Publications by authors named "Maureen Rakovec"

Objective: Sacroiliac joint dysfunction is increasingly recognized as a source of low back pain. Sacroiliac joint dysfunction after lumbosacral fusion is a potential cause of persistent disability and may be difficult to predict. The authors sought to investigate the understudied relationship between spinopelvic parameters and frequency of sacroiliac joint fusion after lumbosacral fusion.

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Objective: Oligodendrogliomas present challenges in management despite their favorable prognosis. Optimal therapeutic strategies are not well-established. We aimed to characterize current practice patterns and identify areas of discordance in oligodendroglioma management.

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Article Synopsis
  • Oligodendroglioma is a brain tumor characterized by specific genetic mutations and treatments typically involve surgery followed by either observational care or a combination of radiation and chemotherapy.
  • This study analyzed data from 277 patients with IDH-mutant, 1p/19q codeleted oligodendrogliomas to examine the impact of different adjuvant treatment regimens on progression-free survival (PFS).
  • Results indicated that patients with grade 3 tumors showed significantly longer PFS when treated with radiation and PCV chemotherapy compared to those receiving radiation with TMZ or no adjuvant therapy, emphasizing the need for more research in this area.
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This report outlines the innovative use of augmented reality (AR) in the surgical planning and treatment of a spinal dural arteriovenous fistula (dAVF) via a minimally invasive technique. AR technology by way of an Apple Vision Pro headset was employed to enhance preoperative visualization and understanding of the pathology, leading to successful surgical ligation of the AVF. This case describes a 56-year-old male presenting with progressive weakness and thoracic myelopathy who showed marked improvement postoperatively, highlighting AR's potential to improve surgical approach and outcomes.

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Article Synopsis
  • Glioblastoma patients often experience functional deficits after surgery, which can negatively impact their daily activities and overall recovery outcomes.
  • A study involving 600 adult glioblastoma patients found that lower scores on the AM-PAC mobility and activity assessments were linked to longer hospital stays, higher chances of readmission, and shorter survival times.
  • The findings suggest that AM-PAC scores could provide valuable insights for predicting recovery and aiding in treatment decisions for glioblastoma patients post-operatively.
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Article Synopsis
  • Oligodendrogliomas, known for specific genetic mutations (IDH1/2) and chromosome deletions (1p/19q), were analyzed in a study to understand the clinical significance of additional genomic alterations like CIC, FUBP1, and TERTp using clinically standardized NGS panels.
  • The analysis included 277 patients diagnosed between 2005 and 2021, revealing that among the 95 patients with NGS reports, CIC, FUBP1, and TERTp were the most commonly altered genes.
  • While these genetic alterations were frequent, the study found that most did not significantly impact progression-free or overall survival, except for a noted reduction in progression-free survival associated with CIC alterations in specific
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With its recent release, the Apple Vision Pro (Apple Inc., Cupertino, CA) represents a promising technological advancement of mixed reality in the field of neurosurgery and medicine more broadly. With all new technologies, it is critical to facilitate early use and assessment of the technology to facilitate adoption by the larger medical community.

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Image guidance technologies can significantly improve the accuracy and safety of intracranial catheter insertions. Augmented reality (AR) allows surgeons to visualize 3D information overlaid onto a patient's head. As such, AR has emerged as a novel image guidance technology that offers unique advantages when navigating intracranial targets.

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Background: Deep-seated intracranial lesions can be accessed using blade retractors that may disrupt white matter tracts, exert pressure on adjacent tissue, and lead to post-operative venous injury. Tubular retractors may minimize disruption to white matter tracts by radially dispersing pressure onto surrounding tissue. This study characterizes perioperative outcomes in patients undergoing biopsy or resection of intracranial pathologies using tubular retractors.

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Purpose: Cushing Syndrome (CS) is a rare endocrine disorder associated with physical and mental symptoms that can drastically affect quality of life (QoL). This study characterizes QoL in patients with CS, describes their treatment experiences, and identifies patient subsets associated with decreased QoL or shared impressions of treatment.

Methods: A 136-question survey addressing QoL factors and treatment experiences was completed by adult patients with CS from the Cushing Support and Research Foundation.

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Oligodendrogliomas are a subtype of adult diffuse glioma characterized by their better responsiveness to systemic chemotherapy than other high-grade glial tumors. The World Health Organization (WHO) 2021 brain tumor classification highlighted defining molecular markers, including 1p19q codeletion and IDH mutations which have become key in diagnosing and treating oligodendrogliomas. The management for patients with oligodendrogliomas includes observation or surgical resection potentially followed by radiation and chemotherapy with PCV (Procarbazine, Lomustine, and Vincristine) or Temozolomide.

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Introduction: Supratotal resection (SpTR) of glioblastoma may be associated with improved survival, but published results have varied in part from lack of consensus on the definition and appropriate use of SpTR. A previous small survey of neurosurgical oncologists with expertise performing SpTR found resection 1-2 cm beyond contrast enhancement was an acceptable definition and glioblastoma involving the right frontal and bilateral anterior temporal lobes were considered most amenable to SpTR. The general neurosurgical oncology community has not yet confirmed the practicality of this definition.

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Objective: Subependymomas are low-grade ependymal tumors whose clinical characteristics, radiographic features, and postsurgical outcomes are incompletely characterized due to their rarity. The authors present an institutional case series and a systematic literature review to achieve a better understanding of subependymomas.

Methods: Adult patients with histologically confirmed subependymoma or mixed subependymoma-ependymoma surgically treated at a tertiary hospital between 1992 and 2020 were identified.

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Objective: Suprasellar meningioma resection via either the transcranial approach (TCA) or the endoscopic endonasal approach (EEA) is an area of controversy and active evaluation. Skull base surgeons increasingly consider patient-reported outcomes (PROs) when choosing an approach. No PRO measure currently exists to assess quality of life for suprasellar meningiomas.

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Background: Gross total resection (GTR) of contrast-enhancing tumor is associated with increased survival in primary glioblastoma. Recently, there has been increasing interest in performing supratotal resections (SpTRs) for glioblastoma.

Objective: To address the published results, which have varied in part due to lack of consensus on the definition and appropriate use of SpTR.

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Background: Although various predictors of adverse postoperative outcomes among patients with meningioma have been established, research has yet to develop a method for consolidating these findings to allow for predictions of adverse health care outcomes for patients diagnosed with skull base meningiomas. The objective of the present study was to develop 3 predictive algorithms that can be used to estimate an individual patient's probability of extended length of stay (LOS) in hospital, experiencing a nonroutine discharge disposition, or incurring high hospital charges after surgical resection of a skull base meningioma.

Methods: The present study used data from patients who underwent surgical resection for skull base meningiomas at a single academic institution between 2017 and 2019.

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Background: Pleomorphic Xanthoastrocytoma (PXA) is a low-grade central nervous system (CNS) tumor with a generally favorable prognosis. However, due to its rarity, optimal adjuvant treatment guidelines have not been established by large scale studies. In this study, we investigated the effect of adjuvant radiation therapy (RT) on overall survival (OS) in adult patients with PXA to help address this unanswered question.

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