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Allan D Levi - One of the best experts on this subject based on the ideXlab platform.

  • the risk of Peripheral Nerve Tumor biopsy in suspected benign etiologies
    Neurosurgery, 2020
    Co-Authors: Roberto J Perezroman, Shelby S Burks, Luca Debs, Iahn Cajigas, Allan D Levi
    Abstract:

    BACKGROUND Peripheral Nerve sheath Tumors (PNSTs) are Tumors with unique clinical and imaging features that present to a variety of physicians. These lesions are often referred for biopsy, which can put Nerve fascicles at risk. Preoperative biopsy may cause distortion of normal anatomic planes, making definitive resection difficult. OBJECTIVE To evaluate the neurological risks of preoperative biopsy in benign PNSTs. METHODS Surgical cases collected retrospectively using a prospectively established database of PNSTs treated by a single surgeon between 1997 and 2019. Patients were dichotomized depending on preoperative biopsy. The effects of biopsy were assessed via history and physical examination both pre- and postdefinitive resection. RESULTS A total of 151 cases were included. Only 23.2% (35) of patients underwent preoperative biopsy, but 42.9% of these experienced new or worsening neurological examination immediately following biopsy. After definitive resection, the rate of neurological deficit was significantly different between the 2 groups with 60% of biopsy patients and 19% of those patients not biopsied experiencing decline in examination (F = 25.72, P < .001). Odds ratio for any postoperative deficit for biopsy was 6.40 (CI [2.8, 14.55], P < .001). Univariate logistic regression of neurological deficit with patient age, sex, Tumor type, and biopsy status showed that only biopsy was associated with the occurrence of any postoperative deficit. CONCLUSION Biopsy of benign PNSTs is associated with a high rate of neurological deficit both immediately following the procedure and after definitive resection. Careful selection is imperative prior to proceeding with biopsy of Nerve sheath Tumors exhibiting benign features given the unacceptably high rate of neurological decline.

  • The Risk of Peripheral Nerve Tumor Biopsy in Suspected Benign Etiologies.
    Neurosurgery, 2020
    Co-Authors: Roberto J Perez-roman, Shelby S Burks, Luca Debs, Iahn Cajigas, Allan D Levi
    Abstract:

    BACKGROUND Peripheral Nerve sheath Tumors (PNSTs) are Tumors with unique clinical and imaging features that present to a variety of physicians. These lesions are often referred for biopsy, which can put Nerve fascicles at risk. Preoperative biopsy may cause distortion of normal anatomic planes, making definitive resection difficult. OBJECTIVE To evaluate the neurological risks of preoperative biopsy in benign PNSTs. METHODS Surgical cases collected retrospectively using a prospectively established database of PNSTs treated by a single surgeon between 1997 and 2019. Patients were dichotomized depending on preoperative biopsy. The effects of biopsy were assessed via history and physical examination both pre- and postdefinitive resection. RESULTS A total of 151 cases were included. Only 23.2% (35) of patients underwent preoperative biopsy, but 42.9% of these experienced new or worsening neurological examination immediately following biopsy. After definitive resection, the rate of neurological deficit was significantly different between the 2 groups with 60% of biopsy patients and 19% of those patients not biopsied experiencing decline in examination (F = 25.72, P 

Ekkehard Hewer - One of the best experts on this subject based on the ideXlab platform.

  • desmoplastic small round cell Tumor a rare cause of a progressive brachial plexopathy
    Muscle & Nerve, 2014
    Co-Authors: Jan Mathys, Istvan Vajtai, Esther Vogelin, Dieter R Zimmermann, Christoph Ozdoba, Ekkehard Hewer
    Abstract:

    Introduction: Desmoplastic small round cell Tumor (DSRCT) is an uncommon, embryonic-type neoplasm, typically presenting as an abdominal mass in young men. A single case of DSRCT arising in the Peripheral nervous system has been reported. Methods: The clinical course, imaging, electrophysiological, intraoperative, histopathological, molecular findings, and postoperative follow-up are reported. Results: A 43-year-old man presented with slowly progressive right brachial plexopathy. Magnetic resonance imaging revealed an enlarged medial cord with heterogeneous contrast enhancement. Histology showed a "small round cell" neoplasm with a polyphenotypic immunoprofile, including epithelial and mesenchymal markers. A pathognomonic fusion of Ewing sarcoma breakpoint region 1 and Wilms Tumor 1 genes (EWSR1/WT1) was present. Treatment involved gross total excision and local radiotherapy. Conclusion: Our findings confirm the occurrence of DSRCT as a primary Peripheral Nerve Tumor. Despite its usually very aggressive clinical course, prolonged recurrence-free survival may be reached. Histomorphology and immunoprofile of DSRCT may lead to misdiagnosis as small cell carcinoma. © 2013 Wiley Periodicals, Inc.

Courtney Pendleton - One of the best experts on this subject based on the ideXlab platform.

  • Percutaneous image-guided biopsy in malignant Peripheral Nerve sheath Tumors
    Acta Neurochirurgica, 2020
    Co-Authors: Courtney Pendleton, B. Matthew Howe, Richard J Spinner
    Abstract:

    Background The decision to biopsy a Peripheral Nerve Tumor is largely based on its presumed behavior and prognosis, determined by patient history, clinical exam, and radiologic characteristics. Percutaneous image-guided biopsy is not without risk in patients with malignant Peripheral Nerve sheath Tumors (MPNSTs); in particular, there may be concern regarding worsening neurologic function, increasing neuropathic pain, and incorrect or absent diagnosis. Methods Following approval by our institutional review board, we reviewed records from 1990 to 2019 at our institution’s three main sites (“our institution”). Patients with pathology-proven MPNST were selected. Further inclusion criteria included image-guided percutaneous biopsy performed at our institution, pathology report available for review, and follow-up documentation to determine post-biopsy complications. Results Three hundred thirty-one patients with MPNST were reviewed. In total, 73 patients undergoing image-guided percutaneous biopsies were included. Twenty-two (30.1%) had biopsy-related complications. This included ten patients with misdiagnosis (13.7%) and six patients with non-diagnostic biopsies (8.2%). Six patients had new or worsened pain that resolved with time and neuropathic pain medication (8.2%), and one patient had subjectively worsened proximal weakness (1.3%) which resolved. Conclusion We found nearly a third of patients undergoing biopsy had a biopsy-related complication. The single largest complication was the inability to obtain an accurate diagnosis (21.9%) with the first biopsy. This may lead to the need for repeat percutaneous or open biopsies, or a non-oncologic initial surgery with implications for disease-free and overall survival. Neurologic complications including exacerbation of pain or a deficit were rare and transient. It remains important that clinicians balance the potential risks and benefits based on individual patient characteristics when determining the necessity of an image-guided percutaneous biopsy.

  • Image-guided percutaneous biopsy of Peripheral Nerve Tumors of indeterminate nature: risks and benefits
    Acta Neurochirurgica, 2020
    Co-Authors: Courtney Pendleton, Richard J Spinner
    Abstract:

    Background Usual management of Peripheral Nerve Tumors is to avoid biopsy in those that are likely benign; the risk of biopsy outweighs the benefit of definitive tissue diagnosis. Biopsy of presumed malignant lesions is performed widely. There is a subset of Peripheral Nerve Tumors that are not easily categorized as benign or malignant based on the clinical and/or radiological features alone. The role of biopsy in Peripheral Nerve Tumors of uncertain character remains controversial and the risk of biopsy (and the potential risk/benefit ratio) for these lesions is not known. Methods Following approval by our institutional review board, we reviewed all notes of a single Peripheral Nerve surgeon from 2000 to 2018 with respect to image-guided percutaneous biopsy of Nerve Tumors. We divided these patients into 3 groups based on clinicoradiologic features. We determined the risk of complications and the “hit rate” for patients with Peripheral Nerve Tumors of uncertain behavior, defined as the percentage of patients sent for percutaneous biopsy who had a malignancy on their final pathology. Results Of 82 patients with Tumors of uncertain behavior, 9 had complications, and 23 had malignant final pathology (a “hit rate” of 27.7%). Neurosurgical referral for biopsy of Tumors of uncertain behavior was made in 60 patients. Twenty-two had malignant final pathology (“hit rate”= 36.7%). Non-neurosurgical referral for biopsy was made in 22 patients with Tumors of uncertain behavior. Two had malignant final pathology (“hit rate”= 4.55%). There was a statistically significant difference between the “hit rate” for the two groups ( p  = 0.021). Conclusions The decision to biopsy a Peripheral Nerve Tumor is largely based on the presumed behavior and prognosis, determined via clinicoradiologic characteristics. Patient care might be improved by delaying percutaneous biopsy of Peripheral Nerve lesions until after a neurosurgical evaluation.

  • Image-guided percutaneous biopsy of Peripheral Nerve Tumors of indeterminate nature: risks and benefits.
    Acta neurochirurgica, 2020
    Co-Authors: Courtney Pendleton, Richard J Spinner
    Abstract:

    Usual management of Peripheral Nerve Tumors is to avoid biopsy in those that are likely benign; the risk of biopsy outweighs the benefit of definitive tissue diagnosis. Biopsy of presumed malignant lesions is performed widely. There is a subset of Peripheral Nerve Tumors that are not easily categorized as benign or malignant based on the clinical and/or radiological features alone. The role of biopsy in Peripheral Nerve Tumors of uncertain character remains controversial and the risk of biopsy (and the potential risk/benefit ratio) for these lesions is not known. Following approval by our institutional review board, we reviewed all notes of a single Peripheral Nerve surgeon from 2000 to 2018 with respect to image-guided percutaneous biopsy of Nerve Tumors. We divided these patients into 3 groups based on clinicoradiologic features. We determined the risk of complications and the “hit rate” for patients with Peripheral Nerve Tumors of uncertain behavior, defined as the percentage of patients sent for percutaneous biopsy who had a malignancy on their final pathology. Of 82 patients with Tumors of uncertain behavior, 9 had complications, and 23 had malignant final pathology (a “hit rate” of 27.7%). Neurosurgical referral for biopsy of Tumors of uncertain behavior was made in 60 patients. Twenty-two had malignant final pathology (“hit rate”= 36.7%). Non-neurosurgical referral for biopsy was made in 22 patients with Tumors of uncertain behavior. Two had malignant final pathology (“hit rate”= 4.55%). There was a statistically significant difference between the “hit rate” for the two groups (p = 0.021). The decision to biopsy a Peripheral Nerve Tumor is largely based on the presumed behavior and prognosis, determined via clinicoradiologic characteristics. Patient care might be improved by delaying percutaneous biopsy of Peripheral Nerve lesions until after a neurosurgical evaluation.

  • harvey cushing s innovative attempt at xenotransplanting a rabbit spinal cord in a patient after resection of a Peripheral Nerve Tumor in 1902
    Neurosurgery, 2011
    Co-Authors: Hasan A Zaidi, Courtney Pendleton, Allan J. Belzberg, Gustavo Pradilla, Aaron A Cohengadol, Alfredo Quinoneshinojosa
    Abstract:

    OBJECTIVE: A review of Harvey Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early work using Nerve xenografts to repair Peripheral Nerve injuries. METHODS: The Johns Hopkins Hospital surgical records from 1896 to 1912 were reviewed. A single case in which Cushing used a xenograft to repair a Peripheral Nerve defect was selected for further study. RESULTS: In August 1902, a 23-year-old woman presented with tingling and numbness in her left foot and focal tenderness in the popliteal region. Cushing performed an exploratory operation, revealing an encapsulated Tumor originating from the internal popliteal Nerve. After resecting the segment of involved Nerve, Cushing harvested the spinal cord from a rabbit and used it to span the 18-cm defect. At a 5-month postoperative follow-up, according to Cushing's clinical notes, the patient had partially regained some sensation in her leg and foot. Seven months later, the patient presented with a local Tumor recurrence, and her leg was amputated. An examination of the amputated specimen demonstrated that the xenograft was still intact without gross evidence of xenograft rejection. CONCLUSION: Despite its questionable functional success, we report a previously unpublished operative case by Harvey Cushing in which a rabbit spinal cord was transplanted into a human to bridge a sciatic Nerve gap. This sheds light on the potential for animal tissue as a source for the treatment of neurological disease in humans.

Shelby S Burks - One of the best experts on this subject based on the ideXlab platform.

  • the risk of Peripheral Nerve Tumor biopsy in suspected benign etiologies
    Neurosurgery, 2020
    Co-Authors: Roberto J Perezroman, Shelby S Burks, Luca Debs, Iahn Cajigas, Allan D Levi
    Abstract:

    BACKGROUND Peripheral Nerve sheath Tumors (PNSTs) are Tumors with unique clinical and imaging features that present to a variety of physicians. These lesions are often referred for biopsy, which can put Nerve fascicles at risk. Preoperative biopsy may cause distortion of normal anatomic planes, making definitive resection difficult. OBJECTIVE To evaluate the neurological risks of preoperative biopsy in benign PNSTs. METHODS Surgical cases collected retrospectively using a prospectively established database of PNSTs treated by a single surgeon between 1997 and 2019. Patients were dichotomized depending on preoperative biopsy. The effects of biopsy were assessed via history and physical examination both pre- and postdefinitive resection. RESULTS A total of 151 cases were included. Only 23.2% (35) of patients underwent preoperative biopsy, but 42.9% of these experienced new or worsening neurological examination immediately following biopsy. After definitive resection, the rate of neurological deficit was significantly different between the 2 groups with 60% of biopsy patients and 19% of those patients not biopsied experiencing decline in examination (F = 25.72, P < .001). Odds ratio for any postoperative deficit for biopsy was 6.40 (CI [2.8, 14.55], P < .001). Univariate logistic regression of neurological deficit with patient age, sex, Tumor type, and biopsy status showed that only biopsy was associated with the occurrence of any postoperative deficit. CONCLUSION Biopsy of benign PNSTs is associated with a high rate of neurological deficit both immediately following the procedure and after definitive resection. Careful selection is imperative prior to proceeding with biopsy of Nerve sheath Tumors exhibiting benign features given the unacceptably high rate of neurological decline.

  • The Risk of Peripheral Nerve Tumor Biopsy in Suspected Benign Etiologies.
    Neurosurgery, 2020
    Co-Authors: Roberto J Perez-roman, Shelby S Burks, Luca Debs, Iahn Cajigas, Allan D Levi
    Abstract:

    BACKGROUND Peripheral Nerve sheath Tumors (PNSTs) are Tumors with unique clinical and imaging features that present to a variety of physicians. These lesions are often referred for biopsy, which can put Nerve fascicles at risk. Preoperative biopsy may cause distortion of normal anatomic planes, making definitive resection difficult. OBJECTIVE To evaluate the neurological risks of preoperative biopsy in benign PNSTs. METHODS Surgical cases collected retrospectively using a prospectively established database of PNSTs treated by a single surgeon between 1997 and 2019. Patients were dichotomized depending on preoperative biopsy. The effects of biopsy were assessed via history and physical examination both pre- and postdefinitive resection. RESULTS A total of 151 cases were included. Only 23.2% (35) of patients underwent preoperative biopsy, but 42.9% of these experienced new or worsening neurological examination immediately following biopsy. After definitive resection, the rate of neurological deficit was significantly different between the 2 groups with 60% of biopsy patients and 19% of those patients not biopsied experiencing decline in examination (F = 25.72, P 

Luca Debs - One of the best experts on this subject based on the ideXlab platform.

  • the risk of Peripheral Nerve Tumor biopsy in suspected benign etiologies
    Neurosurgery, 2020
    Co-Authors: Roberto J Perezroman, Shelby S Burks, Luca Debs, Iahn Cajigas, Allan D Levi
    Abstract:

    BACKGROUND Peripheral Nerve sheath Tumors (PNSTs) are Tumors with unique clinical and imaging features that present to a variety of physicians. These lesions are often referred for biopsy, which can put Nerve fascicles at risk. Preoperative biopsy may cause distortion of normal anatomic planes, making definitive resection difficult. OBJECTIVE To evaluate the neurological risks of preoperative biopsy in benign PNSTs. METHODS Surgical cases collected retrospectively using a prospectively established database of PNSTs treated by a single surgeon between 1997 and 2019. Patients were dichotomized depending on preoperative biopsy. The effects of biopsy were assessed via history and physical examination both pre- and postdefinitive resection. RESULTS A total of 151 cases were included. Only 23.2% (35) of patients underwent preoperative biopsy, but 42.9% of these experienced new or worsening neurological examination immediately following biopsy. After definitive resection, the rate of neurological deficit was significantly different between the 2 groups with 60% of biopsy patients and 19% of those patients not biopsied experiencing decline in examination (F = 25.72, P < .001). Odds ratio for any postoperative deficit for biopsy was 6.40 (CI [2.8, 14.55], P < .001). Univariate logistic regression of neurological deficit with patient age, sex, Tumor type, and biopsy status showed that only biopsy was associated with the occurrence of any postoperative deficit. CONCLUSION Biopsy of benign PNSTs is associated with a high rate of neurological deficit both immediately following the procedure and after definitive resection. Careful selection is imperative prior to proceeding with biopsy of Nerve sheath Tumors exhibiting benign features given the unacceptably high rate of neurological decline.

  • The Risk of Peripheral Nerve Tumor Biopsy in Suspected Benign Etiologies.
    Neurosurgery, 2020
    Co-Authors: Roberto J Perez-roman, Shelby S Burks, Luca Debs, Iahn Cajigas, Allan D Levi
    Abstract:

    BACKGROUND Peripheral Nerve sheath Tumors (PNSTs) are Tumors with unique clinical and imaging features that present to a variety of physicians. These lesions are often referred for biopsy, which can put Nerve fascicles at risk. Preoperative biopsy may cause distortion of normal anatomic planes, making definitive resection difficult. OBJECTIVE To evaluate the neurological risks of preoperative biopsy in benign PNSTs. METHODS Surgical cases collected retrospectively using a prospectively established database of PNSTs treated by a single surgeon between 1997 and 2019. Patients were dichotomized depending on preoperative biopsy. The effects of biopsy were assessed via history and physical examination both pre- and postdefinitive resection. RESULTS A total of 151 cases were included. Only 23.2% (35) of patients underwent preoperative biopsy, but 42.9% of these experienced new or worsening neurological examination immediately following biopsy. After definitive resection, the rate of neurological deficit was significantly different between the 2 groups with 60% of biopsy patients and 19% of those patients not biopsied experiencing decline in examination (F = 25.72, P