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PUBLISHED WORKS

External ventricular drainage in the management of pediatric patients with posterior fossa tumors and hydrocephalus: a retrospective cohort study.
Child's Nervous System
January 2023, Volume 39, pp 887–894

Verhey L, Maharaj A, Patel N, Manoranjan B, Ajani O, FLeming A, Farrokhyar F, Singh SK, Yarascavitch B (2023).


Analysis of surgical and MRI factors associated with cerebellar mutism 

Journal of Neuro-Oncology
July 2017, Volume 133, Issue 3, pp 539-542
Anjali Sergeant, Michelle Masayo Kameda-Smith, Branavan Manoranjan, Brij Karmur, JoAnn Duckworth, Tina Petrelli, Katey Savage, Olufemi Ajani, Blake Yarascavitch, M. Constantine Samaan, Katrin Scheinemann, Cheryl Alyman, Saleh Almenawer, Forough Farrokhyar, Adam J. Fleming, Sheila Kumari Singh, Nina Stein

SUMMARY

Cerebellar Mutism is a rare postoperative complication characterized by significant lack of speech or loss of speech in children, and may also include ataxia, which is a loss of balance; hypotonia, a diminished muscle tone and strength;  and cognitive deficits. Cerebellar Mutism tends to be temporary and resolves within weeks to months of initial onset, although no definitive evidence of its etiology has been determined. Prior clinical studies conducted have suggested that there could be a variety of factors associated with the onset of cerebellar Mutism, including postoperative calcification, Infarction and MRI diffusion abnormalities. Our single centered study investigated 11 patients with Cerebellar Mutism, matching them with 11 controls, attempting to determine whether there are any surgical or MRI markers associated with CM in children after posterior fossa surgery for tumor resection. Understanding these trends will be helpful in elucidating the pathophysiology of the disease and preparing the families of these patients for this unusual complication. Several variables were found to be significantly associated with cerebellar mutism, including the anatomical location of the tumor being at the floor of the fourth ventricle, a compartment in the fluid exchange system of the central nervous system, and infractions, or minor losses of blood supply to areas of the brain. This study will serve as the foundation for our upcoming multi-centered investigation into this phenomenon, hopefully confirming the results elicited here.


Salvage Therapy for Childhood Medulloblastoma: A Single Center Experience
The Canadian Journal of Neurological Sciences
Volume 46, Issue 4 July 2019 , pp. 403-414
Michelle M. Kameda-Smith, Alick Wang, Noora Abdulhadi, Rebecca Voth, Anjali Sergeant, Arjuna Maharaj, David Bakhshinyan, Ashley A. Adile, Akshat M. Pai, Olufemi Ajani, Blake Yarascavitch, M. Cheryl Alyman, JoAnn Duckworth, M. Constantine Samaan, Forough Farrokhyar, Sheila K. Singh, Adam Fleming on behalf of the Pediatric Brain Tumour Study Group

SUMMARY

Introduction: Children diagnosed with medulloblastoma (MB) who are refractory to upfront therapy or experience recurrence have very poor prognoses. Although phase I and phase II trials exist, these treatments bear significant treatment-related morbidity and mortality. Methods: A retrospective review of children diagnosed with a recurrence of MB from 2002 to 2015 at McMaster University was undertaken. Results: Recurrent disease in 10 patients involved leptomeningeal dissemination, with 3 experiencing local recurrence. In three recurrent patients the disease significantly progressed, and the children were palliated. The remaining 10 children underwent some form of salvage therapy, including surgical re-resection, radiation, and chemotherapy, either in isolation or in varying combinations. Of the 13 children experiencing treatment-refractory or recurrent disease, 4 are currently alive with a median follow-up of 38.5 months (75.5 months). Of the eight patients with molecular subgrouping data, none of the Wnt MB experienced recurrence. Conclusion: Recurrent MB carried a poor prognosis with a 5-year overall survival (OS) of 18.2% despite the administration of salvage therapy. The upfront therapy received, available treatment, and tolerability of the proposed salvage therapy resulted in significant heterogeneity in the treatment of our recurrent cohort.


Predictive measures and outcomes of extent of resection in juvenile pilocytic astrocytoma
Journal of Clinical Neuroscience 
Volume 70, P79-84, December 01, 2019
Arjuna Maharaj, Branavan Manoranjan, Leonard H. Verhey, Adam J. Fleming, Forough Farrokhyar
Saleh Almenawer, Sheila K. Singh, Blake Yarascavitch 


SUMMARY

Purpose: The present study aims to determine the tumor-related, clinical, and demographic factors associated with extent of resection (EOR) and post-operative outcomes in JPA patients. Methods: All patients with JPA, identified from a single-center brain tumour data base, were included in this retrospective analysis. Pre-operative MRI scans were reviewed by a single neurosurgeon blinded to the EOR. JPA cases that exhibited no residual tumor post-operatively were assigned to the GTR group, all other tumors were assigned to the <GTR group. Tumor-related, clinical and demographic variables as well as perioperative morbidities were compared between both groups. Results: Of the 28 patients included, 15 had a GTR (46% male; median age: 7.5 years; range: 1.16–14.9) and 13 had <GTR (69.2% male; median age: 10.6 years; range: 0.66–17.68). Tumor location reached statistical significance, as there were significantly more cerebellar tumors in the GTR group (86.7%) compared to the <GTR group (38.5%) ( p = 0.016). GTR cases had a significantly longer average follow-up interval (6.6 months) than <GTR cases (4.5 months) ( p = 0.031). All demographic variables, clinical variables and tumor-related factors showed no significant differences between the two groups. There were no differences between GTR and <GTR cases in terms of perioperative outcomes. Conclusions: This study shows other than location of the lesion in the cerebellum, demographic, clinical and tumor-related variables are not associated with EOR in children with JPA. GTR was associated with an extended follow-up interval but not with increased perioperative morbidities compared to those with <GTR.


Analysis of factors that influence neurosurgical length of hospital stay among newly diagnosed pediatric brain tumor patients
Pediatric Blood and Cancer 
Volume 67, Issue 1 
Muhammad Hasan, Dion Diep, Branavan Manoranjan, Arjuna Maharaj, Sabrina Chaudhry, Saqib Shaheen  Forough Farrokhyar,  Adam J. Fleming,  Olufemi Ajani,  Sheila K. Singh,  Blake Yarascavitch

SUMMARY

Background: Postoperative length of stay (LOS) carries a high burden of healthcare costs. In resource‐intense specialties such as neurosurgery, it is imperative to identify factors that influence LOS to improve care. The current study investigates the potential for variables that affect clinical presentation, tumor characteristics, treatment modalities, and postoperative complications to impact overall LOS in pediatric brain tumor patients. Methods: A retrospective cohort study design was used with patients enrolled in the McMaster Pediatric Brain Tumor Study Group database. All patients up to 18 years of age, presenting with a newly diagnosed brain tumor admitted to and discharged from neurosurgery, were included. Patients were sorted into three cohorts: short LOS (≤3 days), extended LOS (≥20 days), and control LOS (4‐19 days). Results: Of the 124 patients included, 20 (65% male; median age: 9.1 years; range, 0.8‐17.4 years) were considered short LOS, 28 (61% male; median age: 4.7 years; range, 0.4‐14.7 years) were considered extended LOS, and 76 (57% male; median age: 8.5 years; range, 0.3–17.9 years) were considered control LOS. Variables that prolonged LOS were emesis at presentation (P < 0.001), developmental delay (P = 0.02), multiple surgeries (P = 0.004), tumor location (P < 0.05), subtotal resection (P = 0.02), feeding tube (P < 0.001), adjuvant chemoradiotherapy (P < 0.001), and posterior fossa syndrome (P = 0.004). Conclusions:This study identifies variables related to clinical presentation, tumor characteristics, treatment modalities, and postoperative complications associated with extended LOS. These findings uncover novel predictors of LOS that can be used to guide future research and improve health resource management.


A single center experience in the management of progressive juvenile pilocytic astrocytoma
Journal of Neurosurgical Sciences
Ieta Shams, Branavan Manoranjan, Rebecca Voth, Malavan Ragulojan, Olufemi Ajani, Blake Yarascavitch,
Sheila K Singh, Adam J Fleming

ABSTRACTS 

The Factors Determining Quality of Life in Children Diagnosed and Treated for Brain Cancer: A Systematic Survey
Journal of Neuro Oncology 
Mastrolonardo A, Asif MS, Winget K, Cerga K, Doshi A, Kulamurugan A, Aljoghaiman M, Singh SK, Fleming AJ (2022).

Treatment Refractory Pediatric Medulloblastoma

Journal of Neuro Oncology 
November 2017, Volume 19, Issue 6.
Kameda-Smith M, Manoranjan B, Ajani O, Yarascavitch B, Petrelli T, Singh S, Fleming A

Does diagnostic delay affect morbidity in children diagnosed with brain tumors?
Journal of Neuro Oncology 
June 2016, Volume 18(Suppl 3): iii40
Karmur B, Sergeant A, Singh S, Fleming A, Scheinemann K

MRI and Surgical Parameters to Determine the Risk of Cerebellar Mutism
Journal of Neuro-Oncology 
May 2016, Volume 18, Issue 3, pp16
Anjali Sergeant,Brij Karmur,Arjuna Maharaj, Nikunj Patel, Cheryl Alyman, Saleh Almenawer, JoAnn Duckworth, Adam Fleming, Katrin Scheinemann, Forough Farrokhyar, Sheila Singh, Nina Stein

POSTER PRESENTATIONS

Pediatric Optic Pathway Glioma and Other Low-Grade Gliomas in Neurofibromatosis Type 1: a Single Centre Experience
Oral presentation at McMaster Neuroscience Annual Research Day, 2022 and Pediatric Oncology Group of Ontario (POGO) Multidisciplinary Symposium on Childhood Cancer, 2022
Poon M, Mastrolonardo A, Kulamurugan A, Singh SK, Fleming AJ

Epidemiology of Pediatric Brain Tumours: A Single Centre Experience.
Oral presentation at McMaster Neuroscience Annual Research Day, 2022 and Pediatric Oncology Group of Ontario (POGO) Multidisciplinary Symposium on Childhood Cancer, 2022

Kulamurugan A, Mastrolonardo A, Gonzales AA, Ragulojan M, Pai A, Ghayur H, Alyman MC, Fleming AJ, Singh SK

The Role of MRIfGUS in the Treatment of Diffuse Pontine Gliomas: A Narrative Review.
Oral presentation at McMaster Neuroscience Annual Research Day, 2022 and Pediatric Oncology Group of Ontario (POGO) Multidisciplinary Symposium on Childhood Cancer, 2022
Kulamurugan A, Mastrolonardo A, Fleming AJ, Singh SK, Ajani O (2022)

Analysis of Factors that Influence Length of Hospital Stay Among Pediatric Brain Tumor Patients

Poster Presentation to AANS Annual Scientific Meeting 2019, San Diego
Submitted to Paediatric Blood and Cancer as a clinical paper (April 2019)

Dion Diep, Muhammad Hasan, Branavan Manoranjan, Arjuna Maharaj, Sabrina Chaudhry, Saqib Shaheen, Forough Farrokhyar, Adam Fleming, Olufemi Ajani, Sheila Singh, Blake Yarascavitch
 
Tumor-related factors associated with extent of resection in juvenile pilocytic astrocytoma
Poster Presentation at McMaster Neuroscience Research Day 2017
Poster Presentation to AANS Annual Scientific Meeting 2018, New Orleans
Submitted to Child's Nervous System as a clinical paper (April 2019)

Arjuna Maharaj, Branavan Manoranjan, Leonard H. Verhey, Adam J. Fleming, Forrough Farrokhyar, Saleh Almenawar, Sheila K. Singh, Blake Yarascavitch

The Utility of External Ventricular Drainage in the Management of Pediatric Patients with Posterior Fossa Tumors and Hydrocephalus: A Matched Cohort Study
Poster and Oral Presentation at American Association of Neurological Surgeons (AANS)
Annual Scientific Meeting 2017, Los Angeles

Leonard H. Verhey, Arjuna Maharaj, Nikunj Patel, Olufemi Ajani, Blake Yarascavitch, Adam Fleming, Nina Stein, Tina Petrelli, Branavan Manoranjan, Michelle Kameda-Smith, Forough Farrokhyar, Saleh A. Almenawer, Sheila Singh 

Outcomes of diagnostic delay in pediatric brain tumor populations
Oral presentation at McMaster Neuroscience Annual Research Day, 2017
 Karmur B, Maharaj A, Hasan M, Voth R, Sergeant A, Diep D, Kameda M, Manoranjan B, Shams I, Farrokhyar F, Singh S, Fleming A


 

IN PROGRESS


The efficacy of screening imaging in the post-operative follow-up of pediatric brain tumour patients
Journal of Neuro Oncology 
Patel N, Singh S, Karmur B, Diep D, Shams I, Voth R, Fleming A.

Morbidity following diagnostic delay in pediatric brain tumours
Journal of Neuro Oncology 
Karmur B, Kameda-Smith M, Patel N, Hassan M, Maharaj A, Voth R, Diep D, Sergeant A, Scheinemann K, Singh S, Fleming A

A single center experience in determining the number of multi-modality interventions for the management of pediatric low-grade glioma
Journal of Neuro-Oncology 
Shams I, Manoranjan B, Voth R, Ajani O, Yarascavitch B, Singh S, Fleming A.

A single center experience in determining the number of multi-modality interventions for the management of pediatric low-grade glioma
Journal of Neuro-Oncology 
Shams I, Manoranjan B, Voth R, Ajani O, Yarascavitch B, Singh S, Fleming A.

National multicentered retrospective review of intraoperative and imaging
features associated with the development of cerebellar mutism after pediatric posterior fossa tumour resection


Kameda-Smith MM, Cameron Elliott, Vivek Mehta, Lori Bliss, Hanna Moore, Nicholas Sader, Michael K Tso, Mosaab Alsuwaihel, Ayoub Dakson, Jon Chainey, Matthew Eagles, Huphy Ghayur, Malavan Ragulojan, Anjali Sergeant, Cheryl Alyman, Constantine Samaan, Olufemi Ajani, Blake Yarascavitch, Adam Fleming, Forough Farrokhyar, Nina Stein, Sheila K Singh on behalf of the PBTSG and CNRC.

National multicentered retrospective review of salvage therapy in pediatric
medulloblastoma


Kameda-Smith MM, Cameron Elliott, Vivek Mehta, Lori Bliss, Hanna Moore, Nicholas Sader, Michael K Tso, Mosaab Alsuwaihel, Ayoub Dakson, Jon Chainey, Matthew Eagles, Huphy Ghayur, Malavan Ragulojan, Anjali Sergeant, Cheryl Alyman, Constantine Samaan, Olufemi Ajani, Blake Yarascavitch, Adam Fleming, Forough Farrokhyar, Nina Stein, Sheila K Singh on behalf of the PBTSG and CNRC.

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