Kaisorn L Chaichana

Johns Hopkins University, Baltimore, Maryland, United States

Are you Kaisorn L Chaichana?

Claim your profile

Publications (129)416.05 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hydrocephalus can develop secondarily to a disturbance in production, flow and/or absorption of cerebrospinal fluid. Experimental models of hydrocephalus, especially subacute and chronic hydrocephalus, are few and limited, and the effects of hydrocephalus on the subventricular zone are unclear. The aim of this study was to analyze the effects of long-term obstructive hydrocephalus on the subventricular zone, which is the neurogenic niche lining the lateral ventricles. We developed a new method to induce hydrocephalus by obstructing the aqueduct of Sylvius in the mouse brain, thus simulating aqueductal stenosis in humans. In 120-day-old rodents (n=18 per group), the degree of ventricular dilatation and cellular composition of the subventricular zone were studied by immunofluorescence and transmission electron microscopy. In adult patients (age>18years), the sizes of the subventricular zone, corpus callosum, and internal capsule were analyzed by magnetic resonance images obtained from patients with and without aqueductal stenosis (n=25 per group). Mice with 60-day hydrocephalus had a reduced number of Ki67+ and doublecortin+cells on immunofluorescence, as well as decreased number of neural progenitors and neuroblasts in the subventricular zone on electron microscopy analysis as compared to non-hydrocephalic mice. Remarkably, a number of extracellular matrix structures (fractones) contacting the ventricular lumen and blood vessels were also observed around the subventricular zone in mice with hydrocephalus. In humans, the widths of the subventricular zone, corpus callosum, and internal capsule in patients with aqueductal stenosis were significantly smaller than age and gender-matched patients without aqueductal stenosis. In summary, supratentorial hydrocephalus reduces the proliferation rate of neural progenitors and modifies the cytoarchitecture and extracellular matrix compounds of the subventricular zone. In humans, this similar process reduces the subventricular niche as well as the width of corpus callosum and internal capsule.
    Full-text · Article · May 2014 · Experimental Neurology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Glioblastoma is the most common adult primary malignant intracranial cancer. It is associated with poor outcomes because of its invasiveness and resistance to multimodal therapies. Human adipose-derived mesenchymal stem cells (hAMSC) are a potential treatment because of their tumor tropism, ease of isolation, and ability to be engineered. In addition, bone morphogenetic protein 4 (BMP4) has tumor-suppressive effects on glioblastoma and glioblastoma brain tumor-initiating cells (BTIC), but is difficult to deliver to brain tumors. We sought to engineer BMP4-secreting hAMSCs (hAMSCs-BMP4) and evaluate their therapeutic potential on glioblastoma. The reciprocal effects of hAMSCs on primary human BTIC proliferation, differentiation, and migration were evaluated in vitro. The safety of hAMSC use was evaluated in vivo by intracranial coinjections of hAMSCs and BTICs in nude mice. The therapeutic effects of hAMSCs and hAMSCs-BMP4 on the proliferation and migration of glioblastoma cells as well as the differentiation of BTICs, and survival of glioblastoma-bearing mice were evaluated by intracardiac injection of these cells into an in vivo intracranial glioblastoma murine model. hAMSCs-BMP4 targeted both the glioblastoma tumor bulk and migratory glioblastoma cells, as well as induced differentiation of BTICs, decreased proliferation, and reduced the migratory capacity of glioblastomas in vitro and in vivo. In addition, hAMSCs-BMP4 significantly prolonged survival in a murine model of glioblastoma. We also demonstrate that the use of hAMSCs in vivo is safe. Both unmodified and engineered hAMSCs are nononcogenic and effective against glioblastoma, and hAMSCs-BMP4 are a promising cell-based treatment option for glioblastoma. Clin Cancer Res; 20(9); 2375-87. ©2014 AACR.
    Full-text · Article · May 2014 · Clinical Cancer Research

  • No preview · Article · Feb 2014 · Journal of Neurological Surgery, Part B: Skull Base
  • Source
    Kaisorn L Chaichana

    Preview · Article · Jan 2014 · Neuro-Oncology
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study uses OCT and optical property mapping to detect brain tumors in vivo in mice bearing human glioblastoma and in fresh ex vivo brain tissues from 32 patients with high sensitivity and specificity.
    No preview · Conference Paper · Jan 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionSurgery is first-line therapy for glioblastoma, and there is evidence that gross total resection is associated with improved survival. Gross total resection, however, is not always possible, and relationships among extent (percent) of resection (EOR), residual volume (RV), and survival are unknown. The goals were to evaluate whether there is an association between EOR and RV with survival and recurrence and to establish minimum EOR and maximum RV thresholds.Methods Adult patients who underwent primary glioblastoma surgery from 2007 to 2011 were retrospectively reviewed. Three-dimensional volumetric tumor measurements were made. Multivariate proportional hazards regression analysis was used to evaluate the relationship between EOR and RV with survival and recurrence.ResultsOf 259 patients, 203 (78%) died and 156 (60%) had tumor recurrence. The median survival and progression-free survival were 13.4 and 8.9 months, respectively. The median (interquartile range) pre- and postoperative tumor volumes were 32.2 (14.0-56.3) and 2.1 (0.0-7.9) cm(3), respectively. EOR was independently associated with survival (hazard ratio [HR], 0.995; 95% confidence interval [CI]: 0.990-0.998; P = .008) and recurrence (HR [95% CI], 0.992 [0.983-0.998], P = .005). The minimum EOR threshold for survival (P = .0006) and recurrence (P = .005) was 70%. RV was also associated with survival (HR [95% CI], 1.019 [1.006-1.030], P = .004) and recurrence (HR [95% CI], 1.024 [1.001-1.044], P = .03). The maximum RV threshold for survival (P = .01) and recurrence (P = .01) was 5 cm(3).Conclusion This study shows for the first time that both EOR and RV are significantly associated with survival and recurrence, where the thresholds are 70% and 5 cm(3), respectively. These findings may help guide surgical and adjuvant therapies aimed at optimizing outcomes for glioblastoma patients.
    Full-text · Article · Nov 2013 · Neuro-Oncology
  • [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionSurgery is first-line therapy for glioblastoma, and there is evidence that gross total resection is associated with improved survival. Gross total resection, however, is not always possible, and relationships among extent (percent) of resection (EOR), residual volume (RV), and survival are unknown. The goals were to evaluate whether there is an association between EOR and RV with survival and recurrence and to establish minimum EOR and maximum RV thresholds.MethodsAdult patients who underwent primary glioblastoma surgery from 2007 to 2011 were retrospectively reviewed. Three-dimensional volumetric tumor measurements were made. Multivariate proportional hazards regression analysis was used to evaluate the relationship between EOR and RV with survival and recurrence.ResultsOf 259 patients, 203 (78%) died and 156 (60%) had tumor recurrence. The median survival and progression-free survival were 13.4 and 8.9 months, respectively. The median (interquartile range) pre- and postoperative tumor volumes were 32.2 (14.0-56.3) and 2.1 (0.0-7.9) cm3, respectively. EOR was independently associated with survival (hazard ratio [HR], 0.995; 95% confidence interval [CI]: 0.990-0.998; P = .008) and recurrence (HR [95% CI], 0.992 [0.983-0.998], P = .005). The minimum EOR threshold for survival (P = .0006) and recurrence (P = .005) was 70%. RV was also associated with survival (HR [95% CI], 1.019 [1.006-1.030], P = .004) and recurrence (HR [95% CI], 1.024 [1.001-1.044], P = .03). The maximum RV threshold for survival (P = .01) and recurrence (P = .01) was 5 cm3.ConclusionThis study shows for the first time that both EOR and RV are significantly associated with survival and recurrence, where the thresholds are 70% and 5 cm3, respectively. These findings may help guide surgical and adjuvant therapies aimed at optimizing outcomes for glioblastoma patients.
    No preview · Article · Nov 2013 · Neuro-Oncology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Object: Posterior lumbar spinal fusion for degenerative spine disease is a common procedure, and its use is increasing annually. The rate of infection, as well as the factors associated with an increased risk of infection, remains unclear for this patient population. A better understanding of these features may help guide treatment strategies aimed at minimizing infection for this relatively common procedure. The authors' goals were therefore to ascertain the incidence of postoperative spinal infections and identify factors associated with postoperative spinal infections. Methods: Data obtained in adult patients who underwent instrumented posterior lumbar fusion for degenerative spine disease between 1993 and 2010 were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify factors associated with infection. Variables with p < 0.05 were considered statistically significant. Results: During the study period, 817 consecutive patients underwent lumbar fusion for degenerative spine disease, and 37 patients (4.5%) developed postoperative spine infection at a median of 0.6 months (IQR 0.3-0.9). The factors independently associated with an increased risk of infection were increasing age (RR 1.004 [95% CI 1.001-1.009], p = 0.049), diabetes (RR 5.583 [95% CI 1.322-19.737], p = 0.02), obesity (RR 6.216 [95% CI 1.832-9.338], p = 0.005), previous spine surgery (RR 2.994 [95% CI 1.263-9.346], p = 0.009), and increasing duration of hospital stay (RR 1.155 [95% CI 1.076-1.230], p = 0.003). Of the 37 patients in whom infection developed, 21 (57%) required operative intervention but only 3 (8%) required instrumentation removal as part of their infection management. Conclusions: This study identifies that several factors--older age, diabetes, obesity, prior spine surgery, and length of hospital stay--were each independently associated with an increased risk of developing infection among patients undergoing instrumented lumbar fusion for degenerative spine disease. The overwhelming majority of these patients were treated effectively without hardware removal.
    Preview · Article · Nov 2013 · Journal of neurosurgery. Spine

  • No preview · Conference Paper · Oct 2013

  • No preview · Conference Paper · Oct 2013

  • No preview · Article · Oct 2013 · International Journal of Radiation OncologyBiologyPhysics

  • No preview · Article · Oct 2013 · International Journal of Radiation OncologyBiologyPhysics
  • [Show abstract] [Hide abstract]
    ABSTRACT: The management of patients with brain metastases is typically dependent on their prognosis. Recursive partitioning analysis (RPA) is the most commonly used method for prognosticating survival, but has limitations for patients in the intermediate class. The aims of this study were to ascertain preoperative risk factors associated with survival, develop a preoperative prognostic grading system, and evaluate the utility of this system in predicting survival for RPA Class 2 patients. Adult patient who underwent intracranial metastatic tumor surgery at an academic tertiary-care institution from 1997-2011 were retrospectively reviewed. Multivariate proportional hazards regression analysis was used to identify preoperative factors associated with survival. The identified associations were then used to develop a grading system. Survival as a function of time was plotted using Kaplan-Meier method, and survival rates were compared using Log-rank analyses. 421 (59%) of 708 patients were RPA2. The preoperative factors found to be associated with poorer survival were: male gender (p<0.0001), motor deficit (p=0.0007), cognitive deficit (p=0.0004), non-solitary metastases (p=0.002), and tumor size >2cm (p=0.003). Patients possessing 0-1, 2, and 3-5 of these variables were assigned a preoperative grade of A, B, and C, respectively. Patients with a preoperative grade of A, B, and C had a median survival of 17.0, 10.3, and 7.3 months, respectively. These grades all had distinct survival times (p<0.05). The present study devised a preoperative grading system that may provide prognostic information for RPA2 patients, which may also guide medical and surgical therapies before any intervention is pursued.
    No preview · Article · Sep 2013 · World Neurosurgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with cerebellar and non-cerebellar metastases are often included in the same study population, even though posterior fossa lesions typically have different presenting symptoms, clinical outcomes, and complications. This is because the outcomes for patients with cerebellar metastases are unclear. Adult patients who underwent surgery for an intracranial metastasis (single or multiple) between 2007 and 2011 were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify an association between cerebellar location with survival and recurrence. Of the 708 patients who underwent intracranial metastatic surgery, 140 (19.8%) had surgery for cerebellar metastasis. A cerebellar location was associated with poorer survival [RR (95% CI); 1.231 (1.016?1.523), P = 0.04] and increased spinal recurrence [RR (95% CI); 2.895 (1.491?5.409), P = 0.002], but not local (P = 0.61) or distal recurrence (P = 0.88). The factors independently associated with prolonged survival for patients with cerebellar metastases were: decreasing number of intracranial metastases (P = 0.0002), decreasing tumor size (P = 0.002), and radiation (P = 0.0006). The factors associated with prolonged local progression free survival were: decreasing tumor size (P = 0.0009), non small cell lung cancer (NSCLC) (P = 0.006), non-bladder cancer (P = 0.0005), and post-operative radiation therapy (P = 0.02). The factors independently associated with prolonged distal progression free survival were: age > 40 years (P = 0.02), surgical resection (P = 0.01), and whole brain radiation (WBRT) therapy (P = 0.02). Patients with cerebellar metastases have more distinct clinical presentations and outcomes than patients with non-cerebellar lesions. The findings of this study may help risk stratify and guide treatment regimens aimed at maximizing outcomes for patients with cerebellar metastases.
    No preview · Article · Sep 2013 · Neurological Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with a variety of different primary cancers can develop intracranial metastases. Patients who develop intracranial metastases are often grouped into the same study population, and therefore an understanding of outcomes for patients with different primary cancers remain unclear. Adults who underwent intracranial metastatic tumor surgery from 1997?2011 at a single institution were retrospectively reviewed. Primary pathologies were compared using Fisher's exact and Student's t-test, and Cox regression analysis was used to identify factors associated with survival. About 708 patients underwent surgery during the reviewed period, where 269(38%) had non-small cell lung cancer (NSCLC), 106(15%) breast cancer (BC), 72(10%) gastrointestinal (GI) cancers, 88(12%) renal cell cancer (RCC), and 88(12%) melanoma. The most notable differences were that NSCLC patients were older, BC younger, BC had more primary tumor control, and NSCLC less extracranial spread. BC had longer survival, RCC had longer local progression free survival (PFS), and NSCLC had longer distal PFS. The factors independently associated with survival for NSCLC (female, recursive partitioning analysis (RPA) class, primary tumor control, solitary metastasis, tumor size, adenocarcinoma, radiation, discharge to home), BC (age, no skull base involvement, radiation), GI cancer (age, RPA class, Karnofsky performance scale (KPS), lack of preoperative motor deficit, non-esophageal tumors, non-hemorrhagic tumors, avoidance of new deficits), melanoma (preoperative seizures, solitary metastasis, smaller tumor size, discharge to home, chemotherapy), and RCC (KPS, chemotherapy) were distinctly different. These differences between patients with different primary cancers support the fact that patients with intracranial disease are not all the same and should be studied by their primary pathology.
    No preview · Article · Aug 2013 · Neurological Research
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Glioblastoma is the most common and aggressive type of primary brain tumor in adults. Average survival is approximately 1year, but individual survival is heterogeneous. Using a single institutional experience, we have previously identified preoperative factors associated with survival and devised a prognostic scoring system based on these factors. The aims of the present study are to validate these preoperative factors and verify the efficacy of this scoring system using a multi-institutional cohort. Of the 334 patients in this study from three different institutions, the preoperative factors found to be negatively associated with survival in a Cox analysis were age >60years (p<0.0001), Karnofsky Performance Scale score ⩽80 (p=0.03), motor deficit (p=0.02), language deficit (p=0.04), and periventricular tumor location (p=0.04). Patients possessing 0-1, 2, 3, and 4-5 of these variables were assigned a preoperative grade of 1, 2, 3, and 4, respectively. Patients with a preoperative grade of 1, 2, 3, and 4 had a median survival of 17.9, 12.3, 10, and 7.5months, respectively. Survival of each of these grades was statistically significant (p<0.05) in log-rank analysis. This grading system, based only on preoperative variables, may provide patients and physicians with prognostic information that may guide medical and surgical therapy before any intervention is pursued.
    Full-text · Article · Aug 2013 · Journal of Clinical Neuroscience
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Skull base metastases (SBMs) are rare lesions in close proximity to critical neural and vasculature structures. This rarity and complexity have led many to only offer nonsurgical therapies. The surgical outcomes for patients with SBM therefore remain unknown. Design Retrospective, comparison analyses. Setting Johns Hopkins Hospital. Participants All patients who underwent intracranial metastatic tumor surgery. Main Outcome Measure Survival and recurrence. Results Of the 708 patients who underwent intracranial metastatic tumor surgery, 29 (4%) had SBM: 3 (10%) involved the anterior skull base, 7 (24%) the sella, 6 (21%) the orbit, 2 (7%) the sphenoid wing, 3 (10%) the clivus, 4 (14%) the petrous bone, and 4 (14%) the paranasal sinuses. Following surgery, 6 (50%) had improvements in vision and 14 (88%) had improvement and/or maintenance of their cranial nerve symptoms. Three (10%), 0(0%), and 1(3%) developed a new motor, language, and vision deficit, respectively. There were no differences in median survival (10.0 versus 9.2 months, p = 0.48) and local progression-free survival (PFS) (p = 0.52), but there was improved distal PFS (p = 0.04) between patients with and without SBM. Conclusions Patients with SBM are relatively rare. These patients can tolerate surgery with minimal morbidity and mortality, and they have similar prognoses to patients without SBM.
    No preview · Article · Aug 2013 · Journal of Neurological Surgery, Part B: Skull Base
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this video series is to document how indocyanine green (ICG) videography can be used prior to dural opening to help identify and preserve potentially critical draining veins into the sagittal sinus during resection of parasagittal lesions. For both patients, a craniotomy was performed in close juxtaposition to the sagittal sinus. ICG (0.25mg/kg dose) was administered intravenously just prior to dural opening. Using a microscope equipped with fluorescent filters, real-time flow assessment of the underlying veins was done. The identified veins were marked on the dural surface. Dural opening was made by dissecting around these vessels. After tumor resection, ICG was re-administered and videoangiography was conducted to confirm vascular integrity. We document the application of ICG videoangiography using 3-D video recording for two cases of parasagittal meningiomas. We present first a 61-year-old woman with motor seizures in the right side and a tumor volume of 48.32 cc. The second is a 30-year-old woman with right leg weakness and a tumor volume of 16.96 cc. The information provided by this technology changed the surgical procedure. ICG angiography could be divided in arterial, capillary, and venous phases comparable with what is seen in digital subtraction cerebral angiography. This tool not only helps identify critical draining veins that could be injured during dural opening, but also demonstrated vascular integrity after lesion removal. The ICG administration and videoangiography during and after parasagittal tumor resection can be used to avoid vascular damage in neurosurgery.
    Full-text · Article · Jun 2013 · Neurosurgery
  • Kaisorn L Chaichana · Alfredo Quinones-Hinojosa

    No preview · Article · May 2013 · Nature Reviews Neurology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Surgery is first line therapy for glioblastoma (GB) and there is evidence that gross total resection (GTR) is associated with improved survival. GTR, however, is not always possible and the relationship between percent resection (EOR) and survival is unclear. The goals of this study were to evaluate if there is an association between EOR and survival for all GB, eloquent GB, and GB capable of GTR. A better understanding of these associations may help to optimize surgical care for patients with GB. Methods: Adult patients who underwent surgery of a newly diagnosed intracranial GB at an academic tertiary-care institution from 2007-2011 were retrospectively reviewed. Pre and postoperative volumes were measured in a semi-automated fashion using MRI with gadolinium obtained prior to and within 48 hours after surgery. Cox regression analysis was used to identify if an association existed between volumetric EOR and survival. Tumor location was assessed by three neurosurgeons blinded to patient outcomes. Results: 292 patients met the inclusion criteria, where 128 involved eloquent (motor and/or language) cortex and 87 were capable of GTR. The median survival of all patients was 12.7 months, and the median[IQR] pre and postoperative tumor volumes were 29.5 [13.1-54.3]cm3 and 2.8 [0.1-10.5]cm3, respectively. For all GB, increasing EOR was independently associated with survival [HR(95%CI); 0.994(0.990-0.997), p=0.0008], and the minimum EOR survival threshold was >70%. For eloquent tumors, EOR was also independently associated with prolonged survival [HR(95%CI); 0.406(0.240-0.700), p=0.001], and the minimum EOR was >65%. For patients where GTR could be achieved, EOR was independently associated with prolonged survival [HR(95%CI); 0.972(0.958-0.986), p=0.006], and the minimum EOR was >95% (p=0.01). Discussion: Surgery for GB requires a fine balance between EOR and avoiding iatrogenic deficits. This study establishes thresholds necessary for prolonging survival for patients with GB, which differs between patients with and without eloquent tumors.
    No preview · Conference Paper · May 2013

Publication Stats

2k Citations
416.05 Total Impact Points

Institutions

  • 2006-2015
    • Johns Hopkins University
      • • Department of Neurosurgery
      • • Department of Orthopaedic Surgery
      Baltimore, Maryland, United States
  • 2014
    • Johns Hopkins Bloomberg School of Public Health
      Baltimore, Maryland, United States
  • 2008-2014
    • Johns Hopkins Medicine
      • Department of Neurosurgery
      Baltimore, Maryland, United States
  • 2007
    • Duke University
      Durham, North Carolina, United States