Risk of Developing Postoperative Deficits Based on Tumor Location after Surgical Resection of an Intracranial Meningioma

Object Meningiomas occur in various intracranial locations. Each location is associated with a unique set of surgical nuances and risk profiles. The incidence and risk factors that predispose patients to certain deficits based on tumor locations are unclear. This study aimed to determine which preoperative factors increase the risk of patients having new deficits after surgery based on tumor location for patients undergoing intracranial meningioma surgery. Methods Adult patients who underwent primary, nonbiopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate logistic regression analyses were used to identify associations with postoperative deficits based on tumor location. Results Postoperatively, from the 761 included patients, there were 39 motor deficits (5.1%), 23 vision deficits (3.0%), 19 language deficits (2.5%), 27 seizures (3.5%), and 26 cognitive deficits (3.4%). The factors independently associated with any postoperative deficits were preoperative radiation (hazard ratio [HR] [95% confidence interval, CI] 3.000 [1.346–6.338], p = 0.008), cerebellopontine angle tumors (HR [95% CI] 2.126 [1.094–3.947], p = 0.03), Simpson grade 4 resections (HR [95% CI] 2.000 [1.271–3.127], p = 0.003), preoperative motor deficits (HR [95% CI] 1.738 [1.005–2.923], p = 0.048), preoperative cognitive deficits (HR [95% CI] 2.033 [1.144–3.504], p = 0.02), and perioperative pulmonary embolisms (HR [95% CI] 11.741 [2.803–59.314], p = 0.0009). Conclusion Consideration of the factors associated with postoperative deficits in this study may help guide treatment strategies for patients with meningiomas.

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Image-Guided Multisession Radiosurgery of Skull Base Meningiomas

Cancers ◽

10.3390/cancers12123569 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3569

Author(s):

Alfredo Conti ◽

Antonio Pontoriero ◽

Giuseppe Iatì ◽

Salvatore M. Cardali ◽

Anna Brogna ◽

...

Keyword(s):

Skull Base ◽

Stereotactic Radiosurgery ◽

Cranial Nerves ◽

Progression Free Survival ◽

Motor Deficits ◽

Intracranial Meningioma ◽

Treatment Schedule ◽

Fractionated Radiotherapy ◽

Patient Reported ◽

Skull Base Meningiomas

Background: The efficacy of single-session stereotactic radiosurgery (sSRS) for the treatment of intracranial meningioma is widely recognized. However, sSRS is not always feasible in cases of large tumors and those lying close to critically radiation-sensitive structures. When surgery is not recommended, multi-session stereotactic radiosurgery (mSRS) can be applied. Even so, the efficacy and best treatment schedule of mSRS are not yet established. The aim of this study is to validate the role of mSRS in the treatment of skull base meningiomas. Methods: A retrospective analysis of patients with skull base meningiomas treated with mSRS (two to five fractions) at the University of Messina, Italy, from 2008 to 2018, was conducted. Results: 156 patients met the inclusion criteria. The median follow-up period was 36.2 ± 29.3 months. Progression-free survival at 2-, 5-, and 10- years was 95%, 90%, and 80.8%, respectively. There were no new visual or motor deficits, nor cranial nerves impairments, excluding trigeminal neuralgia, which was reported by 5.7% of patients. One patient reported carotid occlusion and one developed brain edema. Conclusion: Multisession radiosurgery is an effective approach for skull base meningiomas. The long-term control is comparable to that obtained with conventionally-fractionated radiotherapy, while the toxicity rate is very limited.

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Contributions of PCSS, CISS, and VOMS for Identifying Vestibular/Ocular Motor Deficits in Pediatric Concussions

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738121994116 ◽

2021 ◽

pp. 194173812199411

Author(s):

Rishi D. Patel ◽

Cynthia R. LaBella

Keyword(s):

Sports Medicine ◽

Tertiary Care ◽

Motor Dysfunction ◽

Motor Deficits ◽

Ocular Motor ◽

Symptom Scale ◽

Level Of Evidence ◽

Cross Sectional ◽

Visual Problems ◽

Clinical Tools

Background: Vestibular/ocular motor dysfunction can occur in pediatric concussions, which can impair reading, learning, and participation in athletics. This study evaluated 3 clinical tools for identifying postconcussion vestibular/ocular motor dysfunction: (1) Post-Concussion Symptom Scale (PCSS), (2) Convergence Insufficiency Symptom Survey (CISS), and (3) Vestibular/Ocular Motor Screening (VOMS). Hypothesis: Evaluating vestibular/ocular motor dysfunction with multiple clinical tools will capture more symptomatic patients than any 1 tool alone. Study Design: Cross-sectional data from a prospective cohort study. Level of Evidence: Level 4. Methods: Patients were between 8 and 17 years old and seen in a tertiary care pediatric sports medicine clinic between August 2014 and February 2018. Data were collected from initial visit and included VOMS, PCSS, and CISS. Descriptive statistics, Pearson’s correlations, and logistic regressions were used to describe relationships between clinical tools. Results: Of the 156 patients (55.1% female; 14.35 ± 2.26 years old) included, this study identified 129 (82.7%) with vestibular/ocular motor dysfunction. Of these 129, 65 (50.4%) reported “visual problems” on PCSS, 93 (72.1%) had abnormal CISS, and 99 (76.7%) had abnormal VOMS. Together, VOMS and CISS identified 64 (49.6%) patients without reported “visual problems” on PCSS. Higher total PCSS scores predicted abnormal CISS (odds ratio [OR], = 1.11; 95% CI, 1.07-1.17) and abnormal VOMS (OR, 1.03; 95% CI, 1.01-1.06). “Visual problems” on PCSS did not predict abnormal CISS or VOMS. Conclusions: Vestibular/ocular motor dysfunction were identified in nearly 83% of study subjects when PCSS, CISS, and VOMS are used together. Clinical Relevance: These results suggest adding CISS and VOMS to the clinical evaluation of concussions can help clinicians identify post-concussion vestibular/ocular motor dysfunction.

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GASTRIC CANCER: A 5 YEAR RETROSPECTIVE ANALYSIS OF CLINICAL, PATHOLOGICAL AND TREATMENT ASPECTS FROM A TERTIARY CARE CENTER IN SOUTH INDIA.

10.36106/gjra/0711411 ◽

2021 ◽

pp. 129-132

Author(s):

B. Ramkumar ◽

J. Kannan ◽

Ingersal. N ◽

Srigopal mohanty ◽

Amit saklani ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

South India ◽

Care Center ◽

Tertiary Care ◽

Tumor Location ◽

Advanced Stage ◽

Tertiary Care Center ◽

Nodal Disease ◽

Female Ratio

Context: Gastric cancer(GC) is fth most common cancer worldwide. Mostly presents with advanced stage and poor overall survival. Methods: Retrospective study on clinical, pathological, pattern of distant metastasis(DM) , treatment aspect of GC treated between January 2014 to December 2018 in a tertiary care center in south India. Statistical analysis : Chi square test and multivariate analysis (MVA) were used for analysis. P <0.05 was considered signicant. Results: Median age at diagnosis is 57 years. Higher male : female ratio. Most common presentation was abdominal pain followed vomiting. Malignant Gastric outlet obstruction(MGOO) was present in 22.7%. Histologically , all patients had adenocarcinoma with predominantly moderate differentiation (51.1%). Liver (19.1%)was most common site of metastasis . Curative surgery was done in 35.5% of patients. D2 lymph node dissection was performed in 12.4% of patient. Patients were given perioperative /preoperative/ adjuvant / palliative chemotherapy. MVA revealed history of tobacco use, body of stomach tumor location, nodal disease were risk factors for DM. Conclusion : The present analysis revealed use of tobacco, alcohol intake were main risk factors for GC. Most of the patients present in advanced stage , so prevention by avoiding risk factors and early detection by signs , symptoms and endoscopy are necessary. Use of tobacco,site of tumor location, nodal disease were factors associated with DM. Aggressive management with both surgery and chemotherapy is warranted for locally advanced disease.

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MBRS-14. INTEGRATING CLINICAL AND GENOMIC CHARACTERISTICS IN PEDIATRIC MEDULLOBLASTOMA SUBTYPES IN A SINGLE COHORT IN TAIWAN

Neuro-Oncology ◽

10.1093/neuonc/noaa222.531 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii400-iii401

Author(s):

Kuo-Sheng Wu ◽

Tai-Tong Wong

Keyword(s):

Dna Methylation ◽

Cluster Analysis ◽

Treatment Strategies ◽

Clinical Results ◽

Tumor Location ◽

Molecular Subgroups ◽

Methylation Array ◽

Metastatic Rate ◽

Pediatric Medulloblastoma ◽

Dna Methylation Array

Abstract BACKGROUND Medulloblastoma (MB) was classified to 4 molecular subgroups: WNT, SHH, group 3 (G3), and group 4 (G4) with the demographic and clinical differences. In 2017, The heterogeneity within MB was proposed, and 12 subtypes with distinct molecular and clinical characteristics. PATIENTS AND METHODS: PATIENTS AND METHODS We retrieved 52 MBs in children to perform RNA-Seq and DNA methylation array. Subtype cluster analysis performed by similarity network fusion (SNF) method. With clinical results and molecular profiles, the characteristics including age, gender, histological variants, tumor location, metastasis status, survival, cytogenetic and genetic aberrations among MB subtypes were identified. RESULTS In this cohort series, 52 childhood MBs were classified into 11 subtypes by SNF cluster analysis. WNT tumors shown no metastasis and 100% survival rate. All WNT tumors located on midline in 4th ventricle. Monosomy 6 presented in WNT α, but not in β subtype. SHH α and β occurred in children, while SHH γ in infant. Among SHH tumors, α subtype showed the worst outcome. G3 γ showed the highest metastatic rate and worst survival associated with MYC amplification. G4 α has the highest metastatic rate, however G4 γ showed the worst survival. CONCLUSION We identified molecular subgroups and subtypes of MBs based on gene expression and DNA methylation profile in children in our cohort series. The results may contribute to the establishment of nation-wide correlated optimal diagnosis and treatment strategies for MBs in infant and children.

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Impact of biomarkers and primary tumor location on the metastatic colorectal cancer first-line treatment landscape in five European countries

Future Oncology ◽

10.2217/fon-2020-0976 ◽

2021 ◽

Author(s):

George Kafatos ◽

Victoria Banks ◽

Peter Burdon ◽

David Neasham ◽

Kimberly A Lowe ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Primary Tumor ◽

Treatment Strategies ◽

Treatment Decisions ◽

Tumor Location ◽

First Line ◽

Primary Tumor Location ◽

The Uk ◽

Prognostic And Predictive Factors

Background: Advances in therapies for patients with metastatic colorectal cancer (mCRC) and improved understanding of prognostic and predictive factors have impacted treatment decisions. Materials & methods: This study used a large oncology database to investigate patterns of monoclonal antibody (mAb) plus chemotherapy treatment in France, Germany, Italy, Spain and the UK in mCRC patients treated in first line in 2018. Results: Anti-EGFR mAbs were most often administered to patients with RAS wild-type mCRC and those with left-sided tumors, while anti-VEGF mAbs were preferred in RAS mutant and right-sided tumors. Adopted treatment strategies differed between countries, largely due to reimbursement. Conclusion: Biomarker status and primary tumor location steered treatment decisions in first line. Adopted treatment strategies differed between participating countries.

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Radiation Therapy in the Treatment of Partially Resected Meningiomas

Neurosurgery ◽

10.1227/00006123-198704000-00003 ◽

1987 ◽

Vol 20 (4) ◽

pp. 525-528 ◽

Cited By ~ 219

Author(s):

Nicholas M. Barbaro ◽

Philip H. Gutin ◽

Charles B. Wilson ◽

Glenn E. Sheline ◽

Edwin B. Boldrey ◽

...

Keyword(s):

Radiation Therapy ◽

San Francisco ◽

Tumor Location ◽

Convincing Evidence ◽

Subtotal Resection ◽

Intracranial Meningioma ◽

Total Resection ◽

Female Ratio ◽

Time To Recurrence ◽

Male Female Ratio

Abstract To address the question of whether radiation therapy is beneficial in the management of partially resected meningiomas, we reviewed the records of all patients admitted to the University of California, San Francisco, between 1968 and 1978 who had a diagnosis of intracranial meningioma. The patients were divided into three groups: 51 patients had gross total resection and did not receive radiation therapy, 30 patients had subtotal resection and no radiation therapy, and 54 patients had subtotal resection followed by radiation therapy. The subtotal resection groups were similar in average age, male: female ratio, and tumor location, which allowed a valid comparison of the effects of irradiation. The recurrence rate in the total resection group was 4% (2 of 51 patients). Among patients in the subtotal resection groups, 60% of nonirradiated patients had a recurrence, compared with only 32% of the irradiated patients. The median time to recurrence was significantly longer in the irradiated group than in the nonirradiated group (125 vs. 66 months, P < 0.05). There was no complication related to irradiation. These results provide convincing evidence that radiation therapy is beneficial in the treatment of partially resected meningiomas.

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Sino-European Differences in the Genetic Landscape and Clinical Presentation of Pheochromocytoma and Paraganglioma

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa502 ◽

2020 ◽

Vol 105 (10) ◽

pp. 3295-3307 ◽

Cited By ~ 1

Author(s):

Jingjing Jiang ◽

Jing Zhang ◽

Yingxian Pang ◽

Nicole Bechmann ◽

Minghao Li ◽

...

Keyword(s):

Paradigm Shift ◽

Tertiary Care ◽

Gene Mutations ◽

Tumor Location ◽

Cross Sectional Study ◽

Cross Sectional ◽

Genetic Landscape ◽

Tertiary Care Centers ◽

Almost All ◽

Generation Sequencing

Abstract Context Pheochromocytomas and paragangliomas (PPGLs) are characterized by distinct genotype-phenotype relationships according to studies largely restricted to Caucasian populations. Objective To assess for possible differences in genetic landscapes and genotype-phenotype relationships of PPGLs in Chinese versus European populations. Design Cross-sectional study. Setting 2 tertiary-care centers in China and 9 in Europe. Participants Patients with pathologically confirmed diagnosis of PPGL, including 719 Chinese and 919 Europeans. Main Outcome Measures Next-generation sequencing performed in tumor specimens with mutations confirmed by Sanger sequencing and tested in peripheral blood if available. Frequencies of mutations were examined according to tumor location and catecholamine biochemical phenotypes. Results Among all patients, higher frequencies of HRAS, FGFR1, and EPAS1 mutations were observed in Chinese than Europeans, whereas the reverse was observed for NF1, VHL, RET, and SDHx. Among patients with apparently sporadic PPGLs, the most frequently mutated genes in Chinese were HRAS (16.5% [13.6-19.3] vs 9.8% [7.6-12.1]) and FGFR1 (9.8% [7.6-12.1] vs 2.2% [1.1-3.3]), whereas among Europeans the most frequently mutated genes were NF1 (15.9% [13.2-18.6] vs 6.6% [4.7-8.5]) and SDHx (10.7% [8.4–13.0] vs 4.2% [2.6–5.7]). Among Europeans, almost all paragangliomas lacked appreciable production of epinephrine and identified gene mutations were largely restricted to those leading to stabilization of hypoxia inducible factors. In contrast, among Chinese there was a larger proportion of epinephrine-producing paragangliomas, mostly due to HRAS and FGFR1 mutations. Conclusions This study establishes Sino-European differences in the genetic landscape and presentation of PPGLs, including ethnic differences in genotype-phenotype relationships indicating a paradigm shift in our understanding of the biology of these tumors.

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Facial Schwannoma Management Outcomes: A Systematic Review of the Literature

Otolaryngology ◽

10.1177/0194599820913639 ◽

2020 ◽

Vol 163 (2) ◽

pp. 293-301

Author(s):

Matthew Bartindale ◽

Jeffrey Heiferman ◽

Cara Joyce ◽

Douglas Anderson ◽

John Leonetti

Keyword(s):

Systematic Review ◽

Facial Nerve ◽

Stereotactic Radiosurgery ◽

Management Strategies ◽

Treatment Strategies ◽

Tumor Location ◽

Subtotal Resection ◽

Review Of The Literature ◽

Total Resection ◽

Clinical Scenarios

Objective To evaluate facial nerve outcomes of various management strategies for facial schwannomas by assimilating individualized patient data from the literature to address controversies in management. Data Sources PubMed–National Center for Biotechnology Information and Scopus databases. Review Methods A systematic review of the literature was performed for studies regarding facial schwannomas. Studies were included if they presented patient-level data, type of intervention, pre- and postintervention House-Brackmann (HB) grades, and tumor location by facial nerve segment. Results Individualized data from 487 patients were collected from 31 studies. Eighty (16.4%) facial schwannomas were managed with observation, 25 (5.1%) with surgical decompression, 20 (4.1%) with stereotactic radiosurgery, 225 (46.2%) with total resection, and 137 (28.1%) with subtotal resection/stripping surgery. Stripping surgery/subtotal resection with good preoperative facial nerve function maintained HB grade 1 or 2 in 96% of cases. With a total resection of intradural tumors, preoperative HB grade did not significantly affect facial nerve outcome (n = 45, P = .46). However, a lower preoperative HB grade was associated with a better facial nerve outcome with intratemporal tumors (n = 56, P = .009). When stereotactic radiosurgery was performed, 40% of patients had improved, 35% were stable, and 25% had worsened facial function. Facial nerve decompression rarely affected short-term facial nerve status. Conclusion The data from this study help delineate which treatment strategies are best in which clinical scenarios. The findings can be used to develop a more definitive management algorithm for this complicated pathology.

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Clinical presentation and treatment in patients with acute coronary syndrome in a tertiary care general hospital in Bangladesh

Asian Journal of Medical and Biological Research ◽

10.3329/ajmbr.v4i1.36829 ◽

2018 ◽

Vol 4 (1) ◽

pp. 117-122

Author(s):

Monalisa Monwar ◽

Ambia Khatun ◽

Masud Parvez ◽

Tarannum Naz ◽

Mir Imam Ibne Wahed ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

General Hospital ◽

Troponin I ◽

Tertiary Care ◽

Treatment Strategies ◽

Acute Chest Pain ◽

Average Hospital ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Depression

Acute coronary syndrome (ACS) is a leading cause of death among people in Bangladesh. The aim of the study was to analyze the clinical course and treatment strategies in patients with ACS and to determine to what extent management of ACS in a tertiary care general hospital in Bangladesh adhered to current guidelines. This study was carried out in the coronary care unit (CCU) of a tertiary care general hospital, Rajshahi, for a period of 3-months. A total number of 240 patients presenting with ACS were included in our study and the most common symptoms were acute chest pain (90%) and dyspnea (49%). The study group comprised of 27% female and 73% male patients with varying risk factors including hypertension (45%), hyperlipidemia (43%), family records of coronary artery disease (CAD) (20%), diabetes (17%) and smoking (15%). The most frequent ECG finding in patients was T wave change (71%), pathological Q wave (67%), ST segment elevation (33%), ST depression (9%), whereas, 12% patients with ACS reported to have normal ECG. Patients with ACS had elevated levels of SGOT and CK-MB. Troponin I level was positive in 100% of the patients with a mean peak troponin level of 1.5± 0.15ng/ml. In clinical setting, the patients were immediately managed with isosorbidedinitrate (58%), streptokinase (40%) and intravenous heparin (LMWH) followed by (46%) and (54%) of aspirin and aspirin-clopidogrel combinations respectively. In addition, long-term management with antihypertensive included β-blocker (58%), calcium channel blocker (29%), ACE-I (25%) and diuretics (12%). Anti-diabetic (18%) drugs were also prescribed in patients with co-existing diabetes and CAD. Adherence to guidelines is limited by lack of funds and resources in the hospital; however, attention must be paid to improve patient outcome. The average hospital stay ranges 2-3 days and hospital mortality was 10%.Asian J. Med. Biol. Res. March 2018, 4(1): 117-122

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Diabetes Mellitus-Related Dysfunction of the Motor System

International Journal of Molecular Sciences ◽

10.3390/ijms21207485 ◽

2020 ◽

Vol 21 (20) ◽

pp. 7485

Author(s):

Ken Muramatsu

Keyword(s):

Motor Control ◽

Motor Neurons ◽

Motor System ◽

Corticospinal Tract ◽

Experimental Studies ◽

Sensory System ◽

Treatment Strategies ◽

Motor Deficits ◽

New Perspective ◽

The Brain

Although motor deficits in humans with diabetic neuropathy have been extensively researched, its effect on the motor system is thought to be lesser than that on the sensory system. Therefore, motor deficits are considered to be only due to sensory and muscle impairment. However, recent clinical and experimental studies have revealed that the brain and spinal cord, which are involved in the motor control of voluntary movement, are also affected by diabetes. This review focuses on the most important systems for voluntary motor control, mainly the cortico-muscular pathways, such as corticospinal tract and spinal motor neuron abnormalities. Specifically, axonal damage characterized by the proximodistal phenotype occurs in the corticospinal tract and motor neurons with long axons, and the transmission of motor commands from the brain to the muscles is impaired. These findings provide a new perspective to explain motor deficits in humans with diabetes. Finally, pharmacological and non-pharmacological treatment strategies for these disorders are presented.

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