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Dural Tear During Thoracic Laminectomy Using Craniotome With Footplate Attachment

Houten, John K; Harter, David H; Schwartz, Amit Y
Laminectomy can be accomplished using the craniotome with a footplate attachment, and the technique has been advanced as a superior alternative to using a high-speed drill-driven burr and Kerrison rongeurs. Laminectomy can be accomplished more rapidly and with less bone destruction, an advantage when planning laminoplasty. There is, however, scant literature describing complications of dural laceration using this technique. A 48-year-old male underwent T7-10 laminectomy for resection of an intramedullary spinal cord tumor. During the upward cut of the hemi-lamina at T7-9, a dural laceration occurred that proved not amenable to direct suture closure. The dural was closed with a dural patch placed along the inner surface of the dura and a fat graft on the outer surface with adjunctive use of a lumbar drain. While the footplate laminectomy technique has merits touted in prior publications, including the ability to open the spinal canal quickly at numerous levels and an enhanced ability to achieve an osteoplastic laminoplasty, surgeons should be cognizant of the risk of associated dural laceration. We believe that it is important to emphasize that the initial placement of the lip of the footplate must be well-seated under the inferior aspect of the lowest lamina and over the ligamentum flavum and that the footplate should not be directed beyond the border of the laminae and facet, as this can result in dura and root injury.
PMCID:8184105
PMID: 34113510
ISSN: 2168-8184
CID: 4900282

Orbital Rosai-Dorfman disease initially diagnosed as IgG4-related disease: a case report

Iyengar, Nishanth S; Golub, Danielle; McQuinn, Michelle W; Hill, Travis; Tang, Karen; Gardner, Sharon L; Harter, David H; Sen, Chandranath; Staffenberg, David A; Thomas, Kristen; Elkin, Zachary; Belinsky, Irina; William, Christopher
Inflammatory orbital lesions include a broad list of diagnoses, many of them with overlapping clinical and radiographic features. They often present a diagnostic conundrum, even to the most experienced orbital specialist, thus placing considerable weight on surgical biopsy and histopathological analysis. However, histopathological diagnosis is also inherently challenging due to the rarity of these lesions and the overlaps in histologic appearance among distinct disease entities. We herein present the case of an adolescent male with a subacutely progressive orbital mass that generated a significant diagnostic dilemma. Early orbital biopsy was consistent with a benign fibro-inflammatory lesion, but corticosteroid therapy was ineffective in halting disease progression. After an initial substantial surgical debulking, histopathological analysis revealed several key features consistent with IgG4-related disease (IgG4-RD), a systemic fibro-inflammatory process typically accompanied by multifocal tumor-like lesions. Surprisingly, within months, there was clear evidence of clinical and radiographic disease progression despite second-line rituximab treatment, prompting a second surgical debulking. This final specimen displayed distinctive features of Rosai-Dorfman disease (RDD), a systemic inflammatory disease characterized by uncontrolled histiocytic proliferation. Interestingly, certain features of this re-excision specimen were still reminiscent of IgG4-RD, which not only reflects the difficulty in differentiating RDD from IgG4-RD in select cases, but also illustrates that these diagnoses may exist along a spectrum that likely reflects a common underlying pathogenetic mechanism. This case emphasizes the importance of surgical biopsy or resection and histopathological analysis in diagnosing-and, ultimately, treating-rare, systemic inflammatory diseases involving the orbit, and, furthermore, highlights the shared histopathological features between RDD and IgG4-RD.
PMCID:7368749
PMID: 32682450
ISSN: 2051-5960
CID: 4531782

Intra-reservoir administration of alteplase to treat a distal ventriculo-atrial shunt obstruction

Delavari, Nader; Mureb, Monica C; Yaun, Amanda; Wisoff, Jeffrey H; Harter, David H; Hidalgo, E Teresa
BACKGROUND:Ventriculoatrial shunts can be afflicted with distal malfunctions due to thrombus formation at the distal tip. Distal tip thrombus formation may occur more commonly in oncologic patients who are predisposed to hypercoagulability. CASE DESCRIPTION/METHODS:A patient who had a ventriculo-atrial shunt placed for leptomeningeal carcinomatosis presented with headaches and confusion and was found to have a partial distal shunt obstruction. Intra-reservoir administration of alteplase resulted in resolution of her symptoms. Nuclear medicine shunt patency test demonstrated restoration of distal flow. CONCLUSIONS:Intra-reservoir administration of alteplase can be a useful non-operative treatment strategy for ventriculo-atrial shunt malfunction. This strategy may be particularly useful in cases with higher peri-operative risk, such as patients with advanced metastatic cancer.
PMID: 31715416
ISSN: 1878-8769
CID: 4185252

Intracranial Angiomatoid Fibrous Histiocytoma [Meeting Abstract]

Spino, Marissa; Delavari, Nader; Harter, David; Jour, George; Snuderl, Matija
ISI:000472806000185
ISSN: 0022-3069
CID: 3973892

Prospective feasibility and safety assessment of surgical biopsy for patients with newly diagnosed diffuse intrinsic pontine glioma

Gupta, Nalin; Goumnerova, Liliana C; Manley, Peter; Chi, Susan N; Neuberg, Donna; Puligandla, Maneka; Fangusaro, Jason; Goldman, Stewart; Tomita, Tadanori; Alden, Tord; DiPatri, Arthur; Rubin, Joshua B; Gauvain, Karen; Limbrick, David; Leonard, Jeffrey; Geyer, J Russel; Leary, Sarah; Browd, Samuel; Wang, Zhihong; Sood, Sandeep; Bendel, Anne; Nagib, Mahmoud; Gardner, Sharon; Karajannis, Matthias A; Harter, David; Ayyanar, Kanyalakshmi; Gump, William; Bowers, Daniel C; Weprin, Bradley; MacDonald, Tobey J; Aguilera, Dolly; Brahma, Barunashish; Robison, Nathan J; Kiehna, Erin; Krieger, Mark; Sandler, Eric; Aldana, Philipp; Khatib, Ziad; Ragheb, John; Bhatia, Sanjiv; Mueller, Sabine; Banerjee, Anu; Bredlau, Amy-Lee; Gururangan, Sri; Fuchs, Herbert; Cohen, Kenneth J; Jallo, George; Dorris, Kathleen; Handler, Michael; Comito, Melanie; Dias, Mark; Nazemi, Kellie; Baird, Lissa; Murray, Jeff; Lindeman, Neal; Hornick, Jason L; Malkin, Hayley; Sinai, Claire; Greenspan, Lianne; Wright, Karen D; Prados, Michael; Bandopadhayay, Pratiti; Ligon, Keith L; Kieran, Mark W
Background/UNASSIGNED:Diagnosis of diffuse intrinsic pontine glioma (DIPG) has relied on imaging studies, since the appearance is pathognomonic, and surgical risk was felt to be high and unlikely to affect therapy. The DIPG Biology and Treatment Study (DIPG-BATS) reported here incorporated a surgical biopsy at presentation and stratified subjects to receive FDA-approved agents chosen on the basis of specific biologic targets. Methods/UNASSIGNED:Subjects were eligible for the trial if the clinical features and imaging appearance of a newly diagnosed tumor were consistent with a DIPG. Surgical biopsies were performed after enrollment and prior to definitive treatment. All subjects were treated with conventional external beam radiotherapy with bevacizumab, and then stratified to receive bevacizumab with erlotinib or temozolomide, both agents, or neither agent, based on O6-methylguanine-DNA methyltransferase status and epidermal growth factor receptor expression. Whole-genome sequencing and RNA sequencing were performed but not used for treatment assignment. Results/UNASSIGNED:Fifty-three patients were enrolled at 23 institutions, and 50 underwent biopsy. The median age was 6.4 years, with 24 male and 29 female subjects. Surgical biopsies were performed with a specified technique and no deaths were attributed to the procedure. Two subjects experienced grade 3 toxicities during the procedure (apnea, n = 1; hypertension, n = 1). One subject experienced a neurologic deficit (left hemiparesis) that did not fully recover. Of the 50 tumors biopsied, 46 provided sufficient tissue to perform the study assays (92%, two-stage exact binomial 90% CI: 83%-97%). Conclusions/UNASSIGNED:Surgical biopsy of DIPGs is technically feasible, associated with acceptable risks, and can provide biologic data that can inform treatment decisions.
PMID: 29741745
ISSN: 1523-5866
CID: 3463742

Integrated Liquid Biopsy Analysis for Pediatric Brain Tumor Patients Using Detection of ctDNA and Circulating Tumor Cells [Meeting Abstract]

Zhu, Kaicen; Barnett, Katherine; Shen, Guomiao; Mohammed, Hussein; Panicucci-Roma, Tania; Serrano, Jonathan; Harter, David; Wisoff, Jeffrey; Yaun, Amanda; Wang, Shiyang; Gardner, Sharon; Snuderl, Matija
ISI:000434064400143
ISSN: 0022-3069
CID: 3156152

Automated cell enrichment and digital cell sorting using dielectrophoretic arrays for isolation of circulating tumor cells in pediatric brain tumor patients [Meeting Abstract]

Barnett, K; Zhu, K; Shen, G; Serrano, J; Harter, D; Wisoff, J; Yaun, A; Wang, S; Gardner, S; Snuderl, M
INTRODUCTION: Liquid biopsy has the potential to revolutionize diagnosis and management of cancer. In brain tumors, detection of cell free tumor DNA (ctDNA) and circulating tumor cells (CTC) is challenging due to low level of the circulating material. We present a novel workflow for detection and capture of CTCs. METHODS: Peripheral blood was obtained from five pediatric patients with astrocytoma (n=2), ependymoma (n=1), dysembryoplastic neuroepithelial tumor (n=1), and medulloblastoma (n=1) at initial resection (n=3) and relapse (n=2). Samples were enriched using the Clear-Bridge ClearCell FX1 system and the suspension stained with antibodies against CD56 and CD45. Samples were analyzed using Silicon Biosystems DEPArray to capture single and pooled CTCs. CTCs were identified by CD56 positivity, while leukocytes were positive for CD45 and NK cells double-positive for CD56 and CD45. RESULTS: CTCs were identified in all 5 patient samples. The number of CD56-positive cells isolated from each sample ranged from 1 to 25 (mean 9). The CD56-positive cells were on average 11.8 mum in diameter (range 9.0-15.7 mum), and CD45-positive cells were on average 10.8 mum in diameter (range 8.9-15.9 mum). Single CTCs and CTC pools are amenable to molecular analysis after whole genome amplification. CONCLUSION: We report a novel integrated workflow for capturing CTCs in pediatric patients with brain tumors. While rare, CTCs circulate in peripheral blood of patients with brain tumors regardless of their grade and are amenable for molecular analysis. This method has the potential to serve as a non-invasive diagnostic and monitoring method for pediatric brain tumors
EMBASE:623098158
ISSN: 1523-5866
CID: 3211372

FEASIBILITY AND SAFETY OF SURGICAL BIOPSY FOR PATIENTS WITH DIPG: PRELIMINARY RESULTS FROM DIPG-BATS [Meeting Abstract]

Gupta, Nalin; Goumnerova, Liliana; Ayyanar, Kanya; Gump, William; Bendel, Anne; Nagib, Mahmoud; Bowers, Daniel; Weprin, Bradley; Bredlau, Amy-Lee; Gururangan, Sridharan; Fuchs, Herbert; Cohen, Kenneth; Jallo, George; Dorris, Kathleen; Handler, Michael; Comito, Melanie; Dias, Mark; Fangusaro, Jason R; Goldman, Stewart; Tomita, Tadanori; Alden, Tord; DiPatri, Arthur; Gardner, Sharon; Karajannis, Matthias; Harter, David; Gauvain, Karen; Limbrick, David; Leonard, Jeffrey; Geyer, JRuss; Leary, Sarah; Browd, Samuel; Khatib, Ziad; Ragheb, John; Bhatia, Sanjiv; MacDonald, Tobey; Aguilera, Dolly; Brahma, Barun; Manley, Peter; Chi, Susan; Mueller, Sabine; Banerjee, Anuradha; Murray, Jeffrey; Nazemi, Kellie; Baird, Lissa; Robison, Nathan; Kiehna, Erin; Krieger, Mark; Sandler, Eric; Aldana, Philipp; Wang, Joanne; Sood, Sandeep; Neuberg, Donna; Puligandla, Maneka; Greenspan, Lianne; Wright, Karen; Prados, Michael; Bandopadhayay, Pratiti; Ligon, Keith; Kieran, Mark
ISI:000415152503125
ISSN: 1523-5866
CID: 2802382

H3 K27M MUTANT GLIOMAS ARE SELECTIVELY KILLED BY ONC201, A SMALL MOLECULE INHIBITOR OF DOPAMINE RECEPTOR D2 [Meeting Abstract]

Chi, Andrew S; Stafford, James M; Sen, Namita; Possemato, Richard; Placantonakis, Dimitris; Hidalgo, Eveline Teresa; Harter, David; Wisoff, Jeffrey; Golfinos, John; Arrillaga-Romany, Isabel; Batchelor, Tracy; Wen, Patrick; Wakimoto, Hiroaki; Cahill, Daniel; Allen, Joshua E; Oster, Wolfgang; Snuderl, Matija
ISI:000415152501151
ISSN: 1523-5866
CID: 2802442

Endothelium-Independent Primitive Myxoid Vascularization Creates Invertebrate-Like Channels to Maintain Blood Supply in Optic Gliomas

Snuderl, Matija; Zhang, Guoan; Wu, Pamela; Jennings, Tara S; Shroff, Seema; Ortenzi, Valerio; Jain, Rajan; Cohen, Benjamin; Reidy, Jason J; Dushay, Mitchell S; Wisoff, Jeffrey H; Harter, David H; Karajannis, Matthias A; Fenyo, David; Neubert, Thomas A; Zagzag, David
Optic gliomas are brain tumors characterized by slow growth, progressive loss of vision, and limited therapeutic options. Optic gliomas contain various amounts of myxoid matrix, which can represent most of the tumor mass. We sought to investigate biological function and protein structure of the myxoid matrix in optic gliomas to identify novel therapeutic targets. We reviewed histological features and clinical imaging properties, analyzed vasculature by immunohistochemistry and electron microscopy, and performed liquid chromatography-mass spectrometry on optic gliomas, which varied in the amount of myxoid matrix. We found that although subtypes of optic gliomas are indistinguishable on imaging, the microvascular network of pilomyxoid astrocytoma, a subtype of optic glioma with abundant myxoid matrix, is characterized by the presence of endothelium-free channels in the myxoid matrix. These tumors show normal perfusion by clinical imaging and lack histological evidence of hemorrhage organization or thrombosis. The myxoid matrix is composed predominantly of the proteoglycan versican and its linking protein, a vertebrate hyaluronan and proteoglycan link protein 1. We propose that pediatric optic gliomas can maintain blood supply without endothelial cells by using invertebrate-like channels, which we termed primitive myxoid vascularization. Enzymatic targeting of the proteoglycan versican/hyaluronan and proteoglycan link protein 1 rich myxoid matrix, which is in direct contact with circulating blood, can provide novel therapeutic avenues for optic gliomas of childhood.
PMCID:5530906
PMID: 28606795
ISSN: 1525-2191
CID: 2595022