scholarly journals Diffuse Low Grade Glioma - A 10-year single institution case series

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv15-iv15
Author(s):  
Shami Acharya ◽  
Priya Sekhon ◽  
Jose Pedro Lavrador ◽  
Ravindran Visagan ◽  
Vijay Narbad ◽  
...  
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Tumour Volume ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Subtotal Resection ◽  
Low Grade ◽  
Single Institution ◽  
The Mean ◽  
Second Procedure

Abstract Objectives To study clinical features and treatment options between 2007–2018 in a population of diffuse low grade glioma (DLGG) patients (WHO Grade2). Methods Single centre retrospective cohort study. Variables reviewed: demographics, extent of resection (biopsy – Bx, subtotal resection – STR, gross total resection – GTR), molecular genetics and outcome. Results N=104.M=61 F=43, average age, 41.8 yrs. For their first surgery, 40.4% underwent a Bx, 32.7% STR, 26.9% GTR. 50.9% of patients had a second procedure due to clinical progression (13.8% Bx, 38.85% STR, 47.2% GTR). We were more surgically aggressive at the second sitting (p=0.0021). After 2014, we were more aggressive in terms of achieving a resection over a biopsy alone (pre 2013: 26 Bx, 24 resection, post 2013: 15 Bx, 28 resection). 35% had 1p19q co-deletion, 70% had 1DH1 mutation and 44.6% with MGMT methylated. There was no difference in survival and extent of resection in 1p19 co-deletions (HR 0.35), however there was in the IDH 1 group (HR 1.25. Post operatively, 37.9% patients had chemotherapy and 57.3 % radiotherapy. 80.5% (Bx 65,9% alive, resection 95% alive) of patients are still alive (longest survival 11.6 yrs). Amongst those who died, the mean overall survival was 4.0 (range 0–7 - 5 years): Of these 14% had undergone a Bx and 6% STR/GTR. The adjusted analysis revealed that EOR is the only revelant factor for survival in the population when adjusted for IDH, 1p19q, tumour volume, age, gender and surgery year (p=0.44). Conclusion Our data emphasises the importance of achieving maximal resection when possible.

TM1-2 Diffuse low grade glioma after the 2016 WHO update, seizure characteristics, imaging correlates and outcomes

2019 ◽  
Vol 90 (3) ◽  
pp. e8.3-e9
Author(s):  
M Roberts ◽  
C Hayhurst ◽  
J Shires ◽  
T Northmore
Keyword(s):  
Molecular Genetics ◽  
Case Series ◽  
Tumour Volume ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Subtotal Resection ◽  
Seizure Outcome ◽  
Low Grade ◽  
Single Institution ◽  
Tumour Characteristics

ObjectivesSeizures are a common presenting symptom in patients with low grade glioma (LGG). Exact mechanisms of epileptogenesis are unknown and the influence of radiological and histological characteristics are not well studied, particularly after the 2016 WHO reclassification of gliomas. We aimed to define predictors of seizure development and outcome in patients with LGG.DesignRetrospective single institution case series.Subjects63 patients who underwent resection of supratentorial LGG in a single institution, 45 presented with seizures.MethodsRetrospective analysis of patient records to assess seizure outcome and other demographics including radiological variables, tumour characteristics, type of surgery and histology based on the 2016 WHO update.ResultsAfter surgery, 33 patients (73%) who presented with seizures were Engel class I at median follow up of 43 months. Complete and near total resection were associated with improved Engel class compared to subtotal resection. Awake craniotomy gave improved seizure outcomes compared to under general anaesthesia (84% vs 65%). Molecular genetics did not predict seizure outcome. Updated histology did not predict seizures at diagnosis, only tumour heterogeneousity on initial MRI (p=0.043). Tumour volume at presentation impacted EOR but not seizure outcome.ConclusionsSeizure outcome is directly related to EOR. Tumour histology based on molecular genetics did not predict seizure development or outcome. Use of awake craniotomy results in greater EOR and improved Engel class.

scholarly journals Profound hearing loss following surgery in pediatric patients with posterior fossa low-grade glioma

2017 ◽  
Vol 5 (2) ◽  
pp. 96-103 ◽  
Author(s):  
Yahya Ghazwani ◽  
Ibrahim Qaddoumi ◽  
Johnnie K Bass ◽  
Shengjie Wu ◽  
Jason Chiang ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Posterior Fossa ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Low Grade Glioma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Low Grade ◽  
Total Resection ◽  
Profound Hearing Loss

Abstract Background Hearing loss may occur in patients with posterior fossa low-grade glioma who undergo surgery. Methods We retrospectively reviewed 217 patients with posterior fossa low-grade glioma, including 115 for whom results of hearing tests performed after surgery and before chemotherapy or radiation therapy were available. We explored the association of UHL with age at diagnosis, sex, race, tumor location, extent of resection, posterior fossa syndrome, ventriculoperitoneal shunt placement, and histology. Results Of the 115 patients, 15 (13.0%: 11 male, 6 black, 8 white, 1 multiracial; median age 7 years [range, 1.3–17.2 years]) had profound UHL after surgery alone or before receiving ototoxic therapy. Median age at tumor diagnosis was 6.8 years (range, 0.7–14.1 years), and median age at surgery was 6.8 years (range, 0.7–14.1 years). Patients with UHL had pathology characteristic of pilocytic astrocytoma (n = 10), ganglioglioma (n = 4), or low-grade astrocytoma (n = 1). Of these 15 patients, 4 underwent biopsy, 1 underwent gross total resection, 1 underwent near-total resection, and 9 underwent subtotal resection. UHL was more frequent in black patients than in white patients (OR 7.3, P = .007) and less frequent in patients who underwent gross total resection or near-total resection than in those who underwent subtotal resection (OR 0.11, P = .02). Conclusions Children undergoing surgery for posterior fossa low-grade glioma are at risk for UHL, which may be related to race or extent of resection. These patients should receive postoperative audiologic testing, as earlier intervention may improve outcomes.

scholarly journals Predictors of stimulation-induced seizures during perirolandic glioma resection using intraoperative mapping techniques

2021 ◽  
Vol 12 ◽  
pp. 117
Author(s):  
Ahmed A. Morsy ◽  
Ayman M. Ismail ◽  
Yasser M. Nasr ◽  
Salwa H. Waly ◽  
Esam A. Abdelhameed
Keyword(s):  
Neurological Status ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Motor Responses ◽  
Intraoperative Mapping ◽  
Subcortical Stimulation ◽  
The Mean ◽  
Mapping Techniques ◽  
Glioma Resection

Background: Intraoperative mapping techniques maximize safety and efficacy during perirolandic glioma resection but may induce seizures and limit the procedure. We aim to report the incidence and predictors of stimulation-induced seizures during mapping either patient is awake or under general anesthesia (GA). Methods: Retrospective analysis of 64 patients (40 awake and 24 GA) with perirolandic glioma underwent resection using intraoperative mapping techniques between 2014 and 2019. Preoperative data, operative details, postoperative neurological status, and extent of resection (EOR) were analyzed. Predictors of intraoperative seizures were assessed. Results: The mean cortical and subcortical stimulation intensities needed to evoke motor responses were significantly lower in awake cases than in GA patients (4.9 ± 0.42 vs. 8.9 ± 1.2 mA) and (8.3 ± 0.62 vs. 12.1 ± 1.1 mA), respectively (P = 0.01). Incidence of intraoperative seizures was lower but statistically non-significant in awake cases (10% vs. 12.5%) (P = 0.76). Preoperative multiple antiepileptic drugs (AEDs) (P = 0.03) and low-grade glioma (P = 0.04) were statistically significant predictors for intraoperative seizures. Mean EOR in awake cases was 92.03% and 90.05% in GA cases (P = 0.23). Postoperative deficits were permanent after 3 months only in 5% of awake patients versus 8.3% of GA group (P = 0.59). Conclusion: Awake craniotomy with intraoperative mapping can be done safely for perirolandic gliomas with lower but statistically nonsignificant incidence of intraoperative seizures and this could be attributed to statistically significant lower stimulation intensities required for mapping. Preoperative multiple AEDs and low-grade glioma are significant predictors for intraoperative seizures.

WP1-17 Risk factors and patterns of progression in a surgical cohort of low grade glioma patients

2019 ◽  
Vol 90 (3) ◽  
pp. e6.2-e6
Author(s):  
S Acharya ◽  
J Lavrador ◽  
R Visagan ◽  
V Narbad ◽  
J Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Subtotal Resection ◽  
Low Grade ◽  
Neurosurgical Procedures ◽  
Volumetric Change ◽  
Who Grade ◽  
Adjusted Analysis

ObjectivesTo understand the risk factors for and patterns of progression of low grade glioma (LGG).DesignSingle centre retrospective cohort study.SubjectsPatients undergoing at least two neurosurgical procedures for LGG, the first being for diffuse LGG (WHO 2). 22 patients included (14M; 8F); mean age at time of first operation 37.7±2.7 years. 20 patients had a Performance Status (PS) 0–1 and 2 patients had a PS 2.MethodsAll patients with LGG diagnosed in between 2009–2018 were retrospectively evaluated. Variables of interest included demographics, staging, performance status, time to re-operation (TTR), extent of resection, molecular genetics (1p19q co-deletion, IDH status). Tumour volumes were estimated from MRI images by the validated ABC/2 equation. Statistical analyses were performed by Stata13.0.ResultsThe tumour progressed in WHO grade in 18 patients (WHO grade 3 (n=15); WHO grade 4 (n=3). Mean time to re-operation after the first surgery was 7.0±1.2 years following gross total resection (GTR) and 3.2±0.7 years following subtotal resection (STR). Non-adjusted analysis of risk factors for time to re-operation (TTR) showed absence of 1p19q co-deletion as a risk factor (p=0.021). Adjusted analysis revealed that GTR, 1p19q mutation, PS 0 at 1 st surgery and tumour volumetric change decrease the risk for re-intervention (p<0.05). Chemo-radiotherapy was not associated with TTR.ConclusionsIn our cohort, TTR in LGG was influenced by the amount of initial resection, 1p19q deletion, PS and post-operative volumetric change.

Low-Grade Glioma Case Series: Lessons Learned from an Evolving 10-Year Single-Institution Multidisciplinary Team Practice

2021 ◽  
Author(s):  
Shami Acharya ◽  
José Pedro Lavrador ◽  
Priya Pavninder Sekhon ◽  
Ravindran Visagan ◽  
Josephine Jung ◽  
...  
Keyword(s):  
Multidisciplinary Team ◽  
Case Series ◽  
Lessons Learned ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Single Institution ◽  
Glioma Case

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Analysis of Clinical, Imaging, and Pathologic Features of 36 Patients with Primary Intraspinal Primitive Neuroectodermal Tumors: A Case Series and Literature Review

2021 ◽  
Author(s):  
Xuefeng Wei ◽  
Xu Zhang ◽  
Zimu Song ◽  
Feng Wang
Keyword(s):  
Literature Review ◽  
Single Case ◽  
Case Reports ◽  
Case Series ◽  
Subtotal Resection ◽  
Study Cohort ◽  
Primitive Neuroectodermal Tumors ◽  
Pathologic Features ◽  
Neuroectodermal Tumors ◽  
The Mean

Abstract Background and Study Aims Primary intraspinal primitive neuroectodermal tumors (PNETs) account for ∼0.4% of all intraspinal tumors, but information about these tumors in the medical literature is limited to single case reports. We report four cases of primary intraspinal PNETs and present a systematic literature review of the reported cases. Materials and Methods We retrospectively reviewed and analyzed the clinical data of 4 patients with primary intraspinal PNETs who underwent neurosurgical treatment at our clinic between January 2013 and January 2020, and of 32 cases reported in the literature. Results The female-to-male ratio was 2.6:1. The mean patient age was 21.42 ± 15.76 years (range: 1–60 years), and patients <36 years of age accounted for 83.30% of the study cohort. Progressive limb weakness and numbness were the chief symptoms (accounting for ∼55.6%). The mean complaint duration was 0.89 ± 0.66 months for males and 2.72 ± 3.82 months for females (p = 0.028). Epidural (41.7%) was the most common site, and thoracic (47.3%) was the most frequent location. Most PNETs were peripheral, and magnetic resonance imaging (MRI) appearance was isointense or mildly hypointense on T1-weighted images and hyperintense on T2-weighted images. Homogeneous contrast enhancement was observed. The 1-year survival rate of patients who underwent chemoradiation after total or subtotal lesion resection was better compared with patients who did not undergo chemotherapy, radiotherapy, or total or subtotal resection. The modality of treatment was associated with survival time (p = 0.007). Conclusion Primary intraspinal PNETs mainly occur in young people with a female preponderance. In patients with a rapid loss of lower limb muscle strength and large intraspinal lesions on MRI, PNETs should be considered. Surgical resection and adjuvant radio chemotherapy are key prognostic factors.

scholarly journals COVD-01. VINBLASTINE MONOTHERAPY INDUCTION FOR LOCALISED CNS GERMINOMA DURING THE COVID-19 PANDEMIC

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii282-iii282
Author(s):  
Rafael Moleron ◽  
Sara Stoneham ◽  
Thankamma Ajithkumar ◽  
Justin Cross ◽  
James Nicholson ◽  
...  
Keyword(s):  
Germ Cell ◽  
Treatment Options ◽  
Single Agent ◽  
Germ Cell Tumour ◽  
Research Priorities ◽  
Tumour Volume ◽  
Cell Tumour ◽  
Low Grade ◽  
Testicular Seminoma

Abstract INTRODUCTION Patients with localised CNS-germinoma have excellent survival. More recently, intensive inpatient chemotherapy (carboPEI=carboplatin/etoposide/ifosfamide in Europe) has been effectively employed to reduce radiotherapy fields and/or dose. Current research priorities focus on reducing treatment burden and long-term sequelae. Of note, outpatient-based single-agent carboplatin chemotherapy is associated with excellent outcomes in metastatic testicular seminoma (an identical pathology) [Alifrangis,EJC,2020]. Recently, successful vinblastine monotherapy was reported in localised CNS-germinoma [Murray,Neurooncol-Adv,2020]. METHODS Due to the COVID-19 pandemic, adapted UK guidelines for germ-cell-tumour management were distributed, including potential non-standard treatment options that would reduce hospital visits/admissions. A 30-year-old patient presented with a 32mmx30mmx35mm diameter solid+multi-cystic localised pineal CNS lesion, consistent radiologically with a germ-cell-tumour with prominent teratoma component. Investigation revealed negative AFP/HCG markers and biopsy-proven pure germinoma. After appropriate consent, the patient commenced 12-week induction with weekly vinblastine monotherapy (low-grade-glioma dosing [Lassaletta,JCO,2016]), with wk6&12 MRI re-assessment prior to definitive radiotherapy. RESULTS Vinblastine was well-tolerated. After initial 4mg/m2 test-dosing (wk1), standard 6mg/m2 was delivered for wk2, but resulted in asymptomatic neutropenia (nadir 0.3x10^9/l) and missed dosing at wk3. Subsequent doses were 4mg/m2, with no further neutropenia. As expected, MRI showed moderate 40% tumour volume reduction by wk12. Surgical resection of the residual presumed teratoma component was undertaken prior to radiotherapy. CONCLUSION Patients with CNS-germinoma have excellent outcomes and reduction of treatment-effects remains a priority. The exquisite chemosensitivity of germinoma, excellent results from monotherapy for metastatic testicular disease, and early promise of vinblastine monotherapy lend itself to further exploration for CNS-germinoma.

scholarly journals Dysembryoplastic neuroepithelial tumor and oligodendroglioma: the diagnostic value of magnetic resonance spectroscopy

1998 ◽  
Vol 4 (4) ◽  
pp. E8 ◽  
Author(s):  
Eric W. Sherburn ◽  
Mark M. Bahn ◽  
Murat Gokden ◽  
Daniel L. Silbergeld ◽  
Keith M. Rich
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Spectroscopy ◽  
Treatment Options ◽  
Diagnostic Value ◽  
Low Grade Glioma ◽  
Resonance Spectroscopy ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Low Grade ◽  
Radiological Findings ◽  
Similar Treatment

Preoperative differentiation between dysembryoplastic neuroepithelial tumor (DNT) and low-grade glioma is often not possible. Dysembryoplastic neuroepithelial tumor is a recently described entity of uncertain origin; however, the diagnosis has important clinical implications. Clinical and radiological findings of DNT and low-grade glioma, especially oligodendroglioma, may be similar. Treatment options and prognosis differ significantly between these two lesions; consequently, accurate diagnosis is imperative. The authors describe two individuals who presented simultaneously at their institution: one patient with an oligodendroglioma and a second patient with DNT. The natural history, neurodiagnostic, and pathological features of each are reviewed with special emphasis on the potential utility of magnetic resonance spectroscopy in differentiating these lesions.

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