Ummey Hani, MBBS, MD

All Publications

• Cervical Disc Arthroplasty Device Failure Causing Progressive Cervical Myelopathy and Requiring Revision Cervical Corpectomy. Clinical spine surgery Parish, J., Monk, S. H., O'Brien, M., Hani, U., Coric, D., Holland, C. M. 2025; 38 (1): 18-25

  Abstract

  Cervical disc arthroplasty is a well-established alternative to anterior cervical fusion but requires precise placement for optimal outcomes. We present the case of a 2-level cervical disc arthroplasty with suboptimal implantation of the interbody devices, requiring revision corpectomy. Supplemental video, Supplemental Digital Content 1 ( http://links.lww.com/CLINSPINE/A358 ) content of the revision surgery is also provided. This report highlights the importance of proper implant sizing and position and reviews the nuances of surgical revision.A retrospective review of the clinical and radiographic data was performed from prior to the index operation through the 3-month postoperative period after the surgical revision.The patient presented approximately 2 years post-cervical arthroplasty with increasing neck pain and early cervical myelopathy. An imaging workup revealed severe cervical stenosis at the caudal level with cord compression and concern for device failure. Intraoperatively, the core of the caudal device was found to have ejected into the spinal canal. A cervical corpectomy of the intervening vertebra with the removal of both devices was performed. The patient had a complete neurologic recovery.Although failure of a cervical disc arthroplasty device is rare, the likelihood can be significantly increased with poor sizing (over or under sizing), asymmetric placement, endplate violation, or poor patient selection. In the case presented herein, early device failure was unrecognized, and the patient went on to develop progressive cervical myelopathy requiring revision corpectomy.

  View details for DOI 10.1097/BSD.0000000000001691

  View details for PubMedID 39248346

• Open Versus Percutaneous Stabilization of Thoracolumbar Fractures: A Large Retrospective Analysis of Safety and Reoperation Rates CUREUS JOURNAL OF MEDICAL SCIENCE Peters, D. R., Owen, T., Hani, U., Pfortmiller, D., Holland, C., Coric, D., Bohl, M., Kim, P. K. 2024; 16 (5): e61369

  Abstract

  Thoracolumbar fractures (TLF) requiring surgical intervention can be treated with either open or percutaneous stabilization, each with some distinct risks and benefits. There is insufficient evidence available to support one approach as superior.Patients who underwent spinal fixation for TLF between 2008 and 2020 were reviewed. Patients with one or two levels of fracture treated with either open or percutaneous stabilization were included. Exclusion criteria were more than two levels of fracture, patients requiring corpectomy, stabilization constructs that crossed the cervicothoracic or lumbosacral junction, history of previous thoracolumbar fusion at the same level, spinal neoplasm, anterior or lateral fixation, and spinal infection. Demographic, operative, and clinical data were collected for all patients.691 patients (377 open, 314 percutaneous) met the inclusion criteria. Patients in the percutaneous cohort sustained lower estimated blood loss (73 vs 334 ml; p< 0.001) and shorter length of surgery (114 vs. 151 minutes; p< 0.001). No differences were observed in the length of hospital stay or overall reoperation rates. Asymptomatic (7.0% vs 0.8%) and symptomatic (3.5% vs 0.5%) hardware removal was more common with the percutaneous cohort, while the incidence of revision surgery due to hardware failure requiring the extension of the construct (1.9% vs 5.8%) and infection (1.9% vs 6.4%) was greater in the open group.Percutaneous stabilization for TLF was associated with shorter operative time, less blood loss, lower infection rate, higher rates of elective hardware removal, and lower rates of hardware failure requiring extension of the construct compared to open stabilization.

  View details for DOI 10.7759/cureus.61369

  View details for Web of Science ID 001241388700025

  View details for PubMedID 38947669

  View details for PubMedCentralID PMC11214468

• Patent bibliometrics in spinal deformity: the first bibliometric analysis of spinal deformity's technological literature. Spine deformity Hani, U., Chen, J. W., Holland, C., McGirt, M. J., Kim, P. K., Chewning, S., Bohl, M. A. 2024; 12 (1): 25-33

  Abstract

  Bibliometric analyses have gained popularity for studying scientific literature, but their application to evaluate technological literature (patents) remains unexplored. We conducted a bibliometric analysis on the top 100 most-cited patents in scoliosis surgery.Multiple databases were queried using The Lens to identify the top 100 scoliosis surgery patents, which were selected based on forward patent citations. These patents were then categorized into 8 groups based on technological descriptors and assessed based on various factors including earliest priority date, year issued, and expiration status.The top 100 most-cited patents included technology underlying anterolateral tethering and distraction systems (n = 11), posterior tethering and distraction systems (n = 23), posterior segmental bone anchor and rod engagement systems (n = 29), interbody devices (n = 10), biological and electrophysiological agents for scoliosis treatment and/or improved arthrodesis (n = 8), intraoperative arthroplasty devices (n = 5), orthotic devices (n = 12), and implantable devices for non-invasive, postoperative alterations of skeletal alignment (n = 2). Seventy-five patents were expired, 21 are still active, and 4 were listed as inactive. The late 1970s and early 2000s saw increased numbers of patent filings. Demonstrated trends showed no meaningful correlation between patent rank and earliest priority date (linear trendline y = 0.2648x - 477.27; R2 = 0.0114), while a very strong correlation was found between patent rank and citations per year (power trendline y = 118.82x--0.83; R2 = 0.8983).Patent bibliometric analyses in the field of spinal deformity surgery provide a means to assess past advancements, better understand what it takes to make a difference in the field, and to potentially facilitate the development of innovative technologies in the future. The method described is a reliable and reproducible technique for evaluating technological literature in our field.

  View details for DOI 10.1007/s43390-023-00767-x

  View details for PubMedID 37845600

  View details for PubMedCentralID 7732641

• Effect of workers' compensation status on pain, disability, quality of life, and return to work after anterior cervical discectomy and fusion: a 1-year propensity score-matched analysis JOURNAL OF NEUROSURGERY-SPINE Hani, U., Monk, S. H., Pfortmiller, D., Stanley, G., Kim, P. K., Bohl, M. A., Holland, C. M., McGirt, M. J. 2023; 39 (6): 822-830

  Abstract

  Patients with workers' compensation (WC) claims are reported to demonstrate poorer surgical outcomes after lumbar spine surgery. However, outcomes after anterior cervical discectomy and fusion (ACDF) in WC patients remain debatable. The authors aimed to compare outcomes between a propensity score-matched population of WC and non-WC patients who underwent ACDF.Patients who underwent 1- to 4-level ACDF were retrospectively reviewed from the prospectively maintained Quality Outcomes Database (QOD). After propensity score matching, 1-year patient satisfaction, physical disability (Neck Disability Index [NDI]), pain (visual analog scale [VAS]), EQ-5D, and return to work were compared between WC and non-WC cohorts.A total of 9957 patients were included (9610 non-WC and 347 WC patients). Patients in the WC cohort were significantly younger (50 ± 9.1 vs 56 ± 11.4 years, p < 0.001), less educated, and were more frequently male, non-Caucasian, and active smokers (29.1% vs 18.1%, p < 0.001), with greater baseline VAS and NDI scores and poorer quality of life (p < 0.001). One-year postoperative improvements in VAS, NDI, EQ-5D, and return-to-work rates and satisfaction were all significantly worse for WC compared with non-WC patients. After adjusting for baseline differences via propensity score matching, WC versus non-WC patients continued to demonstrate worse 3- and 12-month VAS neck pain and NDI (p = 0.010), satisfaction (χ2 = 4.03, p = 0.045), and delayed return to work (9.3 vs 5.7 weeks, p < 0.001).WC status was associated with greater 1-year residual disability and axial pain along with delayed return to work, without any difference in quality of life despite having fewer comorbidities and being a younger population. Further studies are needed to determine the societal impact that WC claims have on healthcare delivery in the setting of ACDF.

  View details for DOI 10.3171/2023.6.SPINE23217

  View details for Web of Science ID 001123174500014

  View details for PubMedID 37503915

• Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center Versus Inpatient Setting: A 1-Year Comparative Effectiveness Analysis NEUROSURGERY Monk, S. H., Hani, U., Pfortmiller, D., Adamson, T. E., Bohl, M. A., Branch, B. C., Kim, P. K., Smith, M. D., Holland, C. M., Mcgirt, M. J. 2023; 93 (4): 867-874

  Abstract

  Ambulatory surgery centers (ASCs) have emerged as an alternative setting for surgical care as part of the national effort to lower health care costs. The literature regarding the safety of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in the ASC setting is limited to few small case series.To assess the safety and efficacy of MIS TLIF performed in the ASC vs inpatient hospital setting.A total of 775 patients prospectively enrolled in the Quality Outcomes Database undergoing single-level MIS TLIF at a single ASC (100) or the inpatient hospital setting (675) were compared. Propensity matching generated 200 patients for analysis (100 per cohort). Demographic data, resource utilization, patient-reported outcome measures (PROMs), and patient satisfaction were assessed.There were no significant differences regarding baseline demographic data, clinical history, or comorbidities after propensity matching. Only 1 patient required inpatient transfer from the ASC because of intractable pain. All other patients were discharged home within 23 hours of surgery. The rates of 90-day readmission (2.0%) and reoperation (0%) were equivalent between groups. Both groups experienced significant improvements in all PROMs (Oswestry Disability Index, EuroQol-5D, back pain, and leg pain) at 3 months that were maintained at 1 year. PROMs did not differ between groups at any time point. Patient satisfaction was similar between groups at 3 and 12 months after surgery.In carefully selected patients, MIS TLIF may be performed safely in the ASC setting with no statistically significant difference in safety or efficacy in comparison with the inpatient setting.

  View details for DOI 10.1227/neu.0000000000002483

  View details for Web of Science ID 001068836700031

  View details for PubMedID 37067954

• Anterior Cervical Discectomy and Fusion Versus Microendoscopic Posterior Cervical Foraminotomy for Unilateral Cervical Radiculopathy: A 1-Year Cost-Utility Analysis NEUROSURGERY Monk, S. H., Hani, U., Pfortmiller, D., Dyer, E., Smith, M. D., Kim, P. K., Bohl, M. A., Coric, D., Adamson, T. E., Holland, C. M., McGirt, M. J. 2023; 93 (3): 628-635

  Abstract

  Anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy (PCF) are the most common surgical approaches for medically refractory cervical radiculopathy. Rigorous cost-effectiveness studies comparing ACDF and PCF are lacking.To assess the cost-utility of ACDF vs PCF performed in the ambulatory surgery center setting for Medicare and privately insured patients at 1-year follow-up.A total of 323 patients who underwent 1-level ACDF (201) or PCF (122) at a single ambulatory surgery center were compared. Propensity matching generated 110 pairs (220 patients) for analysis. Demographic data, resource utilization, patient-reported outcome measures, and quality-adjusted life-years were assessed. Direct costs (1-year resource use × unit costs based on Medicare national allowable payment amounts) and indirect costs (missed workdays × average US daily wage) were recorded. Incremental cost-effectiveness ratios were calculated.Perioperative safety, 90-day readmission, and 1-year reoperation rates were similar between groups. Both groups experienced significant improvements in all patient-reported outcome measures at 3 months that was maintained at 12 months. The ACDF cohort had a significantly higher preoperative Neck Disability Index and a significantly greater improvement in health-state utility (ie, quality-adjusted life-years gained) at 12 months. ACDF was associated with significantly higher total costs at 1 year for both Medicare ($11 744) and privately insured ($21 228) patients. The incremental cost-effectiveness ratio for ACDF was $184 654 and $333 774 for Medicare and privately insured patients, respectively, reflecting poor cost-utility.Single-level ACDF may not be cost-effective in comparison with PCF for surgical management of unilateral cervical radiculopathy.

  View details for DOI 10.1227/neu.0000000000002464

  View details for Web of Science ID 001050079800032

  View details for PubMedID 36995083

• Effect of workers' compensation status on pain, disability, quality of life, and return to work after lumbar spine surgery: a 1-year propensity-matched analysis JOURNAL OF NEUROSURGERY-SPINE Hani, U., Monk, S. H., Pfortmiller, D., Stanley, G., Kim, P. K., Bohl, M. A., Holland, C. M., McGirt, M. J. 2023; 39 (1): 47-57

  Abstract

  Workers' compensation (WC) and litigation have been shown to adversely impact prognoses in a vast range of health conditions. Low-back pain is currently the most frequent reason for WC claims. The objective of this study was to conduct the largest propensity-matched comparison of outcomes between patients with WC and non-WC status who underwent lumbar spinal decompression with and without fusion.Complete data sets for patients who underwent 1- to 4-level lumbar spinal fusion or decompression alone were retrospectively retrieved from the Quality Outcomes Database (QOD), which included 1-year patient-reported outcomes from more than 200 hospital systems collected from 2012 to 2021. Population demographics, perioperative safety, facility utilization, patient satisfaction, disability, pain, EQ-5D quality of life, and return to work (RTW) rates were compared between cohorts for both subgroups. Statistical significance was set at p < 0.05.There were 29,652 patients included in the study. Laminectomy was performed in 16,939 with non-WC status and in 615 with WC, whereas fusion was performed in 11,767 with non-WC status and in 331 with WC. WC patients were more frequently male, a minority race, younger, less educated, more frequently a smoker, had a healthier American Society of Anesthesiologists grade, and with greater baseline visual analog scale (VAS) and Oswestry Disability Index (ODI) scores (p < 0.001). One-year postoperative improvements in VAS, ODI, quality-adjusted life years (QALYs), RTW rates, and satisfaction were all significantly worse for WC versus non-WC patients for both procedures. After adjusting for baseline differences via propensity matching, WC versus non-WC patients continued to demonstrate worse 3- and 12-month VAS and ODI scores, reduced 12-month QALY gain, and delayed RTW after both procedure types.WC status was associated with significantly greater residual disability and pain postoperatively, a lower quality of life, and delayed RTW. Utilizing resources to identify the negative influences on outcomes for WC patients may be valuable in preoperative optimization and could yield better outcomes in these patients.

  View details for DOI 10.3171/2023.2.SPINE221341

  View details for Web of Science ID 001036941300005

  View details for PubMedID 36964725

• Expanding Clinician Access to High-Quality, Low-Cost Biomechanical Research: A Technical Report on the Carolina Neurosurgery and Spine Biomechanics Laboratory. Cureus Hani, U., Chewning, S., Bohl, M. 2023; 15 (4): e37367

  Abstract

  Spine biomechanical research helps us better understand the spine in physiologic and pathologic states and gives us a mechanism by which to evaluate surgical interventions, generate and evaluate models of spine pathologies, and develop novel, data-driven surgical strategies and devices. Access to a biomechanical testing laboratory is therefore potentially invaluable to those who specialize in treating spine pathologies. A number of barriers to access have precluded many clinicians from pursuing their biomechanical research interests, foremost among these is cost. The Carolina Neurosurgery and Spine Biomechanics Research Laboratory (CNSBL) was developed as a model of a low-cost, easy-to-access laboratory capable of generating high-quality data in tests of axial load, tension, torque, displacement, and pathological model testing. Our experience in developing this laboratory suggests that a large number of basic biomechanical research inquiries can be studied in a laboratory composed of less than $7500 USD of hardware. We hope that this model serves as a roadmap for any like-minded practitioners seeking broader access to biomechanical testing facilities.

  View details for DOI 10.7759/cureus.37367

  View details for PubMedID 37182033

  View details for PubMedCentralID PMC10171874

• Predictors of Survival in Patients with Metastatic Brain Tumors: Experience from a Low-to-Middle-Income Country. Asian journal of neurosurgery Anis, S. B., Hani, U., Yousaf, I. 2023; 18 (1): 139-149

  Abstract

  Objective The interplay of static factors and their effect on metastatic brain tumor survival, especially in low-to-middle-income countries (LMICs), has been rarely studied. To audit our experience, and explore novel survival predictors, we performed a retrospective analysis of brain metastases (BM) patients at Shaukat Khanum Memorial Cancer Hospital (SKMCH), Pakistan. Materials and Methods A retrospective review was conducted of consecutive patients who presented with BM between September 2014 and September 2019 at SKMCH. Patients with incomplete records were excluded. Statistical Analysis SPSS (v.25 IBM, Armonk, New York, United States) was used to collect and analyze data via Cox-Regression and Kaplan-Meier curves. Results One-hundred patients (mean age 45.89 years) with confirmed BM were studied. Breast cancer was the commonest primary tumor. Median overall survival (OS) was 6.7 months, while the median progression-free survival (PFS) was 6 months. Age ( p =0.001), gender ( p =0.002), Eastern Cooperative Oncology Group ( p <0.05), anatomical site ( p =0.002), herniation ( p <0.05), midline shift ( p =0.002), treatment strategies ( p <0.05), and postoperative complications (p<0.05) significantly impacted OS, with significantly poor prognosis seen with extremes of age, male gender (hazard ratio [HR]: 2.0; 95% confidence interval [CI]: 1.3-3.1; p =0.003), leptomeningeal lesions (HR: 5.7; 95% CI: 1.1-29.7; p =0.037), and patients presenting with uncal herniation (HR: 3.5; 95% CI: 1.9-6.3; p <0.05). Frontal lobe lesions had a significantly better OS (HR: 0.5; 95% CI: 0.2-1.0; p=0.049) and PFS (HR: 0.08; 95% CI: 0.02-0.42; p =0.003). Conclusion BM has grim prognoses, with comparable survival indices between developed countries and LMICs. Early identification of both primary malignancy and metastatic lesions, followed by judicious management, is likely to significantly improve survival.

  View details for DOI 10.1055/s-0043-1764120

  View details for PubMedID 37056900

• Anterior Cervical Discectomy and Fusion in the Ambulatory Surgery Center Versus Inpatient Setting: One-Year Cost-Utility Analysis. Spine Monk, S. H., Hani, U., Pfortmiller, D., Smith, M. D., Kim, P. K., Bohl, M. A., Coric, D., Adamson, T. E., Holland, C. M., McGirt, M. J. 2023; 48 (3): 155-163

  Abstract

  Retrospective analysis of prospectively collected data.Assess the cost-utility of anterior cervical discectomy and fusion (ACDF) performed in the ambulatory surgery center (ASC) versus inpatient hospital setting for Medicare and privately insured patients at one-year follow-up.Outpatient ACDF has gained popularity due to improved safety and reduced costs. Formal cost-utility studies for ambulatory versus inpatient ACDF are lacking, precluding an accurate assessment of cost-effectiveness.A total of 6504 patients enrolled in the Quality Outcomes Database (QOD) undergoing one-level to two-level ACDF at a single ASC (520) or the inpatient hospital setting (5984) were compared. Propensity matching generated 748 patients for analysis (374 per cohort). Demographic data, resource utilization, patient-reported outcome measures, and quality-adjusted life-years (QALYs) were assessed. Direct costs (1-year resource use×unit costs based on Medicare national allowable payment amounts) and indirect costs (missed workdays×average US daily wage) were recorded. Incremental cost-effectiveness ratios were calculated.Complication rates and improvements in patient-reported outcome measures and QALYs were similar between groups. Ambulatory ACDF was associated with significantly lower total costs at 1 year for Medicare ($5879.46) and privately insured ($12,873.97) patients, respectively. The incremental cost-effectiveness ratios for inpatient ACDF was $3,674,662 and $8,046,231 for Medicare and privately insured patients, respectively, reflecting unacceptably poor cost-utility.Inpatient ACDF is associated with significant increases in total costs compared to the ASC setting without a safety, outcome, or QALY benefit. The ASC setting is a dominant option from a health economy perspective for first-time one-l to two-level ACDF in select patients compared to the inpatient hospital setting.

  View details for DOI 10.1097/BRS.0000000000004500

  View details for PubMedID 36607626

• Review: Patent Bibliometrics in Cranial Neurosurgery: The First Bibliometric Analysis of Neurosurgery's Technological Literature WORLD NEUROSURGERY Hani, U., Mulvaney, G. G., O'Brien, M. D., Jernigan, S., Kim, P., Holland, C., McGirt, M. J., Bohl, M. A. 2023; 171: 115-123

  Abstract

  Bibliometric analyses of the scientific literature have grown increasingly popular in the past few decades. However, patent bibliometric studies, evaluation of technological literature, have not yet been applied in neurosurgery.To perform a pilot patent bibliometric analysis of the top 100 most cited patents in cranial neurosurgery.The Lens was used to query multiple databases, to select the top 100 cranial neurosurgical patents based upon forward patent citations. These were organized into 9 categories based on technological descriptors and were evaluated based on the earliest priority date, year issued, and expiration status, among others.The top 100 most cited patents included technology underlying 3D navigation (n = 31), pharmacology and implants (n = 20), vascular occlusion (n = 5), craniotomy closure (n = 9), focal lesioning and tissue resection (n = 8), brain and systemic cooling (n = 5), neuroendoscopy (n = 8), neuromonitoring and stimulation (6), and technologies improving surgeon performance (n = 8). Ninety-six patents were filed in the United States, 72 were expired, 19 are still active, and 9 were listed as inactive. The highest number of patents was applied for from the mid-1990s to the mid-2000s. Demonstrated trends showed no meaningful correlation between patent rank and earliest priority date (linear trendline y = 0.7107 x -1367.5; R2 = 0.0671), while a very strong correlation was found between patent rank and citations per year (power trendline y = 127.93 x -1.094; R2 = 0.8579).Patent bibliometrics allow evaluation of neurosurgical advancements from the past and enable subsequent development of cutting-edge technology in the future. The described method is a reproducible and reliable technique for evaluating our field's patent literature.

  View details for DOI 10.1016/j.wneu.2022.12.103

  View details for Web of Science ID 000923900000001

  View details for PubMedID 36584892

• A national overview of paediatric and adolescent and young adult surgical neuro-oncology in Pakistan JOURNAL OF THE PAKISTAN MEDICAL ASSOCIATION Urooj, F., Bajwa, M., Khalid, M., Shah, M., Khan, A., Hani, U., Laghari, A., Gilani, J., Jawed, N., Raghib, M., bin Anis, S., Akhunzada, N., Siddiqi, S., Enam, S., Pakistan Brain Tumour Consortium 2022; 72 (11): S85-S92

  Abstract

  To build a comprehensive brain tumour database that will allow us to analyse in detail the prevalence, demographics, and outcomes of the disease in paediatric, adolescent, and young adult age groups.A national cross-sectional study was conducted at 32 centres, and data regarding patient demographics and brain tumours were collected. This data was then stratified based on age groups, healthcare sectors, socioeconomic status, tumour types, and surgical outcomes.Most of the patients who were diagnosed with brain tumours belonged to a lower socioeconomic background and went to public sector hospitals. More males were diagnosed with and treated for brain tumours in the paediatric, adolescent, and young adult populations. The most common tumour in the paediatric population was medulloblastoma (23.7%) and the most common tumour in the adolescent (27.8%) and young adult population (34.7%) was glioma. Significant improvement in KPS scores were seen for: craniopharyngioma (p = 0.001), meningioma (p < 0.0005) and pituitary adenoma (p < 0.0005).This study shows that in all three age groups, there was a greater prevalence in males. Most of the patients belonged to a lower-middle-income class background and most patients presented to public sector hospitals. Greater knowledge of these parameters unique to each age group is the key to understanding and alleviating the burden of disease. Cancer registries, specifically brain tumour registries that keep up-to-date records of these patients, are essential to identify and keep track of these unique parameters to advance medical research and treatment strategies, ultimately lowering the disease burden.

  View details for DOI 10.47391/JPMA.11-S4-AKUB14

  View details for Web of Science ID 001084434600014

  View details for PubMedID 36591634

• Conducting the Pakistan brain tumour epidemiology study - a report on the methodology JOURNAL OF THE PAKISTAN MEDICAL ASSOCIATION Baig, E., Shah, M., Bajwa, M., Khalid, M., Khan, S., Hani, U., Bin Anis, S., Laghari, A., Akhunzada, N., Gilani, J., Jawed, N., Raghib, M., Siddiqi, S., Enam, S., Pakistan Brain Tumour Consortium 2022; 72 (11): S12-S15

  Abstract

  To combat the lack of brain tumour registries, the Pakistan Brain Tumour Epidemiology Study (PBTES) was conducted without any funding from an external source.A retrospective analysis of patient data, including patients of all age groups diagnosed with all histopathological types of brain tumours from all over Pakistan, was performed. For this, Pakistan Brain Tumour Consortium (PBTC) was established, including 32 neurosurgical centres from around the country. Data was collected online through a proforma that included variables such as patient demographics, clinical characteristics, operative details, postoperative complications, survival indices, and current functional status. The data collection and analysis team included principal investigators, core leads, regional leads, regional associates, and student facilitators. Despite logistical concerns and lack of resources, the PBTES was conducted successfully, and a formal brain tumour surveillance database was formed without any external funding, which remains unheard of.The methods applied in this study are reproducible and can be employed not just to develop more robust brain tumour and other cancer registries but also to study the epidemiology of communicable and non-communicable diseases in resource-limited settings, both locally and globally.

  View details for DOI 10.47391/JPMA.11-S4-AKUB02

  View details for Web of Science ID 001084434600003

  View details for PubMedID 36591622

• Comparison of Glioblastoma Outcomes in Two Geographically and Ethnically Distinct Patient Populations in Disparate Health Care Systems. Asian journal of neurosurgery Mirza, F. A., Baqai, M. W., Hani, U., Hulou, M., Shamim, M. S., Enam, S. A., Pittman, T. 2022; 17 (2): 178-188

  Abstract

  Introduction Variations in glioblastoma (GBM) outcomes between geographically and ethnically distinct patient populations has been rarely studied. To explore the possible similarities and differences, we performed a comparative analysis of GBM patients at the University of Kentucky (UK) in the United States and the Aga Khan University Hospital (AKUH) in Pakistan. Methods A retrospective review was conducted of consecutive patients who underwent surgery for GBM between January 2013 and December 2016 at UK, and July 2014 and December 2017 at AKUH. Patients with recurrent or multifocal disease on presentation and those who underwent only a biopsy were excluded. SPSS (v.25 IBM, Armonk, New York, United States) was used to collect and analyze data. Results Eighty-six patients at UK (mean age: 58.8 years; 37 [43%] < 60 years and 49 [57%] > 60 years) and 38 patients at AKUH (mean age: 49.1 years; 30 (79%) < 60 years and 8 (21%) > 60 years) with confirmed GBM were studied. At UK, median overall survival (OS) was 11.5 (95% confidence interval [CI]: 8.9-14) months, while at AKUH, median OS was 18 (95% CI: 13.9-22) months ( p =0.002). With gross-total resection (GTR), median OS at UK was 16 (95% CI: 9.5-22.4) months, whereas at AKUH, it was 24 (95% CI: 17.6-30.3) months ( p =0.011). Conclusion Median OS at UK was consistent with U.S. data but was noted to be longer at AKUH, likely due to a younger patient cohort and higher preoperative Karnofsky's performance scale (KPS). GTR, particularly in patients younger than 60 years of age and a higher preoperative KPS had a significant positive impact on OS and progression-free survival (PFS) at both institutions.

  View details for DOI 10.1055/s-0042-1750779

  View details for PubMedID 36120611

• Benign pituitary adenoma with multiple intracranial metastases-a case report and review of the literature JOURNAL OF SURGICAL CASE REPORTS Hani, U., Tariq, Q., Bari, A., Bin Anis, S., Diwan, A. 2022; 2022 (5): rjab382

  Abstract

  Metastatic benign pituitary adenomas (PAs), also known as pituitary carcinomas (PCs), represent 0.1-0.2% of all intracranial lesions. They are rare and challenging pathologies. We present the case of a 34-year-old female, who presented to the clinic with headache and visual loss. She was diagnosed with PA with multiple extra-axial metastases. Debulking and biopsy of the lesions was done. Postoperatively, there was gross residual disease, and the patient's visual disturbances did not improve. Only 165 cases of PCs have been reported in the current literature. Existing consensus on management of these uncommon lesions is based on trial and previously published case reports and surgery appears to be the only definitive treatment. Further research regarding any non-surgical expectant management is warranted.

  View details for DOI 10.1093/jscr/rjab382

  View details for Web of Science ID 000804414400014

  View details for PubMedID 35665399

  View details for PubMedCentralID PMC9155169

• Post-operative seizure control in patients with glioblastoma. JPMA. The Journal of the Pakistan Medical Association Hani, U., Haider, M. A., Bakhshi, S. K., Shamim, M. S. 2021; 71 (6): 1698-1700

  Abstract

  While the median survival in patients with glioblastoma has not improved significantly over the past decade, aggressive attempts have been made on palliation and improving quality of life in these patients. A confluence of two debilitating pathologies which massively distorts the normal day-to-day functioning of the patients who experience it, seizures in glioblastoma patients portends a poor prognosis. There exists a paucity of reported seizure outcomes after glioblastoma treatment in neurosurgical literature. Herein we present a review examining post-operative seizure control in patients with glioblastoma.

  View details for PubMedID 34111103

• Intramedullary spinal cord lesions in children. JPMA. The Journal of the Pakistan Medical Association Hani, U., Tebha, S. S., Bakhshi, S. K., Shamim, M. S. 2021; 71 (2(B)): 775-777

  Abstract

  Paediatric intramedullary spinal cord lesions are uncommon pathologies, prone to result in dismal prognosis if not managed promptly and aggressively. While children usually present in good functional grades compared to adults, early recognition and treatment is important to improve outcomes. In this review, we present tumour demographics, patient factors, and treatment modalities of intramedullary spinal cord lesions in paediatric patients.

  View details for PubMedID 33941981

• Role of Preoperative Embolization in Management of Central Nervous System Tumours. JPMA. The Journal of the Pakistan Medical Association Hani, U., Baig, A. N., Shamim, M. S., Salam, B. 2021; 71 (1(A)): 172-174

  Abstract

  Preoperative embolization plays a significant role as an adjunct to surgical intervention in the cases of certain vascular tumours of the brain. While the procedure has resulted in facilitated resection of the tumour, and has reduced morbidity and mortality, its application remains debatable within the neurosurgical community, owing to rare, but major post-procedural complications. Herein, we have reviewed the literature to assess the safety and efficacy of preoperative angiographic embolization for brain tumours.

  View details for PubMedID 33484551

• Extra-neural Metastatic Potential of Primary Central Nervous System Malignancies. JPMA. The Journal of the Pakistan Medical Association Hani, U., Bukhari, S. S., Shamim, M. S. 2020; 70 (12(B)): 2485-2488

  Abstract

  Extraneural metastases of primary central nervous system malignancies are rare and challenging pathologies, with unknown metastatic mechanism and no consensus regarding the best treatment regimen. Herein, we have reviewed the literature to help elucidate characteristics, prognostic factors, and treatment outcomes of patients with metastatic primary brain tumours.

  View details for PubMedID 33475572

• Surgical outcomes of intramedullary spinal cord ependymomas. JPMA. The Journal of the Pakistan Medical Association Hani, U., Saeed Baqai, M. W., Shamim, M. S. 2020; 70 (10): 1864-1866

  Abstract

  Intramedullary Spinal Cord Ependymomas (ISCE) are uncommon pathologies that need to be aggressively managed before clinical deterioration sets in. Novel application of different therapeutic strategies is being assessed for improving long-term outcomes in patients presenting with these rare neoplasms. In this review, we have discussed the existing literature on ISCEs, and the role of surgery in determining outcomes in terms of neurological status, progression-free survival (PFS) and overall survival (OS).

  View details for PubMedID 33159773

• Value of achieving a watertight dural closure, and the use of dural sealants after supratentorial cranial surgery. JPMA. The Journal of the Pakistan Medical Association Hani, U., Aziz, H. F., Shamim, M. S. 2020; 70 (8): 1470-1472

  Abstract

  Dural closure at the end of cranial surgery is considered an extremely important step to maintain anatomical continuity, separate the intradural space with the extradural one, and to prevent possible complications related to cerebrospinal fluid leak. Wherein its usefulness in posterior fossa craniotomy is established, many surgeons do not perform it routinely in supratentorial craniotomies, citing unnecessary delay and lack of evidence supporting it. Herein, we have reviewed the data to find evidence in support of watertight suture based dural closures compared to other dural closure techniques, in supratentorial craniotomies.

  View details for PubMedID 32794512

• A Review of Common Endoscopic Intracranial Approaches. Asian journal of neurosurgery Darbar, A., Mustansir, F., Hani, U., Sajid, M. I. 2020; 15 (3): 471-478

  Abstract

  With the evolution of surgical techniques, endoscopy has emerged as a suitable alternative to many instances of more invasive methods. In this review article, we aim to discuss the endoscopic advancements, procedural details, indications, and outcomes of the most commonly practiced neuroendoscopic procedures. We have also summarized the uses, techniques, and challenges of neuroendoscopy in select neurosurgical pathologies.

  View details for DOI 10.4103/ajns.AJNS_367_19

  View details for PubMedID 33145194

• Permanent pre-operative cerebrospinal fluid diversion in paediatric patients with posterior fossa tumours. JPMA. The Journal of the Pakistan Medical Association Hani, U., Bakhshi, S. K., Shamim, M. S. 2020; 70 (6): 1101-1103

  Abstract

  Management options for obstructive hydrocephalus in children with posterior fossa tumours have been debated upon throughout the course of neurosurgical practice. Permanent pre-operative CSF diversion via ventricular shunts or endoscopic third ventriculostomy have been employed to prevent the possible persistence of hydrocephalus after tumour removal, but is considered unnecessary and even dangerous amongst a large group of neurosurgeons. In this paper, we have reviewed the literature for the merits and demerits of pre-operative permanent CSF diversion in paediatric patients presenting with posterior fossa tumours.

  View details for PubMedID 32810118

• Steriotactic Radiosurgery for Vestibular Schwannomas. JPMA. The Journal of the Pakistan Medical Association Hani, U., Bakhshi, S., Shamim, M. S. 2020; 70 (5): 939-941

  Abstract

  The approach to treating vestibular schwannomas ranges from wait-and-scan policies to micro-and radiosurgery. However, in the past few decades, Stereotac tic Radiosurgery (SRS) has emerged as an approved primary treatment option as well. In this review, we have assessed some of the existing literature on the role of SRS in the management of vestibular schwannomas, and to estimate its efficacy in tumour control and conservation of cranial nerve function.

  View details for PubMedID 32400760

• Primary Intracranial Malignant Melanoma. JPMA. The Journal of the Pakistan Medical Association Hani, U., Bakhshi, S. K., Shamim, M. S. 2020; 70 (3): 554-556

  Abstract

  Primary intracranial malignant melanoma (PIMM) are rare brain tumours; more infrequent than melanomas metastasizing to the brain or those extending to the brain from adjacent structures such as the orbit. Complete surgical excision with adjuvant chemotherapy and radiation remains the mainstay of treatment. Herein, we have reviewed the literature to find the treatment modalities for PIMMs that can lead to longer overall survivals and better patient outcomes.

  View details for PubMedID 32207448

• Arteriovenous malformation with associated multiple flow-related distal anterior cerebral artery aneurysms: A case report with poor outcomes. Surgical neurology international Hani, U., Bari, M. E., Bukhari, S. S. 2020; 11: 232

  Abstract

  BACKGROUND: Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder.CASE DESCRIPTION: A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his Glasgow Coma Scale dropped and he underwent emergency embolization with Onyx. This was followed by external ventricular drainage. The patient's neurological status did not improve, and he died following a complicated clinical course.CONCLUSION: Multiple DACA aneurysms are a case of both clinical and anatomical rarity and to avoid complications in the clinical course, one must be judicious about the time spent between symptom onset and embolization.

  View details for DOI 10.25259/SNI_27_2019

  View details for PubMedID 32874735

• Peri-operative Lumbar Drains for Trans-Sphenoidal resection of Pituitary Adenomas JOURNAL OF THE PAKISTAN MEDICAL ASSOCIATION Hani, U., Bakhshi, S., Shamim, M. 2019; 69 (11): 1752-1754

  Abstract

  Trans-sphenoidal approach for resection of pituitary adenomas is a safe and common neurosurgical procedure. It can be done both through microscopic or endoscopic methods, and both methods can be facilitated by a perioperative lumbar drain insertion, that in theory improves tumour resection and reduces risk of post-operative cerebrospinal fluid leak. Herein we have reviewed the literature to find out the evidence in support of perioperative lumbar drain insertion for trans-sphenoidal resections.

  View details for Web of Science ID 000504418800031

  View details for PubMedID 31740895

• Enhanced Recovery after Elective Craniotomy for Brain Tumours. JPMA. The Journal of the Pakistan Medical Association Hani, U., Bakhshi, S. K., Shamim, M. S. 2019; 69 (5): 749-751

  Abstract

  Enhanced recovery after surgery (ERAS) is aimed at accelerated rehabilitation after surgery, and involves a multidisciplinary approach. Significant work has been published on this concept with regards to abdominal surgeries, however, the idea is relatively new for those undergoing neurosurgical procedures. We have reviewed literature on ERAS in patients undergoing craniotomy for brain tumours.

  View details for PubMedID 31105305