Neurosurgery Commons^™

Prognostic Implications Of Histological Clear Cells In High-Grade Intracranial Ependymal Tumors: A Retrospective Analysis From A Tertiary Care Hospital In Pakistan, Fauzan Alam Hashmi, Hamid Hussain Rai, Muhammad Faheem Khan, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Clear cell variant in ependymal tumors is rare. We aimed to compare the features and outcome of the World Health Organization (WHO) Grade 3 ependymal tumors with clear cells to the WHO Grade 3 classic anaplastic ependymoma (AE).
Materials and methods: A retrospective cohort study conducted at the Department of Neurosurgery, Aga Khan University, Pakistan, from 2003 to 2013. The medical records and radiology of patients with proven histopathology were reviewed. The analysis was done on SPSS 20.
Results: Nine cases of clear cell variant and 23 cases of classic AE were found, both of which combined equated to …

Depression In Adult Patients With Primary Brain Tumours: A Review Of Independent Risk Factors, Anum Sadruddin Pidani, Aaida Mumtaz Rao, Muhammad Shahzad Shamim

Section of Neurosurgery

Depression is considered an under-diagnosed problem, especially in patients with malignancies. Patients with brain tumours in particular, have a relatively higher risk of developing depression, which is multifactorial. Herein, the authors review the recent literature on the prevalence of depression in patients with brain tumours, and explore the various risk factors involved.

Use Of Preoperative Apparent Diffusion Coefficients To Predict Brain Tumor Grade, Aneela Darbar, Muhammad Waqas, Syed Faaiz Enam, Shaikh D. Mahmood

Section of Neurosurgery

Introduction: The apparent diffusion coefficient (ADC) sequence is based on the diffusion properties of water molecules within tissues and correlates with tissue cellularity. ADC may have a role in predicting tumor grade for gliomas, and may in turn assist in identifying tumor biopsy sites. The purpose of this investigation was to assess the competence of preoperative ADC values in predicting tumor grades.
Methods: This was a retrospective investigation. We calculated the ADC values in the areas of greatest restriction in solid tumor components, and we recorded the pattern of contrast enhancement. Pathology reports masked to the imaging results were reviewed …

Robotics In Neurosurgery: A Literature Review, Syed Ijlal Ahmed, Gohar Javed, Bakhtawar Mubeen, Syeda Beenish Bareeqa, Hiba Rasheed, Alizay Rehman, Masroor Mubeen Phulpoto, Syeda Sana Samar, Kashif Aziz

Section of Neurosurgery

Robotic surgery has been the forte of minimally invasive stereo-tactic procedures for some decades now. Ongoing advancements and evolutionary developments require substantial evidence to build the consensus about its efficacy in the field of neurosurgery. Main obstacle in obtaining successful results in neurosurgery is fine neural structures and other anatomical limitations. Currently, human rationalisation and robotic precision works in symbiosis to provide improved results. We reviewed the current data about recent interventions. Robots are capable of providing virtual data, superior spatial resolution and geometric accuracy, superior dexterity, faster manoeuvring and non-fatigability with steady motion. Robotic surgery also allows simulation of …

High-Intensity Focused Ultrasound: Past, Present, And Future In Neurosurgery, Syed A. Quadri,, Muhammad Waqas, Inamullah Khan, Muhammad Adnan Khan, Sajid S. Suriya, Mudassir Farooqui, Brian Fiani

Section of Neurosurgery

Since Lynn and colleagues first described the use of focused ultrasound (FUS) waves for intracranial ablation in 1942, many strides have been made toward the treatment of several brain pathologies using this novel technology. In the modern era of minimal invasiveness, high-intensity focused ultrasound (HIFU) promises therapeutic utility for multiple neurosurgical applications, including treatment of tumors, stroke, epilepsy, and functional disorders. Although the use of HIFU as a potential therapeutic modality in the brain has been under study for several decades, relatively few neuroscientists, neurologists, or even neurosurgeons are familiar with it. In this extensive review, the authors intend to …

Correction: First Results On Survival From A Large Phase 3 Clinical Trial Of An Autologous Dendritic Cell Vaccine In Newly Diagnosed Glioblastoma [J Transl Med., 16, (2018) (142)] Doi: 10.1186/S12967-018-1507-6, L. M. Liau, K. Ashkan, D. D. Tran, J. L. Campian, J. E. Trusheim, C. S. Cobbs, J. A. Heth, M. Salacz, M. Schulder, M. L. Bosch, +10 Additional Authors

Journal Articles

© 2018 The Author(s). Following publication of the original article [1], the authors reported an error in the spelling of one of the author names. In this Correction the incorrect and correct author names are indicated and the author name has been updated in the original publication. The authors also reported an error in the Methods section of the original article. In this Correction the incorrect and correct versions of the affected sentence are indicated. The original article has not been updated with regards to the error in the Methods section.

Prognostic Value Of 1p/19q Chromosomal Codeletion In Patients With Oligodendroglioma, Altaf Ali Laghari, Muhammad Usman Khalid, Namra Qadeer, Muhammad Shahzad Shamim

Section of Neurosurgery

Oligodendrogliomas are common intra-axial primary brain tumours, and carry special significance due to several key features, which when present provide better prognosis compared to other intra-axial tumours. One of these features is presence of 1p/19q chromosomal codeletion that seems to not only be a marker of better prognosis but also signifies better response to chemotherapy. Herein the authors review the literature for evidence of the prognostic value of 1p/19q codeletion in OD.

Spatial Distribution Of Road Traffic Crash Fatalities In Karachi: Perspective From 2008-2012, Rashid Jooma, Mir Shabbar Ali, Masood Ali Shaikh

Section of Neurosurgery

Road Traffic Crash (RTC) mortality and morbidity is one of the major public health problems in Karachi. In this study we used geographic information systems (GIS) to visualize and quantify the spatial distribution of RTC mortality and yearly trend from 2008 to 2012, for all 24 administrative subdivisions of Karachi, using Road Traffic Injury Research and Prevention Center's (RTIRPC) data. Cumulatively, 6040 deaths were recorded by RTIRPC, out of which we were able to map 4657 (77.1%) deaths based on location information available in the database. During the 5-year period, highest number of cumulative RTC fatalities were recorded for Kemari, …

Plasma Derived From Human Umbilical Cord Blood: Potential Cell-Additive Or Cell-Substitute Therapeutic For Neurodegenerative Diseases, Jared Ehrhart, Paul R. Sanberg, Svitlana Garbuzova-Davis

Neurosurgery and Brain Repair Faculty Publications

Limited efficacy of current therapeutic approaches for neurodegenerative disease has led to increased interest in alternative therapies. Cord blood plasma (CBP) derived from human umbilical cord blood (hUCB) may be a potential therapeutic. Benefits of CBP injection into rodent models of aging or ischaemic stroke have been demonstrated, though how benefits are elicited is still unclear. The present study evaluated various factors within the same samples of CBP and human adult blood plasma/sera (ABP/S). Also, autologous CBP effects vs. ABP/S or foetal bovine serum supplements on mononuclear cells from hUCB (MNC hUCB) in vitro were determined. Results showed significantly low …

Reduction Of Microhemorrhages In The Spinal Cord Of Symptomatic Als Mice After Intravenous Human Bone Marrow Stem Cell Transplantation Accompanies Repair Of The Blood-Spinal Cord Barrier, David J. Eve, George Steiner, Ajay Mahendrasah, Paul R. Sanberg, Crupa Kurien, Avery Thomson, Cesar V. Borlongan, Svitlana Garbuzova-Davis

Neurosurgery and Brain Repair Faculty Publications

Blood-spinal cord barrier (BSCB) alterations, including capillary rupture, have been demonstrated in animal models of amyotrophic lateral sclerosis (ALS) and ALS patients. To date, treatment to restore BSCB in ALS is underexplored. Here, we evaluated whether intravenous transplantation of human bone marrow CD34⁺ (hBM34⁺) cells into symptomatic ALS mice leads to restoration of capillary integrity in the spinal cord as determined by detection of microhemorrhages. Three different doses of hBM34⁺ cells (5 × 10⁴, 5 × 10⁵ or 1 × 10⁶) or media were intravenously injected into symptomatic G93A SOD1 mice …

Human Umbilical Cord Blood Serum–Derived Α-Secretase: Functional Testing In Alzheimer’S Disease Mouse Models, Ahsan Habib, Huayan Hou, Takashi Mori, Jun Tian, Jin Zeng, Shengnuo Fan, Brian Giunta, Paul R. Sanberg, Darrell Sawmiller, Jun Tan

Neurosurgery and Brain Repair Faculty Publications

Alzheimer’s disease (AD) is an age-related disorder that affects cognition. Our previous studies showed that the neuroprotective fragment of amyloid procurer protein (APP) metabolite, soluble APPα (sAPPα), interferes with β-site APP-cleaving enzyme 1 (BACE1, β-secretase) cleavage and reduces amyloid-β (Aβ) generation. In an attempt to identify approaches to restore sAPPα levels, we found that human cord blood serum (CBS) significantly promotes sAPPα production compared with adult blood serum (ABS) and aged blood serum (AgBS) in Chinese hamster ovary cells stably expressing wild-type human APP. Interestingly, CBS selectively mediated the α-secretase cleavage of human neuron-specific recombinant APP₆₉₅ in a cell-free …

Therapeutic Cocktail Approach For Treatment Of Hyperhomocysteinemia In Alzheimer’S Disease, Michael Leon, Darrell Sawmiller, R. Douglas Shytle, Jun Tan

Neurosurgery and Brain Repair Faculty Publications

In the United States, Alzheimer's disease (AD) is the most common cause of dementia, accompanied by substantial economic and emotional costs. During 2015, more than 15 million family members who provided care to AD patients had an estimated total cost of 221 billion dollars. Recent studies have shown that elevated total plasma levels of homocysteine (tHcy), a condition known as hyperhomocysteinemia (HHcy), is a risk factor for AD. HHcy is associated with cognitive decline, brain atrophy, and dementia; enhances the vulnerability of neurons to oxidative injury; and damages the blood–brain barrier. Many therapeutic supplements containing vitamin B12 and folate have …

Progress And Updates In Stroke Research: Introduction To The Special Issue On Stroke, Yu Luo, John H. Zhang, Paul R. Sanberg, Samantha M. Portis

Neurosurgery and Brain Repair Faculty Publications

As guest editors of this special issue, we are delighted to present 13 articles that discuss advances in stroke research including translational stroke research, stroke research milestones, and proposals for future directions. Stroke is a major cause of disability, and, according to the Centers for Disease Control and Prevention, is the fifth leading cause of death in the US alone. Possible factors contributing to stroke pathogenesis are elucidated and possible treatment modalities are explored in the following special issue of Cell Transplantation.

Human Cord Blood Serum-Derived App Α-Secretase Cleavage Activity Is Mediated By C1 Complement, Ahsan Habib, Darrell Sawmiller, Huayan Hou, Manasa Kanithi, Jun Tian, Jin Zeng, Dan Zi, Zhi-Xu He, Paul R. Sanberg, Jun Tan

Neurosurgery and Brain Repair Faculty Publications

Alzheimer’s Disease (AD) is the leading cause of dementia in the elderly. In healthy individuals, amyloid precursor protein (APP) is cleaved by α-secretase, generating soluble α-amyloid precursor protein (sAPPα), which contributes neuroprotective functions in the neuronal environment. In contrast, in the neurodegenerative environment of AD patients, amyloid-β-peptide (Aβ) of either 40 or 42 residues are generated by increased activity of β- and γ-secretase. These proteins amalgamate in specific regions of the brain, which disrupts neuronal functions and leads to cognitive impairment. Human umbilical cord blood cells (HUCBC) have proven useful as potential immunomodulatory therapies in various models of neurodegenerative diseases, …

Wada Asymmetry In Patients With Drug-Resistant Mesial Temporal Lobe Epilepsy: Implications For Postoperative Neuropsychological Outcomes, Ryan W. Sever, Andrew C. Vivas, Fernando L. Vale, Mike R. Schoenberg

Neurosurgery and Brain Repair Faculty Publications

No abstract provided.

Intra-Arterial Nitroglycerin As Directed Acute Treatment In Experimental Ischemic Stroke, Michael E. Maniskas, Jill M. Roberts, Rebecca Trueman, Annastazia E. Learoyd, Amanda A. Gorman, Justin F. Fraser, Gregory J. Bix

Neuroscience Faculty Publications

BACKGROUND: Nitroglycerin (also known as glyceryl trinitrate (GTN)), a vasodilator best known for treatment of ischemic heart disease, has also been investigated for its potential therapeutic benefit in ischemic stroke. The completed Efficacy of Nitric Oxide in Stroke trial suggested that GTN has therapeutic benefit with acute (within 6 hours) transdermal systemic sustained release therapy.

OBJECTIVE: To examine an alternative use of GTN as an acute therapy for ischemic stroke following successful recanalization.

METHODS: We administered GTN IA following transient middle cerebral artery occlusion in mice. Because no standard dose of GTN is available following emergent large vessel occlusion, we …

Survival Benefit Of Surgery In Recurrent Glioblastoma Multiforme, Usama Khalid Choudry, Saad Akhtar Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

There is an ongoing debate regarding role of surgery for recurrent glioblastoma multiforme (GBM). Older literature hinted at only modest survival benefits with surgery and a high rate of morbidity. However, more recent literature suggests better survival that may be attributed to better surgical techniques and better options in adjuvant treatment. Herein the authors review recent literature with regards to the possible role of surgery in recurrent GBM and also look into the key factors impacting second surgery.

Anaesthetic Management Of Supratentorial Tumor Craniotomy Using Awake-Throughout Approach, Faraz Shafiq, Fahad Salim, Ather Enam, Jai Parkash, Mohammad Faheem

Department of Anaesthesia

The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length …

Reading Between The Joints-Using Spinal Magnetic Resonance Imaging For Evaluation Of Instability, Komal Naeem, S. Ather Enam

Section of Neurosurgery

No abstract provided.

Comparison Between Endoscopic And Microscopic Approaches For Surgery Of Pituitary Tumours, Inamullah Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

Surgical techniques for resection of pituitary tumours have come a long way since it was first introduced in late 18th century. Nowadays, most pituitary surgeries are performed through trans-nasal trans-sphenoidal approach either using a microscope, or an endoscope. Herein the authors review the literature and compare these two instruments with regards to their outcomes when used for resection of pituitary tumours. .