Jenli Dawn Waters, MD

All Publications

• Operative and Therapeutic Advancements in Breast Cancer Metastases to the Brain. Clinical breast cancer Jandial, R., Hoshide, R., Waters, J. D., Somlo, G. 2018; 18 (4): e455-e467

  Abstract

  Patients with breast cancer are surviving longer as the state of the art for care advances. Because patients are surviving longer with primary breast cancer, the incidence of secondary metastatic disease has risen. Metastatic breast cancer to the brain was once thought to be universally fatal. While it is still quite lethal, its treatment after diagnosis is increasingly safe and effective. Critical progress has been made in understanding the interaction between breast metastases and the neural niche, neuroimaging of functional anatomy, minimally invasive image-guided brain surgery, characterizing subtypes of breast cancer based on molecular and genetic profiles, and individualized pharmaceuticals and immunotherapies. In this review, we discuss recent advances that have brought us to state-of-the-art management of metastatic breast cancer to the brain.

  View details for DOI 10.1016/j.clbc.2017.10.002

  View details for PubMedID 29100727

• Space-brain: The negative effects of space exposure on the central nervous system. Surgical neurology international Jandial, R., Hoshide, R., Waters, J. D., Limoli, C. L. 2018; 9: 9

  Abstract

  Journey to Mars will be a large milestone for all humankind. Throughout history, we have learned lessons about the health dangers associated with exploratory voyages to expand our frontiers. Travelling through deep space, the final frontier, is planned for the 2030s by NASA. The lessons learned from the adverse health effects of space exposure have been encountered from previous, less-lengthy missions. Prolonged multiyear deep space travel to Mars could be encumbered by significant adverse health effects, which could critically affect the safety of the mission and its voyagers. In this review, we discuss the health effects of the central nervous system by space exposure. The negative effects from space radiation and microgravity have been detailed. Future aims and recommendations for the safety of the voyagers have been discussed. With proper planning and anticipation, the mission to Mars can be done safely and securely.

  View details for DOI 10.4103/sni.sni_250_17

  View details for PubMedID 29416906

  View details for PubMedCentralID PMC5791508

• Historical perspectives on the biology of brain metastasis. Clinical & experimental metastasis Waters, J. D., Hoshide, R., Jandial, R. 2017; 34 (6-7): 365-367

  View details for DOI 10.1007/s10585-017-9859-5

  View details for PubMedID 28879620

• Non-traumatic cranial lesions 100 Case Reviews in Neurosurgery Waters , J., Harsh , G. Elsevier. 2017
• Normal pressure hydrocephalus 100 Case Reviews in Neurosurgery Rennert , R., Cheung , V., Waters , J. Elsevier. 2017
• Cerebellar hemangioblastoma 100 Case Reviews in Neurosurgery Waters , J., Jandial , R., Chen , M., Aizernberg , M. Elsevier. 2017
• Cushing’s Disease 100 Case Reviews in Neurosurgery Waters , J., Jandial , R., Chen , M., Aizernberg , M. Elsevier. 2017
• Arachnoid cyst 100 Case Reviews in Neurosurgery Waters , J., Jandial , R., Chen , M., Aizernberg , M. Elsevier. 2017
• Immediate post-operative brachytherapy prior to irradiation and temozolomide for newly diagnosed glioblastoma. Journal of neuro-oncology Waters, J. D., Rose, B., Gonda, D. D., Scanderbeg, D. J., Russell, M., Alksne, J. F., Murphy, K., Carter, B. S., Lawson, J., Chen, C. C. 2013; 113 (3): 467-77

  Abstract

  To determine whether immediate post-operative brachytherapy can be safely applied to newly diagnosed glioblastomas to retard tumor progression prior to initiation of external beam radiation therapy (EBRT) and temozolomide. Between 1996 and 2011, eleven patients underwent implantation of GliaSite (n = 9) or MammoSite (n = 2) at the time of surgical resection. Brachytherapy was carried out on post-operative day 2-3, with 45-60 Gy delivered to a 1 cm margin. All patients underwent subsequent standard radiation/temozolomide treatment 4-5 weeks post-irradiation. There were no wound related complications. Toxicity was observed in two patients (2/11 or 18 %), including one post-operative seizure and one case of cerebral edema that resolved after a course of steroid treatment. Immediate post-operative and pre-irradiation/temozolomide magnetic resonance imaging assessment was available for 9 of the 11 patients. Two of these nine patients (22 %) developed new regions of contrast enhancement prior to irradiation/temozolomide. This compares favorably to historical data where 53 % of patient suffer such tumor progression. While there was a trend toward improved 6 month progression free survival in the brachytherapy/temozolomide/radiation treated patients, the overall survival of these patients were comparable to historical controls. This case series demonstrates the safety of immediate post-operative brachytherapy when applied prior to EBRT and temozolomide in the treatment of newly diagnosed glioblastomas.

  View details for DOI 10.1007/s11060-013-1139-x

  View details for PubMedID 23673513

• Strategic design for pediatric neurosurgery missions across the Western Hemisphere. Surgical neurology international Hambrecht, A., Duenas, M. J., Hahn, E. J., Aryan, H. E., Hughes, S. A., Waters, D., Levy, M. L., Jandial, R. 2013; 4: 62

  Abstract

  With growing interest in global health, surgeons have created outreach missions to improve health care disparities in less developed countries. These efforts are mainly episodic with visiting surgeons performing the operations and minimal investment in local surgeon education. To create real and durable advancement in surgical services in disciplines that require urgent patient care, such as pediatric neurosurgery, improving the surgical armamentarium of the local surgeons must be the priority.We propose a strategic design for extending surgical education missions throughout the Western Hemisphere in order to transfer modern surgical skills to local neurosurgeons. A selection criteria and structure for targeted missions is a derivative of logistical and pedagogical lessons ascertained from previous missions by our teams in Peru and Ukraine.Outreach programs should be applied to hospitals in capital cities to serve as a central referral center for maximal impact with fiscal efficiency. The host country should fulfill several criteria, including demonstration of geopolitical stability in combination with lack of modern neurosurgical care and equipment. The mission strategy is outlined as three to four 1-week visits with an initial site evaluation to establish a relationship with the hospital administration and host surgeons. Each visit should be characterized by collaboration between visiting and host surgeons on increasingly complex cases, with progressive transfer of skills over time.A strategic approach for surgical outreach missions should be built on collaboration and camaraderie between visiting and local neurosurgeons, with the mutual objective of cost-effective targeted renovation of their surgical equipment and skill repertoire.

  View details for DOI 10.4103/2152-7806.111092

  View details for PubMedID 23772332

  View details for PubMedCentralID PMC3681000

• Diagnostic yield of stereotactic needle-biopsies of sub-cubic centimeter intracranial lesions. Surgical neurology international Waters, J. D., Gonda, D. D., Reddy, H., Kasper, E. M., Warnke, P. C., Chen, C. C. 2013; 4 (Suppl 3): S176-81

  Abstract

  Stereotactic brain biopsies are widely used for establishing the diagnosis of intracranial lesions. Here we examine whether stereotactic biopsy of smaller brain lesions, defined for this study as being less than 1 cubic centimeter (1 cc) in volume, are associated with lowered diagnostic yield.We conducted a retrospective analysis of 267 consecutive patients who underwent stereotactic brain biopsy between 2007 and 2011. Lesion volumes were calculated and were stratified by <1 or >1 cc.A total of 13 of 246 (5.2%) biopsies for lesions >1 cc resulted in nondiagnostic tissue or an incorrect diagnosis. In contrast, 5 of 21 (23.8%) biopsies for <1 cc lesions yielded nondiagnostic or incorrect diagnosis. Posthoc review of tissue from the <1 cc lesions suggests the neuropathologist's expertise in the handling and analysis of limited specimen as a critical parameter of successful diagnosis. The operative morbidities were low for both the <1 and >1 cc biopsies (0% and 1%, respectively).This study demonstrates that stereotactic cerebral biopsy of lesions less than a cubic centimeter in volume results in a lower diagnostic yield versus larger lesions (76.2% versus 94.8%). While auxiliary measures may be taken to improve diagnostic yield, these patients may be best managed in a specialized center with experienced stereotactic neurosurgeons and neuropathologists.

  View details for DOI 10.4103/2152-7806.110677

  View details for PubMedID 23682345

  View details for PubMedCentralID PMC3654772

• CT322, a VEGFR-2 antagonist, demonstrates anti-glioma efficacy in orthotopic brain tumor model as a single agent or in combination with temozolomide and radiation therapy. Journal of neuro-oncology Waters, J. D., Sanchez, C., Sahin, A., Futalan, D., Gonda, D. D., Scheer, J. K., Akers, J., Palanichamy, K., Waterman, P., Chakravarti, A., Weissleder, R., Morse, B., Marsh, N., Furfine, E., Chen, C. C., Carvajal, I., Carter, B. S. 2012; 110 (1): 37-48

  Abstract

  Glioblastomas are among the most aggressive human cancers, and prognosis remains poor despite presently available therapies. Angiogenesis is a hallmark of glioblastoma, and the resultant vascularity is associated with poor prognosis. The proteins that mediate angiogenesis, including vascular endothelial growth factor (VEGF) signaling proteins, have emerged as attractive targets for therapeutic development. Since VEGF receptor-2 (VEGFR-2) is thought to be the primary receptor mediating angiogenesis, direct inhibition of this receptor may produce an ideal therapeutic effect. In this context, we tested the therapeutic effect of CT322, a selective inhibitor of VEGFR-2. Using an intracranial murine xenograft model (U87-EGFRvIII-luciferase), we demonstrate that CT322 inhibited glioblastoma growth in vivo and prolonged survival. Of note, the anti-neoplastic effect of CT322 is augmented by the incorporation of temozolomide or temozolomide with radiation therapy. Immunohistochemical analysis of CT322 treated tumors revealed decreased CD31 staining, suggesting that the tumoricidal effect is mediated by inhibition of angiogenesis. These pre-clinical results provide the foundation to further understand long term response and tumor escape mechanisms to anti-angiogenic treatments on EGFR over-expressing glioblastomas.

  View details for DOI 10.1007/s11060-012-0948-7

  View details for PubMedID 22875706

  View details for PubMedCentralID PMC4291475

• Spine malignancies Frontiers in Spine and Spinal Cord Repair Waters , J., Navarro-Peran , E., Ciacci , J. Springer. 2011
• Gross total resection versus subtotal resection for central neurocytoma Controversies in Neuro-Oncology: Best Evidence Medicine for Brain Tumor Surgery Waters , J., Gonda , D., Chen , C., Carter , B. Thieme. 2011
• Anterior corpectomy Essential Techniques in Operative Neurosurgery Waters , J., Ciacci , J. Elsevier. 2011
• Stem cell origin of brain tumors. Advances in experimental medicine and biology Waters, D., Newman, B., Levy, M. L. 2010; 671: 58-66

  Abstract

  The biology of both normal and tumor development clearly possesses overlapping and parallel features. Oncogenes and tumor suppressors are relevant not only in tumor biology, but also in physiological developmental regulators of growth and differentiation. Conversely, genes identified as regulators of developmental biology are relevant to tumor biology. This is particularly relevant in the context of brain tumors, where recent evidence is mounting that the origin of brain tumors, specifically gliomas, may represent dysfunctional developmental neurobiology. NSCs are increasingly being investigated as the cell type that originally undergoes malignant transformation--the cell of origin--and the evidence for this is discussed.

  View details for DOI 10.1007/978-1-4419-5819-8_5

  View details for PubMedID 20455495

• Balamuthia mandrillaris meningoencephalitis in an immunocompromised patient. Case report. Journal of neurosurgery Kansagra, A. P., Menon, J. P., Yarbrough, C. K., Urbaniak, K., Waters, J. D., Borys, E., Jandial, R. 2009; 111 (2): 301-5

  Abstract

  Balamuthia mandrillaris is a rare but increasingly recognized cause of amebic encephalitis, yet it remains poorly understood. The condition is almost universally fatal, and due to diagnostic difficulty, most cases are identified postmortem. The authors report a case of Balamuthia amebic encephalitis in a patient with combined variable immunodeficiency in which a rare antemortem diagnosis was made via brain biopsy. Despite broad-spectrum antimicrobial therapy, the outcome was fatal. Such presentations are challenging, and definitive diagnosis may require biopsy in consultation with a skilled neuropathologist.

  View details for DOI 10.3171/2008.9.JNS08718

  View details for PubMedID 19025354

• First Aid Cases for the USMLE Step 1 Waters , J., Le , T., Krause , K., Klein , J., Shivaram , A. McGraw Hill. New York, NY. 2006