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M Maher Hulou, Marcio S Rassi, Kaith Almefty, Wenya Linda Bi, Ian F Dunn, Timothy R Smith, Ossama Al-Mefty
INTRODUCTION: Skull base chordomas are rare tumors, with less than 5% occurring in patients younger than 20 years of age. Current understanding and a consensus management strategy for pediatric chordomas remain lacking. We investigated the clinical and radiological features of chordomas in young patients, with an emphasis on surgical outcomes and predictors of survival following our management protocol of radical surgical resection with adjuvant high-dose radiotherapy. METHODS: Data from 31 patients, age 22 years or younger, referred to the senior author (OAM) from 1993 to 2008 were reviewed...
August 2016: Neurosurgery
Yasser Jeelani, Abdulkerim Gokoglu, Tomer Anor, Ossama Al-Mefty, Alan R Cohen
OBJECTIVE Conventional approaches to the atrium of the lateral ventricle may be associated with complications related to direct cortical injury or brain retraction. The authors describe a novel approach to the atrium through a retrosigmoid transtentorial transcollateral sulcus corridor. METHODS Bilateral retrosigmoid craniotomies were performed on 4 formalin-fixed, colored latex-injected human cadaver heads (a total of 8 approaches). Microsurgical dissections were performed under 3× to 24× magnification, and endoscopic visualization was provided by 0° and 30° rigid endoscope lens systems...
June 24, 2016: Journal of Neurosurgery
Roberta Rehder, Marcos Perocco Luiz da Costa, Ossama Al-Mefty, Alan R Cohen
OBJECTIVE: Despite recent technological advances, direct approaches to the posterolateral incisural space remain surgical challenges. The choice of the operative route depends on the exact location and extent of the target lesion as well as individual preferences. The extreme lateral infratentorial supracerebellar approach to treat pathologies located in the ambient cistern and posterior incisural space is a technically feasible route in selected cases. In this cadaveric study, we demonstrate the benefits of endoscope-assisted microsurgical maneuvers using the extreme lateral supracerebellar infratentorial approach...
July 2016: World Neurosurgery
Emad Aboud, Ossama Al-Mefty
No abstract text is available yet for this article.
April 2016: Journal of Neurosurgery
Parviz Dolati, Alexandra Golby, Daniel Eichberg, Mohamad Abolfotoh, Ian F Dunn, Srinivasan Mukundan, Mohamed M Hulou, Ossama Al-Mefty
OBJECTIVES: This study was conducted to validate the accuracy of image-based pre-operative segmentation using the gold standard endoscopic and microscopic findings for localization and pre-operative diagnosis of the offensive vessel. PATIENTS AND METHODS: Fourteen TN and 6 HS cases were randomly selected. All patients had 3T MRI, which included thin-sectioned 3D space T2, 3D Time of Flight and MPRAGE Sequences. Imaging sequences were loaded in BrainLab iPlanNet and fused...
December 2015: Clinical Neurology and Neurosurgery
Ayal A Aizer, Malak Abedalthagafi, Wenya Linda Bi, Margaret C Horvath, Nils D Arvold, Ossama Al-Mefty, Eudocia Q Lee, Lakshmi Nayak, Mikael L Rinne, Andrew D Norden, David A Reardon, Patrick Y Wen, Keith L Ligon, Azra H Ligon, Rameen Beroukhim, Ian F Dunn, Sandro Santagata, Brian M Alexander
BACKGROUND: The appropriate use of adjuvant therapy in patients with gross totally resected atypical meningioma requires an accurate assessment of recurrence risk. We sought to determine whether cytogenetic/genetic characterization may facilitate better estimation of the probability of recurrence. METHODS: We first analyzed our clinical database, including high-resolution DNA copy number data, to identify 11 common copy number aberrations in a pilot cohort of meningiomas of all grades...
February 2016: Neuro-oncology
Ayal A Aizer, Wenya Linda Bi, Manjinder S Kandola, Eudocia Q Lee, Lakshmi Nayak, Mikael L Rinne, Andrew D Norden, Rameen Beroukhim, David A Reardon, Patrick Y Wen, Ossama Al-Mefty, Nils D Arvold, Ian F Dunn, Brian M Alexander
BACKGROUND: The prognosis for patients with atypical and malignant meningioma is guarded; whether the extent of resection is associated with survival-based outcomes in this population remains poorly defined. This study investigated the association between gross total resection (GTR) and all-cause mortality in patients with atypical and malignant meningioma. METHODS: The Surveillance, Epidemiology, and End Results program was used to identify 575 and 64 patients betweens the ages of 18 and 70 years who were diagnosed with atypical and malignant meningioma, respectively, between 2004 and 2009...
December 15, 2015: Cancer
Hussam Abou Al-Shaar, Kaith K Almefty, Mohammad Abolfotoh, Nils D Arvold, Phillip M Devlin, David A Reardon, Jay S Loeffler, Ossama Al-Mefty
Recurrent aggressive falcine meningiomas are uncommon tumors that recur despite receiving extensive surgery and radiation therapy (RT). We have utilized brachytherapy as a salvage treatment in two such patients with a unique implantation technique. Both patients had recurrence of WHO Grade II falcine meningiomas despite multiple prior surgical and RT treatments. Radioactive I-125 seeds were made into strands and sutured into a mesh implant, with 1 cm spacing, in a size appropriate to cover the cavity and region of susceptible falcine dura...
September 2015: Journal of Neuro-oncology
Daryoush Tavanaiepour, Sarah Jernigan, Mohamad Abolfotoh, Ossama Al-Mefty
Fibrin glue injection has been used to control intraoperative cavernous sinus (CS) venous bleeding. There have been no reported complications related to this maneuver. We present a case where a patient developed a sensory trigeminal nerve deficit after injection of fibrin glue into the posterior CS during resection of a petrosal meningioma. We believe that this deficit was due to the compression of the trigeminal ganglion similar to balloon compression procedures. Although fibrin glue injection may achieve satisfactory cavernous sinus homeostasis, the volume and rate of injection should be kept in mind to avoid a compressive lesion on traversing cranial nerves and surrounding structures, or retrograde filling of the venous tributaries...
July 2015: Journal of Neurological Surgery Reports
Emad Aboud, Ghaith Aboud, Ossama Al-Mefty, Talal Aboud, Stylianos Rammos, Mohammad Abolfotoh, Sanford P C Hsu, Sebastian Koga, Adam Arthur, Ali Krisht
OBJECT: Intraoperative rupture occurs in approximately 9.2% of all cranial aneurysm surgeries. This event is not merely a surgical complication, it is also a real surgical crisis that requires swift and decisive action. Neurosurgical residents may have little exposure to this event, but they may face it in their practice. Laboratory training would be invaluable for developing competency in addressing this crisis. In this study, the authors present the "live cadaver" model, which allows repetitive training under lifelike conditions for residents and other trainees to practice managing this crisis...
November 2015: Journal of Neurosurgery
Varun R Kshettry, Quinn T Ostrom, Carol Kruchko, Ossama Al-Mefty, Gene H Barnett, Jill S Barnholtz-Sloan
BACKGROUND: Because World Health Organization (WHO) grades II and III meningiomas are relatively uncommon, there is limited literature on the descriptive epidemiology of these tumors, and the existing literature predates the 2000 WHO classification revisions. Our purpose was to provide a modern, population-based study of the descriptive epidemiology of WHO II and III meningiomas in the United States. METHODS: The Central Brain Tumor Registry of the United States (CBTRUS) was queried for intracranial meningiomas categorized by WHO grade for the 2004--2010 study period...
August 2015: Neuro-oncology
David J Cote, Robert Wiemann, Timothy R Smith, Ian F Dunn, Ossama Al-Mefty, Edward R Laws
INTRODUCTION: The transsphenoidal approach was initially developed in neurosurgical practice as an operative approach to the pituitary gland. The introduction of the operating endoscope has improved the versatility of the transsphenoidal approach, broadening the spectrum of lesions that can be treated effectively with this operative strategy. METHODS: We performed a retrospective review of all patients who underwent transnasal, transsphenoidal operations at Brigham and Women's Hospital from April 2008 to February 2015 and categorized each case by pathologic diagnosis...
October 2015: World Neurosurgery
Mohammad Abolfotoh, Wenya Linda Bi, Chang-Ki Hong, Kaith K Almefty, Abraham Boskovitz, Ian F Dunn, Ossama Al-Mefty
OBJECT: The combined microscopic and endoscopic technique has shown significant advantages in the management of various lesions through different approaches. Endoscopic-assisted techniques have frequently been applied to cerebellopontine angle (CPA) surgery in the context of minimally invasive craniotomies. In this paper the authors report on the use of the endoscope in the CPA as a tool to increase the extent of resection, minimize complications, and preserve the function of the delicate CPA structures...
November 2015: Journal of Neurosurgery
Wenya Linda Bi, Patrick A Brown, Mohammad Abolfotoh, Ossama Al-Mefty, Srinivasan Mukundan, Ian F Dunn
OBJECT: The anatomical complexity of skull base tumors mandates detailed preoperative planning for safe resection. In particular, the location of critical vascular and bony structures can influence the surgical approach. Traditional methods, such as MRI, MR angiography and/or venography (MRA/MRV), CT angiography and/or venography (CTA/CTV), and digital subtraction angiography, each have their limitations. One alternative that combines the benefits of both detailed anatomy compatible with intraoperative image guidance and visualization of the vascular flow is the 320-detector row dynamic volume CTA/CTV...
July 2015: Journal of Neurosurgery
Shakti H Ramkissoon, Wenya Linda Bi, Steven E Schumacher, Lori A Ramkissoon, Sam Haidar, David Knoff, Adrian Dubuc, Loreal Brown, Margot Burns, Jane B Cryan, Malak Abedalthagafi, Yun Jee Kang, Nikolaus Schultz, David A Reardon, Eudocia Q Lee, Mikael L Rinne, Andrew D Norden, Lakshmi Nayak, Sandra Ruland, Lisa M Doherty, Debra C LaFrankie, Margaret Horvath, Ayal A Aizer, Andrea Russo, Nils D Arvold, Elizabeth B Claus, Ossama Al-Mefty, Mark D Johnson, Alexandra J Golby, Ian F Dunn, E Antonio Chiocca, Lorenzo Trippa, Sandro Santagata, Rebecca D Folkerth, Philip Kantoff, Barrett J Rollins, Neal I Lindeman, Patrick Y Wen, Azra H Ligon, Rameen Beroukhim, Brian M Alexander, Keith L Ligon
BACKGROUND: Multidimensional genotyping of formalin-fixed paraffin-embedded (FFPE) samples has the potential to improve diagnostics and clinical trials for brain tumors, but prospective use in the clinical setting is not yet routine. We report our experience with implementing a multiplexed copy number and mutation-testing program in a diagnostic laboratory certified by the Clinical Laboratory Improvement Amendments. METHODS: We collected and analyzed clinical testing results from whole-genome array comparative genomic hybridization (OncoCopy) of 420 brain tumors, including 148 glioblastomas...
October 2015: Neuro-oncology
Tomasz Czernicki, Przemysław Kunert, Arkadiusz Nowak, Andrzej Marchel
OBJECTIVE: Presentation of our experience in the treatment of anterior clinoidal meningiomas, including evaluation of factors that may affect early and long-term treatment outcomes. METHODS: Thirty patients were operated with strategy of complete tumor resection using fronto-orbito-zygomatic approach. Outcomes were assessed by Glasgow Outcome Scale at discharge and by Karnofsky Performance Scale at follow-up. RESULTS: There were 6 tumors in group I, 20 in group II, and 4 in group III according to Al-Mefty classification...
2015: Neurologia i Neurochirurgia Polska
Emad Aboud, Mohammad Abolfotoh, Svetlana Pravdenkova, Abdulkerim Gokoglu, Murat Gokden, Ossama Al-Mefty
OBJECT: Epidermoid tumors arise from misplaced squamous epithelium and enlarge through the accumulation of desquamated cell debris. Optimal treatment consists of total removal of the capsule; therefore, giant and multicompartmental tumors are particularly challenging. A conservative attitude in handling the tumor capsule is common given concerns about capsule adherence to neurovascular structures, and thus the possibility of recurrence is accepted with the intent of minimizing complications...
April 2015: Journal of Neurosurgery
Cristian Gragnaniello, Filippo Gagliardi, Anthony M T Chau, Remi Nader, Alan Siu, Zachary Litvack, Bruno De Luca, Kevin Seex, Pietro Mortini, Anthony J Caputy, Ossama Al-Mefty
Background and Objectives Few simulation models are available that provide neurosurgical trainees with the challenge of distorted skull base anatomy despite increasing importance in the acquisition of safe microsurgical and endoscopic techniques. We have previously reported a unique training model for skull base neurosurgery where a polymer is injected into a cadaveric head where it solidifies to mimic a skull base tumor for resection. This model, however, required injection of the polymer under direct surgical vision via a complicated alternative approach to that being studied, prohibiting its uptake in many neurosurgical laboratories...
October 2014: Journal of Neurological Surgery. Part B, Skull Base
Ayal A Aizer, Nils D Arvold, Paul Catalano, Elizabeth B Claus, Alexandra J Golby, Mark D Johnson, Ossama Al-Mefty, Patrick Y Wen, David A Reardon, Eudocia Q Lee, Lakshmi Nayak, Mikael L Rinne, Rameen Beroukhim, Stephanie E Weiss, Shakti H Ramkissoon, Malak Abedalthagafi, Sandro Santagata, Ian F Dunn, Brian M Alexander
BACKGROUND: The impact of adjuvant radiation in patients with atypical meningioma remains poorly defined. We sought to determine the impact of adjuvant radiation therapy in this population. METHODS: We identified 91 patients with World Health Organization grade II (atypical) meningioma managed at Dana-Farber/Brigham and Women's Cancer Center between 1997 and 2011. A propensity score model incorporating age at diagnosis, gender, Karnofsky performance status, tumor location, tumor size, reason for diagnosis, and era of treatment was constructed using logistic regression for the outcome of receipt versus nonreceipt of radiation therapy...
November 2014: Neuro-oncology
Ian F Dunn, Wenya Linda Bi, Kadir Erkmen, Paulo A S Kadri, David Hasan, Chi-Tun Tang, Svetlana Pravdenkova, Ossama Al-Mefty
OBJECT: Medial acoustic neuroma is a rare entity that confers a distinct clinical syndrome. It is scarcely discussed in the literature and is associated with adverse features. This study evaluates the clinical and imaging features, pertinent surgical challenges, and treatment outcome in a large series of this variant. The authors postulate that the particular pathological anatomy with its arachnoidal rearrangement has a profound implication on the surgical technique and outcome. METHODS: The authors conducted a retrospective analysis of 52 cases involving 33 women and 19 men who underwent resection of medial acoustic neuromas performed by the senior author (O...
May 2014: Journal of Neurosurgery
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