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1.
Acta Neuropathol Commun ; 8(1): 41, 2020 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-32245394

RESUMO

Meningioma represents the most common primary brain tumor in adults. Recently several non-NF2 mutations in meningioma have been identified and correlated with certain pathological subtypes, locations and clinical observations. Alterations of cellular pathways due to these mutations, however, have largely remained elusive. Here we report that the Krueppel like factor 4 (KLF4)-K409Q mutation in skull base meningiomas triggers a distinct tumor phenotype. Transcriptomic analysis of 17 meningioma samples revealed that KLF4K409Q mutated tumors harbor an upregulation of hypoxia dependent pathways. Detailed in vitro investigation further showed that the KLF4K409Q mutation induces HIF-1α through the reduction of prolyl hydroxylase activity and causes an upregulation of downstream HIF-1α targets. Finally, we demonstrate that KLF4K409Q mutated tumors are susceptible to mTOR inhibition by Temsirolimus. Taken together, our data link the KLF4K409Q mediated upregulation of HIF pathways to the clinical and biological characteristics of these skull base meningiomas possibly opening new therapeutic avenues for this distinct meningioma subtype.

2.
Neuro Oncol ; 22(1): 31-45, 2020 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-31504802

RESUMO

The level of evidence to provide treatment recommendations for vestibular schwannoma is low compared with other intracranial neoplasms. Therefore, the vestibular schwannoma task force of the European Association of Neuro-Oncology assessed the data available in the literature and composed a set of recommendations for health care professionals. The radiological diagnosis of vestibular schwannoma is made by magnetic resonance imaging. Histological verification of the diagnosis is not always required. Current treatment options include observation, surgical resection, fractionated radiotherapy, and radiosurgery. The choice of treatment depends on clinical presentation, tumor size, and expertise of the treating center. In small tumors, observation has to be weighed against radiosurgery, in large tumors surgical decompression is mandatory, potentially followed by fractionated radiotherapy or radiosurgery. Except for bevacizumab in neurofibromatosis type 2, there is no role for pharmacotherapy.

3.
J Craniofac Surg ; 30(8): e799-e802, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633669

RESUMO

OBJECTIVES: The aim of the study was to investigate the association between meningioma volume and the occurrence of clinic-radiologic signs of tumor aggressiveness. For volumetric approximation, the authors evaluated the method of semiautomatic image segmentation at hand of high-resolution MRI-image sequences. METHODS: ITK-SNAP was utilized for semiautomatic image segmentation of 58 gadolinium-contrast enhanced T1-weighted thin-slice MRI datasets for volumetric analysis. Furthermore, multimodal imaging datasets (including T2, FLAIR, T1) were evaluated for radiological biomarkers of aggressiveness and growth potential. Thereby generated data was checked for association with retrospectively collected data points. RESULTS: Location (P = 0.001), clinical disease manifestation (P = 0.033), peritumoral edema (P = 0.038), tumor intrinsic cystic degeneration (P = 0.007), three-dimensional complexity (P = 0.022), and the presence of meningioma mass effect (P = 0.001) were statistically associated with higher tumor volumes. There was no association between higher tumor volumes and histopathological tumor grade. CONCLUSION: The size of a meningioma does not seem to reliably predict tumor grade. Growth potential seems to be influenced by tumor location. Higher tumor volumes were significantly associated with the occurrence of clinical symptoms.


Assuntos
Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Período Intraoperatório , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Imagem Multimodal , Gradação de Tumores , Estudos Retrospectivos , Carga Tumoral
4.
World Neurosurg ; 132: e716-e721, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31421304

RESUMO

BACKGROUND: Postoperative seizures are potential complications of chronic subdural hematoma (cSDH). Knowledge of risk factors may help to identify patients that may benefit from antiepileptic prophylaxis. METHODS: A total of 101 patients (mean age, 70.1 ± 32.1 years) with surgical evacuation of cSDH were enrolled. We retrospectively collected patient characteristics, hematoma specifics, and procedural aspects and evaluated their impact on postoperative seizures within a 14-day follow-up period by means of bivariate logistic regression analysis. RESULTS: Postoperative seizures occurred in 14 patients (13.9%). At discharge, the mean Markwalder grading scale score was 1.1 ± 1.1 and 0.5 ± 0.8 in patients with and without seizures, respectively (P = 0.04). In the univariate analysis, preoperative midline shift (8.3 vs. 4.5 mm, P = 0.045), open craniotomy (85.7% vs. 55.2%, P = 0.031), and membranectomy (57.1% vs. 20.7%, P = 0.004) were significantly associated with postoperative seizures, respectively. In the multivariate analysis, preoperative midline shift (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.26; P = 0.029) and membranectomy (OR, 3.9; 95% CI, 1.0-15.0; P = 0.048) remained as independent risk factors for seizures. CONCLUSIONS: Perioperative antiepileptic prophylaxis may be recommended in patients with preoperative midline shift. Membranectomy may not be routinely applied during surgery.


Assuntos
Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Convulsões/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Craniotomia , Feminino , Seguimentos , Humanos , Masculino , Membranas/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Convulsões/etiologia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(34): e16653, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441840

RESUMO

Brain metastases deriving from esophageal cancer are very rare with scarce data available concerning these patients' outcome. We, therefore, evaluated outcome after surgical resection followed by radiotherapy of brain metastasis from esophageal cancer.A retrospective analysis was conducted on consecutive patients undergoing resection of brain metastasis from esophageal cancer in 2 neuro-oncological centers between 2008 and 2018. Clinical and demographic data were retrieved from electronic patient charts. Post-treatment survival was calculated using Kaplan-Meier estimates.Twenty-five patients were identified. Treatment for primary disease comprised neo-adjuvant radio-chemotherapy followed by surgery (64.0%), surgery and adjuvant radio-chemotherapy (8.0%), radio-chemotherapy only (24.0%), and 1 patient receiving esophageal stenting only. Median time interval since initial diagnosis was 16 (range 0-110) months. All but 1 brain lesion were neurologically symptomatic and median Karnofsky performance score improved postoperatively from 70 to 80. After resection of brain metastases patients received whole-brain (n = 13 (52.0%)) or local fractionated (n = 9 (36.0%)) radiotherapy. In 2 patients adjuvant treatment was impeded by clinical deterioration; 1 patient refused radiotherapy. By the time of analysis 22 patients had died. Median survival after brain metastasis was 6 (95% CI 0.5-11.6) months.Survival after resection of metastasis from esophageal cancer is poor compared to other tumor entities. Nevertheless, resection of symptomatic brain metastases may improve clinical status in the context of a palliative concept.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Neoplasias Esofágicas/patologia , Idoso , Quimiorradioterapia Adjuvante , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
World Neurosurg ; 131: e192-e200, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31330337

RESUMO

OBJECTIVE: Indocyanine green (ICG) videoangiography (VAG) is an established method for assessment of cerebral blood flow during microsurgical clipping of intracranial aneurysms. FLOW 800 is a surgical microscope-integrated software program that shows the cerebral blood flow in color-coded maps, thus providing semi-quantitative and real-time analysis of ICG data. We aimed to establish reference values for FLOW 800 parameters before and after microsurgical clipping of intracranial aneurysms and to evaluate the potential of FLOW 800 to guide intraoperative decisions. METHODS: We retrospectively reviewed 54 patients (mean age, 53.6 ± 11.6 years) who underwent microsurgical clipping for 60 aneurysms and intraoperative evaluation of ICG fluorescence dynamics using FLOW 800 color-coded maps. FLOW 800 data were correlated with patient characteristics, clinical outcomes, and intraoperative decision making. RESULTS: There were no significant differences in FLOW 800 data between ruptured and unruptured aneurysms (P > 0.05). Likewise, the hemodynamic parameters were not significantly different before and after definite clip placement (P > 0.05). However, in 2 cases, analysis of transit times by FLOW 800 analysis showed a hemodynamically significant clip stenosis that might have been missed by conventional ICG-VAG and resulted in adjustment of the clip position. Overall, there was 1 cerebral infarction, which was not related to clip placement. CONCLUSIONS: FLOW 800 is a useful adjunct to ICG-VAG for intraoperative assessment of cerebral perfusion and may help to identify hemodynamically relevant clip stenosis. The beneficial impact of FLOW 800 on clinical outcome after microsurgical clipping needs to be confirmed by comparative studies.


Assuntos
Aneurisma Roto/cirurgia , Angiografia Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Software , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Aneurisma Roto/diagnóstico por imagem , Corantes , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Verde de Indocianina , Aneurisma Intracraniano/diagnóstico por imagem , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem
7.
J Clin Neurosci ; 68: 86-91, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31331751

RESUMO

OBJECTIVE: Clinical data on the new Neuroform Atlas stent for treatment of intracranial aneurysms is limited. We report our experience in stent-assisted coiling procedures of complex, predominantly wide-necked aneurysms. METHODS: This is a retrospective study of consecutive patients treated with the Neuroform Atlas stent between August 2014 and November 2018 at three German tertiary care centers. We evaluated the complication rate, clinical outcome and angiographic result at mid-term follow-up. RESULTS: Thirty-seven aneurysms (elective: 23, previous subarachnoid hemorrhage: 14) were treated in 37 patients (mean age: 59.4 years, 62.2% females). Stent-assisted coiling was successful in all cases, achieving immediate complete aneurysm occlusion by coiling in 83.8% and neck remnants in 16.2%. At 6-month angiographic follow-up, complete aneurysm occlusion was obtained in 80.8% (21/26), neck remnants in 11.5% (3/26) and aneurysm remnants in 7.7% (2/26). Retreatment was necessary in 7.7%. Ischemic stroke occurred in one patient (2.7%). At 6-month clinical follow-up, procedure-related permanent morbidity was 2.7%. CONCLUSIONS: Our results demonstrate that treatment of intracranial aneurysms with the Neuroform Atlas stent is associated with low morbidity and a high aneurysm occlusion rate at mid-term follow-up. Further studies will be necessary to confirm our results.


Assuntos
Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento
8.
Anticancer Res ; 39(5): 2299-2306, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092421

RESUMO

BACKGROUND/AIM: Death receptor 6 (DR6) is a member of the tumor necrosis factor receptor superfamily. The expression of DR6 is elevated in different kinds of tumors including ovarian, breast cancer and adult sarcoma. In these tumors, the receptor may be handled as a new diagnostic and prognostic marker. Thus, we investigated the expression of DR6 in gliomas. MATERIALS AND METHODS: Tumor and control tissues were extracted during neurosurgery and grouped according to the WHO classification. DR6 expression was investigated in low- and high-grade gliomas PCR (n=70), immunofluorescence staining (n=33) and western blot (n=58). Additional analysis of TCGA-data was performed to assess the general alteration of DR6 in cancer and influence of IDH-mutation on DR6 expression in gliomas. RESULTS: The expression of DR6 was significantly enhanced in gliomas (p<0.05). It showed a trend towards rising expression with increasing malignancy of the tumor. Chemotherapy treatment could have an influence on DR6 expression. CONCLUSION: In our investigation, DR6 acts as a potential suitable diagnostic marker for gliomas.


Assuntos
Astrocitoma/genética , Biomarcadores Tumorais/genética , Glioma/genética , Receptores do Fator de Necrose Tumoral/genética , Astrocitoma/tratamento farmacológico , Astrocitoma/patologia , Feminino , Regulação Neoplásica da Expressão Gênica , Glioma/tratamento farmacológico , Glioma/patologia , Humanos , Isocitrato Desidrogenase/genética , Masculino , Mutação , Gradação de Tumores
9.
World Neurosurg ; 130: e17-e25, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31125770

RESUMO

BACKGROUND: Low-grade gliomas (LGGs) are known to progress to glioblastoma (GBM), decreasing the chances of survival. The tumor necrosis factor receptor CD40 and its ligand CD40L have shown value as biomarkers for GBM. The present study evaluated the role of CD40/CD40L in LGG and GBM in differentiating isocitrate dehydrogenase (IDH) wild-type and IDH-mutant GBM. METHODS: The present study was based on patient-derived samples (74 grade II gliomas, 36 grade III gliomas, and 40 cases of GBM) and expression analysis using real-time polymerase chain reaction. Open-access data from The Cancer Genome Atlas (TCGA) and the strong cohorts of TCGA data sets "brain lower grade glioma" and "glioblastoma" were used to run the analysis on mRNA expression as a validation data set. RESULTS: We found that patients with LGG and CD40 overexpression experienced shorter progression-free survival (43 vs. 29 months; hazard ratio, 0.5715; P = 0.0262) and overall survival (116 vs. 54 months; hazard ratio, 0.3431; P < 0.0001). Consistently, relapsed grade II glioma showed greater CD40 expression compared with primary grade II glioma (P = 0.0028). Just as with LGG, CD40 was a negative marker for overall survival in GBM (12 vs. 10 months; hazard ratio, 0.5178; P = 0.0491). In this context, we found greater CD40 expression in IDH wild-type GBM than in IDH-mutant GBM. The data obtained from TCGA supported our findings, with similar results for PFS and OS in LGG and GBM. CD40L expression showed no correlation with the survival data. CONCLUSION: High CD40 expression showed a significant correlation with poor outcomes for both LGG and GBM and was overexpressed in IDH wild-type GBM.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/metabolismo , Antígenos CD40/metabolismo , Glioma/diagnóstico , Glioma/metabolismo , Adulto , Biomarcadores Tumorais/metabolismo , Neoplasias Encefálicas/genética , Progressão da Doença , Feminino , Glioma/genética , Humanos , Isocitrato Desidrogenase/genética , Masculino , Intervalo Livre de Progressão
10.
Radiat Oncol ; 14(1): 73, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036031

RESUMO

BACKGROUND AND PURPOSE: To evaluate the effect of timing of radiotherapy (RT) on survival in patients with newly diagnosed primary glioblastoma (GBM) treated with the same therapeutical protocol. MATERIALS AND METHODS: Patients with newly diagnosed primary GBM treated with the same therapeutical scheme between 2010 and 2015 in our institution were retrospectively reviewed. The population was trichotomized based on the time interval from surgery till initiation of RT (< 28 days, 28-33 days, > 33 days). Kaplan-Meier and Cox regression analyses were used to compare progression free survival (PFS) and overall survival (OS) between the groups. The influence of various extensively studied prognostic factors on survival was assessed by multivariate analysis. RESULTS: One-hundred-fifty-one patients met the inclusion criteria. Between the three groups no significant difference in PFS (p = 0.516) or OS (p = 0.902) could be demonstrated. Residual tumor volume (RTV) and midline structures involvement were identified as independent prognostic factors of PFS while age, O-6-Methylguanine Methyltransferase (MGMT) status, Ki67 index, RTV and midline structures involvement represented independent predictors of OS. Patients starting RT after a prolonged delay (> 48 days) exhibited a significantly shorter OS (p = 0.034). CONCLUSION: Initiation of RT within a timeframe of 48 days is not associated with worsened survival. A prolonged delay (> 48 days) may be associated with worse OS. RT should neither be delayed, nor forced, but should rather start timely, as soon as the patient has recovered from surgery.


Assuntos
Neoplasias Encefálicas/mortalidade , Glioblastoma/mortalidade , Radioterapia/mortalidade , Tempo para o Tratamento , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/radioterapia , Feminino , Glioblastoma/diagnóstico , Glioblastoma/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
11.
J Neurosurg ; : 1-9, 2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-30978687

RESUMO

OBJECTIVECerebral infarction is a significant cause of morbidity and mortality related to microsurgical clipping of intracranial aneurysms. The objective of this study was to determine the impact of aneurysm shape and neck configuration on cerebral infarction after aneurysm surgery.METHODSThe authors retrospectively reviewed consecutive cases of ruptured and unruptured aneurysms treated with microsurgical clipping at their institution between 2010 and 2018. Three-dimensional reconstructions from preoperative computed tomography and digital subtraction angiography were used to determine aneurysm shape (regular/complex) and neck configuration (regular/irregular). Morphological and procedure-related risk factors for cerebral infarction were identified using univariate and multivariate statistical analyses.RESULTSAmong 243 patients with 252 aneurysms (148 ruptured, 104 unruptured), the overall cerebral infarction rate was 17.1%. Infarction tended to occur more often in aneurysms with complex shape (p = 0.084). Likewise, aneurysms with an irregular neck had a significantly higher rate of infarction (37.5%) than aneurysms with regular neck configuration (10.1%, p < 0.001). Aneurysms with an irregular neck were associated with a higher rate of intraoperative rupture (p = 0.003) and temporary parent artery occlusion (p = 0.037). In the multivariate analysis, irregular neck configuration was identified as an independent risk factor for infarction (OR 4.2, 95% CI 1.9-9.4, p < 0.001), whereas the association between aneurysm shape and infarction was not significant (p = 0.966).CONCLUSIONSIrregular aneurysm neck configuration represents an independent risk factor for cerebral infarction during microsurgical clipping of both ruptured and unruptured aneurysms.

12.
Anticancer Res ; 39(4): 1795-1805, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30952719

RESUMO

BACKGROUND/AIM: The glutathione S-transferase pi gene (GSTP1) is a polymorphic gene encoding functionally different Gstp1 isoenzyme proteins. These seem to contribute to xenobiotic metabolism and might also play a role in susceptibility to cancer. The aim of this study was to elucidate the potential role of GSTP1 as a biomarker for disease progression and predictor of chemotherapeutic effect in glioma. MATERIALS AND METHODS: Using quantitative real time PCR and western blotting analysis, a total of 61 astrocytic tumor samples from WHO grade II-IV were investigated. RESULTS: There were no differences in GSTP1 mRNA expression between diffuse astrocytomas, anaplastic astrocytomas, or GBM. No difference was seen between secondary GBM before and after radio-/chemotherapy. CONCLUSION: The expression of GSTP was highly heterogeneous within the surgical specimens. No significant differences in gene and protein expression were detected between the different types of gliomas, suggesting that glioma chemoresistance is probably multifactorial and GSTP1-independent.


Assuntos
Antineoplásicos/uso terapêutico , Astrocitoma/tratamento farmacológico , Astrocitoma/enzimologia , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/enzimologia , Glutationa S-Transferase pi/genética , Transcriptoma , Astrocitoma/genética , Astrocitoma/patologia , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Linhagem Celular Tumoral , Progressão da Doença , Glutationa S-Transferase pi/metabolismo , Humanos , Isoenzimas , Gradação de Tumores , Resultado do Tratamento
13.
Technol Cancer Res Treat ; 18: 1533033819828396, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30943868

RESUMO

To date, diagnosis of IDH1 mutation is based on DNA sequencing and immunohistochemistry, methods limited in terms of sensitivity and ease of use. Recently, the diagnosis of IDH1 mutation by real-time polymerase chain reaction was introduced as an alternative method. In this study, real-time polymerase chain reaction was validated as a tool for detection of IDH1 mutation, and expression levels were analyzed for correlation with course of the disease. A total of 113 tumor samples were obtained intraoperatively from 84 patients with glioma having a diagnosis of diffuse glioma (World Health Organization II), anaplastic glioma (World Health Organization III), secondary glioblastoma ± chemotherapy, primary glioblastoma ± chemotherapy (World Health Organization IV). Tumor samples were snap frozen and processed for sectioning and RNA and protein isolation. Presence of IDH1 mutation was determined by DNA sequencing. Hereafter, quantitative expression of IDH1 messenger RNA was assessed using real-time polymerase chain reaction with specific primers for IDH1 mutation and -wt; protein expression was verified by Western Blot analysis and immunohistochemistry. Additionally, 19 samples of low-grade glioma and their consecutive high-grade glioma were analyzed at different time points of the disease. IDH1 mutation was identified in 63% of samples by DNA sequencing. In correlation with the real-time polymerase chain reaction results, a cutoff value was determined. Above this threshold, sensitivity and specificity of real-time polymerase chain reaction in detecting IDH1 mutation were 98% and 94%, respectively. Quantitative analysis revealed that IDH1 mutation expression is upregulated in secondary glioblastoma (mean ± standard error of mean: 3.52 ± 0.55) compared to lower grade glioma (II = 1.54 ± 0.22; III = 1.67 ± 0.23). In contrast, IDH1 wt expression is upregulated in all glioma grades (concentration >0.1) compared to control brain tissue (0.007 ± 0.0016). Western Blot analysis showed a high concordance to both sequencing and real-time polymerase chain reaction results in qualitative analysis of IDH1 mutation status (specificity 100% and sensitivity 100%). Moreover, semiquantitative protein expression analysis also showed higher expression levels of mutated IDH1 in secondary glioblastoma. In our study, real-time polymerase chain reaction and Western Blot analysis were found to be highly efficient methods in detecting IDH1 mutation in glioma samples. As cost-effective and time-saving methods, real-time polymerase chain reaction and Western Blot analysis may therefore play an important role in IDH1 mutation analysis in the future. IDH1 mutation expression level was found to correlate with the course of disease to a certain extent. Yet, clinical factors as recurrent disease or prior radiochemotherapy did not alter IDH1 mutation expression level.


Assuntos
Western Blotting/métodos , Neoplasias Encefálicas/genética , Glioma/genética , Isocitrato Desidrogenase/genética , Isocitrato Desidrogenase/metabolismo , Mutação , Reação em Cadeia da Polimerase em Tempo Real/métodos , Adulto , Alelos , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Feminino , Glioma/metabolismo , Glioma/patologia , Humanos , Masculino , Pessoa de Meia-Idade
14.
World Neurosurg ; 125: e697-e710, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30735873

RESUMO

OBJECTIVE: The incidence of meningiomas increases with increasing age. Because the median age for the diagnosis is 65 years, the patients' general health condition, comorbidities, and procedural risks will influence the postoperative functional outcomes. The aim of our study was to assess the long-term impairments of health-related quality of life (HRQOL) after meningioma resection in different age groups of elderly patients. METHODS: We analyzed the HRQOL of 133 patients aged >54 years at surgery who had undergone surgical meningioma resection from 2004 to 2010. The median age was 67.3 ± 7.4 years. The average interval between surgery and questionnaire completion was 3.8 ± 2.5 years. Six different 5-year age groups were established. The patients completed the Medical Outcomes Study short-form 36-item questionnaire, and the results were compared with general population values. The Kruskal-Wallis test and Mann-Whitney U test were used for statistical analysis. RESULTS: We found significantly lower levels of physical function, vitality, social role functioning, mental health, and general health perception and significantly greater levels of pain between the older age groups (in particular, 75-79 years) and younger patients aged 55-59 years. The physical component summary showed a steadily and stepwise decline from younger to older patients. However, the most significant differences in HRQOL were not related to age but to comorbidities. CONCLUSION: Our findings suggest that Karnofsky performance scale and American Society of Anesthesiologists scores have a strong effect on long-term HRQOL, especially for older patients after meningioma resection. These data should be a substantial consideration in the preoperative decision-making process.


Assuntos
Meningioma/cirurgia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Período Pós-Operatório , Inquéritos e Questionários , Tempo
15.
World Neurosurg ; 125: e1196-e1202, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30794974

RESUMO

OBJECTIVE: Subarachnoid hemorrhage (SAH) can be associated with a degree of resulting brain damage and subsequent reorganization of the central nervous system. The aim of this study was to evaluate complication rates and clinical outcome in patients with a previous SAH who were treated for a recurrent or an additional, initially unruptured aneurysm. METHODS: A retrospective single-center study was conducted for patients who underwent elective treatment by surgical or endovascular means between 2010 and 2018. We compared patients with a previous SAH and without history of SAH in terms of complication rates and functional outcomes (modified Rankin Scale [mRS]). RESULTS: The study population consisted of 337 patients (non-SAH, 270; SAH, 67) who underwent 390 elective procedures for treatment of 443 aneurysms. Procedure-related complications occurred in 13.5% of patients with a previous SAH and in 13.3% of patients without SAH (P = 1.0). At the 6-month follow-up, the morbidity (defined as any increase on the mRS) was comparable between the SAH group (6.7%) and the non-SAH group (7.6%; P = 0.5). Overall favorable outcome (mRS score ≤2) was achieved by 96.6% in the SAH group and 97.3% in the non-SAH group (P = 1.0). Also, in patients with a previous SAH, the choice of clipping or endovascular treatment did not have a significant impact on clinical outcome at the 6-month follow-up. CONCLUSIONS: Treatment of recurrent or additional aneurysms in patients with a previous SAH can be performed with acceptable complication rates and morbidity by either surgical or endovascular means.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/cirurgia , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/métodos , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Recidiva , Resultado do Tratamento
16.
J Neurointerv Surg ; 11(8): 812-816, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30674636

RESUMO

BACKGROUND: Intrasaccular flow disruption represents a new paradigm in endovascular treatment of wide-necked bifurcation aneurysms. OBJECTIVE: To perform a matched case-control study comparing complications and angiographic outcome using the Woven Endobridge (WEB) device and stent-assisted coiling (SAC). METHODS: Sixty-six patients treated with the WEB at three German tertiary care centers were included and matched with 66 patients treated with SAC based on aneurysm location and unruptured/ruptured aneurysm status. Parameters were retrospectively analysed and compared between the treatment groups using inverse probability of treatment weighting (IPTW) with propensity scores. RESULTS: Procedural complication rates were 12.1% in the WEB group and 21.2% in the SAC group, which was statistically significant after IPTW adjustment (OR=2.2, 95% CI 1.08 to 4.4, p=0.03). Favourable outcome (modified Rankin scale score ≤2) was achieved by 57/66 (86.4%) in the WEB group and 57/66 (86.4%) in the SAC group (p=1.0). At mid-term follow-up, a similar number of aneurysms achieved adequate occlusion (complete occlusion or neck remnant) in the WEB group (93.9%) and in the SAC group (93.9%, p=1.0). Re-treatment was performed in 10.6% after WEB embolization and 12.1% after SAC (p=1.0). CONCLUSIONS: The WEB provides similar mid-term aneurysm occlusion rates to those of SAC, with no additional morbidity and potentially lower complication rates. Long-term outcome analysis will provide a definite conclusion on the use of WEB for intracranial aneurysms.


Assuntos
Angiografia Cerebral/tendências , Embolização Terapêutica/tendências , Procedimentos Endovasculares/tendências , Aneurisma Intracraniano/terapia , Complicações Pós-Operatórias/etiologia , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Estudos de Casos e Controles , Angiografia Cerebral/métodos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento
17.
Eur J Nucl Med Mol Imaging ; 46(3): 591-602, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30327856

RESUMO

PURPOSE: Areas of contrast enhancement (CE) on MRI are usually the target for resection or radiotherapy target volume definition in glioblastomas. However, the solid tumour mass may extend beyond areas of CE. Amino acid PET can detect parts of the tumour that show no CE. We systematically investigated tumour volumes delineated by amino acid PET and MRI in patients with newly diagnosed, untreated glioblastoma. METHODS: Preoperatively, 50 patients with neuropathologically confirmed glioblastoma underwent O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) PET, and fluid-attenuated inversion recovery (FLAIR) and contrast-enhanced MRI. Areas of CE were manually segmented. FET PET tumour volumes were segmented using a tumour-to-brain ratio of ≥1.6. The percentage overlap volumes, and Dice and Jaccard spatial similarity coefficients (DSC, JSC) were calculated. FLAIR images were evaluated visually. RESULTS: In 43 patients (86%), the FET tumour volume was significantly larger than the CE volume (21.5 ± 14.3 mL vs. 9.4 ± 11.3 mL; P < 0.001). Forty patients (80%) showed both increased uptake of FET and CE. In these 40 patients, the spatial similarity between FET uptake and CE was low (mean DSC 0.39 ± 0.21, mean JSC 0.26 ± 0.16). Ten patients (20%) showed no CE, and one of these patients showed no FET uptake. In five patients (10%), increased FET uptake was present outside areas of FLAIR hyperintensity. CONCLUSION: Our results show that the metabolically active tumour volume delineated by FET PET is significantly larger than tumour volume delineated by CE. Furthermore, the results strongly suggest that the information derived from both imaging modalities should be integrated into the management of patients with newly diagnosed glioblastoma.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Glioblastoma/diagnóstico por imagem , Glioblastoma/patologia , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Carga Tumoral , Tirosina/análogos & derivados , Adulto , Idoso , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade
18.
J Neurosurg ; : 1-6, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30544353

RESUMO

OBJECTIVEData on the survival effects of supportive care compared to second-line multimodal treatment for glioblastoma progression are scarce. Thus, the authors assessed survival in two population-based, similar cohorts from two European university hospitals with different treatment strategies at first progression.METHODSThe authors retrospectively identified patients with newly diagnosed glioblastoma treated at two neurooncological centers. After diagnosis, patients from both centers received identical treatments, but at tumor progression each center used a different approach. In the majority of cases, at center A (Greece), supportive care or a single therapeutic modality was offered at progression, whereas center B (Germany) provided multimodal second-line therapy. The main outcome measure was survival after progression (SaP). The influence of the treatment strategy on SaP was assessed by multivariate analysis.RESULTSOne hundred three patients from center A and 156 from center B were included. Tumor progression was observed in 86 patients (center A) and 136 patients (center B). At center A, 53 patients (72.6%) received supportive care alone, while at center B, 91 patients (80.5%) received second-line treatment. Progression-free survival at both centers was similar (9.4 months [center A] vs 9.0 months [center B]; p = 0.97), but SaP was significantly improved in the patients treated with multimodal second-line therapy at center B (7 months, 95% CI 5.3-8.7 months) compared to those treated with supportive care or a single therapeutic modality at center A (4.5 months, 95% CI 3.5-5.5 months; p = 0.003). In the multivariate analysis, the treatment center was an independent prognostic factor for overall survival (HR 1.59, 95% CI 0.17-2.15; p = 0.002).CONCLUSIONSTreatment strategy favoring multimodal second-line treatment over minimal treatment or supportive care at glioblastoma progression is associated with significantly better overall survival.

19.
World Neurosurg ; 120: e1163-e1170, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30218797

RESUMO

OBJECTIVE: Microsurgical clipping of aneurysms demands precise spatial understanding of aneurysm morphology and vascular geometry. We analyzed the impact of preoperative three-dimensional (3D) angiographic imaging on clinical and angiographic outcome after clipping of ruptured intracranial aneurysms. METHODS: This is a retrospective analysis of consecutive patients who underwent microsurgical clipping during the acute phase of subarachnoid hemorrhage between 2010 and 2017. Surgical planning was made based on two-dimensional (2D) or 3D angiographic images. We retrospectively compared complication rates, morbidity, and angiographic outcome between these 2 groups. RESULTS: A total of 157 patients (mean age: 54.8 ± 13.1 years) were included in the study. Preoperative 3D angiographic imaging was available for 117 cases. The rate of procedure-related ischemia was significantly lower in the 3D group (16.2%) than in the 2D group (35.0%; P = 0.013). In the multivariate analysis, 2D imaging alone remained as independent factor for subsequent brain ischemia (odds ratio: 2.8, 95% confidence interval 1.2-6.6; P = 0.018). Favorable outcome (modified Rankin scale ≤2) was more often attained in the 3D group (70.0%) than in the 2D group (41.9%; P = 0.002). The rate of complete aneurysm occlusion was not significantly different between the 2 groups (P = 0.967). CONCLUSIONS: In our study, accurate operation planning using 3D angiography was associated with a lower ischemic complication rate after clipping of ruptured intracranial aneurysms, which may potentially influence clinical outcome.


Assuntos
Aneurisma Roto/cirurgia , Isquemia Encefálica/prevenção & controle , Angiografia Cerebral , Imageamento Tridimensional , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Aneurisma Roto/diagnóstico por imagem , Angiografia Digital , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Cirurgia Assistida por Computador
20.
Acta Neurochir (Wien) ; 160(11): 2169-2176, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30225810

RESUMO

BACKGROUND: Complex aneurysm shape is a predominant risk factor for aneurysm rupture but its impact on clinical outcome after clipping remains unclear. The objective of the present study was to compare complications and morbidity after clipping of unruptured single-sac aneurysms (SSAs) and aneurysms with multiple sacs (MSAs). METHODS: A retrospective, single-center study was conducted for patients that were treated between 2010 and 2018. We analyzed surgical parameters, treatment-related complications, and morbidity, defined as any increase in the modified Rankin scale at 3-month follow-up. RESULTS: We identified 101 patients (mean age: 52.9 ± 10.5 years) that underwent clipping for 57 SSAs and 44 MSAs. The two groups were comparable regarding aneurysm size and neck width. Clipping of MSAs was associated with a longer operation time (p = 0.008) and increased use of intraoperative indocyanine green (p = 0.016) than SSAs. Complications occurred more often in the MSA group (29.5%) than in the SSA group (14.0%; p = 0.057). Morbidity was significantly higher in the MSA group (20.5%) than in the SSA group (3.5%, p = 0.009). In the univariate analysis, the odds of morbidity were 7.1 times greater for MSAs than for SSAs (95% CI 1.4-34.7). CONCLUSIONS: Morbidity after microsurgical clipping is significantly increased in MSAs as compared to SSAs. This may be attributed to a more difficult clip placement with stronger manipulation of the aneurysm dome and the surrounding brain tissue.


Assuntos
Aneurisma Roto/patologia , Aneurisma Intracraniano/patologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso de 80 Anos ou mais , Aneurisma Roto/cirurgia , Feminino , Humanos , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade
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