Publications by authors named "Alexander M Tucker"

19 Publications

  • Page 1 of 1

Acute neurological injury in pediatric patients with single-ventricle congenital heart disease.

J Neurosurg Pediatr 2021 Jul 9:1-9. Epub 2021 Jul 9.

4Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia.

Objective: Single-ventricle congenital heart disease (CHD) in pediatric patients with Glenn and Fontan physiology represents a unique physiology requiring the surgical diversion of the systemic venous return from the superior vena cava (Glenn) and then the inferior vena cava (Fontan) directly to the pulmonary arteries. Because many of these patients are on chronic anticoagulation therapy and may have right-to-left shunts, arrhythmias, or lymphatic disorders that predispose them to bleeding and/or clotting, they are at risk of experiencing neurological injury requiring intubation and positive pressure ventilation, which can significantly hamper pulmonary blood flow and cardiac output. The aim of this study was to describe the complex neurological and cardiopulmonary interactions of these pediatric patients after acute central nervous system (CNS) injury.

Methods: The authors retrospectively analyzed the records of pediatric patients who had been admitted to a quaternary children's hospital with CHD palliated to bidirectional Glenn (BDG) or Fontan circulation and acute CNS injury and who had undergone intubation and mechanical ventilation. Patients who had been admitted from 2005 to 2019 were included in the study. Clinical characteristics, surgical outcomes, cardiovascular and pulmonary data, and intracranial pressure data were collected and analyzed.

Results: Nine pediatric single-ventricle patients met the study inclusion criteria. All had undergone the BDG procedure, and the majority (78%) were status post Fontan palliation. The mean age was 7.4 years (range 1.3-17.3 years). At the time of acute CNS injury, which included traumatic brain injury, intracranial hemorrhage, and cerebral infarct, the median time interval from the most recent cardiac surgical procedure was 3 years (range 2 weeks-11 years). Maintaining normocarbia to mild hypercarbia for most patients during intubation periods did not cause neurological deterioration, and hemodynamic profiles were more favorable as compared to periods of hypocarbia. Hypocarbia was associated with unfavorable hemodynamics but was necessary to decrease intracranial hypertension. Most patients were managed using low mean airway pressure (MAWP) in order to minimize the impact on preload and cardiac output.

Conclusions: The authors highlight the complex neurological and cardiopulmonary interactions with respect to partial pressure of arterial CO2 (PaCO2) and MAWP when pediatric CHD patients with single-ventricle physiology require mechanical ventilation. The study data demonstrated that tight control of PaCO2 and minimizing MAWP with the goal of early extubation may be beneficial in this population. A multidisciplinary team of pediatric critical care intensivists, cardiac intensivists and anesthesiologists, and pediatric neurosurgeons and neurologists are recommended to ensure the best possible outcomes.
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http://dx.doi.org/10.3171/2021.2.PEDS2142DOI Listing
July 2021

Systematic review and evaluation of predictive modeling algorithms in spinal surgeries.

J Neurol Sci 2021 01 2;420:117184. Epub 2020 Nov 2.

Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, United States; Departments of Office of the Patient Experience, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, United States; Departments of Radiation Oncology, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, United States; Departments of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, United States; Departments of UCLA Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, United States; Department of Neurosurgery, Harbor-UCLA Medical Center, 1000 W Carson St, Torrance, CA 90509, United States; Department of Los Angeles Biomedical Research Institute (LA BioMed), Harbor-UCLA Medical Center, 1000 W Carson St, Torrance, CA 90509, United States. Electronic address:

In order to better educate patients, predictive models have been implemented to stratify surgical risk, thereby instituting greater uniformity across surgical practices and prioritizing the safety and outcomes of patients. The purpose of this study is to conduct a systematic review summarizing the major predictive models used to evaluate patients as candidates for spinal surgery. A search was conducted for articles related to predictive modeling in spinal surgeries using PubMed, MEDLINE, and Scopus databases. Papers with area under the receiver operating curve (AUROC) scores reported were included in the analysis. Models not relevant to spinal procedures were excluded. Comparison between models was only attainable for those that reported AUROCs for individual procedures. Based on a combination of AUROC scores and demonstrated applicability to spinal procedures, the models by Scheer et al. (0.89), Ratliff et al. (0.70), the Seattle Spine Score (0.712), Risk Assessment Tool (0.67-0.7), and the Spine Sage calculator (0.81-0.85) were determined to be ideal for predictive modeling in spinal surgeries and were subsequently broken down into their individual inputs and outputs to determine what elements a theoretical model should assimilate. Alongside the model by Scheer et al., the Spine Sage calculator, Seattle Spine Score, Risk Assessment Tool, and a model by Ratliff et al. showed the most promise for patients undergoing spinal procedures. Using the first model as a springboard, new spinal predictive models can be optimized through use of larger prospective databases, with longer follow-up times, and greater inclusion of reliable high impact variables.
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http://dx.doi.org/10.1016/j.jns.2020.117184DOI Listing
January 2021

Mechanical failure of the Mobi-C implant for artificial cervical disc replacement: report of 4 cases.

J Neurosurg Spine 2020 Jul 31:1-7. Epub 2020 Jul 31.

1Department of Neurosurgery, University of California, Los Angeles.

Cervical spondylosis is one of the most commonly treated conditions in neurosurgery. Increasingly, cervical disc replacement (CDR) has become an alternative to traditional arthrodesis, particularly when treating younger patients. Thus, surgeons continue to gain a greater understanding of short- and long-term complications of arthroplasty. Here, the authors present a series of 4 patients initially treated with Mobi-C artificial disc implants who developed postoperative neck pain. Dynamic imaging revealed segmental kyphosis at the level of the implant. All implants were locked in the flexion position, and all patients required reoperation. This is the first reported case series of symptomatic segmental kyphosis after CDR.
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http://dx.doi.org/10.3171/2020.5.SPINE19442DOI Listing
July 2020

Epilepsy surgery for Rasmussen encephalitis: the UCLA experience.

J Neurosurg Pediatr 2020 Jul 17:1-9. Epub 2020 Jul 17.

Departments of1Neurosurgery.

Objective: Rasmussen encephalitis (RE) is a rare inflammatory neurological disorder typically involving one hemisphere and resulting in drug-resistant epilepsy and progressive neurological decline. Here, the authors present seizure outcomes in children who underwent epilepsy surgery for RE at a single institution.

Methods: The records of consecutive patients who had undergone epilepsy surgery for RE at the UCLA Mattel Children's Hospital between 1982 and 2018 were retrospectively reviewed. Basic demographic information, seizure history, procedural notes, and postoperative seizure and functional outcome data were analyzed.

Results: The cohort included 44 patients, 41 of whom had sufficient data for analysis. Seizure freedom was achieved in 68%, 48%, and 22% of the patients at 1, 5, and 10 years, respectively. The median time to the first seizure for those who experienced seizure recurrence after surgery was 39 weeks (IQR 11-355 weeks). Anatomical hemispherectomy, as compared to functional hemispherectomy, was independently associated with a longer time to postoperative seizure recurrence (HR 0.078, p = 0.03). There was no statistically significant difference in postoperative seizure recurrence between patients with complete hemispherectomy and those who had less-than-hemispheric surgery. Following surgery, 68% of the patients could ambulate and 84% could speak regardless of operative intervention.

Conclusions: A large proportion of RE patients will have seizure relapse after surgery, though patients with anatomical hemispherectomies may have a longer time to postoperative seizure recurrence. Overall, the long-term data in this study suggest that hemispheric surgery can be seen as palliative treatment for seizures rather than a cure for RE.
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http://dx.doi.org/10.3171/2020.4.PEDS2098DOI Listing
July 2020

Neurosurgical management of Currarino syndrome: A case series and review of literature.

Surg Neurol Int 2019 24;10:70. Epub 2019 Apr 24.

Department of Neurosurgery, University of Washington, Seattle.

Background: The Currarino syndrome (CS), defined by the triad of anorectal malformations, sacral bone deformities, and presacral masses, is rare. There are few surgical series that discuss conservative management versus the surgical approaches to these lesions. Here, we describe utilizing a combined anterior and posterior approach for resecting these lesions in four patients.

Methods: Four patients with CS were treated with two-stage approaches performed by a multidisciplinary team, including pediatric neurosurgery and general surgery. The first anterior laparoscopic approach mobilized the presacral mass from its ventral attachments. The second posterior procedure detethered the spinal cord, repaired the dural defect, and facilitated removal of the presacral mass.

Results: Gross total resection of all four presacral masses was accomplished without intraoperative complication; all patients clinically improved.

Conclusion: The CS is characterized by a large presacral mass. Here, one must rule out malignancy and also consider diagnosis/resection due to the risks for malignant transformation. The operative approach we described in four patients utilized standard anterior mobilization of the mass, followed by posterior detethering, dural repair, and ultimate resection.
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http://dx.doi.org/10.25259/SNI-26-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744743PMC
April 2019

Epithelioid Osteoblastoma of the Temporal Bone: A Case Report.

World Neurosurg 2019 Mar 3;123:378-382. Epub 2018 Dec 3.

Department of Pathology, University of California, Los Angeles, California, USA. Electronic address:

Background: Epithelioid osteoblastoma of the cranium is extremely rare and can mimic other etiologies on radiographic imaging, pathology, and symptomatology.

Case Description: An 18-year-old male patient had a 3-week history of a palpable left temporal mass. Magnetic resonance imaging revealed a large, extra-axial, hypervascular mass in the left temporal bone, with bony erosion and intracranial extension. The patient underwent surgical near gross-total resection of the mass. Initial frozen microscopic examination of the tumor was inconclusive. The postoperative course was uneventful, and the patient was discharged a few days later. Final pathology confirmed the diagnosis of epithelioid osteoblastoma.

Conclusions: Epithelioid osteoblastoma of the skull base is exceedingly rare but should be included in the differential diagnoses of all extra axial tumors. Preoperative radiographic clues are limited, and final diagnosis relies solely on accurate pathologic examination. A diagnosis of epithelioid osteoblastoma should be considered for all cranial bone-based tumors, as an incorrect diagnosis of another radiographic and histologic mimic could lead to the patient receiving unnecessary and harmful neoadjuvant/adjuvant chemotherapy or radiotherapy.
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http://dx.doi.org/10.1016/j.wneu.2018.11.209DOI Listing
March 2019

Red Blood Cell Transfusions Following Resection of Skull Base Meningiomas: Risk Factors and Clinical Outcomes.

J Neurol Surg B Skull Base 2018 Dec 14;79(6):599-605. Epub 2018 May 14.

Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, United States.

 This article identifies risk factors for and investigates clinical outcomes of postoperative red blood cell transfusion in patients with skull base meningiomas.  Retrospective cohort study.  Single academic medical center.  The transfusion group included patients who had skull base meningiomas and who received packed red blood cell (RBC) transfusion within 7 days of surgery. The no transfusion group included patients who had skull base meningiomas but who did not have RBCs transfused within 7 days of surgery.  In-hospital complication rate, length of stay (LOS), and discharge disposition.  One hundred and ninety-six patients had a craniotomy for resection of a meningioma at our institution from March 2013 to January 2017. Seven patients had skull base meningiomas and received RBC transfusion within 7 days of surgery (the transfusion group). The skull base was an independent risk factor for transfusion after we controlled for the effect of meningioma size (OR 3.89, 95% CI 1.34, 11.25). Operative time greater than 10 hours was an independent risk factor for prolonged hospital stay (OR 8.84, 95% CI 1.08, 72.10) once we controlled for the effect of transfusion. In contrast, transfusion did not independently impact LOS or discharge disposition once we controlled for the effect of operative time.  The skull base is an independent predictor of RBC transfusion. However, RBC transfusion alone cannot predict LOS or discharge disposition in patients who undergo surgical resection of a skull base meningioma.
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http://dx.doi.org/10.1055/s-0038-1651502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6239878PMC
December 2018

Dermoid Cyst of the Prepontine Cistern and Meckel's Cave: Illustrative Case and Systematic Review.

J Neurol Surg B Skull Base 2018 Apr 11;79(2):139-150. Epub 2017 Aug 11.

Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States.

 Dermoid cysts are benign, congenital malformations that account for ∼0.5% of intracranial neoplasms. The authors describe a 42-year-old female with a prepontine dermoid cyst who underwent apparent gross total resection (GTR) but experienced cyst recurrence. To date, very few cases of prepontine dermoid cysts have been reported. The prevalent region where these cysts are located can be difficult to determine. In addition, the authors systematically review the literature to characterize the clinical presentation, anatomical distribution, and surgical outcomes of intracranial dermoid cysts.  Systematic review.  PubMed, Web of Science, and Scopus databases.  Extent of resection, symptom improvement, and recurrence rates.  A total of 69 patients with intracranial dermoid cysts were identified. Three (4.3%) intracranial dermoid cysts were located in the prepontine cistern. The average age of patients was 33.3 years. The most common presenting symptoms were headache (52.2%) and visual disturbances (33.3%). Intracranial dermoid cysts were distributed similarly throughout the anterior, middle, and posterior cranial fossae (29.0%, 36.2%, and 29.0%, respectively). GTR was achieved in 42.0% of cases. Thirty-four (49.3%) patients experienced symptom resolution. Recurrence rate was 5.8% at a mean follow-up of 2.1 years.  Intracranial dermoid cysts most often present as headaches and visual disturbances. Intracranial dermoid cysts were found in the anterior, middle, and posterior cranial fossae at similar frequencies but with clear predilections for the Sylvian fissure, sellar region, and cerebellar vermis. Outcomes following surgical excision of intracranial dermoid cysts are generally favorable despite moderate rates of GTR.
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http://dx.doi.org/10.1055/s-0037-1604332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978864PMC
April 2018

Simultaneous cerebrospinal fluid and hematologic metastases in a high-grade ependymoma.

Surg Neurol Int 2018 26;9:93. Epub 2018 Apr 26.

Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA.

Background: Ependymomas are relatively uncommon tumors that constitute about 7% of all primary intracranial neoplasms. Among these, high-grade ependymomas are locally aggressive and recur most commonly at the primary site following resection. Ependymomas are also known to be the one glial neoplasm that tends to frequently metastasize inside and outside the central nervous system (CNS) that complicates workup and management. Metastasis due to surgical manipulation is common and neurosurgeons should be well-versed in the most effective methods to remove these tumors in order to avoid such metastases.

Case Description: Here, we report a case of a 28-year-old female who initially presented with a parenchymal World Health Organization (WHO) grade III anaplastic ependymoma of the occipital lobe without metastasis. After multiple resections, the patient showed no evidence of disease recurrence for 2 years. During follow-up, new metastasis to the frontal lobe as well as to the lung were discovered 2 years after the initial surgery, without recurrence at the tumor's primary site.

Conclusions: While uncommon, this case demonstrates the possibility for ependymomas to metastasize via cerebrospinal fluid to other locations within the CNS and hematologically to extraneural locations without recurring locally.
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http://dx.doi.org/10.4103/sni.sni_475_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938895PMC
April 2018

Survival Outcomes After Intracranial Hemorrhage in Liver Disease.

Oper Neurosurg (Hagerstown) 2019 02;16(2):138-146

Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California.

Background: Survival outcomes for patients with liver disease who suffer an intracranial hemorrhage (ICH) have not been thoroughly investigated.

Objective: To understand survival outcomes for 3 groups: (1) patients with an admission diagnosis of liver disease (end-stage liver disease [ESLD] or non-ESLD) who developed an ICH in the hospital, (2) patients with ESLD who undergo either operative vs nonoperative management, and (3) patients with ESLD on the liver transplant waitlist who developed an ICH in the hospital.

Methods: We retrospectively reviewed hospital charts from March 2006 through February 2017 of patients with liver disease and an ICH evaluated by the neurosurgery service at a single academic medical center. The primary outcome was survival.

Results: We included a total of 53 patients in this study. The overall survival for patients with an admission diagnosis of liver disease who developed an ICH (n = 29, 55%) in the hospital was 22%. Of those patients with an admission diagnosis of liver disease, 27 patients also had ESLD. Kaplan-Meier analysis found no significant difference in survival for ESLD patients (n = 33, 62%) according to operative status. There were 11 ESLD patients on the liver transplant waitlist. The overall survival for patients with ESLD on the liver transplant waitlist who suffered an in-hospital ICH (n = 7, 13%) was 14%.

Conclusion: ICH in the setting of liver disease carries a grave prognosis. Also, a survival advantage for surgical hematoma evacuation in ESLD patients is not clear.
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http://dx.doi.org/10.1093/ons/opy096DOI Listing
February 2019

Next Generation Case Report: Supraorbital Craniotomy for Anterior Communicating Artery Aneurysm Clipping in Annotated Virtual Reality Environment.

Oper Neurosurg (Hagerstown) 2018 11;15(5):E73-E76

Department of Neurosurgery, University of California-Los Angeles, Los Angeles, California.

Background And Importance: Recent years have seen significant advancements in virtual reality. Implementation of this technology in combination with traditional learning methods is a powerful tool for medical teaching.

Clinical Presentation: This is a 60-yr-old woman who presented with a history of headaches and was found to have an unruptured 4-mm anterior communicating artery aneurysm. After discussion, the patient elected to have the aneurysm treated by surgical clipping. The aneurysm was completely occluded through a supraorbital craniotomy with a single clip. The patient was discharged home in good condition on postoperative day 2. This case was imported into a virtual reality environment with annotated slides and operative video for resident teaching.

Conclusion: As virtual reality technology continues to grow, library of interactive case reports could revolutionize neurosurgical education.
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http://dx.doi.org/10.1093/ons/opy039DOI Listing
November 2018

End-Stage Liver Disease in Patients with Intracranial Hemorrhage Is Associated with Increased Mortality: A Cohort Study.

World Neurosurg 2018 May 13;113:e320-e327. Epub 2018 Feb 13.

Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Head & Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA. Electronic address:

Objective: To determine if end-stage liver disease (ESLD) in patients with intracranial hemorrhage (ICH) is associated with increased mortality.

Methods: This single-center, retrospective cohort study included 53 patients (33 in ESLD cohort and 20 in non-ESLD cohort) who received neurosurgical care between 2006 and 2017. ESLD was defined clinically as severely impaired liver function and at least 1 major complication of liver failure. The primary outcome was mortality.

Results: Overall, in-hospital, and 30-day mortality rates were higher in the ESLD cohort versus the non-ESLD cohort (79 vs. 30%, 79 vs. 20%, and 64 vs. 25%, all P ≤ 0.01). We identified a significant difference in overall survival between ESLD and non-ESLD cohorts on Kaplan-Meier analysis (P = 0.004 with log-rank and Wilcoxon tests). Odds of overall, in-hospital, and 30-day mortality in the ESLD cohort were 8.67 (95% confidence interval [CI], 2.44-30.84), 14.86 (95% CI, 3.75-58.90), and 5.25 (95% CI, 1.53-18.08). Other predictors of overall mortality included primary admission diagnosis of liver disease (odds ratio [OR] = 9.60; 95% CI, 3.75-58.90), higher Child-Pugh (OR = 1.64; 95% CI, 2.66-34.67) and Model for End-Stage Liver Disease (OR = 1.12; 95% CI, 1.04-1.20) scores, lower Glasgow Coma Scale score (OR = 0.73; 95% CI, 0.61-0.88), ICH that developed in the hospital (OR = 4.11; 95% CI, 1.21-13.98), and intraparenchymal hemorrhage (OR = 9.23; 95% CI, 1.72-49.56).

Conclusions: ESLD in patients with ICH is associated with increased mortality.
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http://dx.doi.org/10.1016/j.wneu.2018.02.025DOI Listing
May 2018

Solitary tectal abscess in an immunocompetent patient.

Surg Neurol Int 2017 24;8:257. Epub 2017 Oct 24.

Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.

Background: A solitary abscess involving the tectum, specifically by , is an extremely rare condition with no known reported cases to date.

Case Description: Here, we present a case of isolated solitary midbrain tectum abscess in an immunocompetent 28-year-old male who was empirically diagnosed as a primary tectal tumor at an outside hospital where he also underwent placement of a ventriculoperitoneal shunt (VPS) for obstructive hydrocephalus. Eight weeks later he was readmitted with a VPS infection. He was transferred to our institution where the VPS was removed and he was started on broad-spectrum antibiotics. Cerebrospinal fluid (CSF) culture revealed . All other workup was negative for infectious etiologies. The tectal lesion completely resolved after 15 weeks of intravenous ceftriaxone without surgical aspiration.

Conclusion: We suggest that an empiric diagnosis of tectal glioma should be made with caution for a ring-enhancing mass. CSF should be routinely cultured at the time of operative diversion if abscess is a possibility.
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http://dx.doi.org/10.4103/sni.sni_211_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680667PMC
October 2017

Fatal Colloid Cysts: A Systematic Review.

World Neurosurg 2017 Nov 8;107:409-415. Epub 2017 Aug 8.

Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, USA; Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA; Los Angeles Biomedical Research Institute (LA BioMed), Harbor-UCLA Medical Center, Torrance, California, USA. Electronic address:

Objective: To accurately describe patient characteristics and the clinical presentation of fatal colloid cysts.

Methods: A systematic literature search of 3 popular databases was performed. Inclusion criteria were individuals with sudden-onset death and colloid cysts identified on imaging and/or autopsy. The cause of death must have been ascribed to the colloid cyst to be eligible for data extraction. Deaths precipitated by lumbar puncture were excluded. Clinical data were extracted and descriptive statistics were ascertained. Subgroup analyses were performed to compare adults with pediatric patients.

Results: A total of 107 patients were included in the quantitative synthesis. The mean age was 28.5 years (standard deviation 13.3, range 6-79 years). Male and female patients were affected equally. Headache was the most frequent symptom (n = 86, 80%). There were 6 patients (5 adults and 1 child) who reported positional headaches. The mean duration of signs and symptoms was shorter in adults versus pediatric patients (2.1 days vs. 6.5 days, P = 0.02), and more adults presented with signs and symptoms for less than 24 hours than did pediatric patients (38% vs. 6%, P = 0.01). Colloid cyst mean diameter was 2.0 cm (standard deviation 1.1, range 0.5-7.9 cm) and 96% measured 1 cm or larger.

Conclusions: Our data suggests that the prodrome preceding sudden death in the setting of a colloid cyst may be shorter in adults. Also, most fatal colloid cysts measured 1 cm or larger.
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http://dx.doi.org/10.1016/j.wneu.2017.07.183DOI Listing
November 2017

Isolated Transverse Process Fractures and Markers of Associated Injuries: The Experience at University of California, Los Angeles.

World Neurosurg 2017 Aug 28;104:82-88. Epub 2017 Apr 28.

Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Comprehensive Spine Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. Electronic address:

Objectives: To report a single-institution experience with isolated transverse process fractures (ITPFs) and provide increasing support for the development of evidence-based guidelines. The authors also evaluated the presence of concerning symptoms or red flags that may indicate additional, underlying injuries in the setting of ITPFs.

Methods: The Ronald Reagan UCLA Medical Center patient database was queried (years 2005-2016) using International Classification of Diseases, Ninth Revision, code 805: fracture of the vertebral column without mention of spinal cord injury.

Results: A total of 129 patients with ITPFs were identified. Mean age was 38.1 years (range 15-92 years). Women were more likely to present with abdominal pain and associated kidney injury (P = 0.018 and P = 0.012, respectively). Motor vehicle accident (MVA) was the most common mechanism of injury (n = 81, 62.8%) and was associated with thoracic (P = 0.032) and lower extremity pain/injury (P = 0.005). Back pain was the most common presenting symptom (n = 71, 64.6%) and was associated with intraabdominal and lower extremity injuries (P = 0.032 and P = 0.016, respectively). Chest and neck pain were associated with vascular injuries (P < 0.001 and P = 0.001, respectively). Spine consult (neurosurgery or orthopedic surgery) was frequent (n = 94, 72.9%) and was more common after MVA versus fall (P = 0.018).

Conclusions: Several factors were identified as significant markers of associated injuries, including female sex, MVA, and presenting symptoms. Neck and chest pain were significantly associated with vascular injuries. Clinicians should maintain high indices of suspicion for associated injuries in patients with ITPFs, especially after high-velocity mechanisms.
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http://dx.doi.org/10.1016/j.wneu.2017.04.137DOI Listing
August 2017

Analyzing the efficacy of frequent sodium checks during hypertonic saline infusion after elective brain tumor surgery.

Clin Neurol Neurosurg 2017 May 22;156:24-28. Epub 2017 Feb 22.

Departments of Neurosurgery, Los Angeles, United States; Radiation Oncology, Los Angeles, United States; Head and Neck Surgery, Los Angeles, United States; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, United States. Electronic address:

Objective: To assess the utility of frequent sodium checks (every 6h) in patients receiving hypertonic saline (HS) after elective brain tumor surgeries.

Patients And Methods: A single-institution retrospective review of patients having undergone elective craniotomies for brain tumors and treated with postoperative continuous intravenous infusions of 3% HS was performed. Changes in serum sodium values were analyzed at different time points. The rates of <12.5, 25, and 50cc/h infusions were also examined. Healthcare cost analysis was performed by extrapolating our cohort to the total number of craniotomies performed in the United States.

Results: No significant differences among sodium values checked between 0 to 4, 4-6, 6-8, 8-10, and >10h were observed (P=.64). In addition, no differences in serum sodium values among the rates of <12.5, 25, and 50cc/h were found (P=.30). No patients developed symptoms of acute hypernatremia.

Conclusions: Serum sodium values did not significantly change more than 10h after infusion of HS. Further studies are needed to determine the optimal frequency of routine sodium checks to increase the quality of care and decrease healthcare costs.
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http://dx.doi.org/10.1016/j.clineuro.2017.02.011DOI Listing
May 2017

CT-negative, MRI GRE-positive primary motor cortex contusion causing isolated foot drop.

Surg Neurol Int 2016 9;7(Suppl 28):S756-S758. Epub 2016 Nov 9.

Department of Neurosurgery, University of California-Los Angeles, Los Angeles, California, USA.

Background: Isolated acute foot drop due to traumatic brain injury is exceedingly rare and is often misdiagnosed during initial evaluation. Here, we present the case of a patient who presented with left foot drop after falling off a bicycle.

Case Description: The patient is a 55-year-old male who was mountain biking when he fell, hit his head, and lost consciousness. Neurologic examination of the left leg revealed foot drop, no sensory deficits, and 3+ reflexes at the knee and ankle with clonus. Electroencephalography, computed tomography (CT) of the head, magnetic resonance imaging (MRI) of the lumbar spine, and CT of the lower extremities were all negative. Only MRI of the brain with a gradient echo sequence revealed microhemorrhages focused around the right precentral gyrus. The patient underwent physical therapy, and by 3 months had regained full strength in his left leg.

Conclusion: Central causes of foot drop are exceptionally rare, however, they should be considered in all cases of post-traumatic dorsiflexion paresis. The key to the accurate diagnosis is a high index of suspicion as well as thorough and careful physical examination including reflex and sensory testing. Selective imaging modalities such as MRI or CT can then be used to verify the diagnosis.
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http://dx.doi.org/10.4103/2152-7806.193727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114858PMC
November 2016

TCR Sequencing Can Identify and Track Glioma-Infiltrating T Cells after DC Vaccination.

Cancer Immunol Res 2016 05 11;4(5):412-418. Epub 2016 Mar 11.

Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Although immunotherapeutic strategies are emerging as adjunctive treatments for cancer, sensitive methods of monitoring the immune response after treatment remain to be established. We used a novel next-generation sequencing approach to determine whether quantitative assessments of tumor-infiltrating lymphocyte (TIL) content and the degree of overlap of T-cell receptor (TCR) sequences in brain tumors and peripheral blood were predictors of immune response and overall survival in glioblastoma patients treated with autologous tumor lysate-pulsed dendritic cell immunotherapy. A statistically significant correlation was found between a higher estimated TIL content and increased time to progression and overall survival. In addition, we were able to assess the proportion of shared TCR sequences between tumor and peripheral blood at time points before and after therapy, and found the level of TCR overlap to correlate with survival outcomes. Higher degrees of overlap, or the development of an increased overlap following immunotherapy, was correlated with improved clinical outcome, and may provide insights into the successful, antigen-specific immune response. Cancer Immunol Res; 4(5); 412-8. ©2016 AACR.
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http://dx.doi.org/10.1158/2326-6066.CIR-15-0240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873445PMC
May 2016

Development of amplitude-integrated electroencephalography and interburst interval in the rat.

Pediatr Res 2009 Jan;65(1):62-6

Department of Child Health, University of Bristol, Bristol, BS2 8EG, United Kingdom.

Continuous monitoring of electrocortical brain activity with amplitude-integrated electroencephalography (aEEG) is important in neonatology. aEEG is affected by, for example, maturity, encephalopathy, and drugs. Neonatal research uses rat pups of different ages. Postnatal day (P) 7 rats are suggested to be equivalent neurodevelopmentally to near-term infants. We hypothesized that electroencephalography (EEG) and aEEG in P1-P21 rats follow the same developmental pattern with respect to background activity and the longest interburst interval (IBI) as that seen in infants from 23-wk gestational age (GA) to post-term. We examined aEEG and EEG on 49, unsedated rat pups with two clinical monitors. aEEG traces were analyzed for lower and upper margin amplitude, bandwidth and the five longest IBI in each trace were measured from the raw EEG. The median longest IBI decreased linearly with age by 5.24 s/d on average. The lower border of the aEEG trace was <5 microV until P7 and rose exponentially reaching 10 microV by P12. This correlated strongly with the decrease in IBI; both reflect increased continuity of brain activity with postnatal age. Based on aEEG trace analysis, the rat aEEG pattern at P1 corresponds to human aEEG at 23-wk gestation; P7 corresponds to 30-32 wk and P10 to 40-42 wk.
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http://dx.doi.org/10.1203/PDR.0b013e3181891316DOI Listing
January 2009
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