Publications by authors named "Mohammed A Fouda"

10 Publications

  • Page 1 of 1

Predictors of progression in radiation-induced versus nonradiation-induced pediatric meningiomas: a large single-institution surgical experience.

J Neurosurg Pediatr 2021 Jun 11:1-7. Epub 2021 Jun 11.

1Department of Neurosurgery, Boston Children's Hospital.

Objective: The goal in this study was to outline unique differences between radiation-induced and nonradiation-induced pediatric meningiomas and to identify independent risk factors of tumor recurrence/progression.

Methods: This is a retrospective cohort study of all pediatric meningiomas diagnosed and surgically treated at the authors' institution between 1993 and 2017. Multivariable Cox regression was applied to identify independent risk factors for tumor recurrence/progression.

Results: Thirty-five patients were identified. The primary etiology was nonradiation-induced (n = 24: n = 3 with neurofibromatosis type 2) or radiation-induced (n = 11: acute lymphoblastic leukemia [n = 5], medulloblastoma [n = 4], germ cell tumor [n = 1], and primitive neuroectodermal tumor [n = 1]) meningioma. The mean age at time of diagnosis was 10.7 ± 5.7 years for nonradiation-induced and 17.3 ± 3.5 years for radiation-induced meningiomas. Overall, 8/24 patients with nonradiation-induced meningioma experienced either recurrence or progression of the tumor. Of the 8 patients with tumor recurrence or progression, the pathological diagnosis was clear cell meningioma (n = 3: 2 recurrent and 1 progressive); grade I (n = 2 progressive); grade I with atypical features (n = 2: 1 recurrent and 1 progressive); or atypical meningioma (n = 1 recurrent). None of the patients with radiation-induced meningioma experienced recurrence or progression. Predictors of tumor recurrence/progression by univariate analysis included age at time of diagnosis ≤ 10 years (p = 0.002), histological subtype clear cell meningioma (p = 0.003), and primary etiology nonradiation-induced meningioma (p = 0.04), and there was a notable trend with elevated MIB-1 staining index (SI) (p = 0.09). There was no significant difference between nonradiation-induced and radiation-induced meningiomas (p = 0.258), although there was a trend between recurrent and nonrecurrent meningiomas (p = 0.09). Multivariate Cox regression, adjusted for length of follow-up, identified younger age at diagnosis (p = 0.004) and a higher MIB-1 SI (p = 0.044) as independent risk factors for recurrence. Elevated MIB-1 SI statistically correlated with atypia (p < 0.001). However, there was no significant statistical correlation between tumor recurrence/progression and atypia (p = 0.2).

Conclusions: Younger patient age and higher MIB-1 SI are independent risk factors for recurrence. Atypia was not a predictor of recurrence.
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http://dx.doi.org/10.3171/2021.1.PEDS20819DOI Listing
June 2021

Management strategies for recurrent pediatric craniopharyngioma: new recommendations.

J Neurosurg Pediatr 2021 Mar 5:1-8. Epub 2021 Mar 5.

1Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.

Objective: The goal of this study was to identify the independent risk factors for recurrence or progression of pediatric craniopharyngioma and to establish predictors of the appropriate timing of intervention and best management strategy in the setting of recurrence/progression, with the aim of optimizing tumor control.

Methods: This is a retrospective cohort study of all pediatric patients with craniopharyngioma who were diagnosed and treated at Boston Children's Hospital between 1990 and 2017. This study was approved by the institutional review board at Boston Children's Hospital. All statistical analyses were performed using Stata software.

Results: Eighty patients (43 males and 37 females) fulfilled the inclusion criteria. The mean age at the time of diagnosis was 8.6 ± 4.4 years (range 1.2-19.7 years). The mean follow-up was 10.9 ± 6.5 years (range 1.3-24.6 years). Overall, 30/80 (37.5%) patients developed recurrence/progression. The median latency to recurrence/progression was 12.75 months (range 3-108 months). Subtotal resection with no adjuvant radiotherapy (p < 0.001) and fine calcifications (p = 0.008) are independent risk factors for recurrence/progression. An increase (%) in the maximum dimension of the tumor at the time of recurrence/progression was considered a statistically significant predictor of the appropriate timing of intervention.

Conclusions: Based on the identified independent risk factors for tumor recurrence/progression and the predictors of appropriate timing of intervention in the setting of recurrence/progression, the authors propose an algorithm for optimal management of recurrent pediatric craniopharyngioma to increase the likelihood of tumor control.
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http://dx.doi.org/10.3171/2020.9.PEDS20606DOI Listing
March 2021

Postoperative MR imaging surveillance of pediatric craniopharyngioma: new institutional guidelines.

Childs Nerv Syst 2021 03 3;37(3):853-861. Epub 2020 Oct 3.

Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA.

Purpose: To develop postoperative surveillance protocols that yield efficient detection rates of tumor recurrence or progression using fewer imaging studies and less cost.

Method: This is a retrospective cohort study of all pediatric craniopharyngioma patients who have been diagnosed and treated at Boston Children's Hospital (BCH) between 1990 and 2017. All statistical analyses were performed using Stata.

Results: Eighty patients (43 males and 37 females) fulfilled the inclusion criteria. The mean age at time of diagnosis was 8.6 ± 4.4 years. The mean follow-up period was 10.9 ± 6.5 years. Overall 30/80 (37.5%) patients experienced tumor recurrence/progression. The median latency to recurrence/progression was 12.75 months (range 3 to 108 months), with 76.6% of the recurrences/progressions taking place within the first 2 years postoperatively. Given the lack of any clinical symptoms/signs associated with the vast majority of the recurrent/progressed cases, we propose postoperative MR imaging surveillance protocols that are substantially less intensive than the current practice. Therefore, we recommend the following postoperative MR imaging surveillance protocols, stratified by management strategies; 0, 9, 15, 36, 48, and 60 months for patients who underwent GTR, 0, 3, 6,12, 18, and 24 months for patients who underwent STR alone and 0, 3, 12, 72, 96, and 120 months for patients who underwent STR followed by subsequent XRT.

Conclusion: The proposed postoperative MR imaging surveillance protocols would provide a potential 50% decrement of healthcare costs. It may also minify the psychological burden of frequent MR scanning for these patients and their families.
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http://dx.doi.org/10.1007/s00381-020-04901-2DOI Listing
March 2021

Novel predictive scoring system for morbid hypothalamic obesity in patients with pediatric craniopharyngioma.

Childs Nerv Syst 2021 02 4;37(2):403-410. Epub 2020 Sep 4.

TromboProtea Inc, Boston, MA, USA.

Purpose: To identify the independent risk factors for developing morbid hypothalamic obesity, to propose a predictive scoring system for morbid hypothalamic obesity, and to propose an algorithm for management in order to minimize the risk of developing morbid hypothalamic obesity in patients with pediatric craniopharyngioma.

Methods: A retrospective analysis of all pediatric craniopharyngioma patients diagnosed and treated at Boston Children's Hospital (BCH) between 1985 and 2017. Analysis of the data was conducted using IBM SPSS Statistics.

Results: We identified 105 patients, 90 (47 males and 43 females) fulfilled the inclusion criteria. The median age of patients at time of diagnosis was 8.4 years. The median follow-up was 10.6 years. Morbid hypothalamic obesity was evident in 28 (31.1%) patients at the last follow-up visit. Age of patients at time of diagnosis > 10 years (P = 0.023), preoperative body mass index (BMI) > 95th percentile (P = 0.006), and preoperative papilledema (P < 0.001) were the independent risk factors for developing morbid hypothalamic obesity.

Conclusion: We developed a unique predictive scoring system in order to differentiate between patients with and without high risk for developing morbid hypothalamic obesity.
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http://dx.doi.org/10.1007/s00381-020-04877-zDOI Listing
February 2021

Analysis of 2141 pediatric craniopharyngioma admissions in the USA utilizing the Kids' Inpatient Database (KID): predictors of discharge disposition.

Childs Nerv Syst 2020 12 3;36(12):3007-3012. Epub 2020 May 3.

Department of Neurosurgery, Boston Children's Hospital - Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.

Objectives: To recognize the national trends in management of pediatric craniopharyngioma and to address the significant predictors of discharge disposition.

Methods: We utilized the Kids' Inpatient Database (KID), a pediatric inpatient sample generated by the Healthcare Cost and Utilization Project (HCUP) triennially from 1997 to 2016.

Results: KID contains 2141 pediatric craniopharyngioma admissions. Patient demographics had no effect on discharge disposition. Based on the multivariable logistic regression analysis, we confirmed a significantly higher non-routine discharge rate among patients with hydrocephalus (P = 0.01). Patients who developed diabetes insipidus were at higher risk for non-routine discharge (P = 0.02). Admission of patients to a freestanding children's hospital increased the likelihood of routine discharge (P = 0.001).

Conclusion: Hydrocephalus, diabetes insipidus, and admission to a freestanding children's hospital are significant independent predictors of discharge disposition.
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http://dx.doi.org/10.1007/s00381-020-04640-4DOI Listing
December 2020

Sixty years single institutional experience with pediatric craniopharyngioma: between the past and the future.

Childs Nerv Syst 2020 02 10;36(2):291-296. Epub 2019 Jul 10.

Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.

Purpose: To demonstrate the paradigm shift in management strategies of pediatric craniopharyngioma at our institution over the past six decades.

Methods: Retrospective analysis of all pediatric patients with craniopharyngioma treated at Boston Children's Hospital between 1960 and 2017.

Results: One hundred seventy-eight patients with craniopharyngioma were treated between 1960 and 2017; 135 (70 males and 65 females) fulfilled the inclusion criteria. Forty-five patients were treated in the old era (1960-1984) and 90 patients were treated in the new era (1985-2017). Gross total resection (GTR) was achieved in 4% and 43% of patients in old and new eras respectively. Sub-total resection (STR) and radiotherapy (XRT) were performed in 27% and 28% of patients in old and new eras respectively. STR without XRT was performed in 20% and 29% of patients in old and new era respectively. Cyst drainage and adjuvant radiotherapy were performed in 49% of patients in the old era while no patients in the new era underwent such conservative management. Aggressive surgical resection was associated with a higher risk of worsening visual outcomes (20% vs 16%), panhypopituitarism and diabetes insipidus (86% vs 53%), psycho-social impairment (42% vs 26%), and new-onset obesity (33% vs 22%). The mortality rate was higher in the old era in comparison with that of the new one (9% vs 2%).

Conclusion: There was a paradigm shift in management strategies of pediatric craniopharyngioma over the past six decades which in turn affected the long-term outcomes and quality of life of patients.
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http://dx.doi.org/10.1007/s00381-019-04294-xDOI Listing
February 2020

Management of diastolic heart failure following cardiac surgery.

Eur J Cardiothorac Surg 2009 Feb 11;35(2):241-9. Epub 2008 Dec 11.

King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

A considerable number of patients who undergo cardiac surgery have a variety of comorbid conditions that includes diastolic dysfunction. Abnormalities of diastolic function may lead to diastolic heart failure that can complicate their postoperative course. This form of failure occurs more commonly in patients with hypertensive or valvular heart disease, diabetes mellitus, myocardial ischaemia, as well as in hypertrophic or restrictive cardiomyopathy, and is more prevalent in the elderly. In spite of it being a common cause of heart failure it remains underreported in the postoperative heart. We reviewed relevant literature analysing the different therapeutic approaches and formulated a management plan for diastolic heart failure in the postoperative heart in the intensive care environment based on the most current understanding of this form of cardiac failure.
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http://dx.doi.org/10.1016/j.ejcts.2008.10.038DOI Listing
February 2009

Comparison of neurological outcomes in patients undergoing conventional coronary artery bypass grafting, on-pump beating heart coronary bypass, and off-pump coronary bypass.

Neurosciences (Riyadh) 2007 Jan;12(1):35-41

Division of Cardiac Surgery, King Fahad Cardiac Center, Riyadh, Kingdom of Saudi Arabia.

Objective: To study the differences in the prevalence of neurological complications following coronary artery bypass (CAB) carried out by conventional, on-pump beating and off-pump techniques.

Methods: A retrospective analysis of all isolated coronary bypass operations (n=127) performed in King Fahad Cardiac Center, Riyadh over a period of one year starting from January 2005. Out of 127 patients, 73 underwent conventional CAB graft (CABG), 33 patents on-pump beating heart coronary bypass, and 21 had off pump coronary bypass grafting (OPCAB). All patients had preoperative carotid scans and those who developed neurological complications underwent CT-brain and expert neuro-psychiatric assessment.

Results: Preoperative characteristics of patients in all 3 groups were similar. The bypass times in the conventional CABG group were significantly longer than the on-pump beating group. The maximum number of grafts was in the on-pump beating group, followed by the conventional CABG, and the least in the OPCAB group. Seven out of 73 cases in the conventional bypass group developed neurological events of various severities. Only one out of 33 patients developed acute confusional state in the on-pump beating group and no neurological events were noticed in 21 patients operated by the OPCAB technique. Low ejection fraction, preoperative congestive cardiac failure, non-elective surgery and preoperative catastrophic state were found to be significant risk factors independent of the bypass technique.

Conclusion: This study shows no significant difference in the prevalence of neurological complications among different types of bypass surgery in our institution. There was a trend towards less neurological outcomes in the OPCAB and on-pump beating groups.
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January 2007

Aortic valve replacement in a patient with an aberrant left coronary artery.

Asian Cardiovasc Thorac Ann 2003 Jun;11(2):169-70

Division of Cardiac Surgery, College of Medicine and King Khalid University Hospital, PO Box 7805, Riyadh 11472, Saudi Arabia.

A 22-year-old male undergoing aortic valve replacement was found to have the left coronary ostium arising from the noncoronary cusp area in close proximity to the annulus. He could not be weaned off cardiopulmonary bypass after the operation, even after removal of a Teflon pledget thought to obstruct the left coronary ostium. He underwent bypass grafting to the left coronary system and was then easily weaned off cardiopulmonary bypass.
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http://dx.doi.org/10.1177/021849230301100220DOI Listing
June 2003