Neurosurgery Commons^™

Tert Promotor Status Does Not Add Prognostic Information In Idh-Wildtype Glioblastomas Fulfilling Other Diagnostic Who Criteria: A Report Of The Rano Resect Group, Antonio Dono, Ali M Moosvi, Puneetha S Goli, Allison C Bellman, Phyu P Aung, Yoshua Esquenazi, Leomar Y Ballester

Faculty, Staff and Student Publications

Genomic alterations are critical for the diagnosis, prognostication, and treatment of patients with infiltrating gliomas. Telomerase reverse transcriptase promoter ( TERT p) mutations are among such crucial alterations. Although DNA sequencing is the preferred method for identifying TERT p mutations, it has limitations related to cost and accessibility. We tested telomerase reverse transcriptase (TERT) immunohistochemistry (IHC) as a surrogate for TERT p mutations in infiltrating gliomas. Thirty-one infiltrating gliomas were assessed by IHC using an anti-TERT Y182 antibody. IHC results were analyzed by a board-certified neuropathologist. Tumors were analyzed by targeted next-generation sequencing. A literature review of the use of …

Combining Physics-Based Models With Deep Learning Image Synthesis And Uncertainty In Intraoperative Cone-Beam Ct Of The Brain, Xiaoxuan Zhang, Alejandro Sisniega, Wojciech B Zbijewski, Junghoon Lee, Craig K Jones, Pengwei Wu, Runze Han, Ali Uneri, Prasad Vagdargi, Patrick A Helm, Mark Luciano, William S Anderson, Jeffrey H Siewerdsen

Faculty, Staff and Student Publications

BACKGROUND: Image-guided neurosurgery requires high localization and registration accuracy to enable effective treatment and avoid complications. However, accurate neuronavigation based on preoperative magnetic resonance (MR) or computed tomography (CT) images is challenged by brain deformation occurring during the surgical intervention.

PURPOSE: To facilitate intraoperative visualization of brain tissues and deformable registration with preoperative images, a 3D deep learning (DL) reconstruction framework (termed DL-Recon) was proposed for improved intraoperative cone-beam CT (CBCT) image quality.

METHODS: The DL-Recon framework combines physics-based models with deep learning CT synthesis and leverages uncertainty information to promote robustness to unseen features. A 3D generative adversarial network …

Tips And Tricks For Laparoscopic Cholecystectomy In The Patient With Ventriculoperitoneal Shunt; A Case Report, Carmen Popa, Andrei Moisin, Mihai Faur, Mihaela Racheriu, Ramona Coca, Cristian Mihai Branescu, Tiberiu Trotea, Denisa Tănăsescu

Journal of Mind and Medical Sciences

Laparoscopic surgery in patients with ventriculo-peritoneal shunt is challenging in terms of technical approach. The severity of possible complications and the lack of studies on this association increase the surgeon's discomfort with such surgery. The main complications that may occur are increased intracranial pressure, secondary pneumo-peritoneum pneumocephalus, encephalitis and the risk of catheter injury during laparoscopic procedures. We present the case of a 56-year-old patient operated in 2004 for a basilar artery top aneurysm with subarachnoid hemorrhage and secondary hydrocephalus, for which a ventriculo-peritoneal shunt was fitted. This patient presented in our clinic with diffuse abdominal pain, more accentuated in …

Tumor Suppressor Candidate 2 (Tusc2): Discovery, Functions, And Cancer Therapy, Austin Arrigo, Angelina T Regua, Mariana K Najjar, Hui-Wen Lo

Faculty, Staff and Student Publications

Tumor Suppressor Candidate 2 (TUSC2) was first discovered as a potential tumor suppressor gene residing in the frequently deleted 3p21.3 chromosomal region. Since its discovery, TUSC2 has been found to play vital roles in normal immune function, and TUSC2 loss is associated with the development of autoimmune diseases as well as impaired responses within the innate immune system. TUSC2 also plays a vital role in regulating normal cellular mitochondrial calcium movement and homeostasis. Moreover, TUSC2 serves as an important factor in premature aging. In addition to TUSC2's normal cellular functions, TUSC2 has been studied as a tumor suppressor gene that …

Spatiotemporally Distributed Frontotemporal Networks For Sentence Reading, Oscar Woolnough, Cristian Donos, Elliot Murphy, Patrick S Rollo, Zachary J Roccaforte, Stanislas Dehaene, Nitin Tandon

Faculty, Staff and Student Publications

Reading a sentence entails integrating the meanings of individual words to infer more complex, higher-order meaning. This highly rapid and complex human behavior is known to engage the inferior frontal gyrus (IFG) and middle temporal gyrus (MTG) in the language-dominant hemisphere, yet whether there are distinct contributions of these regions to sentence reading is still unclear. To probe these neural spatiotemporal dynamics, we used direct intracranial recordings to measure neural activity while reading sentences, meaning-deficient Jabberwocky sentences, and lists of words or pseudowords. We isolated two functionally and spatiotemporally distinct frontotemporal networks, each sensitive to distinct aspects of word and …

Neurofibroma Of The Internal Carotid Artery Cavernous Sympathetic Plexus: Illustrative Case, Duncan J Trimble, Bryden H Dawes, Hussein A Zeineddine, Katie B Guttenberg, William C Yao, Meenakshi Bhattacharjee, Spiros L Blackburn

Faculty, Staff and Student Publications

BACKGROUND: Intracranial carotid sympathetic plexus (CSP) nerve sheath tumors have rarely been reported in the literature. This study describes the first reported case of a CSP neurofibroma and the first case of a CSP nerve sheath tumor treated via an endoscopic endonasal approach followed by adjuvant radiosurgery.

OBSERVATIONS: A 53-year-old man presented with 3 days of headaches and diplopia and was found to have a complete left abducens nerve palsy. Computed tomography (CT) revealed a smoothly dilated left carotid canal, CT angiography revealed a superiorly displaced left internal carotid artery (ICA), and magnetic resonance imaging revealed a T2-hyperintense and avidly …

Characterization Of Recurrence Patterns And Outcomes Of Medulloblastoma In Adults: The University Of Texas Md Anderson Cancer Center Experience, Timothy A Gregory, Maximilian Mastall, Heather Lin, Kenneth R Hess, Ying Yuan, Manuela Martin-Bejarano Garcia, Gregory N Fuller, Kristin D Alfaro, Maria K Gule-Monroe, Jason T Huse, Soumen Khatua, Ganesh Rao, David I Sandberg, Jeffrey S Wefel, Debra N Yeboa, Arnold C Paulino, Susan L Mcgovern, Wafik Zaky, Anita Mahajan, Dima Suki, Shiao-Pei Weathers, Rebecca A Harrison, John F De Groot, Vinay K Puduvalli, Marta Penas-Prado, Nazanin K Majd

Faculty, Staff and Student Publications

BACKGROUND: Medulloblastoma in adults is rare and treatment decisions are largely driven from pediatric literature. We sought to characterize recurrent medulloblastoma in adults.

METHODS: From a single-institution dataset of 200 adult patients diagnosed with medulloblastoma during 1978-2017, those with recurrence were analyzed for clinical features, treatment, and outcome.

RESULTS: Of the 200 patients, 82 (41%) with median age of 29 years (18-59) had recurrence after a median follow-up time of 8.4 years (95% CI = 7.1, 10.3). Of these, 30 (37%) were standard-risk, 31 (38%) were high-risk, and 21 (26%) had unknown-risk diseases at the time of initial diagnosis. Forty-eight …

Acute Traumatic Dural Arteriovenous Fistula Of The Superior Sagittal Sinus: Illustrative Case, Mitchell L Pryce, K H Carlos Chung, Hussein A Zeineddine, Bryden H Dawes

Faculty, Staff and Student Publications

Background: Dural arteriovenous fistulas (dAVFs) are aberrant vascular communications between meningeal arteries and venous sinuses or cortical veins. dAVF pathogenesis is incompletely understood; however, formation likely occurs as a result of angioneogensis.

Observations: A 78-year-old man presented after trauma with basal and cortical subarachnoid hemorrhage (SAH). Computed tomography revealed a parietal bone fracture overlying the superior sagittal sinus (SSS). Catheter angiography performed within 24 hours of the injury demonstrated an SSS dAVF supplied by the middle meningeal artery, adjacent to the fracture.

Lessons: The authors present the case of an acute traumatic dAVF adjacent to a calvarial fracture. In this …

Regeneration Of Neurons In Human Brain Tissue; A Revolutionary Concept With Therapeutic Potential, Mackenzie R. Dunn

Biomedical Sciences Undergraduate Research

There is current research to suggest that endogenous neuronal regeneration, exogenous neuronal stem cell transplantation and glial cell reprogramming could be prospective therapeutic treatments for neurodegeneration and traumatic injury. With these conditions, there is significant brain atrophy, loss of neurons and loss of synaptic connections which can have devastating effects on executive functioning, cognition, learning and memory. This review will examine these modern approaches to adult neurogenesis, and assess the viable mechanisms and future outlook of these three therapies for neurological regenerative medicine.

The Brief Case: A New Feature In Journal Of Clinical Microbiology, Makayla M Bavis, Allison M Nicholas, Alexandria J Tobin, Sherri L Christian, Robert J Brown

Faculty, Staff and Student Publications

The energy demand of breast cancers is in part met through the β-oxidation of exogenous fatty acids. Fatty acids may also be used to aid in cell signaling and toward the construction of new membranes for rapidly proliferating tumor cells. A significant quantity of fatty acids comes from the hydrolysis of lipoprotein triacylglycerols and phospholipids by lipoprotein lipase (LPL). The lipid obtained via LPL in the breast tumor microenvironment may thus promote breast tumor growth and development. In this hypothesis article, we introduce LPL, provide a meta-analysis of RNAseq data showing that LPL is associated with poor prognosis, and explain …

Characterization Of Cerebral Hemodynamics With Tcd In Patients Undergoing Va-Ecmo And Vv-Ecmo: A Prospective Observational Study, Giorgio Caturegli, Lucy Q Zhang, Yunis Mayasi, Aaron M Gusdon, Bahattin Ergin, Vladimir Ponomarev, Bo Soo Kim, Steven Keller, Romergryko G Geocadin, Glenn J R Whitman, Sung-Min Cho, Wendy Ziai, Erald (Hopkins Exploration, Research, And Advancement In Life Support Devices) Investigators

Faculty, Staff and Student Publications

BACKGROUND: Extracorporeal membrane oxygenation has a high risk of acute brain injury and resultant mortality. Transcranial Doppler characterizes cerebral hemodynamics in real time, but limited data exist on its interpretation in ECMO. Here, we report TCD mean flow velocity and pulsatility index in a large ECMO population.

METHODS: This was a prospective cohort study at a tertiary care center. The patients were adults on venoarterial ECMO or venovenous ECMO undergoing TCD studies.

RESULTS: A total of 135 patients underwent a total of 237 TCD studies while on VA-ECMO (n = 95, 70.3%) or VV-ECMO (n = 40, 29.6%). MFVs were …

Phage Peptide Technology To Characterize Extracellular Vesicles In The Brain Tumors, Jadelynn Rudolf

Undergraduate Research Conference

Extracellular vesicles (EV) are lipid-bound containers derived from the endosomal membrane network or from the extracellular membrane of cells. They can carry proteins, lipids, miRNAs, and other molecules, and may be involved in intercellular communication via membrane-associated proteins. Glioblastomas (GBM) are aggressive cancers of the brain and spinal cord derived from astrocytes. Extracellular vesicles derived from glioblastomas can make their way through the blood brain barrier and find their way to different bodily fluids, and so could serve as biomarkers for this cancer. We have isolated phage-display peptides from a commercial library of random phage-displayed peptides that will bind glioblastoma …

Tailoring Of Neurosurgical Practice During Covid-19 In A Developing Country: Insights Gained And A Way Forward, Mustafa Mushtaq Husaain, Syeda Alisha Ali Zaida, Mujtaba Khalil, Muhammad Waqas Saeed Baqai, Altaf Ali Laghari, Muhammad Ehsan Bari

Section of Neurosurgery

Background: The coronavirus disease-19 pandemic has aggravated the already neglected neurosurgical specialty in developing countries with a mounting shortage of specialists, long queues of operative patients, and a lack of adequate critical care units.
Methods: We have reviewed the innovative strategies adopted for maintaining an optimal surgical practice while ensuring team safety at the Aga Khan University Hospital, Karachi Pakistan.
Results: There is already a scarcity of resources in developing countries. The international guidelines had to be tailored to the context of the developing world. A multimodal strategy that focused on infection control, continuum of care, and the well-being of …

Group-Based Four-Dimensional Brain Mapping Of Executive Control, Matthew T. Brennan, Kazuki Sakakura Md, Masaki Sonoda Md, Phd, Aimee Luat Md, Neena Marupudi, Sandeep Sood Md, Eishi Asano Md, Phd

Medical Student Research Symposium

Rationale: Humans utilize executive control processes to carry out non-automatic tasks. These tasks require coordination from higher brain centers to both suppress inappropriate behaviors and initiate correct responses. The goal of this study is to generate a novel, dynamic brain atlas to visualize and understand the network dynamics underlying executive control.

Methods: We studied 547 non-epileptic intracranial electrode sites sampled from seven patients with focal epilepsy. Each patient performed two types of verbal tasks: word-reading and Stroop color-naming. Mixed model analysis compared high-gamma cortical activation prior to response onset between the word-reading and Stroop color-naming tasks. Based on mixed model …

Intravital Imaging Of Cellular Response Due To Traumatic Brain Injury Using Confocal Microscopy, Enoch G. Kim, Jeffrey Horbatiuk, Carolyn Harris

Medical Student Research Symposium

Introduction: Cellular reaction to traumatic brain injury is complex and involves considerable interactions between cells and reactivity to foreign bodies. Our objective was to assess neurons, microglia, astrocytes, and intracellular Ca²⁺ signaling by creating a novel confocal microscopy technique involving an air immersed lens that does not sacrifice resolution and limits signal attenuation. This study aimed to create a consistent dynamic methodology to observe the cortical cellular response using real-time intravital imaging as trauma is being induced.

Methods: Once surgical plane was achieved, rodent cortices were exposed via craniotomy and blunt insertion with a silicone shunt catheter into the …

Risk Factors Of Not Reaching Mcid After Elective Lumbar Spine Surgery: A Case Control Study, Travis Hamilton Md, Scott Lim Md, Edwin Telemi Md, Ho Jun Yun Mms, Mohamed Macki Md, Lonni Schultz Phd, Hsueh-Han Yeh Phd, Kylie Springer Ms, Kevin Taliafero Md, Miguelangelo Perez-Cruet Md, Ilyas Aleem Md, Paul Park Md, Richard Easton Md, David Nerenz Phd, Jason Schwalb Md, Muwaffak Abdulhak Md, Victor Chang Md

Medical Student Research Symposium

Background

The therapeutic effect of spine surgery has been traditionally evaluated by physical examination, radiographic findings, and general perception of patient’s health status. However, these assessments are often insufficient to represent surgical outcomes.Patient-reported outcomes (PROs) are tools developed to measures quality outcomes following spinal surgery. Examples include the Patient-Reported Outcomes Measurement Information System Function 4-item Short Form (PROMIS-PF), Visual Analogue Scale (VAS), ODI (Oswestry Disability Index), SF-36 (Short Form Health Survey), and EQ-5D (EuroQuol-5D). The minimum clinically important difference (MCID) is an assessment tool to note the smallest clinical difference in PROs and provides the threshold where patients experience clinical …

Staged Laser Interstitial Thermal Therapy For The Surgical Treatment Of Insular Glioma: A Case Series, Bhargav Ayloo, Ian Y. Lee Md, Hassan Fadel Md, Adam Robin Md, Kelly Shaftel Md, Jacob Pawloski Md, Sameah Haider Md

Medical Student Research Symposium

Staged Laser Interstitial Thermal Therapy for the Surgical Treatment of Insular Glioma: a Case Series

Introduction

Insular gliomas pose one of the most significant challenges in neurosurgical oncology due to the complexity of the surrounding functional and microvascular anatomy. Despite current surgical and technological advancements, resection of insular gliomas can lead to potentially severe neurological morbidities. Laser Interstitial Thermal Therapy (LITT), either alone or combined with surgery, presents a less invasive cytoreductive approach for treating insular gliomas.

Objective

In this work we describe the first-ever reported series of patients with insular gliomas treated with staged LITT operations with or without …

Rhodium‐Catalyzed Asymmetric Arylation Of Cyclobutenone Ketals, David Egea-Arrebola, F Wieland Goetzke, Stephen P Fletcher

Faculty, Staff and Student Publications

Complex cyclobutanes are important motifs in both bioactive molecules and natural products, yet their enantioselective preparation has not been widely explored. In this work, we describe rhodium-catalyzed enantioselective additions of aryl and vinyl boronic acids to cyclobutenone ketals. This transformation involves enantioselective carbometalation to give cyclobutyl-rhodium intermediates, followed by β-oxygen elimination to afford enantioenriched enol ethers. Overall, this addition serves as a surrogate for Rh-catalyzed 1,4-additions to cyclobutenone.

Pragmatic, Prospective Comparative Effectiveness Trial Of Carbon Ion Therapy, Surgery, And Proton Therapy For The Management Of Pelvic Sarcomas (Soft Tissue/Bone) Involving The Bone: The Prosper Study Rationale And Design, Bradford S Hoppe, Ivy A Petersen, Benjamin K Wilke, Todd A Dewees, Reiko Imai, Eugen B Hug, Maria Rosaria Fiore, Jürgen Debus, Piero Fossati, Shigeru Yamada, Ester Orlandi, Qing Zhang, Cihang Bao, Katharina Seidensaal, Byron C May, Anna C Harrell, Matthew T Houdek, Laura A Vallow, Peter S Rose, Michael G Haddock, Jonathan B Ashman, Krista A Goulding, Steven Attia, Sunil Krishnan, Anita Mahajan, Robert L Foote, Nadia N Laack, Sameer R Keole, Chris J Beltran, Eric M Welch, Mohammed Karim, Safia K Ahmed

Faculty, Staff and Student Publications

Surgical treatment of pelvic sarcoma involving the bone is the standard of care but is associated with several sequelae and reduced functional quality of life (QOL). Treatment with photon and proton radiotherapy is associated with relapse. Carbon ion radiotherapy (CIRT) may reduce both relapse rates and treatment sequelae. The PROSPER study is a tricontinental, nonrandomized, prospective, three-arm, pragmatic trial evaluating treatments of pelvic sarcoma involving the bone. Patients aged at least 15 years are eligible for inclusion. Participants must have an Eastern Cooperative Oncology Group Performance Status score of two or less, newly diagnosed disease, and histopathologic confirmation of pelvic …

A Look At The Global Impact Of Covid-19 Pandemic On Neurosurgical Services And Residency Training, Cathleen C Kuo, Alexander O Aguirre, Andrea Kassay, Brianna M Donnelly, Hebatalla Bakr, Mohamed Aly, Ahmed A M Ezzat, Mohamed A R Soliman

Faculty, Staff and Student Publications

BACKGROUND: The COVID-19 pandemic has left an indelible effect on healthcare delivery and education system, including residency training. Particularly, neurosurgical departments worldwide had to adapt their operating model to the constantly changing pandemic landscape. This review aimed to quantify the reduction in neurosurgical operative volume and describe the impact of these trends on neurosurgical residency training.

METHODS: We performed a comprehensive search of PubMed and EMBASE between December 2019 and October 2022 to identify studies comparing pre-pandemic and pandemic neurosurgical caseloads as well as articles detailing the impact of COVID-19 on neurosurgery residency training. Statistical analysis of quantitative data was …