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1.
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
2.
Medicine (Baltimore) ; 100(5): e23056, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592815

RESUMO

ABSTRACT: This study aimed to evaluate the effect of reminiscence therapy-based care (RTBC) program on anxiety, depression, patients satisfaction, and survival benefit in glioma patients after tumor resection.A total of 150 eligible glioma patients were randomized into the RTBC group (N = 75, receiving RTBC) and the control care (CC) group (N = 75, receiving CC). Interventions were performed twice a month for 12 months. Anxiety was evaluated by Hospital Anxiety and Depression Scale (HADS) for anxiety score and Zung self-rating anxiety scale (SAS) score; meanwhile, depression was evaluated by HADS for depression score and Zung self-rating depression scale (SDS) score; additionally, patients satisfaction was scored. A 36-month follow-up was performed, and accumulating overall survival (OS) were calculated.Both anxiety level and depression level were reduced in the RTBC group compared with the CC group at month 9 and month 12 (all P < .05); meanwhile, the proportion of anxious patients and depressed patients were decreased in the RTBC group compared with the CC group at month 12 (all P < .05). Moreover, patients satisfaction scores were increased in the RTBC group compared to the CC group at month 6, month 9, and month 12 (all P < .05). Additionally, accumulating OS showed an increasing tendency in the RTBC group compared to the CC group, but no statistical significance was observed (P = .186).RTBC program ameliorates anxiety, depression, and promotes patients satisfaction in glioma patients after tumor resection.


Assuntos
Ansiedade/terapia , Neoplasias Encefálicas/reabilitação , Depressão/terapia , Glioma/reabilitação , Medicina Narrativa/métodos , Adulto , Fatores Etários , Idoso , Ansiedade/etiologia , Neoplasias Encefálicas/complicações , Comorbidade , Depressão/etiologia , Feminino , Glioma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Fatores Sexuais , Fatores Socioeconômicos
3.
Neurology ; 96(7): e1063-e1069, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33361259

RESUMO

OBJECTIVE: To determine the incidence of venous thromboembolism (VTE) in lower-grade gliomas (LGGs, WHO grades II-III) and to stratify the risk of VTE by molecular subtype in gliomas grade II-IV, we performed a retrospective review of a large cohort of patients with glioma. METHODS: We performed a retrospective analysis of a cohort of 635 adult patients with glioma with molecular testing seen at the University of Virginia with a diagnosis of diffuse glioma established from January 2005 to August 2017. Estimates of cumulative incidence of VTE were calculated with death as competing risk; significance was determined using the Fine and Gray model. RESULTS: Of 256 patients with LGG, 81 were isocitrate dehydrogenase (IDH) wild-type; 113 IDH mutant, 1p/19q codeleted; and 62 IDH mutant, 1p/19q intact. With a median follow-up of 17.9 months, the overall cumulative incidence of VTE was 8.2% for grade II (147 patients), 9.2% for grade III (109 patients), and 30.5% for grade IV (334 patients). In grade II-IV patients, absence of an IDH mutation was associated with a threefold increase in VTE risk when compared to IDH-mutant patients (hazard ratio 3.06, 95% confidence interval 2.03-4.64). In patients with glioblastoma, there was no difference in VTE incidence according to O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. CONCLUSION: Patients with LGG have a higher VTE risk compared to the general population, which is decreased, but not eliminated, in the presence of an IDH mutation. MGMT promoter methylation in glioblastoma does not affect the incidence of VTE.


Assuntos
Neoplasias Encefálicas/complicações , Glioma/complicações , Isocitrato Desidrogenase/genética , Tromboembolia Venosa/epidemiologia , Adulto , Idoso , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Feminino , Glioma/genética , Glioma/patologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mutação , Gradação de Tumores , Regiões Promotoras Genéticas , Estudos Retrospectivos , Risco , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/genética
4.
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
5.
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
6.
Medicine (Baltimore) ; 99(28): e21002, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664104

RESUMO

RATIONALE: The orexin projection system includes the lateral hypothalamus, reticular activating structure, and ventrolateral preoptic nucleus, and this system is related to the pathogenesis of narcolepsy. Here, we report a case of narcolepsy type 2 caused by hippocampal glioma of the right temporal lobe. PATIENT CONCERNS: A 44-year-old male farmer complained of excessive daytime sleepiness (EDS) over the past 3 months and more. INTERVENTIONS: The lesion of the right anteromedial temporal lobe was removed and its pathological examination was carried out. OUTCOMES: General examination showed no abnormalities of his heart, lungs, or abdomen. Neurological examination showed no positive sign. The blood routine and biochemical examination were normal. He scored 7 on the Pittsburg sleep quality index, 16 on the Epworth sleepiness scale, 52 on the self-rating anxiety scale, and 48 on the self-rating depression scale. The multiple sleep latency test data showed 2 periods of sleep-onset rapid eyes movement period across 4 successive tests; the average sleep latency was under 8 minutes, and the rapid eyes movement latency was under 7 minutes. Lesion of glioma in hippocampus area of the right anteromedial temporal lobe was confirmed through magnetic resonance imaging, magnetic resonance spectroscopy, and histological examination. After surgical removal of the glioma from the hippocampus area of the right anteromedial temporal lobe, the patient's EDS symptoms disappeared immediately. He scored 3 on the Epworth sleepiness scale. During our follow-up three months later, he remained well with no complications. DIAGNOSIS: We diagnosed the patient with narcolepsy type 2 according to the 3rd Edition of International Classification of Sleep Disorders (ICSD-3). CONCLUSION: The patient suffered from EDS and was diagnosed with narcolepsy type 2. The narcolepsy type 2 was linked to glioma of the hippocampus area. The hippocampus might be another part of regulating the sleep-arousal pathway, and the glioma secretion might interact with the orexin projection system.


Assuntos
Neoplasias Encefálicas/complicações , Glioma/complicações , Narcolepsia/etiologia , Lobo Temporal , Adulto , Humanos , Masculino , Narcolepsia/classificação
7.
World Neurosurg ; 139: 7-11, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32278819

RESUMO

BACKGROUND: Awake craniotomy (AC) with brain mapping has been successfully used for the resection of lesions located in or near eloquent areas of the brain. The selection process includes a thorough presurgical evaluation to determine candidates suitable for the procedure. Psychiatric disorders including post-traumatic stress disorder (PTSD) are considered potential contraindications for this type of surgery because these patients may be less cooperative to tolerate AC. Here we present the management of a patient with PTSD who underwent an AC using a multidisciplinary team for removal of a dominant hemisphere low-grade insular glioma with speech, motor, and cognitive mapping. CASE DESCRIPTION: A 34-year-old right-handed male military veteran with a previous history of PTSD was scheduled for a left AC for resection of a low-grade insular glioma. He underwent preoperative neurocognitive assessment with a neuropsychologist and clinic visit with a neurosurgeon to characterize his PTSD and potential triggers, explain the procedure in a stepwise fashion, and address any concerns. The intraoperative environment was modified to minimize triggering stimuli, and an asleep-awake-asleep anesthetic protocol was followed. The patient tolerated the procedure well without any postoperative neurologic deficits including cognitive deficits. At 1-month follow-up, he denied any worsening of his PTSD symptoms and recalls the AC as a positive experience. CONCLUSIONS: With a multidisciplinary team, adequate preoperative education, detailed clinical interview to identify triggers, and a controlled intraoperative environment, awake surgery can be carried out safely in a patient with PTSD.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/métodos , Glioma/cirurgia , Cuidados Intraoperatórios/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos , Vigília , Adulto , Anestesia Geral , Mapeamento Encefálico/métodos , Mapeamento Encefálico/psicologia , Neoplasias Encefálicas/complicações , Craniotomia/psicologia , Glioma/complicações , Humanos , Cuidados Intraoperatórios/psicologia , Masculino , Neuropsicologia , Neurocirurgiões , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Transtornos de Estresse Pós-Traumáticos/complicações
8.
Anticancer Res ; 40(4): 2059-2064, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234897

RESUMO

BACKGROUND/AIM: Prolonged use of glucocorticoids (GC) in glioma treatment can lead to adrenal insufficiency (AI) and subsequent steroid dependence due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis. This is challenging to diagnose due to its nonspecific clinical symptoms erroneously ascribed to treatment. This study aimed to evaluate the risk factors predisposing patients with gliomas to develop AI. PATIENTS AND METHODS: Charts in the neuro-oncology clinic from July 2018 to March 2019 were reviewed. Inclusion criteria included >18 y/o with WHO Grade II-IV gliomas, and secondary AI. Demographic profile, tumor characteristics, and treatment profile were compared. RESULTS: The majority of patients were started on high dose dexamethasone at >8 mg daily, and were on dexamethasone for 4-8 months. The minimum dose needed to prevent symptoms was 0.5 mg to 2 mg daily. The majority received standard radiation doses ranging from 54-60 Gy. Most patients had radiation exposure to the HPA axis within the prescription isodose levels. CONCLUSION: Prolonged steroid dependency can result from chronic GC use in patients with glioma. Dose and duration of GC are risk factors for its development. Radiation exposure to the HPA axis may also be a contributing factor.


Assuntos
Insuficiência Adrenal/tratamento farmacológico , Glioma/tratamento farmacológico , Glucocorticoides/efeitos adversos , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Insuficiência Adrenal/induzido quimicamente , Insuficiência Adrenal/patologia , Adulto , Dexametasona/administração & dosagem , Feminino , Glioma/complicações , Glioma/patologia , Glucocorticoides/administração & dosagem , Humanos , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Sistema Hipotálamo-Hipofisário/patologia , Masculino , Pessoa de Meia-Idade , Sistema Hipófise-Suprarrenal/patologia , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/patologia
9.
Brain Behav Immun ; 87: 645-659, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32097763

RESUMO

Glioblastoma is a kind of malignant tumour and originates from the central nervous system. In the last century, some researchers and clinician have noticed that the psychosocial and neurocognitive functioning of patients with malignant gliomas can be impaired. Many clinical studies have demonstrated that part of patients, adults or children, diagnosed with glioblastoma will suffer from cognitive deficiency during their clinical course, especially in long-term survivors. Many nanoparticles (NPs) can inhibit the biological functions of tumours by modulating tumour-associated inflammation, which provokes angiogenesis and tumour growth. As one of the best antiviral nanoparticles (AVNPs), AVNP2 is the 2nd generation of AVNP2 that have been conjugated to graphite-graphene for improving physiochemical performance and reducing toxicity. AVNP2 inactivates viruses, such as the H1N1 and H5N1influenza viruses and even the SARS coronavirus, while it inhibits bacteria, such as MRSA and E. coli. As antimicrobials, nanoparticles are considered to be one of the vectors for the administration of therapeutic compounds. Yet, little is known about their potential functionalities and toxicities to the neurotoxic effects of cancer. Herein, we explored the functionality of AVNP2 on inhibiting C6 in glioma-bearing rats. The novel object-recognition test and open-field test showed that AVNP2 significantly improved the neuro-behaviour affected by C6 glioma. AVNP2 also alleviated the decline of long-term potentiation (LTP) and the decreased density of dendritic spines in the CA1 region induced by C6. Western blot assay and immunofluorescence staining showed that the expressions of synaptic-related proteins (PSD-95 and SYP) were increased, and these findings were in accordance with the results mentioned above. It revealed that the sizes of tumours in C6 glioma-bearing rats were smaller after treatment with AVNP2. The decreased expression of inflammatory factors (IL-1ß, IL-6 and TNF-α) by Western blotting assay and ELISA, angiogenesis protein (VEGF) by Western blotting assay and other related proteins (BDNF, NF-ĸB, iNOS and COX-2) by Western blotting assay in peri-tumour tissue indicated that AVNP2 could control tumour-associated inflammation, thus efficiently ameliorating the local inflammatory condition and, to some extent, inhibiting angiogenesis in C6-bearing rats. In conclusion, our results suggested that AVNP2 could have an effect on the peri-tumor environment, obviously restraining the growth progress of gliomas, and eventually improving cognitive levels in C6-bearing rats.


Assuntos
Antivirais/uso terapêutico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/psicologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Encefalite/etiologia , Encefalite/prevenção & controle , Glioma/complicações , Glioma/psicologia , Nanopartículas/uso terapêutico , Animais , Comportamento Animal , Peso Corporal/efeitos dos fármacos , Região CA1 Hipocampal/efeitos dos fármacos , Região CA1 Hipocampal/patologia , Disfunção Cognitiva/psicologia , Citocinas/biossíntese , Espinhas Dendríticas/efeitos dos fármacos , Espinhas Dendríticas/patologia , Humanos , Potenciação de Longa Duração/efeitos dos fármacos , Masculino , Transplante de Neoplasias , Ratos , Ratos Sprague-Dawley , Reconhecimento Psicológico/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/biossíntese , Fator A de Crescimento do Endotélio Vascular/genética
10.
World Neurosurg ; 137: e437-e446, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32045726

RESUMO

OBJECTIVE: 5-aminolevulinic acid (5-ALA) has been increasingly used in recent years to identify anaplastic foci in primarily suspected low-grade gliomas (LGGs). However, 5-ALA fails to visualize a subgroup of focally anaplastic gliomas. Recently, 2 in vitro studies and 1 in vivo study assumed that antiepileptic drugs (AEDs) and dexamethasone have an influence on the 5-ALA metabolism/visible fluorescence in gliomas. The aim of this study was to analyze for the first time the influence of different AEDs and dexamethasone on visible 5-ALA fluorescence in a large cohort of suspected LGG. METHODS: We retrospectively analyzed adult patients with resection of radiologically suspected diffusely infiltrating LGG after 5-ALA administration at 2 specialized centers. Clinical data on the intraoperative 5-ALA fluorescence status, preoperative treatment with AED/dexamethasone, and the total daily dose in cases of levetiracetam and dexamethasone intake were noted. RESULTS: Altogether, 110 patients with suspected LGG were included. A significantly higher percentage of visible fluorescence was present in World Health Organization grade III/IV (73%) compared with World Health Organization grade II gliomas (11%; P < 0.001). In the multivariate analysis, we did not find an independent correlation between the visible fluorescence status and intake of dexamethasone/AED. Furthermore, the median daily dose of dexamethasone and levetiracetam did not differ significantly between fluorescing and nonfluorescing gliomas. CONCLUSIONS: In the largest series to date, we did not find a drug-related influence of either dexamethasone or different AED on visible 5-ALA fluorescence in suspected LGG. According to our preliminary data, preoperative treatment with these common drugs in neurosurgery can be performed safely before 5-ALA-assisted surgery of suspected LGG.


Assuntos
Corticosteroides/farmacologia , Anticonvulsivantes/farmacologia , Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Convulsões/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Idoso , Ácido Aminolevulínico , Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/metabolismo , Feminino , Fluorescência , Glioma/complicações , Glioma/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Convulsões/metabolismo , Adulto Jovem
11.
World Neurosurg ; 138: 663-671, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31981784

RESUMO

This paper explores the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the prognosis of glioma, and judges the relevant factors affecting the prognosis of glioma. This paper used a Cox proportional hazards model to retrospectively analyze clinical data of 81 patients with complete neuroglioma from the same neurosurgery medical team from January 2012 to November 2018, including DCE-MRI data. To determine the prognostic factors, P < 0.05 was used as the statistical standard, and the survival curve of statistically significant factors was drawn by Kaplan-Meier method. The Cox proportional hazard model analysis showed the preoperative Karnofsky Performance Status Scale (KPS) score, age, tumor pathologic grade, postoperative radiotherapy, temozolomide use, and Ki-67 expression had an impact on the prognosis of patients with neuroglioma. Multivariate analysis and DCE-MRI data showed that age, tumor grade, preoperative KPS score, postoperative radiotherapy, and Ki-67 expression were prognostic factors for patients with glioma. The older the age, the higher the pathologic grade, the higher the Ki-67 expression level, and the lower the KPS score before surgery, the worse the prognosis. Postoperative radiotherapy and appropriate temozolomide chemotherapy will help improve the prognosis of patients with neuroglioma.


Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Procedimentos Neurocirúrgicos , Temozolomida/uso terapêutico , Edema Encefálico/etiologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/terapia , Quimioterapia Adjuvante , Meios de Contraste , Epilepsia/etiologia , Feminino , Glioma/complicações , Glioma/patologia , Glioma/terapia , Cefaleia/etiologia , Humanos , Estimativa de Kaplan-Meier , Avaliação de Estado de Karnofsky , Antígeno Ki-67/metabolismo , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Período Pré-Operatório , Prognóstico , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Carga Tumoral
12.
Intern Med ; 59(2): 271-275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31941873

RESUMO

Anti-leucine-rich glioma inactivated-1 (anti-LGI1) encephalitis is a subgroup of autoimmune encephalitis. We herein report the case of a 60-year-old man who presented with typical symptoms, including short-term memory loss, mental abnormalities, hyponatremia and seizures characterized by faciobrachial dystonic seizures and who was diagnosed with anti-LGI1 encephalitis. At the same time, he was diagnosed with essential thrombocythemia. A significant improvement was obtained by treatment with corticosteroid, immunoglobulin, mycophenolate mofetil, and hydroxyurea. Autoimmune diseases are associated with a significantly increased risk of developing myeloproliferative neoplasms, which may explain the coexistence of anti-LGI1 encephalitis and essential thrombocythema in this patient; however, but more cases and studies are needed to determine whether there is any correlation between these conditions.


Assuntos
Encefalite/complicações , Glioma/complicações , Doença de Hashimoto/complicações , Encefalite Límbica/complicações , Trombocitemia Essencial/complicações , Corticosteroides/uso terapêutico , Autoanticorpos/imunologia , Encefalite/tratamento farmacológico , Doença de Hashimoto/tratamento farmacológico , Humanos , Hiponatremia/etiologia , Peptídeos e Proteínas de Sinalização Intracelular/antagonistas & inibidores , Leucina , Encefalite Límbica/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Convulsões/etiologia , Trombocitemia Essencial/tratamento farmacológico
13.
World Neurosurg ; 134: 629-634.e1, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790835

RESUMO

BACKGROUND: Awake craniotomy is becoming an essential technique, especially for intrinsic brain tumors which have no clear margins and where extent of resection (EOR) matters. However, intraoperative monitoring for awaken patients requires voice feedback in regular settings. Resection of hippocampal glioma is challenging because of its deep-seated location, its extension in an anterior-posterior axis, and being covered with eloquent cortex. We present a native deaf and mute patient, who has been diagnosed of a left pan-hippocampal glioma, who underwent an awake craniotomy using sign language during intraoperative monitoring. CASE DESCRIPTION: The patient was a 58-year-old, right-handed, native deaf and mute woman who was diagnosed with a left pan-hippocampal glioma. Magnetic resonance imaging (MRI) revealed an intrinsic, nonenhanced, expansile lesion involving the pan-hippocampus. Functional MRI preferred a right hemisphere-dominant pattern. Neuropsychologic testing was normal. An awake craniotomy was successfully performed using sign language to preserve her remaining sole method of communication. A standard sleep-awake-sleep protocol with a transmiddle temporal gyrus (2.5 × 1 cm gyrectomy) approach was performed after a negative mapping result. More than 90% EOR was achieved with only a 0.7 cm3 residual tumor at the hippocampal tail. The pathology was anaplastic ganglioglioma, Ki-67 70%, and World Health Organization grade III. Her postoperative neuropsychologic status was the same as preoperative condition. CONCLUSIONS: We demonstrated using sign language for intraoperative monitoring is feasible in a native deaf and mute patient. We also showed a navigation-assisted minimal transcortical approach to achieve >90% EOR for a pan-hippocampal glioma in a single-stage operation.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Línguas de Sinais , Vigília , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Craniotomia , Feminino , Glioma/complicações , Hipocampo/cirurgia , Humanos , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos
14.
J Neuropathol Exp Neurol ; 79(2): 184-193, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31846038

RESUMO

Dogs develop gliomas with similar histopathological features to human gliomas and share with them the limited success of current therapeutic regimens such as surgery and radiation. The tumor microenvironment in gliomas is influenced by immune cell infiltrates. The present study aims to immunohistochemically characterize the tumor-infiltrating lymphocyte (TIL) population of naturally occurring canine gliomas, focusing on the expression of Forkhead box P3-positive (FOXP3+) regulatory T-cells (Tregs). Forty-three canine gliomas were evaluated immunohistochemically for the presence of CD3+, FOXP3+, and CD20+ TILs. In low-grade gliomas, CD3+ TILs were found exclusively within the tumor tissue. In high-grade gliomas, they were present in significantly higher numbers throughout the tumor and in the brain-tumor junction. CD20+ TILs were rarely found in comparison to CD3+ TILs. FOXP3+ TILs shared a similar distribution with CD3+ TILs. The accumulation of FOXP3+ Tregs within the tumor was more pronounced in astrocytic gliomas than in tumors of oligodendroglial lineage and the difference in expression was significant when comparing low-grade oligodendrogliomas and high-grade astrocytomas. Only high-grade astrocytomas presented FOXP3+ cells with tumoral morphology. In spontaneous canine gliomas, TILs display similar characteristics (density and distribution) as described for human gliomas, supporting the use of the dog as an animal model for translational immunotherapeutic studies.


Assuntos
Neoplasias Encefálicas/metabolismo , Fatores de Transcrição Forkhead/metabolismo , Glioma/metabolismo , Linfócitos do Interstício Tumoral/metabolismo , Animais , Antígenos CD20/metabolismo , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/patologia , Complexo CD3/metabolismo , Cães , Feminino , Glioma/complicações , Glioma/patologia , Linfócitos do Interstício Tumoral/patologia , Masculino
15.
J Clin Neurosci ; 71: 275-276, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31848037

RESUMO

Glioma-related epilepsy significantly impact on patients' quality of life, and can often be difficult to treat. Seizures cause significant morbidity for example neurocognitive deterioration, which may result from seizures themselves or due to adverse effects from antiepileptic drugs. Management of tumour with surgery, radiotherapy and chemotherapy may contribute to seizure control, but tumour related epilepsy is often refractory despite adequate treatment with standard anti-epileptic medications. Given the increasing interest in medicinal cannabis (or cannabidiol or CBD) as an anti-epileptic drug, CBD may help with seizure control in glioma patients with treatment-refractory seizures. Here we present a case of a young lady with recurrent glioma who had refractory seizures despite multiple anti-epileptic agents, who had significant benefit with CBD.


Assuntos
Neoplasias Encefálicas/complicações , Canabidiol/uso terapêutico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia Resistente a Medicamentos/etiologia , Glioma/complicações , Adulto , Anticonvulsivantes/uso terapêutico , Feminino , Humanos , Convulsões/tratamento farmacológico , Convulsões/etiologia
16.
Neurol Med Chir (Tokyo) ; 60(1): 37-44, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31748440

RESUMO

After introduction of levetiracetam (LEV), treatment of seizures in patients with malignant brain tumors has prominently improved. On the other hand, we still experience some cases with LEV-uncontrollable epilepsy. Perampanel (PER) is a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoaxazolepropionate acid receptor antagonist that has recently been approved for treating focal epilepsy as a secondary drug of choice. Available literature reporting PER medication in patients with gliomas is still sparse. Here, we report our initial experience with glioma patients and report efficacy of adding low dose 2-4 mg PER to LEV in patients whose seizure were uncontrollable with LEV monotherapy. Clinical outcome data of 18 consecutive patients were reviewed. This included nine males and nine females aged 24-76 years (median, 48.5 years), treated for glioma between June 2009 to December 2018. We added PER to patients with LEV-uncontrollable epilepsy. Adverse effects, irritability occurred in two patients, but continuous administration was possible in all cases. Though epileptic seizures occurred in four cases receiving 2 mg PER, 17 cases achieved seizure freedom by dose increments; final dose, 2-4 mg PER added to LEV 500-3000 mg. Our study revealed anti-epileptic efficacy of low dose PER 2-4 mg as first add-on therapy to LEV in glioma patients who have failed or intolerable to LEV monotherapy. Low dose PER added on to LEV may have favorable efficacy with tolerable adverse effects in glioma patients with LEV-uncontrollable epilepsy.


Assuntos
Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/complicações , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Glioma/complicações , Levetiracetam/uso terapêutico , Piridonas/uso terapêutico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/administração & dosagem , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Terapia Combinada , Resistência a Medicamentos , Epilepsia Resistente a Medicamentos/etiologia , Feminino , Seguimentos , Glioma/diagnóstico por imagem , Glioma/terapia , Humanos , Levetiracetam/farmacologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Procedimentos Neurocirúrgicos , Nimustina/administração & dosagem , Piridonas/farmacologia , Radioterapia Adjuvante , Receptores de AMPA/antagonistas & inibidores , Estudos Retrospectivos , Temozolomida/administração & dosagem , Adulto Jovem
17.
World Neurosurg ; 134: e968-e978, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31734425

RESUMO

OBJECTIVE: To evaluate and understand the clinical behavior and radiologic correlates of tumors originating from the posterior pituitary gland. To review the management strategy for these rare tumors and add to the limited existing literature. METHODS: Retrospective review of 8 cases (5 pituicytomas, 2 spindle cell oncocytomas, and 1 granular cell tumor) managed at our institution between 2004 and 2019. The patients' clinical course, histologic features, and radiologic findings were reviewed. Their management and long-term follow-up is presented and compared with the literature. RESULTS: Long-term follow-up ranged from 1 to 9 years. There was 1 recurrence in a patient with spindle cell oncocytoma, and this was treated with radiotherapy. The endoscopically managed cases resulted in complete tumor excision with no recurrence. CONCLUSIONS: Epidemiologic data on primary tumors of the neurohypophysis is limited because of the rarity of these tumors. This study adds to the literature that these tumors behave as World Health Organization grade I tumors, although close follow-up is recommended as a few cases have shown recurrence. The endoscopic approach resulted in better gross total tumor resection rate in this series.


Assuntos
Adenoma Oxífilo/patologia , Glioma/patologia , Tumor de Células Granulares/patologia , Neuro-Hipófise/patologia , Neoplasias Hipofisárias/patologia , Adenoma Oxífilo/complicações , Adenoma Oxífilo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral Intraventricular/etiologia , Procedimentos Cirúrgicos de Citorredução , Feminino , Glioma/complicações , Glioma/cirurgia , Tumor de Células Granulares/complicações , Tumor de Células Granulares/cirurgia , Hemianopsia/etiologia , Humanos , Hipogonadismo/etiologia , Achados Incidentais , Masculino , Microcirurgia , Pessoa de Meia-Idade , Neoplasia Residual , Neuroendoscopia , Neuro-Hipófise/citologia , Neuro-Hipófise/cirurgia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/cirurgia , Osso Esfenoide
18.
World Neurosurg ; 133: 278-282, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606510

RESUMO

BACKGROUND: Depression following resection of diffuse low-grade glioma has rarely been described. Location of the tumor and surgical route are potential causes. Lesion network mapping (LNM), leveraging high-quality resting-state functional magnetic resonance imaging data from large samples of healthy adults, has been used to explore the broader network connectivity for given lesions. However, LNM has not been applied to large intra-axial masses or surgical lesions. We used LNM to examine a potential cause of postoperative depression in a patient with a cingulate diffuse low-grade glioma (zones I-III). CASE DESCRIPTION: A 34-year-old woman underwent surgery for medically refractory seizures attributable to diffuse low-grade glioma. Near-total resection was attained via a single-stage, transcortical route through the medial prefrontal cortex. Despite freedom from seizure and lack of tumor growth at 42 months of follow-up, she developed symptoms of major depressive disorder soon after surgery that persisted. To identify functional networks potentially engaged by the surgical corridor and tumor resection cavity, both were segmented separately and used as seeds for normative resting-state functional magnetic resonance imaging connectivity mapping. To study depression specifically, networks associated with the tumor and surgical approach were compared with networks associated with subgenual cingulate deep brain stimulation. LNM results suggested that the surgical corridor, rather than the tumor, had greater overlap with deep brain stimulation-based depression networks (32% vs. 8%). CONCLUSIONS: Early postoperative development of major depressive disorder following resection of a cingulate region tumor, although likely multifactorial, should be considered and patients appropriately counseled preoperatively. Further validation of LNM as a viable methodology for correlating symptoms to lesions could make it a valuable tool in selection of surgical approach and patient counseling.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/efeitos adversos , Transtorno Depressivo Maior/etiologia , Glioma/cirurgia , Giro do Cíngulo/cirurgia , Convulsões/cirurgia , Adulto , Neoplasias Encefálicas/complicações , Feminino , Glioma/complicações , Humanos , Complicações Pós-Operatórias/etiologia , Convulsões/etiologia
19.
Arq Neuropsiquiatr ; 77(11): 797-805, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31826136

RESUMO

INTRODUCTION: Drug-resistant epilepsy associated with central nervous system tumors is generally caused by low grade gliomas. This group of tumors is usually found in brain eloquent areas, such as the insular lobe, rolandic cortex and supplementary motor area and, historically, possess a greater risk of postoperative deficits. OBJECTIVE: The aim of this investigation was to present our surgical experience on patients with drug-resistant epilepsy caused by gliomas in eloquent areas. We retrospectively investigated variables that impact seizure control, such as tumor location, extent of resection, invasion into the lenticulostriate arteries in the patient, especially those with insular gliomas. METHODS: Out of 67 patients with eloquent area brain tumors operated on in our service between 2007 and 2016, 14 patients had symptoms of drug-resistant epilepsy. Volumetric analysis, extent of resection (EOR), type of approach and mapping, among other factors were correlated with the 12-month postoperative seizure outcome. RESULTS: Univariate analysis showed that the factors showing statistical relevance with seizure control were preoperative volume (p = 0.005), EOR (p = 0.028) and postoperative volume (p = 0.030). CONCLUSION: There was a statistically significant association between the EOR and the Engel score for epilepsy control: an EOR < 70 was associated with Engel II, III, IV and an EOR > 90 was associated with Engel I. Eloquent area gliomas can safely be resected when surgeons use not only microsurgical anatomy concepts but also brain mapping.


Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Epilepsia Resistente a Medicamentos/etiologia , Epilepsia Resistente a Medicamentos/cirurgia , Glioma/complicações , Glioma/cirurgia , Adolescente , Adulto , Mapeamento Encefálico , Neoplasias Encefálicas/mortalidade , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/mortalidade , Feminino , Glioma/diagnóstico por imagem , Glioma/mortalidade , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Convulsões/etiologia , Convulsões/cirurgia , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
20.
Neurosurg Focus ; 47(6): E9, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31786559

RESUMO

3D ultrasound (US) is a convenient tool for guiding the resection of low-grade gliomas, seemingly without deterioration in patients' quality of life. This article offers an update of the intraoperative workflow and the general principles behind the 3D US acquisition of high-quality images.The authors also provide case examples illustrating the technique in two small mesial temporal lobe lesions and in one insular glioma. Due to the ease of acquiring new images for navigation, the operations can be guided by updated image volumes throughout the entire course of surgery. The high accuracy offered by 3D US systems, based on nearly real-time images, allows for precise and safe resections. This is especially useful when an operation is performed through very narrow transcortical corridors.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Imageamento Tridimensional/métodos , Neuroimagem/métodos , Neuronavegação/métodos , Ultrassonografia/métodos , Adolescente , Sintomas Afetivos/etiologia , Tonsila do Cerebelo/diagnóstico por imagem , Tonsila do Cerebelo/cirurgia , Artefatos , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/cirurgia , Fadiga/etiologia , Medo , Feminino , Glioma/complicações , Glioma/cirurgia , Hemianopsia/etiologia , Hemianopsia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/cirurgia , Adulto Jovem
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