Publications by authors named "Vikram C Prabhu"

48 Publications

Dandy's hemispherectomies: historical vignette.

J Neurosurg 2021 May 14:1-7. Epub 2021 May 14.

To better understand Walter Dandy's intentions and the historical context of his work on hemispherectomy, the authors reviewed his original 1928 publication. Gliomas were considered incurable at that time. Presuming that the loss of motor function denoted a lack of useful tissue in that hemisphere, he pioneered radical removal of the involved cerebral hemisphere. Of the 5 patients operated on by Dandy, 1 died within 48 hours of hemorrhage because of a displaced vascular clip; 1 died of pneumonia in 2 weeks; 2 died of tumor recurrence, at 3 months and 3.5 years, respectively; and a fifth patient was lost to follow-up beyond the 2nd postoperative week. The authors queried the Thomson Reuters Web of Science and Scopus. A total of 88 papers fulfilled inclusion criteria. Half of these papers (44/88) were published after 2012. Only 11% of papers (10/88) quoted Dandy's paper accurately; half of them were published before 1997. Most publications (76% [67/88]) quoted Dandy incorrectly, all of them from 1997 and later. In the remaining 11 papers (13%), the accuracy of the quotes was unclear. The authors found a trend toward more accurate citation in earlier papers. Critically reviewing Dandy's report, with an understanding of the historical context, allows a better understanding of his intentions and the value of his contribution.
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http://dx.doi.org/10.3171/2020.9.JNS202824DOI Listing
May 2021

Effectiveness of a Standardized External Ventricular Drain Placement Protocol for Infection Control.

World Neurosurg 2021 May 4. Epub 2021 May 4.

Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

Introduction: Placement of an external ventricular drain (EVD) is a common procedure routinely completed at bedside by neurosurgical residents. A standardized protocol for placement and maintenance of an EVD is potentially useful.

Methods: This single-institution retrospective review analyzed all patients who underwent placement of an EVD over a 5-year span using a standardized protocol.

Results: A total of 428 EVDs in 381 patients were placed as per this protocol. Overall compliance with the practice protocol was 98.7%. Overall, our infection rate was 1.86% (8 external ventricular drain-related infection [ERIs] over 428 EVDs). There was no difference in age for the ERI cases (median 55, range (50.5-60.5), compared with the non-ERI cases (median of 53, range [38-65]) (P = 0.512). Indications for placement of EVD were hemorrhage (51.9%, n = 198), tumor (16.2%, n = 62), trauma (12.8%, n = 49), hydrocephalus (11.5%, n = 44), cerebellar stroke (2.8%, n = 11), infection (3.1%, n = 12), unknown (1.3%, n = 5). Most EVDs (77.6%, n = 296) were placed bedside by second-year residents (median PGY level 2, interquartile range 1-2.75). Computed tomography confirmed placement in the ipsilateral frontal horn in 72% (n = 277) of EVDs. EVD-related complications were noted in 8.3% of EVDs (n = 32, with 8 infections and 24 tract hemorrhages). The median EVD duration was 10 days; duration of EVD had no statistically significant impact on the risk of an ERI (P = 1). Only replacement of an EVD was associated with an increased risk of infection.

Conclusions: Adherence to a standard EVD placement protocol is useful in maintaining a low risk of ERI regardless of the duration of catheter utilization. Replacement of the catheter through the same access hole as the original catheter is associated with an increased risk of ERI.
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http://dx.doi.org/10.1016/j.wneu.2021.04.113DOI Listing
May 2021

Lumbar Drains for Vascular Procedures: An Institutional Protocol Review and Guidelines.

World Neurosurg 2021 May 5;149:e947-e957. Epub 2021 Feb 5.

Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

Background: Aortic disease requiring open or endovascular repair may result in spinal cord injury in approximately 2%-10% of patients. Cerebrospinal fluid diversion using lumbar drains (LDs) has been validated as a protective measure to mitigate this complication.

Methods: This single-institution retrospective study analyzed the implementation of a standardized protocol and subsequent educational intervention for LDs for aortic vascular procedures over a 4-year period.

Results: In 2016-2019, 45 patients had LDs placed for open or endovascular procedures; group 1 included 19 patients with LDs placed before protocol implementation, and group 2 included 26 patients with LDs placed as per the institutional protocol. Demographics and procedural details in both groups were similar. However, there was a significant difference in the number of patients who had emergent versus planned placement of the LD (group 1, 89.5%; group 2, 50%; P < 0.01), volume of cerebrospinal fluid drained (group 1, 453 mL; group 2, 197 mL; P < 0.01), and compliance with 10 mL/hour drainage recommendation (group 1, 68.4%; group 2, 100%; P < 0.01). In group 1, 5 (31.6%) patients experienced neurological complications compared with only 1 (3.8%) in group 2. LD-related complications occurred 3 patients (15.8%) in group 1, whereas none occurred in group 2. Survey results suggested increased health care worker protocol familiarity with educational interventions.

Conclusions: Implementation of an institutional protocol for LDs for open or endovascular procedures is feasible and beneficial. Educational modules improve familiarity among all health care providers, which can improve patient care and complication avoidance.
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http://dx.doi.org/10.1016/j.wneu.2021.01.068DOI Listing
May 2021

What is New in Neuro-oncology?

Neurol Clin 2021 02 7;39(1):163-179. Epub 2020 Nov 7.

Department of Neurology, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA; Lou & Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center.

Neuro-oncology is a rapidly developing field. A continuous evolution in the understanding of the molecular underpinnings of central nervous system tumors has helped reconfigure the classification of brain tumors. More importantly, it has laid the path forward for the development and investigation of new therapeutics. The authors discuss the classification of brain tumors and novel therapies in brain tumors as well as promising treatments underway.
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http://dx.doi.org/10.1016/j.ncl.2020.09.009DOI Listing
February 2021

Survival benefit of concomitant chemoradiation in adult supratentorial primary glioblastoma. A propensity score weighted population-based analysis.

J Neurosurg Sci 2020 Sep 24. Epub 2020 Sep 24.

Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL, USA.

Background: This population study aims to assess the impact of the implementation of the original Stupp protocol on overall survival in patients with new-diagnosed supratentorial primary GBM.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to study the survival of histologically confirmed adult supratentorial GBM patients diagnosed between 1998 and 2016. Kaplan-Meier, and a univariate and propensity-score weighted multivariate Cox proportional hazard model adjusted for age at diagnosis, sex, race, marital status and extent of resection was used to assess the survival of patients prior to implementation of the Stupp protocol in 2005 (Pre-Stupp) and following implementation of the Stupp Protocol until 2016 (Post Stupp).

Results: 6,390 patients satisfied inclusion exclusion criteria. Median survival times were 13 months for the Pre-Stupp and 15 months for Post-Stupp groups (p<0.001). The 1-,2-, 5- and 10- year survival rates for the Pre-Stupp group were 51, 18, 5 and 2% respectively compared to 59, 27, 8 and 4% on the Post-Stupp group. Propensity-score weighted analysis showed a lower mortality risk for patients who underwent concomitant chemoradiation during the Post-Stupp era [HR 0.77, 95% CI 0.62-0.94]. There was a 42 percent relative reduction in the risk of death for patients treated during the Post-Stupp era.

Conclusions: This population-based propensity-score study with long-term follow-up suggests that the implementation of the Stupp protocol in 2005 had a positive impact on the survival of patients with supratentorial GBM. This "real-world" analysis validates the results of the original randomized control trial on which this protocol is based.
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http://dx.doi.org/10.23736/S0390-5616.20.05023-7DOI Listing
September 2020

Acute Neurological Complications of Brain Tumors and Immune Therapies, a Guideline for the Neuro-hospitalist.

Curr Neurol Neurosci Rep 2020 06 29;20(8):32. Epub 2020 Jun 29.

Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Abbott Hall 1114, Chicago, IL, 60611, USA.

Purpose Of Review: Patients with brain tumors presenting to the emergency room with acute neurologic complications may warrant urgent investigations and emergent management. As the neuro-hospitalist will likely encounter this complex patient population, an understanding of the acute neurologic issues will have value.

Recent Findings: We discuss updated information and management regarding various acute neurologic complications among neuro-oncology patients and neurologic complications of immunotherapy. Understanding of the acute neurologic complications associated with central nervous system tumors and with common contemporary cancer treatments will facilitate the neuro-hospitalist management of these patient populations. While there are aspects analogous to the diagnosis and management in the non-oncologic population, a number of unique features discussed in this review should be considered.
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http://dx.doi.org/10.1007/s11910-020-01056-0DOI Listing
June 2020

Fetal Bovine Collagen Grafts for Repair of Tegmen Defects and Encephaloceles Via Middle Cranial Fossa Approach.

Ear Nose Throat J 2021 Jun 13;100(3_suppl):347S-351S. Epub 2020 Apr 13.

Department of Neurological Surgery, 25815Loyola University Medical Center, Maywood, IL, USA.

To evaluate the use of commercially available allogenic dural graft materials made of fetal bovine collagen, we present an analysis of our case series with use of autologous and allogenic graft materials. Patients who underwent surgical repair of a tegmen tympani defect associated with ipsilateral conductive hearing loss and cerebrospinal fluid (CSF) otorrhea using a middle cranial fossa (MCF) approach from 2004 to 2018 at Loyola University Medical Center were included. Resolution of CSF otorrhea, audiologic outcomes, facial nerve preservation, and surgical complications was analyzed. Thirty-three patients with an average age of 55.3 years (range: 21-78, standard deviation [SD]: 12.9) and body mass index of 34.4 (range: 22-51, SD: 7.4) underwent an MCF repair of a tegmen and dural defect. All patients presented with CSF otorrhea and conductive hearing loss ipsilateral to the defect. Repairs were made with combinations of allograft and autograft in 17 cases, allograft only in 15 cases, and autograft only in 5 cases. Improvement in hearing was noted in 33 cases, and resolution of CSF otorrhea was noted in 36 cases; one patient required repeat surgery which resolved CSF otorrhea. Three patients had minor complications; all these were in the autograft group. The MCF approach coupled with the use of fetal bovine collagen grafts is a safe and viable method to repair tegmen tympani and associated dural defects with salutary outcomes and low morbidity.
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http://dx.doi.org/10.1177/0145561320906906DOI Listing
June 2021

Brachial Plexitis After Stem Cell Transplant.

World Neurosurg 2020 Apr 11;136:74-76. Epub 2020 Jan 11.

Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

Background: Brachial plexitis is characterized by acute onset pain followed by weakness due to dysfunction of the nerves constituting the brachial plexus. The exact pathophysiology of this condition remains unknown but it is known to follow acute infections, such as a viral illness.

Case Description: We describe a case of idiopathic brachial plexitis in a patient after a peripheral stem cell transplant. The acute denervation of nerves in the brachial plexus may be due to reconstitution of his immune system. This is a rare entity and can be a diagnostic dilemma.

Conclusions: Brachial plexitis may follow peripheral stem cell transplantation. Awareness of this phenomenon is helpful to clinicians involved in the care of these patients.
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http://dx.doi.org/10.1016/j.wneu.2019.12.169DOI Listing
April 2020

Commentary: Anatomical Variations in the Location of Veins Draining Into the Anterior Superior Sagittal Sinus: Implications for the Transbasal Approach.

Oper Neurosurg (Hagerstown) 2020 06;18(6):E207-E208

Department of Neurological Surgery, Loyola University Medical Center/Stritch School of Medicine, Chicago, Illinois.

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http://dx.doi.org/10.1093/ons/opz368DOI Listing
June 2020

Synergistic Therapies for Recurrent Malignant Gliomas.

World Neurosurg 2020 01 15;133:237-239. Epub 2019 Oct 15.

Department of Radiation Oncology, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA.

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http://dx.doi.org/10.1016/j.wneu.2019.10.033DOI Listing
January 2020

Caudal Homeobox Gene-2 Staining Defines Intracranial Mature Teratoma with Differentiation to Colonic Adenocarcinoma.

World Neurosurg 2019 Dec 11;132:239-244. Epub 2019 Sep 11.

Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

Background: Malignant transformation of a mature intracranial teratoma into an adenocarcinoma is an extremely rare event and portends a poor prognosis. The clinical progression, radiographic changes, histopathological findings, and immunohistochemistry findings from these unique cases might provide clues regarding this transformation. Caudal homeobox gene-2 (CDX-2) is a specific and robust marker for colonic adenocarcinomas and can also be used to identify differentiation of mature intracranial teratoma into colonic-type adenocarcinoma. To the best of our knowledge, this is the first case report of the use of this specific marker for an intracranial malignancy.

Case Description: We present the case of a 55-year-old right-handed Hispanic-American woman with progressive headaches who was found to have a left posterior parietotemporal tumor with intraventricular extension. Surgical debulking was performed, and the pathologic examination revealed a mature teratoma. Despite surgical resection and radiotherapy, the teratoma progressed to a malignant mature intracranial teratoma both radiographically and histologically. Histological analysis of the third specimen revealed a moderately differentiated adenocarcinoma. The tumor cells were positive for CDX-2 and cytokeratin 20 and negative for cytokeratin 7 and thyroid transcription factor-1, consistent with an enteric/colonic-type adenocarcinoma, demonstrating progressive atypia and malignancy.

Conclusions: Malignant transformation of a mature intracranial teratoma portends a poor prognosis. The exact histopathological diagnosis can facilitate treatment of these patients. CDX-2 is a specific robust marker for identifying differentiation of a mature intracranial teratoma into a colonic adenocarcinoma. This positive staining can also be observed in primary colonic and other adenocarcinomas. To the best of our knowledge, this is the first report of the use of CDX-2 in the diagnosis of an intracranial malignancy. The triangulation of clinical progression, radiographic findings, and histopathological and immunohistochemistry findings provided clues regarding this unique transformation.
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http://dx.doi.org/10.1016/j.wneu.2019.08.216DOI Listing
December 2019

Mercury vs. Water: An Analysis of Multi-Institutional Survey Data Assessing Intracranial Pressure Unit of Measure Awareness.

World Neurosurg 2019 Sep 6;129:e657-e662. Epub 2019 Jun 6.

Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA.

Background: Intracranial pressure (ICP) reporting impacts neurosurgical care. Millimeters of mercury (mmHg) and centimeters of water (cmHO) are both used to report ICP in clinical practice and the literature. In this study, we investigated ICP unit of measure awareness in the neurosurgical community.

Methods: A survey was conducted at four US academic neurosurgery departments asking the following questions: What is your threshold for a concerning ICP? How many minutes is that ICP sustained for you to be concerned? What unit are you implying when you state that ICP? What unit of measure is an ICP reported on the monitor when transduced? When setting an external ventricular drain Becker bag level, what unit of measure do you set it to? Do you ever manually check an ICP based on a column of cerebrospinal fluid? How many cmHO is 20 mmHg?

Results: An ICP of 20 and sustained for five minutes were the two most common answers. Some 71% of residents and 34% of attendings reported using cmHO as the unit of measure; 18% of residents and 24% of attendings implied different units when discussing ICP than the unit they thought was transduced; and 53% of residents and 34% of attendings did not know the transduced ICP unit of measure reported in their intensive care unit.

Conclusions: Variability and discrepancies regarding the ICP unit of measure exist in academic neurosurgery departments. Clinicians should familiarize themselves with their hospital's practices. Institutions and all of medicine may consider standardizing the ICP unit of measure, using mmHg as a universal nomenclature.
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http://dx.doi.org/10.1016/j.wneu.2019.05.238DOI Listing
September 2019

Value of K -67 Labeling Index in Predicting Recurrence of WHO Grade I Cranial Base Meningiomas.

J Neurol Surg B Skull Base 2019 Jun 6;80(3):287-294. Epub 2018 Sep 6.

Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States.

 Assess impact of K -67 labeling index (LI; K -67 LI) on risk of recurrence or progression of WHO grade I meningiomas.  Retrospective study of adult patients who underwent resection of cranial base meningioma between 2004 and 2016.  272 patients fulfilled criteria for inclusion in the study. Average age was 61.8 years; 196 (72%) were females. Simpson's grade 1 resection was noted in 77 patients (32%), grade 2 in 39 (16%), grade 3 in 36 (15%), and grade 4 in 88 (37%). The K -67 LI was low (1-4%) in 214 (78.7%), intermediate (5-9%) in 44 (16.2%), and high (>10%) in 14 (5.2%). Median follow-up was 39 months (IQR: 16-71 months); 221 (87.1%) tumors remained stable or did not recur, 19 (7.4%) recurred, and 14 (5.5%) progressed. Compared with tumors with low K -67 LI, those with intermediate K -67 LI had 2.47 times (2.47 [1.09-5.59],  = 0.03), and those with high K -67 LI had 3.38 times (3.38 [1.16-9.89],  = 0.03) higher risk of recurrence or progression. Tumors with K -67 LI > 4% had a shorter time to recurrence or progression (  = 0.01). Recurrence or progression-free survival rates at 3, 5, and 10 years for tumors with low K -67 LI were 95%, 89%, and 75%, respectively; tumors with intermediate K -67 LI, 87%, 69%, and 52%, respectively; tumors with high K -67 LI, 78%, 49%, and 49%, respectively.  Following surgical resection of a WHO grade I cranial base meningioma, K -67 LI > 4% may predict an increased risk of recurrence or progression of residual tumor.
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http://dx.doi.org/10.1055/s-0038-1669387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534743PMC
June 2019

ResearchGate; Quo Vadis?

World Neurosurg 2019 08 10;128:131-133. Epub 2019 May 10.

Department of Neurology, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA.

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http://dx.doi.org/10.1016/j.wneu.2019.05.016DOI Listing
August 2019

Glioblastoma with primitive neuronal component: Cytologic findings in intraoperative squash preparations.

Diagn Cytopathol 2019 Mar 23;47(3):234-237. Epub 2018 Nov 23.

Department of Pathology, Loyola University Medical Center, Maywood, Illinois.

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http://dx.doi.org/10.1002/dc.23996DOI Listing
March 2019

Oligometastatic Disease State Is Associated with Improved Local Control in Patients Undergoing Three or Five Fraction Spine Stereotactic Body Radiotherapy.

World Neurosurg 2019 Feb 13;122:e342-e348. Epub 2018 Oct 13.

Department of Radiation Oncology, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

Background: The objective of our study was to describe the local control (LC) outcomes with 3- or 5-fraction stereotactic body radiotherapy (SBRT) to the spine in patients with oligometastatic (≤5 systemic metastases) versus polymetastatic disease (>5 metastases).

Methods: We retrospectively reviewed the outcomes of patients who had undergone SBRT for spinal metastases. No patients had undergone previous surgical intervention or had spinal cord compression. All patients were treated with 3-fraction (median dose, 27 Gy; range, 24-30 Gy) or 5-fraction (median dose, 35 Gy; range, 25-40 Gy) SBRT. The Kaplan-Meier method and Spine Response Assessment in Neuro-Oncology criteria were used to determine LC.

Results: We included 61 patients with a total of 72 distinct SBRT targets who had been treated from August 2007 to June 2017. The median follow-up period was 13.58 months. We treated 20 targets and 52 targets with 3 and 5 fractions, respectively. Thirteen patients (18.1%) had undergone previous RT to the SBRT area. Twenty patients (35% of the distinct SBRT targets) had an oligometastatic disease state. The 1-year LC rate was 83% for the entire cohort. On univariable analysis, polymetastases (1-year LC, 73.8% vs. 100%; P = 0.07) showed a trend toward worse LC. On multivariable analysis, patients with an oligometastatic state (hazard ratio, 0.21; P = 0.04) had improved LC.

Conclusions: Our study was hypothesis-generating in that patients with an oligometastatic disease state appear to have improved LC after SBRT, suggesting a biological advantage exists with local therapy for this group of patients not seen for patients with polymetastatic disease.
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http://dx.doi.org/10.1016/j.wneu.2018.10.044DOI Listing
February 2019

The Quest for Predicting Sustained Shunt Response in Normal-Pressure Hydrocephalus: An Analysis of the Callosal Angle's Utility.

World Neurosurg 2018 Jul 1;115:e717-e722. Epub 2018 May 1.

Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA.

Background: Diagnosing normal-pressure hydrocephalus (NPH) and selecting patients who will experience a sustained benefit from fluid diversion surgery remains challenging. This study seeks to evaluate the association between the callosal angle (CA) and the long-term postoperative response to ventriculoperitoneal shunt surgery in a different subgroup population than previously studied to assess its generalizability.

Methods: We studied 72 patients with idiopathic NPH who underwent ventriculoperitoneal shunt surgery and had at least 18 months of follow-up between 2000 and 2016. We recorded their pre- and postoperative symptoms according to the NPH Eide scale and their comorbidities with the Kiefer index. Their CA, as well as Evans' Index, ventricular height, and transependymal signal were measured. Multivariable statistical models were used to determine which factors were associated with postoperative improvement while we controlled for the presence of the NPH triad.

Results: Fifty-nine patients (82%) demonstrated a successful response to surgery at their first postoperative follow-up. However, this declined to 54 patients (75%) at 1 year and 45 (62.5%) patients at their last follow-up. When we controlled for the presence of the triad of symptoms, the CA significantly predicted a good, sustained response to surgery; for every degree decrease in the CA, a patient is 4% more likely to experience benefit from surgery.

Conclusions: The CA is a useful preoperative prognostic tool for predicting which patients will experience a sustained benefit from surgery. Further studies are required to clarify this disease in the context of old age, comorbidity, and possible concomitant neurodegenerative diseases.
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http://dx.doi.org/10.1016/j.wneu.2018.04.150DOI Listing
July 2018

High-grade meningiomas: biology and implications.

Neurosurg Focus 2018 04;44(4):E2

1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and.

The epochal developments in the treatment of meningioma-microsurgery, skull base techniques, and radiation therapy-will be appended to include the rational application of targeted and immune therapeutics, previously ill-fitting concepts for a tumor that has traditionally been a regarded as a surgical disease. The genomic and immunological architecture of these tumors continues to be defined in ever-greater detail. Grade I meningiomas are driven by NF2 alterations or mutations in AKT1, SMO, TRAF7, PIK3CA, KLF4, POLR2A, SUFU, and SMARCB1. Higher-grade tumors, however, are driven nearly exclusively by NF2/chr22 loss and are marked by infrequent targetable mutations, although they may harbor a greater mutation burden overall. TERT mutations may be more common in tumors that progress in histological grade; SMARCE1 alteration has become a signature of the clear cell subtype; and BAP1 in rhabdoid variants may confer sensitivity to pharmacological inhibition. Compared with grade I meningiomas, the most prominent alteration in grade II and III meningiomas is a significant increase in chromosomal gains and losses, or copy number alterations, which may have behavioral implications. Furthermore, integrated genomic analyses suggest phenotypic subgrouping by methylation profile and a specific role for PRC2 complex activation. Lastly, there exists a complex phylogenetic relationship among recurrent high-grade tumors, which continues to underscore a role for the most traditional therapy in our arsenal: surgery.
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http://dx.doi.org/10.3171/2017.12.FOCUS17756DOI Listing
April 2018

Surgical Results of Common Peroneal Nerve Neuroplasty at Lateral Fibular Neck.

World Neurosurg 2018 Apr 31;112:e465-e472. Epub 2018 Jan 31.

Department of Neurological Surgery, Loyola University Medical Center - Stritch School of Medicine, Maywood, Illinois, USA. Electronic address:

Background: Common peroneal nerve (CPN) compressive neuropathy is the most common lower-extremity entrapment neuropathy.

Materials And Methods: A retrospective review of a prospectively maintained single-institution database of all patients with CPN palsy who underwent decompression and neuroplasty over a 5-year period was performed.

Results: Thirty patients underwent a neuroplasty of the CPN over a 5-year period (2010-2015) at our institution. The median age was 45 years, and there was a male preponderance. The average time between first onset of symptoms to surgery was 122.9 weeks and between first clinic visit and surgery was 21 weeks. The etiology of the CPN neuropathy was as follows: in 12 patients, it followed a surgical procedure and in 14 patients, it occurred after a trauma to the lower extremity. In 2 patients, it occurred as a result of a mass lesion compromising the nerve and in 1 patient, a local infection predisposed to CPN palsy. Right and left lower extremities were equally involved. The median body mass index was 28.6. The most common presentation was weakness of the tibialis anterior (TA) and extensor hallucis longus (EHL) and loss of sensation in the distribution of the CPN or one of its major branches. Pain was a presenting symptom in 16 patients. Only 12 of the 30 patients had a positive Tinel's sign at the site of compression over the lateral fibular neck. Preoperative electrophysiologic confirmation of CPN neuropathy was available in all patients. Mean follow-up was 52 weeks. Prone positioning and selective use of the operating microscope provided excellent visualization and surgical exposure of the CPN from the lower popliteal region to the peroneal tunnel. Average operating room time was 170 minutes and average skin-to-skin time 91 minutes. Clinical improvement after surgery in terms of motor function was noted in 24 of the 26 patients who presented with a motor deficit. The most consistent improvement was noted in the TA and EHL; a trend toward greater improvement with shorter time to surgery was noted. No complications related to the surgical site or CPN were encountered, and no patient had a decline in their neurologic examination as a consequence of the surgery. One patient developed a positioning-related right upper-extremity brachial plexus neuropraxic injury after surgery that recovered completely.

Conclusions: Common peroneal neuropathy usually presents with weakness of the TA and EHL and decreased sensation or pain in the distribution of the CPN. Microscope-assisted surgical neuroplasty of the CPN at the lateral fibular neck with the patient in a prone position allows decompression of the nerve from the lower popliteal region to the peroneal tunnel. Significant improvement in motor strength after surgery, particularly of the TA and EHL, was observed in this series.
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http://dx.doi.org/10.1016/j.wneu.2018.01.061DOI Listing
April 2018

Cranial Base Meningiomas.

World Neurosurg 2018 01 7;109:258-262. Epub 2017 Oct 7.

Department of Neurological Surgery, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA.

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http://dx.doi.org/10.1016/j.wneu.2017.09.207DOI Listing
January 2018

Identification of Preoperative and Intraoperative Risk Factors for Complications in the Elderly Undergoing Elective Craniotomy.

World Neurosurg 2017 Nov 7;107:216-225. Epub 2017 Aug 7.

Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

Background: Neurosurgical patients are aging as the general population is becoming older.

Methods: A retrospective review of patients ≥65 years of age who underwent an elective craniotomy from 2007 to 2015 to identify risk factors for 30-day morbidity/mortality was conducted. Key preoperative variables included age, comorbidities, and functional status based on the Karnofsky Performance Status score and modified Rankin Scale score. Outcome variables included long-term care (LTC) complications, neurologic complications, systemic/infectious complications, length of stay, functional outcomes, and mortality.

Results: A total of 286 patients ≥65 years underwent elective craniotomy at Loyola University Medical Center over 8 years. Seventy-two patients had a preoperative neurologic deficit and 95 had a systemic morbidity before surgery. Postoperative neurologic and systemic morbidity was 14% and 23%, respectively. 7% of patients experienced a LTC complication and 5 patients (1.7%) died. Worse preoperative scores on both the Karnofsky Performance Status and modified Rankin Scale predicted increased length of stay and mortality (P < 0.05). Univariable and multivariable analyses showed that patients with preoperative motor deficit, altered mental status, congestive heart failure, smoking history, and chronic steroid use were all more likely to have an LTC complication, and increased anesthesia time and estimated blood loss increased risk for LTC, neurologic, and systemic/infectious complications.

Conclusions: This study identifies factors that predict perioperative complications for elderly patients undergoing elective craniotomies, particularly congestive heart failure, smoking history, chronic steroid use, anesthesia time, and estimated blood loss. Age alone should not preclude elective craniotomy.
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http://dx.doi.org/10.1016/j.wneu.2017.07.177DOI Listing
November 2017

Publication Metrics in Neurosurgery.

World Neurosurg 2017 09 20;105:993-996. Epub 2017 Jun 20.

Library, Health Sciences Division, Loyola University, Chicago, Illinois, USA.

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http://dx.doi.org/10.1016/j.wneu.2017.06.081DOI Listing
September 2017

Industry Funding for Neurosurgery Research.

World Neurosurg 2017 08 23;104:999-1003. Epub 2017 May 23.

Department of Neurological Surgery, Loyola University Medical Center and Stritch School of Medicine, Maywood, Illinois, USA.

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http://dx.doi.org/10.1016/j.wneu.2017.05.084DOI Listing
August 2017

Recurrent Malignant Gliomas: Treatment Options and Their Effect on Patient's Quality of Life.

World Neurosurg 2017 07 24;103:906-910. Epub 2017 Mar 24.

Department of Radiation Oncology, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA.

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http://dx.doi.org/10.1016/j.wneu.2017.03.076DOI Listing
July 2017

Overlapping Surgical Procedures.

Authors:
Vikram C Prabhu

World Neurosurg 2017 05 6;101:759-762. Epub 2017 Mar 6.

Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

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http://dx.doi.org/10.1016/j.wneu.2017.02.117DOI Listing
May 2017

Stereotactic Radiation for Palliation of Skull Base Recurrences of Salivary Gland Carcinomas: Implications for Tumor Targeting.

J Neurol Surg B Skull Base 2017 Feb 18;78(1):82-88. Epub 2016 Jul 18.

Department of Neurological Surgery, Loyola University Medical Center Maywood, Illinois, United States.

 Approximately 3 to 13% of salivary carcinomas recur at the skull base. We report our experience treating these recurrences with stereotactic radiation.  In total, 14 patients with skull base recurrence of salivary gland carcinoma were identified. Patient characteristics, treatment parameters, response to treatment, local recurrence-free/overall survival, and patterns of failure were studied.  All 12 symptomatic patients experienced palliation of symptoms. Two grade 3 toxicities were observed. Local recurrence-free survival after skull base treatment was 28 months (74 months after allowing for additional course of salvage radiotherapy). Overall survival was 153 months from primary diagnosis and 67 months from first skull base failure. Of 13 treatment failures, 8 occurred at margins; the rest were infield. All intracranial failures occurred along meningeal surfaces.  Stereotactic radiation provides well-tolerated palliation for the majority of patients, but with a high rate of local failure. Due to the propensity for meningeal failures, we suggest increasing margins along the meningeal surfaces when treating these patients.
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http://dx.doi.org/10.1055/s-0036-1584884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288110PMC
February 2017

Defensive Medicine in Neurosurgery.

Authors:
Vikram C Prabhu

World Neurosurg 2016 11 1;95:587-589. Epub 2016 Sep 1.

Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

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http://dx.doi.org/10.1016/j.wneu.2016.08.105DOI Listing
November 2016

Evidence-Based Clinical Practice Guidelines in Neurosurgery.

Authors:
Vikram C Prabhu

World Neurosurg 2016 07 18;91:611-3. Epub 2016 Mar 18.

Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

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http://dx.doi.org/10.1016/j.wneu.2016.03.029DOI Listing
July 2016

Operant Conditioning and the Practice of Defensive Medicine.

Authors:
Vikram C Prabhu

World Neurosurg 2016 07 8;91:603-5. Epub 2016 Mar 8.

Department of Neurological Surgery and Radiation Oncology, Loyola University Medical Center, Chicago, Illinois, USA. Electronic address:

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http://dx.doi.org/10.1016/j.wneu.2016.02.111DOI Listing
July 2016