Spinal Myxopapillary Ependymoma Epidemiology

Spinal Myxopapillary Ependymoma Epidemiology

The myxopapillary subtype of ependymomas (MPE) occurs mostly in the thoracolumbar region and is the most common form of ependymoma in the lumbar spine 1) 2) 3) 4).

In one study of 77 myxopapillary ependymomas 5). these tumors represented 27% of all spinal ependymomas and 90% of tumours in the conus medullaris 6) 7) 8) 9) 10) 11) 12).

Usually occurs in the adult population in the third and fourth decades of life and affect males more frequently than females 13) 14) 15).


Abdallah et al. retrospectively reviewed the medical records of 38 primary spinal myxopapillary ependymoma cases who underwent surgery at 2 neurosurgical centers spanning 16 years, from 2004 to 2019. All pediatric cases (patient age <18 years) who were diagnosed with MPE and re-presented with spinal seeding/drop metastases (SSM) were selected as the core sample for this study. Relevant literature was briefly reviewed.

Three pediatric MPE cases (2 females and 1 male) experienced SSM. The mean age at first presentation was 12.0 ± 1.0 years. The mean preoperative course was 2.9 ± 1.2 months. The predominant location was the lumbar spine in 2 tumors (both originated from filum terminale [FT]). Two tumors were located intradural intramedullary. Gross-total resection was achieved in 2 patients. No patient had neurofibromatosis type 2. No adjuvant treatment was given after the first surgery. The mean period between the first diagnosis and diagnosis of SSM was 44.0 ± 31.5 months. The location of SSM in all patients was the sacral spine (1 patient experienced distant metastasis in her brain besides her sacral metastasis). The mean follow-up was 68.3 ± 53.7 months.

They found a statistically significant relationship between SSM in pediatric MPEs and the intramedullary location, FT origin, and number of affected segments. Close clinical and radiological follow-up is essential for pediatric MPE patients. 16).

References

1) , 6) , 13)

Choi JY, Chang KH, Yu IK, et al. Intracranial and spinal ependymomas: Review of MR images in 61 patients. Korean J Radiol. 2002;3:219–228.
2) , 10)

Bavbek M, Altinors MN, Caner HH, Bilezikci B, Agildere M. Lumbar myxopapillary ependymoma mimicking neurofibroma. Spinal Cord. 2001;39:449–452.
3) , 11)

Sonneland PR, Scheithauer BW, Onofrio BM. Myxopapillary ependymoma: A clinicopathologic and immunohistochemical study of 77 cases. Cancer. 1985;56:883–93.
4) , 12)

Celli P, Cervoni L, Cantore G. Ependymoma of the filum terminale: Treatment and prognostic factors in a series of 2 cases. Acta Neurochir. 1993;124:99–103.
5)

Sonneland PR, Scheithauer BW, Onofrio BM: Myxopapillary ependymoma: A clinicopathologic and immunocytochemical study of 77 cases. Cancer 56:883–893, 1985
7)

Sakai Y, Matsuyama Y, Katayama Y, et al. Spinal myxopapillary ependymoma: Neurological deterioration in patients treated with surgery. Spine. 2009;34:1619–1624.
8)

Wippold FJ, Smirniotopoulos JG, Moran CJ, Suojanen JN, Vollmer DG. MR imaging of myxopapillary ependymoma: Findings and value to determine extent of tumour and its relation to intraspinal structures. Am J Radiol. 1995;165:1263–67.
9)

Bagley CA, Wilson S, Kothbauer KF, Bookland MJ, Epstein F, Jallo GI. Long term outcomes following surgical resection of myxopapillary ependymomas. Neurosurg Rev. 2009;32:321–334.
14)

Volpp PB, Han K, Kagan AR, Tome M. Outcomes in treatment for intradural spinal cord ependymomas. Int J Radiation Oncology Biol Phys. 2007;69:1199–1204.
15)

Sun B, Wang C, Wang J, Liu A. MRI features of intramedullary spinal cord ependymomas. J Neuroimaging. 2003;13:346–351.
16)

Abdallah A. Spinal Seeding Metastasis of Myxopapillary Ependymoma: Report of Three Pediatric Patients and a Brief Literature Review [published online ahead of print, 2020 Aug 10]. Pediatr Neurosurg. 2020;1-14. doi:10.1159/000509061

Moyamoya Disease Epidemiology outside of Asia

Moyamoya Disease Epidemiology outside of Asia

Studies from outside of Asia are rare. In Washington state and California, the incidence of MMD was reported to be 0.086/100,000 based on 298 patients. The incidence was the highest in Asians, followed by Blacks, Whites, and Hispanics. The incidence in Asian Americans was 4.6 times higher than that in Whites. Female preponderance was also noted 1).

African-Americans had an earlier disease onset with a median age of 18. However, a more recent study based on the Nationwide Inpatient Sample database reported that MMD appears to be distributed among the races according to their relative proportions in the USA population 2).

From 2005 to 2008, there were an estimated 7,473 (2,236 pediatric and 5,237 adult) patients admitted with a diagnosis of MMD in the USA. MMD patients were most frequently Caucasians. Overall, ischemic stroke was the most common reason for admission in both children and adults. Hemorrhagic stroke was more frequent in adults compared with children, and there was a bimodal age distribution with peaks in the first and fourth decades of life. Female-to-male ratio was 2.2. Thus, MMD in the USA does not seem to differ from East Asian MMD.


The incidence of Moyamoya disease (MMD) in Europe is not well known. In those affected, the risk of brain hemorrhage is considered low. A study of Birkeland et al. aimed to investigate the incidence and clinical presentation of MMD in the Danish population.

Eligible patients were identified in the Danish National Patient Register from 1994 to 2017. They collected clinical and radiological data from individual patient records from neurological, neurosurgical, and pediatric units across Denmark. The diagnosis was validated according to established criteria. They also extracted basic demographic data on the cohort from the Danish Civil Registration System.

A total of 52 patients fulfilled the diagnostic criteria for MMD. Most cases were native Danes and only 15% of cases had an East Asian background. The ratio of female to male patients was 1.8, and the incidence had two peaks: one in childhood and another in young middle age. Until 2007, MMD was only diagnosed sporadically. From 2008 onwards, the incidence rate was 0.07 per 100 000 person-years (95% confidence interval 0.05-0.09 per 100 000 person-years). The most common mode of presentation was ischemic stroke (33%), followed by hemorrhage (23%), headache (17%), and transient ischemic attack (14%).

MMD is rare in Denmark, but associated with a considerable risk of hemorrhage. Thus, MMD should be considered in the workup for ischemic as well as hemorrhagic stroke in children and middle-aged Caucasian3).

References

1)

Uchino K, Johnston SC, Becker KJ, Tirschwell DL. Moyamoya disease in Washington State and California. Neurology. 2005;65(6):956-958. doi:10.1212/01.wnl.0000176066.33797.82
2)

Kainth D, Chaudhry SA, Kainth H, Suri FK, Qureshi AI. Epidemiological and clinical features of moyamoya disease in the USA. Neuroepidemiology. 2013;40(4):282-287. doi:10.1159/000345957
3)

Birkeland P, Tharmabalan V, Lauritsen J, Ganesan V, Bjarkam CR, von Weitzel-Mudersbach P. Moyamoya disease in a european setting: A danish population-based study [published online ahead of print, 2020 Jul 15]. Eur J Neurol. 2020;10.1111/ene.14439. doi:10.1111/ene.14439

Traumatic brain injury epidemiology

Traumatic brain injury epidemiology

In 2019, relevant articles and registries were identified via systematic review; study quality was higher in the high-income countries (HICs) than in the low- and middle-income countries (LMICs). Sixty-nine million (95% CI 64-74 million) individuals worldwide are estimated to sustain a TBI each year. The proportion of TBIs resulting from road traffic accidents was greatest in Africa and Southeast Asia (both 56%) and lowest in North America (25%). The incidence of RTA was similar in Southeast Asia (1.5% of the population per year) and Europe (1.2%). The overall incidence of TBI per 100,000 people was greatest in North America (1299 cases, 95% CI 650-1947) and Europe (1012 cases, 95% CI 911-1113) and least in Africa (801 cases, 95% CI 732-871) and the Eastern Mediterranean (897 cases, 95% CI 771-1023). The LMICs experience nearly 3 times more cases of TBI proportionally than HICs.

Sixty-nine million (95% CI 64-74 million) individuals are estimated to suffer TBI from all causes each year, with the Southeast Asian and Western Pacific regions experiencing the greatest overall burden of disease. Head injury following road traffic collision is more common in LMICs, and the proportion of TBIs secondary to road traffic collision is likewise greatest in these countries. Meanwhile, the estimated incidence of TBI is highest in regions with higher-quality data, specifically in North America and Europe 1).


Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world, making epidemiological monitoring of incidence, prevalence and outcome necessary.

Every 15 seconds someone suffers a traumatic brain injury (TBI) in the United States. TBI causes more deaths in males <35 years old than all other diseases combined, and it is estimated that 2% of the U.S. population lives with TBI-associated disability. Despite extensive research and success in animal studies, successful drug therapies have proved elusive in clinical trials 2).

It is one of leading causes of mortality and disability worldwide and is estimated to surpass many diseases by 2020 3) 4).

It is the leading cause of mortality and morbidity in children 5).

Nonaccidental head injury, as seen in domestic child abuse cases, is often associated with spine injury, and spinal subdural hematoma is the most frequent diagnosis. While spinal epidural hematomas are a rare occurrence, the incidence of spontaneous epidural hematomas occurring in nonaccidental head injury patients is even lower 6).

Epidemiology in China

Sun et al. conducted a nationally representative door-to-door survey in the general population across all age groups in 31 provinces in mainland China in 2013.

All participants were reviewed for a history of physician-diagnosed TBI by trained investigators using a structured questionnaire. TBI survivors were considered as prevalent cases at the prevalent time. The present study also examined the odds of TBI as a function of sex, age, and other demographical variables using logistic regression model. + Of 583,870 participants, 2,673 individuals had suffered from a TBI during their past life, yielding a weighted prevalence of being 442.4 (95% CI 342.2-542.6) per 100,000 person. The TBI prevalence increased with increasing age. The present study observed the multiadjusted ORs of TBI were 1.9 (95% CI 1.8-2.1) for the male, 1.9 (95% CI 1.2-3.1) for the farmers, 1.9 (95% CI 1.2-3.3) for the retiree or homemakers, 3.4 (95% CI 1.5-7.7), and 2.8 (95% CI 1.1-6.6) for those whose education were primary school and high school, respectively. The most common external cause was road traffic accidents among those who were aged 18-34 years old and those whose educational levels were middle school in both genders.

The results indicate TBI was substantially prevalent among Chinese population and underscore the need to develop national strategies to improve the safe education on road and traffic of TBI in rural residents and some subgroup population 7).

Epidemiology in the United States

The Centers for Disease Control and Prevention (CDC) estimate that more than 1.7 million each year in USA sustain TBI. Of these, approximately 1.4 million are treated and released from emergency centers, 275,000 are hospitalized, 80,000 suffer long-term disability and 52,000 die 8) ,and another 235,000 are hospitalized for non-fatal TBI 9).

Incidence of TBI in all industrialized countries is comparable to the U.S., with estimates ranging from 150 to more than 300 per 100,000

Annual incidence of approximately 250-600 patients per 100,000, and mortality of 17 cases per 100,000.

It is one of the most common causes of death in ordinary accidents, natural disasters, or warfare.

These injuries frequently occur outside, leaving injured individuals exposed to environmental temperature extremes before they are transported to a hospital.

Each year, approximately 100,000 patients require neurosurgical evacuation of an intracranial hematoma in the United States 10).

There are strong and demographically stable associations between TBI and substance use. These associations may not only increase the odds of injury but impair the quality of post injury recovery 11).

Epidemiology in India

The exact incidence is unavailable in India.

From August 2012 to May 2013 at Department of Neurosurgery, S.C.B. Medical College, Cuttack, Odisha, India. All the pertinent details from case records of hundred and forty-seven children <15 years with TBI were analyzed. Follow-up was done for 6 months at outpatients department.

Age wise, incidence and severity of TBI is more common in 10-15 years. Males outnumber females with a male: female ratio 2.19:1. Overall, road traffic accident (RTA) is the commonest mode of injury. Assault is not uncommon (7.48% cases). Falls is common in <5 years while RTA is common in 5-15 years. The extradural hematoma was the most common injury pattern; however, surgical consideration was maximal for fracture skull. Overall mortality was 7.48%. Diffuse axonal injury has the maximum individual potential for mortality. We noticed excellent recovery in 68.7%, disabilities in 17.68%, and persistent vegetative state in 5.45% cases.

TBI in children carries good outcome, if resuscitated and referred early to a neurotrauma center, and managed subsequently on an individualized basis with a well-organized team approach. Severe TBI in children has a poor outcome 12).

Epidemiology in Europe

Traumatic brain injury (TBI) is a common reason for presentation at the emergency department (ED) and hospital admission in Europe.

In total, 28 epidemiological studies on TBI from 16 European countries were identified in the literature. A great variation was found in case definitions and case ascertainment between studies. Falls and road traffic accidents (RTA) were the two most frequent causes of TBI, with falls being reported more frequently than RTA 13).

In 2006 it was difficult to reach a consensus on all epidemiological findings across the 23 published European studies because of critical differences in methods employed across the reports 14).

Spain

2015

A search was conducted in the PubMed electronic database using the terms: epidemiology, incidence, brain injur*, head injur* and Europe. Only articles published in English and reporting on data collected in Europe between 1990 and 2014 were included. In total, 28 epidemiological studies on TBI from 16 European countries were identified in the literature. A great variation was found in case definitions and case ascertainment between studies. Falls and road traffic accidents (RTA) were the two most frequent causes of TBI, with falls being reported more frequently than RTA. In most of the studies a peak TBI incidence was seen in the oldest age groups. In the meta-analysis, an overall incidence rate of 262 per 100,000 for admitted TBI was derived.

Interpretation of published epidemiologic studies is confounded by differences in inclusion criteria and case ascertainment. Nevertheless, changes in epidemiological patterns are found: falls are now the most common cause of TBI, most notably in elderly patients. Improvement of the quality of standardised data collection for TBI is mandatory for reliable monitoring of epidemiological trends and to inform appropriate targeting of prevention campaigns 15).

Romania

A coordinated strategy to evaluate this public health problem in Romania would first of all rely on a related advanced monitoring system, to provide precise information about the epidemiology, clinical and paraclinical data, but concerning the social and economic connected consequences, too 16).

References

1)

Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018 Apr 1:1-18. doi: 10.3171/2017.10.JNS17352. [Epub ahead of print] PubMed PMID: 29701556.
2)

Maas, A. I. R., Menon, D. K., et al. (2012). “Re-orientation of clinical research in traumatic brain injury: report of an international workshop on comparative effectiveness research.” Journal of Neurotrauma 29(1): 32-46.
3)

Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: A global perspective. NeuroRehabilitation 2007;22:341-53. Back to cited text no. 1
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Lopez AD, Murray CC. The global burden of disease, 1990-2020. Nat Med 1998;4:1241-3.
5)

K. S. Quayle, D. M. Jaffe, N. Kuppermann et al., “Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated?” Pediatrics, vol. 99, no. 5, article e11, 1997.
6)

Rangwala SD, Birk DM, Tobin MK, Hahn YS, Nikas DC. Spontaneous Resolution of Spinal Epidural Hematoma Resulting from Domestic Child Abuse: Case Report. Pediatr Neurosurg. 2016 Sep 20. [Epub ahead of print] PubMed PMID: 27644085.
7)

Sun D, Jiang B, Ru X, Sun H, Fu J, Wu S, Wang L, Wang L, Zhang M, Liu B, Wang W; for the NESS-China investigators. Prevalence and Altered Causes of Traumatic Brain Injury in China: A Nationwide Survey in 2013. Neuroepidemiology. 2019 Dec 18:1-8. doi: 10.1159/000501911. [Epub ahead of print] PubMed PMID: 31851999.
8)

Faul M, Xu L, Wald MM & Coronado VG. (2010). Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
9)

Corrigan JD, Selassie AW, Orman JA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil 2010; 25: 72–80.
10)

Feinberg M, Mai JC, Ecklund J. Neurosurgical Management in Traumatic Brain Injury. Semin Neurol. 2015 Feb;35(1):50-56. Epub 2015 Feb 25. PubMed PMID: 25714867.
11)

Ilie G, Mann RE, Hamilton H, Adlaf EM, Boak A, Asbridge M, Rehm J, Cusimano MD. Substance Use and Related Harms Among Adolescents With and Without Traumatic Brain Injury. J Head Trauma Rehabil. 2014 Nov 25. [Epub ahead of print] PubMed PMID: 25427256.
12)

Satapathy MC, Dash D, Mishra SS, Tripathy SR, Nath PC, Jena SP. Spectrum and outcome of traumatic brain injury in children <15 years: A tertiary level experience in India. Int J Crit Illn Inj Sci. 2016 Jan-Mar;6(1):16-20. PubMed PMID: 27051617.
13) , 15)

Peeters W, van den Brande R, Polinder S, Brazinova A, Steyerberg EW, Lingsma HF, Maas AI. Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien). 2015 Oct;157(10):1683-96. doi: 10.1007/s00701-015-2512-7. Epub 2015 Aug 14. PubMed PMID: 26269030.
14)

Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien). 2006 Mar;148(3):255-68; discussion 268. Review. PubMed PMID: 16311842.
16)

Popescu C, Anghelescu A, Daia C, Onose G. Actual data on epidemiological evolution and prevention endeavours regarding traumatic brain injury. J Med Life. 2015 Jul-Sep;8(3):272-7. Review. PubMed PMID: 26351526; PubMed Central PMCID: PMC4556905.
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