Subtotal Resection Research Articles (Page 1)

Background and Clinical Significance: Meningiomas are among the most common primary intracranial tumors, usually benign and slow-growing. Extracranial extension is exceptionally rare, particularly when arising from convexity meningiomas extending into the temporal fossa. Such cases pose unique diagnostic and therapeutic challenges due to their atypical growth patterns and anatomical complexity. Case Presentation: A 63-year-old woman previously treated for a right temporal convexity meningioma with subtotal resection and Gamma Knife radiosurgery demonstrated progressive extracranial tumor growth over five years, while the intracranial component remained stable. MRI revealed infiltration of the temporalis and lateral pterygoid muscles and erosion of the temporal bone. Due to extensive extracranial involvement and limited neurosurgical accessibility, resection was performed by a maxillofacial surgical team through a preauricular approach. Intraoperatively, the tumor was encapsulated but adherent to the deep temporal fascia and zygomatic arch. The temporal branch of the facial nerve was identified and preserved. Histopathology confirmed a meningothelial meningioma, WHO Grade I, with low proliferative activity (Ki-67 < 1%). Postoperative recovery was uneventful, with transient facial nerve weakness that resolved within weeks. Conclusions: This report adds to the limited literature describing temporal fossa involvement by convexity meningiomas and illustrates the value of collaboration between neurosurgical and maxillofacial teams. Regular MRI surveillance every 6–12 months is advised for early detection of recurrence.

On August 6, 2024, the FDA granted traditional approval to vorasidenib (Voranigo, Servier Pharmaceuticals, LLC) for the treatment of adult and pediatric patients 12 years and older with grade 2 astrocytoma or oligodendroglioma with a susceptible isocitrate dehydrogenase 1 or 2 mutation following surgery, including biopsy, subtotal resection, or gross total resection. The approval was based on data from a randomized, multicenter, double-blind trial of vorasidenib compared with placebo. The primary objective was to demonstrate the efficacy of vorasidenib based on radiographic progression-free survival (PFS) per blinded independent central review according to the modified Response Assessment for Neuro-oncology for Low-Grade Gliomas criteria. PFS was assessed in 331 patients, and the HR was 0.39 (95% confidence interval, 0.27-0.56; P value < 0.0001). The most common (≥15%) adverse reactions included fatigue, headache, COVID-19, musculoskeletal pain, diarrhea, nausea, and seizure. PFS was considered an appropriate endpoint for this disease, considering the long natural history and the randomized design allowed for the interpretation of the treatment effect in this rare malignancy. This was the first FDA approval for a targeted therapy for isocitrate dehydrogenase-mutant grade 2 gliomas.

Manipulation of the Lower Cranial Nerves and Superior Jugular Bulb During Subtotal Temporal Bone Resection for Advanced Temporal Bone Malignancies: Anatomical Considerations and Surgical Strategies.

Background: Spinal neurofibromas are benign peripheral nerve sheath tumors typically occurring in the thoracic region. Involvement of the C2 vertebra is particularly rare. Atypical presentations of solitary neurofibromas can pose diagnostic challenges when their radiological features resemble other neoplastic entities. Case Report: A 35-year-old male presented with a 3-month history of neck pain and no history of trauma. Physical examination revealed mild bulging and localized tenderness in the posterior neck, with restricted neck extension to 30 degrees. Plain radiography showed a round, expansile lytic lesion with well-defined, nonsclerotic borders on the C2 spinous process, while MRI confirmed enhancing solid components and extensive bone involvement, indicative of a giant cell tumor. The histopathology from the core needle biopsy was inconclusive, showing few inflammatory cells and no evidence of malignancy. The lesion was marginally resected from a posterior approach, achieving only subtotal resection to preserve the vertebral artery. Histopathological analysis from the open biopsy confirmed the diagnosis of neurofibroma. At the 3-month follow-up, postoperative imaging showed the residual tumor. Despite this, the patient reported significant neck pain relief.Discussion: Radiography is insufficient for differentiating spinal tumors; therefore, histopathological biopsy is necessary for an accurate diagnosis. Open biopsy offers higher diagnostic accuracy than core needle biopsy.Conclusion: Neurofibroma should be considered in differential diagnosis for patients initially suspected of giant cell tumors based on radiological findings.

BackgroundThe infiltration of the corticospinal tract (CST) in patients with gliomas may lead to more postoperative paralysis and worse survival than others. The aim of this study is to investigate the clinical outcomes and propose the surgical strategy for these patients.MethodsWe retrospectively identified 101 patients with CST infiltrated by cerebral gliomas on preoperative DTI tractography. Surgical, neurologic, and oncological outcomes were assessed on long-term follow-up.ResultsForty-eight (47.5%) patients harbored grade II gliomas, 26 (25.7%) had grade III gliomas, and 27 (26.7%) had grade IV gliomas. Gross-total resection (GTR) or subtotal resection (STR) was achieved in 67.3% of patients, and partial resection (PR) was achieved in 32.7% of patients. Large tumors (≥ 24.5 ml) and low-grade gliomas (LGGs) were independent prognostic factors for partial resection. Patients with high-grade gliomas (HGGs) and pre-operative motor deficit had a higher risk for permanent paralysis. Thirty-three of 101 patients (32.7%) had long-term paralysis, and 7 patients (6.9%) suffered from severe paralysis. The median PFS and OS were 12 months and 24 months in grade IV gliomas. In multivariate analysis using the Cox model, low tumor grade and IDH1 mutation were independent factors for longer PFS, and low tumor grade was an independent factor for longer OS.ConclusionPreoperative DTI tractography is a valuable tool for determining the extent of CST involvement in patients with gliomas. The risk of postoperative paralysis is extremely high; therefore, careful and conservative resection should be performed to preserve motor function. Despite this challenge, patients can still achieve positive oncological outcomes with standard adjuvant therapy after surgery.

Disclosure: N. Prasad: None. A. Arida: None. J. Shakil: None. R. Al-ward: None.Central etiologies of Cushing's syndrome are commonly attributed to functional corticotroph adenomas. However, rarely, silent corticotroph adenomas can progress and evolve into functional tumors, presenting as Cushing's syndrome late in the disease course. To our knowledge, only a few cases with such progression have been reported in the literature. Here, we present a case of late-onset Cushing's syndrome due to a silent corticotroph adenoma, emphasizing the aggressive nature of these tumors and the evolution of their clinical presentation. A 40 year old male with no past medical history initially presents with fatigue, diffuse weakness and vision loss. Work up revealed left vagal schwannoma with incidental 3 cm pituitary macroadenoma and normal pituitary hormone panel. Patient underwent subtotal resection of the pituitary tumor with resolution of vision loss. However, four months later, he presented to our institution due to persistent disease. A second transsphenoidal surgery was attempted but proved challenging and was thus converted to a right-sided frontotemporal craniotomy. Pathology revealed weakly positive staining for ACTH and KI67 of 1%. Patient refused further management and was lost to follow up. Patient then presented 7 years later with vision loss, weight gain, new onset hypertension, new onset pre-diabetes and muscle loss. Patient’s physical exam notable only for hyperpigmentation. Biochemical work up showed A1c of 5.9%, DHEA 651 g/dL, ACTH 356 pg/mL, AM Cortisol of 56g/dL. He failed dexamethasone suppression test on two occasions and had high 24 urine cortisol indicative of Cushing’s syndrome. MRI notable for large 3.7 cm macroadenoma with suprasellar extension. Patient underwent subtotal resection. Pathology notable for positive ACTH staining and elevated Ki 67 activity with variable expressivity, with some areas with 3-4% activity and other with 12-15% activity. Postoperative residual tumor was subsequently treated with radiation therapy. Silent corticotroph adenomas comprise almost 20% of corticotroph adenomas and typically present with symptoms of mass effect and are incidentally found on imaging. These tumors are classified as high risk due to high rate of recurrence. Uniquely, these tumors typically do not present with Cushing’s syndrome and very rarely can manifest much later in disease course, as with this patient. The mechanism of “silent” presentation of corticotrophs and conversion to functional corticortophs is unknown. These adenomas typically present with mass effect and are typically diagnosed retrospectively. Silent corticotroph adenomas are an aggressive subsect of corticotroph adenomas that do not initially present with Cushing’s syndrome that is otherwise seen in most corticotrph adenomas. Early diagnosis via pathology and monitoring of these patients for Cushing’s is imperative in appropriately treating these patients.Presentation: Saturday, July 12, 2025

Disclosure: K. Winnicki: None. Z.A. Ahmed: None. G. Olson: None. T. Porter: None.Background: The differential of a sellar mass is broad, and prior clinical history is important to take into consideration when formulating a differential diagnosis. Case: A 53 year-old gentleman with a history of multiple myeloma in remission who had undergone an autologous stem cell transplant within the last two years presented for several days of intermittent diplopia. Given the acuity of symptoms, an MRI was performed and revealed a T1-T2 isointense lesion in the right half of the sella extending into the right cavernous sinus with relative hypoenhancement compared to the pituitary gland; leftward deviation of the infundibulum was also noted. Functional testing revealed an 8am cortisol of 11.5 ug/dL (3.7-19.4 ug/dL) with ACTH of 8.8 pg/mL (7.2-63.3 pg/mL), free T4 0.9 ng/dL (0.7-1.5 ng/dL) with TSH 1.898 uIU/mL (0.350-4.940 uIU/mL), LH 5.1 mIU/mL (.57-12.07 mIU/mL), FSH 15.8 mIU/mL (1-10 mIU/mL), random total testosterone 185 ng/dL (264-916 ng/dL), and prolactin 21 ng/mL (3-19 ng/mL). Two days later the patient was noted to have a mild right abduction palsy. Given symptoms and history of multiple myeloma, the patient underwent endoscopic endonasal subtotal resection of the sellar lesion. Upon incision of the dura, a firm, white fibrous material with a gelatinous portion in the sphenoid was noted. Pathology revealed cells with prominent nucleoli, enlarged nuclei, minimal perinuclear Hof region, and minimal cytoplasm; these cells were positive for CD138 and CD20 and negative for synaptophysin and cytokeratin 8/18, suggesting a plasmablastic morphology. Monoclonal free lambda light chains were noted on serum electrophoresis, and bone marrow biopsy revealed evidence of plasma cell neoplasm (most recent bone marrow biopsy eight months prior was without evidence of persistent disease). The clinical picture was most concerning for CNS relapse of the patient’s myeloma; he received five fractions of radiation therapy to the right cavernous sinus, and was started on venetoclax, pomalidomide, and dexamethasone with plans to add carfilzomib in the future. Outpatient endocrinology follow-up was advised. Even in patients with known myeloma, such tumors are rare, and plasmacytomas are far less common than pituitary adenomas. Compared to pituitary adenomas, plasmacytomas have a greater propensity for cavernous invasion and parasellar bone erosion, including the cranial nerve foramina, contributing to a higher rate of cranial nerve palsies; one series of 31 patients found that 65% of patients with plasmacytomas had diplopia at presentation (1). Conclusion: Plasma cell tumors should be considered in the differential for lesions involving the sella, particularly in the presence of cranial nerve palsies. (1) DiDomenico J, Ampie L, Choy W, Lamano JB, Oyon DE, Kesavabhotla K, Bloch O. Sellar plasmacytomas masquerading as pituitary adenomas: A systematic review. J Clin Neurosci. 2018 Apr;50:20-23.Presentation: Monday, July 14, 2025

Surgical management of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS) tumor progression is challenging, particularly regarding facial nerve function and preservation. The aim of this study was to assess whether surgical and facial nerve outcomes are influenced by the VS extent of resection after failed SRS. A retrospective review was conducted on 22 patients (11 male) with VS post-SRS progression who underwent surgical resection during the past 3 decades at our center. The primary outcomes measured were facial nerve function using House-Brackmann (HB) scale and tumor recurrence/progression. Patients were divided into gross total (n = 4) resection (GTR) and near-total (n = 10) resection (NTR) or subtotal (n = 8) resection (STR) groups. The patients in the GTR/NTR and STR groups had comparable ages and Koos grades at the time of surgery. Postoperative HB scores showed significantly better facial nerve preservation in the STR group (P = .02), with no deterioration noted among these patients. By contrast, 7 GTR/NTR patients experienced worsening of facial function; 3 deteriorated to a HB score greater than III. Among these patients with worsening facial function, 1 patient underwent GTR (from HB score I to III), and the other 6 had NTR. The GTR/NTR group had a similar complication rate (n = 7) to the STR group (n = 4, P > .99). Both groups had 100% tumor control at last follow-up with comparable follow-up duration and no tumor recurrence or progression (GTR/NTR, median = 90.8 months [range: 11.8-155.8]; STR, median = 100.6 months [range: 0.5-232]). STR of failed SRS VS tumor progression is associated with better facial nerve preservation and similar tumor control rate compared with GTR/NTR, underscoring the importance of conservative surgical strategies in these patients. Based on these limited results, radical resection might not be necessary for tumor control after failed SRS for VS.

Background:Cavernous sinus hemangioma (CSH) is a rare, benign vascular tumor presenting significant diagnostic and management challenges due to its location and mimicry of other sellar and parasellar masses. This report details such a case, emphasizing the diagnostic complexities and surgical adaptability required.Patient concerns:A 47-year-old female presented with 3 months history of progressive left eye visual decline, intermittent headaches, and neck pain radiating to the left upper limb.Diagnoses:Imaging revealed a large sellar and parasellar mass with mass effect upon adjacent structures.Interventions:Surgical management was initially via an endoscopic transnasal transsphenoidal approach; however, intraoperative findings of high vascularity and cerebrospinal fluid leakage necessitated conversion to a left pterional craniotomy with subtotal resection of this mass. Histopathology confirmed the diagnosis.Outcomes:Postoperatively, the patient had a good general outcome and remains under regular scheduled follow-up.Lessons:Despite being rare, CSH should be considered among the causes of sellar and parasellar masses. Its location can lead to misdiagnosis, but imaging studies and a multidisciplinary team approach can decrease the risk of complications in such cases. While CSH are considered benign vascular tumors, they are associated with the risk of significant blood loss with surgery. This case highlights the importance of preoperative planning, intraoperative adaptability, and a multidisciplinary approach in managing large vascular brain tumors. Early diagnosis and appropriate surgical intervention can significantly improve clinical outcomes in complex cases.

To identify clinical, pathologic, and imaging predictors of progression and survival in intracranial meningioma using the 2021 World Health Organization (WHO) grading system with long-term follow-up. We retrospectively analyzed 132 patients (143 tumors) resected from 1991 to 2011 and regraded tumors per WHO 2021 criteria. Outcomes were progression-free survival (PFS) and overall survival (OS). Immunohistochemical markers from archival tissue included proliferation (MIB-1), hypoxia (GLUT-1, HIF-1α, CA-IX), angiogenesis (VEGF), and vascularity (microvascular density [MVD]) with prespecified thresholds. Preoperative tumor and peritumoral brain edema (PTBE) volumes were segmented to calculate a PTBE ratio (edema: tumor). Cox models evaluated covariates (PFS: WHO 2021 grade 2, MIB-1 > 5%, PTBE ratio; OS: subtotal vs. gross total resection, WHO 2021 grade 2). Median follow-up was 17.1 years. PFS was independently associated with WHO 2021 grade 2 (HR 3.72, 95% CI 1.49-9.32), MIB-1 > 5% (HR 2.56, 95% CI 1.17-5.60), and PTBE ratio (HR 1.22 per 0.1 increment, 95% CI 1.04-1.43). OS was associated with subtotal resection (HR 2.69, 95% CI 1.28-5.65) and WHO 2021 grade 2 (HR 4.27, 95% CI 1.61-11.33). Hypoxia/angiogenesis markers were not significant in multivariable models. Median PFS was not reached; 3- and 5-year estimates were 84.1% and 79.6%. With WHO 2021 regrading and extended follow-up, grade, MIB-1, and PTBE stratify PFS, whereas extent of resection and grade predict OS. These accessible factors may guide counseling and surveillance where molecular profiling is unavailable.

Treatment of clival and petroclival meningiomas remains one of the unresolved problems in contemporary neurosurgery. Studies on this topic are rare, and the objective of our research is to evaluate the current outcomes of endoscopic transnasal approaches in the surgical management of meningiomas of the clival region. This study presents a single-center experience with the endoscopic endonasal transsphenoidal transclival (posterior extended) approach for the resection of clival and petroclival meningiomas. Twenty consecutively treated with histologically confirmed clival and petroclival meningiomas underwent EEA surgery between 2012 and 2024 year. Tumor volume and neurovascular involvement were radiologically assessed. A binostril endoscopic transsphenoidal transclival approach was used with intraoperative Doppler ultrasonography and neuronavigation. Total resection was achieved in 2 cases (10%), subtotal resection in 5 cases (25%), and partial resection in 13 cases (65%). The most common complication was meningitis. Neurological complications were rare. Considering the difficult location of these tumors, the endoscopic transnasal approach serves as an additional option alongside transcranial approaches in the planning of surgical treatment.

Chondromyxoid fibroma (CMF) is a rare tumor usually found in the epiphysis and metaphysis of long bones. In the absence of effective nonsurgical treatment modalities, radical tumor resection is recommended. Spinal CMFs present a unique surgical challenge making total tumor resection often impossible. Little is documented about the long-term prognosis of spinal CMFs after subtotal resection, but inferring from outcomes of extremity CMF surgery, tumor recurrence is to be expected after incomplete resection. The authors present a 6-year follow-up case of an incompletely resected large lumbar CMF involving the L5 vertebra. This case appears to be the largest documented spinal CMF with the longest follow-up period after subtotal resection. Despite a residual tumor in the proximity of the inferior L5 endplate on immediate postoperative imaging, the patient has remained asymptomatic and without soft tissue tumor progression or recurrence for more than 6 years (77 months). The long-term outcome of this case demonstrates that total tumor resection may not be necessary for long-term disease control. This finding is in agreement with 14 previously reported lumbar CMFs, with only 1 documented recurrence at 60 months. https://thejns.org/doi/abs/10.3171/CASE25350.

The surgical resection of cerebral arteriovenous malformations (AVMs) presents a significant neurosurgical challenge, particularly because of the need to achieve complete obliteration of the nidus while preserving neurologic function. AVMs located within or adjacent to eloquent regions such as the motor or language cortex carry a high risk of postoperative deficits. To mitigate these risks, a variety of intraoperative tools have been developed to enhance surgical safety and decision making. Cortical and subcortical mapping is a dynamic technique that helps identify and preserve critical functional areas by applying targeted electrical stimulation to the cortex or subcortical white matter and observing motor or sensory responses. Additional neuromonitoring modalities include electrocorticography (ECoG), somatosensory evoked potentials, and motor evoked potentials, each contributing distinct insights into neural pathway integrity during resection. A systematic review was performed using 2 databases (PubMed/MEDLINE and Scopus), yielding 892 initial results. After applying inclusion and exclusion criteria, six studies were selected for final analysis. These studies collectively included 63 patients who underwent AVM resection with the aid of intraoperative neurophysiologic monitoring or mapping. Intraoperative neurophysiologic monitoring plays a critical role in the safe resection of high-grade or eloquently located AVMs. Although its routine use in low-grade lesions remains debatable, intraoperative neurophysiologic monitoring offers significant intraoperative value by helping surgeons recognize functional limits in real time. In select cases, it enables a strategic shift toward subtotal resection with planned adjuvant radiosurgery, reducing the risk of permanent neurologic deficits.

Abstract BACKGROUND Glioblastoma (GBM) recurrences usually occur locally, but can also develop at a distance from the initial lesion or several sites simultaneously. Although a fundamental influence of growth patterns on prognosis in GBM recurrence is known, there is little preliminary data on prognostic effects and associations of defined stratified growth patterns. Furthermore, possible predictive factors influencing the development of specific growth patterns cannot yet be evaluated with certainty. With this project, we aimed to answer the following questions: (1) Can a more precise analysis of GBM growth patterns in recurrence help with stratification into subgroups? (2) Do GBM growth patterns in relapse correlate with patient prognosis? (3) Can we identify predictors of defined growth patterns? METHODS As part of a retrospective study of two neuro-oncological centers, 251 patients were included, and their demographic data, therapy, tumor, and patient characteristics were retrospectively collected. In addition, the MRI images after initial biopsy/resection and at the time of the first recurrence were evaluated and assigned to defined growth patterns, which were then analyzed for statistical associations with a focus on prediction and prognosis with the previously collected characteristics. RESULTS &amp; CONCLUSIONS We observed apparent differences in progression-free and overall survival between multicentric and multifocal recurrences. This further supports the hypothesis that these are different growth patterns from other origins. Several of the investigated growth patterns in recurrence showed significant associations with longer or shorter progression-free and overall survival compared to the overall collective (e.g. unifocal local and multicentric recurrences, p&amp;lt;0.05). These observations were also confirmed in multivariable survival analyses in which known prognosis-associated factors were included. Patients treated with TumorTreatingFields after subtotal tumor resection presented a significantly prolonged progression-free survival (mPFS 7.2 months vs. 4.8 months; p=0.03), which was due to a longer time to development of local recurrence. This can be interpreted as an indication of improved local tumor control (mPFS 11.1 months vs. 5.2. months; p=0.01). In the collective after subtotal resection, treatment with TumorTreatingFields was accordingly also predictive for the development of non-local tumor recurrence (OR 0.16; p=0.02).

Abstract BACKGROUND Solitary fibrous tumours (SFT) of the central nervous system (CNS), previously known as hemangiopericytomas (HPC), are rare mesenchymal neoplasms characterized by inversions at 12q13, fusing the NAB-2 and STAT-6 genes, leading to nuclear expression of STAT-6 and its consequent detection on immunohistochemistry. The World Health Organization classification defines three grades of SFT/HPC, with higher grade associated with worse outcomes. Maximal safe resection is the mainstay of treatment, and adjuvant radiotherapy (RT) is often added for high-grade or residual disease. However, due to the rarity of SFT, the impact of these factors on long-term outcomes remains unclear. MATERIAL AND METHODS We performed a retrospective review of all patients with CNS SFT treated at our centre from 2003-2020. Clinical characteristics, treatment details, and outcomes were collected from records. OS and PFS were estimated by Kaplan-Meier analysis, and associations of prognostic factors (tumour grade, extent of resection) with outcomes were evaluated using log-rank tests and Cox regression. A subgroup analysis on the basis of preceding literature was also done based on three risk groups: low risk (Grade 1, any extent of resection, or Grade 2 with gross total resection), intermediate risk (Grade 2 with biopsy or subtotal resection), and high risk (Grade 3, any extent of resection). RESULTS Eighty-two patients were included. The median age was 41 years, and 66% were male. Most tumours were intracranial (97.5%, largely supratentorial) and 93% were WHO grade II or III. Near Total Resection and Gross Total Resection was achieved in 45% and 38% patients respectively, and 75% of patients received postoperative RT (PORT). At a median follow-up of 48 months, 5-year PFS was 54% and 5-year OS was 89%. Neither tumour grade nor extent of resection significantly influenced PFS or OS. In subgroup analysis of 52 patients receiving PORT, no significant difference in outcomes was seen between intermediate- and high-risk groups. CONCLUSION Patients with CNS SFT/HPC treated with surgery and adjuvant therapy achieved favourable long-term outcomes in our series. PORT improves high-risk patient outcomes to levels comparable to intermediate-risk patients, supporting an aggressive multimodal approach. Further prospective studies are warranted.

Abstract BACKGROUND Spheno-orbital meningiomas (SOMs) are a unique and complex subgroup of skull base meningiomas. They are characterized by significant hyperostosis of the sphenoid wing and an intradural soft tissue component. Involvement of the orbital compartment causes typical compressive clinical symptoms (proptosis and visual impairment). Gross total resection (GTR) is usually still the primary goal of treatment. So far, there is no consensus in the literature regarding the benefits of GTR or the positive prognostic factors associated with the improvement of proptosis and visual function. The aim of our study was to identify favorable prognostic factors associated with the improvement of proptosis and visual function and to assess the risk-benefit of radical resection. MATERIAL AND METHODS A retrospective single-center review of thirty-five patients who underwent surgery for SOMs between 2000 and 2024 was performed. Preoperative symptoms, surgical, visual, and proptosis outcomes, along with complications, were evaluated. Potential favorable prognostic factors associated with the improvement of proptosis and visual function, as well as the risks of radical surgery, were analyzed statistically. RESULTS All patients underwent surgery through a frontotemporal craniotomy. GTR was achieved in 40%, while subtotal resection (STR) was performed in 60% of cases. Among the 26 patients who had preoperative proptosis, postoperative improvement was observed in 24 (92%). Out of 20 patients with a preoperative visual deficit, 14 (70%) experienced postoperative improvement. A symptom duration of less than 6 months (p = 0.002), opening/resection of the periorbit (p = 0.0014), and GTR (p = 0.009) were statistically significant factors associated with postoperative normalization of proptosis. No statistically significant factor was detected for improvement in vision. GTR was significantly associated with surgical morbidity (p &amp;lt; 0.001). CONCLUSION Surgery for SOMs is a therapeutic challenge. Early GTR, including opening/resection of the periorbit, is associated with proptosis normalization. However, GTR is accompanied by increased surgical morbidity. This study was funded by the grant of Ministry of Health of the Czech Republic - Conceptual Development of Research Organization (Faculty Hospital in Pilsen - FNPl, 00669806)

Abstract BACKGROUND The current standard of care for newly diagnosed high-grade glioma (HGG) is safe surgical resection followed by Radiotherapy (RT) with concurrent Temozolomide (TMZ) followed by adjuvant TMZ for 6 cycles. This retrospective study evaluates survival for patients with HGG treated according to this schema at our institute. MATERIAL AND METHODS Medical records of 246 patients with histologically confirmed HGG who underwent surgery followed by radiotheray with concurrent and adjuvant chemotherapy from 2011 to 2023 were retrospectively reviewed, and their clinicopathological characteristics and survival outcomes were analysed. Thirty-three patients had near total resection,189 had subtotal resection and 24 had biopsy only. 171 (70%) patients were treated with VMAT, 60 (24%) patients were treated with IMRT and 15 (6%) received 3DCRT treatment. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan-Meier survival analysis with log-rank testing. RESULTS A total of 246 patients with HGG were analysed in this study including, 105 grade III glioma and 141 grade IV glioma. At a median follow-up period of 21 months (range; 1-160 months), the median OS for HGG was 37 months, but median OS for grade IV and grade III gliomas was 17 and 88 months, respectively. The estimated OS at 5-year was 14.2% for grade IV glioma, 59.4% for anaplastic astrocytoma and 67.3% for anaplastic oligodendroglioma. Similarly, the 5-year PFS rates was 10.6% for grade IV glioma, 56.3% for anaplastic astrocytoma and 58.6% for anaplastic oligodendroglioma. Toxicity was mostly grade 1/2 thrombocytopenia or neutropenia. CONCLUSION The prognosis of high-grade glioma remains dismal, especially for grade IV glioma. Although the current standard of care for high grade glioma is adjuvant radiotherapy and chemotherapy after maximal safe resection, an individualised treatment approach should be considered to improve survival outcomes.

Abstract BACKGROUND Medulloblastoma(MB) is an exceedingly rare malignancy in adults, with limited prospective data guiding its management. Although multimodal treatment remains the standard, recent molecular profiling has enabled the introduction of targeted therapies, such as SMO-inhibitors for SHH-activated tumors. This study aims to describe clinical characteristics, treatments - including the use of targeted therapy - outcomes, and long-term sequelae in a monocentric cohort of adult MB pts, providing insights to optimize future therapeutic strategies. MATERIAL AND METHODS We retrospectively analyzed adult MB pts treated at Veneto Institute of Oncology, Padua, Italy between November 2011 and February 2025. Clinical, molecular and treatment data, including extent of surgery and RT details were collected. Response was assessed using RANO criteria, treatment-related toxicity according to CTCAEv5.0. Survival outcomes were estimated using the K-M method. RESULTS We included 29 pts (median age 34ys, IQR 22-41; 44.5% males), with a median FU of 71ms (IQR 32-112). At diagnosis, 86% were symptomatic, 55% had an ECOG PS 0, and desmoplastic/nodular was the most frequent histology(48%). Molecular subgrouping was available in 45%, with SHH activation being the most common (31%). All pts received craniospinal-RT; 18 pts(62%) received adjuvant CT with cisplatin-etoposide±cyclophosphamide, 6(21%) cisplatin-lomustine±vincristine, 3(10%) an intensive pediatric regimen and 2(7%) did not received CT due to comorbidities. First-line CR was achieved in 65%. Overall, 38% experienced PD and 24% died. Three pts received vismodegib at recurrence: one (M0 stage, high-risk) received 3 cycles without toxicity, had PD at 3ms from vismodegib start and died at 30ms from diagnosis; one (M2 stage, high-risk) received 5 cycles without toxicity, had PD at 4ms and died at 64ms. One patient (M0 stage, high-risk) received 11 cycles, developed G1 toxicity and did not experience PD until now (11ms). Three patients received re-RT at PD. The 3-year PFS and OS rates were 78% and 92%, respectively. Stratified analyses suggested worse outcomes associated with high-risk class, subtotal resection, and lower baseline ECOG PS. Grade 3-4 toxicity occurred in 29%(7/24 evaluable). Long-term complications included neurocognitive impairment(21%) and RT-induced secondary malignancies (10%) at a median of 46ms. CONCLUSION Our findings confirm the clinical and biological heterogeneity of adult MB, highlighting the need for a multimodal approach. Long-term survivorship is often achievable, though late toxicities remain a concern. Vismodegib showed a significant impact on outcome. Future efforts should focus on integrating molecular profiling into routine practice to better stratify risk and personalize therapies, along with the adoption of treatment de-intensification strategies to mitigate long-term sequelae.

Abstract BACKGROUND To investigate the role of three-dimensional reconstruction of multi-modal images combined with neuronavigation in the operation of gliomas in eloquent regions. MATERIAL AND METHODS A retrospective analysis was conducted on the clinical data of 30 patients with gliomas in eloquent regions who underwent surgical treatment at the Department of Neurosurgery of Peking University Third Hospital from April 2018 to March 2024. Before surgery, the patient’s skull MRI with enhancement, diffusion tensor imaging (DTI), and CT angiography (or magnetic resonance angiography) data were fused to reconstruct nerve tracts, tumors, blood vessels, skulls and other structures, so as to design the optimal surgical path, and used in neuronavigation to guide tumor resection. Degree of tumor resection was evaluated by using MRI results 72 hour post operation. One week, one month, and three months after surgery, the Boston Diagnostic Aphasia Examination (BDAE) was used to assess language function, and the simplified Fugl-Meyer Assessment (FMS) was used to assess motor function. RESULTS Through the three-dimensional image reconstruction, the anatomical relationship in all patients between the tumor and surrounding important structures such as nerve tracts, arteries and veins were clearly shown, the displacement and destruction of the nerve tracts were clarified, and the blood supply arteries and drainage veins were shown. Among the 30 patients, the tumor involved the motor area in 21 cases and language area in 25 cases. Totally resection was achieved in 28 cases (93.3%) and subtotal resection in 2 cases (6.7%). Among the 21 patients with preoperative neurological deficits, at the last follow-up, 20 patients had improved neurological function after surgery, and 1 patient had unchanged neurological function compared with presurgical conditions. Nine patients who had no neurological deficits before surgery developed transient symptoms related to neurological deficits after surgery, which resolved after 1 week. CONCLUSION The use of multimodal images to three-dimensionally reconstruct tumors and surrounding nerve fiber bundles, blood vessels and other important structures, so as to design surgical approaches and apply them to intraoperative navigation to guide the operation, could help protect the eloquent brain area and improve the efficacy of surgery.

Abstract BACKGROUND Adult-onset medulloblastoma (aMB) represents less than 1% of adult brain malignancies. Adult treatment strategies remain poorly defined and are frequently extrapolated from pediatric protocols. This challenge is particularly pronounced in Latin America, where prospective data are lacking and access to diagnostics and treatment remains limited. MATERIAL AND METHODS We conducted a prospective observational cohort study involving adult patients (≥16 years) with newly diagnosed aMB treated between May 2024 and March 2025 across a network of tertiary referral centers in Mexico, including the INCan and the INNN. Eligible patients were consecutively enrolled at diagnosis. This report presents the first 13 patients from this ongoing cohort. RESULTS Median age was 28 years (IQR 21-32), and 53.8% were male. Tumor locations included cerebral hemispheres (53.8%), vermis (38.5%), and fourth ventricle (7.7%). Presenting symptoms were headache (100%), nausea/vomiting (92.3%), ataxia or cerebellar signs (76.9%), and others such as visual disturbances, cranial nerve deficits, and sensory complaints (30.8% each). Hydrocephalus was present in 92.3%, all requiring shunt placement. Metastatic disease (M1-M4) was found in 46.2%, while 53.8% were M0. Per Packer’s criteria, 92.3% had high-risk disease. Histologic subtypes were desmoplastic/nodular (76.9%) and classic (23.1%). Of 11 patients with molecular subgrouping, 54.5% were SHH-activated TP53 wild-type, 18.2% SHH-activated TP53-mutated, and 18.2% non-SHH/non-WNT. Most patients (84.6%) underwent subtotal resection or biopsy; only 2 had gross total resection. Craniospinal irradiation (CSI) at 36 Gy was administered to 92.3%, with a median tumor bed boost of 55.8 Gy. One patient received a posterior fossa boost (54 Gy). The median interval from surgery to radiotherapy was 116.5 days (range 24-187), and the overall treatment time was 46 days (range 26-69). Concurrent vincristine chemotherapy was given to 83.3%. One patient had neoadjuvant chemotherapy; 61.5% received adjuvant chemotherapy. The most common regimen was cisplatin, cyclophosphamide, and vincristine (46.2%), followed by temozolomide (15.4%). Adverse effects included gastrointestinal symptoms and anemia (23.1% each), neutropenia (15.4%), and ototoxicity and neuropathy (7.7% each). CONCLUSION This first prospective Latin American study on aMB highlights the predominance of SHH-activated subtypes, frequent presentation with advanced disease, and significant delays in initiating radiotherapy. Despite limited resources, most patients received multimodal treatment. These findings emphasize the urgent need for earlier diagnosis, faster treatment initiation, and standardized care pathways for aMB in low- and middle-income countries