Journal of Neuro-Oncology最新文献

Purpose: The impact of Carmustine wafer implantation on epileptic seizure control in adult patients with newly diagnosed supratentorial glioblastoma, IDH-wildtype, remains unclear. We assessed whether Carmustine wafer implantation influences postoperative seizure control.

Methods: We conducted an observational, retrospective, single-centre cohort study at a tertiary neurosurgical oncology center between January 2006 and December 2024. We included adults treated with surgical resection for a newly diagnosed supratentorial glioblastoma, IDH-wildtype with or without Carmustine wafer implantation in the early postoperative period and during the first six months of adjuvant oncological treatment.

Results: 676 patients who benefited from a first-line surgical resection with (n = 257) or without (n = 419) Carmustine wafer implantation were included. Epilepsy at diagnosis was present in 244 patients (36.1%), with no difference in prevalence (35.8% vs. 36.3%, p = 0.483) or in preoperative seizure control (96.1% vs. 92.1%, p = 0.070) between groups. Uncontrolled seizures occurred in 17.6% (n = 43/244) of patients in the early postoperative period and in 18.6% (n = 41/221) of patients during the first six months of adjuvant oncological treatment. In multivariable analysis, preoperative uncontrolled seizures (adjusted Odds Ratio 76.9, 95%CI 34.5-187.7, p < 0.001) was independently associated with uncontrolled seizure in the early postoperative period, while Carmustine wafer implantation was not (aOR 0.78, 95%CI 0.36-1.60, p = 0.496). Similarly, a history of epilepsy at diagnosis (aOR 2.38, 95%CI 1.43-3.98, p < 0.001), but not Carmustine wafer implantation (aOR 0.92, 95%CI 0.55-1.54, p = 0.761), predicted uncontrolled seizures during the first six months of adjuvant oncological treatment.

Conclusion: Carmustine wafer implantation does not impact the risk of uncontrolled epileptic seizures in the postoperative and adjuvant oncological treatment periods. No specific adaptation of antiseizure medication is required following Carmustine wafer implantation for newly diagnosed supratentorial glioblastoma, IDH-wildtype patients.

Background: Peritumoral brain edema (PTBE) is a frequent finding in meningiomas and can significantly affect perioperative outcomes. In addition to well-established clinical, radiological, and histopathological risk factors, molecular markers such as Forkhead Box C1 (FOXC1) may also play a crucial role in the development of PTBE.

Methods: We conducted a retrospective, single-center study including 86 patients with histopathologically confirmed meningiomas. Preoperative MRI datasets were analyzed for tumor characteristics using 3D Slicer and ImageJ. FOXC1 expression was assessed immunohistochemically and dichotomized based on receiver operating characteristic (ROC) curve analysis. Univariate analyses were performed to evaluate associations between clinical, radiological, and histopathological variables and the presence of PTBE.

Results: PTBE was significantly associated with low FOXC1 expression (p = 0.015). Furthermore, WHO grade 2/3 meningiomas (p = 0.012), perioperative seizures (p = 0.024), subtype (p = 0.016), tumor laterality (p = 0.04), higher MIB-1 index (p < 0.001) and tumor volume (p = 0.01) were also significantly associated with PTBE. Tumor localization (skull base vs. non-skull-base) and sex showed no significant correlation.

Conclusion: Combining molecular and radiological parameters could improve neurosurgical planning and perioperative management. Further studies are needed regarding the assessment of the response to anti-edematous therapies in low and high FOXC1 expressing meningiomas.

Purpose: Intradural spinal metastases, including intramedullary (IM) and intradural extramedullary (IDEM) lesions, are rare manifestations of advanced systemic malignancy, and the role of surgery remains controversial. This study aimed to clarify how anatomical compartments influence surgical intent, feasibility, and postoperative neurological outcomes.

Methods: We retrospectively reviewed fifteen consecutive patients who underwent surgery for intradural spinal metastases between 2010 and 2024. Lesions were classified as IM (n = 6) or IDEM (n = 9). Clinical presentation, operative characteristics, extent of resection, and adjuvant therapy were evaluated. Neurological function was assessed using the modified McCormick scale (MMCS) before and after surgery.

Results: IM lesions were more frequently associated with severe preoperative neurological impairment and were predominantly located in the thoracic spine, whereas IDEM lesions were distributed across cervical, thoracic, and lumbar levels. Gross total resection was achieved more often in IDEM lesions (44.4%) than in IM lesions (16.7%). Postoperatively, neurological function improved in 5 patients (33.3%), remained stable in 6 (40.0%), and deteriorated in 4 (26.7%). Although improvement occurred in both groups, IDEM lesions more often achieved a favorable final functional status (MMCS grades I-II), whereas IM lesions frequently showed limited functional recovery. No perioperative complications were observed.

Conclusions: Surgical intervention for intradural spinal metastases may be considered selectively as part of a multidisciplinary palliative strategy focused on neurological function. Anatomical compartment influences surgical feasibility, intent, and achievable outcomes. IDEM lesions may allow resection with functional recovery in selected patients, whereas IM lesions generally require a conservative, function-preserving approach with clearly defined goals.