Journal of Neuro-Oncology最新文献

Background: Maximal tumor resection with neurological preservation is central to brain tumor surgery. This study evaluates the integration of an artificial intelligence-based connectomics platform for surgical planning, with exploratory tractometry analysis of postoperative white matter changes.

Methods: We retrospectively reviewed 192 consecutive brain tumor surgeries performed between April 2023 and April 2025 using preoperative connectomic mapping (Quicktome, Omniscient Neurotechnology). Functional outcomes were assessed with Karnofsky Performance Status (KPS). In an opportunistic subgroup (n = 13), paired pre- and postoperative imaging enabled tractometry (Cleartome). Fractional anisotropy (FA) was measured across six major tracts, and three hemispheric FA asymmetry indices were calculated: difference in average FA (Diff FA), asymmetry index (AI), and percentage asymmetry (%Asym).

Results: The cohort included intra-axial and extra-axial tumors. Median KPS remained stable at 3 months after surgery. In the tractometry subgroup, 12 of 13 patients showed postoperative shifts toward improved interhemispheric FA symmetry in at least one tract. Left-hemisphere cases most often showed changes in the uncinate fasciculus (UF) and inferior fronto-occipital fasciculi (IFOF) (median AI = - 0.68 and - 0.20, respectively), while right-hemisphere cases demonstrated alterations in the superior longitudinal fasciculus (SLF) (median AI = + 5.13; %Asym =-8.43). The corticospinal tract (CST) and IFOF improved in 61.5% of analyzed cases. Tract-based asymmetry indices captured subtle connectivity changes not evident in raw FA values alone.

Conclusions: Routine clinical use of AI-guided connectomics in brain tumor surgery was feasible, with stable short-term functional outcomes. Tract-based hemispheric FA asymmetry metrics suggested postoperative microstructural alterations; findings remain preliminary and warrant further prospective validation.

Background: Pediatric brain ependymomas are brain tumors difficult to cure despite the advancements in surgery and radiotherapy. Immunotherapies, specifically immune checkpoint blockades (ICB), are traditionally recognized to have a limited efficacy against cold microenvironment as the ones of ependymomas. By employing the Tumor Immune Dysfunction and Exclusion (TIDE) scoring system, this study tries to predict the responsiveness to ICB across molecular subgroups, recurrent/primary presentation and hot vs. cold subtypes.

Methods: Four GEO datasets from NCBI public library were selected for this study. In total, 150 RNA-bulk sequences of pediatric ependymomas were analyzed (PF-A = 125, ZFTA-RELA = 23, YAP1 = 2). The TIDE algorithm was applied to quantify cytotoxic T-cell infiltration, dysfunction, and exclusion, estimating ICB response probabilities. Group differences were calculated with Kruskal-Wallis and Fisher's exact tests (p < 0.05).

Results: 60% of ependymomas were predicted ICB responders. ZFTA-RELA tumors showed significantly lower TIDE scores than PF-A (-0.099 ± 0.263 vs. 0.060 ± 0.316; p = 0.008) and a higher response rate (78.3% vs. 56.0%; p = 0.063). RELA-fusion tumors exhibited reduced T-cell dysfunction (-0.235 ± 0.221 vs. - 0.098 ± 0.152; p < 0.001). Recurrent tumors demonstrated lower TIDE scores (-0.070 ± 0.328 vs. 0.081 ± 0.296; p < 0.001) and greater predicted response (75.6% vs. 52.4%; p = 0.011). Responders overall had lower TIDE, dysfunction, and exclusion values (all p < 0.01).

Conclusions: Pediatric ependymomas are not uniformly immune-silent. ZFTA-RELA and recurrent tumors exhibit a "primed but suppressed" immune phenotype, where the immune machinery is present but functionally restrained, suggesting greater susceptibility to ICB, whereas PF-A tumors remain immune-excluded and may require microenvironmental modulation to achieve immunotherapy benefit.

Purpose: Meningiomas are common, mostly benign, and often asymptomatic. Minimizing surgical adverse events (AE) is essential to maintain a favorable risk-benefit balance. Traditional AE grading systems often failed to account for disabling complications like neurologic deficits, which led to the development of the multidimensional therapy-disability-neurology grade (TDN). This study evaluates risk factors and consequences of AE in meningioma patients using TDN.

Methods: Pre- and perioperative factors associated with the occurrence and severity of AE at discharge and follow-up were retrospectively identified in a monocentric cohort of consecutive patients undergoing surgery between 2013 and 2022. Significant variables of the univariable analysis were consequently tested in a multivariable analysis. Statistical analysis to detect the relationship between TDN and clinical outcomes was performed.

Results: 367 patients were included with a mean age at surgery of 60.8 years. A total of 95 AE at discharge and 144 AE at follow-up were recorded. Generalized linear models showed a relationship between the modified Rankin Scale on admission, tumor complexity as measured by the Milan Complexity Scale, and preoperative embolization with the frequency of AE at discharge and follow-up. A correlation between TDN, Karnofsky Performance Scale at discharge, and length of hospital stay was observed.

Conclusion: The severity of AE as classified according to TDN correlated with the length of hospital stay and functional outcome following meningioma resection in our cohort and may be predicted by specific pre- and perioperative factors.