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Qu C, Cao Z, Zhou J, He S, Liu F, Liu Z. Preoperative walking exercise to improve prognosis in patients with supratentorial brain tumours after craniotomy: protocol for a randomised controlled trial. BMJ Open 2024; 14:e080787. [PMID: 38754891 PMCID: PMC11097828 DOI: 10.1136/bmjopen-2023-080787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/01/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Cardiopulmonary complications and cognitive impairment following craniotomy have a significantly impact on the general health of individuals with brain tumours. Observational research indicates that engaging in walking is linked to better prognosis in patient after surgery. This trial aims to explore whether walking exercise prior to craniotomy in brain tumour patients can reduce the incidence of cardiopulmonary complications and preserve patients' cognitive function. METHODS AND ANALYSIS In this randomised controlled trial, 160 participants with supratentorial brain tumours aged 18-65 years, with a preoperative waiting time of more than 3-4 weeks and without conditions that would interfere with the trial such as cognitive impairment, will be randomly assigned in a ratio of 1:1 to either receive traditional treatment or additional combined with a period of 3-4 weeks of walking exercise of 10 000-15 000 steps per day. Wearable pedometer devices will be used to record step counts. The researchers will evaluate participants at enrolment, baseline, 14 days preoperatively, 3 days prior to surgery and 1 week after surgery or discharge (select which occurs first). The primary outcomes include the incidence of postoperative cardiopulmonary complications and changes in cognitive function (gauged by the Montreal Cognitive Assessment test). Secondary outcomes include the average length of hospital stay, postoperative pain, participant contentment, healthcare-associated costs and incidence of other postoperative surgery-related complications. We anticipate that short-term preoperative walking exercises will reduce the incidence of surgery-related complications in the short term after craniotomy, protect patients' cognitive function, aid patients' postoperative recovery and reduce the financial cost of treatment. ETHICS AND DISSEMINATION The study protocol has been approved by Ethics Committee of Xiangya Hospital of Central South University (approval number: 202305117). The findings of the research will be shared via publications that have been reviewed by experts in the field and through presentations at conferences. TRIAL REGISTRATION NUMBER NCT05930288.
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Affiliation(s)
- Chunrun Qu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Zeng Cao
- Department of Rehabilitation, Xiangya Hospital, Central South University, Changsha, China
| | - Jun Zhou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shihan He
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fangkun Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Hanihara M, Kawataki T, Kazama H, Ogiwara M, Yoshioka H, Kinouchi H. Maximal Resection of Gliomas Adjacent to the Corticospinal Tract Using 3-T Intraoperative Magnetic Resonance Imaging. World Neurosurg 2024; 185:e1207-e1215. [PMID: 38519017 DOI: 10.1016/j.wneu.2024.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Gliomas adjacent to the corticospinal tract (CST) should be carefully resected to preserve motor function while achieving maximal surgical resection. Modern high-field intraoperative magnetic resonance imaging (iMRI) enables precise visualization of the residual tumor and intraoperative tractography. We prospectively evaluated the extent of resection and distance between the tumor resection cavity and CST using 3-T iMRI combined with motor evoked potentials (MEP) in glioma surgery. METHODS Participants comprised patients who underwent surgery for solitary supratentorial glioma located within 10 mm of the CST. All cases underwent surgery using neuronavigation with overlaid CST under MEP monitoring. The correlation between distance from CST and transcortical MEP amplitude was calculated using Spearman rank correlation. RESULTS Among the 63 patients who underwent surgery, 27 patients were enrolled in the study. Gross total resections were achieved in 26 of the 27 cases. Volumetric analysis showed the extent of resection was 98.6%. Motor function was stable or improved in 24 patients (Stable/Improved group) and deteriorated in 3 patients (Deteriorated group). All patients in the Deteriorated group showed motor deficit before surgery. Mean intraoperative minimal distance was significantly longer in the Stable/Improved group (7.3 mm) than in the Deteriorated group (1.1 mm; P < 0.05). MEP amplitude correlated with minimal distance between the resection cavity and CST (R = 0.64). CONCLUSIONS Resection of gliomas adjacent to CST with a navigation system using 3-T iMRI could result in an ultimate EOR >98%. The combination of intraoperative tractography and MEP contributes to maximal removal of motor-eloquent gliomas.
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Affiliation(s)
- Mitsuto Hanihara
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan.
| | - Tomoyuki Kawataki
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hirofumi Kazama
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Masakazu Ogiwara
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hideyuki Yoshioka
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
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Lundar T, Due-Tønnessen BJ, Frič R, Sundseth J, Brandal P, Due-Tønnessen P. Outcome after treatment of pediatric supratentorial ependymoma: long-term follow-up of a single consecutive institutional series of 26 patients. Br J Neurosurg 2024; 38:514-522. [PMID: 34096810 DOI: 10.1080/02688697.2021.1914821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/16/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Long-term outcome after surgical treatment of supratentorial ependymoma (STE) in children has not been extensively reported. FINDINGS We identified 26 children who underwent primary tumor resection of STE between 1953 and 2011, with at least 8 years follow-up. Ten patients (38%) had anaplastic and 16 had low grade ependymoma. Four of 15 children (26%) treated in the years 1953-1976 survived more than 5 years, but the observed 10-year survival was only 7%. One patient lived for 37 years, and second surgery for a local recurrent lesion disclosed a glioblastoma, possibly secondary to radiotherapy. In contrast, the observed 5-year survival rate for 11 children treated in the years 1992-2011 was 8/11 (73%) and observed 10- and 25-year survival rates were 70% and 66%, respectively. Eight patients were alive and tumor-free with follow-up periods of 8-27 (median 18) years, all treated after 1992. Five of these long-term survivors were 23-39 years old with full-time (n = 3) or part-time (n = 2) work. The last three patients were still children (9-12 years old): one with good function and two with major neurological deficits. The majority of patients (n = 18) received adjuvant radiotherapy and eight children no adjuvant treatment. Repeated resections for residual or recurrent tumor were necessary in 11 patients (42%), mostly due to local disease with progressive clinical symptoms. Eight patients underwent only one repeat resection, whereas three patients had two or more repeat resections within 18 years after initial surgery. Four patients were tumor-free after repeated resections at the latest follow-up, 2-13 years after last surgery. CONCLUSION Pediatric STE has a marked risk for local recurrence even after gross total resection and postoperative radiotherapy, but survival has increased following the introduction of modern treatment in recent years. Repeated surgery is an important part of treatment and may lead to persistent tumor control.
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Affiliation(s)
- Tryggve Lundar
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Department of Neurosurgery, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Radek Frič
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Jarle Sundseth
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Paulina Due-Tønnessen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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Reecher HM, Koop JI, Awad AJ, Kim I, Foy AB, Kaufman BA, Meier NA, Lew SM. Awake craniotomy for supratentorial tumors or epileptogenic lesions in pediatric patients: a 16-year retrospective cohort study. J Neurosurg Pediatr 2024; 33:214-222. [PMID: 38100760 DOI: 10.3171/2023.11.peds23390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Awake craniotomy with intraoperative mapping is the widely accepted procedure for adult patients undergoing supratentorial tumor or epileptogenic focus resection near eloquent cortex. In children, awake craniotomies are notably less common due to concerns for compliance and emotional or psychological repercussions. Despite this, successfully tolerated awake craniotomies have been reported in patients as young as 8 years of age, with success rates comparable to those of adults. The authors sought to describe their experience with pediatric awake craniotomies, including insight regarding feasibility and outcomes. METHODS A retrospective review was completed for all pediatric (age < 18 years) patients at Children's Wisconsin for whom an awake craniotomy was attempted from January 2004 until March 2020. Institutional review board approval was granted. RESULTS Candidate patients had intact verbal ability, cognitive profile, and no considerable anxiety concerns during neuropsychology assessment. Nine patients presented with seizure. Five patients were diagnosed with tumor and secondary epilepsy, 3 with tumor only, and 3 with epilepsy only. All patients who underwent preoperative functional MRI successfully completed and tolerated testing paradigms. A total of 12 awake craniotomies were attempted in 11 patients, with 1 procedure aborted due to intraoperative bleeding. One patient had a repeat procedure. The mean patient age was 15.5 years (range 11.5-17.9 years). All patients returned to or maintained baseline motor and speech functions by the latest follow-up (range 14-130 months). Temporary deficits included transient speech errors, mild decline in visuospatial reasoning, leg numbness, and expected hemiparesis. Of the 8 patients with a diagnosis of epilepsy prior to surgery, 7 patients achieved Engel class I designation at the 1-year follow-up, 6 of whom remained in class I at the latest follow-up. CONCLUSIONS This study analyzes one of the largest cohorts of pediatric patients who underwent awake craniotomy for maximal safe resection of tumor or epileptogenic lesions. For candidate patients, awake craniotomy is safe, feasible, and effective in carefully selected children.
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Affiliation(s)
- Hope M Reecher
- 1Departments of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer I Koop
- 2Departments of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ahmed J Awad
- 1Departments of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Irene Kim
- 1Departments of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew B Foy
- 1Departments of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bruce A Kaufman
- 1Departments of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicholas A Meier
- 3Departments of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sean M Lew
- 1Departments of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Schwartz C, Rautalin I, Grauvogel J, Bissolo M, Masalha W, Steiert C, Schnell O, Beck J, Ebel F, Bervini D, Raabe A, Eibl T, Steiner HH, Shlobin NA, Nandoliya KR, Youngblood MW, Chandler JP, Magill ST, Romagna A, Lehmberg J, Fuetsch M, Spears J, Rezai A, Ladisich B, Demetz M, Griessenauer CJ, Niemelä M, Korja M. Surgical Outcome of Patients With Supratentorial Meningiomas Aged 80 Years or Older-Retrospective International Multicenter Study. Neurosurgery 2024; 94:399-412. [PMID: 37847034 DOI: 10.1227/neu.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/13/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Demographic changes will lead to an increase in old patients, a population with significant risk of postoperative morbidity and mortality, requiring neurosurgery for meningiomas. This multicenter study aims to report neurofunctional status after resection of patients with supratentorial meningioma aged 80 years or older, to identify factors associated with outcome, and to validate a previously proposed decision support tool. METHODS Neurofunctional status was assessed by the Karnofsky Performance Scale (KPS). Patients were categorized in poor (KPS ≤40), intermediate (KPS 50-70), and good (KPS ≥80) preoperative subgroups. Volumetric analyses of tumor and peritumoral brain edema (PTBE) were performed; volumes were scored as small (<10 cm 3 ), medium (10-50 cm 3 ), and large (>50 cm 3 ). RESULTS The study population consisted of 262 patients, and the median age at surgery was 83.0 years. The median preoperative KPS was 70; 117 (44.7%) patients were allotted to the good, 113 (43.1%) to the intermediate, and 32 (12.2%) to the poor subgroup. The median tumor and PTBE volumes were 30.2 cm 3 and 27.3 cm 3 ; large PTBE volume correlated with poor preoperative KPS status ( P = .008). The 90-day and 1-year mortality rates were 9.0% and 13.2%, respectively. Within the first postoperative year, 101 (38.5%) patients improved, 87 (33.2%) were unchanged, and 74 (28.2%) were functionally worse (including deaths). Each year increase of age associated with 44% (23%-70%) increased risk of 90-day and 1-year mortality. In total, 111 (42.4%) patients suffered from surgery-associated complications. Maximum tumor diameter ≥5 cm (odds ratio 1.87 [1.12-3.13]) and large tumor volume (odds ratio 2.35 [1.01-5.50]) associated with increased risk of complications. Among patients with poor preoperative status and large PTBE, most (58.3%) benefited from surgery. CONCLUSION Patients with poor preoperative neurofunctional status and large PTBE most often showed postoperative improvements. The decision support tool may be of help in identifying cases that most likely benefit from surgery.
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Affiliation(s)
- Christoph Schwartz
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
- Current Affiliations: Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
| | - Ilari Rautalin
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
- The National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland , New Zealand
| | - Jürgen Grauvogel
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Marco Bissolo
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Christine Steiert
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Florian Ebel
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland
- Department of Neurosurgery, University of Basel, Basel , Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland
| | - Thomas Eibl
- Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg , Germany
| | - Hans-Herbert Steiner
- Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg , Germany
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
- Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA
| | - Khizar R Nandoliya
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
- Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - James P Chandler
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - Alexander Romagna
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
- Department of Neurosurgery, München Klinik Bogenhausen, Munich , Germany
| | - Jens Lehmberg
- Department of Neurosurgery, München Klinik Bogenhausen, Munich , Germany
| | - Manuel Fuetsch
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , ON , Canada
- Department of Spine and Scoliosis Surgery, Artemed Klinikum München Süd, Munich , Germany
| | - Julian Spears
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , ON , Canada
| | - Arwin Rezai
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
| | - Barbara Ladisich
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
- Department of Neurosurgery, University Hospital St. Pölten, St. Pölten , Austria
| | - Matthias Demetz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck , Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
| | - Miikka Korja
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
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Abate Shiferaw A, Negash AY, Tirsit A, Kunapaisal T, Gomez C, Theard MA, Vavilala MS, Lele AV. Perioperative Care and Outcomes of Patients with Brain Tumors Undergoing Elective Craniotomy: Experience from an Ethiopian Tertiary-Care Hospital. World Neurosurg 2024; 181:e434-e446. [PMID: 37865195 DOI: 10.1016/j.wneu.2023.10.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To describe patients, perioperative care, and outcomes undergoing supratentorial and infratentorial craniotomy for brain tumor resection in a tertiary-care hospital in Ethiopia. METHODS A retrospective cohort study of patients consecutively admitted between January 1, 2021, and December 31, 2021, was performed. We characterized patients, perioperative care, and outcomes. RESULTS The final sample comprised 153 patients; 144 (94%) were 18 years and over, females (n = 48, 55%) with primarily American Society of Anesthesiologists physical class II (n = 97, 63.4%) who underwent supratentorial (n = 114, 75%), or infratentorial (n = 39, 25%) tumor resection. Patients were routinely admitted (95%) to floor/wards before craniotomy; Inhaled anesthetic (isoflurane 88%/halothane 12%) was used for maintenance of general anesthesia. Propofol (n = 93, 61%), mannitol (n = 73, 48%), and cerebrospinal fluid drain (n = 28, 18%), were used to facilitate intraoperative brain relaxation, while the use of hyperventilation was rare (n = 1). The average estimated blood loss was 1040 ± 727 ml; 37 (24%) patients received tranexamic acid, and 57 (37%) received a blood transfusion. Factors associated with extubation were a) infratentorial tumor location: relative risk (RR) 0.45 (95% confidence interval [CI] 0.29-0.69), preoperative hydrocephalus: RR 0.51, (95% CI 0.34-0.79), shorter total anesthesia duration: 277.8 + 8.8 versus 426.77 + 13.1 minutes, P < 0.0001, lower estimated blood loss: 897 + 68 ml versus 1361.7 + 100 ml, P = 0.0002, and cerebrospinal fluid drainage to facilitate brain relaxation: RR 0.52, 95% CI 0.32-0.84). Approximately one in ten patients experienced postoperative obstructive hydrocephalus, surgical site infections, or pneumonia. CONCLUSIONS These findings suggest that certain factors may impact patient outcomes following craniotomy for tumor resection. By identifying these factors, health care providers may be better equipped to develop individualized treatment plans and improve patient outcomes. Additionally, the study highlights the importance of postoperative monitoring and management to prevent complications.
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Affiliation(s)
- Ananya Abate Shiferaw
- Department of Anesthesiology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Amanuel Y Negash
- Department of Anesthesiology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Abenezer Tirsit
- Department of Neurosurgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Thitikan Kunapaisal
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
| | - Courtney Gomez
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Marie A Theard
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
| | - Abhijit V Lele
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA.
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Staribacher D, Kuzmin D, Britz G, Feigl GC. Surgical corridor formation by minimally invasive lateral occipital infracortical supra-/transtentorial (OICST) approach in pineal region tumor surgery: A review of 11 cases. Clin Neurol Neurosurg 2024; 236:108073. [PMID: 38091704 DOI: 10.1016/j.clineuro.2023.108073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/19/2023] [Accepted: 11/26/2023] [Indexed: 02/04/2024]
Abstract
INTRODUCTION The pineal region is a hard-to-reach part of the brain. There is no unequivocal opinion on the choice of a surgical approach to the pineal region. The surgical approaches described differ in both trajectory (infra- and supratentorial, interhemispheric) and size of craniotomy. They have advantages and disadvantages. The minimally invasive lateral occipital infracortical supra-/transtentorial (OICST) approach we have described has all the advantages of the standard supratentorial approach and minimizes its disadvantages, namely, compression and contusion of the occipital lobe. The minimally invasive craniotomy and small surgical corridor facilitate that. METHODS We describe 11 consecutive patients with various pineal region tumors (7 cases of pineal cysts, 2 cases of pinealocytoma, 1 case of medulloblastoma, and 1 case of meningioma) who were operated on in our hospital using the lateral OICST approach. Preoperative planning was performed using Surgical Theater®. The surgical corridor was formed using a retractor made from half of a syringe shortened according to the length of the surgical corridor. Preoperative lumbar drain was used. RESULTS The pineal region tumors were completely resected in all cases. The mean craniotomy size was 2.22 × 1.79 cm. No long-term neurological deficits were reported. CONCLUSIONS The use of semicircular retractors and intraoperative CSF drainage via a lumbar drain allows to form a small surgical corridor to the pineal region via minimally invasive craniotomy. This reduces traction and traumatization of the occipital lobe, as well as minimizes intra- and postoperative risks.
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Affiliation(s)
| | - Dzmitry Kuzmin
- Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany
| | - Gavin Britz
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Guenther C Feigl
- Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany; Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany; Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX, USA.
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Kopachev DN, Ryzhova MV, Kislyakov AN, Shaikhaev EG, Zheludkova OG, Kumirova EV, Meshcheryakov SV, Vlasov PA, Shkatova AM, Semenova ZB, Gushcha AO. [Supratentorial neuroepithelial tumor with PLAGL1 gene fusion - a new type of morphologically variable pediatric brain neoplasm defined by a distinct DNA methylation class. A case report and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2024; 88:62-68. [PMID: 38549412 DOI: 10.17116/neiro20248802162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Methylation analysis has become a powerful diagnostic tool in modern neurooncology. This technique is valuable to diagnose new brain tumor types. OBJECTIVE To describe the MRI and histological pattern of neuroepithelial tumor with PLAGL1 gene fusion. MATERIAL AND METHODS We present a 6-year-old patient with small right frontal intraaxial tumor causing drug resistant epilepsy. Despite indolent preoperative clinical course and MRI features suggesting glioneuronal tumor, histological evaluation revealed characteristics of high-grade glioma, ependymoma and neuroblastoma. RESULTS Methylation analysis of tumor DNA confirmed a new type of a recently discovered neoplasm - neuroepithelial tumor with PLAGL1 fusion (NET PLAGL1). PCR confirmed fusion of PLAGL1 and EWSR1 genes. No seizures were observed throughout the follow-up period. There was no tumor relapse a year after surgery. CONCLUSION Methylation analysis in neurooncology is essential for unclear tumor morphology or divergence between histological and clinical data. In our case, this technique confirmed benign nature of tumor, and we preferred follow-up without unnecessary adjuvant treatment.
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Affiliation(s)
- D N Kopachev
- Research Institute for Emergency Pediatric Surgery and Traumatology, Moscow, Russia
- Neurology Research Center, Moscow, Russia
| | - M V Ryzhova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A N Kislyakov
- Morozov Children's Clinical Hospital, Moscow, Russia
| | | | - O G Zheludkova
- Voyno-Yasenetsky Practical Center for Specialized Medical Care for Children, Moscow, Russia
| | - E V Kumirova
- Morozov Children's Clinical Hospital, Moscow, Russia
| | - S V Meshcheryakov
- Research Institute for Emergency Pediatric Surgery and Traumatology, Moscow, Russia
| | - P A Vlasov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - Zh B Semenova
- Research Institute for Emergency Pediatric Surgery and Traumatology, Moscow, Russia
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Malik R, Mathew P, Panda NB, Bhagat H, Gupta A, Grover VK, Mohanty M. Prevalence and Predictors of Preoperative Anxiety in Patients With An Intracranial Supratentorial Neoplasm Undergoing Surgery. J Neurosurg Anesthesiol 2024; 36:77-81. [PMID: 36418242 DOI: 10.1097/ana.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 09/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preoperative anxiety is common among patients, particularly in neurosurgical patients. The aim of the study was to evaluate the incidence and predictive factors of preoperative anxiety using the state anxiety scale of the State-Trait Anxiety Inventory (STAI-S) among patients undergoing elective craniotomy for a supratentorial neoplasm. This study also determined the optimal Amsterdam Preoperative Anxiety and Information Scale (APAIS) score for the identification of preoperative anxiety in this cohort. METHODS Sixty patients aged 18 to 65 years with American Society of Anesthesiologists physical status score I/II scheduled for elective craniotomy for a supratentorial neoplasm were recruited into this prospective, observational study. Preoperative anxiety was assessed using STAI-S and APAIS questionnaires. Using STAI-S ≥37 to define preoperative anxiety, the optimal APAIS to identify preoperative anxiety was determined using receiver operating characteristic curve analysis. Logistic regression was performed to identify independent predictive factors for preoperative anxiety. RESULTS Sixty percent of patients had preoperative anxiety (STAI-S ≥37). An APAIS score of 10 identified preoperative anxiety with a sensitivity, specificity, and positive predictive value of 97%, 96%, and 97%, respectively. Right-sided tumor location ( P =0.047) and need-for-information on surgery ( P =0.007) were independent predictors of preoperative anxiety. CONCLUSIONS Patients with supratentorial neoplasms have a high incidence of preoperative anxiety; an APAIS score of 10 is the optimal cutoff to identify anxious patients in the preoperative period. Need-for-information about surgery and right-sided tumor laterality are independent predictors of preoperative anxiety.
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Affiliation(s)
- Ritu Malik
- Department of Neuroanesthesia and Critical Care, Kainos Hospital, Rohtak, HR
| | | | | | | | | | | | - Manju Mohanty
- Department of Neurosurgery, PGIMER, Chandigarh, India
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10
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Khan HA, Hill TC, Suryadevara CM, Carter CC, Eremiev AN, Save AV, Golfinos JG, Pacione D. Development and implementation of an Enhanced Recovery After Cranial Surgery pathway following supratentorial tumor resection at a tertiary care center. Neurosurg Focus 2023; 55:E4. [PMID: 38039535 DOI: 10.3171/2023.9.focus23552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/28/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Controlling length of stay (LOS) reduces rates of nosocomial infections and falls, facilitates earlier return to daily activities, and decreases strain on the healthcare system. Complications following supratentorial tumor resection present early in the postoperative period, thereby enhancing the prospect of safe, early discharge. Here, the authors describe their initial experience with the development and implementation of an Enhanced Recovery After Cranial Surgery (ERACS) pathway following resection of supratentorial tumors in select patients. METHODS This was a nonrandomized, ambispective quality improvement study of patients undergoing elective craniotomy for supratentorial tumor resection at New York University Langone Health between November 17, 2020, and May 19, 2022. Eligible patients were prospectively enrolled in either the ERACS pathway or the standard pathway. These prospective cohorts were compared to a retrospective cohort of patients who met eligibility criteria for the pathway. Patients in the ERACS pathway cohort were targeted for discharge on postoperative day 2. The primary outcome metric was hospital LOS. Secondary outcome metrics included duration of intensive care unit (ICU) care and rates of 30-day emergency department visits, readmissions, and complications. RESULTS Over the study period, 188 of 317 patients (59.3%) who underwent supratentorial tumor resection met inclusion criteria for ERACS pathway enrollment. Sixty-three patients were enrolled in the ERACS pathway, and 125 patients completed the standard pathway. The historical cohort consisted of 332 patients who would have been eligible for ERACS enrollment. Patients in the ERACS pathway cohort had a median LOS of 1.93 days compared with 2.92 and 2.88 days for patients in the standard pathway and historical cohort, respectively (p < 0.001). There was a significant reduction in ICU utilization in ERACS pathway patients (16.0 ± 6.53 vs 29.5 ± 53.0 vs 21.8 ± 18.2 hours, p = 0.005). There were no differences in the rates of 30-day emergency department visits (12.7% vs 9.6% vs 10.9%, p = 0.809) and readmissions (4.8% vs 4.0% vs 7.8%, p = 0.279) between groups. CONCLUSIONS Patients in the ERACS pathway cohort experienced reduced LOS and ICU utilization, with similar rates of adverse outcomes compared to standard pathway patients. The authors' initial experience suggests that an accelerated recovery pathway can be safely implemented following supratentorial tumor resection in select patients.
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Affiliation(s)
- Hammad A Khan
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - Travis C Hill
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - Carter M Suryadevara
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - Camiren C Carter
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - Alexander N Eremiev
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - Akshay V Save
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - John G Golfinos
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - Donato Pacione
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
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11
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Tabor JK, O'Brien J, Vasandani S, Vetsa S, Lei H, Jalal MI, Marianayagam NJ, Jin L, Millares Chavez M, Haynes J, Dincer A, Yalcin K, Aguilera SM, Omay SB, Mishra-Gorur K, McGuone D, Morales-Valero SF, Fulbright RK, Gunel M, Erson-Omay EZ, Moliterno J. Clinical and genomic differences in supratentorial versus infratentorial NF2 mutant meningiomas. J Neurosurg 2023; 139:1648-1656. [PMID: 37243548 DOI: 10.3171/2023.4.jns222929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/11/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Mutations in NF2 are the most common somatic driver mutation in sporadic meningiomas. NF2 mutant meningiomas preferentially arise along the cerebral convexities-however, they can also be found in the posterior fossa. The authors investigated whether NF2 mutant meningiomas differ in clinical and genomic features based on their location relative to the tentorium. METHODS Clinical and whole exome sequencing (WES) data for patients who underwent resection of sporadic NF2 mutant meningiomas were reviewed and analyzed. RESULTS A total of 191 NF2 mutant meningiomas were included (165 supratentorial, 26 infratentorial). Supratentorial NF2 mutant meningiomas were significantly associated with edema (64.0% vs 28.0%, p < 0.001); higher grade-i.e., WHO grade II or III (41.8% vs 3.9%, p < 0.001); elevated Ki-67 (55.0% vs 13.6%, p < 0.001); and larger volume (mean 45.5 cm3 vs 14.9 cm3, p < 0.001). Furthermore, supratentorial tumors were more likely to harbor the higher-risk feature of chromosome 1p deletion (p = 0.038) and had a larger fraction of the genome altered with loss of heterozygosity (p < 0.001). Infratentorial meningiomas were more likely to undergo subtotal resection than supratentorial tumors (37.5% vs 15.8%, p = 0.021); however, there was no significant difference in overall (p = 0.2) or progression-free (p = 0.4) survival. CONCLUSIONS Supratentorial NF2 mutant meningiomas are associated with more aggressive clinical and genomic features as compared with their infratentorial counterparts. Although infratentorial tumors have higher rates of subtotal resection, there is no associated difference in survival or recurrence. These findings help to better inform surgical decision-making in the management of NF2 mutant meningiomas based on location, and may guide postoperative management of these tumors.
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Affiliation(s)
- Joanna K Tabor
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Joseph O'Brien
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Sagar Vasandani
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Shaurey Vetsa
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Haoyi Lei
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Muhammad I Jalal
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Neelan J Marianayagam
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Lan Jin
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | | | | | - Alper Dincer
- 3Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Kanat Yalcin
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Stephanie M Aguilera
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | | | - Ketu Mishra-Gorur
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Declan McGuone
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 4Pathology
| | - Saul F Morales-Valero
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Robert K Fulbright
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 5Radiology and Biomedical Imaging, and
| | - Murat Gunel
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 6Genetics, Yale School of Medicine, New Haven, Connecticut
| | - E Zeynep Erson-Omay
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Jennifer Moliterno
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
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12
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Hernández-Palazón J, Doménech-Asensi P, Fuentes-García D, Burguillos-López S, Piqueras-Pérez C, García-Palenciano C. Comparison of 20% mannitol and 3% hypertonic saline for intraoperative brain relaxation during supratentorial brain tumour craniotomy in patients with a midline shift. Neurocirugia (Astur : Engl Ed) 2023; 34:273-282. [PMID: 36931929 DOI: 10.1016/j.neucie.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/13/2022] [Indexed: 03/17/2023]
Abstract
PURPOSE OF THE STUDY A prospective, randomized, double-blind study was designed to assess differences in brain relaxation between 20% mannitol and 3% hypertonic saline (HS) during elective supratentorial brain tumour surgery in patients with midline shift. MATERIAL AND METHODS Sixty patients undergoing supratentorial craniotomy for tumour resection were enrolled to receive either 5mL/kg of 20% mannitol (n=30) or 3% HS (n=30) administered at skin incision. PCO2 in arterial blood was maintained within 35-40mmHg and arterial blood pressure was controlled within baseline values ±20%. The primary outcome was the proportion of satisfactory brain relaxation. The surgeon assessed brain relaxation on a four-point scale (1=excellent with no swelling, 2=minimal swelling, 3=serious swelling not requiring treatment, 4=severe swelling requiring treatment). Postsurgical intracranial changes determined by imaging techniques, postoperative complications, PACU and hospital stay, and mortality at 30 days were also recorded. Appropriate statistical tests were used for comparison; P<0.05 was considered as significant. This trial was registered in Eudract.ema.europa.eu (#2021-006290-40). RESULTS There was no difference in brain relaxation: 2.00 [1.00-2.00] and 2.00 [1.75-3.00] for patients in mannitol and HS groups, respectively (P=0.804). Tumour size (OR: 0.99, 95% CI: 0.99-1.01; P=0.371), peritumoral oedema classification (OR: 0.57, 95% CI: 0.11-2.84; P=0.493), mass effect (OR: 0.86, 95% CI: 0.16-4.87; P=0.864), anaesthesia (OR: 4.88, 95% CI: 0.82-28.96; P=0.081) and midline shift (OR: 5.00, 95% CI: 0.84-29.70; P=0.077) did not have a significant influence on brain swelling in patients treated with either mannitol or HS. No significant differences in perioperative outcomes, mortality and length of PACU and hospital stay were observed. CONCLUSIONS 5mL/kg of 20% mannitol or 3% HS result in similar brain relaxation scores in patients undergoing craniotomy for supratentorial brain tumour with midline shift.
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Affiliation(s)
| | - Paloma Doménech-Asensi
- Department of Anaesthesia, Hospital Clínico Universitario "Virgen de la Arrixaca, Murcia, Spain
| | - Diego Fuentes-García
- Department of Anaesthesia, Hospital Clínico Universitario "Virgen de la Arrixaca, Murcia, Spain.
| | | | - Claudio Piqueras-Pérez
- Department of Neurosurgery, Hospital Clínico Universitario "Virgen de la Arrixaca, Murcia, Spain
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13
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Nedeljkovic A, Ilic R, Nedeljkovic Z, Milicevic M, Raicevic S, Grujicic D. A unique case of intracranial collision tumor composed of ganglioglioma WHO gr I and supratentorial ependymoma WHO gr III: case-based literature review. Childs Nerv Syst 2023; 39:2407-2411. [PMID: 37328662 DOI: 10.1007/s00381-023-06028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/11/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Intracranial collision tumor is a rare entity that represents the coexistence of two histopathological different tumor types in the same area without histological admixture or an intermediate cell population zone. So far, several cases of collision tumors with ganglioglioma as its component have been reported in the literature, while supratentorial ependymoma has never been reported as a collision tumor component. We are presenting a unique case of collision tumor in patient without previous history of head trauma, neurological surgery, radiotherapy, or phakomatosis. METHODS AND RESULTS A 17-year-old male with no previous history of head trauma, neurological surgery, radiotherapy, or phakomatosis was presented to our clinic with grand mal seizure. Brain magnetic resonance imaging with gadolinium contrast was done revealing a contrast-enhancing lesion of right frontal lobe closely related to dura, surrounded by perifocal edema. The patient underwent a gross total tumor resection. Histological examination revealed collision tumor with two distinct components: ganglioglioma and supratentorial ependymoma. CONCLUSION To our best knowledge, no previous reports of collision tumor composed of ganglioglioma and supratentorial ependymoma in a single patient have been reported. We believe that this report could significantly contribute to further surgical practice as well as to treatment decision for these types of collision tumors.
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Affiliation(s)
- Aleksandra Nedeljkovic
- Clinic for Neurosurgery, Clinical Center of Serbia, Koste Todorovica 4, Beograd, Serbia.
| | - Rosanda Ilic
- Clinic for Neurosurgery, Clinical Center of Serbia, Koste Todorovica 4, Beograd, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Belgrade, Serbia
| | - Zarko Nedeljkovic
- Clinic for Neurosurgery, Clinical Center of Serbia, Koste Todorovica 4, Beograd, Serbia
| | - Mihailo Milicevic
- Clinic for Neurosurgery, Clinical Center of Serbia, Koste Todorovica 4, Beograd, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Belgrade, Serbia
| | - Savo Raicevic
- Clinic for Neurosurgery, Clinical Center of Serbia, Koste Todorovica 4, Beograd, Serbia
- Institut for Pathology, Faculty of Medicine, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, Serbia
| | - Danica Grujicic
- Clinic for Neurosurgery, Clinical Center of Serbia, Koste Todorovica 4, Beograd, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Belgrade, Serbia
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14
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Acerbi F, Broggi M, Ferroli P, Falco J. Fluorescein-guided resection of a left frontal pre-rolandic cerebral metastasis: how I do it. Acta Neurochir (Wien) 2023; 165:2519-2524. [PMID: 37284838 DOI: 10.1007/s00701-023-05635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Cerebral metastases (CM) are the most common intracranial tumors; several studies have underlined the fundamental role of neurosurgical lesion removal. METHOD We describe the surgical resection of a left frontal single metastasis. We attempted to achieve a radical resection under the intraoperative guidance of fluorescein, with the aid of intraoperative neurological monitoring. This technique can be applied to each contrast enhancing, intra-axial, infiltrative lesion. CONCLUSION Fluorescein-guided surgery is a valuable tool in CM surgery to increase the rate of resection; further prospective evaluation of the role of fluorescein in this field is in planning, aiming to study the prognostic impact.
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Affiliation(s)
- Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy.
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
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15
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Yuan Q, Yao HJ, Xi CH, Yu C, Du ZY, Chen L, Wu BW, Yang L, Wu G, Hu J. Perioperative risk factors associated with unplanned neurological intensive care unit readmission following elective supratentorial brain tumor resection. J Neurosurg 2023; 139:315-323. [PMID: 36461816 DOI: 10.3171/2022.10.jns221318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to describe the clinical and procedural risk factors associated with the unplanned neurosurgical intensive care unit (NICU) readmission of patients after elective supratentorial brain tumor resection and serves as an exploratory analysis toward the development of a risk stratification tool that may be prospectively applied to this patient population. METHODS This was a retrospective observational cohort study. The electronic medical records of patients admitted to an institutional NICU between September 2018 and November 2021 after elective supratentorial brain tumor resection were reviewed. Demographic and perioperative clinical factors were recorded. A prognostic model was derived from the data of 4892 patients recruited between September 2018 and May 2021 (development cohort). A nomogram was created to display these predictor variables and their corresponding points and risks of readmission. External validation was evaluated using a series of 1118 patients recruited between June 2021 and November 2021 (validation cohort). Finally, a decision curve analysis was performed to determine the clinical usefulness of the prognostic model. RESULTS Of the 4892 patients in the development cohort, 220 (4.5%) had an unplanned NICU readmission. Older age, lesion type, Karnofsky Performance Status (KPS) < 70 at admission, longer duration of surgery, retention of endotracheal intubation on NICU entry, and longer NICU length of stay (LOS) after surgery were independently associated with an unplanned NICU readmission. A total of 1118 patients recruited between June 2021 and November 2021 were included for external validation, and the model's discrimination remained acceptable (C-statistic = 0.744, 95% CI 0.675-0.814). The decision curve analysis for the prognostic model in the development and validation cohorts showed that at a threshold probability between 0.05 and 0.8, the prognostic model showed a positive net benefit. CONCLUSIONS A predictive model that included age, lesion type, KPS < 70 at admission, duration of surgery, retention of endotracheal intubation on NICU entry, and NICU LOS after surgery had an acceptable ability to identify elective supratentorial brain tumor resection patients at high risk for an unplanned NICU readmission. These risk factors and this prediction model may facilitate better resource allocation in the NICU and improve patient outcomes.
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Affiliation(s)
- Qiang Yuan
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 3Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai
- 4Neurosurgical Institute of Fudan University, Shanghai
- 5Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and
| | - Hai-Jun Yao
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 6Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai-Hua Xi
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 6Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chun Yu
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 6Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhuo-Ying Du
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 3Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai
- 4Neurosurgical Institute of Fudan University, Shanghai
- 5Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and
| | - Long Chen
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 6Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bi-Wu Wu
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 6Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Yang
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 6Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Gang Wu
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 3Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai
- 4Neurosurgical Institute of Fudan University, Shanghai
- 5Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and
- 6Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin Hu
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai
- 2National Center for Neurological Disorders, Shanghai
- 3Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai
- 4Neurosurgical Institute of Fudan University, Shanghai
- 5Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and
- 6Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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16
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da Costa MDS, Sarti THM, Vaz H, Dastoli PA, Nicácio JM, Silva FAB, Cappellano AM, Silva NS, Cavalheiro S. Risk for hydrocephalus, hygroma, and tumor dissemination after ventricular opening during resection of supratentorial neoplasms in children. Childs Nerv Syst 2023; 39:1881-1887. [PMID: 36715744 DOI: 10.1007/s00381-023-05861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/22/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE The possibility that ventricular opening generates postoperative complications after surgical tumor treatment often restricts the degree of tumor resection. This study aims to determine whether the ventricular opening is associated with more complications in surgeries for resectioning supratentorial intra-axial brain tumors in the pediatric population. METHODS A retrospective review analysis was performed of patients treated at IOP/GRAACC between 2002 and 2020 under 19 years of age and underwent surgery for supratentorial intra-axial primary brain tumor resection. Data were collected from 43 patients. RESULTS Glial tumor was more common than non-glial (65% vs. 35%, p = 0.09). The ventricular opening was not related to neoplastic spreads to the neuroaxis (6% vs. 0, p > 0.9) or leptomeningeal (3% vs. 0, p > 0.9). Of the patients whose ventricle was opened, 10% developed hydrocephalus requiring treatment, while none of the patients in the group without ventricular opening developed hydrocephalus (p = 0.5). There was also no statistical difference regarding ventriculitis. Postoperative subdural hygroma formation correlated with the ventricular opening (43% vs. 0, p = 0.003). The survival at 1, 5, and 10 years of cases with the ventricular opening was 93.2%, 89.7%, and 75.7%, respectively, while in cases without ventricular opening, it was 100%, 83%, and 83%, respectively, respectively, with no statistical difference between the mortality curves. CONCLUSION Our study demonstrated that ventricular violation was not associated with the occurrence of significant complications. It was related to the formation of subdural hygroma, which did not require additional treatment.
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Affiliation(s)
- Marcos Devanir Silva da Costa
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, Brazil
| | | | - Herison Vaz
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, Brazil
| | - Patricia Alessandra Dastoli
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, Brazil
| | - Jardel Mendonça Nicácio
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, Brazil
| | | | - Andrea Maria Cappellano
- Division of Neuro-Oncology, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, Brazil
| | - Nasjla Saba Silva
- Division of Neuro-Oncology, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, Brazil
| | - Sergio Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, Brazil
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17
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Cao D, Ou Y, Chen X, Guo Z, Chen Y, Chen J. Clinical outcomes after microsurgical resection of giant lateral ventricular meningiomas. Neurosurg Rev 2023; 46:33. [PMID: 36607461 DOI: 10.1007/s10143-022-01932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/13/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
Giant lateral ventricular meningiomas (LVMs), with the largest diameter of at least 5 cm, form a distinct subset. The incidence of giant LVMs is considered to be relatively low. Here, we evaluated clinical characteristics, and clinical outcomes after microsurgical resection, especially functional outcomes and morbidity of giant LVMs. We retrospectively reviewed 49 patients with LVMs, including 18 giant LVMs from 2012 to 2020. And we analyzed clinical, histopathological, surgical, and outcome data at our institution. Giant LVMs were most commonly present in the fourth decade of patients with the male-to-female ratio of 1:2. The most common subtypes were transitional and fibrous. Most lesions were resected via the temporal or parieto-occipital approach in our series. The median volume of blood loss was higher in the giant group (900 vs. 600 ml, p = 0.02). Meanwhile, the median length of hospital stay was prolonged for giant LVMs (20.5 vs. 16.0 days, p < 0.01). The proportion of discharged functional deterioration was higher in giant LVMs (38.9% vs. 6.5%, p = 0.02). However, there was no statistical significance between functional deterioration and tumor size at long-term follow-up (p = 0.28). Giant LVMs patients suffered from neurological and regional complications more commonly, particularly from a postoperative hematoma (4/18 vs. 1/31), and hydrocephalus (2/18 vs. 0/31). Patients with giant LVMs had a high incidence of immediate functional deterioration after microsurgery, and there was no difference in functional deterioration between the giant and non-giant LVMS during long-term follow-up. Microsurgery entails a higher complication rate in giant LVMs. We need to pay special attention to preventing postoperative hematoma and hydrocephalus.
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Affiliation(s)
- Dan Cao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yibo Ou
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xu Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhengqian Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yong Chen
- Department of Neurosurgery Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jian Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Ishida J, Date I. [Surgical Tips and Precautions for Supratentorial Tumors in Children]. No Shinkei Geka 2022; 50:1314-1322. [PMID: 36426531 DOI: 10.11477/mf.1436204697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Pediatric brain tumors account for approximately 15% of all pediatric cancers. Approximately half of the cases are malignant, and entail postoperative radiation therapy and chemotherapy. Herein, we describe perioperative tips and precautions for pediatric supratentorial tumors other than suprasellar tumors from our institution. Postoperative cerebrospinal fluid issues are especially prevalent in children, and three representative cases have been presented for discussion. Further, skull closure deems close attention, being crucial for children's future growth, in terms of a cosmetic aspect.
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Affiliation(s)
- Joji Ishida
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
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Besch G, Parmentier AL, Berthier F, Jaeg H, Villeneuve J, Hammoudi F, Scaringella N, Clairet AL, Vettoretti L, Chopard G, Thines L, Ferreira D, Samain E, Pili-Floury S. Clinical effectiveness of hypertonic sodium lactate infusion for intraoperative brain relaxation in patients undergoing scheduled craniotomy for supratentorial brain tumor resection: A study protocol of a single center double-blind randomized controlled phase II pilot trial. Medicine (Baltimore) 2022; 101:e31038. [PMID: 36221362 PMCID: PMC9542766 DOI: 10.1097/md.0000000000031038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hyperosmolar solutions are prescribed in neurosurgery patients to provide satisfactory intraoperative brain relaxation and to lower cerebral injuries related to surgical retractors. Mannitol is traditionally considered as the first-choice solution for brain relaxation in neurosurgery patients. Hypertonic sodium lactate infusion was reported to provide a higher and longer osmotic effect compared to mannitol in severely brain-injured patients and to prevent impaired cerebral energetics related to brain injuries. To date, the clinical effectiveness of hypertonic sodium lactate infusion has never been studied in neurosurgery patients. The hypothesis of the study is that hyperosmolar sodium lactate infusion may provide satisfactory intraoperative brain relaxation in patients undergoing scheduled craniotomy for supratentorial brain tumor resection. METHODS AND ANALYSIS We designed a phase II randomized, controlled, double-blind, single-center pilot trial, and aim to include 50 adult patients scheduled for craniotomy for supratentorial brain tumor resection under general anesthesia. Patients will be randomized to receive either mannitol (conventional group) or hypertonic sodium lactate (intervention group) infusion at the time of skin incision. Brain relaxation (primary outcome) will be assessed immediately after opening the dura by the neurosurgeon blinded to the treatment allocated using a validated 4-point scale. The primary outcome is the proportion of satisfactory brain relaxation, defined as brain relaxation score of 3 or 4. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee (Comité de Protection des Personnes Est III) and authorized by the French Health Authority (Agence Nationale de Sécurité des Médicaments, Saint-Denis, France). The University Hospital of Besancon is the trial sponsor and the holder of all data and publication rights. Results of the study will be submitted for publication in a peer-review international medical journal and for presentation in abstract (oral or poster) in international peer-reviewed congresses. REGISTRATION The trial is registered with ClinicalTrials.gov (Identifier: NCT04488874, principal investigator: Prof Guillaume Besch, date of registration: July 28, 2020).
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Affiliation(s)
- Guillaume Besch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and EA 3920, University of Franche-Comte, Besancon, France
- *Correspondence: Guillaume Besch, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexandre Fleming, 25030 Besancon, France (e-mail: )
| | - Anne-Laure Parmentier
- Clinical Methodology Center, INSERM CIC 1431, University Hospital of Besancon, and UMR 6249 Chrono Environment, University of Franche-Comte, Besancon, France
| | - Francis Berthier
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Besancon, France
| | - Hélène Jaeg
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Besancon, France
| | - Julien Villeneuve
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Besancon, France
| | - Fethi Hammoudi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Besancon, France
| | - Nans Scaringella
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Besancon, France
| | - Anne-Laure Clairet
- Department of Pharmacy, University Hospital of Besancon, and Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comte (UBFC), INSERM, EFS BFC, Besancon, France
| | - Lucie Vettoretti
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Besancon, France
| | - Gilles Chopard
- Department of Neurology, University Hospital of Besancon, and EA 481 Neuroscience, IFR 133, University of Bourgogne Franche-Comte, Besancon, France
| | - Laurent Thines
- Department of Neurosurgery, University Hospital of Besancon, Besancon, France
| | - David Ferreira
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and EA 481 Neuroscience, University of Bourgogne Franche-Comte, Besancon, France
| | - Emmanuel Samain
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and EA 3920, University of Franche-Comte, Besancon, France
| | - Sebastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and EA 3920, University of Franche-Comte, Besancon, France
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Altieri R, Broggi G, Certo F, Pacella D, Cammarata G, Maione M, Garozzo M, Barbagallo D, Purrello M, Caltabiano R, Magro G, Barbagallo G. Anatomical distribution of cancer stem cells between enhancing nodule and FLAIR hyperintensity in supratentorial glioblastoma: time to recalibrate the surgical target? Neurosurg Rev 2022; 45:3709-3716. [PMID: 36171505 DOI: 10.1007/s10143-022-01863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 11/27/2022]
Abstract
It is ge nerally accepted that glioblastoma (GBM) arise from cancer stem cells (CSC); however, there is little evidence on their anatomical distribution. We investigated the expression and distribution of SOX-2-positive and CD133-positive CSCs both in the enhancing nodule (EN) of GBM and in the FLAIR hyperintensity zones on a surgical, histopathological series of 33 GBMs. The inclusion criterion was the intraoperative sampling of different tumor regions individualized, thanks to neuronavigation and positivity to intraoperative fluorescence with the use of 5-aminolevulinic acid (5-ALA). Thirty-three patients (20 males and 13 females with a mean age at diagnosis of 56 years) met the inclusion criterion. A total of 109 histological samples were evaluated, 52 for ENs and 57 for FLAIR hyperintensity zone. Considering the quantitative distribution of levels of intensity of staining (IS), ES (extent score), and immunoreactivity score (IRS), no difference was found between ENs and FLAIR regions for both the SOX-2 biomarker (respectively, IS p = 0.851, ES p = 0.561, IRS p = 1.000) and the CD133 biomarker (IS p = 0.653, ES p = 0.409, IRS p = 0.881). This evidence suggests to recalibrate the target of surgery for FLAIRECTOMY and 5-ALA could improve the possibility to achieve this goal.
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Affiliation(s)
- Roberto Altieri
- Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio CIampi, 1, 95121, Catania, Italy.
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy.
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, Catania, Italy
| | - Francesco Certo
- Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio CIampi, 1, 95121, Catania, Italy
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giacomo Cammarata
- Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio CIampi, 1, 95121, Catania, Italy
| | - Massimiliano Maione
- Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio CIampi, 1, 95121, Catania, Italy
| | - Marco Garozzo
- Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio CIampi, 1, 95121, Catania, Italy
| | - Davide Barbagallo
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences - Section of Biology and Genetics Giovanni Sichel, University of Catania, Catania, Italy
| | - Michele Purrello
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences - Section of Biology and Genetics Giovanni Sichel, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, Catania, Italy
| | - Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, Catania, Italy
| | - Giuseppe Barbagallo
- Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio CIampi, 1, 95121, Catania, Italy
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
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Uttam P, Hussain N. Extra-Axial supratentorial anaplastic ependymoma: Unusual location of an aggressive tumor, A case report. INDIAN J PATHOL MICR 2022; 65:668-670. [PMID: 35900497 DOI: 10.4103/ijpm.ijpm_372_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Ependymomas are more common in the pediatric population, in whom they are commonly infratentorial. Extra axial location of a supratentorial ependymoma is extremely rare. DIAGNOSIS Radiologically these tumors are often misdiagnosed as meningioma or other extra axial lesions owing to their unusual location and lack of any pathognomonic features. Hence, histopathological examination becomes imperative for proper evaluation and an adequate diagnosis. CASE Herein we report a case of a supratentorial extra axial anaplastic ependymoma misdiagnosed as a metastatic tumor on radiological examination and mimicking meningioma intra operatively, located in the frontal and temporal region in a 20 year old man.
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Affiliation(s)
- Priyanka Uttam
- Department of Pathology and Lab Medicine, AIIMS, Raipur, Chhattisgarh, India
| | - Nighat Hussain
- Department of Pathology and Lab Medicine, AIIMS, Raipur, Chhattisgarh, India
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22
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Zhao K, Dong Y, Su G, Wang Y, Ji T, Wu N, Cui X, Li W, Yang Y, Chen X. Effect of Systemic Lidocaine on Postoperative Early Recovery Quality in Patients Undergoing Supratentorial Tumor Resection. Drug Des Devel Ther 2022; 16:1171-1181. [PMID: 35496368 PMCID: PMC9041358 DOI: 10.2147/dddt.s359755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Lidocaine has been gradually used in general anesthesia. This study was designed to investigate the effect of systemic lidocaine on postoperative quality of recovery (QoR) in patients undergoing supratentorial tumor resection, and to explore its brain-injury alleviation effect in neurosurgical anesthesia. Patients and Methods Sixty adult patients undergoing elective supratentorial tumor resection. Patients were randomly assigned either to receive lidocaine (Group L: 1.5 mg/kg bolus completed 10 min before anesthesia induction followed by an infusion at 2.0 mg/kg/h) or to receive normal saline (Group C: received volume-matched normal saline at the same infusion rate). Primary outcome measures were Quality of Recovery-40 (QoR-40) scores on postoperative day (POD) 1 and 2. Plasma concentrations of S100B protein (S100B), neuron specific enolase (NSE), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) before anesthesia induction and at the end of surgery were assessed. Visual Analogue Scale (VAS) scores were assessed at 1, 2, 6, 12, 24 and 48 h after surgery. Perioperative parameters and adverse events were also recorded. Results Patients between two groups had comparable baseline characteristics. Global QoR-40 scores on POD 1 and POD 2 were significantly higher (P <0.001) in group L (165.5±3.8 vs 173.7±4.7) than those in group C (155.6±4.0 vs 163.2±4.5); and scores of physical comfort, emotional state, and pain in group L were superior to those in group C (P <0.05). In group L, patients possessed lower plasma concentration of pro-inflammatory factors (IL-6, TNF-α) and brain injury-related factors (S100B, NSE) (P <0.05), consumed less remifentanil and propofol, and experienced lower pain intensity. Multiple linear regression analysis demonstrated age and pain were correlated with postperative recovery quality. Conclusion Systemic lidocaine improved early recovery quality after supratentorial tumor resection with general anesthesia, and had certain brain-injury alleviation effects. These benefits may be attributed to the inflammation-alleviating and analgesic properties of lidocaine.
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Affiliation(s)
- Kai Zhao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yushan Dong
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Gaowei Su
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yaolin Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Tao Ji
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Nanling Wu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xiaojie Cui
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Wenzhan Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yanming Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xiuxia Chen
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Correspondence: Xiuxia Chen, Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China, Tel +86 18052268332, Fax +0516-8346-9496, Email
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23
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Kofoed MS, Pedersen CB, Schulz MK, Kristensen BW, Hansen RW, Markovic L, Halle B, Poulsen FR. Fluorescein-guided resection of cerebral metastases is associated with greater tumor resection. Acta Neurochir (Wien) 2022; 164:451-457. [PMID: 33721109 DOI: 10.1007/s00701-021-04796-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/25/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sodium fluorescein (fluorescein) crosses a disrupted blood-brain barrier similarly to gadolinium contrast in contrast-enhancing cerebral tumors. When exposed to light with 560 nm wavelength during surgery, fluorescein emits a yellow-green fluorescent light that can be visualized through an operating microscope equipped with an appropriate emission filter. The distribution of the fluorescence correlates with the contrast on a gadolinium contrast-enhanced MRI. OBJECTIVE The objective of this single-center retrospective study was to investigate if the use of fluorescein would increase the extent of resection and to examine if fluorescein guided resection influences postoperative neurological status. METHODS During the study period from August 2014 to August 2018, 117 patients were operated for cerebral metastases. Of these, 56 operations were guided by fluorescein and 61 by traditional white light. All patients had an early postoperative MRI within 72 h after surgery. RESULTS The use of fluorescein increased the extent of resection in patients with cerebral metastases. The use of fluorescein was not associated with increased postoperative sequelae or neurological damage regardless of underlying primary cancer. CONCLUSION Fluorescein is a helpful supplement in the neurosurgical treatment of cerebral metastases.
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Affiliation(s)
- Mikkel S Kofoed
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark.
| | - Christian B Pedersen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark
| | - Mette K Schulz
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark
| | - Bjarne W Kristensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Rasmus W Hansen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ljubo Markovic
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Bo Halle
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark
| | - Frantz R Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark
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Pikis S, Mantziaris G, Samanci Y, Peker S, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Lee CC, Yang HC, Liscak R, Hanuska J, Alvarez RM, Moreno NM, Tripathi M, Speckter H, Albert C, Sheehan J. Stereotactic Radiosurgery for Incidentally Discovered Cavernous Sinus Meningiomas: A Multi-institutional Study. World Neurosurg 2021; 158:e675-e680. [PMID: 34785361 DOI: 10.1016/j.wneu.2021.11.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The initial management of asymptomatic, incidentally discovered, cavernous sinus (CS) meningiomas remains incompletely defined. This study evaluated the safety and efficacy of stereotactic radiosurgery (SRS) for patients presenting with an asymptomatic CS meningioma. METHODS This is an international, retrospective study included patients treated with upfront SRS for an asymptomatic CS meningioma. Local tumor control, tumor and SRS-related complications, and the development of new neurologic deficits after SRS were evaluated. RESULTS A total of 37 patients (29 men; mean ± SD age: 55.05 ± 11.56 years) treated with upfront SRS for an asymptomatic, CS meningioma were included in the study. The mean ± SD margin dose was 12.27 ± 2.3 Gy. The median clinical and radiological follow-up periods were 66 (IQR 84) and 72 (IQR 84) months, respectively. At the last follow-up, tumor regression and stability were noted in 19 (51.35%) and 18 (48.65%) of CS meningiomas, respectively. SRS-related complications occurred in 2 patients (5.4%) and were managed conservatively. CONCLUSIONS Upfront SRS is a safe and effective treatment option for asymptomatic CS meningiomas. SRS may be considered at the time of initial diagnosis of a CS meningioma. If observation is the initial management chosen, SRS should be recommended when CS meningioma growth is documented on follow-up imaging.
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Affiliation(s)
- Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Benha University, Benha, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Cheng-Chia Lee
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Roman Liscak
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir Hanuska
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Manjul Tripathi
- Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Herwin Speckter
- Department of Radiology, Dominican Gamma Knife Center, Santo Domingo, Dominican Republic; CEDIMAT, Santo Domingo, Dominican Republic
| | - Camilo Albert
- Department of Radiology, Dominican Gamma Knife Center, Santo Domingo, Dominican Republic; CEDIMAT, Santo Domingo, Dominican Republic
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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25
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Witt EE, Eruchalu CN, Dey T, Bates DW, Goodwin CR, Ortega G. Non-English Primary Language Is Associated with Short-Term Outcomes After Supratentorial Tumor Resection. World Neurosurg 2021; 155:e484-e502. [PMID: 34461280 DOI: 10.1016/j.wneu.2021.08.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite research indicating that patients with non-English primary language (NEPL) have increased hospital length of stay (LOS) for craniotomies, there is a paucity of neurosurgical research examining the impact of language on short-term outcomes. This study sought to evaluate short-term outcomes for patients with English primary language (EPL) and NEPL admitted for resection of a supratentorial tumor. METHODS Using the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project New Jersey State Inpatient Database, this study included patients 18-90 years old who underwent resection of a supratentorial primary brain tumor, meningioma, or brain metastasis from 2009 to 2017. The primary outcomes were total, preoperative, and postoperative LOS. Secondary outcomes were complications, mortality, and discharge disposition. Univariable and multivariable analyses compared Spanish primary language (SPL), non-English non-Spanish (NENS) primary language, and EPL groups. RESULTS A total of 7324 patients were included: 2962 with primary brain tumor, 2091 with meningioma, and 2271 with brain metastasis. Patients with SPL (n = 297) were younger and more likely to have noncommercial insurance, lower income, and fewer comorbidities. Patients with NENS (n = 257) had similar age and comorbidities to the EPL group but had a greater proportion of noncommercially insured and low-income patients (P < 0.001). Multivariable analysis showed that patients with NENS had increased postoperative LOS (adjusted incidence rate ratio, 1.10; P = 0.008) and higher odds of a complication (adjusted odds ratio, 1.36; P = 0.015), and patients with SPL had higher odds of being discharged home (adjusted odds ratio, 1.55; P = 0.017). CONCLUSIONS Patients with NEPL have different short-term outcomes after supratentorial tumor resection that varies based on primary language. More research is needed to understand the mechanisms driving these findings and to clarify unique experiences for different populations with NEPL.
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Affiliation(s)
- Emily E Witt
- Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Chukwuma N Eruchalu
- Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tanujit Dey
- Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David W Bates
- Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Duke Center for Brain and Spinal Metastases, Duke University Medical Center, Durham, North Carolina, USA
| | - Gezzer Ortega
- Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Wang Q, Cheng J, Zhang S, Li Q, Hui X, Ju Y. Supratentorial pediatric cortical ependymomas: a comprehensive retrospective study. Neurosurg Rev 2020; 44:1543-1551. [PMID: 32607870 DOI: 10.1007/s10143-020-01336-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/01/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023]
Abstract
Pediatric cortical ependymomas (CEs) are rare; the clinical features and optimal treatment remain ill-defined. We aimed to clarify the clinical characteristics and outcome of pediatric CEs based on institutional series and literature review. Thirteen children with CEs from our department were included in the present study. Furthermore, a search of English language peer-reviewed articles yielded 43 patients with CEs. The clinical data, treatment, and outcome were retrospectively reviewed and statistically analyzed. Our institutional series consisted of nine males and four females. The literature review yielded 56 pediatric CE cases (including ours) for further analysis. Of these 56 cases, frontal lobe (n = 19, 41.3%) was the most common location and most of the tumors were located in the right hemisphere (n = 27, 58.7%). Seizures (n = 23, 41.1%) were the most frequent preoperative symptoms. Thirty patients (n = 30, 53.6%) were WHO grade II. Five continuous patients in our series screened for C11orf95-RELA fusion and all the patients (100%) were RELA fusion positive. Fourteen (26.4%) patients experienced tumor recurrence and 4 (7.5%) patients died during the follow-up. Multivariate survival analysis depicted extent of surgery resection was the only prognostic factor for PFS and patient with gross total resection (P = 0.037, HR 3.682, 95% CI 1.082-13.79) had longer PFS. Furthermore, Log-rank testing for Kaplan-Meier survival analysis showed the extent of surgery resection (P = 0.007) was the only prognostic factor for OS. Pediatric CEs are rare, commonly seen in frontal lobe and right hemisphere. Seizures are the most common symptoms. They may have higher rate of RELA fusions, but favorable outcome. A low incidence of anaplastic histology has been depicted. Gross total resection is significantly associated with longer PFS and OS. Careful follow-up is necessary because the tumors may progress.
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Affiliation(s)
- Qiguang Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, China
| | - Jian Cheng
- Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, China
| | - Qiang Li
- Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, China
| | - Yan Ju
- Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, China.
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De Barros A, Attal J, Roques M, Nicolau J, Sol JC, Charni S, Cohen-Jonathan-Moyal E, Roux FE. Glioblastoma survival is better analyzed on preradiotherapy MRI than on postoperative MRI residual volumes: A retrospective observational study. Clin Neurol Neurosurg 2020; 196:105972. [PMID: 32512407 DOI: 10.1016/j.clineuro.2020.105972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/09/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Establishing an overall survival prognosis for resected glioblastoma during routine postoperative management remains a challenge. The aim of our single-center study was to assess the usefulness of basing survival analyses on preradiotherapy MRI (PRMR) rather than on postoperative MRI (POMR). PATIENTS AND METHODS A retrospective review was undertaken of 75 patients with glioblastoma treated at our institute. We collected overall survival and MRI volumetric data. We analyzed two types of volumetric data: residual tumor volume and extent of resection. Overall survival rates were compared according to these two types of volumetric data, calculated on either POMR or PRMR and according to the presence or absence of residual enhancement. RESULTS Analysis of volumetric data revealed progression of some residual tumors between POMR and PRMR. Kaplan-Meier analysis of the correlations between extent of resection, residual tumor volume, and overall survival revealed significant differences between POMR and PRMR data. Both MRI scans indicated a difference between the complete resection subgroup and the incomplete resection subgroup, as median overall survival was longer in patients with complete resection. However, differences were significant for PRMR (25.3 vs. 15.5, p = 0.012), but not for POMR (21.3 vs. 15.8 months, p = 0.145). With a residual tumor volume cut-off value of 3 cm3, Kaplan-Meier survival analysis revealed non-significant differences on POMR (p = 0.323) compared with PRMR (p = 0.007). CONCLUSION Survival in patients with resected glioblastoma was more accurately predicted by volumetric data acquired with PRMR. Differences in predicted survival between the POMR and PRMR groups can be attributed to changes in tumor behavior before adjuvant therapy.
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Affiliation(s)
- Amaury De Barros
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France.
| | - Justine Attal
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - Margaux Roques
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; Neuroradiology Department, Toulouse University Hospital, Toulouse, France
| | - Julien Nicolau
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France
| | - Jean-Christophe Sol
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France
| | - Saloua Charni
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; CNRS UMR5549 Brain and Cognition (Cerco), Hôpital Purpan, Toulouse, France
| | - Elizabeth Cohen-Jonathan-Moyal
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France; INSERM U1037, Centre de Recherche contre le Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
| | - Franck-Emmanuel Roux
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; CNRS UMR5549 Brain and Cognition (Cerco), Hôpital Purpan, Toulouse, France
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Cohen MA, Cannon RB, Couldwell WT. Resection of Invasive Sphenoorbital and Cavernous Sinus Meningioma via Frontotemporal Craniotomy. World Neurosurg 2020; 141:252. [PMID: 32416238 DOI: 10.1016/j.wneu.2020.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
Sphenoorbital meningiomas require extensive bone removal around the superior and lateral orbital walls, superior orbital fissure, and anterior middle fossa floor. Incomplete resection can lead to recurrence or growth into the cavernous sinus (CS). A 46-year-old woman with a history of childhood leukemia treated with chemotherapy and whole-body radiotherapy had presented to an outside institution in 2004 with headache and vision changes and undergone subtotal resection for right sphenoorbital meningioma. Residual tumor growth caused progressive optic neuropathy, and she underwent multiple orbital decompressions and fractionated radiotherapy. In 2017, she underwent another craniotomy for repeat resection. Additional tumor growth causing neuropathic facial pain syndrome and progressive ophthalmoplegia was treated with orbital enucleation. On referral to our institution, magnetic resonance imaging demonstrated right sphenoorbital and CS meningioma extending into the sella and nearly to the medial border of the contralateral CS. Given her complete ophthalmoplegia and recent orbital enucleation, she underwent revision right frontotemporal craniotomy for radical resection of invasive meningioma, including right internal carotid artery occlusion and CS resection (Video 1). The skull-base defect was repaired with autologous fascia and a free muscle flap. Postoperative transient aphasia and left hemiparesis resolved over several days. At the 1-month follow-up examination, she was neurologically intact, with moderate improvement of facial pain syndrome (preoperative pain score, 9 of 10; postoperative pain score, 6 of 10). Magnetic resonance imaging demonstrated gross total resection. Pathological tissue analysis was consistent with grade 1 meningioma with an increased MIB-1 proliferative index, although, clinically, the tumor behaved more malignantly. The patient provided consent.
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Affiliation(s)
- Michael A Cohen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Richard B Cannon
- Division of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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Saito T, Muragaki Y, Maruyama T, Komori T, Nitta M, Tsuzuki S, Fukui A, Kawamata T. Influence of wide opening of the lateral ventricle on survival for supratentorial glioblastoma patients with radiotherapy and concomitant temozolomide-based chemotherapy. Neurosurg Rev 2019; 43:1583-1593. [PMID: 31705405 DOI: 10.1007/s10143-019-01185-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 01/04/2023]
Abstract
The prognosis for glioblastoma (GBM) varies among patients. Ventricular opening during surgery has been reported as a prognostic factor for GBM patients, but the influence of ventricular opening itself on patient prognosis remains controversial. We presumed that the degree of ventricular opening would correlate with the degree of subventricular zone (SVZ) resection and with prognosis in GBM patients. This study therefore investigated whether the degree of ventricular opening correlates with prognosis in GBM patients treated with the standard protocol of chemo-radiotherapy. Participants comprised 111 patients with newly diagnosed GBM who underwent surgery and received postoperative radiotherapy and temozolomide-based chemotherapy from 2005 to 2018. We classified 111 patients into "No ventricular opening (NVO)", "Ventricular opening, small (VOS; distance < 23.2 mm)", and "Ventricular opening, wide (VOW; distance ≥ 23.2 mm)" groups. We evaluated the relationship between degree of ventricular opening and prognosis using survival analyses that included other clinicopathological factors. Log-rank testing revealed age, Karnofsky performance status (KPS), extent of resection, O6-methylguanine-DNA methyltransferase (MGMT) status, isocitrate dehydrogenase (IDH)1 mutation, and degree of ventricular opening correlated significantly with overall survival. Multivariate analysis identified the degree of ventricular opening (small vs. wide) as the most significant prognostic factor (hazard ratio = 3.674; p < 0.0001). We demonstrated that wide opening of the lateral ventricle (LV) contributes to longer survival compared with small opening among GBM patients. Our results indicate that wide opening of the LV may correlate with the removal of a larger proportion of tumor stem cells from the SVZ.
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Affiliation(s)
- Taiichi Saito
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Masayuki Nitta
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shunsuke Tsuzuki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Corniola MV, Lemée JM, Da Broi M, Joswig H, Schaller K, Helseth E, Meling TR. Posterior fossa meningiomas: perioperative predictors of extent of resection, overall survival and progression-free survival. Acta Neurochir (Wien) 2019; 161:1003-1011. [PMID: 30859321 DOI: 10.1007/s00701-019-03862-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posterior fossa meningiomas (PFMs) often represent surgical challenges due to their proximity to neurovascular structures. Factors predicting the extent of resection (EOR), overall survival (OS), and progression-free survival (PFS) were identified and integrated in a prediction tool to offer evidence-based personalized therapeutic strategies. METHODS All meningiomas managed surgically from 1990 to 2010 from a single-center were reviewed. A classification tree was created using the classification and regression tree recursive partitioning analysis that incorporated patient and tumor data available before surgery in order to predict the rates of gross total resection (GTR). RESULTS A total of 198 patients were identified (female-to-male ratio, 2.7; mean age, 59.1 years) and compared with 1271 supratentorial meningiomas (STMs) operated in the same institution during the same time period. GTR was achieved less often (59.6% versus 81.9%; p < 0.01) in PFMs than STMs. Preoperative neurological symptoms were predictive of higher Simpson grades (OR, 2.19 [1.05; 4.58]; p = 0.04). Age was associated with reduced OS (OR, 1.08 [1.04;1.12]; p < 0.001). A KPS ≥ 70 was associated with higher survival rates (OR, 2.70 [2.19;2.92]; p = 0.02). Higher WHO grades were associated with reduced OS (OR, 3.56 [1.02;12.47]; p = 0.05). The GTR rate varies from 80% in patients without a preoperative deficit to 40% patients with a preoperative deficit, younger than 60 years old, and with adjacent bone invasion. CONCLUSIONS This study provides a classification tree of the predictors of EOR in PFMs, based upon preoperative demographic, clinical, and radiological variables. An evidence-based management protocol with estimated EORs may guide the decision-making process in PFMs.
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Affiliation(s)
- Marco V Corniola
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland.
| | - Jean-Michel Lemée
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland
| | | | - Holger Joswig
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland
| | - Karl Schaller
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eirik Helseth
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Torstein R Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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Guo Y, Xu S, Li X, Ma X. Preliminary study on Sina (Sina Intraoperative Neurosurgical Assist) APP assisted localization of supratentorial lesions by smart phone. J Clin Neurosci 2019; 62:277-281. [PMID: 30612915 DOI: 10.1016/j.jocn.2018.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/23/2018] [Accepted: 12/22/2018] [Indexed: 11/29/2022]
Abstract
This article is aimed at investigating the use of smart phone software Sina in the localization of supratentorial lesions, finding the error between Sina method and neuronavigation, and identifying the reliability of the new method. Neuronavigation and Sina measurement were used to locate the lesion in the patients whose lesion lengths are between 2 cm and 6 cm. The reference point was the center of the lesion. We found the error of Sina method is 13.6 ± 0.55 mm comparing with neuronavigation, so the Sina method still cannot replace the localization method of the neuronavigation system. However, in practical clinical work, with the help of the new method, the lesion can be located more precisely and easily.
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Affiliation(s)
- Yu Guo
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan 250012, China; Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Shujun Xu
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Xiangyu Ma
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan 250012, China.
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Abstract
Background This study aims to identify the prevalence of and risk factors for seizure development after supratentorial brain tumor resection in pediatric patients. This could be used to guide the postoperative management and usage of anti-epileptic drugs (AEDs). Methods Retrospective study was conducted for patients between 0 and 21 years with supratentorial tumor resection between 2005 and 2015 at a single institution. Results Two hundred patients (114 males/86 females) were identified. Median age at resection (±SD) was 9.025 ± 5.720 years and mean follow-up was 4 ± 2 years. Resection was gross total in 82 patients (41%) and partial in 118 patients (59%); 66 patients (33%) experienced preoperative seizures, and 67 patients (34%) experienced postoperative seizures; 18 patients (27%) had early seizures, and 49 patients (73%) had late seizures. Univariate analysis identified risk factors for postoperative seizures as: preoperative seizures (P < 0.001), age less than 2 years (P = 0.003), temporal location (P < 0.001), thalamic location (P = 0.017), preoperative hyponatremia (P = 0.017), World Health Organization grade (P = 0.008), and pathology (P = 0.005). Multivariate regression identified 5 robust risk factors: temporal location (odds ratio [OR] 4.7, 95% CI: 1.7-13.3, P = 0.003), age <2 years (OR 3.9, 95% CI: 1.0-15.4; P = 0.049), preoperative hydrocephalus (OR 3.8, 95% CI: 1.5-9.4; P = 0.005), preoperative seizure (OR 2.8, 95% CI: 1.2-6.5; P = 0.016) and parietal location (OR 0.25, 95% CI: 0.06-0.99; P = 0.049). Extent of resection did not correlate with seizure development (P > 0.05). Conclusions This study reveals 5 risk factors for postoperative seizures after resection of supratentorial tumors. These factors should be considered in postoperative management of these patients.
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Affiliation(s)
- Fadi S Saadeh
- Division of Neurosurgery, Children’s Hospital of Los Angeles, Los Angeles, California
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Edward F Melamed
- Division of Neurosurgery, Children’s Hospital of Los Angeles, Los Angeles, California
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nolan D Rea
- Division of Neurosurgery, Children’s Hospital of Los Angeles, Los Angeles, California
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mark D Krieger
- Division of Neurosurgery, Children’s Hospital of Los Angeles, Los Angeles, California
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Martynov BV, Kholyavin AI, Nizkovolos VB, Parfenov VE, Trufanov GE, Svistov DV. Stereotactic Cryodestruction of Gliomas. Prog Neurol Surg 2018; 32:27-38. [PMID: 29990971 DOI: 10.1159/000469677] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Surgical resection of gliomas affecting functionally important brain structures is associated with high risk of permanent postoperative neurological deficit and deterioration of the patient's quality of life. The availability of modern neuroimaging and neuronavigation permits the application of minimally invasive stereotactic cryodestruction of the tumor in such cases. The authors used this treatment in 88 patients with supratentorial gliomas of various WHO histopathological grades not suitable for microsurgical resection. Postoperative mortality (1.1%) and rate of surgical complications (11.4%) were comparable to reported results of stereotactic brain tumor biopsy, whereas the rate of neurological morbidity (42%) was comparable to outcome after resection of gliomas within eloquent brain areas. The majority of complications were temporary, and permanent deterioration of neurological function was noted in 8% of cases only. The median survival after treatment in patients with glioblastoma and anaplastic astrocytoma was 12.4 and 46.9 months, respectively, and was not reached in cases of diffuse astrocytoma, which compared favorably both with historical controls and literature data. Therefore, it seems reasonable to consider stereotactic cryodestruction in multimodality management strategies of "unresectable" intracranial gliomas, and further studies directed at evaluation of its efficacy are definitely needed.
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Sivakumar W, Jensen M, Martinez J, Tanana M, Duncan N, Hoesch R, Riva-Cambrin JK, Kilburg C, Ansari S, House PA. Intravenous acetaminophen for postoperative supratentorial craniotomy pain: a prospective, randomized, double-blinded, placebo-controlled trial. J Neurosurg 2018; 130:766-722. [PMID: 29676689 DOI: 10.3171/2017.10.jns171464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 10/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Acute pain control after cranial surgery is challenging. Prior research has shown that patients experience inadequate pain control post-craniotomy. The use of oral medications is sometimes delayed because of postoperative nausea, and the use of narcotics can impair the evaluation of brain function and thus are used judiciously. Few nonnarcotic intravenous (IV) analgesics exist. The authors present the results of the first prospective study evaluating the use of IV acetaminophen in patients after elective craniotomy. METHODS The authors conducted a randomized, double-blinded, placebo-controlled investigation. Adults undergoing elective, supratentorial craniotomies between September 2013 and June 2015 were randomized into two groups. The experimental group received 1000 mg/100 ml IV acetaminophen every 8 hours for 48 hours. The placebo group received 100 ml of 0.9% normal saline on the same schedule. Both groups were also treated with a standardized pain control algorithm. The study was powered to detect a 30% difference in the primary outcome measures: narcotic consumption (morphine equivalents, ME) at 24 and 48 hours after surgery. Patient-reported pain scores immediately postoperatively and 48 hours after surgery were also recorded. RESULTS A total of 204 patients completed the trial. No significant differences were found in narcotic consumption between groups at either time point (in the treatment and placebo groups, respectively, at 24 hours: 84.3 ME [95% CI 70.2–98.4] and 85.5 ME [95% CI 73–97.9]; and at 48 hours: 123.5 ME [95% CI 102.9–144.2] and 134.2 ME [95% CI 112.1–156.3]). The difference in improvement in patient-reported pain scores between the treatment and placebo groups was significant (p < 0.001). CONCLUSIONS Patients who received postoperative IV acetaminophen after craniotomy did not have significantly decreased narcotic consumption but did experience significantly lower pain scores after surgery. The drug was well tolerated and safe in this patient population.
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Affiliation(s)
| | | | - Julie Martinez
- 3Neurosciences Clinical Program, Intermountain Healthcare, Murray
| | - Michael Tanana
- 4Department of Biostatistics, Biosocial Research Institute, University of Utah, Salt Lake City, Utah; and
| | | | - Robert Hoesch
- 2Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City
- 3Neurosciences Clinical Program, Intermountain Healthcare, Murray
| | - Jay K Riva-Cambrin
- Departments of1Neurosurgery and
- 5Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | | | - Safdar Ansari
- 2Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City
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Abstract
RATIONALE Cerebellar liponeurocytoma is a rare tumor of the central nervous system (CNS) characterized by low proliferation but high likelihood of recurrence. Because of its rarity and the paucity of systematic follow-up, the biological behaviors and clinical features of this tumor are still poorly understood. We herein reported a case of cerebellar liponeurocytoma originating in the cerebral hemisphere. PATIENT CONCERNS A 11-year-old male with intermittent headache, nausea, and vomiting. The first computed tomography revealed a large mass in the right cerebral hemisphere. He was transferred to our institution for neurosurgical treatment. DIAGNOSIS Magnetic resonance imaging showed a large cystic-solid mass in the right frontal lobe with obvious contrast enhancement. Histopathological examinations showed sheets of isomorphic small neoplastic cells with clear cytoplasm and focal lipomatous differentiation. On immunohistochemistry, tumor cells were positive for synaptophysin, microtubule-associated protein 2, and neuronal nuclei antigen. INTERVENTIONS The patient was performed a right fronto-parietal craniotomy, and gross total resection of the tumor was achieved without adjuvant therapy. OUTCOMES No clinical or neuroradiological evidence of recurrence or residual of the tumor was found 6 years and 2 months after initial surgery. LESSONS Cerebellar liponeurocytoma developing in supratentorial cerebral hemisphere was first reported in the present study. The radiological and histopathological features may be useful in differentiating this rare tumor from other tumors at similar locations. A change in the nomenclature of cerebellar liponeurocytomas should be considered in future World Health Organization (WHO) classifications.
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Affiliation(s)
- Jinxiu Cai
- Department of Radiology, Beijing Tiantan Hospital affiliated to Capital Medical University
| | - Wanlan Li
- Department of Radiology, Beijing Tiantan Hospital affiliated to Capital Medical University
| | - Jiang Du
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing
| | - Nini Xu
- Department of Radiology, Beijing Tiantan Hospital affiliated to Capital Medical University
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital affiliated to Capital Medical University
| | - Jian Zhou
- Department of Radiology, Beijing Tiantan Hospital affiliated to Capital Medical University
| | - Xiaofeng Li
- Department of Nuclear Medicine, Shenzhen Hospital of Southern Medical University, Bao’an, Shenzhen, China
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Shafiq F, Salim F, Enam A, Parkash J, Faheem M. Anaesthetic Management of Supratentorial Tumor Craniotomy Using Awake-Throughout Approach. J Coll Physicians Surg Pak 2017; 27:775-777. [PMID: 29185406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 09/10/2017] [Indexed: 06/07/2023]
Abstract
The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length of stay in hospital.
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Affiliation(s)
- Faraz Shafiq
- Department of Anaesthesiology, The Aga Khan University, Karachi
| | - Fahad Salim
- Department of Anaesthesiology, The Aga Khan University, Karachi
| | - Ather Enam
- Department of Neurosurgery, The Aga Khan University, Karachi
| | - Jai Parkash
- Department of Anaesthesiology, The Aga Khan University, Karachi
| | - Mohammad Faheem
- Department of Neurosurgery, The Aga Khan University, Karachi
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Cui Q, Peng Y, Liu X, Jia B, Dong J, Han R. Effect of anesthesia depth on postoperative clinical ou tcome in patients with supratentorial tumor (DEPTH): study protocol for a randomized controlled trial. BMJ Open 2017; 7:e016521. [PMID: 28899891 PMCID: PMC5595190 DOI: 10.1136/bmjopen-2017-016521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Recent studies have shown that deep anaesthesia is associated with poor outcomes. However, no randomised controlled trials have been conducted to test the causality in patients undergoing brain tumour resection. METHODS AND ANALYSIS DEPTH is a multicenter, randomised, parallel-group, blind trial. The depth of general anaesthesia will be monitored using the bispectral index (BIS). Patients elected for supratentorial tumour resection will be randomly allocated to the deep or the light anaesthesia group in which the target BIS value is 35 or 50, respectively. BIS will be maintained at the target value for more than 90% of the total anaesthesia period. The primary outcome is the disability-free survival rate at postoperative 30 days and 1 year. The secondary outcomes are the mortality and morbidity within 30 days after surgery. ETHICS APPROVAL AND DISSEMINATION Ethical approval has been granted by the Medical Ethics Committee of Beijing Tiantan Hospital, Capital Medicine University. The reference number is KY2016-059-02. The results of this study will be disseminated through presentations at scientific conferences and publication in scientific journals. TRIAL REGISTRATION NCT03033693.
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Affiliation(s)
- Qianyu Cui
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyuan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Jia
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia Dong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Beez T, Burgula S, Kamp M, Rapp M, Steiger HJ, Sabel M. Space-Occupying Tumor Bed Cysts as a Complication of Modern Treatment for High-Grade Glioma. World Neurosurg 2017; 104:509-515. [PMID: 28512049 DOI: 10.1016/j.wneu.2017.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The management of high-grade glioma (HGG) has been affected by recent landmark trials and is now more proactive. More aggressive treatment leads to hospitalization due to side effects, however. Space-occupying tumor bed cysts have been described, but not systematically assessed. We sought to analyze this complication in a contemporary HGG cohort. METHODS We performed a retrospective review of patients with HGG treated between 2007 and 2013, identified patients with space-occupying tumor bed cysts, and reviewed their hospital notes for relevant variables. Statistical analyses were performed, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS Tumor bed cysts were found in 12 of 282 patients (4%). The main symptoms were increased intracranial pressure (n = 11), new focal deficits (n = 6), and pseudomeningocele (n = 3), presenting at a median of 19 days since the last resection. Cysts were treated with cystoperitoneal (n = 7) and ventriculoperitoneal (n = 5) shunts, resulting in clinical benefit in 75% of those treated. Intraoperative opening of ventricles is a risk factor, with an OR of 39.339. We propose a classification system comprising 3 cyst types: isolated cyst, cyst with local cerebrospinal fluid (CSF) disturbance, and cyst with global CSF disturbance. CONCLUSIONS In modern neuro-oncology, the rate of tumor bed cysts complicating HGG management appears stable compared with historical data. Shunt implantation is feasible and effective. We propose a classification system as a common data element for comparison across future studies.
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Affiliation(s)
- Thomas Beez
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
| | - Sven Burgula
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Marcel Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Marion Rapp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Höhne J, Hohenberger C, Proescholdt M, Riemenschneider MJ, Wendl C, Brawanski A, Schebesch KM. Fluorescein sodium-guided resection of cerebral metastases-an update. Acta Neurochir (Wien) 2017; 159:363-367. [PMID: 28012127 DOI: 10.1007/s00701-016-3054-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cerebral metastasis (CM) is the most common malignancy affecting the brain. In patients eligible for surgery, complete tumor removal is the most important predictor of overall survival and neurological outcome. The emergence of surgical microscopes fitted with a fluorescein-specific filter have facilitated fluorescein-guided microsurgery and identification of tumor tissue. In 2012, we started evaluating fluorescein (FL) with the dedicated microscope filter in cerebral metastases (CM). After describing the treatment results of our first 30 patients, we now retrospectively report on 95 patients. METHODS Ninety-five patients with CM of different primary cancers were included (47 women, 48 men, mean age, 60 years, range, 25-85 years); 5 mg/kg bodyweight of FL was intravenously injected at induction of anesthesia. A YELLOW 560-nm filter (Pentero 900, ZEISS Meditec, Germany) was used for microsurgical tumor resection and resection control. The extent of resection (EOR) was assessed by means of early postoperative contrast-enhanced MRI and the grade of fluorescent staining as described in the surgical reports. Furthermore, we evaluated information on neurological outcome and surgical complications as well as any adverse events. RESULTS Ninety patients (95%) showed bright fluorescent staining that markedly enhanced tumor visibility. Five patients (5%); three with adenocarcinoma of the lung, one with melanoma of the skin, and one with renal cell carcinoma) showed insufficient FL staining. Thirteen patients (14%) showed residual tumor tissue on the postoperative MRI. Additionally, the MRI of three patients did not confirm complete resection beyond doubt. Thus, gross-total resection had been achieved in 83% (n = 79) of patients. No adverse events were registered during the postoperative course. CONCLUSIONS FL and the YELLOW 560-nm filter are safe and feasible tools for increasing the EOR in patients with CM. Further prospective evaluation of the FL-guided technique in CM-surgery is in planning.
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Affiliation(s)
- Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
- Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany.
| | - Christoph Hohenberger
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
- Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
- Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
| | - Markus J Riemenschneider
- Institute of Neuropathology, University Medical Center Regensburg, Regensburg, Germany
- Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
| | - Christina Wendl
- Institute of Radiology, Neuroradiology Branch, University Medical Center Regensburg, Regensburg, Germany
- Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
| | - Alexander Brawanski
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
- Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
| | - Karl-Michael Schebesch
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
- Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
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Turel MK, Tsermoulas G, Reddy D, Andrade-Barazarte H, Zadeh G, Gentili F. Endonasal endoscopic transsphenoidal excision of tuberculum sellae meningiomas: a systematic review. J Neurosurg Sci 2016; 60:463-475. [PMID: 27280544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The endonasal endoscopic approach (EEA) for the resection of tuberculum sellae meningiomas (TSMs) has, more recently, been advocated as an alternative approach to deal with this challenging tumor. The aim of this study was to conduct a systematic review of publications of TSMs excised through the transsphenoidal route in the past 10 years and review data on the extent of excision, visual outcomes and complication rates. EVIDENCE ACQUISITION We performed a thorough systematic review of the medical literature following the PRISMA guidelines. A medical librarian retrieved a list of 3443 articles published from 2006-2015 from the MEDLINE, EMBASE and Cochrane Central databases. Two of the authors independently screened for titles and abstracts and excluded 3340 of them. We reviewed the full text of the remaining 103 articles and included in our analysis 12 that met the following inclusion criteria: 1) 5 or more cases reported; 2) the extent of resection, visual outcomes and complication rates that were specifically documented for TSMs excised through the transsphenoidal route. EVIDENCE SYNTHESIS Twelve studies that included 150 patients were analyzed. The mean age was 55 years. The mean tumor volume, reported in 2 studies, was 6.6 cc and mean maximum diameter, reported in 11 studies, was 25 mm. The gross total resection rate was 77.2%. Vision improved in 79.5% of cases and deteriorated in 7.3%. CSF leak postoperatively occurred in 15.3% of patients. In the 11 studies that reported hormonal outcomes, there was a 9.4% transient hyponatremia or diabetes insipidus and 2.2% of patients developed a new permanent endocrine dysfunction. A symptomatic vascular injury was reported in 2.6% of patients. There was one mortality (0.6%). CONCLUSIONS The endonasal endoscopic transsphenoidal excision of TSMs is a feasible, safe and effective surgical option with a low morbidity and mortality. The use of this approach has evolved in the last 10 years and in some centers has replaced the transcranial route for selected cases. Given the limited availability and heterogeneity of comparative observational studies, a direct comparison with transcranial approaches was not performed for the purpose of this review analysis. Likewise, from an epidemiological and statistical perspective a meta-analysis was deemed inappropriate.
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Affiliation(s)
- Mazda K Turel
- Division of Neurosurgery, Toronto Western Hospital, Toronto,ON Canada -
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Liang S, Zhang J, Zhang S, Fu X. Epilepsy in Adults with Supratentorial Glioblastoma: Incidence and Influence Factors and Prophylaxis in 184 Patients. PLoS One 2016; 11:e0158206. [PMID: 27438472 PMCID: PMC4954674 DOI: 10.1371/journal.pone.0158206] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/13/2016] [Indexed: 11/19/2022] Open
Abstract
AIM To analyze the incidence of epilepsy in adult patients with supratentorial glioblastoma, assess the factors influencing the development of epilepsy in these cases, and evaluate patients' response to antiepileptic drugs (AEDs) in a series of 184 patients. METHODS We retrospectively analyzed the 184 adult patients diagnosed with supratentorial glioblastoma. All subjects were treated within our hospital and subsequently died between 2003 and 2013. The incidence of epilepsy was assessed before and after initial resection and reexamined every 2 months thereafter. We evaluated the efficacy of prophylactic AEDs in this patient population based on the gathered incidence data. RESULTS Of 184 patients, 43 (23.37%) were diagnosed with epilepsy before their initial resection. The total incidence of epilepsy (both pre- and postoperative) was 68.48%. The prevalence of active epilepsy reached over 80% in patients with epilepsy and survival of greater than 13 months postoperatively. Patients with glioblastoma in the frontal and/or temporal lobes had a higher prevalence of epilepsy. In the 43 patients with preoperative epilepsy, total resection of glioblastoma resulted in significantly lower seizure frequency. Patients who received epilepsy prophylaxis with AEDs for at least 6 months had significantly fewer seizures and higher Karnofsky scores than those receiving AEDs for less than one month or not at all. CONCLUSION The incidence of epilepsy in adult patients with glioblastoma was high and responded poorly to AEDs in the short term. However, when taken for longer periods, AEDs can reduce the frequency of seizures in patients with glioblastoma.
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Affiliation(s)
- Shuli Liang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China
- Department of Neurosurgery, First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
| | - Junchen Zhang
- Department of Neurosurgery, Affiliated Hospital of Jining Medical College, Jining, 272029, China
| | - Shaohui Zhang
- Department of Neurosurgery, First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
| | - Xiangping Fu
- Department of Neurosurgery, First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
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Neal A, Yuen T, Bjorksten AR, Kwan P, O'Brien TJ, Morokoff A. Peritumoural glutamate correlates with post-operative seizures in supratentorial gliomas. J Neurooncol 2016; 129:259-67. [PMID: 27311724 DOI: 10.1007/s11060-016-2169-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
To examine the impact of glutamate on post-operative seizures and survival in a cohort of patients with grade II to IV supratentorial glioma. A retrospective analysis was performed on 216 patients who underwent surgery for supratentorial gliomas. Primary explanatory variables were peritumoural and/or tumoural glutamate concentrations, glutamate transporter expression (EAAT2 and SXC). Univariate and multivariate survival analysis was performed with primary outcomes of time to first post-operative seizure and overall survival. Subgroup analysis was performed in patients with de novo glioblastomas who received adjuvant chemoradiotherapy. 47 (21.8 %), 34 (15.8 %) and 135 (62.5 %) WHO grade II, III and IV gliomas respectively were followed for a median of 15.8 months. Following multivariate analysis, there was a non-significant association between higher peritumoural glutamate concentrations and time to first post-operative seizure (HR 2.07, CI 0.98-4.37, p = 0.06). In subgroup analysis of 81 glioblastoma patients who received adjunct chemoradiotherapy, peritumoural glutamate concentration was significantly associated with time to first post-operative seizure (HR 3.10, CI 1.20-7.97, p = 0.02). In both the overall cohort and subgroup analysis no glutamate cycle biomarkers were predictive of overall survival. Increased concentrations of peritumoural glutamate were significantly associated with shorter periods of post-operative seizure freedom in patients with de novo glioblastomas treated with adjuvant chemoradiotherapy. No glutamate cycle biomarkers were predictive of overall survival. These results suggest that therapies targeting glutamate may be beneficial in tumour associated epilepsy.
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Affiliation(s)
- Andrew Neal
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia.
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia.
| | - Tanya Yuen
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
| | - Andrew R Bjorksten
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, 3050, Parkville, VIC, Australia
| | - Patrick Kwan
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
| | - Terence J O'Brien
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
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Wang C, Yu X, Shrestha S, Qian C, Wang L, Chen G. A predicted model for postoperative seizure outcomes after the surgical resection of supratentorial cavernous malformations. Medicine (Baltimore) 2016; 95:e4078. [PMID: 27368051 PMCID: PMC4937965 DOI: 10.1097/md.0000000000004078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To explore a predicted model for postoperative seizure outcomes after the surgical resection of supratentorial cavernous malformations.This study was a retrospective review of consecutive patients with cerebral supratentorial cavernous malformations presenting with seizures. All patients underwent surgical resection of CCMs. Univariate and multivariate analyses were performed to determine the predictive value of the preoperative seizure frequency, seizure type, seizure duration, lesion location, lesion size, and the presence of residual hemosiderin.A total of 43 patients met the inclusion criteria. After a mean follow-up period of 40.95 months, 34 patients who were free from postoperative seizures were classified into Engel class I, and the remaining 9 patients were classified into Engel classes II-IV. A univariate analysis showed that the seizure frequency (χ = 13.440, P = 0.004) and seizure duration (χ = 5.145, P = 0.023) prior to surgery were associated with a worse postoperative seizure prognosis. Other covariates including age at onset, gender, a history of the medications taken, smoking status, family history, lesion characteristics, and the role of hemosiderin were not related to seizure outcomes. Logistic regression results demonstrated that the preoperative seizure frequency was an effective predictor (P = 0.004). The receiver operating characteristic curve indicated that area under the curve for the preoperative seizure frequency test was 0.833 (95% confidence interval 0.709-0.957, P = 0.002).The preoperative seizure frequency was a prognostic factor for postoperative seizure outcomes after surgical resection of supratentorial cavernous malformations. To obtain a favorable prognosis for CCM patients with preoperative seizures, early intervention might be a better choice.
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Affiliation(s)
| | | | | | | | | | - Gao Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Correspondence: Gao Chen, Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China ()
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Aver'yanov DA, Lukash AA, Prokudin MY, Skiba IB, Shchegolev B. [NON-CONVULSIVE EPILEPTIC SEIZURE IN PATIENT WITH DELAYED AWAKENING AFTER SUPRATENTORIAL TUMOR REMOVAL]. Anesteziol Reanimatol 2016; 61:143-146. [PMID: 27468507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In some cases after elective neurosurgical procedures we use technique of delayed awakening of patients. Prolonged sedation however can hide the development of epileptic seizures and lead to the status epilepticus formation. This article is a demonstration and discussion of a clinical case of nonconvulsive status epilepticus during delayed awakening of the patient due to prolonged sedation after elective neurosurgical interventionsforsupratentorial brain tumor Presented case suggests the presence of significant risk of nonconvulsive status epilepticus during prolonged sedation. For early detection we advise to use continuous EEG monitoring during the entire period of sedation.
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Sirivanasandha B, Sakaew A, Sutthivaiyakit K, Raksamani K, Waitayawinyu P, Rushatamukayanunt P, Punkla W. An Equivalence Trial Comparing Labetalol and Diltiazem in Controlling Emergence Hypertension after Supratentorial Tumor Surgery. J Med Assoc Thai 2015; 98:1104-1111. [PMID: 26817181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Hypertension and tachycardia during emergence from anesthesia for craniotomy could increase risks of cerebral complications. Several anesthetic, sedative, and antihypertensive drugs have been suggested that may be successful at suppressing these unwanted hemodynamic consequences. OBJECTIVE To study the equivalent efficacy and side effects of two antihypertensive drugs, diltiazem and labetalol. MATERIAL AND METHOD A block randomized control trial was performed in 184 patients who developed emergence hypertensive response after craniotomyfor supratentorial tumor removal. Systolic blood pressure (SBP) of each patient was suppressed by 2.5 mg of study drugs and repeated with fix dosage of 2.5 mg every two to three minutes to maintain SBP lower than 140 mmHg with a cumulative dose within 20 mg. Data regarding demographic, successful rate in controlling hypertension, drug dosage, and incidence of side effects were analyzed. RESULTS The success rate of treatment of labetalol was equivalent to diltiazem (87.1% and 80.2% respectively) [p = 0.003, 95% CI = 6.88 (-2.06 to 15.8)]. There was no statistical significant difference on dosage of drugs used or incidence ofside effect (hypotension, bradycardia, heart block, and bronchospasm). Median (minimum-maximum) dosage of labetalol and diltiazem were 10 mg (2.5-20 mg) and 10 mg (2.5-20 mg) respectively. The expense for labetalol was 1/6 of diltiazem. CONCLUSION Labetalol has equivalent efficacy to diltiazem. Both drugs used low median dosage giving low incidence of side-effects. Labetalol is a good alternative drug to control hypertensive response during emergence from anesthesia for post-craniotomy.
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Delion M, Terminassian A, Lehousse T, Aubin G, Malka J, N'Guyen S, Mercier P, Menei P. Specificities of Awake Craniotomy and Brain Mapping in Children for Resection of Supratentorial Tumors in the Language Area. World Neurosurg 2015; 84:1645-52. [PMID: 26164190 DOI: 10.1016/j.wneu.2015.06.073] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the pediatric population, awake craniotomy began to be used for the resection of brain tumor located close to eloquent areas. Some specificities must be taken into account to adapt this method to children. OBJECTIVE The aim of this clinical study is to not only confirm the feasibility of awake craniotomy and language brain mapping in the pediatric population but also identify the specificities and necessary adaptations of the procedure. METHODS Six children aged 11 to 16 were operated on while awake under local anesthesia with language brain mapping for supratentorial brain lesions (tumor and cavernoma). The preoperative planning comprised functional magnetic resonance imaging (MRI) and neuropsychologic and psychologic assessment. The specific preoperative preparation is clearly explained including hypnosis conditioning and psychiatric evaluation. The success of the procedure was based on the ability to perform the language brain mapping and the tumor removal without putting the patient to sleep. We investigated the pediatric specificities, psychological experience, and neuropsychologic follow-up. RESULTS The children experienced little anxiety, probably in large part due to the use of hypnosis. We succeeded in doing the cortical-subcortical mapping and removing the tumor without putting the patient to sleep in all cases. The psychological experience was good, and the neuropsychologic follow-up showed a favorable evolution. CONCLUSIONS Preoperative preparation and hypnosis in children seemed important for performing awake craniotomy and contributing language brain mapping with the best possible psychological experience. The pediatrics specificities are discussed.
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Affiliation(s)
- Matthieu Delion
- Department of Neurosurgery, Angers Teaching Hospital, Angers, France; Anatomy Laboratory, Medical Faculty, University of Angers, LUNAM, Angers, France.
| | - Aram Terminassian
- Department of Anesthesiology, Angers Teaching Hospital, Angers, France
| | - Thierry Lehousse
- Department of Anesthesiology, Angers Teaching Hospital, Angers, France
| | - Ghislaine Aubin
- Department of Neuropsychology, Angers Teaching Hospital, Angers, France
| | - Jean Malka
- Department of Child Psychiatry, Angers Teaching Hospital, Angers, France
| | - Sylvie N'Guyen
- Department of Pediatric Neurology, Angers Teaching Hospital, Angers, France
| | - Philippe Mercier
- Department of Neurosurgery, Angers Teaching Hospital, Angers, France; Anatomy Laboratory, Medical Faculty, University of Angers, LUNAM, Angers, France
| | - Philippe Menei
- Department of Neurosurgery, Angers Teaching Hospital, Angers, France
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Forest F, Yvorel V, Vassal F, Trombert B, Dumollard JM, Nuti C, Péoc'h M. Cerebral relapsing meningioma: a surgical series with lack of reliability of standard parameters establishing prognosis. Anticancer Res 2015; 35:3559-3562. [PMID: 26026125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Meningioma is the most frequent meningeal neoplasm, usually without relapse or metastasis. Patient follow-up is challenging, not standardized and is decided in multidisciplinary case discussion. Our aim was to determine the clinical and histological factors influencing the time to relapse. PATIENTS AND METHODS We conducted a single-Center retrospective study on 38 patients with surgically-excised relapsing meningiomas and collected clinical and pathological data. RESULTS Our results show that none of the histological factors included in the WHO classification, nor those not included are related to a shorter time to relapse. CONCLUSION In our study, none of the histological, immunohistochemical and clinical parameters evaluated seem to be able to predict the time to relapse in meningioma.
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Affiliation(s)
- Fabien Forest
- Department of Pathology, University Hospital of Saint Etienne-North Hospital, Saint Étienne, France
| | - Violaine Yvorel
- Department of Pathology, University Hospital of Saint Etienne-North Hospital, Saint Étienne, France
| | - François Vassal
- Department of Neurosurgery, University Hospital of Saint Etienne-North Hospital, Saint Étienne, France
| | - Béatrice Trombert
- Department of Medical Informatics, University Hospital of Saint Etienne-North Hospital, Saint Étienne, France
| | - Jean-Marc Dumollard
- Department of Pathology, University Hospital of Saint Etienne-North Hospital, Saint Étienne, France
| | - Christophe Nuti
- Department of Neurosurgery, University Hospital of Saint Etienne-North Hospital, Saint Étienne, France
| | - Michel Péoc'h
- Department of Pathology, University Hospital of Saint Etienne-North Hospital, Saint Étienne, France
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Schebesch KM, Hoehne J, Hohenberger C, Proescholdt M, Riemenschneider MJ, Wendl C, Brawanski A. Fluorescein sodium-guided resection of cerebral metastases—experience with the first 30 patients. Acta Neurochir (Wien) 2015; 157:899-904. [PMID: 25824557 DOI: 10.1007/s00701-015-2395-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical resection is a key element of the multidisciplinary treatment of cerebral metastases (CMs). Recent studies have highlighted the importance of complete resection of CMs for improving recurrence-free and overall survival rates. This study presents the first data on the use of fluorescein sodium (FL) under the dedicated surgical microscope filter YELLOW 560 nm (Zeiss Meditec, Germany) in patients with CM. METHODS Thirty patients with CMs of different primary cancers were included (15 females, 15 males; mean age 61.1 years); 200 mg of FL was intravenously injected directly before CM resection. A YELLOW 560 nm filter was used for microsurgical tumor resection and resection control. Surgical reports were evaluated regarding the degree of fluorescent staining, postoperative MRIs regarding the extent of resection [gadolinium (Gd)-enhanced T1-weighted sequence] and the postoperative courses regarding any adverse effects. RESULTS Most patients (90.0%, n = 27) showed bright fluorescent staining, which markedly enhanced tumor visibility. Three patients (10.0%) (two with adenocarcinoma of the lung and one with melanoma of the skin) showed no or only insufficient FL staining. Another three patients (10.0%) showed residual tumor tissue in the postoperative MRI examination. In two other patients, radiographic examination could not exclude the possibility of very small areas of residual tumor tissue. Thus, gross-total resection was achieved in 83.3% (n = 25) of patients. No adverse effects were registered over the postoperative course. CONCLUSIONS FL and the YELLOW 560 nm filter are safe and practical tools for the resection of CM, but further prospective research is needed to confirm that this advanced technique will improve the quality of CM resection.
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Affiliation(s)
- Karl-Michael Schebesch
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany,
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49
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Ringel F, Sala F. Intraoperative mapping and monitoring in supratentorial tumor surgery. J Neurosurg Sci 2015; 59:129-139. [PMID: 25690027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With the increasing strive for complete resections of supratentorial low or high-grade gliomas, the necessity for intraoperative electrical stimulation methods to map and monitor functional important cortical or subcortical brain areas increased. While many brain functions can be assessed during awake surgery using electrical stimulation, motor function as well as visual function can be mapped and monitored in the asleep patient, as well. Several different methods reviewed in this article are available which lead to an improved functional outcome while increasing the extent of tumor resection and thereby potentially the oncological outcome of the patient.
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Affiliation(s)
- F Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, München, Germany -
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50
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Conte V, Carrabba G, Magni L, L'Acqua C, Magnoni S, Bello L, Colombo A, Stocchetti N. Risk of perioperative seizures in patients undergoing craniotomy with intraoperative brain mapping. Minerva Anestesiol 2015; 81:379-388. [PMID: 25057931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The identification of risk factors associated with perioperative seizures would be of great benefit to the anesthesiologist in managing brain tumor patients undergoing craniotomy with intraoperative brain mapping. METHODS A series of 316 supratentorial craniotomies for tumor resection, in which intraoperative brain mapping was used, were analyzed. From January 2005 to December 2010 the occurrence of intraoperative and immediate postoperative clinical seizures was prospectively recorded into a database. Demographic data, tumor characteristics, preoperative seizure control, intraoperative events and anesthetic management were evaluated as risk factors for intraoperative clinical seizures. Additionally, the association between intraoperative clinical seizures and immediate postoperative seizures was evaluated. In order to determine the best predictors of intraoperative and immediate postoperative clinical seizures, a multivariable analysis by logistic regression was performed. RESULTS Younger age, location of the tumor in the frontal and parietal lobe, brain mapping conducted under general anesthesia and non physiologic values of arterial carbon dioxide (PaCO2) during brain mapping were independent positive risk factors for the development of intraoperative clinical seizures. Location of tumor in the frontal lobe, antiepileptic polytherapy, intraoperative seizures requiring pharmacologic treatment during brain mapping, and blood on postoperative CT scan were independent positive risk factors for the development of immediate postoperative seizures. CONCLUSION Clinical seizures are common intraoperative and postoperative complications of supratentorial craniotomies with intraoperative brain mapping. The identification of those patients at higher risk of seizures may guide intraoperative and postoperative medical management.
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Affiliation(s)
- V Conte
- Neuroscience ICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan University, Milan Italy -
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