On the classification of cerebral tumors: A tribute to Leonid Smirnov.

The corresponding member of the Academy of Medical Sciences of the USSR Professor Leonid Iosifovich Smirnov (1889 - 1955) authored several dozen publications on neuropathology of infections, schizophrenia, cerebral injuries, and brain tumors. Based on his study of pathology of gunshot head injuries during World War II he suggested a doctrine of traumatic on traumatic brain disease. He was the author of the first Russian classification of cerebral tumors and had an impact on the development of neurooncology in the former USSR. The aim of this paper is to show the early development of modern neuropathology at the example of a leading Soviet neuropathologist in the first half of the 20th century and his relevance for modern classification of CNS tumors.

Incidence and prevalence of primary malignant brain tumours in Canada from 1992 to 2017: an epidemiologic study.

BACKGROUND: Primary malignant brain tumours account for more than one-third of all brain tumours and are associated with high morbidity and mortality. The purpose of this study was to estimate the incidence and prevalence of primary malignant central nervous system (CNS) tumours and trends in these rates in Canada from 1992 to 2017. METHODS: We conducted an epidemiologic study using publicly available data from the Canadian Cancer Registry from 1992 to 2017 (1994 to 2015 for prevalence) for all of Canada except Quebec (1992 to 2011). We calculated the incidence and prevalence per 100 000 person-years and the age-standardized incidence and prevalence per 100 000 person-years of primary malignant CNS tumours and stratified them by sex and age (pediatric [≥ 19 yr], adult [20-64 yr] and older adult [> 64 yr]). Our analyses assessed average disease duration, survival differences between males and females, and trends over time. RESULTS: During the study period, the average age-standardized incidence and prevalence rates of all primary malignant CNS tumours were 7.9 and 7.6 per 100 000 person-years, respectively. The incidence and prevalence increased by 37.5% and 40.5%, respectively, over the study period. Males accounted for more than half (26 085 [56.4%]) of all diagnoses and experienced decreased survival compared to females 1 year after diagnosis (p = 0.048). Children accounted for 4605 new diagnoses (10.0%), adults for 23 950 (51.7%), and older adults for 17 735 (38.3%). Age-standardized incidence and prevalence rates were highest among older adults. INTERPRETATION: Overall, the incidence of primary malignant CNS tumours increased from 1992 to 2017, and males and older adults were disproportionately affected. Increased health care resources and awareness are needed to improve identification of these tumours and deliver evidence-based care that balances safety, efficacy and preservation of quality of life for affected patients.

Hans Joachim Scherer: an under-recognized pioneer of glioma research in Belgium.

Hans Joachim Scherer (1906-1946) was a German pathologist who fled Germany to Belgium to work on glioma genesis, growth and progression. Despite being seldom cited, and due to the contributions discussed in this article, Hans Joachim Scherer, can be considered a founding father of contemporary neuropathology and glioma research. We discuss Scherer's achievements in glioma classification, glomerular structures of glioma, primary and secondary glioblastoma, glioma growth patterns, non-resectability of glioma, pseudopalisadic necrosis and the late occurrence of symptoms in glioma.

Historical Perspective on Surgery and Survival with Glioblastoma: How Far Have We Come?

BACKGROUND: Glioblastoma multiforme remains a therapeutic challenge. We offer a historical review of the outcomes of patients with glioblastoma from the earliest report of surgery for this lesion through the introduction of modern chemotherapeutics and aggressive approaches to tumor resection. METHODS: We reviewed all major surgical series of patients with glioblastoma from the introduction of craniotomy for glioma (1884) to 2020. RESULTS: The earliest reported craniotomy for glioblastoma resulted in the patient's death less than a month after surgery. Improved intracranial pressure management resulted in improved outcomes, reducing early postoperative mortality from 50% to 6% in Harvey Cushing's series. In the first major surgical series (1912), the mean survival was 10.1 months. This figure did not improve until the introduction of radiotherapy in the 1950s, which doubled survival relative to those who had surgery alone. The most recent significant advance, chemotherapy with the alkylating agent temozolomide, extended survival by 2.5 months compared with surgery and radiotherapy alone (14.6 and 12.1 months, respectively). This protocol remains the standard regimen for newly diagnosed glioblastoma. The innovative treatments being investigated have yet to show a survival benefit. CONCLUSIONS: With advancements in localization, imaging, anesthesia, surgical technique, control of cerebral edema, and adjuvant therapies, outcomes in glioblastoma improved incrementally from Cushing's time until the introduction of magnetic resonance imaging enabled better degrees of resection in the 1990s. Modest improvements came with the advent of biomarker-driven targeted chemotherapy in the first decade of the current century.

Staged Cranial Surgery for Intracranial Lesions: Historical Perspective.

We follow the development of staged resection from its first description by Walter E. Dandy, one of the founding fathers of neurosurgery, in 1925 in which he removed a large vestibular schwannoma.This historical vignette cites neurosurgical case reports and literature to demonstrate the evolution of staged resection of intracranial lesions, from Dandy's initial use to its becoming a more viable and safe option for the treatment of meningiomas, vestibular schwannomas, and skull base lesions (among numerous other intracranial pathologies). We also discuss the current advancements and future perspectives of staged resection that may show promise in effectively treating a wide range of pathologies while simultaneously reducing morbidity rates-a warrant for further exploration of staged cranial surgery as an important tool in neurosurgery.

Pathophysiology of blood-brain barrier in brain tumor. Novel therapeutic advances using nanomedicine.

Glioblastoma Multiforme (GBM) is one the most common intracranial tumors discovered by Burns (1800) and Abernethy (1804) based on gross morphology of the autopsied material and referred to as "medullary sarcoma" and later "fungus medullare" (Abernethy, 1804; Burns, 1800). Virchow in 1863 was the first German pathologist using histomorphological techniques discovered that GBM is a tumor of glial origin. Virchow (1863/65) also then used the term Glioma for the first time and classified as low-grade glioma and high-grade glioma very similar to that of today according to World health organization (WHO) classification (Jellinger, 1978; Virchow, 1863/65). After almost >50 years of this discovery, Baily and Cushing (1926) based on modern neuropathological tools provide the classification of gliomas that is still valid today (Baily & Cushing, 1926). Although, our knowledge about development of gliomas has advanced through development of modern cellular and molecular biological tools (Gately, McLachlan, Dowling, & Philip, 2017; Omuro & DeAngelis, 2013), therapeutic advancement of GBM still requires lot of efforts for the benefit of patients. This review summarizes new developments on pathophysiological aspects of GBM and novel therapeutic strategies to enhance quality of life of patients. These novel therapeutic approaches rely on enhanced penetration of drug therapy into the tumor tissues by use of nanomedicine for both the diagnostic and therapeutic purposes, referred to as "theranostic nanomedicine" (Alphandéry, 2020; Zhao, van Straten, Broekman, Préat, & Schiffelers, 2020). Although, the blood-brain barrier (BBB) is fenestrated around the periphery of the tumor tissues, the BBB is still tight within the deeper tissues of the tumor. Thus, drug delivery is a challenge for gliomas and requires new therapeutic advances (Zhao et al., 2020). Associated edema development around tumor tissues is another factor hindering therapeutic effects (Liu, Mei, & Lin, 2013). These factors are discussed in details using novel therapeutic advances in gliomas.

[Historical perspective of the studies with the greatest impact on the treatment of gliomas]. / Perspectiva histórica de los estudios con mayor impacto en el tratamiento de los gliomas.

Historically, advances in our knowledge of neuro-oncology and improvements in the survival of patients with brain tumours have been relatively scarce. One of the main turning points can be established from 2005 onwards, when the potential therapeutic role of cytostatics in these tumours was confirmed, thus changing the standard of treatment. Up until that date, only radiation therapy and surgery were considered truly effective treatments. This shift has contributed to the development of new systemic therapies and to an in-depth study of gliomagenesis. Advances in the knowledge of the basic fields of brain tumours have helped improve the design and results of new clinical trials, while clinical outcomes provide feedback and new data to further the understanding of these tumours. However, these promising advances open up new unresolved questions and offer a critical approach to the interpretation of past studies. This review mainly updates the results of trials that changed or modified the clinical practice of the treatment and management of gliomas. Commenting on relevant basic research papers that have not yet been translated into the implementation of changes in the treatment of these patients is excluded.

TITLE: Perspectiva histórica de los estudios con mayor impacto en el tratamiento de los gliomas.Históricamente, los avances en el área de conocimiento de la neurooncología y las mejoras en la supervivencia de los pacientes con tumores cerebrales han sido relativamente escasos. Uno de los principales puntos de inflexión puede establecerse a partir de 2005, cuando se constata el hasta entonces potencial papel terapéutico de los citostáticos en estos tumores, cambiando consiguientemente el estándar de tratamiento. Hasta esa fecha, sólo la radioterapia y la cirugía se consideraban tratamientos realmente eficaces. Este cambio ha contribuido al desarrollo de nuevas terapias sistémicas y a profundizar en el estudio de la gliomagénesis. Los avances en los campos básicos del conocimiento de los tumores cerebrales han ayudado a mejorar el diseño y los resultados de los nuevos ensayos clínicos, al mismo tiempo que los resultados clínicos retroalimentan y ofrecen nuevos datos para seguir avanzando en la comprensión de estos tumores. Sin embargo, estos esperanzadores avances abren nuevas cuestiones aún no resueltas y ofrecen un enfoque crítico a la interpretación de estudios pasados. La presente revisión principalmente actualiza los resultados de los ensayos que cambiaron o modificaron la práctica clínica del tratamiento y el manejo de los gliomas. Se excluyen trabajos relevantes de investigación básica que aún no han tenido traslación en la implementación de cambios en el tratamiento de estos pacientes.

A half century of change in diagnostic neuropathology: from the giants of yore to current brain tumor classification.

The first issue of Human Pathology contains a laudatory review of one of the most treasured books in the history of neuropathology: Neurological Clinicopathological Conferences of the Massachusetts General Hospital, a collection of neurological cases that appeared first in the New England Journal of Medicine in the 1940s, 1950s, and 1960s. Each patient history is discussed by well-known neurologists, neurosurgeons, and neuropathologists. Review of these cases provides a framework to explore diagnostic shifts that have occurred over the past half century. Importantly, while the discussants of these cases were great diagnosticians, they were somewhat limited by the methods available to them at the time; subsequent novel technologies provided opportunities for new insights that were made by the next generation of experts. Today's pathologists (whether neuropathologists or any other pathology subspecialists) are similarly skilled at diagnosis, although their diagnoses are now more often made on biopsies (rather than autopsies) and informed by pre-operative imaging studies as well as post-operative molecular analyses. In turn, one would conclude that, even in the face of future technological changes brought about by disruptive innovations like artificial intelligence and deep molecular analyses, a need will continue for the expertise of pathologists and other clinical diagnosticians.

Francesco Durante and the First Intracranial Tumor Successfully Operated on with Long Survival (1884).

Francesco Durante was born in Sicily, precisely Letojanni Gallodoro. He contributed to the history of neurosurgery in not only Italy but the whole world. In June 1884, he removed a left frontal meningioma, describing a personal technique of craniotomy with a discontinuous osteotangential section flap. It was the first such operation to be performed in any country after which the patient had a long survival. The important and pioneering contribution made by Durante to the history of neurosurgery is testified by his Treaty on Pathology and Surgical Therapy. Durante's procedure for craniotomy remained the best for several years. His contributions are still valid in medicine today, within not only the neurosurgical community but also other surgical disciplines, because he also developed innovative practices in the fields of oncology, general surgery, and orthopedics in addition to designing special surgical instruments.

Frequency and clinicopathological features of metastasis to liver, lung, bone, and brain from gastric cancer: A SEER-based study.

The hematogenous metastatic pattern of gastric cancer (GC) was not fully explored. Here we analyzed the frequency and clinicopathological features of metastasis to liver, lung, bone, and brain from GC patients. Data queried for this analysis included GC patients from the Surveillance, Epidemiology, and End Results Program database from 2010 to 2014. All of statistical analyses were performed using the Intercooled Stata 13.0 (Stata Corporation, College Station, TX). All statistical tests were two-sided. Totally, there were 19 022 eligible patients for analysis. At the time of diagnosis, there were 7792 patients at stage IV, including 3218 (41.30%) patients with liver metastasis, 1126 (14.45%) with lung metastasis, 966 (12.40%) with bone metastasis and 151 (1.94%) with brain metastasis. GC patients with lung or liver metastasis have a higher risk of bone and brain metastasis than those without lung nor liver metastasis. Intestinal subtype had significantly higher rate of liver and lung metastasis, while diffuse type was more likely to have bone metastasis. Proximal stomach had significantly higher risk to develop metastasis than distal stomach. African-Americans had the highest risk of liver metastasis and Caucasian had the highest prone to develop lung and brain metastasis. The median survival for patients with liver, lung, bone, and brain metastasis was 4 months, 3 months, 4 months and 3 months, respectively. It is important to evaluate the status of bone and brain metastasis in GC patients with lung or liver metastasis. Knowledge of metastatic patterns is helpful for clinicians to design personalized pretreatment imaging evaluation for GC patients.

Analyzing of dark past and bright present of neurosurgical history with a picture of musicians.

AIM: Currently, neurosurgery has gone through moments of great renewal, however, in the first half of the 20th century, unwanted outcome after surgical approach had occurred. The aim of this historical overview of a picture of the musicians is to show the development of Neurosurgery in 20 century. METHODS: History of neurosurgery in the first half of the 20th century and the current was investigated through PubMed. A brief tour of some of the major landmarks of contemporary neurosurgery was also made. RESULTS: A musician picture was found which taken in 1928. Two of the musicians suffered neurosurgical disorder, and operated in 1937, both immediately died without gaining conscious at early postoperative period. CONCLUSION: We described the role of neurosurgery in the lives of two famous musicians, George Gershwin and Maurice Ravel. A picture taken 1928, shows the developing of Neurosurgery from first half of 20th century to current.

Traumatic glioblastoma: commentary and suggested mechanism.

The role of head trauma in the development of glioblastoma is highly controversial and has been minimized since first put forward. This is not unexpected because skull injuries are overwhelmingly more common than glioblastoma. This paper presents a commentary based on the contributions of James Ewing, who established a major set of criteria for the recognition of an official relationship between trauma and cancer. Ewing's criteria were very stringent. The scholars who succeeded Ewing have facilitated the characterization of traumatic brain injuries since the introduction of computed tomography and magnetic resonance imaging. Discussions of the various criteria that have since developed are now being conducted, and those of an unnecessarily limiting nature are being highlighted. Three transcription factors associated with traumatic brain injury have been identified: p53, hypoxia-inducible factor-1α, and c-MYC. A role for these three transcription factors in the relationship between traumatic brain injury and glioblastoma is suggested; this role may support a cause-and-effect link with the subsequent development of glioblastoma.

Reflections on 50 Years of Neuroscience Nursing: Neuro-Oncology, Moving Forward by Looking Back.

During the past 50 years, there have been more than 100 articles published in the Journal of Neuroscience Nursing covering the topic of neuro-oncology. This article will explore the historical implications and milestones from these articles. The analysis highlights the scope and depth of the many articles as they relate to the advancements in neuro-oncology.

On the Concepts and History of Glioblastoma Multiforme - Morphology, Genetics and Epigenetics.

Glioblastoma multiforme (GBM) is a grade IV WHO malignant tumor with astrocytic differentiation. As one of the most common clinically diagnosed central nervous system (CNS) oncological entries, there have been a wide variety of historical reports of the description and evolution of ideas regarding these tumors. The first recorded reports of gliomas were given in British scientific reports, by Berns in 1800 and in 1804 by Abernety, with the first comprehensive histomorphological description being given in 1865 by Rudolf Virchow. In 1926 Percival Bailey and Harvey Cushing gave the base for the modern classification of gliomas. Between 1934 and 1941 the most prolific researcher in glioma research was Hans-Joachim Scherer, who postulated some of the clinico-morphological aspects of GBM. With the introduction of molecular and genetic tests the true multifomity of GBM has been established, with different genotypes bearing the same histomorphological and IHC picture, as well as some of the aspects of gliomagenesis. For a GBM to develop, a specific trigger mutation needs to occur in a GBM stem cell - primary GBM, or a slow aggregation of individual mutations, without a distinct trigger mutation - secondary GBM. Knowledge of GBM has been closely related to general medical knowledge of the CNS since these malignancies were first described more than 200 years ago. Several great leaps have been made in that time, in the footsteps of both CNS and advancements in general medical knowledge.

Pathogens and glioma: a history of unexpected discoveries ushering in novel therapy.

In the late 19th century, Dr. William B. Coley introduced the theory that infections may aid in the treatment of malignancy. With the creation of Coley's toxin, reports of remission during viral illnesses for systemic malignancies soon emerged. A few decades after this initial discovery, Austrian physicians performed intravascular injections of Clostridium to induce oncolysis in patients with glioblastoma. Since then, suggestions between improved survival and infectious processes have been reported in several patients with glioma, which ultimately marshaled the infamous use of intracerebral Enterobacter. These early observations of tumor regression and concomitant infection piloted a burgeoning field focusing on the use of pathogens in molecular oncology.

Reprint of-Differential diagnosis: Trepanation.

Trepanation is the scraping, cutting, or drilling of an opening (or openings) into the neurocranium. World surveys reveal that a number of ancient cultures experimented with cranial surgery, and that in some areas these practices continued into modern times. Archaeological discoveries of possible trepanations continue to be made, often from geographic areas or time periods from which the practice was not previously known. Unfortunately, most of these reports describe single crania with healed defects interpreted as trepanations. When evaluating a possible trepanation in a skull that lacks medical history or comes from an archaeological context where there is no other evidence that such operations were performed, a thorough differential diagnosis is essential. Identification of unhealed trepanations is a relatively straightforward exercise, since tool marks provide direct evidence of surgical intervention. A confident diagnosis is more difficult in healed defects of the skull, where the mechanism that produced an opening may be obscured by bone remodeling. There are many possible causes of defects of the skull vault, including congenital and developmental anomalies, trauma, infection, neoplasm, and taphonomic damage. For this reason, a careful differential diagnosis is essential for identifying surgical intervention and distinguishing it from cranial defects caused by other mechanisms.

First Report of Awake Craniotomy of a Famous Musician: Suprasellar Tumor Surgery of Pianist Clara Haskil in 1942.

Clara Haskil (January 7, 1895-December 7, 1960) was one of the most famous female pianists of the 20th century. In her life and work she set new standards in piano playing. However, her career was beset by poor health and the adversities of two world wars. In her lifetime Haskil had three major disorders: juvenile scoliosis requiring treatment in her adolescence, a tumor of the sellar region requiring surgery at age 47 years, and a traumatic brain injury causing her death at the age of 65. Her medical history illustrates the development of surgical methods and rehabilitation in medicine before and after World War II. At an early age, she spent a year in a nursing home for orthopedic diseases due to scoliosis. In 1942, when she was 47 years old, she displayed the first symptoms of a suprasellar brain tumor: headache and hemianopsia. The famous surgeon Marcel David performed surgery on her without general anesthesia while Haskil mentally played a Mozart piano concerto as a neuronal representation to control her memory and mental abilities. Only 3 months after that operation she played a Mozart piano concerto at a concert that began her career as a great interpreter of Mozart. Her neurologic rehabilitation was remarkable and highlighted new methods in the field. In 1960, she traveled to Brussels for a concert. In the train station she stumbled on the stairs and hit her head on one of the steps. Skull fracture and intracranial hematoma were diagnosed. Doctors tried to operate on her but she lost consciousness and died. Haskil created new styles in piano playing, and her medical history offers indications of new concepts in neurosurgery.