Intra-axial Tumors Research Articles

Novel 3D magnetic resonance fingerprinting radiomics in adult brain tumors: a feasibility study.

To test the feasibility of using 3D MRF maps with radiomics analysis and machine learning in the characterization of adult brain intra-axial neoplasms. 3D MRF acquisition was performed on 78 patients with newly diagnosed brain tumors including 33 glioblastomas (grade IV), 6 grade III gliomas, 12 grade II gliomas, and 27 patients with brain metastases. Regions of enhancing tumor, non-enhancing tumor, and peritumoral edema were segmented and radiomics analysis with gray-level co-occurrence matrices and gray-level run-length matrices was performed. Statistical analysis was performed to identify features capable of differentiating tumors based on type, grade, and isocitrate dehydrogenase (IDH1) status. Receiver operating curve analysis was performed and the area under the curve (AUC) was calculated for tumor classification and grading. For gliomas, Kaplan-Meier analysis for overall survival was performed using MRF T1 features from enhancing tumor region. Multiple MRF T1 and T2 features from enhancing tumor region were capable of differentiating glioblastomas from brain metastases. Although no differences were identified between grade 2 and grade 3 gliomas, differentiation between grade 2 and grade 4 gliomas as well as between grade 3 and grade 4 gliomas was achieved. MRF radiomics features were also able to differentiate IDH1 mutant from the wild-type gliomas. Radiomics T1 features for enhancing tumor region in gliomas correlated to overall survival (p < 0.05). Radiomics analysis of 3D MRF maps allows differentiating glioblastomas from metastases and is capable of differentiating glioblastomas from metastases and characterizing gliomas based on grade, IDH1 status, and survival. • 3D MRF data analysis using radiomics offers novel tissue characterization of brain tumors. • 3D MRF with radiomics offers glioma characterization based on grade, IDH1 status, and overall patient survival.

The Current Status in Intraoperative Image-Guided Neurosurgery Associated with Progressive Operating Rooms: A Retrospective Analysis

Shinshu University Hospital has advanced operating rooms including a mobile computed tomography (mCT) room, Smart Cyber Operating Theater (SCOT) with intraoperative magnetic resonance imaging, hybrid operating room (hOR) with intraoperative image-guided surgery, and conventional operating rooms. We investigated the characteristics of cases assigned to each operating room. Five hundred forty neurosurgery cases from January 2018 to April 2021 were analyzed. We analyzed the selection of operating room according to pathology, surgical device requirement, and urgency, and we examined associations between operating room characteristics and these factors. Neurological surgeries were performed in an mCT room, an hOR, a SCOT, and a conventional operating room in 333 (61.7%), 64 (11.9%), 49 (9.1%), and 94 (17.4%) cases, respectively. mCT rooms were more frequently selected than other rooms for vascular/extra-axial tumors, which have a lower need for intraoperative image guidance. Spinal surgeries with segment diagnosis or intraoperative bone removal tended to be performed in the hOR. The rate of SCOT use tended to be higher for intra-axial tumors with poorly circumscribed borders than for vascular/extra-axial tumors. Endoscopic procedures were more frequently performed in the SCOT and mCT rooms than in hORs and conventional operating rooms. Emergency surgeries were often performed in the conventional operating rooms, even in cases where SCOT and hOR seemed suitable. Intraoperative image-guided surgeries were performed according to the characteristics of each operating room best suited for various diseases and operative methods. Further research is needed to prove whether operating room selection improves neurosurgical outcomes.

Prevalence of idiopathic epilepsy and structural epilepsy in 74 Boxer dogs in a referral hospital.

The prevalence of idiopathic epilepsy and structural epilepsy in Boxer dogs is unknown. The aim of this retrospective study was to evaluate the prevalence of structural and idiopathic epilepsy in the Boxer population. A total of 74 Boxer dogs were included in the study from the database of one referral hospital and the following were recorded: signalment, history, clinical findings and results of advanced diagnostic imaging. Five dogs (6.8%) were diagnosed with idiopathic epilepsy, of which one was in the <6 months age group, three were in the 6–72 months age group and one was in the >72 months age group. Sixty-nine dogs (93.2%) were diagnosed with structural epilepsy. Sixty-six had a suspected intracranial neoplasia: Eight were in the 6–72 months age group and represent 66.7% of the dogs in that age group. The other fifty-eight were in the >72 months age group and represent 96.7% of the dogs in that age group. In our Boxer population, 81.8% of the patients had a suspected intra-axial tumor and 22.7% of dogs with an intracranial pathology nevertheless had a normal neurological examination. In conclusion, in the majority of boxer patients the cause of epilepsy is a suspected intracranial neoplasia regardless of the age at presentation. Considering the finding in this study of a low prevalence of presumed idiopathic epilepsy in the Boxer breed, it is recommended that patients who satisfy Tier I confidence level of the “International Veterinary Epilepsy Task Force” (IVETF) also undergo an MRI study of the brain.

BSCI-02 CSF PROTEOMICS AS A MINIMALLY-INVASIVE STRATEGY FOR DISTINGUISHING BRAIN METASTASES FROM OTHER PRIMARY BRAIN MALIGNANCIES

BACKGROUNDAccurate diagnosis and prognostication of intra-axial brain tumors hinges on invasive brain sampling, which carries risk of morbidity. Minimally invasive sampling of proximal fluids, also known as liquid biopsy, can mitigate this risk. Although the cerebrospinal fluid (CSF) is the ideal liquid biopsy source, the traditionally high volumes required for impactful analyses have deterred progress. The objective of this study was to identify diagnostic and prognostic CSF proteomic signatures in glioblastoma (GBM), brain metastases (BM), and central nervous system lymphoma (CNSL).METHODSCSF samples were retrospectively retrieved from the Penn State Neuroscience Biorepository and profiled using shotgun proteomics with low sample volumes. Proteomic signatures were identified using machine learning classifiers and survival analyses.RESULTSUsing 30µL CSF volumes, we recovered 800 unique peptides across 73 samples [20 normal pressure hydrocephalus (NPH, non-tumor control), 22 GBM, 17 BM, and 14 CNSL]. Externally-validated proteomic-based classifiers identified malignancy with AUROC of 0.94 and distinguished individual tumor entities from others with AUROC ≥0.96. More clinically relevant triplex classifiers, comprised of just 3 peptides, distinguished individual tumor entities with AUROC ≥0.90. Novel biomarkers were identified among the top classifiers, including TFF3 and CACNA2D2, and characterized using single-cell RNA sequencing data. Survival analyses validated previously implicated prognostic signatures, including blood brain barrier disruption.DISCUSSIONReliable classification of intra-axial malignancies using low CSF volumes is feasible, which has ramifications for longitudinal tumor surveillance. Novel biomarkers identified here necessitate future validation. Based on emerging evidence, upfront implantation of CSF reservoirs in brain tumor patients warrants consideration.

A phase II pilot randomized controlled trial to assess the feasibility of the “supra-marginal” surgical resection of malignant glioma (G-SUMIT: Glioma supra marginal incision trial) study protocol

BackgroundHigh-grade gliomas are the most common primary malignant brain tumor in adults having a median survival of only 13–16 months. This is despite the current standard of maximal safe surgical resection followed by fractionated radiotherapy and chemotherapy. Extending the tumor resection limit beyond the gadolinium (GAD)-enhancing margin (i.e., supra-marginal resection) could in principle provide an added survival benefit as it has been shown that > 80% of post-operative tumor recurrence is within a 2-cm region surrounding the original GAD-enhancing margin. However, this must be weighed against the risk of potential damage to functional brain tissue.MethodsIn this phase II pilot randomized control trial (RCT), we aim to assess the feasibility of “supra-marginal” resection extending 1 cm beyond the enhancing tumor in adults with radiographic evidence of GAD-enhancing intra-axial tumor consistent with high-grade glioma in a safe anatomical location and a Karnofsky Performance Score > 60. With six academic institutions with established neurosurgical oncology practices in participation, we aim to enroll 72 patients over 2 years. Primary outcomes include evaluating the feasibility of performing a large-scale trial with regard to recruitment, allocation, and outcome documentation as well as safety data. Secondary outcomes include determining if there is an increased survival benefit with supra-marginal resection and impact on quality of life (Modified Rankin Scale (mRS), EuroQol-5D (ED-5D), 30-day all-cause mortality).DiscussionRecent studies have revealed survival advantages comparing supra-marginal resection to standard attempt at gross total resection (GTR) with no additional perioperative surgical risk; however, the current quality of evidence is low and under-powered. Therefore, there are no current practice guidelines, and the philosophy of surgical resection is guided by individual surgeon preferences on an individual patient basis. This creates additional uncertainty and is potentially detrimental to our patients. This clinical equipoise supports the need for an adequately powered RCT to determine whether a supra-marginal resection can have a positive impact on survival for patients with HGGs. Our pilot RCT will test the feasibility of comparing the standard gross total resection of GAD-enhancing tumors and supra-marginal resection to prepare for a larger definitive multicenter RCT.Trial registrationClinicalTrials.gov, NCT04737577. Registered on February 4, 2021

Supratentorial Extra-axial Ependymoma: A Rare Radiological Mimic of Cystic Meningioma

Ependymoma is commonly an intra-axial infratentorial tumour affecting paediatric age group. We report a rare case of supratentorial extra-axial ependymoma in a teenager who presented with worsening headache and mild cognitive impairment. Previously, only few of such cases have been reported in the literature. However, in the last decade, there has been increasing number of this rare entity represented as a solid-cystic mass. In this report, we discuss the radiological features as we think it is mimicking a cystic meningioma and recommend that ependymoma should be considered in the diagnosis of a solid-cystic extra-axial lesion especially when located supratentorially.International Journal of Human and Health Sciences Vol. 06 No. 03 July’22 Page: 338-341

Digital cognitive testing using a tablet-based app in patients with brain tumors: a single-center feasibility study comparing the app to the gold standard.

Healthcare digitization has led to increasing tablet-based apps to improve diagnostics, self-discipline, and well-being in patients. Moreover, patient-reported outcome measures are crucial for optimized treatment, with superior applicability if independent from patient visits. Whereas most uses cover health maintenance, only a few studies have focused on cognitive testing in neurosurgical patients despite its nature as one of the most integrative outcome measures in neurooncology. The authors performed a prospective single-center feasibility study including neurosurgical patients affected by intraaxial tumors and healthy subjects, testing cognitive function by using a digitized app-based approach and conventional paper-and-pencil (PP) tests. Healthy subjects underwent follow-up testing for retest reliability. The authors included 24 patients with brain tumor and 10 healthy subjects, all of whom completed both tests. Equivalent mean performance results were found in the tablet-based digital app and PP counterparts; whereas the digital approach had shorter test duration in patients (29.9 minutes for PP vs 21.9 minutes for app, p = 0.019) and in the healthy cohort (23.2 minutes for PP vs 16.4 minutes for app, p = 0.003), patients with brain tumor scored lower when both test strategies were applied. Results were consistent in healthy subjects after a median of 3 months. Cognitive function assessment is feasible using a digitized tablet-based app, with equivalent results to those of PP tests in healthy subjects and patients with brain tumor. Thus, this approach allows much closer follow-up independent of patient visits and might provide a viable option to improve patient follow-ups.

CSF proteomics for differentiation of brain malignancies.

2021 Background: Accurate diagnosis and prognostication of intra-axial brain tumors hinges on invasive brain sampling, which carries risk of morbidity. Minimally invasive sampling of proximal fluids, also known as liquid biopsy, can mitigate this risk. Although the cerebrospinal fluid (CSF) is the ideal liquid biopsy source, the traditionally high volumes required for impactful analyses have deterred progress. The objective of this study was to identify diagnostic and prognostic CSF proteomic signatures in glioblastoma (GBM), brain metastases (BM), and central nervous system lymphoma (CNSL). Methods: CSF samples were retrospectively retrieved from the Penn State Neuroscience Biorepository and profiled using shotgun proteomics with ultra-low sample volumes. Proteomic signatures were identified using machine learning classifiers and survival analyses. Results: Using 30µL CSF volumes, we recovered 800 unique peptides across 73 samples [20 normal pressure hydrocephalus (NPH, non-tumor control), 22 GBM, 17 BM, and 14 CNSL]. Externally-validated proteomic-based classifiers identified malignancy with AUROC of 0.94 and distinguished individual tumor entities from others with AUROC ≥0.96. More clinically relevant triplex classifiers, comprised of just 3 peptides, distinguished individual tumor entities with AUROC ≥0.90. Novel biomarkers were identified among the top classifiers, including TFF3 and CACNA2D2, and characterized using single-cell RNA sequencing data. Survival analyses validated previously implicated prognostic signatures, including blood brain barrier disruption. Conclusions: Reliable classification of intra-axial malignancies using ultra-low CSF volumes is feasible, which has ramifications for longitudinal tumor surveillance. Novel biomarkers identified here necessitate future validation. Based on emerging evidence, upfront implantation of CSF reservoirs in brain tumor patients warrants consideration.

Mini-craniotomy for intra-axial brain tumors: a comparison with conventional craniotomy in 306 patients harboring non-dural based lesions

The use of a mini-craniotomy approach involving linear skin incision and a bone flap of about 3cm has been reported for several neurosurgical diseases, such as aneurysms or cranial base tumors. More superficial lesions, including intra-axial tumors, may occasionally raise concerns due to insufficient control of the tumor boundaries. The convenience of a minimally invasive approach to intrinsic brain tumors was evaluated by comparing 161 patients who underwent mini-craniotomy (MC) for intra-axial brain tumors with a group of 145 patients operated on by the same surgical team through a conventional craniotomy (CC). Groups were propensity-matched for age, preoperative condition, size and location of the tumor, and pathological diagnosis. Results were analyzed focusing on operative time, the extent of resection, clinical outcome, hospitalization time, and time to start adjuvant therapy. Mini-craniotomy was equally effective in terms of extent of resection (GTR: 70.9% in the MC group vs 70.5% in the CC group) but had shorter operative time (average: 165min in the MC group vs 205min in the CC group p < 0.001) and lower rate of postoperative complications both superficial (1.03% vs 6.5% in the CC group p = 0.009) and deep (4% in the MC group vs 5.5% in the CC group p = 0,47). No relationship was found between the size or location of the tumor and resection rate. The MC group had reduced hospitalization time (average: 5.8days vs 7.6 in CC group p < 0.001) and faster access to adjuvant therapies. 92.5% of the MC patients, which were scheduled for treatment, started radiotherapy within 8weeks after surgery as opposed to 84.1% in the CC group (p = 0.04). These findings support the increasing use of mini-craniotomy for intra-axial brain tumors.

Prediction of Post-operative Long-Term Outcome of the Motor Function by Multimodal Intraoperative Neuromonitoring With Transcranial Motor-Evoked Potential and Spinal Cord-Evoked Potential After Microsurgical Resection for Spinal Cord Tumors.

ObjectiveTo examine the effect of multimodal intraoperative neuromonitoring on the long-term outcome of motor function after microsurgical resection for spinal cord tumors.Materials and MethodsConsecutive fourteen patients with spinal tumors who were surgically treated at the University of Fukui Hospital between 2009 and 2020 [M:F = 10:4, ages ranging from 22 to 83 years (mean ± SD = 58 ± 21 years)] were included in this study. There were eight intra-axial tumors and six extra-axial tumors. There were four patients with hypertension, two patients with diabetes mellitus, and four patients with hyperlipidemia. Three patients were under antithrombotic medication, two were under steroid medication, four were current smokers, and four were current drinkers. Manual muscle test (MMT) of the upper and lower extremities of the patients was examined before surgery, 2 weeks after surgery, and at the final follow-up. The mean follow-up period was 38 ± 37 months. McCormick scores were examined before surgery and at the final follow-up. Microsurgical resection of the tumor was underwent through the posterior approach under transcranial motor-evoked potential (TcMEP) monitoring. The MEP of 46 extremities was recorded during the surgery. Gross total resection was achieved in 13 of 14 surgeries. Spinal cord-evoked potential (Sp-SCEP) monitoring was performed in eight of 14 patients.ResultsThe length of peritumoral edema was significantly longer in patients with deterioration of McCormick scores than in patients with preservation of McCormick scores (p = 0.0274). Sp-SCEP could not predict the deterioration. The ratio of MEP at the beginning of the surgery to that at the end of the surgery was the only significant negative factor that predicts deterioration of motor function of the extremity at the final follow-up (p = 0.0374, odds ratio [OR] 1.02E-05, 95% CI 9.13E+01–7.15E+18). A receiver operating characteristic (ROC) analysis revealed that the cutoff value of the ratio of MEP to predict the deterioration at the final follow-up was 0.23 (specificity 100%, specificity 88%, positive predictive value 100%, and negative predictive value 88%) to predict deterioration at the final follow-up.ConclusionsRatio MEP was the most significant negative factor to predict the deterioration of motor weakness at spinal tumor surgery. The setting of the cutoff value should be more strict as compared to the brain surgery and might be different depending on the institutions.

Supraorbital and mini-pterional keyhole craniotomies for brain tumors: a clinical and anatomical comparison of indications and outcomes in 204 cases.

The authors' objective was to compare the indications, outcomes, and anatomical limits of supraorbital (SO) and mini-pterional (MP) craniotomies in patients with intra- and extraaxial brain tumors, and to assess approach selection, utility of endoscopy, and surgical field overlap. A retrospective analysis was conducted of all brain tumor patients who underwent an SO or MP approach. The analyzed characteristics included pathology, endoscopy use, extent of resection, length of stay (LOS), and complications. On the basis of preoperative MRI data, tumor heatmaps were constructed to compare surgical access provided by both routes, including coronal projection heatmaps for parasellar tumors. From 2007 to 2020, 158 patients underwent 173 (84.8%) SO craniotomies and 30 patients underwent 31 (15.2%) MP craniotomies; 71 (34.8%) procedures were reoperations. Of these 204 operations, 110 (63.6%) SO and 21 (67.7%) MP approaches were for extraaxial tumors (meningiomas in 65% and 76.2%, respectively). Gliomas and metastases together represented 84.1% and 70% of intraaxial tumors accessed with SO and MP approaches, respectively. Overall, 56.1% of tumors accessed with the SO approach and 41.9% of those accessed with the MP approach were in the parasellar region. Axial projection heatmaps showed that SO access extended along the entire ipsilateral and medial contralateral anterior cranial fossa, parasellar region, ipsilateral sylvian fissure, medial middle cranial fossa, and anterior midbrain, whereas MP access was limited to the ipsilateral middle cranial fossa, sylvian fissure, lateral parasellar region, and posterior aspect of anterior cranial fossa. Coronal projection heatmaps showed that parasellar access extended further superiorly with the SO approach compared with that of the MP approach. Endoscopy was utilized in 98 (56.6%) SO craniotomies and 7 (22.6%) MP craniotomies, with further tumor resection in 48 (49%) and 5 (71.4%) cases, respectively. Endoscope-assisted tumor removal was clustered in areas that were generally at farther distances from the craniotomy or in angled locations such as the cribriform plate region where microscopic visualization is limited. Gross-total or near-total resection was achieved in 120/173 (69%) SO approaches and 21/31 (68%) MP approaches. Major complications occurred in 11 (6.4%) SO approaches and 1 (3.2%) MP approach (p = 0.49). The median LOS decreased to 2 days in the last 2 years of the study. This clinical experience suggests the SO and MP craniotomies are versatile, safe, and complementary approaches for tumors located in the anterior and middle cranial fossae and perisylvian and parasellar regions. The SO route, used in 85% of cases, achieved greater overall reach than the MP route. Both approaches may benefit from expanded visualization with endoscopy.

Symptomatic cerebral vasospasm following posterior fossa hemangioblastoma resection: illustrative case.

BACKGROUNDSymptomatic cerebral vasospasm following posterior fossa intra-axial tumor resection is a rare phenomenon with only seven cases previously reported in the literature. The condition appears distinct to vasospasm following supratentorial tumor resection and extra-axial tumor resection of the posterior fossa. It shares, however, similarities with vasospasm following aneurysmal subarachnoid hemorrhage.OBSERVATIONSThe authors describe their experience with a 23-year-old female who developed delayed symptomatic vasospasm following resection of a left parapontine cerebellar hemangioblastoma. Tumor resection was complicated by rupture of a fragile arterialized vein, resulting in significant hemorrhage. The patient developed several episodes of focal and variably reversible neurological deficit. These clinical signs corresponded with angiographically confirmed vasospasm, which responded to standard therapies for vasospasm post aneurysmal subarachnoid hemorrhage.LESSONSThis case and literature review highlight that symptomatic vasospasm is a rare, potentially highly morbid complication of posterior fossa intra-axial tumor resection. This phenomenon may be related to significant intraoperative or postoperative hemorrhage. Postoperative radiological findings such as high risk modified Fisher scale hemorrhage could alert clinicians to this condition.

Methylation Profiling Improves the Care of Pediatric Brain Tumor Patients

Abstract We describe a pediatric patient with an intra-axial tumor; histopathologic examination of the resected specimen was unable to establish a precise diagnosis. While the initial targeted next-generation sequencing (NGS) panel was also nondiagnostic, genomic DNA methylation profiling indicated that the tumor was an astroblastoma, MN1-altered. A more comprehensive NGS panel was then run, which confirmed an MN1-BEND2 fusion. This case displays the limitations and pitfalls of a histological and immunohistochemical-based diagnosis in a case of an infrequently encountered pediatric brain tumor. Furthermore, it highlights the growing need for performing DNA methylation, paired with a comprehensive NGS panel, to ensure an accurate diagnosis in modern surgical neuropathology.

Minimally invasive surgical techniques for intracranial tumour lesions in paediatric neurosurgery: state of art

After a long way of evolution in neurosurgical and intensive care technologies the high-end surgeries have become less challenging and survival rate has improved significantly. Planning a tumour surgery today means not only achieving a total removal but finding a less traumatic strategy that would not decrease quality of the patient’s life. A significant experience of using keyhole surgery, endoscopic assistance, and portal surgery has been obtained in paediatric department of Burdenko Neurosurgical Centre. This literature review is designed to reveal the current state of minimally invasive technologies for transcranial surgery of intraaxial tumours. Representation of the problem demanded a review of publications including original articles and systematic reviews over the last 10 years and some milestone publications.

487 The Human Anti-Ganglioside GM1 Autoantibody Response Following Traumatic and Surgical Central Nervous System Insults

INTRODUCTION: The immune response to central nervous system (CNS) injuries has long been considered a significant contributor to secondary injury following neurotrauma however the autoimmune response to the normal immune-privileged CNS has been insufficiently considered. It has been identified as a possible pathomechanism underlying delayed dementias known to occur after TBI and SCI however the CNS-directed autoantibody response following CNS injury remains poorly understood and the autoimmune response following intra-axial brain surgery is unknown. METHODS: Nine serum samples were collected serially from 17 acute severe TBI, 22 acute SCI, and 24 intra-axial brain tumor resection patients for 30 days; 25 healthy subjects served as a control group. An ELISA assay quantitated IgG and IgM autoantibodies to ganglioside GM-1. The maximum autoantibody titers and their correlation with putative predictors such as age, gender, clinical and radiological measurements were investigated. RESULTS: Anti-GM1 IgG autoantibody titers were increased following SCI, TBI, and brain tumor resection as compared with baseline values and control patients. By contrast, anti-GM1 IgM autoantibody titers did not significantly change following insult nor show promise as a biomarker. The maximum IgG titers measured in the first 30 days were significantly increased in TBI patients (p&lt;0.01), in SCI patients (p&lt;0.01), and in brain tumor resection patients (p&lt;0.05). The highest IgG titers (or peaks) were most commonly seen at day 14 post-insult in TBI and SCI patients while brain tumor patients did not demonstrate acute increases consistent with a peak. Higher GM1 IgG autoantibodies were associated with more severe insults. The Rotterdam score strongly correlated with increased IgG titers in TBI patients (p&lt;0.05). Age and gender did not correlate with GM1 autoantibody titers in any of the types of insult we studied. CONCLUSION: These findings suggest that patients with diverse CNS insults are at risk for CNS-directed autoimmune responses and in particular those with more severe insults. These findings highlight the need to better understand the CNS-directed autoimmune response to insult, its clinical relevance and potential as a therapeutic target.

Assessment of safe and gross total resection of intra-axial brain tumors

Background Safe and gross total resection (GTR) of intra-axial brain-tumor surgery is associated with improving functional outcomes, reducing symptoms, and decreasing the incidence of postoperative complications. Intraoperative imaging helps in achieving the maximum extent of resection. Intraoperative evaluation of the neurological function provides safe tumor resection in eloquent areas. Aim This study aimed to assess the achievement of GTR of intra-axial brain tumors guided by neuronavigation and intraoperative ultrasound and to evaluate the safety of tumor resection in eloquent areas with the use of intraoperative neurophysiological monitoring or awake craniotomy. Patients and methods This study included 30 patients with intra-axial brain tumors in the period from September 2019 to February 2021. Neuronavigation and intraoperative ultrasound were used for all cases, while intraoperative neurophysiological monitoring or awake craniotomy was used for intra-axial brain tumor in eloquent area. Operative details, outcomes, and final results had been recorded and analyzed. Results The mean age was 42 years (4–75 years). GTR was achieved in 18/30 (60%) of all cases. GTR was achieved in 4/10 (40%) of tumors located in the eloquent area, while GTR increased to 14/20 (70%) in noneloquent areas. The mean Karnofsky performance status for all cases has improved from 80 preoperatively to 86.67 postoperatively. Conclusion Neuronavigation and intraoperative ultrasound provides maximization of the extent of resection of intra-axial brain tumors. Intraoperative neurophysiological monitoring or awake craniotomy provides safe tumor resection in eloquent areas.

Tubular retractors for transcranial approaches to intraaxial brain tumors in children

To analyze the efficacy and safety of tubular retractors in surgery of deep brain tumors in children. The study included 17 children with deep brain tumors who underwent surgery between 2020 and 2021. Tubular retractors were used in all cases. The control group consisted of 15 children with a similar disease and standard intraoperative tissue traction technique. All patients underwent MRI of the brain on the first postoperative day. We analyzed severity of traction-induced damage to brain tissue in T2 FLAIR and DWI images. Clinical outcomes and structure of surgical complications were similar in both groups. Tubular retractor turned out to be a tool reducing traction injury. In the main group, postoperative MRI revealed significantly less damage to brain tissue along surgical approach in T2 (edema zone) and DWI (ischemic changes) images.

Leveraging the CSF proteome toward minimally-invasive diagnostics surveillance of brain malignancies.

Diagnosis and prognostication of intra-axial brain tumors hinges on invasive brain sampling, which carries risk of morbidity. Minimally-invasive sampling of proximal fluids, also known as liquid biopsy, can mitigate this risk. Our objective was to identify diagnostic and prognostic cerebrospinal fluid (CSF) proteomic signatures in glioblastoma (GBM), brain metastases (BM), and primary central nervous system lymphoma (CNSL). CSF samples were retrospectively retrieved from the Penn State Neuroscience Biorepository and profiled using shotgun proteomics. Proteomic signatures were identified using machine learning classifiers and survival analyses. Using 30 µL CSF volumes, we recovered 755 unique proteins across 73 samples. Proteomic-based classifiers identified malignancy with area under the receiver operating characteristic (AUROC) of 0.94 and distinguished between tumor entities with AUROC ≥0.95. More clinically relevant triplex classifiers, comprised of just three proteins, distinguished between tumor entities with AUROC of 0.75-0.89. Novel biomarkers were identified, including GAP43, TFF3 and CACNA2D2, and characterized using single cell RNA sequencing. Survival analyses validated previously implicated prognostic signatures, including blood-brain barrier disruption. Reliable classification of intra-axial malignancies using low CSF volumes is feasible, allowing for longitudinal tumor surveillance.

Cystic Glioblastoma of the Third Ventricle: Diagnostic Challenges and Poor Functional Outcome Related to Cystic Haemorrhage

<i>Background: </i>Glioblastoma multiforme (GBM) is the most common intra-axial primary brain tumour in adults, and prognosis is poor. Spontaneous haemorrhage is an uncommon but recognized initial presenting sign of primary brain tumour. Moreover, intra-cystic haemorrhage is frequent, further can affect functional outcome and even reducing survival duration. Most GBM tumours arise in the frontotemporal region, haemorrhagic cystic GBM arise in the third ventricle of the brain is very rare and create a diagnostic dilemma and surgical challenges. Third ventricular GBM can arise from structures on or near the third ventricle wall. Patients with massive intra-cystic haemorrhage can present with a wide spectrum of clinical signs and symptoms related to increased intracranial pressure (ICP), ranging from headache to sudden acute neurological deterioration, coma, and death. Acute deterioration frequently results from massive acute haemorrhage inside the cystic component leading to hydrocephalus, especially when the tumour mass obstructs the foramen of Monro. Due to high tumour-related mortality and sudden death related to acute hydrocephalus, A high index of suspicion is required to avoid misdiagnosis and delayed surgical treatment due to the atypical anatomic and radiologic presentation of cystic haemorrhagic GBM. This case presentation highlights the significant role of haemorrhage inside the GBM cystic component on both diagnosis and clinical course of the disease.

Epidemiological Profile of 96 Intracranial Tumors Treated in a Single Reference Center

Abstract Objectives The present study aims to categorize the prevalence of intracranial tumors surgically treated at the neurosurgery service of Hospital Universitário Evangélico Mackenzie (HUEM) between 2016 and 2018. Material and Methods This survey included patients surgically treated due to primary or metastatic intracranial neoplasia between 2016 and 2018 at a referral center in the city of Curitiba. These patients were analyzed for epidemiological, histopathological, and topographic data, and they underwent an assessment of the outcome at the time of hospital discharge. Results A total of 96 patients met the inclusion criteria. The most prevalent tumor was the glioma, with 39.6% of the sample, with glioblastoma being the most prevalent histological type. Brain metastases and meningiomas represented, respectively, 21.9% and 18.8% of the total. There was a predominance of supratentorial and intra-axial tumors in our sample. Conclusion Glioma was the most commonly found tumor, directly associated with high morbidity and mortality. The development of new and more effective drugs with action directed at the molecular level of intracranial tumors may be the path to a longer survival and improvement in the quality of life of these patients.