Publications by authors named "Ruchit V Patel"

Background: Molecular aberrations have been incorporated into tumour classification guidelines of meningioma. TERT-promoter (TERTp) mutation is associated with worse prognosis and is designated a WHO grade 3 biomarker. However, it remains unclear whether TERTp mutation is context-dependent, with other co-occurring genetic alterations potentially driving its association with prognosis.

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Objective: Ki-67 is a widely used marker of proliferation in meningiomas, influencing prognostic assessment and treatment decisions, including adjuvant radiation therapy. However, it is increasingly appreciated that some meningiomas are enriched with immune infiltration, which may confound Ki-67 interpretation as both immune and tumor cells exhibit proliferative potential. The authors aimed to dissect the cellular source and distribution of Ki-67 within the meningioma microenvironment and explore their clinical, genomic, and biological associations.

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Chromosome-arm copy number alterations (CNAs) are an important component of cancer molecular classifiers. CNAs are often translated into binary chromosome arm calls (arm gain/loss) using an arm call threshold before integration into classification schemes. However, substantial variability exists in thresholds used to define arm calls from CNA data.

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Background: Astrocytoma, isocitrate dehydrogenase-mutant, WHO grade 4 (Astro4), is a new tumor type in the 2021 WHO classification of central nervous system tumors that has been poorly characterized in the literature. This study evaluates predictors of prognosis in a large cohort of newly diagnosed Astro4.

Methods: We retrospectively identified 128 consecutive adult patients who presented with an initial diagnosis of Astro4 at Dana-Farber Cancer Institute and Massachusetts General Hospital between 2010 and 2021.

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Background: Surgical intervention is a cornerstone of adult spinal deformity (ASD) management. However, there remain burdens from complications, including proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Posterior anatomic preservation at the uppermost instrumented vertebra has emerged as an accessible approach to potentially reduce PJK/PJF risk.

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Article Synopsis
  • Molecular features, particularly CDKN2A/B loss, impact survival outcomes in IDH1/2-mutant astrocytomas, with grade 2/3 tumors showing varied survival based on molecular characteristics.
  • In a study of 998 patients, those with intact CDKN2A/B and no focal amplifications had the longest survival, while variations in CDKN2A/B status correlated with poorer outcomes, particularly in grade 4 tumors.
  • The research highlights the potential for improved prognostic predictions in IDHmut-astrocytomas by integrating molecular data with histological grading, revealing distinct profiles linked to survival outcomes.
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  • Scholarship is becoming increasingly important in neurosurgery as grades turn to pass-fail, leading to a focus on metrics like research to distinguish applicants.
  • The study analyzed characteristics of 228 US neurosurgery applicants and found that matched applicants published significantly more during residency compared to unmatched ones.
  • Key factors linked to higher publication output include prior research experience, strong medical school grades, and the academic quality of the residency program, with program R25 status being particularly influential.
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  • Radiomics uses quantitative methods to analyze medical images, revealing hidden patterns that may serve as noninvasive biomarkers in skull base oncology.
  • Applications mainly focus on three tumor types: meningioma, sellar/parasellar tumors, and vestibular schwannomas, with investigations covering areas like tumor detection, classification, grading, and prognosis.
  • Despite advancements and the use of deep-learning methods, challenges such as small sample sizes and limited diversity in data hinder broader adoption, highlighting the need for multi-institutional collaboration to validate radiomic technologies.
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  • CPA meningiomas are challenging to treat due to their location near vital nerves and blood vessels, leading to potential postoperative complications and unpredictable recovery outcomes.
  • A study of 95 patients at Mass General Brigham found that common symptoms included hearing loss, ataxia, and headaches, with gross total resection achieved in 62.1% of cases, which was more likely with smaller tumors and when the internal auditory canal was drilled.
  • Post-surgery, most patients experienced stable or improved hearing, but 25.3% showed tumor progression or recurrence, with lower odds of progression linked to complete resection grades and older age.
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Background And Objective: Department of Veteran's Affairs (VA) Medical Centers play a crucial role in training neurosurgery residents. Although previous studies have examined the impact of VA rotations from the attending perspective, the resident experience remains unexplored. We present a national survey of neurosurgery residents to assess their perceptions of VA rotations, focusing on operative experience, call burden, longitudinal patient care experiences, and overall strengths and limitations.

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  • The study examines the impact of interdisciplinary care networks on outcomes for patients with brain metastases, highlighting its complexity given patient interactions across multiple facilities.
  • The goal is to assess how statewide healthcare metrics correlate with inpatient mortality and hospital length of stay for this patient group.
  • The research analyzed data from nearly 4,700 patients in Massachusetts, revealing significant interdependence in care and varied characteristics of hospitals involved in treating brain metastases.
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  • Investigated barriers and facilitators to maintain an interprofessional situation awareness bundle aimed at reducing in-hospital cardiac arrests in a pediatric care setting.
  • Data collected through interviews with twelve healthcare staff members identified five main themes, including the integration of the bundle into daily practice and culture, and the importance of standardized processes and teamwork.
  • The study concluded that the bundle has been successfully integrated and sustained over 5 years, enhancing communication and decision-making, and highlighting the need to understand its key components for future improvements.
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  • The study investigates the relationship between the location and size of meningiomas (a type of brain tumor) and their clinical and biological characteristics, noting that the anatomic origin can be difficult to determine in larger tumors.
  • Researchers analyzed MRI scans and the World Health Organization (WHO) and molecularly Integrated Grades (IG) of meningiomas from adult patients to create a mapping atlas that correlates tumor location with grade.
  • Results indicate that benign tumors tend to cluster around the midline anterior skull base, while malignant ones are more common in areas like the falcine/parasagittal region, suggesting that molecular classification may provide more specific insights than traditional grading.
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  • Researchers reviewed the NIH ClinicalTrials.gov database to find clinical trials using viral vector gene therapies for neurodegenerative and neurodevelopmental diseases that require neurosurgery.
  • They identified 64 trials targeting conditions like Alzheimer's, Parkinson's, and spinal muscular atrophy, with a focus on the surgical delivery methods used.
  • The study highlighted the predominance of adeno-associated viral vectors (AAVs) and noted advances in delivery techniques, particularly MRI-guided methods that enhance treatment precision.
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  • A study examined how molecular features, clinical metrics, and treatment affect the overall survival of glioma patients amidst recent changes in classification and care standards.
  • The research involved analyzing 4,400 gliomas from various sources, finding that 27.2% had updated molecular classifications that differed from their initial diagnoses; survival rates varied significantly between different patient groups.
  • The study identified key prognostic factors for different glioma types and created survival prediction tools based on age, molecular features, and treatment, aiming to enhance understanding and research on gliomas.
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  • The study examines patient outcomes and transfer patterns after intracranial hemorrhages, revealing most transfers occur for non-traumatic and single compartment bleeds.
  • About a quarter of patients are transferred, with disparities noted based on race, income, and insurance type affecting transfer likelihood.
  • The findings suggest a need for better risk assessment in transfer decisions and address systemic issues influencing these transfers.
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  • Obtaining both CT and MRI scans for neurosurgical planning is beneficial but costly and involves additional radiation exposure; therefore, creating synthetic CT scans from MRI using deep learning shows potential.
  • The study utilized 92,981 paired CT and MRI images from 80 patients, focusing on accuracy, particularly in key dimensions like sella and internal auditory canal (IAC) measurements.
  • Results indicated that the synthetic CT scans accurately reconstructed critical anatomical features, with a median error of 6% in measurements, although variability was noted depending on the specific pathology, especially with meningiomas.
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Background: A cornerstone of surgical residency training is an educational program that produces highly skilled and effective surgeons. Training structures are constantly being revised due to evolving program structures, shifting workforces, and variability in the clinical environment. This has resulted in significant heterogeneity in all surgical resident education, training tools utilized, and measures of training efficacy.

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Background: Surgical intervention is a critical tool to address adult spinal deformity (ASD). Given the evolution of spinal surgical techniques, we sought to characterize developments in ASD correction and barriers impacting clinical outcomes.

Methods: We conducted a literature review utilizing PubMed, Embase, Web of Science, and Google Scholar to examine advances in ASD surgical correction and ongoing challenges from patient and clinician perspectives.

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Rett syndrome is an X-linked neurodevelopmental disorder caused by mutation of Mecp2 gene and primarily affects females. Glial cell dysfunction has been implicated in in Rett syndrome (RTT) both in patients and in mouse models of this disorder and can affect synaptogenesis, glial metabolism and inflammation. Here we assessed whether treatment of adult (5-6 months old) symptomatic Mecp2-heterozygous female mice with N-acetyl cysteine conjugated to dendrimer (D-NAC), which is known to target glia and modulate inflammation and oxidative injury, results in improved behavioral phenotype, sleep and glial inflammatory profile.

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Trimethylation of lysine 27 on histone 3 (H3K27me3) loss has been implicated in worse prognoses for patients with meningiomas. However, there have been challenges in measuring H3K27me3 loss, quantifying its impact, and interpreting its clinical utility. We conducted a systematic review across Pubmed, Embase, and Web of Science to identify studies examining H3K27me3 loss in meningioma.

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Veterans Affairs (VA) medical centers serve as a unique training environment for US residency programs. In this study, we aim to explore the scope and details of VA integration into neurosurgery resident training. We used data from the Accreditation Council for Graduate Medical Education database to provide an overview of neurosurgery training programs with an active VA affiliation and developed a multi-institutional survey to gather information related to rotation design, operative volume, expectations, and core training values.

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Background: Quantitative imaging analysis through radiomics is a powerful technology to non-invasively assess molecular correlates and guide clinical decision-making. There has been growing interest in image-based phenotyping for meningiomas given the complexities in management.

Methods: We systematically reviewed meningioma radiomics analyses published in PubMed, Embase, and Web of Science until December 20, 2021.

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: Posterior fossa tumors (PFTs) are a morbid group of central nervous system tumors that most often present in childhood. While early diagnosis is critical to drive appropriate treatment, definitive diagnosis is currently only achievable through invasive tissue collection and histopathological analyses. Machine learning has been investigated as an alternative means of diagnosis.

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