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1.
Artigo em Russo | MEDLINE | ID: mdl-33864672

RESUMO

Multiple gliomas are determined by synchronous two or more tumors located in different brain regions. It is important to distinguish multiple primary tumors and metastatic brain lesion. In the first case, tumor spread can`t be explained by dissemination along the cerebrospinal fluid pathways, commissural fibers or local metastases. Multiple primary tumors with different histological structures are called bidermal neoplasms. Surgery is preferred in these patients with severe symptoms. The purpose of surgery is maximum resection of tumor. Follow-up may be advisable for small tumors without clinical manifestations. Treatment of multiple gliomas includes surgery, radiotherapy and chemotherapy. Multiple tumor process in children is much more severe compared to a single neoplasia that requires neurological and neuroimaging control and determines treatment strategy. The authors report 3 children with multicentric gliomas, discuss the various aspects of diagnosis and treatment of multiple gliomas and formulate the recommendations for the treatment based on own clinical experience and literature data.


Assuntos
Neoplasias Encefálicas , Glioma , Neurocirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Criança , Glioma/diagnóstico por imagem , Glioma/cirurgia , Humanos , Imagem por Ressonância Magnética , Procedimentos Neurocirúrgicos
2.
BMC Cancer ; 21(1): 248, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685410

RESUMO

BACKGROUND: Low-grade glioma (LGG) is a relatively rare type of brain tumour. The use of antidepressant, sedative and anti-epileptic drugs can reflect the burden of the disease. While epilepsy is well-described in patients with LGG, less is known about depression and anxiety. METHODS: We used nationwide registers to study the use (dispense) of antidepressants, sedatives, and anti-epileptic drugs (AEDs) before and after histopathological LGG diagnosis (WHO grade II). A total of 485 adult patients with a first-time diagnosis and a matched control cohort (n = 2412) were included. Patterns of use were analysed from one year prior to until one year following index date (date of surgery). Logistic regression analysis identified predictors for postoperative use. RESULTS: At one year before index date, patients were dispensed AEDs 4 times more than controls, while antidepressants and sedatives were similar. Sedatives and AED peaked shortly after index date at 25 and 69%, respectively. AEDs then stabilized while sedatives decreased rapidly. For antidepressants, a delayed increase was seen after index date, stabilizing at 12%. At one year after index date, the use of antidepressants, sedatives, and AEDs among patients was 2, 3, and 26 times higher, respectively, compared to controls. Predictor for use of AEDs and sedatives at one year following index was previous use and/or a related diagnosis. Female sex and later index year were additional predictors for antidepressants. CONCLUSIONS: Use of antidepressants, sedatives and AEDs is elevated following diagnosis of LGG. Antidepressants were more commonly dispensed to female patients and in recent years.


Assuntos
Ansiedade/epidemiologia , Neoplasias Encefálicas/cirurgia , Depressão/epidemiologia , Glioma/cirurgia , Convulsões/epidemiologia , Adulto , Fatores Etários , Ansiolíticos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Ansiedade/psicologia , Neoplasias Encefálicas/diagnóstico , Estudos de Casos e Controles , Depressão/tratamento farmacológico , Depressão/etiologia , Depressão/psicologia , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Glioma/complicações , Glioma/diagnóstico , Glioma/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pós-Operatório , Período Pré-Operatório , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Convulsões/tratamento farmacológico , Convulsões/etiologia , Fatores Sexuais , Suécia/epidemiologia
3.
Eur J Radiol ; 138: 109649, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33730659

RESUMO

PURPOSE: To investigate the value of the iodine concentration (IC) measured by dual-layer detector spectral CT (DLDSCT) in evaluating the factors related to the treatment scheme and survival prognosis of patients with glioma. METHODS: From 2018 to 2019, we prospectively collected the data of 99 patients with glioma. The degree of CT enhancement and the IC of low grade gliomas (LGGs, II), high grade gliomas (HGGs, III and IV), grade II and III gliomas, were compared. The predictive performance of the degree of CT enhancement and IC was examined via receiver operating characteristic (ROC) analysis. The correlations between IC and Ki-67 labeling index, isocitrate dehydrogenase (IDH) mutation, chromosome 1p/19q deletion status of the tumor were examined. RESULTS: Both IC and the degree of CT enhancement of patients with HGG were significantly higher than those of patients with LGG (p < 0.001; χ2 =41.707, p <  0.001); IC had large area under the ROC curve for diagnostic HGG (0.931; 95 % CI: 0.882-0.979; p <  0.001). The IC in the grade III gliomas was significantly higher than that in grade II gliomas (p < 0.001); IC had a large area under the ROC curve for diagnostic grade III gliomas (0.865; 95 % CI: 0.779-0.952; p <  0.001). There was a significant positive correlation between IC and Ki-67 LI (r = 0.679; p < 0.001). CONCLUSIONS: The DLDSCT technology can be used as a supplementary method to provide more information for preoperative grading of the gliomas and the prognosis assessment of the patients.


Assuntos
Neoplasias Encefálicas , Glioma , Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Glioma/cirurgia , Humanos , Isocitrato Desidrogenase/genética , Mutação , Gradação de Tumores , Tomografia Computadorizada por Raios X
4.
Medicine (Baltimore) ; 100(10): e24850, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725839

RESUMO

ABSTRACT: Factors associated with the prognosis of low-grade glioma remain undefined. In this study, we examined whether the maximal tumor diameter in the preoperative tumor magnetic resonance imaging (MRI) T2 image is associated with the prognosis of grade II gliomas patients, aiming to provide insights into the clinical prediction of patient outcome.We retrospectively analyzed the clinical data of patients with Grade II glioma, who were hospitalized in Xiangya Hospital, Central South University, from 2011 to 2016. Kaplan-Meier and Cox proportional hazards analyses were performed to determine the association between maximal tumor diameter and prognosis.A total of 90 patients with grade II glioma were included in this study. Mean patient age was 37.7 ±â€Š13.0 years, and 58.9% of them were male. Kaplan-Meier survival analysis of overall survival (overall survival [OS], P = .009) and event-free survival (EFS, P = .002) revealed statistically significant differences between the patients with lesion diameter <7 cm and those with lesion diameter ≥7 cm. The maximal tumor diameter in the preoperative tumor MRI T2 image was identified as a prognostic factor of OS (P = .013), while constituting an independent risk factor for EFS (P = .002) alongside elevated histological grade after recurrence (P = .006).The maximal tumor diameter in the preoperative tumor MRI T2 image independently predicts OS and EFS in patients with grade II glioma.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Glioma/diagnóstico por imagem , Glioma/patologia , Imagem por Ressonância Magnética , Adulto , Neoplasias Encefálicas/cirurgia , Feminino , Glioma/cirurgia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Período Pré-Operatório , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Estudos Retrospectivos
5.
BMC Surg ; 21(1): 55, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482777

RESUMO

BACKGROUND: There are few articles about the surgical techniques of thalamic glioma and the lesions in the basal ganglia area. According to three existing cases and the literature review (Twelve articles were summarized which mainly described the surgical techniques), we discuss the surgical characteristics of lesions of the thalamus and basal ganglia area and summarize the relevant surgical skills. CASE PRESENTATION: Of the three cases, two were thalamic gliomas and one was brain abscess in basal ganglia. According to the three-dimensional concept of the "Four Walls, Two Poles", lesions of the thalamus and basal ganglia were surgically removed, and the operative effect was analysed by relevant surgical techniques. Surgical resection of the lesions of the thalamus and basal ganglia area according to the three-dimensional concept of the "Four Walls, Two Poles" has achieved good surgical results. Relevant surgical techniques, such as the use of retractors, the use of aspirators, the choice of surgical approaches, and the haemostasis strategy, also played an important role in the operation process. CONCLUSIONS: In the presented three cases the three-dimensional concept of the "Four Walls, Two Poles" allowed for safe surgical resection of lesions of the thalamus and basal ganglia.


Assuntos
Doenças dos Gânglios da Base/cirurgia , Gânglios da Base , Abscesso Encefálico/cirurgia , Glioma/cirurgia , Procedimentos Neurocirúrgicos , Tálamo , Adulto , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/cirurgia , Doenças dos Gânglios da Base/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Competência Clínica , Glioma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Tálamo/diagnóstico por imagem , Tálamo/cirurgia , Tomografia Computadorizada por Raios X
6.
Neurosurgery ; 88(3): 457-467, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33476393

RESUMO

Resection of brain tumors involving motor areas and pathways requires the identification and preservation of various cortical and subcortical structures involved in motor control at the time of the procedure, in order to maintain the patient's full motor capacities. The use of brain mapping techniques has now been integrated into clinical practice for many years, as they help the surgeon to identify the neural structures involved in motor functions. A common definition of motor function, as well as knowledge of its neural organization, has been continuously evolving, underlining the need for implementing intraoperative strategies at the time of the procedure. Similarly, mapping strategies have been subjected to continuous changes, enhancing the likelihood of preservation of full motor capacities. As a general rule, the motor mapping strategy should be as flexible as possible and adapted strictly to the individual patient and clinical context of the tumor. In this work, we present an overview of current knowledge of motor organization, indications for motor mapping, available motor mapping, and monitoring strategies, as well as their advantages and limitations. The use of motor mapping improves resection and outcomes in patients harboring tumors involving motor areas and pathways, and should be considered the gold standard in the resection of this type of tumor.


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Monitorização Neurofisiológica Intraoperatória/métodos , Córtex Motor/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Feminino , Glioma/cirurgia , Humanos , Masculino , Córtex Motor/cirurgia
8.
Cochrane Database Syst Rev ; 1: CD013630, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33428222

RESUMO

BACKGROUND: Multiple studies have identified the prognostic relevance of extent of resection in the management of glioma. Different intraoperative technologies have emerged in recent years with unknown comparative efficacy in optimising extent of resection. One previous Cochrane Review provided low- to very low-certainty evidence in single trial analyses and synthesis of results was not possible. The role of intraoperative technology in maximising extent of resection remains uncertain. Due to the multiple complementary technologies available, this research question is amenable to a network meta-analysis methodological approach. OBJECTIVES: To establish the comparative effectiveness and risk profile of specific intraoperative imaging technologies using a network meta-analysis and to identify cost analyses and economic evaluations as part of a brief economic commentary. SEARCH METHODS: We searched CENTRAL (2020, Issue 5), MEDLINE via Ovid to May week 2 2020, and Embase via Ovid to 2020 week 20. We performed backward searching of all identified studies. We handsearched two journals, Neuro-oncology and the Journal of Neuro-oncology from 1990 to 2019 including all conference abstracts. Finally, we contacted recognised experts in neuro-oncology to identify any additional eligible studies and acquire information on ongoing randomised controlled trials (RCTs). SELECTION CRITERIA: RCTs evaluating people of all ages with presumed new or recurrent glial tumours (of any location or histology) from clinical examination and imaging (computed tomography (CT) or magnetic resonance imaging (MRI), or both). Additional imaging modalities (e.g. positron emission tomography, magnetic resonance spectroscopy) were not mandatory. Interventions included fluorescence-guided surgery, intraoperative ultrasound, neuronavigation (with or without additional image processing, e.g. tractography), and intraoperative MRI. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the search results for relevance, undertook critical appraisal according to known guidelines, and extracted data using a prespecified pro forma. MAIN RESULTS: We identified four RCTs, using different intraoperative imaging technologies: intraoperative magnetic resonance imaging (iMRI) (2 trials, with 58 and 14 participants); fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) (1 trial, 322 participants); and neuronavigation (1 trial, 45 participants). We identified one ongoing trial assessing iMRI with a planned sample size of 304 participants for which results are expected to be published around winter 2020. We identified no published trials for intraoperative ultrasound. Network meta-analyses or traditional meta-analyses were not appropriate due to absence of homogeneous trials across imaging technologies. Of the included trials, there was notable heterogeneity in tumour location and imaging technologies utilised in control arms. There were significant concerns regarding risk of bias in all the included studies. One trial of iMRI found increased extent of resection (risk ratio (RR) for incomplete resection was 0.13, 95% confidence interval (CI) 0.02 to 0.96; 49 participants; very low-certainty evidence) and one trial of 5-ALA (RR for incomplete resection was 0.55, 95% CI 0.42 to 0.71; 270 participants; low-certainty evidence). The other trial assessing iMRI was stopped early after an unplanned interim analysis including 14 participants; therefore, the trial provided very low-quality evidence. The trial of neuronavigation provided insufficient data to evaluate the effects on extent of resection. Reporting of adverse events was incomplete and suggestive of significant reporting bias (very low-certainty evidence). Overall, the proportion of reported events was low in most trials and, therefore, issues with power to detect differences in outcomes that may or may not have been present. Survival outcomes were not adequately reported, although one trial reported no evidence of improvement in overall survival with 5-ALA (hazard ratio (HR) 0.82, 95% CI 0.62 to 1.07; 270 participants; low-certainty evidence). Data for quality of life were only available for one study and there was significant attrition bias (very low-certainty evidence). AUTHORS' CONCLUSIONS: Intraoperative imaging technologies, specifically 5-ALA and iMRI, may be of benefit in maximising extent of resection in participants with high-grade glioma. However, this is based on low- to very low-certainty evidence. Therefore, the short- and long-term neurological effects are uncertain. Effects of image-guided surgery on overall survival, progression-free survival, and quality of life are unclear. Network and traditional meta-analyses were not possible due to the identified high risk of bias, heterogeneity, and small trials included in this review. A brief economic commentary found limited economic evidence for the equivocal use of iMRI compared with conventional surgery. In terms of costs, one non-systematic review of economic studies suggested that, compared with standard surgery, use of image-guided surgery has an uncertain effect on costs and that 5-ALA was more costly. Further research, including completion of ongoing trials of ultrasound-guided surgery, is needed.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Glioma/diagnóstico por imagem , Glioma/cirurgia , Ácido Aminolevulínico/administração & dosagem , Viés , Humanos , Cuidados Intraoperatórios , Imagem por Ressonância Magnética Intervencionista/estatística & dados numéricos , Metanálise em Rede , Neuronavegação/métodos , Neuronavegação/estatística & dados numéricos , Imagem Óptica/métodos , Imagem Óptica/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
9.
Neurosurgery ; 88(2): E190-E202, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33313812

RESUMO

BACKGROUND: An early maximal safe surgical resection is the current treatment paradigm for low-grade glioma (LGG). Nevertheless, there are no reliable methods to accurately predict the axonal intratumoral eloquent areas and, consequently, to predict the extent of resection. OBJECTIVE: To describe the functional predictive value of eloquent white matter tracts within the tumor by using a pre- and postoperative intratumoral diffusion tensor imaging (DTI) tractography protocol in patients with LGG. METHODS: A preoperative intratumoral DTI-based tractography protocol, using the tumor segmented volume as the only seed region, was used to assess the tracts within the tumor boundaries in 22 consecutive patients with LGG. The reconstructed tracts were correlated with intraoperative electrical stimulation (IES)-based language and motor subcortical mapping findings and the extent of resection was assessed by tumor volumetrics. RESULTS: Identification of intratumoral language and motor tracts significantly predicted eloquent areas within the tumor during the IES mapping: the positive predictive value for the pyramidal tract, the inferior fronto-occipital fasciculus, the arcuate fasciculus and the inferior longitudinal fasciculus positive was 100%, 100%, 33%, and 80%, respectively, whereas negative predictive value was 100% for all of them. The reconstruction of at least one of these tracts within the tumor was significantly associated with a lower extent of resection (67%) as opposed to the extent of resection in the cases with a negative intratumoral tractography (100%) (P < .0001). CONCLUSION: Intratumoral DTI-based tractography is a simple and reliable method, useful in assessing glioma resectability based on the analysis of intratumoral eloquent areas associated with motor and language tracts within the tumor.


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Glioma/diagnóstico por imagem , Cirurgia Assistida por Computador/métodos , Adulto , Neoplasias Encefálicas/cirurgia , Feminino , Glioma/cirurgia , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade
10.
Neurosurgery ; 88(2): 211-221, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33313852

RESUMO

The goal of glioma surgery is maximal safe resection in order to provide optimal tumor control and survival benefit to the patient. There are multiple imaging modalities beyond traditional contrast-enhanced magnetic resonance imaging (MRI) that have been incorporated into the preoperative workup of patients presenting with gliomas. The aim of these imaging modalities is to identify cortical and subcortical areas of eloquence, and their relationship to the lesion. In this article, multiple modalities are described with an emphasis on the underlying technology, clinical utilization, advantages, and disadvantages of each. functional MRI and its role in identifying hemispheric dominance and areas of language and motor are discussed. The nuances of magnetoencephalography and transcranial magnetic stimulation in localization of eloquent cortex are examined, as well as the role of diffusion tensor imaging in defining normal white matter tracts in glioma surgery. Lastly, we highlight the role of stimulated Raman spectroscopy in intraoperative histopathological diagnosis of tissue to guide tumor resection. Tumors may shift the normal arrangement of functional anatomy in the brain; thus, utilization of multiple modalities may be helpful in operative planning and patient counseling for successful surgery.


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Feminino , Glioma/cirurgia , Humanos , Masculino , Imagem Multimodal/métodos
11.
Neurosurgery ; 88(4): 797-803, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33372205

RESUMO

BACKGROUND: Incidentally discovered suspected diffuse low-grade gliomas (LGGs) on brain imaging pose a challenge to neurosurgeons. Modern surgical series of LGGs favor early prophylactic surgery with a maximal extent of resection. However, some nonevolutive lesions may mimic LGGs on magnetic resonance imaging (MRI). OBJECTIVE: To determine objective criteria to advocate surgical resection of an incidentally discovered suspected LGG based upon MRI findings. METHODS: The prospective cohort of patients referred to our institution for an incidental finding suggestive of LGG was retrospectively reviewed. Stable lesions underwent systematic serial MRI follow-up, while evolutive lesions underwent prophylactic surgery under awake conditions. Initial clinico-radiological features were compared between stable and evolutive lesions in order to determine predictive criteria of further evolution. RESULTS: Among 101 patients referred for surgical resection of incidentally discovered suspected LGG in our center, 19 patients (18.8%) had nonevolutive MRI lesions after a mean follow-up of 46.9 ± 34.9 mo. Insular topography (P = .003), higher mean volume at discovery (19.2 vs 5.2 cm3, P < .001), and adjacent sulcal effacement (P = .001) were associated with evolutive lesions. Histopathological diagnosis of LGG was confirmed in all surgical cases. CONCLUSION: Increasing volume is an effective predictor of LGG diagnosis in incidental MRI findings, as all patients who subsequently underwent surgery had confirmed histopathological diagnosis of diffuse glioma. Approximately 18.8% of incidental findings were stable over time. Insular topography, adjacent sulcal effacement, and volume greater than 4.5 cm3 were predictive of further radiological progression. These significant elements will help neurosurgeons to define personalized strategies in this complex setting of incidental discovery.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Achados Incidentais , Adulto , Neoplasias Encefálicas/cirurgia , Estudos de Coortes , Feminino , Glioma/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Vigília
12.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(6): 268-278, nov.-dic. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-197921

RESUMO

INTRODUCTION: It is common practice to prescribe prophylactic antiepileptic drugs (AED) to high-grade glioma (HGG) patients without a history of seizures, yet with limited evidence supporting its use. Ideally, the effectiveness of prophylactic anticonvulsants must outweigh the occurrence of adverse effects and interactions related to AED. The authors conducted a systematic review and metanalysis of longitudinal studies regarding the effectiveness of prophylactic AED in seizure-naïve HGG patients. MATERIALS AND METHODS: PubMed/MEDLINE, Cochrane Central Register of Controlled trials, Embase and clinicaltrials.gov databases were systematically searched. Of the initial 1773 studies identified, 15 were finally selected for data extraction and analysis. Heterogeneity among studies, pooled hazard ratios, publication bias and sensitivity analyses were performed separately for a 15-study group (HGG patients within larger series of brain tumors) and a 6-study group (exclusively HGG patients). RESULTS: AED prophylaxis did not significantly reduce the incidence of postoperative seizures compared with controls, both in the 15-study group (Mantel-Haenszel random-effects pooled OR 1.08, 95% CI 0.82-1.43, 2123 patients) and in the 6-study group (pooled OR 1.22, 95% CI 0.77-1.92, 540 patients). However, some issues (paucity of prospective trials, overall moderate-risk of bias, and few studies addressing HGG patients exclusively) preclude firm conclusions against routine prophylactic AED prescription. Reported adverse effects attributable to AED were acceptable in the majority of studies. CONCLUSIONS: Within the limitations of this review, the results of this metanalysis do not support the routine administration of prophylactic AED to HGG patients without a history of seizures


INTRODUCCIÓN: Generalmente se administran fármacos antiepilépticos (FAE) a pacientes con gliomas de alto grado (GAG) sin historia previa de crisis, a pesar de una escasa evidencia a favor. Idealmente la efectividad de la profilaxis anticomicial debe compensar la aparición de efectos adversos debidos a la medicación. Realizamos una revisión sistemática y un metaanálisis de estudios longitudinales respecto a la utilidad de los FAE en pacientes con GAG sin historia de crisis previa. MATERIAL Y MÉTODOS: Se revisaron las bases de datos PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase y clinicaltrials.gov. De los 1.773 trabajos inicialmente identificados, 15 fueron seleccionados para la extracción de datos y análisis. Se realizaron análisis de heterogeneidad, sesgo de publicación, cálculo de OR combinadas y análisis de sensibilidad, por separado, en 2 grupos: grupo de 15 estudios (pacientes con GAG incluidos en series de tumores cerebrales) y grupo de 6 estudios (exclusivamente pacientes con GAG). RESULTADOS: La profilaxis con FAE no redujo de forma significativa la incidencia de crisis postoperatorias respecto a los controles, tanto en el grupo-15 (OR combinada de Mantel-Haenszel, efectos aleatorios de 1,08, IC 95%: 0,82-1,43, sobre 2.123 pacientes), como en el grupo-6 (OR combinada de 1,22, IC 95% 0,77-1,92, sobre 540 pacientes). Sin embargo, la escasez de ensayos aleatorizados y de estudios con GAG exclusivamente, junto a un sesgo global moderado, impiden establecer una recomendación sólida contra la profilaxis anticomicial. Los efectos adversos atribuidos a los FAE fueron aceptables en la mayoría de los estudios. CONCLUSIONES: Dentro de las limitaciones de esta revisión, los resultados del metaanálisis no apoyan el uso rutinario de profilaxis antiepiléptica en pacientes con GAG sin historia previa de crisis


Assuntos
Humanos , Anticonvulsivantes/uso terapêutico , Glioma/tratamento farmacológico , Profilaxia Pré-Exposição/métodos , Anticonvulsivantes/efeitos adversos , Convulsões/prevenção & controle , Neoplasias Encefálicas/tratamento farmacológico , Glioma/complicações , Glioma/cirurgia , Estudos Longitudinais , Convulsões/etiologia , Cuidados Pós-Operatórios/métodos , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia
13.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(6): 279-288, nov.-dic. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-197922

RESUMO

INTRODUCCIÓN: Los tumores cerebrales gliales precisan habitualmente de un tratamiento neuroquirúrgico y se asocian con diversas alteraciones cognitivas, emocionales y comportamentales. El mapeo cerebral intraoperatorio es la técnica por excelencia utilizada para optimizar el equilibrio oncofuncional. La valoración e intervención desde la perspectiva neuropsicológica tiene gran relevancia en este tipo de procedimientos. Actualmente, se carece de una estructura protocolizada para la exploración y el seguimiento neuropsicológico que estos pacientes necesitan. MÉTODO: Se realiza un estudio descriptivo retrospectivo de 52 pacientes, todos ellos con diagnóstico de tumor glial, describiendo la estructura del protocolo desarrollado en nuestro centro. Se analizan los datos de la evaluación neuropsicológica, comparando el rendimiento inicial de los pacientes con su rendimiento posterior a la cirugía a corto y a largo plazo. RESULTADOS: Se describe nuestra experiencia en algunas las fases del protocolo, detallando las tareas que se han desarrollado para valorar a los pacientes dentro del quirófano. Los resultados de los datos de las evaluaciones neuropsicológicas objetivan déficits en el momento posterior a la cirugía que remiten en la valoración a largo plazo. CONCLUSIONES: Destacamos la necesidad de dar espacio y protocolizar en la asistencia hospitalaria los aspectos cognitivos y emocionales de los pacientes que sufren cualquier patología que conlleve daño cerebral adquirido. Este tipo de abordaje está orientado a aumentar la calidad de vida de los pacientes oncológicos estructurando y optimizando las tareas durante su intervención quirúrgica, pero también atendiendo a las dificultades neuropsicológicas que manifiesten


INTRODUCTION: Glial brain tumours usually require neurosurgical treatment and they are associated with cognitive, emotional and behavioural impairments. Awake intraoperative brain mapping is the gold standard technique used to optimize the onco-functional balance. Neuropsychological assessment and intervention have relevance in this type of procedures. Currently, there is a lack of protocolled structure for the neuropsychological intervention being able to satisfy patient needs. METHOD: A retrospective descriptive study of 52 patients was performed, all of them with a diagnosis of glial tumour. The structure of the protocol developed in our centre is reported, also data of neuropsychological evaluation, comparing baseline performance with both immediate posterior performance, and long term performance. RESULTS: We describe our experience in each step of the intervention, highlighting the development of eight neurocognitive protocols for intraoperative brain mapping. The results of the neuropsychological examination objectify deficits in the immediate after surgery assessment which are reduced in the long-term assessment. CONCLUSIONS: We emphasize the need of providing and structuring the cognitive and emotional aspects of patients suffering from any pathology that entails acquired brain damage in hospital environment. This type of approach is aimed at increasing the quality of life of cancer patients by structuring and optimizing tasks during their surgical intervention and attending to the neuropsychological difficulties they suffer


Assuntos
Humanos , Masculino , Feminino , Adulto , Procedimentos Neurocirúrgicos/métodos , Testes Neuropsicológicos , Glioma/cirurgia , Neoplasias Encefálicas/cirurgia , Vigília , Sedação Consciente/métodos , Protocolos Clínicos , Estudos Retrospectivos , Cuidados Pós-Operatórios
14.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(6): 289-298, nov.-dic. 2020.
Artigo em Espanhol | IBECS | ID: ibc-197923

RESUMO

INTRODUCCIÓN: El tratamiento de los glioblastomas (GMB) comienza en la mayor parte de los pacientes con una cirugía, ya sea para la extirpación tumoral, ya sea para la obtención de tejido con el que determinar un diagnóstico histológico. Con el fin de obtener el máximo beneficio de estos tratamientos cada paciente debe ser valorado de forma individualizada por un equipo multidisciplinar, constituido por aquellas especialidades involucradas tanto en el diagnóstico como en el tratamiento. MATERIAL Y MÉTODOS: El objetivo de este trabajo es elaborar unas recomendaciones de tratamiento para los pacientes con GBM, para lo cual un experto en cada campo ha descrito lo más relevante de dicha área basado tanto en su experiencia como en la literatura. RESULTADOS: Se han desarrollado los distintos apartados sobre el tratamiento de los GBM y al final de cada apartado se concluye la recomendación del GTNO. CONCLUSIONES: A pesar de que los GBM son tumores agresivos y el pronóstico es malo, los pacientes se pueden beneficiar de tratamientos que mejoren no solo la supervivencia global sino también la calidad de vida. El neurocirujano debe conocer las distintas opciones de tratamientos, sus indicaciones y riesgos para poder participar activamente en la toma de decisiones y ofrecer un tratamiento neuroquirúrgico oportuno a cada situación


INTRODUCTION: Glioblastoma (GBM) treatment starts in most patients with surgery, either resection surgery or biopsy, to reach a histology diagnose. Multidisciplinar team, including specialists in brain tumors diagnose and treatment, must make an individualize assessment to get the maximum benefit of the available treatments. MATERIAL AND METHODS: Experts in each GBM treatment field have briefly described it based in their experience and the reviewed of the literature. RESULTS: Each area has been summarized and the consensus of the brain tumor group has been included at the end. CONCLUSIONS: GBM are aggressive tumors with a dismal prognosis, however accurate treatments can improve overall survival and quality of life. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case


Assuntos
Humanos , Conferências de Consenso como Assunto , Retinoblastoma/terapia , Equipe de Assistência ao Paciente/normas , Neoplasias Encefálicas/cirurgia , Tomada de Decisões , Sociedades Médicas/normas , Glioma/radioterapia , Glioma/cirurgia , Glioma/tratamento farmacológico , Monitorização Neurofisiológica Intraoperatória/normas , Imunoterapia/normas
15.
PLoS One ; 15(12): e0244003, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33373375

RESUMO

PURPOSE: Radiological assessment of primary brain neoplasms, both high (HGG) and low grade tumors (LGG), based on contrast-enhancement alone can be inaccurate. We evaluated the radiological value of amide proton transfer weighted (APTw) MRI as an imaging complement for pre-surgical radiological diagnosis of brain tumors. METHODS: Twenty-six patients were evaluated prospectively; (22 males, 4 females, mean age 55 years, range 26-76 years) underwent MRI at 3T using T1-MPRAGE pre- and post-contrast administration, conventional T2w, FLAIR, and APTw imaging pre-surgically for suspected primary/secondary brain tumor. Assessment of the additional value of APTw imaging compared to conventional MRI for correct pre-surgical brain tumor diagnosis. The initial radiological pre-operative diagnosis was based on the conventional contrast-enhanced MR images. The range, minimum, maximum, and mean APTw signals were evaluated. Conventional normality testing was performed; with boxplots/outliers/skewness/kurtosis and a Shapiro-Wilk's test. Mann-Whitney U for analysis of significance for mean/max/min and range APTw signal. A logistic regression model was constructed for mean, max, range and Receiver Operating Characteristic (ROC) curves calculated for individual and combined APTw signals. RESULTS: Conventional radiological diagnosis prior to surgery/biopsy was HGG (8 patients), LGG (12 patients), and metastasis (6 patients). Using the mean and maximum: APTw signal would have changed the pre-operative evaluation the diagnosis in 8 of 22 patients (two LGGs excluded, two METs excluded). Using a cut off value of >2.0% for mean APTw signal integral, 4 of the 12 radiologically suspected LGG would have been diagnosed as high grade glioma, which was confirmed by histopathological diagnosis. APTw mean of >2.0% and max >2.48% outperformed four separate clinical radiological assessments of tumor type, P-values = .004 and = .002, respectively. CONCLUSIONS: Using APTw-images as part of the daily clinical pre-operative radiological evaluation may improve diagnostic precision in differentiating LGGs from HGGs, with potential improvement of patient management and treatment.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Feminino , Glioma/patologia , Glioma/cirurgia , Humanos , Imagem por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes
16.
J Clin Neurosci ; 82(Pt A): 20-25, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317732

RESUMO

OBJECTIVE: The optimal timing for glioma patients to stop taking antiepileptic drugs (AEDs) and the risk factors of seizure relapse have not been determined. Here, we explored the short-term outcomes and risk factors of seizure relapse in glioma patients after withdrawal of AEDs. METHODS: 91 patients with gliomas who had no seizures at least 2 years after surgery were enrolled in the study. The patients were followed up for 1 year or until the relapse of seizure after AEDs withdrawal. The risk factors of seizure relapse were analyzed by univariate and multivariate analysis. The optimal discrimination point was determined by plotting a receiver operating characteristic (ROC) curve to explore the relationship between the number of risk factors and seizure relapse. RESULTS: 28 patients (30.8%) relapsed during the follow-up period while 63 patients (69.2%) remained seizure-free. Of the 28 relapsed patients, 20 (71.4%) relapsed within the first 6 months after the AEDs withdrawal. Multivariate analyses revealed that subtotal resection (p = 0.026), IDH1 mutation (p = 0.019), and combined use of AEDs (p = 0.037) were independent risk factors for seizure relapse in glioma patients. ROC curve based on the seizure relapse showed that the sensitivity was 0.821 and 1-specificity was 0.238, corresponding to 1.5 independent risk factors for each patient. CONCLUSION: To obtain a favorable outcome for glioma patients with preoperative seizures, only patients with less than two independent risk factors for seizure relapse should consider discontinuing AEDs.


Assuntos
Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/complicações , Glioma/complicações , Convulsões , Adolescente , Adulto , Neoplasias Encefálicas/cirurgia , Feminino , Glioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva , Estudos Retrospectivos , Fatores de Risco , Convulsões/epidemiologia , Convulsões/etiologia , Convulsões/prevenção & controle , Fatores de Tempo , Adulto Jovem
17.
J Clin Neurosci ; 82(Pt A): 49-51, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317738

RESUMO

There has been a growing anxiety in carrying out awake craniotomy surgeries during the SARS-CoV-2 pandemic, not only due to airway management but also close proximity to the team in theatre. We set out to safely perform the first documented awake craniotomy in the UK since the beginning of lockdown. We performed a thorough workup of the patient with minimal hospital visits, using remote communication wherever possible. We modified our existing awake craniotomy protocol/technique guided by local/national policies. An asleep-awake-asleep craniotomy for tumour resection was performed successfully without compromising patient and staff safety with excellent post-operative outcome. With appropriate pre- and peri-operative modifications to established protocols, awake craniotomies with functional mapping can be safely carried out. By incorporating novel aspects to our technique, we believe that this service can safely resume in carefully selected patients.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/métodos , Glioma/cirurgia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pandemias , Vigília
18.
PLoS One ; 15(12): e0243998, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326475

RESUMO

The treatment of children with posterior fossa brain tumours (PFBT) impacts their long term functional and imaging outcomes. This study aimed to evaluate academic achievement correlated with long-term sequelae after different PFBT treatment modalities. The study cohort consisted of 110 survivors (median age at diagnosis 10.1 years and median time of follow up 13.2 years) who completed hearing questionnaires, neurological assessment and MRI of the brain ≥5 years after the end of treatment. There were three treatment groups. A cisplatin group which underwent cisplatin chemotherapy, radiotherapy and surgery (medulloblastoma N = 40), a radiotherapy group which underwent radiotherapy and surgery (astrocytoma/ependymoma N = 30), and a surgery group (astrocytoma N = 40). Academic achievement was correlated to the age at diagnosis, ototoxicity, Karnofsky score (KS), and MRI findings (Fazekas Score (FS)- treatment related parenchymal changes). For a modelled age at diagnosis of five years, the cisplatin group had lower academic achievements compared to the radiotherapy (p = 0.028) and surgery (p = 0.014) groups. Academic achievements evaluated at a modelled age of 10 years at diagnosis did not significantly differ among the treatment groups. The cisplatin group exhibited a higher occurrence of ototoxicity than the radiotherapy (p<0.019) and surgery groups (p<0.001); however, there was no correlation between ototoxicity and academic achievements (p = 0.722) in older age at diagnosis. The radiotherapy group exhibited lower KS than the surgery group (p<0.001). KS significantly influenced academic achievements in all groups (p<0.000). The cisplatin group exhibited higher FS than the surgery group (p<0.001) while FS did not correlate with academic achievement (p = 0.399). Older age is a protective factor for academic achievements irrespective of a treatment modality.


Assuntos
Sucesso Acadêmico , Sobreviventes de Câncer/educação , Glioma/epidemiologia , Neoplasias Infratentoriais/epidemiologia , Adolescente , Fatores Etários , Antineoplásicos/efeitos adversos , Criança , Cisplatino/efeitos adversos , Cisplatino/uso terapêutico , Feminino , Glioma/cirurgia , Glioma/terapia , Humanos , Neoplasias Infratentoriais/cirurgia , Neoplasias Infratentoriais/terapia , Masculino , Procedimentos Neurocirúrgicos/efeitos adversos , Radioterapia/efeitos adversos
19.
Anticancer Res ; 40(11): 6513-6515, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109591

RESUMO

BACKGROUND/AIM: Previously, we identified predictors of survival after irradiation of grade II-IV cerebral gliomas. In this supplementary analysis, survival was calculated in a more appropriate way than the original study. PATIENTS AND METHODS: Ten factors were re-evaluated for survival in patients of the original study including pre-radiotherapy seizures. In the original study, survival was calculated from the end of the last radiotherapy course (primary or re-irradiation). After re-review, this approach was considered inappropriate. Survival should have always been calculated from the first radiotherapy course, as done in this supplementary analysis. RESULTS: On multivariate analysis, WHO-grade II (p=0.006) and upfront resection (p=0.001) were associated with better survival. Unifocal glioma was significant on univariate analysis (p=0.001), where a trend could be identified for age ≤59 years (p=0.057) and seizures (p=0.060). CONCLUSION: The findings of this supplementary analysis regarding the identification of prognostic factors for survival agree with the results of the original study.


Assuntos
Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Prognóstico , Idoso , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Intervalo Livre de Doença , Feminino , Glioma/patologia , Glioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Reirradiação/efeitos adversos , Estudos Retrospectivos
20.
Medicine (Baltimore) ; 99(36): e22029, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899058

RESUMO

This study aims to describe the role of open surgical treatment for focal brainstem gliomas (FBSGs) with the assistance of multimodal neuronavigation and intraoperative neurophysiological monitoring (IOM) in children to investigate the efficacy of microsurgical treatment in pediatric FBSGs. Also the prognostic factors related to the overall survival (OS) of FBSGs to describe the patient and tumor characteristics relevant to prognosis/outcome were focused on. Clinical data of 63 pediatric patients below 16 years of age with FBSGs admitted to the Neurosurgical Unit of Beijing Tiantan Hospital from January 2012 to December 2018 were retrospectively analyzed. All patients underwent initial surgical treatment, followed by magnetic resonance diffusion tensor imaging (DTI), neuronavigation and IOM. Gross or near total resection (GTR or NTR) was achieved in 57/63 (90.5%) cases, and subtotal resection (STR) was achieved in 6/63 (9.5%) cases. Postoperative adjuvant therapy was received by 27/63 (42.9%) cases. Postoperative pathological examination revealed that 36/63 (57.1%) cases had grade I gliomas, 22/63 (34.9%) had grade II, and 5/63 (8.0%) had grade III-IV gliomas according to the WHO classification. The mean Karnofsky score preoperatively was 60, and at the time of follow-up was 90. Consecutively, 6 cases demonstrated disease progression, and 5 of these were deceased. The OS in all patients was 81.2% at 5 years. Histological grade (P < .001) and age at diagnosis (P = .023) showed significant association with prolonged OS. Multimodal neuronavigation and IOM allow very precise intracranial surgery, contributing to a maximally safe resection that might decrease the postoperative disability and mortality rate. This study also showed that pediatric FBSGs were mostly low-grade tumors with excellent surgical outcomes. Consequently, it is suggested that microsurgery can be used to treat FBSGs in children in order to provide better prognosis and survival outcomes.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Glioma/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Neuronavegação/métodos , Adolescente , Quimioterapia Adjuvante , Criança , Pré-Escolar , China/epidemiologia , Imagem de Tensor de Difusão/métodos , Progressão da Doença , Feminino , Glioma/diagnóstico por imagem , Humanos , Lactente , Avaliação de Estado de Karnofsky , Masculino , Microcirurgia/métodos , Gradação de Tumores , Cuidados Pós-Operatórios , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
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