scholarly journals Benefits of glioma resection in the corpus callosum

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Marie-Therese Forster ◽  
Marion Behrens ◽  
Irina Lortz ◽  
Nadine Conradi ◽  
Christian Senft ◽  
...  
Keyword(s):  
Corpus Callosum ◽  
Executive Functioning ◽  
Tumor Resection ◽  
Observation Time ◽  
Neuropsychological Function ◽  
Neuropsychological Sequelae ◽  
Cognitive Domains ◽  
Tumor Reduction ◽  
Glioma Resection ◽  
Neurological State

Abstract Due to anticipated postoperative neuropsychological sequelae, patients with gliomas infiltrating the corpus callosum rarely undergo tumor resection and mostly present in a poor neurological state. We aimed at investigating the benefit of glioma resection in the corpus callosum, hypothesizing neuropsychological deficits were mainly caused by tumor presence. Between 01/2017 and 1/2020, 21 patients who underwent glioma resection in the corpus callosum were prospectively enrolled into this study. Neuropsychological function was assessed preoperatively, before discharge and after 6 months. Gross total tumor resection was possible in 15 patients, and in 6 patients subtotal tumor resection with a tumor reduction of 97.7% could be achieved. During a median observation time of 12.6 months 9 patients died from glioblastoma after a median of 17 months. Preoperatively, all cognitive domains were affected in up to two thirds of patients, who presented a median KPS of 100% (range 60–100%). After surgery, the proportion of impaired patients increased in all neurocognitive domains. Most interestingly, after 6 months, significantly fewer patients showed impairments in attention, executive functioning, memory and depression, which are domains considered crucial for everyday functionality. Thus, the results of our study strongly support our hypothesis that in patients with gliomas infiltrating the corpus callosum the benefit of tumor resection might outweigh morbidity.

Receptor tyrosine kinase gene amplification is predictive of intraoperative seizures during glioma resection with functional mapping

2020 ◽  
Vol 132 (4) ◽  
pp. 1017-1023 ◽  
Author(s):  
Bryan D. Choi ◽  
Daniel K. Lee ◽  
Jimmy C. Yang ◽  
Caroline M. Ayinon ◽  
Christine K. Lee ◽  
...  
Keyword(s):  
Tyrosine Kinases ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
Tumor Grade ◽  
Molecular Data ◽  
Genetic Alterations ◽  
Functional Mapping ◽  
Chi Square ◽  
Kinase Gene ◽  
Glioma Resection

OBJECTIVEIntraoperative seizures during craniotomy with functional mapping is a common complication that impedes optimal tumor resection and results in significant morbidity. The relationship between genetic mutations in gliomas and the incidence of intraoperative seizures has not been well characterized. Here, the authors performed a retrospective study of patients treated at their institution over the last 12 years to determine whether molecular data can be used to predict the incidence of this complication.METHODSThe authors queried their institutional database for patients with brain tumors who underwent resection with intraoperative functional mapping between 2005 and 2017. Basic clinicopathological characteristics, including the status of the following genes, were recorded: IDH1/2, PIK3CA, BRAF, KRAS, AKT1, EGFR, PDGFRA, MET, MGMT, and 1p/19q. Relationships between gene alterations and intraoperative seizures were evaluated using chi-square and two-sample t-test univariate analysis. When considering multiple predictive factors, a logistic multivariate approach was taken.RESULTSOverall, 416 patients met criteria for inclusion; of these patients, 98 (24%) experienced an intraoperative seizure. Patients with a history of preoperative seizure and those treated with antiepileptic drugs prior to surgery were less likely to have intraoperative seizures (history: OR 0.61 [95% CI 0.38–0.96], chi-square = 4.65, p = 0.03; AED load: OR 0.46 [95% CI 0.26–0.80], chi-square = 7.64, p = 0.01). In a univariate analysis of genetic markers, amplification of genes encoding receptor tyrosine kinases (RTKs) was specifically identified as a positive predictor of seizures (OR 5.47 [95% CI 1.22–24.47], chi-square = 5.98, p = 0.01). In multivariate analyses considering RTK status, AED use, and either 2007 WHO tumor grade or modern 2016 WHO tumor groups, the authors found that amplification of the RTK proto-oncogene, MET, was most predictive of intraoperative seizure (p < 0.05).CONCLUSIONSThis study describes a previously unreported association between genetic alterations in RTKs and the occurrence of intraoperative seizures during glioma resection with functional mapping. Future models estimating intraoperative seizure risk may be enhanced by inclusion of genetic criteria.

Curative Effect of Tumor Resection under Microscope for Brain Glioma based on Humanized Nursing Model

2021 ◽  
Vol 7 (5) ◽  
pp. 3266-3275
Author(s):  
Lifeng Huang ◽  
Haiyan Xiang ◽  
Weiming Qian
Keyword(s):  
Tumor Resection ◽  
Postoperative Recovery ◽  
Complete Resection ◽  
Good Effect ◽  
Anxiety And Depression ◽  
Brain Glioma ◽  
Curative Effect ◽  
Data Statistics ◽  
Glioma Resection ◽  
Functional Areas

Previous studies have shown that microsurgery has two main roles in glioma resection, that is, the nerve function is well protected and the degree of tumor resection is improved. On the basis of this experiment, the curative effect of tumor resection under microscope for glioma was studied based on humanized nursing model. By randomly dividing 64 patients into two steps and comparing them in many aspects, the study mainly obtained two inspirations: microglioma resection has good effect, and humanized nursing mode has good effect on postoperative recovery. Finally, some Suggestions and principles for microglioma resection were put forward: the principle of timely operation after diagnosis, the principle of complete resection for nonfunctional areas, the principle of protection for important functional areas, and the principle of recovery plan confirmed by disease examination after surgery. In addition, in terms of the influence of humanized nursing mode on the treatment of glioma under the microscope, the data statistics and SPSS tests show that humanized nursing mode can effectively improve the satisfaction of patients and their families. Relieve anxiety and depression and help patients recover; Lower scores in pain rating statistics, etc. In addition, this experiment has a good basis for development, and all the 64 patients successfully completed the operation without serious complications, which further verified the above conclusions, namely, the maturity and reliability of the technique of microscopic tumor resection for glioma. The technique of tumor resection under microscope can be used in combination with humanized nursing mode, which has good promotion value.

Post-Illumination Pupil Response as a Biomarker for Cognition in α-Synucleinopathies

2021 ◽  
pp. 1-6
Author(s):  
Oliver Steiner ◽  
Jan de Zeeuw ◽  
Sophia Stotz ◽  
Frederik Bes ◽  
Dieter Kunz
Keyword(s):  
Executive Functioning ◽  
Dopamine Transporter ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Cognitive State ◽  
Neurocognitive Disorder ◽  
Sleep Behavior ◽  
Cognitive Domains ◽  
The Brain

Neurodegenerative processes in the brain are reflected by structural retinal changes. As a possible biomarker of cognitive state in prodromal α-synucleinopathies, we compared melanopsin-mediated post-illumination pupil responses (PIPR) with cognition (CERAD-plus) in 69 patients with isolated REM-sleep behavior disorder. PIPR was significantly correlated with cognitive domains, especially executive functioning (r = 0.417, p <  0.001), which was more pronounced in patients with lower dopamine-transporter density, suggesting advanced neurodegenerative state (n = 26; r = 0.575, p = 0.002). Patients with mild neurocognitive disorder (n = 10) had significantly reduced PIPR (smaller melanopsin-mediated response) compared to those without (p = 0.001). Thus, PIPR may be a functional—possibly monitoring—marker for impaired cognitive state in (prodromal) α-synucleinopathies.

scholarly journals A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations

2019 ◽  
Vol 26 (3) ◽  
pp. 331-351 ◽  
Author(s):  
Sanne Franzen ◽  
Esther van den Berg ◽  
Miriam Goudsmit ◽  
Caroline K. Jurgens ◽  
Lotte van de Wiel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Executive Functioning ◽  
Neuropsychological Tests ◽  
Cognitive Domains ◽  
Domain Specific ◽  
Adaptation Procedure ◽  
The Usa ◽  
Low Educated ◽  
Culture Education

AbstractObjective:Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations.Method:A systematic review was performed using six databases, without restrictions on the year or language of publication.Results:Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer’s disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29).Conclusions:Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.

scholarly journals A-146 A Comparison of Neuropsychological Assessment Results and Self-Reported Cognitive Deficits in Traumatic Brain Injury Patients with Variable Neurocognitive Impairment Severity

2020 ◽  
Vol 35 (6) ◽  
pp. 940-940
Author(s):  
Coddaire K ◽  
Peyton L ◽  
Powell J ◽  
Virden T
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functioning ◽  
Neuropsychological Assessment ◽  
Cognitive Deficits ◽  
Neurocognitive Impairment ◽  
Self Report ◽  
Neurocognitive Deficits ◽  
Cognitive Domains ◽  
The Relationship

Abstract Objective This study aimed to determine the relationship between symptom self-report accuracy and objective cognitive functioning in multiple cognitive domains for varying neurocognitive impairment (NCI) subsequent to Traumatic Brain Injury (TBI). Specifically, the discrepancy between self-report and objective findings among participants with mild, moderate, and severe NCI was examined within the cognitive domains of Attention, Executive Functioning, Learning/Memory, and Speech/Language. Method The sample included archival data consisting of neuropsychological scores and self-reported Ruff Neurobehavioral Inventory (RNBI) results of 135 adult TBI patients with mild, moderate, or severe NCI who received neuropsychological assessment at a private practice. Patients were grouped based on level of impairment using Halstead Impairment Index criteria. Results No main effect was found for Attention. Patients with severe NCI had greater discrepancies in Executive Functioning (p = 0.015), Learning/Memory (p = 0.015), and Speech/Language (p &lt; 0.001) function, when compared to those with mild NCI. Additionally, patients with severe NCI demonstrated greater discrepancies in Speech/Language (p &lt; 0.001) function when compared to those with moderate NCI. Conclusion These findings indicate as severity of neurocognitive impairment increases for TBI patients, self-reported cognitive symptomatology—specifically executive functioning, learning/memory, and speech/language—will become less accurate. Clinically, these findings suggest that when working with patients who have severe neurocognitive deficits subsequent to TBI, it is important to consider objective testing as self-reporting may not be accurate. Understanding patient’s genuine deficits will foster patient awareness and acceptance of TBI-related cognitive deficits with increased investment in treatment and improved neurorehabilitation outcomes.

scholarly journals Influence of Surgical Excision on the Survival of Patients With Stage 4 High-Risk Neuroblastoma: A Report From the HR-NBL1/SIOPEN Study

2020 ◽  
Vol 38 (25) ◽  
pp. 2902-2915 ◽  
Author(s):  
Keith Holmes ◽  
Ulrike Pötschger ◽  
Andrew D. J. Pearson ◽  
Sabine Sarnacki ◽  
Giovanni Cecchetto ◽  
...  
Keyword(s):  
High Risk ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Observation Time ◽  
Mycn Amplification ◽  
High Dose ◽  
Local Progression ◽  
Stage 4 ◽  
Operative Complications ◽  
The Impact

PURPOSE To evaluate the impact of surgeon-assessed extent of primary tumor resection on local progression and survival in patients in the International Society of Pediatric Oncology Europe Neuroblastoma Group High-Risk Neuroblastoma 1 trial. PATIENTS AND METHODS Patients recruited between 2002 and 2015 with stage 4 disease > 1 year or stage 4/4S with MYCN amplification < 1 year who had completed induction without progression, achieved response criteria for high-dose therapy (HDT), and had no resection before induction were included. Data were collected on the extent of primary tumor excision, severe operative complications, and outcome. RESULTS A total of 1,531 patients were included (median observation time, 6.1 years). Surgeon-assessed extent of resection included complete macroscopic excision (CME) in 1,172 patients (77%) and incomplete macroscopic resection (IME) in 359 (23%). Surgical mortality was 7 (0.46%) of 1,531. Severe operative complications occurred in 142 patients (9.7%), and nephrectomy was performed in 124 (8.8%). Five-year event-free survival (EFS) ± SE (0.40 ± 0.01) and overall survival (OS; 0.45 ± 0.02) were significantly higher with CME compared with IME (5-year EFS, 0.33 ± 0.03; 5-year OS, 0.37 ± 0.03; P < .001 and P = .004). The cumulative incidence of local progression (CILP) was significantly lower after CME (0.17 ± 0.01) compared with IME (0.30 ± 0.02; P < .001). With immunotherapy, outcomes were still superior with CME versus IME (5-year EFS, 0.47 ± 0.02 v 0.39 ± 0.04; P = .038); CILP was 0.14 ± 0.01 after CME and 0.27 ± 0.03 after IME ( P < .002). A hazard ratio of 1.3 for EFS associated with IME compared with CME was observed before and after the introduction of immunotherapy ( P = .030 and P = .038). CONCLUSION In patients with stage 4 high-risk neuroblastoma who have responded to induction therapy, CME of the primary tumor is associated with improved survival and local control after HDT, local radiotherapy (21 Gy), and immunotherapy.

scholarly journals Corpus callosal atrophy and associations with cognitive impairment in Parkinson disease

Neurology ◽  
2017 ◽  
Vol 88 (13) ◽  
pp. 1265-1272 ◽  
Author(s):  
Jennifer G. Goldman ◽  
Ian O. Bledsoe ◽  
Doug Merkitch ◽  
Vy Dinh ◽  
Bryan Bernard ◽  
...  
Keyword(s):  
Working Memory ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Corpus Callosum ◽  
Parkinson Disease ◽  
Clinical Manifestations ◽  
Cognitive Domain ◽  
Intracranial Volume ◽  
Volume Loss ◽  
Cognitive Domains

Objective:To investigate atrophy of the corpus callosum on MRI in Parkinson disease (PD) and its relationship to cognitive impairment.Methods:One hundred patients with PD and 24 healthy control participants underwent clinical and neuropsychological evaluations and structural MRI brain scans. Participants with PD were classified as cognitively normal (PD-NC; n = 28), having mild cognitive impairment (PD-MCI; n = 47), or having dementia (PDD; n = 25) by Movement Disorder Society criteria. Cognitive domain (attention/working memory, executive function, memory, language, visuospatial function) z scores were calculated. With the use of FreeSurfer image processing, volumes for total corpus callosum and its subsections (anterior, midanterior, central, midposterior, posterior) were computed and normalized by total intracranial volume. Callosal volumes were compared between participants with PD and controls and among PD cognitive groups, covarying for age, sex, and PD duration and with multiple comparison corrections. Regression analyses were performed to evaluate relationships between callosal volumes and performance in cognitive domains.Results:Participants with PD had reduced corpus callosum volumes in midanterior and central regions compared to healthy controls. Participants with PDD demonstrated decreased callosal volumes involving multiple subsections spanning anterior to posterior compared to participants with PD-MCI and PD-NC. Regional callosal atrophy predicted cognitive domain performance such that central volumes were associated with the attention/working memory domain; midposterior volumes with executive function, language, and memory domains; and posterior volumes with memory and visuospatial domains.Conclusions:Notable volume loss occurs in the corpus callosum in PD, with specific neuroanatomic distributions in PDD and relationships of regional atrophy to different cognitive domains. Callosal volume loss may contribute to clinical manifestations of PD cognitive impairment.

scholarly journals Intraoperative stimulation techniques for functional pathway preservation and glioma resection

2010 ◽  
Vol 28 (2) ◽  
pp. E1 ◽  
Author(s):  
Nader Sanai ◽  
Mitchel S. Berger
Keyword(s):  
Preoperative Planning ◽  
Tumor Resection ◽  
Language Function ◽  
Mapping Data ◽  
Surgical Strategies ◽  
Motor Pathways ◽  
Subcortical Stimulation ◽  
Radical Removal ◽  
Functional Pathway ◽  
Glioma Resection

Although a primary tenet of neurosurgical oncology is that survival can improve with greater tumor resection, this principle must be tempered by the potential for functional loss following a radical removal. Preoperative planning with functional and physiological imaging paradigms, combined with intraoperative strategies such as cortical and subcortical stimulation mapping, can effectively reduce the risks associated with operating in eloquent territory. In addition to identifying critical motor pathways, these techniques can be adapted to identify language function reliably. The authors review the technical nuances of intraoperative mapping for low- and high-grade gliomas, demonstrating their efficacy in optimizing resection even in patients with negative mapping data. Collectively, these surgical strategies represent the cornerstone for operating on gliomas in and around functional pathways.

Type, intensity, and duration of chemotherapy (CHT) and their correlation with prognosis of localized soft tissue Ewing tumors (STET): Experience of the Cooperative Weichteilsarkomstudiengruppe (CWS).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10527-10527
Author(s):  
Ewa Koscielniak ◽  
Monika Scheer ◽  
Monika Sparber-Sauer ◽  
Erika Hallmen ◽  
Ivo Leuschner ◽  
...  
Keyword(s):  
Actinomycin D ◽  
Risk Group ◽  
Tumor Resection ◽  
Observation Time ◽  
High Risk Group ◽  
Secondary Resection ◽  
Ewing Tumors ◽  
Risk Patients ◽  
Therapy Stratification ◽  
Optimal Type

10527 Background: The optimal type and intensity of CHT in the treatment of STET is still a matter of debate. The CWS group has treated STET similar to rhabdomyosarcoma. We have analyzed the prognosis of STET in relation to the CHT regimens used in three consecutive CWS studies CWS-91, -96 and CWS- 2002P. Methods: 243 pts with localized STET were included. Their median age was 12 (range 0.1-29) yrs. In the CWS-91 pts with primary tumor resection (IRSG I and II) were treated with VACA (vincristine (VCR), actinomycin D (Act D), cyclophosphamide (CYC), doxorubicin (DOX), for 10 or 20 weeks. All other CWS-91 pts (high risk group, HRG) received EVAIA (ifosfamide (IFO) instead of CYC plus VP16) for 37 weeks. In the CWS-96 and CWS-2002P all STET pts were allocated to the HRG. In CWS-96 therapy was randomized: VAIA (IFO, DOX, Act D, VCR) vs. CEVAIE (Epi-DOX instead of DOX, plus carboplatin and VP16), for 25 weeks. In CWS-2002P VAIA (25 weeks) plus maintenance CHT with CYC and vinblastine (VBL) for 26 weeks were used. The cumulative doses varied: IFO 24-72 g/m², CYC 4.8-7.35 g/m², DOX 120-360 mg/m², Act D 3-9 mg/m², VP16 1.8-5.4 g/m². Irradiation was stratified depending on results of the primary or secondary resection and response. Results: 5 yr event free (EFS) and overall survival (OS) were 64% and 73%. The median observation time of survivors was 9 yrs. 5yr EFS and OS by study were: CWS-91 64 % and 72 %, CWS-96 57% and 70 %, CWS-2002P 78 % and 86 % respectively (n.s.). 5 yr EFS and OS for VACA arm were 79% and 90%. 5 yr EFS and OS by CHT for HRG were: EVAIA 57% and 65%, VAIA 64% and 80%, CEVAIE 45% and 54%, VAIA with CYC/VBL 84% and 87%, respectively (p = 0 .003). 5yr EFS and OS for irradiated (n = 181) vs. not irradiated (n = 48) patients were 63 % and 72% vs. 63% and 79%, respectively. Conclusions: The outcomes between CHT arms differed significantly: CEVAIA correlated with the worst outcome while VAIA with CYC/VBL showed the best results. A small group of low risk patients have an excellent prognosis with substantially reduced CHT. Ewing tumors are biologically heterogeneous and more diversification in therapy stratification is warranted to avoid overtreatment.

Pre- and Intraoperative Tractographic Evaluation of Corticospinal Tract Shift

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. 696-705 ◽  
Author(s):  
Andrea Romano ◽  
Giancarlo D'Andrea ◽  
Luigi Fausto Calabria ◽  
Valeria Coppola ◽  
Camilla Rossi Espagnet ◽  
...  
Keyword(s):  
Corticospinal Tract ◽  
Diffusion Tensor ◽  
Tumor Resection ◽  
Brain Lesions ◽  
Peritumoral Edema ◽  
Brain Shift ◽  
Neuronavigation System ◽  
Dural Opening ◽  
Glioma Resection ◽  
The Brain

Abstract BACKGROUND: Magnetic resonance with diffusion tensor image (DTI) may be able to estimate trajectories compatible with subcortical tracts close to brain lesions. A limit of DTI is brain shifting (movement of the brain after dural opening and tumor resection). OBJECTIVE: To calculate the brain shift of trajectories compatible with the corticospinal tract (CST) in patients undergoing glioma resection and predict the shift directions of CST. METHODS: DTI was acquired in 20 patients and carried out through 12 noncollinear directions. Dedicated software “merged” all sequences acquired with tractographic processing and the whole dataset was sent to the neuronavigation system. Preoperative, after dural opening (in 11) and tumor resection (in all) DTI acquisitions were performed to evaluate CST shifting. The extent of shifting was considered as the maximum distance between the preoperative and intraoperative contours of the trajectories. RESULTS: An outward shift of CST was observed in 8 patients and an inward shift in 10 patients during surgery. In the remaining 2 patients, no intraoperative displacement was detected. Only peritumoral edema showed a statistically significant correlation with the amount of shift. In those patients in which DTI was acquired after dural opening as well (11 patients), an outward shifting of CST was evident in that phase. CONCLUSION: The use of intraoperative DTI demonstrated brain shifting of the CST. DTI evaluation of white matter tracts can be used during surgical procedures only if updated with intraoperative acquisitions.

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