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Article ; Online: Improving Quality Care and Patient Safety With Implementation of an Oversew Stitch in Lumbar Drains.

Brown, Erik C / Fay, Samantha / Raslan, Ahmed M / Sayama, Christina M

Journal for healthcare quality : official publication of the National Association for Healthcare Quality

2023 Volume 46, Issue 2, Page(s) 95–99

Abstract: Abstract: The lumbar drain exit site purse string oversew stitch is a well-described bedside intervention to stop or prevent cerebrospinal fluid (CSF) leak. It is not routinely placed at the time of lumbar drain placement. Via four plan-do-study-act ( ... ...

Abstract	Abstract: The lumbar drain exit site purse string oversew stitch is a well-described bedside intervention to stop or prevent cerebrospinal fluid (CSF) leak. It is not routinely placed at the time of lumbar drain placement. Via four plan-do-study-act (PDSA) cycles, we test the effect of prophylactic utilization of the lumbar drain exit site oversew stitch on house officers' paging burden, need to redress the drain, need to oversew the drain to stop a CSF leak, and need to replace the drain. We found that the simple act of placing an oversew stitch at the time of lumbar drain placement significantly reduced paging burden and reduced the frequency at which an oversew stitch was required to stop a CSF leak. Subjectively, during PDSA cycles during which overstitches were placed prophylactically, in-house residents perceived that there were less lumbar drains on service, although objectively, the overall number was unchanged. We conclude that prophylactic lumbar drain exit site stitch placement reduces risk and bedside interventions for patients and also reduces overall call burden on house officers. This simple intervention may therefore provide a more widespread improvement in care quality beyond lumbar drain care because house officers experience less burnout during their call shifts.
MeSH term(s)	Humans ; Patient Safety ; Drainage/adverse effects ; Cerebrospinal Fluid Leak/etiology ; Quality of Health Care
Language	English
Publishing date	2023-11-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	1472097-8
ISSN	1945-1474 ; 1062-2551
ISSN (online)	1945-1474
ISSN	1062-2551
DOI	10.1097/JHQ.0000000000000414
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Article ; Online: Rare Case of Pediatric Disseminated Choroid Plexus Papilloma: Literature Review and Call for Reclassification.

Mazur-Hart, David J / Yaghi, Nasser K / Larson, Erik W / Pang, Brandi W / Woltjer, Randy L / Pettersson, David R / Sayama, Christina M

Pediatric neurosurgery

2022 Volume 57, Issue 5, Page(s) 348–357

Abstract: Introduction: Choroid plexus tumors are rare neuroectodermal tumors that arise from the choroid plexus. Choroid plexus papillomas (CPPs) represent the lowest grade of these types of tumors and have a WHO grade I designation. Despite their typical low ... ...

Abstract	Introduction: Choroid plexus tumors are rare neuroectodermal tumors that arise from the choroid plexus. Choroid plexus papillomas (CPPs) represent the lowest grade of these types of tumors and have a WHO grade I designation. Despite their typical low grade, some CPPs can exhibit aggressive behaviors including parenchymal invasion and dissemination throughout the neuro-axis. Due to their association with the choroid plexus, patients with CPP commonly present with signs and symptoms of hydrocephalus and increased intracranial pressure. Case presentation: A 2-year-old male presented in extremis with acute hydrocephalus and seizure. He was found to have a large left intraventricular mass with innumerable intraparenchymal and extra-axial cysts throughout his neuro-axis. A literature review revealed five similar disseminated CPP cases with innumerable lesions. This is the youngest reported patient with disseminated CPP and the first with multiple compressive lesions. Following cranial resection and thoracic decompression, the patient's lesions have remained stable (2 years of follow-up). A literature search of the PubMed/Medline databases was performed using the search terms ["disseminated choroid plexus papilloma" OR "choroid plexus papilloma" OR "metastatic choroid plexus papilloma"] up to March 2021. Articles were then screened for similar patient radiographic presentation and histological diagnosis. To mitigate publication bias, referenced articles were utilized to identify other case reports and case series. Discussion/conclusion: We describe a rare case of a lateral ventricle CPP with widespread leptomeningeal dissemination causing acute obstructive hydrocephalus and compressive myelopathy requiring cerebrospinal fluid diversion and intracranial resection followed by thoracic spine decompression. This case report serves to broaden knowledge of disseminated CPP and to encourage complete neuro-axis imaging for choroid plexus tumors. Additionally, we propose a naming paradigm refinement that includes radiographic characteristics.
MeSH term(s)	Male ; Child ; Humans ; Child, Preschool ; Choroid Plexus/surgery ; Magnetic Resonance Imaging ; Papilloma, Choroid Plexus/diagnostic imaging ; Papilloma, Choroid Plexus/surgery ; Choroid Plexus Neoplasms/diagnostic imaging ; Choroid Plexus Neoplasms/surgery ; Hydrocephalus/diagnostic imaging ; Hydrocephalus/etiology ; Hydrocephalus/surgery ; Supratentorial Neoplasms ; Papilloma/complications ; Papilloma/pathology
Language	English
Publishing date	2022-06-27
Publishing country	Switzerland
Document type	Review ; Case Reports ; Journal Article
ZDB-ID	1091757-3
ISSN	1423-0305 ; 1016-2291
ISSN (online)	1423-0305
ISSN	1016-2291
DOI	10.1159/000525746
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Zs.A 1133: Show issues

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Article: Operative Technique: Angiomatoid Fibrous Histiocytoma-Unique Case and Management.

Mazur-Hart, David J / O'Neill, Brannan E / Pang, Brandi W / Hakar, Melanie H / Wood, Matthew D / Gupta, Sachin / Sayama, Christina M / Liu, Jesse J / Dogan, Aclan

Journal of neurological surgery reports

2022 Volume 83, Issue 3, Page(s) e110–e118

Abstract: ... ...

Abstract	Objective
Language	English
Publishing date	2022-09-20
Publishing country	Germany
Document type	Case Reports
ZDB-ID	2653397-2
ISSN	2193-6366 ; 2193-6358
ISSN (online)	2193-6366
ISSN	2193-6358
DOI	10.1055/s-0042-1754320
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Zs.A 6973: Show issues

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Article ; Online: Post-treatment hypermutation in a recurrent diffuse glioma with H3.3 p.G34 Mutation.

Wood, Matthew D / Neff, Tanaya / Nickerson, Joshua P / Sayama, Christina / Raslan, Ahmed M / Ambady, Prakash / Corless, Christopher L / Nazemi, Kellie J

Neuropathology and applied neurobiology

2020 Volume 47, Issue 3, Page(s) 460–463

MeSH term(s)	Adolescent ; Antineoplastic Agents, Alkylating/adverse effects ; Brain Neoplasms/genetics ; Brain Neoplasms/pathology ; Brain Neoplasms/therapy ; Chemoradiotherapy, Adjuvant ; Drug Resistance, Neoplasm/genetics ; Female ; Glioma/genetics ; Glioma/pathology ; Glioma/therapy ; Histones/genetics ; Humans ; Mutation/drug effects ; Neoplasm Recurrence, Local/genetics ; Neurosurgical Procedures ; Temozolomide/adverse effects
Chemical Substances	Antineoplastic Agents, Alkylating ; H3-3A protein, human ; Histones ; Temozolomide (YF1K15M17Y)
Language	English
Publishing date	2020-12-20
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	80371-6
ISSN	1365-2990 ; 0305-1846
ISSN (online)	1365-2990
ISSN	0305-1846
DOI	10.1111/nan.12679
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Zs.A 1241: Show issues

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Article ; Online: Incidence of symptomatic tethered spinal cord in pediatric patients presenting with neurofibromatosis types 1 and 2.

Quinsey, Carolyn S / Krause, Katie / Baird, Lissa C / Sayama, Christina M / Selden, Nathan R

Journal of neurosurgery. Pediatrics

2018 Volume 21, Issue 5, Page(s) 456–459

Abstract: OBJECTIVE The relationship between a tethered cord (TC) and neurofibromatosis type 1 (NF1) and NF2 is not known. The purpose of this study was to define the incidence of TC in pediatric neurosurgical patients who present with NF. METHODS The authors ... ...

Abstract	OBJECTIVE The relationship between a tethered cord (TC) and neurofibromatosis type 1 (NF1) and NF2 is not known. The purpose of this study was to define the incidence of TC in pediatric neurosurgical patients who present with NF. METHODS The authors performed a single-institution (tertiary care pediatric hospital) 10-year retrospective analysis of patients who were diagnosed with or who underwent surgery for a TC and/or NF. Clinical and radiological characteristics were analyzed, as was histopathology. RESULTS A total of 424 patients underwent surgery for a TC during the study period, and 67 patients with NF were seen in the pediatric neurosurgery clinic. Of these 67 patients, 9 (13%) were diagnosed with a TC, and filum lysis surgery was recommended. Among the 9 patients with NF recommended for TC-release surgery, 4 (44%) were female, the mean age was 8 years (range 4-14 years), the conus position ranged from L1-2 to L-3, and 3 (33%) had a filum lipoma, defined as high signal intensity on T1-weighted MR images. All 9 of these patients presented with neuromotor, skeletal, voiding, and/or pain-related symptoms. Histopathological examination consistently revealed dense fibroconnective tissue and blood vessels. CONCLUSIONS Despite the lack of any known pathophysiological relationship between NF and TC, the incidence of a symptomatic TC in patients with NF1 and NF2 who presented for any reason to this tertiary care pediatric neurosurgery clinic was 13%. Counseling patients and families regarding TC symptomatology might be indicated in this patient population.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Neural Tube Defects/etiology ; Neural Tube Defects/pathology ; Neural Tube Defects/surgery ; Neurofibromatosis 1/complications ; Neurofibromatosis 1/pathology ; Neurofibromatosis 2/complications ; Neurofibromatosis 2/pathology ; Neurosurgical Procedures/methods ; Retrospective Studies ; Tertiary Care Centers
Language	English
Publishing date	2018-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2017.12.PEDS17306
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Uk I Zs.135 -Pediatrics-: Show issues

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Article: Dural adhesion to porous cranioplastic implant: A potential safety concern.

Sayama, Christina M / Sorour, Mohammad / Schmidt, Richard H

Surgical neurology international

2014 Volume 5, Page(s) 19

Abstract: Background: Patient-specific implants are used for cranioplastic skull reconstruction when large bone flaps must be replaced or where there are complex or critical contours, especially near the face. These implants have a low complication rate, with ... ...

Abstract	Background: Patient-specific implants are used for cranioplastic skull reconstruction when large bone flaps must be replaced or where there are complex or critical contours, especially near the face. These implants have a low complication rate, with poor fit and postoperative infection being the most common complications. We report here a potentially serious hazard that may arise from the use of porous implants. Case description: A 45-year-old woman sustained severe head trauma in a motor vehicle accident that required urgent surgical intervention. Because of progressive resorption of her native bone flap, she underwent replacement of her native flap with a hard tissue replacement/patient-matched implant cranioplasty. Eight years later, she sustained a traumatic laceration over her vertex that necessitated removal of her cranioplastic implant because of persistent local infection. Intraoperatively, the dural flap was ingrowing and firmly adherent to the inside surface of the porous cranioplasty. After several failed attempts to remove the whole implant piecemeal, we attempted to dissect the dural flap from the brain surface to remove it together with the cranioplastic implant but exposure of the extensive cortical adhesions between the brain surface and the dural flap was compromised by the hard overlying cranioplastic implant. Despite our meticulous attempts to cut off these cortical adhesions, a perisylvian blood vessel was avulsed, resulting in intraparenchymal hemorrhage. Conclusion: In this case, dural adhesion and ingrowth to the underside of the cranioplasty implant led to disastrous bleeding when the implant needed to be removed years after initial implantation.
Language	English
Publishing date	2014-02-18
Publishing country	United States
Document type	Case Reports
ISSN	2229-5097
ISSN	2229-5097
DOI	10.4103/2152-7806.127377
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Article ; Online: Emerging Frontline Leaders' Voices in Response to COVID-19 Crisis.

Taha, Asma A / Zhang, Zhenzhen / Driessnack, Martha / Huntzicker, James J / Eisen, Aaron M / Bernstein, Juliana / Chen, Aiyin / Chandra, Ravi A / Drake, Karen / Fung, Alice / Ladkany, Rand / LaVigne, Brenda / Nardos, Rahel / Sayama, Christina / Tereshchenko, Larisa G / Wilson, Brittany / Steckler, Nicole A

Nursing research

2022 Volume 71, Issue 2, Page(s) 104–110

Abstract: Background: The COVID-19 pandemic has significantly affected healthcare institutions, introducing new challenges for nurse leaders and their colleagues. However, little is known about how the pandemic has specifically affected the lives of these leaders ...

Abstract	Background: The COVID-19 pandemic has significantly affected healthcare institutions, introducing new challenges for nurse leaders and their colleagues. However, little is known about how the pandemic has specifically affected the lives of these leaders and what methods and strategies they are using to overcome pandemic-related challenges. Objectives: The aim of this study was to examine the effect of the 2019 pandemic on emerging healthcare leaders and highlight methods and strategies they used to overcome pandemic-related challenges. Methods: The participants in this study represent a diverse group of interprofessional healthcare faculty enrolled in a transformational leadership course (Paths to Leadership) when the pandemic first appeared. Three months into the pandemic, the leadership cohort was invited to participate in this qualitative study, exploring four questions: Q1: How have you transformed your working styles in response to the pandemic? Q2: How have you adjusted your personal life in response to the pandemic? Q3: How have you used leadership skills learned from Paths to Leadership during the pandemic? Q4: What lessons have you learned from the pandemic? Participant narratives were analyzed by a team of nurse researchers using conventional qualitative content analysis. Results: Themes for Q1 (working styles) included shifted from face-to-face to telework, faced novel disease and decisions, worked more from home, and challenged to maintain contact with professional peers and team. Themes for Q2 (personal life) included accommodate adults working and children learning from home, looked for and found the positive, and continue to struggle. Themes for Q3 (leadership skills) included reflective practice, listening, holding, and reframing. Finally, themes for Q4 (pandemic lessons) included leadership, human connection, be prepared, taking care of ourselves, and connecting with nature. Discussion: The 2019 pandemic brought hardships and opportunities to faculty members enrolled in an interprofessional transformational leadership course. In conjunction with this course, the pandemic provided a unique opportunity for participants to apply newly acquired relationship building, positive organizational psychology, and reframing skills during a time of crisis. Nursing leaders, whose educational offerings may be immediately "put to the test," may find our lessons learned helpful as they develop strategies to cope with unanticipated future challenges.
MeSH term(s)	Adult ; COVID-19 ; Child ; Health Personnel ; Humans ; Leadership ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2022-01-17
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80332-7
ISSN	1538-9847 ; 0029-6562
ISSN (online)	1538-9847
ISSN	0029-6562
DOI	10.1097/NNR.0000000000000571
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Zs.A 697: Show issues

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Article ; Online: Toward rational use of repeat imaging in children with mild traumatic brain injuries and intracranial injuries.

Journal of neurosurgery. Pediatrics

2023 Volume 32, Issue 1, Page(s) 26–34

Abstract: Objective: Limited evidence exists on the utility of repeat neuroimaging in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs). Here, the authors identified factors associated with repeat neuroimaging and predictors of ... ...

Abstract	Objective: Limited evidence exists on the utility of repeat neuroimaging in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs). Here, the authors identified factors associated with repeat neuroimaging and predictors of hemorrhage progression and/or neurosurgical intervention. Methods: The authors performed a multicenter, retrospective cohort study of children at four centers of the Pediatric TBI Research Consortium. All patients were ≤ 18 years and presented within 24 hours of injury with a Glasgow Coma Scale score of 13-15 and evidence of ICI on neuroimaging. The outcomes of interest were 1) whether patients underwent repeat neuroimaging during index admission, and 2) a composite outcome of progression of previously identified hemorrhage ≥ 25% and/or repeat imaging as an indication for subsequent neurosurgical intervention. The authors performed multivariable logistic regression and report odds ratios and 95% confidence intervals. Results: A total of 1324 patients met inclusion criteria; 41.3% of patients underwent repeat imaging. Repeat imaging was associated with clinical change in 4.8% of patients; the remainder of the imaging tests were for routine surveillance (90.9%) or of unclear prompting (4.4%). In 2.6% of patients, repeat imaging findings were reported as an indication for neurosurgical intervention. While many factors were associated with repeat neuroimaging, only epidural hematoma (OR 3.99, 95% CI 2.22-7.15), posttraumatic seizures (OR 2.95, 95% CI 1.22-7.41), and age ≥ 2 years (OR 2.25, 95% CI 1.16-4.36) were significant predictors of hemorrhage progression and/or neurosurgery. Of patients without any of these risk factors, none underwent neurosurgical intervention. Conclusions: Repeat neuroimaging was commonly used but uncommonly associated with clinical deterioration. Although several factors were associated with repeat neuroimaging, only posttraumatic seizures, age ≥ 2 years, and epidural hematoma were significant predictors of hemorrhage progression and/or neurosurgery. These results provide the foundation for evidence-based repeat neuroimaging practices in children with mTBI and ICI.
MeSH term(s)	Humans ; Child ; Child, Preschool ; Retrospective Studies ; Tomography, X-Ray Computed ; Brain Concussion/complications ; Brain Concussion/diagnostic imaging ; Brain Concussion/surgery ; Craniocerebral Trauma/complications ; Hematoma, Epidural, Cranial ; Glasgow Coma Scale ; Seizures ; Brain Injuries, Traumatic/complications ; Intracranial Hemorrhage, Traumatic/diagnostic imaging ; Intracranial Hemorrhage, Traumatic/surgery ; Intracranial Hemorrhage, Traumatic/complications
Language	English
Publishing date	2023-03-31
Publishing country	United States
Document type	Multicenter Study ; Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2023.2.PEDS22393
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Uk I Zs.135 -Pediatrics-: Show issues

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Article ; Online: Standardizing postoperative care for pediatric intradural Chiari decompressions to decrease length of stay.

Mazur-Hart, David J / Bowden, Stephen G / Pang, Brandi W / Yaghi, Nasser K / Nugent, Joseph G / Yablon, Laurie D / Domreis, Wendy O / Ohm, Erika T / Sayama, Christina M

Journal of neurosurgery. Pediatrics

2021 Volume 28, Issue 5, Page(s) 579–584

Abstract: Objective: Amid national and local budget crises, cutting costs while maintaining quality care is a top priority. Chiari malformation is a relatively common pediatric neurosurgical pathology, and postoperative care varies widely. The postoperative ... ...

Abstract	Objective: Amid national and local budget crises, cutting costs while maintaining quality care is a top priority. Chiari malformation is a relatively common pediatric neurosurgical pathology, and postoperative care varies widely. The postoperative course can be complicated by pain and nausea, which can extend the hospital stay. In this study, the authors aimed to examine whether instituting a standardized postoperative care protocol would decrease overall patient hospital length of stay (LOS) as well as cost to families and the hospital system. Methods: A retrospective study of pediatric patients who underwent an intradural Chiari decompression with expansile duraplasty at a single institution from January 2016 to September 2019 was performed. A standardized postoperative care protocol was instituted on May 17, 2018. Pre- and postprotocol groups were primarily analyzed for demographics, LOS, and the estimated financial expense of the hospital stay. Secondary analysis included readmissions, opioid consumption, and follow-up. Results: The analysis included 132 pediatric patients who underwent an intradural Chiari decompression with expansile duraplasty. The preprotocol group included 97 patients and the postprotocol group included 35 patients. Patient age ranged from 0.5 to 26 years (mean 9.5 years). The mean LOS preprotocol was 55.48 hours (range 25.90-127.77 hours), and the mean postprotocol LOS was 46.39 hours (range 27.58-77.38 hours). The comparison between means showed a statistically significant decrease following protocol initiation (95% CI 1.87-16.31 hours, p = 0.014). In the preprotocol group, 21 of 97 patients (22%) were discharged the first day after surgery compared with 14 of 35 patients (40%) in the postprotocol group (p = 0.045). The estimated cost of one night on the pediatric neurosurgical intermediate ward was approximately $4500, which gives overall cost estimates for 100 theoretical cases of $927,800 for the preprotocol group and $732,900 for the postprotocol group. Conclusions: By instituting a Chiari protocol, postoperative LOS was significantly decreased, which resulted in decreased healthcare costs while maintaining high-quality and safe care.
MeSH term(s)	Arnold-Chiari Malformation/surgery ; Child ; Decompression, Surgical ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Neurosurgical Procedures/standards ; Postoperative Care/standards ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-08-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2021.5.PEDS20929
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Article ; Online: Lack of Zoonotic Coronavirus Species Detected Among Children Hospitalized With Pneumonia in the Philippines.

Sayama, Yusuke / Okamoto, Michiko / Saito, Mayuko / Tamaki, Raita / Saito-Obata, Mariko / Quicho, Reynaldo Frederick Negosa / Joboco, Christina Dahlia / Lupisan, Socorro / Oshitani, Hitoshi

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2023 Volume 77, Issue 11, Page(s) 1612–1613

MeSH term(s)	Child ; Humans ; Infant ; Coronavirus ; Philippines/epidemiology ; Pneumonia/epidemiology ; Coronavirus Infections/epidemiology
Language	English
Publishing date	2023-07-19
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciad430
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