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Frazier J.L.,Johns Hopkins Neuro Oncology Surgical Outcomes Research Laboratory | Quinones-Hinojosa A.,Johns Hopkins Neuro Oncology Surgical Outcomes Research Laboratory | Quinones-Hinojosa A.,Brain Tumor Stem Cell Laboratory
World Neurosurgery | Year: 2010

Background: Low-grade gliomas have been documented to undergo transformation into high-grade astrocytomas, and the time interval of this transformation has been reported to generally occur within 5 years in about 50% of patients harboring these low-grade lesions. Several studies have investigated the evolution of low-grade gliomas into malignant gliomas by CT and MRI characteristics, but many have not documented the timing of these transformation processes. Case Description: The authors discuss the cases of 2 patients with histopathologically confirmed grade II astrocytomas after craniotomies that underwent rapid evolution into malignant gliomas within 13 weeks. Interestingly, both low-grade astrocytomas were positive with immunostaining for the epidermal growth factor receptor, in which its amplification has been implicated as a molecular marker of malignant gliomas. In addition, the grade II astrocytomas were negative for p53 in both patients but were found to be positive upon transformation into malignant gliomas. Conclusions: To our knowledge, this is the first report of rapid malignant transformation of lowgrade gliomas, which were proven by histology, within 13 weeks. There may be patients with a subtype of low-grade astrocytomas that may warrant molecular characterization to determine if aggressive adjuvant therapy would be of benefit. © 2010 Elsevier Inc. All rights reserved. Source

Pendleton C.,Brain Tumor Stem Cell Laboratory | Adams H.,Brain Tumor Stem Cell Laboratory | Wand G.,Brain Tumor Stem Cell Laboratory | Quinones-Hinojosa A.,Brain Tumor Stem Cell Laboratory
Pituitary | Year: 2011

A review of Dr. Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early operative experience with acromegaly. Although in 1912 Cushing published selective case studies regarding this work, a review of all his operations for acromegaly during his early years has never been reported. We uncovered 37 patients who Cushing treated with surgical intervention directed at the pituitary gland. Of these, nine patients who presented with symptoms of acromegaly, and one with symptoms of gigantism were selected for further review. Two patients underwent transfrontal 'omega incision' approaches, and the remaining eight underwent transsphenoidal approaches. Of the 10 patients, 6 were male. The mean age was 38.0 years. The mean hospital stay was 39.4 days. There was one inpatient death during primary interventions (10%) and three patients were deceased at the time of last follow-up (33%). The mean time to death, calculated from the date of the primary surgical intervention, and including inpatient and outpatient deaths, was 11.3 months. The mean time to last follow-up, calculated from the day of discharge, was 59.3 months. At the time of last follow-up, two patients reported resolution of headache; four patients reported continued visual deficits, and two patients reported ongoing changes in mental status. This review analyzes the outcomes for 10 patients who underwent surgical intervention for acromegaly or gigantism, and offers an explanation for Cushing's transition from the transfrontal "omega incision" to the transsphenoidal approach while practicing at the Johns Hopkins Hospital. © 2010 Springer Science+Business Media, LLC. Source

Latimer K.,Brain Tumor Stem Cell Laboratory | Pendleton C.,Brain Tumor Stem Cell Laboratory | Martinez A.,Monterrey Institute of Technology | Subramanian P.S.,Brain Tumor Stem Cell Laboratory | Quinones-Hinojosa A.,Brain Tumor Stem Cell Laboratory
Archives of Ophthalmology | Year: 2012

Rapid advances in understanding glaucoma occurred following the invention of the ophthalmoscope in the mid-19th century. To our knowledge, attempts by neurosurgeon Harvey Cushing, MD, to cure the condition during his years at Johns Hopkins Hospital have never been previously reported. The Johns Hopkins Hospital surgical records from 1896 through 1912 were reviewed. A case in which Cushing attempted a surgical cure for a patient diagnosed as having glaucoma was selected for review. In 1905, Cushing performed extirpation of the superior cervical ganglion of a patient believed to have chronic glaucoma experiencing an acute episode who had previously underwent bilateral iridectomies. The patient reported stabilization of vision and decreased pain after the procedure. Respected neurosurgeon Cushing undertook surgical treatment of glaucoma at the turn of the 20th century. His approach provides insight into contemporary glaucoma therapies and pathophysiology. ©2012 American Medical Association. All rights reserved. Source

Undabeitia J.,Cruces Hospital | Pendleton C.,Brain Tumor Stem Cell Laboratory | Jallo G.I.,Brain Tumor Stem Cell Laboratory | Quinones-Hinojosa A.,Brain Tumor Stem Cell Laboratory
Child's Nervous System | Year: 2011

Introduction: Microcephaly has been described throughout history, and physicians in the nineteenth and early twentieth centuries struggled to identify the etiology of this condition in order to better treat it. In 1908, Cushing wrote in Surgery of the Head, in Keen's Surgery Its Principles and Practice, that the use of craniotomies for the treatment of microcephaly was a futile practice, with limited post-operative improvement that did not justify the operative risks. Methods: Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical files of the Johns Hopkins Hospital, from 1896 to 1912, were reviewed. A single case of operative treatment of microcephaly, performed 3 years after Cushing's published opinion on the procedure, was discovered and is described here. Results: In 1911, a 3-year-old girl from Florida presented with complaints of an "inability to walk" and "backward development." The diagnosis of microcephaly, possibly secondary to craniosynostosis, was made. Cushing operated upon her twice, performing bilateral decompressive craniotomies in a two-stage operation, without excision of the synostosis. Post-operatively, he documented improvement in the child's condition and a resolution of some presenting symptoms. Conclusions: Although Cushing published his disapproval of the use of craniotomies in the treatment of microcephaly in 1908, a review of his early surgical files demonstrates that this opinion was based on cases published in the literature, rather than his own operative experience. In 1911, he performed bilateral craniotomies in a 3-year-old patient with microcephaly and documented post-operative improvement in the patient's general condition. © 2011 Springer-Verlag. Source

Pendleton C.,Brain Tumor Stem Cell Laboratory | Adams H.,Brain Tumor Stem Cell Laboratory | Laws E.R.,Harvard University | Quinones-Hinojosa A.,Brain Tumor Stem Cell Laboratory
Pituitary | Year: 2010

Although researchers have discovered that Minnie G. had nearly 50 years of progression-free survival, the absence of her original surgical records have precluded anything more than speculation as to the etiology of her symptoms or the details of her admission. Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, the microfilm surgical records from the Johns Hopkins Hospital, 1896-1912 were reviewed. Using the surgical number provided in Cushing's publications, the record for Minnie G. was recovered for further review. Cushing's diagnosis relied largely on history and physical findings. Minnie G. presented with stigmata associated with classic Cushings Syndrome: abdominal stria, supraclavicular fat pads, and a rounded face. However, she also presented with unusual physical findings: exophthalmos, and irregular pigmentation of the extremities, face, and eyelids. A note in the chart indicates Minnie G. spoke very little English, implying the history-taking was fraught with opportunities for error. Although there remains no definitive etiology for Minnie G.'s symptoms, this report contributes additional information about her diagnosis and treatment. © 2010 Springer Science+Business Media, LLC. Source

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