scholarly journals Insular glioma surgery: an evolution of thought and practice

2019 ◽  
Vol 130 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Shawn L. Hervey-Jumper ◽  
Mitchel S. Berger

OBJECTIVEThe goal of this article is to review the history of surgery for low- and high-grade gliomas located within the insula with particular focus on microsurgical technique, anatomical considerations, survival, and postoperative morbidity.METHODSThe authors reviewed the literature for published reports focused on insular region anatomy, neurophysiology, surgical approaches, and outcomes for adults with World Health Organization grade II–IV gliomas.RESULTSWhile originally considered to pose too great a risk, insular glioma surgery can be performed safely due to the collective efforts of many individuals. Similar to resection of gliomas located within other cortical regions, maximal resection of gliomas within the insula offers patients greater survival time and superior seizure control for both newly diagnosed and recurrent tumors in this region. The identification and the preservation of M2 perforating and lateral lenticulostriate arteries are critical steps to preventing internal capsule stroke and hemiparesis. The transcortical approach and intraoperative mapping are useful tools to maximize safety.CONCLUSIONSThe insula’s proximity to middle cerebral and lenticulostriate arteries, primary motor areas, and perisylvian language areas makes accessing and resecting gliomas in this region challenging. Maximal safe resection of insular gliomas not only is possible but also is associated with excellent outcomes and should be considered for all patients with low- and high-grade gliomas in this area.

2021 ◽  
pp. 197140092198932
Author(s):  
Timo Alexander Auer ◽  
Maike Kern ◽  
Uli Fehrenbach ◽  
Yasemin Tanyldizi ◽  
Martin Misch ◽  
...  

Purpose To characterise peritumoral zones in glioblastoma and anaplastic astrocytoma evaluating T2 values using T2 mapping sequences. Materials and methods In this study, 41 patients with histopathologically confirmed World Health Organization high grade gliomas and preoperative magnetic resonance imaging examinations were retrospectively identified and enrolled. High grade gliomas were differentiated: (a) by grade, glioblastoma versus anaplastic astrocytoma; and (b) by isocitrate dehydrogenase mutational state, mutated versus wildtype. T2 map relaxation times were assessed from the tumour centre to peritumoral zones by means of a region of interest and calculated pixelwise by using a fit model. Results Significant differences between T2 values evaluated from the tumour centre to the peritumoral zone were found between glioblastoma and anaplastic astrocytoma, showing a higher decrease in signal intensity (T2 value) from tumour centre to periphery for glioblastoma ( P = 0.0049 – fit-model: glioblastoma –25.02± 19.89 (–54–10); anaplastic astrocytoma –5.57±22.94 (–51–47)). Similar results were found when the cohort was subdivided by their isocitrate dehydrogenase profile, showing an increased drawdown from tumour centre to periphery for wildtype in comparison to mutated isocitrate dehydrogenase ( P = 0.0430 – fit model: isocitrate dehydrogenase wildtype –10.35±16.20 (–51) – 0; isocitrate dehydrogenase mutated 12.14±21.24 (–15–47)). A strong statistical proof for both subgroup analyses ( P = 0.9987 – glioblastoma R2 0.93±0.08; anaplastic astrocytoma R2 0.94±0.15) was found. Conclusion Peritumoral T2 mapping relaxation time tissue behaviour of glioblastoma differs from anaplastic astrocytoma. Significant differences in T2 values, using T2 mapping relaxation time, were found between glioblastoma and anaplastic astrocytoma, capturing the tumour centre to the peritumoral zone. A similar curve progression from tumour centre to peritumoral zone was found for isocitrate dehydrogenase wildtype high grade gliomas in comparison to isocitrate dehydrogenase mutated high grade gliomas. This finding is in accordance with the biologically more aggressive behaviour of isocitrate dehydrogenase wildtype in comparison to isocitrate dehydrogenase mutated high grade gliomas. These results emphasize the potential of mapping techniques to reflect the tissue composition of high grade gliomas.


2021 ◽  
Author(s):  
Chang Gok Woo

Abstract Background: Nestin, a type VI intermediate filament, is expressed in neuroepithelial cells during embryogenesis and has been expressed in various human tumors. Recent studies have reported that expression is associated with poor prognosis in brain tumors, but the results are inconclusive. In this study, we evaluated usefulness of Nestin expression using immunohistochemistry as a diagnostic and prognostic biomarker for IDH mutation and the new World Health Organization (WHO) classification.Methods: To investigate Nestin expression, immunohistochemistry was performed on 92 adult brain gliomas using tissue microarrays. We further analyzed the clinical characteristics and survival outcomes according to Nestin expression and examined its correlation with another glioma biomarker, IDH mutation.Results: Sixty patients (65.2%) were Nestin-positive (weak and strong). Nestin expression and intensity were significantly correlated with age, location, diagnosis, and IDH mutations. Old age and high-grade gliomas showed a higher frequency and stronger intensity of Nestin expression than those of young age and with low-grade gliomas (p<0.001). Gliomas with IDH mutations that are located in the frontal lobe showed no expression or had weak positivity. Multivariate analysis demonstrated that Nestin expression (weak, hazard ratio [HR] 5.39, p=0.036; strong, HR 8.43, p=0.007) and IDH wildtype (HR 7.63; p=.001) were significant independent prognostic factors. Moreover, patients with tumors expressing Nestin showed shorter survival (p<0.001).Conclusions: Nestin expression exhibits high intensity in high-grade gliomas and is a useful diagnostic marker. High expression and level of Nestin were significantly correlated with worse survival and was considered a significant marker of poor prognosis in new WHO classification, independent of IDH mutation.


2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi240-vi241
Author(s):  
So Young Ji ◽  
Chae Eun Lee ◽  
Tamrin Chowdhury ◽  
Jin Wook Kim ◽  
Chul-Kee Park

Abstract Numerous studies reported a usefulness of 5-ALA fluorescence-guided surgery (FGS) in high grade gliomas. However, fluorescence pattern and intensity is variable among gliomas. In this study, we report our extensive experiences of FGS in various gliomas focusing on epidemiological data of fluorescence pattern. A total of 827 histologically proven glioma patients out of 900 brain tumor patients who had undergone FGS using 5-ALA during the period of 8.5 years between July 2010 and January 2019 were analyzed. Indication for FGS in glioma surgery harbored any evidence of possible high-grade foci at presumed gliomas in preoperative magnetic resonance images (MRI). Among the 827 gliomas, the number of cases corresponding to 2016 World Health Organization (WHO) grade IV, III, II, and I are 528 (58.7%), 193 (21.4%), 87 (9.7%) and 19 (2.1%), respectively. In terms of fluorescence rate, grade IV gliomas showed positive fluorescence in 95.4% of cases including strong intensity in 85.6%. Grade III gliomas showed fluorescence in about half of cases (55.0%), while 45.0% of cases did not show any fluorescence. Anaplastic oligodendroglioma had more positive rate (63.9%) than anaplastic astrocytoma (46.2%). Both grade II and I gliomas still showed positive fluorescence in about one-fourths of cases (24.1% and 26.3%, respectively). Among them ependymoma and pilocytic astrocytoma were fluorescence-prone tumors. This epidemiological data of 5-ALA fluorescence in various grades of gliomas provides fundamental reference to clinical application of FGS using 5-ALA in glioma surgery.


2017 ◽  
Vol 08 (03) ◽  
pp. 407-411 ◽  
Author(s):  
Chika Anele Ndubuisi ◽  
Wilfred C. Mezue ◽  
Martin Nzegwu ◽  
Okwuoma Okwunodulu ◽  
Gabriel Ejembi ◽  
...  

ABSTRACT Background: High-grade gliomas (HGG) are among the most challenging brain tumors despite many research efforts worldwide. Aim: The aim of this study was to evaluate the local challenges that may influence outcome of HGG managed in a neurosurgical center in Nigeria. Methodology: Retrospective analysis of prospectively recorded data of patients managed for intracranial HGG at Memfys Hospital for Neurosurgery, Enugu, Nigeria, between the year 2006 and 2015. Only cases with conclusive histology following surgery were analyzed. Results: Glioma was 60 (23.8%) of 252 histology confirmed brain tumors. HGG represented 53.8% of gliomas with male:female ratio of 2.2:1.0 and peaked from fifth decade of life. Glioblastoma multiforme accounted for 69% of HGG. At 1-year postsurgery, 53% of HGGs were dead and 88% of these deaths were in the World Health Organization Grade IV group. Only 40% of cases could receive adjuvant treatment with only 15% mortality at 1 year in this subgroup that received adjuvant therapy. In addition, 19% of cases had surgery at Karnofsky score (Ks) of ≤70%. However, 94% of mortality at 1 year was related to surgery at Ks of ≤60%. Only four patients had a tumor volume of ≤50 cm3, and among these cases, three patients were independent at 1 year. Patients with tumor volume above 50 cm3 accounted for 94% of mortality. Conclusion: The peak age incidence for HGG seems to be lower than in Caucasians. Most cases present late with poor Ks and big tumor volume. The proportion with access to adjuvant treatment is still poor. Preoperative Karnofsky, extent of resection, duration of hospital, and Intensive Care Unit stay have impact on outcome.


Neurosurgery ◽  
2004 ◽  
Vol 55 (2) ◽  
pp. 358-371 ◽  
Author(s):  
Christopher Nimsky ◽  
Atsushi Fujita ◽  
Oliver Ganslandt ◽  
Boris von Keller ◽  
Rudolf Fahlbusch

Abstract OBJECTIVE: To investigate the contribution of high-field intraoperative magnetic resonance imaging (iMRI) for further reduction of tumor volume in glioma surgery. METHODS: From April 2002 to June 2003, 182 neurosurgical procedures were performed with a 1.5-T magnetic resonance system. Among patients who underwent these procedures, 47 patients with gliomas (14 with World Health Organization Grade I or II glioma, and 33 with World Health Organization Grade III or IV glioma) who underwent craniotomy were investigated retrospectively. Completeness of tumor resection and volumetric analysis were assessed with intraoperative imaging data. RESULTS: Surgical procedures were influenced by iMRI in 36.2% of operations, and surgery was continued to remove residual tumor. Additional further resection significantly reduced the percentage of final tumor volume compared with first iMRI scan (6.9% ± 10.3% versus 21.4% ± 13.8%; P &lt; 0.001). Percentages of final tumor volume also were significantly reduced in both low-grade (10.3% ± 11.5% versus 25.8% ± 16.3%; P &lt; 0.05) and high-grade gliomas (5.4% ± 9.9% versus 19.5% ± 13.0%; P &lt; 0.001). Complete resection was achieved finally in 36.2% of all patients (low-grade, 57.1%; high-grade, 27.3%). Among the 17 patients in whom complete tumor resection was achieved, 7 complete resections (41.2%) were attributable to further tumor removal after iMRI. We did not encounter unexpected events attributable to high-field iMRI, and standard neurosurgical equipment could be used safely. CONCLUSION: Despite extended resections, introduction of high-field iMRI in conjunction with functional navigation did not translate into an increased risk of postoperative deficits. The use of high-field iMRI increased radicality in glioma surgery without additional morbidity.


2019 ◽  
Vol 50 (3) ◽  
pp. 109-115
Author(s):  
Beata Grygalewicz

StreszczenieB-komórkowe agresywne chłoniaki nieziarnicze (B-cell non-Hodgkin lymphoma – B-NHL) to heterogenna grupa nowotworów układu chłonnego, wywodząca się z obwodowych limfocytów B. Aberracje cytogenetyczne towarzyszące B-NHL to najczęściej translokacje onkogenów takich jak MYC, BCL2, BCL6 w okolice genowych loci dla łańcuchów ciężkich lub lekkich immunoglobulin. W niektórych przypadkach dochodzi do wystąpienia kilku wymienionych aberracji jednocześnie, tak jak w przypadkach przebiegających z równoczesną translokacją genów MYC i BCL2 (double hit), niekiedy także z obecnością rearanżacji BCL6 (triple hit). Takie chłoniaki cechuje szczególnie agresywny przebieg kliniczny. Obecnie molekularna diagnostyka cytogenetyczna przy użyciu techniki fluorescencyjnej hybrydyzacji in situ (FISH) oraz, w niektórych przypadkach, aCGH jest niezbędnym narzędziem rozpoznawania, klasyfikowania i oceny stopnia zaawansowania agresywnych, nieziarniczych chłoniaków B-komórkowych. Technika mikromacierzy CGH (aCGH) była kluczowym elementem wyróżnienia prowizorycznej grupy chłoniaków Burkitt-like z aberracją chromosomu 11q (Burkitt-like lymphoma with 11q aberration – BLL, 11q) w najnowszej klasyfikacji nowotworów układu chłonnego Światowej Organizacji Zdrowia (World Health Organization – WHO) z 2016 r. Omówione zostaną sposoby różnicowania na poziomie cytogenetycznym takich chłoniaków jak: chłoniak Burkitta (Burkitt lymphoma – BL), chłoniak rozlany z dużych komórek B (diffuse large B-cell lymphoma – DLBCL) oraz 2 nowych jednostek klasyfikacji WHO 2016, czyli chłoniaka z komórek B wysokiego stopnia złośliwości z obecnością translokacji MYC i BCL2 i/lub BCL6 (high-grade B-cell lymphoma HGBL, with MYC and BCL2 and/or BCL6 translocations) oraz chłoniaka BLL, 11q.


Author(s):  
Petr Ilyin

Especially dangerous infections (EDIs) belong to the conditionally labelled group of infectious diseases that pose an exceptional epidemic threat. They are highly contagious, rapidly spreading and capable of affecting wide sections of the population in the shortest possible time, they are characterized by the severity of clinical symptoms and high mortality rates. At the present stage, the term "especially dangerous infections" is used only in the territory of the countries of the former USSR, all over the world this concept is defined as "infectious diseases that pose an extreme threat to public health on an international scale." Over the entire history of human development, more people have died as a result of epidemics and pandemics than in all wars combined. The list of especially dangerous infections and measures to prevent their spread were fixed in the International Health Regulations (IHR), adopted at the 22nd session of the WHO's World Health Assembly on July 26, 1969. In 1970, at the 23rd session of the WHO's Assembly, typhus and relapsing fever were excluded from the list of quarantine infections. As amended in 1981, the list included only three diseases represented by plague, cholera and anthrax. However, now annual additions of new infections endemic to different parts of the earth to this list take place. To date, the World Health Organization (WHO) has already included more than 100 diseases in the list of especially dangerous infections.


Author(s):  
Yuni Kurniati Yuni Kurniati

ABSTRACT   According to the World Health Organization (WHO), every two minutes a woman dies of cervical cancer in develoving countries. In Indonesia, new cases of cervical cancer is 40-45 cases of day. It is estimated every hour, a women died of cervical center. At the general hospital center Dr. Mohammad Hoesin Palembang, the incidence of women who had cervical cancer incidence year 2011 women who had cervical cancer incidence are 34 people (48,2%). The following factors increase the chance of cervical cancer in women is infection of Human Papilloma Virus (HPV), sexsual behavior, family history of cervical cancer, age, mechanism of how oral contraceptives, smoking, income or socioeconomic status, race , unhealthy diet, the cell abnormal, parity, use of the drug DES (Dietilsbestrol), and birth control pills. The purpose of this study is known of adolescents about cervical cancer in SMA Tebing Tinggi Empat Lawang year 2016. This study used Analytic Survey with Cross Sectional approach. The population in this study were all young women students in SMA Tebing Tinggi Empat Lawang with the number of 171 respondents. The results showed there were 171 respondents (37.5%) of respondents were knowledgeable, and (62.52%) of respondents who are knowledgeable unfavorable. These results indicate that knowledgeable either less than those less knowledgeable in both the SMA Tebing Tinggi Empat Lawang Year 2016. From these results, it is expected that more teens can know about cervical cancer so that it can add a lot of insight and knowledge.     ABSTRAK   Menurut data World Health Organization (WHO), setiap dua menit wanita meninggal dunia karena kanker serviks dinegara berkembang. Di Indonesia, kasus baru kanker serviks 40-45 kasus perhari. Di perkirakan setiap satu jam, seorang perempuan meninggal dunia karena kanker serviks. Di rumah sakit umum pusat Dr. Mohammad Hoesin Palembang, angka kejadian ibu yang mengalami kanker serviks pada tahun 2011 ibu yang mengalami kejadian kanker serviks terdapat 34 orang (48,2%). Faktor-faktor berikut meningkat kan peluang kanker serviks pada wanita yaitu infeksi Human Papiloma virus (HPV), perilaku seks, riwayat keluarga kanker serviks, umur ,mekanisme bagaimana kontrasepsi peroral, merokok, pendapatan atau status social ekonomi, ras, diet tidak sehat, adanya sel abnormal, paritas, menggunakan obat DES (Dietilsbestrol),dan pil KB. Tujuan penelitian ini adalah Diketahuinya pengetahuan remaja tentang Ca Cerviks di SMA Negeri Tebing Tinggi Empat Lawang Tahun 2016. Penelitian ini menggunakan metode survey  analitik dengan pendekatan cross sectional. Populasi pada penelitian ini adalah semua siswi remaja putri di SMA Negeri Tebing Tinggi Empat Lawang dengan jumlah 171 responden.Hasil penelitian menunjukkan dari 171 responden terdapat(37.5 %) responden yang berpengetahuan baik, dan (62.52  %) responden yang berpengetahuan kurang baik. Hasil penelitian ini menunjukan bahwa yang berpengetahuan baik lebih sedikit dibandingkan dengan  yang berpengetahuan kurang baik di SMA Negeri Tebing Tinggi Empat Lawang Tahun 2016. Dari hasil penelitian ini, Diharapkan remaja bisa lebih banyak mengetahui tentang caserviks sehingga dapat menambah banyak wawasan dan pengetahuan.    


2020 ◽  
pp. 1-11
Author(s):  
Robin ROOM ◽  
Jenny CISNEROS ÖRNBERG

This article proposes and discusses the text of a Framework Convention on Alcohol Control, which would serve public health and welfare interests. The history of alcohol’s omission from current drug treaties is briefly discussed. The paper spells out what should be covered in the treaty, using text adapted primarily from the Framework Convention on Tobacco Control, but for the control of trade from the 1961 narcotic drugs treaty. While the draft provides for the treaty to be negotiated under the auspices of the World Health Organization, other auspices are possible. Excluding alcohol industry interests from the negotiation of the treaty is noted as an important precondition. The articles in the draft treaty and their purposes are briefly described, and the divergences from the tobacco treaty are described and justified. The text of the draft treaty is provided as Supplementary Material. Specification of concrete provisions in a draft convention points the way towards more effective global actions and agreements on alcohol control, whatever form they take.


2017 ◽  
Vol 24 (1) ◽  
pp. 55 ◽  
Author(s):  
C. Jain ◽  
L. Caulley ◽  
K.I. Macdonald ◽  
B. Purgina ◽  
C.K. Lai ◽  
...  

Background Non-intestinal-type adenocarcinoma is a malignancy traditionally found in the sinonasal cavity. To our knowledge, this case is the first reported of this rare condition originating in the nasopharynx.Case Presentation A 67-year-old woman with nasopharyngeal non-intestinal-type adenocarcinoma, with an accompanying parapharyngeal mass received primary radiation treatment for both lesions. Her tumour subsequently persisted, with a concomitant conversion in pathology from a low- to a high-grade malignancy.Results Non-intestinal-type and intestinal-type adenocarcinomas of the nasopharynx are extremely rare tumours and do not appear in the World Health Organization classification system. We review the pathophysiologic features of these malignancies and propose modifications to the current classification system.Conclusions Non-intestinal-type adenocarcinoma should be included in the differential diagnosis of nasopharyngeal masses. In our experience, this tumour in this location showed a partial response to primary radiation but later converted from a low- to a high-grade adenocarcinoma.


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