Monday, May 13, 2013

Low-grade and anaplastic oligodendrogliomas: Differences in tumour microvascular permeability evalua

Publication date: Available online 11 May 2013
Source:Journal of Clinical Neuroscience
Author(s): Zhongzheng Jia , Daoying Geng , Ying Liu , Xingrong Chen , Jun Zhang
This study was designed to quantitatively assess the microvascular permeability of oligodendroglioma using the volume transfer constant (K trans) and the volume of the extravascular extracellular space per unit volume of tissue (V e) with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). We aimed to evaluate the effectiveness of K trans and V e in distinguishing between low-grade and anaplastic oligodendroglioma. The maximal values of K trans and V e for 65 patients with oligodendroglioma (27 grade II, 38 grade III) were obtained. Differences in K trans and V e between the two groups were analysed using the Mann-Whitney rank-sum test. Receiver operating characteristic (ROC) curve analyses were performed to determine the cut-off values for the K trans and V e that could differentiate between low-grade and anaplastic oligodendrogliomas. Values for K trans and V e in low-grade oligodendrogliomas were significantly lower than those in anaplastic oligodendrogliomas (p <0.001 and p <0.001, respectively). ROC curve analysis showed that cut-off values of the K trans (0.037min−1) and V e (0.079) could be used to distinguish between low-grade and anaplastic oligodendrogliomas in a statistically significant manner. Our results suggest that DCE-MRI can distinguish the differences in microvascular permeability between low-grade and anaplastic oligodendrogliomas.






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Wednesday, May 8, 2013

Clinical trial participation and outcome for patients with glioblastoma: Multivariate analysis from

Publication date: Available online 29 April 2013
Source:Journal of Clinical Neuroscience
Author(s): Kathryn M. Field , Katharine J. Drummond , Merve Yilmaz , Mark Tacey , Daniel Compston , Peter Gibbs , Mark A. Rosenthal
Glioblastoma multiforme (GBM) is the most common malignant brain tumor in adults. Although multiple clinical and tumor-related variables affect survival outcomes, the effect of clinical trial participation has not been explored. The aim of this study was to determine whether clinical trial participation improves outcome for patients with GBM. Data from patients with GBM were accessed from a dataset collected over 12years (1998–2010) at two institutions. Univariable and multivariate logistic regression analyses were performed to look for relationships between clinical trial participation, other baseline clinical and sociodemographic variables and overall survival (OS). In total, 542 patients were identified and included in the analysis; median age was 62years. Sixty-one patients (11%) were enrolled in a clinical trial. Clinical trial enrollment was associated with improved median survival (14.5months compared to 6.3months, p <0.001) and thisdifference remained significant in multivariate analysis (hazard ratio 0.67, p =0.046). Age, poor performance status and operation type were also independent predictors for OS in multivariate analysis. Disease site, socioeconomic status and co-morbidity did not affect survival outcome. This is the first study in patients with GBM to suggest a survival benefit from clinical trial participation, independent of age and performance status; while also confirming the importance of other previously reported prognostic factors. This should encourage clinicians to offer trial therapies to patients with GBM and encourage patients to participate in available studies.






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Factors associated with survival for patients with glioblastoma with poor pre-operative functional s

Publication date: Available online 29 April 2013
Source:Journal of Clinical Neuroscience
Author(s): Kaisorn L. Chaichana , Juan Carlos Martinez-Gutierrez , Rafael De la Garza-Ramos , Jon D. Weingart , Alessandro Olivi , Gary L. Gallia , Michael Lim , Henry Brem , Alfredo Quinones-Hinojosa
Patients with glioblastoma (GB) are known to have poor prognoses, and among these patients, those with poor neurological function have an even poorer prognosis. Consequently, aggressive surgeries and adjuvant therapies are often withheld because of this dismal outlook. The effects of aggressive therapies in this small subset of patients remain unknown. The goal of this study was to evaluate outcomes and factors associated with survival for poor functioning patients who underwent aggressive resection of their GB. Adult patients who underwent surgical resection of an intracranial primary GB at an academic tertiary-care institution between 1997 and 2007 were retrospectively reviewed. Patients with a Karnofsky Performance Scale (KPS) score of ⩽60 were included. A total of 100 patients with primary GB met the inclusion criteria. The average age (±standard deviation) and KPS score of this cohort were 54±15years and 53±12, respectively. No patient (0%) experienced perioperative mortality, and 0 (0%), 10 (10%), and 3 (3%) of patients incurred a new or increasing language, motor, and visual deficit, respectively. At last follow-up, 88 (88%) patients died with a median survival of 6.6months. The factors associated with improved survival were age <65year (p =0.005), tumor size >2cm (p =0.01), radical tumor resection (p =0.01), and temozolomide (p =0.001). This study identifies a subset of patients with poor functional status who may benefit from aggressive surgical resection.






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Risk Factors For Heart Disease Likely Decrease Brain Function Too

Brain function in adults as young as 35 may decline as their heart disease risk factors increase, according to new research in the American Heart Association journal Stroke. "Young adults may think the consequences of smoking or being overweight are years down the road, but they aren't," said Hanneke Joosten, M.D...





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Chemobrain: A Systematic Review of Structural and Functional Neuroimaging Studies

Publication date: Available online 6 May 2013
Source:Neuroscience & Biobehavioral Reviews
Author(s): Marta Simó , Xavier Rifà-Ros , Antoni Rodriguez-Fornells , Jordi Bruna
Nowadays, chemotherapy-induced cognitive impairment or 'chemobrain' is a well-established clinical syndrome, consisting of moderate to subtle cognitive changes across various domains, especially working memory, executive function and episodic verbal memory that persist only in a subgroup of long-term cancer survivors. In recent years, several studies using neuroimaging techniques have reported structural and functional neural changes associated with chemotherapy. This review provides an overview of the relevant advances that neuroimaging techniques have added to the understanding of the underlying mechanisms of chemotherapy-induced cognitive impairment. In summary, our review showed: (i) a pre-treatment (prior to chemotherapy) widespread decrease in white matter (WM) volume as well as an increased level of activation of the frontoparietal attentional network of cancer patients compared to controls; (ii) an early diffuse decrease of gray matter (GM) and WM volume together with a decrease of the overactivation in frontal regions in chemotherapy-treated patients compared to controls and (iii) a long-term persisting decrease in GM and WM volumes together with a predominantly frontal cortex hypoactivation in only a subgroup of chemotherapy-treated patients.






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Pain: Brain Imaging Key to Novel Treatments at APS

NEW ORLEANS (MedPage Today) -- The emerging science of imaging pain will take center stage at the upcoming American Pain Society (APS) meeting here from May 8-11.





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AHA: Quality of Life Needs Attention (CME/CE)

(MedPage Today) -- Investigating patients' quality of live via standardized health-related quality of life (HRQoL) surveys can help providers deliver better and more appropriate care to patients with cardiovascular disease, according to a new statement from the American Heart Association.





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Leptomeningeal metastasis of an intradural malignant peripheral nerve sheath tumor

Publication date: Available online 7 May 2013
Source:Journal of Clinical Neuroscience
Author(s): Andreas M. Stark , H. Maximilian Mehdorn
Malignant peripheral nerve sheath tumors (MPNST) are defined as any malignant tumor arising from or differentiating towards the peripheral nerve sheath. Intradural MPNST metastases are very rare. We report, to our knowledge, the first case of leptomeningeal metastasis of a MPNST to the spine and intracranial space. A 56-year-old woman with primary intradural MPNST of the S1 nerve root developed leptomeningeal metastases as well as brain metastases 19months after diagnosis. The patient had a history of non-Hodgkins lymphoma for which she had received irradiation to the spine 15years prior to this presentation. She had no stigmata of neurofibromatosis type 1. Patients with MPNST may also develop leptomeningeal metastases as demonstrated in this patient with intradural post-radiation MPNST.






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Saturday, May 4, 2013

Surgical treatment of transsphenoidal encephaloceles: transpalatal versus combined transpalatal and

Journal of Neurosurgery: Pediatrics, Volume 11, Issue 5, Page 505-510, May 2013.
Object Transsphenoidal encephalocele (TSEC) is a rare developmental anomaly with herniation of neural elements including pituitary gland or optic apparatus, through a defect of sphenoid bone. To prevent obstructive dyspnea, endocrine dysfunction, or visual disturbance, surgical correction is usually performed. However, the optimal operative approach has not been determined yet. The authors present their surgical experiences with transpalatal, transcranial, or combined approach. Methods The authors retrospectively analyzed surgical results in patients with TSEC. The charts were reviewed for demographic data, clinical presentation, surgical therapy, and clinical outcomes. Results Seven consecutive patients with TSEC were surgically treated between March 2004 and February 2012. The mean age was 23.9 months (range 2–69 months). Four patients with TSEC who had a bone defect within the sphenoid bone were successfully treated using a transpalatal approach. Two patients with an extensive sphenoethmoidal bone defect that was treated either by a transpalatal or transcranial approach experienced several relapses with a prolapse of the encephalocele. One patient with an extensive sphenoethmoidal bone defect was successfully treated by combined transpalatal and transcranial approach without relapse for 3.6 years. Conclusions The combined transpalatal and transcranial approach is useful for TSEC with an extensive sphenoethmoidal bone defect to dissect the sac and expose the bone defect circumferentially. If dissection is not sufficient, relapse with a prolapse of the encephalocele can ensue. The transpalatal approach is sufficient for TSEC in which a bone defect is limited within the sphenoid bone.





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Neurosurgical management of neurenteric cysts in children

Journal of Neurosurgery: Pediatrics, Volume 11, Issue 5, Page 511-517, May 2013.
Object Neurenteric cysts (NCs) are endothelium-lined structures of presumed endodermal origin. There have been few pediatric series of intracranial NCs reported previously. The authors present their experience in the management of these lesions. Methods A retrospective chart review of all cases of NCs identified between 1977 and 2007 was carried out. Demographics, details of clinical presentation, surgical therapy, and outcome data were extracted. Results Eleven cases were identified, involving 6 girls and 5 boys. The patients' average age was 4.6 years (range 1 day–14 years). Limb weakness was the most common presenting symptom. The location of the cysts was cervical in 2 cases, cervicothoracic in 4 cases, and thoracic in 3 cases. One cyst was anterior to the pons with extension to the left cerebellopontine angle and 1 cyst was at the craniocervical junction. Five patients had an apparently complete initial excision, with 1 recurrence. Four patients were initially treated with incomplete excision and/or cyst drainage, usually into an Ommaya reservoir. A neonate with a large cervicothoracic cyst died of multiple congenital anomalies without any intervention. All other patients were alive at last follow-up. One patient with a radiologically identified presumed cyst, which remained stable, was simply followed up. Several patients required multiple procedures and 1 patient developed hydrocephalus after aseptic meningitis and was treated with CSF shunting. Conclusions Neurenteric cysts are rare in the pediatric population. Total resection, if possible, provides the best long-term outcome. Incomplete excision may lead to multiple procedures, including cyst drainage, but can lead to long-term stability.





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