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Papers by Ahmed I . Lary

Cureus, Nov 7, 2022

Background As a well-documented fact, metastatic brain tumors are the most common cause of brain ... more Background As a well-documented fact, metastatic brain tumors are the most common cause of brain tumors in adults, with an incidence of 9-17%, based on various studies, although it was thought to be higher. The aim of this study was to describe recorded cases of metastatic brain tumors in the adult population of a tertiary care and oncology center in Jeddah, Saudi Arabia. Methods This study was conducted at King Abdulaziz Medical City (KAMC) at King Khalid Hospital in Jeddah, Saudi Arabia, including records from January 2016 to December 2020. The study implemented a retrospective cohort design to fulfill its aim. A data collection sheet containing demographic data such as age and gender, and information pertaining to the primary pathology, multiplicity, and survival outcome was used. Results A total number of 213 patients were enrolled in this study. Overall, 68.1% of the sample comprised of females. Approximately two-thirds (61.9%) of the patients' imaging results revealed multiplicity, whereas the remaining third (38.1%) had solitary lesions. The estimated overall survival median after the diagnosis of brain metastasis was six months (95% CI: 5.5-6.5). Conclusion We recommend conducting a nationwide study to better understand the incidence in accordance to geographical and gender differences. We can further expand our research to include other institutes in Saudi Arabia, and include important predictors such as time from the diagnosis of primary pathology to brain metastasis, disease progression cost, and disease progression in the months prior to the patients' death.

Cureus

Babateen et al. This is an open access article distributed under the terms of the Creative Common... more Babateen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Surgical Neurology International, 2022

Background: Hypertonic saline (HS) and mannitol are hyperosmolar agents that are usually used to ... more Background: Hypertonic saline (HS) and mannitol are hyperosmolar agents that are usually used to reduce intracranial pressure (ICP) and provide a satisfactory brain relaxation. The aim of the study was to perform a systematic review and meta-analysis to compare the efficacy of HS and mannitol on brain relaxation intraoperatively in patient undergoing craniotomies for supra-tentorial brain tumors. Methods: We included systematic review and meta-analysis of randomized control trials. We included randomized control trials that compared equiosmolar HS and mannitol in supratentorial tumors craniotomies and reported at least one of the following outcomes: degree of brain relaxation, ICP, central venous pressure, mean arterial pressure, perioperative fluid input, urine output, Na+ levels, and K+ levels. We searched Medline, Cochrane Central Register of Controlled Trials, and Embase using MESH terms and keywords. The bibliographic references of included studies and trial registries were als...

Objective: (a) To assess the control of glioblastoma-associated seizure in patients receiving dif... more Objective: (a) To assess the control of glioblastoma-associated seizure in patients receiving different anti-epileptic drugs and chemotherapies after total resection and its association with O-methylguanine-DNA methyltransferase (MGMT) promotor methylation and the isocitrate dehydrogenase 1 (IDH1) mutation; (b) to determine which anti-epileptic drug exerts the best effective control on glioblastoma-associated epilepsy; (c) to identify the relationship between seizure control and different anti-epileptic drugs and recurrence interval. Methods: This was a retrospective cohort study of patients with postoperative glioblastoma-associated epilepsy in the period between 2014 and 2019. The correlations between the IDH1 mutation and MGMT promotor methylation with anti-epileptic drugs, chemotherapy type, seizure control, and recurrence interval were analyzed using different statistical methods. Results: This study included 53 adult patients with glioblastoma-associated epilepsy. The IDH1 mut...

Turkish Journal of Pathology, 2021

Objective: Intraoperative frozen section (IOFS) diagnosis of brain tumors plays an important role... more Objective: Intraoperative frozen section (IOFS) diagnosis of brain tumors plays an important role in assessing the adequacy of the sample and determining the treatment plan. The aim of this study was to investigate the diagnostic accuracy between IOFS and permanent sections. Material and Method: The authors reviewed the histopathological results of 383 brain tumors, including IOFS and permanent histological diagnosis. The cases were classified into three diagnostic compatibilities (i) Perfect fit; the diagnosis of IOFS was identical to the permanent diagnosis, (ii) Partial compatibility; IOFS diagnosis was not incorrect but was too broad to be considered full compatibility, (iii) Conflict; IOFS diagnosis is completely different from the permanent diagnosis. The permanent diagnosis was used as a primary criterion and was compared to IOFS diagnosis and recurrence rate using different statistical methods. Results: 84% of the patients underwent craniotomy and tumor resection, while 15% only underwent tumor biopsy. Approximately, 53.8 % of the cases revealed perfect matching in the diagnosis between IOFSs and permanent sections, while 16.2% of the cases revealed complete mismatching in the diagnosis between the sections. The remaining 30% of the cases showed partial compatibility in the diagnosis between the two diagnostic methods. There was no significant difference in recurrence rate among all cases of different diagnostic compatibility (p=0.54). Conclusion: There is a diagnostic discrepancy between IOFSs and permanent sections. However, cases that revealed no consensus in the diagnoses showed no negative effect on the patient outcome. Further studies should be conducted to explore the reasons of this conflict in the two diagnostic methods.

Journal of Neuro-Oncology, 2021

Objective To assess the recurrence interval and predictive significance of TP53 expression and O6... more Objective To assess the recurrence interval and predictive significance of TP53 expression and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in glioblastomas treated with radiotherapy and combined chemotherapies, including temozolomide, lomustine, procarbazine and bevacizumab. Method We reviewed the clinical outcomes of 52 totally resected glioblastoma patients, who received conventional radiotherapy and temozolomide with other chemotherapeutic agents. Correlation of TP53 expression and MGMT promotor methylation with recurrence interval was analyzed using Kaplan Meier estimates. Results No significant association was found between MGMT promotor methylation and TP53 expression in glioblastomas (P-value = 0.158). Patients with non-methylated MGMT who received temozolomide chemotherapy with other chemotherapeutic agents showed significantly later recurrence (P-value = 0.007) compared with patients with non-methylated MGMT who received temozolomide alone. No signifi...

Cureus, 2021

The objectives of this study are to explore the most common causes, patterns, and severities of h... more The objectives of this study are to explore the most common causes, patterns, and severities of head traumas, to evaluate the outcomes of traumatic head injury (TBI) patients followed in the clinic, and to calculate the prevalence of admitted cases. Methods In our retrospective cohort study, we included all the cases of adults above 18 years old diagnosed with head traumas (171 patients). The inclusion criteria were patients who presented to the emergency department at National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia from 2016 to 2020. Patients were categorized according to their Glasgow Coma Scale (GCS) score upon admission. Results Of the 171 patients in this study, 151 (88.3%) were males and 20 (11.7%) were females. The median age of our patients was 31 years. Most of the cases had no medical illnesses 124 (72.5%). The most common mechanism of injury was motor vehicle accidents (MVAs) in the majority of our cases (105, 61.4%), followed by falls from heights (34, 19.9%). The commonest computed tomography (CT) finding was subdural hematoma (47, 27.4%). The majority of the associated injuries were thoracic cases (43, 25.1%), followed by spinal (40, 23.4%). Most of the patients were admitted to NGHA (120, 70.2%), while the rest (51, 29.8%) were transferred from other hospitals. Of the total of 171 patients, 134 (78.4%) were treated conservatively. There were no associations between mortality nor length of stay and patients' demographics, except for GCS on admission showed a significant p-value (<0.005). Conclusion In this study, it was found that the most common causes of TBI are MVAs followed by falls from heights. Therefore, preventive measures such as traffic safety rules need to be addressed.

Annals of Oncology, 2016

ABSTRACT Background: Glioblastoma multiforme (GBM) is the most common primary brain tumor in adul... more ABSTRACT Background: Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults. Despite recent advances in the understanding of the molecular mechanism of tumorigenesis, the outcome remains poor. Atorvastatin is an inhibitor of HMG-CoA reductase, a rate-limiting enzyme in the mevalonate pathway. Preclinical studies have demonstrated pro-apoptotic, anti-proliferative, anti-invasive, and radiosensitizing properties of statins. To date, no prospective studies have addressed the anti-tumor effects of statins in GBM. This trial was designed to determine the efficacy and safety of atorvastatin in combination with radiotherapy and temozolomide (TMZ) in patients with newly diagnosed GBM. Methods: In this open-label, prospective, single-arm, phase II study, eligible patients will receive oral atorvastatin (40 mg/d for 3 weeks and 80 mg/d thereafter) until disease progression or significant toxicity, in combination with standard therapy comprising radiotherapy (60 Gy/30 fractions) and TMZ (75 mg/m2/d) in the 6-wk concurrent phase, then with TMZ (150-200 mg/m2/d on days 1-5 for 6 cycles). The key eligibility criteria includes: adults (≥18 years) with newly diagnosed GBM, who have undergone surgical resection or biopsy, ECOG performance status ≤ 2, adequate organ function, no prior chemotherapy or radiotherapy, stable dose of steroids for ≥14 days prior to registration, and written informed consent. The primary endpoint is progression free survival (PFS) at 6 months (RANO criteria). Secondary endpoints include overall survival (OS), and safety. A minimum of 80% power required at least 32 eligible patients to be enrolled starting January 2014 with a planned interim analysis after the first 15 evaluable patients. Statistical analysis plan includes Kaplan Meir techniques and Cox proportional hazard modeling. ClinicalTrials.gov Identifier: NCT02029573

International Journal of Advanced Research, 2017

Glioblastoma Multiforms, Intracranial cranial hemorrhage, intracerebral hemorrhage, primary brain... more Glioblastoma Multiforms, Intracranial cranial hemorrhage, intracerebral hemorrhage, primary brain tumors. Context: glioblastoma multiform (GBM) is the stage four of glioblastoma tumor(1). It is the most common primary intra-cranial tumors(2). GBM can be presented by intracranial hemorrhage (ICH) with an incidence between 1-10 % and usually occur in the late course of the disease. The general prognosis of GBM with ICH is poor and worsen in elderly(8)(5). Aims: Determining the effect of the hemorrhage on the disease prognosis, exploring the prevalence and predisposing factors. Methods: A retrospective medical record review had performed for patients diagnosed with GBM between 2008 through 2013 at national neuroscience institute in King Fahad Medical City. Inclusion criteria are male and female with age more than 18 years old diagnosed with glioblastoma multiform grade four and were followed in the King Fahad Medical City Clinic. The exclusion criteria is any patients with the hemolytic disorder. Results:. A total of 87 out of 530 patients with GBM were identified. 15 (17.2%) of GBM patients have ICH while 72(82.8%) nonhemorrhagic. 61 (70.1%) were male while 26 (29.9%) were female. No difference between prognosis between hemorrhagic and nonhemorrhagic GBM patients. Tumor size, and gender are not predisposing factors. Conclusion: there were no difference in the prognosis and between hemorrhagic glioblastoma multiform and non-hemorrhagic and gender and Tumor size are not predisposing factors.

Molecular and Clinical Oncology, 2016

Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with ... more Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with one of the worst 5 year survival rates among all human cancer types. To date, no published data are available for the outcome of this disease in Saudi Arabia. The present study performed a single-center, retrospective cohort study to evaluate the outcome of patients with GBM in Saudi Arabia. The Comprehensive Cancer Center at King Fahad Medical city (Riyadh, Saudi Arabia) was used in the present study. All adult patients (≥18 years) diagnosed with histologically proven GBM between January 2008 and December 2013 were included in the present study. A total of 90 patients were treated during the specified period. Of this, 73 (81%) patients underwent resection and 17 (19%) had biopsy only. The majority of patients (n=88; 98%) received radiotherapy (XRT): 67 (76%) with standard and 21 (24%) with hypo-fractionated dosage. Of the total patients, 65 (72%) received combined modality therapy [standard XRT concurrently with Temozolmide (TMZ)]. The 6 month progression-free survival rate was 43% for all patients and 55% for the combined modality subgroup. The median overall survival (OS) for all patients was 13.7 months. However, the median OS for patients treated with combined modality was 19.7 months. In this single-center retrospective study, the outcomes of patients with GBM were similar to those in previously reported studies. An improved outcome was associated with an improved performance status, absence of residual disease and use of adjuvant TMZ.

International journal of health sciences

The treatment recommendations provided in this manuscript are intended to serve as a knowledge ba... more The treatment recommendations provided in this manuscript are intended to serve as a knowledge base for clinicians and health personals involved in treating patients with high-grade malignant glioma. In newly diagnosed patients, complete resection or biopsy is required for histological characterization of the tumor, which in turn is essential to decide the treatment strategy. In patients with good or borderline performance score, radiotherapy (RT), and chemotherapy are the preferred management. In patients with poor performance score, RT with best possible supportive care is the mainstay of the management. All patients have to undergo brain magnetic resonance imaging procedure quarterly or half-yearly for 5 years and then on an annual basis. In patients with recurrent malignant glioma, wherever possible re-resection or re-irradiation or chemotherapy can be considered along with supportive and palliative care. High-grade malignant glioma should be managed in a multidisciplinary cente...

To systematically review reported cases of Seckel syndrome (SS) and point out cases associated wi... more To systematically review reported cases of Seckel syndrome (SS) and point out cases associated with central nervous system (CNS) vasculopathy and provide a summary of their clinical presentation, management, and outcomes including our illustrative case. We conducted a search on the MEDLINE, PubMed, Google Scholar, and Cochrane databases using the keywords “Seckel + syndrome.” We identified 127 related articles reporting 252 cases of SS apart from our case. Moreover, we searched for SS cases with CNS vasculopathies from the same databases. We identified 7 related articles reporting 7 cases of CNS vasculopathies in SS patients. The overall rate of CNS vasculopathy in SS patients is 3.16% (n = 8/253), where moyamoya disease (MMD) accounted for 1.97%. The mean age is 13.5 years (6–19 years), with equal gender distribution (M:F, 1:1). The most common presenting symptoms were headache and seizure followed by weakness or coma. Aneurysms were mostly located in the basilar artery, middle cer...

The aim of this study is to investigate the relationship between isocitrate dehydrogenase-1 (IDH1... more The aim of this study is to investigate the relationship between isocitrate dehydrogenase-1 (IDH1) mutation and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation with recurrence-free interval in glioblastoma patients treated with chemoradiotherapies. Clinical data were collected from 82 patients with totally resected glioblastoma and treated with adjuvant therapies from 2014 to 2019. IDH1 mutation was assessed by immunohistochemistry and MGMT promoter methylation was assessed by different sequencing methods. IDH1 mutation was present in 32 cases and 50 cases were IDH1 wildtype; 54 and 28 patients had unmethylated and methylated MGMT promoter, respectively, Of the 82 patients, 62 patients received chemoradiotherapy while 20 patients only received radiation. Approximately, 61% of patients had a tumor recurrence after 1 year, and 39% showed a recurrence before 1 year of treatment. There was no significant relationship between IDH1 mutation and MGMT promoter methylation...

OBJECTIVES Central nervous system (CNS) tumors are a major and growing global healthcare challeng... more OBJECTIVES Central nervous system (CNS) tumors are a major and growing global healthcare challenge. Western Saudi Arabia has an inconsistent data registry; therefore, the epidemiology of CNS tumors is unclear across the country. This study is aimed to assemble the epidemiological matrix of CNS tumors in the Western Province of Saudi Arabia. METHODS A retrospective analysis was performed using clinical data obtained from 3 neuroscience centers in Western Saudi Arabia in the period 2014-2019. The sample size included 663 adult and pediatric cases from the local and expatriate populations diagnosed with CNS tumors. The distributions of age, sex, clinical presentation, tumor location, type of surgery, histological subtype, genetic characteristics, and recurrence rate were explored. RESULTS The analysis included 500 adult cases and 163 pediatric cases up to 18 years of age with a male-to-female ratio of 1.16. The mean age at diagnosis was 38.0±22.6 years. The supratentorium was the most ...

Background The Wilms tumor 1 (WT1) gene has recently been shown to play a role in gliomagenesis, ... more Background The Wilms tumor 1 (WT1) gene has recently been shown to play a role in gliomagenesis, making it a potential immunotherapy target in glioblastomas. We aimed to investigate the most sensitive method to detect WT1 expression in glioblastoma and explore relationship between WT1 expression and isocitrate dehydrogenase-1 (IDH1) mutation. Methods Clinical and biological data were collected from 44 patients with totally resected glioblastomas, treated with adjuvant therapies, in the period between 2015 and 2019. WT1 protein expression was assessed in all cases using IHC while its gene expression was assessed in 13 clustered samples using quantitative polymerase chain reaction (qPCR). IDH1 mutation was assessed using immunohistochemistry (IHC). McNemar test was used to compare the sensitivity between IHC and RT-qPCR for WT1 gene expression detection. Kaplan Meier curves were used to compare the distribution of recurrence-free interval (RFI) between IDH1 and WT1 expression groups. ...

Common and Uncommon Causes in Adults and Children, 2009

World Neurosurgery

Introduction After the official announcement of the coronavirus disease-19 pandemic on March 11, ... more Introduction After the official announcement of the coronavirus disease-19 pandemic on March 11, 2020, the disease impacted most aspects of health care delivery, especially postgraduate education and training. Method A cross-sectional, online questionnaire-based assessment was performed. The study participants involved neurosurgery residents and program directors (PDs) across the country between May 16 and May 27, 2020. Results Approximately 74 of 95 (77.9%) of the residents experienced an impact on their training calendar. Before the pandemic, 51 residents (53.3%) were involved in 2–3 surgeries per week, but during the pandemic, 66 (69.5%) were attending 0–1 case per week. Fifty-three residents (55.8%) agreed that academic sessions were affected despite the helpful effort of online teaching sessions. Thirty-four (35.8%) residents graded their anxiety during coronavirus disease-19 times as high. Ten PDs (58.8%) confirmed spending 3–5 hours per week on educational activities normally, whereas during the pandemic, 15 PDs (88.2%) reduced their educational hours to 0–2 hours per week. Conclusion Our study showed that educational activities significantly decreased and shifted toward virtual teaching methods. Operative volume showed a substantial reduction for both junior and senior residents. Academic and clinical teaching was the main concern for PDs, and they faced challenges interviewing newly matched residents.

Molecular and Clinical Oncology, 2016

Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with ... more Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with one of the worst 5 year survival rates among all human cancer types. To date, no published data are available for the outcome of this disease in Saudi Arabia. The present study performed a single-center, retrospective cohort study to evaluate the outcome of patients with GBM in Saudi Arabia. The Comprehensive Cancer Center at King Fahad Medical city (Riyadh, Saudi Arabia) was used in the present study. All adult patients (≥18 years) diagnosed with histologically proven GBM between January 2008 and December 2013 were included in the present study. A total of 90 patients were treated during the specified period. Of this, 73 (81%) patients underwent resection and 17 (19%) had biopsy only. The majority of patients (n=88; 98%) received radiotherapy (XRT): 67 (76%) with standard and 21 (24%) with hypo-fractionated dosage. Of the total patients, 65 (72%) received combined modality therapy [standard XRT concurrently with Temozolmide (TMZ)]. The 6 month progression-free survival rate was 43% for all patients and 55% for the combined modality subgroup. The median overall survival (OS) for all patients was 13.7 months. However, the median OS for patients treated with combined modality was 19.7 months. In this single-center retrospective study, the outcomes of patients with GBM were similar to those in previously reported studies. An improved outcome was associated with an improved performance status, absence of residual disease and use of adjuvant TMZ.

Surgical Neurology International

Background: Synovial sarcoma (SS) of the spine is a rare malignant soft-tissue tumor, and there a... more Background: Synovial sarcoma (SS) of the spine is a rare malignant soft-tissue tumor, and there are few reported cases. The aim of this paper is to report a rare case of spinal SS involving the paraspinal muscles, and to review all such cases reported in the literature. Case Description: In this paper, we report a rare case of spinal SS involving the paraspinal muscles in a 12-year-old girl. The patient underwent surgical excision of the mass with adjuvant radiation and chemotherapy. At the 1-year follow-up, there was no evidence of local tumor recurrence, and the patient’s symptoms had improved. In addition, we identified and reviewed 33 reported cases of SS involving the spine. Conclusion: Due to the limited number of reported cases in the literature, it is difficult to predict the outcomes of spinal SS. Further, different treatment modalities have been used to treat spinal SS. However, most of the reported cases had poor outcomes. Therefore, prospective multi-center studies are n...

Cureus, Nov 7, 2022

Background As a well-documented fact, metastatic brain tumors are the most common cause of brain ... more Background As a well-documented fact, metastatic brain tumors are the most common cause of brain tumors in adults, with an incidence of 9-17%, based on various studies, although it was thought to be higher. The aim of this study was to describe recorded cases of metastatic brain tumors in the adult population of a tertiary care and oncology center in Jeddah, Saudi Arabia. Methods This study was conducted at King Abdulaziz Medical City (KAMC) at King Khalid Hospital in Jeddah, Saudi Arabia, including records from January 2016 to December 2020. The study implemented a retrospective cohort design to fulfill its aim. A data collection sheet containing demographic data such as age and gender, and information pertaining to the primary pathology, multiplicity, and survival outcome was used. Results A total number of 213 patients were enrolled in this study. Overall, 68.1% of the sample comprised of females. Approximately two-thirds (61.9%) of the patients' imaging results revealed multiplicity, whereas the remaining third (38.1%) had solitary lesions. The estimated overall survival median after the diagnosis of brain metastasis was six months (95% CI: 5.5-6.5). Conclusion We recommend conducting a nationwide study to better understand the incidence in accordance to geographical and gender differences. We can further expand our research to include other institutes in Saudi Arabia, and include important predictors such as time from the diagnosis of primary pathology to brain metastasis, disease progression cost, and disease progression in the months prior to the patients' death.

Cureus

Babateen et al. This is an open access article distributed under the terms of the Creative Common... more Babateen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Surgical Neurology International, 2022

Background: Hypertonic saline (HS) and mannitol are hyperosmolar agents that are usually used to ... more Background: Hypertonic saline (HS) and mannitol are hyperosmolar agents that are usually used to reduce intracranial pressure (ICP) and provide a satisfactory brain relaxation. The aim of the study was to perform a systematic review and meta-analysis to compare the efficacy of HS and mannitol on brain relaxation intraoperatively in patient undergoing craniotomies for supra-tentorial brain tumors. Methods: We included systematic review and meta-analysis of randomized control trials. We included randomized control trials that compared equiosmolar HS and mannitol in supratentorial tumors craniotomies and reported at least one of the following outcomes: degree of brain relaxation, ICP, central venous pressure, mean arterial pressure, perioperative fluid input, urine output, Na+ levels, and K+ levels. We searched Medline, Cochrane Central Register of Controlled Trials, and Embase using MESH terms and keywords. The bibliographic references of included studies and trial registries were als...

Objective: (a) To assess the control of glioblastoma-associated seizure in patients receiving dif... more Objective: (a) To assess the control of glioblastoma-associated seizure in patients receiving different anti-epileptic drugs and chemotherapies after total resection and its association with O-methylguanine-DNA methyltransferase (MGMT) promotor methylation and the isocitrate dehydrogenase 1 (IDH1) mutation; (b) to determine which anti-epileptic drug exerts the best effective control on glioblastoma-associated epilepsy; (c) to identify the relationship between seizure control and different anti-epileptic drugs and recurrence interval. Methods: This was a retrospective cohort study of patients with postoperative glioblastoma-associated epilepsy in the period between 2014 and 2019. The correlations between the IDH1 mutation and MGMT promotor methylation with anti-epileptic drugs, chemotherapy type, seizure control, and recurrence interval were analyzed using different statistical methods. Results: This study included 53 adult patients with glioblastoma-associated epilepsy. The IDH1 mut...

Turkish Journal of Pathology, 2021

Objective: Intraoperative frozen section (IOFS) diagnosis of brain tumors plays an important role... more Objective: Intraoperative frozen section (IOFS) diagnosis of brain tumors plays an important role in assessing the adequacy of the sample and determining the treatment plan. The aim of this study was to investigate the diagnostic accuracy between IOFS and permanent sections. Material and Method: The authors reviewed the histopathological results of 383 brain tumors, including IOFS and permanent histological diagnosis. The cases were classified into three diagnostic compatibilities (i) Perfect fit; the diagnosis of IOFS was identical to the permanent diagnosis, (ii) Partial compatibility; IOFS diagnosis was not incorrect but was too broad to be considered full compatibility, (iii) Conflict; IOFS diagnosis is completely different from the permanent diagnosis. The permanent diagnosis was used as a primary criterion and was compared to IOFS diagnosis and recurrence rate using different statistical methods. Results: 84% of the patients underwent craniotomy and tumor resection, while 15% only underwent tumor biopsy. Approximately, 53.8 % of the cases revealed perfect matching in the diagnosis between IOFSs and permanent sections, while 16.2% of the cases revealed complete mismatching in the diagnosis between the sections. The remaining 30% of the cases showed partial compatibility in the diagnosis between the two diagnostic methods. There was no significant difference in recurrence rate among all cases of different diagnostic compatibility (p=0.54). Conclusion: There is a diagnostic discrepancy between IOFSs and permanent sections. However, cases that revealed no consensus in the diagnoses showed no negative effect on the patient outcome. Further studies should be conducted to explore the reasons of this conflict in the two diagnostic methods.

Journal of Neuro-Oncology, 2021

Objective To assess the recurrence interval and predictive significance of TP53 expression and O6... more Objective To assess the recurrence interval and predictive significance of TP53 expression and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in glioblastomas treated with radiotherapy and combined chemotherapies, including temozolomide, lomustine, procarbazine and bevacizumab. Method We reviewed the clinical outcomes of 52 totally resected glioblastoma patients, who received conventional radiotherapy and temozolomide with other chemotherapeutic agents. Correlation of TP53 expression and MGMT promotor methylation with recurrence interval was analyzed using Kaplan Meier estimates. Results No significant association was found between MGMT promotor methylation and TP53 expression in glioblastomas (P-value = 0.158). Patients with non-methylated MGMT who received temozolomide chemotherapy with other chemotherapeutic agents showed significantly later recurrence (P-value = 0.007) compared with patients with non-methylated MGMT who received temozolomide alone. No signifi...

Cureus, 2021

The objectives of this study are to explore the most common causes, patterns, and severities of h... more The objectives of this study are to explore the most common causes, patterns, and severities of head traumas, to evaluate the outcomes of traumatic head injury (TBI) patients followed in the clinic, and to calculate the prevalence of admitted cases. Methods In our retrospective cohort study, we included all the cases of adults above 18 years old diagnosed with head traumas (171 patients). The inclusion criteria were patients who presented to the emergency department at National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia from 2016 to 2020. Patients were categorized according to their Glasgow Coma Scale (GCS) score upon admission. Results Of the 171 patients in this study, 151 (88.3%) were males and 20 (11.7%) were females. The median age of our patients was 31 years. Most of the cases had no medical illnesses 124 (72.5%). The most common mechanism of injury was motor vehicle accidents (MVAs) in the majority of our cases (105, 61.4%), followed by falls from heights (34, 19.9%). The commonest computed tomography (CT) finding was subdural hematoma (47, 27.4%). The majority of the associated injuries were thoracic cases (43, 25.1%), followed by spinal (40, 23.4%). Most of the patients were admitted to NGHA (120, 70.2%), while the rest (51, 29.8%) were transferred from other hospitals. Of the total of 171 patients, 134 (78.4%) were treated conservatively. There were no associations between mortality nor length of stay and patients' demographics, except for GCS on admission showed a significant p-value (<0.005). Conclusion In this study, it was found that the most common causes of TBI are MVAs followed by falls from heights. Therefore, preventive measures such as traffic safety rules need to be addressed.

Annals of Oncology, 2016

ABSTRACT Background: Glioblastoma multiforme (GBM) is the most common primary brain tumor in adul... more ABSTRACT Background: Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults. Despite recent advances in the understanding of the molecular mechanism of tumorigenesis, the outcome remains poor. Atorvastatin is an inhibitor of HMG-CoA reductase, a rate-limiting enzyme in the mevalonate pathway. Preclinical studies have demonstrated pro-apoptotic, anti-proliferative, anti-invasive, and radiosensitizing properties of statins. To date, no prospective studies have addressed the anti-tumor effects of statins in GBM. This trial was designed to determine the efficacy and safety of atorvastatin in combination with radiotherapy and temozolomide (TMZ) in patients with newly diagnosed GBM. Methods: In this open-label, prospective, single-arm, phase II study, eligible patients will receive oral atorvastatin (40 mg/d for 3 weeks and 80 mg/d thereafter) until disease progression or significant toxicity, in combination with standard therapy comprising radiotherapy (60 Gy/30 fractions) and TMZ (75 mg/m2/d) in the 6-wk concurrent phase, then with TMZ (150-200 mg/m2/d on days 1-5 for 6 cycles). The key eligibility criteria includes: adults (≥18 years) with newly diagnosed GBM, who have undergone surgical resection or biopsy, ECOG performance status ≤ 2, adequate organ function, no prior chemotherapy or radiotherapy, stable dose of steroids for ≥14 days prior to registration, and written informed consent. The primary endpoint is progression free survival (PFS) at 6 months (RANO criteria). Secondary endpoints include overall survival (OS), and safety. A minimum of 80% power required at least 32 eligible patients to be enrolled starting January 2014 with a planned interim analysis after the first 15 evaluable patients. Statistical analysis plan includes Kaplan Meir techniques and Cox proportional hazard modeling. ClinicalTrials.gov Identifier: NCT02029573

International Journal of Advanced Research, 2017

Glioblastoma Multiforms, Intracranial cranial hemorrhage, intracerebral hemorrhage, primary brain... more Glioblastoma Multiforms, Intracranial cranial hemorrhage, intracerebral hemorrhage, primary brain tumors. Context: glioblastoma multiform (GBM) is the stage four of glioblastoma tumor(1). It is the most common primary intra-cranial tumors(2). GBM can be presented by intracranial hemorrhage (ICH) with an incidence between 1-10 % and usually occur in the late course of the disease. The general prognosis of GBM with ICH is poor and worsen in elderly(8)(5). Aims: Determining the effect of the hemorrhage on the disease prognosis, exploring the prevalence and predisposing factors. Methods: A retrospective medical record review had performed for patients diagnosed with GBM between 2008 through 2013 at national neuroscience institute in King Fahad Medical City. Inclusion criteria are male and female with age more than 18 years old diagnosed with glioblastoma multiform grade four and were followed in the King Fahad Medical City Clinic. The exclusion criteria is any patients with the hemolytic disorder. Results:. A total of 87 out of 530 patients with GBM were identified. 15 (17.2%) of GBM patients have ICH while 72(82.8%) nonhemorrhagic. 61 (70.1%) were male while 26 (29.9%) were female. No difference between prognosis between hemorrhagic and nonhemorrhagic GBM patients. Tumor size, and gender are not predisposing factors. Conclusion: there were no difference in the prognosis and between hemorrhagic glioblastoma multiform and non-hemorrhagic and gender and Tumor size are not predisposing factors.

Molecular and Clinical Oncology, 2016

Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with ... more Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with one of the worst 5 year survival rates among all human cancer types. To date, no published data are available for the outcome of this disease in Saudi Arabia. The present study performed a single-center, retrospective cohort study to evaluate the outcome of patients with GBM in Saudi Arabia. The Comprehensive Cancer Center at King Fahad Medical city (Riyadh, Saudi Arabia) was used in the present study. All adult patients (≥18 years) diagnosed with histologically proven GBM between January 2008 and December 2013 were included in the present study. A total of 90 patients were treated during the specified period. Of this, 73 (81%) patients underwent resection and 17 (19%) had biopsy only. The majority of patients (n=88; 98%) received radiotherapy (XRT): 67 (76%) with standard and 21 (24%) with hypo-fractionated dosage. Of the total patients, 65 (72%) received combined modality therapy [standard XRT concurrently with Temozolmide (TMZ)]. The 6 month progression-free survival rate was 43% for all patients and 55% for the combined modality subgroup. The median overall survival (OS) for all patients was 13.7 months. However, the median OS for patients treated with combined modality was 19.7 months. In this single-center retrospective study, the outcomes of patients with GBM were similar to those in previously reported studies. An improved outcome was associated with an improved performance status, absence of residual disease and use of adjuvant TMZ.

International journal of health sciences

The treatment recommendations provided in this manuscript are intended to serve as a knowledge ba... more The treatment recommendations provided in this manuscript are intended to serve as a knowledge base for clinicians and health personals involved in treating patients with high-grade malignant glioma. In newly diagnosed patients, complete resection or biopsy is required for histological characterization of the tumor, which in turn is essential to decide the treatment strategy. In patients with good or borderline performance score, radiotherapy (RT), and chemotherapy are the preferred management. In patients with poor performance score, RT with best possible supportive care is the mainstay of the management. All patients have to undergo brain magnetic resonance imaging procedure quarterly or half-yearly for 5 years and then on an annual basis. In patients with recurrent malignant glioma, wherever possible re-resection or re-irradiation or chemotherapy can be considered along with supportive and palliative care. High-grade malignant glioma should be managed in a multidisciplinary cente...

To systematically review reported cases of Seckel syndrome (SS) and point out cases associated wi... more To systematically review reported cases of Seckel syndrome (SS) and point out cases associated with central nervous system (CNS) vasculopathy and provide a summary of their clinical presentation, management, and outcomes including our illustrative case. We conducted a search on the MEDLINE, PubMed, Google Scholar, and Cochrane databases using the keywords “Seckel + syndrome.” We identified 127 related articles reporting 252 cases of SS apart from our case. Moreover, we searched for SS cases with CNS vasculopathies from the same databases. We identified 7 related articles reporting 7 cases of CNS vasculopathies in SS patients. The overall rate of CNS vasculopathy in SS patients is 3.16% (n = 8/253), where moyamoya disease (MMD) accounted for 1.97%. The mean age is 13.5 years (6–19 years), with equal gender distribution (M:F, 1:1). The most common presenting symptoms were headache and seizure followed by weakness or coma. Aneurysms were mostly located in the basilar artery, middle cer...

The aim of this study is to investigate the relationship between isocitrate dehydrogenase-1 (IDH1... more The aim of this study is to investigate the relationship between isocitrate dehydrogenase-1 (IDH1) mutation and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation with recurrence-free interval in glioblastoma patients treated with chemoradiotherapies. Clinical data were collected from 82 patients with totally resected glioblastoma and treated with adjuvant therapies from 2014 to 2019. IDH1 mutation was assessed by immunohistochemistry and MGMT promoter methylation was assessed by different sequencing methods. IDH1 mutation was present in 32 cases and 50 cases were IDH1 wildtype; 54 and 28 patients had unmethylated and methylated MGMT promoter, respectively, Of the 82 patients, 62 patients received chemoradiotherapy while 20 patients only received radiation. Approximately, 61% of patients had a tumor recurrence after 1 year, and 39% showed a recurrence before 1 year of treatment. There was no significant relationship between IDH1 mutation and MGMT promoter methylation...

OBJECTIVES Central nervous system (CNS) tumors are a major and growing global healthcare challeng... more OBJECTIVES Central nervous system (CNS) tumors are a major and growing global healthcare challenge. Western Saudi Arabia has an inconsistent data registry; therefore, the epidemiology of CNS tumors is unclear across the country. This study is aimed to assemble the epidemiological matrix of CNS tumors in the Western Province of Saudi Arabia. METHODS A retrospective analysis was performed using clinical data obtained from 3 neuroscience centers in Western Saudi Arabia in the period 2014-2019. The sample size included 663 adult and pediatric cases from the local and expatriate populations diagnosed with CNS tumors. The distributions of age, sex, clinical presentation, tumor location, type of surgery, histological subtype, genetic characteristics, and recurrence rate were explored. RESULTS The analysis included 500 adult cases and 163 pediatric cases up to 18 years of age with a male-to-female ratio of 1.16. The mean age at diagnosis was 38.0±22.6 years. The supratentorium was the most ...

Background The Wilms tumor 1 (WT1) gene has recently been shown to play a role in gliomagenesis, ... more Background The Wilms tumor 1 (WT1) gene has recently been shown to play a role in gliomagenesis, making it a potential immunotherapy target in glioblastomas. We aimed to investigate the most sensitive method to detect WT1 expression in glioblastoma and explore relationship between WT1 expression and isocitrate dehydrogenase-1 (IDH1) mutation. Methods Clinical and biological data were collected from 44 patients with totally resected glioblastomas, treated with adjuvant therapies, in the period between 2015 and 2019. WT1 protein expression was assessed in all cases using IHC while its gene expression was assessed in 13 clustered samples using quantitative polymerase chain reaction (qPCR). IDH1 mutation was assessed using immunohistochemistry (IHC). McNemar test was used to compare the sensitivity between IHC and RT-qPCR for WT1 gene expression detection. Kaplan Meier curves were used to compare the distribution of recurrence-free interval (RFI) between IDH1 and WT1 expression groups. ...

Common and Uncommon Causes in Adults and Children, 2009

World Neurosurgery

Introduction After the official announcement of the coronavirus disease-19 pandemic on March 11, ... more Introduction After the official announcement of the coronavirus disease-19 pandemic on March 11, 2020, the disease impacted most aspects of health care delivery, especially postgraduate education and training. Method A cross-sectional, online questionnaire-based assessment was performed. The study participants involved neurosurgery residents and program directors (PDs) across the country between May 16 and May 27, 2020. Results Approximately 74 of 95 (77.9%) of the residents experienced an impact on their training calendar. Before the pandemic, 51 residents (53.3%) were involved in 2–3 surgeries per week, but during the pandemic, 66 (69.5%) were attending 0–1 case per week. Fifty-three residents (55.8%) agreed that academic sessions were affected despite the helpful effort of online teaching sessions. Thirty-four (35.8%) residents graded their anxiety during coronavirus disease-19 times as high. Ten PDs (58.8%) confirmed spending 3–5 hours per week on educational activities normally, whereas during the pandemic, 15 PDs (88.2%) reduced their educational hours to 0–2 hours per week. Conclusion Our study showed that educational activities significantly decreased and shifted toward virtual teaching methods. Operative volume showed a substantial reduction for both junior and senior residents. Academic and clinical teaching was the main concern for PDs, and they faced challenges interviewing newly matched residents.

Molecular and Clinical Oncology, 2016

Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with ... more Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with one of the worst 5 year survival rates among all human cancer types. To date, no published data are available for the outcome of this disease in Saudi Arabia. The present study performed a single-center, retrospective cohort study to evaluate the outcome of patients with GBM in Saudi Arabia. The Comprehensive Cancer Center at King Fahad Medical city (Riyadh, Saudi Arabia) was used in the present study. All adult patients (≥18 years) diagnosed with histologically proven GBM between January 2008 and December 2013 were included in the present study. A total of 90 patients were treated during the specified period. Of this, 73 (81%) patients underwent resection and 17 (19%) had biopsy only. The majority of patients (n=88; 98%) received radiotherapy (XRT): 67 (76%) with standard and 21 (24%) with hypo-fractionated dosage. Of the total patients, 65 (72%) received combined modality therapy [standard XRT concurrently with Temozolmide (TMZ)]. The 6 month progression-free survival rate was 43% for all patients and 55% for the combined modality subgroup. The median overall survival (OS) for all patients was 13.7 months. However, the median OS for patients treated with combined modality was 19.7 months. In this single-center retrospective study, the outcomes of patients with GBM were similar to those in previously reported studies. An improved outcome was associated with an improved performance status, absence of residual disease and use of adjuvant TMZ.

Surgical Neurology International

Background: Synovial sarcoma (SS) of the spine is a rare malignant soft-tissue tumor, and there a... more Background: Synovial sarcoma (SS) of the spine is a rare malignant soft-tissue tumor, and there are few reported cases. The aim of this paper is to report a rare case of spinal SS involving the paraspinal muscles, and to review all such cases reported in the literature. Case Description: In this paper, we report a rare case of spinal SS involving the paraspinal muscles in a 12-year-old girl. The patient underwent surgical excision of the mass with adjuvant radiation and chemotherapy. At the 1-year follow-up, there was no evidence of local tumor recurrence, and the patient’s symptoms had improved. In addition, we identified and reviewed 33 reported cases of SS involving the spine. Conclusion: Due to the limited number of reported cases in the literature, it is difficult to predict the outcomes of spinal SS. Further, different treatment modalities have been used to treat spinal SS. However, most of the reported cases had poor outcomes. Therefore, prospective multi-center studies are n...