Browsing by Author "Wahood, Waseem"

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    Comparison of Blister Aneurysm Treatment Techniques: A Systematic Review and Meta-Analysis
    (Elsevier, 2021-10) Sanchez, Victoria E.; Haider, Ali S.; Rowe, Scott E.; Wahood, Waseem; Sagoo, Navraj S.; Ozair, Ahmad; El Ahmadieh, Tarek Y.; Kan, Peter; Johnson, Jeremiah N.; Neurological Surgery, School of Medicine
    Objective Blood blister aneurysms are small, thin-walled, rapidly growing side-wall aneurysms that have proven particularly difficult to treat, and evidence-based guidance for treatment strategies is lacking. A systematic review and meta-analysis was performed to aggregate the available data and compare the three primary treatment modalities. Methods We performed a comprehensive literature search according to PRISMA guidelines followed by an indirect meta-analysis that compares the safety and efficacy of surgical, flow-diverting stents (FDS), and other endovascular approaches for the treatment of ruptured blood blister aneurysms. Results A total of 102 studies were included for quantitative synthesis with sample sizes of 687 treated surgically, 704 treated endovascularly without FDS, and 125 treated via flow-diversion. Comparatively, FDS achieved significantly reduced rates of perioperative retreatment compared to both surgical (P=0.025) and non-FDS endovascular (P<0.001). The FDS subgroup also achieved a significantly lower incidence of perioperative rebleed (P<0.001), perioperative hydrocephalus (P=0.012), postoperative infarction (P=0.002), postoperative hydrocephalus (P<0.001), and postoperative vasospasm (P=0.002) when compared to those patients in the open surgical subgroup. While no significant differences were found between groups on the basis of functional outcomes, angiographic outcomes detailed by rates of radiographic complete occlusion were highest for surgical (90.7%, 262/289) and FDS (89.1%, 98/110) subgroups versus the non-FDS endovascular subgroup at (82.7%, 268/324). Conclusion Flow-diversion appears to be an effective treatment strategy for ruptured BBAs with lower rates of perioperative complications when compared to surgical and other endovascular techniques but studies investigating long-term outcomes following flow-diversion warrant further study.
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    LMD-10. The role of immune checkpoint inhibitors in leptomeningeal disease: a systematic review
    (Oxford University Press, 2021-08) Palmisciano, Paolo; Haider, Ali S.; Nwagwu, Chibueze D.; Wahood, Waseem; Sagoo, Navraj S.; Yu, Kenny; Ene, Chibawane I.; O’Brien, Barbara J.; Cohen-Gadol, Aaron A.; El Ahmadieh, Tarek Y.; Neurological Surgery, School of Medicine
    Background: Leptomeningeal disease (LMD) is a devastating complication of advanced malignancy with a poor prognosis and limited therapeutic options. Whether immune checkpoint inhibitors (ICIs) alter disease course is unknown. Methods: We searched PubMed, EMBASE, Scopus, Cochrane, and clinicaltrials.gov according to PRISMA guidelines to analyze the therapeutic role and toxicity profiles of ICIs in the management of LMD. Studies reporting clinical outcome data of patients with LMD treated with ICIs were included. A comprehensive review of clinical characteristics and survival analysis was conducted. Results: We included 14 studies encompassing 61 patients. The median age at LMD diagnosis was 57 years (female=63.9%). Lung cancer (44.3%), breast cancer (27.9%), and melanoma (23.0%) were the most frequent primary tumors. Parenchymal brain metastases occurred in 37 patients, mostly treated with radiotherapy (83.3%). LMD most frequently presented with headache (42.1%) and was diagnosed by MRI findings (leptomeningeal T1-contrast enhancement: 96.7%) and/or positive cerebrospinal fluid cytology (86.5%). Patients received ICIs for a median duration of 7 months (range, 0.5–58.0): pembrolizumab (49.2%), nivolumab (32.8%), and/or ipilimumab (18.0%). The most common concurrent LMD treatments were radiotherapy (54.7%) and steroids (35.7%). Radiological responses at 6-months were complete (33.3%) and partial response (12.5%), stable disease (33.3%), and progression (20.8%). 22 patients developed ICI-related adverse events, mostly mild (100%) and uncommonly severe (15.6%). Median progression-free survival was 5.1 months, median overall survival was 6.3 months, and 12-month survival was 32.1%. Survival was correlated with ICIs (P=0.042), but not with primary tumors (P=0.144). Patients concurrently receiving steroids showed worse survival (P=0.040), with a median overall survival of 1.9 months. Conclusion: ICI therapy shows promise and appears to be well-tolerated in patients with LMD. Concurrent use of steroids is associated with worse survival. The role of ICIs in the multimodal management of LMD and their combination with steroids requires further analysis.
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    Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes
    (MDPI, 2021-12-24) Palmisciano, Paolo; Ferini, Gianluca; Ogasawara, Christian; Wahood, Waseem; Alamer, Othman Bin; Gupta, Aditya D.; Scalia, Gianluca; Larsen, Alexandra M.G.; Yu, Kenny; Umana, Giuseppe E.; Cohen-Gadol, Aaron A.; El Ahmadieh, Tarek Y.; Haider, Ali S.; Neurological Surgery, School of Medicine
    Background: Orbital metastases often lead to severe functional impairment. The role of resection, orbital exenteration, and complementary treatments is still debated. We systematically reviewed the literature on orbital metastases. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched upon PRISMA guidelines to identify studies on orbital metastases. Clinical characteristics, management strategies, and survival were analyzed. Results: We included 262 studies comprising 873 patients. Median age was 59 years. The most frequent primary tumors were breast (36.3%), melanoma (10.1%), and prostate (8.5%) cancers, with median time interval of 12 months (range, 0-420). The most common symptoms were proptosis (52.3%) and relative-afferent-pupillary-defect (38.7%). Most metastases showed a diffuse location within the orbit (19%), with preferential infiltration of orbital soft tissues (40.2%). In 47 cases (5.4%), tumors extended intracranially. Incisional biopsy (63.7%) was preferred over fine-needle aspiration (10.2%), with partial resection (16.6%) preferred over complete (9.5%). Orbital exenteration was pursued in 26 patients (3%). A total of 305 patients (39.4%) received chemotherapy, and 506 (58%) received orbital radiotherapy. Post-treatment symptom improvement was significantly superior after resection (p = 0.005) and orbital radiotherapy (p = 0.032). Mean follow-up was 14.3 months, and median overall survival was 6 months. Fifteen cases (1.7%) demonstrated recurrence with median local control of six months. Overall survival was statistically increased in patients with breast cancer (p < 0.001) and in patients undergoing resection (p = 0.024) but was not correlated with orbital location (p = 0.174), intracranial extension (p = 0.073), biopsy approach (p = 0.344), extent-of-resection (p = 0.429), or orbital exenteration (p = 0.153). Conclusions: Orbital metastases severely impair patient quality of life. Surgical resection safely provides symptom and survival benefit compared to biopsy, while orbital radiotherapy significantly improves symptoms compared to not receiving radiotherapy.
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    The Role of Immune Checkpoint Inhibitors in Leptomeningeal Disease: A Systematic Review
    (International Institute of Anticancer Research, 2021) Palmisciano, Paolo; Haider, Ali S.; Nwagwu, Chibueze D.; Wahood, Waseem; Yu, Kenny; Ene, Chibawanye I.; O'Brien, Barbara J.; Aoun, Salah G.; Cohen-Gadol, Aaron A.; El Ahmadieh, Tarek Y.; Neurological Surgery, School of Medicine
    Background/aim: Leptomeningeal disease (LMD) is a debilitating complication of advanced malignancies. Immune-checkpoint inhibitors (ICIs) may alter disease course. We analyzed the role and toxicity of ICIs in LMD. Materials and methods: We systematically reviewed the literature reporting on outcome data of patients with LMD treated with ICIs. Results: We included 14 studies encompassing 61 patients. Lung-cancer (44.3%), breast-cancer (27.9%), and melanoma (23.0%) were the most frequent primary tumors. Median duration of ICI-treatment was 7-months (range=0.5-58.0): pembrolizumab (49.2%), nivolumab (32.8%), ipilimumab (18.0%). Radiological responses included complete response (33.3%), partial response (12.5%), stable disease (33.3%), progressive disease (20.8%). Twenty-two patients developed ICI-related adverse-events, mild (100%) and/or severe (15.6%). Median progression-free and overall survival were 5.1 and 6.3 months, and 12-month survival was 32.1%. Survival correlated with ICI agents (p=0.042), but not with primary tumors (p=0.144). Patients receiving concurrent steroids showed worse survival (p=0.040). Conclusion: ICI therapy is well-tolerated in patients with LMD, but concurrent steroids may worsen survival.