Publications by authors named "Clark Chen"
Objective: Innovations in robotics continue to reshape the landscape of neurosurgery. Here, the authors evaluated the safety and efficacy of the ExcelsiusGPS robot in the treatment of neuro-oncological, intracranial lesions.
Methods: The authors conducted a retrospective analysis of 19 consecutive adult patients with a neuro-oncological diagnosis who underwent intracranial biopsy and/or laser interstitial thermal therapy (LITT) with the assistance of the ExcelsiusGPS robot and intraoperative CT.
Background: Glioblastoma is the most aggressive malignant brain tumor with poor survival due to its invasive nature driven by cell migration, with unclear linkage to transcriptomic information. The aim of this study was to develop a physics-based framework connecting to transcriptomics to predict patient-specific glioblastoma cell migration.
Methods And Results: We applied a physics-based motor-clutch model, a cell migration simulator (CMS), to parameterize the migration of glioblastoma cells and define physical biomarkers on a patient-by-patient basis.
Objective: Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that allows cytoreduction of brain tumors and can be considered as an alternative to craniotomy. The authors surveyed 27 patients who underwent both craniotomy and LITT during distinct stages of their oncology journey to assess patient-reported outcomes comparing both procedures.
Methods: A 9-question survey was developed and validated to assess patient-reported postoperative recovery, pain level, narcotic use, and procedure preference.
Background: GammaTile (GT), a form of brachytherapy utilizing cesium-131 seeds in a bioresorbable collagen tile, has gained popularity for the treatment of recurrent intracranial tumors and more recently for newly diagnosed metastases. This study reports early experience utilizing GT in upfront brain metastases with a focus on clinical applications and perioperative safety.
Methods: The STaRT Registry (NCT04427384) was queried for all patients receiving GT for upfront metastases from August 2021 to August 2023.
Article Synopsis
- Current chromatin analysis methods struggle with complex tissues, prompting the development of Droplet Hi-C, a new technique using microfluidics for high-throughput, single-cell profiling.
- Droplet Hi-C allowed researchers to map chromatin structures in mouse cortex and assess gene regulation in various cortical cell types, as well as identify genetic changes in human cancers.
- The technique also combines chromatin and transcriptome profiling in single cells, improving insights into the relationship between chromatin architecture and gene expression in both healthy and tumor tissues.*
Background: Generative artificial intelligence (AI) models have emerged as capable of producing human-like responses and have showcased their potential in general medical specialties. This study explores the performance of AI systems on the American Society for Surgery of the Hand (ASSH) Self-Assessment Exams (SAE).
Methods: ChatGPT 4.
Article Synopsis
- Researchers are investigating directionally non-rotating electric field therapy (dnEFT) for treating glioblastoma, which has been less studied compared to tumor-treating fields (TTF).
- In preclinical tests, dnEFT showed effectiveness in inducing apoptosis in glioblastoma cells both in lab settings and in live mouse models, leading to reduced tumor growth and increased survival rates.
- The study highlights the potential for dnEFT to improve outcomes in glioblastoma treatment and supports planning for clinical trials using existing deep brain stimulation technology.
Objective: How maximal safe resection of glioblastoma (GBM) is implemented in the clinical setting remains understudied. Here, we utilized a survey-based approach to understand physician perspectives on this matter.
Methods: Scenarios involving GBMs were presented to physicians who were asked to select from planned subtotal resection, gross total resection (GTR), medical therapy only, or palliative care.
Purpose: GammaTile® (GT) is a brachytherapy platform that received Federal Drug Administration (FDA) approval as brain tumor therapy in late 2018. Here, we reviewed our institutional experience with GT as treatment for recurrent glioblastomas and characterized dosimetric parameter and associated clinical outcome.
Methods And Materials: A total of 20 consecutive patients with 21 (n = 21) diagnosis of recurrent glioblastoma underwent resection followed by intraoperative GT implant between 01/2019 and 12/2020.
Biological sex is an important risk factor in cancer, but the underlying cell types and mechanisms remain obscure. Since tumor development is regulated by the immune system, we hypothesize that sex-biased immune interactions underpin sex differences in cancer. The male-biased glioblastoma multiforme (GBM) is an aggressive and treatment-refractory tumor in urgent need of more innovative approaches, such as considering sex differences, to improve outcomes.
View Article and Find Full Text PDFIntroduction: The efficacy and safety of laser interstitial thermal therapy followed by consolidation radiosurgery (LITT-cSRS) was previously studied in brain metastasis that recurs locally after initial radiosurgery (BMRS). Here, we characterize the clinical outcome of LITT-cSRS in patients with newly diagnosed brain metastasis.
Methods: Between 2017 and 2023, ten consecutive cancer patients with newly diagnosed brain mass of unclear etiology who underwent stereotactic needle biopsy (SNB) and LITT in the same setting followed by consolidation SRS (cSRS) with > 6 months follow-up were identified retrospectively.
Article Synopsis
- - Glioblastoma multiforme (GBM) is a highly aggressive brain cancer that requires effective treatments and biomarkers to personalize therapy for patients.
- - Researchers created patient drug response models by combining tumor gene expression data, drug screening results, and Bayesian networks to discover promising treatments for GBM.
- - The study highlighted several effective drugs, particularly MEK inhibitors, and identified the PHGDH gene as a key factor influencing treatment response, demonstrating the benefits of computational methods in cancer therapy development.
Comprehensive analysis of chromatin architecture is crucial for understanding the gene regulatory programs during development and in disease pathogenesis, yet current methods often inadequately address the unique challenges presented by analysis of heterogeneous tissue samples. Here, we introduce Droplet Hi-C, which employs a commercial microfluidic device for high-throughput, single-cell chromatin conformation profiling in droplets. Using Droplet Hi-C, we mapped the chromatin architecture at single-cell resolution from the mouse cortex and analyzed gene regulatory programs in major cortical cell types.
View Article and Find Full Text PDFOptimizing the treatment of hydrocephalus remains a major challenge in adult and pediatric neurosurgery. Currently, clinical treatment relies heavily on anatomic imaging of ventricular size and clinical presentation. The emergence of functional and structural brain connectivity imaging has provided the basis for a new paradigm in the management of hydrocephalus.
View Article and Find Full Text PDFBackground: With continued evolution in stereotactic techniques and an expanding armamentarium of surgical therapeutic options, non-craniotomy stereotactic procedures in neuro-oncology are becoming increasingly complex, often requiring multi-trajectory approaches. Here we demonstrate that the ClearPoint SmartFrame Array (Solana Beach, California, USA), a second-generation magnetic resonance imaging-compatible stereotactic frame, supports such non-craniotomy, multi-trajectory (NCMT) stereotactic procedures.
Methods: We previously published case reports demonstrating the feasibility of NCMT through the ClearPoint SmartFrame Array.
Purpose: Histone 3 (H3) K27M-mutant diffuse midline glioma (DMG) has a dismal prognosis with no established effective therapy beyond radiation. This integrated analysis evaluated single-agent ONC201 (dordaviprone), a first-in-class imipridone, in recurrent H3 K27M-mutant DMG.
Methods: Fifty patients (pediatric, n = 4; adult, n = 46) with recurrent H3 K27M-mutant DMG who received oral ONC201 monotherapy in four clinical trials or one expanded access protocol were included.
Purpose: Radiation plays a central role in glioblastoma treatment. Logistics related to coordinating clinic visits, radiation planning, and surgical recovery necessitate delay in radiation delivery from the time of diagnosis. Unimpeded tumor growth occurs during this period, and is associated with poor clinical outcome.
View Article and Find Full Text PDFBackground: MRI-guided needle biopsy (INB) is an emerging alternative to conventional frame-based or frameless stereotactic needle biopsy (SNB). Studies of INB have been limited to select case series, and comparative studies between INB and SNB remain a missing gap in the literature. We performed a meta-analysis to compare INB and SNB literature in terms of diagnostic yield, surgical morbidity and mortality, tumor size, and procedural time.
View Article and Find Full Text PDFBackground: Stereotactic radiosurgery (SRS) and recently, hypofractionated radiosurgery (hSRS) are increasingly utilized as treatment for vestibular schwannomas (VS). We performed a meta-analysis of literature comparing these modalities.
Methods: The PubMed database of articles was searched for studies that compared SRS and hSRS in patients with VS.
Article Synopsis
- Glioblastomas are aggressive brain tumors that are hard to treat effectively, and myeloid cells contribute to their treatment resistance through immunosuppression.
- Current therapies typically involve a 6-week radiation plan, but a quicker 3-week approach might benefit older patients or those in poor health.
- This study found that patients undergoing traditional radiation experienced higher levels of monocytes and lower levels of lymphocytes compared to those receiving a shorter radiation schedule, highlighting the need to consider blood cell changes when choosing treatment plans.
Purpose: Stereotactic radiosurgery (SRS) to the resection cavity is essential in the treatment of brain metastasis (BM) amenable to surgical resection. The two most common platforms for SRS delivery include Gamma Knife (GK) and LINAC. Here we collated the available peer-reviewed literature and performed a meta-analysis on clinical outcomes after GK or LINAC resection cavity SRS.
View Article and Find Full Text PDFBackground: The Combination Adenovirus + Pembrolizumab to Trigger Immune Virus Effects (CAPTIVE) study is a phase II clinical trial testing the efficacy of a recombinant adenovirus DNX-2401 combined with the immune checkpoint inhibitor pembrolizumab. Here, we report the first patients in this study who underwent viral delivery through real-time magnetic resonance imaging (MRI) stereotaxis-guided SmartFlow convection delivery of DNX-2401.
Methods: Patients who underwent real-time MRI-guided DNX-2401 delivery through the SmartFlow convection catheter were prospectively followed.
Objective: While postoperative resection cavity radiosurgery (post-SRS) is an accepted treatment paradigm for brain metastasis (BM) patients who undergo surgical resection, there is emerging interest in preoperative radiosurgery (pre-SRS) followed by surgical resection as an alternative treatment paradigm. Here, we performed a meta-analysis of the available literature on this matter.
Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search of all studies evaluating pre-SRS and post-SRS was completed.
Background: Although tractography-guided surgery is used by many surgeons, there is controversy in the published literature as it relates to its clinical utility. Here we adopted a survey-based approach with the goal of attaining a broader view of how tractography influence preoperative planning in a sampling of practicing neurosurgeons.
Methods: Three cases were prepared where the presence of a tumor distorted the optic radiation (case 1), arcuate fasciculus (case 2), and corticospinal tract (case 3).
Background: Plasma cell granuloma (PCG) is a rare clinical entity seen in the neurosurgical literature. It has often been referred to as inflammatory myofibroblastic tumor or inflammatory pseudotumor. No well-defined management guidelines exist in the literature.
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