ABSTRACT
Damage to the posterior language area (PLA), or Wernicke's area causes cortical reorganization in the corresponding regions of the contralateral hemisphere. However, the details of reorganization within the ipsilateral hemisphere are not fully understood. In this context, direct electrical stimulation during awake surgery can provide valuable opportunities to investigate neuromodulation of the human brain in vivo, which is difficult through the non-invasive approaches. Thus, in this study, we aimed to investigate the characteristics of the cortical reorganization of the PLA within the ipsilateral hemisphere. Sixty-two patients with left hemispheric gliomas were divided into groups depending on whether the lesion extended to the PLA. All patients underwent direct cortical stimulation with a picture-naming task. We further performed functional connectivity analyses using resting-state functional magnetic resonance imaging (MRI) in a subset of patients and calculated betweenness centrality, an index of the network importance of brain areas. During direct cortical stimulation, the regions showing positive (impaired) responses in the non-PLA group were localized mainly in the posterior superior temporal gyrus (pSTG), whereas those in the PLA group were widely distributed from the pSTG to the posterior supramarginal gyrus (pSMG). Notably, the percentage of positive responses in the pSMG was significantly higher in the PLA group (47%) than in the non-PLA group (8%). In network analyses of functional connectivity, the pSMG was identified as a hub region with high betweenness centrality in both the groups. These findings suggest that the language area can spread beyond the PLA to the pSMG, a hub region, in patients with lesion progression to the pSTG. The change in the pattern of the language area may be a compensatory mechanism to maintain efficient brain networks.
Subject(s)
Brain Neoplasms , Magnetic Resonance Imaging , Nerve Net , Wernicke Area , Humans , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/physiopathology , Male , Female , Middle Aged , Adult , Wernicke Area/diagnostic imaging , Wernicke Area/physiopathology , Wernicke Area/physiology , Nerve Net/diagnostic imaging , Nerve Net/physiopathology , Glioma/diagnostic imaging , Glioma/physiopathology , Glioma/surgery , Glioma/pathology , Electric Stimulation , Aged , Language , Connectome , Parietal Lobe/diagnostic imaging , Parietal Lobe/physiopathology , Brain Mapping , Young AdultABSTRACT
BACKGROUND: Non-invasive brain mapping using navigated transcranial magnetic stimulation (nTMS) is a valuable tool prior to resection of malignant brain tumors. With nTMS motor mapping, it is additionally possible to analyze the function of the motor system and to evaluate tumor-induced neuroplasticity. Distinct changes in motor cortex excitability induced by certain malignant brain tumors are a focal point of research. METHODS: A retrospective single-center study was conducted involving patients with malignant brain tumors. Clinical data, resting motor threshold (rMT), and nTMS-based tractography were evaluated. The interhemispheric rMT-ratio (rMTTumor/rMTControl) was calculated for each extremity and considered pathological if it was >110% or <90%. Distances between the corticospinal tract and the tumor (lesion-to-tract-distance - LTD) were measured. RESULTS: 49 patients were evaluated. 16 patients (32.7%) had a preoperative motor deficit. The cohort comprised 22 glioblastomas (44.9%), 5 gliomas of Classification of Tumors of the Central Nervous System (CNS WHO) grade 3 (10.2%), 6 gliomas of CNS WHO grade 2 (12.2%) and 16 cerebral metastases (32.7%). 26 (53.1%) had a pathological rMT-ratio for the upper extremity and 35 (71.4%) for the lower extremity. All patients with tumor-induced motor deficits had pathological interhemispheric rMT-ratios, and presence of tumor-induced motor deficits was associated with infiltration of the tumor to the nTMS-positive cortex (p = 0.04) and shorter LTDs (all p < 0.021). Pathological interhemispheric rMT-ratio for the upper extremity was associated with cerebral metastases, but not with gliomas (p = 0.002). CONCLUSIONS: Our study underlines the diagnostic potential of nTMS motor mapping to go beyond surgical risk stratification. Pathological alterations in motor cortex excitability can be measured with nTMS mapping. Pathological cortical excitability was more frequent in cerebral metastases than in gliomas.
Subject(s)
Brain Neoplasms , Diffusion Tensor Imaging , Motor Cortex , Pyramidal Tracts , Transcranial Magnetic Stimulation , Humans , Pyramidal Tracts/physiopathology , Pyramidal Tracts/diagnostic imaging , Pyramidal Tracts/pathology , Brain Neoplasms/physiopathology , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Motor Cortex/physiopathology , Motor Cortex/diagnostic imaging , Motor Cortex/pathology , Male , Female , Middle Aged , Retrospective Studies , Adult , Aged , Glioma/physiopathology , Glioma/pathology , Glioma/diagnostic imaging , Brain Mapping , Evoked Potentials, Motor/physiologyABSTRACT
This study aims to investigate the structural reorganization in the sensorimotor area of the brain in patients with gliomas, distinguishing between those with impaired and unimpaired strength. Using voxel-based morphometry (VBM) and region of interest (ROI) analysis, gray matter volumes (GMV) were compared in the contralesional primary motor gyrus, primary sensory gyrus, premotor area, bilateral supplementary motor area, and medial Brodmann area 8 (BA8). The results revealed that in patients with right hemisphere gliomas, the right medial BA8 volume was significantly larger in the impaired group than in the unimpaired group, with both groups exceeding the volume in 16 healthy controls (HCs). In patients with left hemisphere gliomas, the right supplementary motor area (SMA) was more pronounced in the impaired group compared to the unimpaired group, and both groups were greater than HCs. Additionally, the volumes of the right medial BA8 in both the impaired group were greater than HCs. Contralateral expansions in the gray matter of hand- and trunk-related cortices of the premotor area, precentral gyrus, and postcentral gyrus were observed compared to HCs. Furthermore, a negative correlation was found between hand Medical Research Council (MRC) score and volumes of the contralateral SMA and bilateral medial BA8. Notably, our findings reveal consistent results across both analytical approaches in identifying significant structural reorganizations within the sensorimotor cortex. These consistent findings underscore the adaptive neuroplastic responses to glioma presence, highlighting potential areas of interest for further neurosurgical planning and rehabilitation strategies.
Subject(s)
Brain Neoplasms , Functional Laterality , Glioma , Magnetic Resonance Imaging , Sensorimotor Cortex , Humans , Male , Glioma/diagnostic imaging , Glioma/pathology , Glioma/physiopathology , Female , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Brain Neoplasms/physiopathology , Adult , Middle Aged , Sensorimotor Cortex/diagnostic imaging , Sensorimotor Cortex/pathology , Sensorimotor Cortex/physiopathology , Functional Laterality/physiology , Gray Matter/diagnostic imaging , Gray Matter/pathology , Motor Cortex/diagnostic imaging , Motor Cortex/pathology , Motor Cortex/physiopathology , Brain Mapping , Young AdultABSTRACT
AIMS: We intend to elucidate the alterations of cerebral networks in patients with insular glioma-related epilepsy (GRE) based on resting-state functional magnetic resonance images. METHODS: We collected 62 insular glioma patients, who were subsequently categorized into glioma-related epilepsy (GRE) and glioma with no epilepsy (GnE) groups, and recruited 16 healthy individuals matched to the patient's age and gender to form the healthy control (HC) group. Graph theoretical analysis was applied to reveal differences in sensorimotor, default mode, visual, and executive networks among different subgroups. RESULTS: No significant alterations in functional connectivity were found in either hemisphere insular glioma. Using graph theoretical analysis, differences were found in visual, sensorimotor, and default mode networks (p < 0.05). When the glioma located in the left hemisphere, the degree centrality was reduced in the GE group compared to the GnE group. When the glioma located in the right insula, the degree centrality, nodal efficiency, nodal local efficiency, and nodal clustering coefficient of the GE group were lower than those of the GnE group. CONCLUSION: The impact of insular glioma itself and GRE on the brain network is widespread. The networks altered by insular GRE differ depending on the hemisphere location. GRE reduces the nodal properties of brain networks than that in insular glioma.
Subject(s)
Brain Neoplasms , Epilepsy , Glioma , Magnetic Resonance Imaging , Humans , Glioma/diagnostic imaging , Glioma/physiopathology , Glioma/complications , Male , Female , Adult , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/complications , Brain Neoplasms/physiopathology , Middle Aged , Epilepsy/diagnostic imaging , Epilepsy/physiopathology , Nerve Net/diagnostic imaging , Nerve Net/physiopathology , Insular Cortex/diagnostic imaging , Young Adult , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/physiopathologyABSTRACT
Although epilepsy is the most common comorbidity of brain tumors, epileptic spasms rarely occur. Brain tumors associated with epileptic spasms are mostly low-grade gliomas. To date, few studies in the literature have reported on malignant (Grades 3-4) brain tumors associated with epileptic spasms. Thus, we aimed to investigate the characteristics of malignant brain tumor-associated epileptic spasms. We retrospectively reviewed patients with malignant brain tumors and epileptic spasms in our institution. Data on demographics, tumor histology, magnetic resonance imaging, epileptic spasm characteristics, electroencephalography, and treatment responsiveness were also collected. Six patients were included. In all cases, the brain tumors occurred in infancy in the supratentorial region and epileptic spasm onset occurred after the completion of brain tumor treatment. Anti-seizure medication did not control epileptic spasms; two patients were seizure-free after epileptic surgery. Although all patients had developmental delays caused by malignant brain tumors and their treatment, developmental regression proceeded after epileptic spasm onset. Two patients who achieved seizure-free status showed improved developmental outcomes after cessation of epileptic spasms. This is the first report of the characteristics of malignant brain tumor-associated epileptic spasms. Our report highlights a difficulties of seizure control and possibillity of efficacy of epileptic surgery in this condition. In malignant brain tumor-associated epileptic spasms, it is important to proceed with presurgical evaluation from an early stage, bearing in mind that epileptic spasms may become drug-resistant.
Subject(s)
Brain Neoplasms , Electroencephalography , Humans , Male , Female , Brain Neoplasms/complications , Retrospective Studies , Infant , Child, Preschool , Epilepsy/etiology , Epilepsy/physiopathology , Magnetic Resonance Imaging , Glioma/complications , Glioma/physiopathology , Spasm/etiology , Spasm/physiopathology , Anticonvulsants/therapeutic use , ChildABSTRACT
PURPOSE: Understanding the complex bidirectional interactions between neurons and glioma cells could help to identify new therapeutic targets. Herein, the techniques and application of novel neuroscience tools implemented to study the complex interactions between brain and malignant gliomas, their results, and the potential therapeutic opportunities were reviewed. METHODS: Literature search was performed on PubMed between 2001 and 2023 using the keywords "glioma", "glioblastoma", "circuit remodeling", "plasticity", "neuron networks" and "cortical networks". Studies including grade 2 to 4 gliomas, diffuse midline gliomas, and diffuse intrinsic pontine gliomas were considered. RESULTS: Glioma cells are connected through tumour microtubes and form a highly connected network within which pacemaker cells drive tumorigenesis. Unconnected cells have increased invasion capabilities. Glioma cells are also synaptically integrated within neural circuitry. Neurons promote tumour growth via paracrine and direct electrochemical mechanisms, including glutamatergic AMPA-receptors. Increased glutamate release in the tumor microenvironment and loss of peritumoral GABAergic inhibitory interneurons result in network hyperexcitability and secondary epilepsy. Functional imaging, local field potentials and subcortical mapping, performed in awake patients, have defined patterns of malignant circuit remodeling. Glioma-induced remodeling is frequent in language and even motor cortical networks, depending on tumour biological parameters, and influences functional outcomes. CONCLUSION: These data offer new insights into glioma tumorigenesis. Future work will be needed to understand how tumor intrinsic molecular drivers influence neuron-glioma interactions but also to integrate these results to design new therapeutic options for patients.
Subject(s)
Brain Neoplasms , Glioma , Humans , Glioma/pathology , Glioma/metabolism , Glioma/physiopathology , Brain Neoplasms/pathology , Brain Neoplasms/metabolism , Brain Neoplasms/physiopathology , Neoplasm Invasiveness , Animals , Nerve Net/physiopathology , Nerve Net/pathology , Neurons/pathology , Neurons/physiology , Neurons/metabolismABSTRACT
Gliomas are primary brain tumours that are thought to develop from neural stem or progenitor cells that carry tumour-initiating genetic alterations. Based on microscopic appearance and molecular characteristics, they are classified according to the WHO classification of central nervous system (CNS) tumours and graded into CNS WHO grades 1-4 from a low to high grade of malignancy. Diffusely infiltrating gliomas in adults comprise three tumour types with distinct natural course of disease, response to treatment and outcome: isocitrate dehydrogenase (IDH)-mutant and 1p/19q-codeleted oligodendrogliomas with the best prognosis; IDH-mutant astrocytomas with intermediate outcome; and IDH-wild-type glioblastomas with poor prognosis. Pilocytic astrocytoma is the most common glioma in children and is characterized by circumscribed growth, frequent BRAF alterations and favourable prognosis. Diffuse gliomas in children are divided into clinically indolent low-grade tumours and high-grade tumours with aggressive behaviour, with histone 3 K27-altered diffuse midline glioma being the leading cause of glioma-related death in children. Ependymal tumours are subdivided into biologically and prognostically distinct types on the basis of histology, molecular biomarkers and location. Although surgery, radiotherapy and alkylating agent chemotherapy are the mainstay of glioma treatment, individually tailored strategies based on tumour-intrinsic dominant signalling pathways have improved outcome in subsets of patients.
Subject(s)
Brain Neoplasms , Glioma , Humans , Glioma/genetics , Glioma/physiopathology , Glioma/therapy , Brain Neoplasms/genetics , Brain Neoplasms/therapy , Brain Neoplasms/diagnosis , Brain Neoplasms/physiopathology , Prognosis , Child , Isocitrate Dehydrogenase/genetics , MutationSubject(s)
Glioma , Humans , Glioma/physiopathology , Brain Neoplasms/physiopathology , Brain Neoplasms/diagnosisSubject(s)
Glioma , Neurons , Paracrine Communication , Synapses , Humans , Glioma/metabolism , Glioma/pathology , Glioma/physiopathology , Neurons/metabolism , Neurons/physiology , Synapses/physiology , Synapses/metabolism , Animals , Signal Transduction , Brain Neoplasms/metabolism , Brain Neoplasms/pathologyABSTRACT
OBJECTIVE: We investigated the feasibility of recording cortico-cortical evoked potentials (CCEPs) in patients with low- and high-grade glioma. We compared CCEPs during awake and asleep surgery, as well as those stimulated from the functional Broca area and recorded from the functional Wernicke area (BtW), and vice versa (WtB). We also analyzed CCEP properties according to tumor location, histopathology, and aphasia. METHODS: We included 20 patients who underwent minimally invasive surgery in an asleep-awake-asleep setting. Strip electrode placement was guided by classical Penfield stimulation of positive language sites and fiber tracking of the arcuate fascicle. CCEPs were elicited with alternating monophasic single pulses of 1.1 Hz frequency and recorded as averaged signals. Intraoperatively, there was no post-processing of the signal. RESULTS: Ninety-seven CCEPs from 19 patients were analyzed. There was no significant difference in CCEP properties when comparing awake versus asleep, nor BtW versus WtB. CCEP amplitude and latency were affected by tumor location and histopathology. CCEP features after tumor resection correlated with short- and long-term postoperative aphasia. CONCLUSION: CCEP recordings are feasible during minimally invasive surgery. CCEPs might be surrogate markers for altered connectivity of the language tracts. SIGNIFICANCE: This study may guide the incorporation of CCEPs into intraoperative neurophysiological monitoring.
Subject(s)
Brain Neoplasms , Evoked Potentials , Glioma , Language , Minimally Invasive Surgical Procedures , Humans , Glioma/surgery , Glioma/physiopathology , Male , Female , Brain Neoplasms/surgery , Brain Neoplasms/physiopathology , Middle Aged , Adult , Aged , Evoked Potentials/physiology , Minimally Invasive Surgical Procedures/methods , Electric Stimulation/methods , Intraoperative Neurophysiological Monitoring/methods , Cerebral Cortex/physiopathology , Cerebral Cortex/surgery , Wakefulness/physiologySubject(s)
Brain Neoplasms , Cerebral Cortex , Evoked Potentials , Glioma , Humans , Glioma/physiopathology , Glioma/diagnostic imaging , Brain Neoplasms/physiopathology , Brain Neoplasms/diagnostic imaging , Cerebral Cortex/physiopathology , Evoked Potentials/physiology , Male , Female , Language , Brain Mapping/methods , Neoplasm Grading , Adult , Middle AgedABSTRACT
We retrospectively analyzed data from 15 patients, with a normal pre-operative cognitive performance, undergoing awake surgery for left fronto-temporal low-grade glioma. We combined a pre-surgical measure (fMRI maps of motor- and language-related centers) with intra-surgical measures (MNI-registered cortical sites data obtained during intra-operative direct electrical stimulation, DES, while they performed the two most common language tasks: number counting and picture naming). Selective DES effects along the precentral gyrus/inferior frontal gyrus (and/or the connected speech articulation network) were obtained. DES of the precentral gyrus evoked the motor speech arrest, i.e., anarthria (with apparent mentalis muscle movements). We calculated the number of shared voxels between the lip-tongue and overt counting related- and silent naming-related fMRI maps and the Volumes of Interest (VOIs) obtained by merging together the MNI sites at which a given speech disturbance was observed, normalized on their mean the values (i.e., Z score). Both tongue- and lips-related movements fMRI maps maximally overlapped (Z = 1.05 and Z = 0.94 for lips and tongue vs. 0.16 and -1.003 for counting and naming) with the motor speech arrest seed. DES of the inferior frontal gyrus, pars opercularis and the rolandic operculum induced speech arrest proper (without apparent mentalis muscle movements). This area maximally overlapped with overt counting-related fMRI map (Z = -0.11 and Z = 0.09 for lips and tongue vs. 0.9 and 0.0006 for counting and naming). Interestingly, our fMRI maps indicated reduced Broca's area activity during silent speech compared to overt speech. Lastly, DES of the inferior frontal gyrus, pars opercularis and triangularis evoked variations of the output, i.e., dysarthria, a motor speech disorder occurring when patients cannot control the muscles used to produce articulated sounds (phonemes). Silent object naming-related fMRI map maximally overlapped (Z = -0.93 and Z = -1.04 for lips and tongue vs. -1.07 and 0.99 for counting and naming) with this seed. Speech disturbances evoked by DES may be thought of as selective interferences with specific recruitment of left inferior frontal gyrus and precentral cortex which are differentiable in terms of the specific interference induced.
Subject(s)
Brain Mapping , Brain Neoplasms , Electric Stimulation , Magnetic Resonance Imaging , Speech , Humans , Male , Female , Adult , Speech/physiology , Middle Aged , Brain Neoplasms/surgery , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/physiopathology , Retrospective Studies , Glioma/surgery , Glioma/diagnostic imaging , Glioma/physiopathology , Young Adult , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/physiopathology , Multimodal ImagingABSTRACT
Glioma is the most common primary malignant brain tumor in adults and remains an incurable disease at present. Thus, there is an urgent need for progress in finding novel molecular mechanisms that control the progression of glioma which could be used as therapeutic targets for glioma patients. The RNA binding protein cytoplasmic polyadenylate element-binding protein 2 (CPEB2) is involved in the pathogenesis of several tumors. However, the role of CPEB2 in glioma progression is unknown. In this study, the functional characterization of the role and molecular mechanism of CPEB2 in glioma were examined using a series of biological and cellular approaches in vitro and in vivo. Our work shows CPEB2 is significantly downregulated in various glioma patient cohorts. Functional characterization of CPEB2 by overexpression and knockdown revealed that it inhibits glioma cell proliferation and promotes apoptosis. CPEB2 exerts an anti-tumor effect by increasing p21 mRNA stability and inducing G1 cell cycle arrest in glioma. Overall, this work stands as the first report of CPEB2 downregulation and involvement in glioma pathogenesis, and identifies CPEB2 as an important tumor suppressor gene through targeting p21 in glioma, which revealed that CPEB2 may become a promising predictive biomarker for prognosis in glioma patients.
Subject(s)
Gene Expression Regulation, Neoplastic , Glioma , Oncogene Protein p21(ras) , RNA Stability , RNA-Binding Proteins , RNA-Binding Proteins/blood , RNA-Binding Proteins/genetics , RNA-Binding Proteins/metabolism , Cell Proliferation/genetics , Oncogene Protein p21(ras)/genetics , Oncogene Protein p21(ras)/metabolism , RNA Stability/genetics , Glioma/diagnosis , Glioma/physiopathology , Gene Knockdown Techniques , Apoptosis/genetics , Gene Expression Regulation, Neoplastic/genetics , Cell Cycle Checkpoints/genetics , Biomarkers, Tumor/blood , Down-Regulation/genetics , Cell Line, Tumor , Mice, Inbred BALB C , HEK293 Cells , Humans , Female , Animals , MiceABSTRACT
Objective The purpose of the present study is to demonstrate the usefulness of intraoperative ultrasound guidance as a technique for the assessment, in real time, of tumor resection and as a navigation aid during intra-axial brain lesion removal on patients admitted in the Neurosurgical Department at the Hospital Universitario de Caracas, Caracas, Venezuela, in 2018. Methods A total of 10 patients were enrolled, each with intra-axial brain lesions with no previous neurosurgical procedures and a mean age of 49 years old, ranging from 29 to 59 years old. Results A male predominance was observed with 7 cases (70%) over 3 female cases (30%). Six patients had lesions in the dominant hemisphere. The frontal lobe was the most commonly affected,with 5 cases, followed by the parietal lobe,with 4 cases. After craniotomy, ultrasound evaluation was performed previously to dural opening, during tumor resection and after tumor removal. The mean tumor size in axial, coronal and sagittal views was 3.72 cm, 3.08 cm and 3.00 cm, respectively, previously to dural opening with intraoperative ultrasound. The average tumor depth was 1.73 cm from the cerebral cortex. The location and removal duration from the beginning of the approach (ultrasound usage time) was 83.60 minutes, and the average surgery duration was 201 minutes. Navigation with intraoperative ultrasound served to resect intra-axial tumors more precisely and safely. There was no postoperative complication associated with the surgery in this series of cases. Conclusions Intraoperative ultrasound guidance for intra-axial subcortical tumor resection is a technique that serves as a surgical and anatomical orientation tool.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Brain Neoplasms/surgery , Monitoring, Intraoperative/methods , Ultrasonography , Neuronavigation/methods , Glioma/surgery , Brain Neoplasms/diagnostic imaging , Epidemiology, Descriptive , Neurosurgical Procedures/methods , Craniotomy/methods , Glioma/physiopathology , Glioma/diagnostic imagingABSTRACT
Introducción. Los gliomas de bajo grado presentan un patrón de crecimiento característico a través de las fibras de la sustancia blanca. El crecimiento exofítico en gliomas de bajo grado hemisféricos no se ha descrito previamente. Se presenta un caso de glioma hemisférico de lenta progresión y con crecimiento exofítico. Caso clínico. Varón de 55 años, con crisis parciales motoras secundarias a un oligodendroglioma de grado II de la Organización Mundial de la Salud. El tumor infiltraba la circunvolución frontal superior con extensión exofítica que se extendía por encima de la circunvolución precentral. Fue seguido con controles clinicorradiológicos durante 23 años. El análisis de la evolución radiológica del tumor demostraba un crecimiento tumoral lento, con una velocidad de crecimiento de 0,5 mm al año. Durante la exéresis quirúrgica se definió un plano subaracnoideo entre el componente exofítico y la circunvolución precentral, que se encontraba desplazada inferiormente sin infiltración tumoral. La estimulación eléctrica intraoperatoria no evidenció función en el componente exofítico, pero sí en la circunvolución precentral. No se observaron déficits neurológicos postoperatorios. Conclusiones. La velocidad de crecimiento en gliomas de bajo grado se ha estimado en 4-6 mm al año. El tumor que se describe aquí tiene una velocidad de crecimiento de 0,5 mm al año, muy por debajo de esta media. La identificación de la porción exofítica es un paso importante en la planificación preoperatoria. Este componente es más fácil de resecar debido al plano de clivaje subaracnoideo y a la ausencia de función (AU)
Introduction. Gliomas are characterized by a infiltrative pattern of growth, with cellular migration along the white matter fiber tracts, exophytic growth in low-grade gliomas has not been described yet. A case of hemispheric glioma with slow growing and an exophytic component is presented. Case report. 55 year-old male, with motor partial seizures. MRI shows a WHO grade II oligodendroglioma infiltrating the superior frontal gyrus with exophytic extension above the precentral gyrus. Clinical and radiological follow-up was performed for 23 years. Volumetric assessment of tumor progression revealed a growth rate of 0.5 mm per year. Surgical dissection revealed that the precentral gyrus was displaced inferiorly by the tumor, and a clear subarachnoid plane separated both structures. Functional areas were not identified within the exophytic component. Postoperative neurological deficits were not observed. Conclusions. The growth rate in low-grade gliomas has been estimated between 4 and 6 mm per year. The tumor described here had a growth rate of 0.5 mm per year, far below this average. Preoperative identification of this exophytic growth pattern is of major significance for surgical planning. The exophytic tumor is amenable for a safe and complete resection as it is covered by the arachnoid and pial membranes of the cistern and the surrounding brain (AU)
Subject(s)
Humans , Male , Middle Aged , Glioma/complications , Glioma/diagnosis , Glioma/pathology , Electric Stimulation/methods , Oligodendroglioma/physiopathology , Oligodendroglioma/surgery , Oligodendroglioma , Epilepsy/complications , Epilepsy/physiopathology , Epilepsy , Glioma/physiopathology , Glioma , Glioma/surgery , Magnetic Resonance Imaging/instrumentation , Magnetic Resonance Imaging/methods , Postoperative Complications/physiopathologyABSTRACT
No disponible
Subject(s)
Female , Humans , Middle Aged , Glioma/physiopathology , Glioma , Neoplasm Recurrence, Local , Angiogenesis Inducing Agents/radiation effects , Angiogenesis Inducing Agents/therapeutic use , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Positron-Emission Tomography , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging , Glioma/drug therapyABSTRACT
Objetivo: Analisar a influência da topografia da lesão tumoral na resposta ao tratamento intranasal com álcool perílico (POH) em jovens com glioma maligno recidivo. Método: Tendo como padrão a faixa etária de 0 a 19 anos, foram incluídos pacientes do sexo masculino (#153; #31) e feminino (#178) com glioma maligno em estágio terminal, recebendo terapia de suporte paliativa e administração intranasal diária de 440 mg de POH. Resultados: Cefaleia intensa, tontura, vômito, crise convulsiva, alteração de comportamento, fraqueza muscular, alteração visual e hemiplegia à direita foram os sintomas prevalentes antes da confirmação diagnóstica de glioma. Análise de imagem mostrou lesão tumoral nas regiões troncocerebral (#153), talamomesencefálica esquerda (#178) e frontotemporal e insular direita (#31). Paciente #178 não respondeu ao tratamento, evoluindo a óbito em três semanas, e paciente #31 permaneceu em tratamento com POH por aproximadamente 54 semanas. Apesar de nova recidiva, paciente #153 apresenta doença estável, sem qualquer evidência clínica de recorrência para mais de 200 semanas em tratamento exclusivo com álcool perílico por via intranasal. Conclusão: Pacientes adolescentes com glioma maligno recidivo apresentaram heterogeneidade de sintomas compatível coma região anatômica comprometida, indicando que a topografia da lesão tumoral foi um fator prognóstico de sobrevida, influenciando inclusive na resposta ao tratamento intranasal com o álcool perílico.
Objective: Analyze the influence of tumor topography on response to intranasal perillyl (POH) treatment in youths with high grade glioma. Method: It was included male patients (#153; #31) with 19 years old and female (#178) with 15 years old with recurrent high grade glioma in terminal stage using supportive therapy and 440 mg POH daily intranasal administration. It was established a relation of clinical data and topographic image with therapeutic response to intranasal POH. Results: Intense headache, dizziness, vomiting, seizures, behavior change, muscle weakness, visual changes and right hemiplegia were the symptoms prevalent before the diagnostic confirmation of glioma. Image analysis showed tumoral lesionin the brain-stem (#153), in the left thalamus-mesencephalic region (#178), and right frontal-temporal and insular regions (#31). Patient #178 did not respond to intranasal POH treatment and rapidly progressed to death within 3 weeks; patient #31 remained in treatment with POH for nearly 54 weeks, and despite new recurrence, patient #153 presents stable disease, without any clinical evidence of recurrence for more than 200 weeks and under treatment exclusively with POH by intranasal route. Conclusion: Childhood patients with high grade malignant glioma had heterogeneity of clinical symptoms compatible with anatomical compromised region indicating that topography of the tumoral lesion was a prognostic factor influencing the overall survival and response to intranasal POH.
Subject(s)
Humans , Male , Female , Adolescent , Administration, Intranasal/methods , Monoterpenes/administration & dosage , Monoterpenes/therapeutic use , Glioma/physiopathology , Glioma/drug therapy , Glioma/diagnostic imaging , Prospective StudiesABSTRACT
Introducción. Los gliomas infiltrantes difusos, las neoplasias cerebrales primarias más frecuentes, suponen casi el 80% de los tumores cerebrales malignos. De todos los gliomas, el 60-70% son astrocitarios, y más del 80% de estos tumores se considera de alto grado de malignidad (grados III y IV), según la actual clasificación de la Organización Mundial de la Salud. Los gliomas infiltrantes incluyen los astrocitomas difusos, oligodendrogliomas y oligoastrocitomas. Objetivo. Revisar las características clínicas e histológicas de los gliomas cerebrales y aquellas alteraciones moleculares conocidas que añaden información y tienen un significado diagnóstico, pronóstico o terapéutico. Desarrollo. Actualmente, la clasificación histológica es determinante para el diagnóstico de estos tumores, y ésta establece una gradación o escala de malignidad como predictor de su comportamiento biológico. A lo largo de los últimos años ha habido una explosión de conocimientos acerca de las alteraciones moleculares que subyacen en los gliomas, que ha dado lugar a la aparición de biomarcadores que tienen un valor predictivo y que desempeñan un papel cada vez más importante en el desarrollo del diagnóstico y el pronóstico. Actualmente, el neuropatólogo, en la encrucijada entre la patología y la genética molecular, desempeña un papel importante en la implementación de nuevos tratamientos o ensayos clínicos. Conclusiones. El estudio de biomarcadores, tanto proteómicos como moleculares, debe ser complementario del estudio histopatológico y permite, en ocasiones, determinar factores predictivos o la determinación de vías afectas que pueden convertirse en dianas terapéuticas selectivas(AU)
Introduction. Diffuse infiltrative gliomas, the most common primary brain tumours, account for almost 80% of malignant brain tumours. 60-70% of gliomas are astrocytic and over 80% of these tumours is considered high grade malignancy (grade III and IV) according to current World Health Organization classification. Infiltrating gliomas include diffuse astrocytomas, oligodendrogliomas and oligoastrocytomas. Aim. To review the clinical and histological features of cerebral gliomas, and molecular alterations that add relevant information for novel approaches in diagnosis, prognosis and treatment. Development. The current gold standard diagnosis of these tumours relies on histopathological classification, which provides a grading of malignancy as a predictor of biological behaviour. However emerging molecular abnormalities have been discovered in the last years and these molecular changes are playing an increasingly prominent role as predictive biomarkers or in the development of diagnostic and prognostic. Now the neuropathologist is in crossroads between pathology and molecular biology and he plays a significant role in implementation of treatments and/or clinical trials. Conclusions. The study of proteomics and molecular biomarkers should complement the histopathological analysis and sometimes allows to determine direct or indirect predictive factors as well as the study of affected pathways which may become selective therapeutic targets(AU)
Subject(s)
Humans , Male , Female , Glioma/complications , Glioma/diagnosis , Glioma/etiology , Brain Neoplasms/epidemiology , Oligodendroglioma/complications , Oligodendroglioma/diagnosis , Biomarkers/analysis , Glioma/physiopathology , Glioma , Brain Neoplasms , Oligodendroglioma/physiopathology , OligodendrogliomaABSTRACT
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