Prophylactic antiepileptic drug administration following brain tumor resection: results of a recent AANS/CNS Section on Tumors survey

2016 ◽  
Vol 126 (6) ◽  
pp. 1772-1778 ◽  
Author(s):  
Michael C. Dewan ◽  
Reid C. Thompson ◽  
Steven N. Kalkanis ◽  
Fred G. Barker ◽  
Constantinos G. Hadjipanayis
Keyword(s):  
Brain Tumor ◽  
Clinical Decision Making ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Clinical Decision ◽  
Low Grade ◽  
Seizure Prophylaxis ◽  
Tumor Pathology ◽  
Conflicting Evidence ◽  
Brain Tumor Resection

OBJECTIVEAntiepileptic drugs (AEDs) are often administered prophylactically following brain tumor resection. With conflicting evidence and unestablished guidelines, however, the nature of this practice among tumor surgeons is unknown.METHODSOn November 24, 2015, a REDCap (Research Electronic Database Capture) survey was sent to members of the AANS/CNS Section on Tumors to query practice patterns.RESULTSResponses were received from 144 individuals, including 18.8% of board-certified neurosurgeons surveyed (across 86 institutions, 16 countries, and 5 continents). The majority reported practicing in an academic setting (85%) as a tumor specialist (71%). Sixty-three percent reported always or almost always prescribing AED prophylaxis postoperatively in patients with a supratentorial brain tumor without a prior seizure history. Meanwhile, 9% prescribed occasionally and 28% rarely prescribed AED prophylaxis. The most common agent was levetiracetam (85%). The duration of seizure prophylaxis varied widely: 25% of surgeons administered prophylaxis for 7 days, 16% for 2 weeks, 21% for 2 to 6 weeks, and 13% for longer than 6 weeks. Most surgeons (61%) believed that tumor pathology influences epileptogenicity, with high-grade glioma (39%), low-grade glioma (31%), and metastases (24%) carrying the greatest seizure risk. While the majority used prophylaxis, 62% did not believe or were unsure if prophylactic AEDs reduced seizures postoperatively. The vast majority (82%) stated that a well-designed randomized trial would help guide their future clinical decision making.CONCLUSIONSWide knowledge and practice gaps exist regarding the frequency, duration, and setting of AED prophylaxis for seizure-naive patients undergoing brain tumor resection. Acceptance of universal practice guidelines on this topic is unlikely until higher-level evidence supporting or refuting the value of modern seizure prophylaxis is demonstrated.

scholarly journals A systematic review of perioperative seizure prophylaxis during brain tumor resection: the case for a multicenter randomized clinical trial

2017 ◽  
Vol 43 (5) ◽  
pp. E18 ◽  
Author(s):  
Vyshak Chandra ◽  
Andrew K. Rock ◽  
Charles Opalak ◽  
Joel M. Stary ◽  
Adam P. Sima ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trial ◽  
Brain Tumor ◽  
Randomized Clinical Trial ◽  
Tumor Resection ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Seizure Prophylaxis ◽  
History Of ◽  
Brain Tumor Resection

OBJECTIVEThe majority of neurosurgeons administer antiepileptic drugs (AEDs) prophylactically for supratentorial tumor resection without clear evidence to support this practice. The putative benefit of perioperative seizure prophylaxis must be weighed against the risks of adverse effects and drug interactions in patients without a history of seizures. Consequently, the authors conducted a systematic review of prospective randomized controlled trials (RCTs) that have evaluated the efficacy of perioperative seizure prophylaxis among patients without a history of seizures.METHODSFive databases (PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL/Academic Search Complete, Web of Science, and ScienceDirect) were searched for RCTs published before May 2017 and investigating perioperative seizure prophylaxis in brain tumor resection. Of the 496 unique research articles identified, 4 were selected for inclusion in this review.RESULTSThis systematic review revealed a weighted average seizure rate of 10.65% for the control groups. There was no significant difference in seizure rates among the groups that received seizure prophylaxis and those that did not. Further, this expected incidence of new-onset postoperative seizures would require a total of 1258 patients to enroll in a RCT, as determined by a Farrington-Manning noninferiority test performed at the 0.05 level using a noninferiority difference of 5%.CONCLUSIONSAccording to a systematic review of major RCTs, the administration of prophylactic AEDs after brain tumor resection shows no significant reduction in the incidence of seizures compared with that in controls. A large multicenter randomized clinical trial would be required to assess whether perioperative seizure prophylaxis provides benefit for patients undergoing brain tumor resection.

A Simplified Method of Accurate Postprocessing of Diffusion Tensor Imaging for Use in Brain Tumor Resection

2015 ◽  
Vol 13 (1) ◽  
pp. 47-59 ◽  
Author(s):  
Phillip A. Bonney ◽  
Andrew K. Conner ◽  
Lillian B. Boettcher ◽  
Ahmed A. Cheema ◽  
Chad A. Glenn ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Diffusion Tensor Imaging ◽  
Diffusion Tensor ◽  
Tumor Resection ◽  
Low Grade ◽  
Perceived Difficulty ◽  
Intracranial Lesions ◽  
Brain Tumor Resection ◽  
Frontal Lesions ◽  
Diffusion Tensor Imaging Dti

Abstract BACKGROUND: Use of diffusion tensor imaging (DTI) in brain tumor resection has been limited in part by a perceived difficulty in implementing the techniques into neurosurgical practice. OBJECTIVE: To demonstrate a simple DTI postprocessing method performed without a neuroscientist and to share results in preserving patient function while aggressively resecting tumors. METHODS: DTI data are obtained in all patients with tumors located within presumed eloquent cortices. Relevant white matter tracts are mapped and integrated with neuronavigation by a nonexpert in < 20 minutes. We report operative results in 43 consecutive awake craniotomy patients from January 2014 to December 2014 undergoing resection of intracranial lesions. We compare DTI-expected findings with stimulation mapping results for the corticospinal tract, superior longitudinal fasciculus, and inferior fronto-occipital fasciculus. RESULTS: Twenty-eight patients (65%) underwent surgery for high-grade gliomas and 11 patients (26%) for low-grade gliomas. Seventeen patients had posterior temporal lesions; 10 had posterior frontal lesions; 8 had parietal-temporal-occipital junction lesions; and 8 had insular lesions. With DTI-defined tracts used as a guide, a combined 65 positive maps and 60 negative maps were found via stimulation mapping. Overall sensitivity and specificity of DTI were 98% and 95%, respectively. Permanent speech worsening occurred in 1 patient (2%), and permanent weakness occurred in 3 patients (7%). Greater than 90% resection was achieved in 32 cases (74%). CONCLUSION: Accurate DTI is easily obtained, postprocessed, and implemented into neuronavigation within routine neurosurgical workflow. This information aids in resecting tumors while preserving eloquent cortices and subcortical networks.

scholarly journals Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases

BMC Cancer ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Surabhi Ranjan ◽  
Martha Quezado ◽  
Nancy Garren ◽  
Lisa Boris ◽  
Christine Siegel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
High Grade Glioma ◽  
Clinical Decision ◽  
High Grade

Personality and behavioral changes after brain tumor resection: a lesion mapping study

2021 ◽  
Vol 163 (5) ◽  
pp. 1257-1267 ◽  
Author(s):  
Anne-Laure Lemaitre ◽  
Guillaume Herbet ◽  
Hugues Duffau ◽  
Gilles Lafargue
Keyword(s):  
Brain Tumor ◽  
Tumor Resection ◽  
Behavioral Changes ◽  
Mapping Study ◽  
Lesion Mapping ◽  
Brain Tumor Resection

scholarly journals NI-01 Usefulness of preoperative evaluation of glioma elasticity by the magnetic resonance elastography

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii12-ii13
Author(s):  
Shinichiro Koizumi ◽  
Kazuhiko Kurozumi
Keyword(s):  
Elastic Modulus ◽  
Magnetic Resonance ◽  
Preoperative Evaluation ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Magnetic Resonance Elastography ◽  
Low Grade ◽  
Intracranial Tumors ◽  
Grade 3 ◽  
Malignant Grade

Abstract Introduction: The elasticity of intracranial tumors is difficult to assess non-invasively because the lesion is surrounded by the skull. Therefore, intracranial tumors have not been verified before surgery in terms of elastic modulus. Magnetic resonance elastography (MRE) is an epoch-making method capable of non-invasively imaging the elasticity of internal organs. We have examined the elasticity of meningiomas and pituitary adenomas and reported their usefulness. This time, we measured the glioma elasticity and verified usefulness of MRE. Method: Twenty-four gliomas (mean age 51.8±15.7 years, male: female = 17: 7) who underwent tumor resection after MRE imaging from July 2017 to May 2020 were targeted. The average elasticity was measured as an evaluation of tumor elastic modulus by MRE. Gliomas were divided into a low-grade glioma group (LGG: Grade 1, 2) and a high-grade glioma group (HGG: Grade 3, 4). Then, a comparative statistical study was conducted. Results: The average values of the average elasticity of LGG group (9 cases) and HGG group (15 cases) were 1.8±0.8 kPa and 2.5±0.8 kPa, respectively. The average elasticity was significantly higher in the HGG group (p=0.023). In the ROC analysis, the cutoff value was 2.1 kPa (sensitivity 70%, specificity 70%). Therefore, it was suggested that the tumor is likely to be HGG when the average elasticity is 2.1 kPa or more. Discussion: The glioma elasticity by preoperative MRE was significantly higher in the HGG group. Based on actual surgical experience, the tumor seems to be hard in the HGG group, and it was judged to be consistent with this our MRE research. The preoperative evaluation of glioma elasticity by MRE was considered useful, and it might help in planning a surgical strategy considering malignant grade.

Neurosurgical virtual reality simulation metrics to assess psychomotor skills during brain tumor resection

2014 ◽  
Vol 10 (5) ◽  
pp. 603-618 ◽  
Author(s):  
Hamed Azarnoush ◽  
Gmaan Alzhrani ◽  
Alexander Winkler-Schwartz ◽  
Fahad Alotaibi ◽  
Nicholas Gelinas-Phaneuf ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Brain Tumor ◽  
Tumor Resection ◽  
Psychomotor Skills ◽  
Virtual Reality Simulation ◽  
Brain Tumor Resection

Perioperative Glycemia Management in Patients Undergoing Craniotomy for Brain Tumor Resection: a Global Survey of Neuroanesthesiologists’ Perceptions and Practices

2021 ◽  
Author(s):  
Shaun E. Gruenbaum ◽  
Christian S. Guay ◽  
Benjamin F. Gruenbaum ◽  
Aidos Konkayev ◽  
Andrea Falegnami ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Tumor Resection ◽  
Global Survey ◽  
Brain Tumor Resection

Three-dimensional Force Perception of Robotic Bipolar Forceps for Brain Tumor Resection

2021 ◽  
Author(s):  
Xiu-Heng Zhang ◽  
Heng Zhang ◽  
Zhen Li ◽  
Gui-Bin Bian
Keyword(s):  
Brain Tumor ◽  
Real Time ◽  
Force Measurement ◽  
Measurement Techniques ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Contact Forces ◽  
Surgical Instruments ◽  
Force Perception ◽  
Brain Tumor Resection

Abstract Three-dimensional force perception is critically important in the enhancement of human force perception to minimize brain injuries resulting from excessive forces applied by surgical instruments in robot-assisted brain tumor resection. And surgeons are not responsive enough to interpret tool-tissue interaction forces. In previous studies, various force measurement techniques have been published. In neurosurgical scenarios, there are still some drawbacks to these presented approaches to forces perception. Because of the narrow, and slim configuration of bipolar forceps, three-dimensional contact forces on forceps tips is not easy to be traced in real-time. Five fundamental acts of handling bipolar forceps are poking, opposing, pressing, opening, and closing. The first three acts independently correspond to the axial force of z, x, y. So, in this paper, typical interactions between bipolar forceps and brain tissues have been analyzed. A three-dimensional force perception technique to collect force data on bipolar forceps tips by installing three Fiber Bragg Grating Sensors (FBGs) on each prong of bipolar forceps in real-time is proposed. Experiments using a tele-neurosurgical robot were performed on an in-vitro pig brain. In the experiments, three-dimensional forces were tracked in real-time. It is possible to experience forces at a minimum of 0.01 N. The three-dimensional force perception range is 0-4 N. The calibrating resolution on x, y, and z, is 0.01, 0.03, 0.1 N, separately. According to our observation, the measurement accuracy precision is over 95%.

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