill J, Fallah N, Skinnider MA, Belanger L, Ritchie L, Tsang A, Dong K, Streijger F, Street J, Paquette S, Ailon T, Dea N, Charest-Morin R, Fisher CG, Dvorak MF, Wellington C, Kwon BK, Dionne A, Richard-Denis A, Briand MM, Bourassa-Moreau É, Mac-Thiong JM, Moghaddamjou A, Fehlings MG, Nadeau M, Fisher C, Toor J, Larouche J, Finkelstein J, Whyne C, Yee A, Toor J, Du JT, Versteeg A, Yee N, Finkelstein J, Abouali J, Nousiainen MT, Kreder H, Whyne C, Larouche J, Toor J, Lewis S, Finkelstein J, Larouche J, Yee A, Whyne C, Dhaliwal P, Hasan M, Berrington N, Johnson M, Burger L, Nicholls F, Evaniew N, Cobetto N, Aubin CE, Larson AN, Cheng Y, Fourney D, Hakimjavadi R, Michalowski W, Viktor H, Baddour N, Wai E, Stratton A, Kingwell S, Phan P, Dandurand C, Mawhinney G, Reynolds J, Orosz L, Thomson A, Bhatt F, Guth M, Allen B, Boyd D, Grigorian J, Schuler T, Jazini E, Haines C, Orosz L, Bhatt F, Allen B, Sabet A, Schuler T, Haines C, Jazini E, Orosz L, Thomson A, Namian S, Bharara N, Jazini E, Good C, Schuler T, Haines C, Orosz L, Tewari A, Roy R, Good C, Schuler T, Haines C, Jazini E, Orosz L, Thomson A, Bhatt F, Grigorian J, Schuler T, Haines C, Merril J, Roy R, Jazini E, Wang M, Orosz L, Haines C, Jazini E, Bhatt F, Sabet A, Roy R, Schuler T, Good C, Greene R, Schmidt M, Christie S, Richard-Denis A, Le MT, Lim V, Mac-Thiong JM, Gallagher M, Cheung A, Brown J, Chaudhry H, Yee C, McIntosh G, Christie S, Fisher C, Jarzem P, Roy JF, Bouchard J, Yee A, Eseonu K, Ahn H, Cherry A, Rampersaud R, Davidson B, Rabinovitch L, Nielsen C, Jiang F, Vaisman A, Lewis S, Canizares M, Rampersaud R, Investigators CSORN, Avila M, Burket A, Aguilar-Salinas P, Mongrain R, Ouellet J, Driscoll M, Schmidt-Braekling T, Dobransky J, Kreviazuk C, Gofton W, Phan P, Beaule P, Grammatopoulos G, Street J, Fisher C, Jacobs B, Johnson M, Paquet J, Wilson J, Hall H, Bailey CS, Christie S, Nataraj A, Manson N, Phan P, Rampersaud R, Thomas K, Mcintosh G, Rasoulinejad P, Charest-Morin R, Hindi M, Farimani PL, Mashayekhi MS, Ailon T, Boyd M, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Urquhart J, Ailon T, Bailey C, Boyd M, Charest-Morin R, Dea N, Dvorak M, Glennie A, Kwon B, Paquette S, Rampersaud R, Street J, Fisher C, Vandewint A, Bigney E, El-Mughayyar D, Richardson E, Edward A, Manson N, Attabib N, Kolyvas G, Small C, Investigators CSORN, Mac-Thiong JM, Barthélémy D, Lim V, Richard-Denis A, Driscoll M, Aubin CE, Cobetto N, Roy-Beaudry M, Bellefleur C, Turgeon I, Labelle H, Barchi S, Parent S, Joncas J, Parent S, Labelle H, Barchi S, Mac-Thiong JM, Lee W, Phan P, Bigney E, Richardson E, El-Mughayyar D, Vandewint A, Abraham E, Manson N, Small C, Alugo T, Leroux A, Kolyvas G, Investigators CSORN, Attabib N, McIntosh G, Oxner W, Dunning PC, Glennie A, Wang D, Humphreys S, Noonan V, Urquhart J, Siddiqi F, Rasoulinejad P, Bailey C, Urquhart J, Thornley P, Rampersaud R, Glennie A, Rasoulinejad P, Fisher C, Bailey C, Investigators CSORN, Bigney E, Dumas E, El-Mughayyar D, Cherry A, Vanderwint A, Richardson E, Kerr J, McPhee R, Abraham E, Manson N, Attabib N, Small C, Couture J, Goulet J, Bédard S, LaRue B, Investigators CSORN, Macthiong JM, Bourassa-Moreau E, Ogden C, Gallagher M, Cheung A, Huong VT, Tarabay B, Al-Shakfa F, Yuh SJ, Shedid D, Boubez G, Wang Z, Gueziri HE, Santaguida C, Collins DL, Hall A, Alant J, Barry S, Weise L, Glennie A, Oxner B, Etchegary H, Christie S, Carreon L, Glassman S, Brown M, Daniels C, Polly D, Gum J, Gum J, Glassman S, Brown M, Daniels C, Carreon L, Hong HA, Fallah N, Humphreys S, Walden K, Noonan VK, Phan P, Basiratzadeh S, Wai EK, Phan P, Salo P, Krawetz R, Hart D, Bains I, Swamy G, Yang Q, Godoy A, Smith S, Lin C, Nataraj A, Puskas D, Pahuta M, Marion T, Dea N, Waheed Z, Thorogood N, Nightingale T, Noonan V, Touchette C, Duda T, Almojuela A, Bergeron D, Aljoghaiman M, Sader N, Kameda-Smith M, Alant J, Christie S, Hresko MT, Alzakri A, Parent S, Sucato DJ, Lenke LG, Marks M, Labelle H, Pereira P, Charles YP, Krutko A, Santos C, Park Y, Arzoglou V, Park SW, Franke J, Fuentes S, He S, Hosszu T, Varanda P, Mlyavykh S, Vanhauwaert D, Senker W, Franke J, Park Y, Charles YP, Santos C, Arzoglou V, Song Y, He S, Bhagat S, Hong JY, Vanhauwaert D, Senker W, Pereira P, Senker W, Charles YP, Pereira P, Santos C, Park Y, Arzoglou V, Park SW, Bordon G, Fuentes S, Song Y, Vialle E, Bhagat S, Krutko A, Franke J, Thornley P, Rampersaud R, Glennie A, Rasoulinejad P, Abraham E, Ailon T, Charest-Morin R, Dea N, Dvorak M, Gélinas-Phaneuf N, Kwon B, Manson N, Paquette S, Street J, Thomas K, Fisher C, Bailey C, Mishreky A, Hurry J, El-Hawary R, Jiang E, Fisk F, Taliaferro K, Dea N, Investigators CSORN, Al Anazi M, El-Hawary R, Kindrachuk M, Noyes E, Wu A, Fourney D, Pratt M, Wai E, Stratton A, Kingwell S, Wang Z, Phan P, Robarts S, Razmjou H, Yee A, Larouche J, Finkelstein J, Persad A, Huschi Z, Cheng Y, Fourney D, Rossong H, Zhang H, Johnson M, Goytan M, Zarrabian M, Berrington N, Zeiler F, Charles A, Roy-Beaudy, Parent S, Duong L, Marion T, Guha D, Pahuta M, Hache P, Oitment C, Guha D, Pahuta M, Sarraj M, Oitment C, Guha D, Pahuta M, Miyanji F, McAnany S, Cheung A, Dewitt D, Street J, Jurisica I, Perruccio AV, Rampersaud YR, Niu Y, Perruccio AV, Jurisica I, Rampersaud YR, Glennie A, Alahmari A, Al-Jahdali F, Fisher C, Rampersaud R, Urquhart J, Bailey C, Urquhart J, Bailey C, Urquhart J, Rampersaud R, Glennie A, Fisher C, Bailey C, Urquhart J, Rampersaud R, Glennie A, Fisher C, Bailey C, Harback K, Akpinar I, Adjetey C, Tindall D, Chernesky J, Noonan V, Fernandes RJR, Bailey C, Siddiqi F, Rasoulinejad P, Toor J, Abbas A, Brooks H, Larouche J, Abbas A, Bhatia A, Selimovic D, Larouche J, Yee A, Lewis S, Finkelstein J, Toor J, Abbas A, Toor J, Versteeg A, Finkelstein J, Toor J, Abbas A, Ahn H, Larouche J, Finkelstein J, Whyne C, Yee A, Slomp F, Thiessen E, Lastivnyak N, Maclean LS, Ritchie V, Hockley A, Osborn J, Paquette S, Sahjpaul R, Gal R, Charest-Morin R, Verlaan JJ, Wessels H, Fisher CG, Verkooijen L, Pastrak M, Truong VT, Liberman M, Al-Shakfa F, Yuh SJ, Soder SA, Wu J, Sunna T, Renaud-Charest É, Boubez G, Shedid D, Balasuberamaniam P, Shrikumar M, Chen T, Anthony T, Phillips A, Nathens A, Chapman M, Crawford E, Stark R, Schwartz C, Finkelstein J, Small C, Rampersaud R. Canadian Spine SocietyAbstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments?Abstract 74. How useful is prereferral spine imaging? A quality improvement projectAbstract 82. Early recovery after surgery, predictors of shorter length of stayAbstract 68. Gliding screws on early-onset scoliosis: a 5-year experienceAbstract 66. Reliability of radiographic assessment of growth modulation from anterior vertebral body tethering surgery in pediatric scoliosisAbstract 16. A dangerous curve: impact of the COVID-19 pandemic on brace treatment in adolescent idiopathic scoliosisAbstract 24. Development of a model of interprofessional support interventions to enhance brace adherence in adolescents with idiopathic scoliosisAbstract 94. Recognizing the importance of self-image in adult spinal deformity: results from the Prospective Evaluation of Elderly Deformity Surgery (PEEDS)Abstract 25. Assessing pain as a primary factor in the surgical treatment of adult spinal deformity surgery in patients over 60 years of ageAbstract 72. Application of the Ames-International Spine Study Group (AMES) radiographic modifiers to an asymptomatic population. Are the thresholds for “normal” appropriate?Abstract 109. Exploring the relationship between cannabis and narcotic use on preoperative health considerations in Canadian thoracolumbar patients: a CSORN studyAbstract 36. Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort studyAbstract 91. What do patients expect of palliative treatment for symptomatic spinal metastases? A qualitative studyAbstract 44. Denosumab for giant cell tumours of the spine: molecular predictors of clinical response — a pilot studyAbstract 89. Surgical management and outcomes from “stable” degenerative spondylolisthesis (DS) from the CSORN prospective DS study: What the @#$ % are we doing?Abstract 33. Economic consequences of waiting for lumbar disc herniation surgeryAbstract 108. Motor recovery depends on timing of surgery in patients with lumbar disc herniationAbstract 106. Outcomes following revision decompression for lumbar spinal stenosis when compared to primary decompression: a matched cohort analysis using the Canadian Spine Outcomes and Research Network registryAbstract 64. Patient engagement, remote monitoring and virtual care — a pilot project in rural and remote patients undergoing elective lumbar surgeryAbstract 84. Development of a frailty index from the Canadian Spine Outcomes and Research Network (CSORN) to predict long-term success of surgery for patients with degenerative pathologies of the spineAbstract 102. Posterolateral versus posterior interbody fusion for the management of lumbar degenerative spondylolisthesis: analysis from the CSORN prospective LDS propensity score matched studyAbstract 31. Impact on patient-reported outcomes of ending the posterior construct proximally at C2 versus C3 in degenerative cervical myelopathy patientsAbstract 42. Perioperative factors predict 2-year trajectories of pain and disability following anterior cervical discectomy and fusionAbstract 61. Calculating utilities from the modified Japanese Orthopaedic Association score: a prerequisite for quantifying the value of care for cervical myelopathyAbstract 119. Serum neurofilament light (NF-L) and glial fibrillary acidic protein (GFAP) biomarkers and their association with MRI findings in human acute traumatic spinal cord injuryAbstract 95. The Montreal Acute Classification of Spinal Cord Injury (MAC-SCI): a new tool to detect and characterize spinal cord injury in the trauma patientAbstract 118. Mechanism of injury is associated with neurologic outcomes after cervical sensorimotor complete acute traumatic spinal cord injuryAbstract 13. Patient perspective: diagnosis and prognosis of acute spinal cord injuriesAbstract 136. Predictive analytics to improve dedicated spine trauma operating room resource allocationAbstract 138. Machine learning models to predict surgical resident workload at a level 1 trauma centreAbstract 139. Machine learning to predict duration of surgery and length of stay for single-level discectomy proceduresAbstract 9. Outpatient spinal surgery in ManitobaAbstract 131. Unexpected positive culture in presumed aseptic revision spine surgery: a systematic review and meta-analysisAbstract 50. Lumbar anterior vertebral body tethering: biomechanical assessment of the surgical decision factors influencing the immediate and 2 years postoperative correctionAbstract 145. Does prolonged symptom duration influence surgical outcomes for cervical radiculopathy?Abstract 147. A data-driven cluster analysis approach to create homogenous subgroups for traumatic spine injury: toward improving traditional classificationAbstract 41. The use of neo-adjuvant denosumab in treatment of giant cell tumours of the spineAbstract 5. Complications, revision rates and accuracy of robotic-guided S2 alar-iliac screw placementAbstract 6. Opioid use after spine surgery: How much are we over-prescribing?Abstract 7. Intradiscal injection of autologous bone marrow aspirate concentrate improves low back pain at 1 yearAbstract 8. Augmented reality–assisted spine surgery: an early experience demonstrating safety and accuracy with 218 screwsAbstract 22. Comparison of complications, revision rates and fluoroscopy time using the latest technology in robotic-guided surgery with historical fluoroscopic-guided controlsAbstract 23. Robotic-guided thoracolumbar fusion experience: a multi-surgeon, single-centre study of 628 patients and 3874 robotic-guided screws from 2012 to 2020Abstract 86. A province-wide assessment of the appropriateness of lumbar spine MRIAbstract 134. Concomitant traumatic spinal cord injury and brain injury diagnoses are more frequent and impactful than expectedAbstract 45. Spatial and depth mapping of nascent mineralization on Ti6Al4V surfaces demonstrating hierarchical macro-micro-nanoscale surface featuresAbstract 111. Propensity-matched outcomes comparing lumbar interbody fusion and total disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyAbstract 30. A Canadian-based pilot study of current surgical practice and implant preferences in lumbar fusion surgeryAbstract 32. Local contamination is a major cause of early deep wound infections following open posterior lumbosacral fusionsAbstract 99. Comparing patient preoperative expectations and postoperative expectation fulfillment between minimally invasive versus open fusion surgeryAbstract 146. Outpatient robotic-assisted lumbar spinal fusion using the Mazor X Stealth EditionAbstract 149. Lessons learned from my first 100 robotic-assisted lumbar fusions using the Mazor X Stealth Edition: surgical synergy with MIS, surgical navigation and roboticsAbstract 151. Freehand biomechanical testing for use in lumbar discectomy trainingAbstract 48. Spinal pathology and outcome post-THA: Does segment of arthrodesis matter?Abstract 27. Patient, surgical and institutional factors associated with length of stay in degenerative lumbar spine surgery: national multicentre cohort analysis from the Canadian Spine Outcomes and Research Network (CSORN)Abstract 28. The impact of the increasing proportion of degenerative spine emergency admissionsAbstract 51. Patient’s expectations of surgery for degenerative spondylolisthesis: analysis by site and type of surgery from the Canadian Spine Outcomes and Research Network (CSORN)Abstract 60. The impact of sex on thoracolumbar surgery outcomes in patients with diabetes — a CSORN studyAbstract 81. The impact of older age on rehabilitation outcomes following functional motor-incomplete traumatic spinal cord injuryAbstract 47. Devise and investigate a novel, intramuscular pressure based, muscle activation strategy in a spine stability modelAbstract 17. 3D radiologic outcomes for patients with moderate idiopathic scoliosis curves treated with internal (anterior vertebral growth modulation) versus external bracing: a 2-year observational studyAbstract 18. Is quality of life affected by concomitant isthmic spondylolisthesis when undergoing surgery for adolescent idiopathic scoliosis and nonsurgical management of the spondylolisthesis?Abstract 128. Toward macrostructural and microstructural investigation of the cervical spinal cord through quantitative analysis of T2-weighted and diffusion-weighted imagingAbstract 26. Minimally invasive versus open thoracolumbar spine surgery for patients who have lumbar spinal stenosis and an ASA score of 3 or above: a CSORN studyAbstract 101. Association between surgeon age and outcomes of spine surgery: a population-based retrospective cohort studyAbstract 77. Utilizing machine learning methodology to create a short form of the Multi-Morbidity Index in spinal cord injuryAbstract 70. Ten-year reoperation rate and clinical outcome in patients treated surgically for lumbar spinal stenosisAbstract 105. Assessing the importance of radiographic and clinical parameters when choosing decompression without fusion for LDS: results from the CSORN prospective DS studyAbstract 104. Preoperative cannabis use in Canadian thoracolumbar spine surgery patients: a CSORN studyAbstract 142. Post-traumatic ascending myelitis, about 2 cases, etiologic analysis and treatmentAbstract 55. NanoLOCK surfaces enhance osteoblast activities at the cellular levelAbstract 76. Which scoring system is the most accurate for predicting survival in patients undergoing surgery for spinal metastases from lung cancer?Abstract 11. Pedicle screw insertion using ultrasound-based navigation without intraoperative radiation: feasibility study on porcine cadaversAbstract 85. What barriers prevent patients being discharged from hospital following elective spine surgery?Abstract 15. Propensity-matched comparison of 90-day complications in robotic-assisted versus non-robotic-assisted lumbar fusionAbstract 56. No-tap (2-step) robotic-assisted cortical bone trajectory (RA-CBT) screw insertion is safe and efficient: comparative analysis of 179 patients and 924 RA-CBT screwsAbstract 124. Developing a Web-based application to promote the adoption of a clinical prediction model for independent walking in people with traumatic spinal cord injury — a protocolAbstract 125. Multivariable prediction models for prognostication after traumatic spinal cord injury — a systematic reviewAbstract 148. Expression of blood serum cytokines in the presentation of acute sciaticaAbstract 150. Do patient-reported outcome scores (PROs) correlate with bundled payment plan performance for elective spine surgeries?Abstract 46. Effects of delayed neurosurgery on anxiety, depression and economic burdenAbstract 69. Care close to home — a retrospective analysis of patients undergoing elective lumbar surgery in a rural satellite hospitalAbstract 110. Surgical adverse events for primary tumours of the spine and their impact on prognosis and outcomes: a PTRON studyAbstract 80. Spinal cord stimulation research in the restoration of function for individuals living with spinal cord injuries: a scoping reviewAbstract 132. Workup and management of asymptomatic extracranial traumatic vertebral artery injury: a Canadian Neurosurgery Resident Research Collaborative studyAbstract 12. A surgical treatment algorithm for restoring pelvic balance and health-related quality of life in high-grade lumbosacral spondylolisthesisAbstract 38. Effectiveness of 6 surgical approaches for minimally invasive lumbar interbody fusion: 1-year follow-up results from a global multicentre studyAbstract 39. Clinical outcomes and fusion success in patients with degenerative lumbar disease without spondylolisthesis: comparing anterolateral to posterior MIS approaches from a global multicentre studyAbstract 40. Anterolateral versus posterior approaches to minimally invasive interbody fusion for patients with spondylolisthesis: results at 1-year follow-up from a global multicentre studyAbstract 73. Benefit of minimally invasive lumbar interbody fusion versus traditional interbody fusion versus posterolateral spinal fusion in lumbar degenerative spondylolisthesis: a propensity-matched analysis from the CSORN prospective LDS studyAbstract 67. The effect of fusionless pediatric scoliosis surgery on 3D radiographic spinopelvic alignmentAbstract 62. Calculating utilities from the Neck Disability Index: a prerequisite for quantifying the value of cervical spine careAbstract 63. The psychometric properties of the mJOA for quality-of-life assessments in cervical myelopathyAbstract 59. Low radius of curvature growth friendly implants increases the risk of developing clinically significant proximal junctional kyphosisAbstract 144. Very long–term outcome of single-level minimally invasive lumbar microdiscectomy with a tubular retractorAbstract 112. Metal implant hypersensitivity in patients undergoing spinal surgery: a literature review and case reportAbstract 43. Diagnostic value of the lumbar spinal stenosis (SSHQ) survey in virtual care provided at a tertiary spine programAbstract 54. Is the Calgary Postoperative Pain After Spine Surgery (CAPPS) score correlated with long-term outcomes after lumbar fusion?Abstract 4. Development of a single-entry referral pathway for patients with spinal conditions in Manitoba: a cross-sectional review of impact and potential way forward for Canadian spine programsAbstract 113. Automatization of bone age calculationAbstract 123. An effectiveness and quality-of-life analysis of conservative care versus surgery for moderate and severe cervical myelopathyAbstract 133. Long-term survivorship of cervical spine procedures: a survivorship meta-analysis and meta-regressionAbstract 137. Natural history of degenerative cervical myelopathy: a meta-analysis and neurologic deterioration survival curve synthesisAbstract 14. Does intraoperative vancomycin powder affect postoperative infections in adolescent idiopathic scoliosis?Abstract 37. The clinical impact of nano-surface technology on postoperative opioid consumption in patients undergoing anterior lumbar interbody fusionAbstract 130. Design and implementation of a comprehensive perioperative complex spine communication toolAbstract 87. Stratifying low back pain patients in an inter-professional education and self-management model of care: results of a latent class analysisAbstract 88. Cohort accuracy versus confidence at the patient level: clinical challenges for AI-based prediction of low back pain outcomesAbstract 96. Preoperative disc angle is an important predictor of segmental lordosis after degenerative spondylolisthesis fusionAbstract 97. Preoperative depression, functional and radiographic outcomes after surgery for degenerative lumbar spondylolisthesisAbstract 116. A CSORN study of functional outcomes after surgery for lumbar degenerative spondylolisthesisAbstract 121. A CSORN study of the effect on radiographic alignment outcomes with different surgery type for degenerative lumbar spondylolisthesisAbstract 79. Spinal cord stimulation to restore neurological function: a costing analysisAbstract 107. Biomechanical properties of a novel morselized bone graft cageAbstract 93. Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating roomAbstract 103. Machine learning models can predict subsequent publication of North American Spine Society Annual General Meeting abstractsAbstract 117. The use of primary sacroiliac joint fusion for lower back pain due to sacroiliac joint pathology: a systematic review and meta-analysisAbstract 141. How to make the most of your operative time by optimizing surgical schedulingAbstract 126. Altering physician referral practices remains a challenge: a spine assessment clinic quality improvement studyAbstract 152. Outcomes of workers’ compensation patients undergoing neuromodulation for persistent neuropathic pain conditionsAbstract 90. Expectations of treatment outcomes in patients with spinal metastases: What do we tell our patients? A qualitative studyAbstract 52. Fluoroscopically guided radiofrequency ablation of the superior cluneal nerve: preliminary outcomes data for a minimally invasive approach for treating superior cluneal neuralgiaAbstract 21. Single-stage posterior approach for en bloc resection and spinal reconstruction of T4 Pancoast tumour invading spineAbstract 34. Predictors of sacral ulcers in patients with complete spinal cord injuryAbstract 135. Targeting geographic wait time disparities in Canada: a rapid review of domestic and international strategies to reduce orthopedic wait times in the MaritimesAbstract 143. The influence of coronal plane parameters on patient-reported outcome measures in patients undergoing decompression for lumbar spinal stenosis. Can J Surg 2022. [DOI: 10.1503/cjs.011622] [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: 12/13/2022] Open
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Dakson A, Kameda-Smith M, Staudt MD, Lavergne P, Makarenko S, Eagles ME, Ghayur H, Guo RC, Althagafi A, Chainey J, Touchette CJ, Elliott C, Iorio-Morin C, Tso MK, Greene R, Bargone L, Christie SD. A nationwide prospective multicenter study of external ventricular drainage: accuracy, safety, and related complications. J Neurosurg 2021; 137:1-9. [PMID: 34826821 DOI: 10.3171/2021.7.jns21421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE External ventricular drainage (EVD) catheters are associated with complications such as EVD catheter infection (ECI), intracranial hemorrhage (ICH), and suboptimal placement. The aim of this study was to investigate the rates of EVD catheter complications and their associated risk factor profiles in order to optimize the safety and accuracy of catheter insertion. METHODS A total of 348 patients with urgently placed EVD catheters were included as a part of a prospective multicenter observational cohort. Strict definitions were applied for each complication category. RESULTS The rates of misplacement, ECI/ventriculitis, and ICH were 38.6%, 12.2%, and 9.2%, respectively. Catheter misplacement was associated with midline shift (p = 0.002), operator experience (p = 0.031), and intracranial length (p < 0.001). Although mostly asymptomatic, ICH occurred more often in patients receiving prophylactic low-molecular-weight heparin (LMWH) (p = 0.002) and those who required catheter replacement (p = 0.026). Infectious complications (ECI/ventriculitis and suspected ECI) occurred more commonly in patients whose catheters were inserted at the bedside (p = 0.004) and those with smaller incisions (≤ 1 cm) (p < 0.001). ECI/ventriculitis was not associated with preinsertion antibiotic prophylaxis (p = 0.421), catheter replacement (p = 0.118), and catheter tunneling length (p = 0.782). CONCLUSIONS EVD-associated complications are common. These results suggest that the operating room setting can help reduce the risk of infection, but not the use of preoperative antibiotic prophylaxis. Although EVD-related ICH was associated with LMWH prophylaxis for deep vein thrombosis, there were no significant clinical manifestations in the majority of patients. Catheter misplacement was associated with operator level of training and midline shift. Information from this multicenter prospective cohort can be utilized to increase the safety profile of this common neurosurgical procedure.
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Affiliation(s)
- Ayoub Dakson
- 1Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Michael D Staudt
- 3Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Pascal Lavergne
- 4Université de Laval, CHU de Québec Hôpital-Enfant-Jésus, Laval, Québec, Canada
| | - Serge Makarenko
- 5Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew E Eagles
- 6Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Huphy Ghayur
- 2Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Ru Chen Guo
- 5Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alwalaa Althagafi
- 1Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan Chainey
- 7Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada; and
| | - Charles J Touchette
- 8Division of Neurosurgery, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Cameron Elliott
- 7Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada; and
| | | | - Michael K Tso
- 6Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Ryan Greene
- 1Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laurence Bargone
- 4Université de Laval, CHU de Québec Hôpital-Enfant-Jésus, Laval, Québec, Canada
| | - Sean D Christie
- 1Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Kameda-Smith M, Farrokhyar F. In Reply to the Letter to the Editor Regarding "Determining the Diagnostic Utility of Lumbar Punctures in CT Negative Suspected Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis". World Neurosurg 2021; 147:249. [PMID: 33685022 DOI: 10.1016/j.wneu.2020.12.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Michelle Kameda-Smith
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Forough Farrokhyar
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Kameda-Smith M, Pond G, Farrokhyar F, Seow H. EPCT-11. RURALITY INDEX SCORE AND PEDIATRIC NEURO-ONCOLOGICAL OUTCOME IN ONTARIO. Neuro Oncol 2021. [PMCID: PMC8168186 DOI: 10.1093/neuonc/noab090.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Rapid access to neurosurgical decisions and definitive management are vital for the outcome of neurocritical patients. There are increased challenges of providing services and to maintain critical infrastructure for rural citizens. The relationship between rurality, marginalization and health outcomes has been identified as associated with higher mortality rates and higher rates of many diseases[G1].
Methods
Employing linked administrative databases, we retrospectively analyzed a population based cohort of patients diagnosed with a pediatric brain tumour between 1996 to 2017 in Ontario, Canada. The Ontario Marginalization Index was employed as a surrogate for rurality providing an overall Rurality Index for Ontario (RIO) in addition to the 2016 Ontario Marginalization Index (ON-MARG).
Results
Of 1457 patients included, 54.0% were male, 277 of whom were diagnosed in infancy (i.e., < 3 years of age). Income quintile was evenly distributed with 11.5% classified as living in a rural area of Ontario. The median[G2] distance to the nearest pediatric neurosurgical hospital was 59.6km. The rurality index score (RIO) was 0 in 38.8% of children with the majority of patients with a RIO score of <39. The ON-MARG identified 51.9% of patients living in communities with low concentration of individuals without income from employment. A higher RIO score was not a significant factor (Continuous p=0.092/Ordinal p=0.20) associated with length[G3] of follow up, indicating rurality was not a significant factor for determining compliance to[G4] clinical follow-up. However, a trend towards reduced follow-up compliance in the higher RIO score cohort was identified.
Conclusion
Rurality and social determinants of health of the region pediatric neuro-oncological patients reside were not associated with patient outcome but a trend towards lower follow-up compliance was identified when children were from regions with RIO>39. Implementation of telehealth follow-up for these patients may overcome barrier to clinical follow-up.[G5]
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Affiliation(s)
| | | | | | - Hsien Seow
- McMaster University, Hamilton, ON, Canada
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Kameda-Smith M, Elliott C, Moore H, Sader N, Tso M, Alsuwaihel M, Dakson A, Ajani O, Yarascavitch B, Fleming A, Mehta V, Farrokhyar F, Yikilmaz A, Stein N, Singh S. EPCT-12. NATIONAL MULTICENTERED RETROSPECTIVE REVIEW OF DEMOGRAPHIC, TUMOUR AND INTRAOPERATIVE FEATURES ASSOCIATED WITH THE DEVELOPMENT OF CEREBELLAR MUTISM AFTER PEDIATRIC POSTERIOR FOSSA TUMOUR RESECTION. Neuro Oncol 2021. [PMCID: PMC8168105 DOI: 10.1093/neuonc/noab090.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cerebellar mutism (CM) is a condition characterized by a significant lack or loss of speech in children following posterior fossa (PF) surgery. The biological origin of CM remains largely unclear and remains the subject of ongoing debate. Despite multidisciplinary rehabilitative interventions, the outcome is less favorable than initially described. Given the treatment refractory nature of CM, central to its management is prevention.
Methods
A national multi-centered retrospective review of all the children undergoing posterior fossa resection at 4 Canadian academic pediatric institutions was undertaken. Patient, tumour, surgical features suggested to be associated with the post-operative development of CM were reviewed to identify pre-operative and intra-operative factors that may predict post-operative CM occurrence.
Results
258 pediatric patients were identified after posterior fossa lesion resection. Mean age at surgery was 6.74 years (SD 4.60) and 42.2% were female. Frozen section was available in 90.3% of cases. The majority of final tumour histology was medulloblastoma (35.7%), pilocytic astrocytoma (32.6%), ependymoma (17.1%) and exophytic glioma (1.2%). Intra-operative impression of adherence to the floor of the 4th ventricle was negative in 47.7%, positive in 36.8% of cases. The extent of resection assessed intraoperatively as gross total resection was 69.8% of cases. Intra-operative abrupt changes in blood pressure and/or heart rate was identified in 19.4% and 17.8% of cases. CM was experienced in 19.5% of patients (N=50), with the majority of cases identified by post-operative day 7. The clinical resolution of CM as mainly assessed by a neurosurgeon (86%) and was complete, significantly resolved, slight improvement, no improvement or deterioration in 56.0%, 8.0%, 20.0%, 14.0%, 2.0% respectively.
Conclusion
As a devastating surgical complication, identifying and understanding the biological origin of CM is the first step to complication avoidance. Maximal safe resection irrespective of intra-operative pathology remains the goal to avoid the devastating complication of CM.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nina Stein
- McMaster University, Hamilton, ON, Canada
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Kameda-Smith M, Zhu H, Luo E, Venugopal C, Xella A, Brown K, Fox R, Yee B, Xing S, Tan F, Bakhshinyan D, Adile A, Subapanditha M, Picard D, Moffat J, Fleming A, Hope K, John P, Remke M, Lu Y, Reya T, Reimand J, Wechsler-Reya R, Yeo G, Singh S. MBRS-01. DISSECTING REGULATORS OF THE ABERRANT POST-TRANSCRIPTIONAL LANDSCAPE IN MYC-AMPLIFIED GROUP 3 MEDULLOBLASTOMA. Neuro Oncol 2020. [PMCID: PMC7715904 DOI: 10.1093/neuonc/noaa222.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Medulloblastoma (MB) is the most common solid malignant pediatric brain neoplasm, with Group 3 (G3) MB representing the most aggressive subgroup. MYC amplification is an independent poor prognostic factor in G3 MB, however, therapeutic targeting of the MYC pathway remains limited and alternative therapies for G3 MB are urgently needed. Here we show that an RNA-binding protein, Musashi-1 (MSI1) is an essential mediator of G3 MB in both MYC-overexpressing mouse models and patient-derived xenografts. Unbiased integrative multi-omics analysis of MSI1 function in human G3 MB suggests a paradigm shift beyond traditional gene-based profiling of oncogenes. Here we identify MSI1 as an oncogene in G3 MB driving stem cell self-renewal through stabilization of HIPK1 mRNA, a downstream context-specific therapeutic target for drug discovery.
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Affiliation(s)
| | - Helen Zhu
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Agata Xella
- Sanford Burnham Prebys Medical Discovery Institute, San Diego, CA, USA
| | - Kevin Brown
- University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Remke
- University Hospital Dusseldorf, Dusseldorf, Germany
| | - Yu Lu
- McMaster, Hamilton, ON, Canada
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Kameda-Smith M, Aref M, Jung Y, Ghayur H, Farrokhyar F. Determining the Diagnostic Utility of Lumbar Punctures in Computed Tomography Negative Suspected Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis. World Neurosurg 2020; 148:e27-e34. [PMID: 33285333 DOI: 10.1016/j.wneu.2020.11.152] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND While headache is a common neurologic symptom, subarachnoid hemorrhage (SAH) is a rare and potentially catastrophic cause of sudden-onset severe headache. The utility of the imaging modalities and interventional procedures are central to the investigation of the causes of headache; however, they are not without their limitations, risks, and complications. METHODS A meta-analysis in accordance with the Preferred Reporting for Systematic Reviews and Meta-analysis guidelines was conducted searching PubMed, EMBASE, and Google Scholar. Patients investigated for suspected subarachnoid hemorrhage (SAH) with a negative computed tomography (CT) and positive lumbar puncture (LP) and final diagnosis of SAH were included. The sensitivity of LP in the context of a negative CT and vsubsequent imaging confirming the cause of SAH (computed tomography angiography, magnetic resonance angiography, digital subtraction angiography [DSA]) was quantified. The pooled data were analyzed using the DerSimonian-Laid random effects model. RESULTS Four studies with 2782 patients who presented with headache suspicious for SAH were included with an initial negative CT report and a subsequent LP to rule out SAH. All included studies had an observational prospective cohort design. A combined pooled proportion of 0.383 (0.077, 0.756); 0.086 (0.007, 0.238); and 0.22 (0.04, 0.49) for LP+, DSA+, and DSA/computed tomography angiography+ investigations were estimated with a 95% confidence interval. CONCLUSIONS The current clinical workflow of an LP after a negative CT head for a patient presenting with a sudden-onset severe headache is observed to have a high enough proportion to warrant its continued use despite the sensitivity of modern CT scanners of ≥97%.
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Affiliation(s)
- Michelle Kameda-Smith
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Mohammed Aref
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Youngkyung Jung
- Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Huphy Ghayur
- Health Research Methodology Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Bakhshinyan D, Kameda-Smith M, Manoranjan B, Adile A, Venugopal C, Singh SK. Abstract 3682: Therapeutic targeting of stem cell self-renewal in childhood medulloblastoma: Strategies for blocking recurrence. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Group 3 MB patients face the highest incidence of metastasis and poor overall patient survival. The early onset and highly aggressive nature of MB suggest a stem cell origin, where a highly self-renewing transformed cell of the postnatal cerebellum drives MB tumorigenesis. In this work, we explore how WNT signaling and other essential drivers of self-renewal, BMI1 and MSI1, promote MB progression. We subsequently generate new strategies to therapeutically target mechanisms of MB stem cell self-renewal that drive treatment resistance and relapse in Group 3 MB.
Experimental procedures: We apply stem cell assays, patient-derived human-mouse xenograft (PDX) models, and genomic and bioinformatic profiling of recurrent patient-derived MB. Our established brain tumor initiating cell (BTIC) model provides an excellent tool for the examination of developmental pathways implicated in MB.
New Unpublished Data: A small molecule Bmi1 inhibitor, PTC-028, induced a remarkable decrease in self-renewal as well as reduction of local and spinal metastatic disease in recurrent MB, which is striking as no prior drug has shown efficacy against recurrent Group 3 MB. Although mouse and human neural stem cells (NSCs) express Bmi1 and are mildly sensitive to Bmi1 inhibitors, no significant toxicity was observed in either mouse or human NSCs upon PTC-028 treatment, at doses that induced efficacious killing of MB cells. Another novel therapeutic paradigm includes activating Wnt signaling in otherwise non-Wnt MB, which abrogates self-renewal and tumorigenicity of these highly aggressive tumors. For safe and non-toxic activation of Wnt in preclinical models, we identified L807mts, a novel inhibitor that functions through a substrate-to-inhibitor conversion mechanism within the catalytic site of GSK. A final therapeutic strategy to target self-renewal lies in the discovery of the targetable MB-specific interactome of the RNA binding protein (RBP) Musashi1, another key regulator of stem cell self-renewal. Msi1 is overexpressed in Group 3 MB compared to normal cerebellum, and is associated with poor patient prognosis. shRNA knockdown of Msi1 decreased the self-renewal capacity of MB stem cells and significantly decreased tumor burden and increased survival in our PDX model. Finally, comparative eCLIP (enhanced cross-linking and immunoprecipitation) of MB stem cells and normal NSCs, combined with mass spectrometry and RNA-sequencing of shMsi1 MB cells, has elucidated novel therapeutic targets in the RBP interactome of Msi1
Conclusion: Characterization and therapeutic targeting of self-renewal mechanisms unique to MB BTICs may provide an opportunity to limit treatment-resistant stem cell populations from driving patient relapse in recurrent Group 3 MB, a disease currently lacking any targeted therapies.
Note: This abstract was not presented at the meeting.
Citation Format: David Bakhshinyan, Michelle Kameda-Smith, Branavan Manoranjan, Ashley Adile, Chitra Venugopal, Sheila Kumari Singh. Therapeutic targeting of stem cell self-renewal in childhood medulloblastoma: Strategies for blocking recurrence [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3682.
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Affiliation(s)
| | | | | | - Ashley Adile
- McMaster Univ. Medical Ctr., Hamilton, Ontario, Canada
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15
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Bakhshinyan D, Adile A, Venugopal C, Singh M, Qazi M, Kameda-Smith M, Singh S. MEDU-25. GENES PRESERVING STEM CELL STATE IN GROUP 3 MB BTICs CONTRIBUTE TO THERAPY EVASION AND RELAPSE. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Bakhshinyan D, Kameda-Smith M, Adile A, Manoranjan B, Venugopal C, Singh S. MEDU-10. THERAPEUTIC TARGETING OF STEM CELL SELF-RENEWAL IN CHILDHOOD MEDULLOBLASTOMA: STRATEGIES FOR BLOCKING RECURRENCE. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Kameda-Smith M, Brown K, Zhu H, Luo E, Yee B, Xing S, Venugopal C, Nostrand EV, Bakhshinyan D, Subapanditha M, Adile A, Provias J, Fleming A, Hope K, Reimand J, Lu Y, Yeo G, Wechsler-Reya R, Singh S. MEDU-44. MUSASHI-1 IS A MASTER REGULATOR OF ABERRANT TRANSLATION IN GROUP 3 MEDULLOBLASTOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michelle Kameda-Smith
- McMaster University, Department of Biochemistry, Hamilton, ON, Canada
- McMaster University, Department of Surgery, Division of Neurosurgery, Hamilton, ON, Canada
| | - Kevin Brown
- University of Toronto, Donnelly Center, Department of Molecular Genetics, Toronto, ON, Canada
| | - Helen Zhu
- University of Toronto, Ontario Institute for Cancer Research, Department of Biophysics, Toronto, ON, Canada
| | - EnChing Luo
- UCSD, Department of Cellular and Molecular Medicine, La Jolla, CA, USA
| | - Brian Yee
- UCSD, Department of Cellular and Molecular Medicine, La Jolla, CA, USA
| | - Sansi Xing
- McMaster University, Department of Biochemistry, Hamilton, ON, Canada
| | - Chitra Venugopal
- McMaster University, Department of Biochemistry, Hamilton, ON, Canada
| | - Eric van Nostrand
- UCSD, Department of Cellular and Molecular Medicine, La Jolla, CA, USA
| | - David Bakhshinyan
- McMaster University, Department of Biochemistry, Hamilton, ON, Canada
| | | | - Ashley Adile
- McMaster University, Department of Biochemistry, Hamilton, ON, Canada
| | - John Provias
- McMaster University, Department of Neuropathology, Hamilton, ON, Canada
| | - Adam Fleming
- McMaster University, Department of Pediatrics, Division of Hemalogy and Oncology, Hamilton, ON, Canada
| | - Kristin Hope
- McMaster University, Department of Biochemistry, Hamilton, ON, Canada
| | - Juri Reimand
- University of Toronto, Ontario Institute for Cancer Research, Department of Biophysics, Toronto, ON, Canada
| | - Yu Lu
- McMaster University, Department of Biochemistry, Hamilton, ON, Canada
| | - Gene Yeo
- UCSD, Department of Cellular and Molecular Medicine, La Jolla, CA, USA
| | | | - Sheila Singh
- McMaster University, Department of Biochemistry, Hamilton, ON, Canada
- McMaster University, Department of Surgery, Division of Neurosurgery, Hamilton, ON, Canada
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Abstract
Despite the advances in neuro-interventional techniques and expertise to treat intracranial aneurysms (IAs), there remains a subset of IAs that are considered to be a significant treatment challenge. Working closely with the neuro-interventional community, bioengineers have harnessed their knowledge of anatomy, physiology, biophysics, and new materials to develop novel therapeutic adjuncts for the successful endovascular treatment of simple and complex IAs. This review describes the biological challenges, the landscape of neuro-interventional management of IAs, and the factors pertinent to which therapeutic modality is recommended. Finally, recent technological advances that have emerged over the last decade are discussed, taking the reader through the devices' objectives, utility, and safety profiles. The goal of this review is to (i) provide physicians treating IAs with the pertinent information to facilitate evidence-based clinical decision thereby minimizing morbidity and mortality and (ii) facilitate professionals in the biomedical engineering field with the clinical background and summarize current endovascular IA treatment options available, with the intent to inspire future IA device development and innovation.
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Affiliation(s)
- Akshat M Pai
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Michelle Kameda-Smith
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Brian van Adel
- Department of Surgery, Division of Adult Neurology, McMaster University, Hamilton, Canada
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19
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Yang K, Nath S, Koziarz A, Badhiwala JH, Ghayur H, Sourour M, Catana D, Nassiri F, Alotaibi MB, Kameda-Smith M, Manoranjan B, Aref MH, Mansouri A, Singh S, Almenawer SA. Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e762-e775. [DOI: 10.1016/j.wneu.2018.08.163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
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20
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Singh SK, Bakhshinyan D, Venugopal C, Adile A, Singh M, Qazi M, Manoranjan B, Kameda-Smith M. Abstract 1140: Genes preserving stem cell state in group 3 medulloblastoma brain tumor initiating cells contribute to therapy evasion and relapse. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Of current molecular subgroups, Group 3 patients face the highest incidence of metastatic spread and overall patient survival of less than 50%. Current clinical trials for recurrent MB patients based on genomic profiles of primary, treatment-naïve tumors provide limited clinical benefit, since recurrent metastatic MBs are highly genetically divergent from their primary tumors. By adapting the existing COG (Children's Oncology Group) protocol for children with newly diagnosed high-risk MB to the treatment of immuno-deficient mice intracranially engrafted with human MB brain tumor initiating cells (BTICs), we have characterized the rare treatment-refractory cell population in Group 3 MBs. MB cell populations recovered separately from brains and spines during the course of tumor development and therapy were comprehensively profiled for gene expression analysis, stem cell and molecular features to generate a global, comparative profile of MB cells through therapy to relapse. One of the most intriguing observations from our gene expression data was consistent over-expression in the treatment-refractory cell population of proteins belonging to the Inhibitor of DNA-binding/differentiation (ID) family (transcription factors with a basic helix-loop-helix motif that act as suppressors cellular differentiation), and a longevity-associated protein known as bactericidal/permeability-increasing fold-containing-family-B-member-4 (BPIFB4). This persistent upregulation of genes preserving undifferentiated state and cellular longevity further strengthens the hypothesis of stem-cell like cells driving tumor relapse in MB. Targeting ID1 and BPIFB4 using both knockdown (KD) and knockout (KO) strategies has resulted in decreased self-renewal and tumorigenicity of both primary and recurrent MB cells, further highlighting their potential as novel therapeutic targets in MB. Our differential genomic and gene expression profiles of the “treatment-responsive” tumors against those that fail therapy have successfully contributed to discovery and characterization of novel therapeutic targets for the most aggressive subgroup of MB.
Citation Format: Sheila Kumari Singh, David Bakhshinyan, Chitra Venugopal, Ashley Adile, Mohini Singh, Maleeha Qazi, Branavan Manoranjan, Michelle Kameda-Smith. Genes preserving stem cell state in group 3 medulloblastoma brain tumor initiating cells contribute to therapy evasion and relapse [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1140.
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21
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Singh SK, Manoranjan B, Dvorkin-Gheva A, Venugopal C, Moreira S, Kameda-Smith M, Subapanditha M, Adile A, Bakhshinyan D, Savage N, Yarascavitch B, Ajani O, Fleming A, Doble B. Abstract 148: Canonical Wnt activation as a therapeutic strategy in pediatric medulloblastoma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Brain tumors represent the leading cause of childhood cancer mortality, of which medulloblastoma (MB) is the most frequent malignant pediatric brain tumor. Current molecular subgroups of MB recognize distinct disease entities of which activated Wnt signaling (monosomy 6, exon 3 mutations in CTNNB1, and Wnt gene signature) is associated with a distinct subgroup and the best overall outcome. In contrast, only non-Wnt MBs are characterized by metastatic disease, increased rate of recurrence, and poor overall survivorship. Given the excellent clinical outcome in patients with Wnt-driven MB, we aimed to convert treatment-resistant MB subgroups into an ostensibly benign tumor through selective activation of the canonical Wnt pathway. Initial characterization of patient-derived Wnt and non-Wnt MB lines demonstrated a significant reduction in in vitro self-renewal and proliferative capacity of Wnt MBs. This was further validated by RNA-seq, which identified a marked reduction in the expression of stem cell self-renewal genes Bmi1 and Sox2 in Wnt MBs compared to non-Wnt MBs. Further, Wnt MB-derived xenografts maintained a significant increase in overall survival compared to non-Wnt MB xengrafts, further highlighting the protective nature of activated Wnt signaling in MB. Activated Wnt signaling by way of small molecule Wnt agonists in treatment-refractory MBs resulted in decreased in vitro self-renewal and expression of self-renewal genes, Bmi1 and Sox2. In order to validate the therapy-sensitive nature of Wnt-activated cells, we developed stable patient-derived lines containing a 7XTOPFlash reporter for endogenous Wnt signaling. Rare subclonal Wnt-active cells demonstrated a reduced self-renewal and tumor-initiating capacity through in vivo limiting dilution assays when compared to bulk Wnt-inactive cells. The therapeutic relevance of these findings were demonstrated with an in vivo survival advantage in those mice with orthotopic injections of cells with endogenous Wnt activity when compared to xenografts generated from Wnt-inactive cells. To develop a rationale clinical therapeutic, we used a novel substrate-competitive peptide inhibitor for GSK. Treatment with our peptide inhibitor showed a significant reduction in tumor burden with a corresponding increase in survival of patient-derived tumors that were otherwise treatment-resistant. The clinical utility of our findings is further supported by our analysis of integrated genomics data from 763 primary MBs, in which a validated Wnt gene signature was found to predict improved survivorship among children with poor-outcome and metastatic MBs. Our work establishes activated Wnt signaling as a novel treatment paradigm in childhood MB, identifies a rationale therapeutic approach for recurrent MB, and provides evidence for the context-specific tumor suppressive function of the canonical Wnt pathway.
Citation Format: Sheila Kumari Singh, Branavan Manoranjan, Anna Dvorkin-Gheva, Chitra Venugopal, Steven Moreira, Michelle Kameda-Smith, Minomi Subapanditha, Ashley Adile, David Bakhshinyan, Neil Savage, Blake Yarascavitch, Olufemi Ajani, Adam Fleming, Bradley Doble. Canonical Wnt activation as a therapeutic strategy in pediatric medulloblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 148.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Neil Savage
- McMaster University, Hamilton, Ontario, Canada
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22
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Kameda-Smith M, Venugopal C, Bakhshinyan D, Manoranjan B, Adile A, Subapanditha M, Fleming A, Hope K, Singh S. MBRS-24. INVESTIGATING THE ROLE OF THE RNA BINDING PROTEIN, MUSASHI 1 IN PEDIATRIC GROUP 3 MEDULLOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michelle Kameda-Smith
- McMaster University Stem Cell and Cancer Research Institute, Hamilton, ON, Canada
- McMaster University Division of Neurosurgery, Hamilton, ON, Canada
| | - Chitra Venugopal
- McMaster University Stem Cell and Cancer Research Institute, Hamilton, ON, Canada
| | - David Bakhshinyan
- McMaster University Stem Cell and Cancer Research Institute, Hamilton, ON, Canada
| | - Branavan Manoranjan
- McMaster University Stem Cell and Cancer Research Institute, Hamilton, ON, Canada
| | - Ashley Adile
- McMaster University Stem Cell and Cancer Research Institute, Hamilton, ON, Canada
| | - Minomi Subapanditha
- McMaster University Stem Cell and Cancer Research Institute, Hamilton, ON, Canada
| | - Adam Fleming
- McMaster University Stem Cell and Cancer Research Institute, Hamilton, ON, Canada
- McMaster University Department of Pediatrics, Hamilton, ON, Canada
| | - Kristen Hope
- McMaster University Stem Cell and Cancer Research Institute, Hamilton, ON, Canada
| | - Sheila Singh
- McMaster University Stem Cell and Cancer Research Institute, Hamilton, ON, Canada
- McMaster University Division of Neurosurgery, Hamilton, ON, Canada
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Kameda-Smith M, Wang A, Abdulhadi N, Adile A, Ajani O, Yarascavitch B, Farrokhyar F, Tina P, Samaan C, Alyman C, Singh S, Fleming A. MBCL-09. SALVAGE THERAPY FOR CHILDHOOD MEDULLOBLASTOMA: A SINGLE CENTER EXPERIENCE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Alick Wang
- McMaster University, Hamilton, ON, Canada
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Kameda-Smith M, Manoranjan B, Ajani O, Yarascavitch B, Petrelli T, Singh S, Fleming A. EPID-17. A SINGLE CENTER RESTROSPECTIVE REVIEW OF RECURRENT OR TREATMENT REFRACTORY PEDIATRIC MEDULLOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.294] [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
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25
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Bakhshinyan D, Adile A, Venugopal C, Singh M, Qazi M, Manoranjan B, Kameda-Smith M, Singh S. TMOD-03. GENES PRESERVING STEM CELL STATE IN GROUP 3 MB BTICS CONTRIBUTE TO THERAPY EVASION AND RELAPSE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.1042] [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: 11/13/2022] Open
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26
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Manoranjan B, Venugopal C, Kameda-Smith M, Bakhshinyan D, Subapanditha M, Doble B, Singh S. STEM-21. CONTEXT-SPECIFIC TUMOR SUPPRESSIVE FUNCTION OF THE CANONICAL Wnt PATHWAY IN PEDIATRIC MEDULLOBLASTOMA HIGHLIGHTS A THERAPEUTIC STRATEGY FOR TREATMENT-REFRACTORY SUBGROUPS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.936] [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: 11/13/2022] Open
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27
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Manoranjan B, Venugopal C, Pavlovic Z, Bakhshinyan D, Kameda-Smith M, Subapanditha M, Mahendram S, Moffat J, Doble BW, Singh S. Abstract 5831: Activated Wnt signaling for the treatment of recurrent medulloblastoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Brain tumors represent the leading cause of childhood cancer mortality, of which medulloblastoma (MB) is the most frequent malignant pediatric brain tumor. Current molecular subgroups of MB recognize distinct disease entities of which activated Wnt signaling (monosomy 6, exon 3 mutations in CTNNB1, and Wnt gene signature) is associated with a distinct subgroup and the best overall outcome. In contrast, only non-Wnt MBs are characterized by metastatic disease, increased rate of recurrence, and poor overall survivorship. Given the excellent clinical outcome in patients with Wnt-driven MB, we aimed to convert treatment-resistant MB subgroups into an ostensibly benign tumor through selective targeting by small molecules and transgenic patient-derived lines containing a stabilized beta-catenin mutant. Activated Wnt signaling by way of Wnt agonists in treatment-refractory MBs resulted in decreased in vitro self-renewal and promoted differentiation. Comparative gene expression profiling of control and transgenic lines containing a stabilized beta-catenin mutant demonstrated a reduction in stem cell self-renewal genes following beta-catenin overexpression, including Sox2 and Bmi1. In order to validate the therapy-sensitive nature of Wnt-activated cells, we developed stable patient-derived lines containing a 7XTOPFlash reporter for endogenous Wnt signaling. Rare subclonal Wnt-active cells demonstrated a reduced self-renewal and tumor-initiating capacity through in vivo limiting dilution assays when compared to bulk Wnt-inactive cells. The therapeutic relevance of these findings were demonstrated with an in vivo survival advantage in mice with orthotopic injections of cells containing a stabilized beta-catenin mutant representative of constitutively active Wnt signaling or endogenous Wnt-active cells. Xenografts generated from Wnt-activated tumors were smaller in size, maintained a lower rate of proliferation, and reduction in MB self-renewal genes. To further illustrate the clinical utility of activated Wnt signaling, we modified the Children’s Oncology Group therapy protocol for childhood MB so that xenografts may receive chemo/radiotherapy. Tumors generated from Wnt-active xenografts were much more radiosensitive and displayed a significant reduction in spinal metastasis when compared to mice receiving standard therapy without Wnt activation. To develop a rationale clinical therapeutic, we developed unique agonist antibodies that target the Wnt co-receptor LRP5. Treatment with LRP5 antibodies showed a significant reduction in tumor burden and increase in survival of patient-derived tumors that were otherwise treatment-resistant. Our work establishes for the first time activated Wnt signaling as a novel treatment paradigm in childhood MB, identifies a rationale therapeutic approach for recurrent MB, and provides evidence for the context-specific tumor suppressive function of the canonical Wnt pathway.
Note: This abstract was not presented at the meeting.
Citation Format: Branavan Manoranjan, Chitra Venugopal, Zvezdan Pavlovic, David Bakhshinyan, Michelle Kameda-Smith, Minomi Subapanditha, Sujeivan Mahendram, Jason Moffat, Bradley W. Doble, Sheila Singh. Activated Wnt signaling for the treatment of recurrent medulloblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5831. doi:10.1158/1538-7445.AM2017-5831
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Affiliation(s)
- Branavan Manoranjan
- 1McMaster Stem Cell and Cancer Research Institute, Hamilton, Ontario, Canada
| | - Chitra Venugopal
- 1McMaster Stem Cell and Cancer Research Institute, Hamilton, Ontario, Canada
| | | | - David Bakhshinyan
- 1McMaster Stem Cell and Cancer Research Institute, Hamilton, Ontario, Canada
| | | | - Minomi Subapanditha
- 1McMaster Stem Cell and Cancer Research Institute, Hamilton, Ontario, Canada
| | - Sujeivan Mahendram
- 1McMaster Stem Cell and Cancer Research Institute, Hamilton, Ontario, Canada
| | | | - Bradley W. Doble
- 1McMaster Stem Cell and Cancer Research Institute, Hamilton, Ontario, Canada
| | - Sheila Singh
- 1McMaster Stem Cell and Cancer Research Institute, Hamilton, Ontario, Canada
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Kameda-Smith M, Venugopal C. MEDU-28. INVESTIGATING THE ROLE OF THE RNA BINDING PROTEIN, MUSASHI, IN GROUP 3 MEDULLOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.178] [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: 11/13/2022] Open
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Manoranjan B, Venugopal C, Kameda-Smith M, Bakhshinyan D, Subapanditha M, Doble B, Singh S. TRTH-29. CONTEXT-SPECIFIC TUMOR SUPPRESSIVE FUNCTION OF THE CANONICAL WNT PATHWAY IN PEDIATRIC MEDULLOBLASTOMA HIGHLIGHTS A THERAPEUTIC STRATEGY FOR TREATMENT-REFRACTORY SUBGROUPS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.239] [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: 11/13/2022] Open
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Abstract
We describe an atypical teratoid rhabdoid tumor (AT/RT) with a component of low-grade and anaplastic rhabdoid meningioma in a 7-year-old child. The AT/RT was uniformly negative for INI1 and displayed immunoreactivity for vimentin, P53, CD99, cytokeratins with AE1/AE3 antibodies, epithelial membrane antigen, β-catenin, smooth muscle actin, E-cadherin, and S-100 protein. AT/RT was continuous, with small foci of recognizable low-grade and anaplastic meningioma. The low-grade meningioma was INI1 positive with scattered INI1-negative nuclei, whereas the remaining tumor components were INI1 negative. A recurrent tumor 6 months after partial resection contained only INI1-negative AT/RT. This case supports the hypothesis that rare examples of AT/RT may emerge from a preexisting “parent” neoplasm as a result of a second hit mutation.
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Affiliation(s)
- Boleslaw Lach
- Hamilton Health Sciences, Hamilton General Site, Hamilton, ON, Canada
| | | | - Sheila Singh
- McMaster Children’s Hospital, Hamilton, ON, Canada
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Manoranjan B, Mahendram S, Bakhshinyan D, Kameda-Smith M, Venugopal C, Doble B, Singh S. MB-22ACTIVATED Wnt SIGNALING FOR THE THERAPEUTIC TARGETING OF TREATMENT-REFRACTORY MEDULLOBLASTOMA STEM CELLS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now076.20] [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
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