Kaisorn L Chaichana

Johns Hopkins Medicine, Baltimore, Maryland, United States

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Publications (99)244.12 Total impact

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    ABSTRACT: OBJECTIVE: : Glioblastoma (GB) is rarely in the cerebellum. Because of its rarity, it is poorly understood if cerebellar GB (CGB) behaves similarly to supratentorial GB. Studies have been limited to case reports and small case series. A better understanding of CGB may help guide treatment strategies. METHODS: : Surveillance, Epidemiology and End Results (SEER) database was analyzed from 1973-2009 for all adult patients with GB located in the cerebellum. Stepwise multivariate proportional hazards regression analyses were used to identify factors independently associated with survival. RESULTS: : 208(0.9%) patients with CGB were identified from 23,329 GB patients with known locality. The mean age was 58years. Median survival was 8 months, with 1, 2 and 5-year survival rates of 21%, 13%, and 2%. When compared to supratentorial GB, CGB occurred in younger patients (58±16 vs. 61±13 years, p=0.001), less commonly in "Whites" (85.6% vs. 91.3%, p=0.005), and were smaller (3.7±1.1 vs. 4.5±1.7 cm, p=0.001). A cerebellar location independently predicted poorer survival when compared to other GB locations (p=0.048). In multivariate analysis for patients with CGB, younger age (p<0.001), "Asian or Pacific Islander" race (p=0.046), and radiation therapy (p<0.001) were independently associated with prolonged survival. CONCLUSION: CGB are difficult to analyze using institutional series because of their rarity. This study shows they are clinically different than supratentorial GB. Among patients with CGB, radiation therapy may prolong survival for patients with the rare lesions. This may help guide treatment strategies aimed at prolonging survival for patients with these extremely rare lesions.
    World Neurosurgery 02/2013; · 1.77 Impact Factor
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    ABSTRACT: OBJECTIVE: Malignant osseous spinal neoplasms are aggressive tumors associated with poor outcomes despite aggressive multidisciplinary measures. While surgical resection has been shown to improve short-term local disease control, it remains debated whether surgical resection is associated with improved overall survival in patients with malignant primary osseous spinal neoplasms. The aim of this manuscript is to review survival data from a US cancer registry spanning 30 years to determine if surgical resection was independently associated with overall survival. METHODS: The SEER registry (1973-2003) was queried to identify cases of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing's sarcoma of the mobile spine and pelvis. Patients with systemic metastasis were excluded. Age, gender, race, tumor location, and primary treatments were identified. Extent of local tumor invasion was classified as confined within periosteum versus extension beyond periosteum to surrounding tissues. The association of surgical resection with overall survival was assessed via Cox analysis adjusting for age, radiotherapy, and tumor invasiveness. RESULTS: 827 patients were identified with non-metastatic primary osseous spinal neoplasms (215 chordoma, 282 chondrosarcoma, 158 osteosarcoma, 172 Ewing's sarcoma). Overall, median survival was histology specific (chordoma, 96 months; Ewing's sarcoma, 90 months; chondrosarcoma, 88 months; osteosarcoma, 18 months). Adjusting for age, radiation therapy, and extent of local tumor invasion in patients with isolated (non-metastatic) spine tumors, surgical resection was independently associated with significantly improved survival for chordoma [hazard ratio (95 % confidence interval; 0.617 (0.25-0.98)], chondrosarcoma [HR (95 %CI); 0.153 (0.07-0.36)], osteosarcoma [HR (95 %CI); 0.382 (0.21-0.69)], and Ewing's sarcoma [HR (95 %CI); 0.494 (0.26-0.96)]. CONCLUSION: In our analysis of a 30-year US population-based cancer registry (SEER), patients undergoing surgical resection of primary spinal chordoma, chondrosarcoma, Ewing's sarcoma, or osteosarcoma demonstrated prolonged overall survival independent of patient age, extent of local invasion, or location. Surgical resection may play a role in prolonging survival in the multi-modality treatment of patients with these malignant primary osseous spinal neoplasms.
    European Spine Journal 12/2012; · 2.47 Impact Factor
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    ABSTRACT: OBJECTIVE: The development of venothromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary emboli (PE), is common in brain tumor patients. Their development can be catastrophic. Studies evaluating pre-operative clinical factors that predispose patients to the development of VTE are few and limited. An understanding may help risk stratify patients and guide subsequent therapy aimed at reducing the risk of DVTs/PEs. METHODS: All adult patients who underwent surgery for an intracranial tumor at an academic tertiary care institution between 1998 and 2008 were retrospectively reviewed. Stepwise multivariate logistical regression analysis was used to identify pre-operative factors associated with the development of peri-operative (within 30 days of surgery) DVTs/PEs among patients who underwent surgery of their intracranial tumor. RESULTS: Of the 4293 patients in this study, 126 (3%) patients developed DVT and/or PE in the peri-operative period. The pre-operative factors independently associated with the development of DVTs/PEs were: poorer Karnofsky performance scale (KPS) [odds ratio (OR), 1.040; 95% confidence interval (CI), 1.026-1.052; P<0.0001], high grade glioma (OR, 1.702; 95% CI, 1.176-2.465; P=0.005), older age (OR, 1.033; 95% CI, 1.020-1.046; P<0.0001), hypertension (OR, 1.785; 95% CI, 1.180-2.699; P=0.006), and motor deficit (OR, 1.854; 95% CI, 1.244-2.763; P=0.002). Eighty-six per cent of the patients with DVTs/PEs were treated with either unfractionated or low molecular weight heparin, and 4% of these patients developed intracranial hemorrhage. DISCUSSION: The present study found that poorer functional status, older age, pre-operative motor deficit, high grade glioma, and hypertension each independently increased the risk of developing peri-operative DVTs/PEs. These findings may provide patients and physicians with prognostic information that may guide therapies aimed at minimizing the development of peri-operative DVTs/PEs.
    Neurological Research 12/2012; · 1.18 Impact Factor
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    ABSTRACT: Object Glioblastoma is the most common and aggressive type of primary brain tumor in adults. These tumors recur regardless of intervention. This propensity to recur despite aggressive therapies has made many perceive that repeated resections have little utility. The goal of this study was to evaluate if patients who underwent repeat resections experienced improved survival as compared with patients with fewer numbers of resections, and whether the number of resections was an independent predictor of prolonged survival. Methods The records of adult patients who underwent surgery for an intracranial primary glioblastoma at an academic tertiary-care institution between 1997 and 2007 were retrospectively reviewed. Multivariate proportionalhazards regression analysis was used to identify an association between glioblastoma resection number and survival after controlling for factors known to be associated with survival, such as age, functional status, periventricular location, extent of resection, and adjuvant therapy. Survival as a function of time was plotted using the Kaplan-Meier method, and survival rates were compared using log-rank analysis. Results Five hundred seventy-eight patients with primary glioblastoma met the inclusion/exclusion criteria. At last follow-up, 354, 168, 41, and 15 patients underwent 1, 2, 3, or 4 resections, respectively. The median survival for patients who underwent 1, 2, 3, and 4 resections was 6.8, 15.5, 22.4, and 26.6 months (p < 0.05), respectively. In multivariate analysis, patients who underwent only 1 resection experienced shortened survival (relative risk [RR] 3.400, 95% CI 2.423-4.774; p < 0.0001) as compared with patients who underwent 2 (RR 0.688, 95% CI 0.525-0.898; p = 0.0006), 3 (RR 0.614, 95% CI 0.388-0.929; p = 0.02), or 4 (RR 0.600, 95% CI 0.238-0.853; p = 0.01) resections. These results were verified in a case-control evaluation, controlling for age, neurological function, periventricular tumor location, extent of resection, and adjuvant therapy. Patients who underwent 1, 2, or 3 resections had a median survival of 4.5, 16.2, and 24.4 months, respectively (p < 0.05). Additionally, the risk of infections or iatrogenic deficits did not increase with repeated resections in this patient population (p > 0.05). Conclusions Patients with glioblastoma will inevitably experience tumor recurrence. The present study shows that patients with recurrent glioblastoma can have improved survival with repeated resections. The findings of this study, however, may be limited by an intrinsic bias associated with patient selection. The authors attempted to minimize these biases by using strict inclusion criteria, multivariate analyses, and case-control evaluation.
    Journal of Neurosurgery 10/2012; · 3.15 Impact Factor
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    ABSTRACT: Objective Medial sphenoid wing meningiomas (SWMs) are relatively common tumors that are associated with significant morbidity and mortality, primarily from their anatomic proximity to many critical neurological and vascular structures. A major complication is visual deterioration. This study aimed to identify predictors of visual outcome following medial SWM resection. Design Retrospective, stepwise multivariate proportional hazards regression analysis. Setting Johns Hopkins Hospital. Participants All patients who underwent medial SWM resection from 1998 to 2009. Main Outcome Measures Visual function. Results Sixty-five medial SWM resections were performed. After multivariate proportional hazards regression analysis, preoperative visual decline (relative risk [RR] 95% confidence interval [CI]; 13.431 [2.601 to 46.077], p = 0.006), subtotal resection (RR [95% CI]; 3.717 [1.204 to 13.889], p = 0.02), and repeat surgery (RR [95% CI]; 5.681 [1.278 to 19.802], p = 0.03) were found to be independent predictors of visual decline at last follow-up. Tumor recurrence and postoperative radiation therapy trended toward, but did not reach statistical significance. Conclusion These findings advocate for early and aggressive surgical intervention for patients with medial SWMs to maximize the likelihood of subsequent visual preservation. This may provide patients and physicians with prognostic information that may guide medical and surgical therapy for patients with medial SWMs.
    Journal of neurological surgery. Part B, Skull base. 10/2012; 73(5):321-326.
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    ABSTRACT: Object Choroid plexus tumors (CPTs) are rare intracranial neoplasms that constitute approximately 2%-5% of all pediatric brain tumors. Most of these tumors present with severe hydrocephalus. The optimal perioperative management and oncological care remain a matter of debate. The authors present the epidemiological and clinical features of CPTs from a 20-year single-institutional experience. Methods A total of 39 consecutive patients with pathologically proven CPTs (31 choroid plexus papillomas [CPPs] and 8 choroid plexus carcinomas [CPCs]) were included in this series. Patient demographics, clinical presentation, comorbidities, indications for surgery, radiological studies, tumor location, and all operative variables were reviewed for each case. Multivariate regression analysis was performed to identify independent predictors of tumor recurrence and survival. Results The overall mean age (± SD) was 13.13 ± 19.59 years (15.27 ± 21.10 years in the CPP group and 3.66 ± 3.59 years in the CPC group). Hydrocephalus was noted at presentation in 34% of patients. The most common presenting symptoms were headache (32%) and nausea/vomiting (26%). Gross-total resection (GTR) was achieved in 86% of CPPs and in 71% of CPCs (p = 0.57). There was 100% survival in patients with CPPs observed at the 5- and 10-year follow-up and 71% survival in patients with CPCs at the 5-year follow-up. In a multivariate regression analysis, a diagnosis of papilloma, preoperative vision changes, or hydrocephalus; right ventricle tumor location; and GTR were all independently associated with a decreased likelihood of tumor recurrence at last follow-up. Conclusions The authors' study suggests that patients with CPCs are more likely to experience local recurrence and metastasis; hence, GTR with chemotherapy and radiotherapy, particularly for CPCs, is pivotal in preventing recurrence and prolonging survival. While GTR was important for local control following resection of CPPs, it had a minimal effect on prolonging survival in this patient cohort.
    Journal of Neurosurgery Pediatrics 08/2012; · 1.63 Impact Factor
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    ABSTRACT: The poor prognosis for patients with glioblastoma (GB) heightens the importance of maintaining function throughout treatment. Hyperglycemia has been linked to poor neurological outcomes following stroke, traumatic brain and spinal cord injury. We hypothesized this may also be true following the resection of GB. We assessed associations with post-operative function with the goal of identifying modifiable factors in the peri-operative period with a particular focus on blood glucose levels. Independent associations with worse post-operative function included: patient age, pre-operative motor deficit, deep tumor location, post-operative motor deficit, and elevated mean peri-operative glucose. Interestingly, controlling for associated factors including dexamethasone dosing, patients with elevated peri-operative glucose levels were nearly twice as likely to have new post-operative neurological deficits. These results suggest, together with the broad literature supporting a role for hyperglycemia in neurological injury, that this may represent a modifiable factor in the peri-operative care of these patients.
    Journal of Clinical Neuroscience 05/2012; 19(7):996-1000. · 1.25 Impact Factor
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    ABSTRACT: Study background: Thoracolumbar fractures are among the most common type of traumatic spine fractures. The use of minimally invasive, percutaneous pedicle screw fixation for these fractures has been limited to case reports and small case series. The efficacy of this approach remains unclear. Methods: The evaluation and management of a patient with traumatic T12 burst fracture is presented. In addition, a literature review of the Medline and PubMed databases was conducted. Results: A total of 166 patients from 8 studies were identified. Average age was 46 years. Polytrauma was reported in 27% of patients. Average surgery time was 91 minutes, with an average blood loss of 95 milliliters. Reported complications were non-healing fracture in 3(2%), infection in 1(0.6%), mal-positioned screw in 1(0.6%), and hematoma in 1(0.6%) at a median follow-up time of 26 months. Pain improved by an average of 6 points after surgery according to visual analog score, and mean kyphosis correction in these studies was 8.5°. Conclusions: This review demonstrates that minimally invasive, percutaneous pedicle screw fixation is a viable option for the management of traumatic thoracolumbar fractures in neurologically intact patients. Patients who are older and/or present with polytrauma may most benefit from this type of intervention.
    Journal of Trauma & Treatment. 05/2012; 1(5).
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    ABSTRACT: OBJECTIVE: Seizures are common among patients with meningiomas and are a significant cause of morbidity and poor quality of life. The factors associated with the onset of seizures as well as factors associated with seizure control remains poorly understood. METHODS: Adult patients who underwent primary resection of a supratentorial World Health Organization grade I meningioma at a single institution between 1996 and 2006 were retrospectively reviewed. Multivariate logistical regression analyses were used to identify associations with preoperative seizures, and multivariate proportional hazards regression analyses were used to identify associations with prolonged seizure control after surgical resection. RESULTS: Of the 626 patients in this series, 84 (13%) presented with seizures. The factors independently associated with preoperative seizures were Karnofsky performance score ≤80 (P< 0.0001), absence of headaches (P = 0.0006), and vasogenic edema (P = 0.007). At 48 months postoperatively, 90% were Engel class I, 3% were class II, 0 were class III, and 7% were class IV. The factors independently associated with decreased seizure control after surgical resection were uncontrolled preoperative seizures (P = 0.04), parasagittal tumors (P = 0.03), and tumors along the sphenoid wing (P = 0.05). The association between seizure recurrence and tumor recurrence trended toward but did not achieve statistical significance (P = 0.11). CONCLUSIONS: With the widespread availability of various neuroimaging modalities, there will be increased detection of intracranial meningiomas. The identification and consideration of factors associated with seizure onset and prolonged seizure control may help guide treatment strategies aimed at improving the quality of life for patients with meningiomas.
    World Neurosurgery 03/2012; · 1.77 Impact Factor
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    ABSTRACT: Intracranial dural arteriovenous fistulas (DAVFs) are relatively rare lesions consisting of anomalous connections between dural arteries and venous sinuses and/or cortical veins. Their clinical presentation is quite variable, with symptoms dependent on their location and venous drainage pattern. Lesions with cortical venous drainage, however, have the highest risk of causing the most significant morbidity and mortality. This places an emphasis on promptly suspecting and diagnosing these lesions. This review highlights the etiology, epidemiology, clinical presentation, and clinical course of patients with intracranial DAVFs.
    Neurosurgery clinics of North America 01/2012; 23(1):7-13. · 1.73 Impact Factor
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    ABSTRACT: This review examined Dr. Harvey Cushing's cases in the surgical records of Johns Hopkins Hospital, from 1896 to 1912. 41 patients who underwent cortical stimulation for intra-operative motor mapping were selected for further analysis. We demonstrate that Cushing used cortical stimulation to define primary motor and sensory cortices in the treatment of tumors, trauma, and epilepsy, within adult and pediatric populations. In addition, he performed stimulation of sub-cortical white matter during 4 of these surgeries, setting the stage for contemporary use of this technique in improving post-operative outcomes. This review of Cushing's early intra-operative motor mapping illuminates his contributions, and clarifies his influence on the evolution of cortical mapping from an experimental technique to a staple of contemporary neurosurgery.
    Cortex 01/2012; 48(1):7-14. · 6.16 Impact Factor
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    ABSTRACT: Malignant osseous spinal neoplasms are aggressive tumors associated with poor outcomes despite aggressive multidisciplinary measures. It remains unknown whether increased local tumor invasion at time of treatment predicts worse survival. The surveillance, epidemiology, and end results (SEER) registry was reviewed to determine whether extent of local tumor invasion at presentation was independently associated with overall survival. The SEER registry (1973-2003) was queried to identify cases of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing sarcoma. Extent of local invasion was defined at time of care by histology, radiology, or intraoperative assessment and classified as confined (tumor within periosteum), local invasion (extension to surrounding tissues), or distal metastasis. The association of extent of local tumor invasion with overall survival was assessed by Cox analysis. One thousand eight hundred ninety-two patients were identified (414 chordoma, 579 chondrosarcoma, 430 osteosarcoma, 469 Ewing sarcoma). Overall median survival was histology specific (osteosarcoma, 11 months; Ewing sarcoma, 26 months; chondrosarcoma, 37 months; chordoma, 50 months) and correlated with extent of local tissue invasion or metastasis at presentation. Presence of metastasis was associated with marked decrease in survival (P < 0.001) for all tumor types. For patients with isolated spine tumors, neoplasms confined within the periosteum were associated with improved overall survival independent of age, radiotherapy, or surgical resection for chordoma (hazard ratio [HR], 0.50; P = 0.08), chondrosarcoma (HR, 0.62; P = 0.03), and osteosarcoma (HR, 0.68; P = 0.05), but not Ewing sarcoma (HR, 0.62; P = 0.27). The preoperative radiographic recognition of local tissue invasion may identify patients with a more aggressive tumor and help guide the level of aggressiveness in subsequent treatment strategies.
    World Neurosurgery 12/2011; 76(6):580-5. · 1.77 Impact Factor
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    Khan K. Chaichana, Kaisorn L. Chaichana
    10/2011; , ISBN: 978-953-307-574-7
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    ABSTRACT: Peak incidence of glioblastoma multiforme (GBM) occurs in individuals aged 65 years and older. The goal was to evaluate the efficacy of carmustine wafers in prolonging survival for older GBM patients. One hundred and thirty-three consecutive patients aged 65 years and older who underwent surgery for an intracranial primary (de novo) GBM from 1997-2007 were retrospectively reviewed. Among these 133 patients, 45 patients with carmustine wafer implantation were matched with 45 patients without implantation. These groups were matched for factors consistently shown to be associated with survival (age, Karnofsky performance scale, extent of resection, radiation therapy, and temozolomide). Survival was expressed as estimated Kaplan-Meier plots, and log-rank analysis was used to compare survival curves. Variables with P<0.05 were considered statistically significant. The mean (±standard deviation) age of the cohort was 73±5 years, and the median survival of the entire cohort was 5.9 months. Among patients with and without carmustine wafers, there were no significant differences in pre- and peri-operative variables. However, patients with carmustine wafers demonstrated prolonged survival as compared to patients without wafers. The median survival for patients with carmustine wafers was 8.7 months, while median survival for patients without wafers was 5.5 months (P=0.007). Likewise, in subgroup analysis, patients older than 70 years (P=0.0003) and 75 years (P=0.04) who had carmustine wafers had significantly longer survival than matched patients without wafers. Older patients with GBM may benefit from carmustine wafers. The survival for older patients who received carmustine wafers is significantly longer than matched patients who did not receive carmustine wafers.
    Neurological Research 09/2011; 33(7):759-64. · 1.18 Impact Factor
  • Neurosurgery 09/2011; 69 Suppl Operative:117-21. · 2.53 Impact Factor
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    ABSTRACT: The median survival duration for patients with glioblastoma is approximately 12 months. Maximizing quality of life (QOL) for patients with glioblastoma is a priority. An important, yet understudied, QOL component is functional independence. The aims of this study were to evaluate functional outcomes over time for patients with glioblastoma, as well as identify factors associated with prolonged functional independence. All patients who underwent first-time resection of either a primary (de novo) or secondary (prior lower grade glioma) glioblastoma at a single institution from 1996 to 2006 were retrospectively reviewed. Patients with a Karnofsky Performance Scale (KPS) score ≥ 80 were included. Kaplan-Meier, log-rank, and multivariate proportional hazards regression analyses were used to identify associations (p < 0.05) with functional independence (KPS score ≥ 60) following glioblastoma resection. The median follow-up duration time was 10 months (interquartile range [IQR] 5.6-17.0 months). A patient's preoperative (p = 0.02) and immediate postoperative (within 2 months) functional status was associated with prolonged survival (p < 0.0001). Of the 544 patients in this series, 302 (56%) lost their functional independence at a median of 10 months (IQR 6-16 months). Factors independently associated with prolonged functional independence were: preoperative KPS score ≥ 90 (p = 0.004), preoperative seizures (p = 0.002), primary glioblastoma (p < 0.0001), gross-total resection (p < 0.0001), and temozolomide chemotherapy (p < 0.0001). Factors independently associated with decreased functional independence were: older age (p < 0.0001), coexistent coronary artery disease (p = 0.009), and incurring a new postoperative motor deficit (p = 0.009). Furthermore, a decline in functional status was independently associated with tumor recurrence (p = 0.01). The identification and consideration of these factors associated with prolonged functional outcome (preoperative KPS score ≥ 90, seizures, primary glioblastoma, gross-total resection, temozolomide) and decreased functional outcome (older age, coronary artery disease, new postoperative motor deficit) may help guide treatment strategies aimed at improving QOL for patients with glioblastoma.
    Journal of Neurosurgery 03/2011; 114(3):604-12. · 3.15 Impact Factor
  • Matthew J McGirt, Ziya L Gokaslan, Kaisorn L Chaichana
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    ABSTRACT: Large population-based studies of malignant primary osseous spinal neoplasms are lacking and are necessary to have sufficient statistical power to determine if various patient-related factors are in fact significant indicators of prognosis. Using a 30-year US national cancer registry (Surveillance, Epidemiology, and End Results [SEER]), we introduce a preoperative grading scale that is associated with survival in patients undergoing surgical resection for malignant primary osseous spinal neoplasms. Large-scale retrospective study. SEER registry. Survival. The SEER registry (1973-2003) was queried to identify adult patients undergoing surgical resection of histologically confirmed primary spinal chordoma, chondrosarcoma, or osteosarcoma via International Classification of Disease for Oncology, Third Edition coding. Variables independently associated with survival were determined via Cox proportional hazards regression analysis for all tumor types. A grading scale comprising these independent survival predictors was then developed and applied to each histology-specific tumor cohort. Three hundred forty-two patients who underwent surgical resection of a malignant primary osseous spinal neoplasm (114 chordoma, 156 chondrosarcoma, and 72 osteosarcoma) were identified. Overall median survival after surgical resection was histology specific (osteosarcoma: 22 months; chordoma: 100 months; and chondrosarcoma: 160 months). Increasing age (years) and increasing tumor invasion (confined to periosteum; invasion through periosteum into adjacent tissues; and distal site metastasis) were the only variables independently associated with decreased survival (p<.05) for all tumor types. For spinal chordoma, sacrum/pelvic location (p<.05) and earlier year of surgery (p<.005) were also independently associated with decreased survival. Using variables of patient age, extent of local tumor invasion, and metastasis status in a five-point grading scale, increasing score (1-5) closely correlated (p<.001) with decreased survival for chordoma, chondrosarcoma, and osteosarcoma. In our analysis of a US population-based cancer registry (SEER), a grading scale consisting of age, metastasis status, and extent of local tumor invasion was associated with overall survival after surgical resection of chordoma, chondrosarcoma, and osteosarcoma of the spine. Although this analysis could not take into account specific chemotherapy regimens and variations in surgical technique, this grading scale may offer valuable prognostic data based on variables available to the surgeon and patient before surgery and may help guide level of aggressiveness in subsequent treatment strategies.
    The spine journal: official journal of the North American Spine Society 02/2011; 11(3):190-6. · 2.90 Impact Factor
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    ABSTRACT: Malignant primary osseous spinal neoplasms are aggressive tumors that remain associated with poor outcomes despite aggressive multidisciplinary treatment measures. To date, prognosis for patients with these tumors is based on results from small single-center patient series and controlled trials. Large population-based observational studies are lacking. To assess national trends in histology-specific survival, the authors reviewed patient survival data spanning 30 years (1973-2003) from the Surveillance, Epidemiology, and End Results (SEER) registry, a US population-based cancer registry. The SEER registry was queried to identify cases of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing sarcoma using coding from the International Classification of Disease for Oncology, Third Edition. Association of survival with histology, metastasis status, tumor site, and year of diagnosis was assessed using Cox proportional-hazards regression analysis. A total of 1892 patients were identified with primary osseous spinal neoplasms (414 with chordomas, 579 with chondrosarcomas, 430 with osteosarcomas, and 469 with Ewing sarcomas). Chordomas presented in older patients (60 ± 17 years; p < 0.01) whereas Ewing sarcoma presented in younger patients (19 ± 11 years; p < 0.01) compared with patients with all other tumors. The relative incidence of each tumor type remained similar per decade from 1973 to 2003. African Americans comprised a significantly greater proportion of patients with osteosarcomas than other tumors (9.6% vs 3.5%, respectively; p < 0.01). Compared with the sacrum, the mobile spine was more likely to be the site of tumor location for chordomas than for all other tumors (47% vs 23%, respectively; p < 0.05). Osteosarcoma and Ewing sarcoma were 3 times more likely than chondrosarcoma and chordoma to present with metastasis (31% vs 8%, respectively). Resection was performed more frequently for chordoma (88%) and chondrosarcoma (89%) than for osteosarcoma (61%) and Ewing sarcoma (53%). Overall median survival was histology-specific (osteosarcoma, 11 months; Ewing sarcoma, 26 months; chondrosarcoma, 37 months; chordoma, 50 months) and significantly worse in patients with metastasis at presentation for all tumor types. Survival did not significantly differ as a function of site (mobile spine vs sacrum/pelvis) for any tumor type, but more recent year of diagnosis was associated with improved survival for isolated spinal Ewing sarcoma (hazard ration [HR] 0.95; p = 0.001), chondrosarcoma (HR 0.98; p = 0.009), and chordoma (HR 0.98; p = 0.10), but not osteosarcoma. In this analysis of a 30-year, US population-based cancer registry (SEER), the authors provide nationally representative prognosis and survival data for patients with malignant primary spinal osseous neoplasms. Overall patient survival has improved for isolated spine tumors with advancements in care over the past 4 decades. These results may be helpful in providing historical controls for understanding the efficacy of new treatment paradigms, patient education, and guiding level of aggressiveness in treatment strategies.
    Journal of neurosurgery. Spine 02/2011; 14(2):143-50. · 1.61 Impact Factor
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    ABSTRACT: Lumbar discectomy is the most common surgical procedure performed in the US for patients experiencing back and leg pain from herniated lumbar discs. However, not all patients will benefit from lumbar discectomy. Patients with certain psychological predispositions may be especially vulnerable to poor clinical outcomes. The goal of this study was therefore to determine the role that preoperative depression and somatic anxiety have on long-term back and leg pain, disability, and quality of life (QOL) for patients undergoing single-level lumbar discectomy. In 67 adults undergoing discectomy for a single-level herniated lumbar disc, the authors determined quantitative measurements of leg and back pain (visual analog scale [VAS]), quality of life (36-Item Short Form Health Survey [SF-36]), and disease-specific disability (Oswestry Disability Index) preoperatively and at 6 weeks, 3, 6, and 12 months after surgery. The degree of preoperative depression and somatization was assessed using the Zung Self-Rating Depression Scale and a modified somatic perception questionnaire (MSPQ). Multivariate regression analyses were performed to assess associations between Zung Scale and MSPQ scores with achievement of a minimum clinical important difference (MCID) in each outcome measure by 12 months postoperatively. All patients completed 12 months of follow-up. Overall, a significant improvement in VAS leg pain, VAS back pain, Oswestry Disability Index, and SF-36 Physical Component Summary scores was observed by 6 weeks after surgery. Improvements in all outcomes were maintained throughout the 12-month follow-up period. Increasing preoperative depression (measured using the Zung Scale) was associated with a decreased likelihood of achieving an MCID in disability (p = 0.006) and QOL (p = 0.04) but was not associated with VAS leg pain (p = 0.96) or back pain (p = 0.85) by 12 months. Increasing preoperative somatic anxiety (measured using the MSPQ) was associated with decreased likelihood of achieving an MCID in disability (p = 0.002) and QOL (p = 0.03) but was not associated with leg pain (p = 0.64) or back pain (p = 0.77) by 12 months. The Zung Scale and MSPQ are valuable tools for stratifying risk in patients who may not experience clinically relevant improvement in disability and QOL after discectomy. Efforts to address these confounding and underlying contributors of depression and heightened somatic anxiety may improve overall outcomes after lumbar discectomy.
    Journal of neurosurgery. Spine 02/2011; 14(2):261-7. · 1.61 Impact Factor
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    Clinical neurosurgery 01/2011; 58:117-21.

Publication Stats

1k Citations
244.12 Total Impact Points

Institutions

  • 2008–2014
    • Johns Hopkins Medicine
      • Department of Neurosurgery
      Baltimore, Maryland, United States
    • Harvard Medical School
      • Harvard-MIT Division of Health Sciences and Technology
      Cambridge, MA, United States
    • Albert Einstein College of Medicine
      New York City, New York, United States
    • Tufts Medical Center
      • Department of Neurosurgery
      Boston, MA, United States
  • 2007–2014
    • Johns Hopkins University
      • Department of Neurosurgery
      Baltimore, Maryland, United States
  • 2011–2012
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Angeles, CA, United States
    • Vanderbilt University
      • Department of Neurological Surgery
      Nashville, MI, United States
  • 2009
    • Kennedy Krieger Institute
      Baltimore, Maryland, United States