Brain research to benefit from new cell-marking technique
Neurology News & Neuroscience News from Medical News Today
Original Article: http://www.medicalnewstoday.com/articles/287434.php
Thursday, December 25, 2014
Brain research to benefit from new cell-marking technique
Original Article: http://www.medicalnewstoday.com/articles/287434.php
Wednesday, December 24, 2014
Livros em Revista: Após um tumor Cerebral - Julio Pereira, Neurocirurgião
Livros em Revista: Após um tumor Cerebral - Julio Pereira, Neurocirurgião
A Randomized Trial Comparing Balloon Kyphoplasty and Vertebroplasty for Vertebral Compression Fractures due to Osteoporosis
A Randomized Trial Comparing Balloon Kyphoplasty and Vertebroplasty for Vertebral Compression Fractures due to Osteoporosis
AJNR Blog
Editor's Choice
December 2014
(1 of 3)
Patients with osteoporotic acute thoracic and lumbar vertebral body fractures were randomly assigned to either kyphoplasty or vertebroplasty with 12- and 24-month posttreatment fracture incidence as the primary end point. Kyphoplasty and vertebroplasty had similar long-term improvement in pain and disability with comparable safety profiles and few device-related complications. Procedure duration was shorter with vertebroplasty. Kyphoplasty had fewer cement leakages and a trend toward longer fracture-free survival.
Abstract
BACKGROUND AND PURPOSE
Several trials have compared vertebral augmentation with nonsurgical treatment for vertebral compression fractures. This trial compares the efficacy and safety of balloon kyphoplasty and vertebroplasty.
MATERIALS AND METHODS
Patients with osteoporosis with 1–3 acute fractures (T5–L5) were randomized and treated with kyphoplasty (n = 191) or vertebroplasty (n = 190) and were not blinded to the treatment assignment. Twelve- and 24-month subsequent radiographic fracture incidence was the primary end point. Due to low enrollment and early withdrawals, the study was terminated with 404/1234 (32.7%) patients enrolled.
RESULTS
The average age of patients was 75.6 years (77.4% female). Mean procedure duration was longer for kyphoplasty (40.0 versus 31.8 minutes, P < .001). At 12 months, 7.8% fewer patients with kyphoplasty (50/140 versus 57/131) had subsequent radiographic fracture, and there were 8.6% fewer at 24 months (54/110 versus 64/111). The results were not statistically significant (P > .21). When we used time to event for new clinical fractures, kyphoplasty approached statistical significance in longer fracture-free survival (Wilcoxon, P = .0596). Similar pain and function improvements were observed. CT demonstrated lower cement extravasation for kyphoplasty (157/214 versus 164/201 levels treated, P = .047). For kyphoplasty versus vertebroplasty, common adverse events within 30 postoperative days were procedural pain (12/191, 9/190), back pain (14/191, 28/190), and new vertebral fractures (9/191, 17/190); similar 2-year occurrence of device-related cement embolism (1/191, 1/190), procedural pain (3/191, 3/190), back pain (2/191, 3/190), and new vertebral fracture (2/191, 2/190) was observed.
CONCLUSIONS
Kyphoplasty and vertebroplasty had similar long-term improvement in pain and disability with similar safety profiles and few device-related complications. Procedure duration was shorter with vertebroplasty. Kyphoplasty had fewer cement leakages and a trend toward longer fracture-free survival.
The post A Randomized Trial Comparing Balloon Kyphoplasty and Vertebroplasty for Vertebral Compression Fractures due to Osteoporosis appeared first on AJNR Blog.
Original Article: http://www.ajnrblog.org/2014/12/21/randomized-trial-comparing-balloon-kyphoplasty-vertebroplasty-vertebral-compression-fractures-due-osteoporosis/
Long-term Results of Endonasal Endoscopic Transsphenoidal Resection of Nonfunctioning Pituitary Macroadenomas
Long-term Results of Endonasal Endoscopic Transsphenoidal Resection of Nonfunctioning Pituitary Macroadenomas
Neurosurgery - Most Popular Articles
BACKGROUND: Several studies report early results of endoscopic endonasal transsphenoidal surgery; however, none discuss long-term outcome measures such as tumor recurrence rates and the need for additional surgical procedures. OBJECTIVE: To discuss the long-term outcomes after endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary macroadenomas. METHODS: This is a retrospective study. Patients were included only if they had at least 5 years of clinical and imaging follow-up after surgery. RESULTS: Eighty patients met the study criteria. Grossly complete resection was achieved in 71% of patients. Knosp grade 0 to 2 tumors and tumor with volumes <10 cm3 were significantly more likely to have received a grossly complete resection. There were 7 recurrences (12%) in patients who had received grossly complete resections, with a mean time to recurrence of 53 months. Among the 23 patients who had subtotal resections, 11 (61%) progressed radiographically, and 3 (17%) had symptomatic progression. Knosp score, surgical and radiographic evidence of invasion, and preoperative visual deficits were predictive of recurrence in a univariate analysis, but Knosp grade was the only independent predictor in a multivariate analysis. Kaplan-Meier analysis projected a 10-year progression-free survival rate of 80% and 21% for patients with gross total resections and subtotal resections, respectively. CONCLUSION: At the long-term follow-up, 12% of patients had recurrent tumors after grossly complete resection. Recurrent or residual tumors were treated with either repeat surgery or Gamma Knife radiosurgery. Rates of complete resection, postoperative surgical and endocrinological complications, and additional surgical procedures are similar to previously published reports after microscopic transsphenoidal surgery. ABBREVIATION: ETSS, endoscopic transsphenoidal surgeryOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Long_term_Results_of_Endonasal_Endoscopic.5.aspx
Recurrence pattern analysis after re-irradiation with bevacizumab in recurrent malignant glioma patients
Recurrence pattern analysis after re-irradiation with bevacizumab in recurrent malignant glioma patients
Radiation Oncology
Background: The aim of the present analysis was to evaluate the recurrence pattern in patients with recurrent malignant glioma after re-irradiation in combination with bevacizumab as there is limited data on how to optimally choose dose, fractionation and delineation margins. Methods: Thirty-one patients with recurrent malignant glioma treated with re-irradiation and bevacizumab after previous chemoradiotherapy (concurrent temozolomide 75?mg/m2/d according to the EORTC/NCIC trial) and [18?F]FET-PET and/or MRI confirmed recurrence were retrospectively analyzed. Bevacizumab was applied twice during fractionated re-irradiation (10?mg/kg, d1?+?d15, median 36?Gy, conventionally fractionated). Recurrence patterns were assessed by means of [18?F]FET-PET and/or MRI. Results: Median follow-up was 34.0?months for all patients [95%-CI, 27.7-40.3] and median post-recurrence survival 10.8?months [95%-CI, 9.2-12.4]. Concerning the recurrence patterns, 61.3% of these were located in-field (19 patients), 22.6% were marginal (7 patients) and 16.1% ex-field (5 patients). No influence on the recurrence pattern was observed according to sex, WHO grade, maintenance chemotherapy or MGMT methylation status whereas planning target volume (PTV) size had a significant influence on the recurrence pattern (p?=?0.032). PTV sizes?>?75?ml were associated with a higher in-field recurrence rate and lower median post-recurrence progression-free survival (8.5 vs. 4.9?months, p?=?0.016). Conclusions: After the administration of re-irradiation with bevacizumab the recurrence pattern seems to be mainly centrally located. The PTV size was the main predictor for a marginal/ex-field recurrence.
Original Article: http://www.ro-journal.com/content/PREACCEPT-1210754928146310
Friday, December 19, 2014
Life after a Brain Tumor - Coming out in 2015 #neurosurgicaltv #neurosurgeryblog
Life after a Brain Tumor - Coming out in 2015 #neurosurgicaltv #neurosurgeryblog #ebook #book #tumor
Volume-Outcome Relationships in Neurosurgery
Volume-Outcome Relationships in Neurosurgery
Neurosurgery Clinics of North America
For a variety of neurosurgical conditions, increasing surgeon and hospital volumes correlate with improved outcomes, such as mortality, complication rates, length of stay, hospital charges, and discharge disposition. Neurosurgeons can improve patient outcomes at the population level by changing practice and referral patterns to regionalize care for select conditions at high-volume specialty treatment centers. Individual practitioners should be aware of where they fall on the volume spectrum and understand the implications of their practice and referral habits on their patients.
Original Article: http://www.neurosurgery.theclinics.com/article/S1042-3680(14)00150-8/abstract?rss=yes
Cost-Effectiveness Research in Neurosurgery
Cost-Effectiveness Research in Neurosurgery
Neurosurgery Clinics of North America
Cost and value are increasingly important components of health care discussions. Despite a plethora of cost and cost-effectiveness analyses in many areas of medicine, there has been little of this type of research for neurosurgical procedures. This scarcity is vexing because this specialty represents one of the most expensive areas in medicine. This article discusses the general principles of cost-effectiveness analyses and reviews the cost- and cost-effectiveness–related research to date in neurosurgical subspecialties. The need for standardization of cost and cost-effectiveness measurement and reporting within neurosurgery is highlighted and a set of metrics for this purpose is defined.
Original Article: http://www.neurosurgery.theclinics.com/article/S1042-3680(14)00143-0/abstract?rss=yes
Long-term Results of Endonasal Endoscopic Transsphenoidal Resection of Nonfunctioning Pituitary Macroadenomas
Long-term Results of Endonasal Endoscopic Transsphenoidal Resection of Nonfunctioning Pituitary Macroadenomas
Neurosurgery - Current Issue
BACKGROUND: Several studies report early results of endoscopic endonasal transsphenoidal surgery; however, none discuss long-term outcome measures such as tumor recurrence rates and the need for additional surgical procedures. OBJECTIVE: To discuss the long-term outcomes after endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary macroadenomas. METHODS: This is a retrospective study. Patients were included only if they had at least 5 years of clinical and imaging follow-up after surgery. RESULTS: Eighty patients met the study criteria. Grossly complete resection was achieved in 71% of patients. Knosp grade 0 to 2 tumors and tumor with volumes <10 cm3 were significantly more likely to have received a grossly complete resection. There were 7 recurrences (12%) in patients who had received grossly complete resections, with a mean time to recurrence of 53 months. Among the 23 patients who had subtotal resections, 11 (61%) progressed radiographically, and 3 (17%) had symptomatic progression. Knosp score, surgical and radiographic evidence of invasion, and preoperative visual deficits were predictive of recurrence in a univariate analysis, but Knosp grade was the only independent predictor in a multivariate analysis. Kaplan-Meier analysis projected a 10-year progression-free survival rate of 80% and 21% for patients with gross total resections and subtotal resections, respectively. CONCLUSION: At the long-term follow-up, 12% of patients had recurrent tumors after grossly complete resection. Recurrent or residual tumors were treated with either repeat surgery or Gamma Knife radiosurgery. Rates of complete resection, postoperative surgical and endocrinological complications, and additional surgical procedures are similar to previously published reports after microscopic transsphenoidal surgery. ABBREVIATION: ETSS, endoscopic transsphenoidal surgeryOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Long_term_Results_of_Endonasal_Endoscopic.5.aspx
Cerebral Hypoperfusion-Assisted Intra-arterial Deposition of Liposomes in Normal and Glioma-Bearing Rats
Cerebral Hypoperfusion-Assisted Intra-arterial Deposition of Liposomes in Normal and Glioma-Bearing Rats
Neurosurgery - Current Issue
BACKGROUND: Optimizing liposomal vehicles for targeted delivery to the brain has important implications for the treatment of brain tumors. The promise of efficient, brain-specific delivery of chemotherapeutic compounds via liposomal vehicles has yet to be achieved in clinical practice. Intra-arterial injection of specially designed liposomes may facilitate efficient delivery to the brain and to gliomas. OBJECTIVE: To test the hypothesis that cationic liposomes may be effectively delivered to both normal and glioma-bearing brain tissue utilizing a strategy of intra-arterial injection during transient cerebral hypoperfusion. METHODS: Cationic, anionic, and neutral liposomes were separately injected via the internal carotid artery of healthy rats during transient cerebral hypoperfusion. Rats bearing C6 gliomas were similarly injected with cationic liposomes. Liposomes were loaded with DilC18(5) dye whose concentrations can be measured by light absorbance and fluorescence methods. RESULTS: After intra-arterial injection, a robust uptake of cationic in comparison with anionic and neutral liposomes into brain parenchyma was observed by diffuse reflectance spectroscopy. Postmortem multispectral fluorescence imaging revealed that liposomal cationic charge was associated with more efficient delivery to the brain. Cationic liposomes were also readily observed within glioma tissue after intra-arterial injection. However, over time, cationic liposomes were retained longer and at higher concentrations in the surrounding, peritumoral brain than in the tumor core. CONCLUSION: This study demonstrates the feasibility of cationic liposome delivery to brain and glioma tissue after intra-arterial injection. Highly cationic liposomes directly delivered to the brain via an intracarotid route may represent an effective method for delivering antiglioma agents. ABBREVIATIONS: Chol, cholesterol DiD, DilC18(5) DMPC, dimyristoylphosphatidylcholine DOTAP, dioleoyl-trimethylammonium-propane IA, intra-arterial MCA, middle cerebral artery OP, optical pharmacokinetic TCH, transient cerebral hypoperfusionOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Cerebral_Hypoperfusion_Assisted_Intra_arterial.10.aspx
Thursday, December 18, 2014
Oncopedia.tv - Personalized Oncology
Personalized Oncology is a relatively new field of science which attempts to analyze genes to determine if a persons genetic makeup will make that patient susceptible or resistant to that drugs affect.
Wednesday, December 17, 2014
Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications
Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications
Journal of Neurology, Neurosurgery & Psychiatry current issue
Early neurological deterioration (END) following ischaemic stroke is a serious event with manageable causes in only a fraction of patients. The incidence, causes and predictors of END occurring within 24 h of acute ischaemic stroke (END24) have not been systematically reviewed. We systematically reviewed Medline and Embase from January 1990 to April 2013 for all studies on END24 following acute ischaemic stroke (<8 h from onset). We recorded the incidence and presumed causes of and factors associated with END24. Thirty-six studies were included. Depending on the definition used, the incidence of END24 markedly varied among studies. Using the most widely used change in National Institutes of Health Stroke Scale ≥4 definition, the pooled incidence was 13.8% following thrombolysis, ascribed to intracranial haemorrhage and malignant oedema each in ~20% of these. As other mechanisms were rarely reported, in the majority no clear cause was identified. Few data on END24 occurring in non-thrombolysed patients were available. Across thrombolysed and non-thrombolysed samples, the strongest and most consistent admission predictors were hyperglycaemia, no prior aspirin use, prior transient ischaemic attacks, proximal arterial occlusion and presence of early CT changes, and the most consistent 24 h follow-up associated factors were no recanalisation/reocclusion, large infarcts and intracranial haemorrhage. Finally, END24 was strongly predictive of poor outcome. The above findings are discussed with emphasis on END without a clear mechanism. Data on incidence and predictors of the latter subtype is scarce, and future studies using systematic imaging protocols should address its underlying pathophysiology. This may in turn lead to rational preventative and therapeutic measures for this ominous event.
Original Article: http://jnnp.bmj.com/cgi/content/short/86/1/87?rss=1
Tuesday, December 16, 2014
Last Week's Neurosurgical TV Show
Greeting Neurosurgical Community:
check out last Saturday's Show, with a case presentation by a Spanish Neurosurgeon to a Panel which included 2 Neurosurgeons from Brazil, one from Egypt, one from Saudi Arabia, and other doctors.
We welcome those Neurosurgeons who want to join the panel of any weekly show, or those who wish to present a case, or a didactic presentation.
best
john bennett md
ex-ER Doctor Internet Geek
for Julio Pereira MD
Neurosurgeon
Sao Paulo, Brazil
Monday, December 15, 2014
Imaging-Detected Incidental Thyroid Nodules that Undergo Surgery: A Single-Center Experience Over 1 Year
Imaging-Detected Incidental Thyroid Nodules that Undergo Surgery: A Single-Center Experience Over 1 Year
AJNR Blog
Fellows' Journal Club
November 2014
(3 of 3)
The authors describe the imaging and pathology results of 47 patients who underwent surgery for incidentally found thyroid nodules. All patients had biopsies before surgery but only 4% of these showed benign processes. Surgery eventually demonstrated that 51% of nodules were benign and when malignant the most common histology was papillary type.
Abstract
BACKGROUND AND PURPOSE
Incidental thyroid nodules are commonly seen on imaging, and their work-up can ultimately lead to surgery. We describe characteristics and pathology results of imaging-detected incidental thyroid nodules that underwent surgery.
MATERIALS AND METHODS
A retrospective review was performed of 303 patients who underwent thyroid surgery over a 1-year period to identify patients who presented with incidental thyroid nodules on imaging. Medical records were reviewed for the types of imaging studies that led to detection, nodule characteristics, and surgical pathology.
RESULTS
Of 303 patients, 208 patients (69%) had surgery for thyroid nodules. Forty-seven of 208 patients (23%) had incidental thyroid nodules detected on imaging. The most common technique leading to detection was CT (47%). All patients underwent biopsy before surgery. The cytology results were nondiagnostic (6%), benign (4%), atypia of undetermined significance or follicular neoplasm of undetermined significance (23%), follicular neoplasm or suspicious for follicular neoplasm (19%), suspicious for malignancy (17%), and diagnostic of malignancy (30%). Surgical pathology was benign in 24 of 47 (51%) cases of incidental thyroid nodules. In the 23 incidental cancers, the most common histologic type was papillary (87%), the mean size was 1.4 cm, and nodal metastases were present in 7 of 23 cases (30%). No incidental cancers on imaging had distant metastases.
CONCLUSIONS
Imaging-detected incidental thyroid nodules led to nearly one-fourth of surgeries for thyroid nodules, and almost half were initially detected on CT. Despite indeterminate or suspicious cytology results that lead to surgery, more than half were benign on final pathology. Guidelines for work-up of incidental thyroid nodules detected on CT could help reduce unnecessary investigations and surgery.
The post Imaging-Detected Incidental Thyroid Nodules that Undergo Surgery: A Single-Center Experience Over 1 Year appeared first on AJNR Blog.
Original Article: http://www.ajnrblog.org/2014/12/14/imaging-detected-incidental-thyroid-nodules-undergo-surgery-single-center-experience-1-year/
Neurosurgery TV: Cervical Pain - symptoms of lung cancer
Neurosurgery TV: Cervical Pain - symptoms of lung cancer
Friday, December 12, 2014
ESCRITO EM LETRA DE MÉDICO
ESCRITO EM LETRA DE MÉDICO by Júlio Pereira
https://itun.es/br/7upKN.l
https://itun.es/br/7upKN.l
Bilateral papilledema associated with spinal schwannoma
Bilateral papilledema associated with spinal schwannoma
Neurology recent issues
A 61-year-old man presented with a 4-month history of progressive vision loss and paresthesia between the right L2-L4 dermatome. Funduscopy revealed severe bilateral papilledema (figure 1). Head CT showed mild hydrocephalus. CSF from a lumbar puncture at the L4-L5 level was xanthochromic with an elevated protein level (4,350 mg/dL). Lumbar spine MRI demonstrated a large intradural tumor at the L3-L4 level (figure 2), which was pathologically identified as schwannoma. Surgical removal resolved all symptoms. Papilledema is a rare complication induced by marked elevation of CSF protein, which may disturb CSF absorption and result in high intracranial pressure.1,2
Original Article: http://www.neurology.org/cgi/content/short/83/24/2312?rss=1
Hippocampal EUD in primarily irradiated glioblastoma patients
Hippocampal EUD in primarily irradiated glioblastoma patients
Radiation Oncology
Background: Radiation delivery for malignant brain tumors is gradually becoming more precise. Particularly the possibilities of sparing adjacent normal structures such as the hippocampus are increasing. To determine its radiation exposure more exactly, the equivalent uniform dose (EUD) of the hippocampus was compared with further treatment parameters. This way sparing options could be found. Methods: From the database of the University hospital of Munich 61 glioblastoma patients were selected who received primary radiotherapy in 2011. General data about the etiology, treatment course, survival of the patients and dose parameters were retrieved. Results: In a linear regression analysis the side of the tumor (left hippocampus: p?
Original Article: http://www.ro-journal.com/content/9/1/276
Highly Cited Works in Skull Base Neurosurgery
Highly Cited Works in Skull Base Neurosurgery
ScienceDirect Publication: World Neurosurgery
Publication date:
Source:World Neurosurgery
Author(s): Nickalus R. Khan , Siang Liao Lee , Matthew Brown , Jonathan Reding , Jonathan Angotti , Jacob Lepard , Kyle Gabrick , Paul Klimo Jr. , L. Madison Michael II
Original Article: http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSSEARCH&_method=citationSearch&_piikey=S1878875014013758&_version=1&md5=acb36caf3c19d6e58457df6ae2dbf508
Neurosurgery Internet TV Show Tomorrow 11:00 am
Greetings Neurosurgeons!
We have a Neurosurgical Internet TV Show, LIVE, tomorrow, Saturday Dec 13th, at www.Neurosurgical.TV
Carlos Lluminguano MD, Neurosurgeon, is going to give a didactic presentation of "Neck Pain Due to Undetected Lung Adenocarcinoma"
For info, see http://youtu.be/dewsBEh_plY
Let us know if you want to be on the panel, or have an interested in giving a presentation yourself!
best
John Bennett MD
for Julio Pereira MD Neurosurgeon
Sao Paulo, Brazil
Thursday, December 11, 2014
Surgery of olfactory groove meningiomas: When in Rome, do as the Romans do?
Surgery of olfactory groove meningiomas: When in Rome, do as the Romans do?
ScienceDirect Publication: World Neurosurgery
Publication date:
Source:World Neurosurgery
Author(s): Karl Schaller
Original Article: http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSSEARCH&_method=citationSearch&_piikey=S1878875014012649&_version=1&md5=7fb80b33b61ab08f33ff52431d5eb43c
Cancer Diagnosis Delays 'Not Due to Poor Clinical Care'
Cancer Diagnosis Delays 'Not Due to Poor Clinical Care'
Medscape Today- Medscape
Delays in diagnosing patients with suspected cancer may reflect diagnostic difficulties and the heterogeneity of cancer, not just poor clinical performance.
Medscape Medical News
Original Article: http://www.medscape.com/viewarticle/836375?src=rss
Sunday, December 7, 2014
Neurosurgical Show Yesterday: See Video of It
Hello Neurosurgery Community
See a great Neurosurgery TV show we had yesterday. about a "Remote Surgical Mentoring" Platform, called "Reacts"
Let us know if you want to sit in the panel anytime, or do a case presentation, or lectures.
Happy Sunday!
best
john bennett md
Neurosurgical.TV
for Julio Pereira MD
Neurosurgeon, Sao Paulo, Brazil
Friday, December 5, 2014
Neurosurgical treatment of pediatric low-grade midbrain tumors: a single consecutive institutional series of 15 patients
Neurosurgical treatment of pediatric low-grade midbrain tumors: a single consecutive institutional series of 15 patients
Journal of Neurosurgery: Journal of Neurosurgery: Pediatrics: Table of Contents
Journal of Neurosurgery: Pediatrics, Volume 14, Issue 6, Page 598-603, December 2014.
Object The authors delineate the long-term results of surgical treatment for pediatric low-grade midbrain glioma. Methods A series of 15 consecutive patients (age range 0–15 years) who underwent primary tumor resection for a low-grade midbrain glioma during the years 1989–2010 were included in this retrospective study on surgical morbidity, mortality rate, academic achievement, and/or work participation. Gross motor function and activities of daily living were scored according to the Barthel Index. Results Of the 15 patients, 10 were in their 1st decade (age 0–9 years) and 5 were in their 2nd decade of life (age 10–15 years) at the time of surgery. The male/female ratio was 0.50 (5:10). No patients were lost to follow-up. One patient died in the postoperative period (32 days posttreatment). Another 2 patients died during follow-up. One patient succumbed to acute bleeding in the resection cavity 8 months after surgery, and the other died of shunt failure 21 years after initial treatment. Twelve patients are alive at the time of this writing, with follow-up periods from 3 to 24 years (median 8 years). Among the 12 survivors, the Barthel Index scores were normal (100) in 11 patients and 80 in 1 patient. A total of 25 tumor resections were performed. In 1 patient, further resection was performed 5 days after initial resection due to MRI-confirmed residual tumor. Another 5 patients underwent repeat tumor resection after MRI-confirmed progressive tumor disease and clinical deterioration ranging from 3 months to 4 years after the initial operation. Three of these 5 patients also underwent a third resection, and 1 of the 3 underwent a fourth operation. Six children received adjuvant therapy: local radiotherapy in 2 patients, chemotherapy in 3 patients, and both in 1 patient. Twelve (80%) of the 15 patients needed treatment for persistent hydrocephalus. Conclusions Selected cases of low-grade midbrain gliomas may clearly benefit from resection with favorable results, even for prolonged periods. Three patients in the present series died, one of whom had a prolonged survival period of 21 years. Among the 12 survivors, stable long-term results appeared obtainable in at least 9. One patient died of acute hemorrhage 8 months after initial resection; otherwise, rapid tumor progression and death were not observed. Forty percent of the patients received adjuvant treatment, with local radiotherapy, chemotherapy, or both.
Original Article: http://thejns.org/doi/abs/10.3171/2014.9.PEDS1462?ai=3f6&mi=3ba5z2&af=R
Stereotactic laser ablation of high-grade gliomas
Stereotactic laser ablation of high-grade gliomas
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents
Neurosurgical Focus, Volume 37, Issue 6, Page E1, December 2014.
Evolving research has demonstrated that surgical cytoreduction of a high-grade glial neoplasm is an important factor in improving the prognosis of these difficult tumors. Recent advances in intraoperative imaging have spurred the use of stereotactic laser ablation (laser interstitial thermal therapy [LITT]) for intracranial lesions. Among other targets, laser ablation has been used in the focal treatment of high-grade gliomas (HGGs). The revived application of laser ablation for gliomas parallels major advancements in intraoperative adjuvants and groundbreaking molecular advances in neuro-oncology. The authors review the research on stereotactic LITT for the treatment of HGGs and provide a potential management algorithm for HGGs that incorporates LITT in clinical practice.
Original Article: http://thejns.org/doi/abs/10.3171/2014.9.FOCUS14471?ai=rw&mi=3ba5z2&af=R
Home palliative care and end of life issues in glioblastoma multiforme: results and comments from a homogeneous cohort of patients
Home palliative care and end of life issues in glioblastoma multiforme: results and comments from a homogeneous cohort of patients
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents
Neurosurgical Focus, Volume 37, Issue 6, Page E5, December 2014.
Object Glioblastoma multiforme (GBM) is a rare tumor whose prognosis has remained poor over the years despite innovative radio- and chemotherapies, and important technical advances in neurosurgery such as intraoperative imaging, fluorescence, Cavitron ultrasonic surgical aspirator, and neuronavigation. Particular attention has been dedicated in the last years to the end of life (EOL) period in cancer patients for both ethical and socioeconomic issues. Good palliative care at home avoids improper and expensive hospitalizations, and helps and trains families, caregivers, and patients in facing a difficult situation. Methods In 2012–2013 the authors' group cared for 197 patients with brain tumors. Of these there were 122 with GBMs: 64 died and 58 are still receiving assistance. The clinical conditions are periodically evaluated with the following scales: Barthel Index, Karnofsky Performance Scale, and Mini-Mental State Examination. Home care staff includes 2 neurologists, 5 nurses, 2 psychologists, 3 rehabilitation therapists, and 1 social worker. The intensity of care changes at the different stages of disease, ranging from low to medium levels of intensity at the progression stage (more than 1 access weekly) to high levels of intensity at the EOL stage (at least 3 accesses weekly). Control MRI studies are obtained every 3 months before terminal progression. Results Overall in this sample of patients there were 2838 home visits and 11,714 days of assistance. Thirty-four patients (14 female and 20 male) died at home (53.1%); 22 (13 female and 9 male) at the hospice (34.4%); and 8 (4 female and 4 male) at the hospital (12.5%). A positive impact on caregivers for home assistance was recorded in 97% of cases, for nursing in 95%, communication in 90%, rehabilitation at home in 92%, and social work help in 85%. Also, 72% had an improvement in their quality of life scores due to rehabilitation. End of life palliative sedation with midazolam was necessary in 11% of cases to obtain good control of symptoms such as uncontrolled delirium, agitation, death rattle, or refractory seizures. Intramuscular phenobarbital is the authors' drug of choice for the severe seizures that occurred in 30% of cases. The reduction of steroid dosage is also used to decrease wakefulness. Steroids were withdrawn in 45% of patients dying at home, mild hydration was done in 87%, and tube feeding in 13%. The decision-making process at the EOL stage is time consuming, but the degree of distress of the family is inversely proportional to the extent of the preparatory period. Conclusions A previous paper showed the positive cost-effectiveness of home assistance for a larger group of patients dealing with any kind of malignant brain tumors. The same is enhanced for patients with GBM. This requires a well-trained neuro-oncology team that manages neurological deterioration, clinical complications, rehabilitation, and psychosocial problems with a multidisciplinary approach.
Original Article: http://thejns.org/doi/abs/10.3171/2014.9.FOCUS14493?ai=rw&mi=3ba5z2&af=R
Targeting glioblastoma cancer stem cells: the next great hope?
Targeting glioblastoma cancer stem cells: the next great hope?
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents
Neurosurgical Focus, Volume 37, Issue 6, Page E7, December 2014.
Glioblastoma multiforme (GBM) is the most common primary brain tumor and is notorious for its poor prognosis. The highly invasive nature of GBM and its inherent resistance to therapy lead to very high rates of recurrence. Recently, a small cohort of tumor cells, called cancer stem cells (CSCs), has been recognized as a subset of tumor cells with self-renewal ability and multilineage capacity. These properties, along with the remarkable tumorigenicity of CSCs, are thought to account for the high rates of tumor recurrence after treatment. Recent research has been geared toward understanding the unique biological characteristics of CSCs to enable development of targeted therapy. Strategies include inhibition of CSC-specific pathways and receptors; agents that increase sensitivity of CSCs to chemotherapy and radiotherapy; CSC differentiation agents; and CSC-specific immunotherapy, virotherapy, and gene therapy. These approaches could inform the development of newer therapeutics for GBM.
Original Article: http://thejns.org/doi/abs/10.3171/2014.9.FOCUS14509?ai=rw&mi=3ba5z2&af=R
The role of cancer stem cells in glioblastoma
The role of cancer stem cells in glioblastoma
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents
Neurosurgical Focus, Volume 37, Issue 6, Page E6, December 2014.
Recurrence in glioblastoma is nearly universal, and its prognosis remains dismal despite significant advances in treatment over the past decade. Glioblastoma demonstrates considerable intratumoral phenotypic and molecular heterogeneity and contains a population of cancer stem cells that contributes to tumor propagation, maintenance, and treatment resistance. Cancer stem cells are functionally defined by their ability to self-renew and to differentiate, and they constitute the diverse hierarchy of cells composing a tumor. When xenografted into an appropriate host, they are capable of tumorigenesis. Given the critical role of cancer stem cells in the pathogenesis of glioblastoma, research into their molecular and phenotypic characteristics is a therapeutic priority. In this review, the authors discuss the evolution of the cancer stem cell model of tumorigenesis and describe the specific role of cancer stem cells in the pathogenesis of glioblastoma and their molecular and microenvironmental characteristics. They also discuss recent clinical investigations into targeted therapies against cancer stem cells in the treatment of glioblastoma.
Original Article: http://thejns.org/doi/abs/10.3171/2014.9.FOCUS14494?ai=rw&mi=3ba5z2&af=R
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